Inspection·November 16, 2023

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to properly store resident's refrigerated laboratory specimens at the regulatory requirements of 36 degrees F (Fahrenheit) to 46 degrees F. Residents Affected - Few The findings included: During the review of the facility's policy for Laboratory Specimen Collection and Storage (Date Implemented 12/22/22 and Revised review/Revised 07/01/23), the following were noted: Policy: It is the policy of the facility to assure proper and safe collection and storage of laboratory specimens until pick up by the contracted Laboratory services. Policy Explanation and Compliance Guidelines: 1. The facility will comply with CDC, Laboratory, and other regulatory bodies to provide safe and effective storage of all specimens. 3. Collected specimen requiring refrigeration will be stored in a designated refrigerator and maintained until collected by the laboratory. 4. All specimens will be maintained under required temperature. 6. Refrigerators used for storage of specimen: (d) Temperature should be maintained between 36 degrees F - 46 degrees F. 7. Staff should observe proper storage and labeling requirements for all specimen and should demonstrate safety in regard to the specimen integrity, such duties include but not limited to; a. Report improper refrigerator storage temperatures of Below 36 degrees F, or Above 46 degrees F. Freezer temperature should not exceed 10 degrees F, During a routine tour of the facility on 11/13/23 at 10:30 AM, accompanied by the Administrator and Director of Nursing, it was noted that a specimen refrigerator was located within the Soiled Utility Room on the [NAME] Unit. Observation revealed that upon opening the mini refrigerator, it was noted that it contained a 2-inch-thick layer of ice surrounding the small freezer unit located within (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 3 Event ID: 105755 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 105755 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heartland Nursing & Rehab Center 3600 Old Boynton Road Boynton Beach, FL 33436 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)