Royal Palm Beach Health and Rehabilitation Center

Inspectors wrote3. Record review revealed Resident #1 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident had mild cognitive impairment and requires partial / moderate assistance with activities of daily living (ADLs). The assessment documented the resident had an indwelling catheter. Resident #1 was care planned for at risk for infections related to urinary catheter dependence related to diagnosis of obstructive uropathy. Interventions included enhanced barrier precautions (EBP) and catheter care every shift. An observation of catheter care was conducted on 05/21/25 at 12:20 PM with Staff J and Staff Q, Certified Nurse Assistants. Staff J and Staff Q were waiting in Resident #1's room to perform catheter care. The surveyor entered the resident's room for observation, and Staff J and Staff Q commenced to perform catheter care. [...]

Inspectors wrote2. Review of the facility's policy, Unnecessary Drugs - Without Adequate Indication for Use, with a reference date of 11/2020 and a revision date of 08/02/22, documented: It is the facility's policy that each resident's drug regimen is managed and monitored to promote or maintain the resident's highest practicable mental, physical and psychosocial well-being free from unnecessary drugs. Policy Explanation and Compliance Guidelines: 1. The indications for initiating, withdrawing, or withholding medications(s), as well as the use of non-pharmacological approaches, will be determined by assessing the resident's underlying condition, current signs, symptoms, expressions, preferences, and goals for treatment including identification of underlying causes (when possible). 7. [...]

Inspectors wroteBased on record review and interview, the facility failed to obtain wound culture results in a timely manner for 1 of 28 sampled residents, Resident #12; and failed to administer medications in a timely manner for 1 of 28 sampled residents, Resident #92.

Inspectors wroteBased on observation, interview, and record review, the facility failed to obtain a urology consult in a timely manner and failed to obtain a urine culture in a timely manner for 1 of 2 sampled residents for catheter use, Resident #1.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to obtain a physician's order for CPAP (Continuous Positive Airway Pressure), and failed to develop and implement a care plan for CPAP for 1 of 1 sampled resident, Resident #304.

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure residents did not use full side rails who were not properly assessed for the use of side rails and consent for side rails had been declined for 1 of 52 sampled residents with side rails, Resident #45.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure behavior monitoring for 3 of 5 sampled residents reviewed for unnecessary medications, Residents #34, 76, 14.

Inspectors wroteBased on observations, interviews and record review, the facility failed to provide adaptive equipment for each drink offered to residents who need them when consuming drinks for 1 of 9 residents with orders for adaptive equipment, Resident #19.

Inspectors wroteBased on record review, interview and observations, the facility failed to ensure each toilet was adequately equipped to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area for 1 of 68 resident bathrooms room, room [ROOM NUMBER].

Inspectors wroteBased on observation and interview, the facility failed to provide palatable, attractive, and appetizing meals to ensure residents' satisfaction, as evidenced by sampling of a test tray and 9 of 30 sampled residents voiced concerns regarding the quality of the food, Residents #4, #5, #37, #78, #74, #57, #9, #45, and #65.

Inspectors wroteBased on record review and interview, the facility failed to ensure accurate Minimum Data Set (MDS) comprehensive assessments for 3 of 30 sampled residents, Resident #25, #95, and #96.

Inspectors wroteBased on record review and interview, the facility failed to initiate a level II PASARR assessment for 1 of 5 sampled residents reviewed for psychotropic medications, Resident #2.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a specialty air mattress, provide appropriate wound care and ensure adequate pain medication prior to wound care for 1 of 1 sampled resident, Resident #8, who had a facility acquired pressure ulcer.

