Inspection·April 10, 2025

<table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CILIAIDENTIFICATION NUMBER:100608</td><td>(X2) MULTIPLE CONSTRUCTIONA. BUILDING: B. WING</td><td>(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="5">NAME OF PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP CODEGOLFCREST NURSING CENTER600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4) IDPREFIXTAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLEXTDATE</td></tr><tr><td>N 000N 072SS=D</td><td>INITIAL COMMENTSAn unannounced Relicensure survey was conducted on to at GoffcrestNursing Center. The facility had deficiencies at the time of the survey.59A-4.109(2), FAC; Comprehensive Care Plans59A-4.109 FAC(2) The nursing home licensee develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident&#x27;s medical, nursing, mental and needs that are identified in the comprehensive assessment. The care plan must describe the services that are to be furnished to attain or maintain the resident&#x27;s highest practicable physical, mental and social well-being. The care plan must be completed within 7 days after completion of the resident assessment.This Statute or Rule is not met as evidenced by: Based on interviews and record reviews the facility failed to develop and implement a comprehensive person-centered care plan for for 1 of 1 sampled resident reviewed for . (Resident #37) and failed to develop and implement a comprehensive person-centered care plan for . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .</td><td></td><td></td><td></td></tr></table> AHCAForm3020-0001 X6) DATE STATE FORM 特 NPV211 AHCAForm3020-0001 STATE FORM 检验 NPV211 <table><tr><td>STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER:100608</td><td>(X2) MULTIPLE CONSTRUCTIONA. BUILDING:B. WING</td><td colspan="2">(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="5">NAME OF PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP CODEGOLFCREST NURSING CENTER600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4) IDPREFIXTAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETEDATE</td></tr><tr><td>N 072</td><td>Continued From page 2Review of the Care Progress Note by the Care Consultant company dated documented in part the following: location:Length 4 centimeters (cm), Width: 3.2cm, Depth: 0.2 cm. Status: Recurrent.During an interview conducted on at12:30 PM with the Minimum Data Set (MDS) Coordinator who stated she is the only MDS coordinator and has worked at the facility for 3 years and in the MDS department for about 3 months. The MDS Coordinator stated that the Dietary department, , , department and theSocial Worker all put in their own care plans, and she does all the nursing care plans. The MDS Coordinator stated she would update care plans as needed based on specific findings. When asked when a resident has a or skin care plan and develop a new, would the care plan be implemented or updated, she said yes. When asked what the time frame is to update the care plan when there is a new, she said if there is something new it should be updated within couple of days. When asked if there should be interventions in the care plan for prevention of skin issues or, especially if the resident has had a in the past, she said yes. The MDS Coordinator acknowledged she did not implement a care plan for the , and that the care plan for the should have been resolved a long time ago.2. Record review for Resident #59 revealed the resident was admitted to the facility on with diagnoses that included in part the following:Degenerative , Restless Agitation, and . The</td><td></td><td></td><td></td></tr></table> AHCAForm3020-0001 STATE FORM 检验 NPV211 AHCAForm3020-0001 STATE FORM (2) NPV211 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER:100608</td><td>(X2) MULTIPLE CONSTRUCTIONA. BUILDING:B. WING</td><td>(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="5">NAME OF PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP CODEGOLFCREST NURSING CENTER600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETEDATE</td></tr><tr><td>N 110SS=D</td><td>400.141(1)(h) FS; 59A-4.122(1) FAC Physical Environment - Safe, Clean, Homelike400.141(1)(h) FSMaintain the facility premises and equipment and conduct its operations in a safe and sanitary manner.59A-4.122(1) FACThe licensee must provide a safe, clean, comfortable, and homelike environment, which allows the resident to use his or her personal belongings to the extent possibleThis Statute or Rule is not met as evidenced by:Based on observations and interviews, the facility failed to ensure the residents have a right to a safe, clean, comfortable and homelike environment for 6 of 27 resident rooms observed in the facility.The findings included:1). On at 9:20 AM an observation made in A revealed the following:*The wall behind the bed, was noted to be unsmooth and peeling paint.