Inspection·November 30, 2023

F 0580 11/07/23. Level of Harm - Minimal harm or potential for actual harm An 'Event Note' documented an unsuccessful attempt at notification on 11/07/23 at 23:00 (11:00 PM). Residents Affected - Few Review of the Progress note, dated 11/07/23 at 23:43 (11:43 PM), documented by Staff A, Licensed Practical Nurse (LPN), Note Text: Resident was observed on the floor by the bathroom door around 2100 (9:00 AM). Resident states that he was going to the bathroom. Resident was observed on his side with his head up. Resident is very weak; he couldn't get himself back the bed. Transfer resident back to bed with Hoyer lift. Safety precaution maintained, call light within reach, bed at lowest position. No injuries noted; No complaint of pain. Resident is resting comfortably. Resident #31 was unable provide details of the incident /event and was not interviewable. During an interview, on 11/28/23 at 10:11 AM, with Resident #31's daughter, when asked about the details of the resident's fall, the resident's daughter stated, I haven't noticed any changes in him. They didn't tell me about it. During an interview, on 11/30/23 at 7:48 AM, with Staff B, Registered Nurse (RN) on Suites unit since 2020, when asked about the incident, Staff B replied, I wasn't in that day, when I came in the next day, they told me they found him sitting on the floor in his room. Staff A was the nurse on the floor that day, she would have been responsible to call the family and the doctor. 11-7 [11 PM - 7 AM] didn't do the follow up and did not inform me. When they have the morning meeting, they see everything on the 24-hour report. Staff B reviewed the progress note and stated, there is nothing that says that she called the daughter (referring to Staff A). During an interview, on 11/30/23 at 7:56 AM, with Staff C RN/UM (Unit Manager) on Suites unit, when asked about notifying Resident #31's daughter about the fall, Staff C replied, I would have been coming in and going over the reports and we would go over the 24-hour report in the morning meetings. It would have been reviewed during the morning meeting. If she notified the daughter, she should have put it in the nurse's notes. Staff C confirmed that there was no progress note regarding notifying the resident's family. During an interview, on 11/30/23 at 9:02 AM, with Staff A, when asked about Resident #31's fall on 11/07/23, Staff A replied, I don't know. I was working and I found him on the floor and I asked for help. When asked about notifying Resident #31's representative about the fall, Staff A replied, there was no answer, you have to let the family know. I put the note of what happened, it is protocol to notify the family I leave a note and the facility will follow up. During an interview with the Director of Nursing (DON) on 11/30/23 at approximately 11:00 AM, the DON stated that Resident #31's daughter was in the facility regularly. 2. Record review for Resident #3 revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Fracture of Unspecified Part of Neck of Left Femur Subsequent Encounter for Closed Fracture with Routine Healing, Pressure-Induced Deep Tissue Damage of Sacral Region, and Unspecified Dementia. The Minimum Data Set (MDS) assessment for Resident #3 dated 10/24/23 revealed in Section C, a Brief Interview of Mental Status Score of 7, indicating severe cognitive impairment. In Section H it was documented that the resident had an indwelling catheter. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105039 If continuation sheet Page 2 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of the Palm Beaches, The 301 Northpointe Parkway West Palm Beach, FL 33407 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Physician's orders for Resident #3 revealed an order entered on 11/29/23 with an effective date of 11/27/23 to D/C (Discontinue) Foley cath (catheter). Photographic Evidence Obtained. Review of the Nursing Progress Note for Resident #3 dated 11/27/23 included: Resident son made aware of above mention. [linked]. Review of the Nursing Progress Note for Resident #3 dated 11/27/23 included: Called place to hospice requesting for admission to come to facility for resident. Per Nurse [name], she will send message to admission department. MD [physician] made aware, new order received to D/C F/C [Discontinue Foley / Catheter], monitor for voiding. An interview was conducted on 11/28/23 at 2:45 PM with Staff E, Registered Nurse Unit Manager (RNUM) who stated she has worked at the facility for about 16 months always as the Unit Manager. When asked about the indwelling urinary catheter (Foley) for Resident #3, she stated the resident's Foley was taken out yesterday. When asked by whom, she stated she did it after talking to the doctor (Primary) who gave her the order, and notifying Resident #3's son. During a telephone interview conducted on 11/29/23 at 12:56 PM with the son of Resident #3 who was asked if the resident had an indwelling urinary catheter in place when he was admitted to the facility, he said yes. When asked if any physician or staff member of the facility informed him of the removal of the indwelling urinary catheter, he said 'no, one told him about that, someone called the other day to talk to him about hospice for his father'. