Health inspection·June 21, 2023

F 0660 Plan the resident's discharge to meet the resident's goals and needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide an appropriate discharge plan for 1 of 3 sampled residents (Resident #3). Residents Affected - Few The findings included: Record review revealed Resident #3 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident was cognitively intact, and required extensive to total two-person assist with activities of daily living. The assessment further documented the resident did not have a pressure ulcer, but was at risk for the development of a pressure ulcer. A review of Resident #3's physician orders revealed an order dated 11/30/22 for a wound care consult for coccyx excoriation. A skin/wound progress note dated 12/06/2022 at 12:05 PM documented: Resident was seen by wound care on 12/5/22 related to Stage II wound on the coccyx that she was admitted with. The wound measurement are: 5.0 x 3.0 x 0.1 (centimeters) and is being treated with Hydrophilic paste. Will be followed by the wound NP (Nurse Practitioner) weekly. A Social Service (SS) progress note dated 12/13/22 at 11:57 AM documented: Care plan meeting held today 12/13/22. Resident and her son and daughter in law participated in meeting in person. IDT (interdisciplinary team) reviewed care plans, medications, advance directives, nursing care, therapy services and discharge plan. She is here for short term stay and goal is to return with services to the ALF (assisted living facility). A Social Service progress note dated 12/30/2022 at 4:39 PM documented: SS spoke with resident family -son and daughter-in-law today regarding her discharge plan which is tentatively scheduled for Fri 01/06/23 to return to ALF. SS reviewed discharge plan and protocol and services that will be set up for resident upon discharge home. Resident was here for short term rehab stay and has met her goals in rehab. MD will review the need for Home Health services for PT (physical therapy), OT (occupational therapy) and Nursing. Resident owns wheelchair, rolling walker, commode and shower chair. Resident will be discharge with her medications and 1823 form and family will coordinate transportation. SS will continue to provide services and assist with discharge plan. A review of Resident #3's Wound Care Progress Notes revealed a note dated 01/03/23 documented: wound measurements 7.0 x 2.0 x 0.8 centimeters. Wound coccyx tissue depth has changed, wound stage has changed from stage 2 to unstageable. Recommendation for wheelchair cushion and sharp debridement of non-viable, necrotic, devitalized tissue and accumulation debris to establish the margin of viable Page 1 of 3 105335 105335 06/21/2023 Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445

F 0660 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few tissue to decrease bacterial load and stimulate contraction, granulation, and wound epithelization. Plan of care discussed with facility staff. Follow up in one week for reassessment. A progress note dated 01/06/23 at 11:30 AM documented: Resident admitted to the facility with a dx (diagnosis) of left hip FX (fracture), while here received PT/OT Services. Discharge home today with remaining medications. Resident to return to ALF. Family to transport resident. An interview was conducted with Resident #3's family member on 6/21/23 at 10:00 AM via telephone. The family member stated they were not informed of a pressure ulcer on the resident's coccyx. The resident returned to an ALF (assisted living facility) with a coccyx wound on 01/06/23, with home health orders. The family member stated the resident should not have been discharged with a wound like that, and the ALF should not have accepted her. The ALF stated the resident could not stay there with the wound. An interview was conducted with the Social Services Director (SSD) on 06/21/23 at 2:00 PM. The SSD stated discharge planning starts on admission, and reviewed during care plan meetings. The SSD stated she was not the SSD at this facility when Resident #3 was discharged . The SSD further stated stage 2 pressure ulcers and above, including unstageable pressure ulcers, should not be transferred to an ALF. They do not have the skilled services to care for such wounds. The SSD stated she would notify family and ALF that the resident was not acceptable for return. Resident #3 should not have been discharged to an ALF with her unstageable wound. The ALF should not have accepted her. 105335 Page 2 of 3 105335 06/21/2023 Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to prevent the worsening of a pressure ulcer for 1 of 3 sampled residents (Resident #3). Residents Affected - Few The findings included: Resident #3 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident was cognitively intact, and required extensive to total two-person assist with activities of daily living. The assessment further documented the resident did not have a pressure ulcer, but was at risk for the development of a pressure ulcer. A review of Resident #3's care plan revealed a care plan for potential for impairment to skin integrity related to fragile skin and decreased mobility, dated 12/01/22. A review of Resident #3's physician orders revealed an order dated 11/30/22 for a wound care consult for coccyx excoriation. Further review of the resident's orders revealed an order dated 12/06/22 to cleanse sacrum with Normal Saline, pat dry, and apply Triad every shift and as needed, repositioning often. A skin/wound progress note dated 12/06/2022 at 12:05 PM documented: Resident was seen by wound care on 12/5/22 related to Stage II wound on the coccyx that she was admitted with. The wound measurement are: 5.0 x 3.0 x 0.1 (centimeters) and is being treated with Hydrophilic paste. Will be followed by the wound NP (Nurse Practitioner) weekly. A review of Resident #3's Treatment Administration Record (TAR) and progress notes revealed the wound care orders were not documented as being performed, between 12/6/22 to 12/31/22. A review of Resident #3's orders revealed an order dated 12/30/22 to cleanse sacrum with Normal Saline, pat dry, and apply Tegaderm foam dressing daily every night shift for sacrum wound care. A review of Resident #3's TAR revealed the dressing changes were performed on 12/31/22 until 01/03/23. A review of Resident #3's orders revealed an order dated 01/03/23 to cleanse sacrum with Normal Saline, pat dry, apply Calcium Alginate with Honey and cover with bordered gauze every night shift for sacrum wound care and as needed. A review of Resident #3's Wound Care Progress Notes revealed a note dated 01/03/23 documented: wound measurements 7.0 x 2.0 x 0.8 centimeters. Wound coccyx tissue depth has changed because wound stage has changed from stage 2 to unstageable. Recommendation for wheelchair cushion and sharp debridement of non-viable, necrotic, devitalized tissue and accumulation debris to establish the margin of viable tissue to decrease bacterial load and stimulate contraction, granulation, and wound epithelization. Plan of care discussed with facility staff. Follow up in one week for reassessment. An interview was conducted with the Assistant Director of Nursing (ADON) on 06/21/23 at 2:00 PM. The ADON acknowleged the above. 105335 Page 3 of 3