Health inspection·April 24, 2025

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure all drugs used in the facility were labeled in accordance with clinical professional standards, on two of two floors and two of six medication carts. Findings included: On [DATE] at 12:07 P.M., during observation and interview with Staff A, Registered Nurse (RN), Staff A, RN opened the top drawer of a medication cart. During an inspection of the medication cart, labeling of two translucent brown medication bottles containing eye drops had labels affixed with the following information: Notice to discard after forty-two days, with space to write the medication expiration date after the medication is first used and a yellow label with space to write the medication open date, expiration date, and staff initials. No information was written on the label. The inspection also revealed an insulin injector pen with a label to document the date opened of the medication, instructions to discard after 28 days, and an orange label with instructions, do not use after with space to write the date. The medication did not have dates documented. During an interview, Staff A, RN, said she did not know the expiration dates for the eye drops and insulin and the labels should have been dated. (Photographic Evidence Obtained) On [DATE] at 12:20 P.M. during an observation of a 2nd floor medication storage cart and interview with Staff B, Licensed Practical Nurse (LPN) , there was one insulin injector pen labeled [DATE] as the open date and discard date was not listed. Staff B, LPN said the insulin pen should be discarded 28 days after the first use. She immediately removed the insulin injector pen from the medication cart. During an interview on [DATE] at 12:40 P.M, the Director of Nursing (DON) said when medications are first used, the facility expects staff to write the medication expiration dates on the labels. Review of the facility's policy titled Medication Administration, implemented on [DATE], showed: Policy: Medications are administered by licensed nurses, . and in accordance with professional standards of practice, in a manner to prevent contamination or infection. Policy Explanation and Compliance Guidelines: . 12. Identify the expiration date. If expired, notify the nurse manager. 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 3 Event ID: 105422 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 105422 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pinellas Park FL Opco, LLC 8701 49th St N Pinellas Park, FL 33782 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)