Health inspection·August 12, 2021

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to accurately assess a resident's requirements for assistance to eat for one (Resident #44) of one residents reviewed for nutrition, from a total of 32 residents in the sample. Residents Affected - Few The findings include: Review of the medical record for Resident #44 revealed an admission date of 6/29/2021. Medical diagnoses included dementia, protein-calorie malnutrition, and primary osteoarthritis of the right and left wrists. An annual Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) of 99, indicating the resident was unable to complete the interview. The assessment identified the resident as requiring supervision to eat. On 08/09/21 at 12:33 PM, Resident #44 was observed sitting in her geri-chair in her room. Her tray table was positioned in front of her. Her lunch meal was on the tray table. Spaghetti was on the plate. Resident #44 was observed picking up one spaghetti noodle from her plate using her right hand and then struggling to bring the noodle to her mouth. She repeated this process each time she attempted to eat. On 08/10/21 at 12:10 PM, Resident # 44 was observed sitting in her geri-chair in her room. The chair was reclined and Resident #44 was covered with a white sheet which was littered with a brown cake substance. Her tray table was positioned in front of her. Her lunch meal was on the tray table. She was struggling to use a spoon to cut and eat her dessert. She had difficulty manipulating the spoon. A review of the resident's comprehensive care plans revealed a focus area for malnutrition. The care plan directed staff to assist the resident with meals as needed. (Photographic evidence obtained) Continued review of the medical record revealed a nutrition comprehensive evaluation, dated 6/24/2021 and completed by the Registered Dietician, that indicated the resident was underweight and that she required assistance with meals. (Photographic evidence obtained) On 08/11/21 at 12:35 PM, an interview was conducted with Employee A, Licensed Practical Nurse (LPN). She confirmed she was assigned to Resident #44. She was asked whether the resident required assistance with eating and she replied, yes. When asked whether the resident was able to feed herself she replied, No. On 08/12/21 12:12 PM An interview was conducted with Employee G, Certified Nursing Assistant (CNA). She confirmed that she was assigned to Resident #44 and that she was familiar with the resident's Page 1 of 5 105666 105666 08/12/2021 Lanier Rehabilitation Center 12740 Lanier Road Jacksonville, FL 32226

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few care. She explained that the resident was able to feed herself sometimes but staff needed to assist her more often than not. On 8/12/21 at 3:02 PM an interview was conducted with Employee F, LPN (Unit Manager). The Director of Nursing (DON) directed the survey team to her for MDS questions. She reviewed the MDS assessment dated [DATE] and the documentation that was used to complete the assessment. From 6/24/2021 to 6/30/2021, there were 20 documented meals. Of those 20 meals documented, the resident required total assistance 8 times and extensive assistance 1 time. After reviewing the documentation, Employee F stated, Yes. It looks wrong to me but I wasn't the one who completed this assessment. . 105666 Page 2 of 5 105666 08/12/2021 Lanier Rehabilitation Center 12740 Lanier Road Jacksonville, FL 32226

