Largo Nursing and Rehabiliation Center

Inspectors wroteBased on review of a facility reported incident, record review, and staff interviews, it was determined that the facility failed to ensure an allegation of abuse was reported to the Office of Health Care Quality (OHCQ) timely as required. This was evident for 1 (Resident #1) of 4 residents reviewed during the complaint survey.

Inspectors wroteBased on investigation into a complaint, clinical record review and staff interviews, it was determined that the facility failed to implement provider-recommended interventions to prevent pressure ulcers for residents. This was evident for 1 (Resident #8) of 3 residents reviewed for pressure ulcers during the complaint survey.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure staff provided the appropriate level of assistance for bed mobility to ensure a resident did not fall from their bed for 1 (Resident #6) of 3 sampled residents reviewed for falls. The facility further failed to ensure fall interventions were implemented for 2 (Resident #4 and Resident #6) of 3 sampled residents reviewed for falls.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure fall interventions were implemented as care planned for 2 (Resident #4 and Resident #6) of 3 sampled residents reviewed for falls.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure 1 (Resident #7) of 20 sampled residents was free from a significant medication error when staff administered an anticonvulsant medication, Dilantin, to a resident when there was an order to hold the medication.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure staff wore personal protective equipment (PPE) when they entered the room of a resident on contact precautions and when they provided care to a resident on enhanced barrier precautions (EBP) for 2 (Resident #10 and Resident #12) of 2 sampled residents reviewed for infection control.

Inspectors wroteBased on observations and interview, it was determined that the facility failed to ensure that the environment was in good repair. This was found to be evident in 6 (Resident rooms #239, #240, #237, #245, #235, & 242) out of 6 Resident rooms observed for the environment during the recertification survey.

Inspectors wroteBased on observation and interviews, it was determined the facility failed to ensure medications were properly stored and wasted. This was evident for 3 of 4 medication carts and 1 of 1 medication storage rooms observed during the recertification survey.

Inspectors wroteBased on medical record review and interviews with the resident and staff, the facility was found to have failed in ensuring the resident's right to participate in planning care. This was evident for 1 (Resident #5) of 1 resident reviewed for care plan during the annual survey.

Inspectors wroteBased on interviews, observations, and record reviews, it was determined that the Facility failed to ensure a resident's choices were honored. This was evident for 1 (Resident #61) of 3 residents reviewed for choices during the recertification survey.

Inspectors wroteBased on record reviews and facility staff interviews, it was determined that the facility failed to ensure a resident received a beneficiary notification. This was found to be evident for 1 (Resident #16) of 3 residents reviewed for Beneficiary Notifications during the recertification survey.

Inspectors wrotecite Based on record reviews and staff interviews, it was determined that the facility failed to ensure adequate monitoring for residents receiving antipsychotic medications. This was evident for 3 (Residents #14, #5 #1) out of 3 residents reviewed for Unnecessary Medications during the annual survey.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to thoroughly investigate an allegation of abuse. This deficient practice was identified for 1 out of 1 facility-reported incidents reviewed during the annual survey.

Inspectors wroteBased on medical record review, staff interviews, and review of the facility's discharge practices, it was determined that the facility failed to: 1) provide the resident and/or resident representative with written notification of the bed-hold policy, and 2) notify the Ombudsman of the resident's transfer. This was evident for 1 (Resident #120) of 2 residents reviewed for hospitalization during the annual survey.

Inspectors wroteBased on medical record reviews and staff interviews, it was determined that facility staff failed to ensure the accuracy of Minimum Data Set (MDS) assessments. This was evident for 1 of 3 residents reviewed for unnecessary medications (Resident #14) during the annual survey.

Inspectors wroteBased on interviews and record reviews, it was determined that the facility failed to ensure that residents requiring assistance with Activities of Daily Living (ADLs) received scheduled showers. This was evident for 1 (Resident #6) out of 1 resident reviewed for ADLs during the annual survey.

Inspectors wroteBased on interviews, observations, and record reviews, it was determined that the facility failed to offer comprehensive activities in accordance with resident interests, physical, mental, and psychosocial well-being. This was evident for 3 (Resident #61, Resident #9, Resident # 10) of 24 residents reviewed for activities.

