Health inspection·December 29, 2021

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff and resident interview and record review, the facility failed to ensure two residents (#21 and #16) of twenty-four sampled residents were invited and accommodated with activities that met their interest, and to group activities scheduled during three of three days observed (12/27/2021, 12/28/2021 and 12/29/2021). Residents Affected - Few Findings included: 1. On 12/27/2021 at 10:50 a.m. Resident #21 was observed in her room lying in bed, on top of the covers, dressed for the day and with her eyes closed. An interview on this day at 12:22 p.m. with Resident #21 while in her room revealed her seated in her wheelchair at the bedside. Resident #21 was asked if she attended any out-of-the-room activities and she shook her head side to side indicating, no. Resident #21 explained she was told by staff that she should stay in her room and not attend any group activities due to her health concerns. Resident #21 confirmed she would attend most of the group activities, if she could. Resident #21 explained several staff members told her this. On 12/27/2021 at 1:00 p.m. the South Hallway wall between resident room [ROOM NUMBER] and the main dining room was observed with a large Activities Calendar. The Activities Calendar was dated for the month of 12/2021 and indicated each day had scheduled activities. It was determined for each day from 12/1/2021 to 12/31/2021 all scheduled activities ended at 2:00 p.m. The following activities were scheduled from 12/27/2021 to 12/29/2021: 12/27/2021: 10:00 a.m. Morning walk, 11:00 a.m. Hangman, 2:00 p.m. Bingo; 12/28/2021: 10:00 a.m. Arts and Crafts, 11:00 a.m. Nail Care (a picture of a female hand with painted fingernails on this calendar day, 2:00 p.m. Resident's choice; 12/29/2021: 10:00 a.m. Morning Walk, 11:00 a.m. Coffee Social, 2:00 p.m. Bingo. (Photographic Evidence Obtained) On 12/28/2021 at 10:00 a.m. Resident #21's room door was closed. Upon opening it after knocking, she was observed seated upright in bed. She did not have her television on and there was no music playing. She was dressed for the day. Resident #21 was asked how she was doing, and she stated, I'm doing. She was asked if she had been invited to the scheduled activity this a.m. and she confirmed that she had not. At 1:30 p.m. Resident #21 was visited again while in her room and she did not have her television on, nor was there any music playing. Resident #21 revealed she would attend activities if offered, but nobody offered today. She confirmed she loves any activity related to nail care and Page 1 of 8 105634 105634 12/29/2021 Gulfside Health and Rehabilitation Center 1100 N Pine St Clearwater, FL 33756

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was unaware there was a nail care activity this a.m. (11:00 a.m.). She also would have liked to participate in the arts and crafts activity this a.m. (10:00 a.m.) but was unaware of it. She further confirmed sometimes activities staff come in and ask her if she needs anything for room activities, but that is about it. It was observed at 11:00 a.m. on 12/28/2021 a scheduled group and room to room pretty nails activity. The activities staff did not offer Resident #21 to attend, nor did they visit her while in her room to conduct this activity. An observation on 12/28/2021 at 2:37 p.m. revealed an activities assistant and Staff D, Certified Nursing Assistant (CNA) in Resident #21's room providing the resident with nail care. The resident looked over at this surveyor and said, Thank you so much, they are now helping me with the nail activity. Review of Resident #21's admission Record revealed she was admitted to the facility on [DATE] and readmitted on [DATE] and the diagnoses included: acute respiratory failure, muscle weakness, unsteady gait, need for assistance with personal care, lack of coordination, and glaucoma, malignant neoplasm of upper lobe, right bronchus or lung. Review of the CNA ADL (Activities of Daily Living) flow sheet/task descriptions for the months of 11/2021 and 12/2021, revealed: - To group activities fancy nails and for the Activities Assistant, Activities Director and Certified Nursing Assistant to accommodate. - One to One activities for the Activities Assistant, and Activities Director to accommodate. - Self-Directed / Independent Activities going outdoors, watching TV, reading daily chronicle for the Activities Assistant and Activities Director to accommodate. Review of the current Physician Order Sheet dated for the month 12/2021 revealed: May participate in activities as tolerated per plan of care and