Health 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 Page 1 of 4 106008 106008 06/03/2022 Osprey Point Nursing Center 1104 North Main Street Bushnell, FL 33513

F 0677 dated 5/2/2022, 5/8/2022, and 5/16/2022 showed no record documented for nail care. Level of Harm - Minimal harm or potential for actual harm Review of the facility policy and procedures titled Care of Nails revised in on 9/1/2017 reads, Procedure: Perform hand hygiene. Explain procedure to resident and bring the following equipment to resident's bedside: Basin, optional; towel; emery board; orange stick; nail clippers. Residents Affected - Few 106008 Page 2 of 4 106008 06/03/2022 Osprey Point Nursing Center 1104 North Main Street Bushnell, FL 33513

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** Based on observation, interview and record review, the facility failed to ensure a resident who needs respiratory care was provided such care consistent with professional standards of practice for 1 of 3 residents, Resident #6, in a total sample of 31 residents Residents Affected - Few Findings include: During an observation on 5/31/2022 at 9:18 AM, Resident #6 was in bed receiving oxygen at 2.5 liter/minute via concentrator and nasal cannula. During an observation on 6/1/2022 a 9:29 AM, Resident #6 was in bed receiving oxygen at 2.5 liter/minute via concentrator and nasal cannula. During an observation on 6/2/2022 at 8:50 AM, Resident #6 was in bed receiving oxygen at 2.5 liter/minute via concentrator and nasal cannula. During an observation on 6/2/2022 at 2:00 PM, Resident #6 was in bed receiving oxygen at 2.5 liter/minute via concentrator and nasal cannula. 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 the physician order dated 2/15/2021 for Resident #6 reads, Oxygen 2 L/min [liter/minute] via NC [Nasal Cannula] PRN [as needed] as needed related to chronic obstructive pulmonary disease. Review of Resident #6's care plan dated 3/17/2022, reads, Focus: The resident has congestive heart failure . Interventions: . Oxygen setting: O2 [Oxygen] via nasal prongs @ [at] 2 L PRN. During an interview on 6/2/2022 at 2:01 PM, Staff A, Licensed Practical Nurse (LPN), confirmed that Resident #6 oxygen was at 2.5 liter per minute. During an interview on 6/2/2022 at 2:11 PM, the Director of Nursing (DON) confirmed that Resident #6 oxygen was at 2.5 liter per minute. Review of the facility policy and procedures titled Oxygen Therapy revised on 8/28/2017 reads, Procedure: Physician's order for oxygen therapy shall include: Administration modality; FiO2 [Fraction of Inspired Oxygen] or liter flow; Continuous or PRN; PRN orders must include specific guidelines as to when the resident is to use oxygen. 106008 Page 3 of 4 106008 06/03/2022 Osprey Point Nursing Center 1104 North Main Street Bushnell, FL 33513

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on record review and interview, the facility failed to ensure the physician acknowledged and responded to the pharmacist's recommendations for 1 of 5 residents reviewed for unnecessary medications, Resident #10. Findings include: Review of Resident #10's pharmacy consultation report dated 4/14/2022 reads, 1. Prednisone Tablet 5 mg [milligrams], Give 1 tablet by mouth one time a day for inflammation. Recommendation: Please reevaluate continued Prednisone use. Rationale for Recommendation: Long term oral corticosteroid use has been associated with adverse effects (e.g. hyperglycemia, osteoporosis, GI [gastrointestinal] disorders, hypertension, insomnia). The pharmacy consultation report documented the physician/designee had not acknowledged the recommendation from the pharmacist until 6/1/2022. During an interview on 6/2/2022 at 1:02 PM, the Director of Nursing verified the physician/designee had not acknowledged the recommendation made by the pharmacist on 4/14/2022 until 6/1/2022 (48 days after the recommendation). She confirmed the expectation the physician should respond to non-urgent recommendations from the pharmacist within 21 days and should respond to urgent recommendations from the pharmacist immediately. Review of the facility policy and procedures titled Monthly Drug Regimen Review, last reviewed on 1/13/2022, reads, Procedure: . Non-Urgent: Report provided to the attending physician for timely response: Day 1-14 provide recommendation(s) to physician(s) for review and response; Day 15-21 the DON [Director of Nursing]/designee will contact the physician(s) with any outstanding recommendations; if no response from physician notify the Medical Director for further assistance. Urgent recommendation(s) communicated to the physician/center at the time of the consultant pharmacist visit for timely response. 106008 Page 4 of 4