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105039 If continuation sheet Page 3 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of the Palm Beaches, The 301 Northpointe Parkway West Palm Beach, FL 33407 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, record review and policy review, the facility failed to provide necessary treatment and services to prevent worsening of a pressure ulcer for 1 of 2 sampled residents sampled for pressure ulcers (Resident #254). Residents Affected - Few The findings included: The Policy and Procedure, titlesd, Treatment Protocols for Stage III and Stage IV Pressure Area or Full Thickness Wounds with No Drainage (Shallow or Deep), effective October 2021, documented, Review support surface guideline to ensure the Resident / Patient receives the benefit of a therapeutic bed surface when clinically necessary. Review of the record revealed Resident #254 was initially admitted to the facility on [DATE]. The resident had multiple hospitalizations during her residence at the nursing home and was transferred to the hospital on [DATE] and did not return to the facility. Review of the quarterly Minimum Data Set (MDS) with an assessment reference date of 04/01/23 documented a Brief Interview for Mental Status (BIMS) score of 9, indicating moderate cognitive impairment. The resident had diagnoses that included Acute Kidney Failure, Unspecified Dementia, and Diabetes Mellitus. Review of the care plan for Activities of Daily Living (ADLs), initiated on 02/06/23 and revised 04/24/23, documented the resident needed the assistance of one staff member for turning and repositioning, a glide sheet for bed mobility with the assistance of two staff members, and a mechanical lift to transfer the resident to a chair. On 12/21/22, the resident was admitted from another nursing facility. Review of the resident's record revealed she was treated for a stage 2 sacral pressure wound at the previous facility and the wound had resolved prior to being admitted to this facility. Review of the resident's Electronic Health Record (EHR), from 12/21/22 through a readmission from the hospital on [DATE], revealed the resident did not have a sacral wound but had treatment of skin cream to the buttocks. Review of the readmission data collection evaluation dated 03/20/23 revealed a skin evaluation of coccyx pressure. An admission summary note dated 03/30/23 noted sacral redness to coccyx and a dry dressing applied. On 03/31/23, a wound note revealed a sacral wound with a length of 7.5 centimeters (cm), width of 4.5 cm and a depth of 0.2 cm. The wound note revealed the daughter was notified of the wound. On 04/04/23, a skin and wound evaluation revealed the resident had a stage 3 pressure wound located on her sacrum. The wound measurements were 3.4 centimeters (cm) in length, 0.9 cm in width and 0.3 cm in depth. The resident was seen by a wound care specialist on 04/04/23. The wound was debrided (necrotic tissue removed by a scalpel) and the primary dressing was calcium alginate. On 04/11/23, the wound physician evaluated the sacral wound. The wound measured at 1.4 cm in length, 0.7 cm in width and 0.3 cm in depth. The physician noted the importance of repositioning every 2 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105039 If continuation sheet Page 4 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of the Palm Beaches, The 301 Northpointe Parkway West Palm Beach, FL 33407 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 hours or as needed and consistent use of offloading devices. Level of Harm - Minimal harm or potential for actual harm On 04/18/23, the wound physician evaluated the sacral wound. The wound measured at 6 cm in length, 2.2 cm in width and 0.3 cm in depth. The clinical stage of the wound continued at a stage 3. The physician noted that the wound was not improved and had increased in volume. The wound was again debrided and the treatment was changed to calcium alginate with silver and repositioning often. Residents Affected - Few On 04/21/23, the resident was transferred to the hospital and returned to the facility on [DATE]. On 04/25/23, the wound physician evaluated the resident. The sacral wound now had a length of 8.2 cm, a width of 4.3 cm and a depth of 0.6 cm estimate. The wound was now an unstageable pressure injury per physician notes. The wound was debrided. Per physician note, the staff was educated on the importance of offloading the area and consistent use of offloading devices. Continued treatment of calcium alginate with silver. On 04/30/23, the resident was transferred to the hospital and did not return to the facility. Review of the nursing notes and record lacked any documentation of the resident being turned or repositioned. Interview with Certified Nursing Assistants (CNAs) during the 4-day survey revealed they could not recall the specifics related to