Health inspection·June 18, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, reviews and interviews, the facility's staff failed to notify one (Resident #1) out of three sampled resident's family /representative of a change in condition; as evidenced by Resident #1 had a fall and a progress note written the day of the incident, indicated no next of kin was listed to be notified. The findings included: On 6/16/25 at 1:15 PM Resident#1 was observed seated in the dining area amongst other residents. Resident#1 did not respond when greeted by surveyor. On 6/17/25 at 10:35 AM Resident#1 was observed seated in wheelchair on the patio with staff supervising. Resident #1 stated: Sometimes I have racing thoughts, and I have to calm myself down . Record review of a demographic sheet revealed Resident #1 was admitted on [DATE] and readmitted on [DATE] with diagnosis that included: abnormalities of gait and mobility, lack of coordination and seizures. Record review of a Quarterly Minimum Data Set (MDS) reference dated 5/14/25 indicated Resident #1 is severely impaired cognitively and had no falls since reentry or the prior assessment. Record review of a Care Plan start date 1/24/23 and last reviewed/revised on 5/15/25 revealed Resident #1 was at high risk for fall and injuries secondary to diagnosis that included: Impaired gait, Seizure disorder, Impaired cognition, fall incident occurred 1/24/23. No injury noted with interventions that included: remind resident not to try to get out of bed by him/herself to use call light and request assistance, maintain walkway free from clutter and encourage resident to use call bell and request assistance as needed . Record review of a progress note dated 1/24/23 at 3:00 AM revealed Resident #1 was found on the floor, the Medical Doctor was notified, and next of kin/responsible party not assigned. Record review of a Fall Event Report dated 1/26/23 for Resident #1 section: Notifications revealed Name of Responsible Party: none assigned. On 6/17/25 at 2:45 PM The admission Coordinator stated: Prior to admission, the demographic sheet is created with the proxy/emergency contact in case there is an incident where the family needs to be notified. Page 1 of 3 105172 105172 06/18/2025 Fountain Manor Health & Rehabilitation Center 390 NE 135th St North Miami, FL 33161

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 6/18/25 at 10:34 AM The Director of Nursing stated: The assigned nurse of the resident being transferred is responsible for notifying the first contact at least three times then the next if there are multiple family members listed unless it is specified in the face sheet that a certain family member should not be informed. Further stated, On 1/23/23 [Resident #1] was admitted and on the 24th the resident was found on the floor without an injury, medicated for pain and the medical doctor was notified. The party responsible was listed on the face sheet at the time of the transfer, however there is no progress note indicating that the family was notified about the fall. The nurse who wrote this note has not been employed in the facility for years. Record review of a policy titled Assessing Falls and Their Causes (Revised March 2018) revealed Purpose: The purposes of this procedure are to provide guidelines for assessing a resident after a fall and to assist staff in identifying causes of the fall. Steps in the Procedure: After a Fall: 5. Notify residents' attending physician and family in an appropriate time frame. 105172 Page 2 of 3 105172 06/18/2025 Fountain Manor Health & Rehabilitation Center 390 NE 135th St North Miami, FL 33161

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations, interviews and record review the facility failed to properly store medications in one out of two treatment carts as evidenced by an observation of an unlocked unattended medication/treatment cart. There were 131 residents residing in the facility at the time of the survey. The findings included: On 6/16/25 at 12:59 PM, observation on the 300's hallway revealed an unlocked, unattended medication/treatment cart. The surveyor knocked on the nearest room door and inquired if the assigned nurse was inside the room. On 6/16/25 at 1:09 PM Staff A, wound care nurse exited the room, returned to cart and was notified about the observation and asked about protocol Staff A stated: The cart should always be locked when unattended. Also stated I was helping a resident and left it unlocked by mistake. Interview on 6/18/25 at 10:34 AM, the Director of Nursing revealed: The cart should be locked when unattended. Review of a Policy titled Medication Labeling and Storage 2001 Med Pass, Inc. revealed Policy statement: The facility stores all medications and biologicals in locked compartments under proper temperature, humidity and light controls. Only authorized personnel have access to keys. 105172 Page 3 of 3