Boca Circle Rehabilitation Center

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide adequate nail care to three out of four sampled residents who were unable to perform activities of daily living independently. Observations revealed that one cognitively intact resident had long nails and reported that staff only cleaned her nails, though she sometimes wanted them cut. Another resident, who was moderately cognitively impaired and required set-up assistance for personal hygiene, was observed with dirt-encrusted and unkempt nails. A third resident, who was severely cognitively impaired and required dependent assistance, was also observed with heavily dirt-encrusted nails. Interviews with staff indicated that certified nursing assistants (CNAs) were responsible for providing nail care, but there was no consistent schedule or time frame for this care, with staff stating it was done "as needed" or approximately every three days. Staff members acknowledged during observations that the residents' nails were dirty and needed attention. The facility's policy required that residents unable to perform activities of daily living receive necessary services to maintain grooming and hygiene, but this was not consistently implemented for the residents observed.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to implement and maintain Enhanced Barrier Precautions (EBP) for residents with active wounds, as required by their own infection prevention and control policy. Specifically, three out of four sampled residents with wounds or indwelling medical devices did not have EBP orders in place. For one resident with a stage 2 pressure ulcer and on dialysis, there were no EBP orders, no signage, and no personal protective equipment (PPE) observed in or outside the room, and the resident reported that staff did not wear gowns during direct care. Another resident with multiple unhealed pressure ulcers and a suprapubic catheter also lacked EBP orders, and although signage and PPE were present, the resident stated that staff did not wear gowns during care. A third resident with unhealed pressure ulcers similarly had no EBP orders, though signage and PPE were observed in the room. Record reviews and interviews confirmed that the facility's policy required EBP for residents with wounds or indwelling devices, including clear signage and availability of PPE. The Infection Preventionist acknowledged during interview and record review that all three residents should have had EBP orders in place, and could not provide additional information to explain the lack of compliance. The care plans for these residents referenced following facility protocols for skin breakdown prevention and, in one case, noted the need for EBP, but the required orders and consistent implementation were not present.

Penalty

Fine: $48,825

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to identify and address severe weight loss in a timely manner for two residents, leading to significant nutritional deficiencies. Resident #52, who was admitted with cognitive and physical impairments, experienced a 10.8% weight loss over less than two months. Despite observations of the resident's inability to eat independently due to uncontrollable hand tremors, the facility did not provide adequate assistance during meals or implement nutritional supplements. The Registered Dietitian was not informed of the resident's severe weight loss and did not take timely action to address the nutritional needs. Resident #56 also experienced a severe weight loss of 9.8% in one month and an overall 12% weight loss over six months. The facility's interventions were delayed, with nutritional supplements not being ordered until over a month after the significant weight loss was identified. The resident's meal intake was consistently below 50%, yet the facility failed to ensure the prescribed fortified foods and supplements were consistently provided. The facility's policies on weight monitoring and nutritional assessment were not effectively implemented, leading to a lack of timely interventions for residents experiencing significant weight loss. The Registered Dietitian and staff failed to communicate and document weight changes and nutritional needs adequately, resulting in continued weight loss and potential malnutrition for the residents involved.

Plan Of Correction

Boca Circle Rehabilitation Center failed to identify a severe loss in a timely manner and failed to provide adequate nutritional supplements to prevent further severe loss. **Actions Taken:** 1) Resident #52 was evaluated by the Registered Dietitian on and additional nutritional interventions were implemented. A comprehensive nutritional assessment was completed for Resident #52 on and the resident now attends the dining room for his meals for oversight and assistance as needed. On resident #52 was placed on an appetite stimulant. Resident #52 was placed on weekly and is currently receiving Occupational and Speech therapies. The Resident's responsible party has been updated. Resident #56 was evaluated by the Registered Dietitian on and additional nutritional interventions were implemented. A comprehensive nutritional assessment was completed for Resident #56 on the resident was seen by the Speech Pathologist and her diet was downgraded to Puree and on the resident was placed on an appetite stimulant. Resident #56 is currently receiving Occupational and Speech therapies. The Resident's responsible party has been updated. **Others Identified:** 2) Full house audit completed between by the Registered Dietitian/Designee to identify residents that may have been affected due to delayed loss intervention or missing a nutritional intervention in the electronic medical record or ticket system recommended by the Registered Dietitian. Additional documentation recommended from the full house audit was completed by facility Registered Dietitian by Regional Dietitian completed a full house audit between to ensure residents have been per protocol and monitored appropriately to identify severe loss. Any concerns identified were immediately addressed. **Measures Taken:** 3) Regional Dietitian in-serviced the Registered Dietitian on regarding timely nutrition interventions with a focus on residents with loss as well as ensuring nutritional interventions are placed in electronic medical record and ticket system timely as applicable. Nursing staff were re-educated to refer to resident Kardex in reference to amount of assistance required with meals initiated on by Ellie Schutt, LNHA/Designee. **Ongoing Monitoring:** 4) The Registered Dietitian/Designee will conduct an audit of 10 residents on each unit weekly to ensure the residents with loss have timely documentation with nutritional interventions and verify that the nutritional interventions are placed in the EMR and the ticketed system timely weekly x 4 weeks, and then every 2 weeks x 2 months. Findings of the audits will be reviewed in the QAPI Meetings to ensure substantial compliance. The QAPI committee is responsible for the ongoing compliance.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide adequate nutritional support and timely identification of severe weight loss for two residents. One resident, admitted with communication and anoxic damage, experienced a 6.7% weight loss over six weeks. Despite observations of the resident struggling to eat due to uncontrollable shaking, no nutritional supplements were ordered, and the resident was left unsupervised during meals. The Registered Dietitian was aware of the weight loss but did not implement weekly weight monitoring or additional nutritional interventions, leading to a severe weight loss of 11.5% in less than two months. Another resident experienced a 9.8% weight loss in one month, with an overall 14% loss over three months. The resident's meal intake was less than 50% over the past 30 days, and although interventions such as fortified food and house shakes were initiated, there was a delay in implementing these measures. The Registered Dietitian failed to place an order for the house shake immediately, resulting in a lack of timely nutritional support. Additionally, the facility did not ensure the competency of a resident performing self-care for a tracheostomy. The resident was observed changing her inner cannula without recent competency verification, as the last documented competency was over a year ago. The facility could not locate the competency checklist, and the resident continued to change her inner cannula more frequently than recommended, without proper oversight or documentation in the electronic health record.

