Award Care at Sarasota

Inspectors wroteBased on interviews, review of facility policy, and clinical record review, the facility failed to immediately inform the resident representative when there was a significant change in the resident's physical status and decision to transfer the resident to the hospital for 1 (Resident #1) of 3 residents sampled.

Inspectors wroteBased on interviews, record review, and review of facility policies, the facility failed to report an allegation of neglect that resulted in death within the specified required timeframe for one resident (Resident #1) reviewed.

Inspectors wroteBased on resident and staff interviews and record review the facility failed to ensure 1, (Resident #1), of 3 residents reviewed for accidents was not burned by hot coffee. The facility had not provided the required staff education and equipment to ensure the reheating of residents' food or beverages were served at an appropriate safe temperature.

Inspectors wroteBased on staff interviews and record reviews, the facility failed to ensure 1, (Resident #2), of 3 residents with admitting facility orders for an antibiotic medication were clarified by the residents' primary care physician

Inspectors wroteBased on review of the clinical record, review of facility policy and procedures, and resident and staff interviews, the facility failed to protect residents from misappropriation of resident property when controlled medications were unaccounted for 1(Resident #45). On 2/13/24 it was reported Resident #45's Hydrocodone-Acetaminophen 5 milligrams (mg)-325 mg, 75 tablets were unaccounted for. The facility failed to account for all controlled medications to prevent loss or diversion. On 8/5/24 controlled medications were signed out on the narcotic declining drug inventory sheet as administered for 3(Resident #12, # 42, and #27) who were alert and oriented and reported they had not received the medications that were documented. [...]

Inspectors wroteBased on staff interviews, and review of the facility policy and procedures, the facility failed to implement a system to account for periodic reconciliation and disposition of all controlled substances.

Inspectors wroteBased on review of the clinical record, review of facility policies and procedures, and resident and staff interviews, the facility failed to ensure accuracy of medication administration for 17(Residents #122, #222, #70, #41, #97, #13, #92, #10, #61, #8, #46, #67, #74, #12, #27, #63 and #42) of 17 residents reviewed for significant medication errors.

Inspectors wroteBased on observation, staff and resident interviews and review of facility policies and procedures, the facility failed to ensure 1(Resident #21) of 1 resident reviewed had a wheelchair in good working repair and was safe for resident use.

Inspectors wroteBased on observations, interviews, and record review the facility failed to provide appropriate housekeeping services to ensure the facility remained in good repair, and ensure facility staff were aware of how to report needed repairs to the maintenance staff.

Inspectors wroteBased on interview and record review, the facility failed to ensure a Pre-admission Screening and Record Review (PASARR) Level I and Level II were conducted prior to admission to the facility for 1 resident diagnosed with serious mental illness (#79) of 2 residents reviewed for PASARR.

Inspectors wroteBased on interview and record review, the facility failed to formulate a comprehensive resident-centered care plan that included the services required to ensure proper functioning and maintenance including monitoring, testing, and ways to identify potential problems or complications for 2 (Residents #9, and #22) of 2 reviewed in the facility who had implanted cardiac pacemakers.

Inspectors wroteBased on observation, review of clinical records and resident and staff interviews, the facility failed to assist in making an appointment with a practitioner specializing in the treatment of vision impairments and failed to ensure the resident's glasses were in good repair for 1(Resident #95) of 1 resident reviewed for vision loss.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure one (Resident #104) urinary catheter was secured to allow a free flow of urine to the catheter bag and prevent movement and pulling of the catheter line. Consistent pressure and pulling on the catheter line has a potential to cause irritation to the urethra and contribute to increased urinary tract infections.

Inspectors wroteBased on observation, interview, an record review, the facility failed to post nursing staff two consecutive days and failed to post accurate numbers of nursing staff on two additional days. The findings Included: On 12/9/24 at 9:10 a.m., the federal posting was observed in the lobby of the facility. The last posted date noted was 12/6/24. Review of the federal postings for 11/16/24, and 11/17/24 showed on both dates there were 13 Certified Nursing Assistants (CNA) listed as working on the morning, and the evening shifts. Review of the two-week staffing hours provided by the facility showed on 11/16/24 there were 12 CNA's working on both the morning and evening shift. On 11/17/24 there were 12 CNA's working on the morning shift, and 11 working on the evening shift. [...]

Inspectors wroteBased on observations, review of facility policies and procedures and staff interviews, the facility failed to ensure medications were stored in a safe and secure manner within the facility, including medication carts and resident rooms.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure an effective pest control program to prevent flying insects and roaches within the facility. The findings Included: Resident #104 is a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #104's quarterly MDS dated [DATE] shows a BIMS score of 15 which shows no cognitive deficits. On 12/10/24 at 9:43 a.m. Observation's in Resident #104's room noted small insects were flying around the resident's bed in room [ROOM NUMBER]. Resident #104 said she had seen the flying insects in her room for at least two weeks. Resident #104 said she has roaches coming in her room from around the air conditioner. Resident #78 is a [AGE] year-old male who was admitted to the facility on [DATE]. [...]

