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.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review, policy review and interview, it was determined, the facility staff failed to report and thoroughly
investigate allegations of neglect for 1 of 2 sampled residents (Resident #2).
The findings included:
Facility policy titled Abuse Reporting and Response - No Crime Suspected dated 10/04/22 documents The
facility will report alleged violations related to mistreatment, exploitation, neglect or abuse, including injuries
of unknown source and misappropriation of residents property and report the results of all investigations to
the proper authorities within prescribed timeframe.
Abuse Identification:
Neglect: is defined as the failure of the facility, its employees or service providers to provide goods and
services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional
distress.
Record review conducted on 09/19/23 revealed Resident #2 was admitted to the facility on [DATE] for
rehabilitation and was transferred to the hospital on [DATE] for possible reaction to medication and status
post fall. Resident #2 did not return to the facility.
Interview conducted with the Director of Admissions on 09/19/23 at 11:15 AM revealed Resident #2 did not
want to return to the facility. The Director explained she had a conversation with the hospital case manager,
who advised her the resident did not want to come back because the staff left him to choke on his own
vomit.
The Director was asked if she shared that allegation to the Administrator or the Director of Nursing and
replied, she believe she did.
Interview with the Director of Nursing conducted on 09/19/23 at approximately 12 noon revealed the
Director of admission did share the allegation that the staff left the resident to choke on his vomit and she
then reviewed the record, and determined that no one had documented vomiting or choking.
While speaking to the DON, a staff nurse, standing by her desk was completing a statement form regarding
Resident #2. The DON explained she is getting statements now because she wanted the nurses to
document the findings. The DON was asked why the investigation was being completed now and not
previously when the facility received the allegation. The DON replied when the allegation was made the
(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:
105516
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
105516
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/20/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Darcy Hall of Life Care
2170 Palm Beach Lakes Blvd
West Palm Beach, FL 33409
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)
F 0609
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
resident was alert, he was talking not choking, she can get ambulance records if needed and that if she
investigated every allegation, she would be doing that all day.
Interview with Staff A, a Registered Nurse, conducted via phone on 09/20/23 at 9:20 AM revealed she was
the nurse on duty the night Resident #2 was transferred to the hospital. The nurse recalled she was at the
nurses station completing her documentation and heard someone yelling for help, she walked down the
hallway and saw the resident by the bed on his knees, she asked him what happened and the resident said
he was going to the bathroom and felt weak, then he said he could not breathe and wanted to go to the
hospital, so she called 911 and the paramedics took him to the hospital, the facility policy is to transfer the
patient to the hospital if they request it.
Record review revealed the facility documents and reportable event and incident logs failed to provide
evidence the facility identified the allegation of neglect, reported the allegation to the appropriate agencies
and completed a thorough investigation of the events.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105516
If continuation sheet
Page 2 of 2
