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. Page 1 of 4 105968 105968 06/15/2023 VI at Lakeside Village 2782 Donnelly Drive Lantana, FL 33462

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 06/14/23 at 11:15 AM, the Staff Developer printed the bathing information for Resident #291 from 06/05/23-06/13/23. It noted 3 showers were given to the resident, on 06/05/23 by CNA D, and on 06/07/23 and 06/09/23 by CNA C. On 06/14/23 at 2:35 PM, an interview with CNA C was conducted, regarding the two showers she had marked for the resident last week (on 06/07/23 and 06/09/23). She confirmed she did not give the resident any showers, and she must of documented them in error. On 06/14/23 at 3:30 PM, an interview was conducted with Staff A, Registered Nurse, who was assigned to resident. She stated she did see the aide bring the resident back to her room after receiving a shower today. 105968 Page 2 of 4 105968 06/15/2023 VI at Lakeside Village 2782 Donnelly Drive Lantana, FL 33462

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 provide adequate catheter care for a resident with recurrent Urinary Tract Infections (UTI) for 1 of 1 sampled resident reviewed for catheter care, Resident #5. The findings included: A review of the Skills Checklist for Catheter Care documented, in part, for procedure: Use the first washcloth with soap and water to carefully wash around the catheter where it exits the urethra (opening on the penis). Hold the catheter where it exits the urethra with one hand. While holding the catheter, clean 3-4 inches down the catheter tube. Clean with strokes moving away from the urethra. Use a clean portion of the washcloth for each stroke. Resident #5 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident had severe cognitive impairment and required extensive to total two-person assistance with activities of daily living. The assessment further documented Resident #5 had an indwelling catheter (for urinary drainage) and had received antibiotics. Record review revealed Resident #5 was care planned for an indwelling urinary catheter, with an intervention to provide catheter care every shift and as needed, and anchor as ordered. A review of resident #5's physician orders revealed an order dated 05/23/23 for the indwelling catheter to be secured and anchored at all times and catheter care every shift as per protocol. An observation of catheter care for Resident #5 was conducted on 06/14/23 at 12:20 PM with Staff D, a Certified Nurse Assistant (CNA), and assisted by Staff E, a CNA. Staff D was observed cleaning / wiping the catheter going towards the urethra (opening of the penis) three times with separate wipes. Further observation revealed Resident #5's catheter was not secured or anchored. Staff D proceeded to pull back the resident's foreskin to clean the penis shaft. A heavy layer of thick white substance was observed under the resident's foreskin and around the penis. Staff D used approximately 10 wipes to remove the substance, to enable the completion of catheter care. An interview was conducted with the Director of Nursing (DON) on 06/14/23 at 2:00 PM. The DON was made aware of the above. 105968 Page 3 of 4 105968 06/15/2023 VI at Lakeside Village 2782 Donnelly Drive Lantana, FL 33462

F 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Potential for minimal harm Based on record review and interview, the facility failed to provide the Binding Arbitration Agreement in writing and failed to have evidence that a resident and/or the resident's representative acknowledged understanding of the Binding Arbitration Agreement. The census at the time of the survey was 47 residents with 17 of the residents being new admissions. Residents Affected - Many The findings included: Review of the facility's admission packet documented, in part, Optional Arbitration Clause (If the parties to this Agreement do not wish to include the following arbitration provision, please indicate so by marking an X through this clause. Other parties shall also initial that X to signify their agreement to refuse arbitration). Any controversy or claim arising out of or relating to the Agreement, or the breach thereof, shall be settled by arbitration in accordance with the provisions of the Florida Arbitration Code found at Chapter 682, Florida Statutes, and judgment upon the award rendered by the arbitrator(s) may be entered in any court having jurisdiction. During an interview, on 06/14/23 at 9:14 AM with the Outreach Manager (Admissions and Marketing), when asked about the Binding Arbitration Agreement, the Outreach Manager replied, upon admission, the agreement is explained to the resident or the representative. When asked how the resident or representative acknowledges understanding of the agreement, the Outreach Manager replied, The entirety of the admission packet is good for thirty days and signing the admission packet acknowledges understanding of all of the packet. The Outreach Manager confirmed that the one paragraph in the admission packet was the only reference to the Binding Arbitration Agreement in the entirety of the admission packet. On 06/14/23 at approximately 1:30 PM, the Outreach Manager provided a copy of the facility's Binding Arbitration Agreement. The Outreach Manager stated that she had only had the entire written agreement for about a week. The Outreach Manager was not able to provide documentation of resident or representative acknowledging understanding the Binding Arbitration Agreement upon agreeing to or declining the agreement. 105968 Page 4 of 4