Health inspection·March 7, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On 03/04/2024 at 07:26 AM observed Resident #98 in bed, head of bed elevated, Medical Records Personnel (Staff A) feeding the resident breakfast standing up. Review of the medical records for Resident #98 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to: Gastro-esophageal reflux disease without esophagitis and Dysphagia, oropharyngeal phase. Review of the Physician's Orders Sheet for March 2024 revealed Resident #98 had orders that included but not limited to: Diet-CCHO (Consistent Carbohydrates) diet, Pureed texture, thin consistency. Record review of Resident # 98's Quarterly Minimum Data Set (MDS) dated [DATE] revealed in Section C Section for Cognitive Patterns documented Brief interview for Mental Status score 3, on a 0-15 scale indicating the resident is cognitively impaired. Section GG for function Abilities and Goals documented the resident is dependent for eating. Review of Resident #98's Care plans Reference Date 12/30/2023 revealed resident with self-care deficit and requires supervision with eating and extensive assistance with dressing, hygiene, and total assistance with the rest of Activities of Daily Living (ADL's). ADLS may fluctuate throughout the course of the day. Interventions include- Set up care items and supplies at bedside a needed. Interview on 03/06/2024 at 10:01 AM Staff A stated that she knows that she needs to be sitting when feeding the resident, she started feeding the resident and then realized that she did not have a chair and went out of the room to get a chair. Interview on 03/06/2024 at 11:51 AM, the Director of Nursing (DON) stated regarding facility staff standing up feeding residents: We are going to re-educate staff about residents' dignity, especially feeding residents, you must sit down, you cannot stand over the resident. Review of the facility policy titled, Assistance with Meals revision date July 2017 states: Residents who cannot feed themselves will be fed with attention to safety, comfort, and dignity, for example: a. Not standing over residents while assisting them with meals. Based on observations, interview, and record review the facility failed to ensure six out of thirty-four sampled residents were treated with dignity; as evidenced by staff did not knock on doors and failed to request permission before entering the residents' rooms (Residents #475, #476, #477 and Page 1 of 22 105229 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #478) and staff were observed standing over residents while assisting them to eat (Resident #54 and Resident #98). There were 172 residents residing in the facility at the time of the survey. The findings included: On 03/04/2024 at 7:42 AM housekeeping staff (Staff J) walked into Resident #475's room did not knock or ask permission to enter the resident's room. Staff J was asked about not knocking before entering the resident's room. Staff J revealed staff are supposed to knock and ask for permission before entering residents' rooms. Staff J stated: I always knock and ask for permission, but I have no answer for why didn't knock this time. Moving forward I will knock and request permission before entering a resident's room. Record review of Resident # 475's demographic face sheet revealed the resident was admitted to the facility on [DATE] with diagnosis that include Cerebral Infarction and Chronic Obstructive Pulmonary Disease. Review of the admission Minimum Data Set (MDS) dated [DATE], Section C for cognitive patterns revealed a Brief Interview Mental Status (BIMS) score of 12 out of 15, that suggested moderate cognitive impairment. Section K for swallowing/nutrition status revealed Resident #475 required substantial/maximal assistance for eating and hygiene and dependent for transfer. Observation on 03/04/2024 at 1:52 PM, Staff K Registered Nurse (RN) walked into Resident # 476's room without asking permission or knocking before entering. Record review of demographic face sheet revealed Resident # 476 was admitted to the facility on [DATE] and readmitted on [DATE]. Clinical diagnosis included major depressive disorder and blindness in one eye. Review of the admission MDS dated [DATE] Section C for cognitive patterns revealed a BIMS score of 13 out of a scale of 0-15, that indicated no cognitive impairment. Section GG for Functional Abilities and Goals revealed Resident #476 required setup or clean up assistance for eating, supervision or touching assistance for personal hygiene, substantial/maximal assistance for toileting, and dependent for putting on/taking off footwear. Review of ADL Care Plan initiated on 5/9/2019 and revised on 2/16/2024 revealed Resident #476 required assistance with ADL functions. Interventions included Maintain privacy and dignity. On 03/04/2024 at 7:58 AM, Staff K stated she is aware she should knock and ask permission before entering. Staff K stated: I did not knock or ask permission because my coworker was already in the room with the resident. I will knock ask permission moving forward. On 03/04/2024 at 7:33 AM Nurse Staff E, RN walked into the room shared by Resident # 447's and Resident # 478 room without knocking or asking permission before entering. Record review of Resident # 447's demographic face sheet revealed the resident was admitted to the facility on [DATE] and readmitted on [DATE] with diagnosis that included Osteomyelitis and Diabetes Mellitus. Review of Discharge Return Anticipated MDS dated [DATE] Section C for cognitive patterns revealed a Brief Interview Mental Status (BIMS) score of undetermined out of a scale of 0-15, that indicated severe cognitive impairment. Section GG for Functional Abilities and Goals revealed Resident #477 documented that the resident requires partial/moderate assistance for transferring and hygiene and set up clean up assistance for eating. Review of the ADL Care Plan dated 2/10/2024 revealed Resident #477 needed assistance with ADL care. Interventions include maintaining privacy and dignity. Record review of Resident #478's demographic face sheet revealed the resident was admitted on 105229 Page 2 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few [DATE] with diagnosis that include Diabetes Mellitus. Review of admission MDS dated [DATE] Section C for cognitive patterns revealed a BIMS score of 2 out of a scale of 0-15, that indicated severe cognitive impairment. Section GG for Functional Abilities and Goals revealed Resident #478 required setup or clean up assistance for eating, partial/moderate assistance for hygiene and transfer. Review of the ADL care plan initiated on 2/9/2024 revealed Resident #478 had a self-care deficit. Interventions included encourage resident to do as many ADL tasks for themselves as possible. During an interview on 03/04/2024 at 7:35 AM, Staff E, RN revealed staff are to knock and ask for permission before entering residents' rooms, and he did not knock or ask permission before entering the room because the residents are like family here. Staff E further stated that he will make sure he knocks moving forward. On 03/05/2024 at 11:25 AM the Director of Nurses (DON) stated: Staff are to knock on door and introduce themselves before entering a resident's room. This is to provide the resident with a homelike environment. I