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. (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 2 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 02/15/2024 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)