*The standing fan across from the resident&#x27;s bed was covered with dust and debris.2). On at 11:30 AM an observation made in revealed an uncovered fluorescent bulb in the entryway, inside of the room.3). On at 11:40 AM an observation</td><td>N 110</td><td>F584/ N110Light bulbs replaced in Light covers replaced in and 24, 33 Standing fan cleaned in, Walls smoothed and painted in, Leaking faucet fixed in, and Call light pull cord removedfrom grab bar inResident room environmental rounds completed by Administrator and Maintenance DirectorInservice Administrator and Maintenance Director on preventative maintenance rounds and correcting maintenance concernsAdministrator or designee to perform resident room environmental rounds weekly for 30 days, and monthly ongoing.Administrator or designee to report findings of environmental rounds to QAPI committee meeting monthly</td><td>X5COMPLETEDATE</td></tr></table> AHCAForm3020-0001 STATE FORM 检验 NPV211 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER:100608</td><td>(X2) MULTIPLE CONSTRUCTIONA. BUILDING:B. WING</td><td>(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="5">NAME OF PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP CODEGOLFCREST NURSING CENTER600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLEXTATE</td></tr><tr><td>N 110</td><td>Continued From page 5made in revealed the following:* An uncovered fluorescent bulb in the entryway, inside of the room.* The A/C vents were covered with dust and debris.* The lightbulb in the bathroom was out.* Unpainted plaster on the bathroom wall, next to the soap dispenser*A leaky faucet in the bathroom sink.4). On at 11:30 AM an observation made in revealed the following:* An uncovered fluorescent bulb in the entryway, inside the room.* A leaky faucet in the bathroom sink.* A call light pull cord wrapped around the grab bar in the bathroom.5). On at 10:50 AM an observation made in revealed a missing light bulb in the entryway, inside the room.6). On at 11:15 AM an observation made in A revealed an uncovered fluorescent bulb in the entryway, inside the room.A side-by-side tour of the facility was conducted on at 10:20 AM with the Director of Maintenance who stated he has been at the facility for 1.5 weeks and the Administrator who started the week of survey. They acknowledged the above findings. The Administrator stated they will be working on the aforementioned items to get them corrected right away.Class III</td><td></td><td></td><td></td></tr></table> AHCAForm3020-0001 STATE FORM 检验 NPV211 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER:100608</td><td>(X2) MULTIPLE CONSTRUCTIONA. BUILDING:B. WING</td><td>(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="5">NAME OF PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP CODEGOLFCREST NURSING CENTER600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETEDATE</td></tr><tr><td rowspan="2">N 201N 201SS=G</td><td rowspan="2">Continued From page 6400.022(1)(I), FS Right to Adequate and Appropriate Health Care(I) The right to receive adequate and appropriate health care and protective and support services, including social services; mental health services, if available; planned recreational activities; and therapeutic and rehabilitative services consistent with the resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the agency.This Statute or Rule is not met as evidenced by:A. Based on review of policy and procedure, record review and interview, the facility failed to:1) promptly notify the ordering physician and promptly administer oral to a resident, in a timely manner, for a resident with a ( ) for 1 of 1 sampled resident(Resident #16); and, 2) failed to accurately document and assess the status and condition for a resident with a skin condition for 1 of 1 sampled resident(Resident #2).The findings included:1) Record review of the facility policy and procedure titled General Laboratory Information provided by the Director of Nursing (DON), reviewed 2024, documented in the Policy Statement: Communicating Urgent Results...Notification will be provided to the Principal Investigator, Physician, or his/her authorized representative, as permitted or required by state and federal law, and these authorized personnel will have the responsibility of interpreting the result (s) in the context of the patient&#x27;s clinical condition. The authorized personnel will be responsible for taking immediate action, if</td><td rowspan="2">N 201N 201</td><td></td><td></td></tr><tr><td>N201Resident #16 received ordered completed on with no adverse effects.Resident #2 surgical site was dressed and documented on with suture removalAudit of residents with surgical sites for documentation and care plan development and implementationAudit of residents with current orders for, for completion of physician notification and prompt start of if indicated,100% Inservice for all licensed nurses on results with prompt physician notification and prompt start of ordered treatment100% Inservice for all licensed nurses for documentation of surgical sites and care plan