Health inspection·August 10, 2023

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. During an observation on [DATE] at 10:01 AM of Resident #61's room there was an inhaler on the over the bed table. The medication label read Advair Diskus. (Photographic evidence obtained) During an observation on [DATE] at 8:15 AM of Resident #61's room there was an inhaler on the over the bed table. The medication label read Advair Diskus. During an observation on [DATE] at 10:16 AM of Resident #86's room sitting on the bed side table there was a small medicine cup with a green-colored gelled substance. (Photographic evidence obtained) During an Interview on [DATE] at 10:17 AM Resident #86 stated, That is Bio-Freeze. The CNA [Certified Nursing Assistant] left it here for me. Review of Resident #61's medical record documented a physician order dated [DATE] which read Advair Diskus Aerosol Powder Breath Activated 250-50 mcg/dose [micrograms] 1 inhalation inhale orally every 12 hours for COPD/Asthma [chronic obstructive pulmonary disease]. Rinse with water after use. Do not swallow. Review of Resident #86's medical record did not provide for documentation of a physician's order for Bio-Freeze. During an interview on [DATE] at 10:18 AM with Staff A, LPN stated, Resident #86 should not have Bio-Freeze at the bedside. During an interview on [DATE] at 10:19 AM Staff A, LPN stated, Resident #61 should not have an inhaler at the bedside. During an interview on [DATE] at 10:26 AM the DON stated, My expectation is that no medications should be left at a resident's bedside. Based on observation, interview, and record review the facility failed to ensure drugs and biologicals were stored and labeled in accordance with accepted professional standards for 2 of 4 medication carts and 3 of 4 resident hallways. Findings include: Page 1 of 5 105638 105638 08/10/2023 Parklands Care Center and Rehab 1000 SW 16th Ave Gainesville, FL 32601

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 1. During an observation on [DATE] at 9:37 AM of the East Short Hall Medication Cart, there were five loose circular tablets and one Loperamide tablet packet observed in the cart where the over-the-counter medications are stored. During an interview on [DATE] at 9:44 AM Staff C, License Practical Nurse (LPN) stated, Medication should not be loose in the medication cart they should be discarded. The Loperamide package is not even [supposed to be] stored in the vitamin section. I am not sure why it was up here, but it will fall on me since I had the cart. During an observation on [DATE] at 9:45 AM of the East Long Hall Medication Cart, there were three loose circular tablets observed. There was one open Breo Ellipta 100/25 inhaler with no open or expiration date, one open Incruse Ellipta inhaler with no open or expiration date, one open artificial tears with no open or expiration date and one expired plastic vial of artificial tears. During an interview on [DATE] at 9:48 AM Staff D, LPN stated, Upon opening medication it should be dated with an open and expiration date. If the medication is expired, it should be discarded and reordered. Loose pills should not be in the medication cart, maybe they fell out. They should have been discarded. During an observation on [DATE] at 10:05 AM Resident #93's room was empty, on top of the night stand draw there was a container of Bio Freeze. During an interview on [DATE] at 10:10 AM Resident #93 stated, I use the ointment for the pain that gets in my arms. The staff will apply it for me. I am not able to do so myself. During an interview on [DATE] at 1:30 PM the Assistant Director of Nursing stated, [Resident #93's name] does not have a self-administration assessment, he is not able to self-administer medication. During an interview on [DATE] at 2:39 PM the Director of Nursing (DON) stated, Medication is labeled once it is open with an open and expire date. Any loose medication should be discarded, not left in the cart. Eye drops should follow manufactures' instructions for expiration after opening. This [the instructions] are located in the binder in the medication cart. Review of the Breo Ellipta manufacturer's instructions read, Safely throw away Breo in the trash 6 weeks after you open the foil tray or when the counter reads 0, whichever comes first. Write the date you open the tray on the label on the inhaler. Review of the Incruse Ellipta manufacturer's instructions read, Safely throw away Incruse in the trash 6 weeks after you open the tray or when the counter reads 0, whichever comes first. Write the date you open the tray on the label on the inhaler. 3. During an observation on [DATE] at 12:38 PM Resident #23 had two bottles of moisture shield skin protectant on the bedside table. (Photographic evidence obtained) During an interview on [DATE] at 12:38 PM Resident #23 stated, The nurse always leaves that there, so she remembers to use it. Review of Resident #23's medical record did not provide for documentation of a physician's order for the resident to self-administer medications. 105638 Page 2 of 5 105638 08/10/2023 Parklands Care Center and Rehab 1000 SW 16th Ave Gainesville, FL 32601