have done in-services in the past regarding knocking on the door and asking permission to enter. On 03/07/2024 at 3:34 PM, Staff F, Certified Nursing Assistant (CNA) stated the protocol for entering a resident's room is to knock on door and ask for permission before entering. On 03/07/2024 at 3:37 PM, Staff G, CNA stated the facility's protocol for entering a resident's room is to knock on door and ask for permission before entering. On 03/07/2024 at 3:38 PM, Staff H, CNA stated when staff enters a resident's room they are to knock first and ask for permission before they enter. Review of the facility's Policy and Procedure titled, Dignity. Revised February 2021, Policy Statement: Each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem. Policy Interpretation and Implementation: 7. Staff are expected to knock and request permission before entering residents' rooms. Observation on 03/04/2024 at 12:14 PM, Staff I, RN was observed standing while assisting to feed Resident #54 lunch. Record review of demographic face sheet revealed Resident #54 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnosis that included Diabetes Mellitus. Review of Medicare 5-day MDS dated [DATE], Section C for cognitive patterns revealed a BIMS score of 4 out of a scale of 0-15, that indicated severe cognitive impairment. Section GG for Functional Abilities and Goals revealed partial/moderate assistance for eating, substantial/ maximal assistance for hygiene and dependent for toileting. Review of the ADL Care Plan initiated on 8/2/19 and revised on date 12/21/2023 revealed Resident #54 needed assistance with ADL care. Interventions included maintaining privacy and dignity. On 03/04/2024 at 12:14 PM, Staff I, RN stated: Staff are to be seated next to resident when assisting to feed meals to maintain the dignity of the residents. I was standing while assisting to feed [Resident#54] lunch because [Resident #54] normally eats alone but today needed help. Moving forward I will take a seat next any resident she assists to feed a meal. 105229 Page 3 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0550 Level of Harm - Minimal harm or potential for actual harm On 03/05/2024 at 11:19 AM DON stated: It is protocol for staff to be seated when assisting residents with meals. This is to ensure the dignity of the residents. I have done in-services in the past regarding the proper way to assist with feeding residents. Residents Affected - Few 105229 Page 4 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure the Minimum Data Set (MDS) assessment for four (Resident #75, Resident #83, Resident #138, Resident #150) out of four residents reviewed for resident assessments were accurately coded. There were 171 residents residing in the facility at the time of the survey. Residents Affected - Few The findings included: Record review of the facility's policy titled, MDS (Minimum Data Service) revised September 2021, reviewed January 2024 documented: Policy Statement: The Assessment Coordinator and/or the Interdisciplinary Assessment Team will follow the established processes for completing, submitting and making corrections to the MDS; Policy Interpretation and Implementation: Completion of MDS-1) Interdisciplinary Team will complete sections of MDS for a resident in the facility; Correction of Error-5) If an error is discovered after the encoding period determine if the error is major or minor. MDS Coordinator may modify assessment within 2 years of ARD (assessment reference date) and modification can be completed 14 days after is discovered. 1) Record review of the Demographic Face Sheet for Resident #75 documented the resident was admitted on [DATE] with a diagnosis of metabolic encephalopathy, anoxic brain damage, diabetes mellitus, epilepsy, major depressive disorder, insomnia, and anxiety disorder. Review of the Physician's Order Sheet (POS) and Medication Administration Records (MAR) for December 2023, January 2024, February 2024, and March 2024 documented the resident was receiving the following medications: Clonazepam 0.5 mg (milligrams) 1 tab (tablet) PO (by mouth) BID (twice a day) for anxiety, Escitalopram Oxalate 10mg tab 1 tab PO one time a day for major depressive disorder and Trazodone HCL (hydrochloric acid) 100 mg tab 1 tab PO HS (at night) for major depressive disorder. Review of the Minimum Data Service (MDS) Annual assessment dated [DATE] for Resident #75 documented the resident's Mental Status (BIMS) Summary Score was 05, indicating severe cognitive impairment and section A question Preadmission Screening and Resident Review (PASRR): Resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition, was coded as No and Level II Preadmission Screening and Resident Review (PASRR) Conditions were not coded for A) Serious mental illness; B) Intellectual Disability or C) Other related conditions. Review of the Psychotropic Drug Use Care Plan for Resident #75, written 4/07/2022 documented the resident was currently receiving antianxiety and antidepressants medications. Review of the PASRR Level I Screen for Resident #75 dated 4/06/2022 documented: Section I: PASRR Screen Decision-Making: Depressive disorder; Section II: Other Indications for PASRR Screen Decision-Making: All questions in this section were coded No. Review of the PASRR Level I Screen dated on 1/21/2024 documented: Section I: PASRR Screen Decision-Making: Anxiety Disorder, Depressive Disorder and Other-Intellectual Development Disorder, Moderate, Current diagnosis of an ID (intellectual disability) and Section II: Other Indications for PASRR Screen Decision-Making: 1) Is there an indication the individual has or may have had a disorder resulting in functional limitations in major life activities that would otherwise be appropriate for the 105229 Page 5 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0641 Level of Harm - Minimal harm or potential for actual harm individual's developmental stage was coded Yes, 2) Does the individual typically have or may have had at least one of the following characteristics on a continuing or intermittent basis was coded Yes and 3) Is there an indication that the individual has received recent treatment for a mental illness with an indication that the individual has experienced at least one of the following? A. Psychiatric treatment more intensive than outpatient care was coded Yes. Residents Affected - Few Review of the PASRR Level II Determination Summary Report for Resident #75 dated 2/15/2024 documented the resident met the state definition of serious mental illness and specialized services were not recommended. Interview and record review with the Assistant Director of Nursing (ADON) on 3/07/2024 at 11:04 AM. He confirmed the resident did receive a PASRR Level II on 2/15/2024. He stated, A [local state agency] came in February 2024 to evaluate her to make sure she qualified. She was interviewed because of the traumatic brain injury, and she qualified for a Level II. MDS should have made the change to reflect a Level II was done. Interview and record review with Staff L, Registered Nurse (RN), MDS Coordinator on 3/07/2024 at 1:10 PM. He confirmed the resident did receive a PASRR Level II on 2/15/24. He stated: Her annual is due 3/10/2024 and the Level II will be captured on it. Subsequent interview on 