Health inspection·April 29, 2021

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure appropriate documentation of advance directives for 1 (Resident #65) of 6 residents reviewed for advanced directives. The findings included: A review of the Advance Care Planning-Code Status Clinical insight FYI (For your information) #65 August 2019, provided by the facility revealed documentation Social Service should ensure code status has been established and is appropriately communicated within the medical and electronic record. Ultimately, it is important Social Service does a thorough screen regarding the patient's wishes. A review of the resident record for Resident #65 revealed the resident was admitted on [DATE] with diagnoses including Senile Degeneration of the Brain. A review of Resident #65's physician orders, dated 3/26/21, revealed Resident #65 was a full code. A review of the Social Services assessment dated [DATE] revealed, Resident #65 and the spouse provided the information. The advance care planning listed Durable Power of Attorney-Health Care (DPOA-HC). The form was signed by Social Services Coordinator Staff B. The admission Minimum Data Set (MDS) Assessment, dated 4/2/21, revealed Resident #65 had a BIMS score of 5 (severe cognitive impairment). On 4/27/21 at 12:24 p.m., during a telephone interview, Resident #65's spouse said she was the resident's Power of Attorney for Health Care (POA-HC) and Resident #65's code status was Do Not Resuscitate (DNR). On 4/28/21 at 9:04 a.m., in an interview, the Admissions Coordinator said if a resident's BIMS was 5, they would get a Certificate of Incapacity and the resident's POA would make all healthcare decisions, including DNR status. She said she did not ask Resident #65's spouse about the DNR. On 4/28/21 at 9:17 a.m., in an interview, the Social Services Coordinator Staff B said she met with Resident #65 and signed the Social Service Assessment, but did not conduct the interviews for the assessment. She said she does not think he (Resident #65) could tell if he was a DNR or not. She said the facility was going to the spouse and son for decision making. She said the resident's BIMS score of 5 Page 1 of 7 105842 105842 04/29/2021 Crescent Health and Rehabilitation Center 5401 Sawyer Rd Sarasota, FL 34233

F 0578 Level of Harm - Minimal harm or potential for actual harm should have triggered her and Social Services Staff C, who conducted the interviews for the Social Service Assessment, to get the incapacity letter for Resident #65. She said they should have obtained the incapacity letter from the doctor, then the DNR, and ensured the POA-HC was in the chart. She said there were definitely balls dropped in Resident #65's case. Residents Affected - Few 105842 Page 2 of 7 105842 04/29/2021 Crescent Health and Rehabilitation Center 5401 Sawyer Rd Sarasota, FL 34233

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. Based on observation, interview, and record review, the facility failed to properly store medications for 2 (Residents #47 and #78) of 5 residents reviewed for medication storage. The findings included: A review of the facility policy, medication and treatment administration guidelines, medication storage and security, , 2018 HCR Healthcare, Limited Liability Company (LLC), Nursing Procedures - M, New Procedure: 12/2014, Updated: 03/2018, page 3 of 4, Medication storage and security: Medications and biologicals are securely stored in a locked cabinet, cart, or medication room, accessible to only licensed nursing staff and pharmacist or authorized pharmacy staff, and maintained under a lock system when not actively utilized and attended to by nursing staff for medication administration, receipting, or disposal Self-administered medications stored in a patient's room must be secured in a locked storage unit. On 4/26/21 at 12:11 p.m., observed Resident #47 in his room with prescription box for Lumigan (used to treat glaucoma) eye drops sat on his bedside table. Next to the box was a small bottle of Lumigan eye drops. Resident #47 confirmed they were his eye drops. He said he put them in his eyes at night. **Photographic Evidence Obtained** On 4/26/21 at 12:16 p.m., observed the shared bathroom for Resident's #47 and #78 to have a bottle of prescription 5-Fluorouracil 0.51% cream (used to treat scaly or crusted skin areas) on the counter next to the sink. Resident #78's name was on the bottle. **Photographic Evidence Obtained** On 4/26/21 at 3:48 p.m., observed Resident #47 sitting in his room. The prescription eye-drop box and eye drop bottle of Lumigan sat on the bedside table in front of the resident. **Photographic Evidence Obtained** On 4/27/21 at 9:12 a.m., observed Resident #47 sitting in his room. The prescription bottle of Lumigan eye drops and the box were on the bedside table in front of the resident. Resident #47 said he gave himself his eye drops, one in each eye at night. **Photographic Evidence Obtained** On 4/27/11 at 11:01 a.m., observed the prescription eye drops of Lumigan remained on the resident's bedside table. **Photographic Evidence Obtained** On 4/27/21 at 4:10 p.m., in an interview, Resident #47 said his eye drops were in his shirt pocket. He removed the bottle from his shirt pocket to display them. 105842 Page 3 of 7 105842 04/29/2021 Crescent Health and Rehabilitation Center 5401 Sawyer Rd Sarasota, FL 34233

