Health inspection·October 27, 2021

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to practice appropriate wound care in an attempt to prevent potential wound infection during a wound care observation for 1 of 1 sampled resident, Resident #16, reviewed for wound care. Residents Affected - Few The findings included: Review of the facility's employee handbook Personal, Hygiene and Dress Code provided by the Employee Services Coordinator documented .Minimal jewelry should be worn due to safety and infection control concerns . Review of Resident #16's clinical record revealed documentation of an initial admission to the facility on [DATE], with the latest readmission on [DATE]. The resident's diagnoses included, in part, Multiple Sclerosis, Anemia, Paraplegia, Respiratory Disorders, Disorders of Bone Density and Heart Diseases. Review of the resident's Minimum Data Set (MDS) quarterly assessment, dated 07/20/21, documented the resident was totally dependent on the staff for her activities of daily living (ADLs). The resident's Brief Interview Mental Status (BIMS) score was 3 of 15, indicating severe cognition impairment. Review of the physician orders, dated 10/01/21, documented, cleanse wound to sacrum with normal saline solution (NSS), apply Aquacel AG and cover with a dry dressing daily. On 10/25/21 at 3:08 PM, observation revealed Resident #16 was lying down in bed on her back with an air mattress in place. An interview was conducted with the resident who stated she had a sore on her back, but was unsure if the dressing was changed every day. During the interview, the resident agreed with the surveyor observing her dressing change by the nurse. On 10/26/21 at 9:25 AM, arrangements for Resident #16's wound care observation to be done by Staff E, a Licensed Practical Nurse (LPN), was made. On 10/26/21 at 9:35 AM, an interview was conducted with the Director of Nursing (DON) who stated the wound care specialist did the resident's dressing early that morning. The DON stated Resident #16 was admitted with a right buttock stage 4 pressure ulcer. On 10/27/21 at 9:58 AM, wound care observation for Resident #16 was performed by Staff E, LPN, who was assisted by the facility's Staff Development Coordinator (SDC). At 9:59 AM, observation revealed Staff E retrieved the wound care supplies that included a jar of normal saline solution, Aquacel AG, a red bag, wad of gauzes, two drapes, two foam trays, a barrier and dry dressings, and entered the Page 1 of 13 105679 105679 10/27/2021 Regents Park of Sunrise 9711 W Oakland Park Blvd Sunrise, FL 33351

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident's room. Staff E draped the resident's overbed table, placed the red bag on top of the trash can, performed hand hygiene and donned gloves. Staff E then opened the supplies packaging, dated the dry dressing foam, grabbed the trash can, placed it behind her, continued with the same pair of gloves and pulled the resident's overbed table up. Staff E continued to wear the same gloves that she had touched the contaminated trash can and the table with, and placed her contaminated gloved hands on top of the clean gauzes located in the clean field. Staff E removed her gloves, performed hand hygiene, donned gloves, returned to the resident's bedside, removed the resident's brief, placed a drape under the resident's buttocks, and removed the soiled wound dressing. Observation revealed Resident #16's wound was bleeding a moderate amount of blood on the drape. Staff E removed her gloves, performed hand hygiene, and donned gloves. Continued observation revealed Staff E was ready to clean the resident's wound with the gauzes that she contaminated with her gloved hands prior. Staff E was noted to also be wearing a bracelet on her right wrist with several charms dangling, the charms were not inside her gloves. Continued observation revealed Staff E reached for the normal saline jar that was located behind the tray containing the gauzes and her bracelet charms were observed touching the clean gauzes. Staff E was stopped and was apprised of the observations. She stated she did not realize she had touched the gauzes with her gloves. Staff E was asked to get new gauzes because she had contaminated the field. Observation revealed Staff E cleaned the resident's sacrum wound with a gauze and her dangling bracelet charms were touching the blood collected on the drape underneath the resident's buttock. At 10:30 AM, Staff E stated there was no paper towel in the room. Observation revealed Staff E was provided with several loose paper towel by a staff member. Staff E then placed them under her left arm touching her uniform while she was performing hand hygiene, then dried her hands with the loose paper towel. On 10/27/2 at 10:59 AM, a joint interview was conducted with Staff E and the SDC. They were apprised of observations and the concerns. Staff E stated the bracelet charms were inside the gloves. She was apprised the charms were not inside the gloves. She stated she did not realize the bracelet was touching the blood on the drape. The SDC stated she did not notice that Staff E charms were touching the blood on the drape. She stated that they should have waited for a paper towel to be put on canister rather that holding it under the arm. She confirmed the concern with the bracelet charms touching the clean gauzes and the bloody drape. Observation then revealed Staff E disinfecting her bracelet with a Sani Cloth wipe on her hand. She wiped her bracelet with bare hands, and was no wearing gloves. She was apprised that she was cleaning a blood contaminated bracelet with bare hands. On 10/27/21 at 11:03 AM, a side-by-side review of the Sani Cloth wipes container was conducted with the SDC that documented that the wipes are to be use with protective disposable gloves. 105679 Page 2 of 13 105679 10/27/2021 Regents Park of Sunrise 9711 W Oakland Park Blvd Sunrise, FL 33351