Inspectors wroteBased on interview and observation, it was determined that the facility failed to provide quality of care to residents. This was evident for 1 (Resident #56) out of 1 resident reviewed during the annual survey.

Inspectors wroteBased on observations, medical record reviews, and staff interviews, it was determined that the facility failed to implement measures to prevent pressure ulcers. This was evident for 1 (Resident #6) of 1 resident reviewed for pressure ulcers during the annual survey.

Inspectors wrotecited:Based on interview and record review, it was determined that the facility failed to provide sufficient pain management. This was found to be evident for 1 (Resident #75) out of 1 resident reviewed for pain management during the annual survey.

Inspectors wroteBased on observation of medication administration, review of medical records, and interviews with facility staff, it was determined that the facility failed to ensure a medication error rate of less than 5%. This was evident for 2 medication administration errors out of 25 medication administration opportunities observed which resulted in a medication error rate of 8% during the recertification survey .

Inspectors wroteBased on observation and interview, it was determined that the facility failed to (1) store food under sanitary conditions and (2) ensure food items in the nourishment refrigerators were properly labeled and dated. This was found evident during the kitchen review conducted as part of the annual survey and has the potential to affect most residents.

Inspectors wroteBased on interview and record review, it was determined that the facility failed to accurately document resident records. This was evident for 1 (Resident #75) of 1 resident reviewed for pain management during the annual survey.

Inspectors wroteBased on observation, interview and record review, it was determined that the facility failed to maintain proper infection prevention and control practices by (1) failing to maintain sanitary and safe practices related to the resident care environment and supplies, and (2) failing to ensure staff were wearing required personal protective equipment (PPE). This was found evident during the Infection Control review conducted during the annual survey and has the potential to affect most residents.

Inspectors wroteBased on administrative record review and interviews with facility staff it was determined the facility failed to ensure that allegations of abuse were immediately reported. This was found to be evident for 1 resident (# 1) of 44 residents reviewed during a complaint survey.

Inspectors wroteBased on observations, record reviews and interviews, it was determined that the facility failed to ensure the proper process of discharge for the resident. This was evident for 1 (#3) resident out of 1 resident investigated during the facility's complaint survey.

Inspectors wroteBased on observation, record review, and interview of facility staff, it was determined the facility failed to: 1) ensure medications and hazardous items were safely and securely stored and limit access to authorized personnel only. This was evident for two of three units observed; 2) investigate the root cause of the falls and initiate nursing interventions to prevent further falls, and 3) assess resident's fall risk regularly before actual fall incidents. This was evident for two (Resident #38 and # 323) of five residents reviewed for falls during the annual survey. As a result of the findings of unsecured medications and hazardous items, a state of immediate jeopardy was declared on 1/12/24 at 4:45 PM and communicated to the facility Administrator at 4:48PM. An immediate jeopardy summary tool was provided to the facility at 4:51PM. [...]

Inspectors wroteBased on record review, and interview with the resident and staff it was determined the facility staff failed to ensure all residents were free from abuse and mistreatment. As a result of this deficient practice, Resident #18 experienced actual harm as evidenced by a laceration requiring 6 sutures to the forehead. This was evident for 1 (#18) of 28 residents reviewed for abuse.

Inspectors wroteBased on review of administrative documents, and interviews of residents and staff, it was determined that the facility failed to ensure that grievances and concerns from the resident group were documented, reviewed, and responses provided to the group in writing. This was evident in review of 7 of 7 resident council meeting minutes.

Inspectors wroteBased on surveyor observation and staff interview, it was determined the facility staff failed to keep the building clean, neat, attractive and in good repair. This was evident for 3 of 3 nursing units on both floors of the facility.

Inspectors wroteBased on interviews of facility staff, it was determined that the facility failed to ensure a full-time clinically qualified nutrition professional for the oversight of food preparation and the daily kitchen operation. All the residents in the facility have the potential to be affected by not having a qualified nutritional professional with the appropriate competencies and skill sets to carry out food and nutrition services.

