Health inspection·January 12, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior for 2 of 2 Units (100 & 200 Units) that included residents' rooms, storage areas, and common areas. The findings included: During the initial resident screenings conducted by the surveyors on 01/09/23 and the Environment Tour conducted on 01/11/23 at 10 AM accompanied with the Director of Maintenance, the following were noted: First Floor (100 Unit): a. First Floor Dining Room: Two of two ceiling vents were noted to be heavily soiled and black type mold matter. b. Physical Therapy room [ROOM NUMBER]: Room floor perimeter was heavily soiled and not being cleaned on a regular basis. Room windows noted to be covered with a white film. c. Physical Therapy room [ROOM NUMBER]: Two of two ceiling vents were noted to be heavily soiled and dust laden. Main Hallways: the hallways near the nurses' stations and south hallway were heavily soiled and stained. d. Clean Utility room [ROOM NUMBER]: Three IV poles were located with room were noted to have large amounts of dried brown matter. e. First Floor Community Shower: Stall #1 had broken floor tiles, stall #2 had stained tiles, and ceiling vent was dust laden. f. room [ROOM NUMBER]: Wardrobe closet had missing doorknob. g. room [ROOM NUMBER]: Toilet seat was loose and falling off. h. room [ROOM NUMBER]: Room wallpaper was torn and falling off walls, toilet required recaulking to the floor, and wardrobe closet was missing doorknob. Page 1 of 16 105911 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

F 0584 i. room [ROOM NUMBER]: Wardrobe closet was missing doorknob. Level of Harm - Minimal harm or potential for actual harm j. room [ROOM NUMBER]: Toilet required recaulking to the floor. k. room [ROOM NUMBER]: Wardrobe closet was missing doorknob. Residents Affected - Some l. room [ROOM NUMBER]: The portable toilet seat was noted to be rust laden. m. room [ROOM NUMBER]: Room wallpaper was in disrepair and peeling away from walls, toilet required recaulking to the bathroom floor, the portable toilet seat was rust laden, and wardrobe closet was missing doorknob. n. room [ROOM NUMBER]: Room wallpaper was in disrepair and peeling away from walls. o. room [ROOM NUMBER]: Room wallpaper was in disrepair and peeling away from walls and wardrobe closet missing doorknob. Second Floor (200 Unit): a. Second Floor Dining Room: Room walls required repainting. b. room [ROOM NUMBER]: Portable toilet seat was rust laden, room chair exterior was heavily worn, and nightstand drawers were not shutting properly. c. room [ROOM NUMBER]: Nightstand drawers did not close properly, over-bed table exterior was in disrepair, portable toilet seat was rust laden, and toilet seat was loose. d. room [ROOM NUMBER]: Exterior damage noted to closet door, peeling wallpaper in bathroom, window blinds were falling off, and bathroom call cord was wrapped around wall handrail. e. room [ROOM NUMBER]: Large black scuff marks noted to room walls, portable toilet seat and toilet were covered in dried brown matter, and toilet required recaulking to bathroom floor. f. room [ROOM NUMBER]: Toilet required recaulking to the bathroom floor, and portable toilet seat was rust laden. Following the 01/11/23 tour, the findings were again confirmed with the Director of Maintenance and Administration. It was noted that the facility has a computerized TELS system for staff to document housekeeping and maintenance issue, bu it was revealed that staff were not utilizing the system. 105911 Page 2 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