resident choice with order date of 11/17/2021. Review of the current care plans with the next review date of 2/15/2022 revealed the following areas: - Has Cancer of lung post hospitalization Chemo/radiation readmission 5/12/2021 with interventions in place to include: Reverse isolation per orders - Resident will choose her own activities of choice daily, with interventions in place to include: Invite remind escort to activity of choice i.e. fancy nails, post activity calendar in room, promote out of room activities and socialization. An interview on 12/28/2021 at 2:40 p.m. with Staff D, CNA confirmed Resident #21 was not in attendance at the group nail care activity this a.m. She did not know why the resident did not attend, but she confirmed she did not offer to accommodate her to that activity. Staff D did not know what the term Reverse Isolation meant and could not confirm if Resident #21 was on Reverse Isolation or not. On 12/29/2021 at 11:25 a.m. an interview with Staff A, CNA and Staff B, CNA was conducted. Staff A 105634 Page 2 of 8 105634 12/29/2021 Gulfside Health and Rehabilitation Center 1100 N Pine St Clearwater, FL 33756

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few revealed she had Resident #21 on her work assignment today and knows her pretty well. She revealed Resident #21 stays in her room most of the day and has seen her in some group activities recently to include the Christmas Party, and a field trip to [local store] within the past week. Staff A explained Resident #21 does like group activities, but as of late she had been in her room more and more. Staff B, who cares for Resident #21 during the 3:00 p.m. -11:00 p.m. shift, also confirmed Resident #21 has gone to group activities in the past but has been observed staying in her room more and more lately. Staff B confirmed Resident #21 had been seen at the Christmas group party and also attended a trip to [local store] recently. When both Staff A and B were asked what Reverse Isolation meant, they stated it was to keep the Resident safe from others and the resident was supposed to stay in the room. They were unaware of what precautions they needed to do or what the intervention included with relation to Reverse Isolation. Staff A confirmed Resident #21 does receive treatments and her immune system is at risk. Staff A and B confirmed there should not be any problems with Resident #21 attending various group activities and they would ensure she sits away from others, but in a position where she could enjoy that activity. On 12/29/2021 at 11:32 a.m. an interview with the Staff C, Licensed Practical Nurse (LPN) confirmed Resident #21 had a compromised immune system and receives medical treatments. She also confirmed Resident #21 has a care plan intervention of, on Reverse Isolation. Staff C explained this intervention was to ensure the resident was isolated and does not get sick from others. She confirmed that Resident #21 should stay in her room as much as possible but should not keep her from attending various group activities. She was unaware that Resident #21 was told she needed to stay in her room and not go to any of the group activities because of the need to be isolated in her room. Staff C confirmed she will need to get clarification with regards to what exactly Reverse Isolation means and what they (direct care staff, and activities staff) need to do to work around it and ensure Resident #21's rights and activity choices are met. Review of the Quarterly Minimum Data Set (MDS) assessment, dated 10/26/2021 revealed the following: Section C - Cognitive Patterns a Brief Interview for Mental Status score of 15 out of 15, which indicated Resident #21 was cognitively intact; Section G - Functional Status indicated Activities of Daily Living (ADLs) included Supervision with most ADLs other than dressing and bathing, which was limited assist; Section F Preferences for Customary Routine Activities was not completed. Review of the previous MDS assessments to include: 11/8/2021 - End of PPS; 10/26/2021 - Quarterly; 10/19/2021 - Entry; 10/12/2021 - Discharge with return anticipated; 9/7/2021 - Entry; 8/13/2021 - Quarterly; 7/18/2021 - Entry; and 7/14/2021 - Discharge with return anticipated revealed all Activities/Preferences sections were not assessed and documented. The last MDS assessment that had the Activities/Preference section completed was: 5/19/2021 - admission day 5, which indicated: Activities/Preferences - Section A. how important is it to you to choose what clothes to wear - Very Important, Section E. how important is it to you to do things with groups of people - Somewhat