development and implementation for surgical sitesDON or designee to audit weekly for prompt notification of, results to physician with prompt start of ordered treatment and surgical site documentation</td><td></td></tr></table> AHCAForm3020-0001 STATE FORM 检验 NPV211 <table><tr><td>STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENfICATION NUMBER:100608</td><td>(X2) MULTIPLE CONSTRUCTIONA. BUILDING: B. WING</td><td>(X3) DATE SURVEYCOMPLETED04/10/2025</td><td></td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODEGOLFCREST NURSING CENTER 600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td><td></td></tr><tr><td>(X4)ID PREFERX TAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>ID PREFERX TAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETE DATE</td></tr><tr><td>N 201</td><td>Continued From page 7needed. If the authorized personnel are not qualified to make these decisions, he/she has the responsibility of communicating the information to a qualified person immediately ....All critical results are called in to the facility, three attempts are made to communicate with resident&#x27;s nurse, DON or unit manager. If unable to communicate verbal results, Biogalax will send an &quot;Urgent Fax&quot; memo. The &quot;Urgent Fax&quot; form will state the Name, DOB of the patient and &#x27;Attention to Nurse, DON or Unit Manager.&#x27; All critical results must be reported to nurse, DON, or unit manager at facility ....Record review revealed Resident #16 was re-admitted to the facility on with diagnoses which included , Type 2 with Complications, and , , and a History of Recurrent . He had a Brief Interview Mental Status (BIM) score of 15, indicative of intact cognition.Review of Resident #16&#x27;s record documented that the Physician&#x27;s order had not been entered and uploaded into the facility&#x27;s computer system by Staff I, a Licensed Practical Nurse, (LPN), until Wednesday at 7:35 PM. Furthermore it was not translated and captured in the system, until later the next day on Thursday and read as such: &quot; Oral Capsule 100 mg (Macro) to give one (1) capsule by two (2) times a day for ( ) for ten (10) days,&quot; as ordered by the resident&#x27;s current primary care physician PCP.There had also been two (2) different previously entered computerized physician&#x27;s orders which indicated for: 1) , and Culture</td><td>N 201</td><td>with care plan development and implementation.DON or designee to report findings of all audits to QAPI committee meeting monthly.Resident #37 care plan updated for maintenance and prevention100% audit of residents with, for development and implementation of care plans as identified. 100% Inservice of all licensed nursing staff for care plan development and implementation for, DON or designee to audit residents with for care plan development and implementation weekly for 30 days and monthly ongoing.DON or designee to report findings of care plan audits to QAPI committee meeting monthly.Resident #51 was sent to hospital on . Resident #51 remains in hospital as of . Resident # 167 and #169 orders for feeding were clarified and corrected on 100% audit of all feeding residents for orders to meet nutritional needs, one order and RD documentation.Inservice DON and Registered Dietician of documentation and feeding order requirements DON or designee to audit for feeding orders and RD documentation with feeds weekly times 4 weeks and then monthly ongoing.</td><td></td></tr></table> AHCAForm3020-0001 STATE FORM 续表 NPV211 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER:100608</td><td>(X2) MULTIPLE CONSTRUCTIONA. BUILDING:B. WING</td><td>(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="5">NAME OF PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP CODEGOLFCREST NURSING CENTER600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLEXTATE</td></tr><tr><td>N 201</td><td>Continued From page 8dated Monday ----&quot;one time only for,for one (1) day.&quot; And, 2) datedWednesday ----&quot;one time only for,for three (3) days.&quot;Next, computerized record review of the nursing progress notes entered by Staff I, a Licensed Practical Nurse, (LPN) documented that, on Wednesday at 07:03 AM, &quot;Per outgoing nurse report resident has labs ....and, ....Unable to collect,this shift even after enforcing extra fluid intake.Tried several times, but remained unsuccessful due to patient , in adult briefs by the time this writer had gone to him four (4) times.Oncoming nurse will be made aware. Collection cup left at bedside. tubing, specimen envelope and requisition, will be given to relieving nurse.&quot; Staff I, also documented on Thursday at 06:15 AM, &quot; + , drawn and picked up yesterday results remain pending. Oncoming nurse will be made aware ....&quot;Further record review of the Laboratory Report for Resident #16 dated revealed that Resident #16&#x27;s specimen for (E-) had been previously collected on Tuesday, received, resulted and reported on Thursday at 5:43 PM.Additional computerized record review was conducted of the two (2)---a) Physician Progress note dated at 01:00 AM by Resident #16&#x27;s PCP documented .....