Health inspection·July 21, 2022

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, medical record review, staff and resident interviews, and facility policy review, the facility failed to ensure that one (Resident #44) in a sample of 25 residents was provided respiratory care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences. Resident #44 was administered oxygen at a flow rate which exceeded his physician's order. Residents Affected - Few The findings include: On 7/18/22 at 12:25 PM, Resident #44 was observed lying in bed with his oxygen (O2) concentrator set at 5 liters per minute (LPM). His nasal cannula was observed in his hands. The resident then placed the prongs of the nasal cannula in his mouth. On 7/18/22 at 3:00 PM, Resident #44 was observed lying in bed, awake, with no nasal cannula in place. His oxygen concentrator was running and the flow rate was set at 5 LPM. (Photographic evidence obtained) On 7/19/22 at 10:20 AM, Resident #44 was observed lying in bed, awake. His O2 concentrator flow rate was set at 5 LPM (Photographic evidence obtained) His nasal cannula tubing was in his mouth. He was asked if he knew what his oxygen flow rate was supposed to be set at. He stated, I think 2 or 3? He was asked if he ever changed the oxygen flow rate on the concentrator by his bed. He stated, No, I don't touch that. The nurses do that. On 7/19/22 at 2:40 PM, Resident #44 was observed lying in bed, awake. His O2 nasal cannula prongs were in his mouth. The O2 concentrator flow rate was set at 5 LPM. The resident was asked why his oxygen tubing was in his mouth. He stated, It annoys me. It hurts my nose. On 7/20/22 at 10:15 AM, Resident #44 was observed lying in bed, awake. His O2 nasal cannula prongs were in his mouth. His oxygen concentrator flow rate was set at 5 LPM. (Photographic evidence obtained) A review of the resident's medical record, revealed that he was diagnosed with Chronic Obstructive Pulmonary Disease (COPD). His physician' orders read: 9/22/20: Oxygen at 2 LPM per nasal cannula via O2 concentrator and/or tank PRN for SOB (shortness of breath) 9/22/20: O2 sats: pulse oximetry every shift and PRN. Page 1 of 3 105651 105651 07/21/2022 Blue Palms Health and Rehabilitation Center of Day 325 S Segrave Street Daytona Beach, FL 32114

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A care plan review for Resident #44 revealed the following focus, goal, and interventions created on 12/27/21 (revised 6/3/22): Focus: Resident has altered respiratory status/difficulty breathing r/t COPD and takes prednisone routinely. Goal: Resident will have no s/sx (signs or symptoms) of poor oxygen absorption through the next review date. (revision 5/4/22) Interventions: Oxygen therapy as ordered. Focus, goal, and intervention created 10/20/20: Focus: The resident has Emphysema/COPD related to hx (history) of smoking. Goal: The resident will display optimal breathing pattern daily through review date. Interventions: Oxygen therapy as ordered. In an interview with Certified Nursing Assistant (CNA) J on 7/20/22 at 4:15 PM, she was asked if she monitored the rate of oxygen for Resident #44. She stated, The nurses monitor the rate but he's mostly at 2 LPM. The nurses tell us what the rate should be. She was asked if she reported to the nurse if the oxygen concentrator is not set at 2 LPM. She stated, I would tell the nurse but I haven't had to. She was asked if she had ever seen Resident #44 change the oxygen flow rate on his oxygen concentrator. She stated, No, I haven't seen him. I don't think he would change it. In an interview with Registered Nurse (RN) I on 7/20/22 at 4:30 PM, she was asked if she was caring for Resident #44 today. She stated yes. She was asked what his oxygen order was and she stated, He's at 2 liters per minute continuously by nasal cannula. She was asked if he kept his nasal cannula in place. She stated, Sometimes he takes it off and will then put it back on, The doctors is aware of that. I check his sat (oxygen saturation) often and it's always good, always above 90%. She was asked how often she checked the flow rate on his oxygen concentrator. She stated, Three or four times on my shift. She was asked if the rate ever needed to be adjusted and she stated, No, it's ordered for 2 LPM and he doesn't need that changed. She was asked if he ever changed the rate on his oxygen concentrator himself. She stated, No, he wouldn't do that. She was asked how often she checked the nasal cannula to ensure it was in place and she replied, I check that three or four times a shift when I check his rate and his oxygen sat. She was asked if she had seen Resident #44 put the nasal cannula prongs in his mouth. She stated, No, I haven't seen that. A review of the facility's policy titled Oxygen Administration, Safety, Mask Types (Reviewed/revised: 6/29/22) revealed: Purpose: To administer and store oxygen in a safe manner. To keep oxygen equipment clean and maintained in good condition. To administer various levels of oxygen concentration and/or humidity in a safe manner. Oxygen Concentrator: 8. Turn flow rate control slowly clockwise until center of ball in flow rate indicator moves up to 105651 Page 2 of 3 105651 07/21/2022 Blue Palms Health and Rehabilitation Center of Day 325 S Segrave Street Daytona Beach, FL 32114

F 0695 the number of liters per minute as ordered by the physician (usually one to two LPM). Level of Harm - Minimal harm or potential for actual harm 10. Place cannula on resident as follows: Residents Affected - Few Fit outlet prongs into nares and place elastic band around head behind ears. Tape can be applied to make cannula stay in place if necessary and cheekbones and ears can be padded to prevent irritation. The curve of the nasal prongs should point down so that they follow the anatomy of the nasal passages. According to the National Library of Medicine at https://www.ncbi.nlm.nih.gov/books/NBK430743 (Accessed on 7/21/22 at 8:10 p.m.), Oxygen is vital to sustaining life. However, breathing oxygen at higher than normal partial pressure leads to hyperoxia and can cause oxygen toxicity or oxygen poisoning. Those at particular risk for oxygen toxicity include . patients exposed to prolonged high levels of oxygen. Extended exposure to above-normal oxygen partial pressures, or shorter exposures to very high partial pressures, can cause oxidative damage to cell membranes leading to the collapse of the alveoli in the lungs. . 105651 Page 3 of 3