Health inspection·March 18, 2021

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observations, record reviews and interviews, the facility failed to ensure a medication error rate of less than 5% for two (Residents #66 and #18) of three residents sampled for medication administration review. There were 27 opportunities for error with six medication errors identified, for a medication error rate of 22.22%. Residents Affected - Few The findings include: 1. A review of Resident #66's medical record revealed current physician's orders for Potassium 20 meq (milliequivalents) by mouth two times a day, Lactobacillus by mouth every day, Prednisone 10 mg (milligrams) by mouth every day, and Ascorbic Acid 500 mg by mouth two times a day. On 3/17/21 at 8:20 AM, an observation of medication administration was made with Employee A, Registered Nurse (RN), for Resident #66. Employee A failed to administer the Potassium 20 meq, Lactobacillus, Prednisone 10 mg (milligrams) and Ascorbic Acid 500 mg per physician's orders. On 3/17/21 at 9:00 AM, an interview was conducted with Employee A. She confirmed that she missed four of Resident #66's medications during the morning medication pass. She stated she failed to scroll to the next page of the Medication Administration Record (MAR) for the medications listed there. 2. A medical record review for Resident #18 revealed that an apical pulse (a pulse site on the left side of the chest over the pointed end of the heart) check was required prior to administration of digoxin. The parameters instructed nursing to hold medication for a pulse of less than 60. The record review also revealed that rinsing the resident's mouth with water after administration of advair diskus was required. On 3/17/21 at 8:40 AM, an observation of medication administration was made with Employee A, RN, for Resident #18. Employee A failed to take an apical pulse prior to administering digoxin 125 mcg (micrograms), and she failed to have Resident #18 rinse her mouth with water after administering advair diskus aerosol powder. On 3/17/21 at 9:00 AM, an interview was conducted with Employee A. She confirmed that she failed to check the apical pulse prior to administering Resident #18's digoxin, and she failed to ensure the resident rinsed her mouth with water after she received her advair diskus. On 3/17/21 at 9:15 AM, an interview was conducted with Employee I, Regional Nurse. She confirmed that the nurse missed four of Resident #66's medications during the medication pass at 8:20 a.m. Employee I confirmed that an apical pulse should have been taken prior to administering digoxin, and she confirmed that after administering advair diskus, the resident should have rinsed their mouth with Page 1 of 3 106064 106064 03/18/2021 Life Care Center of Jacksonville 4813 Lenoir Avenue Jacksonville, FL 32216

F 0759 water. Level of Harm - Minimal harm or potential for actual harm . Residents Affected - Few 106064 Page 2 of 3 106064 03/18/2021 Life Care Center of Jacksonville 4813 Lenoir Avenue Jacksonville, FL 32216

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, interviews and record review, the facility failed to appropriately store medication in one (1) (Bermuda Cart #1) of two (2) medication carts observed, from a total of four (4) medication carts in the facility. The findings include: On 03/17/21 at 9:05 AM, an observation of the medication cart was made during medication pass with Employee A, Registered Nurse (RN). An unopened insulin pen for Resident #29 was observed, and Employee A confirmed that it should have been in the refrigerator. (Photographic evidence obtained) A review of the facility's policy and procedure titled Storage and Expiration of Medications, Biologicals, Syringes and Needles, with an effective date of 12/07/07 and a revised date of 04/15/19, revealed on page 2 number 11, that the facility should ensure medications and biologicals were stored at their appropriate temperatures according to the United States Pharmacopeia guidelines for temperature ranges. Refrigerated (36 - 46 degrees F (Fahrenheit) NOT IN USE - Insulin Aspart 100 unit/ml (milliliter) Pen. Outdated, contaminated or deteriorated medication and those in containers that are cracked, soiled or without secure closures, are immediately removed from stock, locked in the medication room in a segregated area, and disposed of according to procedure for medication destruction and re-ordered from the pharmacy if a current order exists. On 03/17/21 at 9:15 AM, an interview was conducted with Employee I, Regional Nurse. She confirmed that the unopened insulin pen should have been stored in the refrigerator until it was opened. . 106064 Page 3 of 3