&quot;Nursing has concerns regarding change in mental status, but patient appears to be at baseline mental status ...., CMP, ammonia, A1C ordered for ....and b) Physician Progress note dated at 01:00 AM by Resident #16&#x27;s PCP</td><td></td><td>DON or designee to report findings of audits to QAPI committee meeting monthly.</td><td></td></tr></table> AHCAForm3020-0001 STATE FORM 检验 NPV211 AHCAForm3020-0001 STATE FORM 续前 NPV211 10 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 11 of 38 AHCAForm3020-0001 STATE FORM 检验 NPV211 12 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 13 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 14 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 15 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 16 of 38 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER:100608</td><td>(X2) MULTIPLE CONSTRUCTIONA. BUILDING:B. WING</td><td>(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="5">NAME OF PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP CODEGOLFCREST NURSING CENTER600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETEDATE</td></tr><tr><td>N 201</td><td>Continued From page 16the upper portion above her left , anywhere in the resident&#x27;s record for either of these three (3) above dates.The DON recognized and acknowledged on at: 3:14 PM, that the resident&#x27;s complete skin status, including her , , , should be assessed and should have been documented in detail in the resident&#x27;s record.B. Based on observations, interviews and record review the facility failed to ensure that a resident receives care, consistent with professional standards of practice, to prevent, and does not develop , for 1 of 1 sampled resident reviewed for , (Resident #37).The findings included:Record review for Resident #37 revealed the resident was admitted to the facility on with diagnoses that included in part the following:Type 2 , , , and Unspecified Abnormalities of Gait and Mobility.The Minimum Data Set assessment dated documented in Section C a BriefInterview of Mental Status score of 10, indicating moderate , .Review of the Physician&#x27;s Orders for Resident #37 revealed in part the following orders:*An order dated Weekly skin assessment every Tuesday 7:00 AM to 7:00 PM Shift.*An order dated for , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .</td><td></td><td></td><td></td></tr></table> AHCAForm3020-0001 STATE FORM 续前 NPV211 17 of 38 AHCAForm3020-0001 STATE FORM 检验 NPV211 18 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 19 of 38 AHCAForm3020-0001 STATE FORM (2) NPV211 <table><tr><td>STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENIFICATION NUMBER:100608</td><td>(X2) MULTIPLE CONSTRUCTIONA. BUILDING: B. WING</td><td>(X3) DATE SURVEYCOMPLETED04/10/2025</td><td></td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP CODEGOLFCREST NURSING CENTER600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td><td></td></tr><tr><td>(X4) IDPREFIXTAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td>PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETERDATE</td></tr><tr><td>N 201</td><td>Continued From page 20by her and dated &quot;Resident #37 does not have any history of , on herDuring a telephone interview conducted on at 1:45 PM with the AdvancedRegistered Nurse Practitioner (ARNP) from the care company who was asked about the documentation of the care for Resident #37 dated , she said she put recurrent because that is what the DON had told her that the resident had a in the past. She stated this was the first time she had seen the resident, and she did not review the chart, she just documented based on what the DON had told her.C. Based on observations, interviews, and record reviews, the facility failed to provide nutritional assessments and interventions in a timely manner which resulted in significant loss for 1 of 1 sampled resident (Resident #51); The facility also failed to follow Physician&#x27;s orders for 2 of 5 sampled residents (Resident #167 and Resident #169).The findings included:A review of the facility&#x27;s policy titled &quot;Weighing and , &quot;at-risk&quot; Protocol&quot; and revised inshowed the following: .Nursing to complete all , with .on the following parameters: 0- .variances of .- loss or gain.Identification: When all .