Health inspection·March 28, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior for 12 of 30 resident rooms, 1 of 1 clean linen storage rooms, and 1 of 1 clean nursing wound storage supply room located on the Second Floor Geriatric Unit. The findings included: During the initial observational tour conducted on 03/25/24 and the Environment Tour conducted on 03/28/24 at 10:30 AM accompanied with the Administrator, Director of Nursing, and Director of Housekeeping, and on the Geriatric Unit located on the second floor of the facility, the following was noted: a. room [ROOM NUMBER]: The exteriors of the room chairs (2) were noted to be heavily worn, in disrepair, and areas of paint stains, bathroom call bell cord was wrapped around the bathroom handrail (the resident stated she utilizes the bathroom independently), and one of 2 bathroom lights was not working. b. room [ROOM NUMBER]: The exteriors of the room chairs (2) were noted to be heavily worn, in disrepair, the exteriors bathroom wall handrails (2) were noted to be rust laden, the shower room floor was noted to have large areas of peelings paint, and the bathroom floor was noted to be soiled and heavily stained. c. room [ROOM NUMBER]: The bathroom toilet required re-caulking to the floor, the bathroom wall was noted to have areas of dried brown matter, the exterior of room chairs (2) heavily worn and stained, the room electric wall cover was broken, and the bathroom emergency call cord was wrapped around the wall handrail. d. room [ROOM NUMBER]: Large areas of the bathroom floor were heavily black stains, the bathroom portable over-commode chair was rust laden, the bathroom wall was damaged and in disrepair, and the exteriors of room chairs (2) were heavily worn and stained. e. room [ROOM NUMBER]: the exterior of the room chair was heavily worn and stained, large areas of the shower room floor were noted to have peeling paint, the bathroom floor soiled and stained, live roach were noted on bathroom floor, the bathroom toilet had noted areas of dried brown matter, the bathroom and room baseboards were in disrepair. Page 1 of 6 105175 105175 03/28/2024 Plantation Nursing & Rehabilitation Center 4250 NW 5th St Plantation, FL 33317

F 0584 Level of Harm - Minimal harm or potential for actual harm f. room [ROOM NUMBER]: The exterior of room chairs were noted to be heavily worn and stained with a white paint-like substance. g. room [ROOM NUMBER]: The exterior of the room chairs was noted to be heavily worn and stained with a white paint-like substance, and the room wall corners were damaged and in disrepair. Residents Affected - Few h. room [ROOM NUMBER]: The bathroom emergency call pull cord was wrapped numerous times around the wall handrails (the resident stated she utilizes the bathroom), one of two bathroom light bulbs were not working, and the exterior of room chair was heavily worn and stained with a white paint-like substance. i. room [ROOM NUMBER]: The exterior of the room chair was heavily worn and stained with a white paint-like substance, and the room dresser was noted to have broken drawers (2). j. room [ROOM NUMBER]: The exterior of the room dresser was noted to be heavily worn and stained and would not close properly. k. room [ROOM NUMBER]: The room dresser drawers (2) were noted to be in disrepair and would not close properly. l. room [ROOM NUMBER]: The bathroom toilet required re-caulking to the floor, the bathroom ceiling tiles (5) were stained brown in color, the shower room floor was noted to have large areas of peeling paint, the bathroom emergency pull cord was wrapped numerous times around the wall hand rails, and the exterior of the room chair was noted to be heavily worn and stained with a white paint-like substance. m. Clean Linen Storage Room: Approximately 5 of the room ceiling tiles were noted to be stained brown in color. n. Clean Nursing Wound Storage Supply Room: The entrance area to room had a heavy build-up of a unidentified black substance, the room walls were soiled and dust laden, the room floor was heavily soiled and had a build-up of supply trash. Following the 03/28/24 tour, the findings were again discussed and confirmed with the Administrator. 105175 Page 2 of 6 105175 03/28/2024 Plantation Nursing & Rehabilitation Center 4250 NW 5th St Plantation, FL 33317

