Health inspection·October 13, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record reviews the facility failed to ensure residents received treatment and care in accordance with professional standards of practice, related to failure to ensure weekly skin checks were completed for two residents (#2 and #3) of three sampled residents. Findings included: Residents Affected - Some Resident #3 was admitted to the facility on [DATE] and discharged on 09/07/25. Review of the admission record showed diagnoses included but not limited to vascular dementia with other behavioral disturbance, stage III chronic kidney disease, diabetes, anxiety disorder, major depressive disorder, and cerebrovascular disease. Review of the physician orders for Resident #3 showed to perform weekly skin checks. Review of the skin evaluation dated 09/05/2025 showed - scratches on the bilateral arms. Multiple superficial scratches to bilateral arms. Dried blood present around the affected area. No active bleeding observed. Review of Resident #3's electronic medical record (EMR) revealed there were no other documented skin evaluations for the period August through September 2025. Review of the care plans showed there was no care plan for skin integrity or a focus addressing weekly skin checks. During an interview on 10/13/25 at 12:40 p.m. Staff A, Licensed Practical Nurse (LPN) stated she does not normally work in the resident's area. She stated the nurses are supposed to do weekly skin checks and document it under the assessment tab of the electronic medical record. She stated the Weekly Skin Only Evaluation Schedule was listed by room numbers, which was subdivided by the day of the week and the shift. Staff A stated the nurses were to see which room was due on their shift, and perform the weekly skin check. During an interview on 10/13/25 at 12:45 p.m. the acting Director of Nursing (DON) stated the nurses were to perform weekly skin checks. He stated the nurses were supposed to do them and document them in the assessment section in the electronic medical record. He reviewed Resident #3's electronic medical record and stated the resident did not have any weekly skin assessments performed. During an interview on 10/13/25 at 1:44 p.m. Staff B, Nurse Practitioner (NP) stated she sees her physician provider's residents only. She stated she was at the facility 5 days a week. Staff B stated they have 88 or 90 residents in the facility. She stated she does not see all of their residents weekly. She stated she tries to see the long-term care residents at least every 2 weeks and sometimes (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: 105350 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 105350 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Haven Nursing and Rehab Center 1351 San Christopher Dr Dunedin, FL 34698 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)