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 observation, interview, and record review, the facility failed to ensure a timely nutritional assessment, provide dietary supplements, and ensure consistent weight documentation for 2 of 2 sampled residents reviewed for nutrition, Resident #93 and #28. Resident #93 had a significant weight loss and had a pressure ulcer, which would indicate a need for increased nutrition. Residents Affected - Few The findings included: A review of the facility's policy titled, Weight Management, revised October 2017, showed that weights are completed on admission and readmission, then weekly for 4 weeks, then monthly unless the physician orders more frequently. Weight loss with 5 percent or more in 30 days should be documented in the progress note and the care plan updated with interventions. 1. Record review revealed Resident #93 was readmitted to the facility on [DATE], with diagnoses to include anemia, type 2 diabetes, dysphagia (difficulty swallowing), and unspecific protein-calorie malnutrition. A review of the admission MDS (Minimum Data Set) assessment, dated 09/30/21, showed Resident #93 needed extensive assistance of one person for eating. A physician order, dated 09/30/21, documented, weekly weights times 4 every 7 days for 4 weeks. A review of the weight log revealed an admission [DATE]) weight documented at 118.0 pounds, and another weight was taken on 10/04/21 at 118.0 pounds. No other weights were recorded between 10/04/21 and 10/25/21. The care plan, dated 10/06/21, showed that Resident #93 is at nutritional risk related to significant weight loss and a mechanically altered diet. The Nutritional Evaluation Comprehensive, dated 09/30/21, revealed no recommendations for dietary supplements to be provided for Resident #93. Review of the progress note dated 10/21/21 showed that Resident #93 has an unstageable right buttock wound, right anterior foot wound, and right heel wound. It further showed that a Prostat sugar-free (protein supplement) is given for wound healing to Resident #93. During an observation on 10/24/21 at 12:52 PM, Resident #93 was in her room eating her lunch meal. A closer observation did not show any nutritional supplements provided with the lunch meal. During an observation on 10/24/21 at 12:20 PM, Resident #93 was in her room eating her lunch meal. The closer observation did not show any nutritional supplements provided with the lunch meal. In an observation conducted on 10/26/21 at 9:10 AM, Resident #93 was in her room eating her breakfast meal. Closer observation showed Staff B (Certified Nursing Assistant) helping Resident #93 with her breakfast. In this observation, Staff B stated that Resident #93 is eating very well and usually consumes 100 percent of her meals. A review of the task section in the electronic system for a percentage of food consumed showed that between 10/13/21 and 10/25/21, Resident %93 ate only 11 meals at 100 percent. In an interview conducted on 10/26/21 at 10:15 AM with Staff D (Restorative Certified Nurse Assistant), she stated weekly weights are taken on Mondays; and monthly weights are taken on the first day of the month. They use 2 Hoyer lift scales on each unit. Staff D reported that the Dietitian gives her the list of all residents who needed to be weighed weekly. She then gives it back to the 105679 Page 3 of 13 105679 10/27/2021 Regents Park of Sunrise 9711 W Oakland Park Blvd Sunrise, FL 33351

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Dietitian when she is done. She said, she could input the weighs into the electronic system. A copy of the weights is also given to the unit manager. All resident's weights are taken upon admission and for 4 weeks after. In an interview conducted on 10/26/21 at 12:06 PM with Staff C (Restorative Certified Nurse Assistant), she stated weekly weights are taken on Mondays. And monthly weights are taken on the first day of the month. Staff C reported working mainly on the C wing and showed surveyors the weights recorded on 10/04/21 for the C wing. A closer observation of the written weight log showed that Resident #93 recorded weight was 96 pounds and not 118 pounds (lbs) as recorded by the Dietitian in the electronic system. Staff C confirmed that the facility's Dietitian is the one who provides her with the list of residents who are on weekly weights. In an observation conducted on 10/26 21 at 12:35 PM, the surveyor requested a new weight be taken on Resident #93. Staff B and Staff C (Restorative Certified Nursing Assistants) were observed