Health inspection·January 27, 2022

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 adequate and appropriate health care to address the edema (swelling) for 1 (Resident #8) of 15 residents reviewed for treatments and care. Residents Affected - Few The findings included: The facility policy titled Nursing admission Assessments and Orders with a revised date of 9/2017 read, . This initial or temporary plan of care is to address major medical needs/ concerns and total ADL [Activities of daily living] needs . The ADL needs of the resident and current care and treatment approaches shall be identified . on the MAR [Medication Administration Record] and TX [Treatment] records. Review of the admission Minimum Data Set (MDS) assessment with a target date of 1/20/22 showed Resident #8 was admitted to the facility on [DATE]. The active diagnoses included coronary artery disease (CAD), heart failure and hypertension (HTN). The Order Summary Report listed a physician's order with a start date of 1/20/22 for offloading boots to be placed to Resident #8's bilateral lower extremities (BLE) when in recliner every day and night shift for preventative measures. On 1/24/22 at 10:15 a.m., Resident #8 was observed sitting in a wheelchair in his room. His legs were not elevated. The resident's bilateral lower extremities were noted with edema (swelling caused by excess fluid trapped in the tissues), the right leg greater than the left leg. Resident #8 was wearing yellow socks and black shoes. The socks were rolled down to the ankle. Both lower legs were discolored. The right leg had dry, cracked skin. Resident #8 said he was being treated for the swollen legs. He was not wearing the offloading boots as ordered. The Interim admission Care plan dated 1/14/22 did not list interventions to address the edema of the resident's legs. On 1/24/22 at 2:38 p.m., Resident #8 was observed sitting in a recliner wearing yellow socks and black shoes. His legs remain swollen. The legs were not elevated, and the resident was not wearing the offloading boots as ordered. On 1/25/22 at 9:29 a.m., Resident #8 was observed awake and alert sitting in a recliner. Resident #8's legs were swollen with edema with the right being worse than the left. There was dry, cracked skin on Resident #8's right lower leg. Resident #8 was wearing yellow socks rolled down to his ankles and black shoes. The feet were in the down position and resting on the floor. Page 1 of 2 106070 106070 01/27/2022 Desoto Health and Rehab 475 Nursing Home Dr Arcadia, FL 34266

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 1/26/22 at 9:38 a.m., Resident #8 was awake and alert sitting in a recliner in his room. His legs were not elevated, and he was not wearing the offloading boots as ordered. The resident was wearing yellow socks and black shoes. Resident #8 said he has not had his shoes and socks off for a few days. On 1/26/22 at 9:45 a.m., in an interview Certified Nursing Assistant (CNA) Staff A said she was taking care of Resident #8 today. She said she got report from the night shift CNA who told her about Resident #8's continence status, and that he needed two people to assist with transfers. CNA Staff A said the night shift CNA did not tell her anything else about Resident #8's care. On 1/26/22 at 11:00 a.m., during an interview, Licensed Practical Nurse (LPN) Staff B said she lets the CNAs know what's going on with the residents. She said for instance, Resident #8 refuses to elevate his legs and is non-compliant with stuff. On 1/26/22 at 11:00 a.m., in an interview with the Director of Nursing (DON) present, Resident #8 said his shoes or socks had not been removed since he's been at the facility except for when the doctor came. The DON acknowledged Resident #8's edema of the lower legs. The DON said staff should be treating Resident #8 for edema with interventions to alleviate the symptom. Review of the Treatment Administration Record (TAR) showed on 1/24/22, 1/25/22 and 1/26/22, staff signed indicating the offloading boots were applied to the Resident's lower extremities. On 1/26/22 at 03:07 p.m., in an interview the DON confirmed Resident #8 had an order for off-loading boots, but staff were not applying them. The DON confirmed the baseline care plan did not address the edema and said there should have been interventions in the baseline care plan to address the Resident's lower extremities edema. 1/27/22 at 9:35 a.m., Resident #8 was observed in his room, sitting in the recliner with lower legs elevated and wearing offloading boots. Resident #8 said he was more comfortable. On 1/27/22 at 9:53 a.m., in an interview Physical Therapist Assistant (PTA) Staff C he said he has not seen Resident #8 wearing offloading boots to the bilateral lower legs. He said no one told him Resident #8 needed the off-loading boots applied. On 1/27/22 at 10:02 a.m., the DON confirmed staff had been signing off on the treatment administration record (TAR) the offloading boots were applied to Resident #8, but they had not been doing it. 106070 Page 2 of 2