Pearl at Fort Lauderdale Rehabilitation and Nursin

Inspectors wroteBased on observations and interviews, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety, sanitary conditions, and to ensure the prevention of foodborne illnesses for 187 of 196 residents.

Inspectors wroteBased on observations, interview and record review, the facility's Quality Assurance and Performance Improvement Activities (QAPI/QAA) failed to demonstrate that an effective plan of actions was implemented to correct identified quality deficiencies in the problem area as evidenced by repeated deficient practices for F550, Resident Rights / Exercise of Rights; F692, Nutrition / Hydration Status Maintenance; F755, Pharmacy Services / Procedures / Pharmacist / Record; F809, Frequency of Meals / Snacks at Bedtime; and F880, Infection Prevention and Control. These repeated deficient practices have the potential to affect all 196 residents residing in the facility at the time of this survey.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to treat residents in a dignified manner for 5 of 5 sampled residents observed during dining observations, Resident #48, Resident #38, Resident #311, Resident #115, and Resident #67, as evidenced by calling residents 'feeders' and staff standing to feed residents.

Inspectors wroteBased on record review, observations and interviews, the facility failed to accurately complete the Minimum Data Set (MDS) assessments related to medications and diagnosis for 3 of 5 sampled resident reviewed for unnecessary medications, Resident #77, Resident #167, and Resident #168.

Inspectors wrote4. Review of Resident #77's clinical record documented an admission on [DATE] with no readmissions. The resident diagnoses included Tobacco Use, Cognitive Communication Deficit, Nicotine Dependence, Persistent Mood Disorders, Generalized Anxiety Disorder, and Unspecified Dementia. Review of Resident #77's MDS quarterly assessment dated [DATE] documented a BIMS score of 14 indicating the resident had no cognition impairment. Review of Resident #77's clinical record documented the Smoking assessment was conducted in for July, August and November 2024. . Review of a physician order dated 08/20/24 documented, Nicotine Patch 24 Hour 7 MG (milligrams) 24HR (hour). Apply 1 patch transdermally one time a day for Smoking Cessation and remove per schedule. Review of Resident #77's active care plan, titled, Resident has history smoking, initiated and updated on 11/20/24. [...]

Inspectors wrote2. Review of the facility policy and procedure, titled, Activities of Daily Living (ADL), provided by the Director of Nursing (DON) published 09/26/24, documented in the Policy Statement: Residents will be provided with care, treatment and services as appropriate to maintain or improve their ability to carry out activities of daily (ADLs). Residents who are unable to carry out activities of daily (ADLs) independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene .2. Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: a. hygiene (bathing, dressing, grooming and oral care); .6. [...]

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure appropriate urinary catheter care for 1 of 1 sampled resident reviewed for urinary catheter care, Resident #102.

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure that the facility's scales were calibrated for accuracy and failed to ensure that nutritional supplements were provided in a timely manner for 2 of 10 sampled residents reviewed for nutrition, Resident #100 and Resident #311.

Inspectors wroteBased on review of policies and procedures, observation, record review and interview, the facility failed to obtain a current specified physician's order to address the care and maintenance of an Intravenous (IV) / Peripherally Inserted Central Catheter (PICC) line and to label and date the resident's PICC line site dressing for 3 of 3 sampled residents observed, Resident #308, Resident #185 and Resident #198.

Inspectors wroteBased on review of policy and procedure, observation, record review and interview, the facility failed to ensure that it obtained current physician's orders for Oxygen therapy administration for 1 of 6 sampled residents observed receiving continuous Oxygen on the South wing, Resident #309; and failed to monitor residents receiving Nebulizer treatments, according to standards of care, for 1 of 1 sampled resident, Resident #120.

Inspectors wroteBased on observations, interview and record review, the facility failed to follow physicians' orders for fluid restrictions for 2 of 2 sampled residents reviewed for dialysis, Resident #123 and Resident #89.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure controlled substance medication reconciliations were accurate for 4 of 12 sampled residents reviewed during the controlled substance record review, Residents #14, #168, #186, and #201.

Inspectors wroteBased on record review, observations and interviews, the facility failed to ensure residents' medication regimen (psychotropic's, antipsychotic, antiplatelet and hypoglycemic medications) were monitored appropriately as evidenced of the lack of written documentation of medication side effects, medication efficacy and behavior that were being monitored for 5 of 5 sampled residents, Resident #77, #86, #167, and #145, for unnecessary medications, and for 1 of 1 sampled resident, Resident #73, reviewed for Mood / Behavior.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to store residents glucometers in a sanitary manner; failed to securely lock the North wing medication storage door, and failed to secure medications at the bedsides for 1 resident, Resident #407. The resident census at the time of survey was 196.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to follow their menu for the regular diet during 1 of 2 observations in the main kitchen. This has the potential to affect 117 residents on a regular diet. The census at the time of survey was 196.

Inspectors wroteBased on observations, review and record review, the facility failed to provide food in a form designed to meet individual needs for the Pureed diet consistency for 2 of 2 sampled residents observed during dining, Resident #22 and Resident #48. This has the potential to affect 17 residents on a Pureed diet.

Inspectors wrote3. Review of the facility policy and procedure, titled, Resident Food Preferences, provided by the Director of Nursing (DON) published 03/13/23, documented in the Policy Statement: Individual food preferences will be assessed upon admission and communicated to the interdisciplinary team. Modifications to diet will only be ordered with the resident's or representative's consent Policy Interpretation and Implementation: 1. Upon the resident's admission (or within twenty-four (24) hours after his/her admission) the dietician or nursing staff will identify a resident's food preferences. 2. When possible, staff will interview the resident directly to determine current food preferences based on history and life patterns related to food and mealtimes. 3. Nursing staff will document the resident's food and eating preferences in the care plan. 4. [...]

