Health inspection·February 17, 2022

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interview, the facility failed to ensure the MDS (Minimum Data Set) assessment accurately reflected the resident status for 2 (Resident #21 and #45) of 2 sampled residents reviewed for vision and behavior. Inaccurate MDS assessments can result in a resident not receiving appropriate health care. Residents Affected - Few The finding included: 1. Review of the clinical record for Resident #21 revealed an admission date of 6/9/21. The admission Minimum Data (MDS) assessment with an assessment reference (ARD) date of 6/16/21 noted the resident's vision was highly impaired (Object identification in question, but eyes appear to follow object), and used corrective lenses. The Quarterly MDS assessment with an ARD date of 9/16/21 noted the resident did not use corrective lenses and her vision was adequate (sees fine detail, such as regular print in newspapers/books). The Quarterly MDS assessment with an ARD date of 12/17/21 and the significant change in status MDS assessment with an ARD date of 1/28/22 noted Resident #21 used corrective lenses and her vision was adequate. Review of the hospice documentation dated 4/15/21 showed Resident #21's diagnoses included macular degeneration (Eye disease that causes vision loss). On 2/14/22 at 3:44 p.m., in an interview Resident # 21 said her eyes are not that good and she did not wear glasses. On 2/16/22 at 12:20 p.m., in an interview, the Life Enrichment Director said she performed the vision assessment for Resident #21 and coded the MDS of 9/16/21, 12/17/21 and 1/28/22. She said Resident #21's vision was impaired at the time of admission. On 2/16/22 at 12:54 p.m., the Life Enrichment Director said she called Resident #21's sister and verified the resident never owned corrective lenses. The Life Enrichment Director confirmed the Resident's vision and use of corrective lenses were coded incorrectly in the MDS assessments of 9/16/21, 12/17/21 and 1/28/22. 2. Review of Resident #45's clinical record revealed a Social Service note dated 1/25/22 at 3:17 p.m., that read, . Threats to harm self . Resident displaying aggression towards staff, screaming out, and verbalizing desire and plan to die . Psychiatrist initiated baker act [Emergency involuntary psychiatric admission and mental health examination Request for a person who cannot or will not Page 1 of 6 106137 106137 02/17/2022 The Preserve 14750 Hope Center Loop Fort Myers, FL 33912

F 0641 request help for themselves]. Resident #45 was transported to an acute care hospital. Level of Harm - Minimal harm or potential for actual harm On 1/29/22 a nursing progress note indicated Resident #45 returned to the facility. Residents Affected - Few A progress note dated 1/30/22 at 10:54 a.m., read, Patient aggressive towards nurse and staff has been refusing to cooperate with care. Patient screaming and cursing. The Significant change in status assessment with an assessment reference date of 1/31/22 noted Resident #45 did not exhibit physical or verbal behavioral symptoms directed toward others such as (threatening others, screaming at others, cursing at others). Review of the steps for assessment listed in the Center For Medicare and Medicaid Resident Assessment Instrument manual (October 2019) showed instructions to, . Review the medical record for the 7-day look-back period. Interview staff, across all shifts and disciplines, as well as others who had close interactions with the resident during the 7-day look-back period . Code 1, behavior of this type occurred 1-3 days: if the behavior was exhibited 1-3 days of the last 7 days, regardless of the number or severity of episodes that occur on any one of those days . On 2/16/22 at 10:26 a.m., in an interview, the Registered Nurse (RN) MDS Coordinator verified the significant change in status MDS assessment was inaccurate and did not reflect Resident #45's behavior exhibited in the last 7 days. 106137 Page 2 of 6 106137 02/17/2022 The Preserve 14750 Hope Center Loop Fort Myers, FL 33912

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, staff, and resident interviews the facility failed to ensure 1 (Resident #21) of 2 sampled residents with impaired vision receive appropriate treatment and assistance with meals. Residents Affected - Few The findings included: On 2/14/22 at 12:25 p.m., Resident #21 was observed in bed. Her lunch tray was on the floor with the food items on the floor. On 1/14/22 at approximately 12:30 p.m., Certified Nursing Assistant (CNA) Staff I was observed picking up the meal tray from the floor. In an interview the CNA said Resident #21 was blind and at times had accidents while eating since she could not see. On 2/14/22 at 1:27 p.m., in an interview Certified Nursing Assistant (CNA) Staff A said Resident #21 was blind, could barely see shapes and needed assistance with her meals. On 2/14/22 at 3:44 p.m., in an interview Resident #21 said she did not wear glasses and said her eyes are not that good. Review of the clinical record for Resident #21 revealed an admission date of 6/9/21. The Quarterly Minimum Data Set (MDS) assessments dated 9/16/21 and 12/17/21 and the Significant change in status MDS assessment dated [DATE] noted Resident #21's vision was adequate. The assessments also noted the resident was receiving hospice services. Review of the hospice documentation dated 4/15/21 showed Resident #21's diagnoses included macular degeneration (Eye disease that causes vision loss). The Significant change in status MDS assessment of 1/28/22 noted Resident #21 required physical assistance of one person, supervision, oversight, encouragement or cueing with eating. The care plan for activities of daily living noted the resident received hospice services and a decline in ability to perform activities of daily living was expected. The intervention dated 1/21/22 noted the resident was independent for eating and on 1/31/22 noted staff was to assist with meal set up. On 2/16/22 at 12:54 p.m., the Life Enrichment Director confirmed the Resident's vision was coded incorrectly in the MDS assessments of 9/16/21, 12/17/21 and 1/28/22 and the care plan was not individualized with specific approaches to ensure Resident #21's received the necessary assistance with her meals. 106137 Page 3 of 6 106137 02/17/2022 The Preserve 14750 Hope Center Loop Fort Myers, FL 33912

