Health inspection·June 20, 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 record review, observations, and interviews, the facility failed to obtain physician orders for a skin tear sustained during a fall and failed to perform a dressing change as per professional standards for 1 of 1 sampled resident (Resident #111) reviewed for skin tears. Residents Affected - Few The findings included: Review of the facility's policy, titled, Skin Tear-Abrasions and Minor Breaks, Care of, revised on 09/2013, documented, in part, .establish a clean field .steps in the procedure .wash and dry your hands thoroughly, put on gloves, loosen tape and remove soiled dressing, pull glove over dressing and discard . wash and dry your hands thoroughly .put on clean gloves .cleanse the wound with ordered cleanser, if using gauze, use clean gauze for each cleansing stroke., clean from the least contaminated area to the most contaminated area (usually, from the center outward) . Review of the facility's policy, titled, Handwashing/Hand Hygiene, revised on 08/2015 documented, in part, .use alcohol-based hand rub .or, alternatively, soap and water for the following situations: .after removing gloves .hand hygiene is the final step after removing and disposing of personal protective equipment .perform hand hygiene before applying non-sterile gloves . Review of Resident #111's clinical record documented an admission on [DATE] with no readmissions. The resident's diagnoses included Cerebral Infarction, Memory Deficit Following Cerebral Infarction, Pneumonia, and Major Depressive Disorder. Review of Resident #111's Minimum Data Set (MDS) admission assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 15, indicating the resident had no cognition impairment. The assessment documented under Functional Abilities and Goals the resident needed supervision to partial assistance from the staff to complete the activities of daily living (ADLs). Review of Resident #111's care plan titled, (Resident's name) is at risk for falls and/or fall related injury related to: generalized weakness, limited endurance, impaired balance, unsteady gait, requires staff assist with transfers and ambulation .06/12/24 Resident fell in his room sustained skin tear to right elbow, treatment applied. The care plan was initiated on 05/29/24 and revised on 06/12/24. The care plan documented an intervention that read . Perform frequent checks of resident . The resident's care plan titled, (Resident's name) has a potential for skin impairment / pressure ulcers and is noted to have skin impairment as follows: -gluteal skin tear-groin rash/redness . The care plan was initiated on 05/29/24. Resident #111's skin care plan did not address the resident's skin tear sustained on 06/12/24. (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 3 Event ID: 106106 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 106106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glades West Rehabilitation and Nursing C 15955 Bass Creek Road Pembroke Pines, FL 33027 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)