Lakeside Health Center

F-F684 for specific dates and times.)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 19 105268 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 105268 B. Wing 06/20/2024

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

Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407

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 0756 During the continued phone interview on 06/20/24 beginning at 11:07 AM, the consultant pharmacist stated

he looked at all the medications and parameters for the residents. When asked if he had identified the Level of Harm - Minimal harm or concerns with the insulin and clonidine, the consultant pharmacist stated he had not made any potential for actual harm recommendations regarding the insulin or clonidine in the past 6 months.

Residents Affected - Few 33103

2) Review of Resident #26 Record review revealed Resident #26 was admitted to the facility on [DATE REDACTED] with

a diagnosis to include Hypertensive Chronic Kidney Disease, Anxiety Disorder, Atrial Fibrillation, Hyperlipidemia, Cardiac Pacemaker, Dementia, Cardiomyopathy, Type II Diabetes.

A review of the Physicians Orders document Diltiazem HCl tablet 30 MG. Give 1 tablet by mouth two times a day (9:00 AM and 5:00 PM) for hypertension, to hold for SBP less than 130. start date 02/06/24.

On the following dates the systolic blood pressure (SBP) was less than 130 and the nurse gave the resident

the medication Diltiazem HCl tablet 30 MG.

06/01/24 9:00 AM: B/P 126/78 and 5:00 PM: B/P 120/67

06/02/24 9:00 AM: B/P 129/73

06/03/24 9:00 AM: B/P 125/66

06/08/24 9:00 AM: B/P 115/55

06/11/24 9:00 AM: B/P 128/80 and 5:00 PM: B/P 110/74

06/13/24 5:00 PM: B/P 119/60

06/14/24 9:00 AM: B/P 127/60

06/15/24 5:00 PM: B/P 127/81

06/17/24 9:00 AM: B/P 110/56

06/19/24 5:00 PM B/P 116/65

05/01/24 9:00 AM: B/P 129/79 and 5:00 PM: B/P 116/67

05/05/24 9:00 AM: B/P 129/78

05/07/24 5:00 PM B/P 122/78

05/09/24 9:00 AM: B/P 129/79

05/10/24 9:00 AM: B/P 128/69 and 5:00 PM: B/P 121/68

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 19 105268 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 105268 B. Wing 06/20/2024

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

Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407

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 0756 05/11/24 9:00 AM: B/P 101/74

Level of Harm - Minimal harm or 05/12/24 5:00 PM: B/P 122/79 potential for actual harm 05/13/24 9:00 AM: B/P 124/68 and 5:00 PM B/P 127/76 Residents Affected - Few 05/14/24 5:00 PM B/P 119/68

05/15/24 9:00 AM: B/P 121/64

05/16/24 5:00 PM: B/P 129/73

05/17/24 9:00 AM: B/P 123/65

05/20/24 5:00 PM: B/P 128/76

05/25/24 9:00 AM: B/P 121/67

05/26/24 5:00 PM B/P 128/71

05/27/24 9:00 AM: B/P 124/62

05/30/24 5:00 PM: B/P 128/71

05/31/24 9:00 AM: B/P 107/57

04/02/24 5:00 PM: B/P 126/77

04/04/24 9:00 AM: B/P 112/67 and 5:00 PM: B/P 113/76

04/05/24 9:00 AM: B/P 117/76 and 5:00 PM: B/P 117/76

04/06/24 9:00 AM: B/P 122/67 and 5:00 PM: B/P 118/61

04/10/24 9:00 AM: B/P 116/85 and 5:00 PM: B/P 121/59

04/11/24 5:00 PM: B/P 128/73

04/12/24 9:00 AM: B/P 129/78 and 5:00 PM: B/P 113/54

04/13/24 5:00 PM: B/P 126/84

04/14/24 9:00 AM: B/P 124/84

04/15/24 5:00 PM: B/P 117/65

04/16/24 9:00 AM: B/P 117/65 and 5:00 PM: B/P 126/85

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 19 105268 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 105268 B. Wing 06/20/2024

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

Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407

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 0756 04/17/24 9:00 AM: B/P 118/67 and 5:00 PM: B/P 126/85

Level of Harm - Minimal harm or 04/19/24 5:00 PM: B/P 121/67 potential for actual harm 04/21/24 9:00 AM: B/P 124/79 Residents Affected - Few 04/22/24 9:00 AM: B/P 125/89

04/26/24 5:00 PM: B/P 120/61

3) A review of Resident #53 record review revealed Resident #53 was admitted to the facility on [DATE REDACTED] with

a diagnosis to include Hypertension, Dementia, Alzheimer's Disease, Chronic Kidney Disease. A review of

the Physician Orders reveal Resident #53 was on Amlodipine Besylate Tab 5 MG. hold SBP (Systolic Blood Pressure) is less than 110 or Heart Rate is less than 60. The start date is 07/04/22.