Inspectors wroteBased on medical record review, resident and staff interviews it was determined that facility failed to assess a resident's needs and preferences and respond to resident that expressed dissatisfaction with the food provided by the facility and was eating food provided by family members. This was evident for 1 (Resident #109 ) of 10 residents that were reviewed with expressed concerns with the food provided by the facility.

Inspectors wroteBased on interview, observation and record review, it was determined that the facility administration failed to provide effective oversight for the facility to ensure that resident needs were met as evidenced by failing to: 1) ensure that the facility had sufficient nursing staff, 2) ensure that the facility was kept clean and in good repair, 3) ensure residents were protected from potential hazards in the environment, 4) employ qualified kitchen and Dietitian staff, 5) ensure residents' social services needs were met, and 6) ensure an effective Quality Assurance and Performance Improvement (QAPI) program. This was evident during the survey and had the potential to affect all residents.

Inspectors wroteBased on interview and record review it was determined that the facility failed to have an effective Quality assurance and performance improvement (QAPI) program. This was evident during the QAPI facility task investigation during the recertification survey and had the potential to affect all residents, families, and visitors.

Inspectors wroteBased on observation and staff interview it was determined the facility failed to: 1) keep the kitchen walk-in freezer in safe operating condition. This was evident during the initial tour of the kitchen and during 2 subsequent visits; and 2) ensure two assistive shower chairs and one sitting chair in a resident room were in safe condition for use evident in one of one seated style shower chair and one of one adjustable shower chair and one of two sitting chairs located in room [ROOM NUMBER] on the [NAME] Wing.

Inspectors wroteBased on observation, resident and staff interviews, and medical record reviews, it was determined that the facility failed to treat residents with dignity and respect as evidenced by: 1) not removing a staff member from resident's assignment after the resident requested it, and 2) failure to ensure timely emptying of a resident's urinal. This was evident for 2 (#72, #11) of 7 residents reviewed for dignity. Additionally, the facility failed to 3) properly transport a resident in the hallway, evident for 1 resident (Resident #114) during a random observation on the facility nursing units. The findings Include: 1) On 1/8/24 at 10:05 AM during an interview, Resident #72 was asked if he/she was treated with dignity and respect by staff. Resident #72 told the surveyor that they did not get along with Staff #49, a Geriatric Nursing Assistant (GNA). [...]

Inspectors wroteBased on interview, review of facility reported incident investigations and policy, it was determined the facility failed to thoroughly investigate allegations of abuse, neglect, misappropriation of resident property, and injuries of an unknown source, and failed to ensure measures were taken to prevent further abuse of the Resident #87 while the investigation was in progress. This was evident for 7 residents (Resident #87, #319, #369, #39, #470, #418, #419) of 28 residents reviewed for abuse.

Inspectors wroteBased on medical record review and interviews with staff and a resident, it was determined that the facility failed to ensure that an interdisciplinary team, which included the resident and or the resident's representatives, contributed to the resident's comprehensive care plan as evidenced by the failure to conduct a care plan meeting for residents at quarterly intervals. Additionally, facility staff failed to document and evaluate each care plan to ensure the interventions continued to be appropriate for the resident's condition. This was evident for 5 residents (Resident #5, #75, #17, #39, #96) reviewed for care planning.

Inspectors wroteBased on interviews with residents and staff interview, and a review of the facility's documentation, it was determined that the facility failed to have sufficient nursing staff to meet the needs of the residents. This was evident for 3 of 23 complaints submitted to the Office of Health Care Quality (OHCQ), the regulatory agency and 7 (Resident #3, #18, #39, #67, #72, #109, and #272) of 10 interviewable residents, and 3 out of 5 staff interviews.

Inspectors wroteBased on observation, record review, and interview it was determined the facility failed to act upon multiple pharmacy drug problems that were identified. This was evident for 1 of 5 residents (#1) reviewed for unnecessary medications.

Inspectors wroteBased on record review and staff interview it was determined the facility failed to: 1) ensure a resident was free from unnecessary medications. This was evident for 1 (Resident #1) of 5 residents reviewed for unnecessary medications; and 2) reconcile and transcribe medication orders accurately to the medication administration record as evidenced by transcribing a medication twice. By failing to reconcile and transcribe orders accurately the resident received up to twice the amount of medication ordered. This was identified for 1 (#12) of 66 residents; and 3) ensure physicians orders for pain medication clearly identified when staff were to give each of 2 medications as needed for pain, and administered as needed pain medications when the resident indicated their pain level was low or absent. [...]

