Health inspection·April 1, 2022

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On 3/29/22 at 9:48 a.m. during an interview with Resident #80 observed a roach crawling on the wall. The roach was behind resident#80's the night table. On 3/31/22 at 10:17 a.m. during an interview with Resident #80 observed Resident #80's room being dirty and cluttered. On 3/31/22 at 1:44 p.m. in an interview with Agency Certified Nursing Assistant Staff X when asked what the protocol was for pest control, she stated that she will tell the nurse if she sees any roaches. Staff X said she saw ants before. (No specific time provided.) During interview with maintenance director on 3/31/22 at 1:45 p.m. said they had a contract with pest control company and last visit was December 2021. He provided additional weekly visits from to 3/29/22. Maintenance Director said he had not had complaints of cockroaches. Maintenance director said the facility has a system in place and staff reports to him as needed. He proceeded to show the binder utilized by staff to report them. On 3/31/22 at 2:02 p.m. during an interview, the Director of Housekeeping said they had 4 staff that clean daily and when the housekeepers get on the floor they go in the rooms and clean around 10:00 a.m. The Director of Housekeeping said she did not have a cleaning schedule. She said there were two people working 14 hours a day from 6:00 a.m. to 2:00 p.m. and 2:00 p.m. to 7:00 p.m. in laundry. On 3/29/22 at 10:14 a.m., room [ROOM NUMBER] bathroom observed with feces on the toilet, unbagged, unlabeled bedpan on the floor under the sink, and rusty bedframe for 504 bed A closest to the door. Photographic evidence obtained. On 3/29/22 at 10:19 a.m., room [ROOM NUMBER] bed A closest to the door observed with rusty bed frame. Photographic evidence obtained. On 3/29/22 at 10:23 a.m., room [ROOM NUMBER] bathroom observed with toilet bowl ring and feces, soiling of the caulk around the toilet base at the floor, and an empty, soiled toilet paper holder. Photographic evidence obtained. On 3/29/22 at 10:41 a.m., room [ROOM NUMBER] bathroom observed with feces and circular water level ring in the toilet bowl. An orange peel, brown paper towel, and straw were observed on the floor under the sink. A bucket was being used as a waste basket. Photographic evidence obtained. Page 1 of 14 105702 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 3/29/22 at 3:03 p.m. room [ROOM NUMBER] bathroom observed with feces around the toilet bowel and seat, an empty urinal and measuring cylinder on the back of the toilet. Photographic evidence obtained. On 3/30/22 at 10:00 a.m., room [ROOM NUMBER] bathroom observed with feces and water ring in the toilet bowel. The orange peel, brown paper towel and straw remained on the floor under the bathroom sink. The bucket was being used as the waste can. Photographic evidence obtained. On 3/30/22 at 10:30 a.m., room [ROOM NUMBER] bathroom remained with feces on the toilet bowel and the unbagged, unlabeled pink bedpan on the floor under the sink. Photographic evidence obtained. On 3/30/22 at 2:38 p.m., the orange peel remained on the floor under the bathroom sink and the bucket was being used as the waste can in room [ROOM NUMBER]. Photographic evidence obtained. On 3/30/22 at 2:39 p.m., the unbagged, unlabeled pink bedpan remained on the floor under the bathroom sink in room [ROOM NUMBER]. Photographic evidence obtained. On 04/01/22 at 9:18 a.m., the Housekeeping Supervisor said the housekeepers start in the morning sweeping residents' rooms and taking out the trash and cleaning the bathrooms. She said she has 2 housekeepers and should have 4. She said the administrator is aware of the housekeeper shortage. On 4/1/22 at 10:19 a.m., the unbagged, unlabeled pink bedpan remained on the floor under the bathroom sink in room [ROOM NUMBER]. Photographic evidence obtained. On 04/01/22 at 02:15 p.m., Housekeeper Staff W said he's worked at the facility for 3 years. He said he thinks housekeeping is short staffed, but it is possible to get all the work done as expected. On 4/1/22 at 2:19 p.m., the orange peel and brown paper towel remained on the floor in room [ROOM NUMBER], and the bucket was being used as the waste can. Photographic evidence obtained. Based on observations, staff interviews and review of facility policies the facility failed to maintain a clean, safe, and homelike environment for residents evidenced by nonfunctioning clocks in resident rooms, calls bells not being within resident's reach, insects in resident rooms and common areas, and dirty rooms for four days of observations. The findings included: Review of facility policy, Answering the Call Light, which said, The purpose