turning and repositioning this resident. On 11/29/23 at 12:54 PM, an interview was conducted with Staff E, Registered Nurse and Unit Manager (RN/UM). Staff E was asked what a pressure reducing device to the chair and bed was. Staff E replied they have gel cushions for the chair and special mattresses for the bed if the sacral wound is stage 3 or above or if the family asks for a special mattress. In a phone interview with the family member of the resident, she revealed that on 04/14/23, she asked for an air mattress and was told the resident did not qualify for it. An interview was conducted with the Director of Nurses (DON) on 11/30/23 at 10:56 AM. She stated the resident was assessed at a stage 3 on 03/31/23. When asked about the mattress that was on Resident # 254's bed, she replied that all the residents have a special mattress for pressure reduction. A review of the mattress description provided by the Administrator revealed the mattresses in the facility are support mattresses that are pressure reduction and help decrease skin problems in moderate to high risk residents. In a subsequent interview with the DON on 11/30/23 at 12:36 PM, she stated the facility does not have a policy for when a resident has a stage 3 sacral wound that they (the residents) are put on an alternating pressure relief mattress but that is what they do. The DON stated they rent those mattresses. She stated that they did not rent an alternating pressure relief mattress for Resident #254 but the resident should have had an alternating pressure relief mattress. The offloading that was planned by the wound care physician was not provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105039 If continuation sheet Page 5 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of the Palm Beaches, The 301 Northpointe Parkway West Palm Beach, FL 33407 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Resident #79 was admitted to the facility on [DATE] with diagnoses that included Hydrocephalus, Personal history of other malignant neoplasm of the skin and Atrial Fibrillation. Resident #79 had a Brief Interview of Mental Status (BIMS) score of 9 according to the quarterly Minimum Data Set (MDS) with an assessment reference date (ARD) of 10/24/23, indicating the resident had moderate cognitive impairment. On 11/27/23 at 12:17 PM, an observation was made of the resident sitting in his room. The resident had a IV (intravenous) site on his left upper arm covered with a clear occlusive dressing which was covered with a gauze wrap. The resident was unable to verbalize if he was currently on an antibiotic or not. Review of a physician order, dated 11/22/23, revealed an order to Change IV Dressing on right arm every 7 days as well as PRN (as needed) for soiling and/or dislodgement. There was no IV in the resident's right arm, only the left arm. An interview was conducted with the Director of Nurses (DON) on 11/27/23 at 3:30 PM, who stated the resident pulled out the IV on his right arm and on 11/23/23, it had to be replaced and was put in the left arm. When asked about the order that stated the IV was still on the right arm, she stated that it was never changed when the IV site was changed. 3. Resident #95 was admitted to the facility on [DATE], hospitalized on [DATE], then readmitted on [DATE]. Resident #95 diagnoses included Osteomyelitis of vertebra, cervical region, Type 2 Diabetes Mellitus, and Pressure ulcer of sacral region stage 4. The resident's BIMS score was 15, according to the 5-day MDS with an ARD of 11/14/23, indicating the resident was cognitively intact. Review of the Electronic Health Record (EHR) revealed the resident had a physician order dated 11/11/23 for wound care for the coccyx wound. The order was to clean the wound with Dakins 0.5%, pat dry, apply calcium alginate and collagen powder to wound bed and cover with foam dressing every evening shift for wound to buttock. The Treatment Administration Record (TAR) was signed by a nurse as completed from 11/11/23 to 11/27/23. The EHR also revealed an order for negative pressure wound therapy to coccyx. Negative pressure wound therapy dressing was to be completed on Tuesday and Friday. The order was dated 11/13/23 and discontinued on 11/29/23. It was marked as completed on the TAR on 11/14/23, 11/17/23, 11/21/23, 11/24/23 and 11/28/23. On 11/28/23 at 4:01 PM, an interview was conducted with Registered Nurse / Unit manager, Staff C. Staff C stated when she came in this morning the wound vac was not responding and was malfunctioning. She stated Resident #95 said the nurse came in and had to reset it from about 3:00 AM through the rest of the night. Staff C stated that she tried to fix it when she came in at 6:00 AM but could not. She called the physician around 8:30 AM and received an order for a wet to dry dressing so the resident could go to a doctor visit. When asked about the order for the calcium alginate dressing, Staff C stated that she was unaware of that order and maybe she should have used that order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105039 If continuation