Inspectors wroteBased on record review, staff and resident interviews, review of facility policies, the facility failed to ensure medications were administered as scheduled for 1(Resident #999) of 3 residents reviewed for medication administration. The failure to administer medications accurately places the residents at risk for adverse health consequences, sub-optimal therapy, or pharmacological effects.

Inspectors wroteBased on observation, record review, and interview, the facility failed to store food in accordance with professional standards for food service safety. The facility also failed to ensure regular cleaning of ice machines to prevent buildup of dust and bio growth. This had the potential to affect all 113 residents who reside in the facility and consume an oral diet.

Inspectors wroteBased on observations, interviews, and record review the facility failed to implement an individualized in room activity program to support the physical, mental, and psychosocial well-being of 1 (Resident #45) of 21 residents dependent on staff to meet their needs.

Inspectors wroteBased on observation, review of facility policy, and procedures, resident and staff interviews, the facility failed to ensure menus were developed and prepared to meet resident choices, and nutritional needs. The facility failed to identify and document resident preferences and respond to them.

Inspectors wroteBased on record review and staff interview the facility failed to implement effective corrective actions for deficiencies identified on the recertification survey completed on 3/23/23.

Inspectors wroteBased on record review, staff, resident and resident representative interview, the facility failed to inform and assist with formulation and/or revision of advance directives for 2 (Resident #45, Resident #26) of 3 residents surveyed for advance directive.

Inspectors wroteBased on observation, record review, review of the Resident Assessment Instrument (RAI), staff, and resident representative interviews, the facility failed to ensure the comprehensive assessment accurately reflected the resident's oral status for 1 (Resident #45) of 3 residents sampled for dental services.

Inspectors wroteBased on observation, staff and resident interview and record review the facility failed to ensure residents' participation in care plan for 2 (Resident #4 and #26) of 13 residents reviewed for care planing.

Inspectors wroteBased on record review and staff interview, the facility failed to coordinate care and services and obtain timely necessary appointment with an outside specialist for 1 (Resident #26) of 6 residents reviewed for compliance with physician's order.

Inspectors wroteBased on observation, record review, staff and resident interviews, the facility failed to implement processes to identify and ensure the proper storage of medications at residents' bedside for 3 (#67, #98 and #101) of 3 residents observed with unsecured medications at the bedside.

Inspectors wroteBased on interviews and record reviews, the facility failed to administer the annual influenza vaccine to 1 (Resident #412) 5 residents reviewed for immunization.

Inspectors wroteBased on interviews and record reviews, the facility failed to administer the COVID-19 vaccine to 1 (Resident #412) of 5 residents reviewed for COVID-19 immunization.

Inspectors wroteBased on observation, review of the facility's abuse and neglect policy and procedure, record review, and staff interview, the facility failed to protect one (Resident #19) of one sampled vulnerable resident with dementia from neglect by failing to provide supervision, to ensure the necessary care and services were provided.

Inspectors wroteBased on observation, record review, staff and resident interviews, the facility failed to provide the necessary care and services to maintain grooming and personal hygiene for 3 (Resident #19, #42 and #63) of 17 sampled residents.

Inspectors wroteBased on observation and staff interview, the facility failed to properly discard expired, over the counter medication in 1 of 2 medication rooms reviewed. This had the potential to administer expired medication to Residents. Additionally, 3 of 3 carts observed in the North and South wings were found with loose pills at the bottoms of the carts.

Inspectors wroteBased on record review and staff interview, the facility failed to implement policies and procedures to ensure residents and staff were offered the COVID vaccine, educated on the risk and benefits of the vaccine, informed regarding additional dose requirements, and given the opportunity to refuse the COVID-19 vaccine.

Inspectors wroteBased on observation, record review, and staff interview, the facility failed to provide Restorative Nursing Program as recommended by Rehabilitation Therapy to prevent decline and maintain abilities with Activities of Daily Living (ADLs) for 1 (Resident #38) of 2 residents reviewed. This has the potential to lead to a decline in functional ability.

Inspectors wroteBased on record review, facility policy review, and staff and resident interviews, the facility failed to have documentation of a fall investigation to ensure adequate preventive interventions for 1 (Resident #5) of 2 residents reviewed for falls.

Inspectors wroteBased on observation, record review, resident and staff interview, the facility failed to maintain a suprapubic catheter in a safe and sanitary manner or notify the physician of symptoms of a suspected urinary tract infection (UTI) for 1(Resident #50) of 1 resident sampled with an indwelling catheter.

Inspectors wroteBased on observation and resident and staff interview, the facility failed to ensure a safe, comfortable, and home like environment for 1 (Resident #43) of 2 residents sampled.