Inspection·July 28, 2022

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 interviews and record reviews, the facility failed to provide treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices for one (Resident #2) of 29 residents sampled, by failing to apply physician-ordered topical medication. Residents Affected - Few The findings include: On 7/26/22 at 11:00 AM, an attempt was made to interview Resident #2. When asked if she had any concerns, she nodded yes. She had communication difficulty and was difficult to understand. She touched her knees, then said her daughter's name. When asked if her daughter should be contacted, she nodded yes. In a telephone interview on 7/26/22 at 2:41 PM, Resident #2's daughter stated she visited her mother regularly and attended her care plan meeting. She stated her only concern was that her mother's speech had gotten worse and she thought her mother had had mini strokes. She stated she had requested that her mother be evaluated by the speech therapist but she had not heard anything back about that. She also mentioned that her mother had been receiving medication very late. She had spoken to the nurse about the late medication administration because her mother required pain medication timely due to her arthritis. A medical record review revealed that Resident #2 was admitted to the facility on [DATE] with a re-entry on 4/23/22 and a primary diagnosis of ostoarthritis. Secondary diagnoses included bilateral osteoarthritis of the knee, cognitive/communication deficit, and pain. A review of the resident's July 2022 Physician's Order Sheets revealed the following active orders: Diclofenac Sodium 1% cream (100 grams), apply to knees topically four times a day for arthritis, and Efudex Cream 5 % (Fluorouracil), apply to forearms, hands, fingers topically every shift for skin growth. A review of the annual minimum date set (MDS) assessment, dated 7/22/22, revealed that a Brief Interview for Mental Status score could not be obtained. The resident required limited assistance with bed mobility and toilet use, and supervision assistance with transfers. Her active diagnoses included arthritis with a pain regimen in place. A review of the resident's care plan, with a review date of 7/13/22, revealed the resident had a communication problem related to unspecified voice and resonance disorder, and was at risk for complications related to pain due to osteoarthritis. Interventions included: Staff to anticipate and meet resident needs and administer pain medication. (Copy obtained) (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 5 Event ID: 105756 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 105756 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Hilliard 3756 W Third St Hilliard, FL 32046 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)