Health inspection·December 2, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure residents received medications as ordered by physician for 1 of 3 residents reviewed, Resident #2. Residents Affected - Few Findings include: Review of Resident #2's admission record showed the resident was admitted on [DATE] with the diagnoses including muscle weakness, abnormalities of gait and mobility, and need for assistance with personal care. Review of Resident #2's physician order dated 7/11/2024 read, Milk of Magnesia [MOM] Suspension 400 MG [milligram]/5 ML [milliliter], Give 30 ml by mouth every 12 hours as needed for constipation daily if no BM [Bowel Movement] for 2 days. Review of Resident #2's Medication Administration Record (MAR) for July 2024 showed no entries documented on 7/11/2024 through 7/18/2024 for administration of Milk of Magnesia with the start date of 7/11/2024 and discontinuation date of 7/18/2024. Review of Resident #2's physician order dated 7/11/2024 read, Bisacodyl Suppository 10 mg (Bisacodyl), Insert 1 suppository rectally every 24 hours as needed for constipation daily if MOM is not effective. Review of Resident #2's MAR for July 2024 showed no entries documented on 7/11/2024 through 7/15/2024 and on 7/17/2024 and 7/18/2024 for administration of Bisacodyl Suppository with the start date of 7/11/2024 and discontinuation date of 7/18/2024. Review of Resident #2's physician order dated 7/11/2024 read, Disposable Enema Enema 19-7 GM [gram]/118 ml (Sodium Phosphates), Insert 1 application rectally every 24 hours as needed for constipation daily if MOM is not effective. Review of Resident #2's MAR for July 2024 showed no entries documented on 7/11/2024 through 7/18/2024 for administration od Disposable Enema with the start date of 7/11/2024 and discontinuation date of 7/18/2024. Review of Resident #2's nursing progress note dated 7/16/2024 at 4:39 AM authored by Staff A, Licensed Practical Nurse (LPN), showed the resident called 911 around 2 AM and stated she needed enema and she had yet to receive it. Page 1 of 2 106115 106115 12/02/2024 Bridgewater Park Health & Rehabilitation Center 9280 South West 81st CT Ocala, FL 34481

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a telephone interview on 12/2/2024 at 10:38 AM, Resident #2 stated that the last time she had a BM was 7/7/2024 and was admitted to the facility on [DATE]. During a telephone interview on 12/2/2024 at 12:52 PM, Staff A, LPN, stated, This was the first night that I was assigned to [Resident #2's name]. She complained to me that she did not receive her enema. I told her that I would give it to her. I gave her a suppository. I just assumed that day shift had given her the Milk of Magnesia. She should have received MOM first, then the suppository or the enema. During an interview on 12/2/2024 at 12:58 PM, Staff B, LPN Supervisor, stated. [Resident #2's name] was not administered MOM on day 2 [7/13/2024] of admission when she had not had a BM and should have been with additional suppository or laxative if no BM occurred. During a telephone interview on 12/2/2024 at 1:16 P, Staff D, LPN, stated, I gave her [Resident #2] a suppository when she called 911 for constipation. I am not sure what our bowel protocol is, but we have to have physician orders and follow the orders. During an interview on 12/2/2024 at 1:30 PM, Staff E, Physician Assistant-Certified (PA-C), stated, Physician orders must be followed. No harm occurred to the resident [Resident #2]. If a resident complains of constipation or there is no documentation of a BM within 2 days of admission, physician orders should have been followed. MOM should have been administered, if no bowel movement with 24 hours after the MOM, then suppository or enema should have been given. I have been informed that morning of 7/16/2024 prior to the resident going to the hospital that an enema had been given. The resident called 911 herself. During an interview on 12/2/2024 at 2:00 PM, the Assistant Director of Nursing (ADON) stated, The MOM was not administered as ordered on 7/12/2024 and should have been with a suppository 24 hours later by 7/14/2024, then enemas. The physician would be notified if no BM after orders were followed, and the resident still did not have a BM. During an interview on 12/2/2024 at 2:20 PM, the Director of Nursing (DON) stated, MOM was not administered as ordered when constipation was identified. If the resident [Resident #2] requested an enema because she was constipated and there were orders the enema should have been given. There is no written protocol or policy related to bowel regiment but there is batch orders that is placed. The MOM nor the enema was administered as ordered. Review of the facility's policy and procedure titled Bowel Elimination Policy read, Policy: It is the policy of this facility to ensure residents receive proper treatment for constipation . Definition: Constipation - A buildup of hardened feces in the bowel that the resident cannot move naturally. Diarrhea may be a sign of a fecal impaction because only liquid material is able to pass the blockage. Fecal impaction can cause urinary difficulty from the pressure in puts on the bladder . 1. Follow specific physician orders for the resident . 4. The nurse that is notified of no bowel movement in 48 hours will give the first line of intervention for those residents who have not had a bowel movement for two day (six shifts), as ordered by physician. 5. If no results from the first intervention, an enema will be given on the next shift. If no order for enema, call physician and obtain order. Review of the facility's policy and procedure titled Following Physician Orders/Parameters read, Purpose: To administer resident care in a safe and effective manner and following physician orders and ordered parameters. 106115 Page 2 of 2