Palm Garden Of Port Saint Lucie

F-F695).

On 03/25/24, the nursing progress notes revealed there was a rash on the right side of the resident's back. There was no physician notification or follow-up pertaining to the rash on the back documented.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 1 of 9 105600 Department of Health & Human Services Printed: 09/17/2025 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 105600 B. Wing 07/25/2024

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

Palm Garden of Port Saint Lucie 1751 SE Hillmoor Drive Port Saint Lucie, FL 34952

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 0684 The resident had significant weight gain from her admission on 12/18/23 until the transfer date of 05/19/24. There was a total weight gain of 16 pounds (approximately 13%) during this 5-month period. There were Level of Harm - Minimal harm or nutritional notes in the progress notes stating there was weight gain and to continue the plan of care, with the potential for actual harm last note being on 05/05/24. The resident was on a regular diet with no other nutritional interventions. The resident was consuming 26-75% of meals. There was no other explanation of the weight gain for this Residents Affected - Few resident found in the record.

On 05/15/24, a nursing progress note revealed the resident had pitting edema bilaterally to the lower extremities. The provider was made aware and ordered Lasix (a diuretic) 20 mg tablet by mouth to be administered every morning for 3 days. No further assessments were noted in the nurses' notes regarding

the edema. There were no physician or nurse practitioner notes in the record regarding edema since this order on 05/15/24.

On 05/19/24, the resident was transferred to a higher level of care per family request. The family was concerned due to the patient not speaking clearly and all extremities were red and swollen. Further review of Resident #303's record did not reveal any assessments related to the edema, respiratory, or speech concerns, apart from the assessment done by the weekend supervisor on 05/19/24 after the family's request to send the resident to the hospital.

The last quarterly Minimum Data Set (MDS) completed on this resident was done on 04/21/24 which revealed this resident had clear speech and made self understood. There were no further nurses' notes in

the record regarding any changes to the resident's speech.

Review of the care plan dated 01/29/34, for Resident #303 included a care plan for potential complications related to diagnosis of Hypertension, and the use of diuretic. The interventions included, in part, to observe and report to the nurse or physician any edema, headache, tingling or numbness in the extremities, dizziness, pain, lightheadedness / blurred vision, palpitations, urinary retention, shortness of breath or generalized weakness. If edema is present, encourage the resident to elevate the effected extremity as tolerated. There were no additional care plans related to the resident's edema.

There was no evidence that vital signs were documented for this resident since 03/04/24, apart from the day

the resident was transferred out of the facility. There was an order by the resident's physician to check vital signs twice a day on the morning and evening shift starting on 03/05/24 through the date the resident was transferred. (Refer to

F-F842).

Review of the Emergency Medical Services (EMS) report for the transport of Resident #303 to the hospital emergency department revealed EMS had arrived at the resident at the facility at 1758 (5:58 PM); the resident was sitting upright awake and alert with mumbled speech; the stroke assessment was negative aside from mumbled speech which staff at the facility stated has been like this for over a week; the resident had diffuse pinpoint rash with large darker spots throughout all extremities; the resident felt tired but no itching; Vital signs were stable; and they could not start an IV (intravenous) access due to edema in all extremities.

The resident's record was again reviewed to ensure there were no assessments regarding the change in the resident's speech or the edema to all extremities. There were no assessments or nursing notes located regarding a change in the resident's condition.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 2 of 9 105600 Department of Health & Human Services Printed: 09/17/2025 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 105600 B. Wing 07/25/2024

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

Palm Garden of Port Saint Lucie 1751 SE Hillmoor Drive Port Saint Lucie, FL 34952

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 0684 Review of the hospital emergency department (ED) notes revealed Resident #303 arrived on 05/19/24 at 1824 (6:24 PM). The notes reflected the resident was not talking much, but responded by nodding yes or no. Level of Harm - Minimal harm or She had diffuse swelling over all extremities with and associated petechial rash, and pulseless feet bilaterally potential for actual harm with associated cyanotic changes. The extremities were mottled and cold. The resident's temperature was 91.9 degrees Fahrenheit (F) at 6:37 PM. Further testing and labs completed resulted in a diagnosis of Residents Affected - Few Myxedema coma, which is a life-threatening clinical condition that consists of severe Hypothyroidism with decompensation. The patients are extremely ill with significant hypothermia and depressed mental status.

This condition occurs as an accumulation of waste products and fluids in the body due to low thyroid function. The fluid and waste accumulation in tissues does not resolve with diuretics. Treating the underlying thyroid condition is the only way to resolve Myxedema. Resident #303 was admitted to the intensive care unit (ICU) in critical condition.

A subsequent review of all nurses' progress notes did not reveal a change in the resident's speech or address the edema and rash over all extremities. Vital signs including temperature could not be located in Resident #303's record.

