Health inspection·April 20, 2023

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 Based on observations, record review, and staff interviews, the facility failed to ensure that residents unable to carry out activities of daily living (ADLs), received necessary care and services to maintain proper grooming and personal hygiene, by failing to provide nail care for one (Resident #18) of 39 sampled residents. Residents Affected - Few The findings include: On Tuesday, 04/18/2023 at 8:56 AM, Resident #18 was observed with long, untrimmed fingernails. [NAME] matter was observed underneath her nails. Resident #18 was asked if she wanted her nails trimmed, or if she preferred them in the current condition. She replied that she wanted them trimmed. A medical record review revealed that Resident #18 required extensive assistance with personal hygiene care, and on 03/31/2023, she was care planned with a focus area for ADL Deficit related to debility and health status, with an intervention to provide physical assistance with routine care in the AM and PM and as needed. A review of the resident's Minimum Data Set (MDS) assessment, dated 4/6/23, revealed that the resident had a Brief Interview for Mental Status (BIMS) score of 13 out of a possible 15 points, indicating intact cognition. She was documented as requiring extensive assistance of one person for provision of hygiene care. Though there were no specific questions related to nail care, it was noted that the following were very important to Resident #18: Choosing what clothes to wear, choosing between a tub bath, shower, bed bath or sponge bath; taking care of her personal things; and choosing her own bedtime. The resident was documented as frequently incontinent of bowel and bladder. No behaviors were noted, and she was not receiving psychotropic medication. On Wednesday, 04/19/2023 at 9:40 AM, Resident #18's fingernails were observed and remained untrimmed and unclean, just as they were observed on 04/18/2023. On Wednesday, 04/19/2023 at 2:30 PM, Resident #18's fingernails were observed and remained untrimmed and unclean, just as they were observed earlier this day and on 04/18/2023. On 04/19/2023 at 3:12 PM, an interview was conducted with the Activities Director (AD) who stated she had worked at the facility for 17 years, with 14 of those years in the AD role. When she was asked what services were provided to the residents by her department, she said the activities department provided all social entertainment, community outings, and salon services. When asked if this included nail care/trimming, she replied, Yes, nails are done on Saturdays and anyone can get their nails done. She further stated four times a month, nails were done for the residents. She concluded that there was no reason for a resident not to have their nails done unless there was something else Page 1 of 7 105586 105586 04/20/2023 Oak View Health and Rehabilitation Center 833 Kingsley Ave Orange Park, FL 32073

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few happening on a particular Saturday. If nails were not done, a nurse or family member could request to have the resident's nails done. On 04/20/2023 at 10:35 AM, an interview was conducted with Certified Nursing Assistant (CNA) B regarding her regular routine with residents and their ADL care. She said she would enter the resident's room, introduce herself, ask the resident what they needed, and whether they had therapy. She performed personal care such as doing their hair, talking to them, feeding them, and helping them get dressed. When asked to provide more detail about the personal care she provided, she said when she gave residents their showers, she would look for skin tears, bruising, and whether something was off. In that event, she would tell the supervisor. When asked about nail care, she said, Oh yes, of course, we can do it or Activities will. On 04/20/23 at 11:40 AM, an interview with CNA C revealed that she was familiar with Resident #18. When asked about Resident #18's shower days, she could not answer and said she would have to look in the shower book to verify which days those were. She was shown Resident #18's fingernails and was asked if she had any concerns with their condition. Before the question was finished, CNA C said she would take care of Resident #18's fingernails and let the nurse and the Activities Department know. Before she left the resident's room, she was asked to confirm that Resident #18's fingernails needed attention, and she replied, yes in affirmation. . 105586 Page 2 of 7 105586 04/20/2023 Oak View Health and Rehabilitation Center 833 Kingsley Ave Orange Park, FL 32073

