Health inspection·December 8, 2022

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, records reviewed and interviews, the facility failed to ensure narcotics/controlled substances were reconciled for 1 out of 5 medication carts (Unit 4 cart # 1) observed in the facility. There were 185 residents residing in the facility at the time of this survey. The findings included: On 12/06/2022 at 9:52 AM during the narcotic count and review of medication for cart 1 on unit 4 located on the second floor of the facility with Registered Nurse (RN) (Staff A) revealed, the narcotic count was inaccurate for Resident # 12's Alprazolam tablet 0.25 MG (milligram) and Resident # 82's, Lorazepam tablet 0.5 MG. Review of Resident #12's narcotic count sheet revealed, Alprazolam tablet 0.25 MG (1) tablet was last signed out as given at 7:48 AM on 12/05/2022 and the remaining tablets noted as 19, the medication bingo card had 18 tablets. On 12/06/2022 at 9:54 AM review of Resident #12's Electronic Medication Administration Record (EMAR) with Staff A revealed, Alprazolam tablet 0.25 MG (1) tablet was not signed off as given. Resident #82's narcotic count sheet revealed, Lorazepam tablet 0.5 MG (1) tablet was last signed out as given at 12/5/22 at 5:00 PM, the remaining tablets documented was noted as 27 but the medication bingo card had 26 tablets remaining On 12/06/2022 at 9:55 AM Staff A was observed signing Residents #12's EMAR and narcotic sheet for Alprazolam tablet 0.25 MG (1) tablet as given. Review of the medical records for Resident #12 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to: Anxiety Disorder Unspecified. Review of the Physician's Orders Sheet for December 2022 revealed Resident #12 had orders that included but not limited to: Alprazolam tablet 0.25 MG. Give 1 tablet by mouth every 12 hours as needed for anxiety for 14 Days. Record review of Resident #12 's Quarterly Minimum Data Set (MDS) dated [DATE] revealed: Section C -for Cognitive patterns documented Brief Interview for Mental Status Score (BIMS) 11, on a 0-15 scale indicating the resident is cognitively moderately impaired. Page 1 of 4 686124 686124 12/08/2022 Harmony Health Center 9820 N Kendall Drive Miami, FL 33176

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the medical records for Resident #82 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to: Anxiety Disorder Unspecified. Review of the Physician's Orders Sheet for December 2022 revealed Resident #82 had orders that included but not limited to: Lorazepam tablet 0.5 MG. Give 1 tablet by mouth two times a day related to Anxiety Disorder Unspecified. Record review of Resident # 82's Quarterly Minimum Data Set (MDS) dated [DATE] revealed: Section C -for Cognitive patterns documented Brief Interview for Mental Status Score (BIMS) 3, on a 0-15 scale indicating the resident is cognitively impaired. Interview on 12/06/22 at 9:52 AM with Registered Nurse Staff A, when asked about narcotic medications not being signed out, Staff A stated, she gave the resident the Alprazolam 0.25 mg but she forgot to signed it out in the narcotic book and on the EMAR. Staff A stated normally I usually signed out the narcotic right away when I take it out of the bingo card, but the resident was very agitated and I was trying to get her the medicine as soon as possible. During an interview on 12/06/22 at 2:42 PM with the Director of Nursing (DON), and Assistant Director of Nursing (ADON), it was revealed that they did a one-to-one in-service with the nurse, and all nursing staff, starting with the morning shift. Review of the undated facility's policy and procedure titled, Controlled substance Handling, states: All controlled drugs will be subject to special receipt, handling, storage, disposal, and record keeping. Procedure #9-Upon removal of a controlled substance from the packaging for administration, shall document the doses removed on the narcotic descending count sheet record. Procedure #10-Immediately after a dose is administered, the license nurse will document administration in the electronic MAR, or if MAR is on paper, will document all of the following information on the paper medication administration record: Date and time of administration, dose administered, signature of nurse administering the dose. (Do not sign before actually administering the drug). 686124 Page 2 of 4 686124 12/08/2022 Harmony Health Center 9820 N Kendall Drive Miami, FL 33176

