Health inspection·September 9, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to protect the resident's right to be free from physical abuse for 1 of 2 sampled residents (Resident #3) by a resident (Resident #2) with a history of physical abuse to staff and other residents. This is evident by the lack of supervision of Resident #2, contributing to re-offended physical abuse towards Resident #3. The findings included: Review of the closed record for Resident #2 revealed the resident was admitted to the facility on [DATE] with diagnoses which included Dementia, Adjustment Disorder with Anxiety, and Major Depressive Disorder. Further review revealed a comprehensive assessment dated [DATE] that documented the resident had severe cognitive impairment and required substantial/maximum assistance with activities of daily living. Resident #2 was transferred to the hospital on [DATE] for weight loss and functional decline per family request. Resident #2 was care planned for physically aggressive/combative behaviors with interventions included: administer medications as ordered, psych consult as indicated, and document observed behaviors and attempted interventions. Resident #3 was admitted to the facility on [DATE] with diagnoses which included Dementia. Record review revealed a comprehensive assessment dated [DATE] that documented the resident had severe cognitive impairment and required partial/moderate assistance with activities of daily living. A review of Resident #2's progress notes revealed a note, dated 08/18/24 at 3:54 PM, that documented: Received report from resident (Resident #3) that a naked man came in her room and hit her with his fist. CNA (Certified Nurse Assistant) confirmed that this resident (Resident #2) was naked and removed from other resident's (Resident #3) room after hearing the resident call for help. Resident unable to give description. Resident assessed, no new injuries noted, family and NP (Nurse Practitioner) notified. A progress note dated 08/20/24 at 4:02 PM documented: This writer received report from CNA that she heard another resident (roommate of Resident #2) yell for help, upon entering the room she found this resident (Resident #2) over other resident (the roommate) with bed remote in hand, in the striking position, removed this resident (Resident #2) from resident's (roommate of Resident #2) room. A progress noted dated 08/22/24 at 2:57 PM documented: IDT (Interdisciplinary Team) Meeting: [Resident #2] discussed in meeting in regards to resident's behaviors. Psych was in to see resident, (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 2 Event ID: 105268 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 105268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407 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)