3/07/2024 at 1:48 PM he confirmed that he would be opening a new comprehensive assessment today for the resident to reflect the Level II. On 3/07/2024 at 1:28 PM interview via telephone with RN, Corporate MDS Consultant stated: I will have them open up an early comprehensive MDS to reflect the PASRR Level II. 2) Record review of the Demographic Face Sheet for Resident #83 documented the resident was admitted on [DATE] with a diagnosis of polyneuropathy, chronic respiratory failure, peripheral vascular disease, anxiety, hypertension, post-traumatic stress disorder (PTSD), bipolar disorder and gastrostomy status. Review of the Physician's Order Sheet (POS) and Medication Administration Records (MAR) for December 2023, January 2024, February 2024, and March 2024 documented the resident was receiving the following medications: Olanzapine 15 mg (milligrams) tab (tablet) 1 tab via PEG tube HS (at night) for bipolar disorder, Valproic Acid 250 mg/5 ml (milliliters) Solution 5 ml via PEG tube TID (three times a day) for bipolar disorder and Buspirone HCL 5 mg tab 1 tab via PEG tube BID (twice a day) for anxiety. Review of the Minimum Data Service (MDS) admission assessment dated [DATE] for Resident #83 documented the resident's Mental Status (BIMS) Summary Score was 12, indicating minimum cognitive impairment and section A question Preadmission Screening and Resident Review (PASRR): Resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition, was coded as No and Level II Preadmission Screening and Resident Review (PASRR) Conditions were not coded for A) Serious mental illness; B) Intellectual Disability or C) Other related conditions. Review of the Psychotropic Drug Use Care Plan for Resident #83, written 12/01/2023 documented the resident was currently receiving antianxiety and bipolar medications. Review of the PASRR Level I Screen for Resident #83 dated on 11/30/2023 documented: Section I: 105229 Page 6 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few PASRR Screen Decision-Making: Antianxiety Disorder, Bipolar Disorder, Depressive Disorder and Other-PTSD; Section II: Other Indications for PASRR Screen Decision-Making: All questions in this section were coded No. Review of the PASRR Level II Determination Summary Report for Resident #83 dated 1/21/2024 documented the resident was not considered to have met the state definition of serious mental illness. Interview and record review with the Assistant Director of Nursing (ADON) on 3/07/24 at 11:22 AM. He confirmed the resident did receive a PASRR Level II on 1/21/2024. He stated, A Level I was done, and a Level II was done and the MDS should reflect it. Interview and record review with Staff L, Registered Nurse (RN), MDS Coordinator on 3/07/2024 at 1:05 PM. He confirmed the resident did receive a PASRR Level II on 1/21/2024. He stated, The MDS is not incorrect and won't be done until the next comprehensive one. On 3/07/2024 at 1:28 PM interview via telephone with RN, Corporate MDS Consultant stated: I will have them open up an early comprehensive MDS to reflect the PASSR Level II. 3) Record review of the Demographic Face Sheet for Resident #138 documented the resident was admitted on [DATE] with a diagnosis of encephalopathy, anxiety disorder, peripheral vascular disease, psychotic disorder, and dementia. Review of the Physician's Order Sheet (POS) and Medication Administration Records (MAR) for December 2023, January 2024, February 2024, and March 2024 documented the resident was receiving the following medications: Depakote 250 mg (milligrams) DR (delayed release) tab (tablet) 1 tab PO (by mouth) one time a day for anxiety disorder, Citalopram Hydrobromide 10mg tab 1 tab PO one time a day for depression and Risperidone 1 mg tab 1 tab PO HS (at night) for psychosis. Review of the Minimum Data Service (MDS) admission assessment dated [DATE] for Resident #138 documented the resident's Mental Status (BIMS) Summary Score was 13, indicating minimum cognitive impairment and section A question Preadmission Screening and Resident Review (PASRR): Resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition, was coded as No and Level II Preadmission Screening and Resident Review (PASRR) Conditions were not coded for A) Serious mental illness; B) Intellectual Disability or C) Other related conditions. The MDS Annual assessment dated [DATE] documented the resident's BIMS Summary Score was 04, indicating severe cognitive impairment and section A question Preadmission Screening and Resident Review (PASRR): Resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition, was coded as No and Level II Preadmission Screening and Resident Review (PASRR) Conditions were not coded for A) Serious mental illness; B) Intellectual Disability or C) Other related conditions. Review of the Psychotropic Drug Use Care Plan for Resident #138, written 1/13/2023 documented the resident was currently receiving antianxiety, antidepressants and antipsychotic medications. Review of the PASRR Level I Screen for Resident #138 dated 1/13/2023 documented: Section I: PASRR Screen Decision-Making: Psychotic Disorder; Section II: Other Indications for PASRR Screen Decision-Making: All questions in this section were coded No. Review of the PASRR Level II Determination Summary Report for Resident #138 dated 5/11/2023 105229 Page 7 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0641 documented the resident was not considered to have met the state definition of serious mental illness. Level of Harm - Minimal harm or potential for actual harm Interview and record review with the Assistant Director of Nursing (ADON) on 3/07/2024 at 11:10 AM. He confirmed the resident did receive a PASRR Level II on 5/11/2023. He stated, A Level I was done, and a Level II was done and the MDS should reflect it. Residents Affected - Few Interview and record review with Staff L, Registered Nurse (RN), MDS Coordinator on 3/07/2024 at 1:08 PM. He confirmed the resident did receive a PASRR Level II on 5/11/2023. He stated, She is not considered to have a serious mental illness. On 3/07/2024 at 1:28 PM interview via telephone with RN, Corporate Consultant MDS stated: I will have them open up an early comprehensive MDS to reflect the PASRR Level II. 4) Record review of the Demographic Face Sheet for Resident #150 documented the resident was admitted on [DATE] with a diagnosis of degenerative disease of nervous system, encounter for palliative care, anxiety disorder, Schizoaffective disorder, hypertension, dementia, and major depressive disorder. Review of the Physician's Order Sheet (POS) and Medication Administration Records (MAR) for January 2024, February 2024 and March 2024 documented the resident was receiving the following medications: Seroquel 300 mg (milligrams) tab (tablet) 0.5 tab via PEG tube HS (at night) for Schizoaffective disorder, Seroquel 50mg tab 1 tab via PEG-tube BID (twice a day) for Schizoaffective disorder and Remeron 15 mg tab 1 tab via PEG tube HS for depression. Review of the Minimum Data Service (MDS) admission assessment dated [DATE] for Resident #150 documented the resident's Mental Status (BIMS) Summary Score was 03, indicating severe cognitive impairment and section A question Preadmission Screening and Resident Review (PASRR): Resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition, was