F 0761 **Photographic Evidence Obtained** Level of Harm - Minimal harm or potential for actual harm On 4/28/21 at 10:35 a.m., Unit Manager Staff E went into the shared room of Residents #47 and #78. She confirmed the prescription eye drops of Lumigan were on Resident #47's bedside table. Unit Manager Staff E went into the shared bathroom. She confirmed the prescription 5-Fluorouracil 0.51% cream was on the bathroom counter. She confirmed neither of the medications were secured in a locked storage unit. Residents Affected - Few 105842 Page 4 of 7 105842 04/29/2021 Crescent Health and Rehabilitation Center 5401 Sawyer Rd Sarasota, FL 34233

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and interview, the facility failed to maintain accurate meal consumption documentation for 1 (Resident #45) of 3 ensure residents reviewed for nutritional intake. The findings included: A review of the facility's Documentation policy, dated 11/2013 and updated 07/2017 Revealed the Nursing Assistant documentation in the clinical record is expected to follow established practices as outlined in Documentation Guidelines for the Clinical Record. The policy directs the CNA to document meal consumption and nutritional supplement offering after each meal or supplement. The consumption is to be documented in the Electronic Health Record (EHR). A review of Resident #45's medical record revealed the resident was readmitted to the facility on [DATE], post hospitalization. On 3/1/21, the resident weighed 146.4 pounds (lbs.), on 4/16/21, the resident weighed 123.8 lbs. which was a -15.75% loss. A review of the Certified Nursing Assistant's (CNA) documentation, the Amount of Meal Taken form, for 30 days from 3/29/21 through 4/27/21, revealed on the following days: 3/29/21, 3/31/21, 4/2/21, 4/3/21, 4/4/21, 4/5/21, 4/6/21, 4/10/21, 4/11/21, 4/12/21, 4/18/21, 4/19/21, 4/20/21, 4/22/21 staff documented Resident #45 refused his meals. On 4/27/21 at 12:04 p.m., in an interview, the facility Dietitian said it was difficult to get a good calorie count with Resident #45. The resident's food consumption was not always available. The resident might not eat breakfast until 2:00 p.m., and might not eat lunch and dinner until night and all during the night. The Dietitian stated the CNAs were not used to documenting the food consumption. On 4/27/21 at 3:52 p.m., in an interview, the Director of Nursing (DON), said, There are days where the Resident's food consumption was not documented. The Resident eats outside of the normal times the Certified Nursing Assistants monitor the consumption time. It is known he eats late at night. She said The CNAs during the day, check the section noting he refused. I agree it looks like he did not eat the whole day. I have documentation noting his unusual eating times. No, his food consumption is not documented in another area. The DON confirmed by not having an accurate accounting of the resident's food intake it was difficult to do an accurate calorie count. 105842 Page 5 of 7 105842 04/29/2021 Crescent Health and Rehabilitation Center 5401 Sawyer Rd Sarasota, FL 34233

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on interview and maintenance review, the facility failed to have documentation of maintenance of resident care equipment to ensure safe operating condition. Residents Affected - Many The finding included: On 4/28/21 at 3:00 p.m., a tour of the facility's laundry with the Housekeeper Supervisor was conducted. The laundry room had 2 washing machines and 3 dryers. The Housekeeping Supervisor stated the temperature of the machines were 160 degrees. The washing machines had three filters and had the following chemicals: sanitizer chlorine, detergent, softener, which were calibrated to run during the different washing cycles. On 4/28/21 at 3:15 p.m., in an interview, Housekeeper Supervisor stated, The service was once a month, not sure of the last service or the changing of the filters. It was monthly service, it changed last year due to COVID-19. When the chemical dispenser indicator light turns red, it tells me which chemical needs to be changed out. I can order the chemicals and I put on protection to change the containers. I can't find the service invoices. The housekeeper supervisor verified she did not have documentation the washing machines had been serviced for at least a year making it impossible to determine if the washing machines were in safe operating condition. The facility was unable to provide the washing machine services sheets, ECO Lab service contract, maintenance services, filter changes, chemical calibrations for the entire year of 2020 and to date in 2021. 105842 Page 6 of 7 105842 04/29/2021 Crescent Health and Rehabilitation Center 5401 Sawyer Rd Sarasota, FL 34233

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to provide a sanitary environment for 2 residents (Resident #47 and Resident #78) of 5 residents reviewed for sanitary environment. On 4/26/21 at 12:16 p.m., during a tour of the facility, an uncovered, unlabeled urinal was observed on the back of the toilet of room [ROOM NUMBER] which was a double occupancy room. Two uncovered, unlabeled toothbrushes, sitting in cups of water were also observed on the bathroom counter. The same observation was made on 4/27/21 at 9:12 a.m. and 4/27/21 at 11:01 a.m. On 4/28/21 at 10:14 a.m., observed the two toothbrushes remained uncovered and unlabeled on the counter of the double occupancy room [ROOM NUMBER]. On 4/28/21 at 10:44 a.m., Unit Manager Staff E went into room [ROOM NUMBER] and confirmed the items were not labeled or stored properly. On 4/29/21 at approximately 1:30 p.m., the Administrator said she could not locate a specific policy for the storage of the urinal and toothbrushes. 105842 Page 7 of 7