Health inspection·April 6, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to notify the Physician of an elevated blood sugar for 1 of 1 residents sampled for glucose monitoring during medication administration (Resident #37). Residents Affected - Few The findings included: On 04/05/23 at 4:45 PM, observations of medication administration were conducted with Staff B, a Licensed Practical Nurse (LPN). Staff B was observed taking Resident #37's blood sugar with a glucometer. The blood sugar result was 474 milligrams per deciliter (mg/dL). Normal values for blood sugar can range between 70 mg/dL and 130 mg/dL. Staff B proceeded to inject Resident #37 with 6 units of Insulin Lispro 100 UNIT/ML (milliliter) per physician order. Staff B did not call the physician per order that reads contact physician every 8 hours as needed for blood sugar greater that 400 call MD and recheck in one hour. She also did not recheck the blood sugar. Review of the Medication Administration Record (MAR) for Resident #37 revealed on 04/01/23 the blood sugar was 396 mg/dL, on 04/02/23 the blood sugar was 404 mg/dL and on 04/03/23 the blood sugar was 404 mg/dL. These were all recorded by Staff B. Resident #37 was admitted to the facility on [DATE] with diagnoses that included Chronic obstructive pulmonary disease, Type 2 diabetes mellitus and Hypertension. The resident's Brief Interview for Mental Status was 15 on the quarterly assessment with an assessment reference date of 02/22/23. This indicated the resident was cognitively intact. During interview, it was discussed with the Director of Nurses (DON) on 04/05/23 at 1:00 PM that Staff B did not call the physician per order when Resident #37's blood sugar was 474 ml/dL. Progress notes were reviewed and no call was made to the physician on 04/04/23 or previous days when the blood sugars were greater than 400 mg/dL. The DON agreed that the physician should have been notified per order and will discuss with Staff B. Page 1 of 6 105268 105268 04/06/2023 Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and policy review, the facility failed to provide anchors for catheter tubing for 2 of 3 sampled residents observed for catheter care (Residents # 54 and #66). The findings included: The policy of the facility titled Indwelling Urinary Catheter (Foley) Management issued 04/01/22 and reviewed 08/22/22 states Additional care practices related to catheterization Keeping the catheter anchored to prevent excessive tension on the catheter, which can lead to urethral tears or dislodging the catheter, and securing the catheter to facilitate flow of urine, preventing kinking of the tubing. On 04/06/23 at 9:24 AM, catheter care was observed on Resident #54 with Staff A, a Certified Nursing Assistant (CNA). The resident was in a wheelchair with a leg bag and transferred to the bed for Foley catheter care. Staff A cleansed the area around the tubing on the Foley catheter and cleansed the tubing with soap and water. She dried the tubing with a towel, applied a new leg bag after cleaning the connection with alcohol. During the observation of catheter care, there was no anchor for the tubing either before the bag was changed or after the new bag was applied. An interview was conducted with Staff A immediately after catheter care was completed asking where the anchor was for the catheter. Staff A replied they do not do that here. Resident #54 was admitted to the facility on [DATE] with diagnoses that included Neuromuscular dysfunction of the bladder, Chronic kidney disease, and Unspecified dementia. His Brief Interview for Mental Status (BIMS) assessment was 8 which indicated he was moderately impaired on the quarterly Minimum Data Set (MDS) with an assessment reference date of 03/29/23. During an interview, it was discussed with the Director of Nursing (DON) on 04/06/23 at 11:36 AM, regarding the observation of catheter care without the anchor present. The DON stated the residents have anchors on their catheter tubing. An observation was conducted subsequent to the interview of Resident #66 on 04/06/23 at 11:40 AM, who was in bed with a Foley catheter to bedside drainage. She did not have an anchor on her catheter tubing and no care plan that stated that she refused an anchor. Resident #66 was admitted to the facility on [DATE] with diagnoses that included Colostomy, Diabetes type 2 and Depression. She had a catheter for a Stage 4 wound. An additional interview was conducted with the DON after the observations were made of the residents with Foley catheters. She stated that the anchors are in the facility and all CNAs will be educated to use them. 105268 Page 2 of 6 105268 04/06/2023 Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the medication error rate was not 5 percent or greater. The medication error rate was 6.41 percent, 2 medication errors were identified while observing a total of 31 opportunities, affecting Resident #27. Residents Affected - Few The findings included: On 04/05/23 at 10:08 AM, a medication pass observation was conducted with Licensed Practical Nurse (LPN) Staff C for Resident #27. Staff C was observed preparing the resident's medications to include eye drops and 7 oral medications. One of the medications prepared and given was Aspirin EC (enteric coated) 81mg (milligrams) 1 by mouth. The medication ordered was Aspirin Tablet Chewable give 81mg by mouth one time a day for CAD (Coronary Artery Disease). On 04/05/23 at 10:45 AM the medications for Resident # 27 were reconciled to the Medication Administration Record (MAR). A additional error was discovered at this time. Staff C omitted administering Carvedilol Tablet 25mg 1 tablet by mouth. Carvedilol is used to treat heart failure and hypertension. Resident #27 was admitted to the facility on [DATE] with diagnoses that included Vascular Dementia, Hemiparesis and Hemiplegia following Cerebral Vascular Accident and Type 2 Diabetes Mellitus. On 04/05/23 at 11:45 AM, an interview was conducted with the Director of Nurses (DON) apprising her of the medication pass observation and the reconciliation of the medications administered by Staff C. The DON stated that she will be educating the nurse. 105268 Page 3 of 6 105268 04/06/2023 Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407

