Vivo Healthcare Sebring

Inspectors wroteBased on observation, interviews and record review the facility failed to store food in accordance with professional standards for food safety, related to label and dating opened items, discarding items that were expired and not discarding items covered in bio-growth, in one of one walk-in cooler. Findings Included: During an observation of the walk-in cooler on 04/13/2026 at 10:53 a.m. the following was observed: A box of individually wrapped butter was found open, with butter smeared on the box and at least two of the individually wrapped blocks were open, exposing the butter. The box and the individual blocks were not dated/labeled. A produce box containing green bell peppers. Inside the box were approximately a dozen peppers with black circles on the surface that had a fuzzy black and white bio growth, and two of the peppers had a fuzzy white blue/green substance on the pepper. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure a medication administration error rate of less than five percent. A total of twelve medication administration opportunities were observed with four errors for two (#4 and #5) of four residents sampled for medication administration, which resulted in a medication administration error rate of 33.33%.

Inspectors wroteBased on record review, and staff interviews the facility failed to ensure the Preadmission Screening and Resident Review (PASARR) Level I for three residents (#63, #56 and #30) of twenty four sampled residents were revised for accuracy to include diagnoses recognized at the time of admission and later identified.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure behavior monitoring for psychotropic medication was in place for five residents (#32, #56, #59, #63 and #65) and failed to appropriately monitor the side effects for psychotropic medication for one resident (#56) of seven sampled residents.

Inspectors wroteOn 5/20/2024 at 3:38 p.m. an observation of room [ROOM NUMBER] B revealed a can of activICE (over the counter topical pain reliever) sitting on the table next to the bathroom door. The cap was missing. The resident in the room stated it was hers but she can't use it anymore because the spray top is missing due to falling on the floor. Based on observation, record review, and interview the facility failed to provide an environment that was clean, safe, and sanitary for residents on one units (B Wing) of two units and two shower rooms (A Wing and B Wing) of two shower rooms.

Inspectors wroteBased on observations, record reviews, and interviews the facility failed to assess two residents (#73 and #178) out of twenty-eight sampled residents for the self-administration of medications and to ensure the self-administered medications were safely stored.

Inspectors wroteBased on record review, interview and observation, the facility failed to ensure reasonable accommodations were made to ensure one resident (#29) of twenty four sampled residents was provided the right sized incontinent supplies.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure a care plan had been developed and implemented for one resident (#70) out of one resident sampled for respiratory services.

Inspectors wroteBased on record review and interview the facility failed to revise the comprehensive care plan related to dialysis services for one resident (#45) of two residents sampled for dialysis.

Inspectors wroteBased on observations, record reviews, and interviews the facility failed to assess altered skin conditions and provide wound care according to facility protocol, physician orders, and professional standards for two residents (#15 and #71) out of two residents sampled for non-pressure related skin conditions.

Inspectors wroteBased on record review and interview the facility failed to ensure a pharmacy recommendation and physician order was implemented for one resident (#65) of two residents sampled for monthly drug regimen review.

Inspectors wroteBased on observation, interview and record review, the facility failed to monitor side effects for one residents (#63) related to diuretic therapy and pain medication of seven sampled residents.

Inspectors wroteBased on observations, record reviews, and interviews the facility failed to ensure the medication error rate was less than 5.00%. Twenty-five medication administration opportunities were observed and four errors were identified for two residents (#78 and #3) of ten residents observed. These errors constituted a 16% medication error rate.

Inspectors wroteBased on observations, record reviews, and interviews the facility failed to implement an effective infection control program related to adhering to transmission-based precautions for one resident (#69) out of one resident observed with Contact Precautions and providing eye drops to one resident (#58) out of one resident observed during the administration of eye drops.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to maintain accurate and complete medical records by failing to fully document the occurrence of falls in the medical record for two (#3 and #4) of three residents sampled for documentation related to falls.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure proper storage of respiratory equipment for five (Resident #3, #28, #45 #48, #49) of 17 facility residents receiving respiratory therapy during three (5/9/2022, 5/10/2022, and 5/11/2022) of four days observed.

Inspectors wroteBased on observations, interviews and policy review, the facility did not ensure the kitchen was maintained in a sanitary manner during 3 of 4 days of survey.

Inspectors wroteBased on observations, interviews, record review and review of the Center for Disease Control and Prevention (CDC) guidelines, the facility failed to implement and maintain an infection prevention and control program to mitigate the spread of COVID-19 and other infections on two (101-110 and 119-128) of six hallways and one of one laundry area.

Inspectors wroteBased on observation, interview, and record review the facility failed to review and revise the resident centered care plan related to behaviors for one (#21) of 30 sampled residents.

Inspectors wroteBased on observations, interviews and record review, the facility failed to provide dressing changes to an intravenous (IV) catheter site in accordance with physician orders for one (#5) of four residents in the facility receiving IV therapy.

Inspectors wroteBased on observations, interviews and record review the facility failed to ensure medications were stored and secured appropriately in one (A Wing) of two treatment carts and three (B-North, A-North, A-South) of four medication carts.

Inspectors wroteBased on observations, record review and interviews, the facility failed to provide a clean and homelike environment by leaving resident personal belongings in bags and boxes for five residents (#8, #10, #28, #35, and #41) of 26 sampled residents for four of four days.

Inspectors wroteBased on observations, interviews, and record reviews, the facility did not ensure that care was provided in a dignified manner for one resident (#28) of one resident sampled for dignity.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure self-administration of medications was clinically appropriate for one resident (#28) of four residents sampled for medication administration.

Inspectors wroteBased on interviews, record reviews, and review of facility policy, the facility failed to make prompt efforts to resolve a grievance for one resident (#9) of one resident sampled for grievances.

Inspectors wroteBased on observation, interview and record review, the facility failed to develop a baseline care plan that included minimum healthcare information necessary to properly care for two residents (#2 and #276) of nine residents with an indwelling urine catheter.

Inspectors wroteBased on observations, interviews, and review of facility policy, the facility failed to store respiratory equipment in accordance with professional standards of practice for two residents (#28 and #35) of three residents sampled for respiratory care.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure proper labeling and storage of drugs and biologicals in accordance with professional standards in one medication room (100 unit) of two medication storage rooms in the facility and two (100 unit and 200 unit) of six medication carts in the facility.