Health inspection·October 30, 2023

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on record review and interview, the facility failed to implement policies and procedures for ensuring timely reporting of abuse or mistreatment for three out of three sampled residents (Residents #4, 5, and #8). There were 98 residents residing in the facility at the time of the survey. The findings included: Review of facility's abuse log noting Abuse, neglect, Mis-Management of Funds, Incidents of Unknown Origin log from January 2023 to October 2023 revealed: On February 18, 2023, at 11:15 AM, an incident or altercation happened between Resident #4 and Resident #8. Further review showed that the facility reported the incident to the Agency for Healthcare Administration (AHCA) Immediate Report system on February 20, 2023, at 03:07 PM. Review of the facility's incident report revealed that Staff A, Registered Nurse (RN), was aware of the incident on February 18, 2023, at 10:50 AM and reported it to the Director of Social Worker and the Director of Nursing (DON) on February 20, 2023 at 09:45 AM. During an interview with the Director of Social Worker on 10/30/2023 at 11:37 AM regarding the incident, the Director of Social Worker stated, There were 2 patients involved. They were aggressive toward each other. [Resident #4] tried to kick [Resident #8], but the kick did not land. [Resident #8] threw a cup of water that was in his hand to [Resident #4]. After reviewing the camera, the kick wasn't landed. Further interview at 01:27 PM on 10/30/2023 regarding the incident reporting, the Director of Social Worker stated, The incident on the 18th of February was during a weekend. When I got here on Monday, I reported it. It must be in the afternoon when they reported it to me. The immediate report, I had my laptop with me. I reported it the time they told me that. It shows on the bottom of this report that I reported it 02/18/23 at 11:04 AM. I would not be able to make this up. I don't know; there must be some kind of glitch in the system. Further review of the facility's abuse log revealed that on March 21, 2023 at 07:15 PM, Resident #5's family member reported that Resident #5 was verbally abused by a staff member. Further review showed that the facility did not report the incident to the Agency for Healthcare Administration (AHCA) Immediate Reporting system until March 23, 2023, at 04:26 PM. During an interview with the Director of Social Worker on 10/30/2023 at 11:32 AM regarding the incident, the Director of Social Worker stated, There was something wrong with my passwords. No one could have reported it. The time seen in the report is 4:00 PM the next day. It was an issue. We spent the whole day with AHCA trying to report it. It was unsubstantiated. Further interview at 12:35 PM on Page 1 of 3 105172 105172 10/30/2023 Fountain Manor Health & Rehabilitation Center 390 NE 135th St North Miami, FL 33161

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 10/30/2023 regarding the incident reporting, the Director of Social Worker stated that the abuse reports were reporting on time. She then stated, What happened is that the resident called her son at about 03:45 PM and had her son to come to the facility. The son reported it at about 07:00 PM, and the time we knew about it, we reported it. For this one in March, it also happened during the weekend. It was reported to me on the 20th. There was a glitch in the system. Both incidents happened the same day during the weekend. I don't know why the system showed 1 month later. On 10/30/2023 at 02:25 PM, during an interview with the Director of Nursing (DON) regarding the February 18, 2023 incident, the DON stated, for Resident #4 and Resident #8, it happened on a weekend, a Saturday. I remember that day [Director of Social Worker] had a problem with her login. We were trying to get in contact with AHCA to see why she couldn't report it. I don't remember if it was our system or theirs. On 10/30/2023 at 02:28 PM, during an interview with the DON regarding the March 21, 2023 incident, the DON stated, For [Resident #5], the incident happened on a weekend. We didn't find out until Monday. [The son] came on Monday and reported it to us. He stated what happened during the weekend. I don't remember exactly the incident, but I remember we found out on Monday when the son came to report it. I know [the son] usually came in the afternoon after lunch because of his .; wait for transportation. I never saw him come in the morning. The day he came, he spoke to the [Director of Social Worker]. Review of the facility's policy and procedures relating to reporting abuse to State agencies and other entities/individuals, revised December 2009, revealed: Policy statement: All suspected violations and all substantiated incidents of abuse will be immediately reported to appropriate state agencies and other entities or individuals as may be required by law. Policy Interpretation and Implementation: 1. Should a suspected violation or substantiated incident of mistreatment, neglect, injuries of an unknown source, or abuse (including resident to resident abuse) be reported, the facility Administrator, or his/her designee, will promptly notify the following persons or agencies (verbally and written) of such incident as appropriate: a. The State licensing/certification agency responsible for surveying/licensing the facility; b. The Resident's Representative (Sponsor) of Record; c. Adult Protective Services; 105172 Page 2 of 3 105172 10/30/2023 Fountain Manor Health & Rehabilitation Center 390 NE 135th St North Miami, FL 33161

F 0609 d. Level of Harm - Minimal harm or potential for actual harm Law enforcement officials (as required); e. Residents Affected - Few The resident's Attending Physician. 2. Verbal/written notices will be submitted to agencies as required by law. An Immediate Report will be submitted as soon as possible, but no later than 24 hours of discovery of the incident. If the events that cause the allegation involve abuse or result in serious bodily injury, they must be reported within two hours after the allegation is made. If such incident and such notice may be submitted via special carrier, fax, e-mail, or by telephone. Notice will include, as appropriate . 105172 Page 3 of 3