Health inspection·May 4, 2023

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 ensure residents received respiratory care services consistent with professional standards of practice for 3 of 7 residents reviewed for oxygen administration, Residents #62, #68, and #265 (Photographic evidence obtained). Residents Affected - Few Findings include: 1. During an observation on 5/1/2023 at 1:00 PM, Resident #68 was lying in bed, being administered oxygen via nasal cannula. The oxygen concentrator was set to 3.5 liters per minute. During an observation on 5/2/2023 at 8:14 AM, Resident #68 was lying in bed, being administered oxygen via nasal cannula. The oxygen concentrator was set to 3 liters per minute. Review of Resident #68's admission record revealed the resident was admitted on [DATE] with diagnoses including chronic diastolic (congestive) heart failure, chronic obstructive pulmonary disease (COPD) with (acute) exacerbation, other asthma, peripheral vascular disease, and hypertensive heart disease with heart failure. Review of Resident #68's physician order dated 11/29/2022 read, Oxygen at 2 L/min [Liters/ Minute] via NC [nasal cannula] as needed. every shift for COPD. During an interview on 5/3/2023 at 8:58 AM, Staff B, LPN, stated, [Resident #68's name] has an order for 2 liters. His concentrator is set to 3.5 liters and that is not correct. 2. During an observation on 5/1/2023 at 11:43 AM, Resident #265 was lying in bed, being administered oxygen via nasal cannula. The oxygen concentrator was set to 2 liters per minute. During an observation on 5/2/2023 at 8:18 AM, Resident #265 was in bed, being administered oxygen via nasal cannula. The oxygen concentrator was set to 2 liters per minute. During an interview on 5/3/2023 at 8:42 AM, Staff B, LPN, stated, The order says that she [Resident #265] is supposed to get 4 liters of oxygen. Her concentrator is set to 2 liters per minute. Review of Resident #265's admission record revealed the resident was admitted on [DATE] with diagnoses including acute and chronic respiratory failure with hypoxia, and occlusion and stenosis of right carotid artery. Review of Resident #265's physician order dated 4/29/2023 read, Oxygen 4 LPM continuous via nasal Page 1 of 5 106115 106115 05/04/2023 Bridgewater Park Health & Rehabilitation Center 9280 South West 81st CT Ocala, FL 34481

F 0695 cannula every shift for oxygen therapy maintain O2 SAT's [Oxygen saturation] above 92%. Level of Harm - Minimal harm or potential for actual harm 3. During an observation on 5/1/2023 at 1:37 PM, Resident #62 was observed in bed, being administered oxygen via nasal cannula. The oxygen concentrator was set to 1.5 liters per minute. Residents Affected - Few During an observation on 5/2/2023 at 8:23 AM, Resident #62 was lying in bed, being administered oxygen via nasal cannula. The oxygen concentrator was set to 2 liters per minute. Review of Resident #62's admission record revealed the resident was admitted on [DATE] with diagnoses including chronic obstructive pulmonary disease, chronic diastolic (congestive) heart failure, solitary pulmonary nodule, atherosclerotic heart disease of native coronary artery without angina pectoris (chest pain), and shortness of breath. Review of Resident #62's physician order dated 10/10/2022 read, Oxygen: 3 L/min via nasal cannula. as needed for SOB [Shortness of Breath] Note: for O2 sat below 92%. During an interview on 5/3/2023 at 8:39 AM, Staff C, Licensed Practical Nurse (LPN), stated, [Resident #62's name] is supposed to be on 3 liters per minute, and her concentrator is set to 1.5 liters per minute. That is not correct. During an interview on 5/3/2023 at 9:48 AM, the Director of Nursing stated, The nurses need to follow physician orders to ensure the correct settings for oxygen is being used. Review of the facility policy and procedure tilted Oxygen Therapy last revised in June 2022 read, Oxygen Administration- Concentrator. 1. Verify physician order (except in an emergency) . 5. Attach tubing and delivery device (nasal canula/ mask) and adjust the flow rate to the ordered liter flow. 106115 Page 2 of 5 106115 05/04/2023 Bridgewater Park Health & Rehabilitation Center 9280 South West 81st CT Ocala, FL 34481