coded as No and Level II Preadmission Screening and Resident Review (PASRR) Conditions were not coded for A) Serious mental illness; B) Intellectual Disability or C) Other related conditions. Review of the Psychotropic Drug Use Care Plan for Resident #150, written 1/03/2024 documented the resident was currently receiving antidepressants and antipsychotic medications. Review of the PASRR Level I Screen for Resident #150 dated on 1/09/2024 documented: Section I: PASRR Screen Decision-Making: Depressive Disorder, Schizoaffective Disorder, IQ of 70 or less; Section II: Other Indications for PASRR Screen Decision-Making: 1) Is there an indication the individual has or may have had a disorder resulting in functional limitations in major life activities that would otherwise be appropriate for the individual's developmental stage was coded Yes, 2) Does the individual typically have or may have had at least one of the following characteristics on a continuing or intermittent basis was coded Yes and 3) Is there an indication that the individual has received recent treatment for a mental illness with an indication that the individual has experienced at least one of the following? A. Psychiatric treatment more intensive than outpatient care was coded Yes. Review of the PASRR Level II Determination Summary Report for Resident #150 dated 2/16/2024 documented the resident met the state definition of serious mental illness and specialized services were not recommended. 105229 Page 8 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the PASRR Level II Care Plan for Resident #150, written 2/22/2024 documented the resident was admitted with a Mental Illness/Intellectual Disability/Developmental Disability Retardation condition and does not require specialized services. Interview and record review with the Assistant Director of Nursing (ADON) on 3/07/2024 at 11:20 AM. He confirmed the resident did receive a PASSR Level II on 2/16/2024. He stated, A Level I was done, and a Level II was done and the MDS should reflect it. The Level II care plan was done and is not coded on the MDS. Interview and record review with Staff L, Registered Nurse (RN), MDS Coordinator on 3/07/2024 at 1:01 PM. He confirmed the resident did receive a PASRR Level II on 2/16/2024. He stated, We don't do a modification of the MDS unless there is a correction. It will reflect on the next comprehensive assessment that will be done next year. Subsequent interview on 3/07/2024 at 1:48 PM he confirmed that he would be opening a new comprehensive assessment today for the resident to reflect the Level II. On 3/07/2024 at 1:28 PM interview via telephone with RN, Corporate MDS Consultant stated: I will have them open up an early comprehensive MDS to reflect the PASRR Level II. Interview and record review with Staff L, Registered Nurse (RN), MDS Coordinator on 3/07/2024 at 3:19 PM of the Education Sign-In Sheet dated 3/07/2024. He revealed the MDS Coordinators received education on the accuracy of PASRR MDS. The education summary documented the PASRR Level II and opening early comprehensive assessment to capture changes in PASRR audits. 105229 Page 9 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews the facility failed to ensure residents assessments were coordinated with the pre-admission screening and resident review (PASRR) program for four (Resident #75, Resident #83, Resident #138, Resident #150) out of seven residents reviewed. There were 171 residents residing in the facility at the time of the survey. The findings included: 1) Record review of the Demographic Face Sheet for Resident #75 documented the resident was admitted on [DATE] with a diagnosis of metabolic encephalopathy, anoxic brain damage, diabetes mellitus, epilepsy, major depressive disorder, insomnia and anxiety disorder. Review of the Physician's Order Sheet (POS) and Medication Administration Records (MAR) for December 2023, January 2024, February 2024 and March 2024 documented the resident was receiving the following medications: Clonazepam 0.5 mg (milligrams) 1 tab (tablet) PO (by mouth) BID (twice a day) for anxiety, Escitalopram Oxalate 10mg tab 1 tab PO one time a day for major depressive disorder and Trazodone HCL (hydrochloric acid) 100 mg tab 1 tab PO HS (at night) for major depressive disorder. Review of the Minimum Data Service (MDS) Annual assessment dated [DATE] for Resident #75 documented the resident's Mental Status (BIMS) Summary Score was 05, indicating severe cognitive impairment and section A question Preadmission Screening and Resident Review (PASRR): Resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition, was coded as No and Level II Preadmission Screening and Resident Review (PASRR) Conditions were not coded for A) Serious mental illness; B) Intellectual Disability or C) Other related conditions. Review of the Psychotropic Drug Use Care Plan for Resident #75, written 4/07/2022 documented the resident was currently receiving antianxiety and antidepressants medications. Review of the PASRR Level I Screen for Resident #75 dated on 4/06/2022 documented: Section I: PASRR Screen Decision-Making: Depressive disorder; Section II: Other Indications for PASRR Screen Decision-Making: All questions in this section were coded No. Review of the PASRR Level I Screen dated on 1/21/2024 documented: Section I: PASRR Screen Decision-Making: Anxiety Disorder, Depressive Disorder and Other-Intellectual Development Disorder, Moderate, Current diagnosis of an ID (intellectual disability) and Section II: Other Indications for PASRR Screen Decision-Making: 1) Is there an indication the individual has or may have had a disorder resulting in functional limitations in major life activities that would otherwise be appropriate for the individual's developmental stage was coded Yes, 2) Does the individual typically have or may have had at least one of the following characteristics on a continuing or intermittent basis was coded Yes and 3) Is there an indication that the individual has received recent treatment for a mental illness with an indication that the individual has experienced at least one of the following? A. Psychiatric treatment more intensive than outpatient care was coded Yes. Review of the PASRR Level II Determination Summary Report for Resident #75 dated 2/15/2024 documented the resident met the state definition of serious mental illness and specialized services were not 105229 Page 10 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0644 recommended. Level of Harm - Minimal harm or potential for actual harm Interview and record review with the Assistant Director of Nursing (ADON) on 3/07/2024 at 11:04 AM. He confirmed the resident did receive a PASSR Level II on 2/15/2024. He stated, A [local state agency] came in February 2024 to evaluate her to make sure she qualified. She was interviewed because of the traumatic brain injury and she qualified for a Level II. MDS should have made the change to reflect a Level II was done. Residents Affected - Few Interview and record review with Staff L, Registered Nurse (RN), MDS Coordinator on 3/07/2024 at 1:10 PM. He confirmed the resident did receive a PASRR Level II on 2/15/2024. He stated, Her annual is due 3/10/2024 and the Level II will be captured on it. Subsequent interview on 3/07/2024 at 1:48 