Health inspection·December 14, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview, and record review, the facility failed to ensure comfortable and safe temperature levels were maintained in 4 of 4 facility shower rooms, and failed to ensure a clean and homelike environment in 3 of 5 resident rooms. Finding include: 1. During an interview on 12/11/2023 at 10:06 AM, Resident #106 stated the facility shower rooms were cold and he passed on showers sometimes because the shower room was so cold. During an observation on 12/11/2023 at 10:23 AM, the ambient air temperature was 66.7 degrees Fahrenheit in the B Wing shower room directly across from the nurses' station. During an observation on 12/11/2023 at 10:25 AM, the ambient air temperature was 67.6 degrees Fahrenheit in the B Wing shower room located to the right side across from the nurses' station. During an observation of the A Wing shower room located to the left side across from the nurses' station on 12/11/2023 at 11:02 AM with the Administrator, the ambient air temperature was 66.2 degrees Fahrenheit. During an observation of the A Wing shower room located directly across from the nurses' station on 12/11/2023 at 11:04 AM with the Administrator, the ambient air temperature was 67.8 degrees Fahrenheit. During an interview on 12/13/2023 at 9:30 AM, the Administrator stated that the temperature range of 71 to 81 degrees Fahrenheit is a comfortable and safe temperature range expected to be maintained in the facility. 2. During an observation of Resident #81's room on 12/11/2023 at 2:00 PM, the baseboard was not attached to the wall and was lying face down on the floor. There was a thick substance on the back side of the baseboard and a moderate amount of flakey white debris on the baseboard and the floor surrounding the detached baseboard. The wall where the baseboard had been attached had missing paint and exposed drywall. (Photographic evidence obtained). During an observation of Resident #81 on 12/12/2023 at 1:15 PM, the baseboard was not attached to the wall and was lying face down on the floor. There was a thick substance on the back side of the baseboard and a moderate amount of flakey white debris on the baseboard and the floor surrounding the detached baseboard. The wall where the baseboard had been attached had missing paint and exposed Page 1 of 9 105606 105606 12/14/2023 Northbrook Center for Rehabilitation and Healing 575 Lamar Ave Brooksville, FL 34601

F 0584 drywall. Level of Harm - Minimal harm or potential for actual harm During an observation of Resident #81 on 12/13/2023 at 12:30 PM, the baseboard was not attached to the wall and was lying face down on the floor. There was a thick substance on the back side of the baseboard and a moderate amount of flakey white debris on the baseboard and the floor surrounding the detached baseboard. The wall where the baseboard had been attached had missing paint and exposed drywall. Residents Affected - Few During an interview on 12/13/2023 at 12:45 PM, the Regional Maintenance Director stated, That should not be like that. It is the responsibility of the maintenance department to fix. 3. During an observation of Resident #57's room on 12/11/2023 at 10:49 AM, there was an outlet on the wall without a cover. (Photographic evidence obtained). During an observation Resident #57's room on 12/13/2023 at 12:19 PM, the outlet on the wall had no cover. 4. During an observation of Resident #75's room on 12/11/2023 at 2:10 PM, there was an outlet on the wall without a cover. (Photographic evidence obtained). During an observation of Resident #75's room on 12/13/2023 at 12:20 PM, the outlet on the wall had no cover. During an interview on 12/13/2023 at 12:45 PM, the Regional Maintenance Director stated, That should not be like that [outlets that are not covered]. That is not safe. It is the responsibility of the Maintenance Department to fix. Review of the facility policy and procedures titled Environmental Services-Safe Environment last reviewed on 1/18/2023, reads, Policy: In accordance with residents' rights, the facility will provide a safe, clean, comfortable and homelike environment, allowing the resident to use his or her personal belongings to the extent possible. This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk. Definitions . Comfortable and safe temperature levels means that the ambient temperature should be in a relatively narrow range that minimizes resident's susceptibility to loss of body heat and risk of hypothermia or hyperthermia or and is comfortable for the residents. 105606 Page 2 of 9 105606 12/14/2023 Northbrook Center for Rehabilitation and Healing 575 Lamar Ave Brooksville, FL 34601