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 interviews and record review, the facility failed to ensure an accurate assessment, reflective of the resident's status at the time of the assessment for 2 of 29 sampled residents (Resident #10 and #109), as evidenced by Resident #10 did not a smoking assessment completed after a significant change and Resident #109 had an inaccurant assessment completed related to disharge. Residents Affected - Few The findings included: A review of the facility's policy, titled, Smoking Guidelines, revealed, in part, Evaluate patients / residents that smoke utilizing the Smoking Evaluation tool either (a) upon admission/move-in; (b) when a previous non-smoking patient/resident takes up smoking; (c) if unsafe smoking practices are observed in a current smoker; or, (d) when a patient/resident that smokes has a significant change in medical condition. 1. Record review revealed Resident #10 was initially admitted to the facility on [DATE] for rehabilitation with a history of Chronic Kidney Disease, Osteomyelitis of the left foot, Hyperthyroidism, Hyperlipidemia, Diabetes and Hypertension. Further review of the electronic medical record (EMR) revealed the resident was discharged to the hospital for a below the knee amputation on 03/06/22.The resident was re-admitted on [DATE] post below knee amputation. Record review revealed Resident #10 was smoking prior to his hospitalization and upon readmission to the facility. On 01/10/23, the EMR revealed that the last smoking evaluation was dated 02/14/20. A review of the significant change Minimum Data Set (MDS) with an assessment reference date (ARD) of 03/21/22 revealed under section J, Other Health Conditions, the response to the question Current Tobacco Use was answered 'no'. The resident's Brief Interview for Mental Status (BIMS) was 15, which indicated he was cognitively intact. An interview that was conducted with Resident #10 on 01/09/23 at 11:18 AM revealed he smoked before and after he went to the hospital in March 2022. An interview with the Director of Nurses on 01/11/23 at 10:30 AM revealed they realized yesterday (01/10/23) that a smoking assessment was not done when he had a significant change and it should have been done at that time. This was confirmed with Staff A, MDS coordinator, on 01/11/23 at 3:02 PM. During the interview conducted with Staff A, MDS coordinator, Staff A who confirmed that the question of current tobacco use should have been a 'yes' answer. 2. Resident #109's EMR was reviewed for hospitalization. She was admitted to the facility on [DATE] post dislocation of the left hip and was discharged home on [DATE]. A review of the discharge MDS with an ARD of 10/31/22 revealed the resident was discharged to an acute hospital. An interview was conducted with Staff A, MDS coordinator, on 01/11/23 at 3:05 PM, who confirmed it was mistake that it was coded as a discharge to hospital and confirmed the resident was discharged home. 105911 Page 3 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 coordinate care with Hospice for 1 of 1 sampled resident for hospice care (Resident #31). Residents Affected - Few The findings included: Resident #31 was admitted to the facility on [DATE]. A comprehensive assessment, dated 12/09/22, documented the resident had mild cognitive impairment and required total two-person assistance with activities of daily living. The assessment further documented the resident received hospice services. Resident #31 was care planned for hospice services, with interventions that included hospice staff to visit to provide care, assistance, and/or evaluation. Record review revealed an order, dated 12/05/22, for Resident #31 to be admitted to hospice. Review of Resident #31's progress notes revealed a physician note, dated 12/02/22, that documented the resident's case was discussed with family members. The resident lost his apartment and had nowhere to live. Family wanted the resident to remain in facility with hospice services. A progress note, dated 12/03/22 at 3:12 PM, documented: 'Observed patient on the floor AA (awake and alert), became very agitated pulled out all his clothes including his underwear, had feces all over, removed his oxygen, earlier patient refused all his meds. Doctor and family notified. New order received from doctor to administer 5mg Haldol (antipsychotic) IM (injection into the muscle), med given to patient. No SS (sign and symptoms) of distress or discomfort noted, no injury noted or reported at this time.' A progress note, dated 12/03/22, at 10:46 PM documented: 'Patient continued to display combative behaviors, patient has refused oxygen along with vital signs acquisition as well as meals. patient has taken off clothing and throw it at staff when staff attempted to assist him with ADL (activities of daily living) patient has told staff I will jump off this bed and smash my face in. 911 called in order to ensure patients transfer to the hospital, however without a written baker act police were unable to transfer patient, MD [medical doctor] notified, patient continue to display combativeness, the evening nurse then attempted to acquire vital signs for medication administration patient still proceeded to display combativeness, hospice notified, family member on file notified, patient transferred per providers orders.' A progress note, dated 12/04/22 at 6:39 AM, documented: 'Hospice called, patient admitted in psych unit at the hospital.' Resident #31 was readmitted to the facility on [DATE]. A review of the hospital referral, dated 12/04/22, documented: 'Patient to follow-up with an outpatient psychiatrist arranged by the facility.' A review of Resident #31's records revealed no documentation of hospice involvement with the resident post readmission. An interview was conducted with the hospice nurse on 01/11/23 at 12:30 PM. The hospice nurse stated the resident was admitted to hospice on 12/02/22. The hospice nurse stated she had seen Resident 105911 Page 4 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