Plan Of Correction

Actions Taken: 1) Resident #52 was evaluated by the Registered Dietitian on and additional nutritional interventions were implemented. A comprehensive nutritional assessment was completed for Resident #52 on and the resident now attends the dining room for his meals for oversight and assistance as needed. On resident #52 was placed on an appetite stimulant. Resident #52 was placed on weekly and is currently receiving Occupational and Speech therapies. The Resident's responsible party has been updated. Resident #56 was evaluated by the Registered Dietitian on and additional nutritional interventions were implemented. A comprehensive nutritional assessment was completed for Resident #56 on the resident was seen by the Speech Pathologist and her diet was downgraded to Puree and on the resident was placed on an appetite stimulant. Resident #56 is currently receiving Occupational and Speech therapies. The Resident's responsible party has been updated. Others Identified: 2) Full house audit completed between by the Registered Dietitian/Designee to identify residents that may have been affected due to delayed loss intervention or missing a nutritional intervention in the electronic medical record or ticket system recommended by the Registered Dietitian. Additional documentation recommended from the full house audit was completed by facility Registered Dietitian by Regional Dietitian completed a full house audit between to ensure residents have been per protocol and monitored appropriately to identify severe loss. Any concerns identified were immediately addressed. Measures Taken: 3) Regional Dietitian in-serviced the Registered Dietitian on regarding timely nutrition interventions with a focus on residents with loss as well as ensuring nutritional interventions are placed in electronic medical record and ticket system timely as applicable. Nursing staff were re-educated to refer to resident Kardex in reference to the amount of assistance required with meals initiated on by Ellie Schutt, LNHA/Designee. Ongoing Monitoring: 4) The Registered Dietitian/Designee will conduct an audit of 10 residents on each unit weekly to ensure the residents with loss have timely documentation with nutritional interventions and verify that the nutritional interventions are placed in the EMR and the ticketed system timely weekly x 4 weeks, and then every 2 weeks x 2 months. Findings of the audits will be reviewed in the QAPI Meetings to ensure substantial compliance. The QAPI committee is responsible for the ongoing compliance.

Penalty

Fine: $48,825

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to treat a resident in a dignified manner and provide personal privacy. Resident #108, who was admitted with diagnoses including hemiplegia and hemiparesis following a cerebral infarction, was observed on two occasions lying on her bed with the door open, uncovered, and without underwear. The resident was seen playing with her Foley catheter during one of these observations. The resident's Minimum Data Set (MDS) assessment indicated a Brief Interview of Mental Status (BIMS) score of 99, suggesting an inability to complete the interview, and a dependency on assistance for movement in bed. A Certified Nursing Assistant (CNA) interviewed acknowledged the importance of maintaining dignity and privacy, stating that residents should not be exposed and that doors should be closed during care or changing, especially for residents who are not fully conscious.

Plan Of Correction

Boca Circle Rehabilitation Center failed to treat the resident in a dignified manner and provide personal privacy. Actions Taken: 1) On resident #108 was provided with personal privacy during personal care by the C.N.A. Education was initiated on with staff regarding providing dignity and privacy for residents during personal cares. Others Identified: 2) Full house audit was conducted by the DON/Designee on to ensure privacy was being provided during personal care. No other concerns were noted. Measures Taken: 3) Nursing Staff were re-educated on regarding regarding resident rights, dignity and privacy during personal cares and that privacy curtains must be pulled and the door closed so residents are treated in a dignified manner. New staff will receive this education during general orientation. Ongoing Monitoring: 4) Unit Manager or designee will audit personal care and resident right to privacy during personal cares weekly x 4 weeks and then every 2 weeks x 2 months. Audit results will be reviewed in Center QAPI meeting monthly until substantial compliance has been met.

