Palm Beach Nursing Center
PALM BEACH NURSING CENTER in LAKE WORTH, FL — inspection on June 28, 2024.
Found 19 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
The surveyor asked her what she thought about the curtain.
She confirmed they were not able to close all the way, and the roommate's visitors would be able to see his body if they were to come back in the room.
During that time the resident's roommate returned to the room to say goodbye to him.
On 06/27/24 at 12:52 PM, the resident was in the process of receiving care and the curtains were not replaced, they were still short with a huge gap. 2) On 06/25/24 at 9:37 AM while the surveyor was standing in the hallway, there were two nurses standing in the hallway as well.
Staff B, Registered Nurse (RN) was heard telling Staff C, (the North and South unit manager) that she was looking for the HIV medication for a resident.
She stated the resident's room number loud enough that the surveyor was able to hear it.
During that time there was one housekeeper staff standing immediately next to them, and all the residents' doors in the unit were open with the potential for them to hear about a resident's diagnosis.
At 9:39 AM, an interview was held with Staff C who acknowledged the nurse had spoken loudly while in the hallway and repeated a resident diagnosis. 3) On 06/25/24 at 10:13 AM, while interviewing a resident in her room, the door was closed.
The Human Resources staff knocked on the door, he didn't wait for permission to enter the room, and he then commenced to walk in the room.
Once he saw the surveyor standing there, he apologized and left.
On 06/28/24 at 10:22 AM, an interview was held with the Social Service Director (SSD) and the Director of Nursing (DON).
They were made aware of the privacy concerns. 4)
Review of the record revealed Resident #77 was admitted to the facility on [DATE].
Review of the current Minimum Data Set (MDS) assessment dated [DATE] documented the resident had a Brief Interview for Mental Status (BIMS) score of 13, on a 0 to 15 scale, indicating he was cognitively intact. Resident #77 resided in a room with the bed at the window.
On 06/24/24 at 10:24 AM, Staff S, Certified Nursing Assistant (CNA), looked out of the opened door of Resident #77, with his gloves on and the curtain pulled around the bed at the door, and stated he was taking care of someone.
Within a minute or two, the CNA left the room.
Upon entering the room while the CNA was gone, after gaining permission, Resident #77 was observed lying on top of the bed totally naked, with the bed covers at the foot of the bed and out of reach.
The curtain was not drawn around the bed.
The surveyor excused herself and went back out into the hallway, just outside of the room.
Within a minute or two, Staff S returned to the room with a bag of clean linens.
During an interview on 06/24/24 at 11:39 AM, when asked about the lack of privacy, Resident #77 stated staff sometimes pull the curtain for privacy, but sometimes do not. Resident #77 stated he had gotten used to it, and just shrugged his shoulders.
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
During the tour, the stained privacy curtain in room [ROOM NUMBER] could not be verified, as the resident was receiving care during this time.
On 06/28/24 at 11:32 AM, the Housekeeping Manager confirmed the presence of the stained privacy curtain in room [ROOM NUMBER]. He stated staff were, at this time, replacing the stained curtain with a clean curtain.
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
Review of the record lacked any documented evidence of this interaction or any follow-up by the
During an interview on 06/28/24 at 12:12 PM, when asked if there had been any follow-up regarding the interaction observed on 06/24/24, the SSA stated he would get the SSD.
On 06/28/24 at 12:33 PM, the SSD stated she was not made aware of any concerns between Resident #38 and Resident #40.
When told of the observation and interaction with the SSA, the SSD stated she had not been made aware.
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
condition.
Resident #78, dated 06/27/24.
3) Resident #93 was admitted on [DATE] with diagnoses including Unspecified Psychosis, Anxiety, Depression, and Dementia.
A Level I PASSAR was completed on 05/22/24.
Several sections of the PASSAR form were left blank: Social Security Number Present Location of Individual Being Evaluated Representative's Name, Address, Telephone Number Medicaid Identification Number or Other Health Insurance Name and Number No check marks were present in Section A (MI or suspected MI) even though resident does have diagnoses of mental illness (Psychosis, Anxiety Disorder) No check marks were present under SERVICES.
There was no indication as to Finding based on (check all that apply): No answer was checked to Question #4: Has the individual exhibited actions or behaviors that may make them a danger to themselves or others? Section IV does not have a check mark in response to the statement Individual may be admitted to an NF (check one of the following: Under the signature of the person completing the form, the box asking for information regarding what agencies received a copy of the PASSAR is left blank.
On 06/26/24 01:54 PM, the Social Service Director was informed that the PASSAR for this resident was not complete.
She stated, The PASSARs we have been getting from the hospital are almost always not filled out entirely.