PM he confirmed that he would be opening a new comprehensive assessment today for the resident to reflect the Level II. On 3/07/2024 at 1:28 PM interview via telephone with RN, Corporate Consultant MDS. She stated, I will have them open up an early comprehensive MDS to reflect the PASRR Level II. 2) Record review of the Demographic Face Sheet for Resident #83 documented the resident was admitted on [DATE] with a diagnosis of polyneuropathy, chronic respiratory failure, peripheral vascular disease, anxiety, hypertension, post-traumatic stress disorder (PTSD), bipolar disorder and gastrostomy status. Review of the Physician's Order Sheet (POS) and Medication Administration Records (MAR) for December 2023, January 2024, February 2024 and March 2024 documented the resident was receiving the following medications: Olanzapine 15 mg (milligrams) tab (tablet) 1 tab via PEG tube HS (at night) for bipolar disorder, Valproic Acid 250 mg/5 ml (milliliters) Solution 5 ml via PEG tube TID (three times a day) for bipolar disorder and Buspirone HCL 5 mg tab 1 tab via PEG tube BID (twice a day) for anxiety. Review of the Minimum Data Service (MDS) admission assessment dated [DATE] for Resident #83 documented the resident's Mental Status (BIMS) Summary Score was 12, indicating minimum cognitive impairment and section A question Preadmission Screening and Resident Review (PASRR): Resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition, was coded as No and Level II Preadmission Screening and Resident Review (PASRR) Conditions were not coded for A) Serious mental illness; B) Intellectual Disability or C) Other related conditions. Review of the Psychotropic Drug Use Care Plan for Resident #83, written 12/01/2023 documented the resident was currently receiving antianxiety and bipolar medications. Review of the PASRR Level I Screen for Resident #83 dated on 11/30/2023 documented: Section I: PASRR Screen Decision-Making: Antianxiety Disorder, Bipolar Disorder, Depressive Disorder and Other-PTSD; Section II: Other Indications for PASRR Screen Decision-Making: All questions in this section were coded No. Review of the PASRR Level II Determination Summary Report for Resident #83 dated 1/21/2024 documented the resident was not considered to have met the state definition of serious mental illness. Interview and record review with the Assistant Director of Nursing (ADON) on 3/07/2024 at 11:22 AM. 105229 Page 11 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few He confirmed the resident did receive a PASRR Level II on 1/21/2024. He stated, A Level I was done and a Level II was done and the MDS should reflect it. Interview and record review with Staff L, Registered Nurse (RN), MDS Coordinator on 3/07/2024 at 1:05 PM. He confirmed the resident did receive a PASRR Level II on 1/21/2024. He stated, The MDS is not incorrect and won't be done until the next comprehensive one. On 3/07/2024 at 1:28 PM interview via telephone with RN, Corporate MDS Consultant. She stated, I will have them open up an early comprehensive MDS to reflect the PASRR Level II. 3) Record review of the Demographic Face Sheet for Resident #138 documented the resident was admitted on [DATE] with a diagnosis of encephalopathy, anxiety disorder, peripheral vascular disease, psychotic disorder and dementia. Review of the Physician's Order Sheet (POS) and Medication Administration Records (MAR) for December 2023, January 2024, February 2024 and March 2024 documented the resident was receiving the following medications: Depakote 250 mg (milligrams) DR (delayed release) tab (tablet) 1 tab PO (by mouth) one time a day for anxiety disorder, Citalopram Hydrobromide 10mg tab 1 tab PO one time a day for depression and Risperidone 1 mg tab 1 tab PO HS (at night) for psychosis. Review of the Minimum Data Service (MDS) admission assessment dated [DATE] for Resident #138 documented the resident's Mental Status (BIMS) Summary Score was 13, indicating minimum cognitive impairment and section A question Preadmission Screening and Resident Review (PASRR): Resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition, was coded as No and Level II Preadmission Screening and Resident Review (PASRR) Conditions were not coded for A) Serious mental illness; B) Intellectual Disability or C) Other related conditions. The MDS Annual assessment dated [DATE] documented the resident's BIMS Summary Score was 04, indicating severe cognitive impairment and section A question Preadmission Screening and Resident Review (PASRR): Resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition, was coded as No and Level II Preadmission Screening and Resident Review (PASRR) Conditions were not coded for A) Serious mental illness; B) Intellectual Disability or C) Other related conditions. Review of the Psychotropic Drug Use Care Plan for Resident #138, written 1/13/2023 documented the resident was currently receiving antianxiety, antidepressants and antipsychotic medications. Review of the PASRR Level I Screen for Resident #138 dated on 1/13/2023 documented: Section I: PASRR Screen Decision-Making: Psychotic Disorder; Section II: Other Indications for PASRR Screen Decision-Making: All questions in this section were coded No. Review of the PASRR Level II Determination Summary Report for Resident #138 dated 5/11/2023 documented the resident was not considered to have met the state definition of serious mental illness. Interview and record review with the Assistant Director of Nursing (ADON) on 3/07/2024 at 11:10 AM. He confirmed the resident did receive a PASRR Level II on 5/11/2023. He stated, A Level I was done and a Level II was done and the MDS should reflect it. Interview and record review with Staff L, Registered Nurse (RN), MDS Coordinator on 3/07/2024 at 1:08 PM. He confirmed the resident did receive a PASRR Level II on 5/11/2023. He stated, She is not 105229 Page 12 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0644 considered to have a serious mental illness. Level of Harm - Minimal harm or potential for actual harm On 3/07/2024 at 1:28 PM interview via telephone with RN, Corporate MDS Consultant. She stated, I will have them open up an early comprehensive MDS to reflect the PASRR Level II. Residents Affected - Few 4) Record review of the Demographic Face Sheet for Resident #150 documented the resident was admitted on [DATE] with a diagnosis of degenerative disease of nervous system, encounter for palliative care, anxiety disorder, Schizoaffective disorder, hypertension, dementia and major depressive disorder. Review of the Physician's Order Sheet (POS) and Medication Administration Records (MAR) for January 2024, February 2024 and March 2024 documented the resident was receiving the following medications: Seroquel 300 mg (milligrams) tab (tablet) 0.5 tab via PEG tube HS (at night) for Schizoaffective disorder, Seroquel 50mg tab 1 tab via PEG-tube BID (twice a day) for Schizoaffective disorder and Remeron 15 mg tab 1 tab via PEG tube HS for depression. Review of the Minimum Data Service (MDS) admission assessment dated [DATE] for Resident #150 documented the resident's Mental Status (BIMS) Summary Score was 03, indicating severe cognitive impairment and section A question Preadmission Screening and Resident Review (PASRR): Resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition, was