Health inspection·July 28, 2022

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to maintain a homelike environment in 4 of 67 rooms observed (rooms #104, #111, #209, and the laundry room). The findings included: On 07/26/22 at 10:00 AM, the following observations were made room [ROOM NUMBER]: a) An unlocked, rusty paper towel holder in the bathroom; b) Gaps 2-3 inches wide along the lower sides of a/c unit; c) The baseboard and wall just outside of the bathroom were soft, and there was a hole in the wall; d) The light switch for the room was crusted with a dark matter. On 07/28/22 at 9:50 AM, an observation made in room [ROOM NUMBER], just inside the entry door, revealed a black circular substance on the ceiling. On 07/28/22 at 10:00 AM, an observation was in room [ROOM NUMBER] revealed the privacy curtain was dislodged from most hooks and dragging on the floor. During tour of laundry room conducted on 07/28/22 at 3:15 PM with Director of Housekeeping, the wall behind the washing machines was missing part of the baseboard, and there was a long, large gap between the floor and the bottom of the wall. During an interview conducted on 07/28/22 at 3:25 PM with the Director of Housekeeping, he stated he thinks there was an overflow of water at one time, and the baseboard was removed and probably was forgotten to be replaced. During an interview conducted on 07/28/22 at 3:45 PM with the Director of Maintenance, he stated he has been working with the facility for about 5-6 years. When asked how often he checks the facility for maintenance issues, he stated he checks the common areas every day, and the rooms get checked once a month. Also, he stated staff that go into the room can report any maintenance issue through the computer system. The system allows the staff member to enter maintenance concerns into the computer system, and the request goes to Director of Maintenance's phone as well as on the corporate computer for him to see. He prioritizes work to be done based on safety first, and then, as quickly he Page 1 of 7 105755 105755 07/28/2022 Heartland Nursing & Rehab Center 3600 Old Boynton Road Boynton Beach, FL 33436

F 0584 can. Depending on the situation, he may have to contact a vendor or contractor. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 105755 Page 2 of 7 105755 07/28/2022 Heartland Nursing & Rehab Center 3600 Old Boynton Road Boynton Beach, FL 33436

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews, the facility failed to ensure implementation of the care pland to provide assistive devices to prevent accidents for 1 of 1 sampled resident (Resident #27). The findings included: Review of the facility's policy, titled, Behavior Management Guidelines, dated 03/2022, documented the following: Wandering and exit seeking behavioral symptoms of special concern in the elderly and, or dementia population. Patients are evaluated upon admission for a history of, or risk factors for wandering and, or exit seeking. Interventions to consider include Personal security bracelet. Record review for Resident #27 revealed the resident was admitted to the facility on [DATE] with the most recent re-admission on [DATE]. The resident's diagnoses included Dementia with Behavioral Disturbances, Type 2 Diabetes Mellitus without Complications, Insomnia, Anxiety Disorder, Recurrent Depressive Disorders, Unspecified Fall, Subsequent Encounter, and Cognitive Social or Emotional Deficit Following other Cerebrovascular Disease. The Minimum Data Set (MDS) for Resident #27, dated 04/27/22, revealed in Section C should a brief interview of mental status be conducted with an answer of 'no' (the resident is rarely/never understood). Section E revealed wandering - presence and frequency, has the resident wandered, was answered behavior of this type occurred daily. Section G revealed bed mobility, transfer, dressing, toilet use, and personal hygiene all had self-performance of extensive assistance with support of one-person physical assist. Review of the care plan, dated 07/16/22, for Resident #27 had a focus on exit seeking/ elopement risk. The goal included to not leave center unattended. Interventions included calmly redirect to an appropriate area, check alert bracelet placement every shift and functioning every day. Review of the admission / re-admission evaluation for Resident #27, dated 07/16/22, revealed that during the evaluation the resident was irritable and resistive. The resident had a history of or the presence of the following behaviors: physical behaviors towards others (e.g., hitting others), verbal behaviors directed at others, anxiety/uneasiness about surroundings, verbalizes desire to exit. On 07/26/22 at 10:00 AM, an observation of Resident # 27 wrists and ankles revealed no safety alert bracelet. Initially there were no orders to check placement or function of alert bracelet for Resident #27, nor was there any entry on the medication administration record or the treatment administration record. After an interview was conducted with the Director Of Nurses (DON) on 07/26/22, the medical record revealed the following orders: On 07/27/22, Alert bracelet - check placement Q shift [every shift] for Check placement of alert bracelet. On 7/27/22, Alert bracelet - check function on the day shift every day shift for Check function of alert bracelet. During an interview conducted on 07/26/22 at 3:00 PM with the Minimum Data Set (MDS) Director, she stated that on admission the nurse develops a baseline care plan and that drives the initial care plan and Nursing assessment and physician orders. Just after the resident is admitted , the MDS Coordinator reviews orders, chart, and nurses' notes/assessments to see if anything needs to be expanded upon. Comprehensive care plan comes from the review of the chart and assessments and CAA (care area 105755 Page 3 of 7 105755 07/28/2022 Heartland Nursing & Rehab Center 3600 Old Boynton Road Boynton Beach, FL 33436

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few assessments) and the MDS. She stated that if there is an intervention for an alert bracelet for a resident, there also should be an order to check the alert bracelet, and that should be on the resident's treatment administration record (TAR). During an interview conducted on 07/26/22 at 3:30 PM with the DON, she was asked, if on admission, or readmission, a resident is identified as exit seeking, or verbalized the wish to exit, and when that nurse checks off an intervention for checking alert bracelet, should there be an order from the physician; the DON stated, Yes. 105755 Page 4 of 7 105755 07/28/2022 Heartland Nursing & Rehab Center 3600 Old Boynton Road Boynton Beach, FL 33436