Important, Section F. how important is it to do your favorite activities - Very Important, Section G. how important is it to you to go outside to get fresh air when the weather is good Very Important, Section H. how important is it to you to participate in religious services or practices Somewhat Important. On 12/29/2021 at 11:00 a.m. an interview with the Activities Director revealed that she was responsible for completing the Activities/Preference section of the MDS and did not know why the Activities/Preference sections for the MDS assessments, as listed above, were not completed. She revealed that 105634 Page 3 of 8 105634 12/29/2021 Gulfside Health and Rehabilitation Center 1100 N Pine St Clearwater, FL 33756

F 0679 Level of Harm - Minimal harm or potential for actual harm MDS coordinator checks behind her and if there are any problems she will notify her and they will make changes. Review of the Activities Quarterly assessment dated [DATE] Section B. Attendance Summary revealed resident (#21) prefers small groups and independent activities and indicated likes fancy nails activities. Residents Affected - Few Review of the Activities Initial assessment dated [DATE] did not indicate anything related to Resident #21 not wanting to attend or be part of activities. Review of the nurse progress notes (Social Service IDT), dated 7/20/2021 12:33 (12:33 p.m.) revealed: Readmit from hospital on 7/8/2021. She is in a private room and has been staying in the room due to reverse isolation. Discharge Plan is Long Term Care; Note dated 8/16/2021 12:10 (MDS care plan note - Care Plan meeting held. History of prolonged hospital stays with chemo and radiation treatment. She is currently followed by oncology and is under weekly chemo treatment. Use of wheelchair is primary means of mobility. She is on reverse isolation so stays in her room except for appointments. She stays active in activities or interest i.e. watching television; Note dated 9/10/2021 09:16 revealed, remains on reverse isolation There were no notes that reflected resident did not or does not want to attend group activities, or outside room activities. On 12/29/2021 at 1:45 p.m. an interview with the Director of Nursing (DON) revealed Reverse Isolation means the resident should be wearing personal protective equipment to include masks while in her room to ensure she does not contract anything from staff or other residents. The DON further confirmed that Resident #21 does receive medical treatments that compromise her immune system, and they want her to be protected as much as possible. She further confirmed Resident #21 would be able to leave the room when she wants and she should not be held back from doing group activities. She was unaware Resident #21 had not been invited to group activities as of late but revealed Reverse Isolation should not stop her from choosing her activities or when she can leave her room. 2. On 12/27/2021 at 10:30 a.m., 11:15 a.m., 1:00 p.m. and 2:45 p.m. Resident #16 was observed in her room and lying in bed with her eyes open. Resident #16 was observed under the covers but with her arm placed over the covers on her lap. During all four observed times, Resident #16 was in her room with no television on and no music on. Activities and nursing staff did not offer nor accommodate Resident #16 to any of the scheduled activities on 12/27/2021. In addition, during each observed time, there was no indication of audio books playing. On 12/28/2021 at 7:43 a.m. Resident #16 was observed in her room and lying in bed with the covers over her. Further observations at 10:15 a.m., 12:00 p.m., 1:00 p.m. and 2:45 p.m. revealed Resident #16 being visited by a nursing aide. Upon going in her room, both the television was off, there were no audio books on, nor was there any music playing. On 12/28/2021 at 2:50 p.m. an interview with Staff B, CNA and Staff D, CNA revealed they were both knowledgeable of Resident #16 and her care. Staff B had Resident #16 on her work assignment. Staff B and D confirmed Resident #16 usually stays in her room most of the day and she does not attend most group activities. Both Staff B and D were not knowledgeable if Resident #16 had any type of individual activities that would include music in the room, specific television programs to play while she is in her room and did not know if she has audio books to be played while in her room. Staff B and D 105634 Page 4 of 8 105634 12/29/2021 Gulfside Health and Rehabilitation Center 1100 N Pine St Clearwater, FL 33756

