Health inspection·November 20, 2020

F 0557 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. Based on record review, observation and staff and resident interview, the facility failed to ensure retention of personal property for 1 (Resident # 18) of 1 resident reviewed for personal belongings Residents Affected - Few The findings included: On 11/16/20 at 10:22 a.m., in an interview, Resident #18 was alert and oriented. She said she was missing clothes and other items including her hairbrush, personal care items and her books. She said her name was on the clothes and she was also missing blankets. Resident #18 said she had been moved to a different room downstairs and the contents of her bedside dresser was still upstairs. The content of the bedside dresser did not get moved down to her new room. She was scheduled to stay in the new downstairs room. She said she was very upset since without her books she had nothing to do in her room since group activites were limited due to Covid. She said she told several CNA's and other staff her personal items and clothes were still upstairs in her old room. She said she was frustrated and did not understand why the staff could not bring her her personal items. Resident #18 said no one responded to her request to get her personal belongings. On 11/16/20 at 10:30 a.m., record review revealed Resident #18 had a room change and was moved downstairs on 11/12/20. On 11/16/20 at 10:23 a.m., in an observation, Resident #18 showed the clothes in the dresser at the foot of her bed which do not belong to the resident. There were men's shirts and many clothes that would be too big for the resident to wear. The resident was observed wearing the same shirt from 11/16/20 through 11/19/20. On 11/17/20 at 3:48 p.m., during an observation of the bedside table in Resident #18's old room, Licensed Practical Nurse, Staff M, said Resident #18 moved downstairs a few days ago. On 11/17/20 at 3:49 p.m., in an interview Staff M said Resident # 18's personal belongings were in the bedside dresser of her old room, and she was not sure why the clothes were still there. Page 1 of 19 106092 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

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 provide assistance with activities of daily living to 1 (Resident #41) of 1 resident reviewed resulting in the resident not having weekly bed baths or showers, her hair washed, and fingernails being clipped and cleaned. Residents Affected - Few The findings included: Record review of Resident #41's care plan stated she needed extensive assistance of 1 to 2 staff members to assist her with her ADL care. An intervention listed on the care plan was to provide scheduled showers as needed with the option of a sponge bath on non-shower days. On 11/16/20 at 1:54 p.m., Resident #41 was observed to have contractures in both of her hands. Her fingernails on both her hands were observed to be long and with dirt and debris. The resident's hair was observed to be unwashed and unbrushed with noted visible dandruff in her hair. Resident #41 said she was not capable of taking a shower because she had to have 2 staff members assist her with a Hoyer lift, and she was told by staff she could not have a shower. The resident said staff did clean her when she had a bowel movement, but she could not remember the last time she had had a full bed bath. She said she was not capable of washing her hair on her own because of the contractures in her hands. Review of the Certified Nursing Assistant (CNA) documentation from 11/5/20 to 11/18/20 revealed in the last 14 days Resident #41 had one bed bath and no showers. Review of the resident's [NAME] shows the resident is scheduled to have a shower three times weekly on Monday, Wednesday, and Friday. On 11/19/20 at 9:00 a.m. in an interview, Resident #41 said she still had not received a bed bath. She said facility staff members had spoken to her yesterday and told her that they did have the capability of getting her in the shower room without her having to stand up. She said she was told by a unknown staff member they were going to work on getting her a shower. On 11/19/20 at 9:00 a.m., Resident #41 said she still had not received a bed bath. She said a facility staff member had spoken to her yesterday and told her that they did have the capability of getting her in the shower room without her having to stand up. She said she was told by an unknown staff member they were going to work on getting her a shower. 106092 Page 2 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on observation and staff interview, the facility failed to assure infection control practices were maintained in the managing of the urinary catheter tubing and drainage collection bag to reduce potential contamination for 1 (Resident #41) of 1 sampled residents with indwelling catheters by allowing the drainage bag and/or tubing to be in contact with the floor. The findings included: On 11/16/20 at 9:30 a.m., Resident #41's Foley Catheter's (Catheter placed in the bladder to drain urine) clear tubing was observed with brown stains giving an appearance the line was completely full. The drainage bag was in a trash bag tied to the bed rail. Resident #41 said she's had the catheter for years and several urinary tract infections. On 11/17/20 at 10:00 a.m., Licensed Practical Nurse (LPN) Staff M verified the Foley line was stained and needed to be changed. LPN Staff M verified the drainage bag was tied to the bed with a trash bag. Staff M said the bag did not have a hook to secure the bag to the bed. On 11/19/20 at 8:30 a.m., in an observation Resident #41's Foley drainage bag was observed in a stained and dirty privacy bag placed on the floor under the resident's bed. Photographic evidence obtained On 11/19/20 at 8:40 a.m., LPN Staff FF verified the privacy bag was dirty, stained and stored on the floor. On 11/19/20 at 8:50 a.m., in an interview Resident #41's attending physician's said Resident #41 had a history of Urinary Tract Infections and the Foley drainage bag should not be sitting on the floor due to the potential of infection to the resident. 