Health inspection·February 11, 2021

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Resident #23 was admitted to the facility 12/01/20 with diagnoses that included viral pneumonia, and end stage renal disease. A review of the resident's physician's orders dated 12/01/20 read, Oxygen 2 liters per minute (LPM) as needed for shortness of breath or oxygen saturation less than 94% on room air. An observation of the resident's oxygen concentrator was made with the DON on 2/10/21 at 11:47 AM. The concentrator filter was covered with dust. The DON acknowledged the filter was not clean and was covered with dust. Residents Affected - Few 3. Resident #25 was admitted to the facility on hospice services on 12/21/20. Her diagnoses included kidney disease and multiple myeloma. Physician orders dated 12/21/20 included Oxygen at 2 LPM when sleeping for comfort. On 2/08/21 at 2:37 PM, and 2/09/21 at 12:31 PM, resident #25 was received oxygen via nasal cannula. The concentrator filter was noted to be covered with dust. 4. Resident #43 was admitted to the facility on [DATE] with diagnoses that included Chronic Obstructive Pulmonary Disease. His admission physician orders included O2 at 2 LPM via nasal cannula. On 2/09/21 at 11:29 AM, resident #43 was in bed with oxygen being administered via nasal cannula at 2 LPM. The left side of the concentrator filter was noted to be dusty. On 2/10/21 from 11:47 and 12:03 PM, the O2 concentrators for residents #23, #25 and #43 were observed with the Director of Nursing (DON). The DON acknowledged the filters were covered in gray dust. She said the RT was responsible for changing the O2 tubing weekly and cleaning the filters when needed. The Operator's Manual for the oxygen concentrators section 6- Maintenance. The concentrators were designed to minimize routine preventative maintenance. At a minimum, clean the concentrator cabinet filters weekly. Remove the filters and clean at least weekly dependent upon environmental conditions. Clean the cabinet filters with a vacuum cleaner or wash in warm soapy water and rinse thoroughly. Dry the filters thoroughly before reinstallation. Review of the electronic maintenance log showed the oxygen concentrators were maintained monthly, not weekly. They were last noted to be cleaned on 1/09/2021 by the Director of Maintenance. The Cleaning and Disinfection of Oxygen Concentrators Policy Statement revised on 1/12/2021 noted: Resident-care equipment, such as oxygen concentrators will be cleaned and disinfected according to facility cleaning procedure. There was no staff personnel specifically assigned to complete the task. On 2/10/21 At 1:30 PM, the Administrator, DON and the Director of Maintenance explained that Page 1 of 3 105701 105701 02/11/2021 Solaris Healthcare Merritt Island 500 Crockett Blvd Merritt Island, FL 32954

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few maintenance completed a monthly maintenance review of the concentrators which included inspection of the oxygen concentrators, cleaning the filters and changing the filters if needed. They said they were not aware the filters were to be cleaned weekly. The Facility assessment dated /updated and reviewed with Quality Assurance Assessment and Quality Assurance Performance Improvement committee on 12/8/20 noted the facility was able to provide care for residents with respiratory system conditions included Chronic obstructive Pulmonary Disease, Pneumonia Asthma, Chronic lung Disease and Respiratory failure. The facility averaged 20 residents receiving oxygen therapy. Based on observation, interview and record review, the facility failed to ensure oxygen concentrator external filters were clean for 4 of 4 residents reviewed for respiratory care out of 30 residents receiving oxygen via concentrators, (#4, #23, #25, #43). Findings: 1. Review of resident #4's medical record revealed she was admitted to the facility on [DATE] with multiple sclerosis (MS), chronic obstructive pulmonary disease (COPD), and cognitive communication deficit. The resident's quarterly Minimum Data Set assessment dated [DATE], noted she was cognitively intact and received oxygen therapy. A care plan for being at risk for impaired gas exchange related to COPD and MS included goal that she would have adequate air exchange and interventions for duo-nebulizer treatments, chest percussion vest, monitor lung sounds, rest periods and respiratory therapy as needed. The resident's physician orders included Oxygen at 2 liters/minute (LPM) via nasal cannula (NC) as needed. On 02/09/21 at 10:20 AM, resident #4 stated, I always wear my oxygen at night which is set at 2 L. On 02/08/21 at 2:19 PM, 02/09/21 at 4:18 PM, and on 02/10/21 at 11:08 AM observations of the resident #4's oxygen concentrator revealed the left external filter's outer edges covered with gray dust. The right external filter was fully covered with large amount of gray dust which was able to be lifted off the filter. On 02/10/21 at 11:10 AM, Licensed Practical Nurse (LPN) A stated the Respiratory Therapist (RT) came in on the weekend and was responsible for changing and dating the O2 tubing. The nurses are responsible for the oxygen concentrators. On 02/10/21 at 2:00 PM, the Director of Nursing (DON) acknowledged the filters covered with dust. She said the Respiratory Therapist worked on the weekends and was responsible for changing the O2 tubing, humidifiers and checking and cleaning the oxygen concentrator filters. When the filters are not kept clean, the resident may not receive adequate level of oxygen. They are breathing in dirty air which is a potential for respiratory infection. On 02/11/21 at 6 PM, a phone interview was conducted with the Respiratory Therapist (RT). The RT stated he had worked weekends at the facility for 21 years. He said he was responsible for changing 105701 Page 2 of 3 105701 02/11/2021 Solaris Healthcare Merritt Island 500 Crockett Blvd Merritt Island, FL 32954

F 0695 and dating the oxygen tubing and changing the nebulizer equipment. I believe that someone in the Maintenance Department is responsible for checking the oxygen concentrators on a monthly basis. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 105701 Page 3 of 3