Inspection·June 21, 2023

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record reviews the facility failed to ensure one resident (#3) was assessed and determined to be clinically appropriate and safe to administer medications of the seven residents sampled. Residents Affected - Few Findings included: An observation on 6/21/23 at 9:30 a.m. revealed three medications unattended on Resident #3's bedside table. (Photographic Evidence Obtained) Resident #3 was interviewed in his room on 6/21/23 at 9:47 a.m. During the interview Resident #3 stated the pills were his morning pills and described them as a vitamin, an antibiotic for a boil that popped, and an antacid. Review of Resident #3's Medication Administration Record (MAR) for June 2023 showed no order for self-administration of medications and his morning oral medication regimen was: *Cephalexin 500 milligrams by mouth every 12 hours for left buttock cellulitis for 10 days at 0600 (6:00 a.m.), *Divalproex ER 500 milligrams by mouth one time a day at 0900 (9:00 a.m.), *Vitamin D3 125 micrograms by mouth one time a day for vitamin deficiency at 0900, *Famotidine 20 milligrams by mouth in the morning for gastro esophageal reflux disease at 1000 (10:00 a.m.). On 6/21/23 at 11:30 a.m. an interview was conducted with Staff B, Licensed Practical Nurse (LPN). Staff B said medications should not be on the bedside table or left in resident rooms and nurses are expected to observe residents take their medications. Staff B stated she was unaware the medications were in the room. Staff B said Resident #3 had a disagreement with the nurse from the previous shift about receiving his insulin and the medications may have been left over from the morning. On 6/21/23 at 2:09 p.m. during an interview with the Assistant Director of Nursing she stated medications should never be left in resident rooms for them to take later, and it is basic nursing to observe residents take their medications. Review of facility policy titled, Administering Medications, revised April 2019, showed: (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 2 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 06/21/2023 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)