Penalty

Fine: $48,825

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to appoint a guardian in a timely manner for a resident with severe cognitive impairment. The resident, who was admitted from another nursing facility, had a Brief Interview for Mental Status (BIMS) score of 2, indicating severe cognitive impairment. The resident's family had not been involved for years, and the only listed representative, a cousin, had requested to be removed from the contact list. Despite the resident's need for a legal representative, the facility had not successfully appointed a guardian. Interviews with the Social Service Director (SSD) and the Administrator revealed that the facility had been attempting to address the guardianship issue since early 2024, but progress was hindered by difficulties in finding an attorney. The SSD admitted that the facility had been working on the issue longer than initially thought, but no paperwork was found to support this. The Administrator was unaware of the resident's need for guardianship until the day of the interview and stated that the facility lacked a policy on guardianship. The process of obtaining guardianship typically takes 6 to 9 months, depending on the court system.

Plan Of Correction

Boca Circle Rehabilitation Center failed to appoint a guardian in a timely manner for 1 of 1 resident sampled for guardianship. Actions Taken: 1) Resident #56 continues to reside at the facility. On Center SSD obtained a proxy for resident #56. SSD was re-educated by Ellie Schutt, LNHA on to ensure of a guardian is done timely. Others Identified: 2) On a residents records were audited to ensure that residents with a less than 12 had a designated representative or legal surrogate. Any concerns identified were immediately addressed. Measures Taken: 3) Social Services staff and members if the Interdisciplinary team were re-educated on obtaining guardianship or a proxy timely on residents who are unable to direct their care by Ellie Schutt, LNHA. Newly hired Social Service staff and nursing management will receive this education during general orientation. Ongoing Monitoring: 4) Social Services or designee will audit residents with a of less than 12 to ensure that residents identified have a guardian or a proxy in place to ensure that residents have the right to designate a representative upon admission, weekly x 4 weeks, and then every 2 weeks x 2 months. Audit results will be reviewed in Center QAPI meeting monthly to ensure compliance has been met.

Penalty

Fine: $48,825

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to complete a Level 2 Preadmission Screening and Resident Review Process (PASARR) for a resident who was sampled for PASARR. The resident was admitted to the facility with diagnoses including Paralytic Syndrome, Bipolar Disorder, Current Episode Depressed, and Peripheral Vascular Disease. A Level 1 PASARR was conducted at the hospital prior to the resident's admission, indicating a hospital discharge exemption with an expectation of less than 30 days of nursing facility services. However, the resident's stay exceeded this period, necessitating a Level 2 PASARR, which was not completed. During a review of the Electronic Health Record (EHR), it was found that the Level 2 PASARR was missing. The Social Service Director (SSD) confirmed the absence of the Level 2 PASARR and acknowledged that it should have been completed based on the Level 1 PASARR findings. The SSD was unable to locate the Level 2 PASARR in the resident's records, indicating a lapse in the facility's compliance with the PASARR process requirements.

Plan Of Correction

The facility failed to complete a Level 2 Pre admission Screening and Resident Review Process (PASARR) for Resident #50. **Actions Taken:** 1) The Center Social Service Director submitted information for Preadmission Screening and Resident Review (PASARR) for a re-evaluation for resident #50. New PASARR for resident #50 was received on and a Level 2 was obtained. **Others Identified:** 2) A full house audit of current residents' Preadmission Screening and Resident Review (PASARR) was conducted to ensure that any resident with a new mental health diagnosis(s) had a PASARR evaluation completed and any mental health diagnosis(s) were identified on the current PASARR screen. Those residents identified that do not have an accurate PASARR evaluation on file will be resubmitted for a new PASARR screening no later than. Social Service staff and Nursing management are scheduled to attend Kepro training on PASARRs. **Measures Taken:** 3) The Administrator provided education to the Social Worker(s), Nursing management, and Admissions team on the requirements of the Preadmission Screening and Resident Review (PASARR) processing for mental and individuals with. **Ongoing Monitoring:** 4) The Social Worker(s) and Admission Director will audit each resident's PASARR Screen at the time of admission, during monthly Behavioral meetings, and quarterly thereafter to ensure accuracy. The Social Worker will report on the findings of the audits in the QAPI Meetings to ensure substantial compliance. The QAPI committee is responsible for the ongoing compliance.

Penalty

Fine: $48,825

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide necessary assistance during dining for two residents, specifically Resident #71 and Resident #52, who were reviewed for activities of daily living (ADLs). Resident #71 was admitted with diagnoses including Atherosclerotic Heart Disease and Neuromuscular Dysfunction of the Bladder. The Minimum Data Set (MDS) assessment indicated that Resident #71 had a moderately impaired mental status and required supervision or touching assistance during dining. However, observations on two separate occasions revealed that Resident #71 was left unattended with her meal trays for extended periods, without any staff present to assist or encourage her to eat. Interviews with facility staff revealed inconsistencies in understanding the level of assistance required by Resident #71. A Certified Nurse Assistant (CNA) acknowledged that the resident sometimes needed to be fed and encouraged to eat, while a Registered Nurse (RN) believed the resident could eat without staff presence. The MDS Coordinators clarified that supervision or touching assistance meant the resident needed help with tray setup and encouragement during meals. Despite this, the CNAs, who were responsible for dining assistance, were not consistently present to provide the necessary support, leading to the deficiency in care.

