Health inspection·March 23, 2023

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Residents Affected - Few Based on observations, interviews, medical record review, and a review of the facility's policies and procedures, the facility failed to ensure residents who required respiratory care received care consistent with professional standards of practice and their comprehensive care plans, for two (Residents #87 and #76) of three residents reviewed for respiratory care, from a total of 36 residents in the sample. The findings include: 1. An observation of Resident #87 was made on 03/20/23 at 11:59 AM in her room. An oxygen concentrator was in the room and the flow rate (gauge) was set between the 1 and 2 measurement, indicating oxygen was flowing at a rate of 1.5 liters per minute (lpm). (Photographic evidence obtained) Resident #87's nasal cannula was lying on the bed. The resident stated she took it off for a few minutes, becasue it hurt her nose. She stated her oxygen flow rate should be set at 2 lpm. On 03/22/23 at 10:00 AM, Resident #87 was observed in her bed. Her oxygen concentrator was on and her nasal cannula was in place. She was observed with labored breathing as evidenced by the deep rise and fall of her chest. She stated she did not feel well, however denied difficulty breathing. Her oxygen concentrator was set at 1.5 lpm. (Photographic evidence obtained) Resident #87 again reported that her oxygen flow rate should be set at 2 lpm. On 03/22/23 at 1:46 PM and again at 2:28 PM, Resident # 87 was observed with her oxygen in use. Both observations found that the oxygen concentrator was set at 1.5 lpm. (Photographic evidence obtained) A review of Resident #87's medical record found that she was admitted to the facility on [DATE]. She had an annual Minimum Data Set (MDS) assessment, dated 02/05/23, that noted she had a Brief Interview for Mental Status (BIMS) score of 14 out of a possible 15 points, indicating she was cognitively intact. She required limited assistance with activities of daily living. Her diagnoses included, but were not limited to, coronary artery disease, hypertension, asthma/COPD (chronic obstructive pulmonary disease), interstitial pulmonary disease unspecified (a group of disorders that cause lung scarring and affect breathing) and bronchiectasis (a condition in which the lung's airways become damaged). Resident #87 was documented as receiving oxygen while a resident of the facility. Resident #87 was care planned on 02/11/22 for her diagnosis of COPD with a goal to be free from signs and symptoms of respiratory infections through the next review date. Interventions included, but were not limited to, Oxygen (O2) settings: O2 via (nasal cannula) at 2 liters (continuous), Page 1 of 3 105928 105928 03/23/2023 Life Care Center of Orange Park 2145 Kingsley Ave Orange Park, FL 32073

