Medicana Nursing And Rehab Center

F-F656, (Comprehensive Resident Centered Care Plan), during the Recertification and Relicensure survey with an exit date of 09/14/23.

Review of the QAPI program with the Administrator revealed the lack of an effective corrective action plan for

the above deficiency.

During an interview with the facility's Administrator on 01/16/25 at 2:43 PM, the Administrator was apprised that this deficiency would be cited on the current survey. This was acknowledged by the Administrator.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 15 105259 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 105259 B. Wing 01/16/2025

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

Medicana Nursing and Rehab Center 1710 Lake Worth Road Lake Worth, FL 33460

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** 36734 potential for actual harm Based on observation, interview, and record review, the facility failed to follow up for a Vancomycin Resistant Residents Affected - Few Enteroccocus (VRE) (a multi-drug resistant organism) infection and precautions for 1 of 3 sampled residents reviewed for antibiotic therapy (Resident #60), and failed to wear appropriate personal protective equipment (PPE) during of care of resident on enhanced barrier precautions (EBP) (Resident #71).

The findings included:

1). Record review revealed Resident #60 was admitted to the facility on [DATE REDACTED]. A comprehensive assessment dated [DATE REDACTED] documented the resident had moderate cognitive impairment and was dependent for activities of daily living.

Record review revealed Resident #60 was on enhanced barrier precautions for ESBL (a multi-drug resistant organism) in the urine from 12/03/24 - 12/11/24.

A review of Resident #60's orders revealed an order dated 12/14/24 for a urinalysis culture and sensitivity.

The culture was reported positive for VRE (a multi-drug resistant organism) on 12/18/24.

An order dated 12/19/24 for Zyvox (an antibiotic) was ordered for 600 milligrams 2 times a day for Bacteriuria (urine infection) for 7 days.

Further record review revealed no evidence of Resident #60 being placed on any precautions, or of any follow-up after the antibiotic was administered.

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2) Review of the facility's policy titled, Infection Prevention and Control, dated 06/28/24, revealed, Enhanced Barrier Precautions may be implemented for those with a documented or suspected infection or colonization with a multi-drug resistant organism, or have risk of acquiring infections based on portals of entry or indwelling medical devices such as indwelling urinary catheter; g-tube, central lines, tracheostomy, or wounds requiring a dressing; regardless of infection or colonization status, or reported by the infection preventionist laboratory based on the centers' antibiogram when available. Equipment includes the use of gown and gloves during the direct care of resident that consists of close contact such as: bathing, dressing, incontinent care, transferring, indwelling device care, and other activities that may have the resident in close contact with the staff member.

Clinical record review revealed Resident #71 was admitted to the facility on [DATE REDACTED] and 09/25/24, with a diagnosis that included Diabetes. The quarterly comprehensive assessment with a, reference date of 11/01/24, recorded no brief interview for mental status score, indicating Resident #71 was rarely/never understood.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 15 105259 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 105259 B. Wing 01/16/2025

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

Medicana Nursing and Rehab Center 1710 Lake Worth Road Lake Worth, FL 33460

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 additional clinical records evidenced the following physician orders: Dated 12/15/24 for Enhanced Barrier Precautions every 24 hours for Chronic Wound; dated 12/02/24 physical therapy treatment 3 times Level of Harm - Minimal harm or per week for 12 weeks, for wound care, Low frequency, non-contact, non-thermal ultrasound, Vaporox. potential for actual harm Dated 01/01/25 for the right lateral ankle and left heel wound.

Residents Affected - Few On 01/15/25 at 12:42 PM, Resident #71 was observed lying in bed, she was receiving wound therapy with

the Vaporox machine of the left heel wound. While the surveyor was standing in the room, on 01/15/25 at 12:48 PM, a staff member, Staff K, a physical therapist arrived. Staff K began attending to the Vaporox machine, by removing the bag that covered the left foot, and Staff K raised Resident #71's left foot, and a large wound with drainage was observed to the left heel, during that time, Staff K did not wear a gown while touching Resident #71's foot.

On 01/16/25 at 12:37 PM, a phone call was placed to Staff K to inquire about the facility's Enhanced Barrier Precaution (EBP) process and procedure. She voiced that she was aware of the EBP procedure. She acknowledged she didn't wear a gown while providing direct care to the resident.

