Health inspection·November 30, 2023

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview the facility failed to ensure resident assessments accurately reflected the resident's status for 2 residents, (Resident #17 and Resident #19), of 5 residents reviewed for restraints and unnecessary medications. Residents Affected - Few Findings include: 1. Review of Resident #17's minimum data set assessment, dated 10/11/2023, documented under Section P titled Restraints and Alarms physical restraints in the form of bed rails were used daily. Review of Resident #17's care plan, revised on 11/19/2020, documented BED MOBILITY: The resident uses bilateral ¼ side rails to maximize independence with turning and repositioning in bed. Review of Resident #17's physician's order dated 2/13/2023 documented Bilateral ¼ side rails as enablers, and order dated 5/14/2022 documented 1/4 side rails x 2 while in bed for positioning, mobility and sense of security. Both physician's orders appeared on the Order Summary Report dated Active Orders As Of: 11/29/2023. 2. Review of Resident #19's minimum data set assessment, dated 10/13/2023, documented under Section P titled Restraints and Alarms physical restraints in the form of bed rails were used daily. Review of Resident #19's care plan, revision on 1/24/2022, SIDE RAILS: ¼ SR [side rail] when in bed as enablers for increased independence with bed mobility. Review Resident #19's physician's order dated 2/13/2023 documented Bilateral ¼ side rails as enablers. During an interview on 11/29/2023 at 7:59 AM, Staff B (Registered Nurse) stated [Resident #17's Name and Resident #19's Name] bed rails were used as enablers during turning. They [Resident #17 and Resident #19] could not get out of bed without assistance and the bed rails help them with mobility. They were not restrained in any way by the bed rails. During an interview on 11/29/2023 at 8:06 AM, the Minimum Data Set Coordinator agreed the bedrails were not used to restrain [Resident #17's Name and Resident #19's Name]. He stated [Resident #17's Name and Resident #19's Name] minimum data set assessments had been coded incorrectly. Page 1 of 8 106008 106008 11/30/2023 Osprey Point Nursing Center 1104 North Main Street Bushnell, FL 33513

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Based on interview and record review, the facility failed to ensure residents with newly evident or possible serious mental disorder, intellectual disability, or a related condition were reviewed for level II pre-admission screening and resident review (PASARR) for 1 of 3 residents. (Resident #19) Findings include: Review of Resident #19's most recent PASARR Level l, dated 9/6/2021, documented Resident #19 as having no diagnosis or suspicion of serious mental illness or intellectual disability. Review of Resident #19's admission record documented Resident #19 was later diagnosed with unspecified psychosis not due to a substance or known physiological condition, onset date: 1/20/22. Review of Resident #19's psychiatry subsequent note, date of service 11/17/2023, documented chief psychiatric complaints included Parkinson's psychosis. Review of Resident #19's clinical records failed to reveal documentation that the resident was referred to the appropriate state designated authority for a Level II evaluation and determination following the identification of a newly evident or possible serious mental disorder. During an interview on 11/28/2023 beginning at 1:50 PM, the Director of Nursing stated the facility did not have documentation Resident #19's Level I PASARR had been revised to show the new diagnosis of unspecified psychosis and to initiate a Level II PASARR screening. 106008 Page 2 of 8 106008 11/30/2023 Osprey Point Nursing Center 1104 North Main Street Bushnell, FL 33513

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 provide treatment and care in accordance with professional standards of practice for 2 of 3 residents reviewed for intravenous infusion and wound care (Resident #48 and #35). Residents Affected - Some Findings include: 1. During an observation on 11/28/23 at 7:45 AM of Resident #48's peripherally inserted central catheter (PICC) line dressing revealed was not dated, there was no gauze or bio-patch, and the stabilizer is observed outside of the transparent dressing. The PICC line had residue, there was a kink in the catheter and the insertion site had bloody leakage (photographic evidence). During an interview on 11/28/23 at 7:45 AM, Resident #48 stated My PICC line has been in since October 21st; I finished my antibiotics yesterday. Yesterday, the nurse taped the bandage because she told me it was probably coming out soon. No one has said anything to me about removing it before I go home. Review of the electronic medical record for Resident #48 documented an admission date of 10/26/23, with a pertinent diagnosis of chronic osteomyelitis of left ankle and foot, chronic ulcer of left foot, and diabetes. The PICC line was placed on 10/21/23 during the hospitalization prior to being admitted to facility. Review of the prescription from the hospital dated 10/23/23 reads Vancomycin HCI (Hydrochloride) 1 g (gram) Intravenous Solution Reconstituted. Inject 1 (one) g into the vein every 12 hours for 35 days. End date of [DATE]. Review of the Medical Certification For Medicaid Long-Term Care Services and Patient Transfer Form [commonly known as the 3008], Resident #48 arrived at the facility with PICC line noted in the left arm and the date inserted was 10/21/23. Review of the physician's order dated 10/31/23 for Resident #48 reads IV's (Intravenous): Evaluate site for leakage/bleeding/signs of infection every shift. Review of Treatment Administration Record (TAR) for the period of 11/1/23 through 11/30/23 read, IV's: Evaluate site for leakage/bleeding/signs of infection every shift. There was no documentation on November 1, November 16, and November 17 by the nurse indicating the evaluation was completed. Review of the physician's order dated 11/1/23 for Resident #48 read, Change PICC line dressing every week on Wednesday night shift. Review of the physician's order dated 10/31/23 for Resident #48 read, Change dressing on admission or 24 hours after insertion and weekly thereafter and PRN (as needed). Review of the physician's order dated 11/1/23 for Resident #48 read, PICC or MIDLINE: Measure upper arm circumference and external catheter length on admission, with each dressing change and PRN, every night shift, every Wednesday, for PICC line dressing change. 106008 Page 3 of 8 106008 11/30/2023 Osprey Point Nursing Center 1104 North Main Street Bushnell, FL 33513