(weekly and monthly) are completed, the Dietary Department will review .for significant .loss and &quot;at risk&quot; .loss and determine variances with .as noted above. The DietaryDepartment will notify nursing staff of significant</td><td></td><td></td><td></td></tr></table> AHCAForm3020-0001 STATE FORM (2) NPV211 21 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 22 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 23 of 38 AHCAForm3020-0001 STATE FORM 经验 NPV211 AHCAForm3020-0001 STATE FORM 续前 NPV211 25 of 38 AHCAForm3020-0001 STATE FORM 检验 NPV211 26 of 38 AHCAForm3020-0001 STATE FORM 检验 NPV211 AHCAForm3020-0001 STATE FORM 续前 NPV211 28 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 29 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 30 of 38 AHCAForm3020-0001 STATE FORM 检验 NPV211 31 of 38 AHCAForm3020-0001 STATE FORM (2) NPV211 32 of 38 AHCAForm3020-0001 STATE FORM 续表 NPV211 33 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 34 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 35 of 38 AHCAForm3020-0001 STATE FORM 检验 NPV211 35 of 38 AHCAForm3020-0001 STATE FORM 续前 NPV211 37 of 38 AHCAForm3020-0001 STATE FORM 检验 NPV211 38 of 38 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER105009</td><td colspan="2">(X2) MULTIPLE CONSTRUCTIONA. BUILDINGB. WING</td><td colspan="2">(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIERGOLFCREST NURSING CENTER</td><td colspan="3">STREETADDRESS, CITY, STATE, ZIP CODE600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td colspan="2">SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETIONDATE</td></tr><tr><td>F 000F 558SS=D</td><td colspan="2">INITIAL COMMENTSAn unannounced Recertification survey was conducted on to at GolfcrestNursing Center. The facility is not in compliance with 42 CFR Part 483, Requirements for Long Term Care Facilities.Responsible Accommodations Needs/Preferences CFR(s): 483.10(e)(3)§483.10(e)(3) The right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences except when to do so would endanger the health or safety of the resident or other residents.This REQUIREMENT is not met as evidenced by:Based on observations, interviews and record review the facility failed to ensure call lights are within reach for 2 of 20 sampled residents(Residents #2 and #10).The findings included:1. Record review for Resident #10 revealed the resident was admitted to the facility on with diagnoses that included in part the following:Left , , , andFollowingAffecting Unspecified Side, and(.Generalized). The Minimum Data Set assessment dated documented in Section C a Brief Interview of Mental Status score of 15, indicating a , response.On at 9:15 AM an observation was made of Resident #10 sitting up in bed with the call light draped behind the of the bed and</td><td>F 000F 558</td><td colspan="3">F558Call lights for resident #2 and #10 were placed within reach of the residents.Audit of 100% of residents that their call lights were in reachEducate 100% of staff to place call lights within reach of residentsCall light observation audits to be performed by DON or designee 5 times per week for 30 days, and then monthly ongoing.DON or designee to report findings of call light observation audits to QAPI committee meeting monthly.</td></tr></table> X5 DATE 72025 a 10 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is required to continued program participation. 1 of 56 3 of 56 4 of 56 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER105009</td><td colspan="2">(X2) MULTIPLE CONSTRUCTIONA. BUILDINGB. WING</td><td colspan="2">(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIERGOLFCREST NURSING CENTER</td><td colspan="3">STREETADDRESS, CITY, STATE, ZIP CODE600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td colspan="2">SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5)COMPLETIONDATE</td></tr><tr><td>F 584</td><td colspan="2">Continued From page 481&quot;F; and§483.10(i)(7) For the maintenance of comfortable sound levels.This REQUIREMENT is not met as evidenced by:Based on observations and interviews, the facility failed to ensure the residents have a right to a safe, clean, comfortable and homelike environment for 6 of 27 resident rooms observed in the facility.The findings included:1). On at 9:20 AM an observation made in A revealed the following:*The wall behind the bed, was noted to be unsmooth and peeling paint.*The standing fan across from the resident&#x27;s bed was covered with dust and debris.2). On at 11:30 AM an observation made in revealed an uncovered fluorescent bulb in the entryway, inside of the room.3). On at 11:40 AM an observation made in revealed the following:* An uncovered fluorescent bulb in the entryway, inside of the room.* The A/C vents were covered with dust and debris.* The lightbulb in the bathroom was out.* Unpainted plaster on the bathroom wall, next to the soap dispenser*A leaky faucet in the bathroom sink.