Inspection·February 13, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review, the facility failed to ensure scheduled medications were administered as ordered and according to professional standards of practice for 17 of 18 residents reviewed for medication administration out of a total sample of 19 residents, (#1, 4, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 & 19). Findings: On 2/12/24 at 11:09 AM, Registered Nurse (RN) A was observed at her medication cart on the A wing. She explained she had just finished administering morning medications. She acknowledged the morning medications were administered late. On 2/12/24 at 11:03 AM, Licensed Practical Nurse (LPN) B stated the usual nurse staffing for day shift at the facility was four nurses, two on each wing. LPN B explained that occasionally, like yesterday they were staffed with only 3 nurses so one nurse had a split assignment between the two units. She noted that when this occurred, medications were often given late, as they did not receive help from Administrative staff such as the Director of Nursing (DON), the Unit Managers (UM) or the Minimum Data Set (MDS) nurse. On 2/12/24 at 10:23 AM, RN C stated when a nurse called off, they had only 3 nurses working on the medication carts. She confirmed she did not receive help from the UM or DON to ensure medications were administered timely. On 2/13/24 at 10:35 AM, LPN D was at the medication cart on the A wing. She confirmed she was late in administering medications and indicated she had not yet started on the 1-9 hall of the A wing. She noted the residents in rooms 1-9 would not receive their medication on time. LPN D stated a nurse had called off today and I have been putting out fires all morning. She explained since this was her first time working on the A unit, she did not want to rush and make a mistake. On 2/13/24 at 10:42 AM, the A wing UM stated she did not realize medications were late for 1-9 hall of the A wing. She confirmed with LPN D that she had not yet administered 9:00 AM medications for residents in rooms 1-9 of the A wing, and that LPN D had not asked anyone for help. The A wing UM stated there were nurses available who could assist LPN D to administer medications such as the MDS nurses. The A wing UM stated it was facility policy to administer medications an hour before or an hour after they were scheduled. She stated nurses were supposed to notify the physician if the medications were late and get an order to either hold them or give them late. The A wing UM stated it was best practice to give medications on time and consistently so that medications could work optimally and for best efficacy as the physician ordered. (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: 105325 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 105325 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Space Coast Healthcare and Rehabilitation Center 125 Alma Blvd Merritt Island, FL 32953 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)