F 0732
Post nurse staffing information every day.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, interview, and record review, the facility failed to ensure nurse staffing information
was posted on a daily basis.
Residents Affected - Few
Findings Include:
Observation of the posted nurse staffing information on 4/26/2022 at 9:28 AM revealed the posted nurse
staffing information was dated 4/25/2022.
During an interview on 4/26/2022 at 9:41 AM, the Administrator stated that he had not realized the posted
nurse staffing information was from the previous day and had not been updated.
During an interview on 4/29/2022 at 8:36 AM, the Director of Nursing reported nursing shifts were 7:00 AM
to 7:00 PM and 7:00 PM to 7:00 AM.
Review of the facility policy titled Posting Direct Care Daily Staffing Numbers, last reviewed on 1/22/2022,
reads, Policy: Our facility will post, on a daily basis for each shift, the number of nursing personnel
responsible for providing direct care to residents . 1. Within two (2) hours of the beginning of each shift, the
number of Licensed Nurses (RNs, LPNs, and LVNs) and the number of unlicensed nursing personnel
(CNAs) directly responsible for resident care will be posted in a prominent location (accessible to residents
and visitors) and in a clear and readable format.
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:
105805
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
105805
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/29/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Radiant Nursing and Rehab at Palatka
501 S Palm Ave
Palatka, FL 32177
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)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation, interview, and record review, the facility failed to ensure kitchen equipment were
maintained in a sanitary manner.
Residents Affected - Few
Findings Include:
During a tour of the main kitchen on 4/26/2022 beginning at approximately 9:26 AM with the Kitchen
Manager, the uncovered deep fryer had oil that was dark brown with debris floating in it and an extensive
build-up of dark murky oil. Along the sides of the fryer, there was extensive build-up of a white substance
that had dripped down the side of the deep fryer. (photographic evidence obtained).
During an interview on 4/26/2022 at approximately 9:30:AM, the Kitchen Manger confirmed the oil is dark
brown with floating debris inside and has a build-up of a white substance.
Review of the facility policy titled Deep Fryer Cleaning reads, Deep fryer will be cleaned on a regular basis
as recommended by the manufacturer. Procedures: 1. Clean element whenever oil filtered or changed. 2.
Wipe down the exterior at the ended of day. 3. Clean the fry baskets at the end of the day. 4. Boil out every3-6 months. 5. Inspect the fryer annually.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105805
If continuation sheet
Page 2 of 3
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
105805
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/29/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Radiant Nursing and Rehab at Palatka
501 S Palm Ave
Palatka, FL 32177
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)
F 0842
Level of Harm - Minimal harm
or potential for actual harm
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in
accordance with accepted professional standards.
Based on interview and record review, the facility failed to ensure the medical records related to meal intake
percentages were complete for 2 of 3 residents reviewed for nutrition, Resident #3, and Resident #20.
Residents Affected - Some
Findings Include:
Review of Resident #3's care plan, initiated on 9/14/2021, revealed the resident had chronic pain related to
arthritis and diabetic neuropathy. Resident #3's care plan documented nutritional interventions that included
monitor/record/report to nurse loss of appetite, refusal to eat and weight loss.
Review of Resident #3's clinical records revealed a Point of Care Response History for Eating Meal
Percentage dated 3/30/22- 4/26/22 failed to reveal completed documentation of the amount of the meal
Resident #3 had eaten each meal. Documentation of the percentage of the meal Resident #3 had eaten
was missing for 3 meals on 5 days, 2 meals on 5 days and 1 meal on 15 days during the period reviewed.
Review of Resident #20's clinical record revealed Resident #20 had diagnoses that included mild
protein-calorie malnutrition and adult failure to thrive.
Review of Resident #20's care plan, initiated on 4/11/2020, revealed the resident was at nutritional risk
related to a history of weight loss, refusals of meals and history of leaving more than 25% of most meals
uneaten. Resident #20's care plan documented nutritional care interventions that included record intake.
Review of Resident #20's clinical record revealed a Point of Care Response History for Eating Meal
Percentage dated 4/4/22- 4/26/22 failed to reveal completed documentation of the amount of the meal
Resident #20 had eaten each meal. Documentation of the percentage of the meal Resident #3 had eaten
was missing for 3 meals on 5 days, 2 meals on 3 days and 1 meal on 14 days during the period reviewed.
During an interview on 4/7/2022 at 9:03 AM, the Director of Nursing verified that the amount eaten
percentage data had not been entered for Resident #3 and Resident #20. She stated, I don't know if we
have a policy, but they are supposed to do it [enter the percentage eaten data].
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105805
If continuation sheet
Page 3 of 3
