Health inspection·February 22, 2024

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure oxygen was administered consistent with professional standards of practice for 1 of 2 residents reviewed for respiratory services, Resident #13 (Photographic evidence obtained). Residents Affected - Few Findings include: Review of Resident #13's admission record revealed the resident was admitted on [DATE] with the diagnoses that included acute and chronic respiratory failure, obstructive sleep apnea, congestive heart failure, and anemia. During an observation on 2/19/2024 at 9:40 AM, Resident #13 was in bed, receiving oxygen at 3 liters per minute via nasal cannula. During an observation on 2/20/2024 at 8:42 AM, Resident #13 was in bed, receiving oxygen at 3 liters per minute via nasal cannula. During an observation on 2/21/2024 at 8:11 AM, with Staff B, Licensed Practical Nurse (LPN), Resident #13 was receiving oxygen at 3.5 liters per minute via nasal cannula. During an interview on 2/21/2024 at 8:11 AM, Staff B, LPN, confirmed that Resident #13 was receiving oxygen at 3.5 liters per minute via nasal cannula. Review of Resident #13's physician order dated 1/25/2024 read, Oxygen at 2 LPM [liters per minute] via NC [nasal cannula] PRN [as needed] for SOB [shortness of breath]. Review of Resident #13's care plan dated 1/24/2024 read, Focus: Oxygen: The resident has oxygen therapy as needed r/t [related to] episodes of shortness of breath . Interventions/Tasks . Administer oxygen as ordered. During an interview on 2/21/2023 at 8:18 AM, Staff A, LPN, stated, Physician orders are written for oxygen at a rate of 2 liters via nasal cannula. I should have completed rounds with off going shift and checked for proper rate when I completed my resident assessment, but I did not. During an interview on 2/21/2023 at 8:20 AM, Staff B, LPN, stated, Physician orders are to be followed. I will check her oxygen saturation and call the doctor to verify the rate of oxygen delivery. During an interview on 2/21/2024 at 9:20 AM, the Director of Nursing stated, It is my expectation Page 1 of 3 105397 105397 02/22/2024 Evergreen Woods 7045 Evergreen Woods Trl Spring Hill, FL 34608

F 0695 that physician orders are followed. Level of Harm - Minimal harm or potential for actual harm Review of the facility policy and procedures titled Oxygen Therapy with an effective date of November 2023 read, Policy: Oxygen is provided to residents based on physician's orders to supplement oxygen as needed per disease process. Residents Affected - Few 105397 Page 2 of 3 105397 02/22/2024 Evergreen Woods 7045 Evergreen Woods Trl Spring Hill, FL 34608

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure foods were stored in a sanitary manner in 1 of 2 nourishment rooms, Nourishment room [ROOM NUMBER]. Findings include: During an observation of Nourishment room [ROOM NUMBER] on 2/19/2024 at 9:30 AM, with the Food Services Manager, there were three quart-sized containers filled with unidentifiable liquids on the bottom shelf of the refrigerator with no label or expiration date, three 1/2 sandwiches wrapped in plastic on a tray on the second shelf of the refrigerator with no label or expiration date, one large plastic grey bowl filled with apple sauce on the top shelf of the refrigerator with no label or expiration date, and two plastic bags with Deli meat on the top shelf of the refrigerator with no label or expiration date. During an interview on 2/19/2024 at 9:40 AM, the Food Services Manager acknowledged the unlabeled and undated liquids and foods in the refrigerator and stated, It is the dietary staff's responsibility to keep the nourishment rooms clean and to make sure everything in the refrigerators is labeled and dated. Everything in here should be labeled with an expiration date marked on it. Review of the facility policy and procedures titled Safe handling, storage, and reheating of food from visitors or outside source read, with an effective date of March 2022, read, Procedure . Later Consumption: When food items are intended for later consumption, the nursing staff will: 1. Ensure the food item(s) are in a sealed container, stored in the nourishment room/pantry refrigerator label [Sic.] with current date and name of the resident. 2. Food will be stored for up to 3 days and then discarded. 105397 Page 3 of 3