An interview with the Director of Nursing (DON) on 07/25/24 at approximately 10:00 AM revealed the staff do not necessarily document an assessment daily on all long-term care residents and vital signs are done as ordered by the physician.

All the nursing progress notes were requested from the facility on 07/25/24 at approximately 10:15 AM. The Director of Nursing (DON) provided all the nurses notes for Resident #303 at approximately 10:40 AM, stating this was all the nursing progress notes for this resident. The DON confirmed the vital signs were not recorded in the record.

32078

2. Record review documented Resident #36 was admitted to the facility on [DATE REDACTED] with a diagnosis that included Diabetes Mellitus Type 2. Review of the resident's Quarterly Minimum Data Set (MDS) assessment completed on 05/20/24 showed Resident #36 received 7 days of insulin injections during the 7-day look back period. The resident's care plan initiated on 05/15/24 included a plan of care for the diagnosis and treatment of Diabetes.

Review of the current physicians' orders for blood glucose monitoring and Diabetes management were as follows:

a. NovoLog FlexPen Subcutaneous Solution Pen-injector, 100 units\ml; Inject as per sliding scale subcutaneously before meals and at bedtime for DM2 [Diabetes Mellitus 2]:

if 150 - 200 = 2 units;

201 - 250 = 4 units;

251 - 300 = 6 units;

301 - 350 = 8 units;

351 - 400 = 10 units.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 3 of 9 105600 Department of Health & Human Services Printed: 09/17/2025 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 105600 B. Wing 07/25/2024

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

Palm Garden of Port Saint Lucie 1751 SE Hillmoor Drive Port Saint Lucie, FL 34952

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 0684 Over 400, Give 10 units and call MD.

Level of Harm - Minimal harm or Call MD for b\s [blood sugar] under 60. potential for actual harm b. Metformin HCl Oral Tablet, 1000 MG; give 1 tablet by mouth two times a day. Residents Affected - Few c. Humulin N Subcutaneous Suspension, 100 units\ml; Inject 30 units subcutaneously in the morning.

Review of the electronic Medication Administration Record (eMAR) on 07/06/23 at 1630 hours [4:30 PM], revealed Resident #36's blood glucose level was recorded at 53 mg/dl. There was no documentation in the resident's record that the physician was notified of the blood glucose level being below 60.

On 07/17/24 at 1630 hours [4:30 PM], Resident #36's blood glucose level was recorded at 50 mg/dl.

There was no documentation in the resident's record indicating that the physician was notified of the blood glucose level below 60. On 07/17/24 at 20:28 hours [8:28 PM], there was an administration note regarding Metformin HCl Oral Tablet 1000 MG. It documented to hold med due to BS 50 [hold medication due to Blood Sugar 50].

Review of Resident #36's eMAR showed the blood glucose levels were not recorded for the 6:30 AM required testing time for 07/17/24, 07/19/24, 07/21/24 and 07/24/24. Since there were no recorded blood glucose levels on these dates at 6:30 AM, there was no insulin per sliding scale documented as being provided.

Resident #36's Blood Glucose readings within the past 7 days were recorded as follows:

07/17/24:

6 :30 AM - No record

11:30 AM - 121 [mg/dl]

4:30 PM - 50*

9:00 PM - 134.

07/18/24:

6:30 AM - 152

11:30 AM - 204

4:30 PM - 140

9:00 PM - 225.

07/19/24:

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 4 of 9 105600 Department of Health & Human Services Printed: 09/17/2025 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 105600 B. Wing 07/25/2024

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

Palm Garden of Port Saint Lucie 1751 SE Hillmoor Drive Port Saint Lucie, FL 34952

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 0684 6:30 AM - No record

Level of Harm - Minimal harm or 11:30 AM - 143 potential for actual harm 04:30 PM - 257 Residents Affected - Few 09:00 PM - 112.

07/20/24:

6:30 AM - 216

11:30 AM - 269

4:30 PM - 98

9:00 PM - 94.

07/21/24:

6:30 AM - No record

11:30 AM - 154

4:30 PM - 241

9:00 PM - 146.

07/22/24:

6:30 AM- 105

11:30 AM - 161

4:30 PM 142

9:00 PM - 98.

07/23/24:

6:30 AM - 114

11:30 AM - 141

4:30 PM - 112

9:00 PM - 151.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 5 of 9 105600 Department of Health & Human Services Printed: 09/17/2025 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 105600 B. Wing 07/25/2024

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

Palm Garden of Port Saint Lucie 1751 SE Hillmoor Drive Port Saint Lucie, FL 34952

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 0684 07/24/24:

Level of Harm - Minimal harm or 6:30 AM - No record potential for actual harm 11:30 AM - 144 Residents Affected - Few No further record review.

