Health inspection·January 9, 2025

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure 2 of 3 residents reviewed for Care Planning were offered participation in plans or revisions to their care, out of a total sample of 54 residents, (#39, #86). Findings: 1. Review of the medical record revealed resident #39, an [AGE] year old male was admitted to the facility from an acute care hospital on 4/02/23. The resident's diagnoses included, abnormalities of gait and mobility, insomnia, major depressive disorder, anxiety disorder, osteoarthritis, Chronic Obstructive Pulmonary Disease (COPD), presence of cardiac pacemaker, acute kidney failure, atrial fibrillation (abnormal heart rhythm), artificial opening of urinary tract, and type 2 diabetes mellitus. The Minimum Data Set (MDS) Quarterly Assessment with an Assessment Reference Date (ARD) of 12/31/24 revealed during the look-back periods, resident #39 scored 15 out of 15 on the Brief Interview for Mental Status (BIMS) that indicated he was cognitively intact. The assessment showed there were no delusions or behaviors, the resident did not walk, required a wheelchair for mobility, staff supervision and assistance to complete activities of daily living (ADLs), he had frequent, very severe/horrible pain, received high-risk insulin, anti-coagulant (blood thinner), hypoglycemic (sugar lowering), and anticonvulsant (seizure) medications, and no active discharge plan to the community occurred. On 1/06/25 at 3:38 PM, resident #39 was observed sitting in a wheelchair in the facility's activity room. The resident explained he was not aware of his plan of care meetings, nor had he been invited to attend. He said he had problems with his meals, shoulder pain, and he hadn't received therapy that could help with his strength and movement in a long time. The resident stated, I need updates; I have a lot going on. Review of resident #39's Comprehensive Care Plan included focuses, interventions, and goals for Activities, Advanced Directives, ADL assistance and therapy services, ADL self-care performance deficit, insomnia, discharge planning, hearing deficit, risk for oral/dental health problems, diabetes mellitus, risk for falls, anticoagulant therapy, compression fracture, medication self-administration, potential nutritional problems, knee pain, risk for skin integrity breaks, suprapubic catheter care, bladder obstruction, impaired visual function, and COPD. The Order Summary Report included active physician's orders for Biofreeze Gel for pain, Melatonin 3 milligrams (MG) at bedtime for insomnia, Eliquis (blood thinner) 5 MG twice daily for blood clots, Gabapentin 100 MG three times daily for neuropathy, Brinzolamide 1% Suspension eye drops twice daily for glaucoma, Metoprolol 12.5 MG twice daily for blood pressure, Lantus Insulin 12 units at (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 5 Event ID: 106060 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 106060 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Palm Bay 175 Villa Nueva Ave Palm Bay, FL 32907 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)