Health inspection·September 30, 2021

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm 2. A review of Resident #17' s clinical record revealed a care plan specifying Resident #17 had an Activities of Daily Living (ADLs) self-care performance deficit and required extensive assistance with hygiene. Residents Affected - Few Record review showed Resident #17 had the following diagnosis: Cerebral Vascular Accident (CVA) with right sided weakness, psychosis, bipolar disorder, and depression. On 9/27/21 at 1:03 p.m., Resident #17's fingernails were observed extending over 1/2 inch from the tip of finger with a large amount of brown substance under the nail beds. On 9/27/21 at 1:14 p.m., Resident #17 said she was unable to do her own nail care and needed the staff to do it. She said at times the activities department would do nails and she would like to go. 3. A review of Resident #101's clinical record revealed a care plan specifying Resident #101 had an Activities of Daily Living (ADLs) self-care performance deficit and required extensive assistance with hygiene. Record review showed Resident #101 had the following diagnosis: Lumbar fracture, Dementia, failure to thrive, cognitive communication deficit, and lack of coordination. On 9/27/21 on 10:56 a.m., Resident #101 was observed with dirty fingernails on both hands. Resident #101 was observed in her bed and was able to answer questions. Resident #101's fingernails appeared to be approximately 1/2 inch long above the tips of her fingers and each nail had dark brown substance under them. On 9/27/21 at 10:58 a.m., Resident #101 said she needed assistance to get washed up and get her nails cleaned and trimmed. She said she was unable to do that herself. On 9/28/21 at 11:20 a.m., observed Resident #101 in bed. The resident's spouse was attempting to clean her nails in soapy water and brush. On 9/28/21 at 4:05 p.m., in an interview, the Administrator said a couple of months ago a concern was brought forward about nails being long and not clean. The Administrator said the facility started a plan to look into the issue. Based on observation, resident and staff interviews, record review, and review of facility policies and procedures, the facility failed to provide the necessary care and services to maintain grooming and hygiene for 3 (Resident #17, #63, and #101) of 3 dependent residents reviewed for assistance Page 1 of 6 105524 105524 09/30/2021 Port Charlotte Rehabilitation Center 25325 Rampart Blvd Port Charlotte, FL 33948

F 0677 with activities of daily living. This has the potential to cause psychological harm to the resident. Level of Harm - Minimal harm or potential for actual harm The findings included: Residents Affected - Few A review of the facility policy, CCHC 0608 Fingernail Care specified, Purpose. To promote circulation to the hands. To clean fingernails. 1. A review of Resident #63' s clinical record revealed a care plan specifying Resident #63 had an Activities of Daily Living (ADLs) self-care performance deficit. The Significant Change Minimum Data Set with a date of 8/26/21 documented Resident #63 required extensive assistance of one person with hygiene. Resident #63 had diagnoses including dementia with behavioral disturbance. On 9/27/21 at 11:03 a.m., Resident #63's fingernails were observed extending over 1/2 inch from the tip with a large amount of brown substance under the nail beds. Resident #63 was observed to have greasy, uncombed hair and was unshaved with approximately 4 days growth. The same observation was made on 9/28/21 at 8:49 a.m. A review of the daily charting from 9/21/21 through 9/29/21 noted documentation the Certified Nursing Assistants (CNA's) provided bathing on 9/24/21 and 9/28/21 and daily hygiene care on 9/22/21 through 9/29/21, during the morning shift. On 9/29/21 at 1:02 p.m., in an interview CNA Staff O said there was a shower book, and they follow the schedule, it goes by room number not resident names. CNA Staff O said sometimes Resident #63 refused care, but I come back and try again, and he will say okay. He can feed himself but that is about it. He does not like to get out of bed, so I give him a bed bath. The CNA said, I document the shower on the shower sheets and in the computer. On 9/29/21 at 1:17 p.m., in an interview Licensed Practical Nurse (LPN), Unit Manager Staff P said, the CNA's must try and make 3 attempts to encourage the resident to shower then they tell the nurse, and the nurse will try. If the nurse can't get the resident to bathe and receive ADL care, then we document it. We can't force the resident to get showered or anything. LPN Staff P said, once the CNA turns in the shower sheet and the nurse document's it, then we shred the shower sheet. The CNAs document the care they provided in the computer system. On 9/29/21 at 1:25 p.m., in an interview CNA Staff N said she had worked at the facility for about 2 years and worked with Resident #63 all the time. CNA Staff N said, he tries to refuse care but if you go back and ask again, he will say ok. He will get showers but once it is done, he wants to go right back to bed. CNA Staff N said, I gave him a bed bath and a shave today. I was not here on 9/27/21 and 9/28/21. CNA Staff N said Resident #63 was not combative with care but will try and push you way when he doesn't want to be bothered but I just come back to him, and he will let me. CNA Staff N said the CNAs did nail care, cleaning and filing. Review of the clinical record for Resident #63 showed 2 completed CNA Shower Review sheets for 105524 Page 2 of 6 105524 09/30/2021 Port Charlotte Rehabilitation Center 25325 Rampart Blvd Port Charlotte, FL 33948