106092 Page 3 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0711 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. Based on record review and staff interview the facility failed to ensure physician progress notes for 12 (Residents #2,# 4, #6, #12, #34, #41, #42, #53, #57, #66, #67, and #70) of 12 residents reviewed were readily accessible and available for inspection in the resident's files. The findings included: On 11/18/20 at 1:00 p.m., record review of Resident #2, admission date 2/24/20, revealed there were no physician progress notes in the facility. When asked, the Director of Nursing was unable to provide any physician progress notes. On 11/18/20 at 1:00 p.m., record review of Resident #4, admission date 3/19/19, revealed there were no physician progress notes in the facility. When asked, the Director of Nursing was unable to provide any physician progress notes. On 11/18/20 at 1:00 p.m., record review of Resident #6, admission date 7/15/20, revealed there were no physician progress notes in the facility. When asked, the Director of Nursing was unable to provide any physician progress notes. On 11/18/20 at 1:00 p.m., record review of Resident #12, admission date 9/15/20, revealed there were no physician progress notes in the facility. When asked, the Director of Nursing was unable to provide any physician progress notes. On 11/18/20 at 1:00 p.m., record review of Resident #34, admission date 2/25/19, revealed there were no physician progress notes in the facility. When asked, the Director of Nursing was unable to provide any physician progress notes. On 11/18/20 at 1:00 p.m., record review of Resident #41, admission date 7/27/20, revealed there were no physician progress notes in the facility. When asked, the Director of Nursing was unable to provide any physician progress notes. On 11/18/20 at 1:00 p.m., record review of Resident #53, admission date 9/5/15, revealed there were no physician progress notes in the facility. When asked, the Director of Nursing was unable to provide any physician progress notes. On 11/18/20 at 1:00 p.m., record review of Resident #57, admission date 8/9/19, showed there was one physician progress notes in the electronic health record. The note was dated 1/10/20. When asked, the Director of Nursing was unable to provide any further physician progress notes. On 11/18/20 at 1:00 p.m., record review of Resident #66, admission date 4/25/20, revealed there was one physician progress note in the electronic health record. The note was dated 5/15/20. When asked, the Director of Nursing was unable to provide any further physician progress notes On 11/18/20 at 1:00 p.m., record review of Resident #67, admission date 6/30/17, revealed there was one physician progress note dated 1/10/20 in the electronic health record. When asked, the Director of Nursing was unable to provide any further physician progress notes. 106092 Page 4 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0711 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 11/18/20 at 1:00 p.m., record review of Resident #70, re-admission date 1/29/20, revealed there was one physician progress note dated 1/10/20 in the electronic health record. When asked, the Director of Nursing was unable to provide any further physician progress notes. On 11/18/20 at 1:48 p.m., in an interview the Administrator said the physician was at the facility two nights ago and he liked to write his notes by hand. On 11/19/20 at 8:41 a.m., in an interview, the Physician said his kept his notes, he did not turn them into the facility. He said the facility knew what was going on by the orders he wrote. He came in twice a week to see his patients. On 11/20/20 at 9:05 a.m., in an interview, the Director of Nursing (DON) said the physician should be typing his notes in the electronic record like the other physicians. On 11/20/20 at 9:41 a.m., in an interview, the Administrator said he was aware that this was an issue. 