Inspection·December 4, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few muscle wasting, cognitive communication deficit, unspecified dementia, contracture of right hand, altered mental status, need for assistance with personal care, contracture of right elbow, major depressive disorder, and hemiplegia and hemiparesis following cerebral infarction affecting right dominant side. A review of the quarterly minimum data set (MDS) assessment, dated 9/3/23, revealed that Resident #3 had a brief interview for mental status (BIMS) score of 15 out of 15 possible points, indicating intact cognition. He required total dependence with transfer, extensive assistance with bed mobility, toilet use, dressing and personal hygiene. He required limited assistance with locomotion on/off unit and was independent with eating. A review of Resident #3's care plan, last revised on 6/15/23 revealed he had an ADL (activities of daily living) Self-care performance deficit as evidence by: cannot complete ADL tasks independently and requires individualized interventions to improve function. Interventions included AM/HS routine care: provide assistance as needed to perform ADL functions including but not limited to personal hygiene, oral care, and bathing. (Copy obtained) During an interview with Employee D, CNA conducted on 12/4/23 at 2:48 pm, she stated it was her job to assist resident's with their ADLs. She stated that the CNAs provide the resident's with their ADL supplies and those residents who can shave independently are allowed to do so, however, they must be supervised at all times. She stated that staff should not leave the residents unattended. She explained that once the resident uses the razor, staff are to throw them in the sharps container. When asked about the observation of Resident #3 having the razors in his possession and being left unsupervised in the women's restroom. She stated Resident #3 should not have been left alone in the women's restroom because resident's should not be unsupervised when shaving or showering. She also stated he should not have had the razors in his possessions and residents should not store the razors in their rooms. During an interview with Employee F, CNA conducted on 12/4/23 at 4:17 pm, she was asked about providing ADL care for residents and shaving supplies. She explained she assisted residents with their ADLs, and it was the CNAs responsibility for getting the residents their supplies. She stated residents were not allowed to keep shaving supplies. She stated that after razors were used, they had to be discarded in the sharps container located in the shower room. She confirmed that residents were supposed to be supervised while they shaved. On 12/4/23 at 3:37 pm the Administrator/Risk Manager approached the surveyor and stated the facility would begin education on residents with sharps. He was asked to elaborate. He began to read from the facility's policy titled Standard Precautions emphasizing other sharp instruments and devices. He was asked about residents storing sharp items in their room. He stated used devices should be disposed of appropriately. He referenced Section 8 of the policy Titled Safe Needle Handling. He was asked if that applied to razors and other shaving supplies. He shrugged his shoulders and did not give a verbal answer. He was asked if residents were supposed to have razors and other shaving supplies in their rooms. He again stated used supplies should be properly disposed of. He did not provide any additional policies on storing sharp items such as razors. He did not answer if and/or where residents could store these items. No additional information was provided. An interview was conducted with Employee H, Licensed Practical Nurse (LPN) on 12/4/2023 at 5:20 pm. When asked about residents with sharps she stated the razors are one time use. She stated for safety purposes residents should be supervised when shaving. She stated the CNAs should be assisting the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105429 If continuation sheet Page 2 of 3 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 105429 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE First Coast Health and Rehabilitation Center 7723 Jasper Avenue Jacksonville, FL 32211 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)

F 0689 residents while shaving and then discarding the razor. She confirmed that the residents are not to store razors in their room. Level of Harm - Minimal harm or potential for actual harm A review of the facility's policy Standard Precautions effective October 2021 revealed: Residents Affected - Few 8. Safe Needle Handling a. Take care to prevent injuries when using needles, scalpels, and other sharp instruments or devices; when handling sharp instruments after procedures; when cleaning used instruments; and when disposing of used needles. d. Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers located as close as practicable to the area in which items were used. . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105429 If continuation sheet Page 3 of 3