Health 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 Page 1 of 3 105755 105755 11/16/2023 Heartland Nursing & Rehab Center 3600 Old Boynton Road Boynton Beach, FL 33436

F 0770 Level of Harm - Minimal harm or potential for actual harm the refrigerator. It was also noted that a specimen was located within the unit, which documented the name of Resident #361 and a documented date of 11/13/23 of a stool specimen. A review of the Specimen Refrigerator Temperature Log for November 2023, noted the following temperature documentation: Residents Affected - Few 11/01/23 = 20 degrees F. 11/02/23 = 28 degrees F. 11/03/23 = 30 degrees F. 11/04/23 = 20 degrees F. 11/05/23 = 19 degrees F. 11/06/23 = 26 degrees F. 11/07/23 = 22 degrees F. 11/08/23 = 24 degrees F. 11/09/23 = 30 degrees F. 11/10/23 = 34 degrees F 11/11/23 = 30 degrees F. 11/12/23 = 32 degrees F. 11/13/23 = 26 degrees F. At the request of the surveyor, the Specimen Refrigerator Temperature Logs were reviewed from May 2023 through October 2023. The review noted the following: May 2023 - 31-day temperature log noted a range from 20 F to 32 degrees F. June 2023 - 30-day temperature log noted a range of 24 F to 34 degrees F. July 2023 - 30-day temperature log noted a range of 24 F to 32 degrees F. August 2023 - 31-day temperature log noted a range of 24 F to 30 degrees F. September 2023 - 30-day temperature log noted a range of 24 F to 30 degrees F. October 2023 - 31-day temperature log noted a range of 24 F to 30 degrees F. The results were reviewed with the Administrator on 11/14/23 at 11:15 AM, and it was again confirmed that the specimen refrigerator temperature was below the regulatory range of 36 degrees F to 46 105755 Page 2 of 3 105755 11/16/2023 Heartland Nursing & Rehab Center 3600 Old Boynton Road Boynton Beach, FL 33436

F 0770 degrees F. It was also discussed that was a potential of inaccurate laboratory findings of the specimens. Level of Harm - Minimal harm or potential for actual harm It was discussed with the Administrative Staff at the time of the observation, that the temperatures were well below the regulatory temperature of 36 degrees F to 46 degrees F and there was the potential of freezing the specimens resulting in inaccurate laboratory findings. The surveyor requested that the refrigerator be replaced or repaired to ensure regulatory temperatures are maintained. The Administrator was requested to put a new thermometer in the refrigerator unit to ensure the actual interior temperature. Residents Affected - Few On 11/13/23 10:00 AM, the Administrator informed the surveyor that a new thermometer had been placed within the refrigerator unit, and the temperature was recorded at 34 degrees F. The surveyor informed the Administrator that the temperature was still not within the regulatory requirements for specimen refrigerator temperatures of 36 degrees F to 46 degrees F and requested that the refrigeration unit should not be utilized for specimen storage. On 11/15/23 at 8 AM, the Administrator informed the surveyor that a new refrigerator had been purchased for the use of resident specimen storage. During the review of the clinical record of Resident #361 on 11/14/23, the following were noted: Date of admission: [DATE] Diagnoses: Fracture of Right Femur, Sarcopenia, Psychosis, and Dementia Nursing Progress Notes: 11/12/13 - Resident having loose stools and it has a foul odor. Nurse Practitioner called and order received to collect stool for C-diff (Clostridioides Difficile). Stool collected. 11/15/23 - Resident continues to have loose stool. After stool is collected give Imodium 2 mg X 2 tabs PO (by mouth) for loose stool. Physician Orders: 11/12/23 - (Laboratory) CMP (Comprehensive Metabolic Panel), CBC (Complete Blood Count) , Vitamin D, Folate, TSH (Thyroid Stimulating Hormone) on Monday Stool for C-diff. 105755 Page 3 of 3