of this procedure is to respond to the resident's requests and needs When the resident is in bed or confirmed to a chair be sure the call light is within easy reach of the resident. On 3/29/22 at 7:46 a.m., the call bell for Resident # 94, room [ROOM NUMBER] bed 2, was observed in bed with the call bell on the floor not within resident's reach while resident was in bed. On 3/30/22 at 9:03a.m., observed Resident #90, room [ROOM NUMBER] bed 2, in wheelchair with call bell not in reach. Observed call bell clipped to itself on the wall behind the room dividing curtain. * Resident #48, room [ROOM NUMBER] bed 1, observed sitting on bed with call bell on floor behind head of bed. * 105702 Page 2 of 14 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 3/30/22 at 9:46 a.m., the call bell for Resident # 94, room [ROOM NUMBER] bed 2, was observed in bed with the call bell on the floor not within resident's reach while resident was in bed. * On 3/30/22 at 9:55 a.m., the call bell for Resident #21, room [ROOM NUMBER] bed 1, observed behind headboard of bed not within reach of resident. Resident #49, room [ROOM NUMBER] bed 2, call bell observed on the floor under bed not within reach. * On 3/30/22 at 10:26 a.m., the call light was observed inside of drawer next to bed for Resident #100, room [ROOM NUMBER] bed 2, and not accessible to resident. * On 3/30/22 at 3:30 p.m., observed Resident #95, room [ROOM NUMBER] bed 2, in wheelchair with call light clipped to bed not within reach for resident. On 3/29/22 at 7:20 a.m., during initial tour of secured memory unit observed several rooms with inaccurate clock settings or nonfunctioning clocks. Inaccurate or nonfunctioning clocks observed in resident rooms 101, 103, 104, 105, 202, 203, and 205. On 3/30/22 at 11:00 a.m., observed non-working or inaccurate clocks unchanged in rooms 101, 103, 104, 105, 202, 203, and 205. On 3/30/22 at 3:00 p.m., observed non-working or inaccurate clocks unchanged in rooms 101, 103, 104, 105, 202, 203, and 205. On 3/31/22 at 9:00 a.m., observed non-working or inaccurate clocks unchanged in rooms 101, 103, 104, 105, 202, 203, and 205. On 3/31/22 at 9:21 a.m., interviewed while walking through unit with Unit Manager Registered Nurse (RN) asked unit manager if it was important for residents with dementia, Alzheimer's, or confusion to have working clocks in their rooms. Unit Manager RN said, It is important for their clocks to work so that they can be oriented to the best of their ability to date and time. Unit Manager RN confirmed clocks in residents' rooms including 101, 103, 104, 105, 202, 203, and 205 were not accurate or not working. Unit Manager RN, said I guess no one has noticed but I will make sure to have it addressed. During walk through with Unit Manager RN she confirmed Resident #95, room [ROOM NUMBER] bed 2, was in wheelchair and call bell was clipped to bed and not within reach for resident. Unit Manager RN also confirmed Resident #90, room [ROOM NUMBER] bed 2, was in wheelchair and call bell was clipped to wall not within reach. Unit manager RN said, I have work to do. The staff must remember to have the call bells within reach of the residents at all times. On 4/1/22 at 8:52 a.m., observed small brown crawling bug on wall at eye level outside of room [ROOM NUMBER]. Registered Nurse (RN), Staff S, was in hall passing medications and asked Staff S what it was. RN, Staff S, replied, Yuck that's a roach. I am afraid of roaches. Let me get maintenance. RN, Staff S, walked away to call maintenance. Continued to observe crawling bug and facility administrator was present in hallway, waved him over and, asked administrator what the bug was. Administrator replied, I think it is a roach. Administrator proceeded to kill crawling brown insect and called the maintenance director over from down the hall saying, We need to file a report and call exterminator. Maintenance director picked up bug and said he would call. 105702 Page 3 of 14 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