F 0803 Level of Harm - Minimal harm or potential for actual harm 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 and record review, it was determined that the facility to follow the lunch menu on 04/03/23. Residents Affected - Few 1) During the review of the facility's approved menu for the lunch meal of 04/03/23, it was noted that a 3 ounce portion of Sliced Ham was to be served to residents with a physician ordered regular diet. Further review of the weeks Cycle Menu noted that all other lunch and dinner meals documented only a 2 ounce protein portion to be served. During the observation of the tray assembly line in the Main Kitchen on 04/03/23 at 11:45 AM, the surveyor requested that an averaged portion of Sliced Ham that was going to be served to the residents be weighed on the facility's calibrated portion scale. Following the weighing of 2 sliced ham portions noted only 2 ounces recorded and being served as a standard resident portion for regular diets. 105268 Page 4 of 6 105268 04/06/2023 Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, it was determined that the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety that effected potentially 89 of the facility's 91 residents. The findings included: 1) During the initial kitchen/food service sanitation tour conducted on 4/3/23 at 9 AM, accompanied by the Certified Dietary Manager (CDM), the following were noted: (a) A food delivery cart was noted to be located in the main Dining Room by the entrance exit door to the kitchen. Further observation noted that the open cart contained 5 resident breakfast trays. The CDM informed the surveyor that the trays were waiting to be distributed to resident rooms and that the trays had been sitting for some time. At the request of the surveyor the temperature of the milk (8 ounce cartons) were taken with the facility's calibrated thermometer. The 5 cartons of milk were recorded at 56 degrees F. The surveyor informed the CDM that the milk must be held at the minimum requirement of 41 degrees F or below. Photographic evidence obtained. (b) During the tour it was noted a pan of what appeared to be hamburger patties on top of the grill. The cook on duty (Staff D) stated that the patties were Salisbury Steaks (SS) that had been cooked earlier and were left out to be pureed. At the request of the surveyor the temperature of the SS were taken with the facility's calibrated thermometer and were recorded at 96 degrees F. The surveyor informed the CDM that hot foods must be kept at the regulatory minimum temperature of 135 degrees F, The CDM stated that the SS would be discarded and remade and held at required temperatures. Photographic evidence obtained. (c) Observation of the dietary rest room located within the dietary department was noted that the internal walls and door were dust laden. The hand sink and toilet were noted to be heavily soiled. Photographic evidence obtained. (d) The wall vents located at the [NAME] end of the kitchen and at the entrance to the dry/canned room storage were noted to have a heavy build-up of dust and dirt. It was discussed with the CDM that there was a potential for food contamination due to the blowing dust and dirt. Photographic evidence obtained. (e) The exterior of the ceiling air-conditioning vent located at the entrance to the dish machine area was noted to be full of condensation that was dripping heavily into a basin located underneath the vent. Further observation noted the basin to be full of condensation. It was discussed with the CDM that the condensation could result in contamination of clean resident dishes moving underneath the vent. Photographic evidence obtained. 105268 Page 5 of 6 105268 04/06/2023 Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (f) Observation of the wall mounted hand-washing sink was noted to be clogged and a build-up of soiled water was in the sink. Photographic evidence obtained. (g) Observation of Reach-in refrigerator #1 noted a leftover contained of Tuna Fish. Further investigation noted the contained to be labeled with a preparation date of 3/29/23 and a discard/use by date of 3/31/23. The surveyor informed the CDM that today's date of 04/03/23 was 3 days after the documented discard date. The CD stated that the tuna fish should have been discarded on 03/01/23. Photographic evidence obtained. 2) During a second observation of the tray line assembly in the main kitchen on 04/03/23 at 11:55 AM, the surveyor requested a temperature check of foods on the tray line. Temperatures of foods were taken by the CDM with the use of the facility's calibrated thermometer. The temperature testing revealed that cold foods were not being held at the regulatory temperature of 41 degree F as evidenced by the following: * Bologna Sandwich (3) = 56 degrees F * Tuna Sandwich (2) = 47 degrees F 105268 Page 6 of 6