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Based on record review and interview, the facility failed to ensure residents were referred to the appropriate state designated authority for a Level II evaluation and determination for 1 of 3 residents reviewed for Preadmission Screening and Resident Review (PASRR), Resident #68. Findings include: Review of Resident #68's admission record revealed the resident was diagnosed with bipolar disorder, schizophrenia, and anxiety disorder with onset date of 11/18/2023. Review of Resident #68's Level I PASRR dated 11/1/2023 reads, No diagnosis or suspicion of Serious Mental Illness or Intellectual Disability indicated. Level II PASRR evaluation not required. Review of Resident #68's hospital progress note dated 10/31/2023 showed history of dementia, schizophrenia, and bipolar disorder. Review of Resident #68's psychiatry subsequent note dated 12/1/2023 showed the resident's chief psychiatric complaints included depression, anxiety, and schizoaffective disorder. During an interview on 12/13/2023 at 8:50 AM, the Social Services Director stated the facility did not have any documentation that indicated Resident #68's Level I PASRR had been revised to show a diagnosis of bipolar disorder, schizophrenia, or dementia and to initiate a Level II PASRR screening. 105606 Page 3 of 9 105606 12/14/2023 Northbrook Center for Rehabilitation and Healing 575 Lamar Ave Brooksville, FL 34601

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 Based on record review and interview, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice for notifying the physician of hypoglycemic episodes for 1 of 3 residents reviewed, Resident #82. Residents Affected - Few Findings include: Review of Resident #82's physician order dated 9/11/2023 reads, Insulin Glargine Subcutaneous Solution Pen-Injector 100 unit/ml [milliliter]. Inject 30 unit two times daily related to type II diabetes with diabetic neuropathy. Review of Resident #82's nursing progress note dated 10/30/2023 showed insulin was held due to low BS (blood sugar). Review of Resident #82's nursing progress note dated 11/5/2023 showed insulin was held due to low BS. Review of Resident #82's nursing progress note dated 11/6/2023 showed insulin was held due to low BS. Review of Resident #82's nursing progress note dated 11/21/2023 showed insulin was held due to low BS. Review of Resident #82's nursing progress note dated 11/23/2023 showed insulin was held due to low BS. Review of Resident #82's nursing progress note dated 11/25/2023 showed insulin was held due to low BS. Review of Resident #82's nursing progress note dated 11/26/2023 showed insulin was held due to low BS. Review of Resident #82's nursing progress note dated 12/1/2023 showed insulin was held due to low BS. Review of Resident #82's nursing progress note dated 12/5/2023 showed insulin was held due to low BS. Review of Resident #82's nursing progress note dated 12/10/2023 showed insulin was held due to low BS. Review of Resident #82's nursing progress note dated 12/12/9/2023 showed insulin was held due to low BS. Review of Resident #82's care plan dated 7/25/2023 showed the resident had diabetes mellitus. The interventions included administration of diabetes medication as ordered by doctor, and monitoring, documenting and reporting any signs of hypoglycemia. 105606 Page 4 of 9 105606 12/14/2023 Northbrook Center for Rehabilitation and Healing 575 Lamar Ave Brooksville, FL 34601

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 12/11/2023 at 12:30 PM, the Director of Nursing (DON) stated that if there was an occasion that physician orders were not followed for insulin due to a low blood sugar, the physician should be notified for orders to give or to hold the insulin. Review of the facility policy and procedure titled Nursing- Hypoglycemia/ Hyperglycemia last reviewed on 1/18/2023, reads, General Guidelines . 2. Check blood glucose level if signs or symptoms indicate possible hypoglycemia . 5. Notify physician of the hypoglycemic episode and/or effectiveness of treatment and recheck blood sugar as indicated by physician. 105606 Page 5 of 9 105606 12/14/2023 Northbrook Center for Rehabilitation and Healing 575 Lamar Ave Brooksville, FL 34601