using a Hoyer lift with serial number 04H790688 to take the weight on Resident #93. The first weight was recorded at 110.0 pounds, and a second reweight was noted at 108.0 pounds. This was a 8.47 percent weight loss which is significant weight loss. In an interview conducted on 10/26/21 at 12:50 PM with the facility's Maintenance Director, he reported that two Hoyer lift scales are used to take the weights on all residents. One is located on the C wing, and the other one is located on the B wing. When asked the last time the two Hoyer lift scales were calibrated, he said, on March 30, 2021, of this year. He further said that the two scales were supposed to be calibrated 3 weeks ago but were not. He called to request the outside company to come in for the scheduled maintenance that was missed but was told that they do not have anyone available to come to calibrate the scales. In an interview conducted on 12/26/21 at 1:56 PM with the facility's clinical Dietitian, she reported that she is in constant communication with the nurse manager regarding who has an order for weekly weights. She said she provides a list to Staff C and Staff D on a Monday, and they will take the weekly weights for the residents on the list. The completed list is given to her the next day on a Tuesday. The Dietitian reported that the nursing supervisor is the one who puts the weights in the electronic system. A weight loss that is more than 5 percent in 30 days is considered significant weight loss. She said she would try and address the weight loss that same day as it is identified. In this interview, she acknowledged that the weight loss that was missed on Resident #93, was an oversight on her part. She also said that she did not know that Resident #93 had an order for weekly weights but now she knows. The surveyor expressed concern regarding the Prostat supplements not given to Resident #93. 2. Review of the facility's policy titled, Nutrition Assessment and Progress Note, dated January 2021, documented the following: Assessment and documentation of nutritional concerns is recorded in a timely manner in the medical record. Progress notes are completed for intermittent documentation as needed and with changes in nutrition status or care. Review of the facility's policy titled, Weight Management, dated January 2021, documented the following: The dietitian or authorized clinical designee, in conjunction with the facility interdisciplinary team (IDT), will monitor and evaluate resident weights for significant changes or other changes that may indicate changing nutritional status. The dietitian will document assessment of weight change and interventions. The dietitian will reassess the nutritional needs and intake of the resident with a weight change. The dietitian and/or designee will track resident weights monthly to ensure 105679 Page 4 of 13 105679 10/27/2021 Regents Park of Sunrise 9711 W Oakland Park Blvd Sunrise, FL 33351

F 0692 that all significant weight changes are recognized. Level of Harm - Minimal harm or potential for actual harm Review of the record showed that Resident #28 was admitted to the facility on [DATE] with the following diagnoses: Dehydration, Hypokalemia, Hypomagnesemia, Weakness, Dysphagia, and Cognitive Communication Deficit. Residents Affected - Few Review of Section C of the Quarterly Minimum Data Set (MDS), dated [DATE], documented that Resident #28 had a Brief Interview for Mental Status of 10, which indicated that she was moderately cognitively impaired. Review of the care plan, dated 08/20/21 documented that Resident #28 had a nutritional problem or potential nutritional problem related to Dehydration, Hypokalemia, and Hypomagnesemia. Interventions were for the Registered Dietitian (RD) to consult and follow as needed. Review of the weights showed that Resident #28 weighed 131.4 lbs. on 07/04/21, 114 lbs. on 08/05/21, and 109 lbs. on 09/02/21. This showed that Resident #28 experienced a severe weight loss of 13.2% between 07/04/21 and 08/05/21. This further showed that Resident #28's weight continued to trend downwards from 08/05/21 to 09/02/21. Review of the Certified Nursing Assistant (CNA) Tasks for 'Amount Eaten', dated 09/27/21 - 10/25/21, showed that Resident #28 had a varied oral intake with mostly a 25-50% consumption of her meals. Review of the Nutrition Progress Note, dated 09/01/21, documented that Resident #28 experienced a 15% weight loss in 30 days and had a varied oral intake. The RD recommended Medpass (nutritional supplement) twice per day for additional calories. This showed that an assessment regarding Resident #28's severe weight loss of 13.2% was not assessed by the RD until 27 days after the weight loss had occurred. During an interview conducted on 10/26/21 at 1:59 PM, the RD stated that she was responsible for conducting comprehensive assessments, quarterly assessments, monthly assessments, and progress notes. She reported that all of her assessments and notes were documented in PointClickCare (electronic charting system). She said, residents would be considered to be at high nutritional risk if they were on dialysis, had wounds, or experienced weight loss. When asked what would be considered a significant change in weight, she stated