North Beach Rehabilitation Center

F-F558 Reasonable Accommodations Needs/Preferences was cited related to the facility failure to ensure reasonable accommodations related call lights.

F-F880 Infection Prevention & Control.

Interview with Administrator on 01/09/2025 at 4:00 PM. He revealed the QAPI (Quality Assurance and Performance Improvement) meetings are held on the second Tuesday of each month or as needed. He stated that QAPI committee members are Administrator, Director of Nursing, Assistant Director of Nursing, Medical Records, MDS Coordinator, Staff Coordinator, Activities Director, Social Services Director, Rehabilitation Director, Admission Director, Maintenance Director, Housekeeping Director, Dietary Manager, Medical Director. Human Resources Director, Corporate Officer. During the morning meetings and clinical meetings, they reviewed the last meeting and focused on the deficiencies the facility had for the last survey. Quality Assurance is continuously monitored and communicated with the department heads and tracked to ensure the correct actions implemented.

Record review of Quality Assurance/Quality Assurance Performance Improvement QAPI/QAA Goals/Purpose Statement: Our purpose is to provide excellent quality resident/patient care and services. Quality is defined as meeting or exceeding the needs, expectations and requirements of the patients cost-effectively while maintaining good resident/patient outcomes and perceptions of patient care. NBRC has

a Performance Improvement Program which systematically monitors, analyses and improves its performance to improve resident/ patient outcomes. It recognizes that the value in healthcare is the appropriate balance between good measures, excellent care and services and cost. We will monitor our operations for compliance with federal and state regulations.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 19 105217 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 105217 B. Wing 01/09/2025

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

North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

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 48906 potential for actual harm Based on observations, record review, and interviews the facility failed to follow infection prevention and Residents Affected - Some control practices with one out of two vital signs machines in the facility and one out of three dryer lint traps in

the laundry room, as evidenced by staff member not disinfecting the vital signs machine after measuring a resident's blood pressure and Clean laundry (curtains) stored in washing area.

The findings included:

1) On 01/06/25 at 8:03 AM Staff A, Licensed Practical Nurse (LPN) was observed measuring a resident's blood pressure using a vital sign machine. Afterwards, Staff A, LPN placed the used vital sign machine in the hallway near the nursing station. Staff A, LPN then returned to administering medications. Staff A, LPN did not disinfect machine or cuff and no sanitizing wipes were observed in the vital signs machine's basket.

On 01/06/25 at 9:32 AM Staff A, LPN was asked about the protocol after using the blood pressure machine

on a resident, Staff A, LPN stated: The protocol is to disinfectant with the Sanitizing cloths. I was supposed to clean the machine but forgot.

Record review of a Policy titled, Infection Control Guidelines for All Nursing 2005 MED-PASS, Inc. (Revised August 2012) Purpose: To provide guidelines for general infection control while caring for residents. 1. Standard Precautions will be used in the care of all residents in all situations regardless of suspected or confirmed presence of infectious diseases. Standard Precautions apply to blood, body fluids, secretions, and excretions regardless of whether they contain visible blood, non-intact skin, and/or mucous membranes.

On 01/09/25 at 12:09 PM, interview with the Infection Preventionist revealed there are two vital signs machines in the facility. Staff are responsible to disinfect the vital signs machines with disinfectant wipes

after usage to prevent any cross contamination or break outs throughout the facility. Also revealed there are two vital signs machines.

On 01/09/25 at 8:51 AM a Laundry Tour was conducted with The Director of Housekeeping. Upon entrance to the wash area there was a cart partially covered with linens in a plastic bag (photo submitted) The Director of Housekeeping revealed the plastic bag contained clean curtains that were being stored in the wash area for purposes of space.

Record review of a Policy titled, Departmental (Environmental Services) Infection Control Departmental (Environmental Services) Laundry and Linen revealed Level I: Purpose: The purpose of this procedure is to provide a process for the safe and aseptic handling, washing, and storage of linen. General Guidelines: Standard Precautions 1. Separate soiled and clean linen always.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 19 105217