Health inspection·September 8, 2022

F 0842 Level of Harm - Potential for minimal harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure accurate documentation for 4 of 22 sampled residents. Medication physician orders for Residents #18, #20, and #36 documented improper diagnoses. The Minimum Data Set (MDS) Discharge Report for Resident #51 documented an incorrect discharge location. The findings included: 1) Review of the record revealed Resident #18 was admitted to the facility on [DATE]. Review of the current physician orders documented the following: An order dated 08/04/22 for the medication melatonin, used for insomnia (sleeping issues), documented a diagnosis or reason for use as hyperlipidemia (high cholesterol level). An order dated 08/30/22 for the medication ferrous sulfate (an iron supplement), used to treat low iron blood levels, documented a diagnosis of hyperlipidemia. 2) Review of the record revealed Resident #20 was admitted to the facility on [DATE]. Review of the current physician orders documented the following: An order dated 05/01/22 for Milk of Magnesia, used for constipation, documented a diagnosis or reason for use as hyperlipidemia (high cholesterol level). An order dated 05/01/22 for Glucagon, used to treat very low blood sugar levels, documented a diagnosis of hyperlipidemia. An order dated 05/01/22 for Tizanidine, used for muscle spasms, documented a diagnosis of macular degeneration (an eye disorder). An order dated 05/01/22 for Acetaminophen (Tylenol) used for pain or fever, documented a diagnosis of hyperlipidemia. An order dated 05/01/22 for Calcium-Vitamin D, a mineral supplement used for bone formation and maintenance, documented a diagnosis of hyperlipidemia. An order dated 05/01/22 for Ferrous Sulfate, used to treat low blood levels, documented a diagnosis of hyperlipidemia. (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: 106013 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 106013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chatsworth at Pga National 347 Hiatt Drive Palm Beach Gardens, FL 33418 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)