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 observation, interview and record review, the facility failed to accurately assess 2 residents (#35 and #54) out of 2 residents with oxygen and pacemakers. Residents Affected - Few The findings included: Review of the medical record revealed Resident #35 was admitted to the facility in September 2020 with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD). Review of the Minimum Data Sets (MDS) dated [DATE], 1/26/22, and 3/19/22 revealed Resident #35 was using oxygen while admitted to the facility. Review of the January, February, and March 2022 Medication Administration Record (MAR) for Resident #35 revealed an active order for Oxygen 2 liters per minute via nasal cannula as needed for shortness of breath. The order had a start date of 12/5/21. There were no initials from nursing staff on the MAR signifying Resident #35 was using oxygen at the facility during the months of January, February, or March. Review of the care plans for Resident #35 revealed no oxygen care plan had been formulated for Resident #35 indicating appropriate individualized interventions for oxygen use. On 3/29/22 at 9:15 a.m., Resident #35 was observed sitting on the side of his bed, wearing a nasal canula. The nasal canula was connected to an oxygen concentrator next to the bed. The oxygen concentrator was set at 5 liters per minute. Resident #35 said the nurses told him to use the oxygen, so he uses the oxygen. On 3/30/22 at 12:32 p.m., Resident #35 was observed for a 2nd time sitting on the side of his bed, wearing a nasal canula. The nasal canula was connected to the oxygen concentrator next to the bed. The oxygen concentrator was set at 5 liters per minute. On 03/31/22 at 09:47 a.m. during an observation of Resident #35 in his room with the Assistant Director of Nursing (ADON), the ADON acknowledged the oxygen concentrator was set to 5 liters per minute. At that time, Resident #35 said he had turned the concentrator to 5 liters per minute. Resident #35 confirmed he puts the oxygen on and takes the oxygen off whenever he wants to. On 04/01/22 at 08:36 a.m., the MDS coordinator confirmed the MDS of 12/17/21, 1/27/22, and 3/19/22 indicated Resident #35 uses oxygen while at the facility. The MDS coordinator said she had failed to create the oxygen care plan for Resident #35 because the Medication Administration Records (MARS) indicated Resident #35 was not using the oxygen. The MDS Director said when she realized Resident #35 had been using the oxygens on 3/31/22, she formulated the oxygen care plan for Resident #35. Review of the medical record indicated Resident #54 was admitted to the facility on [DATE] with diagnosis of Cardiac Pacemaker. Review of the Minimum Data Sets (MDS) dated [DATE] and 1/21/22 indicated the Cardiac Pacemaker was not included in the coding of the active diagnosis for Resident #54. 105702 Page 4 of 14 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the care plans for Resident #54 revealed there was no care plan created for Resident #54's Cardiac Pacemaker with individualized interventions indicating how to care for the device. On 3/31/22 at 1:32 p.m. Resident #54 said she has a pacemaker originally inserted on August 2021. She said she is concerned because no one at the facility is monitoring the pacemaker. She said she has asked staff to arrange a cardiology appointment, but they have not arranged the appointment. On 3/31/22 at 4:12 p.m., the MDS Director said she has worked at the facility for 6.5 years and has coded the MDS for 15 years. She said her duties include uploading the active diagnosis list into the MDS and creation of the care plans into the electronic health records. She confirmed Resident #54's MDS was not coded for the Cardiac Pacemaker. The MDS coordinator confirmed there was no care plan for the Pacemaker either. The MDS coordinator said there should have been a Pacemaker care plan for Resident #54, but it was overlooked. On 3/31/22 at 5:10 p.m., Registered Nurse (RN) Staff V said she knew the resident had a pacemaker but has never done anything for the pacemaker and is not sure what is going on with it. 105702 Page 5 of 14 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and staff interview, the facility failed to develop a comprehensive plan of care to address the identified problem of edema (swelling) for 1 (Resident #41) of 1 residents reviewed for edema. The findings included: Resident #41 was admitted to the facility on [DATE]. Review of the resident's diagnoses upon admission showed no history of edema. Review of the Resident #41's EMPC Nursing Comprehensive Assessment V3.2 completed at the time of admission showed Resident #1 had +1 edema to her extremities at the time of her admission. Review of resident #41's physician's orders shows she had an order for the diuretic Hydrochlorothiazide 25 mg daily (used to treat swelling) for edema ordered on 1/29/22. The order was discontinued on 3/7/22. At 3/30/22 at 9:52 a.m. Resident #41 was observed in the Starlight dining room sitting in a wheelchair with her legs not elevated. Edema was observed to both lower extremities. The swelling extended above the resident's ankles. The resident's socks observed to be indented around her lower legs due to the excessive edema in her legs. On 3/30/22 at 11:23 a.m. Resident #41 was observed in the Starlight dining room with her legs still not elevated, sitting in a