Health inspection·April 1, 2022

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. An interview was conducted with Resident #154 on 03/28/22 at 11:35 AM. Resident #154 stated he was lactose intolerant. Resident #154 stated he likes to get the facility's fruit and cottage cheese platter, but they do not offer him a lactose-free cottage cheese as requested. Record review revealed Resident #154 was admitted to the facility on [DATE]. An admission comprehensive assessment documented Resident #154 as cognitively intact. A review of Resident #154's food preferences, dated 03/11/22, documented the resident had a dislike for dairy, and to serve menu alternate. A review of Resident #154's food preferences, dated 03/29/22, documented a supplement / preference for non-dairy foods / beverages for the resident. A review of Resident #154's orders revealed an order dated 03/31/22 for Lactaid tablet every 4 hours as needed for lactose intolerance to be given with meals that contain dairy. Further review of Resident #154's record did not reveal any documentation of why the resident's food preferences documented on 03/11/22 were not followed. An interview was conducted with the Director of Nursing (DON) on 04/01/22 at 2:00 PM. The DON did not know why the resident's food preferences documented on 03/11/22 were not followed. Based on observations, interviews, and record review, the facility failed to have provisions of eggs cooked to order as menu suggests with the potential to affect all 45 residents, and the facility failed to honor a resident's choice of a lactose free diet for 1 of 18 sampled residents (Resident #154). The findings included: 1. Review of the approved 7-week cycle menus showed that egg of choice was offered as a daily breakfast option. During an observation conducted on 03/29/22 at 1:22 PM, it was noted that the walk-in cooler contained pasteurized liquid eggs and unpasteurized shell eggs. The Sous Chef stated that the pasteurized liquid eggs were used for the nursing home and that the unpasteurized shell eggs were used for the assisted living facility / independent living sections within the campus. Page 1 of 14 105851 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview conducted on 03/29/22 at 1:25 PM, the Certified Dietary Manager (CDM) stated that egg of choice would include the following options: sunny side up, scrambled or hardboiled. In an interview conducted on 03/29/22 at 1:59 PM, the Executive Chef stated that the facility has been unable to obtain pasteurized shell eggs. According to him, the residents would only receive pasteurized liquid eggs as they were not sending the unpasteurized shell eggs to the Nursing Home residents. The Executive Chef stated, We used to send them eggs sunny side up when we had pasteurized shell eggs, but we are not sending things like that now. If someone ordered sunny side up eggs, then we tell them that they can't order things like that now. In an interview conducted on 03/30/22 at 12:00 PM, the Executive Chef was asked when he last received pasteurized shell eggs. The Executive Chef stated, I last received them 1 truck delivery or so ago. He further stated that he usually gets 2 truck deliveries per week. According to him, if Staff B, Cook, received an order for undercooked eggs, she would not provide the resident with their choice and would send the eggs to the resident fully cooked. In an interview conducted on 03/30/22 at 12:08 PM, Staff D, Dietary Aide (DA), stated that when delivering meal trays, the dietary aides would tell the residents that they were out of their selected egg of choice. She further stated that an alternate would be provided instead. Review of the Sysco Purchase Order showed that large pasteurized shell eggs were delivered to the facility on [DATE]. Review of the Sysco (wholesale food distributor) invoice dated 03/25/22 showed that medium unpasteurized shell eggs were ordered and out of stock. Further review of the Sysco invoice dated 03/25/22 showed that large unpasteurized shell eggs were substituted and delivered to the facility on [DATE]. During an interview conducted on 03/30/22 at 12:16 PM, the Executive Chef stated that he last received pasteurized shell eggs on 03/01/22. When asked why unpasteurized shell eggs were ordered on 03/25/22, the Executive Chef stated that pasteurized shell eggs were ordered and that Sysco was out of pasteurized shell eggs and provided them with unpasteurized shell eggs instead. During an interview conducted on 03/30/22 at 12:39 PM, the Registered Dietitian (RD) stated, I think they only do scrambled eggs and omelets. I've been working for the facility since 2014 and I've never seen them undercooked. During an interview conducted on 03/31/22 at 7:27 AM, Staff B stated that she worked in the facility Monday through Friday and was responsible for preparing breakfast and lunch for the nursing home. Staff B-Cook further stated that she did not use unpasteurized shell eggs and that the facility used liquid pasteurized eggs for their recipes. Staff B stated that she was aware the unpasteurized shell eggs were in the walk-in cooler but only used liquid pasteurized eggs. She further stated, I know I'm only supposed to