Health inspection·October 21, 2021

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. Based on observation, record review, policy review and resident and staff interviews, the facility failed to complete and document an assessment for entrapment, alternatives attempted, discuss risks versus benefits and obtain informed consent prior to the installation of bed rails for 1 resident (Resident # 63) of 1 resident reviewed for use of bed rails. This has the potential to lead to serious negative consequences for the resident. The findings included: Review of the facility Bed Rail Guidelines Policy dated 4/2014 and updated 11/2016 and 3/2020 revealed Prior to the utilization of a bed rail, the interdisciplinary team completes . resident assessment for risk of entrapment The utilization of bed rails requires the interdisciplinary team to complete a patient evaluation of the risks versus benefits of the bed rail identification of previous interventions utilized the potential negative consequences of bed rail use are explained, and informed consent is obtained. On 10/18/21 10:30 a.m. Resident #63 was observed in bed with four bed rails noted in the up position. On 10/18/2021 at 3:15 p.m. In an interview with Resident #63 and residents' husband, they said the resident was admitted to the hospital from home for treatment of Pneumonia and a bed sore for 3 weeks prior to being admitted to this facility. They said their doctor ordered a specific wound bed to be used at facility before the resident left the hospital to keep resident from moving so her wounds could heal. The husband said the doctor only lets her sit on side of bed for 20 minutes a day so the new skin on her wound is not injured. On 10/19/2021 at 9:30 a.m., Resident #63 was observed awake and lying in bed. All four bed rails were noted in the up position. On 10/19/2021 at 2:00 p.m., record review of Resident #63 revealed there was no documentation of an assessment for possible entrapment, alternatives attempted, discussion of risks versus benefits or informed consent prior to installation of the bedrails. On 10/20/2021 at 9:35 a.m. Resident #63 was observed lying in bed. All four bed rails were noted in the up position. On 10/20/2021 at 10:15 a.m. in an interview with the Assistant Director of Nursing she confirmed (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: 105389 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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)