Health inspection·November 25, 2020

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, interviews, and policy review the facility did not ensure the care plan was implemented for one resident (#17) of 25 residents reviewed for personal hygiene. Findings included: On 11/23/2020 at 8:55 a.m. during the initial tour of the facility, an observation of Resident #17 revealed that he had long fingernails that extended beyond the fingertip with ½ inch of dark debris under the nail. Resident #17 was asked if he wanted his fingernails cleaned and trimmed, his response was that no one had asked him, but was agreeable to have his fingernails trimmed and cleaned. The medical record for Resident #17 was reviewed which revealed that he had been admitted to the facility on [DATE] with multiple diagnoses to include to chronic kidney disease stage 3, depression and cardiomyopathy. A review of the current [NAME] sheet for the CNAs (certified nursing assistant) indicated that the resident was to receive personal hygiene with one person assist and staff were to assist with showers. A review of the care plan with a focus documented as [Resident #17] has ADL (activities of daily living) Self Care Performance Deficit r/t (related to) dx (diagnoses) of heart failure, cardiomyopathy, generalized weakness. Requires assistance with adls, transfer and mobility. Resident requesting showers once a week prefers on Tuesday .initiated on 1/22/16 and revisited on 3/4/19. Interventions included, Personal Hygiene: 1 person assist, initiated on 5/6/20. Observations of Resident#17 were conducted on several occasions as follows: On 11/23/2020 at 8:55 a.m. and 11:07 a.m. Additional observations made on 11/24/2020 at 10:55 a.m. Fingernails remained untrimmed and dirty. A review of the annual MDS (minimum data set) assessment dated [DATE] under Section G - Functional Status, the Activities of Daily Living for Resident #17 were coded for personal hygiene as 3, which indicated extensive assistance and requires a one person assist. Section C - Cognitive Patterns revealed a BIMS (brief interview for mental status) as a 15 indicating the resident was cognitively intact. On 11/24/20 at 10:55 a.m. an interview was held with the Director of Nursing (DON) regarding her expectations for the lack of personal hygiene for Resident #17 in regard to his long/dirty fingernails. She reported that sometimes he has refused, but that he still will have clean nails. She explained Page 1 of 6 105878 105878 11/25/2020 Pinellas Point Nursing and Rehab Center 5601 31st St S Saint Petersburg, FL 33712

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that she kept the shower sheets for residents in her office for 30 days. A review of the shower sheets for Resident#17 for the month of November 2020 revealed only three shower sheets (11/2/20, 11/9/20, and 11/12/20) for the resident and none had an indication of refusal from this resident to have his nails trimmed. On 11/24/20 at 11:33 a.m. an interview was conducted with Staff G, CNA. Staff G reported that sometimes the resident refuses and starts to yell if I try to cut his nails, they are hard and long. Staff G was asked if he would document the resident's refusal, and he said on the shower sheet. He was shown three shower sheets for the month on November 2020 that the DON provided and that none had an indication of a refusal. Staff G stated that he had just trimmed the resident's nails today. A review of the facility policy titled, Resident Dignity & Personal Privacy, with a revision date of 4/4/2019, indicated under the title of Procedure: Assist the resident with grooming; groom appropriately and to the resident's desire. 105878 Page 2 of 6 105878 11/25/2020 Pinellas Point Nursing and Rehab Center 5601 31st St S Saint Petersburg, FL 33712