use pasteurized eggs for upstairs. When asked what egg of choice meant, Staff B stated it meant boiled, scrambled, or omelet. At this time, the Dining Services Director stated that they did not prepare or offer undercooked egg options even with pasteurized shell eggs. He further stated, We do not do soft boiled eggs either. The Dining Services Director then acknowledged that the approved breakfast menus needed to be updated. During an interview conducted on 03/31/22 at 8:18 AM, the Dining Services Director stated, We do not do sunny side up eggs in healthcare. We do not use unpasteurized eggs, we use liquid eggs. 105851 Page 2 of 14 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview conducted on 03/31/22 at 10:05 AM, the RD stated that she approved the facility's menus annually. When asked what egg of choice meant, she stated, It should be egg chef choice because we don't allow long term care residents to choose eggs, we only provide them with scrambled. I don't know why it's signed with egg of choice when we offer scrambled. Our menus have always been like that. When asked about her expectations of the menu when it says egg of choice but residents are only offered scrambled. She stated, I don't know how to answer that. I'm not sure how to answer the verbiage, I can call the corporate office and see how they would like me to answer that. When asked about ordering food items for the kitchen, she stated that the Executive Chef and Dining Services Director were responsible. When asked about the unpasteurized shell eggs, she stated, In regards to this week, I know they threw away unpasteurized eggs. They should only be purchasing pasteurized eggs. In an interview conducted on 03/31/22 at 10:39 AM, the Executive Chef stated that he must have been the one who placed the order for the unpasteurized shell eggs that were delivered on 03/25/22. When asked about ordering, he stated that they order based on the product number listed on the order guide. The surveyor informed the Executive Chef that the product number on the order guide for the shell eggs did not reflect pasteurized shell eggs. The Executive Chef then stated that he did not remember if he ordered pasteurized shell eggs. Review of the Sysco invoices dated October 2021 - March 2022 showed that unpasteurized shell eggs were delivered to the facility on [DATE], 10/26/21, 11/09/21, 11/19/21, 02/08/22, and 03/25/22. Review of the Sysco Purchase Order dated 10/15/21 showed that shell eggs had not been ordered. Review of the Sysco Purchase Order dated 10/26/21 showed that medium unpasteurized shell eggs were ordered. Review of the Sysco Purchase Order dated 11/09/21 showed that medium unpasteurized shell eggs were ordered. Review of the Sysco Purchase Order dated 11/19/21 showed that no shell eggs had been ordered. Review of the Sysco Purchase Order dated 02/08/22 showed that medium pasteurized shell eggs were ordered and substituted for large unpasteurized shell eggs. Review of the Sysco Purchase Order dated 03/25/22 documented that medium unpasteurized shell eggs were ordered and substituted for large unpasteurized shell eggs. This showed that the facility did not place orders for pasteurized shell eggs in order to accommodate egg of choice as listed on the approved breakfast menus. During an interview conducted on 03/31/22 at 4:07 PM, Staff D-DA and Staff E-Dietary Supervisor were asked what they do when a resident orders soft boiled, sunny side up, poached, or undercooked eggs. Staff E stated, We really don't serve that, it's usually just what's on the menu when it says scrambled eggs. I've never allowed them to order sunny side up or poached eggs. When asked about eggs of choice, she stated that they offered omelets and eggs with cheese. When asked what types of eggs the residents could receive, they stated, Scrambled eggs, omelet, egg and cheese. Soft boiled, poached, sunny side up is not on the menu. 105851 Page 3 of 14 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0584 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation and interview, the facility failed to provide a homelike environment for a clean and debris-free flooring for 9 of 40 rooms (211, 212, 214, 218, 225, 226, 234, 237, and 240). Residents Affected - Few The findings included: An observation of the facility was conducted throughout the survey from 03/28/22- 04/01/22. The flooring at the doorway entry to the resident's rooms were noted with dirty, peeling, black duct tape in the following rooms: 211, 212, 214, 218, 225, 226, 234, 237, and 240. An interview was conducted with the Director of Maintenance on 04/01/22 at 2:00 PM. The Director of Maintenance acknowledged the above. 105851 Page 4 of 14 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