</td><td>F 584</td><td colspan="2">F584/ N110Light bulbs replaced inLight covers replaced inand 24, 33 Standing fan cleaned in, Walls smoothed and painted in, Leaking faucet fixed in, and Call light pull cord removedfrom grab bar inResident room environmental roundscompleted by Administrator andMaintenance DirectorInservice Administrator and MaintenanceDirector on preventative maintenancerounds and correcting maintenanceconcernsAdministrator or designee to performresident room environmental roundsweely for 30 days, and monthly ongoing.Administrator or designee to reportfindings of environmental rounds to QAPIcommittee meeting monthly</td><td></td></tr></table> 5 of 56 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER 105009</td><td colspan="2">(X2) MULTIPLE CONSTRUCTION A. BUILDING _ B. WING _</td><td colspan="2">(X3) DATE SURVEY COMPLETED 04/10/2025</td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIER GOLFCREST NURSING CENTER</td><td colspan="3">STREETADDRESS, CITY, STATE, ZIP CODE 600 NORTH 17TH AVE HOLLYWOOD, FL 33020</td></tr><tr><td>(X4)ID Prefix Tag</td><td colspan="2">SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>ID Prefix Tag</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETION DATE</td></tr><tr><td>F 584</td><td rowspan="2" colspan="2">Continued From page 5 4). On at 11:30 AM an observation made in revealed the following: *An uncovered fluorescent bulb in the entryway, inside the room. *A leaky faucet in the bathroom sink. *A call light pull cord wrapped around the grab bar in the bathroom. 5). On at 10:50 AM an observation made in revealed a missing light bulb in the entryway, inside the room. 6). On at 11:15 AM an observation made in A revealed an uncovered fluorescent bulb in the entryway, inside the room. A side-by-side tour of the facility was conducted on at 10:20 AM with the Director of Maintenance who stated he has been at the facility for 1.5 weeks and the Administrator who started the week of survey. They acknowledged the above findings. The Administrator stated they will be working on the aforementioned items to get them corrected right away. Develop/Implement Comprehensive Care Plan CFR(s): 483.21(b)(1)(3) $483.21(b) Comprehensive Care Plans $483.21(b)(1) The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at $483.10(c)(2) and $483.10(c)(3), that includes measurable objectives and timeframes to meet a resident&#x27;s medical, nursing, and mental and, needs that are identified in the comprehensive</td><td rowspan="2">F 584 F 656</td><td rowspan="2"></td><td rowspan="2"></td><td rowspan="2"></td></tr><tr><td>F 656 SS=D</td></tr></table> 6 of 56 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER105009</td><td colspan="2">(X2) MULTIPLE CONSTRUCTIONA. BUILDINGB. WING</td><td colspan="2">(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIERGOLFCREST NURSING CENTER</td><td colspan="3">STREETADDRESS, CITY, STATE, ZIP CODE600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td colspan="2">SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)</td><td>(X5) COMPLETIONDATE</td></tr><tr><td rowspan="2">F 656</td><td rowspan="2" colspan="2">Continued From page 6assessment. The comprehensive care plan must describe the following:(i) The services that are to be furnished to attain or maintain the resident&#x27;s highest practicable physical, mental, and well-being as required under \( \$ {483.24} \), \( \$ {483.25} \) or \( \$ {483.40} \); and(ii) Any services that would otherwise be required under \( \$ {483.24} \), \( \$ {483.25} \) or \( \$ {483.40} \) but are not provided due to the resident&#x27;s exercise of rights under \( \$ {483.10} \), including the right to refuse treatment under \( \$ {483.10}\left( c\right) \left( 6\right) \) .(iii) Any specialized services or specialized rehabilitative services the nursing facility will provide as a result of PASARR recommendations. If a facility disagrees with the findings of the PASARR, it must indicate its rationale in the resident&#x27;s medical record. ( )In consultation with the resident and the resident&#x27;s representative(s). (A) The resident&#x27;s goals for admission and desired outcomes.(B) The resident&#x27;s preference and potential for future discharge. Facilities must document whether the resident&#x27;s desire to return to the community was assessed and any referrals to local contact agencies and/or other appropriate entities, for this purpose.(C) Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements set forth in paragraph (c) of this section.\( \$ {483.21}\left( b\right) \left( 3\right) \) The services provided or arranged by the facility, as outlined by the comprehensive care plan, must-(iii) Be culturally-competent and -informed.This REQUIREMENT is not met as evidenced by:Based on interviews and record reviews the facility failed to develop and implement a</td><td rowspan="2">F 656</td><td colspan="2"></td><td rowspan="2"></td></tr><tr><td colspan="2">F656Resident #37 care plan updated for</td></tr></table> 7 of 56 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER105009</td><td colspan="2">(X2) MULTIPLE CONSTRUCTIONA. BUILDINGB. WING</td><td colspan="2">(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIERGOLFCREST NURSING CENTER</td><td colspan="3">STREETADDRESS, CITY, STATE, ZIP CODE600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td colspan="2">SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5)COMPLETIONDATE</td></tr><tr><td>F 656</td><td>Continued From page 7comprehensive person-centered care plan for,for 1 of 1 sampled residentreviewed for, (Resident #37) andfailed to develop and implement a comprehensiveperson-centered care plan for,medication for 1 of 1 sampled resident reviewedfor . . . /Behavior (Resident #59).The findings included:1. Record review for Resident #37 revealed theresident was admitted to the facility onwith diagnoses that included in part the following:Type 2, andUnspecified Abnormalities of Gait and Mobility.The Minimum Data Set assessment dateddocumented in Section C a BriefInterview of Mental Status score of 10, indicatingmoderate . . .Review of the Physician&#x27;s Orders for Resident#37 revealed an order datedfor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .