Health inspection·September 6, 2023

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure appropriate treatment and services for enteral nutrition was provided for 1 of 3 residents (Resident #3). Findings include: During an observation on 9/06/2023 at 8:10 AM Resident #3 was lying in bed receiving enteral nutrition via a feeding pump running Jevity 1.5 at 60ml (milliliters) per hour and 40ml per hour auto water flushes. During an observation on 9/06/2023 at 10:48 AM Resident #3 was lying in bed receiving enteral nutrition via a feeding pump running Jevity 1.5 at 60ml per hour and 40ml per hour auto water flushes. During an interview on 9/6/2023 at 10:51 AM Staff A, License Practical Nurse (LPN) stated, [Resident #3's name] should be at 20ml per hour flushes but I will check. Staff A looked up physician order in electronic medical record. Staff A stated The order was changed yesterday. It should be at 80 ml per hour. I see they have it on 40ml per hour not on 80ml I will change it. During an interview on 9/6/2023 at 10:58 AM the Director of Nursing (DON) stated, Staff should provide services in accordance with doctors' orders. Review of the admission record documented Resident #3 was admitted on [DATE] with diagnoses including cerebellar ataxia with defective DNA (deoxyribonucleic acid) repair, muscle weakness, other generalized epilepsy and epileptic syndromes, aphasia, gastrostomy status, gastro-esophageal reflux disease without esophagitis, dysphagia, and aphasia. Review of the physician's order for Resident #3 dated 6/29/2023 reads, Enteral Feed Order every shift for Nutrition Support. NPO/TF (Nothing By Mouth/Tube Feeding): Administer Jevity 1.5 HN (High-Protein Nutrition) at 60mL/HR (milliliters/per hour), Continuous x 20 hours with Water Flush at 40ml/Every HR x 20 Hours via G-Tube (Gastronomy Tube). On at 2 pm and OFF at 10 am Up and running for a total of 20 hours. Review of the physician's order for Resident #3 dated 9/05/2023 reads, Enteral Feed Order every shift for Nutrition Support. NPO/TF: Administer Jevity 1.5 HN at 60 ml/HR, Continuous Hours with Water Flush at 80 ml/Every HR via G-Tube. Review of the policy and procedure titled Medication Administration via Enteral Tube last reviewed (continued on next page) 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 2 Event ID: 105664 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)