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 (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 5 Event ID: 106115 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106115 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgewater Park Health & Rehabilitation Center 9280 South West 81st CT Ocala, FL 34481 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)