Health inspection·March 5, 2020

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure proper procedures were followed before administering medication for one (Resident #48) observed, of 3 total residents in the facility with gastric tubes (GT). Findings included: A facility provided policy titled, 6.5 Medication Administration: Administration by Enteral Route dated 7/01/2013, with revision date September 201401/01/13, Page 01 of 02 reads: PURPOSE: To provide guidelines for administration of medication via enteral routes. MEDICATION ADMINISTRATION: Nurses checks placement and patency by: If you hear this sound, gently draw back on the piston of the syringe. The appearance of gastric contents implies that the tube is patent and in the stomach. If no gastric contents appears, the tube may be against the lining or the tube may be obstructed. On 03/04/2020 at 1:00 p.m. an observation of medication administration with Staff C, Licensed Practical Nurse (LPN), who works on the [NAME] Low Hall, was conducted with Resident #48. Staff C, (LPN) put a stethoscope to the resident's stomach and stated, I hear the swoosh (air). Staff C (LPN) did not follow standard nursing practice and technique, which is to check residual volume in Resident #48's GT before administering the 01:00 p.m. medications. Staff C (LPN) was observed administering the following 01:00 p.m. medications: -Sodium Bicarbonate Tablet 650 MG Give 2 Tablets via G-Tube (GT) four times a day for Indigestion. -Midodrine HCL Tablet 2.5MG Give 1 Tablet via G-Tube (GT) three times a day for Hypotension. According to Nursing 2020 (https://journals.lww.com/nursing/Fulltext/2004/04000/Measuring_gastric_residual_volume.17.aspx) Release the GT clamp. To verify tube placement and patency, aspirate for gastric contents, note the residual volume, and follow your facility's policy for reinstalling it. Clamp the GT, remove the syringe, and take out the plunger. (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 3 Event ID: 105071 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 105071 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bayside Care Center 811 Jackson St N Saint Petersburg, FL 33705 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)