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, interview, and record review, the approved facility menu was not being followed for physician ordered diets that included: Regular Diet (total 7 residents - included sampled Residents #9 and #85), Soft & Bite Sized Level 6 (total 7 residents - included sampled Resident #2), and Moist & Minced Level 5 (included Resident #3). The findings included: Review of the approved menu for the Lunch meal of 03/27/24 noted the following to be served: - Regular Chicken Stew - 12-ounce portion to be served - Soft Bite Sized Level 6 (SB6) - 4-ounces [NAME] with Thickened Sauce - Moist & Minced Level 5 (MM5) - 4-ounces [NAME] with Thickened Sauce Observation of the tray line assembly in the Main Kitchen on 03/27/24 at 11:30 AM, accompanied with the Corporate Food Service Director (CFSD) noted the following: a. Staff B, the PM cook, was noted to be utilizing a #12 scoop (2-3 ounces) as a standard serving of the Regular Chicken Stew. The surveyor reviewed the approved lunch menu which documented a 12-ounce portion. Interview with Staff B, at the time of the observation, stated he thought a #12 scoop provided a 12-ounce portion. The CFSD informed Staff B that a #6 scoop X 2 should have been utilized as a standard portion. b. Observation of the lunch meal tray line noted that the Steamed [NAME] with Thickened Sauce was not prepared for SB6 diet, and the MM5 diet. Interview with Staff A, the AM cook, at the time of the observation noted that she was unaware the approved menu included Steamed [NAME] with Thickened Sauce was included on the menu for SB6 and MM 5 Diets. Review of the facility Diet Census for 03/27/24 noted the following physician ordered diets: - Moist & Minced Level 5 - 1 resident (included sampled Resident #3). - Soft & Bite Sized Level 6 - 7 residents (included sampled Resident #2). - Regular Diet = 2 residents (included sampled Resident's # 9, and #85). Review of the facility's Mechanically Altered Diets (SB5 & MM5) submitted by the Corporate Dietitian on 03/27/23 noted the following: Review of Soft & Bite Sized Level 6 (SB6) included: Level 6 used if not able to bite off pieces of food safely but are able to chew bite sized pieces down into little pieces that are safe to swallow. S&B foods need a moderate amount of chewing for the tongue to collect the food in a ball and bring it to the back of the mouth for swallowing. The pieces are bite sized to reduce choking risk. S&B foods are eaten using a fork, spoon, or chopsticks. No 105175 Page 3 of 6 105175 03/28/2024 Plantation Nursing & Rehabilitation Center 4250 NW 5th St Plantation, FL 33317

F 0803 bigger than 1.5 cm X 1.5 cm for adults. Level of Harm - Minimal harm or potential for actual harm Rice requires a sauce to moisten it and hold it together. [NAME] should not be sticky or gluey, and should not separate into individual grains when cooked and served. May require a thick, smooth, non-pouring sauce to moisten and hold together. Residents Affected - Few Review of Minced & Moist #5 (MM5) included: Level 5 used if you're not able to bite off pieces of food safely but have some chewing ability. People are unable to chew down into little pieces that are safe to swallow . MM foods only need a small amount of chewing for the tongue to collect the food into a ball and bring to the back of the mouth for swallowing. It is important that MM foods are not sticky because this can cause foods to stick to the cheeks, teeth, and roof of mouth. These foods are for eating using a spoon and fork. Rice requires a sauce to moisten and hold it together . [NAME] should not be sticky or gluey and should not separate when cooked and served. May require a thick, smooth, non-pouring sauce to moisten and hold the rice together. 105175 Page 4 of 6 105175 03/28/2024 Plantation Nursing & Rehabilitation Center 4250 NW 5th St Plantation, FL 33317

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, record review, and interview, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety that included failure to hold hot and cold foods at the regulatory temperature of 41 degrees Fahrenheit (F) or below, or 135 degrees F or higher. The findings included: Review of the facility's Policy and Procedures for Food Temperatures (Manual 3-24 - 2015) documented, in part, the following: 1. All hot food items must be cooked to appropriate internal temperatures, held and served at a temperature of at least 135 degrees Fahrenheit (F). 2. All cold food items must be maintained and served at a temperature of 41 degrees F or below. 3. Tray line and alternative meal preparations an service areas will avoid the following methods: Holding foods in the temperature danger zone (41 degrees F to 135 degrees F). Holding foods on a steam table for more than 4 hours. During the observation of the lunch tray line assembly in the main kitchen on 03/27/24, at 11:45 AM and accompanied with the facility's Corporate Food Service Director (CFSD), revealed the temperatures of tray line foods were taken with the facility's calibrated digital food thermometer. The findings noted that foods were not being held at the regulatory temperatures of 41 degrees F or less for cold foods and 135 degrees or higher for hot foods. The temperatures were recorded as follows: a. Pureed Seasoned Cabbage & Carrots (25 portions) = 106 degrees F. b. Individual Low fat Yogurt (3 portions) = 46 degrees F. c. Individual Health Shakes (6 portions) = 46 degrees F. d. Thickened Apple Juice (2 portions) = 45 degrees F e. Individual Regular Milk Cartons (3 portions) = 48 degrees F. f. Thickened Cranberry Juice (3 portions) = 46 degrees F. g. Individual Tossed Salads (7 portions) = 64 degrees F. Following the temperature testing of 03/27/24, the hot and cold recorded temperatures were again confirmed with the Corporate Food Service Director (CFSD). The CFSD stated that the hot food failed to be within regulatory temperature prior to being transferred to the steam table and the cold foods 105175 Page 5 of 6 105175 03/28/2024 Plantation Nursing & Rehabilitation Center 4250 NW 5th St Plantation, FL 33317

F 0812 failed to be refrigerated properly prior to the start of the tray line. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 105175 Page 6 of 6