Plan Of Correction

The facility failed to provide assistance during dining. **Actions Taken:** 1) Resident #71 remains in the facility in stable condition. A screen was conducted on [date]. The resident now attends the dining room for her meals for oversight and assistance as needed. Staff E, CNA and staff F, RN were re-educated to refer to resident Kardex in reference to the amount of assistance required with meals on [date] by Aristine Recht, Assistant Director of Nursing. **Others Identified:** 2) A full house audit was conducted by the Director of Nursing/Designee on [date] to ensure residents were provided assistance during dining. Any concerns identified were immediately addressed. **Measures Taken:** 3) Nursing staff were re-educated on providing assistance to residents during dining as per resident Kardex on [date] by DON/Designee. Newly hired nursing staff will receive this education during general orientation. **Ongoing Monitoring:** 4) The Director of Nursing/Designee will conduct an audit of 10 residents on each unit weekly to ensure the residents receive assistance during dining weekly for 4 weeks, and then every 2 weeks for 2 months. Findings of the audits will be reviewed in the QAPI Meetings to ensure substantial compliance. The QAPI committee is responsible for the ongoing compliance.

Penalty

Fine: $48,825

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure the competency of a resident in performing respiratory care, specifically in changing her tracheostomy inner cannula. Resident #58, who was admitted with diagnoses including Respiratory Failure and Tracheostomy Status, was observed to change her own inner cannula without recent documented competency verification. The resident, who is cognitively intact, reported changing her inner cannula up to three times a day, despite instructions to change it only twice daily. The facility's respiratory therapist confirmed that the resident's competency was last assessed over a year ago, and no current documentation of competency was found in the Electronic Health Record (EHR). The surveyor's investigation revealed that the facility could not locate the competency documentation, as it was reportedly on paper with a previous company. The Regional Nurse Consultant acknowledged the absence of the competency record in the EHR. Additionally, the resident's EHR indicated that she was running out of inner cannulas due to frequent changes, and the facility had doubled her order to prevent shortages. The resident was re-educated on the inner cannula change process only after the surveyor's intervention.

Plan Of Correction

Boca Circle Rehabilitation Center failed to ensure the residents competency when performing care. Actions Taken: 1) Resident #58 was evaluated by the on & and competency and education was completed and uploaded into the electronic medical record. Staff P. was provided education on by the Regional on ensuring documented education and competency is documented for residents that perform self-care. Others Identified: 2) Full house was conducted by the DON/Designee on to ensure residents with that perform their own care have a competency completed. No concerns noted. Measures Taken: 3) Nursing Staff were in serviced on ensuring residents with who perform their own care are assessed for competency starting on by DON/Designee. Newly hired staff and nursing staff will receive this education during general orientation. Ongoing Monitoring: 4) The Director of Nursing/Designee will conduct weekly audits to verify that residents with that care have perform their own care, have a competency completed weekly x 4 weeks, and then every 2 weeks x 2 months. Audit results will be reviewed in Center QAPI meeting until substantial compliance is met.

Penalty

Fine: $48,825

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to adequately monitor the behaviors and side effects of a resident on psychotropic medications, leading to a deficiency in the resident's care. The resident, who was admitted with anxiety disorder and major depressive disorder, was prescribed Lorazepam for anxiety and Paroxetine for depression. The care plan required the facility to administer these medications as ordered and to monitor and document any side effects and the occurrence of target behavior symptoms per facility protocol. However, a review of the Medication Administration Record for December 2024 and January 2025 revealed that there was no documentation of behavior or side effect monitoring for the resident. During an interview, a Licensed Practical Nurse stated that residents on such medications are monitored for behaviors and side effects, and this information is documented in the electronic Medication Administration Record. However, when asked to provide documentation for this resident, the nurse was unable to do so. The facility's Administrator was informed of these findings, indicating a lapse in the facility's adherence to its own protocols for monitoring residents on psychotropic medications.

Plan Of Correction

Boca Circle Rehabilitation Center failed to monitor behaviors and side effects of medication. Actions Taken: 1) Resident #52's medication administration record has been updated to include behavior and side effect monitoring was implemented on Stafi L, LPN, was re-educated by the DON/Designee on to ensure medication administration records have behavior and side effect monitoring present were indicated. Others Identified: 2) A full house audit was conducted by the Director of Nursing/Designee on to ensure behavior and side effect monitoring is in place for residents receiving medications. Behavior and side effect monitoring was implemented as indicated. Measures Taken: 3) Licensed Nurses were re-educated on the components of this regulation with an emphasis on ensuring the residents on medications have behavior and side effect monitoring in place on the medication administration record. Newly hired licensed staff will receive this education during general orientation. Ongoing Monitoring: 4) The Director of Nursing/Designee will conduct weekly audits of 10 residents on each unit to verify that residents on medications have behavior and side effect monitoring in on the medication administration record weekly x 4 weeks, and then every 2 weeks x 2 months. Audit results will be reviewed in Center QAPI meeting until substantial compliance has been met.

