Health inspection·February 24, 2022

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm Based on observations and staff interviews, the facility failed to ensure that two (Residents #85 and #5) of three residents observed during medication administration, from a total sample of 27 residents, were provided privacy during medical treatment. Residents Affected - Few The findings include: On 2/22/22 at 11:00 AM, Registered Nurse (RN) A was observed performing blood glucose monitoring for Resident #85. RN A obtained the necessary equipment, entered the resident's room, and left the door open after verifying the resident's identity. The nurse pricked the resident's finger for blood and obtained a blood glucose result without pulling the resident's curtain to provide privacy. RN A stated the blood sugar was 211 and the resident required insulin. After hygiene, the nurse obtained 2 units of insulin and went back to Resident #85 with the door still open and the privacy curtain not pulled. The nurse administered the insulin in the resident's left lower abdomen. When asked whether she provided privacy during the process, she replied, I completely forgot about that. On 2/22/22 at 11:45 AM, Licensed Practical Nurse (LPN) B obtained the necessary equipment for blood glucose monitoring and entered Resident #5's room. The nurse did not knock on the resident's door, did not ask permission to enter, and left the door open after verifying the resident's identity. LPN B pricked the resident's finger for blood and obtained a blood glucose result without pulling the resident's curtain to provide privacy. Resident #5 was in the bed close to the door and could be observed from the hallway. LPN B stated the blood sugar reading was 463. He added that the blood sugar was beyond the parameters and the resident's physician would have to be contacted. He returned to the resident and stated LPN D/Unit Manager contacted the physician and orders were given to administer 12 units of insulin and recheck the resident's blood sugar after an hour. LPN B obtained the 12 units of insulin, entered the resident's room without closing the door or pulling the curtain for privacy, and administered the insulin in the resident's left upper arm. During a medication administration observation on 2/23/21 at 9:07 AM, LPN C was observed entering Resident #5's room without knocking on the door or requesting permission to enter. LPN C left the door open, and did not pull the privacy curtain closed before administering medication to the resident. In an interview on 2/23/22 at 9:30 AM, LPN C confirmed that she had not provided privacy to Resident #5 during medication administration. . Page 1 of 2 105822 105822 02/24/2022 Gardens Healthcare & Rehabilitation Center 1704 Huntington Village Circle Daytona Beach, FL 32114

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observations, record reviews, and staff interviews, the facility failed to ensure a medication error rate of less than 5%, based on 2 errors with 35 opportunities for error, resulting in an error rate of 5.714%. Residents Affected - Few The findings include: During a medication administration observation on 2/23/21 at 9:07 AM, Licensed Practical Nurse (LPN) C was observed obtaining medication for Resident #5. The nurse obtained and administered one tab of Lasix 20 milligrams (mg) ( medication to remove excess fluid ), and one tablet of glipizide 2 mg (medication to help regulate blood sugar) to Resident #5. A review of Resident #5's medical record, revealed that her current physician's orders included Glipizide 5 mg two tablets by mouth two times a day for diabetes, and Furosemide (Lasix) 20 mg two tablets by mouth one time a day related to edema. (Copies obtained) In an interview on 02/23/22 at 9:30 AM, LPN C confirmed that she had administered one Lasix pill and one glipizide pill. When asked to review Resident #5's physician's orders, LPN C stated, I overlooked the order. I needed to give 2 pills of Lasix and glipizide. She stated she would go back and administer the two remaining pills to Resident #5. A review of the facility's policy and procedure titled: Standards and Guidelines: Medication Administration (Last revised on 01/01/2021), revealed the standards read, It will be the standard of this facility to administer medication in a timely manner and as prescribed by the physician, unless otherwise clinically indicated or necessitated by other circumstances, such as lack of availability of medication or refusal of medication by the resident. The guideline included: 2. The Director of Nursing services is responsible for the supervision and direction of all personnel with medication administration and duties and functions. 5. Should a dosage seem excessive considering the resident's age and medical condition, or medication orders seem to be unrelated to the resident 's current diagnosis or medical condition the person preparing /administering the medication shall contact the resident's physician or the facility's Medical Director for further instruction. 8. After successfully identifying the resident to receive medication administration, the individual administering the medication should ensure that right medication , right dosage right time and right method of administration are verified. . 105822 Page 2 of 2