Health inspection·February 12, 2025

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Let each resident or the resident's legal representative access or purchase copies of all the resident's records. Based on record review and interviews, the facility failed to honor the right of a resident or his/her legal representative to receive medical records timely, within two working days, for three (#1, #7, and #8) of three sampled residents reviewed for medical record request. Findings included: On 02/12/2025 at 9:55 a.m., a phone interview was conducted with Resident #1's representative. When asked if she was involved in the admission process for (Resident #1), she stated, yes. When asked if she signed a contract during the admission process, she stated, No contract, I just signed a consent to treat. When asked if she had requested medical records, she stated, I asked for a copy of the medical cost responsibilities. An interview conducted on 02/12/2025 at 2:09 p.m. with the Nursing Home Administrator, when asked if the resident/representative had requested medical records for Resident #1, she stated no, the only thing she asked for was a copy of the insurance conversion letter, which I supplied her with. No documentation was provided as to the date of the request or the fulfillment of the request. A review of the medical record request log for 12/2023 through the date of survey reflected no listing for medical record request for Resident #1. Further review of the log reflected the following entries for 12/2024 listed: Resident #8 requested medical records on 12/19/2024, by attorney office. Record fulfillment was documented to be 02/27/2024. Resident #7 requested medical records on 12/16/2024, by (representative). Record fulfillment was documented to be January 17, 2025. An interview was conducted on 02/12/2025 at 4:11 p.m. with the Medical Records Coordinator. For Resident #8, she said she had made an error on the fulfillment date, it should have been 01/27/2025. She stated the date received column was when she received the request, then she would forward the request to the facility's attorney and wait for a response. She stated she had 30 days to fulfill a medical records request. A review of the facility's policy and procedure for Access to Personal and Medical Records, revised 05/2017, documented the policy statement: Each resident has the right to access and/or obtain copies of his or her personal and medical records upon request. The policy interpretation and (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: 105149 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 105149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE North Healthcare and Rehabilitation Center 1301 16th 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)