Inspection·April 23, 2024

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 observations, interviews, and record review, the facility failed to follow the Physician's orders for wound treatment (Resident #4), and failed to obtain a physician order for wound care (Resident #5), for 2 of 3 sampled residents reviewed for wound care (Residents #4 and #5). Residents Affected - Few The findings included: 1) Review of Resident #4's clinical record documented an admission to the facility on [DATE] and a readmission on [DATE]. The residents diagnoses included Non-Traumatic Intracerebral Hemorrhage, Encephalopathy, Unsteadiness on Feet, Diabetes Mellitus and Unspecified Open Wound, Lower Leg. Review of Resident #4's Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 14 indicating that the resident had no cognition impairment. The assessment documented under Functional Abilities and Goals that the resident was dependent on the staff to complete most the activities of daily living except eating. Review of the resident's care plan titled (Resident name) has impaired skin integrity. Potential for further breakdown . initiated on 05/19/22 and revised on 05/25/23 documented an intervention that read .wound treatment as ordered . Review of Resident #4's physician order dated 01/19/24 documents cleanse with normal saline open area to left lower leg shin, apply Xeroform dressing every other day. On 04/23/24 at 9:13 AM, observation revealed Resident #4 in his room sitting in a motorized wheelchair. An interview was conducted with the resident who voiced no concerns and that his leg dressing was changed daily. Observations revealed a dressing on the resident's left lower leg, partial covered by a splint. On 04/23/24 at 9:16 AM, a side by side observation of Resident #4's left lower leg dressing was conducted with Staff A, Certified Nursing Assistant (CNA). The observation revealed the resident's dressing was dated 04/18/24. Photographic evidence obtained. On 04/23/24, at 10:50 AM, a side by side observation of Resident #4's left lower leg dressing was conducted with the Wound Care Nurse (WCN). The observation revealed the resident's dressing was dated 04/23/24. The WCN stated the floor nurse were responsible to do Resident #4's left lower leg dressing changes. Subsequently, the photographic evidence was presented to the WCN. On 04/23/24 at 10:57 AM, an interview was conducted with Staff B, Registered Nurse (RN) who stated (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 2 Event ID: 106038 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 106038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alexander "sandy" Nininger State Veterans Nursing 8401 W Cypress Dr Pembroke Pines, FL 33025 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)