Inspection·November 8, 2023

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 a resident from repeated physical abuse for 1 of 1 sampled resident reviewed for abuse (Resident #1). The findings included: A review of the Facility's policy Abuse Prevention, issued on 10/04/22 and reviewed on 07/18/23, Documented: It is the policy of this facility to prevent and prohibit all types of abuse, neglect, misappropriation of resident property, and exploitation. Procedure #4 documented: To identify, assess, care plan for appropriate interventions, and monitor residents with needs and behaviors, which might lead to conflict or neglect, such as verbally aggressive behavior and physically aggressive behavior. A review of the facility's abuse log revealed a resident (Resident #2) to resident (Resident #1) substantiated allegation specifically, of abuse on 10/14/23 and 10/26/23. Resident #1 was assaulted by Resident #2 on 10/14/23. Resident #2 was transferred to the hospital for unrelated concerns on 10/14/23. Resident #2 returned to the facility on [DATE]. Without any interventions in place, Resident #1 was again assaulted by Resident #2 on 10/26/23. Both residents resided in a locked memory care unit in adjacent rooms. Record review revealed Resident #1 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident had cognitive deficit and was independent with activities of daily living. The resident was care planned for wandering with decreased attention span. Record review revealed Resident #2 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident had severe cognitive deficit, and required supervision with set-up help only for activities of daily living. The resident was care planned for behavior problems, tends to be aggressive with other residents if they actually go into his room/bed. On 10/14/23 altercation with another resident in which he struck the resident in the face. The resident has exhibited physically aggressive behavior towards others related to impulse control. An intervention dated 10/14/23 included a psych consultation for aggressive/assaultive episodes. A review of Resident #1's progress note dated 10/14/23 at 9:50 AM revealed the resident was involved in an altercation with another resident (Resident #2), in which the other resident (Resident #2) walked up to Resident #1 and slapped him on his head and forehead, unprovoked, causing injury to his nose and forehead. First aid was provided, and appropriate entities were notified. (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 11/08/2023 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)