sheet Page 6 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of the Palm Beaches, The 301 Northpointe Parkway West Palm Beach, FL 33407 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Staff C could not determine why the resident had 2 orders for the same wound and stated that it might have been a backup order for the wound vac or a dressing that is put under the wound vac. The observation for the wound vac therapy dressing was conducted on 11/29/23 at 5:45 PM. On 11/29/23, the order for wet to dry dressing was discontinued. The wound vac was discontinued. A new order was received to revert back to: cleansing the wound with normal saline, apply collagen powder, to wound bed, pack with alginate dressing cover with island or foam dressing. On 11/29/23, the DON was made aware the resident had 2 orders for the sacral wound and verbalized understanding that there should not have been 2 orders for the same wound. Based on observations, interviews, and record review, the facility failed to maintain accuracy of records for 3 of 23 sampled residents, Residents #3 #79, and #95. The findings included: Review of the facility's policy, titled, Late Entry, Addendum, Corrections and Clarification, with an effective date of June 2022, included: The facility will utilize the following procedures when documentation problems or mistakes occur, and changes or clarifications are necessary. Late Entry: At times it will be necessary to make an entry that is late (out of sequence) to provide additional documentation to supplement entries previously written. When a pertinent entry was missed or not written in a timely manner, a late entry will be used to record the information in the medical record. Guidelines Late Entry 1. Document the late entry as soon as possible timeframe. 2. Record the late entry on the next available chronological line of the applicable form. 3. State Late Entry at the beginning of the documentation. 4. Enter the current date and time. 5. Identify date and time (if known), for which the late entry is written. 6. Document the late entry. 7. Draw a line from the end of your entry to your signature. 8. Sign your name and title at the end of the line. 1. Record review for Resident #3 revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Fracture of Unspecified Part of Neck of Left Femur Subsequent Encounter for Closed Fracture with Routine Healing, Pressure-Induced Deep Tissue Damage of Sacral Region, and Unspecified Dementia. The Minimum Data Set assessment (MDS) for Resident #3 dated 10/24/23 revealed in Section C a Brief Interview of Mental Status Score of 7, indicating severe cognitive impairment. In Section H, it was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105039 If continuation sheet Page 7 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of the Palm Beaches, The 301 Northpointe Parkway West Palm Beach, FL 33407 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 documented that the resident had an indwelling catheter. Level of Harm - Minimal harm or potential for actual harm Review of the Physician's orders for Resident #3 revealed an order dated 10/22/23 for Urinary Catheter: Urinary catheter care daily and as needed every day shift for Preventative Measure and as needed for preventative measure with a discontinued date of 11/28/23. Residents Affected - Few Review of the Physician's orders for Resident #3 revealed an order dated 10/22/23 for Urinary Catheter: Drain urinary catheter bag every shift and prn [as needed] every shift and as needed with a discontinued date of 11/28/23. Review of the Physician's orders for Resident #3 revealed an order dated 11/28/23 as S/P (Status / Post) Foley catheter removal, monitor for voiding if not voiding in 6-8 hours, reinsert Foley and notify MD [physician] every shift for 2 days. (The actual verbal order was received on 11/27/23). Review of the Physician's orders for Resident #3 revealed an order entered on 11/29/23 with an effective date of 11/27/23 to D/C (Discontinue) Foley cath. Photographic Evidence Obtained. Review of the Treatment Administration Record (TAR) for Resident #3 included an order as S/P Foley catheter removal, monitor for voiding if not voiding in 6-8 hours, reinsert Foley and notify MD every shift for 2 Days revealed documentation as being completed from 11/28/23 starting with the evening shift (3:00 PM to 11:00 PM) until night shift (11:00 PM to 7:00 AM) on 11/29/23. Review of the TAR for Resident #3 printed on 11/29/23 at 2:11 PM did not reveal an order to remove / discontinue indwelling urinary catheter (Foley). Review of the TAR for Resident #3 printed on 11/30/23 at 11:05 AM revealed the order dated 11/27/23 to D/C foley cath was documented as signed off by Staff E RNUM on 11/27/23. Review of the time stamped TAR for Resident #3 revealed the order to D/C foley cath was actually entered on 11/29/23 at 7:25 AM and signed off on 11/29/23 at 7:27 AM by Staff E RN/UM. On 11/27/23 at 10:49 AM, an observation was made of Resident #3 lying in bed with no catheter drainage bag seen. On 11/27/23 12:50 PM, a second