chair near the door of the dining room. On 3/30/22 at 2:35 p.m. Resident #41 was observed in the Starlight dining room. She was still sitting in a wheelchair with her legs not elevated. On 3/31/22 at 3:10 p.m. Registered Nurse, Staff A said if a resident had edema, she would ensure a resident had ted hose and elevated their feet as much as possible to relieve the swelling. On 3/31/22 at 3:30 p.m. Licensed Practical Nurse, Staff E verified she was assigned to Resident #41. Staff E said Resident #41 had had Edema in her legs since she was admitted to the facility. Staff E said Resident #41 had been on a diuretic which was discontinued due to her having loose stools at the time. Staff E said she was not aware of a care plan or interventions in place to reduce the swelling in the resident's lower extremities. On 3/31/22, record review of Resident #41 revealed no evidence of a care plan in place to help manage Resident #41's edema On 4/1/22 at 2:02 p.m. the Director of Nursing (DON) said Resident #41 had chronic edema and he did not think there were any interventions which would reduce the swelling in the resident's legs other than a diuretic. The DON verified the facility had no documentation of a care plan or interventions that had been attempted to reduce the swelling in the resident's lower extremities. 105702 Page 6 of 14 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observations, staff interviews, resident record review and review of facility policy the facility failed to provide necessary services to maintain good grooming for 2 (Residents #94 and #202) of 2 residents requiring assistance with activities of daily living. This has the potential to cause psychological harm to the resident. Residents Affected - Few The findings included: Review of facility policy titled, Activities of Daily Living (ADLs), revised 11/28/2016 stated, The Center must provide the necessary care and services to ensure that a patient's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrate that such diminution was unavoidable. Activities of daily living (ADLs) include: Hygiene- bathing, dressing, grooming and oral care . ADL care is documented every shift by the nursing assistant on the ADL flow record or in Point Click Care (PCC) ADL Point of Care (POC) . A patient who is unable to carry out ADLs receives the necessary services to maintain good nutrition, foot care, grooming and dressing, hair care, nail care, oral care, perineal care, shaving the patient, shower, tub bath and use of the bedpan, urinal or commode. On 3/29/22 at 7:47 a.m., Resident #94 was observed in bed wearing a hospital gown, which appeared dirty, with disheveled hair, unshaved and long fingernails, especially his thumb nails. Left wrist brace was dirty with what appeared to be dried food on brace. Resident #94 was asked if staff members ever offer to cut his nails. Resident #94 replied, No. On 3/29/22 at 08:46 a.m., observed Resident #202 in room still in hospital gown. Resident was sitting on side of bed, hair appeared uncombed and disheveled. On 3/30/22 at 8:30 a.m., observed Resident #94 awake in bed, appearance, and clothing unchanged from 3/29/22. On 3/30/22 at 9:43 a.m., in an interview, Certified Nursing Assistant (CNA), Staff D, working for six months at facility, said she was assigned to Resident #94 that day. CNA, Staff D said Resident #94 had a bed bath yesterday, so she was just setting up to do his ADL care. CNA, Staff D was asked what ADL care included. CNA, Staff D, replied, Mouth care, washing his face and hands, shaving if needed, combing his hair for him, really whatever is needed to have him clean and ready for the day. On 4/1/22 at 9:08 a.m., observed Resident #94 in bed in hospital gown, CNA, Staff D, said to surveyor upon entry, I am just getting ready to help him clean up. On 3/30/22 at 835 a.m., observed Resident#202 in bed awake, not dressed wearing nightgown, disheveled with hair uncombed. On 3/30/22 at 3:30 p.m., Resident #202 observed awake still in night clothes, still in bed and hair appears disheveled and uncombed. On 3/31/22 at 1:34 p.m., reviewed clinical record for Resident #94 including care plan with focus stating, The Resident has an ADL Self Care Performance Deficit as Evidenced by need for assist with self-care, initiated 6/15/2021. Interventions for this focus included, check nail length and trim and clean on bath day and as necessary, provide sponge bath when full bath or shower cannot be 105702 Page 7 of 14 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few tolerated, the resident is totally dependent on 1-2 staff to provide bath/ shower per schedule and as necessary, the resident is totally dependent on 1 staff for personal hygiene and