Inspection·January 12, 2023

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents received care and services for central venous access devices in accordance with professional standards of practice for 1 of 5 reviewed residents with a central venous access device, Resident #57. Residents Affected - Few Findings include: Review of Resident #57's medical records revealed the resident was admitted on [DATE] with the diagnoses including infection following procedure, deep incisional surgical site, personal history of Methicillin Resistant Staphylococcus Aureus infection, and adult failure to thrive. Review of IV Company Patient Information sheet for Resident #57 revealed a peripherally inserted central catheter (PICC) line had been inserted on 11/9/2022. Review of Omnicare Central Vascular Access Devise (CVAD)- Physician/ Licensed Independent Practitioner (LIP) Order Sheet dated 11/9/2022 and 12/14/2022 for Resident #57 reads, Flushing/Locking orders: Use SASH [Saline/Administer medication/Saline/Heparin] Technique OR SAS [Saline/Administer/Saline] . Non-valved Catheter (SASH) 10 ml [milliliter] NS [normal saline] Before Med, 10 ml NS After med, Then: 5 ml Heparin 10 units/ml . Treatment Orders . Change Needleless Connector: On admission, Q [every] week and PRN [as needed], After blood draws or transfusions . Change Catheter Site Dressing: 24 hours post PICC insertion, On admission, Q week and PRN with transparent dressing, Q 2 days with gauze dressing, Change catheter securement devise with dressing change. Measure external catheter length on admission, with each dressing change and prn. Notify physician/LIP if the external catheter length has changed since last measurement. PICCs: Measure upper arm circumference (10 cm [centimeters] above antecubital) on admission, with each dressing change, and prn. Observe Site: Q 2 hours during continuous therapy, Q shift with intermittent therapy or when not in use, Before and after administration of intermittent medications, During dressing changes, Routinely for S/S [sign and symptoms] infiltration/extravasation at a frequency based on therapy and patient condition, Document in notes at least Q shift considering prescribed therapy and patient condition. Review of Resident #57's Treatment Administration Record (TAR) for November 2022 revealed no documentation on change of PICC 24 hours after insertion. Review of Resident #57's TAR for November 2022, December 2022 and January 2023 revealed no documentation on measurement of external catheter length, upper arm circumference with each dressing change and PRN. Review of the nursing progress notes from November 9, 2022 (date of PICC line insertion) through (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 7 Event ID: 105724 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105724 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ocala Oaks Rehabilitation Center 3930 E Silver Springs Blvd Ocala, FL 34470 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)