Health inspection·December 8, 2022

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff and residents' interview, the facility failed to promote the resident's rights to make choices related to dining location for 3 (#44, #6, #11) of 10 residents reviewed for choices. The findings included: 1. On 12/5/22 at 12:51 p.m., during observation of the lunch service, residents were noted to have trays being delivered to their rooms and eating at the bedside table in their rooms. No residents were in the dining room. The same observation was made for the lunch meal of 12/6/22, 12/7/22, and 12/8/22. On 12/5/22 at 12:47 p.m., the Certified Dietary Manager (CDM) said communal dining never resumed since the COVID pandemic. She said residents had been dining in their rooms for the past 2-3 years. She said they had begun discussing going back to using the dining room, but it has not happened. 2. On 12/5/22 at 12:57 p.m., Resident 44 said he didn't know why they ate in their rooms. He said he would prefer to eat in the dining room to be able to talk with people. He said they just redid the dining room, and it was a waste of money to not use it. On 12/7/22 at 9:18 a.m., the Administrator said the residents have not dined in the dining room in at least three years. The Administrator said he was aware pandemic restrictions on communal dining were lifted over a year ago. He said initially the pandemic shut the dining room down and then they did a renovation which the pandemic caused issues with getting supplies. He said the renovation was completed shortly after Hurricane [NAME] which occurred on 9/28/22. He said they had not had servers for the dining room in at least three years and they needed to get the dining room in order with staff, but had no specific date or plans when the dining room would be reopened for dining. 3. On 12/6/22 at 09:32 a.m., Resident #6 said she has been a resident at the facility for several years and always ate her meals in the dining room. She said she is very social and likes talking to people. Resident #6 said dining in her room was terrible, she did not like it. On 12/7/22 at 9:08 a.m., in a telephone interview, Resident #6' Health Care Surrogate said the resident told her she wants to eat in the dining room. She said Resident #6 told her it was disappointing she had to eat Thanksgiving dinner in her room. On 12/07/22 at 12:04 p.m., Resident #6 said she has been telling the staff she wants to dine in the Page 1 of 6 105584 105584 12/08/2022 Sarasota Memorial Nursing & Rehabilitation Center 5640 Rand Blvd Sarasota, FL 34238

F 0550 dining room. She said there were other residents who do not like eating in their rooms either. Level of Harm - Minimal harm or potential for actual harm 4. On 12/6/22 at 11:00 a.m., Resident #11 said she misses having her meals in the dining room. She misses the social aspect of dining in the dining room. Residents Affected - Few On 12/6/22 at 2:05 p.m., Certified Nursing Assistant (CNA) Staff N said all residents dine in their rooms and have been doing it since COVID-19 began. She said some residents don't like it, but that's the way it is. 105584 Page 2 of 6 105584 12/08/2022 Sarasota Memorial Nursing & Rehabilitation Center 5640 Rand Blvd Sarasota, FL 34238

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff and resident interview and record review, the facility failed to ensure an assessment for clinically appropriate self-administration of medications and a care plan was completed for 3 (Residents #301, #303 and #11) of 20 residents reviewed for medications left at the bedside. Residents Affected - Few The findings included: The Self-administration policy provided by facility revised 5/9/22 indicated, Residents have the right to self-administer medications if the interdisciplinary has determined that it is clinically appropriate and safe for the resident to do so. As part of their overall evaluation .2-The Nursing Assessment of Self-Medication tool is completed which identifies the resident's ability to read and understand medication labels . 1. Resident #301 was admitted on [DATE] with diagnoses of unspecified glaucoma, hypertension, and major depression. On 12/5/22 at 11:24 a.m., observation revealed a bottle of artificial tears, a bottle of Timolol Maleate 0.5 % ophthalmic solution, and a bottle of Alphagan 0.1% ophthalmic solution stored on Resident #301's nightstand. Resident #301 said she has been self-administering her drops since her admission on [DATE]. Photographic evidence obtained. The physician's order for Resident #301 included Timolol Maleate 0.5 % eye drops, one drop by ophthalmic (eye) route in left eye two times per day and Alphagan 0.1 % eye drops, one drop by ophthalmic (eye) route in left eye two times per day. On 12/5/22 at 11:35 a.m., a review of the clinical record failed to reveal documentation the interdisciplinary determined it was clinically appropriate and safe for the resident to self-administer the Timolol Maleate, the artificial tears or the Alphagan. On 12/7/22 at 8:10 a.m., review of the Medication Administration Record (MAR) for Resident #301 revealed Registered Nurse (RN) Staff C signed administration of the timolol on 12/3/22 at 8:00 a.m. RN Staff C said Resident #301 told her she had already done it and she signed. She said, I don't necessarily observe her doing so. On 12/7/22 at 9:04 a.m., Licensed Practical Nurse (LPN) Unit Manager Staff I said it was her understanding Resident #301 has been self-administering her eye drops since her admission and the nurses have been signing off the administration of the eye drops on the MAR. Staff I said, we did not have a self-administration tool until 12/5/22. On 12/8/22 at 9:12 a.m., LPN Staff G said Resident #301 mentioned wanting to administer her eye drops and could not remember if she had told the management or followed up. 2. On 12/5/22 at 12:57 p.m., observation revealed a bottle of Nyamyc powder (antifungal) stored on Resident #303's nightstand. Resident #303 said she came with the medication from the hospital and 105584 Page 3 of 6 105584 12/08/2022 Sarasota Memorial Nursing & Rehabilitation Center 5640 Rand Blvd Sarasota, FL 34238

