Health inspection·June 10, 2021

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Residents Affected - Few Based on interviews and record reviews, the facility failed to ensure the completion of pre-admission screening for individuals with a mental disorder and individuals with an intellectual disability for one (Resident #39) of 27 residents in the sample. The findings include: A medical record review for Resident #39 indicated he was admitted to the facility on [DATE]. His diagnoses included intermittent, explosive disorder, bipolar disorder and schizophrenia. His physician's orders revealed orders for Paroxetine 30 milligrams (Mg) by mouth (PO) every day (QD) for depression, and Risperidone 1 mg two times a day (BID) for bipolar disorder. A 5-day admission Minimum Data Set (MDS) assessment revealed the resident had not been evaluated via Level II Pre-admission Screening and Resident Review (PASRR) to determine serious mental illness and/or mental retardation or related condition. Further review indicated that Resident #39 had a Brief Interview for Mental Status score (BIMS) of 07 out of 15 possible points, indicating severe cognitive impairment. The resident also reported feeling depressed or hopeless, feeling tired and having little energy for 2- 6 days, and received antispychotic and antidepressant medication for 7 days and antianxiety medication for 3 days during the look back period. His care plan indicated that he was on antianxiety, antidepressant and psychotropic medications related to anxiety, depression and bipolar disorders respectively. A review of the Level I PASRR dated 4/19/2021, Section 1, revealed the following: Schizophrenia onset prior to [AGE] years of age. Currently receiving services for mental illness (MI), and Intellectual disability (ID). Section II 1. indicated that Resident #39 had or may have had a disorder in functional limitation in major life activities that would otherwise be appropriate for the individual's developmental stage. Previously received services for MI and ID. Section IV was incomplete. (Copy obtained) A review of the Hospital Discharge summary dated [DATE], revealed: Past medical history indicated mental deficiency, schizophrenia, and intermittent explosive disorder. Resident's father described him as never having issues with depression, always just wild due to his schizophrenia and requiring seroquel, risperdal, and carbamazepine, and never on an anti-depressant. During an interview on 06/09/2021 at 12:35 PM, the Director of Nursing (DON) and the Assistant Director of Nursing (ADON) were asked about Resident #39's Level II PASRR. They confirmed that the level II PASRR was not completed. They also stated that Resident #39 lived in a group home owned by his parents prior to admission. When asked whether the resident had received a psychiatric evaluation, they stated, No. They added that the facility did not have a psychiatric physician and residents were Page 1 of 4 105820 105820 06/10/2021 University Crossing 6210 Beach Blvd Jacksonville, FL 32216

F 0645 Level of Harm - Minimal harm or potential for actual harm evaluated on an as-needed basis by the hospital psychiatric physician. The DON stated the facility did not have a policy for PASRR. . Residents Affected - Few 105820 Page 2 of 4 105820 06/10/2021 University Crossing 6210 Beach Blvd Jacksonville, FL 32216

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that drugs and biologicals used in the facility were safely stored for two (Residents #321 and #322) in a total sample of 27 residents. The findings include: 1. On 6/7/2021 at 10:30 AM, Resident #321 was observed lying in bed. There was a container of medication observed on the bedside table. (Photographic evidence obtained) Resident #321 stated in an interview on 6/7/21 at 10:35 AM that she was admitted to the facility on [DATE]. Upon arrival, she was notified that her transplant medication was not available. She stated she had to ask a friend to bring the medication from home, as she could not stay without it. She further stated she had been taking it as prescribed. A medical record review for Resident #321 indicated that she was admitted to the facility on [DATE] with a diagnosis of kidney transplant. Physician's orders included mycophenolate mofetil (Cellcept) capsule 250 milligrams (mg), give 750 mg every 12 hours for transplant. 2. On 6/7/2021 at 11:00 AM, Resident #322 was observed seated in a reclining chair with the bedside table in front of him. There was a bottle of nasal spray on the bedside table, and an anti-fungal powder was observed on the resident's nightstand. (Photographic evidence obtained) In an interview on 6/7/2021 at 11:30 AM, Resident #322 stated he used the nasal spray because at times, he got a dry nose due to the use of oxygen. When asked about the powder on the nightstand, he stated he had a groin infection and the nurses put the powder on daily. On 6/9/2021 at 1:00 PM, the nasal spray and the anti-fungal powder medications were still at the bedside. On 6/9/2021 at 2:08 PM, Employee B, Registered Nurse (RN), confirmed that the resident should not have the antifungal powder or nasal spray at the bedside, as the resident had not been assessed for self-administration of medication. She added that she would discuss it with the nurse responsible for the resident's care. A medical record review for Resident #322 indicated that the resident had skin irritation at the groin, and Chronic Obstructive Pulmonary Disease (COPD). Current physician's orders revealed an order for miconazole nitrate powder, apply to the groin for irritation, Oxygen 3 liters via nasal canula for COPD, Ipratropium-Albuterol solution 0.5-2.5 (3) Mg/3 Milliliters (ML) vial, inhale orally every 8 hours (scheduled) and every 8 hours as needed for COPD, Budesonide suspension 0.5mg/2ML inhale orally every 12 hours for COPD. There were no orders for nasal spray. In an interview on 6/9/2021 at 3:33 PM, Employee D, RN/Unit Manager, confirmed that the resident did not have orders for nasal spray, nor should he have medications at the bedside. When asked about Resident #321's and #322's assessments for self-administration, she stated neither resident had an assessment. She added Resident #322 was very forgetful and therefore not a good candidate for self-administration. She also mentioned that all medications were supposed to be in the medication/treatment 105820 Page 3 of 4 105820 06/10/2021 University Crossing 6210 Beach Blvd Jacksonville, FL 32216

F 0761 carts at all times. Level of Harm - Minimal harm or potential for actual harm Another interview was conducted with the Director of Nursing (DON) on 6/10/2021 at 9:00 AM. She stated when a resident arrived at the facility, nurses were to make every effort to ensure that he/she received their medications as ordered. She added there were times when some medications were not available due to insurance coverage, and residents were asked to bring in their home prescription. In this case, the nurse should have documentation indicating that the medication belonged to the resident, and medication should be administered by the nurse and not left at the bedside. The DON also stated medications received from the resident should be added to the inventory sheet. When asked about administration of over-the-counter medications, she stated no medications should be administered without a physician's order. Residents Affected - Few A review of the facility's policy and procedure titled Nursing Medication Safety (Policy #UC NUR-014, revised on 05/2021) revealed: The purpose of this policy is to communicate safe medication practices to the nursing staff members, patients and their families and facilitate medication safety at all times throughout their stay. All RNs and LPNs will actively participate in safe medication practices in accordance with the procedures specified. 1.Medications are to be administered to the Guest/Residents only when prescribed by a licensed physician. 4. Safe storage and handling of medication: Upon delivery to nursing units, medications are kept in secure areas until administration. These areas include medication rooms, medication carts and refrigerators. 5. Requirements for specific type of orders i. Guest's own supply of medication of medication/self-administration: Policies and processes are not in place as guest are not to self-administer medication and/or maintain medication at the bedside. . 105820 Page 4 of 4