Inspection·June 16, 2025

F 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. 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 reviews, the facility failed to appropriately respond to and resolve grievances for 1 of 3 sampled residents, Resident #1. Residents Affected - Few The findings included: Review of the policy titled, Social Services-Grievance Process, with an effective date of 04/01/24, revealed the following: Grievances may be voiced through verbal complaint to a staff member (p.1); the facility shall implement a process whereby when there is grievance, it should be documented on the facility grievance report (p.2). Record review revealed Resident #1 was admitted to the facility on [DATE] and had a resident-initiated discharge on [DATE]. Resident #1's diagnoses included Pulmonary Hypertension, Muscle Wasting and Atrophy, Type 2 Diabetes Mellitus with Peripheral Angiopathy without Gangrene, Atrial Fibrillation, Hypothyroidism, and Chronic Kidney Disease. Review of the admission Minimum Data Set (MDS) assessment dated [DATE], under Section C for the Brief Interview of Mental Status (BIMS) revealed a score of 14, indicating Resident #1 had intact mental cognition. Review of the facility's grievance record for 05/2025 did not include any complaint or concern from Resident #1's son. An interview was conducted with Resident #1's son on 06/18/25 at 12:00 PM who stated he reported complaints to the former and the new Administrators regarding the care of his mother which included medications, falls, non-functioning bed and TV, and resident's rights. The former and the new Administrators did not indicate any updates or progress regarding his complaints. He was very much concerned about Resident #1's medications which were not given until the night before a resident- initiated discharge from the facility. An interview was conducted with Staff A, Social Services, on 06/16/25 at 1:51 PM, who stated she has been working in the facility for 16 years. When asked how she informs residents of the grievance process, responded, A staff would take a grievance, then a management meeting would follow, and a grievance would be assigned to the appropriate person. When asked the usual response time for most grievances, she responded, Two days, if it is a small matter, but for a room change, it might take longer than the usual time. When asked regarding the malfunctioning bed and television (TV), she responded, The Maintenance Director is very responsive. It is very unusual that the TV is not working because the facility buys new TVs to replace the ones that are not working. When asked how she would know (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: 106005 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 106005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West Delray Nursing & Rehab Center 16200 S Jog Road Delray Beach, FL 33446 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)