coded as No and Level II Preadmission Screening and Resident Review (PASRR) Conditions were not coded for A) Serious mental illness; B) Intellectual Disability or C) Other related conditions. Review of the Psychotropic Drug Use Care Plan for Resident #150, written 1/03/2024 documented the resident was currently receiving antidepressants and antipsychotic medications. Review of the PASRR Level I Screen for Resident #150 dated on 1/09/2024 documented: Section I: PASRR Screen Decision-Making: Depressive Disorder, Schizoaffective Disorder, IQ of 70 or less; Section II: Other Indications for PASRR Screen Decision-Making: 1) Is there an indication the individual has or may have had a disorder resulting in functional limitations in major life activities that would otherwise be appropriate for the individual's developmental stage was coded Yes, 2) Does the individual typically have or may have had at least one of the following characteristics on a continuing or intermittent basis was coded Yes and 3) Is there an indication that the individual has received recent treatment for a mental illness with an indication that the individual has experienced at least one of the following? A. Psychiatric treatment more intensive than outpatient care was coded Yes. Review of the PASRR Level II Determination Summary Report for Resident #150 dated 2/16/2024 documented the resident met the state definition of serious mental illness and specialized services were not recommended. Review of the PASRR Level II Care Plan for Resident #150, written 2/22/2024 documented the resident was admitted with a Mental Illness/Intellectual Disability/Developmental Disability Retardation condition and does not require specialized services. Interview and record review with the Assistant Director of Nursing (ADON) on 3/07/2024 at 11:20 AM. He confirmed the resident did receive a PASRR Level II on 2/16/2024. He stated, A Level I was done and a Level II was done and the MDS should reflect it. The Level II care plan was done and is not coded on the MDS. 105229 Page 13 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0644 Level of Harm - Minimal harm or potential for actual harm Interview and record review with Staff L, Registered Nurse (RN), MDS Coordinator on 3/07/2024 at 1:01 PM. He confirmed the resident did receive a PASRR Level II on 2/16/2024. He stated, We don't do a modification of the MDS unless there is a correction. It will reflect on the next comprehensive assessment that will be done next year. Subsequent interview on 3/07/2024 at 1:48 PM he confirmed that he would be opening a new comprehensive assessment today for the resident to reflect the Level II. Residents Affected - Few On 3/07/2024 at 1:28 PM interview via telephone with RN, Corporate MDS Consultant. She stated, I will have them open up an early comprehensive MDS to reflect the PASRR Level II. Interview and record review with Staff L, Registered Nurse (RN), MDS Coordinator on 3/07/2024 at 3:19 PM of the Education Sign-In Sheet dated 3/07/2024. He revealed the MDS Coordinators received education on the accuracy on PASRR MDS. The education summary documented the PASRR Level II and opening early comprehensive assessment to capture changes in PASRR audits. 105229 Page 14 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews the facility failed to ensure a resident received an accurate Preadmission Screening and Resident Review (PASRR) Level I screening for one (Resident #13) of seven residents reviewed. There were 171 residents residing in the facility at the time of the survey. Residents Affected - Few The findings included: Record review of the Demographic Face Sheet for Resident #13 documented the resident was admitted on [DATE] with a diagnosis of diabetes mellitus, dementia, hypertension, insomnia, peripheral vascular disease, atherosclerotic heart disease, major depressive disorder and anxiety disorder. Review of the Physician's Order Sheet (POS) and Medication Administration Records (MAR) for December 2023, January 2024, February 2024 and March 2024 documented the resident was receiving the following medications: Valproic Acid 250 mg (milligrams)/5 ml (milliliters) 2.5 ml PO (by mouth) BID (twice a day) for anxiety disorder and Mirtazapine 7.5 mg tab (tablet) 1 tab PO HS (at night) for major depressive disorder. Review of the Minimum Data Service (MDS) admission assessment dated [DATE] for Resident #13 documented the resident's Mental Status (BIMS) Summary Score was 06, indicating severe cognitive impairment and section A question Preadmission Screening and Resident Review (PASRR): Resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition, was coded as No and Level II Preadmission Screening and Resident Review (PASRR) Conditions were not coded for A) Serious mental illness; B) Intellectual Disability or C) Other related conditions. Review of the Psychotropic Drug Use Care Plan for Resident #13, written 9/08/2023 documented the resident was currently receiving antidepressant medications. Review of the PASRR Level I Screen for Resident #75 dated on 4/06/2022 documented: Section I: PASRR Screen Decision-Making: Depressive disorder; Section II: Other Indications for PASRR Screen Decision-Making: All questions in this section were coded No. Review of the PASRR Level I Screen dated on 9/04/2023 documented: Section I: PASRR Screen Decision-Making, diagnoses for anxiety disorder and depressive disorder were not checked. Level II was not conducted. Interview and record review with the Assistant Director of Nursing (ADON) on 3/07/2024 at 11:13 AM. He confirmed the diagnoses should have been checked on the PASRR Level I Screen dated on 9/04/2023 and that the PASRR Level I is incorrect. Interview and record review with Staff L, Registered Nurse (RN), MDS Coordinator on 3/07/2024 at 12:57 PM. He confirmed that the PASRR Level I was corrected today to include the diagnoses. He stated, The MDS did not reflect the diagnoses. Subsequent interview and record review with Staff L, Registered Nurse (RN), MDS Coordinator on 3/07/2024 at 1:21 PM of the PASRR Level I dated 3/07/2024 revealed a new PASRR Level I was done to include the diagnoses of anxiety disorder, depressive disorder and other (insomnia). 