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 observations, interviews, and record review, the facility failed to place nutrition orders and obtain weights in a timely manner for 1 of 4 sampled residents reviewed for nutrition (Resident #2); and failed to conduct nutrition assessments in a timely manner for 1 of 4 sampled residents reviewed for nutrition (Resident #24). Residents Affected - Few The findings included: Review of the facility's policy, titled, Nutrition and Weight Management Program, version 1.0, documented the following: Ongoing monitoring of weight is integral to the plan to manage the resident's weight. Residents are upon admission, weekly for 4 weeks, then monthly to evaluate trends or in accordance with physician's orders. Residents who are not cognitively impaired may choose not to be weighed. Document this preference in the resident's care plan. All weights are recorded in the resident's electronic health record. Review of the facility's policy, titled, Nutritional Care Planning Process, revised on 04/30/21, documented the following: Quarterly, each resident is nutritionally reviewed and problems, goals, and approaches on the care plan are updated. Dietary Progress notes may be used for notations needed between reviews. Review of the facility's policy, titled, Nutritional Quarterly Review, revised on 07/02/18, documented the following: Quarterly Nutritional Risk Review and Quarterly Minimum Data Set should be done at least quarterly on those residents for whom dietary goals have been established through the interdisciplinary care planning process. The quarterly reviews need to correlate with the quarterly Minimum Data Set. 1. Review of the record documented Resident #2 was re-admitted to the facility on [DATE] with diagnoses that included, in part: Protein-Calorie Malnutrition, Irritable Bowel Syndrome, Anemia, Gastroesophageal Reflux Disease, and Hypertension. Review of Section C of the Minimum Data Set (MDS), dated [DATE], documented Resident #2 had a Brief Interview for Mental Status (BIMS) score of 10, which indicated that she was moderately cognitively impaired. Review of the weights showed that Resident #2 weighed 108 pounds on 12/27/21 and 116 pounds on 03/03/22. Further review showed that there were no weights taken between 12/27/21 and 03/03/22. Review of the Care Plan, revised on 03/28/22, documented Resident #2 was at risk for compromised nutritional status and significant weight fluctuation. Interventions were to obtain and document resident weights as ordered for additional nutritional intervention. Review of the Nutrition Progress Note, dated 12/29/21, showed that the Registered Dietitian (RD) documented the following: Recommend to resume previously recommended oral supplements including Ensure and appetite stimulant Eldertonic. Review of all Physician's Orders showed that Eldertonic had not been ordered following the RD's recommendation on 12/29/21. 105851 Page 5 of 14 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview conducted on 03/31/22 at 3:47 PM, the Certified Dietary Manager / Dietetic Technician Registered (CDM/DTR) was asked about the timing of weights upon admission and stated, I would have to check the policy for weights. According to her, all weights were documented in PointClickCare (electronic charting system). She stated that if a resident refused to be weighed, it would be documented under progress notes in PointClickCare. When asked about the weights for Resident #2, she confirmed the resident's weight was taken on 12/27/21 and on 03/03/22. When asked about nutrition supplements, the CDM/DTR stated that she and the RD were responsible for placing orders. The CDM/DTR then stated that if she recommended a nutrition supplement, she would check the orders to see if it went through. When asked about the order for Eldertonic for Resident #2 following the RD's recommendation on 12/29/21, the CDM/DTR reviewed PointClickCare and stated, I don't see that it was placed. In an interview conducted on 04/01/22 at 7:19 PM, the RD stated that upon admission, residents are to be weighed once per week for the first 4 weeks and then monthly thereafter. When asked about re-admissions, the RD stated that residents who are re-admitted to the facility would also be weighed once per week for the first 4 weeks and then monthly thereafter. According to her, weights were documented in PointClickCare. When asked about weight refusals, the RD stated, Weight refusals should be documented. I would ask the Director of Nursing (DON) where they would document that. When asked about nutrition supplements, the RD stated that the CDM or nurses would be responsible for placing the orders from her recommendations. The surveyor then informed the RD of the findings, and the RD acknowledged the findings. In an interview conducted on 04/01/22 at 10:23 AM, the DON stated that weight refusals would be documented under Health Status Progress Notes or Nutrition Progress Notes. The DON then reviewed Resident #2's Health Status and Nutrition Progress Notes from 12/27/21 to 03/03/22 and confirmed that there were no weight refusals documented. The DON acknowledged the surveyor's findings. 