Inspection·September 19, 2024

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record and policy review, the facility failed to follow through with request for pain medication for 1 of 3 sampled residents reviewed for pain management, Resident #51. Residents Affected - Few The findings included: Review of the facility's policy, titled, Controlled Drug Management, effective December 2020, documented, in part, Controlled substance drugs may be ordered from the Pharmacy, a script must be sent to the pharmacy. The physician may call in a controlled substance to the pharmacy. After the pharmacy has the script or the order from the physician, they may provide a code to the nurse which will allow him/her to remove the controlled substance from the emergency narcotic kit if the medication is available in the kit. Nurses will enter in the log the number of pills removed and the approval pharmacy code provided. Narcotics will be filled by the pharmacy as soon as all required elements are provided and delivered to the facility on the next scheduled delivery. Record review revealed Resident #51 was initially admitted to the facility on [DATE] and readmitted on [DATE]. The resident's diagnoses included, Chronic Obstructive Pulmonary Disease, unspecified, Chronic pain syndrome, Primary Osteoarthritis, right hand and left hand, and Generalized anxiety disorder. Review of the quarterly Minimum Data Assessment (MDS) assessment, with an assessment reference date of 09/28/24, documented a Brief Interview for Mental Status (BIMS) score of 15, indicating the resident was cognitively intact. Review of the resident's pain care plan dated 01/31/24 revealed a problem of: Resident reports pain related to overall condition. Has diagnosis (dx) of Chronic pain syndrome. Goal: Resident's comfort will be maximized as evidenced by decreased verbal expressions of pain thru next review date. Approach: Medications as ordered, observe for effectiveness and side effects, Notify Medical Doctor (MD) if interventions are unsuccessful or if current compliant is significant change from resident past experience with pain. An interview was conducted with Resident #51 on 09/18/24 at 10:00 AM. The resident stated she went to the emergency room last evening because she had pain in her neck and the facility had not given her the pain medication that helped in 2 days. She stated she was told it was not available. On 09/18/24 at 10:35 AM, an interview was conducted with Staff E, Licensed Practical Nurse (LPN). She confirmed that the resident did not currently have Norco available. Norco (hydrocodone-acetaminophen 5-325 milligrams (mg) is a pain medication that contains an opioid that is used to manage severe pain when other non-opioid pain medications do not treat pain well enough. (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 5 Event ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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)