Sometimes, we get a form with just the resident's first name and nothing else on the form. I try to catch them, but I miss some.
On 06/27/24 at 11:40 AM, a fully completed Level I PASSAR was provided by the Social Services Director, dated 06/27/24.
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
Review of the current Minimum Data Set (MDS) assessment dated [DATE], documented the resident had a Brief Interview for Mental Status (BIMS) score of 4, on a 0 to 15 scale, indicating cognitive impairment.
This MDS also documented the resident needed from partial to moderate assistance for personal hygiene tasks.
Review of the current care plan initiated on 01/17/24, and revised on 02/01/24, revealed Resident #8 had an ADL (activities of daily living) self-care performance deficit related to late effects of a stroke affecting his right side.
This care plan instructed staff to provide up to moderate assistance of one person for personal hygiene and grooming.
During an observation on 06/24/24 at 2:32 PM, Resident #8 was sitting in his wheelchair, pleasantly answering questions. An observation of the resident's fingernails revealed they were trimmed, but black debris was noted under most of his nails on both hands.
When asked if staff help him clean his nails, Resident #8 stated, No. A short beard was also noted.
When asked if he likes his beard, the resident stated, No, I'd like it cut off.
When asked if he could do it himself, he stated, Not anymore. I used to.
When asked if staff offer to shave him, he stated they do not.
An observation on 06/26/24 at 8:59 AM revealed Resident #8 had been shaved, but his fingernails remained dirty.
During an observation on Friday 06/28/24 at 11:26 AM, Resident #8 had just gotten up into his wheelchair. As per his roommate, who was alert and oriented, the resident prefers to get up between 10 AM and noon.
Staff N, Certified Nursing Assistant (CNA), was in the room and stated she had just finished providing morning care and put lotion on the resident's hands. Resident #8 was rubbing his hands back and forth and fresh lotion was noted.
Three fingernails on each hand remained with black noted under each nail.
When asked the process for keeping fingernails clean, the CNA explained they clean the nails as needed, with a wooden stick that is flat on the end.
When asked if she does it routinely for the residents, Staff N stated.
When I work I do it.
When shown the resident's fingernails, the CNA agreed they needed to be cleaned.
When asked why she had not done so, the CNA stated she had no reason.
Review of staff assignments for the week revealed Staff N, CNA, had worked that same assignment on Tuesday 06/25/24, Wednesday 06/26/24, and Thursday 06/27/24.
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
called the resident's physician, who prescribed Lasix (a diuretic that helps reduce sodium and fluid
today.
In an interview on 06/28/2024 at 02:40 PM, Resident #82 stated the Nurse gave him a medication, but it was not the same. He needed something for his heart failure and the Nurse did not explain to him what the substitute medication was for.
In an interview with the Director of Nursing (DON) on 06/28/2024 at 2:36 PM, she stated the medication is usually stored in the Medication Storage Cart.
She asked this Surveyor to accompany her upstairs to show the Medication Storage Cart where the resident's medication is usually kept.
She tried her keys on the Medication Cart Middle located in front of the Nurses' Station on the second floor, but they did not work.
The DON came back at 2:50 PM unlocked and opened Medication Cart Middle with the new set of keys and started searching for the missing medication, but did not find the missing medication.
She then stated The resident's Bumetanide (Diuretic) medication is not here.
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
updated progress notes were electronically written on 06/26/2024 by Social Services Director at
eyeglasses inquiries from the office.
The facility's Social Services Director did not provide any documentation regarding the lost prescribed eyeglasses.
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
unaware of the resident's redness and grimacing observed during the incontinence care earlier that
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
During observation and interview on 06/24/2024 at 1:22 PM, this resident said he is always on 3
usually a container of a distilled water given concurrently with oxygen therapy to provide moisture to the inhaled air thus preventing nasal mucosa dryness) dated 06/16/2024.
The long oxygen clear tubing was dated 06/12/24 (tag wrapped around the tubing).
During observation on 06/25/24 at 12:30 PM, Resident # 82 was sitting in bed with the same clear oxygen tubing (dated 06/12/24). He added that Staff did not change his oxygen tubing. It was supposed to be changed last Sunday (06/23/2024).
The same canister (humidifier) was dated 06/16/2024.
On 06/27/24 at 12:27 PM, during observation this Surveyor noticed the oxygen tubing is connected directly to the oxygen concentrator (the canister of humidifier was missing; observed during the first days of survey), delivering 3 Liters per minute (L/min).
There was a new green colored tubing connected to a clear nasal cannula tubing with tape tag dated 06/23/24.
Resident # 82 stated they just changed the tubing but did not provide a new humidifier (green top plastic cannister was gone). (The order states to change humidifier every Sunday night).