105229 Page 15 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observations, interviews and record review, the facility failed to ensure controlled medications (narcotics) reconciliation was accurate for two narcotic medications (Lorazepam and Clonazepam) as evidenced by the number of total pills in bingo cards were less than the amount recorded on Medication Monitoring/ Control Record. There were 172 residents residing in the facility at the time of survey. The findings included: On 03/06/2024 at 9:18 AM, the surveyor approached nursing station 4 where Staff C Registered Nurse (RN) was seated behind the desk and asked Staff C if morning medication administration was completed and requested to review the medication cart, Staff C agreed. A narcotic count was done with Staff C, RN. Review of Medication Monitoring/ Control Record revealed Lorazepam 0.5 milligrams (mg) totaling 10 signed off by Staff C on 3/5/2024 at 7:11 PM. Observation of the bingo card revealed physical total of Lorazepam 0.5 mg pills was 9. (see photo evidence). The surveyor reviewed the Electronic Medication Record and verified that the narcotic was given on 3/6/2024 by Staff C. On 03/06/2024 at 9:19 AM when Staff C, RN was asked about the discrepancy. Staff C stated: I have been working at facility for 1 year. nurses are to sign out narcotics when they are removed from package. I did not sign this narcotic out because I forgot. Next time I will sign at the moment I administer the narcotic. It is important to sign so I can know what time the resident can receive the next dose. On 03/06/2024 at 10:21 AM the surveyor approached nursing station 3 (back) cart and verified Staff D, RN completed morning medication administration and requested to check medication cart. Staff D agreed. A narcotic count was done with Staff D, RN. Review of the Medication Monitoring/ Control Record revealed Clonazepam 1 mg totaling 3 signed out by Staff D on 3/5/2024 at 2:30 PM and observation of bingo card revealed physical total of Clonazepam 1 mg pills was 9. (see photo evidence). The Electronic Medication Record indicated that the narcotic was given on 3/6/2024 by Staff D. On 03/06/2024 at 10:22 AM Staff D, RN stated nurses are supposed to sign out narcotic once it is removed from the bingo card. I did not sign because someone called me to help with another resident. Moving forward I will sign out narcotic at the time I remove from bingo card. The importance is to ensure documentation is accurate and in a timely manner. On 03/06/2024 at 10:25 AM, the Nurse Consultant stated: The procedure for signing out narcotics includes pop out the narcotic pill then sign out the pill at the time it is popped. On 03/06/2024 at 10:30 AM, Staff B, RN Supervisor stated: Nurses are to pop out narcotic pill and sign removal of pill on narcotic count sheet at that time. Review of Policy and Procedure entitled, Preparation and General Guidelines. Revised January 2018. IIA7: Controlled Substances: Policy: Medications included in the Drug Enforcement Administration (DEA) classification as controlled substances are subject to special handling, storage, disposal, and record keeping in the facility, in accordance with federal and state laws and regulations. Procedures: E. Accurate accountability of the inventory of all controlled drugs is maintained at all times. When a controlled substance is administered, the licensed nurse administering the medication 105229 Page 16 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0755 Level of Harm - Minimal harm or potential for actual harm immediately enters the following information on the accountability record and the medication administration record (MAR): 1) Date and time of administration (MAR, Accountability Record). 2) Amount administered (accountability Record) 3) Remaining quantity (Accountability Record) 4) Initial of the nurse administering the dose, completed after the medication is actually administered (MAR, Accountability Record). Residents Affected - Few 105229 Page 17 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview the facility failed to ensure the arbitration agreements presented to three residents (Resident number 83, Resident number 54 and Resident number 150) out of three residents reviewed informed residents or their representatives of the nature and implications of any proposed binding arbitration agreement, to inform their decision on whether or not to enter into such agreements. There were 171 residents residing in the facility at the time of the survey. Residents Affected - Few The findings included: Record review of the Binding Arbitration Agreements Policy and Procedure (implemented 3/2020, revised 3/2023) documented: Policy-This facility asks all residents to enter into an agreement for binding arbitration. Policy Explanation and Compliance Guidelines: 3) The agreement must not contain any language that prohibits or discourages the resident or anyone else from communication with federal, state or local officials, including but not limited to, federal and state surveyors, other federal or state health department employees and representatives of the Office of the State Long-Term Care Ombudsman. Review for Voluntary Arbitration agreements on facility letterhead documented the following: 1) The facility offers arbitration agreements; 2) The facility asks residents to enter into an arbitration agreement and provides new admissions with the arbitration agreement during the admission process and 3) The Admissions Director is responsible for the binding arbitration agreements. Review of the facility Voluntary Arbitration Agreements documented the following: Resident number 83's representative signed and dated on 12/12/2023, Resident number 54's representative signed and dated on 12/20/2023 and Resident number 150's representative signed and dated on 1/07/2024 did not document that the binding arbitration agreement allow the resident or anyone else to communicate with federal, state or local officials such as federal and state surveyors, other federal or state health department employees and representative of the Office of the State Long Term Care Ombudsman. On 3/07/2024 at 9:16 AM, interview with the Director of Admissions. She stated, Some of the residents have signed a voluntary arbitration agreement. Interview and record review with the Director of Admissions on 3/07/2024 at 9:19 AM confirmed that the Voluntary Arbitration Agreement did not document that the binding arbitration agreement allow the resident or anyone else to communicate with federal, state or local officials such as federal and state surveyors, other federal or state health department employees and representative of the Office of the State Long Term Care Ombudsman. 105229 Page 18 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on observations, interview and record review, the facility failed to demonstrate the implementation of effective plan of actions to correct identified deficiencies in problem areas, resulting in repeated deficient practices for F550 Residents Right/Exercise of Rights, as evidenced by the facility's failure to ensure six residents out of thirty-four sampled residents were treated in a dignified manner. There were 171 residents residing in the facility at the time of survey. The finding included: Record review of the facility's survey history revealed, during a recertification survey with exit dated 12/01/2022, F550 Residents Rights/Exercise of Rights was cited due to the facility's failure to provide services in a manner that maintained dignity for 3 of 3 sampled residents. During this recertification survey that was conducted from 03/04/2024 through 03/072024, the facility was cited F550 for Residents Rights/Exercises of Rights related to staff failure to knock on doors and failed to request permission before entering the residents' rooms (Residents #475, #476, #477 and #478) and staff were observed standing over Resident #54 and Resident #98 while feeding the residents. During an interview with the Nursing Home Administrator and Director of Nursing on 03/07/2024 at 2:55 PM. The Administrator stated that The Quality Assurance and Performing Improvement (QAPI) committee had a meeting every month on the Third Thursday. The Administrator stated the QAPI committee members are Medical Director, Administrator, Director of Nursing, Assistant Director of