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to secure medications left at bedside for 1 of 6 residents observed during medication pass (Resident #48); and failed to secure medications in a safe manner for 1 of 6 medication carts potentially affecting 19 residents on the 100 Pod. The findings included: 1. Review of the facility Medication and Treatment Administration Guidelines, updated 03/2018, revealed Medication Storage and Security: Medications and biologicals are securely stored in a locked cabinet, caret, or medication room, accessible to only licensed nursing staff and pharmacist or authorized pharmacy staff and maintained under a lock system when not actively utilized and attended to by nursing staff for medication administration, receipting, or disposal. On 07/27/22 at 9:56 AM, an observation was made of Staff A, Licensed Practical Nurse (LPN), administering the eye drops to Resident #48 and then left the remaining medications at the bedside while she threw away the dirty tissues and her gloves in the bathroom. During an interview conducted on 07/27/22 at 9:58 AM with Staff A-LPN, when asked why she left the oral medications at the bedside to throw away the dirty tissues, she stated, Oh, I guess I was not thinking. 2. On 07/27/22 at 10:08 AM, an observation was made of Staff A-LPN, leaving her medication cart unlocked and unattended just outside of residents' room while she took medications into the residents' bathroom to get a paper towel. There were 8 residents in the common area of the 100 pod at the time with one resident who was on the other side of the medication cart sitting at a table (this is a secured unit with wandering residents). During an interview conducted on 07/27/22 at 10:10 AM, when Staff A-LPN was asked why she left the medication cart unlocked and unattended, she stated, I guess I was just nervous. 105755 Page 5 of 7 105755 07/28/2022 Heartland Nursing & Rehab Center 3600 Old Boynton Road Boynton Beach, FL 33436

F 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation and interview, the facility failed to maintain the garbage dumpster in a clean, sanitary condition. Residents Affected - Some The finding included: On 07/25/22 at 9:40 AM, during an initial main kitchen tour accompanied by the Certified Dietary Manager, the garbage dumpster was observed to be very dirty. The outside of the dumpster had built up dried food and stains all over the outside. The Certified Dietary Manager also observed the dumpster. On 07/25/22 at 10:30 AM, an interview was conducted with the Certified Dietary Manager. She stated that the Housekeeping Department is responsible for cleaning the dumpster. On 07/27/22 at 3:41 PM, an interview was conducted with the Maintenance Director. He acknowledged the finding. 105755 Page 6 of 7 105755 07/28/2022 Heartland Nursing & Rehab Center 3600 Old Boynton Road Boynton Beach, FL 33436

F 0842 Level of Harm - Potential for minimal harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on record review and staff interview, the facility failed to accurately complete PASSAR (Preadmission Screening and Record Review) documents for 2 of 2 sampled residents (Resident #72 and Resident #76). The findings included: 1. A review of Resident #72's Level I PASARR, completed on 05/15/22, showed that this resident's PASAAR documented had a check mark in Section I A signifying a Mental Illness or suspected Mental Illness (MI) as Other: Dementia. There was also a check mark signifying a Yes in Section II.1, The individual has or may have had a disorder resulting in functional limitation in major life activities that would otherwise be appropriate for the individual's developmental stage. Resident did not meet the definition of a provisional admission or a hospital discharge exemption. Section II.5 documented that this resident did have a primary diagnosis of Dementia, and Section II.6 showed resident did not have a secondary diagnosis of Dementia, related neurocognitive disorder (including Alzheimer's disease) and the primary diagnosis is an Severe Mental Illness (SMI) or Intellectual Disability (ID). 2. A review of Resident #76's Level I PASARR, completed on 06/02/22, showed that this resident's PASAAR documented had a check mark in Section I A signifying a Mental Illness or suspected Mental Illness (MI) as Other: Dementia. There was also a check mark signifying a Yes in Section II.1, The individual has or may have had a disorder resulting in functional limitation in major life activities that would otherwise be appropriate for the individual's developmental stage Resident did not meet the definition of a provisional admission or a hospital discharge exemption. Section II.5 documented that this resident did have a primary diagnosis of Dementia, but there was no indication in question II.6 as to whether the individual had a secondary diagnosis of Dementia, related neurocognitive disorder (including Alzheimer's disease) and the primary diagnosis is an Severe Mental Illness (SMI) or Intellectual Disability (ID). According to the directions specified on the PASSAR form, A Level II PASRR evaluation must be completed prior to admission if any box in Section I.A or I.B is checked and there is a yes checked in Section II.1, II.2, or II.3, unless the individual meets the definition of a provisional admission or a hospital discharge exemption. On 07/27/22 at 10:50 AM, an interview was conducted with the Social Service Director (SSD) and Director of Nursing (DON). At this time, neither the SSD or the DON could answer as to why a Level II was not initiated for this resident. On 07/27/22 at 2:05 PM, upon further review, the Social Services Director (SSD) explained, I am not experienced in doing PASSARs for residents with Dementia. They are supposed to be done at the hospital, but the hospital has not been doing them because of the waiver that was issued during COVID. I have been doing the PASSARs at the time of admission. It was explained to the Social Services Director that, by definition, Dementia is not considered a MI or ID. The SSD confirmed at this time that she had completed the PASSAR forms incorrectly, and the PASSAR should have reflected that the resident did not need a Level II screening. She stated, I have already corrected these forms, and I will do an audit and make sure all the PASSARS are completed accurately. 105755 Page 7 of 7