Based on observations, interviews, resident record review, and review of a facility policy Oxygen Administration, the facility failed to ensure respiratory care, specifically the provision of oxygen therapy, was not provided without a physician order for Resident Identifier (RI) #39. This had the potential to affect RI #39, one resident reviewed for respiratory care. Findings included: Review of a facility policy titled Oxygen Administration, effective August 2019, revealed the following: Policy Oxygen will be administered per physician's order. RI #39 was readmitted to the facility on on 1/20/2022 and had diagnoses that included Anxiety, Dyspnea, Obstructive Sleep Apnea, and Chronic Respiratory Failure with Hypoxia. On 12/12/2023 at 04:37 PM RI #39 was receiving oxygen at two liters per minute (2 l/m) by nasal cannula and Registered Nurse (RN) #1 verified that Resident #39 was receiving oxygen by nasal cannula at 2 l/m. During an interview on 12/13/2023 at 03:15 PM with the Assistant Director of Nursing (ADON), she revealed RI #39 did not have an order to administer oxygen. The ADON said she was not sure why RI #39 did not have an order for the oxygen, RI #39 previously had an order but it had been discontinued. The ADON stated she was going to call the doctor and get an order; the risks for using oxygen without an order could include confusion, elevated C02 (carbon dioxide), & dryness of nasal membranes. The ADON stated that an order was needed to administer oxygen.

Based on observation, interview, and review of a facility policy titled Labeling and Dating, the facility failed to label and date a bag of ground chicken observed in the refrigerator on 12/12/2023 during the initial tour of the kitchen. This had the potential to affect 18 of 76 residents who received Dysphagia Mechanical Soft (Dys Mech) and Dysphagia Advanced (Dys Adv) diet texture meals from the kitchen. Findings include: An undated facility policy titled Labeling and Dating, documented: . Importance of Labeling and Dating Proper labeling and dating ensures that all foods are stored, rotated, and utilized in a First In First Out (FIFO) manner. This will minimize waste and ensure that items that are passed their due date are discarded. Guidelines for Labeling and Dating All food should be dated upon receipt before being stored. Food labels must include: The food item name . Leftovers must be labeled and dated with the date they are prepared and the use by date. On 12/12/2023 at 1:17 PM, during the initial tour of the kitchen, the surveyor observed a bag of ground chicken with no date or label in the refrigerator. A Diet Guide Sheet provided by the facility documented: . Monday (Day 23) . Dinner . BBQ Chicken Thigh . Dys Adv (Dysphagia Advanced) Ground . Dys Mech (Dysphagia Mechanical) Ground . On 12/14/2023 at 11:05 AM an interview was conducted with the Dietary Manager (DM). The DM said, the undated and unlabeled chopped chicken observed on 12/12/2023 during the initial tour of the kitchen was served during dinner on 12/11/2023 to resident's who received Dysphagia advanced and Dysphagia mechanical diets. The DM said, items should be dated and labeled when placed in the refrigerator to make sure it can be pulled properly to ensure freshness of the food. She said, the bag of chicken was not labeled and dated due to staff forgetting to do so on 12/11/2023. The DM said, the possible negative outcome of not dating or labeling food placed in the refrigerator was the chance residents could receive outdated food.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and review of a facility policy titled, Infection Control Guide and a facility document titled, Standard Precautions, the facility failed to ensure: a staff member implemented Airborne Isolation Precautions in a manner to prevent the spread of infection. Airborne Isolation Precautions were clearly identified for Resident Identifier (RI) #278 the use of Personal Protection Equipment upon entering the room of , a resident for whom Airborne Isolation Precautions were clearly identified, This deficient practice affected RI #278, 1 of 3 residents reviewed for transmission based precautions. Findings Include: A review of a facility policy titled, Infection Control Guide, with no date, revealed: .use .personal protective equipment (PPE) .gloves, gowns and eye protection in situations where exposure . RI #278 was admitted to the facility on [DATE]. On 12/13/2023 at 4:59 PM, a review of the physician orders dated 12/07/2023 revealed resident to be placed on airborne isolation precautions. A review of RI #278's base line care plan, dated 12/07/2023, revealed: Resident COVID positive .Airborne Isolation Precautions to be observed . On 12/12/2023 at 2:15 PM, a Director of Care Coordination, was observed entering RI #278's room without applying a gown. A sign posted on the resident's door read Airborne Isolation Bed: Stop You will need the following PPE for this isolation: . FACE SHIELD . Gown . Gloves . Mask . On 12/12/2023 at 2:36 PM, after 21 minutes inside the room, the Director of Care Coordinator, opened the door of RI #278's room and asked Medication Assistant, Certified (MAC) #1 to hand her a yellow isolation gown from the isolation box outside of room. MAC #1 handed the Director of Care Coordinator a yellow isolation gown from outside of RI #278's room. On 12/12/2023 at 12:47 PM, an interview was conducted with MAC #1. MAC #1 was asked, what kind of isolation was RI #278 placed on. MAC #1 stated, airborne isolation due to COVID diagnosis. MAC #1 was asked when a resident was on airborne isolation precautions, what kind of Personal Protected Equipment should a staff member put on before entering a resident room. MAC #1 stated face mask, gloves, and a gown. MAC #1 was asked when Director of Care Coordination opened RI #278 room door was she wearing a gown. MAC #1 stated, no. MAC #1 was asked what does company policy say to do when a resident is placed on Airborne isolation. MAC #1 stated Personal Protective Equipment is required. On 12/12/2023 at 03:18 PM, an interview was conducted with Director of Care Coordinator, she was asked, what kind of isolation was RI #278 placed on. Director of Care Coordination stated, airborne isolation due to COVID. Director of Care Coordination, was asked, when a resident was on airborne isolation precautions, what kind of Personal Protected Equipment should a staff member put on before entering a resident room. Director of Care Coordination stated gloves, face shield, mask, but she did not have a gown. She was asked what was the concern of not donning proper PPE. Director of Care Coordination stated, infection control. She was asked what does facility policy say to do when a resident is placed on Airborne isolation. She stated to donn proper PPE. The Director of Care Coordination was asked did she follow company policy and she stated, no. On 12/14/2023 at 04:31 PM, an interview was conducted with the Infection Control Preventionist. Infection Control Preventionist was asked what kind of isolation was RI #278 on. Infection Control Preventionist stated, airborne isolation due to COVID diagnosis. He was asked, according to the facility's policy, what kind of precautions should a staff member take when entering a resident's room with airborne isolation precautions. He stated, put on N95, gloves, gown and face shield. Infection Control Preventionist was asked why should staff dress appropriately with Protected Personal Equipment when entering a resident room with contact isolation precautions. He replied to prevent the spread from resident to resident and to protect themselves and their families. He was asked what the concern was of a person not wearing the proper PPE when entering a COVID positive room. He replied, contracting the virus or spreading it.