Inspection·October 5, 2023

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on interview and record review, the facility failed to implement their policy and procedures on abuse for one (Resident #1) out of one sampled resident whose abuse report was reviewed. This facility practice had the potential to have a negative impact on the health and safety of all 263 residents residing in the facility at the time of the survey. The findings included: Review of the facility's Abuse Reporting Timeline Audit revealed an abuse of unknown injury or fracture occurred on 09/25/2023. Review of Immediate Federal Report revealed the Immediate Report was completed and filed on 09/27/2023 at 8:28 PM while the administrator was notified on 09/25/2023 at 10:30 AM. Interview with the Director of Nursing (DON) on 10/05/2023 at 01:55 PM, the DON confirmed that the initial report was filed about 2 days after the alleged abuse first reported. The DON stated, The procedure is to report the incident right away. I had a case where they sent the resident to the hospital without bruises or redness. After they told me there was a fracture, I did the report. It was a teachable moment. The day I received the result that the resident had a fracture, I reported it right away, and I did a QAPI (Quality Assurance and Performance Improvement) to explain my report. We did the PIP (Performance Improvement Plan). The staff sent the resident to the hospital without mentioning it to me. Yes, the alleged abuse was on September 25, 2023 and I filed the report on September 27, 2023, but that's when I received the x-ray report. The DON reported, one of our nurses reported it to the administrator. The administrator then told our charge nurse, but she forgot to tell me. Review of the facility's Abuse, Neglect, Exploitation or Misappropriation Policy and Procedure dated September 2022 revealed: Policy Statement: All reports of resident abuse (including injuries of unknown origin), neglect, exploitation, or theft/misappropriation of resident property are reported to local, state, and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Findings of all investigations are documented and reported. Policy Interpretation and Implementation Reporting Allegations to the Administrator and Authorities (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 3 Event ID: 105510 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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)