Health inspection·March 10, 2022

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure oxygen was administered consistent with professional standards of practice for 1 of 3 residents, Resident #30, in a total sample of 34 residents. Residents Affected - Few Findings: During an observation on 03/08/2022 at 10:52 AM of Resident #30 it showed the resident was being administered oxygen at 2 liters per minute (2L/min) via nasal cannula. During an observation on 03/09/2022 at 10:03 AM of Resident #30 it showed the resident was being administered oxygen at 3.25 L/min (liters per minute) via nasal cannula. During an observation on 03/09/2022 at 12:23 PM of Resident #30 it showed the resident was being administered oxygen at 3.25 L/min via nasal cannula. Review of the physician's order dated 2/28/2022 read: Continuous oxygen at 4 liters/min via nasal canula each shift. During an interview conducted on 03/09/2022 at 2:00 PM Staff A, Licensed Practical Nurse (LPN) stated, Looks like it's [oxygen setting] is between 3 to 3 1/2 liters per minute. The Certified Nursing Assistants never adjust the oxygen, only the LPNs adjust the oxygen; even the respiratory therapist will ask the LPNs, before they adjust it. I'd be surprised if he could get out of bed alone and change it. Review of the physician's order for Resident #30 was conducted with Staff A, LPN. Staff A verified the physician's order as written is for oxygen at 4L/min. Review of Resident #30's care plan initiated on 01/21/2022 read: Resident #30 has a potential for complications of respiratory distress r/t (related to) dx (diagnosis) of: SOB (shortness of breath), PNA (pneumonia) HX (history), hypoxia HX, COPD (chronic obstructive pulmonary disease), and CHF (congestive heart failure). Goal: Resident will remain free from cardiovascular complications thru the next review dated. Interventions: O2 sats [saturation] as ordered. Administer O2 [oxygen] as ordered. Observe for signs and symptoms of respiratory distress; update physician if noted. Vital signs as ordered and as needed. Elevate HOB [head of bed]>30 degrees to minimize SOB as needed. Page 1 of 2 105621 105621 03/10/2022 North Campus Rehabilitation and Nursing Center 700 N Palmetto St Leesburg, FL 34748

F 0801 Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Level of Harm - Minimal harm or potential for actual harm Based on interview and policy review, the facility failed to ensure dietary staff met required qualifications. Residents Affected - Many Finding: An initial tour of the kitchen was conducted on 03/07/2022 at 09:19 AM with the Assistant Manager (AM). An interview was conducted with the AM on 3/07/22 at 9:30 AM. The AM stated the facility does not have a Certified Dietary Manager (CDM) or full time Dietician that oversees the day-to-day operations of the dietary department. She is the full-time day cook and tries to see to some of the needs of the department but has no training as a Dietary Manager. She currently orders the food and makes the schedule for the dietary staff. The department is supposed to have a CDM and has been without a CDM for four months. She was hired as a cook by the previous CDM but was not trained on all the duties of a Dietary Director. The AM stated that a consulting dietician is scheduled each week on Thursday to complete assessments and does not oversee the kitchen operations. An interview was conducted with the consulting Registered Dietician (RD) on 3/7/2022 at 11:45 AM. The RD confirmed that the dietary department does not currently have a CDM and that the company is actively seeking to hire one. Review of the policy titled, Professional Staffing dated October 2019, under the section titled Policy Statement read, It is the center policy that the Dining Services department employs sufficient staff, with appropriate competencies and skill sets to carry out the functions of food and nutritional services, taking into consideration the resident assessments, individual plans of care and the number, acuity and diagnosis of the center's resident population. If a qualified dietician or other clinically qualified nutrition professional is not employed full-time, a qualified director of food and nutrition will be employed. Review of a document titled, Responsibilities and Duties read, Article II, Section 2.1 Engagement and Initial Culinary Responsibilities read: (e) Next Level will provide a full-time culinary services manager (the Culinary Manager), support from a registered dietician and adequate staffing to meet all applicable Federal, state, and local legal requirements. 105621 Page 2 of 2