Inspection visit
Inspection
7 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 7 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0578
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to
participate in experimental research, and to formulate an advance directive.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to obtain Advance Directives and physician order for code
status for 1 of 28 residents reviewed for Advance Directives, (#459).
Findings:
Resident #459 was admitted to the facility on [DATE] with diagnoses that included dementia and altered
mental status.
Review of the resident's admission Minimum Data Set (MDS) assessment dated [DATE] indicated a Brief
Interview of Mental Status (BIMS) score of 5 that indicated severe cognitive impairment.
Review of the Hospital admission Data dated 12/2/2020 indicated resident #459 was not capable of making
his own medical decisions.
A review of the resident's medical record revealed no documentation that indicated the resident/responsible
party's wishes for code status.
On 1/4/2021 at 1:40 PM, the Unit Manager of Wing 1 stated she was unable to find a physician order for
code status for resident #459. She said the process was, Upon admission, the Social Worker discusses the
code status with the resident/family/responsible party and verifies the code status. Any documents
supporting the decision are requested. Those documents are then placed in the resident's medical record
under the Advance Directives tab. The physician is then notified, and an order is obtained and placed in
front of the medical record. The order is then submitted electronically. If a resident becomes unresponsive,
the staff calls for help and checks the hard chart for an order for either Do Not Resuscitate Order (DNRO)
or Full Resuscitation Order. The Unit Manager stated that if resident #459 was found unresponsive, Full
Resuscitation would be initiated and 911 called as there was no order for code status.
During a telephone conversation on 1/4/21 at 1:55 PM, resident #439's daughter stated she had Durable
Power of Attorney for Health Care and a Living Will dated 1/16/2020. She stated the document named her
as the resident's Health Care Agent for his health decisions. She added, The will states he does not want
anything done to keep him alive if he stops breathing. He just wants to go peacefully. The resident's
daughter noted the facility had not contacted her about her father's advanced directives.
On 1/4/21 at 2:15 PM, interviews were attempted with resident #459's admitting nurse and the
(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 9
Event ID:
105448
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
105448
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/06/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Titusville Rehabilitation & Nursing Center
1705 Jess Parrish CT
Titusville, FL 32796
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)
F 0578
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
facility's Social Worker at the time of his admission [DATE]. Both no longer worked at the facility and could
not be reached.
During an interview on 1/4/2021 at 2:40 PM, the Medical Director stated the Resident/Responsible Party
should be interviewed to determine their wishes related to Code Status and all documentation in place
should an event occur.
On 1/4/21 at 10:05 AM, the Director of Nursing (DON ) did not explain why resident #439 did not have a
DNR in place according to his wishes. The DON did not explain why the Social Worker did not follow-up to
find out the resident's wishes and ensure a DNRO order was placed at the front of his medical record.
Review of the Code Status Orders and Response Policy dated 2/2020, read, The physician order for full or
Do Not Resuscitate is written based on the wishes of the resident/resident representative. Advance
Directives will be honored. Code status orders and wishes will be reviewed on admission, quarterly and as
needed by the Interdisciplinary Team (IDT). Code status physician's order (DNR or Full Code), state
specific forms and/or resident preference will be filed as the first item within the medical record. Social
services will be notified if resident has any general questions and concerns about advance directives.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105448
If continuation sheet
Page 2 of 9
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
105448
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/06/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Titusville Rehabilitation & Nursing Center
1705 Jess Parrish CT
Titusville, FL 32796
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)
F 0636
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every
12 months.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to complete discharge assessment for 1 of 3 residents
reviewed for resident assessments of a total sample of 28 residents, (#1).
Findings:
Resident #1 was admitted to the facility on [DATE] and discharged home with home health services on
07/18/20.
A review of the medical record revealed that a discharge Minimum Data Set (MDS) assessment was not
completed as required.
On 01/05/21 at 3:52 PM, the MDS Coordinator described the facility's process for discharged residents.
She stated that MDS Coordinators had to review the discharge orders, then complete and submit the MDS
assessment. She said she did not get resident's #1's discharge completed. She added, I don't know how I
missed it especially since the computer system sends an alert.
Section 5.2 of the RAI Version 3.0 Manual indicated that for all non-admission Omnibus Budget
Reconciliation Act (OBRA) and Prospective Payment System (PPS) assessment, the MDS completion date
(Z0500B) must be no later than 14 days after the Assessment Reference Date (A2300).