2. Review of the record documented that Resident #24 was admitted to the facility on [DATE] with diagnoses that included, in part: Hyperlipidemia, Hypertensive Heart Disease, Osteoarthritis, Dementia and Parkinson's Disease. Review of Section C of the MDS, dated [DATE], documented Resident #24 had a BIMS score of 03, which indicated that she was severely cognitively impaired. Review of Section G of the MDS, dated [DATE], documented that Resident #24 required limited assistance with one-person physical assist for eating. Review of the Care Plan, revised on 03/28/22, documented Resident #24 was at risk for compromised nutritional status. Interventions were for the RD to assess nutritional and hydration needs as indicated. Review of all Nutrition Progress Notes in PointClickCare showed that there was only one RD note, which was dated 05/14/21. In an interview conducted on 03/31/22 at 3:47 PM, the CDM/DTR stated that nutrition assessments were conducted according to the policy used by the facility. According to her, she was responsible for quarterly and significant change assessments, and the RD was responsible for conducting initial assessments and following up with high-risk residents. When asked where nutrition assessments were documented, the CDM/DTR stated that all notes would be documented in PointClickCare. She further stated that initial assessments, quarterly assessments, and significant change assessments would be documented under progress notes. When asked about the nutrition assessments for Resident #24, the CDM/DTR 105851 Page 6 of 14 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0692 stated, I see there's one 05/14/21 from the RD. I do not see anything else. Level of Harm - Minimal harm or potential for actual harm In an interview conducted on 04/01/22 at 7:19 PM, the RD stated that she conducted initial assessments and monthly assessments to check on residents with wounds, tube feeding or dialysis. When asked about the timing of assessments upon admission, the RD stated, If they are high risk, tube feeding, dialysis, or significant change, they need to be seen within 72 hours. Otherwise, I would have 7 days. Then I believe they should be seen quarterly. The RD stated that nutrition assessments would be documented in PointClickCare. When asked about the assessments for Resident #24, the RD stated, We monitor our patients at least monthly. If there's no issue, there's no reason to write a note. The RD then acknowledged that there was no documentation to show that Resident #24 had been assessed since 05/14/21. Residents Affected - Few In an interview conducted on 04/01/22 at 10:23 AM, the DON acknowledged the surveyor's findings. 105851 Page 7 of 14 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to ensure that an oxygen concentrator's (a device that delivers oxygen) filter was clean and debris free for 1 of 2 sampled residents reviewed for oxygen (Resident #7). Residents Affected - Few The findings included: An observation of Resident #7 was conducted on 03/28/22 at 3:00 PM. The resident was observed awake in bed receiving oxygen therapy. Further observation of the resident's oxygen concentrator revealed a filter laden with a large amount of dust and debris. A side-by-side observation of Resident #7's oxygen concentrator with the Director of Maintenance on 04/01/22 at 12:00 PM revealed a filter laden with a large amount of dust and debris. An interview was conducted with the Director of Maintenance during the side-by-side observation. The Director of Maintenance stated he did not know who was responsible for maintaining / cleaning the oxygen filters. The Director of Maintenance stated that housekeeping cleans the oxygen concentrator when the resident is discharged / leaves the facility. 105851 Page 8 of 14 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0803 Level of Harm - Minimal harm or potential for actual harm Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observations, interviews and record review, the facility failed to follow the approved menu for 1 of 3 residents on pureed diets, which included sampled resident (Resident #37). Residents Affected - Few The findings included: Review of the approved breakfast menu for pureed diets for 03/29/22 documented that the following items were to be served: pureed pancakes, pureed bread and pureed oatmeal. During an observation of the breakfast tray line conducted on 03/29/22 at approximately 7:30 AM, it was noted that the pureed bread and the pureed oatmeal were missing from the breakfast tray line. When asked about the pureed bread, Staff B, Cook, stated that pureed pancakes were to be served in place of pureed bread. The surveyor showed Staff B the approved breakfast menu which documented that both pureed bread and pureed pancakes were to be served. When asked again about the pureed bread, Staff B acknowledged that it was missing from the breakfast tray line. When asked about the pureed oatmeal, Staff B stated that she only made pureed oatmeal on Mondays, Wednesday, and Fridays, and confirmed that she did not make pureed oatmeal for the breakfast tray line on 03/29/22. The Certified Dietary Manager (CDM) acknowledged that the approved breakfast menu for the pureed diets was not being followed. Review of the facility diet census, dated 03/29/22, documented that 3 residents were on pureed diets, which included Resident #37. 