oral care. Review of Resident #94 POC documentation showed no shower or bath was given on the following scheduled shower/bath days during March 2022; 3/1/22, 3/4/22, 3/8/22, 3/15/22, 3/22/22. Resident #94 missed five out of eight scheduled shower/ bath with no refusals documented. Personal hygiene care was not documented or refused for nine days during March 2022 including 3/1/22, 3/2/22, 3/4/22, 3/5/22, 3/6/22, 3/7/22, 3/8/22, 3/9/22, and 3/20/22. On 3/31/22 at 2:15 p.m., reviewed clinical record or resident #202 including care plan initiated on 8/5/2021 with focus stating, The Resident has an ADL Self Care Performance Deficit as Evidenced by need for assist with self-care, initiated 6/15/2021. Interventions for this focus included, check nail length and trim and clean on bath day and as necessary, provide sponge bath when full bath or shower cannot be tolerated, the resident requires up to and including extensive assistance staff to provide bath/ shower per schedule and as necessary, the resident requires up to and including extensive assistance for personal hygiene and oral care. Review of Resident #202 POC documentation showed no shower or bath was given on the following scheduled shower/bath days during March 2022; 3/5/22, 3/12/22, 3/19/22, 3/26/22, 3/29/22. Resident #94 missed five out of nine scheduled shower/ bath with no refusals documented. Personal hygiene care was not documented or refused for six days during March 2022 including 3/5/22, 3/6/22, 3/9/22, 3/12/22, 3/13/22, and 3/27/22. On 3/31/22 at 3:59 p.m., interviewed agency CNA, Staff F, about ADL care and documentation in POC. CNA Staff F, said, I know how to document in POC, I mark all the ADLS that are completed and if they refuse you mark that and let the nurse know. On 3/31/22 at 4:30 p.m., reviewed ADL documentation for Resident #94 and #202 with Unit Manager Registered Nurse (RN) who confirmed no documentation on identified shifts for showers, baths, or ADL care. Unit Manager RN said, There is no way to know if it has been done or not. I know it looks as though we haven't been providing that care for the resident. Unit Manager RN confirmed the expectation is CNA to report to nurse if someone refuses ADL care and to document in POC. On 4/1/22 at 1230 p.m., interviewed Director of Nursing (DON) who confirmed missing documentation for showers, baths, and ADL care for resident #94 and #202. DON said, I know ADL care is lacking and we are working on it. DON confirmed expectation that staff document ADL care and any refusal is documented and reported to the nurse assigned to the resident. 105702 Page 8 of 14 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on observation, resident and staff interview, and record review, the facility failed to provide treatment and care in accordance with professional standards for suture removal for 1 (Resident #8) of 1 resident reviewed for suture removal. Residents Affected - Few The findings included: Record Review of the Facility Policy on Skin Integrity Management, Practice Standards #2. Complete comprehensive evaluation of the patient upon admission/re-admission to the Center. #3. Identify patient's skin integrity status and need for prevention, intervention, or treatment modalities through review of all appropriate assessment information. On 3/29/22 at 11:10 a.m. in an interview, Resident #8 said he was admitted to the facility a few months ago after an automobile injury and hospital admission. Resident #8 said a few days ago he found sutures from the injury that were never removed by the facility after he was admitted . Resident #8 exposed the right side of his chest under the arm to reveal the sutures. On 3/31/22 at 10:10 a.m., the Assistant Director of Nursing (ADON) said the nurse performs skin checks once a week on the residents at the facility. The ADON said the skin check is a head-to-toe inspection of the skin used to detect anything unusual. Review of the medical record indicated Resident #8 had skin checks performed by nurses at the facility on 12/24/21, 12/31/21, 1/7/22, 1/19/22, 1/26/22, 2/2/22, 2/9/22, 2/11/22, 2/18/22, 2/25/22, 3/4/22, and 3/11/22. The sutures were not identified on any of the skin checks. Review of the progress notes for Resident #8 from 12/17/21 through 3/31/22 did not include identification of the sutures. On 03/31/22 at 10:10 a.m. during a 2nd interview with the ADON and Resident #8 in his room, the ADON observed the sutures in Resident #8's right side chest under his arm. The ADON said there appeared to be 4 intact sutures. At that time, the ADON said the sutures had been overlooked by the facility and should have been removed. Review of Resident #8's Medication Administration Record (MARS) for March 2022 revealed an order on dated 3/31/22 at 11:45 a.m. for removal of sutures right lateral chest (under arm) one time only. 105702 Page 9 of 14 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

