Health inspection·March 27, 2025

F 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. 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 medically related social services for one of three sampled residents (#2) related to assistance with a room change or assistance with a transfer to another facility as requested. Residents Affected - Few Findings included: On 03/27/2025 at 9:30 AM, Resident #2 was observed lying in bed. Resident #2 said she spoke to the Social Service Director (SSD) in the past about a room change. Resident #2 stated she cannot sleep because her roommate talks all night and keeps the lights on. Resident #2 stated she also talked to the SSD about transferring to a rehab in Jacksonville that specialized in Guillain-Barre Syndrome because the rehab could maybe help her get better. A follow-up interview was conducted on 03/27/2025 at 11:30 AM with Resident #2. Resident #2 stated she talked to the SSD a couple of weeks ago about the room change and was told they did not have any room available. Review of Resident #2's admission Record showed she was admitted to the facility in 2023 and most recently readmitted on [DATE]. Review of the quarterly Minimum Data Set (MDS) dated [DATE] showed a Brief Interview for Mental Status (BIMS) score of 14, indicating cognitively intact. Review of a 02/17/2025 Social Service Progress Note electronically signed by the SSD showed Quarterly note-2/14/25, [Resident #2] is alert and oriented and able to make all of her needs known .She has a [family member] that calls daily and visits monthly and has an occasional visit from prior coworkers. [Resident #2] prefers to stay in bed most days. She plans to stay here for long term care but understands she may choose to discharge if she chooses. She also has episodes of feeling tired and feeling down/depressed trouble sleeping and poor appetite at times. She is followed by psychosocial for history of Trauma. We will continue to follow current plan of care. A review of Resident #2's progress notes and assessment forms for February 2025 through March 27, 2025 at 2:58 PM showed no documentation relating to a room change, roommate concerns, or a request to transfer to another facility. During an interview on 03/27/2025 at 12:37 PM, with the Nursing Home Administrator (NHA), the Director of Nursing (DON), and the SSD, the SSD stated when Resident #2 requested a room change, they only had a male room available. The SSD stated, When I went back to her room, she decided they [her and her roommate] were getting along, and she did not want a room change. It [the conversation] (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: 105482 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 105482 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Breezy Hills Rehab and Care Center 5245 N Socrum Loop Rd Lakeland, FL 33809 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)