Health inspection·October 2, 2020

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and medical record review, the facility failed to honor the choice and desire for showers for four (Residents # 22, 36, 7, and 41) of five residents sampled for activities of daily living (ADLs) out of a total sample of 29 residents. Findings included: 1. Record review revealed Resident #22 was re-admitted to the facility on [DATE] with diagnoses that included COVID -19, pneumonia, generalized muscle weakness and epilepsy. The Minimum Data Set (MDS) assessment dated [DATE], showed a Brief Interview of Mental Status (BIMS) score of 13 (indicating cognitively intact). Review of Section E: Behavior: revealed that Resident #22 did not exhibit physical or verbal behavioral symptoms or rejection of care. Section F: Interview for Daily Preferences: was coded with the numeral 1, which indicated it was very important to the resident to choose between a tub bath, shower, bed bath or sponge bath. Section G: Functional Status: indicated the resident needed one person physical help with part of the bathing activity. During an observation of Resident #22 on 9/29/20 at 10:30 a.m., the resident was lying in bed with the bedside table over his bed. He stated Well, I've been a resident here for about 8 years. They do come and offer sponge baths, but I've been asking for a shower. I haven't had a shower in over 2 months. The aides told me that I couldn't have a shower because of the virus. But it would feel good to be under some running water. Those sponge baths really don't do much. Review of Resident #22's physician's orders from August and September 2020 revealed no orders to avoid showering the resident. His care plan, initiated on 8/12/2020, revealed that Resident #22 had a self-care deficit requiring daily extensive to total assistance with ADLs and more specifically, that he needed extensive assistance with showers. Nursing progress notes from August through September 2020 were reviewed and revealed that the resident was alert and oriented and able to make his needs known. Nursing progress notes revealed that total care was rendered for the resident. No progress notes indicated refusal of care, and the notes did not indicate that any showers were given. Review of the CNA Flow Sheet for August 2020 revealed that Resident #22 received 2 showers in the month of August; a shower on 8/24/2020 (day shift) and on 8/29/2020 (evening shift). There was no CNA flow sheet for the month of September 2020 in the ADL logbook, and the facility was unable to provide one. The September 2020 shower list sheet for Resident #22's hall revealed that the resident did not receive a shower in September. 2. Record review revealed Resident #36 was re-admitted to the facility in March of 2020 with Page 1 of 5 105891 105891 10/02/2020 Ybor City Center for Rehabilitation and Healing 1709 Taliaferro Ave Tampa, FL 33602

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some diagnoses that included generalized muscle weakness, cerebrovascular disease and cerebral infarction. The Minimum Data Set (MDS) assessment dated [DATE], showed a Brief Interview of Mental Status (BIMS) score of 11 (indicating moderate cognitive impairment). Review of Section E: Behavior: revealed that Resident #36 did not exhibit physical or verbal behavioral symptoms or rejection of care. Section F: Interview for Daily Preferences: was coded with the numeral 1, which indicated it was very important to the resident to choose between a tub bath, shower, bed bath or sponge bath. Section G: Functional Status: indicated the resident needed one person total assistance with bathing. During an observation of Resident #36 on 10/01/20 at 11:30 a.m., the resident was sitting in his wheelchair next to his bed. His responses were slow. He was asked if he had a shower recently. He shook his head no. He said, no showers. When asked if he could remember when his last shower was given, he shook his head indicating no and said, long time ago. When asked if he liked showers or bed baths, Resident #36 said showers. Review of Resident #36's physician's orders from August and September 2020 revealed no orders to avoid showering the resident. His care plan, initiated on 3/03/2020, revealed that Resident #36 had a self-care deficit requiring daily extensive to total assistance with ADLs including bathing. His care plan also included interventions for verbal aggression/behaviors, but these were related to the resident wanting to be helped out of bed at his preferred times. Nursing progress notes from August through September 2020 were reviewed and revealed that the resident was alert and oriented and able to make his needs known. No progress notes indicated refusal of care, and they did not indicate that any showers were given. Review of the CNA Flow Sheet for September 2020 and the September 2020 shower list sheet for Resident #36's revealed that Resident #36 only received 1 shower for the whole month; otherwise only bed baths and sponge baths were given. The facility did not provide the CNA flow sheet for the month of August 2020. 3. Record review revealed Resident #7 was re-admitted to the facility in mid August 2020 with diagnoses that included generalized muscle weakness, acute respiratory failure, osteoarthritis of knee, morbid obesity and fibromyalgia. The Minimum Data Set (MDS) assessment dated [DATE], showed a Brief Interview of Mental Status (BIMS) score of 15 (indicating cognitively intact). Review of Section E: Behavior: revealed that Resident # 7 did not exhibit physical or verbal behavioral symptoms or rejection of care. Section F: Interview for Daily Preferences: was coded with the numeral 1, which indicated it was very important to the resident to choose between a tub bath, shower, bed bath or sponge bath. Section G: Functional Status: indicated the resident needed one person total assistance with bathing. During an observation of Resident #7 on 9/29/20 at 10 a.m., the resident was sitting up in her bariatric bed. She was asked if she had a shower recently. Resident #7 stated Well, no. I haven't had a shower in about 2 months, only sponge baths. I was told by the staff that I could only have a sponge bath due to the virus. I asked them for a shower several times. I hope I will be able to take a shower soon. You know, a sponge bath is not the same as having a shower. I don't feel clean. Review of Resident #7's physician's orders from August and September 2020 revealed there were no orders to avoid showering the resident. Her care plan, initiated on 2/18/2020, revealed that Resident #7 had a self-care deficit requiring daily total assistance with ADLs including bathing. Nursing progress notes from August through September 2020 were reviewed and revealed that the resident was alert and oriented and able to make her needs known. Progress notes did not indicate there was refusal 105891 Page 2 of 5 105891 10/02/2020 Ybor City Center for Rehabilitation and Healing 1709 Taliaferro Ave Tampa, FL 33602