F 0677 Level of Harm - Minimal harm or potential for actual harm 9/14/21 and 9/16/21. The clinical record showed no documentation Resident #63 refused care from 9/24/21 through 9/28/21. On 9/30/21 at 12:54 p.m., in an interview, the facility Administrator said CNAs were responsible for nail care. Residents Affected - Few On 9 /30/21 at 1:23 p.m., in an interview, LPN Unit Manager Staff P said Resident #63 did not want his nails cleaned and trimmed all the time and did not receive a shave daily because he would not want it. LPN Staff P confirmed there was no documentation the resident refused care or did not want daily hygiene care. On 9/30/21 at 3:00 p.m., in an interview, the Administrator confirmed the CNAs were responsible to provide nail care and hygiene during resident care. 105524 Page 3 of 6 105524 09/30/2021 Port Charlotte Rehabilitation Center 25325 Rampart Blvd Port Charlotte, FL 33948

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. Based on observation, record review, policy review, staff, resident, and family interviews, the facility failed to ensure 7 (Resident #261, #31, #63, #49, #67, #257, and #8) of 10 residents reviewed for accidents were assessed for alternative interventions prior to the use of bed rails or if an alternative was identified, why the alternative failed to meet the resident's need. In addition, the facility failed to have ongoing routine maintenance of the bed rails in accordance with manufacturer's recommendations. The findings included: The facility's Safe and Effective Use of Bed Rails policy dated 2018 indicated, To prevent entrapment and other safety hazards associated with bed rail use, the facility must attempt to use appropriate alternatives prior to installing a side or bed rail. If a side or bed rail is used, the facility must ensure correct installation, use and maintenance of bed rails, including but not limited to the following: assess the resident for risk of entrapment from the bed rails prior to installation. 1. On 9/27/21 at 12:23 p.m., Resident #31's bed was observed with bed/side rails raised on both sides of the bed. Both rails were able to be moved and were not tightly affixed to the bed. Resident #31 was present and said the rails were to keep him from falling out of bed. He did not ask for them, the rails were just up when he got there. Resident #31's clinical record revealed an admission form dated 8/3/21. The form indicated the resident arrived at the facility at 12:40 p.m. A physician's order was received on 8/3/21 at 2:41 p.m., for bilateral quarter side rails. Section L of the admission form indicated side rails were currently in use and were indicated. The intervention to be used as an alternative was listed as a low bed but there was no explanation as to why a low bed failed to meet the need as an alternative. 2. On 9/27/21 at 10:51 a.m., Resident #49 was observed lying in bed, with side rails raised on both sides of the bed. The resident said rails had been on her bed since she had been there and did not request them. She did not use them other than to pull herself up in bed. The left rail was noted to be loose and not tightly affixed to the bed. Resident #49 said that was one she used the most and is probably why it is loose. Resident #49's clinical record revealed an admission form dated 8/21/20. Section L of the admission form indicated side rails were currently in use and were indicated. No alternatives to side rails were reviewed/utilized. 3. On 9/27/21 at 12:59 p.m., Resident #67 was observed lying in bed with side rails raised on both sides of the bed. The resident's wife was present and said she did not know what the rails were for and were already on the bed when he arrived. She thought all the beds had them and she did not request them. Resident #67's clinical record revealed an admission form dated 8/21/21. The form indicated the resident arrived at the facility at 5:00 p.m. A physician's order was received on 8/3/21 at 7:03 p.m., for bilateral quarter side rails. Section L of the admission form indicated side rails were currently in use and were indicated. No alternatives to side rails were reviewed/utilized. 4. On 9/27/21 at 2:07 p.m., Resident #257's bed was observed with side rails raised on both sides of the bed. Resident #257 was present and said the rails were on her bed when she got there, and they didn't offer her anything else instead of the rails. She said someone offered to remove them if she 105524 Page 4 of 6 105524 09/30/2021 Port Charlotte Rehabilitation Center 25325 Rampart Blvd Port Charlotte, FL 33948