Review of the MARS (Medication Administration Record) for April 2024, May 2024, and June 2024 reveal the Amlodipine Besylate Tab 5 MG 1 tablet twice daily with an order to hold if systolic blood pressure (SBP) is less than110 or Heart rate is less than 60 start date 07/04/22.

The following dates show the medication was given outside parameters to hold:

04/07/24 5:00 PM: B/P 98/74

04/16/24 18:13: Heart rate 58

04/17/24 5:00 PM: Heart rate 54

05/11/24 9:00 AM: B/P 105/54 and Heart rate 58

05/16/24 9:00 AM: Heart rate 56

05/27/24 9:00 AM: Heart rate 56

06/15/24 9:00 AM: Heart rate 56

05/18/24 9:00 AM: Heart rate 55

Review of the Pharmacy Reviews for 12/24-05/24 by the Pharmacist does not mention anything that he had concerns with the nurse giving a medication when it should have been held.

During an interview on 06/20/24 at 9:36 AM with the DON (Director of Nursing), she was asked to review the MARS (Medication Administration Record) for April 2024, May 2024 and June 2024 for Resident #26 and Resident #53. She reviewed the MARS for these residents and acknowledged the medications were given when it specifically documented to hold the medication. She stated I did in-service after pharmacist mentioned it on another resident. I did the Inservice on 04/29/24.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 19 105268 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 105268 B. Wing 06/20/2024

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

Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407

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 0756 During an interview on 06/20/24 at 10:02 AM with RN, Unit Manager, he was asked to review the physician orders vs the MARS for April 2024, May 2024 and June 2024. He acknowledged that the nurses did not hold Level of Harm - Minimal harm or the medication as per physician order. potential for actual harm

During an interview on 06/20/24 at 10:20 AM, with Staff G, LPN (Licensed Practical Nurse) she was asked to Residents Affected - Few Review Resident #23 and Resident #53 orders and MAR for these residents. She was asked to look at the resident's B/P vs the medication order on the days she worked and gave the medication. She didn't understand what the concern was and was asked if she should have held the medications for when the systolic B/P was below 130 for Resident #26. She did not have an answer and why she gave it.

During a telephone interview on 06/20/24 at 10:51 AM with the Pharmacist he stated that I look at all medications and parameters, but I don't make recommendations he then stated I would make a recommendation if I had a concern but had no concerns with these two residents.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 19 105268 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 105268 B. Wing 06/20/2024

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

Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407

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 0758 Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic Level of Harm - Minimal harm or medications are only used when the medication is necessary and PRN use is limited. potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 25404 Residents Affected - Few Based on policy review, record review, and interview, the facility failed to ensure psychotropic medications for 1 of 7 residents reviewed for medication use, were limited to 14 days or extended only with an indicated duration for use. Resident #22 had a PRN (as needed) order for lorazepam, a psychotropic medication, initiated on 02/29/24, with no indication for the duration of use.

The findings included:

1) Review of the policy 3.8 Psychotropic Medication Use, revised 10/24/22 documented, 9. For psychotropic medications, excluding antipsychotics, that the attending physician believes a PRN order for longer than 14 days in appropriate, the attending physician can extend the prescription beyond 14 days for the resident by documenting their rationale in the resident's medical record. This policy lacked that the PRN order needed to indicate a duration for use, as per regulatory compliance.

Review of the record revealed Resident #22 was admitted to the facility on [DATE REDACTED], with an admission to Hospice services as of 10/05/23. Admitting diagnoses included anxiety disorder.

Review of the current order dated 02/29/24 documented the use of 0.5 milligrams of Lorazepam (an anti-anxiety medication that is also a psychotropic medication), every four hours, as needed for anxiety. Further review of this order lacked any end date or duration for the medication.

