Inspection·July 19, 2023

F 0624 Prepare residents for a safe transfer or discharge from the nursing home. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to provide an appropriate discharge plan for 1 of 3 residents reviewed for appropriateness of discharge, (#2). Residents Affected - Few Findings: Resident #2 was a [AGE] year old, admitted to the facility on [DATE]. Her last readmission to the facility was 6/14/23 following hospitalization due to a fall in the facility. Her diagnoses included Intellectual Disorder, mild, Schizoaffective Disorder, Bipolar type, history of Rhabdomyolysis, unspecified fall, anemia, thyroid gland disease, and anxiety disorder. The resident's medical record contained a Florida Preadmission Screening and Resident Review (PASRR) Level II Determination Summary Report completed at the acute care hospital on 1/19/23. The report documented a summary of medical and social history that documented her condition and previous living arrangement prior to hospitalization which was an assisted living facility. The assessment noted a skilled nursing home placement at the time of assessment was appropriate to include physical, occupational, speech therapy along with psychiatric medication management and supportive counseling. The PASRR recommendation showed the following: She should be monitored for symptoms of mood liability or psychosis, and any problems should be reported to treatment team. It appears that these services cannot be effectively provided in a less restrictive environment at this time, but it is recommended that every effort be made to transition her to a less restrictive setting, such as assisted living facility or group home, with an application for Agency for Persons with Disabilities (APD) services, once she has completed her rehabilitation services . On 7/18/23 at 2:30 PM, the facility's Administrator indicated the resident had completed her therapy at the facility and there had been no referral or application made to the APD for resident #2. Review of the clinical record confirmed there was no documentation found that showed a referral or application was made to APD to assist the resident in any transition, services, or care. Review of the resident's medical record showed she had been served a 30 day facility initiated discharge notice (AHCA Form 3120-0002) on 6/22/23. The form documented the location to which the resident was to be discharged to, listed the name and address of the resident's Power of Attorney (POA). The form noted the Reason for Discharge of Transfer was Your needs cannot be met at this facility. Resident requires mental health support, preferably in a small environment. (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: 105377 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 105377 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Longwood Health and Rehabilitation Center 1520 S Grant St Longwood, FL 32750 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)