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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** 3. During an observation of Resident #164's room on 5/1/2023 at 10:21 AM, there was an opened Menthol and [NAME] Oxide Ointment with the prescription label stored on Resident #164's dresser. There were no facility staff in the room. Review of Resident #164's care plan, initiated on 3/20/2023, did not reveal any documentation that Resident #164 had been assessed as able to safely self-administer medications. During an interview on 5/3/2023 at 9:25 AM, Staff A, Registered Nurse (RN), confirmed that medications should be returned to and stored in the medication room after use. During an interview on 5/3/2023 at 10:40 AM, the Director of Nursing stated that she was aware the topical medication stored on Resident #164's dresser in his room was prescribed at another facility. She stated she believed Resident #164's spouse brought the topical ointment into the facility. Review of the facility policy and procedure titled Guidelines For Medication Storage and Labeling last reviewed on 2/9/2023 read, Purpose: Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. General Guidelines: 1. Medications and biological in medication rooms, carts, and refrigerators are maintained within: a. Secured (locked) locations, accessible only to designated staff. 2. During an observation of Resident #41's room on 5/1/2023 at 9:18 AM, there was Clotrimazole Betamethasone Dipropionate Cream 1%/ 0.05% on the resident's TV stand. Review of Resident #41's care plan revealed no documentation that the resident could self-administer medications. During an interview on 5/3/2023 at 8:42 AM, Staff C, Licensed Practical Nurse (LPN), stated, [Resident #41] is not supposed to have medications at her bedside. There is no care plan for medication at her bedside. During an interview on 5/3/2023 at 9:48 AM, the Director of Nursing stated, My expectation is that no medications are to be left at the bedside unless there is a physician order and a care plan stating that it is the resident's preference to administer their own medication. All meds should be kept in a lock box when the resident is done with it. Based on observation, interview, and record review, the facility failed to ensure medications were securely stored in 3 of 4 Halls in the rooms of Resident #41, Resident #55, Resident #324, and Resident #164 (Photographic evidence obtained). Findings include: 1. During an observation of Resident #55's room on 5/1/2023 at 9:53AM, there was an Aluterol 106115 Page 3 of 5 106115 05/04/2023 Bridgewater Park Health & Rehabilitation Center 9280 South West 81st CT Ocala, FL 34481

F 0761 Inhaler on top of the resident's bedside table. No nursing staff was present in the room. Level of Harm - Minimal harm or potential for actual harm Review of Resident #55's physician orders revealed no orders for self-administration of medications. Residents Affected - Some During an interview on 5/1/2023 at 9:53 AM, Resident #55 stated, The nurse left the inhaler here but will be right back to pick it up. 2. During an observation of Resident #324's room on 5/1/2023 at 10:07 AM, there were one opened bottle of Nystatin topical powder and Timolol Maleate Ophthalmic Solution 0.5% (eye drops) on the resident's bedside table. During an interview on 5/1/2023 at 10:07 AM, Resident #324 stated, Those medications are mine. I administer them myself. I have administered them for over 3 years now. Review of Resident #324's physician orders revealed no orders for self-administration of medications. During an interview on 5/2/2023 at 1:25 PM, the Director of Nursing stated, I was aware [Resident #55's name] inhaler was left in the room. The nurse told me. [Resident #55's name] does not have a self-administration order. [Resident #324's name] does not have a self-administration order. When residents are admitted , if they bring medication, nurse calls the doctor and gets approval for those medications. If the resident can self-administer, the medication will be kept in top drawer and key will be provided. Prior to the resident being allowed to self-administer, the nurse will do a self-administration assessment and demonstration will be required. This will all be documented in the system. 106115 Page 4 of 5 106115 05/04/2023 Bridgewater Park Health & Rehabilitation Center 9280 South West 81st CT Ocala, FL 34481

F 0848 Provide a neutral and fair arbitration process and agree to arbitrator and venue. Level of Harm - Potential for minimal harm Based on record review and interview, the facility failed to ensure the arbitration agreements provided for the selection of a venue convenient to both parties for 3 of 3 reviewed residents, Residents #114, #115 and #166. Residents Affected - Many Findings include: Review of the facility's Voluntary Binding Arbitration Agreements presented to Resident #114 on 5/1/2023, presented to Resident #115 on 5/1/2023 and presented to Resident #166 on 5/2/2023 failed to show the arbitration agreement provided for the selection of a venue convenient to both parties. During an interview on 5/2/2023 at 9:00 AM, the Administrator confirmed the facility arbitration agreements presented to Residents #114, #115 and #166 did not contain information related to selection of a venue convenient to both parties. 106115 Page 5 of 5