Health inspection·March 2, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide showers per resident preferences for 2 of 2 sampled residents reviewed for showers (Resident #62 and 80). The findings included: Review of the facility policy, titled, Resident Showers, dated 04/22, revealed the following compliance guideline - Residents will be provided showers as per request or as per facility schedule protocols and based upon resident safety. 1. Resident #62 was admitted to the facility on [DATE]. Resident #62 had a medical history significant for a right femur fracture, high blood pressure, asthma, Parkinson's disease, prostate cancer, falls, depression, and dementia. An admission Minimum Data Set (MDS), dated [DATE], documented Resident #62 had a Brief Interview of Mental Status (BIMS) score of 12, which indicates he had mild mental impairment. This MDS documented Resident #62 required extensive assistance of one staff member for personal hygiene (i.e., showering); and documented Resident #62 told the staff it was very important for him to choose between a tub bath, shower, bed bath, or sponge bath. Review of Resident #62's care plans, physician orders, and progress notes revealed there was no documentation for why Resident #62 had not received regular showers since his admission. During the initial tour of the facility and initial interview conducted on 02/27/23 at 9:35 AM, Resident #62 stated he had not received a shower since he had been at the facility. A review was conducted of the Certified Nursing Assistant (CNA) Task for Bathing for a 30-day look back period. It was documented on this task that Resident #62 received a shower on 02/10/23. This indicated Resident #62 had only received one shower in 21 days. A second interview was conducted with Resident #62 on 03/01/23 at 1:00 PM, who stated he had not received a shower since the initial discussion on 02/27/23. When asked if he remembered the staff asking on admission what his shower preferences were, he said he was pretty out of it when he was admitted and did not remember the staff asking about his shower preferences. He said since his admission to the facility, he had received one shower. 2. Resident #80 was admitted to the facility on [DATE]. Resident #80 had a medical history Page 1 of 4 105360 105360 03/02/2023 Tamarac Center for Rehabilitation and Healing 7901 NW 88th Avenue Tamarac, FL 33321

F 0561 significant for a leg fracture, high blood pressure, heart failure, kidney failure, and diabetes. Level of Harm - Minimal harm or potential for actual harm An admission Minimum Data Set (MDS) was done on 02/18/23. This MDS documented Resident #80 had a Brief Interview of Mental Status (BIMS) score of 15, which indicated he was cognitively intact. This MDS documented Resident #80 required extensive assistance of one staff member for personal hygiene (i.e., showering); and that Resident #80 told the staff it was somewhat important for him to choose between a tub bath, shower, bed bath, or sponge bath. Residents Affected - Few During the initial tour of the facility and initial interview conducted on 02/27/23 at 9:35 AM, Resident #80 stated he had not received a shower since he had been at the facility. Review of Resident #80's Care Plans, Physician Orders, and Progress Notes revealed there was no documentation for why Resident #80 had not received showers since his admission. A review was conducted of the Certified Nursing Assistant (CNA) Task for Bathing for a 30-day look back period. It was documented on this task that Resident #80 received a shower on 02/17/23 and 02/22/23. This indicated Resident #80 had only received two showers in 19 days. A second interview was conducted with Resident #80 on 03/01/23 at 1:00 PM, who stated he had not received a shower since the initial discussion on 02/27/23. When asked if he remembered the staff asking on admission what his shower preferences were, he said he was awake and oriented when he was admitted and did not remember the staff asking about his shower preferences. Resident #80 stated again that, since his admission to the facility, he had not received any showers. When told the staff had documented two showers, he stated he did not receive any showers. An interview was conducted with Staff A, CNA on 03/01/23 at 1:10 PM. When asked how the CNAs know which days each resident is supposed to receive a shower, Staff A showed the surveyor a Staffing Binder and stated the shower schedules are kept in there. She showed the surveyor a page which indicated each of the resident rooms and what days and times each resident is to receive a shower. Further review of this paper revealed Resident #80 was supposed to receive a shower on Wednesdays and Saturdays on the 7:00 AM to 3:00 PM shift. An interview was conducted with the facility's Assistant Director of Nursing (ADON) on 03/02/23 at 9:28 AM. When asked how the CNAs know when each resident is supposed to be showered, she stated it is pre-populated on the daily assignment sheets that are given to each CNA at the start of the shift. When asked if this means a resident receives a bed bath on the assigned day, she stated no, the residents receive a shower on the assigned days, not a bed bath. 105360 Page 2 of 4 105360 03/02/2023 Tamarac Center for Rehabilitation and Healing 7901 NW 88th Avenue Tamarac, FL 33321