Penalty

Fine: $48,825

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide the correct diet consistency for residents on a pureed diet, as observed in three residents. The pureed Chicken Pot Pie served to these residents was lumpy, and the green beans shell were easily identifiable, which did not meet the required pureed consistency. This inconsistency was observed during meal times in both the main dining room and individual resident rooms. The residents involved had various medical conditions, including Atrial Fibrillation, Gastro-Esophageal Reflux Disease, Combined Systolic and Diastolic Heart Failure, Muscle Wasting and Atrophy, and Hemiplegia following a Cerebral Infarction. All three residents were unable to conduct interviews due to their mental status, as indicated by their Brief Interview of Mental Status (BIMS) scores. The Speech Therapist at the facility confirmed that pureed food should be blended into a uniform consistency, but admitted that no training had been conducted with the kitchen staff since her employment began in July. The District Manager stated that she routinely checks the pureed food consistency before it is served, but the deficiency was still present. The facility's policy referenced the National Dysphagia Diet guidelines, which require a homogenous, pudding-like consistency for pureed foods, a standard that was not met in these instances.

Plan Of Correction

Boca Circle Rehabilitation Center failed to provide the correct diet consistency for the Pureed diet. **Actions Taken:** 1) Resident #35 & #108 remain in the facility in stable condition. Resident #102 no longer resides in the facility. **Others Identified:** 2) Full house was conducted by the Dietary Manager/Designee to ensure the residents diet consistencies were correct. Any concerns identified were immediately addressed. **Measures Taken:** 3) Dietary Staff were in serviced on ensuring the residents diet consistency is accurate by Certified Dietary Manager. Nursing staff were re-educated to monitor diet consistency during meal tray check/pass. Newly hired dietary staff and nursing staff will receive this education during general orientation. **Ongoing Monitoring:** 4) The Dietary Manager/Designee will conduct daily audits 5X/week to verify that residents diet consistencies are correct x 4 weeks, and then 2X/week for 2 weeks then weekly for 2 months. Audit results will be reviewed in Center QAPI meeting until substantial compliance has been met.

Penalty

Fine: $48,825

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide meals that met the dietary preferences, allergies, and intolerances of four residents during dining observations. Resident #56, who has severe cognitive impairment, did not receive the fortified mashed potatoes listed on their meal ticket. Resident #15, with no cognitive impairment, was missing ice cream from their meal tray. Resident #118, also with no cognitive impairment, expressed frustration over consistently receiving green vegetables, which they had explicitly stated they disliked. Resident #368, newly admitted and without a completed Minimum Data Set, reported that their food preferences were not considered, receiving items they do not consume, and described the food as inedible and served cold. The facility's meal distribution process was observed to have multiple checkpoints intended to ensure meal tickets match the trays, involving aides and nurses. However, during observations, it was noted that the Licensed Practical Nurses (LPNs) distributing the trays did not uncover the plates to verify the food consistency against the meal tickets. Despite the District Manager's assertion of a thorough checking process, discrepancies in meal delivery were evident, as seen in the cases of the residents mentioned. Interviews with staff revealed inconsistencies in the meal distribution process. Staff B, an LPN with over 11 years of experience, claimed to check the meal tickets and uncover plates to verify consistency, yet observations contradicted this. Similarly, Staff A, another LPN, admitted to not uncovering plates during distribution, relying on Certified Nursing Assistants to report inconsistencies. These lapses in procedure contributed to the failure in meeting residents' dietary needs and preferences, as documented in the survey findings.

Plan Of Correction

Boca Circle Rehabilitation Center failed to provide food that meets residents' preferences and intolerances. **Actions Taken:** 1) Resident #56 was seen by the Registered Dietician on and remains in the facility in stable condition. Resident #15 was seen by the Registered Dietician on and remains in the facility in stable condition. Resident #118 remains in the facility in stable condition. Resident was seen by the Registered Dietician on and food preferences have been updated. Resident #368 remains in the facility in stable condition. Resident was seen by the Registered Dietician on and food preferences have been updated. Staff A, LPN was reeducated on verifying plated food matches residents' meal ticket on by Ellie Schutt, LNHA. Staff B, LPN was reeducated on verifying plated food matches residents' meal ticket on by Ellie Schutt, LNHA. Staff D, LPN was reeducated on verifying plated food matches residents' meal ticket on by Ellie Schutt, LNHA. **Others Identified:** 2) A facility audit was conducted by the Dietary Manager/Designee on to ensure provision of food to meet residents' preferences and intolerances. Residents' dietary preferences were updated as indicated. **Measures Taken:** 3) Dietary Staff were in-serviced on ensuring the residents' diet preferences are honored including condiments on by CDM. Education for Licensed Nurses and CNAs was initiated on regarding checking the meal tickets and meal tray for correct consistency by DON/Designee. Newly hired dietary and nursing staff will receive this education during general orientation. **Ongoing Monitoring:** 4) Dietary Manager/Designee will conduct audits 5x/week to verify that residents' dietary preferences are correct and Licensed Nurses are checking meal trays for correct consistency x 4 weeks, and then every week x 4 weeks, followed by weekly x 1 month. Audit results will be reviewed in Center QAPI meeting until substantial compliance has been met.

