Health inspection·May 19, 2022

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2) During an interview, conducted with Resident #124, who speaks a foreign language, on 05/16/22 at 11:36 AM, the resident said that they left her uncleaned, in feces, for more than one hour. During the conversation with the resident, her authorized representatives (AR) who translated for this writer via telephone confirmed that Resident #124 had complained about this issue multiple times. She also reported that the concern was discussed with the Director of Nursing (DON) the week prior. The AR said that three days ago, they had a three-way conversation with the DON during which they voiced their displeasure regarding the care. Resident #124 and her AR agreed that it occasionally took between one and half hour to one hour for the staff to provide timely hygienic and pericare to the Resident. The AR said that on many occasions, when they come to the facility to visit, they find the resident in tears because she is left soiled for a long time. During a follow-up interview with one of the Resident's authorized representatives on 05/16/22 at 11:43 AM, it was reported that Resident #124 had once called them on the phone in tears begging for their assistance. Resident #124 had asked them to call the facility to request that they change the resident because she has been waiting for a long time to be cleaned. The AR said one time as she was complaining to the Director of Nursing, she overheard the Certified Nursing Assistant (CNA) telling the DON that she could not provide care to Resident #124 because she was not done caring for another resident. The CNA said that she could not leave the person she was caring for to assist another. At 11:46 AM, Resident #124's roommate, who was alert and oriented to place, time, and people also reported that they do leave Resident#124 in feces for a long time. She added that it sometimes takes more than one hour. She continued and stated that when they called the nurses for assistance, they come in and ask how can they help?', then left and said that they will return, but it took a long time (sometimes over one hour) before anyone returns. Resident #124 also complained on 05/16/22 at 11:36 AM that she was served a banana that was over ripened with the skin partially slit or peeled. The resident left it on the table and said I will not eat that. This writer observed that the banana's skin was not intact (Photographic evidence obtained). Resident #124 was admitted to the facility on [DATE]. Her admitting diagnoses included Multiple Sclerosis; Parkinson's disease; Psychotic Disorder; Parkinson's Dementia with Psychosis. Pressure ulcer of Sacral; and Acute embolism. Review of the Minimum Data Set (MDS) Section C titled cognitive pattern showed that the resident obtained a score of 13/15 on the Brief interview for Mental Status (BIMS). Page 1 of 14 106109 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Care plan dated 5/9/2022 showed that Rresident #124 had an activity of daily living (ADL) selfcare deficit. The record also revealed that CNA staff would complete set up and provide assistance with bathing, grooming, mobility, toileting, and eating. During an interview with the DON on 05/19/22 at 11:54 AM, she reported that she did not have a policy regarding timeliness of care. However, she stated that residents are cared for as needed on a priority basis. Based on interview, observation, and record review, the facility failed to treat in a dignified manner 2 of 12 sampled residents (Resident #20 & Resident #124) specifically, the facility used improper feeding assistance protocols while feeding Resident #20, failed to provide timely hygienic care to Resident #124, and failed to serve food in intact form to Resident #124. The findings included: Review of an un-dated facility policy and procedure for Feeding a Resident provided by the DON reviewed 04/28/10 indicated, Procedure: To protect resident's dignity and ensure that during assisting and/or feeding meals that you are seated at eye level of resident 2. Sit down next to the resident . 1) During an observational screening tour conducted on 05/16/22 at 12:36 PM, Resident #20's lunch tray was brought into her room. At 12:54 PM, Staff D, a Certified Nursing Assistant (CNA), was observed standing up next to the resident's bed feeding her the ordered lunch meal of general soft, bland texture. There was an available, empty chair in the room directly across from Resident #20's bed. Resident #20 was admitted to the facility on [DATE] with diagnoses which included Sepsis, Metabolic Encephalopathy, Acute Respiratory Failure with Hypoxia, Dependence on supplemental oxygen, Vitamin D Deficiency, Nutritional Deficiency, Weakness, Unspecified lack of coordination, Dysphagia and Nutritional Deficiency. She had a Brief Interview Mental Status (BIM) score of 7, indicating severely impaired cognition. An interview was conducted with Staff D, on 05/16/22 at 1:04 PM, regarding standing up while feeding Resident #20 her lunch meal when there was an empty, available chair in the Resident #20's room for her to