</td><td></td><td></td><td></td><td></td><td></td></tr></table> 8 of 56 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER105009</td><td colspan="2">(X2) MULTIPLE CONSTRUCTIONA. BUILDINGB. WING</td><td colspan="2">(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIERGOLFCREST NURSING CENTER</td><td colspan="3">STREETADDRESS, CITY, STATE, ZIP CODE600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td colspan="2">SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5) COMPLETIONDATE</td></tr><tr><td>F 656</td><td colspan="2">Continued From page 8Report improvements and declines to the MD.Follow facility policies/protocols for theprevention/treatment ofMonitor/document/report PRN any changes inskin status: appearance, color, . . . healing, signs/symptoms of , size, stage.In summary the review of the care plan forResident #37 was not updated to indicate theidentified and did not indicate the. . . . . . . to the . . . . . . had been resolved.In summary the facility acquired,was not updated on the care plan, additionally there were no interventions in placefor Resident #37 to prevent the development of a. .Review of the Care Progress Note by theCare Consultant company dateddocumented in part the following: location:Length 4 centimeters (cm), Width: 3.2cm, Depth: 0.2 cm. Status: Recurrent.During an interview conducted on at12:30 PM with the Minimum Data Set (MDS)Coordinator who stated she is the only MDS coordinator and has worked at the facility for 3 years and in the MDS department for about 3 months. The MDS Coordinator stated that the Dietary department, . . . . . . . department and theSocial Worker all put in their own care plans, and she does all the nursing care plans. The MDS Coordinator stated she would update care plansas needed based on specific findings. When asked when a resident has a . . . or skin careplan and develop a new , . . . . . . . would thecare plan be implemented or updated, she saidyes. When asked what the time frame is to</td><td>F 656</td><td colspan="2"></td><td></td></tr></table> 10 of 56 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER105009</td><td colspan="2">(X2) MULTIPLE CONSTRUCTIONA. BUILDINGB. WING</td><td colspan="2">(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIERGOLFCREST NURSING CENTER</td><td colspan="3">STREETADDRESS, CITY, STATE, ZIP CODE600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td colspan="2">SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)</td><td>(X5) COMPLETIONDATE</td></tr><tr><td>F 656F 684SS=D</td><td colspan="2">Continued From page 10Review of the Care Plan for Resident #59revealed there was no care plan for,medications including interventions to monitor for behaviors or side effects.During an interview conducted on at9:30 AM with the Minimum Data Set (MDS)Coordinator who was asked if a resident who has,medications ordered would have a care plan, she said they should have a care plan for the,medication and include monitoring for behaviors and side effects. When asked about Resident #59, she acknowledged the resident had,medications ordered and no care plan in place.Quality of CareCFR(s): 483.25§ 483.25 Quality of careQuality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents&#x27; choices.This REQUIREMENT is not met as evidenced by:Based on review of policy and procedure, record review and interview, the facility failed to:1) promptly notify the ordering physician and promptly administer oral to a resident, in a timely manner, for a resident with a ( ) for 1 of 1 sampled resident(Resident #16); and, 2) failed to accurately document and assess the status and condition for a resident with a skin condition for 1 of 1 sampled</td><td>F 656F 684</td><td colspan="3">Resident #16 received ordered completed on with no adverse effects.Resident #2 surgical site was dressed and documented on with suture removalAudit of residents with surgical sites for documentation and care plan development and implementation</td></tr></table> 11 of 56 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER105009</td><td colspan="2">(X2) MULTIPLE CONSTRUCTIONA. BUILDINGB. WING</td><td colspan="2">(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIERGOLFCREST NURSING CENTER</td><td colspan="3">STREETADDRESS, CITY, STATE, ZIP