106092 Page 5 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, policy review and staff interview, the facility failed to ensure medications were secure and inaccessible to unauthorized staff, residents, and visitors and were not kept under direct observation of authorized staff for 1 (Staff L) of 2 staff assisting with review for medication storage. The findings included: Review of facility policy titled Storage of Medications Reviewed/Revised December 15, 2018 stated the following in Guideline Bullet #6: Compartments containing medications are locked when not in use. Trays or carts used to transport such items are not left unattended. (Compartments include, but are not limited to drawers, cabinets, rooms, refrigerators, carts and boxes.) On 11/17/20 at 9:52 a.m., Licensed Practical Nurse (LPN) Staff L was assisting this surveyor with review of the 1st floor west medication cart. Staff L asked if it would be ok if she opened the cart for me and then left to go do something. The Director of Nursing (DON) was passing by at the time and advised Staff L that it would not be ok. The DON then proceeded down the hall. Staff L then unlocked the medication cart and the controlled substance drawer for me. At 9:55 a.m., with medication cart and controlled substance drawer still open to this surveyor, Staff L walked into room [ROOM NUMBER] with a graduated cylinder. She was out of view of the of the medication cart as this surveyor was reviewing the controlled substance drawer. On 11/17/20 10:32 a.m., in an interview, Staff L said she walked away as the aide needed help and had a patient turned on their side. Staff L said she should not have left this surveyor alone at the cart, especially with the narcotics. On 11/17/20 10:20 a.m., in an interview, the DON put her hands on her head and said she had been standing right there and told Staff L not to do it. The DON said they were trained to keep the medications secure and in view at all times. 106092 Page 6 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, record review, and interview, the facility failed to ensure 4 (Residents #24, #55, #58 and #65) of 4 residents on Pureed diets recieved the prescribed diet. (all foods have been ground, pressed, and/or strained to a soft, smooth consistency like a pudding). The facility failed to follow their policy for 4 (Residents #10, #11, #26, and #45) of 4 residents reviewed who were to be served double portions. The failures could potentially cause significant unintentional weight loss. The findings included: On 11/18/20 at 3:28 p.m., a review of the Exceptional Living Centers, Inc. Dietary Policies and Procedures dated 11/05, Subject: Altered Portions, 32 ELC, Inc. Dietary Policy & Procedure Manual revealed the following Policy: The dietary professional shall interview all residents upon admission and periodically as needed for food preferences and meal satisfaction. Altered portion sizes will be served upon request only with a physician's order. Procedure #3 included for double portions, serve two portions of meat, casseroles, potatoes or starch, vegetable and/or salad, dessert, and bread and margarine. On 11/18/20 at 11:07 a.m. during observation of the lunch tray line process, the Certified Dietary Manager (CDM) said the only substitution for lunch was peas and carrots instead of zucchini as listed on the menu. The portion size listed on the menu for the entrée for regular and puree diets was to be 8 ounces. At the beginning of tray line, Dietary Staff O started serving 4 ounces until after surveyor intervention. At 11:58 a.m., Dietary Staff O ran out of the puree entrée and asked for more. He asked again at 12:05 p.m. and it was not prepared until 12:15 p.m. When Dietary Staff N was asked what was in the puree entrée, he said meat and sauce but no noodles. At 12:30 p.m., Staff N said there was no puree garlic bread, he said he substituted mashed potatoes. Staff N did agree there was no pasta in the second batch of puree meat and sauce. The CDM confirmed Residents #24, #55, #58 and #65 should have been served puree garlic bread as listed on the menu. Residents #10, #11, #26 and #45 who were to receive double portions were served only 12 ounces of the entrée instead of 16 ounces and regular portion sizes for the other menu items. At the end of the tray line service, there was no leftover main entrees (regular or puree) or puree vegetables. 106092 Page 7 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Actual harm Based on observation, record review and interview, the administration failed to use its resources effectively and efficiently. The facility failed to self-identify deficient practices which had the likelyhood to produce negative outcomes. Residents Affected - Some The findings included: On 11/20/20 at 1:00 p.m., during the Quality Assurance interview the facility Administrator said he was not aware the facility had an issue with the cleaning and disinfection of the blood glucose meters. The administration staff did not identify the nursing staff was not following the manufacturer's instructions for cleaning and disinfecting the Assure Prism multi-use Blood Glucose Monitoring System (blood glucose meters). The DON said they did not have a policy or procedure for the process and said she would have to look at manufacturer's directions for the correct process. She said she thought you could wipe it with an alcohol wipe. This practice likely put 17 residents who have glucose monitoring at risk of contracting bloodborn pathogen's. On 11/19/20 at 2:29 p.m., in an interview the Director of Nursing (DON), who was the designated Infection Preventionist, said I have not taken any Infection Preventionist training. No one in the facility has taken any additional infection control classes. The facility failed to have a qualified infection control preventionist. The DON who was the identified Infection Control Preventionist could not produce any minutes from the Antibiotic Stewardship