Health inspection·May 18, 2023

F 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to show effective coordination to ensure 1 resident (#94) of 2 residents reviewed received podiatry services to maintain good foot health for identified foot concerns. Residents Affected - Few The findings included: Review of the facility policy on Foot Care effective 10/17/22: It is the policy (of the facility) to ensure residents receive care and treatment to maintain good foot health. 1b. If necessary, the facility will assist the resident in making appointments with a qualified person, arranging for transportation to and from such appointments. 2b. A comprehensive assessment process is used for identifying conditions that increase the risk for impaired skin integrity of the foot. 2c. The comprehensive assessment will include an assessment of the feet for disorders which may require treatment including but not limited to corns, neuromas, calluses, bunions, hammertoes, heel spurs, and nail disorders. 3aiii. Referrals to podiatrists will be made when appropriate. Review of the clinical record for Resident #94 revealed an admission date of 5/11/23. Review of the Interdisciplinary Note dated 5/11/23 at 5:38 p.m. revealed Resident 94's heels and toes were dry, flaky, red, and blanchable. Resident may need to see the podiatrist. Review of the Skin Evaluation for Resident #94 dated 5/11/23 at 5:39 p.m. revealed the term Inapplicable for Foot problems, Infections of the foot, Open Lesions of the Foot, and Nails/Calluses Trimmed Last 90 days. The nurse documented, She may need to be seen by the podiatrist . Assistant Director of Nursing (ADON) was present during skin assessment. Review of the second Skin Evaluation for Resident #94 dated 5/11/23 at 6:56 p.m. revealed the term Inapplicable for Foot problems, Infections of the foot, Open Lesions of the Foot, and Nails/Calluses Trimmed Last 90 days. Review of the Baseline care plan dated 5/12/23 did not include interventions for foot care or podiatry. On 5/15/23 at 3:02 p.m., observed Resident 94 in her room sitting in recliner. Resident #94 said her toes were pretty bad and would like the toenails to be cut because she was not able reach them. The resident said they had not been done in a while. The resident was wearing sandals and her toes were visible. The toes on each foot overlapped. The toenails on both feet were thick and extending approximately half an inch from the nail bed. The nail Page 1 of 3 106104 106104 05/18/2023 Renaissance at the Terraces 26475 South Tamiami Trail Bonita Springs, FL 34135

F 0687 of the 5th toe on each foot were curled over the toes. Resident #94's feet had an unpleasant smell. Level of Harm - Minimal harm or potential for actual harm Review of the Interdisciplinary Note dated 5/12/23 at 10:17 a.m. by the Social Services Coordinator (SSC) did not include mention of podiatry care. Residents Affected - Few Review of Interdisciplinary Notes dated 5/15/23 and 5/16/23 for Resident #94 revealed no new skin concerns. Review of the Physician's Orders and Care Plans for Resident #94 revealed no instructions or interventions for foot or podiatry care. On 5/17/23 at 3:54 p.m., the SSC said she was responsible for arranging podiatry services. The SSC said the nurses complete a Skin Evaluation and let her know who needs podiatry care. The podiatrist comes to the facility every nine weeks and whenever necessary when there is an identified concern. The SSC said the podiatrist sees all residents; the last visit was on 5/12/23. She said the staff was not allowed to cut the residents' toenails due to the risk of injury. On 5/17/23 at 4:36 p.m., the ADON said the admitting nurse completes a thorough head to toe skin evaluation when residents are admitted and within 24 hours a second skin evaluation is done to make sure nothing is missed. She confirmed staff do not cut toenails. The ADON said she remembers observing Resident #94's feet, including the long toenails, and overlapping toes. The ADON said she did not tell the SSC to add Resident #94 to the podiatry list when she identified the problem. The ADON said she did not arrange for podiatry care for #94. The ADON went into Resident #94's room, removed Resident #94's socks, exposing overlapping toes with long, thick toenails. Resident #94 remarked, they are really bad. Resident #94 said she could not cut her own toenails. The ADON asked Resident #94 if she wanted podiatry care and Resident #94 said yes. On 5/18/23 at 8:34 a.m., the SSC said she was not aware Resident #94 needed podiatry care until this morning. The SSC said the next podiatry visit was scheduled for 6/9/23 and provided the list of residents to be seen, including Resident #94. On 5/18/23 at 9:22 a.m., the SSC said if she had known Resident #94 needed podiatry care, she could have arranged it to be done on 5/12/23, preventing delay. On 5/18/23 at 10:27 a.m., Registered Nurse (RN) Staff A said she wrote the Interdisciplinary Note on 5/11/23 which noted Resident #94 may need podiatry. Staff A said she did not notify the SSC Resident #94 needed podiatry care. She said she dropped the ball and took responsibility. 106104 Page 2 of 3 106104 05/18/2023 Renaissance at the Terraces 26475 South Tamiami Trail Bonita Springs, FL 34135

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record review, the facility failed to ensure proper cleaning of the CPAP (Continuous Positive Airway Pressure) machine to prevent respiratory infections for 1 (Resident #93) of 1 resident requiring the use of the CPAP machine. Residents Affected - Few The findings included: The facility's policy for CPAP machine with an effective date of 5/18/23 noted, It is the policy of the facility to clean CPAP equipment in accordance with current Centers for Disease Control guidelines and manufacturer recommendations in order to prevent the occurrence or spread of infection . Respiratory therapy equipment can become colonized with infectious organisms and serve as a source of respiratory infections . Empty the (water) chamber completely after each use and wipe dry . Clean mask and tubing daily after use, dry well. Cover with plastic bag or completely enclosed in machine storage when not in use. Review of the clinical record for Resident #93 revealed an admission date of 5/10/23. Diagnoses included unspecified sleep apnea (sleep disorder in which breathing repeatedly stops and starts). The Respiratory Care Plan started on 5/11/23 revealed Resident #93 utilizes CPAP for sleep apnea. The interventions included monitoring for proper functioning of the device and making sure it was clean. The care plan, the Medication Administration Record and the Treatment Administration Record for May 2023 did not include instructions to properly care for the CPAP machine, including a schedule for emptying, the water chamber, and cleaning the face mask, water chamber and tubing. Review of the Physician Orders of 5/18/23 revealed no instructions for the use of the CPAP machine. Review of the Progress Notes for Resident #93 from 5/10/23 through 5/18/23 revealed no interventions, instructions, monitoring, or cleaning of the CPAP machine. On 5/16/23 at 4:33 p.m., a CPAP machine was observed stored on the nightstand next to Resident #93's bed. Resident #93 said she uses the machine every night, but no one has helped her clean the machine since her admission to the facility on 5/10/23. On 5/17/23 at 9:25 a.m., Resident #93 said the CPAP machine has been on the nightstand since her admission and was last cleaned on 5/8/23. The resident said no one at the facility has asked her about cleaning the machine. The resident said every night she uses the bottle of water the hospital gave to her for the water chamber. A bottle of water dated 5/9/23 was observed on the nightstand next to the machine. On 5/18/23 at 9:06 a.m., Licensed Practical Nurse (LPN) Staff B said she has cared for Resident #93 the past several days this week and did not clean the CPAP machine. The Assistant Director of Nursing who was present during the interview said she did not add orders for the care of the CPAP machine. She said she dropped the ball on it. 106104 Page 3 of 3