F 0684 Level of Harm - Minimal harm or potential for actual harm #31 on 12/03/22, and at that time, the resident was not displaying any behaviors. The hospice nurse stated she was aware of Resident #31 being admitted to the hospital for behaviors on 12/03/22. The hospice nurse was referring to a handheld electronic device for notes not available / documented in Resident #31's records. The hospice nurse stated she would provide documentation of hospice notes. The hospice nurse further stated they do not consult psychiatry for their patients. Residents Affected - Few 105911 Page 5 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to assess 1 of 1 sampled resident (Resident #322), who was admitted with Foley catheter (urinary catheter), for continued need for Foley catheter and possible removal of the Foley catheter . The findings included: Resident #322 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident had severe cognitive impairment and required extensive two-person assist for activities of daily living. The assessment further documented the resident had a Foley catheter. Record review revealed an order, dated 01/05/23, to maintain indwelling catheter for obstructive uropathy (an obstruction in the urinary tract). Further record review did not reveal any documentation of a trial or attempt to remove Resident #322's Foley catheter. An interview was conducted with Resident #322's representative on 01/12/23 at 12:00 PM. The representative stated Resident #322 did not have a Foley catheter prior to the admission to the facility. The representative stated the resident had the Foley catheter placed for surgery prior to the admission to the facility. The representative stated the facility had not attempted to remove the catheter or consult a urologist regarding the Foley catheter. An interview was conducted with the Director of Nursing (DON) on 01/12/23 at 1:00 PM. The DON acknowledged the above. 105911 Page 6 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

F 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide treatment for 1 of 1 sampled resident reviewed for psychosocial behaviors (Resident #31), as evidenced by lack of non-pharmalogical interventions and lack of follow-up with a psychiatrist. The findings included: A review of the facility's policy, titled, Behavior Management Guidelines, dated 03/2022, documented in part: non-pharmacological interventions should be attempted prior to the use of any psychoactive medication. The policy further documented: Patients, families / responsible parties are educated regarding the risks / benefits of psychoactive medications prior to the first dose being administered, and signed consents are obtained. Resident #31 was admitted to the facility on [DATE]. A comprehensive assessment, dated 11/11/22, documented the resident had no cognitive impairment, and required extensive two-person assistance with activities of daily living. The assessment further documented the resident had moods of feeling down and depressed and little interest or pleasure in doing things nearly every day. There was no behavior documented. A review of Resident #31's progress notes revealed a physician note, dated 12/02/22, that documented the resident's case was discussed with family members. The resident lost his apartment and had nowhere to live. Family wanted resident to remain in facility with hospice services. A progress note, dated 12/03/22 at 3:12 PM, documented: 'Observed patient on the floor AA (awake and alert), became very agitated pulled out all his clothes including his underwear, had feces all over, removed his oxygen, earlier patient refused all his meds. Doctor and family notified. New order received from doctor to administer 5 mg Haldol (antipsychotic) IM (injection into the muscle), med given to patient. No SS (sign and symptoms) of distress or discomfort noted, no injury noted or reported at this time.' There was no evidence of any non-pharmacological interventions to Resident #31 prior to the injection of an anti-psychotic, or consent obtained. There was no documentation of the resident's condition until 7 hours after being medicated. A progress note, dated 12/03/22 at 10:46 PM, documented: 'Patient continued to display combative behaviors, patient has refused oxygen along with vital signs acquisition as well as meals. Patient has taken off clothing and throw it at staff when staff attempted to assist him with ADL (activities of daily living) patient has told staff I will jump off this bed and smash my face in. 911 called in order to ensure patients transfer to the hospital, however without a written baker act police were unable to transfer patient, MD notified, patient continue to display combativeness, the evening nurse then attempted to acquire vital signs for medication administration patient still proceeded to display combativeness, hospice notified, family member on file notified, patient transferred per providers orders.' Resident #31 was readmitted to the facility on [DATE]. A review of the hospital referral, dated 105911 Page 7 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

F 0742 12/04/22, documented: 'Patient to follow-up with an outpatient psychiatrist arranged by the facility.' Level of Harm - Minimal harm or potential for actual harm Further record review revealed no follow up with psychiatric services had been arranged for Resident #31, as of 01/11/23. The resident continued to display behaviors. Residents Affected - Few An interview was conducted with the Director of Nursing (DON) on 01/11/23 at 1:00 PM. The DON stated Resident #31 was upset that he was staying at the facility, and the resident wanted to go home. The DON acknowledged the resident was still displaying behaviors and had not been referred to see a psychiatrist. 105911 Page 8 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