F 0689 Level of Harm - Minimal harm or potential for actual harm Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, interview, record review, the facility failed to ensure the absence of accident hazards for 1 resident (Resident #35) out of 1 residents observed for accident hazards. Residents Affected - Few The findings included: Record review of the facility Resident Smoking Policy and Procedure, 2020. This policy will maintain an environment that remains as free of accident hazards as possible #1b. Residents are not permitted to have any smoking paraphernalia in their room or on their person. On 3/19/22 at 9:15 a.m. Resident #35 was observed in his room using oxygen running at 5 liters per minute. There was a pack of cigarettes and a lighter on his bedside tray table in open view observable from 6 feet away. Resident #35 said he keeps the cigarettes and lighter in his room all the time. On 3/19/22 at 9:47 a.m. Resident #35 was observed in his room. The oxygen was running at 5 liters per minute. The cigarettes and lighter were on the bedside tray table in open view observable from 6 feet away. On 3/30/22 at 12:15 p.m. Resident #35 was observed in his room. The oxygen was running at 5 liters per minute. The cigarettes and lighter were on the bedside tray in open view observable from 6 feet away. On 03/30/22 03:15 p.m. Resident #35 was observed in his wheelchair sitting in the hallway. The pack of cigarettes and the lighter were stored in his gray t-shirt pocket. The cigarettes and lighter were in plain view and observable from 6 feet away. On 04/01/22 at 12:39 p.m., the Director of Nursing (DON) was made aware of the cigarettes and lighter in Resident #35's room. The DON acknowledged the lighter was an accident hazard and should not be stored in the resident's room. The DON searched the resident's belongings and found the lighter in Resident #35's robe pocket. 105702 Page 10 of 14 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, and interviews, the facility failed to provide oxygen therapy, in accordance with physician's orders for 1 resident (Resident #80) of 2 residents reviewed for oxygen administration. Failure to follow prescribed oxygen therapy may result in inadequate oxygen treatment or an increased risk of side effects and complications. Residents Affected - Few Findings included: Received a copy of policy and procedure for oxygen administration. Record review of Oxygen Administration policy, Revised 12/12/20: Oxygen will be administered as per MD order to aid in breathing. Emergency oxygen may be administered by licensed nurse without a M.D. order. The M.D. will be consulted as soon as possible and order oxygen if continuation is required. On 3/29/22 at approximately 8:00 a.m. observation revealed Resident #80 was asleep in bed. The Continuous Positive Airway Pressure (CPAP) mask was on the bed next to resident #80. Resident #80 was receiving oxygen therapy via nasal canula that was connected to an oxygen concentrator. The concentrator was set at 5 liters per minute (LPM). On 3/29/22 at 9:45 a.m. in an interview, Resident #80 said he uses the (CPAP) machine and mask. At the time of the interview, Resident #80 was receiving oxygen therapy treatment via nasal cannula connected to an oxygen concentrator that was set at 5.5 liters per minute. Resident #80 said he puts the nasal cannula (NC) on and then CPAP mask over the nasal cannula. Resident #80 did not know how many liters (L) of oxygen (O2) he has. Resident #80 said the nursing staff adjust the oxygen concentrator. There is an order dated 5/5/21 for O2 2L via NC as needed to maintain oxygen saturation greater than 90%. On 3/29/22 at 10:43 a.m. observation revealed Resident #80 receiving oxygen treatment via nasal cannula connected to an oxygen concentrator that was set at 5.5 liters per minute. On 3/30/22 at 08:52 a.m. observed Resident #80 receiving oxygen treatment via nasal cannula connected to an oxygen concentrator that was set at 4 liters per minute. Resident #80 again said he uses the O2 nasal cannula and the CPAP mask on top. Record review for Resident #80 revealed physician orders dated May 5, 2021 Resident to wear CPAP with 2 liters O2 (oxygen), on at 10 p.m., off at 7 a.m. for diagnosis sleep apnea. Another physician order dated May 5, 2021, stated O2 2 liters per nasal cannula as needed to maintain sats (oxygen saturation) greater than 90%. Neither of these orders was listed on Resident #80's MAR. On 3/31/22 at 10:17 a.m. Resident #80 was observed receiving oxygen