Health inspection·August 11, 2021

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure medications were ordered timely upon admission. The facility also failed to get physician authorization for giving medication outside of the prescribed time for 1 of 5 residents reviewed for unnecessary medications out of a total sample of 49 residents (resident #156). Findings: Resident #156 was a [AGE] year-old woman admitted to the facility on [DATE] at 12 PM. Her diagnoses included metabolic encephalopathy, insomnia, delusional disorder, dementia, anxiety disorder and psychosis. A review of the physician admission orders included a written prescription for antianxiety medication, Alprazolam 1 milligram tablet at bedtime. Review of the Medication Administration Record (MAR) from 8/06/21 to 8/09/21 documented that Alprazolam was scheduled to be given at 9 PM. A review of the MAR noted on 8/06/21 at 10:23 PM, Alprazolam was not administered as the drug was not available. On 8/07/21 at 9:53 PM, a note on the MAR showed the medication was not given as not delivered from pharmacy. On 8/08/21 at 9:51 PM and 8/09/21 at 10:29 PM, the MAR showed Alprazolam was not given as it was not available. A review of the MAR showed Alprazolam was given on 8/10/21 at 3:51 AM. On 8/11/21 at 1 PM, resident #156 was lying in her bed. She was awake and alert. She said she wanted to go home. She said she was at the nursing home because of a urinary tract infection but was feeling better. On 8/11/21 at 4:14 PM, Registered Nurse (RN) A said that resident #156 was very difficult to awaken yesterday. She acknowledged there was not a written progress note from the nurse that gave the Alprazolam outside the scheduled hour on 8/10/21 at 4 AM. RN A acknowledged the resident may have been difficult to arouse as she received the medication at close to 4:00 AM. She said she had informed the Director of Nursing (DON) and the physician about the resident being very sleepy. She added the resident was seen by the physician and was awake and alert today. On 8/11/21 at 4:28 PM, RN B said he worked the 3-11 PM shift on 8/08/21. He did not give a reason why resident #156 did not receive her 9 PM dose of Alprazolam on 8/08/21. He did not explain why he did not order the medication from pharmacy on 8/08/21 when he identified and documented the Page 1 of 3 105546 105546 08/11/2021 South Orange Health and Rehabilitation Center 1730 Lucerne Terrace Orlando, FL 32806

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Alprazolam was not available at 9:51 PM. He said the medication arrived on his shift after midnight on 8/10/21. He said he gave the medication to the resident at 3:51 AM as she was crying. He acknowledged it was outside the prescribed time and he did not notify the physician before giving it. On 8/11/21 at 5:10 PM, the 3-11 PM Licensed Practical Nurse (C) said she worked the 3 to 11 PM shift on 8/06/21 and 8/09/21. LPN C acknowledged she did not administer Alprazolam to resident #156. I was aware the medication was available in the emergency drug kit. I had to send the prescription to pharmacy to use it. It was late and I did not send it to the pharmacy on 8/06/21. I was off on 8/07/21 and 8/08/21. The nurse on duty should have followed up with the pharmacy. I did not remember if she had a written prescription. On 08/11/21 at 5:16 PM, the Director of Nursing said she spoke with RN B. She acknowledged he did not call the doctor when the medication was not given at the designated time. She said he gave the resident the medication as she was very agitated. On 8/11/21 at 5:23 PM, during a phone interview, the pharmacy technician said the written prescription for resident #156's Alprazolam dated 8/06/21 was sent to the pharmacy on 8/09/21 and dispensed on midnight run. The technician said it was signed as delivered to the facility on 8/10/21 at 2:20 AM. 105546 Page 2 of 3 105546 08/11/2021 South Orange Health and Rehabilitation Center 1730 Lucerne Terrace Orlando, FL 32806

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review and interview, the facility failed to maintain the dumpster area in a sanitary manner and ensure the dumpster lids remained closed, to prevent the harborage and feeding of pests. Residents Affected - Some Finding: On Sunday, 8/8/21 at 9:20 AM, the facility's dumpster was over filled with clear garbage bags and the lids to the dumpster were pushed all the way back. The clear garbage bags were filled with milk/food cartons, personal protection equipment and other facility refuse. On the ground in front and back of the dumpster were 2 face shields and clear garbage bags filled with refuse as well as other debris. On 8/8/21 at 9:27 AM, the Assistant Maintenance Staff stated the dumpster does not get emptied on Sundays. He did not explain why the dumpster lids were not closed and stated he had never seen the dumpster this full. He acknowledged there were garbage bags on the ground, on the lids of the dumpster, as well as other debris on the ground. On 8/11/21 at 11:44 AM, the Maintenance Director said the dumpster was emptied by a disposal company everyday except Sundays. He stated the disposal company did not empty the dumpster on Saturday and he provided an email conversation with the disposal company. Review of the emails revealed the disposal company made no actual claim the garbage pick up was missed, only that the facility had called that garbage pick up was skipped. The Maintenance Director stated that neither he nor his assistant worked this past Saturday but there was one floor technician on the weekend. He explained the floor technicians removed the garbage from the facility and put it into the dumpster. He added the Nurses and Certified Nursing Assistants did not bring trash out to the dumpster. The only other staff that brought trash to the dumpster were dietary staff. He stated that floor technicians were aware to call him if there were any facility issues but he did not receive any phone calls that the dumpster was over filled. He stated he only learned the dumpster was over filled and the dumpster lids were left open, when he came to the facility. 105546 Page 3 of 3