Health inspection·December 18, 2020

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Residents Affected - Few Based on observation, record review and interview, the facility failed to carry out physician's orders for one (Resident #253) of one resident reviewed for the care area of edema, from 33 residents sampled. The findings include: On 12/16/20 at 1:45 PM, an observation and interview with Resident #253 was conducted. She was observed sitting in her wheelchair. Her left leg was edematous (swollen) but was not elevated. During the interview she stated, I fell at home and I broke my leg. I had surgery on my hip. I am here to get better. I think this leg is supposed to be wrapped. They are not doing anything to it. A review of the residents medical record revealed she was admitted to the facility on [DATE] with a fracture of the left femur. A review of the physician's orders revealed an active order to apply an ace wrap compression bandage to bilateral (both) lower extremities in the morning and take them off at bedtime. The order also instructed staff to elevate bilateral lower extremities. This order was written on 12/16/20. An observation and interview with Resident #253 on 12/17/20 at 2:00 PM, revealed she had no ace wrap bandages on her lower extremities as ordered. She stated, No one is doing anything to my left leg. I think the swelling on my left leg is not getting any better. It is not painful but it is swollen. An interview with the Licensed Practical Nurse (Employee D) on 12/17/20 at 2:15 PM revealed, I did not see a treatment order for [Resident #253]. She doesn't get any treatment for her legs. On 12/17/20 at 2:40 PM, the Unit Manager, Registered Nurse E was made aware of the above information. She verified Resident #253 did not have on ace wrap compression bandages to her bilateral lower extremities as ordered. She also verified the facility had not followed the physician's order. She stated, She has ace wrap compression orders for her legs. I will notify the physician. He is here today. . Page 1 of 3 105645 105645 12/18/2020 Bartram Crossing 6209 Brooks Bartram Drive Jacksonville, FL 32258

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 observations, interviews, review of the medical record, and review of the Respiratory Care-Oxygen Therapy Policy and Procedure, the facility failed to follow physician's orders by not discontinuing oxygen orders for one (Resident #51) of 33 sampled residents. Residents Affected - Few The findings include: A record review was conducted for Resident #51 which noted an admission date of 11/27/2020 with diagnoses including hypertension, atherosclerotic heart disease and atrial fibrillation. A review of the current medication administration record (MAR) noted Oxygen at 2 Liters (L) via nasal cannula started on 11/28/2020 and discontinued on 12/8/2020. On 12/15 at 9:00 AM, the resident was observed lying in bed. He had oxygen infusing via nasal cannula. He reported it was set at 2 L and he used it. An observation was conducted of Resident #51 on 12/16 at 3:54 PM in his room. He was lying in bed watching TV. He had an air mattress and oxygen at 2 L via nasal cannula was infusing. An observation was conducted of Resident #51 on 12/17 at 10:39 AM lying in bed visiting with his wife. He was wearing a nasal cannula with 2 L of oxygen infusing via oxygen concentrator. On 12/17/20 at 02:18 PM the resident was observed lying in bed. He reported he had finished therapy. He was observed wearing a nasal cannula and receiving oxygen at 2 L per minute. An interview was conducted with Employee A, Licensed Practical Nurse (LPN), on 12/17 at 3:30 PM. The LPN was asked if the resident was still receiving oxygen. She replied, Yes, he had his oxygen on today. After reviewing the MAR, the LPN confirmed the oxygen was discontinued on 12/8/2020. Employee A proceeded to call the Advanced Registered Nurse Practioner (ARNP), and received an order for as needed (PRN) Oxygen at 2 L via nasal cannula if oxygen saturations were below 92. She confirmed the resident's oxygen saturation was running 93-100 % according to the MAR documentation for checking oxygen saturations every shift, which stopped on 12/8. The LPN reviewed several physician's notes and did not see an order to continue the oxygen. She confirmed there was no order for oxygen to be administered after 12/8/2020. A review of the Respiratory Care-Oxygen Therapy policy and procedure, dated May 2017, noted oxygen therapy is administered as ordered by the physician or as an emergency measure until a physician's order can be obtained. . 105645 Page 2 of 3 105645 12/18/2020 Bartram Crossing 6209 Brooks Bartram Drive Jacksonville, FL 32258

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on record review and interviews, the facility failed to ensure an accurate, complete medical record for one (Resident #51) of six residents sampled for unnecessary medications, from a sample of 33 residents. Apical pulses were not documented for Digoxin with parameters before administration on the Medication Administration Record (MAR). The findings include: A record review was conducted for Resident #51, which noted an admission date of 11/27/2020 with diagnoses including hypertension, atherosclerotic heart disease and atrial fibrillation. A review of the current MAR noted Digoxin 125 mcg (micrograms)give 2 tablets by mouth everyday for atrial fibrillation, dated 11/28/2020. Digoxin is not to be administered before taking an apical pulse and if below 60, Digoxin should be held. Apical pulses were not documented on the MAR An interview was conducted with Employee A, Licensed Practical Nurse (LPN) on 12/17/2020 at 3:30 PM. She was asked where apical pulses were documented for the Digoxin, and she reported apical pulses were taken at the time of administration, but she did not document them. She proceeded to look in the computer and changed the keying in so apical pulses could be documented with the medications. She confirmed the apical pulses were not documented in the computer, and there were parameters for administering Digoxin. A review of the RNpedia noted on it's website: WARNING: Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 in adult or < 90 in infant; retake pulse in 1 hr. If adult pulse remains < 60 or infant < 90, hold drug and notify prescriber. Note any change from baseline rhythm or rate. 105645 Page 3 of 3