Inspection·May 27, 2021

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation and interview, the facility failed to ensure medications were secured, locked and inaccessible to unauthorized staff, residents, and visitors, or under direct observation of authorized staff by 1 (LPN Staff A) of 4 staff observed administering medications. The facility also failed to remove expired medications from active supply for 1 (Memory care) of 3 medication carts observed and failed to document the opened date of a multi-dose vial of medication for 1 (Second floor medication room) of 2 medication storage rooms observed. The findings included: Facility policy titled, Medication Administration, revised 11/03, 11/06, 7/18 indicated: The nurse is to '' take the medication cart to the vicinity of the resident's room. The cart should be visible to the nurse administering medication. it may remain unlocked only when it is in the direct line of sight of the nurse . Facility Policy titled, Medication Storage in the facility, effective date January 2017 indicated: All expired medications will be removed from the active supply and destroyed in the facility, regardless of the amount remaining . when the original seal of a manufacturer's container or vial is initially broken, the container or vial will be dated. The nurse shall place a date opened sticker on the medication and enter the date opened and the new date of expiration. The expiration date of the vial or container will be 30 days unless the manufacturer recommends another date. 1. On 5/25/21 at 9:16 a.m., Licensed Practical Nurse (LPN) Staff A was observed preparing medications for Resident #369. LPN Staff A placed several medications in a medication cup, placed some of the medications back in the cart, locked the cart, and left a blister pack of Tramadol (narcotic pain medication) on top of the med cart containing 11 pills of Tramadol. LPN Staff A entered Resident #369's room and was out of direct line of sight of the medication cart and the blister pack of Tramadol. Upon return to the cart at 9:26 a.m., LPN Staff A said she had left the Tramadol on top of the cart because she was nervous. 2. On 5/26/21 at 12:14 p.m., a random audit was made of the medication cart in the Memory Care unit with LPN Staff B. Expired medications were found for Resident #95 including: 2 blister packs of Carvedilol (for high blood pressure) expired 4/17/21, 1 blister pack of Lasix (diuretic) expired 4/17/21, 1 blister pack of Potassium (supplement) expired 4/17/21, and 1 blister pack of Pramipexole (treats Parkinson's/restless leg) expired 4/17/21. ** Photographic evidence on file** (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: 105147 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 105147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pines of Sarasota 1501 N Orange Ave Sarasota, FL 34236 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)