Health inspection·August 18, 2022

F 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure residents were informed of services available in the facility and charges for those services including any charges not covered under Medicare for 1 resident (Resident #388) of 3 residents reviewed when Medicare Part A coverage was ending. Residents Affected - Few Findings include: Review of Resident #388's clinical record documented that the last covered Medicare Part A day was 6/02/22. Review of Resident #388's clinical record revealed no documented Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage, Form 10055 (SNF ABN) was provided to the resident. During an interview on 8/17/22 at 2:00 PM the Admissions Director (AD) confirmed the facility failed to complete the SNF ABN for Resident #388 when Medicare Part A coverage was ending. Page 1 of 9 105413 105413 08/18/2022 Aviata at Brooksville 1445 Howell Ave Brooksville, FL 34601

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview the facility failed to ensure residents' personal privacy and confidentiality of personal and medical records. Residents Affected - Few Findings Includes: During an observation on 8/16/2022 at 8:32 AM it showed the computer kiosk was on the medication cart was opened facing the hallway. Resident #40's medication information was visible on the kiosk and documented enteral feed, acidophilus capsule, trazadone, vitamin C, and zinc tablet. One resident was standing directly in front of the medication cart, one was to the right of the medication cart, and one resident was walking in the hallway. The report sheet and vital sign sheet were face up on the medication cart and documented personal medical information for 26 residents that could be viewed by residents/visitors walking in the hallway. The report sheets revealed the following information, the residents' names, diagnosis, treatments, if they go do dialysis, have pressure ulcers, their DNR (do not resuscitate) status, if they consume thickened liquids, are on comfort measures, and if they have wound dressing changes. During an observation on 8/16/2022 at 8:41 AM Staff F, LPN approached and witnessed the medication cart with the report and vital sign sheets visible. During an interview on 8/16/2022 at 8:41 AM Staff F, LPN stated, The report/vital signs sheets should not be on top of the medication cart where they can be viewed, they should be turned up side down. The resident's kiosk information should not be opened where anyone can see it. During an observation on 8/16/2022 at 8:43 AM Staff H, LPN returned to the medication cart. During an interview on 8/16/2022 at 8:43 AM Staff H, LPN stated I do not know how to make the resident's information not be visible in the kiosk without closing the kiosk completely out and re-starting it each time. I should not have left the kiosk open. I should have turned the report sheets so that anyone walking in the hallway could not see the sheets. During an observation on 8/16/2022 at 1:58 PM of the A-1 hallway medication cart it showed the computer Kiosk was opened to the physician orders page for Resident #68. The documentation provided for the name of the medications, dates the medications were ordered, and the dates the medications were stopped. A resident was seated in a wheelchair directly adjacent to the medication cart. During an interview on 8/16/2022 at 2:05 PM Staff I, LPN stated, I left the kiosk open to show [Resident #68's name] order detail page. I left to go to the Unit Managers office. I should have closed the kiosk and not left it opened. Review of the policy and procedure titled, Clinical Medical Records last reviewed on 6/27/2022 did not address the confidentiality of medical information. 105413 Page 2 of 9 105413 08/18/2022 Aviata at Brooksville 1445 Howell Ave Brooksville, FL 34601

