Health inspection·December 22, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of policy and procedure, record review and interview, the facility failed to ensure that the resident was seen by a Dermatologist for diagnostic follow-up, based on signs, symptomatology and per physician's written order, for 1 of 4 sampled residents, reviewed (Resident #4). Residents Affected - Few The findings included: Review of the facility policy and procedure titled Physician Orders provided by the Director of Nursing (DON) revised July 2020 documented in the Policy Statement: Orders for .treatments will be consistent with principles of safe and effective order writing. Nursing staff must follow safe and effective transcription of physician's orders and safe and effective ./treatment .Policy Interpretation and Implementation 4. Nurse must follow physician orders as prescribed, any changes in physician orders must be communicated to physician and a new order must be obtained and transcribed . Review of Resident #4's closed record, it was revealed the Resident was re-admitted to the facility on [DATE] with diagnoses which included Diabetes Mellitus Type II with Hyperglycemia, Parkinsonism, Peripheral Vascular Disease, Atherosclerotic Heart Disease, Generalized Anxiety Disorder, Malignant Neoplasm of Unspecified Testis, Hypertension and Cerebral Infarction. He had a Brief Interview Mental Status (BIM) score of 14 (cognitively intact). On 10/12/23 the physician's written order documented: Dermatology Consult diagnosis Rash/Itching to back and bilateral lower extremities. Subsequent record review revealed that Resident #4's physician documented in two (2) different progress notes, one (1) dated 10/09/23 and the other dated 10/24/23, that Resident #4 was noted to have a generalized rash on abdomen .using Benadryl with no improvement, twice documenting the need for a Dermatology evaluation/assessment to be done as ordered. An interview was conducted on 12/21/23 at 5:14 PM with Staff A, a Certified Nursing Assistant (CNA), in which she was asked whether or not Resident #4 had a reddened rash on his body. Staff A responded by saying, yes, and he had some cream that was put all over his body, for his itching and scratching, which she said he had for some time. An interview was conducted on 12/22/23 at 10:56 AM with Staff B, a Licensed Practical Nurse (LPN), in which she was asked about the reddish rash located on Resident #4's body. Staff B acknowledged that Resident #4 had medicated cream ordered and applied to the rashes located mainly on his back and in his Abdominal Thoracic area. Staff B went on to say that Resident #4 had been scratching for a period of time, and he had been ordered some Benadryl for this. Staff B added that she was unable to Page 1 of 4 105505 105505 12/22/2023 Margate Health and Rehabilitation Center 5951 Colonial Drive Margate, FL 33063

F 0684 recall whether or not Resident #4 had ever been seen by a Dermatologist. Level of Harm - Minimal harm or potential for actual harm During an interview conducted with the Infection Control Nurse, on 12/21/23 at 2:53 PM, she stated that she had been aware that Resident #4 had been having a skin issue, which required follow-up by a Dermatologist. She explained that she tried assisting one of the resident's assigned nurses, in contacting the Dermatologist office, in order to have them come out to the facility to see this resident. The Infection Control Nurse stated that she could not recall whether or not Resident #4 was actually seen, at any time, in the facility by a Dermatologist. Residents Affected - Few Further record review of Resident #4's care plans documented the following .Focus: 1) Resident noted with dry lower extremities, 2) Resident has a rash noted to chest & upper back and, 3) Resident was re-admitted with Skin alteration and is at risk for further skin breakdown Interventions include: . Dermatology consult as needed and provide any needed treatments per MD order. Goals: Resident will have resolved/decreased risk of infection by next review date, Resident's rash will resolve and Resident will minimize risk for further skin breakdown daily through next review date; this was not done. During an interview and side-by-side record review conducted on 12/22/23 at 1:47 PM with Staff C, RN, Unit Manager of the [NAME] wing, she stated that she had seen and reviewed the 10/12/23 physician's order for Resident #4 to have a Dermatology consult for diagnosis: Rash/itching to back and bilateral lower extremities. However, she revealed that Resident #4 had never been