meetings. The DON could not produce any documentation of Antibiotic Stewardship activities or meetings. She said they were Zoom calls, but minutes were never taken regarding what was talked about. The facility failed to provide evidence of a functional Antibiotic Stewardship program. The DON who was the identified Infection Control Preventionist was not able to produce any documentation of tracking, trending or any other analysis of infections in the facility. This has the likelyhood of further spread of infections to the other residents in the facility. The administration failed to identify broken equipment and maintain a safe and sanitary environment in the laundry room which could lead to infections since the entire resident population uses the laundry services. The administration failed to identify issues with the resident call bell system and maintain a fully functioning resident call bell system including the auditory function in the facility. This has the likelihood for residents to be injured due to the inability of the staff hear the auditory portion of the call bell system. The administration failed to ensure residents in the facility were provided prescribed diet portions sizes. Eight residents were identified as not receiving enough food which could contribute to unintentional weight loss. The Infection Preventionist required qualifications are to have completed specialized training in infection prevention and control, the facility failed to have a qualified Infection Preventionist. 106092 Page 8 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0835 The facility failed to maintain physicians visit notes from one physician, the administrator said he was aware of the problem. Level of Harm - Actual harm Residents Affected - Some 106092 Page 9 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0865 Have a plan that describes the process for conducting QAPI and QAA activities. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review and staff interview the facility administration failed to demonstrate effective ongoing Quality Assurance and Performance Improvement (QAPI) resulting in repeat non compliance in the areas of providing assistance with activities of daily living for dependent residents, effective administration to maintain the highest practicable well being of residents, maintaining an effective infection prevention and control program and a clean, safe environment for the residents. Residents Affected - Many The findings included: Review of the facility's history revealed on 5/2/20 the facility administration failed to report suspected COVID-19 case to the Department of Health as directed by the Florida Department of Health (DOH) to coordinate the State's response to the COVID-19 pandemic. The facility also failed to enact appropriate COVID-19 precautions and observe proper social distancing placing all residents of the facility at risk of COVID-19 infection. On 5/14/20 the facility failed to ensure a dependent resident on the COVID unit received the necessary assistance for bathing and shaving which can result in health and social consequences for the resident. The facility also failed to maintain a safe, functional and sanitary environment in the laundry room. 3. During the Recertification survey conducted on 11/16/20 through 11/20/20 the facility also failed to consistently ensure 1 (Resident #41) of 1 dependent resident reviewed received the necessary assistance with bed bath, showers, hair washing, and grooming. The facility failed to identify broken equipment on the dirty side of the laundry room to maintain a safe, sanitary, functional laundry area. The facility also failed to identify and implement actions to maintain a fully functional resident call bell system which could result in residents not receiving timely assistance in case of an emergency. 4. The facility administration failed to ensure all licensed staff were educated and implemented appropriate measures for cleaning and disinfection of glucometers according to manufacturer's specification. This consistent failure to properly disinfect the shared blood glucometers placed all residents who used the glucometers at high risk of indirect transmission of blood borne pathogens. The facility also failed to have a qualified Infection Preventionist. 5. On 11/19/20 at 2:29 p.m., during an interview the Director of Nursing (DON) said she was the designated Infection Preventionist but had not taken any Infection Preventionist training or any additional infection control classes. The DON also had no documentation of Antibiotic stewardship activities or meetings. She said they held Zoom calls but did not document what was discussed. She said she just kept tract of number of the number of infections and the name of residents for QAPI meeting presentation. 106092 Page 10 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0865 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many On 11/20/20 at 1:00 p.m., during a review of the facility's Quality Assurance Program the Administrator said he was not aware the facility had an issue with the cleaning and disinfection of glucometers. The facility failed to have documentation of an effective Quality Assurance and Performance Improvement program to identify, correct and maintain improvement to ensure continuous quality of care, quality of life and resident safety. 