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to provide appropriate nutritional services by failing to provide assistance to eat for one (Resident #44) of two residents reviewed for nutrition, from a total of 32 residents in the sample. Residents Affected - Few The findings include: A review of the medical record for Resident #44 revealed an admission date of 6/29/2021. Medical diagnoses included dementia, protein-calorie malnutrition, and primary osteoarthritis of the right and left wrists. An annual Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) of 99, indicating the resident was unable to complete the interview. The assessment identified the resident as requiring supervision to eat. On 08/09/21 at 12:33 PM, Resident #44 was observed sitting in her geri-chair in her room. Her tray table was positioned in front of her. Her lunch meal was on the tray table. Spaghetti was on the plate. Resident #44 was observed picking up one spaghetti noodle from her plate using her right hand and then struggling to bring the noodle to her mouth. She repeated this process each time she attempted to eat the spaghetti. A readycare shake carton was on the tray. The shake carton had not been opened. On 08/10/21 at 12:10 PM, Resident # 44 was observed sitting in her geri-chair in her room. The chair was reclined and Resident #44 was covered with a white sheet which was littered with a brown cake substance. Her tray table was positioned in front of her. Her lunch meal was on the tray table. She was struggling to use a spoon to cut and eat her dessert. She had difficulty manipulating the spoon. The remainder of the lunch meal was untouched. A readycare shake carton was on the tray. The shake carton had not been opened. A review of the resident's comprehensive care plans revealed a focus area for malnutrition. The care plan directed staff to assist the resident with meals as needed and to provide supplements as ordered. (Photographic evidence obtained) Further review of the medical record for Resident #44 revealed a nutrition comprehensive evaluation, dated 6/24/2021, and completed by the Registered Dietician, that indicated the resident was underweight and that she required assistance with meals. (Photographic evidence obtained) A nutrition comprehensive evaluation dated 7/29/2021 and completed by the Registered Dietician, indicated taht Resident #44 required assistance with meals and that she was receiving house shakes during meals to assist with calorie/protein needs. The assessment also indicated the resident was receiving remeron as an appetite stimulant. (Photographic evidence obtained) A review of the resident's weights revealed a weight of 115.4 on 8/5/2021 and 111.6 on 8/11/2021. On 08/11/21 at 12:35 PM, an interview was conducted with Employee A, Licensed Practical Nurse (LPN). She confirmed, she was assigned to Resident #44. She was asked whether the resident required assistance with eating and she replied, Yes. When asked whether the resident was able to feed herself she replied, No. 105666 Page 3 of 5 105666 08/12/2021 Lanier Rehabilitation Center 12740 Lanier Road Jacksonville, FL 32226

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 8/11/21 at 2:44 PM, an interview was conducted with Employee B, Certified Nursing Assistant (CNA). She confirmed that she was assigned to Resident #44. She explained that the resident was completely independent with meals and that all we have to do is take the tray in and set it up. On 08/12/21 at 12:12 PM, an interview was conducted with Employee G, CNA. She confirmed that she was assigned to Resident #44 and that she was familiar with the resident's care. She explained that the resident was able to feed herself sometimes but staff needed to assist her more often than not. . 105666 Page 4 of 5 105666 08/12/2021 Lanier Rehabilitation Center 12740 Lanier Road Jacksonville, FL 32226

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview and policy and procedure review, the facility failed to adequately monitor laboratories as ordered by a physician for one (Resident #15) of five residents reviewed for unnecessary medications, from a total of 32 residents in the sample. Residents Affected - Few The findings include: A medical record review for Resident #15 revealed she was admitted on [DATE], with the following diagnoses: dementia with Lewy body, delusional disorder, histrionic personality disorder and generalized anxiety disorder. A review of Resident #15 current physician orders dated 6/4/21, revealed complete blood count (CBC), comprehensive metabolic panel (CMP), glycated hemoglobin (A1C), thyroid-stimulating hormone (TSH) and valproic acid test (VPA) every night shift every 3 months, starting on 7th for 1 day for prophylaxis. (Copy obtained) There was no documentation in the medical record for Resident #15 that the above-mentioned laboratory orders were completed. The previous CBC, CMP, A1C, TSH and VPA were completed on 3/5/21. (Copy obtained) Further review of Resident #15's current physician order dated 7/30/21, revealed she is receiving Valproic Acid 250 milligrams/5milliters for psychosis related to dementia with Lewy body twice a day via a gastrostomy tube. A review of the last laboratory test on 3/5/21 for Resident #15 revealed a VPA level of 9.4, which is below the reference range of 50-100 microgram/milliliter. The Medical Doctor reviewed the lab results, but there were no other orders to check until 6/4/21. An interview was conducted with the Director of Nursing (DON) on 8/12/21 at 3:03 PM. She confirmed the lab order for Resident #15 was not done on 6/7/21. The physician was notified on 8/12/21, that the laboratory was not completed as ordered. A review of facility policy, titled Psychotropic Medication Assessment and Monitoring dated 10/30/18, stated each resident's drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used: without adequate monitoring. (Copy obtained) 105666 Page 5 of 5