treatment via nasal canula connected to an oxygen concentrator that was set at 4 liters per minute. The resident had a CPAP mask on top of the nasal canula. CPAP was running as well. Registered Nurse (RN), staff A, was present at time of observation. Staff A, Registered Nurse (RN), said Resident #80 had on both Oxygen and a CPAP. Staff A observed the Oxygen concentrator that was running at 4 liters per minute. Staff A also observed the CPAP over the Oxygen therapy. Staff A said Resident #80 liked it like that. When Staff A, RN, looked at the oxygen concentrator in Resident #80's room she stated: The O2 is too high. Staff A, RN, adjusted the oxygen concentrator and said the oxygen concentrator was supposed to be on 3 liters. Staff A checked the oxygen orders on the computer for Resident #80 and verified that the order stated 2 LPM via nasal canula. When surveyor asked Staff A if she was going to leave O2 concentrator 105702 Page 11 of 14 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

F 0695 at 3 liters per minute, Staff A, stated: Yes, I am going to leave it at 3 liters and check on him later. Level of Harm - Minimal harm or potential for actual harm On 3/31/22 at 10:50 a.m. during an interview the Director of nursing (DON) acknowledged that the oxygen order for Resident #80 was for 2 LPM via nasal canula. DON acknowledged that there was no order on record indicating that CPAP and O2 therapy can be administered at the same time. He said Resident #80 liked it like that. He said they needed to re-educate the resident. DON said they need to notify the physician to obtain a new order. Residents Affected - Few 105702 Page 12 of 14 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on interview, and record review the facility failed to ensure two residents' (Resident #44, and #19) of 5 residents surveyed for unnecessary medications were free from significant medication errors. Residents Affected - Few The Findings included: 1. Record review of Resident #44 revealed a physician's order dated 3/16/22 for, Ceftriaxone Sodium Powder Inject 1 gram intramuscularly one time only for UTI (Urinary Tract Infection) for 1 Day. Review of Resident #44's Medication Administration Record (MAR) shows on 3/16/22 Licensed Practical Nurse, Staff Y documented a number 9 on the MAR. for Ceftriaxone. Review of the code on the MAR shows 9 means, See Progress Note. The progress notes for Resident #44 documented on 3/16/22 at 4:22 p.m. showed the medication was not available. There was no documentation on the MAR to show Resident #44 received the antibiotic ordered. On 3/31/21 at 3:35 p.m. the Director of Nursing (DON) verified there was no documentation Resident #44 received the intermuscular antibiotic medication ordered by the physician. The DON said the antibiotic was always available in a locked box in the medication room. He said Staff Y must not have been aware of this because she was an agency nurse. 2. Review of Resident #19's physician's order shows the resident was to have coverage with Humalog insulin 4 times daily at 6:30 am, 11:30 am, 4:30 pm, and 9:00 pm. The coverage was to be given with any blood glucose greater than 200. Review of Resident #19's MAR shows on 3/6/21 there was no documentation the resident's blood sugar was obtained or the resident received insulin coverage at 11:30 a.m. and 9:00 p.m. Review of the documented blood glucose results show on 3/6/22 only two blood glucose levels were obtained by facility staff at 5:46 am and 4:54 p.m. The electronic record showed Resident #19 did not have a blood glucose record obtained the morning of 3/13/22. Resident #19's MAR shows the resident did not receive insulin coverage on 3/13/22 at 6:30 a.m. The electronic record showed no blood glucose was obtained on the morning of 3/19/22. Resident #19's MAR shows the resident did not receive insulin coverage at 6:30 a.m. on 3/19/22. The electronic record shows no blood glucose was obtained on the morning of 3/26/22. Resident # 19's MAR shows the resident did not receive insulin coverage at 11:30 a.m. on 3/26/22. There is no documentation a blood glucose was not obtained at 9:00 p.m. on 3/27/22. Resident #19's MAR shows the resident did not receive insulin coverage at 9:00 p.m. on 3/27/22. On 3/31/22 at 3:35 p.m. the DON verified Resident #19's blood glucose was not obtained as ordered 105702 Page 13 of 14 105702 04/01/2022 Vivo Healthcare Meadows 5157 Park Club Drive Sarasota, FL 34235

F 0760 on 3/6/22, 3/19/22, 3/26/22, and 3/27/22. The DON verified he had failed to obtain blood glucose to ascertain the need to provide insulin coverage to Resident #19 on the morning of 3/13/22. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 105702 Page 14 of 14