sit in. Staff D replied that, it is easier for me to stand and feed her. During an interview conducted on 05/18/22 at 12 PM, with the Registered Nurse (RN)/Charge Nurse, the Assistant Director of Nursing (ADON) and the Director of Nursing (DON), they all further acknowledged and recognized that the staff member should have been seated next to the resident during her lunch meal. 106109 Page 2 of 14 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined that the facility failed to provide housekeeping and maintenance service necessary to maintain a sanitary, orderly, and comfortable interior. The findings include: During the Environmental Tour conducted on 05/17/22 at 1 PM, accompanied with the Administrator and Director of Maintenance, the following were noted: room [ROOM NUMBER]: The room walls were in disrepair that included; large scuff marks, peeling paint, and numerous small holes. room [ROOM NUMBER]: The room walls were in disrepair that included; large scuff marks, peeling paint, and numerous small holes. The portable commode chair noted to have areas of rust on the exterior. room [ROOM NUMBER]: The room walls were in disrepair that included; large scuff marks, peeling paint, and numerous small holes. The cord to the over-bed light (D-Bed) was missing. Bathroom door in disrepair with peeling paint and large cuff marks. room [ROOM NUMBER]: The ceiling vent located in the bathroom was dust laden. room [ROOM NUMBER]: The room base boards were in disrepair and were separating from the room walls. room [ROOM NUMBER]: The room walls were in disrepair that included; large scuff marks, peeling paint, and numerous small holes. Room base boards also in disrepair. room [ROOM NUMBER]: Wet towels on room floor to soak up leak from bathroom. Bathroom door frame had large areas of peeling paint. room [ROOM NUMBER]: The room walls were in disrepair that included; large scuff marks, peeling paint, and numerous small holes. the room floor was heavily soiled. Bathroom door exterior was in disrepair which included peeling paint. room [ROOM NUMBER]: The room walls were in disrepair that included; large scuff marks, peeling paint, and numerous small holes. The bathroom commode toilet seat was broken in half and could not be used by the residents . room [ROOM NUMBER]: The room walls were in disrepair that included; large scuff marks, peeling paint, and numerous small holes. Room base boards also in disrepair. Room chair seat stained and soiled. The privacy curtain is not long enough to provide personal privacy. room [ROOM NUMBER]: The room walls were in disrepair that included; large scuff marks, peeling paint, and numerous small holes. Room base boards also in disrepair. room [ROOM NUMBER]: The room walls were in disrepair that included; large scuff marks, peeling 106109 Page 3 of 14 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0584 Level of Harm - Minimal harm or potential for actual harm paint, and numerous small holes. Room base boards also in disrepair. Bathroom floor heavily soiled. Bathroom door exterior was in disrepair. Hallway PPE Dispenser: The screws holding the PPE supplies were out of the walls and the dispenser was ready to fall to the floor. Residents Affected - Some Biohazard Room: The entry door exterior was soiled, and large black scuff noted. Storage Room: The entry door exterior was soiled, and large black scuff noted. Central Supply Room: Room floor heavily soiled and large large dust balls noted . Following the 05/17/22 tour, the findings were again confirmed with the Administrator and Director of Maintenance. The Administrator stated that staff are required to document housekeeping/maintenance issues on a log book located at the nurses station . It was further stated that staff are not documenting in the book as required. A review of the maintenance log book on 05/17/22 noted that none of the issues noted during the environmental tour were documented in the April and May 2022 Maintenance Log Book . 106109 Page 4 of 14 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and review of policy and procedure, it was determined that the facility failed to ensure that it provided sufficient care and services e.g. oversight, encouragement and on-going assistance, to allow for adequate nutritional consumption during the breakfast and lunch meals, as evidenced by inaccuracy of solid oral intake recorded for three (3) meals for 1 of 4 sampled residents, observed during breakfast and lunch, Resident #20. Residents Affected - Few The findings included: Review of facility Certified Nursing Assistant (CNA) job description revised 11/2020, indicated that the Job Summary: Assists professional nursing personnel in providing patient care in assigned area. Assists patients with activities of daily living, provides for personal care, emotional support and performs more complex clinical skills under the direction of professional nursing personnel Essential Functions: Serves and removes patient meal tray in timely manner. Assists with feeding and/or preparing items such as opening milk container and cutting food for patient. Review of the facility policy and procedure for Food and Fluid Intake - Patient Care provided by the Director of Nursing (DON), reviewed 08/31/14 indicated, Rationale: Patient's food, fluid at meals and snacks are monitored to determine adequacy of nutrient intake. Responsible Disciplines: Licensed Nurses, Certified Nursing Assistants. Procedure: 1. Observe the food and beverages served to the patient at meals and snacks. 