Inspection·June 3, 2022

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, interview, and record review, the facility failed to ensure a resident who is unable to carry out activities of daily living received the necessary services to maintain good personal hygiene for 1 of 3 sampled residents, Resident #6, in a total sample of 31 residents. Residents Affected - Few Findings include: During an observation on 6/1/2022 at 9:18 AM, Resident #6 was in bed eating breakfast. Resident #6's fingernails were untrimmed, jagged and dirty (Photographic evidence obtained). During an interview on 6/1/20 22 at 9:20 AM, Resident #6 stated, I would like my fingernail trimmed. During an observation on 6/2/2022 at 1:44 PM, Resident #6 was had fingernails untrimmed, jagged and dirty. During an interview on 6/2/2022 at 2:01 PM, Staff A, Licensed Practical Nurse (LPN), confirmed that Resident #6's fingernails were untrimmed, jagged and dirty. During an interview on 6/2/2022 at 2:11 PM, the Director of Nursing confirmed that Resident #6's fingernails were untrimmed, jagged and dirty. Review of Resident #6's admission records revealed the resident was initially admitted on [DATE] and readmitted on [DATE] with diagnoses that included chronic obstructive pulmonary disease, unspecified cerebral infarction, cerebral infraction, other lack of coordination, need for assistance with personal care, cognitive communication deficit. Review of Resident #6's Minimum Data Set (MDS) dated [DATE], reads, Section G- Functional Status. G0110. Activities of Daily Living (ADL) Assistance. J. Personal Hygiene: 1. Self-performance: 3. Extensive Assistance. Support: 3. Two + persons physical assist. Review of Resident #6's care plan dated 3/17/2022 reads, [Resident #6's name] has an ADL self-care performance deficit r/t [related to] impaired mobility, weakness, self limiting behavior . Interventions: . Bathing/Showering: Check nail length and trim and clean on bath day and as necessary. Report any changes to the nurse. Record of CNA (Certified Nursing Assistant) Bath Sheets dated 4/14/2022, 4/21/2022, 5/14/2022, 5/18/2022, and 5/28/2022 for Resident #6 showed the resident did not receive nail care. Bath sheets (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 106008 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106008 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Osprey Point Nursing Center 1104 North Main Street Bushnell, FL 33513 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)