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 ensure food safety by thawing frozen turkeys in an unsafe manner. There were 185 residents admitted to the facility at the time of the survey. The findings included: During the initial kitchen tour on 12/5/22 at 8:36AM with Staff B, the Dietary Manager. Four (4) large packs of frozen turkey were observed in the kitchen thawing in a sink at room temperature. This was observed in the pre wash area for pots. Staff B, acknowledged the turkey wasn't being thawed in the proper manner. After this observation, food service staff placed the turkey in pans and placed them in walk in refrigerator #2. The turkey was on the 12/5/22 dinner menu. Review of the facility's undated policy and procedure for Food: Preparation. The policy statement documents, All foods are prepared in accordance with the FDA (Food and Drug Administration) Food Code. Procedures: 2. Dining Services staff will be responsible for food preparation procedures that avoid contamination by potentially harmful physical, biological and chemical contamination. 5. The Cook(s) thaws frozen items that requires defrosting prior to preparation using one of the following methods: Thawing in the refrigerator, in a drip-proof container, and in a manner that prevents cross-contamination; Thawing the item in a microwave oven, then transferring immediately to conventional cooking equipment; Completely submerging the item under cold water (at a temperature of 70 F (Fahrenheit) or below) that is running fast enough to agitate and float off loose ice particles; Cooking directly from the frozen state, when directed. 686124 Page 3 of 4 686124 12/08/2022 Harmony Health Center 9820 N Kendall Drive Miami, FL 33176

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on record review and interview, the facility failed to demonstrate effective an plans of correction were implemented to correct identified quality deficiencies in the problem area related to repeated deficient practices for F 812 Food Procurement, Store/Prepare/Serve-Sanitary as the facility failed to properly follow meat thawing procedures. This practice has the potential to increase the risk of negative resident outcomes and to affect all 185 residents residing in the facility at the time of this survey. The findings included: Review of the facility's survey history revealed, during a recertification survey with an exit date of 02/12/2021, Food Procurement, Store/Prepare/Serve Sanitary was cited related to the facility failed to store food at appropriate temperatures at or below 41 degrees Fahrenheit (F) in a walk-in cooler, failed to wash and sanitize dishes under sanitary conditions by operating a dish machine which did not reach the manufacturer recommended wash and rinse temperatures, failed to prepare and store food and clean dishes free from potential contamination, and failed to maintain equipment in two of three nourishment rooms under safe conditions to prevent potential contamination of food. During an interview on 12/08/2022 at 6:05 PM, the Administrator and the Director of Nursing (DON) revealed, the Quality Assessment and Assurance Committee (QAA) meets every fourth Thursday of every month. The administrator stated that the QAA Committee is comprised of the following members: Medical Director, Administrator, Risk Manager, Director of Nursing, and all other head of departments. Administrator noted that in September 2022, they developed a Performance Improvement Plan (PIP) for restorative nursing and in November 2022 they developed a PIP for PASRR. Both the Administrator and DON stated that when there is a deviation from expected performance, they open a Performance Improvement Plan (PIP) and conduct audit process. Administrator stated, we have a meeting with the team, and everybody is made aware of the issue, we also do in-service of what is going on. She stated that if the staff had any quality concerns they could report to the Risk Manager, the Administrator, and the Director of Nursing. The Director of Nursing and Administrator stated that when they recognize a deficiency, they work on the deficiency that is larger. The Administrator stated that they know that corrective actions they have been implemented are occurring effectively primarily through auditing and the involvement of staff depends on the department, and the medical director is always made aware of auditing and any decision-making process. The Administrator continued and added we track to see where the deficiency is occurring and move up or down within the department of the facilities. Moreover, the Administrator and the Director of Nursing stated, we had no concerns with the kitchen or any other department, and if there is a deficiency we are going to do a Plan of Correction, audit, and in-services competency. 686124 Page 4 of 4