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some wanted. Resident #257's clinical record revealed an admission form dated 9/5/21. Section L of the admission form indicated side rails were currently in use and were indicated. No alternatives to side rails were reviewed/utilized. 5. On 9/28/21 at 9:19 a.m., Resident #261's bed was observed with bilateral side rails and the right side rail was raised. Resident #261 was present and said the side rails were there so I don't fall out of bed and were already on the bed when he arrived. He didn't recall any discussion about the rails and kept the left one down so he could get in and out of bed. Resident #261's clinical record revealed an admission form dated 9/9/21. Section L of the admission form indicated side rails were not indicated. An informed consent for the use of side rails was signed on 9/9/21 and the resident did not consent to the use of side rails. A physician's order was received on 9/9/21 at 10:50 p.m. for bilateral quarter side rails for positioning/enabler. The intervention to be used as an alternative was listed as therapy but there was no explanation as to why therapy failed to meet the need as an alternative. On 9/29/21 at 12:00 p.m., Registered Nurse (RN) Staff V said the residents were assessed for bed rails upon admission and she was not aware of any alternatives to the bed rails. RN Staff V confirmed Resident#261's admission form identified no side rails were indicated and side rails were currently in use on the resident's bed. On 9/29/21 at 11:28 p.m., the Director of Maintenance said he did not know the manufacturer's maintenance recommendations for the side rails and had more than one type of bed. He said he had 150 beds and checked 5 random beds a week for entrapment zones but had no routine maintenance schedule in regard to bed safety. On 9/29/21 at 12:26 p.m., in an interview, reviewed concerns with the Administrator of bed rails being on the beds of new admissions for immediate use and no routine maintenance in accordance with manufacturers' recommendations. The Administrator said she thought the bed rails were being secured to prevent use until the assessment was completed. Reviewed there was no indication of this being done and no evidence of alternatives being attempted prior to using the bed rails. On 9/30/21 at 9:49 a.m., the Administrator provided documentation of the manufacturer recommendations for the 2 types of beds in use at the facility. The preventative maintenance for one was to conduct inspections monthly and the second was for quarterly. The Administrator acknowledged the manufacturers' recommendations were not being followed. 6. On 9/27/21 at 11:01 a.m., bilateral upper 1/4 side rails were noted in the up position on the bed of Resident #8. Resident #8 said he did not ask for them but did use the side rail. A clinical record review revealed no documented evidence of appropriate alternatives attempted prior to the installation of bed rails on the bed of Resident #8. 7. On 9/28/21 at 10:01 a.m., bilateral upper 1/4 siderails were noted in the up position on the bed of Resident #63. A clinical record review revealed no documented evidence of appropriate alternatives attempted prior to the installation of bed rails on the bed of Resident #63. On 9/29/21 at 2:38 p.m., in an interview, Licensed Practical Nurse (LPN) Unit Manager Staff P said, 105524 Page 5 of 6 105524 09/30/2021 Port Charlotte Rehabilitation Center 25325 Rampart Blvd Port Charlotte, FL 33948

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some upon admission the resident is asked if they want side rails or not and if they want them, they sign a consent, and the side rails are raised. Staff P said the side rails were on the bed, they came with the bed and were zip tied if the resident did not want them. LPN Staff P said the nurse was responsible to zip tie the side rails to the bed frame. LPN Staff P confirmed she was unaware of alternative interventions that could be used in the facility before the side rails were raised. LPN Staff P said she and the nurses would check the bed for entrapment by checking to see if the resident was able to fit their head through the side rail. She said she did not actually measure the mattress, bed frame, or side rails for gaps. LPN Staff P confirmed she did not know another way to check for entrapment and said the side rails came on the bed so of course they were compatible. LPN Staff P confirmed some of the residents had air mattresses that did not come with the bed and said she did not know how to check for entrapment with the different mattresses. 105524 Page 6 of 6