Inspection·March 12, 2021

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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, staff interview, and facility record review, the facility failed to ensure resident medications were stored and supervised in a manner that was free from access to other residents during one (3/11/2021) of four days observed, and on one (East wing) of two units. It was observed that loose pills and capsules were placed visibly in the space between the wall and the back of the handrail on a main hallway. Findings included: On 3/11/2021 at 1:00 p.m., the 200 East hallway was observed during the lunch meal service. While standing in the main hallway, between resident rooms [ROOM NUMBERS], the space between the wall and the back of the handrail was observed with loose pills and capsules. Further observations revealed one orange round tablet, one white round tablet, and one large white capsule. The medications were easily visible from the hallway and could easily be accessed by anyone who walked by. This area was observed with high traffic of both residents and staff members. There were three residents who were observed using the wall handrail to self propel up and down the hallway and had access to the loose medications. The surveyor stood in the area until 1:57 p.m. and during that period, no staff observed the loose medications. At 1:57 p.m., Staff C, Housekeeper was observed at the end of the hall and was wiping down the wall handrails. At 1:58 p.m., an interview with the East wing Unit Manager, Staff B confirmed the loose pills in the handrail area between rooms [ROOM NUMBERS]. She expressed surprised that the loose pills were there and unsupervised. She confirmed that when nursing staff do medication pass, they were to always ensure each resident receiving medications took the medications properly and swallowed them. She further confirmed that nurses were to supervise residents as they took their medications. She did not know how the loose pills got out in the hallway and in the handrail area and did not know how long they had been there. She immediately spoke with Staff A, Certified Nursing Assistant (CNA) and Staff C as they were in the immediate area. Staff A revealed that she did not know how the medications got there and that the staff look for items placed in between handrails and the hallway wall. Staff C said that she and the other housekeeping staff clean high touch surfaces to include wiping down of the hallway handrails about every two hours. Staff C could not recall if the loose medications were in that area earlier when she wiped down the handrails. Staff C could not recall any other time that she or other housekeeping staff had found loose pills. She indicated that if she had, she would immediately take them to a nurse for disposal. On 3/12/2021 at 8:00 a.m., the Nursing Home Administrator provided documentation that indicated (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 2 Event ID: 105451 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 105451 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Peninsula Health Center by Harborview 900 Beckett Way Tarpon Springs, FL 34689 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)