Inspection·December 4, 2025

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, resident interview, staff interviews, record review, and policy review, the facility failed to ensure the interdisciplinary team assessed and determined residents were capable of self-administration of medications prior to allowing 1 of 20 sampled residents to self-administer medications. (Resident #2) The findings include: An observation of Resident #2 was conducted on 12/1/25 at 11:41 AM. The resident was in bed and a green, round pill was observed in a medication cup on top of the overbed table. The resident stated the medication was a Tums (a medication used for upset stomach and nausea) and that the nurse brought it in a while ago. (Photographic evidence was obtained.) A review of Resident #2's electronic medical record revealed the resident had a current physician order dated 10/26/23 for Tums oral tablet chewable 500 mg give one tablet two times a day for gastroesophageal reflux disease. A review of the quarterly minimum data set with an assessment reference date of 11/13/25 revealed Resident #2 had a brief interview of mental status score of 15, indicating the resident was cognitively intact. The record revealed no assessment or care plan for Resident #2 to self-administer medications. A telephone interview was conducted with Employee A (Licensed Practical Nurse), who worked on 12/1/25 and would have administered this medication. She stated she gave Resident #2 her 9:00 AM medications on 12/1/25. She stated she did not observe the resident ingest her Tums, but acknowledged she was supposed to observe the resident take the medication. An interview was conducted with the Director of Nursing (DON) on 12/3/25 at 11:10 AM. The DON stated the nurse is expected to observe the resident ingest the medications. An additional interview was conducted with the DON on 12/4/25 at 9:20 AM. The DON confirmed Resident #2 was not assessed or care planned to self-administer medications. Review of the undated facility policy for Administration of Drugs revealed self-administration of drugs is permitted when approved by the interdisciplinary team, including the physician, and documented. Residents Affected - Few 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: 105328 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 105328 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Santa Rosa Center for Rehabilitation and Healing 5386 Broad St Milton, FL 32570 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)