Inspection·December 13, 2024

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure baseline care plan summaries were reviewed with or a copy provided to the resident and/or the resident representative for 2 of 4 residents reviewed for baseline care plan, of a total sample of 10 residents, (#1, and #2). Findings: 1. Resident #1's electronic medical record (EMR) revealed the resident was admitted on [DATE] with diagnoses of cerebral infarction (stroke), hemiplegia, type 2 diabetes, speech and language deficits, abnormal posture, need for assistance with activities of daily living (ADLs). He resided in the facility for 10 days and was discharged on 11/07/24. On 12/12/24 at 2:57 PM, Registered Nurse (RN) C stated the care plan was initiated upon admission, then Minimum Data Set (MDS) nurses completed the comprehensive care plan. She stated that resident #1 did not receive a baseline care plan from the nurse on admission and there were other people who had to sign off on it as well, as part of a team effort. RN C explained the resident was supposed to get a copy of the baseline care plan once it was finished. On 12/12/24 at 3:51 PM, Licensed Practical Nurse (LPN) B stated nurses completed the baseline care plans in the computer. She explained she thought the MDS nurse reviewed the care plans with residents and then gave them a copy once they were completed. On 12/13/24 at 12:26 PM, and 1:12 PM, the Director of Nursing (DON) stated the nurse who held the key was expected to do the initial admission assessment, and the nursing baseline care plan. She explained the care plan should be signed by the resident, family or representative, and a copy given to them. The DON conveyed the baseline care plan stayed with the admission packet and was placed with the admission paperwork for the clinical team to review in the morning. She stated the clinical team reviewed the packets in the morning for accuracy and completeness. Resident #1's EMR was reviewed with the DON which revealed there was no baseline care plan present for resident #1. The DON confirmed there was no baseline care plan scanned into the computer record for resident #1. On 12/13/24 at 5:15 PM, the Lead MDS Coordinator, stated nursing was responsible for the residents' baseline care plans, and it was a team effort to complete it. 12/13/24 at 5:20 PM, the DON provided a paper copy of resident #1's baseline care plan. The document revealed an admission date of 10/28/24 with baseline care plan dated 10/29/24. The care plan included a summary of goals, interventions, physician orders, services, and treatments. Further review (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 7 Event ID: 105430 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 105430 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Winter Park 1700 Monroe Ave Maitland, FL 32751 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)