seen by any Dermatologist for his skin condition during his facility stay. Since Resident #4 was scheduled but failed to keep an appointment with a Dermatologist, Staff C was asked the following question: did you make any other attempts to call any other Dermatologist during that time, in order to have this resident's skin condition assessed and evaluated, per the physician's order? Her response was, no. Furthermore, Staff C acknowledged that she had not made any notation in the resident's medical record documenting her prior contact with the Dermatologist office in order to schedule, or re-schedule an evaluation for this resident, as ordered, prior to discharge. Staff C went on to say that she had not contacted her supervisor, nor the resident's attending physician, to notify them of the above. Record review of the resident's documented pain scale level for the month of October 2023 revealed that on six (6) days-October 4th, 8th, 11th, 12th, 13th and 29th; each ranged from 3-9/10. The weekly computerized skin check forms for Resident #4 dating from 09/21/23 through 10/26/23 did not documBased on review of policy and procedure, record review and interview, the facility failed to ensure that the resident was seen by a Dermatologist for diagnostic follow-up, based on signs, symptomatology and per physician's written order, for 1 of 4 sampled residents, reviewed (Resident #4). The findings included: Review of the facility policy and procedure titled Physician Orders provided by the Director of Nursing (DON) revised July 2020 documented in the Policy Statement: Orders for .treatments will be consistent with principles of safe and effective order writing. Nursing staff must follow safe and effective transcription of physician's orders and safe and effective ./treatment .Policy Interpretation and Implementation 4. Nurse must follow physician orders as prescribed, any changes in physician orders must be communicated to physician and a new order must be obtained and transcribed . Review of Resident #4's closed record, it was revealed the Resident was re-admitted to the facility on [DATE] with diagnoses which included Diabetes Mellitus Type II with Hyperglycemia, Parkinsonism, 105505 Page 2 of 4 105505 12/22/2023 Margate Health and Rehabilitation Center 5951 Colonial Drive Margate, FL 33063

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Peripheral Vascular Disease, Atherosclerotic Heart Disease, Generalized Anxiety Disorder, Malignant Neoplasm of Unspecified Testis, Hypertension and Cerebral Infarction. He had a Brief Interview Mental Status (BIM) score of 14 (cognitively intact). On 10/12/23 the physician's written order documented: Dermatology Consult diagnosis Rash/Itching to back and bilateral lower extremities. Subsequent record review revealed that Resident #4's physician documented in two (2) different progress notes, one (1) dated 10/09/23 and the other dated 10/24/23, that Resident #4 was noted to have a generalized rash on abdomen .using Benadryl with no improvement, twice documenting the need for a Dermatology evaluation/assessment to be done as ordered. An interview was conducted on 12/21/23 at 5:14 PM with Staff A, a Certified Nursing Assistant (CNA), in which she was asked whether or not Resident #4 had a reddened rash on his body. Staff A responded by saying, yes, and he had some cream that was put all over his body, for his itching and scratching, which she said he had for some time. An interview was conducted on 12/22/23 at 10:56 AM with Staff B, a Licensed Practical Nurse (LPN), in which she was asked about the reddish rash located on Resident #4's body. Staff B acknowledged that Resident #4 had medicated cream ordered and applied to the rashes located mainly on his back and in his Abdominal Thoracic area. Staff B went on to say that Resident #4 had been scratching for a period of time, and he had been ordered some Benadryl for this. Staff B added that she was unable to recall whether or not Resident #4 had ever been seen by a Dermatologist. During an interview conducted with the Infection Control Nurse, on 12/21/23 at 2:53 PM, she stated that she had been aware that Resident #4 had been having a skin issue, which required follow-up by a Dermatologist. She explained that she tried assisting one of the resident's assigned nurses, in contacting the Dermatologist office, in order to have them come out to the facility to see this resident. The Infection Control Nurse stated that she could not recall whether or not Resident #4 was actually seen, at any time, in the facility by a Dermatologist. Further