Nspire Healthcare Miami Lakes

Inspectors wroteBased on observations, interviews and record review facility failed to ensure that residents' information was kept confidential on one (Unit one,100-wing med cart) out of four med carts and on one out of 2 units as evidenced by: 1) Open unattended computer screen on the 100-wing med cart. 2) Document with residents' medical information posted on the bulletin board in front of Unit 1. There were 116 residents residing in the facility at the time of survey.

Inspectors wroteBased on observations, interviews and record review the facility failed to ensure one (Resident #109) out of two sampled residents with contractures and one (Resident # 8) out of two sampled residents receiving dialysis received treatment and care in accordance with the comprehensive person-centered care plan as evidenced by: 1)Resident #109 who has a right-hand contracture had no splint device in place. 2) The facility's staff did not administer a phosphorus binding agent in accordance with Resident #109's dialysis care plan. There were 116 residents residing in the facility at the time of survey.

Inspectors wroteBased on observations, interviews and record review the facility failed to ensure that one (Resident #109) out of two sampled residents with skin conditions and contracture received treatment and care in accordance with professional standards of practice as evidenced by a dressing on Resident#109's right lower leg that had not been changed in three days despite a physician order for dressing change every other day and no splint device in place on the residents contracted right hand. There were 116 residents residing in the facility at the time of survey.

Inspectors wroteBased on observations, interviews and record review facility failed to ensure a safe environment on two (100 and 300 wings) out of four wings as evidenced by unattended housekeeping carts containing hazardous chemicals left unlocked by housekeeping staff. There were four housekeeping carts in the facility at the time of survey

Inspectors wroteBased on observations, interviews and record review the facility failed to ensure that one (Resident #100) out of two sampled residents with an indwelling urinary catheter, tubing was properly positioned as evidenced by: observation of Resident #100's indwelling urinary tubing coiled and kinked preventing urine from flowing freely and increasing the risk for catheter-associated urinary tract infections and other serious medical issues. There were eight residents with indwelling urinary catheters residing in the facility at the time of surveyThe

Inspectors wroteBased on observations, interviews and record review the facility failed to follow infection control protocol for one (Resident #34) out of seven sampled residents as evidenced by: an observation of a toothbrush in a shared bathroom belonging to Resident #34. There were 116 residents residing in the facility at the time of survey.

Inspectors wroteBased on observations, record review and interview the facility failed to ensure food was prepared under sanitary conditions as evidenced by failure to 1) maintain equipment in the kitchen in a clean sanitary manner, 2) the Unit 2 Pantry Freezer did not contain a thermometer and 3) the Unit 1 Pantry microwave in a clean sanitary manner. This has the potential to affect one hundred and fourteen out of one hundred and fifteen residents who eat orally residing in the facility at the time of the survey.

Inspectors wroteBased on observations, record review and interviews facility failed to provide dignity for one resident (#87) out twelve residents who are assisted with meals as evidenced by an observation of staff standing while assisting Resident#87 with a meal. There were 119 residents residing in the facility at the time of survey. The Findings Included: On 8/26/24 at 8:35 AM Resident#87 was seated in the upright position in bed. Staff H, Registered Nurse (RN) was standing while assisting Resident#87 with breakfast. On 8/26/24 08:40 AM Staff H, RN stated, It is the protocol of this facility to set up the resident in the upright position and be at eye level for meals. I'm not sure if I can stand while assisting residents with meals. Also stated I have not received any in-services regarding this. Lastly stated I started in July of 2023. [...]

Inspectors wroteBased on observations, record review and interview facility failed to accurately code a Minimum Data Set (MDS) for one resident (Resident #34) out of nine sampled residents, as evidenced by hearing aids not included in Section B of the Medicare 5-day MDS with reference date of 7/8/24 despite Resident #34 using hearing aids on a daily basis.

Inspectors wroteBased on observations, interview and record review facility failed to implement care plans for two residents ( Resident #302 and Resident #252) out of nine sampled as evidenced by splinting device not applied for Resident#302 and no skin treatment done for Resident#252.

Inspectors wroteBased on observations, record review and interview the facility failed to implement precautions to prevent catheter related injuries for two residents (Resident # 352 and Resident # 21) out of the three residents with indwelling catheters residing in the facility. As evidenced by Resident # 352 and Resident #21 indwelling catheter tubing were each observed touching the floor; and failed to ensure one out of one resident (Resident #252) with a prescribed order for skin tear treatment was implemented timely. Resident # 352 On 08/28/24 at 9:37 AM Resident #352 was observed seated in her wheelchair propelling along the hallway outside he room, the indwelling urinary catheter tubing was on touching the floor self-propelling wheelchair. (Photo evidence) Review of Resident #352's admission Record indicated an admission dated 08/08/2024. Clinical Diagnoses include but not limited to: [...]

Inspectors wroteBased on observations, interview and record review, the facility's quality assurance and assessment committee failed to demonstrate an effective plan of action was implemented to correct identified quality deficiency in the problem areas related to repeated deficient practice for F641 Accuracy of Assessments. The facility was cited for F641 in 2023. This repeated deficient practice has the potential to affect any of the 115 residents residing in the facility at the time of the survey.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a 1) convection oven, food steamer and gas range stove used to prepare food for residents were in good repair and clean and 2) the Unit 1 Pantry microwave was clean. This has the potential to affect one hundred and fourteen out of one hundred and fifteen residents who eat orally residing in the facility at the time of the survey.

Inspectors wroteBased on observations, interview and record review, the facility failed to provide a safe, clean, homelike environment in one out of two nursing units for one (Resident #218 residing in room [ROOM NUMBER]-D). The facility had 107 residents at the time of the survey.

Inspectors wroteBased on record review and interview, the facility failed to accurately code the Minimum Data Set (MDS) assessment for one (Resident # 114) out of 24 residents reviewed for resident assessments. As evidenced by inaccurate coding of MDS section A, subsection A2100 for Discharge Status for Resident #114. There were 107 residents residing in the facility at the time of the survey.

Inspectors wroteBased on Record Review and Interview, the facility failed to demonstrate effective plan of actions were implemented to correct identified quality deficiencies in the problem area related to repeated deficient practices for F584 Safe/Clean/Comfortable/Homelike Environment and F641 Accuracy of Assessment. This practice has the potential to increase the risk of negative outcomes for all residents in the facility. There was a census of 107 residents residing in the facility at the time of this survey.