105851 Page 9 of 14 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record review, the facility failed to maintain food safety requirements with storage, preparation, and distribution in accordance with professional standards for food service safety which included: failure to maintain sanitary conditions. The findings included: 1. During the initial tour of the kitchen conducted on 03/28/22 at 8:57 AM, accompanied by the Executive Chef, the following was noted: a. One chain lanyard with about 10 keys and one orange notebook were stored on top of the food preparation table. The Executive Chef stated that he had placed these items on top of the food preparation table prior to the surveyor's entrance to the kitchen. b. In the walk-in cooler, about 20 condiment cups containing red sauce were missing labels identifying the product name and use by date. c. In the walk-in cooler, the floor was observed with brown residue and cracked floor panels. d. One light bulb in the walk-in cooler was out. e. In the dry storage area, about 8 boxes containing food products (ice cream cones, saltine crackers, miniature marshmallows, barbecue sauce, cheesecake mix, and soda cans) were stored on top of a wooden pallet. The Executive Chef acknowledged that they should not have been stored on a wooden pallet that was not designed to be easily cleanable for shelving. f. In the dry storage area, one 46 fluid ounce carton of Imperial mildly thick nectar consistency thickened apple juice from concentrate had a use by date of 03/22/22. g. In the dry storage area, two 6.5 pound cans of whole white potatoes, one 6 pound can of apricots in light syrup, and one 105 ounce can of peach halves were dented. 2. During the tour of the second floor satellite kitchen conducted on 03/28/22 at 9:27 AM, accompanied by Staff A, Dietary Aide, and the Certified Dietary Manager (CDM), the following was noted: h. At the request of the surveyor, the CDM checked the chemical concentration of the sanitation bucket located near the handwashing sink using the facility's test strips. The concentration was recorded between 700-848 parts per million (ppm). The CDM stated that the chemical concentration should have been between 272-700 ppm. The CDM acknowledged that a high chemical concentration of 700-848 ppm would result in a toxic chemical residue that would remain on the surface of the products being cleaned. i. The reach-in freezer was observed with an approximately 4-inch tear in the gasket on the door. j. The reach-in refrigerator was observed with 2 approximately 1-inch tears in the gasket on the bottom left door. 105851 Page 10 of 14 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many k. One metal container of thickener powder was observed with a condiment cup inside. The CDM and Staff A acknowledged that the condiment cup/scoops should not be stored inside the container with food products. l. One box of 1000 count plastic lids was stored directly on the floor of the dining room. The CDM acknowledged that the box of plastic lids should not have been stored directly on the floor. Following the tour, the surveyor informed the CDM of all findings and the CDM acknowledged all findings. 3. During an observation of the breakfast tray line conducted on 03/29/22 at approximately 7:30 AM, accompanied by Staff A and the CDM, the following was noted: m. Two clean steam table lids were observed with food residue. Staff A stated that the steam table lids were supposed to be placed in the dishwasher at the end of each meal service. Staff A further stated that she did not take the steam table lids out of the dishwasher that morning because they were already on the tray line. The CDM acknowledged that the clean steam table lids were dirty. 105851 Page 11 of 14 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0825 Provide or get specialized rehabilitative services as required for a resident. 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 restorative nursing services as care planned for 1 of 3 sampled residents reviewed for rehabilitation (rehab), Resident #9. Residents Affected - Few The findings included: Review of the record documented that Resident #9 was admitted to the facility on [DATE] with diagnoses that included: Osteoarthritis, Muscle Weakness, Dislocation of Left Shoulder, and Spinal Stenosis. Review of Section C of the Minimum Data Set, dated [DATE], documented Resident #9 had a Brief Interview for Mental Status score of 15, which indicated that she was cognitively intact. Review of the Care Plan, dated 02/07/22, documented Resident #9 was in the restorative program due to muscle weakness. Interventions included: Nursing Restorative Program for active assisted range of motion for both lower extremities, hips, knees, and ankles; both upper extremities, elbows, wrists, fingers, in all available planes of movement for 3 sets of 20 two times daily for 6-7 times weekly. In an interview conducted on 03/28/22 at approximately 12:40 PM, Resident #9 stated that she was supposed to get therapy 5 times per week but was only getting therapy 2 times per week. In an interview conducted on 04/01/22 at 8:55 AM, the Director of Rehab stated that Resident #9 was to receive restorative nursing therapy. When asked how often Resident #9 was to receive restorative nursing therapy, the Director of Rehab provided the surveyor with the Restorative Program Training Documentation form, dated 09/03/21, which documented Resident #9 was to receive restorative nursing