record review of Resident #4's care plans documented the following .Focus: 1) Resident noted with dry lower extremities, 2) Resident has a rash noted to chest & upper back and, 3) Resident was re-admitted with Skin alteration and is at risk for further skin breakdown Interventions include: . Dermatology consult as needed and provide any needed treatments per MD order. Goals: Resident will have resolved/decreased risk of infection by next review date, Resident's rash will resolve and Resident will minimize risk for further skin breakdown daily through next review date; this was not done. During an interview and side-by-side record review conducted on 12/22/23 at 1:47 PM with Staff C, RN, Unit Manager of the [NAME] wing, she stated that she had seen and reviewed the 10/12/23 physician's order for Resident #4 to have a Dermatology consult for diagnosis: Rash/itching to back and bilateral lower extremities. However, she revealed that Resident #4 had never been seen by any Dermatologist for his skin condition during his facility stay. Since Resident #4 was scheduled but failed to keep an appointment with a Dermatologist, Staff C was asked the following question: did you make any other attempts to call any other Dermatologist during that time, in order to have this resident's skin condition assessed and evaluated, per the physician's order? Her response was, no. Furthermore, Staff C acknowledged that she had not made any notation in the resident's medical record documenting her prior contact with the Dermatologist office in order to schedule, or re-schedule an evaluation 105505 Page 3 of 4 105505 12/22/2023 Margate Health and Rehabilitation Center 5951 Colonial Drive Margate, FL 33063

F 0684 Level of Harm - Minimal harm or potential for actual harm for this resident, as ordered, prior to discharge. Staff C went on to say that she had not contacted her supervisor, nor the resident's attending physician, to notify them of the above. Record review of the resident's documented pain scale level for the month of October 2023 revealed that on six (6) days-October 4th, 8th, 11th, 12th, 13th and 29th; each ranged from 3-9/10. Residents Affected - Few The weekly computerized skin check forms for Resident #4 dating from 09/21/23 through 10/26/23 did not document any descriptive information nor interventions done; it was only documented as, no new skin impairment noted at this time. The nursing progress notes reviewed from 09/12/23 thru 10/30/23 (well-over one month) contained no documentation of skin progression, no clarifying description, nor any response to treatment for Resident #4's on-going fragile, compromised skin condition or status, at the time. During the survey, the Surveyor, along with the facility Administration, attempted to call the referring dermatologist office, with the phone number provided to the resident and the resident's family upon discharge. It was discovered and revealed that an incorrect phone number/information had been provided to the resident and his family, for follow-up. The DON recognized and acknowledged that on 12/22/23 at 3 PM there was a written physician's order for Resident #4 to have a Dermatologist consult prior to discharge from the facility; this was not done even after the resident's own general primary physician wrote an order for (any available) Specialist Dermatological consult, weeks prior to the resident's discharge from the facility. ent any descriptive information nor interventions done; it was only documented as, no new skin impairment noted at this time. The nursing progress notes reviewed from 09/12/23 thru 10/30/23 (well-over one month) contained no documentation of skin progression, no clarifying description, nor any response to treatment for Resident #4's on-going fragile, compromised skin condition or status, at the time. During the survey, the Surveyor, along with the facility Administration, attempted to call the referring dermatologist office, with the phone number provided to the resident and the resident's family upon discharge. It was discovered and revealed that an incorrect phone number/information had been provided to the resident and his family, for follow-up. The DON recognized and acknowledged that on 12/22/23 at 3 PM there was a written physician's order for Resident #4 to have a Dermatologist consult prior to discharge from the facility; this was not done even after the resident's own general primary physician wrote an order for (any available) Specialist Dermatological consult, weeks prior to the resident's discharge from the facility. 105505 Page 4 of 4