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105448
If continuation sheet
Page 3 of 9
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
105448
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/06/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Titusville Rehabilitation & Nursing Center
1705 Jess Parrish CT
Titusville, FL 32796
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)
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
interview and record review, the facility failed to refer 2 of 28 sampled residents with diagnoses of serious
mental health illness for Pre-admission Screening and Resident Review (PASRR) Level 2 , (#14, #42).
Residents Affected - Few
Findings:
1. Review of resident #14's medical record revealed he was admitted to the facility on [DATE]. His
diagnoses included seizures, anxiety disorder, recurrent depression, schizophrenia, and cognitive
communication deficit.
Review of the State PASRR form dated 5/30/18, section A, mental illness (MI) or suspected MI, check all
that apply, was left blank. This section included documented areas of diagnoses of Anxiety, Depressive
disorder, and Schizophrenia. Section IV PASRR Screen Completion area documented a blackened box that
represented No diagnosis or suspicion of SMI (serious mental illness) or intellectual disability (ID) indicated,
Level II PASRR evaluation not required.
Review of the resident's General Progress Note dated 8/26/20 and completed by an Advanced Professional
Registered Nurse and Licensed Clinical Social Worker documented: Chief complaint/Nature of Presenting
Problem: Schizophrenia, major depressive disorder, general anxiety disorder. Diagnoses documented
Disorganized Schizophrenia, Generalized anxiety disorder, Major depressive disorder, recurrent, moderate.
The resident's record did not show that a PASRR level 2 had been completed.
In an interview with the Administrator and Social Worker on 1/6/20 at 2:15 PM, they related the resident had
not been referred to the appropriate entity for a Level 2 PASRR and it was not indicated on the Level I. They
were informed by the surveyor of the documented diagnosis of the resident having a SMI.
Review of the facility policy titled, PASRR Requirements Level I and Level II-Florida, Page 1 under PASRR
Level I-Procedure #2 read: Social services or RN will review to determine if a Serious Mental Illness (SMI)
and Intellectual disability or both exists while reviewing the PASRR form. The existence of either or both
conditions triggers the requirement for Level II review and will be provided to the appropriate State Agency
by the social services director upon admission. The Social services director /Nursing administration will
review for completion and accuracy during the clinical meeting process.
Page 2 section PASRR Level II #3 read: Level II PASRR must be completed if the below are listed but not
limited to:
The second bullet read: the resident has a primary or secondary diagnosis of dementia or related
neurocognitive disorder, and a suspicion or diagnosis of SMI, ID, or both, and are currently exhibiting
interpersonal issues, difficulty maintaining concentration, persistence and pace.
2. Review of resident #42's medical record revealed she was admitted to the facility on [DATE]. Her
diagnoses included major depressive disorder and unspecified psychosis. Review of the resident's
medication record revealed the resident received antipsychotic medication, Haldol, for psychosis;
Schizophrenia.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105448
If continuation sheet
Page 4 of 9
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
105448
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/06/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Titusville Rehabilitation & Nursing Center
1705 Jess Parrish CT
Titusville, FL 32796
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)
F 0645
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Review of the State PASRR form dated 1/23/20 revealed on page 5, Section IV PASRR Completion,
Individual may not be admitted to a Nursing Facility. Use this form and required documentation to request a
Level II PASRR evaluation because there is a diagnosis of or suspicion of: (check one of the following). The
Serious Mental illness was checked by the hospital who completed the PASRR form.
Further review of the medical record did not show a Level II screen. In an interview with the facility
Administrator and Social Worker on 1/6/20 at 2:30 PM, they stated that a PASRR level 2 had not been
referred or completed. They stated that serious mental illness (SMI) was checked on the Level I PASRR.
Event ID:
Facility ID:
105448
If continuation sheet
Page 5 of 9
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
105448
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/06/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Titusville Rehabilitation & Nursing Center
1705 Jess Parrish CT
Titusville, FL 32796
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)
F 0694
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to provide intravenous (IV) care and services
according to standards of practice and plan of care for 1 of 1 residents reviewed for IV care, out of 28 total
sampled residents, (#65).
Residents Affected - Few
Findings:
Resident #65 was admitted to the facility on [DATE] from an acute care hospital with diagnoses that
included urinary tract infection (UTI). He had a Midline IV line inserted 12/29/20 in the left arm for
administration of IV antibiotics. He was receiving Ceftriaxone (IV antibiotic) daily for UTI until 1/3/21. He had
additional orders in effect dated 12/31/20 for nurses to document the IV site appearance every shift (3 times
per day) and flush every 8 hours.