2. Determine intake of meal or snack once the patient has finished consuming the food and/or beverage. 3. Offer an alternate for foods not eaten. 4. Document the intake on designated paper or electronic form. Document substitute offered/consumed, if applicable. 5. Review documentation for trends. 6. Notify the physician and the registered dietician of intake that has declined over the past three (3) consecutive days and/or complications while consuming food and/or fluid, as applicable (e.g. choking, swallowing difficulties, etc.) 7. Document in patient's electronic medical record, complications observed at meal service and any consumption issues (e.g. choking, swallowing difficulties, refusal of meals and/or fluids, decline in intake, etc.) During an observational screening tour conducted on 05/16/22 at 11:15 AM, Resident #20's head of the bed was elevated. The full Monday morning breakfast tray was observed untouched on Resident #20's bedside table. It was noted that there were scrambled eggs with ham pieces/chunks, cream of wheat, fresh fruit, a full carton of milk and four (4) oz. of juice. The only item on the tray noticed to be empty/consumed was the Ensure Plus Vanilla eight (8) oz. containing 350 calories. Resident #20 had only consumed approximately less than (<) 10% of her breakfast meal. (Photographic evidence obtained). Resident #20 was admitted to the facility on [DATE] with diagnoses which included Sepsis, Metabolic Encephalopathy, Acute Respiratory Failure with Hypoxia, Dependence on Supplemental Oxygen, Vitamin D Deficiency, Nutritional Deficiency, Weakness, Unspecified lack of coordination, Dysphagia and Nutritional Deficiency. She had a Brief Interview Mental Status (BIM) score of 7 (severely impaired). Further observations on 05/16/22 at 12:28 PM, Resident #20's Monday morning breakfast tray, still noted to be untouched on her bedside table; over an additional hour after it was observed earlier as being still untouched. 106109 Page 5 of 14 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 05/17/22 at 9:40 AM observations revealed Resident #20's head of the bed was elevated. Her Tuesday morning breakfast tray had been previously delivered to the floor and distributed to her at 8:30 AM. The partially consumed breakfast tray was still observed on Resident #20's bedside table. It was noted that there was a chopped sausage patty, full fruit cup and an unopened container of milk, all still present on her tray. Resident #20 only drank four (4) oz. of her juice and approximately 30 cc of her coffee; the resident had only consumed approximately less than (<) 25% of her breakfast meal. (Photographic evidence obtained). Further observations revealed on 05/17/22 at 11:21 AM, Resident #20's Tuesday morning breakfast tray was still noted to be sitting on her bedside table; almost three (3) hours after it had arrived earlier to the floor. On 05/18/22 at 11:05 AM, an interview was conducted with Staff E, (CNA), regarding Resident #20's breakfast intake on today's date of 05/18/22. She acknowledged that the resident's intake was low at 30%. She stated that she set up the resident's breakfast tray and she ate 30% of her meal---eggs, oatmeal and some milk. Staff E, did not indicate nor document whether the resident had refused any portion of her breakfast, nor if she had provided an alternate to the resident. Neither did Staff E, indicate or document that she had notified Resident #20's nurse of any consumption issues for the resident. On 05/18/22 at 11:12 AM, an interview was conducted with Staff B, a Licensed Practical Nurse (LPN), regarding Resident #20's inadequate breakfast and lunch meal intake between the dates of 05/16/22 and 05/18/22. She also acknowledged that the resident's intake was low as 5-20%. Staff B, also did not indicate nor document whether the resident had refused any portion of her breakfast, nor if she had provided an alternate to the resident. Neither did Staff B, indicate or document that she had notified the facility's dietician of Resident #20's low/poor intake or any other consumption issues for the resident, during the time frame above. On 05/19/22 at 11:45 AM, an interview was conducted with the Registered Dietician/Licensed Dietician (RD/LD), regarding Resident #20's breakfast and lunch meal intake between the dates of 05/16/22 and 05/18/22. She further acknowledged that the resident's intake was low at <25%. The RD/LD also added that each resident's oral intake must be communicated effectively and recorded accurately in order for her to be able to appropriately calculate and determine the resident's nutritional needs/status. Record review indicated that Resident #20 was ordered a general, soft bite size, thin liquid diet as