Health inspection·August 26, 2024

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 observation, interviews, and record review, the facility failed to provide treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices, by failing to provide dermatology consults as ordered for one (Resident #4) of four sampled residents. Residents Affected - Few The findings include: On 8/26/2024 at 11:44 am, Resident #4 was observed in her room with several areas of blotches (dark red in color) and scaly skin on the palm of her left hand. A blue plastic glove was covering her right hand. When questioned about her hands, Resident #4 stated, she had an unknown skin condition which affected both her hands. She stated that it was present upon her admission into the facility. She was getting a topical cream for it; however, she hadn't received it in some time. She did not know if it had been discontinued nor did she know the proper diagnosis. Resident #4 explained that the facility nurses had advised her that she needed to see a dermatologist, but she had not seen one yet. The condition was painful, and she wore the glove on her right hand to keep it moisturized. With the resident's permission the glove was removed. Multiple blotches (dark red in color), dry peeling, scaly skin and an open area to the palm of the resident's right hand were observed, along with redness and peeling to several of the fingers on her right hand. (Photographic evidence obtained) Review of Resident #4's medical record revealed an admission date of 2/3/2023. Her diagnoses included encephalopathy; acute respiratory failure with hypoxia; unspecified atrial fibrillation (Afib); other symptoms & signs involving cognitive functions and dependence on supplemental oxygen. Review of the quarterly minimum data set (MDS) assessment dated [DATE] revealed a brief interview for mental status (BIMS) score of 13 out of 15 possible points, indicating intact cognition for Resident #4. Review of the clinical skin assessment revealed Resident #4 was at risk for developing pressure ulcers however; no pressure ulcers were present. Treatments included: applications of ointments/medications other than to feet. Review of the resident's physician orders included: dermatology consult dated 4/15/2024, dermatology consult for reddened dry flaky skin to bilateral palms 8/25/2023, and weekly skin checks. Review of the most recent care plan revised on 8/15/2024 included: FOCUS At risk for alteration in skin integrity related to decreased mobility, GOAL The resident will have no alteration in skin integrity; INTERVENTION Preventative skin care with turning and positioning, pericare, lotions and other (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: 105366 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 105366 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare University 3648 University Blvd S Jacksonville, FL 32216 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)