Health inspection·August 3, 2023

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, interview, and record review, the facility failed to maintain a safe, clean, comfortable, homelike environment in the facility and in the laundry area. Residents Affected - Few The findings included: Review of the facility policy, titled, Dryer Fire Prevention Policy, review date 10/12/15, revealed the following directions for dryer lint maintenance: Clean lint screens in commercial dryers after each use. 1. Observation by 3 of 3 surveyors during tours of the facility conducted during the survey week (07/31/23 to 08/03/23) noted that the 230-240 hallway had an offensive, urinary, molded, musty smell throughout the hallway. The surveyors informed the facility administration about the issue on 08/01/23. 2. Observation by 3 of 3 surveyors during tours of the facility conducted during the survey week (07/31/23 to 08/03/23) noted that large stains were present on the carpet of the second-floor lobby area and in the entrances of the dining room and activities room. The surveyors informed the facility administration about the issue on 08/01/23. 3. Tours of the facility's laundry areas were conducted on 08/01/23 at 11:10 AM with the Housekeeping Supervisor, the facility's Administrator, and the Director of Housekeeping. Observation on the second floor revealed there was a Laundry Room which contained one washing machine. The Housekeeping Supervisor stated this washing machine is used for the aprons worn by the staff. Please note, there was no dryer in this room. When asked where the aprons are dried, the Housekeeping Supervisor stated she did not know. Next to the washing machine leaned against the wall was a mop, bucket, broom, dustpan, and garbage can without a lid. In the first-floor laundry room, there were four washing machines, three of which had rectangular lids on the tops. Under these rectangular lids were trays. The Director of Housekeeping stated she thought they were detergent dispensing trays. Inside these dispensing trays and on the undersides of the lids was a large amount of black, slimy, mold-like substance and standing water which could contaminate the clean laundry inside the machines. The Director of Housekeeping stated these dispensing trays were not used, but rather the detergent was auto filled through another mechanism. When asked how often the trays are cleaned, the Director of Housekeeping stated she did not know. When asked if the black, slimy, mold-like substance was contaminating the inside of the washing machines, she again stated she did not know. Page 1 of 9 105851 105851 08/03/2023 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 Residents Affected - Few Hanging on the laundry room wall was a dryer lint trap record sheet, which showed three time slots for the staff to fill out for lint removal each day. When asked how often the dryer lint traps are cleaned out each day, the Director of Housekeeping stated three times per day. When asked what the hours are for laundry operation each day, the Director of Housekeeping stated 6:00 AM to 1:30 PM. When asked why the lint traps are not cleaned every 2 hours or after each use, the Director of Housekeeping and the facility Administrator stated they did not know. When asked to see the lint traps, it was observed that four of four dryer lint traps had a large buildup of lint and debris in each lint trap. One of the four dryers also had a gasket which was torn. The surveyor explained that it is a fire hazard to have a buildup of lint in the dryer lint traps and that the lint traps. In the clean linen folding room, the floor was noted to be dirty and worn. One of three clothing racks was worn and rusted all over. The surveyor explained that both of these areas of concern could cause contamination of clean clothing and linens. 4. In the Soiled Linen Room on the second floor, there were two dirty linen carts both of which had dirt and debris located in the bottoms of the carts. One of the two carts also had a broken-down cardboard box lying in the bottom of the cart. In the Soiled Linen Room near the hand washing sink was a paper towel dispenser that was noted to be lacking paper towels. Further observation revealed the paper towel dispenser was filled with condensation which was dripping from the bottom of the dispenser. When asked why this paper towel dispenser was empty and filled with condensation, the Housekeeping Supervisor stated, I don't know. We never use this one. 5. In the Central Supply Room located on the second floor, the surveyor observed two purses sitting on top of a table which contained care supplies for residents. There were two employees working in this room, as it is also used as the Medical Records Department. Both employees had food and beverages out among the supplies. The surveyor explained that purses, food, and beverages can contaminate the care supplies in the room. 105851 Page 2 of 9 105851 08/03/2023 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 Residents Affected - Few 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 observation, interview, and record review, the facility failed to follow the approved menus and failed to provide a variety of foods to the residents on the L3/Mechnical Soft Diet, for 2 of 6 sampled residents, Resident's #9 and #27; and for residents on the L1/Pureed Diet, for 2 of 3 sampled residents, Resident's #5 and #18. The census at the time of the survey was 40. The findings included: 1. Review of the approved menu for the lunch meal of 07/31/21 for the L1/Pureed Diets noted the following to be served: - Broccoli Shape with Lemon Sauce - Peach Shaped Ice Cream. Observation of the lunch meal in the satellite kitchen on 07/31/23 at 12:00 PM noted the following for the L1/Pureed Diets: -Pureed Broccoli Shapes w (with) Lemon Sauce not available -Peach Shape Ice cream not available. Residents receiving the pureed diet received vanilla ice cream. 