Health inspection·March 12, 2024

F 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical and administrative record review and interview, the facility failed to ensure timely completion of the Comprehensive Assessments for 2 of 3 sampled resident, Residents #2 and #3, as evidenced by lack of timely initial and periodically a comprehensive, accurate, standardized reproducible assessment of each resident's functional capacity. The findings included: 1. Review of the clinical record for Resident #2 on 03/05/24 revealed the resident was admitted to the facility on [DATE]. Review of the record failed to provide evidence that the resident had a Comprehensive Assessment completed for the resident. The Minimum Data Set (MDS) is part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid-certified nursing homes. It is a core set of screening, clinical and functional status elements, including common definitions and coding categories, which forms the foundation of a comprehensive assessment. Review of the electronic record, MDS, noted that the resident's initial assessment was in process, showing all areas were red and incomplete 36 days later. An interview was conducted on 03/05/24 at 3:12 PM with the MDS Coordinator, who, when asked about the resident's MDS, stated, It's just late. She further explained that they are behind on completing MDSs. She stated she started at the facility in July and the facility was behind then and we remain behind now. She further confirmed that the MDS is to be completed within 14 days after admission. 2. Review of the clinical record for Resident #3 on 03/05/24 revealed that the facility initiated a significant change MDS on 02/07/24. On 03/05/24, 27 days later, the MDS remained incomplete. An interview was conducted on 03/05/25 at approximately 4:30 PM with the MDS Coordinator, who stated they created the Significant Change MDS assessment for the resident and again stated that It's just late. Page 1 of 5 105762 105762 03/12/2024 Prosper Health and Rehabilitation Center 11375 Prosperity Farms Road Palm Beach Gardens, FL 33410

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical and administrative record review and interview, the facility failed to provide evidence that an accurate nutritional assessment was completed for 1 of 2 sampled residents reviewed for weight loss, Resident #1, who experienced a weight loss. Residents Affected - Few The findings included: 1. Review of the clinical record for Resident # 1 revealed the resident was admitted to the facility on [DATE] with a diagnosis that included Chronic Respiratory Failure with Hypoxia. The resident has a gastrotomy tube (GT / PEG) receiving enteral tube feeding. On 10/05/23, the facility had identified a concern that the resident required tube feeding (GT) related to Dysphagia, CVA (cerebral vascular accident); and had elevated needs for wound healing. The tube feeding provided the resident's sole source of nutrition and had remained NPO (nothing by mouth). Review of the resident's admissions and discharges documented the following: -transferred to the hospital on [DATE]; returned on 10/29/23. -transferred to hospital on [DATE]; returned on 11/13/23. -transferred to hospital on [DATE]; returned on 01/03/24. -discharged to hospital on [DATE]. Review of the resident's documented weights included a stable weight until November 13, 2023, at which time the resident was readmitted from a hospitalization. The resident had experienced a significant weight loss of 17.6 pounds, going from a recorded weight of 176 pounds (of 10/30/24, prior to hospitalization) to 158.4 pounds (on readmission). Additional documented weights for the resident were as follows: 11/14/23 - 156.7 pounds. 11/15/23 - 156.6 pounds. 11/22/23 -154 pounds. 11/29/23 - 152.6 pounds. 12/06/23 - 153 pounds. 12/13/23 - 152.1 pounds. 01/03/24 - 148 pounds. 01/04/24 -147.6 pounds. 105762 Page 2 of 5 105762 03/12/2024 Prosper Health and Rehabilitation Center 11375 Prosperity Farms Road Palm Beach Gardens, FL 33410

