Health inspection·October 28, 2022

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 record review, observation, and interview, the facility failed to obtain a physician order for oxygen administration, failed to keep a resident's oxygen tubing off the floor, failed to change oxygen tubing, and failed to label portable oxygen cannula/tubing according to the plan of care. These failures affect one of three residents (R30) reviewed for respiratory care on the sample list of 19. Residents Affected - Few Findings include: R30's Physician Order Sheet (POS) dated October 2022 had an oxygen administration order added 10/27/22 as follows: Oxygen per nasal cannula at 3 (three) liters per nasal cannula (sic) continuous. Change oxygen equipment every Sunday. R30's Minimum Data Set (MDS) dated [DATE] documents R30's Brief Interview of Mental Status score of seven out of a possible 15, indicating severe cognitive impairment. The same MDS documents R30 was on oxygen while not a resident at the facility and while residing in the facility. R30's Care Plan dated 9/3/22 documents the following: Category Respiratory. I (R30) am receiving oxygen therapy due to diagnoses of History Respiratory Failure and anoxic brain injury. Care Plan Goal, Exhibits no shortness of breath per my (R30) report. Intervention (1.) Provide Humidification, label with date, change weekly. Intervention (6.) Change oxygen tubing weekly and as needed. Label with date. Keep tubing off floor. Store tubing in bag attached to concentrator or wheelchair. (7.) Administer oxygen therapy at three liters per nasal cannula or mask. On 10/25/22 at 11:03 AM, R30 had an oxygen bed-side concentrator with humidifier bottle dated as changed 10/21/22. R30 has nasal cannula and tubing dated as changed 10/08/22. R30's oxygen flow rate was set at a delivery rate of two liters (physician ordered at three liters and identified on the care plan) per nasal cannula. R30 also has oxygen tubing with additional eight foot extension oxygen tubing. The oxygen tubing laid on the floor partially coiled that extended from R30's nasal cannula down onto the floor and over five feet to the oxygen concentrator. R30 also had an E-cylinder portable oxygen tank with undated tubing/nasal cannula laid on a bedside table. The E-tank portable oxygen was in R30's wheelchair. R30 stated I am not sure if they change anything. I really don't know for sure. On 10/25/22 at 11:35 pm V4, Registered Nurse (RN) confirmed R30's oxygen tubing placement and tubing date. V4, RN stated (R30's) tubing should never be on the floor. Tubing should be changed and dated when changed every week. On 10/26/22 at 9:05 am V2, Director of Nursing (DON) confirmed R30 does not have a physician order Page 1 of 3 145416 145416 10/28/2022 Heartland Nursing & Rehab 410 Northwest Third Casey, IL 62420

F 0695 Level of Harm - Minimal harm or potential for actual harm for oxygen. V2 also stated V2, DON heard about the problem with R30's oxygen tubing on the floor and dated 10/08/22. V2, DON also stated Tubing and humidifier bottles should be changed weekly and prn (as needed). Of course, the oxygen tubing should never be on the floor. I educated staff and we have provided the bags to put the tubing in, for everyone on oxygen. Residents Affected - Few 145416 Page 2 of 3 145416 10/28/2022 Heartland Nursing & Rehab 410 Northwest Third Casey, IL 62420

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review the facility failed to properly label and store hot dogs, failed to maintain a sanitary can opener, and failed to use approved sanitizer for wiping bucket use. These failures have the potential to affect all 43 residents in the facility. Findings include: On 10/25/1022 at 11:55AM, a half-full bulk pack of uncooked hot dogs was stored in the kitchen walk-in-cooler. The hot dog package was not labeled with the date opened or a use-by date, as required. At 12:00PM, a one-gallon bleach jug was located on a cart in the kitchen nearby sanitizer wiping buckets. V3 (Dietary Manager) was present and reported the jug of bleach was used for preparing sanitizer solution. The jug was not labeled for food service use and did not have the required pesticide registration identification. V3 reported being unsure if the bleach product was food grade. On 10/25/2022 at 12:00PM, the kitchen can opener mounted on a preparation table was soiled with accumulations of food debris and the receiver was leaking a brown liquid onto the floor surface below the can opener. V3 was present and stated Aww, yeah, yes it (the can opener) does (need cleaned). On 10/26/2022 at 12:26PM, the hot dog package from above was located on a food preparation table and remained unlabeled. V3 reported the kitchen normally takes a week and a half through two weeks to use an entire package of hot dogs. V3 reported the food in the kitchen is available for all residents to use. The facility Resident Census and Conditions of Residents report (10/25/2022) documents 43 residents reside in the facility. 145416 Page 3 of 3