Health inspection·October 20, 2023

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. 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, it was determined that the facility failed to provide care and services for assistance with eating for 2 (Resident #381 and #383) of 10 sampled residents reviewed for nutrition. Residents Affected - Few The findings included: 1) Observation of the lunch meal on 10/17/23 noted tray served to the room of Resident #384. Resident appeared to be alert with visual impairment. The nurse was noted to inform the resident where food items were located on the tray but left the room without returning during the meal observation. Further observation noted the resident was attempting to take hot chicken off of the bone with great difficulty and became agitated with the attempts. it was also noted that the resident ate with hands and could not locate food item on tray. The resident was noted to be covered with food matter while attempting to self feed. The resident stated to the surveyor that he is not receiving the assistance needed with the meals. During a second lunch meal observation conducted on 10/19/23 at 12:30 PM, it was again noted Resident #384 was attempting to strip the meat off of the chicken bone. It was noted that the resident front was covered with food debris. Resident stated that he was not informed of where food items were located on the tray and is not receiving the assistance need with meals. Observation of the breakfast meal on 10/20/23 at 7:30 AM, noted the Occupational Therapist (OT) was in the room and instructing and assisting the resident with the meal. The OT explained where all food were located on the tray and also made 4 small pieces of bread with egg for the resident to eat. The resident stated to the surveyor that this is the first time he has receive the assistance attempting to self feeding. The OT stated to the surveyor Resident #384 was screened upon admission and required set up with assistance with meals but has not receiving staff assistance with meals. The OT further stated that staff need to be inserviced on feeding assistance with Resident #384. Record review Resident #384: Date of admission: [DATE] Diagnoses: 'Unspecified Injury to head, Glaucoma, *Legal Blindness Current MD Orders: (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 7 Event ID: 105067 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 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)