Inspection visit
Health inspection
4 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 4 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0644
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Coordinate assessments with the pre-admission screening and resident review program; and referring for
services as needed.
2. On 3/19/24, a review of Resident #41's medical record revealed an initial admission date of 11/22/22 with
a primary diagnosis of Chronic Obstructive Pulmonary Disease with (acute) Exacerbation, and other
diagnoses of Major Depressive disorder, Schizoaffective disorder unspecified, and Bipolar disorder
unspecified.
Review of Resident #41's PASARR Level 1 Screening form dated 10/6/23 completed by the Director of
Nursing (DON), noted the diagnoses boxes for Schizoaffective Disorder and Bipolar Disorder in Section 1:
PASARR Decision-Making were not checked.
Review of the facility's Resident Assessment - Coordination with PASARR (Pre-admission Screening and
Resident Review) Program policy implemented on 11/2020 said an individual with a mental disorder,
intellectual disability, or a related condition will receive care and services in the most integrated setting
appropriate to the resident needs. All admissions to the facility will be screened for serious mental disorders
or intellectual disabilities and related conditions in accordance with the State's Medicaid rules for screening.
On 3/21/24 at 11:21 a.m., in an interview the DON said she was currently responsible to ensure all
residents admitted to the facility had a completed and accurate PASARR Level 1 Screening form to
determine if the resident would benefit from a Level II PASARR evaluation to determine if the resident could
benefit from any specialized services.
The DON reviewed Resident #41's medical record and confirmed Resident #4's initial admission to the
facility was 11/22/22 and confirmed she had completed Resident #41's PASARR Level 1 screening form
dated 10/6/23. The DON said after she reviewed Resident #41's PASARR Level 1 screening form dated
10/6/23, the PASARR was inaccurate because she did not check the diagnoses boxes for Schizoaffective
Disorder and Bipolar Disorder as required per their facility policy and she would need to update Resident
#41's PASARR Level 1 screening form with the appropriate diagnoses.
Based on record review and staff interview, the facility failed to ensure the accuracy of a Pre-admission
Screening and Resident Review by failing to make the necessary corrections for 2 (Residents #14 and
Resident #41) of 5 residents with a new diagnosis of mental illness.
The findings included:
1. The facility policy Resident Assessment implemented 11/2020 and revised 10/2023 stated, This facility
coordinates assessments with the preadmission screening and resident review (PASARR) program under
Medicaid to ensure that individuals with a mental disorder, intellectual disability, or a
(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:
105497
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
105497
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/21/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Venice Health and Rehabilitation Center
1240 Pinebrook Road
Venice, FL 34292
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 0644
related condition receives care and services in the most integrated setting appropriate to their needs.
Level of Harm - Minimal harm
or potential for actual harm
Any resident who exhibits a newly evident or possible serious mental disorder, intellectual disability, or a
related condition will be referred promptly to the state mental health or intellectual disability authority for a
level II resident review.
Residents Affected - Few
Review of the clinical record for Resident #14 revealed an admission date of 12/1/2021. The documented
diagnoses at the time of admission included a primary diagnosis of Encephalopathy, Chronic Obstructive
Pulmonary Disease, Atrial Fibrillation, Hyperlipidemia, Gastro-Esophageal Reflux Disease and Major
Depressive Disorder.
The Quarterly Minimum Data Set (MDS) assessment noted the resident's cognition was moderately
impaired with a Brief Interview for Mental Status (BIMS) score of 10.
The level I PASARR completed at a local hospital was dated 11/30/21, prior to admission. Section 1A and
1B where not checked for serious Mental Illness or Intellectual Disabilities.
The list of medical diagnoses noted Resident #14 was diagnosed with schizoaffective disorder on 12/12/22
and generalized anxiety disorder on 5/17/23.
The clinical record lacked documentation the level I PASARR was updated with the new diagnoses of
mental illness.
On 3/21/2024 at 1:40 p.m. the Director of Nursing, (DON), verified there was not an updated PASARR
screening for Resident #14. She said Resident #14 required a level II screening because of a significant
change of condition since her original admission. The DON said it was her responsibility to ensure PASARR
was completed on every resident, and it should have been correctly completed and a Level II screening
completed for Resident #14.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105497
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
105497
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/21/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Venice Health and Rehabilitation Center
1240 Pinebrook Road
Venice, FL 34292
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 0690
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate
catheter care, and appropriate care to prevent urinary tract infections.
Based on observation, facility policy and procedures review, record review and staff interviews, the facility
failed to maintain urinary catheters in a safe and sanitary manner for 3(Residents #44, #51 and #65) of 5
residents reviewed with indwelling urinary catheters.
The findings included:
The facility policy Catheter Care implemented 11/2020 (revised 1/6/23) documented It is the policy of this
facility to ensure that residents with indwelling catheters receive appropriate catheter care and maintain
their dignity and privacy when indwelling catheters are in use.
