Inspection·February 24, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record reviews and interviews the facility failed to develop a comprehensive care plan for one (Resident #2) and failed to implement care plan for two (Resident # 6 and Resident # 7) out of seven sampled residents. As evidenced by a fall care plan was not developed for Resident #2 who is at high risk for falls; and staff failed to implement Care Plan interventions to prevent worsening of wounds for Resident # 6 and Resident #7. The findings included: Resident #2 On 02/24/2025 at 11:10 AM Resident #2 was observed sitting in his wheelchair watching television, no distress noted. Review of Resident #2's the clinical revealed he was admitted to the facility on [DATE] and readmitted on [DATE]. Clinical diagnoses include, but were not limited to, History of Falling and Osteoarthritis. Record review of Nurses Notes dated 12/09/2024 revealed during rounds, the resident was noted lying on the floor on his left side beside the bed. Resident remained alert and verbally responsive, no acute distress observed, active range of motion completed, resident was able to move upper extremities, resident reports pain to left shoulder, rated 4/10, pain management measures in place, Nurse Practitioner (NP) made aware, no new orders at this time, call placed to resident's Power of Attorney (POA). Record review of Nurses Notes dated 12/10/2024 revealed the X-ray results received with the following conclusion: Modest osteoarthritis, but no pelvic or hip fracture. Results relayed to NP no new orders received. care ongoing. Record review of Nurses Notes dated 01/05/2025: During rounds, the resident was found on the floor lying on his left side beside the bed. The resident remained alert and verbally responsive. The call light was noted on the bed. Reddened area noted to top of scalp and skin tear to left knee. Vital signs obtained .active range of motion done. The resident was transferred to bed via mechanical lift. Neurological assessment completed. Resident's skin tears to his left knee cleanse with normal saline, pat dry and standard techniques applied. Safety measures maintained, bed at lowest position with call light within reached. The physician made it aware. New orders received for skull X-ray. On 01/07/2025 the resident's daughter was made aware of the [NAME] X-ray result that there was no fracture. (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: 686125 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 686125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lilac at Silver Palms 14601 NE 16th St North Miami, FL 33161 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)