Inspectors wroteBased on observation, interview, and record review, the facility failed to obtain a urology consult for a resident with frequent Urinary Tract Infections in a timely manner for 1 of 3 sampled residents reviewed for activities of daily living (ADLs), Resident #17; failed to assess a resident for catheter removal in a timely manner for 1 of 3 sampled residents reviewed for catheters, Resident #77; failed to ensure proper peri and Foley (indwelling urinary catheter) care for 1 of 3 sampled residents reviewed for catheters, Resident #148; and failed to ensure complete administration of ordered antibiotics for 2 of 2 sampled residents reviewed for infection, Residents #148 and #149.

Inspectors wroteBased on observation, interview, and review of menus and recipes, the facility failed to provide a sufficient amount of protein for 1 of 1 meal specifically reviewed for portion sizes (the lunch meal on 02/08/24).

Inspectors wroteBased on interviews, observations and record reviews, the facility failed to provide individual closet space for 1 of 1 sampled resident, Resident #347, whose room lacked an individual closet space with clothes racks and shelves, accessible to the resident.

Inspectors wroteBased on observation, record review and interview, the facility failed to provide a safe, clean comfortable homelike environment for 3 of 3 units observed.

Inspectors wroteBased on interview, record review and policy review, the facility failed to report an alleged resident to resident act of aggression for 1 of 1 sampled resident reviewed for abuse (Resident #22).

Inspectors wroteBased on interview and record review, the facility failed to initiate a Level I PASRR and refer appropriately for a Level II PASRR upon the development of behaviors and aggression for 1 of 1 sampled resident (Resident #22).

Inspectors wroteBased on record review and interview, the facility failed to complete a baseline care plan for 2 of 30 sampled residents reviewed, Resident #20 and #25.

Inspectors wroteBased on interview and record review, the facility failed to conduct care plan conferences for 2 of 30 sampled residents reviewed for care plan conferences, Resident #25 and #42. The fndings included: 1. Record review for Resident #25 revealed an admission to the facility on [DATE]. The resident's Brief Interview for Mental Status (BIMS) was 15, indicitvie of an intact cognition. The pertinent diagnosies included Atherosclerotic Heart Disease. Further record review revealed there was no evidence that the resident had attended a care plan conference. On 09/20/22 at 11:09: 00AM, an interview was conducted with Resident #25 who stated she had not attended a care plan conference / meeting since she was admitted . 2. Record review of Resident #42's EMR and paper chart revealed an adnission on 04/27/22. The resident BIMS was documented as 15, indicating intact cognition. [...]

Inspectors wroteBased on observation, interview, policy review and record review, the facility failed to secure indwelling catheter for 1 of 1 sampled resident reviewed for catheters, Resident #1; failed to monitor and address critical lab results for 1 of 1 sampled resident for critical lab reviews, Resident #62; failed to provide care and services, including assessments post injury, for 1 of 1 sampled residents reviewed for injury of unknown origin, Resident #26; and failed to order a repeat MRI for 1 of 1 sampled resident reviewed for ordered diagnostics testing, Resident #75.

Inspectors wroteBased on observation, interview, record review and policy review, the facility failed to ensure documentation of informed consent, entrapment assessment, benefit of use, failed alternatives, and mattress compatibility prior to installation and use of side rails for three of three sampled residents observed (Resident #1, #26 and #237).

Inspectors wroteBased on observations, record review and interview, the facility failed to provide behavioral monitoring for residents on antipsychotics for 2 of 6 sampled residents, Resident #10 and Resident #65; and failed to monitor side effects and administer medication in a timely manner for Resident #65.

Inspectors wroteBased on interview record review and interview, the facility failed to follow the dietitian signed menus for 4 of 6 sampled residents reviewed for food concerns, Residents #14, #25, #35 and #42.

Inspectors wroteBased on record review and interview, the facility failed to maintain accurate resident records for 2 of 6 sampled residents, Resident #65 and Resident #79.

Inspectors wroteBased on observation and interview, the facility failed to maintain a pest free environment for 2 of 2 sampled residents, Residents #6 and #57.

Inspectors wroteBased on interview and record review, the facility failed to notify residents' representatives and family members of new positive Covid-19 cases in a timely manner.