Treasure Isle Care Center

F-F550-Resident Rights/Exercise of Rights related to staff standing while feeding a resident (Resident #131) and observation of two residents (Resident #27 and Resident #473) wearing hospital type gowns in dining area and

F-F725 Sufficient Nursing Staff.

On 6/13/2024 at 3:02 PM Quality Assurance and Performance Improvement (QAPI) overview was conducted with the NHA, DON and Assistant NHA. It was reported that the last meeting was held on 5/21/2024. The DON reported the meetings are held monthly and all department heads attends the meetings.

For concerns with dignity the DON reported education is ongoing. Anything that occurs we educate the staff.

For staffing concerns the NHA and DON reported the facility does not use Agency staff. The DON revealed:

On weekends we add the unit manager but from Monday to Friday a unit manager on each unit. On the weekends we only have one supervisor because during the weekend we have more nurses.

The NHA, Assistant NHA and DON were informed that there are concerns with the facility's Quality Assurance and Performance Improvement based on the identified concerns.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 28 of 30 105408 Department of Health & Human Services Printed: 09/23/2025 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 105408 B. Wing 06/13/2024

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

Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141

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** 48906 potential for actual harm Based on observations, record review and interviews, the facility failed to follow infection control standards Residents Affected - Some and transmission-based precautions to prevent the spread of infections as evidenced by observations of trash in hallways and Staff not donning appropriate Protective Equipment before entering Resident #136's room. There were 136 residents residing in the facility at the time of survey.

The findings included:

On 06/10/2024 at 6:41 AM, a bag of trash was observed on the floor in nursing section four in front of a residen's room. (see photo evidence)

On 6/11/2024 at 9:45 AM Staff F, Registered Nurse (RN) was observed entering room without donning appropriate personal protective equipment (PPE). Staff F, RN stopped by surveyor and asked if it was according to protocol to enter without donning gloves for a resident under contact precaution and Staff F, RN replied: No, according to the sign I am supposed to don gloves before I enter the room.

On 6/11/2024 at 10:00 AM Staff G, charge nurse revealed, staff should perform hand hygiene and then don all appropriate PPE before entering any room with signs for Contact Precaution.

On 6/11/2024 at 12:18 PM A bag of trash was observed on floor in the hallway. (see photo evidence)

Record review of demographic sheet for Resident #136 revealed an admitted [DATE REDACTED] with diagnosis that included: Candidiasis.

Record review of Quarterly Minimum Data Set (MDS) dated [DATE REDACTED] Section C for cognitive status revealed a Brief Interview for Mental Status (BIMS) score was undetermined and section GG for Functional status revealed dependent for Activities of Daily Living (ADL).

Record review of Care Plan revised on 10/05/2023 and initiated on 01/10/2023 for ADL self-care performance deficit cannot. Interventions that included: Contact Precaution.

Record review of physician orders dated 12/16/2022 revealed Contact Precaution every shift for History of candida auris.

On 6/13/2024 at 10:24 AM Staff G, charge nurse/ Infection Control Preventionist reported staff are required to take trash out of room in a tied plastic bag, holding it away from their body, not touching the floor and then place it in the bin located in the Soiled Utility room.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 29 of 30 105408 Department of Health & Human Services Printed: 09/23/2025 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 105408 B. Wing 06/13/2024

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

Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141

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 Record review of Policy effective date October 2021 Topic: Infection Prevention and control Program Policy:

The infection Prevention and Control Program is comprehensive program that addresses detection, Level of Harm - Minimal harm or prevention and control of infections and communicable diseases among residents, visitors, volunteers, those potential for actual harm individuals providing services under contractual agreement and personnel. The Infection Prevention and Control Program, in addition, will facilitate activities to improve antibiotic use to reduce adverse events, Residents Affected - Some prevent emergence of antibiotic resistance, and promote better outcomes for residents. Procedure: c. Implementation of Infection control and prevention measures. Prevention of spread of infections is accomplished by use of Standard Precautions, organism specific precautions, and other barriers, appropriate treatment and follow up, and employee work restrictions for illness.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 30 of 30 105408