Health inspection·September 1, 2022

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, record review and interview, the facility failed to provide showers per residents' request and preference, for 1 of 2 sampled residents reviewed for preferences (Resident #94). The findings included: Record review for Resident #94 documented an admission date of 04/09/21 with diagnoses that included Stroke with Left Sided Paralysis, Chronic Kidney Disease, Hypertension and Diabetes. A Minimum Data Set (MDS), dated [DATE], documented the resident as cognitively intact and requiring extensive assistance for all activities of daily living except eating which required limited assistance. A care plan, dated 04/12/21, documented Resident #94 needed assistance for Activities of Daily Living (ADL) with the intervention to provide assistance / supervision as needed. A care plan dated 07/09/2021 documented Resident #94 wishes to remain Long Term Care in the center with the intervention provide services according to care plan in effort to enhance well-being. On 08/30/22 at 8:38 AM, Resident #94 said he has had a shower once in the last month. He stated he is supposed to have a shower every Thursday and Sunday. He said he keeps asking the staff for a shower, but they just give him a bed bath. He stated he did not understand and has almost given up. The facility Intervention / Task form For Resident #94 documented ADL- Bathing Type is Shower Sunday and Thursdays. If patient refuses or is not available, you must notify the Director of Clinical Services. Review of the Intervention / Task form documented one shower given between the dates of 07/30/22 through 08/30/22. On 08/31/22 at 9:46 AM, Staff A, Certified Nursing Assistant / CNA, stated the unit has a shower book; and every morning she checks it to know her residents' shower schedule for the day. She said if the resident does not want a shower, there is a refusal form that must be filled out. She said the unit manager also signs the shower refusal form acknowledging the resident did not shower and it gets charted on the resident's chart. On 09/01/22 at 12:35 PM, the Unit Manager of Independence Wing stated there were no shower refusal forms for Resident #94. Page 1 of 2 105592 105592 09/01/2022 Palm Garden of Vero Beach 1755 37th Street Vero Beach, FL 32960

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 facility policy review, record review and interview, the facility failed to follow physicians' orders for monitoring residents' blood glucose, for 1 of 1 sampled resident, reviewed for diabetic management, Resident #94. Residents Affected - Few The findings included: Review of the facility policy, titled, Nursing Change in a Residents Condition, dated October 2014, documented, The Nurse Supervisor / Charge Nurse will notify the resident's Attending Physician or On-Call Physician when there has been: Instruction to notify the physician of changes in the resident's condition. The nurse supervisor / charge nurse will record in the resident's medical record information relative to changes int the resident's medical/mental condition or status. A blood glucose test is a blood test that measures the level of glucose (sugar) in a person's blood. Normal blood sugar levels range between 70-100 milligram per deciliter (mg/dl). Record review for Resident #94 documented an admission date of 04/09/21 with diagnoses that included Stroke, Chronic Kidney Disease, Hypertension and Diabetes. A Minimum Data Set (MDS), dated [DATE], documented the resident as cognitively intact and required extensive assistance for all activities of daily living except eating which required limited assistance. A physician's order, dated 04/13/21 read, Fingerstick three times a day for Diabetes, insulin dependent, notify Medical Doctor if blood sugar below 70 or greater than 450. The care plan, dated 04/27/21, documented, resident is at risk for hyperglycemia (high blood sugar) complications related to Diabetes. The care plan lists interventions to include monitor blood sugars as ordered, medications as ordered, and report to physician signs and symptoms of unstable blood sugars. On 08/30/22 at 8:44 AM, Resident #94 stated he is diabetic, and his blood sugar is not well controlled. He said, my blood sugar goes really high, and they do not seem to do anything about it. On 08/06/22 at 4:30 PM, Resident #94's blood sugar was documented as being 500 mg/dl, and at 9:00 PM, his blood sugar was documented as being 533 mg/dl. On 08/07/22 at 6:00 AM, Resident #94's blood sugar was documented as being 533 mg/dl. On 08/19/22 at 4:30 PM, Resident #94's blood sugar was documented as being 466 mg/dl. There was no documentation of physician notification of the blood sugars greater than 450 in the chart. On 08/31/22 at approximately 11:00 AM, the Directo Of Nursing (DON) and the Administrator were asked for the documentation that the physician was notified of blood sugars greater than 450 mg/dl for Resident #94 on 08/06/22, 08/07/22 and 08/19/22. They verified there was no documentation in the physician progress notes, the nursing progress notes, or a Change in Residents Condition notation. 105592 Page 2 of 2