Health inspection·February 6, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure accuracy of Minimum Data Set (MDS) assessments for 1 (Resident #55) of 4 residents reviewed for discharge assessments. Residents Affected - Few Findings include: Review of Resident #55's admission record documented that Resident #55 was admitted to the facility on [DATE] with diagnoses including: altered mental status, chronic obstructive pulmonary disease (COPD), seizures, cerebral infarction, transient cerebral ischemic attack, anxiety disorder, dysphagia and osteoarthritis. Review of Resident #55's Minimum Data Set (MDS) titled Discharge Return Not Anticipated dated 11/20/2024 showed the resident was discharged to acute hospital on [DATE]. Review of Resident #55's social services notes dated 11/14/2024 at 9:31 AM read, Met with resident and resident stated [Resident #55's Niece's name] came up here and talked to her about transferring and the resident stated she wanted to transfer where she [Social Services Director's name] was working. Referral process initiated. Review of Resident #55's social services note dated 11/15/2024 read, Received a call from [Facility name] who stated they approved the referral and will pick up the resident on 11/20/2024 at 10:00 AM. Review of Resident #55's admission & Discharge summary dated [DATE] read, Resident [Resident #55's name] transferred to SNF [skilled nursing facility]. During an interview on 2/4/2025 at 1:50 PM, the MDS Coordinator confirmed Resident #55 was discharged to another skilled nursing facility and the MDS dated [DATE] was inaccurate. Review of the facility policy and procedure titled Resident Assessment Instruments (RAI) with the last review date of 1/25/2024 read, Policy: It is the policy of the facility to adhere to the following procedures related to the proper documentation and utilization of a resident's Minimum Data Set (MDS) to ensure a comprehensive and accurate assessment of residents will be completed in the format and in accordance with time frames stipulated by Department of Health and Human Services Center for Medicare and Medicaid Services. This assessment system will provide a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capacities and assist staff to identify health problems for care plan development. (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: 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 02/06/2025 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)