Penalty

Fine: $48,825

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to adhere to the posted schedule for meal tray deliveries during two separate observations. On the first observation, lunch trays were significantly delayed across various dining areas and halls, with actual delivery times ranging from 12:52 PM to 1:43 PM, despite scheduled times between 11:30 AM and 12:10 PM. A second observation revealed similar delays, with trays arriving between 11:50 AM and 12:25 PM, contrary to the scheduled times of 11:30 AM to 12:00 PM. These discrepancies were confirmed through interviews with residents who consistently reported late meal deliveries. Two residents, both cognitively intact with a Brief Interview of Mental Status Score of 15, expressed concerns about the late meal deliveries. One resident, diagnosed with Parkinson's and muscle weakness, reported that lunch meals often arrived between 12:30 PM and 1:00 PM, sometimes even later. Another resident, with diagnoses of muscle weakness and difficulty walking, stated that it was common for trays to arrive around 1:30 PM on their unit. The kitchen District Manager acknowledged that meal timing changes were made for breakfast and dinner but inadvertently omitted lunch, contributing to the delays.

Plan Of Correction

Boca Circle Rehabilitation Center failed to follow their posted scheduled meal time for tray delivery. **Actions Taken:** 1) Residents residing in the facility have the potential to be affected by the alleged deficient practice. The facility has reviewed and readjusted mealtimes. Updated postings have been made available to residents and visitors. A resident council meeting was held on the updated posting of mealtimes. **Others Identified:** 2) A facility audit was conducted by the Certified Dietary Manager to ensure the residents' meals were delivered timely. **Measures Taken:** 3) Dietary Staff were in-serviced by the CDM on the components of this regulation with an emphasis on ensuring the meals are delivered as per the posted mealtimes. Newly hired dietary staff will receive this education during general orientation. **Ongoing Monitoring:** 4) The Dietary Manager/Designee will conduct audits to verify that the meal delivery follows the posted meal delivery times 3x weekly for 4 weeks, and then weekly for 4 weeks, and every 2 weeks for 1 month. Audit results will be reviewed in the Center QAPI meeting until substantial compliance has been met.

Penalty

Fine: $48,825

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure the proper disposal of garbage and refuse in a sanitary manner, as observed during a survey. The facility's policy, dated August 2017, mandates that all garbage and refuse be collected and disposed of safely and efficiently, with coordination between the Dining Service Director and the Director of Maintenance to maintain cleanliness around the exterior dumpster area. However, during an observation, a large blue metal construction dumpster was found to contain garbage bags and multiple food boxes, emitting a foul smell and attracting insects. The maintenance director acknowledged that he had repeatedly informed the kitchen staff that the construction dumpster was designated solely for construction waste and not for kitchen garbage, which could attract rodents and insects. Despite his efforts, the issue persisted, and he noted that he was not present at the facility 24/7 to enforce compliance. The facility's Administrator was informed of these findings during an interview.

Plan Of Correction

Boca Circle Rehabilitation Center failed to ensure disposal of garbage and refuse in a sanitary manner. Actions Taken: 1) On the Director of Dietary corrected the deficient practice to ensure disposal of garbage and refuse was done in a sanitary manner. Others Identified: 2) The construction dumpster is set to be removed on . The garbage and refuse identified were disposed of in a sanitary manner on by the CDM. Measures Taken: 3) Dietary and Maintenance staff were re-educated on by Ellie Schutt, LNHA on ensuring disposal of garbage and refuse in a sanitary manner. Newly hired dietary and maintenance staff will receive this education during general orientation. Ongoing Monitoring: 4) The Dietary Manager/Designee will conduct audits 3x weekly to verify appropriate disposal of garbage and refuse x 4 weeks, then weekly x 4 weeks, and then every 2 weeks x 1 month. Audit results will be reviewed in Center QAPI meeting until substantial compliance has been met.

Penalty

Fine: $48,825

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to adhere to proper hand hygiene protocols during medication administration and respiratory treatments for two residents. One resident, who was cognitively intact and diagnosed with Chronic Obstructive Pulmonary Disease, was observed receiving respiratory treatment via nebulizer without the staff performing hand hygiene before or after handling the nebulizer mask and medications. The staff member acknowledged the lapse in hand hygiene during the medication administration process. Another resident, with diagnoses including Cerebral Infarction and Major Depressive Disorder, was observed receiving medication from a nurse who directly touched oral capsules and pills with gloved hands instead of using a cap to transfer them to a medication cup. The nurse acknowledged the improper handling of medications, and the Director of Nursing confirmed that the medications should not have been touched directly with gloved hands. Additionally, the facility did not follow sanitary procedures during the disconnection of dialysis treatment for a resident with End Stage Renal Disease. The staff member performing the disconnection touched a hand sanitizing bottle and then proceeded to disconnect the dialysis access site without changing gloves or performing hand hygiene again. This failure to maintain proper infection control practices was acknowledged by the staff involved.