F 0790 Provide routine and 24-hour emergency dental care for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, the facility failed to assist one (Resident #26) of two residents reviewed for dental care, from a total sample of 37 residents, in obtaining routine and/or 24-hour emergency dental care. Failure to provide dental care could result in infection and unnecessary pain. Residents Affected - Few The findings include: On 04/17/23 at 2:15 PM, Resident #26 was observed with broken teeth. He stated it bothered him to chew and no one had spoken with him about it. He added that his roommate received dental care and he thought that was becasue he had different insurance. Resident #26 stated he only ate breakfast. Lunch and dinner were almost always too tough for his teeth. When he was asked if he had notifed anyone about this, he said, When I refuse food, I normally tell them that it was too tough, but no one has ever offered me an alternative. I didn't know it was even an option because no one ever mentioned that I could get a different meal. A review of the medical record revealed that Resident #26 was admitted to the facility on [DATE] with diagnoses including encephalopathy, major depressive disorder, and iron deficiency anemia. The resident's 04/01/21 physician's order indicated that the resident was on a regular diet. A review of the certified nursing assistant (CNA) task list from 04/01/23 through 04/20/23, revealed that the resident consumed 50-75 percent (%) of breakfast and 0-25% of lunch and dinner. (Copies obtained) A review of the Annual Minimum Data Set (MDS) assessment, dated 03/10/23, revealed the resident had a Brief Interview for Mental Status (BIMS) score of 07 out of a possible 15 points, indicating moderate to severe cognitive impairment. He required supervision with bed mobility, transfers, and toileting, and he was documented as independent with eating. The Oral/Dental Status section of the assessment indicated obvious or likely cavity or broken natural teeth. A review of the Quarterly MDS assessment, dated 12/22/22, revealed that the Oral/Dental Status section of the assessment was blank. A review of the resident's care plan, dated 04/01/23, indicated the resident was at Risk for Pain and Discomfort due to broken and carious (decayed) teeth. An intervention read, Obtain dental consult as needed. The resident has a need to maintain adequate nutrition and hydration. In an interview with the Social Services Director (SSD) on 04/19/23 10:13 AM, she was asked about the provision of dental services provision for the residents. She stated the facility was contracted with a dental provider. She added that she sent a resident census monthly to the dental provider, and the company contacted those residents that were not on the list to see if they would like be to enrolled. A review of the list the SSD provided, revealed that Resident #26 was contacted with no response. The SSD could not provide a process for residents who were contacted and did not respond, or those that did not qualify for dental services. She confirmed that Resident #26 would not qulaify for dental services from this provider. She stated all residents were assessed quarterly, and if any issues were identified, the facility tried to find services for the resident. During a 04/20/23 interview with Registered Nurse (RN) E/Unit Manager at 1:50 PM, she stated the 105586 Page 3 of 7 105586 04/20/2023 Oak View Health and Rehabilitation Center 833 Kingsley Ave Orange Park, FL 32073

F 0790 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few unit managers were expected to conduct quarterly assessments, which included dental and vision. She stated that she was not aware of the dental concerns for Resident #26. She added that she had been in the position for three days, therefore, she had not conducted the previous assessment of Resident #26. She reviewed the MDS assessment and the care plan, which indicated that the resident had dental concerns. She stated she would find out if anything had been done for the resident. She returned shortly thereafter and confirmed that she could not find any dental notes for Resident #26. She said that the resident did not qualify for services from the facility's dental provider, and that she had made an emergency dental appointment. During the course of the survey, the facility was unable to provide a policy for dental care and services. . 105586 Page 4 of 7 105586 04/20/2023 Oak View Health and Rehabilitation Center 833 Kingsley Ave Orange Park, FL 32073

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on interviews, record review, a review of the Food Code, and policy and procedure review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety, by failing to ensure that one of three resident meals (04/19/23 Lunch Meal) was served at a safe temperature. This failure had the potential to impact all residents eating the meal from the facility's kitchen. The findings include: During a tour of the kitchen on 04/19/2023 at 10:58 AM, an observation of the Food Sample Temperature Form located in the temperature logbook, dated April 16-22, 2023, revealed it was incomplete. (Copy obtained) An observation of the tray line was conducted on 04/19/23 at 11:02 AM during the tour. [NAME] F was observed obtaining temperatures of the food on the tray line. The cook was asked to explain the calibration process and what the temperature of the thermometer should be. She stated she was unaware of the answer to the calibration process and what the temperature of the thermometer should be. Assistant Dietary Manager G confirmed that the calibration process was to shake the thermometer. Three of the three thermometers observed had temperatures that fluctuated between 32.5 °F and 33.9 °F in an ice water bath. It was explained that the thermometer needed to calibrate to 32 °F to show accuracy. The cook was successful in calibrating the fourth thermometer to 32 °F. On 04/19/23 at 11:05 AM, [NAME] F was asked who was responsible for completing the food temperature logs. She replied, Whoever is the assigned cook. When asked who took temperatures of the food after setting up the tray line, she replied, The cook. On 04/19/23 at 4:40 PM, [NAME] J made several attempts, using two of two thermometers, to demonstrate the calibration process. Temperatures fluctuated between 32.5 F and 33.7 F when saturated in an ice water bath. The calibration process was incomplete. No temperatures were logged. Assist Dietary Manager G reported that the thermometer used at lunchtime was no longer working. On 04/20/23 at 10:04 AM, Assistant Dietary Manager G was asked who checked the food temperatures. She stated, The cook checks temperatures for each meal. When asked who was responsible for providing dietary training to the staff, she replied, I provide monthly in-services. All Dietary staff have a 9-day competency to complete and all are SerSafe trained. When asked who checked thermometers to ensure they were accurate and working as expected, she replied, I check thermometers weekly but weekly checks are not documented. All staff are supplied with thermometers. When asked to explain the calibration process, she replied, Put the thermometer in a glass of ice water, wait until the reading is 32 °F, and clean with an alcohol wipe between food temperatures. When asked what happened when a thermometer did not calibrate to 32 °F, Assistant Dietary Manager G stated, The thermometer should be replaced if not working. A review of the facility's policy and procedure titled General HACCP Guidelines for Food Safety (dated: 2010), revealed: Staff must be educated and supervised on all HACCP information and procedures. A good training program and the proper systems and tools will help to assure a successful HACCP/Food Safety program. Procedure: 7. Food temperatures for Meal Service: Check to be sure the staff actually take food temperatures and take them correctly. Teach staff what to do if temperatures are in 105586 Page 5 of 7 105586 04/20/2023 Oak View Health and Rehabilitation Center 833 Kingsley Ave Orange Park, FL 32073

