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. . Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 105645 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105645 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bartram Crossing 6209 Brooks Bartram Drive Jacksonville, FL 32258 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)