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. (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 6 Event ID: 105175 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 105175 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plantation Nursing & Rehabilitation Center 4250 NW 5th St Plantation, FL 33317 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)