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
by many of the residents during the initial interview process.
The following 4 residents in attendance
Resident #84, who has a BIMS of 14 out of 15; Resident #14; who has a BIMS of 15 out of 15; and Resident #15, who has a BIMS of 13 out of 15. Resident #54, who has a BIMS of 15 and had never attended a Resident Council meeting before, attended for approximately 5 minutes in the beginning.
Each of these 5 residents confirmed that staff response to call lights is very bad at night and on weekends. Resident #15 stated, Staff will come in and tell you they are coming back, but they never do.
Residents #88, #84, #54, and #14 all stated that during the nights and on weekends, it often takes a couple hours to get help, and sometimes staff will never come at all.
The 4 regular Resident Council attendees confirmed that incontinent care is not done in a timely manner, especially at night. Resident #14 stated: I have had to stay in wet briefs all night because I couldn't get staff to answer the call light. I would hear them laughing and talking outside my room, but as soon as I turn on my call light, they all seem to disappear.
These 4 Resident Council Attendees also stated that the food is consistently served cold.
They each stated they have complained to the Dietary Department about the food being served cold. Resident #14 stated, Even though there has been a small improvement lately, it hasn't been a consistent improvement.
The 4 resident Council attendees ( Residents #88, #84, #15, and #14) confirmed that food trays will often sit in the carts for a long time before staff pass them out to the residents.
Also, each of the Residents Council attendees stated there are many times the food is not served according to the resident's preferences.
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
During the reconciliation of medications, the record revealed the current order for the Methocarbamol 500 mg was to give two tablets.
During an interview on 06/27/24 at 6:19 PM, when asked to verify the order for the Methocarbamol administered to Resident #64, Staff U, LPN agreed she should have provided two tablets. 2) A medication administration observation for Resident #57 was made on 06/27/24 at 5:59 PM with Staff U, Licensed Practical Nurse (LPN).
The LPN explained the resident had a blood pressure medication due, so she obtained a blood pressure reading.
Upon return to the medication cart, the LPN obtained three medications to include a probiotic, an anti-seizure medication, and Losartan 50 milligrams (the anti-hypertensive/blood pressure medication).
When asked if that was all that was due at that time, the LPN's response was yes.
When asked how many pills the nurse had poured into the medication cup for administration, the LPN stated three.
Staff U administered the three medications to Resident #57.
During the reconciliation of medications, record review revealed the resident was only due to receive the probiotic and anti-seizure medication, and that the Losartan was not due to be administered until 10 PM.
During a side-by-side review of the record and continued interview on 06/27/24 at 6:19 PM, Staff U, LPN confirmed the order documented the Losartan was to be given at 10 AM and 10 PM.
The LPN stated the medication came up on the electronic MAR to administer.
The LPN could not figure out why.
During an interview on 06/27/24 at 6:35 PM, when explained to the Assistant Director of Nursing (ADON) and upon review of the MAR, she determined the medication had either not been provided that morning, or not been signed off as administered by the First Floor Unit Manager, who had taken the assignment late due to a call off.
That failure by the morning nurse caused the Losartan to remain on the electronic MAR to be administered.
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
Review of the current Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #66 was cognitively impaired and always incontinent of urine.
Review of the orders, lab results, Treatment Administration Record (TAR), and corresponding progress notes revealed the following: a) An order dated 12/24/23 documented staff were to obtain urine for a urinalysis. A corresponding nursing progress note dated 12/24/23 at 8:23 PM documented the family reported the resident was complaining of pain when urination.
This note further documented upon assessment by the nurse, Resident #66 said it was very painful and with a burning sensation.
The record lacked any results of the urinalysis and any further documentation. b) An order dated 05/26/24 documented staff were to obtain urine for a urinalysis. A corresponding nursing progress note dated 05/27/24 at 11:28 PM documented unable to obtain, incontinent.
The record lacked any results or additional information regarding the ordered urinalysis, although the TAR documented a checkmark indicating it was completed. c) An order dated 06/16/24 documented staff were to obtain urine for a urinalysis.
The record lacked any results, the laboratory requisition documented not collected, and the TAR indicated it was completed.
The progress notes lacked any further information related to the urinalysis.
During a side-by-side review of the record and interview on 06/27/24 at 10:24 AM, the Assistant Director of Nursing (ADON) explained the process for a urinalysis was after obtaining the order, the request is put directly into the laboratory website and a requisition is printed out and put into their laboratory binder.
The ADON stated if staff were unable to collect the urine, they should notify the physician and obtain order to either attempt another collection or do a straight catheterization to obtain the urine.
The ADON searched the laboratory website and was unable to locate results for the above three ordered urinalysis.
