Health inspection·February 17, 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 follow physician orders to ensure resident received oxygen as prescribed, and failed to properly store oxygen tubing for 1 resident [R9] of 3 [R15, R272] residents in the sample of 12 residents. Residents Affected - Few Findings include, R9's medical record documents in part: admitted on [DATE], with the medical diagnosis of chronic obstructive pulmonary disease, hypertensive heart disease syncope and collapse, atrial fibrillation, and congestive heart failure. Minimum data set brief interview for mental status score = 15 indicates R9 is cognitively intact. Physician order, dated 2/3/2023, respiratory oxygen per nasal cannula at 1 to 2 liters per minute continuous titrate to oxygen level is greater than 92% every shift. Care plan, dated 2/3/23, documents R9 requires oxygen therapy related to chronic obstructive pulmonary disease; intervention-Administer oxygen per MD orders. On 02/14/23 at 9:27 AM, R9 stated, I usually have on my oxygen, I don't know how long it has been off, I would guess it has been over an hour or more, because I'm finished with breakfast. I did not put the oxygen tubing on the couch. I've been in the bed all morning, and I cannot reach the couch from my bed. On 2/14/23 at 9:35 AM, surveyor and V4 [Registered Nurse] entered R9's room and observed R9's nasal cannula tubing lying directly on the seat of the couch. V4 stated, I'm not sure who placed (R9's) nasal canula on the couch instead of plastic bag. I don't see a plastic bag for (R9's) nasal cannula; I will go get another nasal canula and plastic bag for storage. The nasal canula lying on the seat of the couch could cause an infection. (R9) is fine; she does not receive oxygen all the time only as needed. On 2/14/23 at 1:34 PM, V4 stated, (R9) does have an order for continuous oxygen. I noticed on the shift report the physician assistant told the nursing staff to start weaning (R9) off oxygen. The nurses are responsible to remove the oxygen then record the oxygen saturation. I did not remove (R9's) oxygen, and I'm not sure who did or how long the oxygen was off. I do not see a physician order to wean (R9) off oxygen; the nurse did not place the order in. Typically, when I get information in report, I follow the plan. I did not check to see if there was a physician order. I was not the nurse who removed (R9's) oxygen today, and I am not sure who removed (R9's) oxygen or how long the oxygen was not on (R9). On 2/16/23 at 11:20 AM, V2 [Director of Nursing] stated, I been working here for 21 years as a floor nurse, but I been the Director of nursing here for 6 months. I completed one to one in-service Page 1 of 2 145869 145869 02/17/2023 Alden Estates of Skokie 4626 Old Orchard Road Skokie, IL 60076

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with V4 [Registered Nurse] regarding once she receives a verbal order from the physician assistant, to get the order approved by the primary care physician and enter the order on the resident's electronic medication administration record. I also in-serviced all other nurses regarding physician orders. If a resident's oxygen is removed from their airway and not being monitored, the resident could have respiratory distress or shortness of breath. I also completed one to one in-service with V4 [Registered Nurse] regarding infection control, that oxygen nasal cannula tubing needs to be stored in a plastic bag when it is not in use to prevent infection. I also in-serviced all other nursing staff regarding infection control. If the resident oxygen tubing is not kept in a plastic bag, it could potentially cause an infection. On 2/16/23 at 1:45 PM, V1[Administrator] stated, The facility does not have a policy on oxygen tubing storage. Policy documented in part; Physician's Orders for Medication or Treatments -Medications will be dispensed and subsequently administered to a resident only upon the clear, complete, signed order of a lawfully authorized prescriber. -Verbal orders will be received only by licensed nurses or pharmacists and subsequently confirmed in writing by the prescribing physician. Each medication order is documented in the resident's medical record with the date and signature of the person receiving the order Policy: Documents in part: -Infection Prevention and Control Program The primary mission is to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. 145869 Page 2 of 2