Inspection·May 22, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on observations, record reviews and interviews, the facility failed to follow the plan of care for 1 of 2 residents sampled for pressure injuries. (Resident #36) Residents Affected - Few The findings include: On 5/19/25, Resident #36 was observed lying in bed. There was no low air loss mattress in use. Further observations on 5/20/25 at 1:24 PM and 3:32 PM as well as on 5/21/25 at 8:45 AM and again at 11:40 AM revealed Resident #36 lying in bed with no low air loss mattress in use. On 5/20/25, a record review was conducted for Resident #36. The care plan, revised last on 7/1/24, contained skin impairment interventions which included the use of a low air loss mattress. (photographic evidence obtained). A review of the orders showed no physician orders for a low air loss mattress. On 05/21/25 at 09:49 AM, an interview with the Director of Nursing (DON) was conducted. The DON was asked who is responsible for ensuring care plans are implemented. The DON stated that Minimum Data Set nurses and clinical managers follow up on this. The DON stated the resident had been on a low air loss mattress but it was removed for cleaning and has not been placed back on the bed yet and acknowledged it was not on the bed at this time. On 5/21/25 at 10:01 AM, the Central Supply staff checked the mattress and stated it was a regular mattress. 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: 105487 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 105487 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bay Breeze Senior Living and Rehabilitation Center 3387 Gulf Breeze Parkway Gulf Breeze, FL 32561 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)