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Medication Administration Record (MAR) for the period of 11/1/23 through 11/30/23 read, PICC or MIDLINE: Measure upper arm circumference and external catheter length on admission, with each dressing change and PRN, every night shift, every Wednesday, for PICC line dressing change. There was no circumference and length documented on November 8 and November 21 and on November 15, there was no documentation of circumference, length or dressing change documented by the nurse to indicate if the measurements were completed. During an interview on 11/28/23 at 9:00 AM Staff A, Licensed Practical Nurse (LPN) stated, The dressing should be dated and initialed. I did look at it, but I didn't look at it closely. I looked at the dressing through the mesh. During an interview on 11/28/23 at 9:10 AM the Director of Nursing (DON) stated, This is not acceptable. It should have been a full dressing change regardless of whether the PICC line was supposed to be removed or not. My expectation is for the nurses to change the dressing weekly or when soiled or dislodged completely. During an interview on 11/29/23 at 11:18 AM the Medical Director observed the photographic evidence and stated, I see the kink and the site looks like it has some irritation. The Medical Director stated that he expected the PICC line to be better dressed and this was an opportunity to do better. Review of the policy titled Central Vascular Access Device (CVAD) Dressing Change, revision date 6/1/21 reads Application. Licensed Nurses Providing Infusion Therapy in the Post-Acute Care Facility. Considerations: 2. The catheter insertion site is potentially entry site for bacteria that may cause a catheter related infection. Procedure.16. Apply transparent dressing, covering catheter insertion site and securement device, if applicable, according to manufacturer's instructions. Smooth around the catheter starting at the insertion site and moving periphery. 23. Label dressing with: 23.1 Date end time. 23.2 Nurse's initials. 24. Document in the medical record includes, but is not limited to: 24.1 Date and time. 24.2 Site assessment. 24.3 Length of external catheter. 24.4 Arm circumference. 24.5 Reason for dressing change. 24.6 Patient response to procedure. 24.7 Patients/significant other teaching. 2. On 11/29/23 at 1:45 PM, an observation of wound care for Resident #35, with Staff B Registered Nurse (RN) was completed. Staff B, RN was observed to start wound care without washing her hands and donned clean gloves. Staff B, RN was observed to remove the old dressing from the resident wound and proceed to clean the wound without removing the soiled gloves. Staff B, RN was observed to clean the wound perimeter and move towards the center of wound wiping the area several times folding over the gauze repeating the move. Staff B, RN was observed to continue to scrub wound in the same direction towards the center using a new gauze several times rather than discarding after each pass. Staff B, RN was observed to remove the soiled gloves and don clean gloves without performing hand hygiene. Staff B, RN was observed to apply med honey and calcium alginate and cover with a foam bordered dressing, remove gloves, discard unused supplies, and leave the room without performing hand hygiene. During an interview on 11/29/23 at 1:55 PM Staff B, RN stated The way I scrubbed the wound repeatedly was not good and I did not perform hand hygiene. During an interview on 11/29/23 at 02:04 PM, the Director of Nursing (DON) stated, That is something every nurse should know. The wound should be cleaned from the center out. My expectation is for all the nurses that do wound care, change gloves and wash/sanitize their hands. 106008 Page 4 of 8 106008 11/30/2023 Osprey Point Nursing Center 1104 North Main Street Bushnell, FL 33513

F 0684 Level of Harm - Minimal harm or potential for actual harm Review of the policy and procedure titled Dressing, Dry/Clean, revised September 2013 read, Level III. Purpose. The purpose of this procedure is to provide guidelines for the application of dry, clean dressings. Steps in the Procedure. 15. Cleanse the wound with ordered cleanser. If using gauze, use clean gauze for each cleansing stroke. Clean from the least contaminated area to the most contaminated area (usually, from the center outward). Residents Affected - Some 106008 Page 5 of 8 106008 11/30/2023 Osprey Point Nursing Center 1104 North Main Street Bushnell, FL 33513