of 04/19/22. During a record review of the most recent Nutritional note assessment dated [DATE] by the (RD/LD), she indicated that Resident #20's solid oral intake was initially at 75-100%. Review of Resident #20's Activities of Daily Living (ADL) Verification Worksheet for the dates of 05/16/22 through 05/18/22 it was documented by (CNA) staff that Resident #20's solid oral intake was 75%-100%. However, when in fact, direct observation of Resident #20's solid oral intake over the three (3) day-time frame (photographic evidence obtained) revealed that Resident #20 had only consumed <25% for two (2) of her breakfast meals and one (1) of her lunch meals. Nurses' progress notes dated 05/17/22 through 05/18/22 did not show any recorded oral intake/consumption issues for Resident #20. 106109 Page 6 of 14 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review revealed that Resident #20's Minimum Data Set (MDS) section G Functional Status for eating dated 04/18/22 only indicated that the resident only required Supervision---oversight, encouragement or cueing along with just Setup help. However, all other categories (Bed mobility, Transfer, Walk-in-room, locomotion on/off unit, Dressing, Toilet use and Personal hygiene), under this same heading revealed overall, that Resident #20 required extensive assistance to total dependence with one (1) to two (2) person physical assist. On 05/18/22 at 12:59 PM, an interview was conducted with the Minimum Data Set (MDS) Coordinator/RN, regarding the surveyors observation of Resident #20's low/inadequate of her breakfast and lunch meals over the past three (3) days from 05/16/22 thru 05/18/22. Following this information, the MDS Coordinator indicated that she had located and reviewed two (2) facility staff nursing progress notes dated 05/18/22 by Staff F, a LPN and Staff G, a LPN, in which both documented that Resident #20 was complaining of not breathing correctly, even with the oxygen connected, body aches and abnormal lung sounds/crackles. Medical Doctor (MD) made aware. New medication order received for Duoneb one unit dose every 6 hours (PRN) and (STAT) Chest X-ray (CXR) with results recorded as: Mild Congestive Heart Failure (CHF) versus non-specific Interstitial Lung Disease (COVID) 19 test done with negative results. Remains afebrile. The MDS Coordinator indicated that she will now speak with the dietician and the plan will be to re-assess the resident within the fourteen (14) day Significant Change time frame. The MDS Coordinator indicated that the change/decline in Resident #20's oral intake over the last few days had not been communicated to her by facility nursing staff. On 04/15/22 the care plan documented, Problem: Resident #20 is at risk for nutritional/dehydration risk related to diagnosis of Sepsis Pneumonia with Antibiotics Encephalopathy, with therapeutic/mechanically altered diet; diuretic use at risk for weight loss. Interventions: Meals in room assist with set-up, on general, soft bite diet with thin liquids .Goals: Resident #20 will have no complications related to weight loss, skin integrity or nutrition/hydration status through next review date of 07/19/22. However, further record review revealed Resident #20's weekly weights were: 200.40 lbs. on 04/12/22, 200 lbs. on 04/18/22, 200 lbs. on 04/25/22, 197 lbs. on 05/02/22, 198 lbs. on 05/10/22 and 198 lbs. on 05/17/22, indicative of a slow downward decrease in her overall weight. In fact, direct observation of the resident's breakfast and lunch meal intake between the dates of 05/16/22 and 05/18/22 revealed that Resident #20's oral intake relative to her functional limitations and medical diagnoses, would not be adequate without direct, on-going physical assistance with eating from facility staff. During consecutive interviews conducted on 05/19/22 at 10:30 AM with the Registered Nurse, Charge Nurse, Assistant Director of Nursing (ADON), Director of Nursing and the Administrator, all further acknowledged and recognized that Resident #20's intake was low at <25% for the breakfast and lunch meals between the dates of 05/16/22 and 05/18/22 and that the resident's solid oral intake was inaccurately recorded on the Activities of Daily Living (ADL) Verification Worksheet as being more than was observed by this surveyor for the three (3) meals. 106109 Page 7 of 14 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

