Health inspection·November 16, 2023

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 observations, interview and record review, facility failed to follow physician orders as evidenced by the physician prescribed 3 Liters per Minutes (LPM) continuous oxygen for one out of 34 sampled residents (Resident # 314)) as evidenced by observation of the resident receiving 4 LPM/4.5 LPM of oxygen. Residents Affected - Few The finding included: During observation on 11/13/2023 at 10:07 AM, the Resident was seated on her bed, finishing her breakfast. Resident # 314 was observed with a nasal cannula in place. It was observed that the oxygen concentrator was set up at 4 LPM. (Photographic evidence). The resident was not observed with distress or anxiety. During observation of resident # 314 on 11/14/2023 at 09:13 AM. Resident was seated on her bed, having breakfast. Resident was observed with a nasal cannula in place. It was observed that the oxygen concentrator was set up at 4.5 LPM (Photographic evidence). No distress or anxiety was noted. The call light was within reach. Record review of the clinical records for Resident # 314 revealed, the resident was admitted to the facility on [DATE] and transferred to the hospital on [DATE] due to respiratory failure. Clinical diagnoses included, but were not limited to, Pneumonia, Unspecified Organism; Type 2 Diabetes Mellitus without Complications; Hyperparathyroidism, Unspecified; Personal History of COVID-19. Record review of the Physician Orders dated 10/25/2023 revealed, the physician prescribed Oxygen at 3 LPM via nasal cannula. Monitor oxygen saturation every shift. Call physician for oxygen saturation less than 92 % every shift. Record review of Physician Orders dated 11/14/2023 revealed, the resident was transferred to emergency room of a local hospital for a Bronchoscopy. The Resident's diagnoses were worsening pneumonia and respiratory compromise/failure. Record review of Nurses Notes dated 11/14/2023 at 18:50 PM revealed, the resident was noted with abdominal breathing and shortness of breath. The Oxygen saturation dropped from 96 to 70 %. Oxygen was administered via nonbreathier mask via tank at 15 liters. The Oxygen saturation increased to 97 %. Emergency medical services (EMS) was activated immediately. EMS arrived at 19:10 PM and the resident was transported to the hospital. Review of Medicare 5 days Minimum Data Set (MDS) Section C - Cognitive Patterns dated 10/29/2023 revealed the Brief Interview for Mental Status (BIMS) summary score was 14 out of 15, indicating the Page 1 of 2 105610 105610 11/16/2023 Palm Garden of Aventura 21251 E Dixie Highway North Miami Beach, FL 33180

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident was cognitively intact. Section I - Active Diagnosis revealed the resident's diagnoses were Pneumonia and Personal History of COVID-19. Section O Special Treatments, Procedures and Programs revealed the resident was receiving continuous oxygen therapy. Record Review of Care Plan initiated on 10/25/2023 and with the next review date 01/25/2023 the resident had potential for respiratory distress/ difficulty breathing related to COVID-19, Pneumonia. Goal: The resident will maintain normal breathing pattern as evidenced by normal respirations, normal skin color, and regular respiratory rate/pattern through the review date. Interventions: Administer treatments as ordered. Monitor for effectiveness and side effects. Assist to position resident with proper body alignment for optimal breathing pattern. Monitor/document changes in orientation, increased restlessness, anxiety, and air hunger. Monitor for sign and symptoms of respiratory distress and report to physician as needed: Increased Respirations; Decreased Pulse oximetry; Increased heart rate (Tachycardia); Restlessness; Diaphoresis; Headaches; Lethargy; Confusion; Hemoptysis; Cough; Pleuritic pain; Accessory muscle usage; Skin color changes to blue/grey. o Monitor/document/report abnormal breathing patterns to physician: increased rate, decreased rate, periods of apnea, prolonged inhalation, prolonged exhalation, prolonged shallow breathing, prolonged deep breathing, use of accessory muscles, pursed-lip breathing, nasal flaring. During and interview with Staff A, Registered Nurse/Unit Manager on 11/16/2023 at 11:24 AM. She stated the nurse was responsible to check the oxygen concentrator every shift following doctor's orders. She stated, the resident needed more oxygen, but the nurse did not call the doctor to change the order. She stated the resident was transferred to the hospital due to respiratory failure. She stated, the nurses had in-services education for oxygen administration and follow doctor's orders. Record review of Facility's Policy and Procedures for Oxygen Administration dated and revised on 07/2023 revealed, Purpose: To provide the guest/resident with enhanced oxygen concentration of inspired room air. Procedure: 1- Verify physician's order to include, but not limited to: -flow rate, -duration of use (as needed, continuous, etc.)-parameters for monitoring oxygen saturation as indicated. During interview with the facility's Corporate Nurse on 11/16/2023 at 12:44 PM she stated, the facility did not have policy and procedures to follow doctor's orders. She stated the facility followed regulations on following doctor's orders. 105610 Page 2 of 2