F 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility to follow physician ordered fluid restrictions for 1 of 7 sampled residents reviewed for nutrition (Resident #265) The findings included: Review of the facility's Guideline and Procedure for Fluid Restriction noted the following: Purpose: To facilitate the management and communication of the patient's individualized Fluid Restriction plan by the interdisciplinary team. Procedure: #3 - Dietitian recommends an update to the order to include the amount per shift for nursing. #5 - No water pitcher at bedside, unless part of the individualized beverage plan. #7 - The nurse acknowledges on the MAR/TAR [Medication Administrator Record / Treatment Administration Record] the fluids that were provided per order. During the observation of the breakfast meal conducted on 01/09/23, it was noted Resident #265 appeared to be underweight / malnourished and with cognitive impairment. The meal tray was to be served to the room of Resident #265. Further observation of the resident's meal ticket noted to document Low Sodium and 1200 ml of Fluids. Further observation noted the meal tray to include: 120 ml Juice 120 ml milk 16 oz water (Nursing -Styrofoam Container and straw) on overbed tray and on meal tray. Nursing staff noted to be assisting the resident to drink water from the container. A second and third observation conducted of the lunch meal on 01/09/23 and breakfast meal on 01/10/23 again noted the meal tray to include: 120 ml Juice 120 ml milk 16 oz water (Nursing -Styrofoam Container with straw) on overbed tray and on the meal tray. Nursing staff noted to be assisting the resident to drink water from the container. A review of the clinical record of Resident #265 on 01/10/23 noted: Date Of admission: [DATE] 105911 Page 9 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

F 0808 Discharge to Hospital: 01/10/23 Level of Harm - Minimal harm or potential for actual harm Diagnoses: Hepatic Failure, Dysphagia, Symptoms & Signs Concerning Food and Fluid Intake, Cirrhosis of Liver, Diabetes Type 2, Edema, and Fluid Overload, Residents Affected - Few Review of current physician orders noted the following: 12/30/22 - Fluid Restriction 1200 ml/Day 01/01/23 - Weigh Every 3 days 01/09/23 - Prosource 30 ml BID (Twice Per Day) 01/09/23 - Pureed/No Added Salt Diet Weight History included: 01/07/23 = 143.8 pounds 12/30/22 = 146 pounds A review of the facility's Dietitian Fluid Worksheet, dated 01/01/23 noted the following: Physician Ordered Fluid Restriction order: 1200 ml Total Nursing Fluid Allotment =360 ml, (Day Shift=240 ml , Evening and Night Shift =60 ml each shift) Dietary Fluid Allotment = 840 ml Fluid Breakdown: Breakfast Meal= 120ml juice, 120ml milk, 120ml hot beverage Lunch Meal = 8 oz (240 ml cold beverage) Dinner Meal = 8 oz (240 ml cold beverage). During the review of the January 2023 Treatment Administration Record (TAR) noted that the only documentation in the record included 1200 ml Fluid Restriction. Further review noted that the 360 ml daily allotment of 360 ml and specific allotment of 240 ml per day shift and 60 ml per evening and night shift was not documented. The lack of documentation on the January 2023 TAR was reviewed with the Director of Nursing and Corporate Nurse for their review. The review revealed that the specific nursing fluid allotment per day and specific fluid allotment per shift should have been included on the TAR and licensed nursing staff were required to follow and document the specific fluid intake for the day, evening and night shifts. It was also revealed that the facility's Fluid Restriction Policy was not followed for nursing staff to ensure the TAR/MAR documented to include the amount per shift and document that fluids 105911 Page 10 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

F 0808 were provided per order. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 105911 Page 11 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