Plan Of Correction

Boca Circle Rehabilitation Center failed to properly follow hygiene protocol and handle medications in a sanitary manner. Disconnecting treatment in an unsanitary manner. Actions Taken: 1) Residents #90 no longer resides at the center. Resident #101 was seen by MD on and remains at baseline without signs or symptoms of. Resident #79 was seen by MD on and remains at baseline without signs or symptoms of. Staff C, LPN/Unit manager, was reeducated on by hygiene protocol during treatments. Staff D, RN, was reeducated on by DON/Designee on handling medications in a sanitary manner while dispensing medications. Staff M, patient care tech, was reeducated on by Karen Castelloni, to follow sanitary procedures for disconnecting treatment. Others Identified: 2) A full house audit of nurses doing medication administration and performing hygiene was initiated by the DON/Designee on. Any concerns identified were immediately addressed. DON/Designee conducted an audit on of the treatment being disconnected. No concerns noted. Measures Taken: 3) License Nurses were reeducated on by DON/Designee on the components of this regulation with an emphasis on appropriate and frequent hygiene during medication administration, handling medications in a sanitary manner, and proper hygiene protocol during treatments. Staff were reeducated on disconnecting the treatment in a sanitary manner by Karen Castelloni. Newly hired licensed nurses and staff will receive this education during general orientation. Ongoing Monitoring: 4) The Director of Nursing/Designee will conduct audits to verify appropriate hygiene during medication administration, handling medications in a sanitary manner, and proper hygiene protocol during treatments and staff disconnecting the treatment in a sanitary manner 3x weekly times x 4 weeks, and then weekly x 4 weeks and then every 2 weeks x 1 month. Audit results will be reviewed in Center QAPI meeting until substantial compliance has been met. F 880

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to treat a resident with dignity and provide personal privacy, as observed during the survey process. The resident, who was admitted with multiple diagnoses and was fully dependent on assistance for mobility, was seen lying on her bed without underwear or a blanket, with the door open, on two separate occasions. During an interview, a Certified Nurse Assistant (CNA) acknowledged the importance of maintaining residents' dignity and privacy, stating that doors should be closed when providing care and that residents should always wear underwear, especially if they are not fully clothed.

Plan Of Correction

Boca Circle Rehabilitation Center failed to treat the resident in a dignified manner and provide personal privacy. **Actions Taken:** 1) On resident #108 was provided with personal privacy during personal care by the C.N.A. Education was initiated on with staff regarding providing dignity and privacy for residents during personal cares. **Others Identified:** 2) Full house audit was conducted by the DON/Designee on to ensure privacy was being provided during personal care. No other concerns were noted. **Measures Taken:** 3) Nursing Staff were re-educated on regarding regarding resident rights, dignity and privacy during personal cares and that privacy curtains must be pulled and the door closed so residents are treated in a dignified manner. New staff will receive this education during general orientation. **Ongoing Monitoring:** 4) Unit Manager or designee will audit personal care and resident right to privacy during personal cares weekly x 4 weeks, and then every 2 weeks x 2 months. Audit results will be reviewed in Center QAPI meeting monthly until substantial compliance has been met.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain its commercial cooking facility in accordance with NFPA 101 standards. During a fire safety tour, it was observed that the seams of the kitchen's commercial cooking hood suppression system were not sealed or made greasetight. This deficiency was identified during an inspection conducted on February 4, 2025, at 11:09 AM, with the Maintenance Director present. The Maintenance Director acknowledged the findings during an interview conducted concurrently with the observations. The issue was further reviewed with the Administrator, the Regional Maintenance Director, and the Maintenance Director during the exit conference on the same day at 2:40 PM. The report cites specific sections of NFPA 96 and NFPA 101 that were not adhered to, indicating a failure to comply with the required fire safety standards for commercial cooking operations.

Plan Of Correction

Corrective Actions The facility's kitchen hood seams were sealed to ensure that the kitchen hood was grease tight on 2/5/2025. Identification of Others Potentially Affected The facility only has one kitchen hood, so no further evaluations are needed. Systemic Changes The Maintenance Director, or designee, will continue to perform documented monthly inspections of the facility's kitchen hood to ensure the kitchen hood seams remain sealed and grease tight on an ongoing basis as part of the facility's life safety program. Quality Assurance Results of the monthly kitchen hood inspections will be presented at the monthly QA meetings for 3 months. If substantial compliance is not met after 3 months, results of the ongoing monthly inspections will be brought to QA meetings until substantial compliance is met.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain and test their Essential Electrical System in accordance with NFPA 99 standards. During a record review conducted on February 4, 2025, it was identified that there was no documentation available for weekly voltage checks for two generator batteries. Additionally, there was no documentation for monthly sealed battery conductance tests for these same batteries. This lack of documentation indicates that the facility did not perform the required maintenance and testing procedures for their generator batteries. The Regional Director of Maintenance was present during the record review and acknowledged the findings. The absence of these critical maintenance records suggests a failure to adhere to the necessary protocols for ensuring the reliability and safety of the facility's emergency power systems. This deficiency was noted as a violation of the NFPA 99 and NFPA 110 standards, which are essential for maintaining the operational readiness of the facility's electrical systems.

