Inspection·June 26, 2024

F 0692 Provide enough food/fluids to maintain a resident's health. 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 follow a systematic approach to ensure residents were not over hydrated due to health conditions and followed physician ordered fluid restrictions to promote the highest practicable outcome for 1 of 3 residents reviewed for nutrition/hydration issues, of a total sample of 38 residents, (#5). Residents Affected - Few Findings: On 6/24/24 resident #5 was observed in his room on the [NAME] Wing of the facility at approximately 1:34 PM. The resident was awake with some confusion and his wife was in the room with him. She explained her husband was incontinent and it took a long time for staff to change him. The resident's wife indicated her husband had not been in the facility very long and hoped he would return home. She expressed concern he was about to change rooms and be placed in a room on the East Wing where the staff were not familiar with her husband's care. Medical record review revealed resident #5's most recent admission to the facility on 6/09/24. The resident's diagnosis included heart Disease, renal Disease, high blood pressure, prostate issues and hyponatremia (low sodium). The Minimum Data Set assessment dated [DATE] noted the resident scored a 10/15 on the Brief Interview for Mental Status which indicated moderately impaired cognition. Review of the physician's orders revealed resident #5 was on a 1000 milliliters (ml) per day fluid restriction for hyponatremia. Hyponatremia occurs when the concentration of sodium in your blood is abnormally low. Sodium is an electrolyte, and it helps regulate the amount of water that's in and around your cells. In hyponatremia, one or more factors- ranging from an underlying medical condition to drinking too much water -cause sodium in your body to become diluted. When this happens, your body's water level rises, and your cells begin to swell. This swelling can cause many health problems, from mild to life-threatening, (retrieved on 7/15/24 from www.mayoclinic.org). The resident's physician notated how resident #5's fluid restriction would be administered. Dietary was to provide a total of 700 ml of fluid per day in increments of: breakfast 360 ml; lunch 180 ml; and dinner 160 ml. Nursing staff was to provide 300 ml additional fluid per day 120 ml on the 7 AM-3 PM shift; 120 ml on the 3 PM-11 PM shift and 60 ml on the 11 PM-7 AM shift. On 6/25/24 at 2:29 PM, resident #5 was observed in his new room on the East Wing. He was lying in bed with a large cup of water on the bedside table. The cup held approximately 16 ounce of fluid equal to 473 ml, which exceeded the 120 ml nursing was to provide on the 7 AM-3 PM shift and the allotted amount for the entire day. (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 3 Event ID: 105793 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 105793 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Oaks Nursing and Rehab Center 2225 Knox McRae Dr Titusville, FL 32780 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)