Health inspection·February 8, 2023

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, and interview, the facility failed to ensure residents received nutritional supplement as ordered by physician for 1 of 3 residents reviewed for nutrition, Resident #93. Residents Affected - Few Findings include: During an interview on 2/5/2023 at 9:08 AM, Resident #93 stated, They give me egg salad sandwich every night and I won't eat it. Review of Resident #93's weights revealed 125.2 pounds on 8/29/2022, 122.6 pounds on 9/6/2022, 126.4 pounds on 10/1/2022, 121 pounds on 11/1/2022, 120.2 pounds on 12/1/2022, 116.8 pounds on 1/3/2023, and 115.6 pounds on 2/1/2023. Review of the physician orders dated 7/13/2022 for Resident #93 reads, In the evening HS [hours of sleep] snack: Turkey sandwich. Review of Nutrition Risk Evaluation dated 2/1/2023 for Resident #93 authored by the Registered Dietician reads, BMI indicative of underweight. Resident is experiencing weight loss (116 lbs [pounds] on 2/1, 129 lbs on 8/1). Therapeutic diet may be appropriate for resident with hx [history] of renal disease. PO [oral] intake varies, poor to good. Resident is an independent diner. Resident is ordered to receive PO supplement BID [Twice a day] in addition to HS sandwich. Resident may be at risk for malnutrition due to weight loss, low BMI [Body Mass Index), varying PO intake. Resident may provide snacks- pudding BID. Revie of the dietary note dated 2/7/2023 for Resident #93 authored by the Registered Dietician reads, BMI indicative of underweight. Resident is experiencing weight loss (116 lbs on 2/1, 129 lbs on 8/1). Therapeutic diet may be appropriate for resident with hx of renal disease. PO intake varies, poor to good. Resident is an independent diner. Resident is ordered to receive PO supplement BID in addition to HS Turkey sandwich and pudding BID. During an interview on 2/7/2023 at 8:55 AM, Staff B, Certified Nursing Assistant (CNA), stated, He refuses his sandwich at night. During an interview on 2/7/2023 at 9:23 AM, the Dietary Manager stated, He was coded for egg salad because that is what he probably asked for. I can change it to his preference. During an interview on 2/7/2023 at 9:45 AM, the Registered Dietician stated, I wrote for a turkey sandwich on purpose because he is a renal patient and will benefit from the turkey sandwich. By Page 1 of 5 105638 105638 02/08/2023 Parklands Care Center and Rehab 1000 SW 16th Ave Gainesville, FL 32601

F 0692 eating the egg salad sandwich, he will not benefit at all. I will talk to the dietary manager and make sure he gets a turkey sandwich. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 105638 Page 2 of 5 105638 02/08/2023 Parklands Care Center and Rehab 1000 SW 16th Ave Gainesville, FL 32601

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, record review, and interview, the facility failed to ensure residents received respiratory care and services consistent with professional standards of practice for 1 of 5 residents reviewed for respiratory care, Resident #18. Residents Affected - Few Findings include: Review of Resident #18's records revealed the resident was admitted with diagnoses including respiratory failure with hypoxia (lungs not moving air), asthma, chronic obstructive pulmonary disease, pulmonary edema (fluid in the lungs), and heart failure (heart cannot pump correctly). During an observation on 2/5/2023 at 10:47 AM, Resident #18 was receiving oxygen via nasal cannula at 3 liters per minute. During an interview on 2/5/2023 at 10:47 AM, Resident #18 stated, I've been on 2 liters oxygen for a long time. I do not adjust the oxygen. I can't even see it. Review of Resident #18's physician orders dated 1/4/2023 reads, O2 [oxygen] at 2 L/min [liters/minute] via Nasal Canula. During an observation on 2/6/2023 at 8:12 AM, Resident #18 was receiving oxygen via nasal cannula at 3 liters per minute. During an observation on 2/6/2023 at 12:51 PM, Resident #18 was receiving oxygen via nasal cannula at 3 liters per minute. During an observation accompanied with the Director of Nursing (DON) on 2/6/2023 at 4:45 PM, Resident #18 was receiving oxygen via nasal cannula at 3 liters per minute. During an interview on 2/6/2023 at 4:45 PM, the Director of Nursing (DON) confirmed the oxygen was being administered at 3 liters per minute, stating, I expect that oxygen rate is checked during nursing assessment each shift and expect the physician orders to be followed. 105638 Page 3 of 5 105638 02/08/2023 Parklands Care Center and Rehab 1000 SW 16th Ave Gainesville, FL 32601

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 foods and beverages were stored in a safe and sanitary manner in 2 of 2 facility nourishment rooms. Residents Affected - Some Findings include: During a tour of the [NAME] Hall nourishment room accompanied with the Dietary Manager on 2/5/2023 at 10:00 AM, there were one undated and unlabeled cup of liquid on the counter, one undated pitcher of purple liquid in the refrigerator, one open can of energy drink in the refrigerator, and one undated take-out container of unlabeled and undated food items stored in the [NAME] Hall refrigerator. During an interview on 2/5/2023 at 10:00 AM, the Dietary Manager acknowledged that open, undated and unlabeled food items were stored in the [NAME] Wing nourishment room refrigerator. During a tour of the East Hall nourishment room accompanied with the Dietary Manager on 2/5/2023 at 10:07 AM, there were two open, undated and unlabeled trays of cookies stored on the countertop in the East Hall nourishment room. During an interview on 2/5/2023 at 10:07 AM, the Dietary Manager acknowledged that open, undated and unlabeled food items were stored in the East Wing nourishment room refrigerator. Review of the facility policy and procedure titled Foods Brought by Family/Visitors reviewed on 12/20/2022, reads, Policy Interpretation and Implementation . 7. Food brought by family/visitors that is left with the resident to consume later will [Sic.] labeled and stored in a manner that is clearly distinguishable from facility-prepared food. a. Non-perishable foods will be stored in re-sealable containers with tight fitting lids. Intact fresh fruit may be stored without a lid. b. Perishable foods must be stored in resealable containers with tight-fitting lids in a refrigerator. Containers will be labeled with the resident's name, the item and the use by date. 105638 Page 4 of 5 105638 02/08/2023 Parklands Care Center and Rehab 1000 SW 16th Ave Gainesville, FL 32601

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to ensure garbage and refuse were disposed of properly. Residents Affected - Some Findings include: During an observation of the facility dumpsters and surrounding areas accompanied with the Dietary Manager on 2/5/2023 at 10:08 AM, the dumpster nearest the kitchen exit was overfilled and propped open with cardboard boxes. The lids of the second dumpster were cracked. The lids of the dumpster furthest from the kitchen exit were cracked and bent and did not close flush with the dumpster upper rim. There was garbage and refuse that included take-out food containers, candy wrappers, straws, used gloves, used masks, plastic bags, plastic utensils, used milk carton and plastic forks scattered on the ground surrounding the dumpsters. There was additional garbage and refuse that included an empty milk carton, a plastic grocery bag, clear plastic bags and food wrappers scattered on the ground in the areas surrounding the dumpsters and employee break side of the facility (Photographic evidence obtained) During an interview on 2/5/2023 at 10:08 AM, the Dietary Manager acknowledged that there was garbage and refuse scattered on the grounds around the dumpsters and surrounding areas. She verified the areas should be cleared of garbage and refuse. 105638 Page 5 of 5