Inspection·October 3, 2024

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on observation, record review and interviews, the facility failed to update a side rails care plan for one resident with a seizure disorder (#109) out of 18 residents with padded assist rails as evidenced by a physician's order for Resident #109 with directions to keep both side rails in the up position and a care plan with interventions that included side rails to be in the down position. There were 171 residents residing in the facility at the time of survey. The findings included: On 9/30/24 at 10:25 AM Resident #109 was observed in bed with eyes open, holding a toy. Two quarter length side rails observed in the up position. The right-side rail had a blue padding attached and the left side rail had no padding. A padding was noted on the recliner near the resident. Record review of a demographic sheet for Resident #109 revealed an admission date of 5/2/24 with diagnosis that included but not limited to: seizures, psychotic disturbance, anxiety disorder restlessness and agitation. Record review of a Significant Change in Status Minimum Data Set (MDS) with a reference date of 9/5/24 Section C (Cognitive Status) revealed a Brief Interview for Mental was undetermined and Section GG (functional status) revealed Resident#109 was dependent on staff for all Activities of Daily Living. Record review of a May 2024 physicians order sheet revealed an order for two assist rails up (in place) due to (Seizure precautions with padding) every shift every day. Record review of a Potential for injury due to seizure disorder care plan initiated on 9/12/2024 with a goal to not sustain any injury related to seizure disorder thru next review date revealed interventions that included: two assist side rails down, horizontal, with padding to rails as prescribed. On 10/03/24 at 1:33 PM; Staff D, Registered Nurse (RN) was asked to explain why the interventions for the side rails in the care plan differ from the orders,; Staff D stated: The nurses will follow the physician's order. We create the care plan according to the physician's order. The interventions are always resident specific. On 10/03/24 at 2:39 PM, the Director of Nursing (DON) was informed by surveyor about the difference in the care plan interventions for Resident #109's side rails and the physician's order. The DON replied, The reason the interventions do not match the order is because The MDS nurse used the old (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 10 Event ID: 105719 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 105719 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palace at Kendall Nursing and Rehabilitation Cente 11215 SW 84th Street Miami, FL 33173 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)