Inspection·April 2, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined, the clinical staff failed to complete an assessment after a resident sustained an injury; failed to obtain and report all pertinent information to the provider to ascertain the best course of treatment; failed to complete an incident report after the injury was reported by the resident; and failed to complete an investigation to determine if the resulting injury, a fractured wrist, met the criteria for an adverse event. These failures affected 1 of 3 sampled residents (Resident #1). The findings included: Clinical record review revealed Resident #1 was admitted to the facility for rehabilitation services on 02/10/24. Review of the Fall risk assessment dated [DATE] revealed the resident was assessed at high risk with a score of 12 (a score greater than 10 deems the individual as high risk). Review of the Minimum Data Set admission assessment with reference date 02/13/24 documented the resident was assessed as independent for skills of daily decision making; was occasionally incontinent of bladder, had occasional pain, shortness of breath while lying flat or with exertion and had no prior falls. The resident was receiving antibiotic, antidepressant, antiplatelet, hypoglycemic, diuretic and anticoagulant medications. Resident #1's Care Plan dated 02/17/24 documented the resident is at risk for falls related to impaired hearing, impaired vision, unsteady gait, poor balance, use of antihypertensive medications and use of psychotropic medications. The resident potential for sustaining a fall-related injury will be minimized by utilizing fall precautions/interventions though next review date. The interventions included: o Encourage and assist resident to use bed in the lowest position as tolerated. o (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: 106148 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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)