Health inspection·February 15, 2024

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** Based on record review and interview, the facility failed to ensure documentation was available to show whether dialysis treatment was started timely; the facility failed to ensure bathing preference was documented; and the facility failed to ensure physician order for self-administration of peritoneal dialysis was timely recorded, for 1 of 3 sampled residents (Resident #1). The findings included: Record review revealed, Resident #1, was admitted to the facility on [DATE], with diagnosis which included: End Stage Renal Disease (ESRD). Review of the admission Minimum Data Set assessment (MDS), reference date 01/09/24, revealed, Resident #1 had brief interview for mental status (BIMS) score of 14, which indicated Resident #1 was cognitively intact. Review of the self-administration evaluation record, dated 01/03/24, recorded, Resident #1 requested to continue to complete her peritoneal dialysis (PD), while at the facility. Resident #1 was completing her PD at home and desired to continue to complete her PD at the facility, and she was evaluated to be safe. Additional review of Resident #1's record, evidenced a physician order dated 01/15/24 for Peritoneal Dialysis (PD). Review of laboratory test dated 01/04/24 for complete blood count (CBC), and basic metabolic panel (BMP), showed high potassium level of 6.4, and low sodium level of 131. 01/09/24 CBC, BMP showed low sodium level of 127 and high potassium level of 5.7. A subsequent review of Resident #1's record was conducted, in search of documented evidence to show when the PD was started, a nursing progress note dated 01/08/2024 at 8:01 PM, indicated Resident (#1) attended dialysis today. There were no progress notes prior to this date regarding the PD treatment. Further review of Resident #1's record in search of bathing preference, there was no documented evidence of her bathing preference. Under task in the computer record, it simply indicated bathing. There was no specific bathing type recorded, no shower scheduled was recorded. It was revealed that Resident #1 had received a bed bath from 01/02/24 through 01/16/24. No documented evidence of providing showers was recorded. On 02/14/24 at 1:53 PM during an interview with a family member, who visited regularly, she had voiced concern regarding showers. She revealed that, the facility did not have scheduled showers, the residents/families had to request showers. Page 1 of 2 105067 105067 02/15/2024 Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 02/15/24 at 10:26 AM, an interview was held with Staff A, a certified nursing assistant/restorative aide, an inquiry was made regarding how do they document for showers. Staff A proceeded to retrieve a tablet, she viewed the [NAME] for a random resident, she did not find shower schedule for that resident. Staff A revealed that the facility doesn't schedule showers anymore. On 02/15/24 at 10:35 AM, an interview was held with Staff B, a registered nurse (RN), she voiced the facility doesn't schedule showers anymore, they leave it up to the resident and their families to ask for shower. When asked what about the residents who can't ask for shower, how do they ensure that they receive showers? Staff B voiced that the staff knows the residents and if they look unclean, they would have showered them. On 02/15/24 at 10:48 AM, an interview was held with the Director of Nursing (DON). The DON voiced Resident #1 wanted to do her own PD, the facility assessed her, and she was determined safe. The DON added, dialysis should have been started the next day of admission. When asked for evidence of when Resident #1 started PD, the DON proceeded to review the records. She agreed that the progress note for starting the PD treatment was dated as of 01/08/24. The DON voiced there was no documentation for dialysis treatment prior to that date. The DON acknowledged the physician order for PD was late, the order date was 01/15/24. During the interview process an inquiry was made regarding bathing preference for Resident #1, the DON acknowledged there was no documented evidence for showers, and there was no bathing preference recorded for Resident #1. The DON further revealed the facility have changed the bathing preference process because there was an issue before, where residents/families had concern of the staff forcing residents to take showers, hence, the facility wanted to make it individualized and changed the process. During the interview, a request was made regarding the facility's policy regarding bathing and preferences. The policy was not provided. 105067 Page 2 of 2