Health inspection·December 30, 2020

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, clinical record reviews, and interviews, the facility failed to respect the right to dignity for three (#56, #59, and #60) of 16 residents receiving extensive or total assistance with eating as evidenced by staff members standing over, in front of, and to the side of the residents while assisting them with mid-day nutrition. Findings included: On 12/29/20 at 1:00 p.m., an observation was conducted of Staff Member F, Certified Nursing Assistant (CNA), standing in front of Resident #56 while assisting with eating. The observation revealed the resident was dependent on the staff member with oral intake and she did not attempt to feed herself. During this observation, Resident #56's roommate, Resident #59, was assisted with the mid-day meal by Staff Member G, CNA. Resident #59 was sitting in a wheelchair with an over-the-bed (obt) table in front of her wheelchair. The staff member was standing on the other side of the obt. Resident #59 held a carton of milk but did not attempt to use utensils or fingers to feed herself. At 1:00 p.m., the resident room next to Resident #56's and 59 was also observed. Resident #60 was sitting in a wheelchair with the short side of an obt in front of her. Standing to the side of Resident #60 and in front of the long side of the obt was Staff Member E, CNA. The meal tray was sitting on the obt in front of the staff member. Resident #60 did not attempt to feed herself. At 1:02 p.m., Staff Member F brought Resident #56's lunch tray out of the room and placed it in the meal cart. Staff Member F reported that it was common for staff to stand up while assisting residents with eating. At 1:07 p.m., while Staff E was assisting Resident #60, a chair was observed in the resident's room approximately 4 foot from the staff member. At 1:12 p.m., Staff E & G continued to stand while assisting Resident #59 and Resident #60 with the lunch meal. Staff Member E removed the meal tray, at 1:14 p.m., from Resident #60's room. The staff member stated that they (CNA's) sat with the residents in the dining room to assist them with eating but now there was no chair in the room. Following this statement, Staff E acknowledged that there was a chair in Resident #60's room and stated, well there is. Staff E reported that she was educated on how to assist residents with eating and confirmed that the education included not standing while assisting the residents. At 1:21 p.m., after finishing the lunch meal with Resident #59, Staff G confirmed she had been educated on how to assist residents with eating and staff members were to be sitting. She reported Page 1 of 3 105700 105700 12/30/2020 Northdale Rehabilitation Center 3030 Bearss Ave Tampa, FL 33618

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #59 had been trying to lay her head down so the staff member had to stand up to assist her and did not think there was a chair in the residents' room. The staff member looked into the room during the interview and confirmed that there was a chair on the other side of the residents' bed. 1. A review of Resident #56's admission Record revealed diagnoses to include oropharyngeal phase dysphagia. The 5-day Minimum Data Set (MDS) dated [DATE] identified a score of 0 out of 15 on the Brief Interview for Mental Status (BIMS), which indicates severe cognitive impairment. The MDS also identified that Resident #56 was totally dependent on one staff member for eating. A review of the staff documentation of Resident #56's Eating - Self Performance from 12/1 - 12/30/20 days indicated that out of 85 opportunities the resident received total assistance from staff 53 times, extensive assistance 3 times, limited assistance twice (2), and was marked not applicable 27 times. Resident #56's care plan identified that the resident had the following focus care areas: *Activities of Daily Living self-care deficit related to increased weakness, decreased balance and coordination; - at risk for decreased nutritional status and dehydration related to past medical history (PMH) as well as the need for a therapeutic and mechanically (mech) altered diet; The interventions for this focus area included: nursing staff to assist with meals as needed. 2. Review of Resident #59's admission Record revealed diagnoses not limited to hemiplegia and hemiparesis following cerebral infarction affecting right dominant side and unspecified convulsions. The 5-day MDS, dated [DATE], identified the BIMS score as 10 out of 15, indicating a moderate cognitive impairment. The MDS functional status section indicated that the resident required extensive assist from one person for eating. The staff documented eighty-nine (89) opportunities of Resident #59's self-performance while dining. The performance was as following: - Independent: 24 times; - Supervision: 5 times; - Limited: 17 times; - Extensive: 6 times; - Total Dependent: 9 times; - Not Applicable: 28 times. The care plan for Resident #59 identified an Activities of Daily Living (ADL) deficit as evidenced by the requirement of needing assistance to complete ADL's and that the resident was at nutritional and hydration risk related to a multitude of issues including the need for some assistance with meals. The interventions included instructions for staff to cue as needed during meals as the resident 105700 Page 2 of 3 105700 12/30/2020 Northdale Rehabilitation Center 3030 Bearss Ave Tampa, FL 33618

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few tends to fall asleep, encourage and assist as needed to consume foods, and/or supplements, and fluids, and to assist with eating as needed. 3. Review of Resident #60's admission Record revealed diagnoses not limited to unspecified Alzheimer's Disease. The 5-day MDS, dated [DATE], identified a Brief Interview of Mental Status score of 0 indicating a severe cognitive impairment. The MDS revealed the resident was totally dependent upon one staff member for eating. A review of the 12/1 - 12/30/20 eating self-performance task for Resident #60 revealed that out of 85 opportunities, the resident required the following assistance: - Independent: 1; - Limited: 2; - Extensive: 1; - Total: 54; - Not Applicable: 26. A review of Resident #60's care plan indicated that the resident had a self-care deficit related to weakness and the interventions instructed staff to assist with ADL's (including eating) as needed. The care plan identified that the resident was at risk for nutrition /dehydration related to medical history and diagnoses. The interventions instructed staff to assist with ADL's, including eating, as needed. At 12/29/20 at 2:52 p.m., the Corporate Director of Infection Prevention & Control stated she was unable to find a policy regarding dining assistance. She stated the folded cardboard was used as a staff educational presentation due to COVID-19. A photo was taken as she held the cardboard. She stated the expectation was to sit while assisting the resident. When the observation was discussed with her, she stated the facility was told to get rid of all the chairs that were in the rooms due to them being upholstered. The cardboard CNA Meal Assistance education instructed staff to sit while feeding the resident. The Annual Education form, provided by the facility identified that Staff Members F and G had completed the education on 10/16/20 and Staff E had completed the education on 10/14/20. On 12/30/20 at 2:54 p.m., the Director of Nursing (DON) stated the facility was educating staff not to stand while assisting residents to eat and that she had spoken with the involved staff members. The Corporate Nurse stated the facility would be purchasing chairs that could be cleaned in between uses. 105700 Page 3 of 3