that a significant change in weight would be 2% in one week, 5% in 30 days, 7.5% in 90 days, and greater than 10% in 180 days. She further said, PointClickCare would notify her of any residents that experienced a significant change in weight. If a resident experienced a significant change in weight, she stated that she would follow up with them the same day. When asked about Resident #28, the RD stated that she was considered to be at high nutritional risk. When asked about the severe weight loss of 13.2% between 07/04/21 - 08/05/21, the RD stated that her and the Director of Nursing noticed in the beginning of September 2021 that an assessment was not done to address this weight loss. She further stated, I did my interventions and documented on that day and put a Quality Assurance and Performance Improvement plan in place. It was discussed with the Interdisciplinary Team that same day. It was an oversight. 2. Review of the facility's policy titled, Nutrition Assessment and Progress Note, dated January 2021, documented the following: Assessment and documentation of nutritional concerns is recorded in a timely manner in the medical record. Progress notes are completed for intermittent documentation as needed and with changes in nutrition status or care. 105679 Page 5 of 13 105679 10/27/2021 Regents Park of Sunrise 9711 W Oakland Park Blvd Sunrise, FL 33351

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility's policy titled, Weight Management, dated January 2021, documented the following: The dietitian or authorized clinical designee, in conjunction with the facility interdisciplinary team (IDT), will monitor and evaluate resident weights for significant changes or other changes that may indicate changing nutritional status. The dietitian will document assessment of weight change and interventions. The dietitian will reassess the nutritional needs and intake of the resident with a weight change. The dietitian and/or designee will track resident weights monthly to ensure that all significant weight changes are recognized. Review of the record showed that Resident #28 was admitted to the facility on [DATE] with the following diagnoses: Dehydration, Hypokalemia, Hypomagnesemia, Weakness, Dysphagia, and Cognitive Communication Deficit. Review of Section C of the Quarterly Minimum Data Set (MDS) dated [DATE] documented that Resident #28 had a Brief Interview for Mental Status of 10, which indicated that she was moderately cognitively impaired. Review of the Care Plan dated 08/20/21 documented that Resident #28 had a nutritional problem or potential nutritional problem related to Dehydration, Hypokalemia, and Hypomagnesemia. Interventions were for the Registered Dietitian (RD) to consult and follow as needed. Review of the weights showed that Resident #28 weighed 131.4 lbs. on 07/04/21, 114 lbs. on 08/05/21, and 109 lbs. on 09/02/21. This showed that Resident #28 experienced a severe weight loss of 13.2% between 07/04/21 - 08/05/21. This further showed that Resident #28's weight continued to trend downwards from 08/05/21 - 09/02/21. Review of the Certified Nursing Assistant (CNA) Tasks for Amount Eaten dated 09/27/21 - 10/25/21 showed that Resident #28 had a varied oral intake with mostly a 25-50% consumption of her meals. Review of the Nutrition Progress Note dated 09/01/21 documented that Resident #28 experienced a 15% weight loss in 30 days and had a varied oral intake. The RD recommended Medpass (nutritional supplement) twice per day for additional calories. This showed that an assessment regarding Resident #28's severe weight loss of 13.2% was not assessed by the RD until 27 days after the weight loss had occurred. During an interview conducted on 10/26/21 at 1:59 PM, the RD stated that she was responsible for conducting comprehensive assessments, quarterly assessments, monthly assessments, and progress notes. She reported that all of her assessments and notes were documented in PointClickCare (electronic charting system). According to her, residents would be considered to be at high nutritional risk if they were on dialysis, had wounds, or experienced weight loss. When asked what would be considered a significant change in weight, she stated that a significant change in weight would be 2% in one week, 5% in 30 days, 7.5% in 90 days, and greater than 10% in 180 days. According to her, PointClickCare would notify her of any residents that experienced a significant change in weight. If a resident experienced a significant change in weight, she stated that she would follow up with them the same day. When asked about Resident #28, the RD stated that she was considered to be at high nutritional risk. When asked about the severe weight loss of 13.2% between 07/04/21 - 08/05/21, the RD stated that her and the Director of Nursing noticed in the beginning of September 2021 that an assessment was not done to address this weight loss. She further stated, I did my interventions and documented on that day and put a Quality Assurance and Performance Improvement plan in place. It was discussed with the Interdisciplinary Team that same day. It was an oversight. 105679 Page 6 of 13 105679 10/27/2021 Regents Park of Sunrise 9711 W Oakland Park Blvd Sunrise, FL 33351