observation was made of Resident # 3 lying in bed with no catheter drainage bag seen. During an interview conducted on 11/27/23 at 10:49 AM, Resident #3, who was asked if he has a urinary catheter, said I don't know what you are talking about. During an interview conducted on 11/28/23 at 2:22 PM with Staff D, Registered Nurse, who stated she has worked at the facility for about 5 years. When asked if Resident #3 had an indwelling urinary catheter she stated no, it was removed today or yesterday by the Unit Manager. When asked was it was documented that the indwelling urinary catheter was removed, she said it should be documented in the nurse's notes by the nurse who removed it. During an interview conducted on 11/28/23 at 2:45 PM with Staff E, Registered Nurse / Unit Manager (RNUM), who stated she has worked at the facility for about 16 months always as the Unit Manager. When asked about the indwelling urinary catheter (Foley) for Resident #3, she stated the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105039 If continuation sheet Page 8 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of the Palm Beaches, The 301 Northpointe Parkway West Palm Beach, FL 33407 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Foley was taken out yesterday (11/27/23). When asked by whom, she stated she did it after talking to the doctor (Primary) who gave her the order. When asked if she documented in the resident's chart that she removed the indwelling urinary catheter, she said she was not sure if she put a note in. When asked when she removed the indwelling urinary catheter, she said it was in the late afternoon yesterday but could not remember what the time was. When asked if she communicated this to the day shift (7:00 AM-3:00 PM) nurse, she said no, she told the evening shift nurse (3:00 PM-11:00 PM). She acknowledged she did not document the Foley being taken out until today (11/28/23). She stated she put in a late entry into the resident's electronic chart to document the Foley being removed. When asked if she had put in an order to remove the indwelling urinary catheter, she said she forgot to do that as well and was informed by the day nurse today that there was no order to remove the Foley. She put the order in the resident's chart today (11/28/23) to remove the Foley. When the RN/UM showed this surveyor the order she put into the chart to remove the Foley, it also included to monitor for voiding if not voiding in 6-8 hours, reinsert Foley and notify MD. The RN/UM then acknowledged there was no documentation of the resident voiding. The RN/UM stated that she was told by the night shift (11:00 PM-7:00 AM) nurse that the resident had voided. An interview was conducted on 11/28/23 at 3:30 PM with Staff F, Registered Nurse (RN), who stated she has worked at the facility since March of 2023. When asked if a resident has an indwelling urinary catheter (Foley) where do they document the care, the RN stated it would come up as an alert in the Treatment Administration Record (TAR) to document. When asked where and who would document any urine output for a resident, she stated it would be the nurse and it would depend on how the order is written, they would document under order for urinary catheter drainage or the actual amount voided if the order is written like that, both ways would be documented in the TAR. When asked if the resident had an order for an indwelling urinary catheter and if the indwelling urinary catheter was removed but the order was not discontinued, the RN stated the Unit Manager is responsible for discontinuing the orders. When asked about Resident #3 and if he had an indwelling urinary catheter, she said he did not have a Foley when she worked yesterday (11/27/23 on the Evening Shift 3:00 PM to 11:00 PM). The Unit Manager informed her the Foley had been removed and the resident had already voided. When asked why she documented on the TAR for Resident #3 that he had an indwelling urinary catheter and a leg strap in place for the urinary catheter, she said it was probably because the order was not discontinued, and it alerted her it needed to be addressed. When asked if it may have been better to indicate in the TAR under urinary catheter a code indicating see nurses note and make a note that the resident did not have an indwelling urinary catheter, she said that probably should have been what she should have done. During a telephone interview conducted on 11/29/23 at 1:15 PM with Resident #3's Primary Physician, he was asked if he had seen the resident, and he said yes. When asked about the indwelling urinary catheter for Resident #3, he asked what room he was in, and it was provided to the physician. The Primary Physician then stated that he gave an order to discontinue the Foley catheter verbally over the phone and the staff informed him that the resident refused to have the Foley removed. When asked what the current status of the Foley catheter for Resident is #3, he said he still has it (Foley) in. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105039 If continuation sheet Page 9 of 9