F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation and interview, the facility failed to provide housekeeping and maintenance services to ensure a
clean, sanitary and comfortable environment for 4 ( Rooms #210, #214, #115, #110) of 13 rooms observed,
1(200 hall) of 4 halls observed, and 1 (Resident #1) of 3 residents interviewed.
The findings included:
1. During a tour of the facility on 3/6/25, multiple environmental issues were observed with wallpaper,
flooring, cove base, and walls including:
Floors in the activity room in the 200 hall were stained and cracked.
photographic evidence obtained
room [ROOM NUMBER] had cove base missing and peeling away from the walls.
photographic evidence obtained
Handrail in the 200 hall had a dried black substance on it.
photographic evidence obtained
Common hallways had peeling wallpaper with orange discoloration in spots.
photographic evidence obtained
room [ROOM NUMBER]'s wall was cracking, missing plaster and paint, cove based peeling from wall in
which someone had placed a screw to hold it in.
photographic evidence obtained
rooms [ROOM NUMBERS] with dirty scuffed walls.
photographic evidence obtained
Corners and crevices where the floors meet the walls/cove base with caked in imbedded dirt. photographic
evidence obtained
(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
03/06/2025
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)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
2. On 3/6/25 at 10:15 a.m., in an interview Resident #1 said his bed did not work properly and had been
that way since he came to the facility a few months prior. He explained the control to move the head of the
bed up and down did not work and he had to get of bed, get to his walker at the foot of the bed, where he
could sit on his walker and adjust the bed with the buttons on the footboard of the bed. He said it was
difficult for him. Resident #1 said he had told many staff and everyone knew about it. At this time, it was
observed the remote to operate the bed was between the mattress and the foot board. The cord was
wadded up and the control was hanging towards the floor at the foot of the bed.
The control was not working and did not adjust the bed's position.
Resident #1 said he had asked multiple people, including the Administrator to clean it . Everyone said
they'd send someone right back, but it had never been cleaned.
photographic evidence obtained
On 3/6/25 at 10:17 a.m., Certified Nurse Assistant (CNA) Staff A was observed entering Resident #1's
room. In an interview he said the bed control had been broken at least 2-3 days. He attempted to use the
controller. He wiggled and moved the cord around, he was able to get the foot of the bed to move, but not
the head. When asked if he had reported the issue, he said Maintenance said they replaced the bed.
On 3/6/25 at 10:39 a.m., in an interview the Maintenance Director said he didn't know Resident #1's bed
control was not working. The Maintenance Director went to Resident #1's room and used the bed control to
raise the head of the bed. He was not able to lower the head of the bed with the control. The Maintenance
Director removed the bed control and said he'll look into it.
On 3/6/25 at 12:00 p.m., in an interview the Administrator verified the environmental concerns. He said he
was not aware of the problem with Resident #1's bed. He thought staff had been entering work orders in
their computerized work order program, but apparently the process hadn't been working.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105389
If continuation sheet
Page 2 of 2