F 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to provide snacks at bedtime per physician order for 1 of 7 sampled residents reviewed for nutrition (Resident #41). The findings included: Resident #41 was initially admitted to the facility on [DATE] with diagnoses that included Type 2 Diabetes, long term current use of insulin, and Atherosclerotic Heart Disease. The quarterly Minimum Data Set (MDS) with an assessment reference date (ARD) of 12/08/22 revealed a Brief Interview for Mental Status (BIMS) of 15 which indicated the resident is cognitively intact. On 01/09/23 at 11:47 AM, Resident #41 was interviewed as part of the initial pool process. The resident stated that his morning blood sugars have been low and he is supposed to get snacks at night but he is not always getting them. Resident #41 stated he would like to have a sandwich at night like a ham and cheese sandwich, but all that is available at night are graham or saltine crackers. A review was conducted of the resident's electronic medical record (EMR). The resident had a Physician's order dated 12/06/22 for HS [hour of sleep] snacks at bedtime to start on 12/07/22. An interview was conducted with the Food Service Director (FSD) on 01/11/23 at 10:36 AM as to what snacks are prepared for a resident who has an order for snacks at bedtime. The Food Service Director replied that he had a list in the kitchen of the residents who receive sandwiches in the evening. He returned with the list, titled, Residents Night Time Snack Requests, with names of 6 residents on it but not included on the list was Resident #41. The Food Service Director was told that Resident #41 is not on this list and he responded that he has other lists but could not timely provide the lists. The Food Service Director stated at this time that he was sure that Resident [#41] gets a sandwich at night. On 01/11/23 at 10:56 AM, the FSD came back after interviewing Resident #41 and said the resident said it is not consistent that he gets a sandwich. A review of Resident #41's fasting blood sugars for December 2022 and January 2023 revealed 4 times in January 2023 that the blood sugar was 70 or under at 6:00 AM including 2 times in the 50s. In December 2022, there were 5 mornings that the resident's blood sugar was under 70 including 2 times that it was in the 50s. Normal blood sugars for diabetics taken in the morning before meals could range from 80-130 mg/dl (milligrams/deciliters). Resident #41 has a Physician order for Glucagon to be administered if his blood sugar is less than 60. Glucagon is an injection given when the blood sugar is low to raise the blood sugar and fatty acids in the bloodstream. On 01/12/23 at 12:00 PM, the resident was served a tuna salad sandwich dated 01/11/23 in the dining room at lunch time and became upset. The resident stated that this must be the sandwich I was supposed to get last night because I did not get it, so it was served to me for lunch. 105911 Page 12 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

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 Based on observation, interview and record review, the facility failed to provide appropriate adaptive eating equipment for 1 of 7 sampled residents reviewed for nutrition (Resident #74). Residents Affected - Few The findings included: Review of clinical record of Resident #74 noted the following: Date Of admission: readmission - 05/03/22 Diagnoses: Cognitive Communication Deficit, Dysphagia, Disorder of Muscles and Seizures Current Physician Orders: 09/23/22 - Angle spoon, angel form, scoop dish for all meals for dominate Right Hand 07/22/22 - CHO Controlled No Added Salt (NAS). MDS (Minimum Data Set): dated 12/08/22 included: Sec C: BIMS= 14 - (Cognition intact) Sec D: No Mood Issues Sec G: Eating = Supervision Sec K: 62 (inches) / 171# (pounds), Therapeutic Diet. Care Plan, dated12/29/22, included: *ADL Self Care deficit related to physician limitations < Angle spoon, and fork, and scoop dish for all meals for Right dominate hand. During the observation of the lunch meal in the main kitchen on 01/09/23 at 11:30 AM, it was noted the meal tray for Resident #74 included both a right-angled spoon and fork and no knife. A review of the meal ticket also located on the resident's lunch tray documented 'Adaptive Equipment - Curved Left Spoon, Curved R [right] Fork, Scoop Plate'. During a second observation conducted during the observation of the breakfast meal in the main kitchen on 01/10/23 at 7:30 AM, it was again noted that a right-angled fork, knife and spoon were included on the tray. Interview with the Food Service Director at the time of the observation stated that there are no curved left adaptive eating equipment. On 01/11/23 at 8 AM, an interview was conducted with Occupational Therapist (OT) who stated that 105911 Page 13 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

F 0810 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the dietary department meal tray card for Resident #74 is incorrect and submitted documentation dated 09/22/22 that documented an order for 'angle spoon, angle fork, and scoop dish for all meals'. The OT further stated that the resident was re-assessed on 01/10/23 because the issues was brought to her attention and now the resident requires a built-up Spoon, built-up Fork, Built-up Knife and scoop plate with all meals. The OT further stated the resident was having difficulty self-feeding because of the incorrect curved equipment that has been provided to the resident for months. Interview conducted with the alert and oriented Resident #74 on 01/11/23 revealed that she now can eat properly and easier with the correct built-up fork, knife and spoon being provided. 105911 Page 14 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

