Inspection·March 6, 2025

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and interview, the facility failed to ensure the Preadmission Screening and Resident Review (PASRR) Level I for mental disorder (MD), or Intellectual Disability (ID) was accurately completed for one resident ( Resident #17) out of six residents sampled, as evidenced by Resident #17 Level I PASRR dated 09/15/2023 was not updated to reflect a diagnosis of Anxiety Disorder. Residents Affected - Few The findings included: On 03/03/2025 at 09:22 AM Resident #17 was observed sitting in bed speaking to staff member. Appeared slightly anxious while talking about her current living situation. Record review of Resident #17's admission and clinical records revealed the resident was admitted to the facility on [DATE]. Medical diagnoses include but not limited to: Major depressive disorder Anxiety disorder Unspecified and insomnia. Review of Resident #17's PASRR Level I dated 09/15/2023 revealed identification of only two mental diagnoses of Depressive Disorder and Insufficient Sleep Syndrome under 1A. Section 1B was not checked for Serious Mental Illness (SMI), Section 2,3 (A/B) and 4 (A/B) were checked. Section II Part A & B were checked. Section IV was completed. Record Review of a Quarterly admission Minimum Data Set (MDS) Section A (identification) dated 01/08/2025 revealed Resident #17 was not considered by the Level II PASRR process to have serious mental illness and/or intellectual disability or a related condition. Section I revealed resident #17 had Anxiety and Depression. Sections O (special treatments and therapy) revealed total number of minutes Psychological Therapy (by any licensed mental health professional) administered for at least 15 minutes to the resident in the last seven (7) days was zero (0). Record Review of Orders dated 12/26/2024 revealed Resident #17 is currently receiving Buspirone HCl Oral tablet 5 mg (milligrams) Directions: Give 1 tablet by mouth two times a day for Anxiety Disorder, Unspecified. Record Review of Care Plan dated 12/26/2024 revealed Resident #17 is at risk for possible adverse side effects of psychotropic medications. Resident is on: Sertraline HCl Oral Tablet 50 mg, START Buspirone HCl Oral Tablet 5 mg. Goals: Demonstrate decreased need for psychoactive medication. Resident will not show signs and symptoms of possible side effects of psychotropic medication such as: hypotension, headache, constipation, nausea/vomiting, dry mouth, dizziness, insomnia, drowsiness, sedation and blurred vision through (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: 105432 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 105432 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Care Center 899 NW 4th Street Miami, FL 33128 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)