Health inspection·February 22, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interview, the facility failed to maintain a safe and clean environment for 7 of 62 occupied rooms. (Rooms 314, 316, 404, 405, 407, 409, 411) The findings include: On 2/19/24 at 12:30 PM, during the initial tour of the facility, the following environmental issues were observed: In occupied room [ROOM NUMBER], a rusted toilet seat riser was in use inside the bathroom. In occupied room [ROOM NUMBER], the drawer and armoire had layers of paint peeling. In occupied room [ROOM NUMBER], a brown substance was observed on the wall. In occupied room [ROOM NUMBER], the dresser and armoire had peeled off layers of paint and there was a hole on the wall. In occupied room [ROOM NUMBER], the wall and ceiling had bubbled paint and a water-like stain around the ceiling and air conditioning unit. In occupied room [ROOM NUMBER], there was paint peeling on the wall and the toilet seat riser inside the bathroom was rusted. In occupied room [ROOM NUMBER], there was a rusted toilet seat riser inside the bathroom. (Photographic evidence was obtained of all above issues) On 2/22/24 at 10:15 AM, a follow up tour was conducted with the Maintenance Director. He stated the toilet seat risers in rooms 314, 409 and 411 will be replaced with new ones. He further stated the peeling layers on the furniture on room [ROOM NUMBER] will be fixed and the hole on the wall repatched and paint over, as well as the brown-colored stain on room [ROOM NUMBER] will be cleaned and painted over. Upon looking at the bubbled paint on rooms [ROOM NUMBERS], he stated the facility will need to investigate the cause of it and will make some repairs. Page 1 of 2 105970 105970 02/22/2024 Marianna Nursing and Care Center 2600 Forest Glen Trail Marianna, FL 32446

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Based on observations, staff interviews, and resident record review, the facility failed to implement and follow the recommendations of the Registered Dietician (RD) for 1 of 1 residents sampled for enteral feeding. (Resident #64) The findings include: On 02/21/24 at 9:05 AM, an interview with Staff B, a Licensed Practice Nurse (LPN), was conducted. Staff B stated that Resident #64's used to receive continuous enteral feeding (24 hours a day). She stated the enteral feeding was changed some time in January 2024. Resident #64's Treatment Administration Record (TAR) was reviewed with Staff B. The TAR revealed, on 01/11/2024, an entry for Jevity 1.5 (a nutritional supplement) to be infused at 65 ml/hr for 20 hours a day (to be discontinued between 10:00 am and 2:00 pm). This order was confirmed with Staff B. On 02/21/24 at 9:57 AM, an interview was conducted with Staff A, a licensed practical nurse (LPN) and unit manager. Staff Member A stated that the tube feeding is now scheduled to run at 22 continuous hours per day. Staff Member A then accessed Resident #64's electronic medical record (EMR) and realized the resident's enteral feeding was ordered for 20 hours per day. Staff Member A stated she must have confused the continuous feed with another resident. On 02/21/24 at 10:00 AM, an additional review of Resident #64's EMR revealed a dietary progress notes from the RD dated 02/06/2024, which identified the resident to be overweight / borderline obese with a BMI (body mass index) higher than desired for a bed bound and tube fed resident. The resident's current weight was documented at 174 pounds with a BMI of 29.9. The RD estimated the resident's nutritional needs, based on current weight adjustment, and documented a target weight of 133 lbs. The RD's recommendations indicated to decrease Jevity rate to 55 mL/hr and change water flush to 45 mL/hr. Weekly weights for 3 weeks and draw CMP (Comprehensive Metabolic Panel - lab work). Additional review of the record revealed a failure to identify the completion of weekly weights and failed to include the results of a CMP. On 02/21/24 at 10:39 AM, Resident #64 was observed in bed in high position with a tube feed infusing at 65 ml/hr. On 02/22/24 at 10:13 AM, a follow-up interview was conducted with Staff B, LPN, to inquire about the procedure for new dietitian recommendations. Staff B indicated that when the dietitian made recommendations, these were communicated to the unit manager who processed them from there. Staff B, LPN was unsure of the entire process as she was not involved in that part. On 02/22/24 at 10:20 AM, a follow-up interview was conducted with Staff A, LPN, to clarify the process when new recommendations were received from the dietitian. Staff A indicated that the dietitian emailed the Interdisciplinary team (IDT), which included upper management. The unit manager on the applicable unit would then take the recommendations to the provider for orders, and the unit manager would then put the new orders in the EMR. She acknowledged that the current dietitan recommendations did not match the current order. 105970 Page 2 of 2