Inspection·December 12, 2024

F 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to provide adaptive equipment for a resident when consuming liquids for 1 out of 2 sampled residents reviewed for adaptive equipment, affecting Resident #6. Residents Affected - Few The findings included: Review of the facility's policy titled, Adaptive Feeding Equipment Policy and Procedure, with an effective date of 09/25/24, included in part, the following: To provide adaptive equipment to obtain and/or maintain a resident highest practicable level. Residents requiring assistance in feeding are potential candidates for a restorative dining program or adaptive utensil use, as determined by the occupational therapist. The dietary department should be notified of residents needing adaptive feeding equipment; the equipment is stored and maintained in the dietary department. Appropriate utensils should be placed on the resident's food tray, at each meal, and returned to the dietary department, on the food tray, for sanitization. Record review for Resident #6 revealed the resident was originally admitted to the facility on [DATE], with readmission on [DATE], with diagnoses that included, in part, the following: Anoxic Brain Damage, Dysphagia, Other Speech Disturbances, and Electrocution. Review of the Minimum Data Set assessment for Resident #6 dated 11/07/24 documented in Section C that a Brief Interview of Mental Status was not completed, due to the resident is rarely/never understood. Review of the Physician's Orders for Resident #6 revealed an order dated 05/31/17 for NAS (No Added Salt), Pureed, and No straw. Review of the Physician's Orders for Resident #6 revealed an order dated 03/11/22 for aspiration precautions: 90 degrees all meals, no straws, and small bites/sips. Review of the Physician's Orders for Resident #6 revealed an order dated 07/17/23 for adaptive equipment - nosey cup with liquids, to enhance feeding. Review of the Care Plan for Resident #6 dated 11/19/24 with a problem of resident is at risk for alteration in nutrition/hydration and weight fluctuations related to impaired cognition secondary to anoxic brain damage, other abnormal involuntary movements, and vary PO (oral) intake. He is at increased risk for aspiration related to diagnosis of dysphagia and needed mechanically altered diet. The (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 2 Event ID: 105838 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 105838 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edward J Healey Rehabilitation and Nursing Center 5101 West Blue Heron Blvd Riviera Beach, FL 33418 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)