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, interview and record review the facility failed to ensure nurse staffing information was posted on a daily basis for 1 of 4 days. Residents Affected - Many Findings include: On Monday, 11/27/2023 at 9:05 AM, observation of the posted nurse staffing information revealed the daily nurse staffing information had not been posted since Tuesday, 11/21/2023. During an interview on 11/27/2023 at 9:25 AM, the Director of Nursing stated the Staffing Coordinator was responsible for updating the nurse staffing information. During an interview on 11/28/2023 at 7:51 AM, the Administrator reported the Staffing Coordinator had completed the nurse staffing information, but the staff assigned to post the nurse staffing information had forgotten to post the staffing information sheets. During an interview on 11/28/2023 at 11:43 AM, the Administrator reported the facility did not have a policy related to posting nurse staffing information but was aware the nurse staffing information should have been posted. 106008 Page 6 of 8 106008 11/30/2023 Osprey Point Nursing Center 1104 North Main Street Bushnell, FL 33513

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on interview and record review the facility failed to maintain resident medical records that were accurately documented and complete for 1 of 3 residents reviewed for intravenous infusion and wound care (Resident #48). Findings include: Review of the physician's order dated 10/31/23 for Resident #48 reads IV's (Intravenous): Evaluate site for leakage/bleeding/signs of infection every shift. Review of Treatment Administration Record (TAR) for the period of 11/1/23 through 11/30/23 read, IV's: Evaluate site for leakage/bleeding/signs of infection every shift. There was no documentation on November 1, November 16, and November 17 by the nurse indicating the evaluation was completed. Review of the physician's order dated 11/1/23 for Resident #48 read, Change PICC line dressing every week on Wednesday night shift. Review of the physician's order dated 10/31/23 for Resident #48 read, Change dressing on admission or 24 hours after insertion and weekly thereafter and PRN (as needed). Review of the physician's order dated 11/1/23 for Resident #48 read, PICC or MIDLINE: Measure upper arm circumference and external catheter length on admission, with each dressing change and PRN, every night shift, every Wednesday, for PICC line dressing change. Review of Medication Administration Record (MAR) for the period of 11/1/23 through 11/30/23 read, PICC or MIDLINE: Measure upper arm circumference and external catheter length on admission, with each dressing change and PRN, every night shift, every Wednesday, for PICC line dressing change. There was no circumference and length documented on November 8 and November 21 and on November 15, there was no documentation of circumference, length or dressing change documented by the nurse to indicate if the measurements were completed. During an interview on 11/28/23 at 12:00 PM, the Director of Nursing (DON) stated, I don't see where the documentation was done on the circumference and length of catheter on November 8th and November 21st. I see on the 15th [of November] they missed all the circumference, length of catheter and dressing change. My expectation is for nurses to follow the doctor's orders. Review of the policy titled Central Vascular Access Device (CVAD) Dressing Change, revision date 6/1/21 reads Application. Licensed Nurses Providing Infusion Therapy in the Post-Acute Care Facility. Procedure. 24. Documentation in the medical record includes, but is not limited to: 24.1 Date and time. 24.2 Site assessment. 24.3 Length of external catheter. 24.4 Arm circumference. 24.5 Reason for dressing change. 24.6 Patient response to procedure. 24.7 Patients/significant other teaching. 106008 Page 7 of 8 106008 11/30/2023 Osprey Point Nursing Center 1104 North Main Street Bushnell, FL 33513

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to ensure staff performed hand hygiene during wound care to prevent the possible development and transmission of infections for 1 of 3 resident (Resident #35). Residents Affected - Few Findings include: On 11/29/23 at 1:45 PM, an observation of wound care for Resident #35, with Staff B Registered Nurse (RN) was completed. Staff B, RN was observed to start wound care without washing her hands and donned clean gloves. Staff B, RN was observed to remove the old dressing from the resident wound and proceed to clean the wound without removing the soiled gloves. Staff B, RN was observed to clean the wound perimeter and move towards the center of wound wiping the area several times folding over the gauze repeating the move. Staff B, RN was observed to continue to scrub wound in the same direction towards the center using a new gauze several times rather than discarding after each pass. Staff B, RN was observed to remove the soiled gloves and don clean gloves without performing hand hygiene. Staff B, RN was observed to apply med honey and calcium alginate and cover with a foam bordered dressing, remove gloves, discard unused supplies, and leave the room without performing hand hygiene. During an interview on 11/29/23 at 1:55 PM, Staff B, RN, stated, I should have changed my gloves, and I did not even have hand sanitizer in there. During an interview on 11/29/23 at 2:04 PM, the Director of Nursing (DON) stated, My expectation is for all the nurses that do wound care, change gloves, and wash/sanitize their hands. Review of the policy and procedure titled Dressing, Dry/Clean, revised September 2013 read, Level III. Purpose. The purpose of this procedure is to provide guidelines for the application of dry, clean dressings. Steps in the Procedure. 5. Wash and dry your hands thoroughly. 6. Put on clean gloves. Loosen tape and remove soil dressing. 7. Pull glove over dressing and discard into plastic or biohazard bag. 8. Wash and dry your hands thoroughly. 13. Put on clean gloves. 15. Cleanse the wound with ordered cleanser. If using gauze, use clean gauze for each cleansing stroke. Clean from the least contaminated area to the most contaminated area (usually, from the center outward). 19. Remove disposable gloves and discard into designated container. Wash your and dry your hands thoroughly. 106008 Page 8 of 8