Health inspection·May 12, 2022

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on observations, record review and interviews, the facility failed to monitor behaviors for one (Resident #6) of five residents selected for unnecessary medications review, from a total of 23 residents in the sample. Residents Affected - Few The findings include: An observation and interview was conducted with Resident #6 in her room on 5/10/22 at 3:36 p.m. The resident was sitting in her wheelchair at bedside smiling and talking. She did not remember which medications she took. A medical record review revealed an admission date of 12/27/18 and a diagnosis of anxiety disorder. Active physician's orders revealed an order dated 4/22/22 for lorazepam (Ativan, sedative) 0.5 mg (milligrams) to be administered daily. The active care plan included the following Focus Areas: Behavior Problem - manipulative due to ineffective coping skills. Intervention: Monitor behavior and side effects of psychotropic medication. Uses antianxiety medication. Intervention: Monitor behaviors and administer medications as ordered. A review of the May 2022 Medication Administration Record (MAR) revealed no documentation of behaviors, medication side effects, or nonpharmacological interventions for Lorazepam. (Photographic Evidence Obtained) There was no documentation in the medical record to verify that behaviors, medication side effects, or nonpharmacological interventions were being monitored/provided. An interview was conducted with Licensed Practical Nurse (LPN) B on 5/12/22 at 10:59 a.m. She stated resident behaviors were monitored and documented on the Medication Administration Record (MAR). An interview was conducted with LPN A on 5/12/22 at 11:04 a.m. He stated resident behaviors were documented on the MAR daily. He confirmed there was no behavior monitoring documented for Resident #6. An interview was conducted with the Assistant Director of Nursing (ADON) on 5/12/22 at 12:10 p.m. She confirmed behavior monitoring for Resident #6 was not documented and should have been on the MAR. The ADON stated she would initiate that now. Page 1 of 4 105826 105826 05/12/2022 Pavilion at Jacksonville, The 1771 Edgewood Ave W Jacksonville, FL 32218

F 0757 . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 105826 Page 2 of 4 105826 05/12/2022 Pavilion at Jacksonville, The 1771 Edgewood Ave W Jacksonville, FL 32218

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, interviews with staff, and a review of the Policy and Procedure for General Guidelines for Medication Administration, the facility failed to monitor apical pulses for digoxin administration and to obtain a digoxin level for one (Resident #29) of 23 sampled residents. An apical pulse should be obtained before administering digoxin (heart medication), because it is not administered if the apical pulse is below 60. The medication should be monitored through laboratory work due to a narrow safety range. Residents Affected - Few The findings include: A medical record review was conducted for Resident #29 revealing an admission date of 12/17/21 with diagnoses including atrial fibrillation and chronic obstructive pulmonary disease (COPD). A physician's order dated 12/18/21 read, digoxin 125 mcg (micrograms) given via gastrostomy tube (feeding tube) in the morning (9:00 a.m.). The May 2022 Medication Administration Record (MAR) noted digoxin 125 mcg administered via gastrostomy tube daily for atrial fibrillation. There were no apical pulses documented before administration of the medication. The April 2022 MAR was reviewed and also noted no documentation for apical pulse before administration of digoxin. A review of the medical record found no documentation of a laboratory order to monitor digoxin levels. The manufacturer recommended that levels must be monitored because the drug had a narrow safety range. Therapeutic levels were between 0.8 - 2.0 ng/ml (nanograms per milliliter). A toxic level was greater than 2.4 ng/ml (emedicine.medscape.com, accessed on 5/12/22 at 4:30 p.m.) A review of the resident's vital signs documentation revealed his radial pulses were usually taken at 12:00 p.m. or later. (Photographic Evidence Obtained) An interview was conducted with the Assistant Director of Nursing (ADON) on 5/11/22 at 2:05 p.m. She stated the apical pulse was taken and documented before administering digoxin and should be documented on the resident's MAR. An interview was conducted with the ADON on 5/12/22 at 10:51 a.m. She confirmed the apical pulses were not being documented, and the order was changed in the computer with parameters for apical pulse monitoring. After reviewing the resident's medical record, the ADON reported a digoxin level was not ordered and the physician was notified. A STAT (immediate) order for a digoxin level was obtained. A review of the Policy and Procedure for General Guidelines for Medication Administration (dated 9/2018), noted Medications are administered as prescribed in accordance with good nursing principles and practices. . 105826 Page 3 of 4 105826 05/12/2022 Pavilion at Jacksonville, The 1771 Edgewood Ave W Jacksonville, FL 32218

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record review, the facility failed to 1) Ensure food items had not expired, 2) Document food items' use by dates, 3) Keep thermometers in cooling units that contained food, 4) Use sanitizer in the three-compartment sink every time it was used, and 5) Keep food temperature logs for every meal. This deficient practice could potentially affect all residents receiving food from the facility's kitchen. The findings include: On 5/9/22 at 10:35 AM an observation of the kitchen was made revealing the following: A bag of hotdog buns with a green/yellow substance on them was observed on the bread rack. Also observed were two bags of hamburger buns with a green substance on several of the buns. The bags were dated 4/13/22. (Photographic evidence obtained) The Certified Dietary Manager (CDM), present during the observation, was asked about the bread and stated that the bread delivery usually switches the old bread out for new bread. He was asked about the last delivery and reported it was on 5/4/22. The CDM stated bread was delivered every week. White flour was seen being stored in a large plastic container which had no date on it. Observations were made of a milk cooler having five expired milk cartons dated 5/5/22 on them. It was also noted that there was no thermometer in this unit. The small freezer across from the milk cooler was also noted with no thermometer inside. On 5/9/22 at 10:45 AM, the CDM was asked to find the thermometers in these units. He was unable to locate them. He was asked if these two units should have had thermometers in them and he stated yes. The three-compartment sink was filled with water and had pots in it. At 10:55 AM, Dietary Aide Z was asked to test the sink's sanitizer at this time. The test strip did not change color, and was tested two more times with the same result. The CDM told Dietary Aise Z to change out the sanitizer bucket. The sink was tested after the sanitizer was added and the test strip revealed the appropriate 200 Parts Per Million (PPM). Dietary Aide Z was asked about the use of the sanitizer. She stated she put the sanitizer solution in the sink before adding the pots or dishes to the sink. She was asked about the sanitizer and she stated she had gotten busy and did not test the sanitizer this morning. On 5/12/22 at 10:27 AM, an observation of the food temperature logs was made. More than one day was observed in which meal temperatures had not been documented on the log. At this time the CDM was asked how many times a day the food temperatures should be taken when the food was on the steam table. He stated, three. A review of facility's policy titled Sanitation inspection was conducted. There was no policy date noted. The policy instructed staff to conduct inspections to ensure food service areas were clean, sanitary, and in compliance with applicable state and federal regulations. . 105826 Page 4 of 4