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to meet professional standards and ensure that Hospice documentation was readily available for 1 of 1 sampled resident reviewed for Hospice, Resident #59.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to follow the Enhanced Barrier Precautions (EBP) guidelines for 4 of 4 sampled residents reviewed for EBP, Resident #26, Resident #465, Resident #139, and Resident #460; failed to ensure employees kept fingernails trimmed as per facility's policy; and failed to keep a nebulizer mask stored in a sanitary manner.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that the baseline care plans were completed within 48 hours for 3 of 5 sampled residents, Resident #36, Resident #508 and Resident #189.

Inspectors wroteBased on observations and an interview, the facility failed to ensure that a nourishing snack was served to residents as required when the time lapse between the dinner and the breakfast meals was greater than 14 hours. This was observed for 1 of 1 sampled resident during observations, Resident #121. It had the potential to affect 22 of 24 residents on oral diets in the wing of rooms that included rooms 201A through 212 B.

Inspectors wroteBased on observation, interviews, record and policy review, the facility failed to identify and treat a wound in a timely manner for 1 of 1 sampled resident, reviewed for diabetic wounds, Resident #148.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to prevent a significant weight loss of 8.33% and failed to provide nutritional intervention in a timely manner for 1 of 1 sampled resident reviewed for tube feeding, Resident #522.

Inspectors wroteBased on observations, interviews, and record review, the facility's staff failed to encourage and ensure that residents practiced hand hygiene before eating meals for 5 of 5 sampled residents observed during mealtimes, Resident #127, Resident #123, Resident #133, Resident #138, and Resident #39. This had the potential to affect 49 residents that are on the 300 unit. The facility also failed to follow proper infection control standards during medication administration observation for 2 of 7 sampled residents, Resident #15 and Resident #9.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to conduct proper admission, readmission, and quarterly smoking assessments for 10 of 10 sampled residents, reviewed for smoking safety, and as identified by the facility as smokers.

Inspectors wroteBased on review of policy and procedure, observation, interview and record review, the facility failed to maintain residents' privacy in a dignified manner for 3 of 5 sampled residents observed, Resident #130, Resident #268 and Resident #267.

Inspectors wroteBased on interviews and record reviews, the facility failed to transmit Resident Assessments in a timely manner for 20 of 24 sampled residents reviewed for Minimum Data Set (MDS) discrepancies, Residents #142, 143, 26, 120, 13, 20, 65, 136, 118, 140, 135, 95, 63, 117, 77, 67, 92, 48, 51 and 146.

Inspectors wroteBased on review of policy and procedure, observation, interview and record review, the facility failed to ensure proper usage and documentation of hand splints for 1 of 2 sampled residents reviewed for hand splints, Resident #265.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide nutritional interventions in a timely manner for 2 of 6 sampled residents, reviewed for nutrition, Resident #365 and Resident #340.

Inspectors wroteBased on records review, observations and interviews, the facility failed to ensure that residents medications refills were reorder in a timely manner for 3 of 7 sampled residents reviewed for medications and timeliness of administration, Resident #44, # 89, and #434.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that PRN (as needed) physician orders for psychotropic drugs are limited to 14 days for 1 of 5 sampled residents for unnecessary medication (Resident #144).

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide the correct fluid consistency for 1 of 6 sampled residents reviewed for nutrition, Resident #63.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure that a nourishing snack was available at bedtime if more than 14 hours passed between the evening and breakfast meals. This was observed for 3 of 3 sampled residents during dining observations, Resident #138, Resident #39 and Resident #92. It had the potential to affect 33 residents who resided on the 300 Unit, of the census of 181 residents.

Inspectors wroteBased on observation, staff interview and record review, the facility failed to perform appropriate nutrition monitoring on a resident with oral intake; failed to re-assess by monitoring weights per facility policy; and failed to address or prevent the resident's avoidable significant severe, weight loss of 36 percent for 1 of 6 sampled residents reviewed for nutritional risk (Residents #78).

Inspectors wroteBased on observations, interviews and record review, the facility failed to monitor and follow the care plan for eating assistance for 1 out of 28 sampled Residents (Resident #2).

Inspectors wroteBased on observation, interview and record review, the facility failed to order, receive and administer pain medications for 1 of 2 sampled residents reviewed for pain management (Resident #49).

Inspectors wroteBased on observation, interviews, record review and policy review; the facility failed to remove narcotics from 2 of 8 medication carts for 3 of 3 sampled residents who did not have current orders for the narcotics, Resident #84, #135 and #438.

Inspectors wroteBased on interviews and record review, the facility failed to ensure that a psychotropic (drugs that affect a person's mental state) medication ordered by the practitioner were necessary and the resident's representative was aware and involved in the decision for 1 of 5 sampled residents reviewed for unnecessary medications (Resident #110).

Inspectors wroteBased on observations, interviews and record review, the facility failed to secure medications for 1 of 1 sampled residents (Resident #190) identified in the north wing.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to follow physician's orders for 3 of 3 sampled resident reviewed for nutrition, therapeutic diets (mechanical soft) for Residents #110, #51, and #34.

Inspectors wroteBased on observation, record review and interviews; the facility failed to carry out a physician's order for blood testing for 1 of 5 sampled residents reviewed for unnecessary medications (Resident #11).