Inspection·April 30, 2024

F 0609 Level of Harm - Minimal harm or potential for actual harm Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on record review, policy review and interview, the facility staff failed to immediately report an allegation of abuse involving 1 of 2 sampled residents (Resident #1). Residents Affected - Few The findings included: Review of the facility policy titled, Grievances, last revised 06/2023, documented The Grievance Officer will coordinate actions with the appropriate state and federal agencies depending on the nature of the allegations. all alleged violations of neglect, abuse and or misappropriation of property will be reported and investigated under guidelines for reporting abuse and neglect, as per state law. Review of the facility policy titled, Abuse, Neglect, Exploitation, Misappropriation, Mistreatment and Injury of Unknown Origin (ANEMMI), last revised 10/2022 documented the following: Reporting and Response: All allegations of possible ANEMMI will be immediately reported to the abuse hotline by the Administrator or Designee and will be evaluated to determine the direction of the investigation Alleged violations are reported immediately, but not later than 2 hours after the allegation is made, if the vents that cause the allegation involve abuse or result in serious bodily injury, or no later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury. Review of a grievance dated 03/25/24 involving Resident #1 documented Patient reports aide is being mean and pulling on her arm multiple times, even after asking her not to .Aide is giving her a hard time about needing to be changed more (because her feeding tube). The document noted the grievance was resolved on 03/25/24. Interview with Resident #1 conducted on 04/29/24 at 10:15 AM revealed an incident of abuse. The resident explained she initially reported the aide's actions to the therapists, she was so upset, she could not do her therapy and the staff recognized something was wrong and inquired about what was happening, she started to cry and the therapist helped her with writing the complaint. Resident #1 explained during care Staff A, a Certified Nursing Assistant, was mean to her, she kept pulling on her arms during care, despite her telling not to do so because it was painful. Resident #1 elaborated she had a stroke and her shoulders and arms are still stiff and painful. Interview with the Speech Therapist conducted on 04/30/24 at 12:05 PM revealed her recollection of (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: 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 04/30/2024 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)