F 0679 continued to say they believed activities staff visit Resident #16 while in her room. Level of Harm - Minimal harm or potential for actual harm Review of Resident #16's admission Record revealed she was admitted to the facility on [DATE] and readmitted to the facility on [DATE] and diagnoses included but not limited to: aphasia, quadriplegia, contractures right hand, right knee, left hand, and left knee. Residents Affected - Few Review of the current Annual MDS assessment dated [DATE] revealed: Section C - Cognitive Patterns her BIMS was not scored but revealed Short/Long Term memory deficits with severely impaired decision making skills; Section E Behaviors had none documented; Section G Functional Status showed Activities of Daily Living/ADL as Total Dependence with most ADL with two person assist; Section F Preferences for Customary Routine Activities was documented activities as not assessed, however, documented as yes for listening to music. Review of all nurse progress notes to include activities notes dated from 7/1/2021 to 12/29/2021 did not indicate any documentation indicating Resident #16 refused or refuses any activities to include social activities, group activities, music activities. Review of the CNA task description notes/documentation revealed the following [NAME] ADL flow sheets: A. Group Activities - frequency as necessary with activities assistant, activities director and certified nursing assistants. B. One to One Activities - frequency as necessary with activities assistant, activities director and certified nursing assistants. C. Resident to be Dressed and Out From Bed as tolerated (Tuesday/Thursday 7[a.m.]-3 [p.m.]) by Certified Nursing Assistant. Review of the Activities Quarterly assessment dated [DATE] revealed: 1:1 visits, Spanish talking books, semi-active during visits. Review of the current care plans with the next review date of 1/26/2022 revealed the following areas: - Has little involvement in group activities, related to health issues. 2/19/2020 room visits semi active. 5/13/2020 no changes. 1/21/21 continue one to one visits with activities. Continue Plan of Care 4/19/2021 one to one visits . Semi active visits with interventions in place to include: [NAME] contacts with family, friends peers and volunteers, Impart sense of warmth and caring by speaking to resident and gentle touch during activities, Keep instructions simple, observe activities for involvement on a routine basis, promote out of room activities and socialization, stimulation in room i.e. tv and radio. On 12/29/2021 at 10:30 a.m. an interview with the Activities Director revealed she was not aware staff were not playing audio books for Resident #16, nor was she aware staff were not playing any type of music in the room while Resident #16 was in bed. She revealed nursing staff and activities staff are all responsible for setting up the audio book, playing music or turning on the television for her. The Activities Director nor Staff C, LPN/ Unit Nurse had documentation to support any of the activities were set up, offered and or conducted for Resident #16. Staff C confirmed Resident #16 has 105634 Page 5 of 8 105634 12/29/2021 Gulfside Health and Rehabilitation Center 1100 N Pine St Clearwater, FL 33756

F 0679 not refused audio books, has not refused music or television in the past. Level of Harm - Minimal harm or potential for actual harm Further interview with the Activities Director revealed the facility has two activities staff to include her and her assistant works on Saturday, and nursing staff are responsible for following and conducting the scheduled activities for Sundays. The Activities Director further revealed that she has been the activities director for approximately three months. The Activities Director confirmed that she, along with residents will plan for months activities and also confirmed that all scheduled activities are last scheduled at 2:00 p.m. The Activities Director revealed that she along with her assistant leave the facility around 5:00 p.m. and further confirmed that they should have more scheduled activities after 2:00 p.m. every day. She did not know the reason why scheduled activities stopped at 2:00 p.m. every day. The Activities Director explained that it is the responsibility of activities staff and nursing staff to invite and accommodate residents to scheduled activities daily. The Activities Director explained that they have been doing small group activities for a couple months now and that she and her assistant also do 1:1 group activities for residents who do not participate in group activities. Residents Affected - Few When asked, the Activities Director was not aware what Reverse Isolation meant and could not confirm if Resident #21 was on that