Inspection·July 18, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on record review and interviews, the facility failed to follow the care plans for 1 of 3 residents sampled for continuous positive airway pressure (CPAP) machine use (Resident #3) and 1 of 3 residents sampled for urinary catheter care (Resident #9). The findings include: Resident #3 On 7/17/23 at 12:48 PM, a telephone interview was conducted with Resident #3's daughter, who stated her mother used a CPAP machine (a device used to treat sleep apnea) at night. She stated that the facility did not provide the distilled water required for CPAP usage, resulting in her mother not being able to use the machine unless family members brought the distilled water. On 7/17/23 at 2:47 PM, Resident #3 was observed with a CPAP on the bedside table inside her room. A gallon bottle of distilled water was observed on the floor. A review of Resident #3's clinical record was conducted. Review of the care plan included interventions for CPAP at night as ordered related to Chronic Obstructive Pulmonary Disease (COPD). A review of physician orders revealed no order for the CPAP. On 7/17/23 at 3:01 PM, an interview with the Director of Nursing (DON) was conducted. The DON reviewed Resident #3's physician's orders with the surveyor and confirmed there were no orders for CPAP. The DON reviewed the resident's care plan and stated Resident #3 had been receiving CPAP services. The DON stated the admission nurse was responsible to check the admission orders and to call the physician to obtain orders for CPAP use, but it was not done. A review of facility policy Use of CPAP/BIPAP/APAP (undated) was conducted. The policy stated obtain MD order that includes the following: specifies what type of machine is required, contains the specific pressure, diagnosis for use, for cleaning mask and tubing instructions. Resident #9 On 7/17/23 at 5:01 PM, an observation of Resident #9's urinary catheter tubing showed cloudy urine. On 7/18/23 at 10:16 AM, an observation of Resident #9's urinary catheter tubing again showed cloudy urine. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 105364 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105364 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Hills Health & Rehabilitation Center 3333 Capital Medical Blvd Tallahassee, FL 32308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)