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents received respiratory care services consistent with professional standards of practice for 2 of 3 residents reviewed for respiratory care services, Residents #52 and #49. Residents Affected - Few Findings include: 1. During an observation on 12/11/2023 at 11:13 AM, Resident #52 was resting in bed, receiving oxygen via nasal cannula at 2 1/2 liters per minute (Photographic evidence obtained). During an observation 12/12/2023 at 8:58 AM, Resident #52 was resting in bed, receiving oxygen via nasal cannula at 2 1/2 liters per minute. During an observation 12/12/2023 at 1:48 PM, Resident #52 was resting in bed, receiving oxygen via nasal cannula at 2 1/2 liters per minute. Review of Resident #52's admission record revealed the resident was admitted on [DATE] with the diagnoses including pleural effusion, heart failure, chronic obstructive pulmonary disease. Review of Resident #52's physician order indicated administration of Oxygen at 3 liters per minute via nasal cannula. During an interview on 12/12/2023 at 1:55 PM, Staff A, Registered Nurse (RN), stated, The setting looks a little less than 2 1/5 liters. I should have looked at the setting as part of my assessment. During an interview on 12/13/2023 at 8:17 AM, the Director of Nursing stated, My expectation is when the nurse does an assessment to do a head to toe and check the head of bed, check oxygen setting to make sure the resident is good. 2. During an observation on 12/11/2023 at 10:46 AM, Resident #49 was lying in bed, receiving oxygen via nasal canula at 4 liters per minute (Photographic evidence obtained). During an observation on 12/12/2023 at 9:30 AM, Resident #49 was lying in bed, receiving oxygen via nasal canula at 4 liters per minute. Review of Resident #49's physician order dated 10/19/2022 reads, Oxygen @ [at] 2 L/Min [liters per minute] via NC [Nasal Cannula] continuous inhalation every shift related to Hypoxemia. During an interview on 12/13/2023 at 12:35 PM, Staff E, Licensed Practical Nurse (LPN), acknowledged that Resident #49's oxygen concentrator was set on 4 liters per minute. Review of the facility policy and procedures titled Nursing- Oxygen Administration last reviewed on 1/18/2023, reads, Purpose. The purpose of this procedure is to provide guidelines for oxygen administration. Procedure . 9. Adjust the delivery devise so that it is comfortable to the resident and the proper flow of oxygen is being administered. 105606 Page 6 of 9 105606 12/14/2023 Northbrook Center for Rehabilitation and Healing 575 Lamar Ave Brooksville, FL 34601

F 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure residents received adaptive equipment for eating for 1 of 4 residents reviewed, Resident #275. Residents Affected - Few Findings include: During an interview on 12/11/2023 at 10:29 AM, Resident #275's wife stated Resident #275 spilled his food as he tried to eat as he was not provided with his curved utensils as ordered. During an observation on 12/11/2023 at 12:37 PM, Resident #275 was attempting to feed himself broccoli and cauliflower blended vegetables. Resident #275 had a scoop plate and regular utensils. As Resident #275 attempted to place the food in his mouth with the regular utensils, food spilled onto his shirt. Review of Resident #275's order summary showed an order for adaptive equipment with meals including a scoop plate and left-hand curved utensil. During an interview on 12/12/2023 at 11:45 AM, the Dietary Manager (DM) stated that adaptive devices should be on the tray for residents as the physician ordered. The DM confirmed Resident #275 did not receive his utensils as ordered. Review of Resident #275's care plan dated 12/8/2023 showed the resident was nutritionally at risk with the interventions to include adaptive equipment as ordered. During an interview on 12/13/2023 at 12:33 PM, Staff D, Certified Nursing Assistant (CNA), stated, When passing trays to the residents, the staff are to ensure that adaptive equipment is provided as listed on the tray ticket per the physician order. No adaptive equipment was on [Resident #275's name] tray ticket or she would have gone to the dietary department and retrieved it. During an interview on 12/12/2023 at 11:17 AM, the Registered Dietician (RD) confirmed that Resident #275 had an order for a left-curved utensil and that she had added it to the care plan. Review of the facility policy and procedures titled Meal Service last reviewed on 1/18/2023 reads, Policy: The facility believes that all residents should be treated with dignity and respect at all times. A respectful, positive dining experience is essential to the residents' quality of life and helps to identify residents' needs and improve their overall nutritional status. Residents will be properly roomed and their needs attended to during the meal services. Procedure . 7. Assistive devices will be provided as ordered. 105606 Page 7 of 9 105606 12/14/2023 Northbrook Center for Rehabilitation and Healing 575 Lamar Ave Brooksville, FL 34601

