Manorcare Health Services

F-F584 during the Recertification and Relicensure survey with exit dates of 04/2019, 01/2021, 01/2022 and 04/19/23.

F-F812 was cited during the Recertification and Relicensure survey with exit dates of 1/2021, 01/2022, 04/19/23.

During an interview with the facility's Administrator on 07/18/24 at 2:30 PM, the Administrator was apprised that these 2 deficiencies will be cited again on this current survey. The Administrator stated he will be working to remedy this.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 26 of 28 105481 Department of Health & Human Services Printed: 09/17/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105481 B. Wing 07/18/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Boca Del Mar Nursing and Rehab Center 375 NW 51st Street Boca Raton, FL 33431

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)

F 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 39142 potential for actual harm Based on interview, record review, and observation, the facility failed to provide laundry services in a safe Residents Affected - Some and sanitary manner and failed to appropriately use Personal Protection Equipment (PPE) as related to care provided to residents on Enhanced Barrier Precautions for 2 of 2 residents, Resident #40, and Resident #72, observed for Enhanced Barrier Precautions. There were 28 residents on Enhanced Barrier Precautions at

the time of the survey.

The findings included:

The policy statement for the policy titled, Laundry dated March 2022, states: Linens are handled, stored, processed, and transported in such a manner as to prevent the spread of infection and provide infection free laundry for residents. Staff should be familiar with the recommended equipment, application of supplies, equipment maintenance, and sound safety practices.

The facility's policy titled, Infection Prevention and Control dated November 2019, revealed Enhanced Barrier Precautions expand the use of PPE (personal protective equipment) beyond situations in which exposure to blood and body fluids is anticipated and refer to the use of gown and gloves during high contact resident care activities High-contact resident care activities .device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator

1) On 07/16/24 at 2:25P, a tour of the facility's laundry room was conducted with the Administrator and Regional Maintenance Director (RMD) attending. On the way to the laundry room an observation was made of the laundry chute room. In the laundry chute room it was noted that there were two bags of laundry on the floor. The laundry bin was overfull, which indicated the two bags had fallen from the bin. This caused an opportunity for cross contamination of laundry. In the laundry room on the dirty laundry side, an observation was made of a large, lidded bin where the lid was askew. The bin was full of dirty laundry, some of which was un-bagged. Laundry bins are supposed to be closed with a lid or covered with a non-permeable cover to prevent cross-contamination. In the clean laundry area an observation was made of three of three yellow, open topped, laundry bins where there was debris and dirt on the bottom of the bins. According to the RMD,

these bins were used to transport clean laundry to the folding area. The dirt and debris would have caused cross contamination to clean laundry if the staff had proceeded to use the bins without cleaning them. The RMD had the staff clean the bins immediately.

The RMD and Administrator both agreed that the observations made constituted infection control issues.

Photographic evidence acquired.

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2) Review of Resident #72's clinical record documented an admission on 12/01/18 and a readmission on 12/03/20. The resident's diagnoses included Cerebral Infarction, Hemiplegia, Diabetes Mellitus and Aphasia.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 27 of 28 105481 Department of Health & Human Services Printed: 09/17/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105481 B. Wing 07/18/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Boca Del Mar Nursing and Rehab Center 375 NW 51st Street Boca Raton, FL 33431

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)

F 0880 Review of Resident #72's physician order date 12/04/20 documented NPO (nothing by mouth) diet.

Level of Harm - Minimal harm or On 07/16/24 at 9:30 AM, medication administration via a PEG (tube feeding) observation for Resident #72 potential for actual harm performed by Staff M, RN was conducted. Staff M stated Resident #72 had a PEG tube and he had to crush all medications to be administered via the PEG tube. Observation revealed Staff M crushed the resident's Residents Affected - Some Amlodipine, B-12 vitamin and Senna tablets. Staff M stated he will put gloves on and open the probiotic capsule.

On 07/16/24 at 9:44 AM, Staff M entered Resident #72's room, without hand sanitation, donned gloves, opened the probiotic capsule and pour into a cup, pushed buttons on the feeding pump to flush the tube with water, repositioned the bed, poured water into the medications cups, retrieved the feeding tube syringe, and without donning a gown, connected the syringe to the PEG tube, checked for residual (0),then administered

the medication via PEG without wearing a gown (barrier). Observation revealed a sign by the bathroom door titled, Enhanced Barrier Precautions.

On 07/16/24 at 10:02 AM, during an interview, Staff M, was asked when they would wear a gown with Resident #72 and replied when they were doing care. Staff M was asked to review the Enhanced Barrier Precautions sign posted by the resident's bathroom door. Staff M stated he was supposed to wear a gown while he was administering the residents medication via PEG tube and he did not.

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3) Resident #40 was admitted to the facility on [DATE REDACTED] with diagnoses that included Parkinson's disease, Chronic kidney disease, Other obstructive and reflux uropathy, Dementia, Bipolar disease and Schizophrenia. The resident's Brief interview for mental status (BIMS) score was 8 on the admission Minimum Data Set (MDS) with an assessment reference date of 05/24/24. This indicated the resident had mild cognitive impairment.

An observation of Foley catheter care was conducted with Staff E, Certified Nursing Assistant (CNA), on 07/17/24 at 1:30 PM. The enhanced barrier sign was visible on the bathroom door of the resident's room. Staff E performed Foley care wearing gloves but not wearing a gown per the enhanced barrier precaution policy. The surveyor asked Staff E if she was aware what enhanced barrier precautions meant and she stated she did. Reviewed with Staff E that she did not wear a gown during Foley care and she stated she did not see the sign. Reviewed with Staff E that even though she did not see a sign she should be aware that while doing Foley care she should have a gown and gloves on. Staff E acknowledged that this was correct.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 28 of 28 105481