Inspection·July 9, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and clinical and administrative record review, the facility failed to ensure the necessary care and services were provided for 1 of 2 sampled residents, (Resident # 2), reviewed for medical appointments and/or medical procedures, as evidenced by the facility's failure to provide the necessary nursing supervision during transport to medical procedure for an incapacitated resident; and failed to ensure the health care surrogate was fully informed and adhered to preferences voiced or informed when changes are made prior to implementation. The findings included: Review of the clinical record for Resident #2, revealed the resident was admitted to the facility on [DATE] with diagnoses that included Cerebrovascular Accident (CVA), Hypertension (HTN), Diabetes Mellitus (DM), Dysphagia following cerebral infarction, Epilepsy and expressive aphasia. Review of the Significant Change MDS (Minimum Data Set) assessment dated [DATE] revealed the resident had a BIMS (Brief Interview of Mental Status) score of 1, indicating severe cognitive impairment. The resident is dependent on staff for total care of all activities of daily living (ADLs). An interview was conducted on 07/08/25 in the morning with a family member of Resident #2 who stated that her non-verbal, total care family member was sent to a facility more than 80 miles away unaccompanied by nursing staff to receive a procedure under anesthesia.The family member and health care proxy gave approval for her family member to have a feeding tube inserted and was asked her hospital preferences. She provided the facility with multiple local hospitals within 15 miles of the facility. The resident was sent to Miami (80 miles away) without her prior knowledge or approval. She stated the facility contacted her when the resident had already left the facility and was traveling to Miami. She was informed that her family member was staying overnight, thus they did not send an aide to accompany her. She stated she had informed the caller that she did not approve of the transport to Miami, especially for her incapacitated family member to travel alone with just the transport driver. She further stated the facility was aware that she could not attend the appointment and requested that they cancel the transport. This was not done. The family member stated she was later informed that the resident would not be staying overnight but would be returning to the facility later that day. She further stated that the original information for this appointment she was provided for [another hospital - Name provided in Palm Beach County] on 06/09/25 and she would be accompanied by a Certified Nursing Assistant (CNA) since she (the family member) was out of the country. Since they rescheduled the appointment to 06/10/25, all information changed and it was not approved by her, who was the health care proxy. Review of the Nursing Progress Note on 06/03/25 at 10:10 AM, documented, Verbal orders received to send resident to ER [Emergency Room] for PEG [Percutaneous Endoscopic Gastrostomy] tube placement. Call placed to resident's family member regarding PEG tube placement and that NP [Nurse Practitioner] would like to send to ER for placement. Resident's family member would like for resident to go to [Name provided - hospital in Palm Beach County] for PEG tube placement. This writer will contact resident's family member on transportation Residents Affected - Few (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 07/09/2025 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)