On 01/16/25 at 1:30 PM an interview was held with the Director of Nursing (DON) and she was informed of

the breach of infection control by Staff K.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 15 105259 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 105259 B. Wing 01/16/2025

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

Medicana Nursing and Rehab Center 1710 Lake Worth Road Lake Worth, FL 33460

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 0881 Implement a program that monitors antibiotic use.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 36734 potential for actual harm Based on record review and interview, the facility failed to have an effective antibiotic stewardship program Residents Affected - Few for 2 of 3 sampled residents reviewed for antibiotic therapy (Residents #60 and #62).

The findings included:

A review of the facility's policy titled Antibiotic Stewardship, dated 10/24/17, documented: The facility will establish a multidisciplinary antibiotic stewardship program that defines optimal antibiotic use and provides guidance for optimal antibiotic prescribed by physician/prescribers. The antibiotic stewardship program and its members will have accountability to the facility's quality assurance/performance improvement committee.

The members of the antibiotic stewardship committee should include at a minimum the medical director of

the facility, the director of nursing services, and the facilities consultant pharmacist.

A. The medical director should set the standards for antibiotic prescribing.

B. The director of nursing should establish the standards of nursing for assessment, resident monitoring and

the communication of changes in condition when an infection is suspected.

C. The consultant pharmacist should review antibiotic orders during interim and monthly medication regimen

review to ensure antibiotics are ordered appropriately.

1). Resident #60 was admitted to the facility on [DATE REDACTED]. A comprehensive assessment dated [DATE REDACTED] documented the resident had moderate cognitive impairment and was dependent for activities of daily living.

Review of Resident #60's orders revealed an order dated 12/03/24 for Ertapenem (antibiotic) 1 gram intravenously (IV) every 24 hours for ESBL (a multi drug resistant organism) (MDRO) in the urine for 9 days.

An antibiotic stewardship note dated 12/5/24 documented McGreer not met (McGreer criteria (Stone 2012) are used for retrospectively counting true infections. To meet the criteria for definitive infection, more diagnostic information (e.g., positive laboratory tests) is often necessary.) The antibiotic order was reduced to 7 days (until 12/10/24) on 12/05/24 per antibiotic stewardship suggestion.

An order dated 12/15/24 for Ceftriaxone (an antibiotic) was ordered for 1 gram every 24 hours for 5 days for

an elevated white blood cell (WBC) count.

An antibiotic stewardship note dated 12/16/24 documented McGreer not met.

An order dated 12/19/24 for Zyvox (an antibiotic) was ordered for 600 milligrams 2 times a day for Bacteriuria (urine infection) for 7 days.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 15 105259 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 105259 B. Wing 01/16/2025

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

Medicana Nursing and Rehab Center 1710 Lake Worth Road Lake Worth, FL 33460

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 0881 An interview was conducted with the Nurse Practitioner (NP) that ordered the antibiotics for Resident #60 on 01/15/25 at 11:30 AM. The NP stated she does not use the McGreer criteria to determine if a resident needs Level of Harm - Minimal harm or antibiotics. The NP stated it is used as a guideline only. The NP further stated she does not attend any potential for actual harm meetings with the facility and does not communicate with the attending physicians.

Residents Affected - Few An interview was conducted with the Infection Control Preventionist (ICP) on 01/15/25 at 12:00 PM. The ICP stated the facility uses the McGreer criteria for infection surveillance to determine if antibiotic use is required.

The ICP stated Resident #60's antibiotics were ordered by a Managed Care nurse practitioner (NP), who is not a staff of the facility. The ICP further stated the interdisciplinary team (IDT) meets monthly to discuss facility infections and use of antibiotics. The ICP stated the Managed Care NP does not attend. The surveyor questioned the ICP if she includes/informs the attending physician of the ordered antibiotic use, and the ICP stated no.

An interview was conducted with Resident #60's attending physician on 01/16/25 at 10:00 AM. The physician stated he did not know Resident #60 had tested positive and was treated for ESBL and VRE. The physician stated he would look into it.

2). Record review revealed Resident #62 was admitted to the facility on [DATE REDACTED]. A comprehensive assessment dated [DATE REDACTED] documented the resident was cognitively intact and was dependent for activities of daily living.

Record review revealed an order dated 11/29/24 for Ceftriaxone (antibiotic)1 gram intramuscularly one time only for abnormal labs (elevated white blood cell count).

An antibiotic stewardship note dated 11/29/24 documented McGreer not met.

An interview was conducted with Resident #62's attending physician on 01/16/25 at 10:00 AM. The physician stated he was not aware of the one time dose of antibiotics the resident received for an elevated white blood cell count.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 15 105259