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review and staff interviews the facility failed to assist one Resident #(17) with necessary services to maintain good grooming and personal hygiene of 25 sampled residents who were in need of assistance to carry out activities of daily living . Residents Affected - Few Findings included: A review of the facility policy titled, Resident Dignity & Personal Privacy with a revision date of 4/4/2019, indicated under the title Procedure: Assist the resident with grooming; groom appropriately and to the resident's desire. The medical record for Resident #17 was reviewed which revealed that he had been admitted to the facility on [DATE] with multiple diagnoses but not limited to chronic kidney disease stage 3, depression and cardiomyopathy. A review of the current [NAME] sheet for the CNAs (certified nursing assistant) indicated that the resident was to receive personal hygiene with one person assist and staff were to assist with showers. A review of the annual MDS (minimum data set) assessment dated [DATE] under Section G Functional Status, the Activities of Daily Living for Resident #17 were coded for personal hygiene as 3, which indicated extensive assistance and requires a one person assist. Section C - Cognitive Patterns revealed a BIMS (brief interview for mental status) as a 15 indicating the resident was cognitively intact. On 11/23/2020 at 8:55 a.m. during the initial tour of the facility, an observation of Resident #17 revealed that he had long fingernails that extended beyond the fingertip with ½ inch of dark debris under the nail. Resident #17 was asked if he wanted his fingernails cleaned and trimmed, his response was that no one had asked him, but was agreeable to have his fingernails trimmed and cleaned. Observations of Resident#17 were conducted on several occasions as follows: On 11/23/2020 at 8:55 a.m. and 11:07 a.m. Additional observations made on 11/24/2020 at 10:55 a.m. Fingernails remained untrimmed and dirty. On 11/24/20 at 10:55 a.m. an interview was held with the Director of Nursing (DON) regarding her expectations for the lack of personal hygiene for Resident #17 in regard to his long/dirty fingernails. She reported that sometimes he has refused, but that he still will have clean nails. She explained that she kept the shower sheets for residents in her office for 30 days. A review of the shower sheets for Resident#17 for the month of November 2020 revealed only three shower sheets (11/2/20, 11/9/20, and 11/12/20) for the resident and none had an indication of refusal from this resident to have his nails trimmed. On 11/24/20 at 11:33 a.m. an interview was conducted with Staff G, CNA. Staff G reported that sometimes the resident refuses and starts to yell if I try to cut his nails, they are hard and long. Staff G was asked if he would document the resident's refusal, and he said on the shower sheet. He was shown three shower sheets for the month on November 2020 that the DON provided and that none had an indication of a refusal. Staff G stated that he had just trimmed the resident's nails today. 105878 Page 3 of 6 105878 11/25/2020 Pinellas Point Nursing and Rehab Center 5601 31st St S Saint Petersburg, FL 33712

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, observations, interviews, policy review, review of the Consumer Product Safety Commission did not ensure safe water temperatures were maintained in one resident bathroom of twenty resident bathrooms and for four residents (#9, #14, #24, and #29) of 25 residents in the facility with the potential to be affected. Findings included: Resident #9 was admitted to the facility with a diagnosis of dementia according to the face sheet in the admission record. A review of the Minimum Data Set (MDS) assessment dated [DATE] reflected a BIMS (brief interview for mental status) summary score of 2, indicating that Resident #9 had impaired cognition. Further review of the assessment showed Resident #9 was dependent on one person for toileting and personal hygiene assistance. Resident #14 was admitted to the facility with a diagnosis of dementia according to the face sheet in the medical record. A review of the MDS assessment dated [DATE] reflected a BIMS summary score of 2, indicating impaired cognition. Further review of the assessment showed Resident #14 required extensive assistance of one person for toilet use and personal hygiene. Resident #24 was admitted to the facility with a diagnosis of dementia, according to the face sheet in the admission record. A review of the MDS assessment dated [DATE] reflected a BIMS summary score of 0, indicating severe cognitive impairment. Further review of the assessment reflected extensive assistance for toilet use and personal hygiene of one person. Resident #29 was admitted to the facility with a diagnosis of dementia, according to the face sheet in the medical record. Review of the MDS assessment dated [DATE] showed a BIMS summary score of 6, indicating cognitive impairment. Further review showed extensive assistance of two persons for toilet use, and extensive assistance of one person for personal hygiene. A review of the facility map reflected Residents #9, #14, #24, and #29 shared a bathroom. On 11/23/20 at 11:34 a.m. an observation was conducted in Residents' #9, #14, #24, and #29's shared bathroom. The hot water in the bathroom sink was so hot the state surveyor was unable to keep her hand under it. On 11/23/20 at 12:20 p.m. an interview was conducted with the Maintenance Director at the facility. He said he uses a thermometer to check the water temperatures in the bathrooms. If there is a 105878 Page 4 of 6 105878 11/25/2020 Pinellas Point Nursing and Rehab Center 5601 31st St S Saint Petersburg, FL 33712

