Ocala Health and Rehabilitation Center

Inspectors wroteBased on observation, interview, record review, and policy and procedure review, the facility failed to ensure staff used appropriate Personal Protective Equipment (PPE) while providing care to residents on enhanced barrier precautions for 6 (Resident #11, #8, #175, #18, #36, and #16) of 12 residents reviewed for infection control and failed to ensure cleansing the needleless connector of a peripherally inserted central catheter and midline catheter according to professional standards of practice and policy and procedure during medication administration for 2 of 3 (Resident #175 and #27) resident observations of intravenous medication administration to prevent the possible spread of infection and communicable diseases.

Inspectors wroteBased on interview and record review, the facility failed to ensure accuracy of the Minimum Data Set (MDS) assessment reflecting accurate diagnoses for 2 (Resident #6 and #35) of 5 residents reviewed for Preadmission Screening and Resident Reviews (PASRR - a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care).

Inspectors wroteBased on interview and record review the facility failed to submit a Preadmission Screening and Resident Review (PASRR) Level II for 1 of 6 reviewed for behavioral health management. (Resident #35)

Inspectors wroteBased on record review and interview, the facility failed to ensure Preadmission Screening and Resident Review (PASRR) was accurately completed for 1of 6 residents reviewed for behavioral health management. (Resident #42)

Inspectors wroteBased on observation, interview, and record review the facility failed to provide wound care dressing changes within professional standards of practice for 2 (Resident #127 and #92) of 4 residents reviewed for wound care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure peripherally inserted catheters and midline catheter dressing changes were completed according to professional standards of practice and intravenous fluid was administered according to facility policy and procedure and professional standards of practice for 2 (Resident #175 and #27) of 2 residents reviewed with a peripherally inserted central catheter line or midline catheter.

Inspectors wroteBased on interview and record review the facility failed to ensure accurate nurse staffing information was posted on a daily basis on 1 of 4 days of the survey.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents' drug regimens were free from unnecessary drugs, specifically without adequate monitoring or adequate indications for use, in 2 (Resident #62 and Resident #152) out of 7 residents reviewed for unnecessary medications. 1) Review of Resident #152's physician orders dated 03/30/2022 read, Midodrine [a prescription oral medication primarily used to treat severe symptomatic orthostatic hypotension, a condition that causes a sudden drop in blood pressure] tablet 5mg (milligram): amt (amount) 1 tab Oral. Special Instructions: Dx (diagnosis) Hypotension [blood pressure is abnormally low, preventing adequate blood flow to the brain and heart]; Do not give post 6pm; Hold for systolic [the pressure in your arteries when your heart pumps blood throughout your body. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure medical records were complete and accurate for pain management and adrenergic agonist medication administration for 3 of 8 residents reviewed for medication management (Resident #42, Resident #62, and Resident #152).

Inspectors wroteBased on record review and interview, the facility failed to ensure resident assessment were completed accurately to reflect the resident discharge status for 1 of 3 residents reviewed for discharge, Resident #158.

Inspectors wroteBased on record review and interview, the facility failed to ensure the Preadmission Screening and Resident Review (PASRR) was completed for 1 of 3 residents reviewed for PASRR, Resident #90.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents received blood pressure medication as ordered by the physician for 1 of 7 residents reviewed for medication administration, Resident #43.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure restriction of the use of assistive devices for fluids was implemented for 1 of 8 residents reviewed for nutrition, Resident #26.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure foods were stored in a safe manner in 3 of 3 nourishment rooms.

Inspectors wrote2. Review of Resident #39's admission record showed the resident was most recently admitted on [DATE] with diagnoses including type 2 diabetes mellitus, chronic kidney disease (stage 4), hypokalemia, hypothyroidism, and adult failure to thrive. Review Resident #39's physician order dated 2/13/2024 read, Accu-checks [Blood glucose testing] AC/HS [before meals and at bedtime] cover w/ [with] Novolog [short acting insulin] 100 unit/ml vial . > [greater than] 399 mg /DL [deciliter] 7 U [units] & Call MD [medical doctor]. Special Requirement Brief Instructions . Notify MD for BG [blood glucose] less than 60 mg/dl or greater than 399 mg/dl. Review of Resident #39's physician order dated 5/22/2024 read, Novolin R [regular, human short acting insulin] 100 unit/ml vial. Administer 12 U subcutaneous if BS is > 399. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff used appropriate personal protective equipment (PPE) while providing direct care for 2 of 5 residents on transmission-based precautions, Residents #154 and #96, and failed to ensure staff followed infection control standards by not cleaning the multi-use medical equipment in between resident use, not sanitizing the surface area during medication administration and not cleaning the medication syringe after enteral medication administration to prevent the possible spread of infection and communicable diseases.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all foods were stored, covered, labeled, and discarded in accordance with professional standards for food service safety in the main kitchen and 2 of 3 nourishment rooms and failed to ensure sanitary standards were maintained in the walk-in cooler, walk-in freezer, and the stock/storage room.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure respiratory care services were provided consistent with professional standards of practice for oxygen administration for 4 out of 7 residents reviewed for respiratory care. (Resident #15, Resident #129, Resident #156, Resident #9) Findings Include: 1.) During an observation on 2/13/23 at 11:53 AM Resident #15 was observed sitting in bed receiving oxygen through a nasal cannula. The oxygen concentrator was observed set on 2.5 liters of oxygen. Review of the physician orders for Resident #15 dated 8/30/22 read Oxygen @ 2 L/Min [at 2 liters per minute] per nasal cannula PRN (as needed) for short of breath and low oxygen saturations. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that drugs and biologicals used in the facility were stored and labeled in accordance with currently accepted professional principles in 4 of 6 medication carts (south hall, north back hall, north hall, east hall) and failed to ensure medications were secured (photographic evidence obtained).

Inspectors wroteBased on observation, interview, and record review the facility failed to post daily nurse staffing information on 1 of 5 days of the survey.