The ADON also was unable to provide any progress notes or reason for the failure to obtain and or follow through with their process. 2)
Review of the record revealed Resident #73 was admitted to the facility on [DATE].
Review of the record revealed an order dated 03/14/24 to obtain a CMP (comprehensive metabolic panel) and a CBC (complete blood count) on 03/15/24.
Review of the corresponding Treatment Administration Record (TAR) documented the blood work was completed as evidenced by a checkmark.
Further review of the record lacked any results or documentation about the ordered laboratory services.
During an interview on 06/28/24 at 12:13 PM, the Second Floor Unit Manager was told of the concern and stated she would look into the missing blood work. As of the exit conference on 06/28/24 at 6:45 PM no further information had been provided.
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Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
#14 stated, Even though there has been a small improvement lately, it hasn't been a consistent
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
Review of the current orders lacked an order for double portions, indicating it was a preference for the resident.
105466 06/28/2024
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
Review of progress note dated 06/27/2024 at 1:00 AM revealed that Resident # 31 was in bed, and restless while asking to be sent out to the hospital. He was complaining of burning on urination with the indwelling urinary catheter in place. He was sent to the hospital the same day.
F-F690).
b) Failure to ensure timely and appropriate respiratory care for Residents #78, #51, #31, and #82. (Refer to
F-F695).
c) Failure to ensure palatable and hot food as voiced by Residents #82, #89, #93, and #77. (Refer to
Review of the latest skin evaluation completed on 06/27/24 documented a rash to the sacrum with orders in place.
This assessment lacked any redness to the perineal area.
Review of the current care plans initiated on 04/30/23 confirmed the bowel and bladder incontinence and the resident's need for total assistance with incontinence care.
During an interview on 06/24/24 at 2:50 PM, the son of Resident #66 volunteered, Mom gets lots of UTIs here.
She did not get them at home.
An observation of incontinence care for Resident #66 was made on 06/27/24 at 11:24 AM with Staff T, Certified Nursing Assistant (CNA).
Upon removal of the resident's adult brief and during personal care to the resident's front side, the skin was noted to be red, and the resident was grimacing as if uncomfortable.
The CNA did not notice the resident's grimacing.
The CNA provided appropriate care to the resident's front area, then assisted the resident to her side.
Staff T then cleaned the resident's back side by wiping from the buttock toward the front with each cleansing swipe and rinse. Resident #66 continued to grimace.
When asked by the surveyor if that hurt, the resident stated, Yes, that hurts.
The CNA acknowledged and provided care more gently. A diffuse red rash was noted on the resident's upper buttock and lower back.
105466
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 105466 B.
Wing 06/28/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
Review of the record revealed the resident's Brief Interview for Mental Status (BIMS) score was 13, on a scale of 0 to 15, indicating the resident was cognitively intact.
b)
During an interview on 06/24/24 at 10:33 AM, Resident #31 stated he often has to wait an hour for staff to assist him with repositioning.
The resident's BIMS score was 14, indicating he was cognitively intact.
c)
During an interview on 06/25/24 at 11:43 AM, Resident #74 stated he has been left in his chair for up to five hours because there is not enough staff.
The resident also stated sometimes incontinent care is provided at 1 PM, and then he is not provided incontinent care again until 9 PM. Resident #74 stated there is not enough staff to help reposition him either. Resident #74 had a BIMS score of 13, indicating he is cognitively intact.
d)
During an interview on 06/24/24 at 1:05 PM, Resident #63 stated his only complaint is that the 11 PM to 7 AM staff are not attentive.
The resident stated he has to yell and scream, they just won't come, and he feels the staff are sleeping at night.
When asked what assistance he required during the night, Resident #63 explained that he has a sacral pressure ulcer and although he can't lie on his sides for a long period of time, he would like to get off of his back at times. He further stated if staff do put him on his side, they won't come back to put him back on his back when he calls. Resident #63 had a BIMS score of 15, indicating he was cognitively intact.
e)
During an interview on 06/24/24 at 10:58 AM, Resident #45 stated when she does number 2 (defecate) in the morning, sometimes she doesn't get changed until the afternoon. Resident #45 was admitted to the facility on [DATE] and stated that had happened three times.
The resident voiced there's not enough staff.
Although the resident's BIMS score was an 08, indicating she had some cognitive issues, she was able to be interviewed.
f)
During an interview on 06/24/24 at 11:30 AM, Resident #221 stated, I don't think there is enough staff.
During the night I have to wait a long time to get someone to answer my call for help.
Sometimes they don't come. Resident #221 was a new admission, was alert and oriented, and able to be interviewed.
105466
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 105466 B.
Wing 06/28/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Beach Nursing Center 4405 Lakewood Road Lake Worth, FL 33461
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.