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** 3. Review of Resident #55's clinical record documented an initial admission to the facility on [DATE] with no readmissions. The resident's diagnoses included in part, Hemiplegia and Hemiparesis following Cerebral Infarction affecting left non-dominant side, Type 2 Diabetes Mellitus, Epilepsy, Major Depressive Disorder, Gastrostomy Status (a stomach tube feeding in place), Cognitive Communication Deficit, Hypernatremia (high level of sodium-salt), Hypocalcemia (low level of calcium), Schizoaffective Disorder and Anemia. Review of the Minimum Data Set admission assessment, dated 06/14/21, documented a Brief Interview Mental Status (BIMS) score 2 of 15, indicating severe cognitive impairment. The record also documented that the resident was totally dependent on staff for tube feeding. Review of the physicians' orders, dated 06/14/21, documented, One time a day Enteral Feed: Glucerna 1.2 via PEG (a stomach tube feeding) tube to infuse at a rate of 85 ml (millimeters)/hr (hour) until a total volume of 1700 ml is infused in 24 hours. Start at 1:00 PM .every shift verify infusion . The physician orders, dated 06/11/21, documented, NPO (Nothing by Mouth) diet. The physician's order, dated 06/11/21, documented, Delegate to dietitian the responsibility to alter, change, or modify dietary orders including . enteral feeding . On 10/24/21 at 1:01 PM, observation revealed Resident #55's tube feeding formula bottle labeled as, 10/24/21 at 12:00 AM at 85 ml/hr. Observation revealed approximately 800 ml of formula remaining in 1,500 ml bottle indicating that 700 ml was actually infused and the amount that should have been infused in 13 hours should have been 1,105 ml. Resident #55 had 405 ml of his feeding formula missing. Further observation revealed the resident tube feeding was not connected. On 10/24/21 at 3:17 PM, observation revealed Resident #55's tube feeding formula bottle labeled as 10/24/21 at 12:00 AM at 85 ml/hr. Observation revealed approximately 550 ml of formula remaining in 1,500 ml bottle indicating that 950 ml was actually infused and the amount that should have been Infused in 15.25 hours should have been 1,296 ml. Resident #55 had 346 ml of his feeding formula missing. On 10/24/21 at 3:22 PM, an interview was conducted with Staff I, a Licensed Practical Nurse, and stated that she reconnected Resident #55 to the same bottle that was hanged on the pole dated and timed as 10/24/21 12:00 AM. On 10/25/21 at 8:55 AM, observation revealed Resident #55's tube feeding formula bottle labeled as 10/24/21 at 9:00 PM at 85 ml/hr. Observation revealed approximately 700 ml of formula remaining in 1,500 ml bottle indicating that 800 ml was actually infused and the amount that should have been Infused in 12 hours should have been 1,020 ml. Resident #55 had 220 ml of his feeding formula missing. On 10/25/21 at 12:13 PM, observation revealed Resident #55's tube feeding formula 105679 Page 7 of 13 105679 10/27/2021 Regents Park of Sunrise 9711 W Oakland Park Blvd Sunrise, FL 33351

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few bottle labeled as 10/24/21 at 9:00 PM at 85 ml/hr. Observation revealed approximately 700 ml of formula remaining in 1,500 ml bottle indicating that 800 ml was actually infused and the amount that should have been Infused in 15.25 hours should have been 1,296 ml. Resident #55 had 496 ml of his feeding formula missing. Further observation revealed the resident tube feeding was not connected. On 10/25/21 at 3:28 PM, an interview was conducted with Staff I who stated she stopped Resident #55 tube feeding around 8:30 AM and connected him back at 1:00 PM. On 10/26/21 at 9:00 AM, observation revealed Resident #55's tube feeding formula bottle labeled as 10/25/21 at 1:00 PM at 85 ml/hr. Observation revealed approximately 150 ml of formula remaining in 1,500 ml bottle indicating that 1350 ml was actually infused and the amount that should have been infused in 20 hours should have been 1,700 ml. Resident #55 had 350 ml of his feeding formula missing. On 10/26/21 at 10:44 AM, an interview was conducted with Staff J, a Registered Nurse, who stated that she will be connecting Resident #55's his tube feeding around 1:00 PM. Observation revealed the resident tube feeding formula bottle, dated 10/25/21, hung at 1:00 PM, was running at 85 ml/hr. and still had 50 ml remaining in 1500 ml bottle. On 10/26/21 at 1:00 PM, observation of Resident #55 tube feeding administration performed by Staff J, a Registered Nurse, was conducted. An interview was conducted with Staff J who stated Resident #55's physician order for tube feeding was Glucerna at 85 ml/hr. for a total of 1700 ml in 24 hrs. She stated once 1700 ml is infused, they turn the machine off. She stated they initiate a new bottle every day at 1:00 PM. Observation revealed Staff J labeled a bottle of Glucerna 1.2 with date of 10/26/21 and time as of 1:08 PM. The bottle had 1500 ml of Glucerna formula. Staff J then proceeded to connect the resident tube feeding formula. 