106092 Page 11 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Immediate jeopardy to resident health or safety df Residents Affected - Some On 11/19/20 at 2:30 p.m., the DON who was the identified Infection Control Preventionist said the facility had an infection prevention and control program. She said the policies are all in the computer and need to be updated. She showed binders full of monthly infection numbers for the QAPI (Quality Assurance and Performance Improvement) program meetings, but the rest of the pages for tracking and trending of infections were blank for each month. She was not able to produce any documentation of tracking, trending or any other analysis of infections in the facility to prevent the further spread of infections. Based on observation, record review and interview the facility failed to follow the manufacturer's instruction for cleaning and disinfecting of the Assure Prism multi Blood Glucose Monitoring System (blood glucose meter) for 2 (Residents #15 and Resident #64) of 3 residents reviewed who had physicians' orders for blood sugar test (a blood sugar test was a procedure that measures the amount of sugar, or glucose, in your blood). Inadequate disinfection may result in indirect contact transmission (the transfer of an infectious agent through a contaminated inanimate object). Certain pathogens could contaminate and survive on equipment and environmental surfaces for long periods of time. The facility was unable to show documentation of a functioning infection control program. The failure to properly disinfect the blood glucose meters used for multiple residents resulted in a pattern of noncompliance at Immediate Jeopardy (IJ), scope and severity of K starting on 11/18/20. The Administrator was notified of the IJ on 11/18/20 at 4:00 p.m. The immediacy was removed on 11/20/20 at 1:25 p.m., after the facility completed the removal plan which included: Glucometer disinfection policy and assigned individual glucometers to diabetic residents. The facility provided documentation Licensed and Registered Staff were educated and demonstrated competency on procedure for proper disinfection of the glucometers to prevent indirect transmission of highly infectious diseases, including blood borne pathogens. Any new or outstanding licensed or registered staff will be educated and demonstrate competency on proper disinfection of glucometers prior to their scheduled shift. The facility initiated random audits during medication administration to ensure licensed staff are properly disinfecting glucometers. The results of the audits will be reviewed in the monthly Quality Assurance and Performance Improvement (QAPI) meetings until compliance is maintained. The scope and severity was lowered to an E after credible evidence of measures taken to correct the IJ. The findings included: According to the Journal of Diabetes Science and Technology (March 2009): Finger-stick devices, blood glucose testing meters, or even a health care worker's hands may all become vehicles for indirect transmission of viruses if they become contaminated with blood. Since Hepatitis B Virus (HBV) is 106092 Page 12 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0880 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some highly infectious and environmentally stable, even invisible amounts of blood are sufficient to spread infection. According to the Food and Drug Administration: For blood glucose meters, the primary viruses of concern for bloodborne pathogen transmission between multiple patients are Human Immunodeficiency Virus (HIV), HBV, and Hepatitis C Virus (HCV). However, due to its robust nature, HBV is the most common virus in the observed outbreaks to date. Therefore, Blood Glucose Monitoring System sponsors should demonstrate that their disinfection protocol is effective against human Hepatitis B Virus. Studies have demonstrated that viruses can remain infective on surfaces for different time periods. The disinfection solvent you choose should be effective against HIV, Hepatitis C, and Hepatitis B virus. Outbreak episodes have been largely due to transmission of Hepatitis B and C viruses. However, of the two, Hepatitis B virus is the most difficult to kill. Please note that 70% ethanol solutions are not effective against viral bloodborne pathogens . https://www.fda.gov/medical-devices/vitro-diagnostics/letter-manufacturers-blood-glucose-monitoring-systems-listed-fda According to the Centers for Disease Control: Unsafe practices during assisted monitoring of blood glucose and insulin administration that have contributed to transmission of HBV or have put persons at risk for infection include: . Using a blood glucose meter for more than one person without cleaning and disinfecting it in between uses. [Blood glucose meters are devices that measure blood glucose levels.] . .Whenever possible, blood glucose meters should be assigned to an individual person and not be shared. https://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html 1. On 11/17/20 11:19 a.m., during an observation Registered Nurse (RN) Staff E was observed taking a blood glucose level on Resident #15 using the blood glucose meter (BG meter). When Staff E completed the task, she wiped the BG meter with an alcohol prep pad, placed it on top of medication cart to dry for a