Inspectors wroteBased on medical record review, interviews, and observations it was determined the facility failed to maintain complete and accurate medical records in accordance with accepted professional standards. This was evident: 1) for 1 (#18) of 3 residents reviewed for Hospitalization, 2) for 1 out of 9 residents (#30) reviewed for wounds, 3) for 1 (Resident #323) out of 3 residents reviewed for hospital visits, and 4) 1 (MD00145026) of 23 facility reported incidents reviewed during the survey.

Inspectors wroteBased on record review and staff interview, it was determined that the facility failed to maintain an effective infection control program by failure to: 1) place an order for isolation precautions for those diagnosed with C-diff, which was evident for 1 (Resident #23) of 4 residents reviewed for transmission-based precautions; 2) perform hand hygiene while conducting wound dressing, which was evident for 2 (Resident #103 and #175) of 9 residents' reviews for wound dressing; 3) keep linens from contamination, which was evident for 1 (Arcadia unit) of 1 linen closet and laundry room observation; 4) conduct an annual review of infection control policies; and 5) ensure consistent infection prevention monitoring of waterborne infection, which was evident by incomplete water temperature monitoring logs reviewed during the survey.

Inspectors wroteBased on interviews and the review of the facility records and residents' medical records, it was determined that the facility failed to monitor and track antibiotic usage and resistance data. This was evident by 1) the indications for antibiotic use were not documented for their orders, and 2) the facility's antibiotic stewardship program failed to document essential elements for antibiotic use. This was found to be true for 2 (Resident #3 and #53) of 3 residents reviewed for antibiotic use, and a review of the facility's antibiotic stewardship program during the annual survey.

Inspectors wroteBased on review of facility records and interview with staff it was determined the facility failed to provide a behavioral health training program for all staff which included but was not limited to providing care for residents diagnosed with mental, psychosocial, or other behavioral health condition and Individualized non-pharmacological approaches to care. This was evident for 1 (#18) of 4 residents reviewed for Behavioral-Emotional.

Inspectors wroteBased on clinical record review and staff interviews, it was determined that the facility failed to ensure the resident/responsible party was offered the opportunity to develop an advance directive. This was evident for 1 (#82) of 4 sampled residents for advance directives during an annual survey.

Inspectors wroteBased on record review and interview with staff, it was determined the facility failed to ensure that allegations of abuse and injuries of unknown origin were reported to the state agency within required timeframes. This was evident for 3 (#87, #7, #18) of 28 residents reviewed for abuse during the facility's Recertification survey.

Inspectors wroteBased on medical record review and interview with staff, it was determined the facility staff failed to permit each resident to remain in the facility unless the transfer/discharge was necessary for the resident's welfare and the residents need could not be met in the facility, failed to ensure appropriate information was communicated to the receiving health care institution and failed to ensure that a resident was sent home with appropriate discharge instruction paperwork. This was evident for 2 (#18, #322) of 4 residents reviewed for hospitalization and discharge

Inspectors wroteBased on record review and interview, it was determined that the facility failed to provide the required notice of discharge/transfer when a resident was transferred to a hospital. The was evident for 1 resident (Resident #13) of 26 residents reviewed for facility reported incidents.

Inspectors wroteBased on review of the medical record and interview with staff, it was determined that the facility staff failed to sufficiently prepare and orient residents for their transfer to the hospital. This was evident for 1 (#18) of 3 residents reviewed for hospitalization.

Inspectors wroteBased on record review and staff interview, it was determined that the facility failed to offer a bed-hold notice to the resident or resident's representative before the facility transferred a resident to the hospital. This was evident for 2 (Residents #173 and #169) of 3 resident records reviewed for hospitalization, and for 1 resident (Resident #13) of 26 residents reviewed for facility reported incidents.

Inspectors wroteBased on record review and interview, it was determined the facility failed to accurately code significant weight loss of a resident on the Minimum Data Set (MDS) assessment. This was evident for 1 of 7 (#30) residents reviewed for nutrition during the facility's recertification survey.