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview, and record review, the facility failed to ensure housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable environment for 4 of 13 residents' rooms, Residents #3, #38, #50 and #54 observed on the A Wing. Findings include: During a tour of the A Wing conducted on 08/15/22 beginning at 10:00 AM, Residents #3, #38 and #54's window frames and vertical blinds were observed to have cobwebs and multiple black marks. Residents #3 and #54's foot boards on their beds were observed to have the edge stripping peeling and hanging from the bed onto the floor. Resident #38's footboard was missing the edge stripping completely leaving an exposed rough edge, and the over the head bed light was not fully attached to the wall. Resident #50's privacy curtains were observed to have brown colored stain streaks on them. [Photographic Evidence Obtained]. During a tour of the A Wing conducted on 08/16/22 beginning at 1:00 PM, Resident #3, #38 and #54's window frames and vertical blinds were observed to contain cobwebs and multiple black spots on the blinds. Resident #3 and #54's foot boards on their beds were observed to have the edge stripping peeling and hanging from the bed onto the floor. Resident #38's footboard was missing the edge stripping completely leaving an exposed rough edge, and the over the head bed light was not fully attached to the wall. Resident #50's privacy curtains were observed to have brown colored stain streaks on them. During an interview on 08/16/2022 the Director of Housekeeping confirmed Resident #50's privacy curtains needed to be cleaned and stated, We do not have any replacement curtains and so these will have to be taken down, washed and put back up and we have one washing machine running right now. He further confirmed Resident #3 and #38's vertical blinds and window frames contained cobwebs and multiple black spots on the blinds. During an interview on 08/16/22 at 12:20 PM the Director of Maintenance confirmed Residents #3, #38 and #54's footboards on their beds were observed with peeling stripping or missing stripping and Resident #38's over head of the bed light was not fully attached to the wall. Review of the policy and procedure titled, Maintenance dated 11/30/14 and last reviewed on 6/27/22 read, Policy: The facility's physical plant and equipment will be maintained through a program of preventative maintenance and prompt action to identify areas/items in need of repair .The Director of Environmental Services will perform daily rounds of the building to ensure the plant is free of hazards and in proper physical condition. 105413 Page 3 of 9 105413 08/18/2022 Aviata at Brooksville 1445 Howell Ave Brooksville, FL 34601

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure the accuracy of resident assessments for 1 of 3 residents, Resident #90 reviewed for discharge status. Residents Affected - Few Findings include: Review of Resident #90's medical record documented the resident was last admitted to the facility on [DATE] and was discharged to home on 5/25/2022. Review of the Minimum Data Set (MD) dated 5/25/2022 documented Resident #90 was discharged to the hospital return not anticipated under Section A. During an interview on 8/18/2022 at 8:45 AM with Minimum Data Set (MDS) Registered Nurse (RN) stated, This is a coding error. [Resident #90's name] went home and not out to the hospital. During an interview via telephone on 8/18/2022 at 9:11 AM Staff F, Licensed Practical Nurse (LPN) stated, [Resident #90's name] went home. He did not go to the hospital. Review of the nursing progress note dated 5/25/2022 at 12:55 PM by Staff F, LPN read, [Resident #90's Name] discharged to home with home health services per orders. Resident left facility via stretcher. Accompanied by 3 attendants. All medications including narcotics sent with resident per orders. 105413 Page 4 of 9 105413 08/18/2022 Aviata at Brooksville 1445 Howell Ave Brooksville, FL 34601

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 respiratory care was provided consistent with professional standards for 1 of 3 residents, Resident #26, reviewed for respiratory care. Residents Affected - Few Findings: Review of the medical record for Resident #26 documented the resident was admitted into the facility on [DATE] with diagnoses to include malignant neoplasm of larynx, tracheostomy. During an observation on 08/15/22 at 02:29 PM it showed Resident #26 was in bed with tracheostomy site clean and currently capped. There was an oxygen cylinder at the bedside and humidifier machine with tubing on the floor, uncovered and not dated. The oxygen nasal cannula tubing was wrapped around the oxygen cylinder, undated and uncovered. The yankauer suction catheter was unclean and placed on top of the humidifier machine, uncovered and undated. The suction cannister was half full of secretions and the cannister was not dated. During an observation on 8/16/2022 at 10:22 AM it showed Resident #26's air humidifier tubing was on the floor. The oxygen tubing continued to be undated and uncovered. The yankauer suction catheter was unclean, uncovered and placed on top of the humidifier machine, and the suction cannister continued to be half full of secretions and was undated. Review of the physicians' orders dated 11/13/2021revealed: Humidified air via trach mask for two hours in the morning and two hours at night as tolerated four times a day. Trach suction as needed. During an interview Staff C, Licensed Practical Nurse/Unit Manager of the A Wing (UM) on 8/17/2022 at 9:50 AM stated the respiratory supply tubing is changed weekly on Tuesdays by the Central Supply Aide. The UM stated she rounds the Unit every 30 minutes. During an observation on 8/17/2022 at 9:56 AM with the UM of Resident #26's room the UM confirmed the oxygen tubing was not dated, was uncovered, the humidifier tubing was touching the floor, undated and uncovered, the yankauer suction catheter was unclean and uncovered, and the suction cannister was half full of secretions and undated. During an interview Staff D, on 8/17/2022 at 10:05 AM the Central Supply Clerk stated she has work on this position for the past two months. Staff D stated that she is responsible for changing the respiratory tubing in the facility. I change the tubing every Monday. I get the list of residents with oxygen and nebulizer from the nurses, and the last updated list was 6/15/2022. When asked when she last changed the oxygen tubing and humidifier tubing for Resident #26, Staff D replied, Never, I did not know about him. Staff D confirmed tubing is supposed to be bagged/covered and dated every time they are changed. Review of the list of residents using oxygen and nebulizer revealed it was updated on 6/15/2022 and Resident #26 was not on the list. Review of policy and procedure titled, Equipment Change Schedule last reviewed on 6/23/2022 reads, Policy: An equipment change schedule provides a schedule for changing disposable equipment at regular intervals as determined by manufacturer's recommendations and standard of practice. Nasal Cannula 105413 Page 5 of 9 105413 08/18/2022 Aviata at Brooksville 1445 Howell Ave Brooksville, FL 34601