2. Review of the record showed that Resident #73 was admitted to the facility on [DATE] with the following diagnoses: Gastrostomy Status, Dysphagia, Cerebral Infarction, Protein Calorie Malnutrition, Muscle Wasting and Atrophy, Congestive Heart Failure, Chronic Kidney Disease, Type 2 Diabetes Mellitus, and Dementia. Review of the 5-Day Minimum Data Set (MDS) assessment, dated 10/16/21, documented that Resident #73 had a Brief Interview for Mental Status of 00, which indicated that she was severely cognitively impaired. Review of Section K of the MDS, dated [DATE], documented that Resident #73 was on a feeding tube while a resident in the facility. Review of the care plan, dated 10/03/21, documented that Resident #73 was receiving enteral nutrition because of dysphagia. Interventions were to administer enteral nutrition as ordered. Review of the Physician's Orders documented that Resident #73 was to receive, Glucerna 1.2 (tube feeding formula) via percutaneous endoscopic gastrostomy (PEG) at 60 milliliters (ml) per hour until a total volume of 1,200 ml had infused in 24 hours. It was further documented that the tube feeding was to start at 1:00 PM. During an observation conducted on 10/24/21 at 11:16 AM, Resident #73 was observed sleeping in her bed. Resident #73's tube feeding was running at 45 ml per hour with a bottle of Glucerna 1.2 which was noted with a start date and time of 10/23/21 at 2:00 PM. Closer observation showed that there was about 600 ml out of 1,500 ml of formula remaining in the bottle. This showed that about 900 ml of formula had been infused and that Resident #73 had only received 900 ml (1,080 calories) out of 1,200 105679 Page 8 of 13 105679 10/27/2021 Regents Park of Sunrise 9711 W Oakland Park Blvd Sunrise, FL 33351

F 0693 ml (1,440 calories) from her Physician ordered tube feeding regimen. Level of Harm - Minimal harm or potential for actual harm During an observation conducted on 10/24/21 at 12:51 PM, Resident #73 was observed sleeping in her bed. Resident #73's tube feeding was running at 45 ml per hour with a bottle of Glucerna 1.2 which was noted with a start date and time of 10/23/21 at 2:00 PM. Closer observation showed that there was about 550 ml out of 1,500 ml of formula remaining in the bottle. This showed that about 950 ml of formula had been infused and that Resident #73 had only received 950 ml (1,140 calories) out of 1,200 ml (1,440 calories) from her Physician ordered tube feeding regimen. Residents Affected - Few During an observation conducted on 10/25/21 at 9:06 AM, Resident #73 was observed laying in her bed. Resident #73's tube feeding pump was turned off and a bottle of Glucerna 1.2, dated 10/25/21, was hanging from the pole. Closer observation showed that there was about 700 ml of formula remaining in the 1,000 ml formula bottle. During an observation conducted on 10/25/21 at 11:06 AM, Resident #73 was observed laying in her bed. Resident #73's tube feeding pump was turned off and a bottle of Glucerna 1.2, dated 10/25/21, was hanging from the pole. Closer observation showed that there was still about 700 ml of formula remaining in the 1,000 ml formula bottle. This showed that Resident #73's tube feeding formula had not been infused in 2 hours. During an interview conducted on 10/25/21 at 1:46 PM, Staff E, Licensed Practical Nurse, stated that nurses were responsible for hanging, starting, and stopping tube feedings. Staff E said, tube feedings would be stopped for care, administration of medications, distension, if a resident felt full or uncomfortable, if the residuals were greater than the doctor's recommendations, or if the tube feeding was complete. When asked about Resident #73, Staff E stated that Resident #73 was to receive Glucerna 1.2 at 60 ml per hour until a total volume of 1,200 ml had been infused over 24 hours. She further stated that her tube feeding was to start at 1:00 PM. When asked how Resident #73 tolerated her tube feeding, Staff E stated that Resident #73 tolerated her tube feeding well and had no issues. When asked why Resident #73's tube feeding formula had not been infused for 2 hours, Staff E stated that she turned the tube feeding on between 8:15 AM - 8:20 AM. The surveyor informed Staff E that the tube feeding was off at 9:06 AM and 11:06 AM and that the amount of formula administered had not changed. Staff E stated that when she went into Resident #73's room at 11:30 AM, the tube feeding pump was already on. She stated, Maybe one of the aides was in there and stopped it and put it back on. During an interview conducted on 10/25/21 at 2:39 PM, Staff F, Certified Nursing Assistant, stated that she started a bed bath for Resident #73 between 10:00 AM - 10:30 AM. Staff F said, bed baths take about 25-30 minutes to complete. Staff F reported that she also changed Resident #73's adult briefs around 8:00 AM, 10:30 AM, 12:30 PM, and 1:20 PM. She said the tube feedings were placed on hold when residents received care. She further stated that she usually called the nurse to turn on and turn off the tube feeding for care. When asked about Resident #73, Staff F stated that she called the nurse to turn it on and off for her care today. During an interview conducted on 10/26/21 at 1:59 PM, the Registered Dietitian (RD) stated that nurses were responsible for starting and stopping tube feedings. The RD said, tube feedings would be stopped for care, for cleaning, and for bowel movement changes. She reported that tube feeding would typically be stopped for an hour for care. When asked about Resident #73, she stated that she would be considered high nutritional risk and that she was on a tube feeding due to having a poor intake. According to her, Resident #73 had a Physician's Order for Glucerna 1.2 at 60 ml per hour until a total volume of 1,200 ml had been infused within 20 hours. She further reported that the start time was 105679 Page 9 of 13 105679 10/27/2021 Regents Park of Sunrise 9711 W Oakland Park Blvd Sunrise, FL 33351