F 0695 humidified. (Photographic evidence obtained) Level of Harm - Minimal harm or potential for actual harm A review of Resident #87's March 2023 Medication Administration Record (MAR) found oxygen was signed off as having been provided at 2 lpm every shift. Residents Affected - Few Certified Nursing Assistant (CNA) B was interviewed on 03/22/23 at 2:34 PM. He stated Resident #87 did use oxygen, but only a nurse could set the flow rate. Every time a CNA checked it and found the flow rate setting to be inaccurate, they informed the nurse. Nurses let the CNAs know the appropriate oxygen settings for each individual resident who was receiving oxygen. Licensed Practical Nurse (LPN) D was interviewed on 03/23/23 at 9:37 AM. He stated Resident #87 was on continuous oxygen and would take it off and replace the cannula independently. Nurses adjusted her oxygen levels and she was receiving oxygen at 2 lpm. She did sometimes experience shortness of breath but also had anxiety. He was asked to check the flow rate setting of her concentrator, which he did on 03/23/2023 at 10:05 AM. The flow rate was set between 1.5 and 2 lpm. (Photographic evidence obtained) LPN D stated the ball in the gauge should be right in the middle of the 2 on the gauge, indicating the flow rate was 2 lpm. He was shown the photos of prior observations. He reviewed the photos and said, No, that is not 2 liters. He stated he adjusted her concentrator to 2 lpm this morning but the ball dropped to where it currently was. He thought the gauge needed to be fixed. In an interview with the Unit Manager on 03/23/23 at 11:06 AM, she was asked how the gauge should look if oxygen was flowing at 2 lpm. She demonstrated using her fingers that the ball should be right in the middle of the 2 liter line. When shown the photos of Resident #87's oxygen flow rate setting, she confirmed that they were not reflective of 2 lpm settings. A review of the facility's policy titled Administration of Medications (issued 04/24/19, reviewed 08/25/22 and revised 02/13/23) found it stated it was the facility's policy to ensure medications were administered safely and appriopriately per the physician's orders to address residents' diagnoses and signs and symptoms. Under the section titled Procedure, it stated under section B: Staff who are responsible for medication administration will adhere to the 10 Rights of Medication Administration. Subsection 1. Reference the Right Drug and subsection 3., the Right Dose. (Photographic evidence obtained) 2. During a tour of the facility on 03/20/23 at 12:55 PM, Resident #76 was observed sitting in her wheelchair at the side of her bed wearing a nasal cannula. Her oxygen concentrator, located at bedside, was observed with the flow rate set at 3.5 lpm. (Photographic evidence obtained) On 03/21/23 at 10:22 AM, another observation of Resident #76's oxygen concentrator revealed it was set to 3.0 lpm. (Photographic evidence obtained) A review of Resident #76's physician's order, dated 4/12/22, revealed she was to receive oxygen at 2 lpm via nasal cannula, as needed, for shortness of breath. (Copy obtained) On 03/22/23 at 8:49 AM, another observation of Resident #76's oxygen concentrator revealed it was set at 3.0 lpm. (Photographic evidence obtained) A review of Resident#76's medical record revealed she was admitted into the facility on [DATE] and then readmitted on [DATE]. Her diagnoses included congestive heart failure; respiratory failure, unspecified with hypoxia; respiratory failure, unspecified with hypercapnia; type 2 diabetes mellitus 105928 Page 2 of 3 105928 03/23/2023 Life Care Center of Orange Park 2145 Kingsley Ave Orange Park, FL 32073

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with diabetic chronic kidney disease; pleural effusion; hypertensive heart disease with heart failure; cognitive/communicative deficit; dysphagia, and dependence on supplemental oxygen. A review of the March 2023 Medication Administration Record (MAR) revealed oxygen at 2 lpm via nasal cannula as needed for shortness of breath had no nursing initials indicating the oxygen was provided per the order. (Copy obtained) A review of the quarterly Minimum Data Set (MDS) assessment, dated 03/07/23, revealed that Resident #76 had a Brief Interview for Mental Status (BIMS) score of 10 out of a possible 15 points, indicating moderate cognitive impairment. The assessment also documented that she was receiving oxygen therapy. A review of Resident #76's care plan, dated 08/06/21, revealed she had oxygen therapy related to congestive heart failure, recent respiratory failure, and perceived Shortness of Breath (SOB). Interventions included: Change resident's position every 2 hours to facilitate lung secretion movement and drainage. Encourage or assist with ambulation as indicated. Give medications as ordered by physician. Oxygen settings: Oxygen at 2 liters via nasal cannula, continuous, humidified to maintain sats (blood oxygen level) >92%. On 03/22/23 at 8:53 AM, LPN A confirmed that the oxygen concentrator for Resident #76 was set to administer oxygen at 3.5 lpm. LPN A confirmed that Resident #76's physician's order was for an oxygen flow rate of 2 lpm. LPN A reported that nursing was responsible for ongoing monitoring of oxygen therapy, ensuring the resident was provided the correct oxygen flow rate per the order, as well as weekly tubing changes. Correct oxygen settings were identified in the MAR. Correct oxygen settings were communicated from one staff person to another in report during shift change or by checking the MAR. On 03/22/23 at 9:20 AM, the Director of Nursing (DON) confirmed that correct oxygen settings were identified by nurses in the Electronic Medical Record (EMR). Night shift nursing staff were responsible for weekly tubing changes, every 7 days on Wednesdays. A review of the facility's policy and procedure titled Oxygen Administration/Safety/Storage/Maintenance (dated: 12/03/22), revealed: Oxygen will be administered in accordance with physicians' orders and current standards of practice. (Copy obtained) . 105928 Page 3 of 3