F 0695 Level of Harm - Minimal harm or potential for actual harm change every 7 days or when contaminated. Suction cannister/tubing change cannister every fourteen (14) days. Change yankauer suction catheter change every 30 days, clean and rinse between uses. Change when evidence of gross contamination or mechanical dysfunction. Change humidifier bottle once every seven (7) days. Residents Affected - Few 105413 Page 6 of 9 105413 08/18/2022 Aviata at Brooksville 1445 Howell Ave Brooksville, FL 34601

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review the facility failed to ensure expired medications were not stored with active medications and failed to ensure medications were labeled according to standard of practice. Findings include: During an observation on 08/15/22 beginning at 10:41 AM showed in the A-1 front hall medication cart an Albuterol inhaler was not labeled with a resident's name. Latanoprost eye drops 2.5 mg for Resident #54 did not show the date the eye drops were opened. The instructions on the eye drops read to discard after 42 days. One bottle of artificial tears was not labeled with a resident's name or the date the bottle was opened, the manufacturer's recommendation is to discard the medication 28 days after opening. One bottle of Refresh eye drops 0.5 ML (milliliters) was not labeled with a resident's name or the date the container was opened, the manufacturer's recommendation is to discard the medication 90 days after opening. During an interview on 8/15/2022 at 10:50 AM Staff E, Licensed Practical Nurse (LPN) stated, I checked that medication cart (A-1) carefully all except the eye drops and inhalers. I don't know why there are no residents' names or when they were opened. [Resident #54's name] eye drops should have shown the date that the eye drops were opened because they were to expire 42 days after opening. During an observation on 8/15/2022 at 10:57 AM of the medication cart (#2) on the A-2 hallway showed the following, Resident #39's Humalog Insulin was opened on 7/11/2022. The instructions on the Humalog Insulin read to discard after 28 days. Latanoprost eye drops 2.5 MG (milligrams) for Resident #3 did not show the date the eye drops were opened. The instructions on the eye drops read to discard after 42 days. Two bottles of artificial tears were not labeled with a resident's name and were documented with an open date. One bottle of artificial tears eye drops for Resident #47 was not labeled with an open date. During an interview on 8/15/2022 at 11:06 AM Staff J, LPN stated, I do not know why the Humalog Insulin for [Resident #39's name] was opened on 7/11/2022 and is past the 28 day time frame of being opened. The Humalog Insulin expires 28 days after opening. I don't know why the Latanoprost eye drops for [Resident #3's name] did not show the date the eye drops were opened. The eye drops are to be discarded 42 days after opening. I don't know why the two bottles of artificial tears did not show a resident's name and no open date. I am not sure why the bottle of artificial tears eye drops for [Resident #47's name] did not show when the eye drops were opened. Eye drops and insulin have a short time for administration after being opened. During an observation on 8/15/2022 at 11:13 AM of the B-hallway medication cart the following was observed Resident #36's Levemir Insulin Pen did not show the date the Insulin was opened. The Insulin read that it expires 42 days after opening. Resident #37's Lantus Insulin did not show the date the Lantus Insulin was opened and did not show the date Resident #37's Fliasp Insulin was opened. Resident #78's Levemir Insulin did not show the date the insulin was opened. Instruction on the Levemir Insulin read it expires 42 days after it is opened. Resident #7's Novolin Insulin was opened on 6/28/2022. The directions read the Novolin Insulin expires 28 days after opening. Resident #72's Lantus 105413 Page 7 of 9 105413 08/18/2022 Aviata at Brooksville 1445 Howell Ave Brooksville, FL 34601