On 07/25/24 at approximately 10:00 AM, the Director of Nursing (DON) was notified of the missing documentation in Resident 36's medical record.

On 07/25/24 at 11:42 AM, Resident #36's Primary Care Physician approached me to inform me that the facility staff had notified him when the resident's blood sugar had been below 60. This physician stated, I am going to remove this order [parameters] because the resident's blood sugar has been stable.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 6 of 9 105600 Department of Health & Human Services Printed: 09/17/2025 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 105600 B. Wing 07/25/2024

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

Palm Garden of Port Saint Lucie 1751 SE Hillmoor Drive Port Saint Lucie, FL 34952

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 0695 Provide safe and appropriate respiratory care for a resident when needed.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 37970 potential for actual harm Based on record review and policy review, the facility failed to ensure the respiratory status of residents were Residents Affected - Few evaluated prior to and after respiratory treatments were administered for 2 of 4 sampled residents reviewed for respiratory services, Resident #14 and 303.

The findings included:

Review of the facility policy, titled, Medication Administration, Nebulizer, M11.0, dated 07/2023 revealed in part, the following:

2. Review and special precautions and perform needed evaluations prior to administering medications to the guest/resident.

Review guest / resident allergies.

Review pertinent lab results, as indicated.

Perform needed evaluations prior to administering specific medications (e.g., pulse, blood pressure, respirations)

7. Evaluate respiratory status.

After the respiratory /nebulizer treatment the policy stated in part:

17. Evaluate respiratory status to include, but not limited to:

Breath sounds.

Cough effort and sputum production.

Heart rate.

Respiratory rate.

1. Review of Resident #14's record revealed the resident was admitted on [DATE REDACTED] with diagnoses including but not limited to Chronic Obstructive Pulmonary Disease (COPD), Hypertension (HTN), Pneumonia, Myocardial Infarction (MI), Dementia, Acute Upper Respiratory Infection, and Heart Failure.

Review of the physician orders, 03/01/24, revealed an order for Albuterol Sulfate Inhalation Nebulization Solution 2.5 mg (milligrams)/ml (milliliter) inhale via nebulizer two times a day for SOB (shortness of breath).

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 7 of 9 105600 Department of Health & Human Services Printed: 09/17/2025 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 105600 B. Wing 07/25/2024

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

Palm Garden of Port Saint Lucie 1751 SE Hillmoor Drive Port Saint Lucie, FL 34952

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 0695 Subsequent review of Resident #14's medication administration record (MAR) for July 2024 revealed the nebulizer treatments were administered as ordered. Further review of the record did not reveal respiratory Level of Harm - Minimal harm or assessments were completed prior to and post administration of the nebulizer respiratory treatment. potential for actual harm 2. Review of Resident #303's record revealed the resident was admitted to the facility on [DATE REDACTED] with a Residents Affected - Few diagnosis of Cerebral Atherosclerosis, HTN, Anxiety, Edema, palliative care, and Hyperlipidemia (HLD).

Review of the physician orders revealed an order dated 03/10/24 for Ipratropium-Albuterol Inhalation Solution 0.5-2.5 (3) mg/3ml. Inhale 3ml orally every 6 hours as needed for wheezing. Subsequent review of

the MAR for March 2024 revealed the nebulizer respiratory treatment was administered on 03/10/24, 03/22/24, 03/25/24 and 03/27/24. Further review did not reveal a respiratory evaluation prior to or after the administration of the respiratory treatment.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 9 105600 Department of Health & Human Services Printed: 09/17/2025 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 105600 B. Wing 07/25/2024

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

Palm Garden of Port Saint Lucie 1751 SE Hillmoor Drive Port Saint Lucie, FL 34952

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 0842 Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 37970

Residents Affected - Few Based on record review and interview, the facility failed to ensure vital signs were documented as ordered for 1 of 4 sampled residents reviewed for vital signs, Resident #303.

The findings included:

Review of Resident #303 record revealed the resident was admitted on [DATE REDACTED] with diagnoses that included Cerebral Atherosclerosis, Hypertension (HTN), Anxiety, Edema, palliative care, and Hyperlipidemia.

Review of the physician orders dated 03/05/24 included an order to obtain vital signs every shift, day and evening shift.

Review of the Medication Administration Record (MAR) revealed the vital signs were signed off as being completed. Further review of the MAR failed to document any of the vital signs.

Review of the vital signs record did not reveal vital signs were documented after 03/04/24, apart from the day

the resident was transferred out via emergency medical services (EMS) to the hospital at 1839 (6:39 PM).

Review of the nursing progress notes did not have any documentation regarding vital signs.

On 07/25/24 at approximately 10:00 AM, the Director of Nursing (DON) provided a copy of all nursing documentation and confirmed this was all the documentation for Resident #303.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 9 105600