therapy two times per day for 6-7 days per week. Review of the Nursing Restorative Program - Active Range of Motion Tasks, dated 03/03/22 - 03/31/22, showed that there was no documentation to show that therapy was provided to Resident #9 on the following days: 03/05/22, 03/07/22, 03/09/22, 03/12/22, 03/13/22, 03/14/22, 03/18/22, 03/19/22, 03/20/22, 03/21/22, 03/24/22, 03/25/22, 03/26/22, 03/27/22, and 03/28/22. Further review of the Nursing Restorative Program Active Range of Motion Tasks, dated 03/03/22 - 03/31/22, showed that there was no documentation to show that therapy was provided to Resident #9 two times per day on the following days: 03/03/22, 03/04/22, 03/06/22, 03/08/22, 03/10/22, 03/11/22, 03/15/22, 03/16/22, 03/17/22, 03/22/22, 03/23/22, 03/29/22, and on 03/30/22. In an interview conducted on 04/01/22 at 9:07 AM, Staff C, Restorative Certified Nursing Assistant, and the Assistant Director of Nursing (ADON) stated that restorative nursing was documented under the Nursing Restorative Program - Active Range of Motion Tasks in PointClickCare (electronic charting system). According to them, this is where completion or refusal of restorative nursing services would be documented. They further stated that if a resident were to receive multiple sessions within the same day, this is also where completion or refusal of each session would be documented. Staff C and the ADON reviewed the Nursing Restorative Program - Active Range of Motion Tasks dated 03/03/22 - 03/31/22 and acknowledged that documentation to show that Resident #9 had received or refused therapy was missing. In an interview conducted on 04/01/22 at 9:30 AM, the Director of Nursing (DON) stated that 105851 Page 12 of 14 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0825 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #9 would often refuse restorative nursing therapy. When asked for documentation of refusals, the DON stated that refusals should have been documented under the Nursing Restorative Program - Active Range of Motion Tasks. The DON acknowledged that documentation showing Resident #9 had refused restorative nursing therapy was missing. The DON then reviewed Resident #9's Care Plan, dated 02/07/22, and confirmed that there was no documentation showing Resident #9 had refused restorative nursing. The DON acknowledged that documentation to show that Resident #9 had received or refused restorative nursing therapy was missing. 105851 Page 13 of 14 105851 04/01/2022 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to maintain the laundry room in a clean and sanitary manner; failed to have a dedicated clean linen utility chest for 5 of 5 clean utility chests; and failed to provide and encourage hand sanitation prior to meal intake for 2 of 20 sampled residents observed in the dining room, Resident #153 and #35. Residents Affected - Some The findings included: A review of the facility's policy Infection Prevention and Control Program for Skilled Communities, dated 08/2018, documented: Hand hygiene means cleaning your hands with soap and water, antiseptic hand wash, antiseptic hand rub, or surgical hand asepsis. Key situations where hand hygiene should be performed included before eating and after handling soiled linen. 1. During Dining observation on 03/28/22 at 12:30 PM, Resident #35 was observed sitting in the dining room. Resident #153 was observed entering into the dining room and sitting at the same table as Resident #35. Resident #153 was observed eating a bowl of soup at 12:40 PM. Both residents were observed eating their lunch entrees at 1:25 PM. Resident #35 and Resident #153 were questioned if staff ensured or encouraged hand hygiene prior to eating meals. Both residents denied encouragement of hand hygiene prior to eating the meal. An interview was conducted with the Director of Nursing on 04/01/22 at 1:00 PM. The DON confirmed residents should be encouraged to perform hand hygiene prior to eating. 2. A tour of the laundry room was conducted with the Director of Housekeeping and the Nursing Home Administrator on 04/01/22, beginning at 12:00 PM. During the tour, the following was observed: a) Two light fixtures in the ceiling with dirt and debris in the storage room. b) Two laundry carts with dirt and debris on the bottom. c) Staff G, a laundry technician, was observed bringing in a dirty laundry bin, containing dirty linen. Staff G was observed leaving the laundry room without washing his hands. d) Two dirty mop heads were observed in the personal clothing dirty laundry bin. e) Chipped paint was observed on the wall directly adjacent to the clean linen folding table and clean personal clothes hamper/rack. An observation of 5 of 5 of the clean linen utility chests with the Director of Housekeeping and the Nursing Home Administrator on 04/01/22, starting at 12:15 PM revealed: miscellaneous personal socks, clothing, a metal tin with puzzle pieces inside and styrofoam cups. An interview was conducted with the Director of Housekeeping was conducted on 04/01/22 at 12:30 PM. The Director acknowledged the above. The Director stated no personal clothing or personal items should be stored in the clean linen utility chests. 105851 Page 14 of 14