four seconds then placed the BG meter back in top drawer of the med cart. Staff E then used the blood glucose meter on another resident. On 11/17/20 at 11:26 a.m., in an interview Staff E said the BG meters were used for multiple residents. Staff E said she wiped it down with an alcohol prep pad after using on a residents. At at the end of the shift, Staff E would wipe it down with a Clorox wipe. On 11/17/20 at 11:42 a.m., in an interview the Director of Nursing (DON) said the BG meters were supposed to be wiped down with an alcohol pad, Clorox wipe, or some disinfectant was supposed to be used. The DON said they did not have a policy and procedure for the process and said she would have to look at manufacturer's directions for the correct process. On 11/17/20 at 1:50 p.m., in an interview Licensed Practical Nurse (LPN) Staff L said she used one of the wipes on the med cart to wipe down the BG meters for about 15-20 seconds and then sets it down to dry. On 11/18/20 at 12:50 p.m., Staff M (LPN) was observed taking a Blood Glucose level on Resident #64. 106092 Page 13 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0880 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some When Staff M completed the task, she wiped the BG meter sideways and vertically with a Micro Kill wipe for approximately 4-5 seconds and set the machine down to air dry. When Staff M was completely done cleaning the machine, she was asked to read the instructions on the Micro Kill. The Micro Kill label notes it is effective against HIV, HBV, and HCV in 2 minutes wet time. Staff M said she did not know if she had ensured a wet time of 2 minutes when cleaning the BG meter. The Manufacturer's instruction manual for the Assure Prism multi Blood Glucose Monitoring System revealed the following: Pages 38-39 of manual indicates the meter should be cleaned and disinfected after use on each patient. This Blood Glucose Monitoring System may only be used for testing multiple patients when Standard Precautions and the manufacturer's disinfection procedures are followed. The manufacturer has validated Clorox Germicidal wipes, Dispatch Hospital Cleaner Disinfectant Towels with Bleach, Cavi Wipes 1 and PDI Super Sani Cloth Germicidal disposable wipe for disinfecting the Assure Prism Multi meter. Page 42-43 of manufacturer's instruction manual indicate a 2-step process for cleaning and disinfecting. Clean first using 1 wipe to wipe the entire surface of the meter 3 times horizontally and 3 times vertically then disposing of the wipe. No actual drying time is necessary before starting the disinfecting process. Next disinfect using a second wipe and wipe the entire surface of the meter 3 times horizontally and 3 times vertically, disposing the towelette and allowing exteriors to remain wet for the corresponding contact time of the disinfectant. photographic evidence obtained On 11/18/20 at 7:50 a.m., the DON said they did not have a policy and procedure for cleaning the BG meters. She said she would develop a policy using the manufacturer's instructions and educate staff on proper procedure. On 11/18/20 at 4:00 p.m., the Administrator said he would develop a system for monitoring proper cleaning of the BG meters and ensure that all staff are trained in the proper process. 106092 Page 14 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on staff interview and lack of minutes from any Antibiotic Stewardship meetings, the facility was not able to provide evidence of a functioning Antibiotic Stewadship Program that develops, promotes, and implements a facility-wide system to monitor the use of antibiotics. Residents Affected - Many The findings included: The DON who was the identified Infection Control Preventionist could not produce any minutes from the Antibiotic Stewardship meetings or activities. She said they were Zoom calls, but minutes were never taken regarding what was talked about. The facility failed to provide evidence of a functional Antibiotic Stewardship program. 106092 Page 15 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0882 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. Based on staff interview and review of the Infection Preventionist required qualifications to have completed specialized training in infection prevention and control, the facility failed to have a qualified Infection Preventionist. The findings included: On 11/19/20 at 2:29 p.m., in an interview the Director of Nursing (DON), who was the designated Infection Preventionist, said I have not taken any Infection Preventionist training. No one in the facility has taken any additional infection control classes. The facility failed to have a qualified infection control preventionist to assist staff with infection control concerns and educate the staff on current infection control practices. This is evidenced by the blood glucose monitoring issues identifed during this survey. 