CODE600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td colspan="2">SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5)COMPLETIONDATE</td></tr><tr><td>F 684</td><td colspan="2">Continued From page 11resident (Resident #2).The findings included:1) Record review of the facility policy and procedure titled General Laboratory Information provided by the Director of Nursing (DON), reviewed 2024, documented in the Policy Statement: Communicating Urgent Results ....Notification will be provided to the Principal Investigator, Physician, or his/her authorized representative, as permitted or required by state and federal law, and these authorized personnel will have the responsibility of interpreting the result (s) in the context of the patient&#x27;s clinical condition. The authorized personnel will be responsible for taking immediate action, if needed. If the authorized personnel are not qualified to make these decisions, he/she has the responsibility of communicating the information to a qualified person immediately ....All critical results are called in to the facility, three attempts are made to communicate with resident&#x27;s nurse, DON or unit manager. If unable to communicate verbal results, Bigalax will send an &quot;Urgent Fax&quot; memo. The &quot;Urgent Fax&quot; form will state the Name, DOB of the patient and &quot;Attention to Nurse, DON or Unit Manager.&quot; All critical results must be reported to nurse, DON, or unit manager at facility ....Record review revealed Resident #16 was re-admitted to the facility on with diagnoses which included , Type 2 with Complications, and , , and and a History of Recurrent . He had a Brief Interview Mental Status (BIM) score of 15, indicative of intact cognition.</td><td>F 684</td><td colspan="2">Audit of residents with current orders for, for completion of physician, notification and prompt start of if indicated,100% Inservice for all licensed nurses on results with prompt physician, notification and prompt start of ordered treatment100% Inservice for all licensed nurses for documentation of surgical sites and care plan development and implementation for surgical sitesDON or designee to audit weekly for prompt notification of , results to physician with prompt start of ordered treatment and surgical site documentation with care plan development and implementation.DON or designee to report findings of all audits to QAPI committee meeting monthly.</td><td></td></tr></table> 12 of 56 13 of 56 14 of 56 15 of 56 16 of 56 17 of 56 18 of 56 19 of 56 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER105009</td><td colspan="2">(X2) MULTIPLE CONSTRUCTIONA. BUILDINGB. WING</td><td colspan="2">(X3) DATE SURVEYCOMPLETED04/10/2025</td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIERGOLFCREST NURSING CENTER</td><td colspan="3">STREET ADDRESS, CITY, STATE, ZIP CODE600 NORTH 17TH AVEHOLLYWOOD, FL 33020</td></tr><tr><td>(X4)IDPREFIXTAG</td><td colspan="2">SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td>(X5)COMPLETIONDATE</td></tr><tr><td>F 686</td><td colspan="2">Continued From page 21$483.25(b) Skin Integrity$483.25(b)(1)Based on the comprehensive assessment of a resident, the facility must ensure that:(i) A resident receives care, consistent with professional standards of practice, to prevent and does not develop, unless the individual&#x27;s clinical condition demonstrates that they were unavoidable; and(ii) A resident with, receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent and prevent new from developing.This REQUIREMENT is not met as evidenced by:Based on observations, interviews and record review the facility failed to ensure that a resident receives care, consistent with professional standards of practice, to prevent, and does not develop, for 1 of 1 sampled resident reviewed for.(Resident #37).The findings included:Record review for Resident #37 revealed the resident was admitted to the facility on with diagnoses that included in part the following:Type 2, and Unspecified Abnormalities of Gait and Mobility.The Minimum Data Set assessment dated documented in Section C a Brief Interview of Mental Status score of 10, indicating moderate . . .Review of the Physician&#x27;s Orders for Resident #37 revealed in part the following orders:</td><td>F 686</td><td colspan="2">F686Resident #37 orders updated for turning and repositioning every 2 hours as tolerated to allow for CNA documentation and care plan developed and implemented for100% audit with , for turning and repositioning documentation and care plan development and implementation.Inservice 100% of licensed nurses on turning and repositioning order entry for CNA documentation and care plan development and implementation forDON or designee to audit orders for turning and repositioning to allow documentation by CNAs and care plan development and implementation for2 times weekly for 30 days, and then monthly ongoing.DON or designee to report findings of audits to QAPI committee meeting</td><td></td></tr></table>