Plan Of Correction

Corrective Actions The following actions occurred on 2/17/2025: A. The weekly generator inspection form was updated to include a battery voltage reading for both generator batteries. B. The monthly generator inspection form was updated to include a battery conductance reading for both generator batteries. Identification of Others Potentially Affected Both facility generator batteries were accounted for, so no further evaluation was needed. Systemic Changes The Maintenance Director, or designee, will continue to perform documented weekly generator inspections to include documentation of the battery voltage, and monthly generator testing to include documentation of the battery conductance testing, on an ongoing basis as part of the facility's life safety program. Quality Assurance Results of the weekly inspections and monthly battery testing will be presented at the monthly QA meetings for 3 months. If substantial compliance is not met after 3 months, monthly inspections will continue, and results will be brought to QA meetings until substantial compliance is met.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain egress doors equipped with delayed egress locking arrangements in accordance with NFPA 101 standards. During a fire safety tour, it was observed that several egress doors were not compliant. Specifically, the 500 Hallway Lobby double exit doors and the Main Lobby double interior egress doors were missing the required signage on both leaves. Additionally, the Main Lobby double-interior-egress doors were missing signage from the left leaf. Furthermore, the Therapy Lobby double exit doors, which were equipped with 30-second delayed egress locks, failed to open when tested. These observations were made in the presence of the Maintenance Director, who acknowledged the findings. The issues were subsequently reviewed with the Administrator, the Regional Maintenance Director, and the Maintenance Director during an exit conference.

Plan Of Correction

Corrective Actions 1. The following egress doors had signage added to indicate the presence of a 30 second delayed egress locking arrangement on 2/5/2025. A. 500 Hallway Lobby double exit doors. (30 second Delay Signage) B. Main Lobby double interior egress doors. (15 second Delay Signage) C. Main Lobby double interior egress doors, left leaf. (15 second Delay Signage) 2. The Therapy Lobby double exit doors were evaluated and made to function properly when the delayed egress locking arrangement was initiated on 2/5/2025. Identification of Others Potentially Affected The Maintenance Director, or designee, performed a facility-wide assessment of the other egress doors to ensure the following: 1. Doors with a delayed egress locking arrangement had the correct signage. 2. Doors with a delayed egress locking arrangement functioned properly. Systemic Changes The Maintenance Director, or designee, will continue to perform documented monthly inspections of all egress doors with a delayed egress locking arrangement to ensure the correct signage is in place, and to ensure the doors properly function, on an ongoing basis as part of the facility's life safety program. Quality Assurance Results of the monthly egress door inspections will be presented at the monthly QA meetings for 3 months. If substantial compliance is not met after 3 months, results of the ongoing monthly inspections will be brought to QA meetings until substantial compliance is met.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain the integrity of their fire/smoke barrier construction as required by NFPA 101 standards. During a fire safety tour conducted on February 4, 2025, with the Regional Maintenance Director and the Maintenance Director, it was observed that there were penetrations through both sides of the 1-hour smoke wall in two different hallways. Specifically, at 11:58 AM, a penetration was found above the ceiling of the double fire-rated doors in the 100 Hallway. Similarly, at 12:10 PM, another penetration was identified above the ceiling of the double smoke doors in the 300 Hallway. These penetrations compromise the fire resistance rating of the smoke barriers, which are crucial for restricting the movement of fire and smoke within the facility. The Maintenance Director acknowledged these findings during the observations. The issue was further discussed with the Administrator, the Regional Maintenance Director, and the Maintenance Director during the exit conference held on the same day at 2:40 PM. The report emphasizes that these examples are not exhaustive, suggesting that a thorough inspection of each barrier should be conducted to ensure all penetrations are identified and properly sealed. The penetrations in fire-rated barriers must be sealed with a UL-listed approved system to restore the wall, ceiling, or floor to its original fire or smoke-rated integrity, ensuring the safety of the facility's occupants in the event of a fire emergency.

Plan Of Correction

Corrective Actions The following locations had penetrations sealed with fire stopping on 2/5/2025: A. 100 Hallway smoke barrier. B. 300 Hallway smoke barrier. Identification of Others Potentially Affected The Maintenance Director, or designee, performed a facility-wide assessment of the other fire and smoke barriers to ensure all penetrations are sealed with fire stopping. Systemic Changes The Maintenance Director, or designee, will perform monthly inspections X 3 months of the fire and smoke barriers to ensure all penetrations are sealed with fire stopping. Inspections will continue semi-annually thereafter on an ongoing basis as part of the facility's life safety program. Quality Assurance Results of the monthly fire and smoke barrier inspections will be presented at the monthly QA meetings X 3 months. If substantial compliance is not met after 3 months, monthly inspections will continue, and results will be brought to QA meetings until substantial compliance is met.