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 1:00 PM. The RD stated that Resident #73 tolerated her tube feeding well. The surveyor informed the RD of the findings and the RD acknowledged that Resident #73's tube feeding had not been administered as per Physician's Orders. Based on observations, interviews and record review, the facility failed to ensure that enteral nutrition were followed by the physician's order and did not exceed the expiration date for 3 of 3 sampled residents, Resident #64, #73, #55, reviewed for tube feeding. The findings included: 1. Record review showed that Resident #64 was readmitted [DATE] with diagnoses of Cerebral infarction, Dysphagia, and muscle wasting. Review of Minimum Data Set (MDS) assessment, dated 08/20/21, showed that Resident #64 is with no Brief Interview of Mental Status (BIMS) score, which is indicative of severe cognitive impairment. A physician order, dated 09/14/21, showed, to provide enteral feeding one time a day with TwoCal (tube feeding formulary) to infuse at a rate of 55 milliliters (ml) until a total volume of 1100ml is infused and to start at 1:00 PM. In an observation conducted on 10/24/21 at 9:10 AM, Resident #64 was observed in bed. Closer observation showed tube feeding TwoCal running at 55ml which started at 11:00 AM on 10/23/21. The tube feeding bottle was at the 250ml mark out of the 900ml total capacity bottle. According to the Physician's order, the tube feeding infusing for 20 hours, should have administered 1100ml, and a new tube feeding bottle should have started after the 900ml capacity bottle finished. In another observation conducted on 10/24/21 at 12:50 PM, the same tube feeding bottle was still infusing at 55ml and noted to be at the 100ml mark out of 900ml total capacity bottle. According to the Physician's order, the tube feeding infusing for 20 hours, should have administered 1100ml, and a new tube feeding bottle should have started after the 900ml capacity bottle finished. In an observation conducted on 10/25/21 at 1:46 PM, Resident #64 was observed in bed. His tube feeding bottle was running at 55ml which started at 12:00 PM on 10/24/21. Closer observation showed that the tube feeding mark was at 100ml out of the 900ml total capacity bottle. According to the Physician's order, the tube feeding infusing for 20 hours, should have administered 1100ml, and a new tube feeding bottle should have started after the 900ml capacity bottle finished. Review of the care plan dated 11/19/21 showed that Resident #64 is on tube feeding because of dysphagia, and to administer the enteral feeding as ordered by the Doctor. Resident #64 is also dependent on enteral feeding for nutrition and hydration. In an interview conducted on 10/25/21 at 1:50 PM, with Staff A, (Registered Nurse), she stated that the tube feeding bottle was already running at 55ml when she arrived this morning. She further stated that it is due to be changed now, after 24 hours as per order. Staff A further reported Resident #64 is tolerating his tube feeding well with no issues. In an interview conducted on 10/25/21 at 2:10 PM, with the facility's Administrator, she stated that Resident #64's tube feeding was stopped yesterday due to the president's wife visiting from 2:00 PM to 6:00 PM. She continued to say Resident #64's likes to take Resident #64 outside and asked for the tube feeding to be stopped. The Administrator said the tube feeding was probably held for 4 hours for the duration of the visit. 105679 Page 10 of 13 105679 10/27/2021 Regents Park of Sunrise 9711 W Oakland Park Blvd Sunrise, FL 33351

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A telephone interview was conducted with Resident #64's wife on 10/25/21 at 2:25 PM who confirmed that she was at the facility visiting her husband on 10/24/21. She stated that she was here from 2 PM to 4 PM and did not request the tube feeding to be stopped. The wife expressed concern that the tube feeding was not be stopped during her visits. Record review of the Clinical Dietitian Assessment, dated 10/14/21, revealed the tube feeding regimen of TwoCal 55ml for 20 hours for a total volume of 1100ml will be providing 100 percent of Resident #64's nutritional needs. She further reported that Resident #64 is tolerating his tube feeding well. In an observation conducted on 10/26/21 at 9:03 AM, Resident #64 was observed in bed. Observation of the tube feeding bottle showed that it was running with Nutren 2.0 at 55ml, which started on 10/25/21 at 2:00 PM. The bottle showed that 300ml of formula was administered, with 600ml of formula left in the bottle. In an interview conducted on 10/26/21 at 1:50 PM, with the facility's Clinical Dietitian, she stated that the tube feeding was not administered according to the Physician's orders. She further reported the tube feeding may have been stopped for personal care by staff. The surveyor expressed concern regarding the tube feeding not being administered according to physician's orders. 105679 Page 11 of 13 105679 10/27/2021 Regents Park of Sunrise 9711 W Oakland Park Blvd Sunrise, FL 33351