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Insulin was not labeled with an open date on the pen or bag. Resident #13's artificial tears were opened on 5/3/2022. Resident #89's Latanoprost eye drops and Brimonidine eye drops were not labeled with an open date. Resident #33's artificial tears were opened on 12/22/2021. During an interview on 8/15/2022 at 11:32 AM Staff I, LPN stated, I do not know why the Insulins did not show the dates they were opened for [Residents' # 36, #37, #78, #7 and #72 names]. I do not know why the insulins that were opened were out of date according to discarding them after the 28 or 42 days. These insulins should have been removed from the medication drawer. I do not know why the eye drops for [Resident #89's name] did not show the date the eye drops were opened, or why the eye drops for [Resident #33's name] were opened on 12/21/2021 and are still on the cart. During an observation on 8/16/2022 at 8:32 AM it showed on top of the medication cart was one bottle of stool softener and a white plastic cup that contained a white powder. One resident was observed standing directly in front of the medication cart, one was to the right of the medication cart, and a resident was observed walking in the hallway. There was no staff observed in the area at the time of the observation. During an observation on 8/16/2022 at 8:41 AM Staff F, LPN approached and witnessed the medication cart and the unattended medications on top of the medication cart. During an interview on 8/16/2022 at 8:41 AM Staff F, LPN stated, The medications should be secure inside of the medication cart. During an observation on 8/16/2022 at 8:43 AM Staff H, LPN returned to the medication cart. During an interview on 8/16/2022 at 8:43 AM Staff H, LPN stated I should not have left the medications on top of the medication cart. During an observation on 8/16/2022 at 4:00 PM during the medication pass Staff G, LPN removed the accucheck supplies from the medication cart and proceeded to enter Resident #39's room. The nurse left the medication cart unlocked/unsecured. Numerous residents were observed directly in front of and adjacent to the medication cart. The medication cart was not in the line of vision for the nurse to observe the cart. During an interview on 8/16/2022 at 5:09 PM Staff G, LPN stated I forgot to lock the medication cart. I should not have left the cart unlocked. Review of the policy and procedure titled, Storage and Expiration of Medications, Biologicals, Syringes and Needles last revised 6/27/2022 read, Facility should ensure that all medications . are securely stored in a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors. Facility should ensure that medications have an expiration date on the label. Once any medication is opened, facility should follow manufacturer/supplier guideline with respect to expiration dates for opened medications. 105413 Page 8 of 9 105413 08/18/2022 Aviata at Brooksville 1445 Howell Ave Brooksville, FL 34601

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety. Residents Affected - Few Findings include: During the initial tour of the main kitchen on 08/15/22 beginning at 9:45 AM it showed there were two containers labeled cole slaw; one contained was labeled with a discard date of 8/8/22 and the other container was labeled with a made date of 08/07/22. There was one container labeled chicken salad with a made date of 08/05/22. (Photographic Evidence Obtained). During an interview on 08/15/22 at 9:45 AM the Certified Dietary Manager confirmed the containers of food should have been discarded on the dates listed on the lids or within a week of being made. Review of the policy and procedure titled, Food Storage: Cold Foods, with a last reviewed date of 06/27/22 read, All time/temperature control for safety foods, frozen and refrigerated will be appropriately stored in accordance with guidelines of the FDA (Food and Drug Administration) Food Code .Procedures. 5. All foods will be stored wrapped or in covered containers, labeled and dated and arranged in a manner to prevent cross contamination. 105413 Page 9 of 9