Health inspection·November 15, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observations, interviews and record review, the facility failed to ensure accurate documentation for dispensing and administration of controlled substances for two residents (Resident#15 and #16) of two residents sampled for pain medication administration. Findings included: 1) A review of Resident #16's Clinical Face Sheet revealed an admission date of 09/19/2023. The Medical Diagnoses list included: Multiple Sclerosis and chronic pain syndrome. A review of Resident #16's Medication Administration Record (MAR) for 10/2023, revealed a physician order as follows: Oxycodone HCI (hydrochloride) Oral Tablet 20 MG (milligrams) give 1 tablet by mouth every 4 hours as needed for non-acute pain 6-10, start date of 09/22/2023. A review of Resident #16's Grievance form, dated 10/30/2023, revealed the following: (Resident #16) stated that the two nurses did not fill his order and he was mad that his pain pills almost ran out. The form revealed the grievance had been investigated and the summary of the investigation was, They (sic) was no lapse in medication and (Resident #16) never ran out of medication. The allegation of the complaint was not confirmed, with no corrective actions listed. An interview was conducted on 11/15/2023 at 2:38 p.m. with the Social Service Director (SSD), and the Nursing Home Administrator. The SSD stated the grievance for Resident #16 had been investigated and signed off by the resident. A review of the Controlled Medication Utilization Record for Resident #16 revealed the following discrepancies when compared to the MAR: 10/04/2023, medication was signed for on the control sheet at 2130 (9:30 p.m.), but not reflected as administered. 10/05/2023, medication was signed for on the control sheet at 12:32 p.m., but not reflected as administered. 10/06/2023, the MAR reflected administration at 6:01 a. m., but the time on the controlled sheet was blank. 10/06/2023, medication was signed for on the control sheet at 10:00 a.m., but not reflected as (continued on next page) 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 REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 105045 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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)