F 0561 of care, and they did not indicate that any showers were given. Level of Harm - Minimal harm or potential for actual harm Review of the CNA Flow Sheet for September 2020 revealed that Resident #7 did not receive a shower for the whole month; only bed baths and sponge baths were given. The facility did not provide the CNA flow sheet for the month of August 2020. Review of the August and September 2020 shower list sheet for Resident #7's hall revealed that no showers were given to this resident. Residents Affected - Some 4. Record review revealed Resident #41 was admitted to the facility in September of 2019 with diagnoses that included generalized muscle weakness, peripheral vascular disease and abnormal posture. The Minimum Data Set (MDS) assessment dated [DATE], showed a Brief Interview of Mental Status (BIMS) score of 12 (indicating moderate cognitive impairment). Review of Section E: Behavior: revealed that Resident #41 did not exhibit physical or verbal behavioral symptoms or rejection of care. Section F: Interview for Daily Preferences: was coded with the numeral 1, which indicated it was very important to the resident to choose between a tub bath, shower, bed bath or sponge bath. Section G: Functional Status: indicated the resident needed one person total assistance with bathing. During an observation of Resident #41 on 9/29/20 at 11:00 a.m., the resident was sitting in her wheelchair next to her bed. She was looking for something in one of the drawers of her nightstand. She was asked about bathing. Resident #41 said I used to get showers. I haven't had a shower in a very long time. They just bring me a wet washcloth and I clean the important areas. I was told that no one could have a shower because of the illness, you know, the virus. I told them I prefer showers. Review of Resident #41's physician's orders from August and September 2020 revealed there were no orders to avoid showering the resident. Her care plan, initiated on 9/19/2020, revealed that Resident #41 had a self-care deficit requiring daily extensive to total assistance with ADLs including total assistance with showers per schedule. Nursing progress notes from August through September 2020 were reviewed and revealed that the resident was alert and oriented and able to make her needs known. Progress notes did not indicate refusal of care, and they did not indicate that any showers were given. Review of the CNA Flow Sheet for September 2020 revealed that Resident #41 did not receive a shower for the whole month; only bed baths and sponge baths were given. The facility did not provide the CNA flow sheet for the month of August 2020. Review of the August and September 2020 shower list sheet for Resident #7's hall revealed that the resident did not receive a shower during these months. Review of the Shower List Sheet for the hall of Resident #22, #6, #7, and #41 revealed the following instructions on the bottom of the sheet: CNA's are to do showers as scheduled. Make sure to sign after each shower is given. Please notify the nurse immediately if the resident refuses. Nurses, these are to be turned in daily to the DON. Each sheet was dated at the top. Review of these shower sheets for 13 days (8/2/20, 8/5, 8/21, 9/3, 9/7, 9/11, 9/14, 9/18, 9/25, 9/28 and 9/29/20) revealed that only a very small percentage of residents received a shower in the months of August and September 2020. An interview was conducted on 10/1/20 at 10:45 a.m. with Staff F, a Certified Nursing Assistant (CNA). Staff F stated There was a period over the last few months that we couldn't give the residents showers. I was told during CNA report that because of the COVID 19 virus, we couldn't take residents to the shower rooms in the main hall by the entrance (300 hall). That was where most residents were taken for showers. So, we were giving the residents bed baths/sponge baths instead. When asked if residents in the 400 hall had showers in their own rooms, Staff F said Yes, most do, but those showers 105891 Page 3 of 5 105891 10/02/2020 Ybor City Center for Rehabilitation and Healing 1709 Taliaferro Ave Tampa, FL 33602

