Inspection·July 8, 2024

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to coordinate medication administration times with dialysis services for 2 of 3 sampled residents reviewed (Residents #1 and #6). In addition, the facility failed to ensure the completion of dialysis communication records to validate continuity of care for Resident #1. Residents Affected - Few The findings included: 1a) Clinical record review revealed Resident #1 was admitted to the facility on [DATE] for rehabilitation services. Resident #1's pertinent diagnoses included End Stage Renal Disease, Metabolic Encephalopathy and Diabetes. Medication Administration Records (MAR) dated 05/2024 and 06/2024 indicated Resident #1 did not receive the following medications as prescribed. The explanation documented by the nursing staff noted, Resident in Dialysis: On 06/08/24 Calcium Acetate 667 mg, Ipratropium Nebulizer and Zinc 220 mg. On 06/04/24 Megestrol Acetate Suspension 40 MG/ML, give 5 ml by mouth one time a day for poor appetite for 3 Days. On 05/25/24 Calcium Acetate (Phos Binder) Oral Capsule 667 MG. The facility failed to coordinate medication administration with dialysis care to prevent medication omissions. Interview with the Risk Manager who assisted in navigating the electronic record on 07/08/24 at approximately 5:20 PM confirmed the findings. 1b) Review of the facility documents titled, Dialysis Transfer Form which documented the resident's assessment pre and post dialysis treatment revealed the nursing staff failed to document the assessment post dialysis treatment on 05/25/24. The post assessment form captures condition of the access site, vital signs, signs and symptoms of infection and any additional comments. Interview with the Risk Manager conducted on 07/08/24 starting at 4:42 PM, who assisted in locating the missing information, revealed the facility checks vital signs every shift, there is no other documentation regarding the access site (Catheter) or signs of infection after the dialysis treatment. The nursing staff failed to document medications given to the resident pre dialysis treatment on (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 6 Event ID: 105555 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 105555 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Jupiter Rehabilitation and Healthcare Center 17781 Thelma Ave Jupiter, FL 33458 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)