Inspectors wroteBased on review of the medical record and interview with staff, it was determined that the facility staff failed to accurately complete assessments and refer residents for Preadmission Screening and Resident Review (PASRR) level II determination. This was evident for 1 (#18) of 4 residents reviewed for Behavioral-Emotional.

Inspectors wroteBased on resident interview, review of medical records, and staff interviews, it was determined that the facility failed to provide the resident and their representative with a summary of the baseline care plan within 48 hours of a resident 's admission. This was evident for 3 (Resident #50, #96 and #173) of 48 residents reviewed for baseline care plans.

Inspectors wroteBased on observation, medical record review, and interview, it was determined the facility staff failed to develop and initiate comprehensive person-centered care plans for residents residing in the facility. This was evident for 1 (#18) of 4 residents reviewed for Behavioral-Emotional health needs, and 2 (#75, #23) of 48 residents reviewed for comprehensive care plans.

Inspectors wroteBased on observation, record review, and interview, it was determined the facility failed to meet professional standards of practice by failing to ensure staff followed physician orders for administration of medications and documentation. This was evident for 1 (Resident #12) of 4 residents observed for medication administration during a recertification survey.

Inspectors wroteBased on observation, medical record review and interview, it was determined that the facility failed to provide activity services to meet the needs of the resident. This was found to be evident for 1 (Resident #39) of four residents reviewed for activities during the investigative portion of the survey.

Inspectors wroteBased on complaints, reviews of medical records, and interviews, it was determined that the facility failed to: 1) ensure right orders for treatment were put in and documented on, and 2) identify and implement interventions for a resident with significant weight loss. This was evident for 2 (#55, #324) of 66 residents reviewed during a recertification/complaint survey.

Inspectors wroteBased on observation, medical record review, and interview, it was determined the facility failed to: 1) implement preventative measures to prevent the development of pressure ulcers. This was evident for 3 (Resident #169 and #370, #30) out of 9 residents reviewed for pressure ulcers during the survey; and 2) ensure the Hoyer lift sling was removed from under a resident (Resident #31) when the Hoyer lift was used to assist the resident's transfer between surfaces. This was evident for 1 of 23 complaints investigated during the survey.

Inspectors wroteBased on medical record review, staff interview, and observation, it was determined that the facility failed to provide appropriate treatment and services upon admission for the care of a resident with an indwelling catheter. This was evident for 1 (Resident #57) of 4 residents reviewed for Foley catheter during the survey.

Inspectors wroteBased on observations, record review, and interviews, it was determined that the facility failed to recognize, evaluate, and manage residents' pain. This was evident for 1 Resident (#50) reviewed for pain during the survey.

Inspectors wroteBased on medical record review and interview with staff, it was determined the facility staff failed to ensure that the care of each resident was supervised by a physician. This was evident for 1 (#18) of 3 residents reviewed for hospitalization, and for 1 (#96) of 7 residents reviewed for nutrition during the survey.

Inspectors wroteBased on record review and interview, it was determined the facility failed to ensure physician evaluation of a resident's current medication regimen. This was evident for 1 out of 7 (Resident #1) residents reviewed for unnecessary medications during the facility's recertification survey.

Inspectors wroteBased on a review of employee files and interviews, it was determined that the facility failed to put a system in place to ensure Licensed Practical Nurses (LPNs) and Geriatric Nursing Assistants (GNAs) were competent with their skill sets. This was found to be evident for 3 (one LPN and two GNAs) out of 5 employee files reviewed for competencies and skill sets.

Inspectors wroteBased on a review of Geriatric Nursing Assistant (GNA) employee records and staff interviews, it was determined the facility failed to conduct yearly performance reviews at least every 12 months. This was evident for 2 (GNA # 40 and #42) out of 2 GNAs records reviewed during this survey.

Inspectors wroteBased on review of the medical record and interview with staff, it was determined the facility staff failed to identify and provide appropriate treatment and services to assist residents in attaining their highest practicable mental health. This was evident for 1 (#18) of 4 residents reviewed for Behavioral-Emotional.