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure food was properly stored and staff followed professional standards for food service safety. Residents Affected - Few Findings include: A walk-through tour of the kitchen was conducted on 12/11/2023 at 9:15 AM with the Dietary Manager (DM). The walk-through of the walk-in cooler revealed a case of raw shell eggs stored over a case of opened raw bacon. A gallon milk container with approximately 8 cups of milk remaining in the container was stored in the cooler with an expiration date of 12/6/2023. There were 33 cups of an apple dessert stored in the cooler without a label or date. Four male dietary staff members with facial hair of a beard or mustache did not have a restraint or beard guard. During an interview on 12/11/23 at 9:35 AM, the DM identified the unlabeled cups as apple pies that were leftover. The DM stated that the products should be labeled according to the policy and all products should be covered and dated when stored. The DM confirmed that the container of milk had an expiration date of 12/6/2203 and should have been discarded on 12/6/2023. The DM confirmed that he and other dietary staff did not have on hair or beard restraints as per the policy. Review of the facility policy and procedure titled Food Storage last reviewed on 1/81/2023 reads, Procedure . 2. Refrigerators . d. Date, label and tightly seal all refrigerated foods using clean, nonabsorbent, covered containers that are approved for food storage . f. Store raw meats and eggs on the bottom shelf to prevent contamination of other foods. Review of the facility policy and procedure titled Employee Sanitation last reviewed on 1/18/2023 reads, Procedure . 3. Employee Cleanliness Requirements . b. Hairnets, headbands, caps, beard coverings, or other effective hair restraints must be worn to keep hair from food and food-contact surfaces. 105606 Page 8 of 9 105606 12/14/2023 Northbrook Center for Rehabilitation and Healing 575 Lamar Ave Brooksville, FL 34601

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure the call light system was properly within reach for 3 of 5 residents reviewed for call light system, Residents #77, #374, and #49 (Photographic evidence obtained). Residents Affected - Few Findings include: During an observation on 12/11/2023 at 9:45 AM, Resident #77's call light system was on the floor, not within reach of the resident. During an observation on 12/11/2023 at 10:00 AM, Resident #374's call light system was hanging on his headboard, not within reach of the resident. During an observation on 12/11/2023 at 10:42 AM, Resident #49's call light system was attached to the blanket at the foot of the bed, not within reach of the resident. During an interview on 12/11/2023 at 11:00 AM, Staff B, Licensed Practical Nurse (LPN), stated, The CNAs [certified nursing assistants] are supposed to make sure the call light is reachable for the resident before they leave the room. During an interview on 12/11/2023 at 11:04 AM, Staff C, CNA, stated, I don't usually work on this floor, and I will check on the residents every 2 hours. During an interview on 12/14/2023 at 9:30 AM, the Director of Nursing stated that her expectation was to have the staff place the call light within reach of each resident before they leave the room. Review of the facility's policy and procedure titled Call light, Answering last reviewed on 1/18/2023 reads, Procedure . 5. Make the resident as comfortable as possible. Position the call light within easy reach of the resident. 105606 Page 9 of 9