F 0554 has been using it since admission on a small area on her abdomen. Level of Harm - Minimal harm or potential for actual harm Photographic evidence obtained Residents Affected - Few On 12/5/22 at 1:18 p.m., a review of Resident #303's clinical record revealed an admission date of 11/14/22. The physician's order did not include the use of Nyamyc powder to the resident's abdomen. On 12/8/22 at 9:58 a.m., Registered Nurse Minimum Data Set Coordinator said Resident #303 did not have a care plan for self -administration of medication or a self-administration assessment. On 12/7/22 at 9:04 a.m., Licensed Practical Nurse (LPN) Unit Manager, Staff I said she was told Resident #303 had an ointment in her possession. She said Resident #303 came with it from the hospital, and she did not know she was using it. On 12/8/22 at 12:01 p.m., the Director of Nursing (DON) said she was aware medications were left at bedside and facility protocols were not followed. 3. Review of Section C of the Minimum Data Set (MDS) for Resident #11 dated 11/1/22 revealed a Brief Interview for Mental Status (BIMS) score of 13, indicating intact cognition. Review of the Medication Administration Records (MARs) for Resident #11 dated December 2022 revealed a physician's order for antacid, 2 tablets, two times a day with food at 9:00 a.m. and 5:00 p.m. starting 8/2/22. The antacid was signed off each day from 12/1/22 through 12/8/22 at 9:00 a.m., indicating the nurse gave the medication. On 12/06/22 at 11: 00 a.m. and 12:15 p.m., Resident #11 was observed in her room sitting up in a chair, tray table in front of the resident. There were two round tablets in a plastic medication cup on the tray table in front of her. Resident #11 confirmed they were the antacid the nurse gives her at 9:00 a.m. with meals to prevent gas. She said the nurse gives them to her in the cup and she takes them when she wants to. She said if she does not take them, she puts them in her drawer. On 12/08/22 at 9:47 a.m., Unit Manager Staff M said there is no medication self-administration assessment for Resident #11. Staff M said before a resident can self-administer medications on their own at the facility, they must pass an assessment indicating it is a safe thing for the resident to do. The Unit Manager said if the resident passes the assessment, an order is obtained from the physician, and it is documented in the care plan. Staff M said she was not aware staff was allowing Resident #11 to take the antacid on her own. On 12/08/22 at 9:57 a.m., Minimum Data Set (MDS) Registered Nurse (RN) Staff L confirmed there was no assessment, physician's order, or care plan indicating Resident #11 was deemed safe to take her own antacid while at the facility. On 12/8/22 at 10:22 a.m., the Unit Manager said Resident #11 confirmed with her staff was allowing her to self-administer the antacid. 105584 Page 4 of 6 105584 12/08/2022 Sarasota Memorial Nursing & Rehabilitation Center 5640 Rand Blvd Sarasota, FL 34238

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, record review and resident and staff interview, the facility failed to ensure proper storage of medications left at the bedside for 2 (Residents #301, and #303) of 20 residents reviewed for medication storage. The facility failed to remove expired medications in 1 ( South Unit Medication Cart A) of 3 medication carts reviewed for proper storage and labeling of medications. The findings included: The facility's Medication Storage and Disposal/Destruction policy revised on 5/23/22 noted medications and biologicals including treatments items are secured in a locked cart which is inaccessible to residents or visitors. Medications with expiration dates will not be kept stored and will be disposed of as per appropriate procedure. Facility should dispose of discontinued medication, outdated medications or medications left in facility after a resident has been discharged in a timely fashion. 1. On 12/5/22 at 11:24 a.m., observation revealed a bottle of artificial tears, a bottle of Timolol Maleate 0.5 % ophthalmic solution, and a bottle of Alphagan 0.1% ophthalmic solution stored on Resident #301's nightstand. Resident #301 said she did not have a locked box to store the bottles of eye drops. Photographic evidence obtained. On 12/7/22 at 11:50 a.m., Certified Nursing Assistant (CNA) Staff B said Resident #301 kept the bottles of eye drops on the table. On 12/8/22 at 9:12 a.m., Licensed Practical Nurse (LPN) Staff G said Resident #301 mentioned wanting to administer her eye drops and could not remember if she had told the management or followed up. 2. On 12/5/22 at 12:57 p.m., observation revealed a bottle of Nyamyc powder (antifungal) stored on Resident #303's nightstand. Resident #303 said she came with the medication from the hospital and has been using it since admission on a small area on her abdomen. Photographic evidence obtained On 12/7/22 at 9:04 a.m., Licensed Practical Nurse (LPN) Unit Manager, Staff I said she was told Resident #303 had an ointment in her possession. She said Resident #303 came with it from the hospital, and she did not know she was using it. 3. On 12/5/22 at 12:02 p.m., observation of South Unit medication cart A with Registered Nurse Staff F revealed one bottle of Nitroglycerin 0.4 milligram (mg) with an expiration date of 11/2022, and two bottles of Nitroglycerin 0.4 mg with an expiration date of 9/11/22. On 12/5/22 at 12:12 p.m., RN Staff F said the expired Nitroglycerin should not be in the cart and should have been sent to pharmacy . 105584 Page 5 of 6 105584 12/08/2022 Sarasota Memorial Nursing & Rehabilitation Center 5640 Rand Blvd Sarasota, FL 34238

F 0761 On 12/8/22 at 12:01 p.m., the Director of Nursing (DON) said she was aware medications were left at bedside and facility protocols were not followed. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 105584 Page 6 of 6