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and staff and resident interviews, the facility failed to ensure urinary catheters were maintained in a safe and sanitary manner for 3 (Resident #16, #32 and #37) of 3 residents sampled with indwelling urinary catheter. The findings included: 1. Review of the clinical record for Resident #32 revealed a quarterly MDS assessment dated [DATE] which noted the Resident required extensive physical assistance of two persons for bed mobility and toilet use. On 2/14/22 at 4:26 p.m., and 2/15/22 at 9:15 a.m., during observations Resident #32 was in bed and the urinary catheter drainage bag was resting on the floor. 2. Review of the clinical record for Resident #16 revealed a Quarterly Minimum Data Set (MDS) assessment dated [DATE] noting Resident #16 required extensive physical assistance of one person for bed mobility and personal hygiene. On 2/15/22 during random observations at 9:26 a.m., 11:30 a.m., and 2:07 p.m., Resident #16 was in bed and the urinary catheter drainage bag was resting on the floor. On 2/16/22 at 9:00 a.m., Resident #16 was observed in bed and the urinary catheter drainage bag was on the floor. The Infection Preventionist verified the observation and said the urinary catheter drainage should not be on the floor and was an infection control concern. The Infection Preventionist said there should be a blue pad under the drainage bag to separate it from contact with the floor. On 2/16/22 at 9:12 a.m., Certified Nursing Assistant (CNA) Staff J said the urinary catheter drainage bag should never be on the floor because of germs and the risk of urinary tract infections. Staff J said it was common knowledge and part of the facility training to keep the urinary catheter drainage bag off the floor. 3. Review of the clinical record for Resident #37 revealed a significant change in status MDS assessment dated [DATE] which noted the Resident required extensive physical assistance of one person for toileting. On 2/17/22 at 11:38 a.m., Resident #37 was observed in bed and the urinary catheter drainage bag was on the floor. There was no blue pad under the drainage bag to prevent contact with the floor. 106137 Page 4 of 6 106137 02/17/2022 The Preserve 14750 Hope Center Loop Fort Myers, FL 33912

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Based on observation, interview, and record review the facility failed to ensure sufficient dietary staff to carry out the functions of the food and the nutrition services effectively in serving meals for 3 residents (Resident #12, Resident #20, and Resident #364) of 16 residents surveyed for dietary services. The findings included: On 2/14/22 at 9:10 a.m., observed residents on the second and third floor having breakfast in their rooms. The dining rooms on the second and third floor were not in use. On 2/15/22 at 2:22 p.m., in a resident council meeting, the residents in attendance voiced concern related to eating in their rooms and not the dining room. Resident #20 said he would like to eat in the dining room instead of his room all the time. Resident #12 complained the dining room was not opened to the residents. Resident #12 said when he ate in the dining room, he got hot food and silverware instead of plastic forks and spoons. He said it had been a while since the dining room was opened to residents. Resident #12 said none of the staff will say when the dining room will be opened again. Resident #364 said she would like to have her meals in the dining room instead of in her room all alone. On 2/15/22 at 9:15 a.m. the Culinary Director said the dining room was initially closed because of COVID 19 but it had been a month since the facility had a positive COVID-19 case. The Culinary Director said the dining rooms remained closed due to dietary staffing challenges in serving residents in the dining room. On 2/17/22 at 9:30 a.m., the Culinary Director said she has been trying to fill two dietary aide positions since December of 2021. She stated although she uses agency staff at times, they are not reliable. The Culinary Director did not provide an answer when asked if she was aware residents had been complaining about not being able to dine together in the dining room. On 2/17/22 at 11:30 a.m., the Administrator said the facility had been meaning to open the dining rooms again since there had not been any COVID case. The Administrator said he was not aware residents had been complaining about not being able to eat in the dining area. He said he was not aware the dining room had not been opened due to staffing issues. On 2/15/22 at 9:49 a.m., in an interview the Culinary Director said the facility has not reinstated the dining room style experience because they were facing a staffing challenge for both nursing and dietary. 106137 Page 5 of 6 106137 02/17/2022 The Preserve 14750 Hope Center Loop Fort Myers, FL 33912

F 0802 On 2/15/2022 at 10:43 a.m., in an interview Resident #364 said she eats all her meals in her room but would like to eat in the dining room to be engaged and converse with other residents. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 106137 Page 6 of 6