Nursing, Infection Prevention, Maintenance Director, Registered Dietitian, Activities Director, Social Services Director, and Departments Heads. The identified concerns related to repeat deficient practices were discussed. The Director of Nursing stated the QAPI committee is working closely with staff providing in-services education related to dignity. Record review of the Policy and Procedures for Quality Assurance and Performance Improvement implemented on 11/28/2017, revised on 01/03/2024 revised by Administrator and Interdisciplinary Team revealed Policy: It is the policy of this facility to develop, implement, and maintain an effective, comprehensive, data driven QAPI program that focuses on indicators of the outcomes of care and quality of life. Goal: Our goal is to create an exceptional person-centered care environment where the residents are involved in their own care and their needs are addressed individually. We want to cultivate an ongoing performance improvement process to support and improve our residents' quality of care and quality of life. QAPI goals: Using the goal, purpose, and guiding principles we developed or goals by stating what we want to accomplish, how we will measure our progress, how we will determine an achievable goal, how the goals determined to be relevant to the care we deliver, and how we will choose a timeline to attain the goal. 105229 Page 19 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to maintain appropriate infection control standards related to biohazard disposal of wound dressing. As evidenced by soiled wound dressing observed on the floor in resident's room. There were 171 residents residing at the facility at the time of the survey. Residents Affected - Few The findings included: On 03/06/2024 at 06:35 AM an observation of [room #] was conducted, a soiled wound dressing, approximately 4x4 in size was observed on the floor close to Bed A (Photo Available), several facility staff were observed going in and out of Room. On 03/06/2024 at 07:51 AM, housekeeping staff was observed cleaning rooms on the 300 hallways where the room was located. The housekeeping cart was in the hallway, no biohazard disposal supplies were seen on the cart. The surveyor checked room [] and the soiled wound dressing was no longer on the floor. During an interview on 03/06/2024 at 11:56 AM, the Director of Nursing (DON) stated: I will educate the wound care nurse and all nursing staff about infection control. Maybe one of the residents in the room was moving around and turning in the bed, and the dressing slipped off onto the floor, to be honest maybe it was an accident. The wound dressings are disposed of in the red biohazard bag and placed in the red bins in the soiled utility room. On 3/7/2023 at 01:43PM, when the Assistant Director of Nursing (ADON) was told about the wound care dressing found on the floor in room [] the ADON stated he will educate staff about picking up items from the floor, and discarding them in the correct disposal manner . He further stated: Maybe the wound dressing belonged to Resident #55 who resides in the room that has a colostomy bag. Review of the facility's policy titled Infection Control revision date October 2018 states: This facility's infection control policies and practices are intended to facilitate maintaining a safe, sanitary, and comfortable environment and to help prevent and manage transmissions of diseases and infection. 105229 Page 20 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, record review and interviews, the facility failed to provide a safe environment for residents as evidenced by four employee bathrooms not specifically labeled and locked when not occupied. There were 172 residents residing in the facility at the time of the survey. The findings included: On 03/05/2024 at 9:26 AM, during facility tour with Staff B, Registered Nurse (RN) Supervisor observation revealed the bathrooms at each nursing were unlocked. (see photo evidence) Residents were observed walking throughout the facility. The bathrooms did not have a sign that specified employee bathroom. The bathroom on nursing station two was not labeled. No call devices were observed inside the bathrooms near the nursing stations. On 03/05/2024 at 10:29 AM, The bathrooms in the lobby were observed to be locked. The key for lobby bathrooms kept in drawer at front desk. No call devices were observed inside the bathrooms in lobby. On 03/05/2024 at 09:30 AM, Staff B RN supervisor reported that the bathrooms near the nursing stations are for employees and visitors. There should be a sign on bathrooms to ensure everyone knows who the bathroom is for. All bathrooms are unlocked. There is no sign on the bathroom at station 2. There are signs indicating bathroom in nursing stations 1, 3 and 4. The bathroom on Station 4 (locked unit) should be locked due to the residents' mental incapacities and wandering behaviors. The residents are not allowed to use restrooms at nursing stations for privacy and dignity. On 03/05/2024 at 09:58 AM; The administrator stated, bathrooms should be labeled bathroom. Residents can use all the bathrooms in facility upon request and staff are available to assist. Bathrooms do not need to be locked because there are no hazardous chemicals inside. We allow the freedom of the residents to use bathroom of their choice. Staff should always be with residents when using a restroom that is not in their room to ensure safety. No other safety precautions need to be inside bathrooms that are used by residents. On 03/05/2024 at 11:19 AM, the Director of Nursing (DON) stated: Bathrooms located near the nursing stations are for employees only. When a staff member is hired, I orient staff to the facility, so they know which bathrooms to use. Residents never enter employee bathrooms. I will label the bathrooms near the nursing stations to emphasize to any visitors that this is an employee bathroom. The bathrooms can remain unopened when not in use. I have not witnessed or received any report of residents entering the employee bathroom. The DON did not provide an answer when asked if there is a potential for residents to enter the unlocked bathrooms near nursing stations. On 03/07/2024 at 9:05 AM, the Director of Environmental Services stated: The employee bathrooms are located by nursing stations. The employee bathrooms were only able to be locked once someone is inside, but I changed all four locks so that each bathroom door requires a key to enter and automatically locks once inside. I have worked here for six years, and we have had the same locks without any issue. Review of Policy and Procedure entitled, Safety and Supervision of Residents (revised January 2024) Policy Statement: Our facility strives to make the environment as free from accidents hazards as 105229 Page 21 of 22 105229 03/07/2024 Sands at South Beach Care Center, The 42 Collins Avenue Miami Beach, FL 33139

F 0921 Level of Harm - Minimal harm or potential for actual harm possible. Resident safety and supervision and assistance to prevent accidents are facility wide priorities. Policy Interpretation and Implementation: Facility - Oriented Approach to Safety: 1. Our facility - oriented approach to safety address risks for groups of residents. Residents Affected - Some 105229 Page 22 of 22