2. Review of the approved menu for the brealfast meal of 08/01/23 for the L3/Mechnaical Soft diets noted the following to be served: -Cold Cereal Slurry -Ground Sunrise Omelet -Crustless Bread. Observation of brealfast meal in the satellite kitchen on 08/01/23 at 7:45 AM noted the following for residents on the L3/Mechnaical Soft Diet: -Cold Cereal Slurry was not preprared or served -Ground Sunrise Omelet not preprared or served -Crustless Bread not preprared or served. 3. Review of the approved menu for the breakfast meal of 08/02/23 for the L3/Mechanical Soft Diet noted the following to be served: -Sunny Ground Omelet 105851 Page 3 of 9 105851 08/03/2023 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0803 -Crustless Bread Level of Harm - Minimal harm or potential for actual harm -Slurry Cinnamon Roll. Residents Affected - Few Observation of the breakfast meal in the satellite kitchen on 08/02/23 at 8:15 AM noted the following for residents on the L3/Mechanical Soft Diet: -Sunny Ground Omelet - not prepared or served -Crustless bread - not prepared or served. -Slurry Cinnamon Roll - not prepared or served. 4. Review of the approved menu for the lunch meal of 08/02/23 for the L3/Mechanical Soft Diet noted the following to be served: -Ground Turkey Ala King -Crustless Bread -Vegetable Juice -Assorted Pudding. Review of the approved menu for the lunch meal of 08/02/23 for the L1/Pureed Diet noted the following to be served: -Vegetable Juice -Assorted Pudding -Pureed Asparagus Shape. During the observation of the lunch meal in the satellite kitchen on 08/02/23 at 12:00 PM, the following were noted: a. L3/Mechanical Soft Diet: -The Turkey Ala King entrée was not prepared for as per the menu. Ground turkey with gravy was served as the entrée -Crustless bread was not prepared or served -Vegetable Juice was not available -The regular diets were served Coconut Cream Pie. The Mechanical Soft diets were served vanilla pudding. The menu should have included Coconut Pudding. b. L1/Pureed Diet: 105851 Page 4 of 9 105851 08/03/2023 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0803 -The vegetable juice was not available Level of Harm - Minimal harm or potential for actual harm -The regular diets were served Coconut Cream Pie. The Pureed Diet was served vanilla pudding. The menu should have included Coconut Pudding Residents Affected - Few -The L1/Pureed Deit should have included Pureed mushrooms that were documented to be served to the Regular Diet. 4. During the review of the facility's diet and census for 07/31/23, the following were noted: -Six facility residents had physician ordered L3/Mechanically Soft Diet that included sampled Residents #9 and #27. -Three facility residents had physician ordered L1/Pureed Deit that included sampled Residents #5 and #18. 105851 Page 5 of 9 105851 08/03/2023 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 - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, the facility failed to store, prepare, distribute an serve food in accordance with professional standards for food service safety that included labeling and dating of perishable food, proper cleaning of food preparation equipment on a scheduled basis, proper maintenance of refrigeration equipment on a regular scheduled basis, holding of hot foods at regulatory, temperatures, and proper maintenance of dish machine equipment. The findings included: 1. During the initial Kitchen / Food Service Observation Tour of the Main Kitchen conducted on 07/31/223 at 9:00 AM, and accompanied with the facility's Certified Dietary Manager (CDM), the following were noted: (a) The main service hallway was noted to be heavily soiled and stained throughout. It was noted that recent food deliveries were being stored in the hallway. It was also discussed with the CDM that resident food transportation carts are travelled through the soiled hallways on the way to the Skilled Nursing Unit. The surveyor requested the hallways be cleaned and sanitized prior to the next food deliveries and food prior to the next food cart transportation. Photographic Evidence Obtained. (b) Observation of the walk-in refrigerator noted that there were 4 large containers of raw chicken (approximately 40 pounds) located on the food shelves. Further observation noted that none of the 4 boxes were labeled with a date that they were stored or thawed. The CDM stated that the containers of chicken required a documented storage