Health inspection·February 10, 2022

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and review of policy and procedure, it was determined that the facility failed to ensure that it secured medications for Resident #37, during a Medication Pass Observation and properly disposed of over-the-counter (OTC) medication for Resident #13, during an observational room tour. The findings included: 1) On 02/07/22 at 9:50 AM during a Medication Administration Observation, it was noted that there were three (3) unidentified, loose pills---one (1) orange and two (2) pink on Resident #37's floor, one (1) near the doorway and two (2), near her bedside table, unsecured and accessible to other residents, staff and visitors. Resident #37 was originally admitted to the facility on [DATE] with diagnoses which included Dementia, Osteoarthritis, Major Depressive Disorders and History of Falling. She had a Brief Interview Mental Status (BIM) score of 6 (severely impaired). Photographic evidence obtained of the three (3) loose, unidentified pills located on the floor in Resident #37's room. On 02/07/22 at 9:52 AM an interview was conducted with Staff A, a Registered Nurse (RN), in which she acknowledged that the pills should not have been there and should have been discarded. 2) During an observational room tour conducted on 02/07/22 at 11:15 AM of Resident #13's room, it was noted that there was a container of (OTC) vaporizing Chest rub sitting on Resident #13's bedside table; the container had no expiration date on it. And, in Resident #13's bathroom located on the over-sink shelf, it was noted that there was a one-half (1/2) used bottle of (OTC) Sore Throat Spray with an expiration date of 07/23, also unsecured and accessible to other residents, staff and visitors. Resident #13 was re-admitted to the facility on [DATE] with diagnoses which included Chronic Obstructive Pulmonary Disease, Asthma, Shortness of Breath, Emphysema, Diabetes Mellitus and Obesity. Resident #13 is currently out of the facility since 02/02/22 after transfer to Hospital with a determined diagnosis of Renal Failure. She had a Brief Interview Mental Status (BIM) score of 13 (cognitively intact). Photographic evidence obtained of the container of (OTC) Chest rub on the resident's bedside table and (OTC) Sore Throat Spray in the resident's bathroom. On 02/07/22 at 12:47 PM it was still noted that there was a container of vaporizing Chest rub sitting on Resident #13's bedside table and it was also still noted on the over-sink shelf, that there was a one-half (1/2) used bottle of Sore Throat Spray. On 02/07/22 04:08 PM it was still noted that there was a container of vaporizing Chest rub sitting on Resident #13's bedside table and it was also still noted on the over-sink shelf, that there was a Page 1 of 4 105686 105686 02/10/2022 Springtree Rehabilitation & Health Care Center 4251 Springtree Drive Sunrise, FL 33351

F 0761 one-half used bottle of Sore Throat Spray. Level of Harm - Minimal harm or potential for actual harm On 02/08/22 at 10:30 AM An interview was conducted with Staff B, a Licensed Practical Nurse (LPN), in which she acknowledged that neither the chest rub medication nor the sore throat spray bottle, should have been there and should have been properly stored/secured. Residents Affected - Few 3) On 02/07/22 at 3:56 PM during an evening observational tour, it was noted that there was a single, loose, unidentified green pill located on the floor of unit two (2) in the 100's unit hallway leading down to the resident rooms. The pill was unsecured and accessible to residents, staff members and visitors. Photographic evidence obtained of the loose, unidentified green pill on the 100-unit hallway. During an interview conducted on 02/07/22 at 4:06 PM with Staff C, an (LPN) she indicated that the pill looks like a green iron tablet and she acknowledged that the pill should not have been there and should have been properly discarded. On 02/08/22 at 12:02 PM an interview was conducted with the Director of Nursing (DON) and she further acknowledged that the loose pills should have been discarded and that the chest rub medication and the sore throat spray bottle, should not have been there and should have been properly stored/secured. Review of facility policy and procedure for Medication Storage in the Facility---Storage of Medications, provided by the Director of Nursing (DON), dated April 2018 Policy: Medications and biologicals are stored safely, securely and properly following manufacturer's recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. 105686 Page 2 of 4 105686 02/10/2022 Springtree Rehabilitation & Health Care Center 4251 Springtree Drive Sunrise, FL 33351

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, it was determined that the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety that included; failure to hold hot foods at regulatory temperatures at 135 degrees or greater. This potentially effected 28 facility residents that included sampled Residents #5, #7, #38, #59. and #184. The findings included; During the second Kitchen/Food service observation tour conducted on 02/08/22 at 9:30 AM, it noted that numerous containers of foods were noted to be located on a utility cart near the oven area. Further observation noted that the pans contained : Ground Cooked Beef - 10 portions prepared on 02/07/22. Pureed Chicken - 10 Portions prepared on 02/07/22. Baked Fish - 6 portions prepared on 02/07/22. Baked Potatoes - 8 portions prepared on 02/07/22. At the request of the surveyor the temperatures of these foods were taken by the Corporate Food Service Manager with the use of the facility's calibrated digital thermometer and were recorded as follows; Ground Cooked Beef = 60 degrees F Pureed Chicken = 56 degrees F Baked Fish = 53 degrees F Baked Potatoes = 60 degrees F Interview with the cook at the time of the observation noted that the foods were prepared on 02/07/22 and were going to be reheated and served as menu alternates, mechanical soft, and pureed foods for the lunch meal of 02/08/22. The cook stated that the foods were taken out of the refrigerator and were waiting to reheated for the lunch meal. It was also discussed that potentially hazardous foods are to be held at regulatory temperatures of below 41 degrees F or above 135 degrees F . It was also discussed that foods (Chicken, fish, beef should be prepared daily and not ahead of time and served as left overs. A review of the facility's Diet Census for 02/08/22 noted that there were 21 residents with physician ordered mechanical Soft Diet that included; Residents #5, #59, and #184, and 7 residents with physician ordered pureed diets that included: Residents #7, and #38). 105686 Page 3 of 4 105686 02/10/2022 Springtree Rehabilitation & Health Care Center 4251 Springtree Drive Sunrise, FL 33351

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, it was determined that the facility failed to dispose of garbage and refuse in a safe and sanitary manor. Residents Affected - Some The findings included: During the observation of the dumpster/refuse area accompanied with the Corporate Food Service Manager on 02/08/22 at 9:30 AM, the following were noted: 1) Upon exit of the rear door of the facility in route to the dumpster area, it was noted that there was an open trash barrel next to the exit door. Further observation noted that the open barrel was full of staff discarded Personal Protection Equipment (PPE) that included masks, gloves, and gowns. The Corporate Director stated that it was not the facility's procedure for disposing of infectious PPE's. The surveyor requested that the barrel contents be safely discarded as soon as possible and educate staff on proper disposal of PPE's. 2) Observation of the dumpster noted that 1 of 2 garbage dumpsters was noted to have a large hole in the bottom right corner. It was also noted that a rag had been placed in the hole. It was discussed with the Corporate Director that the hole was large enough for the entrance of vermin or potential leakage out of the dumpster of garbage/trash. The surveyor requested that the Dumpster Company be contacted immediately for a replacement dumpster. 3) Observation of the dumpsters (2) noted that there was thick build-up of black mold matter between the 2 dumpsters. The surveyor discussed with the Corporate Director that the area is not being being cleaned and sanitized on regular basis. 4) Observation noted that the walk way from the facility exit door to the dumpster (approximately 25 feet) was stained and covered with a thick black mold type matter. It was discussed with the Corporate Director that each time staff walk through the area that mold type matter is transferred into the facility. * Photographic evidence obtained. 105686 Page 4 of 4