Health inspection·September 21, 2023

F 0695 nasal cannula at a rate of 3 Liter per minute, continuously on every shift for shortness of breath. Level of Harm - Minimal harm or potential for actual harm Upon review of resident's Medicare 5-day Minimum Data Set (MDS) dated [DATE], section C (Cognitive Patterns) revealed a Brief Interview for Mental Status score of 04 on a scale of 00 to 15 indicating resident is cognitively impaired. Section G (Functional Status) revealed resident required extensive assistance with bed mobility, transfer and toilet use by two staff and personal hygiene, dressing by one staff and total dependence for locomotion and eating from one staff member. Sections J (Health Conditions, pain) revealed resident had no pain or health conditions for last 5 days. Section O (Special Treatments, Procedures, and Programs) revealed resident received oxygen, physical and occupational therapy for the last 14 days. Residents Affected - Few Review of Care plan reference date 06/15/2023 revealed, resident #54 has a potential for respiratory complication related to diagnosis (dx): Chronic Obstructive Pulmonary Disease (COPD). Interventions included: Oxygen Settings: Oxygen Via Nasal Cannula at 3 L/min continuous. Every shift for Shortness of Breath related to COPD. Give aerosol or bronchodilators as ordered. Monitor/document any side effects and effectiveness. Budesonide Inhalation Suspension 0.5 Milligrams (mg)/2milliliters (mL), 2 ml inhale orally via nebulizer every 12 hours. Keep Head of bed (HOB) elevated. Monitor respiratory pattern/effort. Monitor vital signs. Observe for acute respiratory insufficiency: Anxiety, Confusion, Restlessness, Shortness of breath at rest, Cyanosis, Somnolence. Observe/document for anxiety. Offer support, encourage resident to vent frustrations, fears. Reassure. Give as needed medications for anxiety as ordered. Observe/document/report any respiratory infection: Fever, Chills, increase in sputum (document the amount, color, and consistency), chest pain, increased difficulty breathing, increased coughing and wheezing. Provide adequate by mouth (PO) fluids with and in-between meals. Provide adequate rest periods between activities. Review of the Nursing Progress Note dated 8/11/2023 at 6:51 PM revealed, resident was stable and had oxygen by nasal cannula at 3 Liters per minute. Interview with Registered Nurse (Staff A) at 09:50AM on 09/21/2023 (translated by Licensed Practical Nurse, Staff B), Staff A stated she was the nurse for resident # 54. Staff A reported, the resident's order for oxygen was 3 Liters per minute continuously. Staff A reported, she checked the resident's oxygen delivery four times a day to ensure it was at the correct setting. Staff A reported, the treatment nurse checked the oxygen saturation for all residents once a shift, enters the result into the treatment record of the Electronic Medication Administration Record, and reports any concern to nursing and the nurse calls the doctor. Staff A reported, the oxygen tubing is changed once a week on Sundays. Staff A reported, the doctor is notified if a change in baseline is observed. Review of the undated Policy and Procedure for Oxygen Administration revealed, Purpose: The Purpose of this procedure is to provide guidelines for safe oxygen administration. Preparation: Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. Steps in the Procedure: 10. Adjust the oxygen delivery device so that it is comfortable for the resident and the proper flow of oxygen is being administered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105432 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 105432 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Care Center 899 NW 4th Street Miami, FL 33128 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 0732 Post nurse staffing information every day. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to have daily nurse staffing posted prior to the beginning of shifts on 2 of 2 nursing stations. This had the potential to affect the 115 residents who resided in the facility at the time of this survey. Residents Affected - Many The findings included: During an observation on the second and third floor nurse's station, on 09/18/23 at 6:42 AM, it was noted that the staffing information was not posted, and both boards were blank. (Photo Evidence) On 09/21/23 at 08:38 AM Staff C, the Certified Nursing Assistant (C N A) Coordinator reported, she has been working in the facility for over 30 years and she oversees the CNA's schedule. They have a minimum 8 CNA's in the morning, in the afternoon 6, and at night 5 on each floor. The facility always has one CNA extra in case its needed. The secretary of each floor oversees writing on the board the schedule for every day. During the weekends there are always secretaries who oversee doing that. If there is only one, she must write on the board for the two floors. On 09/21/23 at 09:38 AM Staff D, Unit Clerk, who works on the 3rd floor stated that she has been working in the facility for 25 years, she works from 7:00 AM to 3:30 PM. Her job duties during her shift are; to answer the phone, makes doctor's appointments, transportation, write the names of the CNA's and the RN's on the board. Last weekend she stated, I forgot to write it, I do not know what happened, because this weekend I was in charge of both floors. Policy and procedures for Posting Direct Care Daily Staffing Numbers dated July 2016: Policy Statement Our facility will post on a daily basis for each shift, the number of nursing personnel responsible for providing direct care to residents. Policy interpretation Within two (2) hours of the beginning of each shift, the number of licensed nurses Registered Nurses, Licensed Practical Nurse and Licensed Vocational Nurse (RNs, LPNs, LVNs) and the number of unlicensed nursing personnel (CNAs) directly responsible for resident care will be posted in a prominent location (access to residents and visitors) and in a clear and readable format. Within two (2) hours of the beginning of each shift, the shift supervisor shall compute the number of direct care staff and complete the Nursing Staff Directly Responsible for Resident Care form. The shift supervisor shall date the form, record the census and post the staffing information in the location(s) designated by the administrator. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105432 If continuation sheet Page 3 of 3