Health inspection·June 15, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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** Based on interview and record review, the facility failed to accommodate a resident's choice or preference for showers, for 1 of 12 sampled residents, Resident # 291. The findings included: Resident #291 was admitted to the facility on [DATE], for short term rehabilitation. Review of the MDS (Minimum Data Set) assessment dated [DATE] indicated it was very important to the resident to choose between a shower, bed bath, or sponge bath. It indicated she required partial assist with bathing with one-person assist. The Brief Interview for Mental Status (BIMS) score was 15 of 15, indicating she was cognitively intact. Review of the care plan, dated 06/07/23, stated she is able to verbalize personal preferences regarding activities of daily living (ADLs) as well as leisure activities. The goal was that the resident will confirm her personal preferences which will be honored to the extent possible daily. The approach included to assist in the resident's preference for bathing which is to be offered showers and choose to accept or not. On 06/12/23 at 10:30 AM, an interview was conducted with Resident #291 regarding choices and preferences. She stated she has not had a shower since she was admitted . She stated she didn't want it in the morning because she goes to therapy at 10:00 AM, and prefers to have a shower in the afternoon. On 06/14/23 at 9:00 AM, the resident stated she was offered a shower this morning but had told the staff she didn't want it because she had therapy at 10 o'clock. She told staff she prefers showers in the afternoon. No showers had been received yet. On 06/14/23 at 11:00 AM, an interview was conducted with the Certified Nursing Assistant, CNA B, who was assigned to the resident. She stated she asked the resident if she wanted a shower this morning but she said no. She stated she had not given the resident a shower this week. When asked if she asked the resident what time she would prefer to have a shower, she said no. On 06/14/23 at 1:30 PM, CNA B, reported to the surveyor that she gave the resident a shower today before lunch. On 06/14/23 at 2:00 PM, Resident #291 confirmed she received her first shower today. (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 4 Event ID: 105968 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 105968 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE VI at Lakeside Village 2782 Donnelly Drive Lantana, FL 33462 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)