Health inspection·October 7, 2021

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and staff interview, the facility failed to obtain a Do Not Resuscitate Order (DNRO) in accordance with the advanced directives of 1 (Residents #31) of 1 resident reviewed for advance directives. The failure to have accurate physician orders has the potential to lead to confusion in regards to the resident's end of life advance directive being honored. The findings included: The facility's policy for Advance Directives- revised procedure for processing an advance directive, dated [DATE]; noted Social Services Director (SSD) documents in the medical record a note that the advance directive document was received and details of the documents. SSD updates the log for DNR orders and delivers a copy of the advance directive to the charge nurse of on the unit where the resident resides. The charge nurse documents receipt of the advance directive by putting the order into the record and changing the Code status if appropriate. Director of Nursing/Assistant Director of Nursing follows up with the check of nursing orders in the medical record. Resident #31's clinical record revealed an active physician's order dated [DATE], for the resident to be a Full Code, indicating the resident was to receive cardiopulmonary resuscitation (CPR) in the event his heart stopped beating. The clinical record also contained a DNRO form signed by the resident and physician on [DATE]. On [DATE] at 1:06 p.m., in an interview Registered Nurse (RN) Staff M confirmed Resident #31 had a current physicians order for CPR but his record also contained a signed DNRO form. RN Staff M said she would first look under the advance directive section of the chart for the DNRO form before starting CPR but acknowledged would want everything to match to avoid any confusion and would contact the resident's physician to get the code status order changed after she spoke to the resident to verify his wishes. In an interview on [DATE] at 12:48 p.m., the Social Services Director (SSD) said the admission paperwork for Resident #31 did not have any advance directives. She did visit with the resident on [DATE] and discussed his advance directive in regards to CPR but did not document the conversation about his wishes in the clinical record. The resident did express his desire to be a DNR, so she had the resident sign the DNRO form and sent it to the physician. She acknowledged when he first arrived would have been full code status but after the DNRO form was signed, the order should have been changed. Page 1 of 2 106035 106035 10/07/2021 Inn at Sarasota Bay Club 1303 North Tamiami Trail Sarasota, FL 34236

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation and staff interview, the facility failed to store resident medications in a manner to prevent loss and efficacy of the medications for 3 of 3 medication carts. The findings included: The facility's Medication Storage In The Facility policy, ID1: Storage Of Medications, dated March 2019 stated, all medications dispensed by the pharmacy are stored in the container with the pharmacy label. Orally administered medications are kept separate from externally used medications and treatments such as ointments and creams. 1. On 10/5/21 at 9:14 a.m., observation of the Coral Unit medication cart revealed an open unlabeled plastic medication cup with 3 different medications inside the top drawer. Licensed Practical Nurse (LPN) Staff K was present during the observation and said she was the only nurse administering medications from the cart and did not put the pills there or know to which resident they belonged. LPN Staff K immediately removed the pills and disposed of them without attempting to identify the medications or if they were intended for a resident who did not receive them. There were other loose pills not in their original packaging and pill debris inside the second drawer of the cart. LPN Staff K confirmed this finding at the time of the observation. 2. On 10/5/21 at 10:01 a.m., observation of the Sand Dollar Unit medication cart revealed an open unlabeled jar of Vaseline being stored in the top drawer along with the medications. LPN Staff L was present during the observation and said the Vaseline had been for a treatment to Resident #29. LPN Staff L said the treatment had been discontinued and removed the jar from potential use. There were loose pills and pill debris inside the second drawer of the cart and to the right of the narcotic lock box. LPN Staff L confirmed this finding at the time of the observation. 3. On 10/5/21 at 10:23 a.m., observation of the Triton Unit medication cart revealed loose pills and pill debris in the second medication drawer. A white capsule and gel caplet were among the debris next to the narcotic lock box. Registered Nurse (RN) Staff M was present during the observation and confirmed this finding. **Photographic Evidence Obtained** 106035 Page 2 of 2