Review of the most current psychiatric progress note dated 03/12/24 documented Resident #22 was prescribed the Lorazepam 0.5 mg every four hours PRN (as needed), but lacked any duration of use.

During a phone interview on 06/20/24 at 11:07 AM, when asked about the PRN Lorazepam use greater than 14 days, the consultant pharmacist stated there should be a re-evaluation for use to continue the medication more than 14 days, and agreed the medication should have a specific duration of time. The consultant pharmacist stated his last recommendation related to the Lorazepam was on 02/28/24, as it was ordered every two hour as needed, and the order was changed to every four hours, as needed.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 19 105268 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 105268 B. Wing 06/20/2024

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

Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407

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** 25404

Residents Affected - Few Based on policy review, record review, and interview, the facility failed to ensure complete and accurate clinical records for 1 of 7 sampled residents reviewed for medication use, as evidenced by contradictions in psychotropic medication doses for Resident #37; and for 1 of 1 sampled resident on transmission based precautions (TBPs) as evidenced by the lack of timely orders for contact precautions for Resident #61.

The findings included:

Review of the policy Nursing Documentation reviewed 08/10/2023 documented, Medical Records: . The medical record must also reflect the resident's condition and the care and services provided across all disciplines to ensure information is available to facilitate communication among the interdisciplinary team.

The medical record must contain an accurate representation of the actual experience of the resident and include enough information to provide a picture of the resident' progress, including his/her response to treatment and/or services, and changes in his/her condition, plan of care goals, objectives and/or interventions.

1) Review of the record revealed Resident #37 was admitted to the facility on [DATE REDACTED], had a short hospitalization as of 05/27/23 with readmission to the facility on [DATE REDACTED]. Resident diagnoses included anxiety disorder, depression, and psychotic disorder with delusions.

Review of the current physician orders revealed the following:

a) As of 03/19/24 the resident was prescribed clonazepam (an antianxiety medication) 0.5 mg (milligrams) once daily.

b) As of 01/18/24 the resident was prescribed seroquel (an antipsychotic medication) 100 mg in the morning and 50 mg at bedtime.

c) As of 12/08/23 the resident was prescribed trazodone (an antidepressant medication) 25 mg at bedtime.

Review of the most current physician progress note dated 06/10/24, by the physician who ordered the above three medications, documented Resident #37 was on clonazepam 1 mg, seroquel 50 mg and 25 mg, and trazodone 50 mg. These doses contradicted the current active orders.

Review of the previous physician progress note dated 02/15/24, by the nurse practitioner, documented Resident #37 was on trazodone 50 mg at bedtime, which contradicted the order.

During a side-by-side review of the record and interview on 06/20/24 at 2:19 PM, the Director of Nursing (DON) agreed with the inaccurate physician documentation related to the medication usage for Resident #37.

38212

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 19 105268 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 105268 B. Wing 06/20/2024

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

Lakeside Health Center 2501 N Australian Avenue West Palm Beach, FL 33407

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 2) The policy titled, Contact Precautions and reviewed by the facility on 06/03/24 documents in part:

Level of Harm - Minimal harm or 2. The licensed professional independent practitioner orders isolation for suspected or diagnosed infections. potential for actual harm

During a review of the residents on Enhanced Barrier Precautions and Contact Precautions it was noted that Residents Affected - Few Resident #61 did not have an order written for contact precaution until 2 days after the results were reviewed by the facility.

The laboratory results of the stool sample collected on Resident #61 indicated her stool was positive for Clostridium difficile (C. Difficile) on 06/14/24 and documented as reviewed by the facility on 06/15/24.

The chart was reviewed for Resident #61 and the order for contact precautions were written on 06/17/24.

On 06/20/24 at 10:05 AM, an interview was conducted with the Infection Preventionist. She was asked about

the order for the contact precautions on Resident #61 and why they were written 2 days post confirmation of

the facilities review of the laboratory results. She stated she always does her audits of the Isolation and Enhanced Barrier Precautions on Mondays and she realized she hadn't written the order for Resident #61's contact isolation. She stated she does not ever back date anything, so the order was written after the diagnosis and precautions were instituted.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 19 105268