F 0812 the tdz. Be sure temperatures are taken again halfway through tray line to assure safety. (Copy obtained) Level of Harm - Minimal harm or potential for actual harm Reference: United States Food and Drug Administration Food Code 2017. 4-502.11 Utensils and Temperature and Pressure Measuring Devices. Page 170. https://www.fda.gov (Accessed on 04/28/23 at 3:30 PM): Good Repair and Calibration . (B) Food Temperature Measuring Devices shall be calibrated in accordance with manufacturer's specifications as necessary to ensure their accuracy. Residents Affected - Some . 105586 Page 6 of 7 105586 04/20/2023 Oak View Health and Rehabilitation Center 833 Kingsley Ave Orange Park, FL 32073

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on kitchen food service observations, staff interviews, and facility document review, the facility failed to maintain the kitchen freezer in safe operating condition with the potential to place the health of all residents who consumed foods from the facility's kitchen at risk. Freezer units in disrepair may no longer be capable of properly cooling or holding time/temperature control to maintain foods at safe temperatures. Residents Affected - Few The findings include: An initial tour of the kitchen was conducted on 04/17/23 at 10:05 AM. During the tour, observations of the walk-in freezer identified condensation buildup on shelves on the left side of freezer, around the door area, and on the plastic freezer shields. (Photographic evidence obtained) A second observation of the walk-in freezer on 04/19/23 at 4:48 PM, identified condensation buildup in the same area and around the door area to include the plastic freezer shields. (Photographic evidence obtained) Assistant Dietary Manager G stated she was responsible for reporting damaged Dietary equipment to the Maintenance Department. She confirmed having reported the condensation buildup in the freezer to maintenance. She stated, When the condensation builds up, a maintenance order request is submitted to Maintenance. Maintenance comes and chisels ice from the door. On 04/20/23 at 3:42 PM, Maintenance Assistant K reported that the Dietary freezer defrosted 6-7 times per day and drips, they have buildup. Maintenance Assistant K stated, Dietary will inform maintenance of the condensation buildup. When asked how often Maintenance received requests from the Dietary Department related to condensation buildup in the freezer, he replied, Once a week or every other week. Maintenance will go and chip away the ice. He further stated the freezer door had recently been replaced and the facility had been in contact with the service provider through emails regarding the current condensation issue. During the interview, he was asked to provide documented evidence of the service requests and emails related to the condensation issue. The following documents were provided on 04/20/23 at 4:10 PM: 1. A work order quote for a 36 freezer door (right), dated 05/05/22, and 2. An invoice from the facility's mechanical services provider for an HVAC quote to replace a faulty stage one compressor, dated 5/5/2022. Both documents were dated approximately 11.5 months prior to the survey, and no emails indicating ongoing communication with the service provider over that time frame were provided for review. A request of the Administrator for the facility's Kitchen Equipment Maintenance policy and procedure was made multiple times, however, no policy was provided by the the time of survey exit. Reference: United States Food and Drug Administration Food Code 2017. 4.501.11. Good Repair and Proper Adjustment. Page 165. https://www.fda.gov (Accessed on 04/28/2023): Equipment shall be maintained in a state of repair and condition that meets the requirements specified under Parts 4-1 and 4-2. . 105586 Page 7 of 7