Inspectors wroteBased on review of the medical record and interview with staff, it was determined the facility failed to ensure it had sufficient staff members who possess the basic competencies and skills sets to meet the behavioral health needs of residents by failing to implement person-centered care approaches and non-pharmacological interventions designed to meet the individual behavioral health goals and needs of each resident. This was evident during review of 1 (#18) of 28 residents reviewed for Abuse.

Inspectors wroteBased on interviews and record reviews, it was determined that the facility failed to provided Medically related Social Services This was evident for 1 complaint (MD00175251) of 23 complaints investigated during the annual survey.

Inspectors wroteBased on observation, interview, and medical record review, it was determined the facility failed to ensure that its medication error rates are not 5 percent or greater. This was found to be evident based on errors identified during medication administration for one (Resident #12) out of four residents observed. The observations were made on one of two nursing units and involved one of two different nurses.

Inspectors wroteBased on observations and interviews it was determined that the facility failed to properly store medications. Medications were stored in an area where residents and unauthorized staff could access them. This was evident on 2 of 3 nursing units.

Inspectors wroteBased on interviews and medical record review, it was determined that the facility failed to ensure that residents who required dental services on a routine or emergent basis received necessary or recommended dental services in a timely manner. This was evident for 1 (Resident #96) of 4 residents reviewed for dental service, and 1 complaint of 23 complaints investigated during the annual survey.

Inspectors wroteBased on observation, record review, and interview it was determined the facility failed to have an effective process in place for the kitchen to accurately serve according to medical orders and effectively institute dietary changes when they are made, and provide documentation in the medical record for rationale of nutritional changes. This was evident for 3 out of 10 residents (#87, #11, #30) reviewed for food concerns during the facility's recertification survey.

Inspectors wroteBased on surveyor interview and observation, it was determined that the facility failed to have adequate and functional mechanically operated exhaust ventilation, as necessary to control moisture and odors to ensure good air circulation to keep all parts of the facility odor free. This was evident during the initial tour of the facility.

Inspectors wroteBased on documentation review and interview, it was determined the facility failed to ensure nurse aides receive the required training, including dementia care and abuse prevention, no less than 12 hours per year. This was evident for 3 Geriatric Nursing Assistants (GNAs) (#29, #40, and #42) of 3 GNA training records reviewed.

Inspectors wroteBased on review of surveyor requested documents and interviews, it was determined that the facility failed to provide accurate reports regarding residents who received a Beneficiary Notice. Due to this failure, this required survey task was unable to be completed.

Inspectors wroteBased on observations and interviews, it was determined that the facility failed to post nursing staffing for the entire building. This was observed during the survey.

Inspectors wroteBased on record review and interviews it was determined that the facility failed to provide Quality Assessment and Performance Improvement (QAPI) training to staff. This was evident during completion of the Extended Survey portion of the survey and had the potential to affect all residents, families, and visitors.

Inspectors wroteBased on medical record review and staff interviews it was determined that the facility failed to revise and update the comprehensive care plan that addressed the resident's change in condition. This was evident 1 out of 36 residents reviewed, involving Resident #89, during the survey process. The care plan is a guide that addresses the unique needs of each resident. It is used to plan, assess and evaluate the effectiveness of the resident's care.

Inspectors wroteBased on hospital records and hospital complainant interview, the facility staff failed to ensure that Resident #217's oral care was being done. This was evident for 1 out of 36 residents investigated during the survey process.

Inspectors wroteBased on complaint and hospital records, the facility staff failed to provide appropriate oral care for Resident #217 according to professional standards of practice. This is evident for 1 out of 33 residents investigated during the survey process.

Inspectors wroteBased on medical records and staff interview, it was determined that the facility staff failed to have a plan in place to manage Resident # 93's pain related to a fall and hospital visit. The was evident for 1 out of 33 residents investigated during the survey process.

Inspectors wroteBased on observation, the facility failed to complete the refrigerator temperature log sheets for the month of January 2019. This was evident for 1 out of 3 months observed.

Inspectors wroteBased on review of resident records and staff interviews, the facility failed to document the use of a low bed and continue to document the neurological assessment for Resident #264 after 8:30 AM on 10/18/18. This was evident for 1 out 1 resident reviewed.