precaution or not. She did confirm that Resident #21 does like group activities at times but sometimes wants to stay in her room. The Activities Director could not provide any documentation to support Resident #21 refuses going to scheduled activities. The Activities Director was unaware Resident #21 missed the nail care activity that was held on 12/28/2021 at 11:00 a.m. She confirmed Resident #21 loves that activity and that she should have been invited and assisted with that activity during the time it was conducted. She was also unaware Resident #16 was not provided with a music or television activity of choice for the days of 12/27/2021 and 12/28/2021. On 12/29/2021 at 2:45 a.m. an interview with the Director of Nursing revealed Residents #21 and #16 should have been offered and accommodated with activities of their interest, and as scheduled on 12/27/2021 and 12/28/2021. She revealed Resident #21 should have attended the Pretty Nails activities when it was scheduled and staff should have provided and accommodated Resident #16 with audio books, music and television through the day, on days 12/27/2021 and 12/28/2021. A review of the policy and procedure titled, Resident Self Determinations and Participation (Activities), with no revision date and a copyright date of 2021, revealed: The facility's activity program is designed to promote and facilitate resident self-determination through support of resident choice and resident rights. Each resident has the opportunity to exercise his or her autonomy regarding those things that are important in his or her lift. The policy explanation and compliance guidelines revealed: #1. A resident's right to self-determination includes but not limited to: d. The right to participate in other activities, including social, religious, and community activities that do not interfere with the rights of other residents in the facility. #2. The Activity Director shall assist the resident to maintain as normal a lifestyle as possible while in the facility through the provision of activities consistent with the resident's interests. 105634 Page 6 of 8 105634 12/29/2021 Gulfside Health and Rehabilitation Center 1100 N Pine St Clearwater, FL 33756

F 0679 #5. Resident preferences and interests shall be accommodated. Strategies to make accommodations shall be documented in the resident's care plan. Examples include, but not limited to: Level of Harm - Minimal harm or potential for actual harm a. Scheduling therapy sessions around resident's favorite TV show or activity. Residents Affected - Few b. Getting resident out of bed in time for preferred activities. #6. The Activity Director should assist in obtaining supplies or equipment to assist the resident in developing a lifestyle in the facility, similar to that at home (examples may include a TV, hearing aid, radio, newspapers, writing paper and pencils, etc.). 105634 Page 7 of 8 105634 12/29/2021 Gulfside Health and Rehabilitation Center 1100 N Pine St Clearwater, FL 33756

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observations, staff interview and facility record review, the facility failed to ensure the daily nurse staffing numbers were posted to reflect the current date for one day (12/27/2021) of three days observed. Residents Affected - Many Findings included: On 12/27/2021 at 8:58 a.m. upon entering the building a sheet of paper, that was hanging on the wall and behind clear plastic, revealed the nurse staffing numbers sheet. The current sheet read: [Name of Facility], date of 12/23/2021, and indicated numbers for nurses and aides for all three shifts to include 11:00 p.m.-7:00 a.m., 7:00 a.m.-3:00 p.m. and 3:00 p.m.-11:00 p.m. On 12/29/2021 at 12:17 p.m. an interview with the receptionist, Staff E was obtained. Staff E revealed she was unaware of what the nurse staffing numbers sheet was, but usually the Staffing Coordinator completes the sheet on the wall and posts it daily. On 12/29/2021 at 12:22 p.m. an interview with the Staff F, Staffing Coordinator revealed she was responsible for updating and posting the nurse staffing numbers sheet daily. She revealed when she was not at the facility, particularly on the weekends, the nurse supervisor or even the Administrator if he is here, was responsible to post the sheet. Staff F revealed during the weekdays, she usually posts the sheet before 9:00 a.m. Staff F confirmed the Nursing Staffing sheet was not posted for resident and visitor review for the dates 12/24/2021, 12/25/2021, 12/26/2021 and 12/27/2021. Staff F further confirmed there was only one place they hang this information, which was in the front lobby area. 105634 Page 8 of 8