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record review, the facility failed to maintain food safety requirements with storage, preparation, and distribution in accordance with professional standards for food service safety that included failure to maintain sanitary conditions and failure to maintain adequate holding temperatures. The findings included: A. During the initial tour of the kitchen conducted on 10/24/21 at 8:52 AM, accompanied by the Administrator and Staff K, Cook, the following were noted: 1. At the request of the surveyor, Staff K calibrated the facility's metal stemmed thermometer to check the temperature of the cold items for the breakfast tray line. The temperature test revealed that the temperature of the thickened milk inside of the milk cooler was at 50 degrees F. It was noted that the ice inside the milk cooler had melted. Staff K stated, Maybe we need to put in more ice because the ice is melting and going towards the drain. Staff K acknowledged that the thickened milk was not at the regulatory temperature of 41 degrees F or below. 2. In the dishwashing area, about 30 utensils were stored in the handwashing sink. Staff K and Staff G, Porter, stated that they did not know why the utensils were stored in the handwashing sink. 3. In the dishwashing area, one serving utensil with food residue was stored on top of about 25 clean cups. Closer observation showed that there was food residue inside of the tray that the clean cups were stored in. 4. At the request of the surveyor, Staff K checked the chemical concentration of the sanitation bucket located underneath the thawing sink using the facility's test strips. The concentration was recorded at about 400 parts per million (ppm). It was discussed with Staff K that a high chemical concentration of 400 ppm would result in a toxic chemical residue that would remain on the surface of the products being cleaned. 5. At the request of the surveyor, Staff K checked the chemical concentration of the sanitation bucket located underneath the milk cooler using the facility's test strips. The concentration was recorded at about 400 ppm. Staff H, Diet Aide, stated that she normally filled the sanitation buckets and that the chemical concentration should have been around 200 ppm. 6. At the request of the surveyor, Staff K checked the chemical concentration of the sanitation bucket located underneath the prep sink using the facility's test strips. The concentration was recorded at about 400 ppm. 7. In the dry storage area, one box of 1000 count plastic knives, one box of 1000 count plastic forks, and one box of 1000 count plastic spoons were uncovered. Staff K stated that staff were always leaving the bags of utensils opened. 8. In the dry storage area, one, 46 fluid ounce can of V8 vegetable juice was observed with a dent. 105679 Page 12 of 13 105679 10/27/2021 Regents Park of Sunrise 9711 W Oakland Park Blvd Sunrise, FL 33351

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 9. The floor of the walk-in freezer was observed with paper garbage and an accumulation of debris. Staff K stated that he was surprised that the floors were not cleaned. Staff K and the Administrator stated that the floors were swept daily and that the stock person cleaned the freezer floors with a mop twice per week. 10. In the walk-in refrigerator, one hotel pan of food was missing a label identifying the product and use-by date. The Administrator stated that she was informed by the kitchen staff that someone must have torn the label off of the pan of food. 11. The floor of the walk-in refrigerator was observed with 5 plastic containers of juice, 1 orange, and onion peels. B. During an observation of the breakfast tray line conducted on 10/25/21 at 7:15 AM, accompanied by the Food Service Director (FSD), the following were noted: 12. At the request of the surveyor, the FSD calibrated the facility's digital thermometer to check the temperature of the items on the breakfast tray line. The temperature test revealed that the temperature of the sausage patties was at 115 degrees F (Fahrenheit), the temperature of one cottage cheese plate was at 47.5 degrees F, and the temperature of a second cottage cheese plate was at 46.8 degrees F. The FSD stated that the sausage patties needed to go back and that the cottage cheese plates would be discarded. The FSD acknowledged that the temperature of the cottage cheese plates were not at the regulatory temperature of 41 degrees F or below and that the sausage patties were not at the regulatory temperature of 135 degrees F or above. 13. During the temperature test of the breakfast tray line, one brown pest crawled up the side of the plate warmer and onto the clean plates. The surveyor informed the FSD and the FSD stated that the plates needed to be cleaned. 105679 Page 13 of 13