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 and serve food in accordance with professional standards for food service safety that included failure to ensure proper temperature and chemical sanitizing levels in the dish machine and 3-compartment sink, failure to store food to prevent contamination / food borne illness, failure to ensure hot and cold foods are held at regulatory temperatures, and failure to ensure silverware is handled in a sanitary manner. The findings included: 1. During the initial food service / kitchen sanitation tour conducted on 01/09/23 at 9:00 AM, accompanied with the Food Service Director (FSD), the following was noted: (a) Observation noted the high temperature dish machine was in use by staff. At the request of the surveyor, the final rinse temperature was taken and noted to be 175 degrees F (Fahrenheit). The surveyor informed the Food Service Director (FSD) the regulatory minimum final rinse temperature was 180 degrees F. At the FSD's request, 3 more attempts were conducted to check the final rinse temperature and all were recorded at below 175 degrees F. The surveyor informed the FSD that the dish machine should not be used until the final rinse temperature of a minimum 180 degrees F was obtained. On 01/09/23, a representative for the dish machine / chemical company was in the facility to evaluate the dish machine's final rinse temperature. The technician approached the surveyor and informed that a new final rinse temperature gauge was needed and had been replaced. A test of the dish machine final rinse temperature on 01/10/23 at 8:00 AM noted the final rinse to be recorded by the surveyor at 185 degrees F. (b) Observation of the walk-in refrigerator noted a food storage rack to contain a large pan of raw chicken (30 portions). Further observation noted the storage shelf below the pan of raw chicken contained a pan of cooked ground chicken and a pan of cooked chicken pieces. The surveyor immediately informed the FSD that there was a potential for food contamination from raw chicken being stored over / above cooked chicken and to recommend to the FSD to discard the pans of cooked chicken. It was also discussed the regulatory requirement of storage of cooked and raw foods. The FSD stated it is the facility policy to never store raw foods (chicken) over cooked foods and that all raw foods be placed on the bottom shelf at all times to prevent food contamination / food borne illness. During the observation of the 01/09/23 lunch meal, it was noted the cooked chicken that had been located in the walk-in refrigerator was served to the facility's residents. (c) During the observation of the 3-compartment sink, the surveyor requested the FSD to test the sanitizing sink to ensure regulatory level of the chemical sanitizer. The FSD informed the surveyor that a new sanitizing chemical was installed recently and the FSD was unsure what the chemical was. The FSD tested that sanitizing sink with the appropriate test strip. It was noted an insufficient level of chemical was present. It was noted that the test strip tuned blue, but the test information documented that the test strip should turn green in color. The surveyor informed that the 3-compartment sink should not be utilized until the regulatory chemical levels were present. On 01/09/23 at approximately 9:00 AM, the technician for the chemical company was in the kitchen to 105911 Page 15 of 16 105911 01/12/2023 Westgate Health and Rehabilitation Center 2300 Village Blvd West Palm Beach, FL 33409

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some test the chemical level of the 3-compartment sink. Interview with the technician noted that the chemicals triturated into the sink were insufficient to meet regulatory chemical level requirements. (d) During the tour, it was noted that a staff's personal phone was located directly on a food preparation / serving counter. The surveyor informed the FSD that the counter was contaminated from the phone and requested that phone be removed and the counter be chemically re-sanitized. (e) During the tour, it was noted that the clean silverware was not being handled in a sanitary manner. Specifically, staff were noted to be wiping the clean silverware with a cloth prior to rolling the silverware in a paper napkin and continued using the same cloth. The surveyor informed the FSD that the cloth used for wiping can become soiled and contaminate the silverware. The surveyor requested that the silverware be rewashed / sanitized prior to meal service. 2. During the observation of the food assembly line in the main kitchen on 01/09/23 at 11:30 AM, food temperatures were taken by the FSD utilizing the facility's calibrated food thermometer. The findings of the temperature tests indicated that hot and cold food were not being held at 135 degrees F or greater or 41 degrees F or below, as evidenced by the following: * Chicken Jambalaya (large pan) = 130 F * Ground Jambalaya (1/2 pan ) = 114 F * Pumpkin Pie (slices) = 50 degrees F * Pureed Pumpkin Pie = 56 degrees F * Turkey Sandwiches (10 each) = 56 degrees F The surveyor informed the FSD that the foods could no be served to residents until regulatory temperature were obtained and held at proper temperatures. 105911 Page 16 of 16