date. Photographic Evidence Obtained. (c) The main service hallway was noted to have a large, uncovered trash bin stored within the area. Further observation of the bin noted open food containers and soiled cleaning cloths. The surveyor informed the CDM that all trash / garbage must have a secured lid when not in use. Photographic Evidence Obtained. (d) The entrance / exit service hallway door that leads to the main kitchen and laundry areas was noted not to shut properly leaving large open areas to the outside. It was discussed with the CDM that the opening could allow potential pests, dirt and debris into the facility. Photographic Evidence Obtained. (e) Observation of the walk-in freezer noted that the commercial unit is located outside due to the facility's interior freezer unit being under repair. Upon entering, it was noted that the 2 refrigeration units located inside were completely covered in ice. Further observation noted that all of the foods located within unit were covered in a thick layer of ice. It was discussed with the CDM that the ice could cause food freezer burn and result in food borne illness. Photographic Evidence Obtained. 105851 Page 6 of 9 105851 08/03/2023 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 - Some (f) Observation and chemical testing of the cleaning cloth buckets noted that 1 of the buckets failed to be filled with a chemical solution that meets regulatory requirement. Photographic Evidence Obtained. (g) The convection oven was noted to be heavily soiled with a thick black layer of carbon. It was discussed with the CDM that the oven is not being cleaned on a regular basis. The CDM confirmed the surveyor's findings. Photographic Evidence Obtained. (h) Observation of the dish machine noted that 1 of the 3 internal separation curtains was broken. It was discussed with the CDM that the internal separation curtains are necessary to prevent contamination of dishware while moving through the machine. The CDM stated that a new curtain would be ordered immediately. Photographic Evidence Obtained. (i) Observation of the ceiling mounted lights noted that a set of lights that was located over a food preparation area did not have a protective covering. It was discussed with the CDM that there was the potential for the light to crack or brake causing small piece of glass to fall into prepared foods. Photographic Evidence Obtained. 2. During the observation of the satellite kitchen located with the second floor SNF (Skilled Nursing Facility) unit noted that the six shelves within the unit were in disrepair that included being rust ladened. The CDM confirmed the surveyor's findings and stated that new shelving would be ordered. Photographic Evidence Obtained. 3. During the observation of the breakfast meal conducted on 08/01/23 in the satellite kitchen located on the second floor of the SNF, the following ws noted: a. The floor drain located in the far corner of the kitchen was noted to have a thick layer of black mold type substance. b. The ceiling mounted air-conditioning vents located above the stem table was laden with dirt and dust. The air steam from the unit was noted to blow directly over and onto foods located in the steam table. The issues were confirmed with the CDM at the time of the observation. Photographic Evidence Obtained. 4. During the observation of the lunch meal service in the satellite kitchen on 08/01/23 at 12 PM, temperatures of hot located in the hot storage hold box were taken with the facility's calibrated digital thermometer. The finding noted that hot foods were not kept at the regulatory requirement of 105851 Page 7 of 9 105851 08/03/2023 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0812 135 degrees Fahrenheit (F) as per the following: Level of Harm - Minimal harm or potential for actual harm a. Individual Pureed Fish Molds (4) = 125 degrees F. b. Individual Pureed Turkey Molds (4) = 128 degrees F. Residents Affected - Some The findings of the observations conducted on 07/31/23 and 08/01/23 were confirmed with the Administrator on 08/01/23. 105851 Page 8 of 9 105851 08/03/2023 Stratford Court of Boca Raton 6343 via DE Sonrisa Del Sur Boca Raton, FL 33433

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to dispose of garbage and refuse properly. The findings included: Residents Affected - Some During the observation of the garbage / refuse area on 07/31/23 at 10:00 AM and accompanied with the the facility's Certified Dietary Manager (CDM), the following were noted: 1. The ground areas surrounding the commercial dumpster was noted to be covered with numerous soiled PPE (personal protective equipment) such as gloves, masks, gowns, etc., trash and food garbage debris, soiled food containers and an old tire. 2. Two 55-gallon drums, of which old cooking oil was being stored, were noted to be leaking. It was noted that a large thick layer of oil surrounded one of the dumpster ground areas. The CDM confirmed the dumpster findings and stated that the environmental service would be notified of the issues. The findings and photographs were reviewed with the facility's Administrator. Photographic Evidence Obtained of the garbage / dumpster areas. 105851 Page 9 of 9