F 0561 Level of Harm - Minimal harm or potential for actual harm are in a tight space, and the toilet sticks out and makes it difficult to transfer residents from the wheelchair into the shower chair. So, we were taking them to the main hall showers. There is only one room on the 400 hall, room [ROOM NUMBER], which has a wider space to accommodate the wheelchairs, but they are all male residents in that room, and we can't take female residents in there to take showers. When asked if the administration was aware of this issue with showers, Staff F nodded yes. Residents Affected - Some An interview was conducted on 10/1/20 at 1:40 p.m. with Staff E, a Licensed Practical Nurse (LPN) on the 400 Hall. He confirmed that the CNA documents the showers or baths on the CNA flow sheet and on the shower list sheets. He confirmed that he turned in the shower sheets daily to the DON. He was asked what he knew about showers not being given to the residents on the 400 hall. Staff E stated If you heard that showers were not given on this hall due to the COVID virus, then that is what happened. There were a lot of residents being transferred back and forth from the COVID hall to this hall. So, it was hard to keep up with their shower schedules. There was a risk of transferring these residents to the other hall because of the isolation for COVID. An interview regarding showers was conducted on 10/1/20 at 4:45 p.m. with Staff G (an LPN), and Staff H (a CNA), from the evening shift. Staff G confirmed that the shower sheets are given to the DON. Staff G stated I can only speak for the 3-11 p.m. shift. I never heard that residents couldn't have showers because of the COVID virus. That doesn't make any sense. I do agree that the showers in most of these rooms on the 400 hall are set up in such small spaces, that it is difficult to maneuver with the wheelchair around the toilet. Staff H said Yes, but it can be done. We just use the sit to stand lift and manipulate the lift to get them into the shower chair that's in the shower. I wasn't told that showers can't be given because of COVID-19. All my people get taken care of, that's all I can say. If the residents refuse, we tell the nurse and they document it. A interview was conducted with the Assistant Director of Nursing (ADON/Infection Preventionist) on 10/1/20 at 5 p.m. She was asked if there had been a restriction on showers. The ADON shook her head no, and the surveyor disclosed that a few staff had mentioned that showers were restricted due to the virus. The ADON then stated, Yes, we did stop showers because we were being cautious, and we didn't want the COVID to spread. An interview was conducted regarding showers with the Director of Nursing (DON) and the ADON on 10/2/20 at 1 p.m. Two surveyors were present. The DON stated At the end of July, we had a huge outbreak and about 13 residents were positive for COVID 19 and at least 6 staff were positive. We did tell staff not to give showers for the months of August and September because of the safety issues. We weren't sure of how it spread, if it was airborne or not. We didn't want them being transferred from the 400 hall to the main hall for showers. The DON was asked if there were any showers in the rooms on the 400 hall. The DON stated No. After the surveyor disclosed that she had observed showers in at least 2 rooms on the 400 hall, the DON said Oh yes, I'm sorry, I forgot. Some rooms do have their own showers on the 400 hall. When asked why residents were not given showers in their own rooms or in the 400 hall, the DON stated, We thought the showers in the rooms were small spaces and we didn't want the virus to spread rapidly in these small spaces. The DON was asked how shower schedules were determined. The DON stated when the resident gets admitted , we ask them about their preferences, like on what 3 days they want to be showered and on what shift. That is put on the Shower list sheet. The CNA must sign that and the CNA flow sheet in the ADL logbook. If the resident refuses a shower, the CNA must tell the nurse, and the nurse must go and encourage the resident to comply. The nurse is expected to document this in the progress notes and document the outcome. On the Shower List sheet or the CNA flow sheet, they are supposed to mark R for refused. I do get a copy of the shower list sheet with signatures at the end of each shift, submitted by the nurse. 105891 Page 4 of 5 105891 10/02/2020 Ybor City Center for Rehabilitation and Healing 1709 Taliaferro Ave Tampa, FL 33602

F 0561 The DON was asked for a policy regarding completion of ADL tasks or honoring resident preferences regarding daily activities/tasks. The facility was unable to provide a policy regarding these issues. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 105891 Page 5 of 5