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, interview and review of policy and procedure, it was determined that the facility failed to 1) properly secure prescription and over-the-counter (OTC) medications for 2 of 4 sampled residents observed during a Medication Administration Observation, Resident #175 and Resident #174; 2) failed to ensure that it kept stored resident medication in the medication cart locked and secured at all times for 1 of 2 medication carts observed, medication cart #1; 3) failed to ensure that it secured medication in its packaging in 1 of 2 medication carts observed, medication cart #1; and 4) the facility failed to promptly and properly discard/dispose of a used insulin needle syringe for 1 of 2 medication carts observed, Medication cart #2. The findings included: Review of un-dated facility Licensed Nurse job description indicated that Essential Functions: maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department. Review of the facility policy and procedure for Long Term Care (LTC) Facility's Pharmacy Services and Procedures Manual - Storage and Expiration Dating of Medications, Biologicals provided by the Director of Nursing (DON) reviewed 01/01/22 indicated that Applicability policy 5.3 sets forth the procedures relating to the storage and expiration dates of medications, biologicals, syringes and needles Facility should ensure that all medications and biologicals, including treatment items are securely stored in a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors .Facility should ensure that the medications and biologicals for each resident are stored in the containers in which they were originally received Bedside Medication Storage: Facility should not administer/provide bedside medications or biologicals without a Physician/Prescriber order and approval by the Interdisciplinary Care Team and Facility Administration. Facility should store bedside medications or biologicals in a locked compartment within the resident's room. 1) During a Medication Administration Observation on 05/16/22 at 9:45 AM with Staff A, a Registered Nurse (RN), for Resident #175, it was noted that there was a visible unsecured used tube of prescribed Lidocaine 2.5 and Prilocaine 2.5 located on Resident #175's bedside nightstand. It was accessible to other residents, staff members and visitors. (Photographic evidence obtained). Resident #175 was admitted to the facility on [DATE] with diagnoses which included Atherosclerosis of Coronary Artery Bypass Graft without Angina Pectoris, End stage Renal Disease with Dependence of Renal Dialysis and Diabetes Mellitus Type II. He had a Brief Interview Mental Status (BIM) score of 14 (cognitively intact). On 05/17/22 at 9:41 AM, it was noted that there was an unsecured used tube of prescribed Lidocaine 2.5 and Prilocaine 2.5 still located on Resident #175's bedside nightstand. On 05/17/22 at 12:33 PM, it was noted that there was an unsecured used tube of prescribed Lidocaine 2.5 and Prilocaine 2.5 still located on Resident #175's bedside nightstand. 2) During a Medication Administration Observation on 05/16/22 at 11:53 AM with Staff B, a Licensed 106109 Page 8 of 14 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Practical Nurse (LPN), for Resident #174, it was noted that there was a used over the counter (OTC) bottle of Bausch and Lomb dry eye bottle located on the resident's overnight table with an expiration date of: 11/23. It was accessible to other residents, staff members and visitors. (Photographic evidence obtained). Resident #174 was admitted to the facility on [DATE] with diagnoses which included Pneumonia, Chronic Obstructive Pulmonary Disease, Hypertension, Chronic Kidney Disease stage III, Morbid Obesity, Anxiety Disorder and Gastroesophageal Reflux Disease and Diabetes Mellitus Type II. He had a Brief Interview Mental Status (BIM) score of 13 (cognitively intact). On 05/17/22 at 9:44 AM it was noted that there was a used over the counter (OTC) bottle of Bausch and Lomb dry eye bottle still located on the Resident #174's overnight table. On 05/17/22 at 12:33 PM, it was noted that there was a used over the counter (OTC) bottle of Bausch and Lomb dry eye bottle still located on the Resident #174's overnight table. 05/18/22 10:08 AM, it was noted that there was with still a used over the counter (OTC) bottle of Bausch and Lomb dry eye bottle located on the resident's overnight table. 3) On 05/17/22 at 9:10 AM prior to conducting a Medication Administration with Staff C, a Registered Nurse (RN), it was noted that Medication Cart #1, located across from the nurses station, was unlocked, unsecured and unattended containing fifteen (15) resident medications, all accessible to staff members, visitors and residents. (Photographic evidence obtained). On 05/17/22 at 9:13 AM, an interview was conducted with Staff C, an (RN), regarding the unlocked, unsecured, unattended medication cart and she acknowledged that the medication cart was left unlocked and should not have been. 4) During a Medication Storage observation on 05/17/22 at 9:49 AM, conducted with the Assistant Director of Nursing/Wound Care (ADON/Wound care) and with Staff C, an (RN) for Medication Cart #1, located across from the nurses station, it was noted that there was one (1) loose, unidentified, unsecured pink colored pill located in the bottom of the second drawer of the medication cart #1. (Photographic evidence obtained). On 05/17/22 at 9:53 AM, an interview was conducted with Staff C, an (RN), regarding the loose, unsecured, unidentified pink pill located at the bottom of the 2nd drawer in medication cart #1, and she acknowledged that the medication should not have been there and should have been secured in a package. The (DON) further acknowledged and recognized that all of the resident medication should have been kept secured and locked