F 0761 Level of Harm - Minimal harm or potential for actual harm During an observation on [DATE] at 8:17 AM Resident #107 had a large bag of Honey Lemon cough suppressants on the nightstand table. (Photographic evidence obtained) During an interview on [DATE] at 9:55 AM, Resident #107 stated, Those are my cough drops, I keep them there in case I need one. Residents Affected - Some During an interview on [DATE] at 1:17 PM Staff E, CNA stated, I am not sure if residents are supposed to have any medications left in their room. Review of Resident #107's medical record did not provide documentation of a physician's order for the resident to self-administer medications. Review of the facility policy and procedure titled P&P Medication/Biological Storage with a last reviewed date of [DATE] reads, Policy: It will be the policy of this facility to store medications, drugs and biologicals in a safe, secure and orderly manner. Procedure: 2. The nursing staff shall be responsible for maintaining medication storage and preparation areas in a clean, safe and sanitary manner. 8. Drugs shall be stored in an orderly manner in cabinets, drawers, carts or automatic dispensing systems. Each resident's medication shall be assigned to an individual cubicle, drawer or other holding areas to prevent the possibility of mixing medications of several residents. Review of the facility policy and procedure titled Storage of Medications with a last reviewed date of [DATE] reads, 5a. The nurse shall place a date opened sticker on the medication and record the date open and the new date of expiration. The expiration date of the vial or container will be 30 days from opening, unless the manufacture recommends another date or regulations/guidelines require different dating. 105638 Page 3 of 5 105638 08/10/2023 Parklands Care Center and Rehab 1000 SW 16th Ave Gainesville, FL 32601

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to prevent the possible spread of infection during medication administration through a peripherally inserted central catheter (PICC) for 1 of 4 residents, Resident #62. Residents Affected - Few Findings include: During an observation on 8/9/2023 at 2:12 PM of Staff B, License Practical Nurse, Staff B primed (placing IV (intravenous) fluid in the IV tubing to remove all air prior to attaching the IV tube to the patient) the IV tubing for Resident #62, cleansed the resident's hep-lock (an IV catheter placed in a vein to administer medication or fluid into the bloodstream), and connected the IV tubing to the resident's hep-lock to administer IV medication. Staff B disconnected the IV tubing from the resident's hep-lock stating she had not flushed the IV hep-lock (flushing is performed before and after administering IV fluids or medications to assess placement and patency). After disconnecting the tubing Staff B released the resident's arm. The hep-lock in the resident's arm was observed to brush across the skin of the right side of the resident's back and come to rest with the hep-lock coming in contact with the resident's incontinence pad (an impermeable multi-layered sheet with high absorbency that is used to soak up urine). Staff B did not cleanse the adaptor to the hep-lock and flushed 5 ml (milliliters) of normal saline into the adaptor using a syringe. Staff B released the resident's arm and the hep-lock was observed to brush across the skin of the resident's right side. Staff B removed the IV tubing from the pole, did not cleanse the IV tubing adaptor or the adaptor to the hep-lock and connected the IV tubing, and started the infusion pump to administer the medication. The IV infusion pump sounded an alarm and had a message displayed on the face of the pump which read, air in line. Staff B disconnected the IV tubing from the hep-lock, primed the IV tubing with normal saline, cleansed the resident's hep-lock, connected the IV tubing to the hep-lock, and started the medication administration. During an interview on 8/9/2023 at 2:29 PM Staff B, LPN stated, I did not notice when the needleless connector came in contact with [Resident #62's name's] skin or pad. I should have definitely cleaned the needleless connector again. During an interview on 8/9/2023 at 2:35 PM the Director of Nursing stated, The needleless connector should have been cleaned every time it touched the resident's skin. Review of Resident the physician order for Resident #62 dated 7/12/2023 read, Cefazolin Sodium Injection Solution Reconstituted 2 GM (Cefazolin Solution) use 2 gram intravenously every 8 hours for bacteremia [viable bacteria in the blood] until 8/19/2023 23:59 [11:59 PM]. Review of the physician order for Resident #62 dated 7/13/2023 read, Normal Saline Flush Solution (Sodium Chloride Flush) use 5 cc [cubic centimeter] intravenously every 8 hours for prophylaxis. Flush central venous catheter with 5 ml [milliliters] NS [normal saline] before and after medication administration. Review of the facility policy and procedure titled, P&P IV Infusion with a last review date of 3/21/2023 read, Policy: It is the policy of this facility to provide administration of intravenous fluids, medications and electrolytes for the purpose of hydration and management of infections or other medical conditions. 105638 Page 4 of 5 105638 08/10/2023 Parklands Care Center and Rehab 1000 SW 16th Ave Gainesville, FL 32601

F 0880 Level of Harm - Minimal harm or potential for actual harm Review of the facility competency titled, Administering Medication Through a Saline Lock Competency read, Cleanse saline lock cap. Cleanse injection cap and properly flush device with saline. Maintain aseptic technique [a set of practices that protects patients from healthcare-associated infections] throughout the procedure. Residents Affected - Few 105638 Page 5 of 5