F 0689 problem he calls a professional servicer to come out. Level of Harm - Minimal harm or potential for actual harm On 11/23/20 at 12:25 p.m. in a follow up interview with the Maintenance Director, he said he checks the water temps (temperature) every Monday, Wednesday, and Friday. Residents Affected - Few On 11/23/20 at 12:28 PM an observation and interview was conducted with the Maintenance Director in the shared bathroom for Residents #9, #14, #24, and #29. After calibrating a thermometer in ice water, the Maintenance Director reported the water temperature should read around 110 to 111 degrees Fahrenheit. The Maintenance Director brought the thermometer into the shared bathroom and placed it under running hot water. The thermometer temperature peaked at 120 degrees Fahrenheit. The Maintenance Director confirmed the thermometer reading was 120 degrees. On 11/23/20 at 12:39 p.m. another interview was conducted with the the Maintenance Director in the boiler room outside of the facility. He said there is a hot water heater with a holding tank. An electrical servicing company provides services to them. The last service was maybe two months ago. Upon observation of the hot water heater system and lines, a blue valve handle was present. The Maintenance Director indicated if he turns the handle clockwise it opens it up more; increasing the temperature, and counter clockwise closes it.; decreasing the water temperature. He said the water is heated and then goes into the holding tank nearby. There wasn't a thermometer present on the holding tank indicating what the temperature was. An immediate audit of all hot water temperatures in resident bathrooms was requested. On 11/23/20 at 1:37 p.m. an interview was conducted with the Nursing Home Administrator (NHA) and the [NAME] President (VP) of Operations. The NHA said 115 degrees was the maximum temperature the water should be. The Maintenance Director checks the water temperatures three times a week. The NHA said older buildings fluctuate that's why we check the temperatures three times a week. We are constantly adjusting the temperatures. The Maintenance Director said he turns it down. The VP of Operations said today (11/23) is the day he checks them, so it could be a problem that cropped up today. If it comes out of the heater at 120 degrees, it's going to mix with cold water. On 11/23/20 at 1:49 p.m. an observation was conducted in the boiler room with the NHA and VP of Operations. There were two thermometers on the lines near the water heater indicting the temperature was 120 degrees Fahrenheit. The NHA said he couldn't confirm the thermometers near the water heater was the temperature setting. He said he doesn't know where the setting is. The NHA said he was happy they were doing the water temperature checks and confirmed he reviews them periodically. The NHA said the Maintenance Director told him if he opens the blue valve handle the water gets hotter and if he closes it the temperature goes down. On 11/23/20 at 1:55 p.m. the VP of Operations said the Maintenance Director was trained by the Area Director who will be here (facility) in the morning. The VP of Operations said there is a mixer on the hot water system. On 11/23/20 at 2:31 p.m. another interview was conducted with the Maintenance Director. He said he turned the temperature down before he completed the audit because the NHA instructed him too. A review of the policy titled, Monitoring Water Temperatures, dated 1/26/16, reflected that there wasn't any indication of what the hot water temperatures should be. Review of the Surveyor Guidance for Hot Water Temperatures from the Florida Agency for Health Care 105878 Page 5 of 6 105878 11/25/2020 Pinellas Point Nursing and Rehab Center 5601 31st St S Saint Petersburg, FL 33712

F 0689 Administration, dated 10/2011 reflected the following: Level of Harm - Minimal harm or potential for actual harm (page 2-3) The following are some regulatory requirements for hot water temperatures in health care facilities (this is not all inclusive): 42 CFR Part 483.470 only requires that water temperature is safe. Residents Affected - Few The temperature setting in the guidance indicated 105-115 degrees was the acceptable range. On 11/24/20 at 8:58 a.m. an additional interview was conducted with the NHA. He confirmed the facility policy didn't indicate a safe water temperature range. He said the maintenance director knows the temperature can't be set higher than 120 degrees. It's supposed to be 105-115 degrees. 105878 Page 6 of 6