F 0692 01/05/24 - 147.8 pounds. Level of Harm - Minimal harm or potential for actual harm 01/06/24 - 147.8 pounds. This calculated to 8.9-pound weight loss from 11/14/23 to 01/06/24. Residents Affected - Few Further review of the clinical record revealed on 11/14/23, a Malnutrition Risk and Morbid Obesity Assessment was completed by the Dietitian. This assessment did not address the resident's weight loss noted on readmission of 11/13/24. The record review revealed there was not another assessment completed by the Dietitian until 01/15/24. An interview was conducted on 03/05/24 at 12:15 PM with the Assistant Director of Nursing (ADON), who stated the resident started vomiting and the resident's tube feeding was placed 'on hold'. The resident had returned to the hospital for a few days and had returned to the facility with the noted weight loss. An interview was conducted on 03/05/24 at 1:36 PM with the Dietitian, who confirmed the 11/14/23 assessment was inaccurate and did not reflect the resident's noted weight loss after hospitalization. She stated she is not sure why she would have noted the old weight instead of the new weight. When the resident came back to the facility after the hospitalization, the tube feeding was decreased to 55 ml/hr and they had gradually increased the resident's feeding to 70 ml/per hour. Review of the facility's policy regarding the Dietitian, documented the Dietitian is responsible for completing the basic requirements of clinical nutritional assessment and documentation for all residents. The policy also included the following: c. High-Risk Residents are those who are identified as but not limited to, residents with pressure sores, receives enteral feeding, receives hemodialysis, and hospice. High risk residents will be evaluated on a monthly and/or as needed basis depending on presence of acute changes. d. Significant/Severe weight change are those residents who are identified with a significant/Severe weight loss or gain of 5% or more in 1 month; 7.5 % or more in 3 months; and 10% or more in 6 months. i. Significant/Severe weight change notes will be completed using a template in the progress note. ii. Upon completion, the RD will update/revise the care plan as indicated and document a care plan note referencing the completion of the assessment. There was no evidence that the assessments were completed by the Dietitian. 105762 Page 3 of 5 105762 03/12/2024 Prosper Health and Rehabilitation Center 11375 Prosperity Farms Road Palm Beach Gardens, FL 33410

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical and administrative record review and interview, the facility failed to ensure the staff maintained the resident's respiratory supplies and equipment that are consistent with acceptable standards of practice and physician orders, as evidenced by the observation of multiple resident's respiratory supplies not dated, were expired or were improperly stored. Residents Affected - Few The findings included: Review of the facility's policy, titled, Cleaning and Disinfection of Resident-Care Items and Equipment, documented, in part, Resident-care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC recommendations for disinfection and the OHSA Bloodborne Pathogens Standard. b. Semi-critical items consist of items that may come in contact with mucous membranes or non-intact skin (e.g., respiratory therapy equipment). Such devices should be free from all microorganisms, although small numbers of bacterial spores are permissible. Physician order prescribes for the oxygen tubing and Nebulizer kit tubing to be changed weekly and as needed. An observational tour of the facility on [DATE] revealed the facility did not aseptically maintain the respiratory supplies by ensuring they were appropriately dated, changed and/or stored to ensure adherence of sanitary and infection control conditions. Observation revealed the following: On the 200 wing: room [ROOM NUMBER] W - the Nebulizer tubing was dated [DATE]. room [ROOM NUMBER] W - Nebulizer kit was not dated and left open to the air. The equipment was also left out in the open. It was stored on top of the nightstand. The resident also has a CPAP (continuous positive airway pressure) machine and is on oxygen. room [ROOM NUMBER] W - Nebulizer kit was not stored in a plastic bag. The Nebulizer kit was left out in the open on top of the nightstand. On the 300 wing: room [ROOM NUMBER] W - Nebulizer kit was dated [DATE], 11 days ago and the Nebulizer kit was left out in the open, on top of the Nebulizer machine stored on the nightstand. The surveyor returned to the resident's room on [DATE] and the Nebulizer kit dated [DATE] remained. room [ROOM NUMBER] W - there was no date on the Nebulizer tubing. On the 400 wing: 105762 Page 4 of 5 105762 03/12/2024 Prosper Health and Rehabilitation Center 11375 Prosperity Farms Road Palm Beach Gardens, FL 33410

F 0695 room [ROOM NUMBER] - there was no date on oxygen tubing. Level of Harm - Minimal harm or potential for actual harm On the 500 wing: room [ROOM NUMBER] W - the Nebulizer kit and oxygen did not have a date on tubing. Residents Affected - Few room [ROOM NUMBER] W - there was no date on the oxygen tubing. room [ROOM NUMBER] D - the Nebulizer tubing was open to air and it was not stored in a bag. An interview was conducted on [DATE] at approximately 4:30 PM with the Administrator. Reviewed with the Administrator that the surveyor observed multiple residents equipment, whose respiratory supplies were not dated, left open and some were beyond being changed one week ago. 105762 Page 5 of 5