A midline catheter is put into a vein by the bend in your elbow or your upper arm . The midline tube ends in
a vein below your armpit .midline catheter may allow you to receive long-term intravenous (IV) medicine or
treatments .(www.drugs.com).
On 01/03/21 at 12:45 PM, resident #65 was observed in bed. He had a transparent dressing on his left
upper arm midline IV site with no date. The lower portion of the transparent dressing had gauze under it
which was soiled with dark brown substance and was lifting off the skin. The resident was alert and oriented
and said that he was getting IV antibiotics for a UTI and his nurse just left his room.
On 01/04/21 at 11 AM, resident #65 was observed in bed and the midline IV in his left forearm appeared
same as yesterday's observation. There was no date on the dressing which was soiled and lower 1/3 of the
dressing was lifting off the skin.
A review of the medication administration record (MAR) revealed that nursing staff documented:
Flushing IV 01/03/21- 6 AM, 2 PM and 11 PM
01/04/21- 6 AM and 2 PM
IV site appearance was unremarkable on : 01/03/21- Day, Evening and Night shift
01/04/21- Day shift
The nurses' documentation of resident #65's IV site appearance contradicted actual observations
conducted by surveyor on both days (01/03 to 01/04/21).
Resident #65's care plan initiated on 12/31/20 for IV Medications included interventions to Check dressing
site daily. Change per facility policy/MD (medical doctor) orders .
On 1/04/21 at 5:20 PM, Licensed Practical Nurse (LPN) A was in resident # 65's room and observed the
resident's midline dressing on left upper arm without a date, soiled and lifting off the skin. LPN A said, the
Wing III Unit Manager (UM) was aware of the condition of his IV site as of this morning as she brought it to
her attention. LPN A said, she was too busy to change the dressing and could
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105448
If continuation sheet
Page 6 of 9
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
105448
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/06/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Titusville Rehabilitation & Nursing Center
1705 Jess Parrish CT
Titusville, FL 32796
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)
F 0694
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
not get to it yet. LPN A noted the standard of practice regarding soiled dressing was that it should have
been changed this morning when identified as not changing it could lead to infection.
On 01/04/21 at 5:37 PM, the Wing III UM said she saw resident #65's soiled IV dressing at lunch time when
she was setting up his lunch tray. She stated she spoke to assigned LPN A about the need to change
resident #65's dressing. She indicated that LPN A did not inform her that she was too busy to change the
dressing or needed help. The UM then checked the resident's orders and said the nurse should have
changed the dressing immediately as it was loose and soiled. She added that the resident had physician
orders to change the dressing as needed if soiled.
On 01/04/21 at 6:00 PM, LPN B verified that he was assigned to resident #65 on 01/03/21 day shift, 7 AM
to 7 PM. He said he did not notice that resident #65's IV dressing was soiled or lifting off the skin yesterday
(01/03/21). He said he gave the resident's IV antibiotics and documented twice on his shift that he checked
the site. LPN B indicated it was the facility policy to change IV dressings within 24 hours of admission and
there was no excuse as he should have changed it yesterday because not changing it could lead to blood
infection.
On 01/06/21 at 12:02 PM, the Director of Nursing (DON) said the expectation was that nurses checked the
IV site every time they went into resident rooms to give medications or flush IV. she added the nurses
should have changed the IV dressing timely as not changing it could have caused infection or the IV could
have come out.
According to the facility Infection Control policy dated 08/16, Dressing Changes .Transparent,
semi-permeable membrane (TSM) dressings are changed a minimum of every 7 days and /or prn (as
needed) whenever the dressing becomes wet, loose, or soiled
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105448
If continuation sheet
Page 7 of 9
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
105448
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/06/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Titusville Rehabilitation & Nursing Center
1705 Jess Parrish CT
Titusville, FL 32796
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)
F 0695
Provide safe and appropriate respiratory care for a resident when needed.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review, the facility failed to ensure respiratory therapy was provided as
per physician orders for 2 of 5 residents of a total sample of 28 residents, (#73, #508).
Residents Affected - Few
Findings:
1. Resident #73 was re-admitted to the facility from an acute care hospital on [DATE]. The resident's
diagnoses included chronic obstructive pulmonary disease (COPD) and fracture of the left lower leg.
The Medical Certification for Medicaid Long Term Care Services and Patient Transfer 3008 Form dated
12/23/20 indicated the resident was on continuous oxygen (O2) at 2 liters per minute (LPM) via nasal
cannula.
A review of the resident's medical record revealed physician orders dated 01/03/21 for Oxygen at 2 LPM via
NC continuously for COPD every shift for shortness of breath (SOB). The resident's care plan for oxygen
noted an intervention to administer as ordered .
