Inspection·November 19, 2024

F 0675 Honor each resident's preferences, choices, values and beliefs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to preserve the quality of life related to therapy services for one (#6) out of 6 sampled residents. Residents Affected - Few Findings included: Review of Resident #6's admission Record revealed she was admitted to the facility on [DATE] with medical diagnoses of adjustment disorder with anxiety, chronic pain, spinal stenosis, lower back pain, edema, chronic pain syndrome, obesity, and bed confinement status. The resident also had a diagnosis of patient's noncompliance with other medical treatment and regimen due to unspecified reason with an onset date of 9/1/24. An interview was conducted on 11/19/24 at 4:45 PM with Resident #6. She said she wanted to have therapy so she could gain strength to be able to sit on the side of her bed and in her wheelchair again. She said she used to be able to sit in her wheelchair but now she just laid in bed all day, every day. She said it had been over a year since she had therapy and the last time she had therapy she was provided with therapy three times a week. She said she was able to have a Certified Nursing Assistant (CNA) help her roll over and sit up on the side of the bed and transfer into her wheelchair and she could move around her room in her wheelchair. She said the CNAs were supposed to keep working with her, but they had not helped, and she could not get anyone to help her with therapy. She said she told the Director of Nursing (DON) she wanted occupational therapy, and she said she would let them know to come look at her, but therapy never came. She said she had asked many times to have therapy again and they would not give her therapy, and she did not know why. Review of Resident #6's quarterly Minimum Data Set (MDS) with an assessment reference date (ARD) of 9/13/24, Section C - Cognitive Patterns, revealed a brief interview for mental status (BIMS) score of 15 out of 15 which indicated she was cognitively intact. A phone interview was conducted on 11/19/24 at 4:50 PM with the Director of Therapy. She said they performed an occupational therapy screen on Resident #6 about a month ago and the resident wanted to have one person assist with perineal care, but she needed three-person maximum assistance for care. She said the resident would not use the full body mechanical lift machine because her back hurt her. The only way they could provide therapy services was if she used the full body mechanical lift to get into her wheelchair so they could assess her sitting tolerance in the wheelchair in the therapy gym. The Director of Therapy said since she would not use the full body lift, therapy could not work with her. She said Resident #6 was on therapy services about a year ago and she met her goals. She was discharged to the function maintenance program where the CNA's work on exercises to maintain her level of function. (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 4 Event ID: 105409 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 105409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfview Nursing Center 3636 10th Ave N Saint Petersburg, FL 33713 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)