up; this was not done. 5) On 05/16/22 at 9:40 AM, during a Medication Pass Observation, an uncapped, exposed insulin syringe was visibly noted to be located on the edge, just inside of medication #2's cart attached needle/sharps box in which the medication cart's lid flap was wide open. The uncovered/exposed insulin needle tip was accessible to other staff members, visitors and residents. (Photographic evidence obtained). An interview was conducted with Staff A, a Registered Nurse on 05/16/22 at 9:50 AM, regarding the 106109 Page 9 of 14 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few used, exposed insulin needle syringe and she acknowledged that the un-capped/exposed insulin needle syringe should not have been there and should have been promptly and properly secured inserted inside of the needle box. During an interview conducted on 05/16/22 at 10:30 AM, the Registered Nurse (RN)/Charge Nurse and the Director of Nursing (DON), they both further acknowledged and recognized that the un-capped/exposed insulin needle syringe should not have been there and should have been promptly and properly secured inserted inside of the medication cart attached needle box; this was not done. Review of facility policy and procedure on 05/19/22 at 12:05 PM for Work Practices - Sharps Category Infection Control provided by the (DON) release date 09/29/16 indicated Policy: [NAME] healthcare professionals exercise safe infection practices to protect patients and themselves from injury and to prevent the spread of infections and/or biological pathogens. Procedure: .2. Immediately or as soon as possible after use, contaminated sharps are placed in appropriate containers until properly reprocessed .4. Sharps contaminated with blood or other potentially infectious materials (OPIM) are not stored or processed in a manner requiring employees to reach by hand into the containers where these sharps have been placed. Review of un-dated facility Registered Nurse job description on 05/18/22 at 2:15 PM indicated that Essential Functions: maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department. 106109 Page 10 of 14 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, the facility failed to store, prepare, distribute and served food in accordance with professional standards for food service safety. Residents Affected - Many The findings include: During the initial kitchen/food service observation tour conducted on 05/16/22 at 9 AM, accompanied with the Consultant Dietitian and Food service Supervisor, the following were noted: Observation of the ceiling air-conditioning vent that was located within the food production area was noted to have the exterior surface of the vent covered with condensation. Further observation noted that droplets of condensation were falling down from the vent. It was discussed with the facility's representatives at the time of the tour, that there was the potential for the droplets to fall on foods, preparation surfaces and equipment, and staff that could result in food contamination and food borne illness. 106109 Page 11 of 14 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, it was determined that the facility did not dispose of garbage and refuse properly and the garbage storage area and loading dock were not maintained in a sanitary condition. Residents Affected - Many The findings included: During the initial kitchen/food service observation tour conducted on 05/16/22 at 9 AM, accompanied with the Consultant Dietitian and Food service Supervisor, the following were noted: Observation of the outside garbage/refuse (dumpster) area revealed that there were large areas of unidentified trash and garbage surrounding the ground area of the dumpster. It was also noted that there was a thick heavy build-up of black matter with offensive odor and numerous flying insects also surrounding the ground area. An interview conducted with the Director of Housekeeping at the time of the observation confirmed the surveyors findings and stated that each time the dumpster is removed for emptying, the ground area is to be thoroughly cleaned daily when the dumpster is removed for emptying. it was further stated that the cleaning is not being done on a regular basis. On 05/18/22 at 7:30 AM, the dumpster area was again observed. It was noted that the issues were worsening and that the ground area around and beneath the dumpster was littered with open trash and garbage, offensive odor, and flying insects. The surveyor requested the Administrator and Director of Maintenance to view the dumpster area and confirmed the surveyors findings. The Administrator stated that the area is not being properly cleaned on a daily basis. Observation conducted on 05/19/22 at 8:30 AM again noted that the ground area beneath and around the dumpster was thick with a heavy build-up of trash and garbage. The Administrator was requested to view the observation and confirmed the surveyors findings. The Administrator stated at the time of the observation that the dumpster is too small to contain all of the facility's trash and garbage. It was also stated that the facility is not being notified by the waste company of when the dumpster/compacter is moved from the pad so that facility staff may clean and sanitize the area. * Photo evidence obtained 106109 Page 12 of 14 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0923 Have enough outside ventilation via a window or mechanical ventilation, or both. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, it was determined that 1 of 1 sampled resident's (Resident #125) Residents Affected - Few was residing in a room without working mechanical ventilation and poor air circulation. The findings included: During the environmental tour conducted on 05/17/22 at 1 PM, accompanied with the Administrator and Director of Maintenance, it was noted that Resident #125's room was very warm. Further observation noted that Resident #125 was seated in a chair with a large box fan behind her. An interview conducted with the resident at the time of the observation revealed to state that the room air-conditioning has not been working for approximately 4 days and that she is constantly hot. The resident further stated that she informed numerous staff of the air-conditioning issues without the issues being resolved. Resident #125 further stated that she was given the box fan 4 days ago by an unknown maintenance staff. An observation of the wall air conditioning control revealed that the unit was set at 60 degrees F, however the room temperature was at 82 degrees F. Resident stated that the room temperature never went below 80 degrees F for approximately 4 days. Interview with the Maintenance Director at the time of the observation revealed that he was not aware of the air-conditioning issues and that the maintenance log located at the nurses station failed to document the non-working air-conditioning in Resident #125's room. A review of the Maintenance Log for May 2022 located at the nurses station confirmed that there was no documented entry of the air-conditioning issue for Resident #125. During the observation, the surveyor requested that the air-conditioning issue be corrected by the end of 05/17/22 or required to move the resident to another room with working air-conditioning. An observation was again conducted on 05/18/22 at 7:30 AM and, it was noted that the air-condition control was set at 72 degrees F and also indicated that the room temperature was also 72 degrees F. The resident thanked the surveyor and stated that the issues would not have been addressed and corrected without the surveyors intervention. The resident further stated that the room temperature is perfect now. On 05/18/22 the Director of Maintenance approached the surveyor and stated that the air-conditioning issue in the room of Resident #125 was corrected on 05/17/22. Further stated that a air-conditioning fuse had to be replaced that was located above the ceiling. The Director went on again to state that he had not been made aware of the issue and that staff are not utilizing the Maintenance Log located at the nurses station to report any maintenance issues. Review of the clinical record of Resident #125 noted an admission date of 05/13/22 with diagnoses that included: Major Depressive Disorder, COPD, Anxiety Disorder, and Morbid Obesity. Review of admission nursing assessment dated [DATE] documented that the resident is orientated x 2. Review of MDS dated [DATE] noted documentation of Section C was a BIMS score of 15 (no cognitive impairment) . Review of Nurses Notes from 05/07-16/22 did not not note documentation of the air-conditioning issue. (Photograhphic Evidence Obtained). 106109 Page 13 of 14 106109 05/19/2022 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0924 Put firmly secured handrails on each side of hallways. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, it was determined that resident corridors walls were not equipped with firmly secured handrails on each side, which potential effected 6 resident's including Resident's #20 and #174. Residents Affected - Few The findings included: During the environmental tour conducted on 05/17/22 at 1 PM, accompanied with the Administrator and Director of Maintenance, it was noted that the corridor wall mounted handrail that was located outside of room [ROOM NUMBER], #230, #231, #232, which houses 6 residents that included Resident's #20 and #174, was detached from the wall. Further observation noted that the entire rail of approximately 5 feet was ready to fall from the wall and the attachment screws were visible and almost out of the walls. It was discussed that the handrail situation was a potential fall hazard for residents requiring the use of the handrail, and the surveyor requested that staff be made aware of the handrail issue and that the handrail be repaired immediately. The Director of Maintenance stated that he was not informed of the handrail issues and that the issues was not documented on the maintenance log located at the nurses station. Interviews conducted with staff who requested not to be identified stated that the detached handrail issues has been on-going 2-3 weeks and that handrail was reported to Maintenance. 106109 Page 14 of 14