Nspire Healthcare Miami Lakes

F-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.

The findings included:

Review of the facility policy and procedure titled Quality Assurance Performance Improvement Program (QAPI) revision date 10/24/22 states: The center and organization have a comprehensive, data driven Quality Assurance Performance Improvement Program that focuses on indicators of the outcomes of care and quality of life.

Procedures:

Identifying quality deficiencies and Corrective Action:

The center will review department system data.

If a quality deficiency is identified, the committee will oversee the development of corrective actions

The center may choose the method of corrective action i.e. Plan, Do, Study, Act or Performance Improvement Project.

Review of the Quality Assurance and Performance Improvement (QAPI) Committee Meeting Sign-in Sheets dated 06/2024,07/2024, and 08/2024 documented the facility had a QAA Committee meetings monthly. Attendees included: Administrator, Medical Director, Director of Nursing (DON), Assistant Director of Nursing (ADON), Infection Control Preventionist/Risk Manager, Dietary Manager, Clinical Dietician, Director of Housekeeping, Director of Maintenance, Director of therapy, Director of Human resources, Director of admissions, Director of Business office, Director of Social Services, Director of Activities, MDS (Minimum Data Set) Coordinator, and Discharge Planner.

Interview on 08/29/24 at2:20 PM with the Administrator/QA, Stated, the QAA Committee meets every month

on the last Thursday of the month, the last meeting was held in the month of 08//2024. The committee consists of the Medical Director, Administrator, Director of Nursing (DON), Assistant Director of Nursing (ADON), Infection Preventionist and all interdisciplinary team members. The purpose of QAPI is to identify any potential issues or any concerns where we will need additional education to be provided to the staff. QAPI is an ongoing program, a working tool, where multiple members get together to come up with solutions for problems and issues. We review previous agendas, see what is completed, what needs to be continued, what is resolved and address any new identified issues. We have Clinical meetings daily at 9am in the morning, we review issues from the prior day, we involve family of residents in planning of care and have the patient present if they are alert and oriented.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 13 105709 Department of Health & Human Services Printed: 09/11/2025 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 105709 B. Wing 08/29/2024

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

Nspire Healthcare Miami Lakes 5725 NW 186 Street Hialeah, FL 33015

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 0908 Keep all essential equipment working safely.

Level of Harm - Minimal harm or 31581 potential for actual harm Based on observation, interview and record review, the facility failed to ensure a 1) convection oven, food Residents Affected - Few 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.

The findings included:

Record review of the facility's policy titled Maintenance (effective date 11/2014) documented: Policy-The facility's physical plant and equipment will be maintained through a program of preventive maintenance and prompt action to identify areas/items in need of repair; Procedure-The Director of Environmental Services will follow all policies regarding routine periodic maintenance and all employees will report physical plant areas or equipment in need of repair or service to their supervisor.

1) Observation of the initial kitchen tour on 8/26/24 at 7:59 AM with the Certified Dietary Manager, Senior Food Service Director revealed brown like stains on the inside and outside of the convection oven doors. Photographic evidence submitted.

On 8/26/24 at 8:00 AM, interview with the Certified Dietary Manager, Senior Food Service Director. He stated, We do a weekly clean of the oven. He confirmed the brown like stains on the inside and outside of

the convection oven doors.

Observation of the initial kitchen tour with the Certified Dietary Manager, Senior Food Service Director on 8/26/24 at 8:02 AM revealed the food steamer was not working.

Interview with Staff A, [NAME] on 8/26/24 at 8:03 AM. She stated, The steamer does not work and it keeps shutting off.

Observation of the initial kitchen tour with the Certified Dietary Manager, Senior Food Service Director on 8/26/24 at 8:05 AM revealed only one side of the gas range stove was working.

Interview with the Staff A, [NAME] on 8/26/24 at 8:06 AM. She stated, Only one side of the range is working.

2) Observation of the Unit 1 Pantry Refrigerator on 8/27/24 at 11:38 AM revealed the microwave used to warm up resident's foods was not clean, had brown, dried substances and contained brown-like rust stains in

the microwave. Photographic evidence submitted.

Observation and interview of the Unit 1 Pantry Microwave with the DON on 8/27/24 at 11:40 AM. She confirmed brown, dried substances and brown-like rust stains were in the microwave.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 13 105709