Health inspection·November 9, 2023

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview the facility failed to ensure the minimum data set (MDS) was completed accurately for 1 of 3 residents, Resident #104, reviewed for discharge. Residents Affected - Few Findings include: Review of Resident #104's care plan, with an initiation date of 9/29/2023, read, Resident wished to be discharged to the community. Resident #104's care plan included discharge planning interventions that included discharge teaching with resident, family; caregivers, engage resident, family and caregivers in discharge planning; establish a pre-discharge plan with the resident/family/caregivers; review with resident discharge goals and discuss appropriate interventions to achieve goals. Review of Resident #104's progress note, dated 10/12/2023, revealed Resident #104 was planning to discharge home this afternoon. Review of Resident #4's MDS Summary Discharge Return Not Anticipated, dated 10/12/2023, read, Section A. Identification Information F. Entry/discharge reporting 10. Discharge - return not anticipated and G. Type of Discharge 2. Unplanned. During an interview on 11/8/2023 at 12:05 PM, the Administrator confirmed Resident #104's Discharge Return Not Anticipated MDS had been coded incorrectly. Resident #104's Discharge Return Not Anticipated MDS should have been coded as a planned discharge. Page 1 of 4 105401 105401 11/09/2023 Ayers Health and Rehabilitation Center 606 NE 7th St Trenton, FL 32693

F 0656 Level of Harm - Minimal harm or potential for actual harm 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 interview the facility failed to develop and implement a comprehensive care plan to meet the needs for urinary tract infections for 1 of 3 residents, Resident #80. Residents Affected - Few Findings include: Review of the medical record for Resident #80 documents diagnoses that include history of uterine prolapse, diverticulosis of large intestine, acute post hemorrhagic anemia, iron deficiency anemia, essential primary hypertension, gastroesophageal reflux disease, and history of venous thrombosis and embolism. During an interview on 11/06/23 at 1:44 PM Resident #80 stated, I have had several UTI's [urinary tract infections]. I just finished antibiotics for one. Review of the laboratory results document dated 10/23/2023 a urine culture result of greater than 100,000 CFU (colony forming units) with a final result of Escherichia Coli. Dated 8/23/202 a urine culture of greater than 100,000 CFU with a final result of Escherichia Coli. Dated 7/4/2023 a urine culture result of greater than 100,000 CFU with a final result of Escherichia Coli and dated 6/19/2023 a urine culture result of greater than 100,000 CFU with a final result of Escherichia Coli. Review of Resident #80's care plan did not contain a plan of care for urinary tract infections with measurable objectives, interventions, and timetables to meet the resident's needs. During an interview conducted on 11/8/2023 at 9:50 AM Staff A, Certified Nursing Assistant (CNA) stated, Oh she goes to the bathroom on her own and really doesn't need our help much. During an interview conducted on 11/8/2023 at 10:45 AM the Director of Nursing (DON) stated, I do see that she has had multiple UTI's. I do not see any training or education to the resident, or that the resident has been assessed for proper cleaning after using the bathroom. I do not see any care plan related to frequent UTI's or that she was at risk for UTI's. We should have a care plan related to her recurrent UTI's due to her history of uterine prolapse. Review of the policy and procedure titled, Care Plans, Comprehensive Person-Centered with a last approval date of 4/26/2023 read, Policy Statement: A comprehensive person centered care plan that includes measurable objectives and timetables to meet the residents physical psychosocial and functional needs is developed and implemented for each resident. Policy Interpretation. Implementation: 1. The interdisciplinary team (IDT) in conjunction with the resident and his/her family of legal representative develops and implements a comprehensive, person centered care plan for each resident. 9. Care Plan interventions are chosen only after data gathering, proper sequencing of events, careful consideration of the relationship between the resident's problem areas and their causes and relevant clinical decision making. 11. Assessments of residents are ongoing and care plans are revised as information about the residents and the resident's conditions change. 105401 Page 2 of 4 105401 11/09/2023 Ayers Health and Rehabilitation Center 606 NE 7th St Trenton, FL 32693

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on observation, interview, and record review the facility failed to ensure the necessary care and services to maintain urine flow into a catheter bag was provided and failed to ensure proper infection control techniques for 1 of 2 residents, Resident #87, reviewed for urinary catheter care. Findings include: Review of the admission record for Resident #87 documents diagnoses that include unspecified dementia without behavioral disturbances, essential hypertension, anemia, unspecified protein calorie malnutrition, hyperlipidemia, gastroesophageal reflux disease, obstructive sleep apnea, major depressive disorder, age related osteoporosis, and neurogenic bladder. During an observation conducted on 11/06/23 at 9:16 AM Resident #87 was resting in bed. A urinary catheter bag, without a privacy shield, was visible from the doorway on the left side of the bed. The urinary catheter tubing had loops in the tubing and was touching the floor. The loop of the urinary catheter tubing touching the floor had amber colored urine collected in the tubing that was unable to empty into the urinary catheter drainage bag. During an observation conducted on 11/08/23 at 7:38 AM Resident #87 was resting in bed. A urinary catheter bag was observed outside of the privacy bag. Loops were observed in the catheter tubing and the tip of the port, used to open the system for emptying the urinary catheter drainage bag, was resting on the floor. On the floor were a few drops of yellow urine near the port that was resting on the floor. There was yellow urine that had collected in the tubing that was not able to empty into the urinary catheter drainage bag. Review of the physician orders dated 7/12/2023 read, Suprapubic catheter: Catheter care Q [every] shift and PRN [as needed] every shift for catheter care. Empty drainage bag and provide pericare. Position catheter bag and tubing below the level of the bladder, check tubing is free of kinks and securement device is in place. During an interview conducted on 11/8/2023 at 9:30 AM Staff A, Certified Nursing Assistant stated, All urinary catheter bags should have a privacy shield on and not have loops on the floor. There is urine in the tubing that cannot drain into the bag. During an interview conducted on 11/8/2023 at 9:37 AM Staff B, Licensed Practical Nurse stated, The catheter bag should be in the privacy bag. The patient keeps her bed low that it's hard to have the tubing not loop, the tip of the catheter bag should not be on the floor. During an interview conducted on 11/8/2023 at 11:30 AM the Director of Nursing stated, I expect all staff to maintain any catheters correctly and have them in a privacy shield and they should not touch the floor or have loops in the tubing to promote proper drainage. Review of the policy and procedure titled, Suprapubic Catheter Care, with the last approval date of 4/26/2023 read, General Guidelines: Purpose: The purpose of this procedure is to prevent skin irritation around the stoma and to prevent infection of the resident's urinary tract. 4. The urinary drainage bag must be held or positioned lower than the bladder at all times to prevent urine in the tubing and drainage bag from flowing back into the urinary bladder. 5. Check the bag frequently to be 105401 Page 3 of 4 105401 11/09/2023 Ayers Health and Rehabilitation Center 606 NE 7th St Trenton, FL 32693

F 0690 sure the tubing is free of kinks. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 105401 Page 4 of 4