106092 Page 16 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to provide a nurse call system which relayed the call directly to a staff member or to a centralized staff work area on the first floor. This in the event of a resident emergency could result in staff not being aware or notified thereby endangering the resident from receiving immediate medical assistance. Residents Affected - Some All residents on the first floor had the likelyhood of being effected by this practice. The findings included: On 11/16/20 at 10:30 a.m., in an interview Resident # 30 said the facility unhooked the call bell ringer at the nurse station from the light system so the nurses could no longer hear the call system. On 11/16/20 11:30 a.m., in an interview Resident #36 said the facility unhooked the call bell ringer at the nurse station from the light system so the nurses could no longer hear the call system. On 11/16/20 at 12:10 p.m., in an observation on the first floor, the nurse call light was observed on at the nurse station but there was no audible sound. On 11/17/20 at 1:30 p.m., in an observation on the first floor, the nurse call light was observed on at the nurse station and above rooms [ROOM NUMBERS] but there was no audible sound. On 11/17/20 at 1:50 p.m., in an observation on the first floor, the nurse call light was observed on at the nurse station and above room [ROOM NUMBER] but there was no audible sound. On 11/19/20 at 10:12 a.m., in an observation on the first floor, the nurse call light was observed on at the nurse station and above room [ROOM NUMBER] but there was no audible sound. On 11/19/20 at 2:35 p.m., in an interview by the Fire Life Safety Surveyor with Licensed Practical Nurse Staff L asked if she remembered when the first-floor nurse call system stopped alerting at the nurse station. She said that she wasn't sure but it was sometime during the COVID pandemic and that it was a while ago. She also said to ask the Administrator. On 11/19/20 at 2:38 p.m., in an interview by the Fire Life Safety Surveyor the Administrator said that the first-floor nurse call system had been damaged by water and that parts to repair it were not available because the system was obsolete. When asked if he knew when the system went down, he said he wasn't sure but it had happened sometime during the COVID pandemic and would have to check emails to see when he tried to contact the vendor for repairs and that he thinks the original vendor was out of business and they were currently seeking a new vendor to replace the system. On 11/19/20 at 2:40 p.m., while the Fire Life Safety Surveyor reviewed the facility Comprehensive Emergency Management Plan, the plan had provisions for failure of the Resident Emergency Call System. The plan stated the residents in affected areas are provided telephones and hand bells. It also stated that On 11/19/20 at 2:43 p.m., in an interview by the Fire Life Safety Surveyor the Administrator said that they did not provide residents with hand bells, but all residents had telephones. When asked if 106092 Page 17 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some there was 24-hour coverage to answer the telephones, the administrator said no, the front desk was only staffed for 12 hours per day. He said that the facility had purchased 4 wireless doorbells that were given to he said no. On 11/20/20 at 10:20 a.m., in an interview Resident #54 stated he had a facility phone in his room but did not know how to call the front desk. He said his roommate (Resident #2) had a phone but kept pulling it out of the jack when raising and lowering his bed so the facility moved his bed over but never fixed his broken jack. He said the audible portion was not working before the COVID pandemic and remembered it was prior to February 2020. On 11/20/20 at 11:59 a.m., in an observation the audible and visual emergency system was heard and functional. The Administrator had told the Maintenance Director to get the old call bell system that he was told was broken and plug it in to see if it worked. On 11/20/20 at 11:59 a.m., during an observation, after plugging in the old system, the audible and visual emergency system for the entire first floor was heard and functional. 106092 Page 18 of 19 106092 11/20/2020 Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview the facility failed to identify broken equipment on the dirty side of the laundry room. The facility failed to maintain a safe, sanitary, functional laundry area. The facility also failed to maintain clean and sanitary The findings included: On 11/16/20 at 8:45 a.m., observation of the dirty side of the laundry room revealed a very wet floor. Staff JJ said the pipes had been leaking for a while. When staff JJ turned on the faucet in the sink to wash her hands, water sprayed out of the faucet. The pipes under the sink were corroded and leaking. Four buckets were being used to catch the leaking water. On 11/16/20 9:15 a.m., the Maintenance Director said he checked for maintenance issues, and the cleaning and vacuuming of the dryer ventilation system in the laundry room on a monthly basis. At that time was not able to provide any documentation of a schedule. Prior to exit the administrator and maintenance director provided a Maintenance Cleaning and Vacuuming Monthly Checklist. The checklist showed the last date of the maintenance inspection of the laundry room was 11/6/20. On 11/16/20 at 12:30 p.m., during interview the Administrator and DON both said they did not know the condition of the laundry room. On 11/17/20 at 11:54 a.m., during an enviromentatl tour the following was found: Stained privacy curtains in rooms 101, 103, 105, 106, 107, 109, 111, 113, 206, and 210. Sheets with wholes in them from being so thin in room [ROOM NUMBER] B. 106092 Page 19 of 19