A review of the Treatment Administration Record (TAR) dated 01/03 to 01/04/21 revealed the nurses
documented every shift (3 times) per day that the resident received the ordered dose of oxygen at 2 LPM.
On 01/03/21 at 12:20 PM and 01/04/21 at 11:05 AM and 5:10 PM, resident #73 was observed in bed with
O2 via nasal cannula. The concentrator was set at 3.5 LPM. Resident #73 was alert and oriented to person
and place and denied adjusting her oxygen concentrator.
On 01/04/21 at 5:15 PM, Licensed Practical Nurse (LPN) A entered the resident's room and stated the
resident's O2 concentrator was set at 3.5 LPM. LPN A stated the oxygen should be at 2 LPM. She said the
resident had COPD and getting increased oxygen could make her condition worse and cause increased
shortness of breath.
On 01/04/21 at 5:44 PM, Wing III Unit Manger (UM) stated that resident #73 was ordered to receive oxygen
at 2 LPM via NC. The UM added that the assigned nurses should have checked the liter flow every time
they went in the resident's room to ensure the prescribed rate. The UM indicated that too much oxygen with
resident that has COPD could have an adverse reaction. She said that resident #73 went out to a doctor's
appointment today at 11:30 AM and the nurse should have checked the oxygen rate when she returned to
ensure it was at 2 LPM. The UM was asked about the resident's ability to adjust her oxygen concentrator.
She stated that, even if she could get to the concentrator, I don't know that she would try to adjust it.
On 01/04/21 at 5:53 PM, LPN B verified he was assigned to resident #73's care yesterday, on 01/03/21 (7
AM to 7 PM). He said he checked her oxygen concentrator rate and put it at 2 LPM. He could not remember
if he checked during his shift. LPN B said that if the resident received a higher rate of oxygen, she could
stop breathing.
On 01/06/21 at 11:44 AM, the Director of Nursing (DON) said the nurses should have observed the oxygen
concentrator setting every time they went in resident rooms to ensure the correct dose was being
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105448
If continuation sheet
Page 8 of 9
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
105448
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/06/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Titusville Rehabilitation & Nursing Center
1705 Jess Parrish CT
Titusville, FL 32796
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)
F 0695
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
given. She added that if residents with COPD received too much oxygen, this could cause increased
shortness of breath.
2. Review of resident #508's medical record revealed he was admitted to the facility on [DATE] with
diagnoses that included cerebrovascular accident and hypothyroidism. A physician order dated 12/31/20
read, Oxygen at 2 LPM via n/c continuous for shortness of breath.
On 01/04/21 at 1:14 PM, the resident was observed resting on his bed. He was confused and not able to
answer questions appropriately. He received oxygen via nasal cannula, attached to a portable oxygen
concentrator set at 3 liters per minute.
On 01/04/21 at 5:11 PM, the resident was observed in bed with O2 set at 3 LPM via n/c.
On 01/04/21 at 5:33 PM, the Wing 3 Unit Manager stated that the resident's O2 concentrator was set at 3
LPM. She checked the physician orders and said the orders were for the oxygen to be given at 2 LPM
continuously for SOB. The UM explained that nurses were expected to check O2 at the start, end and
throughout the shift. She added that nurses should checked the oxygen settings any time they went into the
resident's room. The UM could not explain why the oxygen was not set at the prescribed rate.
Review of the policy titled, Oxygen Therapy and Devices read, purpose is to maintain normal body function.
It indicated that oxygen is a drug which must be ordered by a physician. The policy also included to verify
physician order, apply device to the patient with appropriate liter flow .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105448
If continuation sheet
Page 9 of 9
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Back to topCitations
7 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F578 - The right to request, refuse, and/or discontinue treatment, to participate in or
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
F645 - Preadmission Screening for individuals with a mental disorder and individuals
PASARR screening for Mental disorders or Intellectual Disabilities
F636 - Resident Assessment
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
F694 - Parenteral Fluids
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
- 0024GeneralS&S Epotential for harm
Establish policies and procedures for volunteers.
- 0321GeneralS&S Dpotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
FAQ · About this visit
Common questions about this visit
What happened during the January 6, 2021 survey of TITUSVILLE REHABILITATION & NURSING CENTER?
This was a inspection survey of TITUSVILLE REHABILITATION & NURSING CENTER on January 6, 2021. The surveyor cited 7 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at TITUSVILLE REHABILITATION & NURSING CENTER on January 6, 2021?
Yes, 7 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate ..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.