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to ensure the physician's orders were followed as ordered for 1 of 10 sampled residents (Resident #16) during medication administration observation review as evidenced by performing Resident #16's blood glucose test and administering insulin after a meal instead of before meal as per physician order. Residents Affected - Few The findings included: Review of the facility's policy, titled, Blood Glucose Monitoring implemented on 04/22 documented, The facility will perform blood glucose monitoring as per physician's order . Review of Resident #16's clinical record documented an initial admission to the facility on [DATE] and a readmission on [DATE]. The resident diagnoses included Acute Kidney Failure, Heart Failure, Anorexia and Type 2 Diabetes Mellitus. Review of Resident #16's Minimum Data Set (MDS) quarterly assessment, dated 12/31/22, documented a Brief Interview of the Mental Status (BIMS) score of 8, indicating the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed extensive assistance from the nursing staff to complete her activities of daily living. Review of Resident #16's care plan, initiated on 01/23/19 with a revision date on 01/16/23, titled, Resident has Diabetes Mellitus, documented, 'Resident has Potential for signs and symptoms of hypoglycemia (low blood sugar level) /hyperglycemia (high blood sugar level). The care plan interventions included: Accu-checks (blood glucose testing) as ordered initiated on 01/23/19 .Administer medication as per order initiated on 01/23/19 .'. Review of Resident #16's physician order, dated 08/22/22, documented, Humalog KwikPen 100 unit/ML Solution pen-injector. Inject subcutaneously before meals and at bedtime related to Type 2 Diabetes Mellitus .Inject as per sliding scale: if 201- 250 = 3 units; 251- 300 = 6 units; 301- 350 = 9 units; 351- 400 = 12 units, greater than 400 give 12 units and call MD. On 02/28/23 at 12:38 PM, observation revealed Resident #16 complained of pain and asked for a pain pill while Staff B, Licensed Practical, was in the resident's room administering Resident #16's roommate's medication. Observation revealed Resident #16 had her lunch tray on the table in front of her and stated she was done with lunch. Further observation revealed the resident ate two cups of yogurt and ate a small amount of mashed potatoes and a piece small of meat. Staff B, LPN stated she would check to see if the resident had an order for pain medication. Staff B proceeded to review Resident #16's electronic medication administration record. During the review, Staff B stated the resident was due for Insulin at 11:30 AM and added that she could give it one hour before or one hour after a meal. Staff B stated she was only 10 minutes behind the scheduled time. On 02/28/23 at 12:42 PM, observation revealed Staff B, LPN performed Resident #16's blood sugar/glucose testing. Staff B stated the resident blood sugar/glucose test results was 229 [mg/Dl] and needed 3 units of Insulin. At 12:43 PM, observation revealed Staff B administered 3 units of Humalog Pen Insulin to Resident #16 and two (2) Tylenol 325 milligrams for pain. On 02/28/23 at 2:10 PM, an interview was conducted with the facility's Consultant Pharmacist (CP). 105360 Page 3 of 4 105360 03/02/2023 Tamarac Center for Rehabilitation and Healing 7901 NW 88th Avenue Tamarac, FL 33321

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The CP was apprised Resident #16 had her 11:30 AM blood glucose test done and insulin administration during lunch time rather than before meals as per physician order. A side-by-side review of Resident #16's physician order, dated 08/22/22, for Humalog Insulin Pen with sliding scale coverage was conducted with the CP. The CP stated the blood glucose test should have been done before meals as ordered. On 02/28/23 3:20 PM, an interview was conducted with Staff B, LPN who stated that she got report that Resident #16 had BG (blood glucose) checks/test to be done. Staff B stated it was her second time coming to the facility and forgot that the resident needed a blood sugar test at 11:30 AM. On 03/01/23 at 9:16 AM, an interview was conducted with Staff C, LPN who acknowledged that Resident #16, blood sugar/glucose checks should have been done and the insulin administration before meals as per physician order. Staff C acknowledged Staff B did not follow physician's orders. On 03/02/23 at 11:21 AM, an interview was conducted with the facility's Director of Nursing (DON). The DON was apprised of Staff B not following physician orders for Resident #16's blood sugar/glucose testing. The DON stated Staff B did not do it intentionally and that it was an isolated incident. The DON was apprised that Staff B noticed that Resident #16 was due for a blood sugar check when she logged in into the resident's electronic medication administration record to check for pain medication as requested by the resident. On 03/02/23 at 12:20 PM, an interview was conducted with Staff D, LPN who stated residents' blood glucose testing are to be done before meals as per physician orders. 105360 Page 4 of 4