1. Review of the clinical record revealed Resident #44 had an admission date of 9/10/23 with diagnoses
including cerebral palsy, obstructive and reflux uropathy, and renal calculus.
The Quarterly Minimum Data Set (MDS) (standardized assessment tool that measures health status in
nursing home residents) with an assessment reference date of 3/13/24 documented Resident #44 was
dependent on staff for toileting, personal hygiene, and bathing.
The MDS noted Resident #44's cognitive skills for daily decision making were severely impaired.
On 3/18/24 at 11:06 a.m., Resident #44 was in her bed and the catheter drainage bag was observed
attached to the bed frame and was resting on the floor. The drainage bag was not in a protective, privacy
bag.
Photographic evidence obtained.
Review of the care plan initiated 9/11/23 specified to keep catheter drainage bag off the floor.
On 3/18/24 at 2:39 p.m., during an observation and interview, the catheter drainage bag was observed
partially on the floor, hanging from the bed frame with the bed in a lower position. The drainage bag was not
in a protective, privacy bag. In an interview, Resident #44 said she did not know why she had the catheter
and said, it might be because of the wound on my backside.
On 3/20/24 at 8:53 a.m., in an interview Certified Nursing Assistant (CNA) Staff C said she works Resident
#44's assignment and is aware the drainage bags should never be on the floor. The CNA said the facility
had provided education to her regarding catheter care. She said she makes sure when the residents are
out of bed, she puts the drainage bag in a bag attached to the wheelchair so no one can see it and it is off
the floor.
2. Review of the clinical record revealed Resident #51 had an admission date of 2/16/24 with diagnoses
including dementia, acute kidney disease, obstructive and reflux uropathy, hydronephrosis, stage 3 chronic
kidney disease and suprapubic catheter.
The admission MDS with an assessment reference date of 2/23/24 documented Resident #51 required
substantial to maximum assistance with toileting.
The MDS noted Resident #51's cognitive skills for daily decision making were moderately impaired.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105497
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
105497
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/21/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Venice Health and Rehabilitation Center
1240 Pinebrook Road
Venice, FL 34292
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 0690
Level of Harm - Minimal harm
or potential for actual harm
On 3/18/24 at 9:29 a.m., Resident #51 was observed in bed, he had removed his hospital gown and had
nothing but a brief on. He did not respond to verbal questions. The catheter drainage bag was observed on
the floor and was not in a protective, privacy bag.
Photographic evidence obtained.
Residents Affected - Some
On 3/18/24 at 10:57 a.m., CNA Staff E was in the room and confirmed the drainage bag was on the floor
and not in a protective, privacy bag. Staff E raised the bed to prevent the catheter tubing and drainage bag
from coming into contact with the floor. CNA Staff E said the drainage bag was not supposed to be on the
floor. She said, sometimes residents want you to place the catheter on one side of the bed only and don't
want it behind them in the wheelchair (w/c) so we do what they ask us to do.
On 3/19/24 at 8:27 a.m., Resident #51 catheter drainage bag was observed touching the floor and was not
in a protective, privacy bag.
Registered Nurse (RN) Staff G confirmed the observation and adjusted the drainage bag and tubing, so it
was off the floor.
Photographic evidence obtained.
3. Review of the clinical record revealed Resident #65 had an admission date of 2/15/21 with a readmission
date of 7/15/23. Diagnoses included dementia, acute kidney disease, obstructive and reflux uropathy,
hydronephrosis, stage 3 chronic kidney disease and suprapubic catheter.
The significant change MDS with an assessment reference date of 2/13/24 documented Resident #65 was
dependent on staff assistance for toileting.
The MDS noted Resident #65's cognitive skills for daily decision making were severely impaired.
On 3/18/24 at 10:32 a.m., Resident #65 was observed in bed, the bed was in a low position. The Foley
catheter drainage bag was on the floor resting partially on the wheel of the bed. The drainage bag was not
in a protective, privacy bag.
Photographic evidence obtained.
On 3/18/24 at 4:15 p.m., Resident #65 was observed in the activity room, his catheter drainage bag was
attached to the wheelchair but not in a privacy protected bag. The drainage bag and tubing were in contact
with the wheel of the chair.
Photographic evidence obtained.
On 3/20/24 at 9:01 a.m., in an interview CNA staff F said she was assigned to work the 400 and 500
hallways and knew the residents who had indwelling catheters. Staff F said the drainage bag is not
supposed to be on the floor. She said when in the w/c you put it behind them in a bag. When in bed you
place it on the bedframe. If the resident had a low bed, sometimes it touches the floor because the bed is
low. The CNA said she had in-service training on catheter care but did not remember when. Staff F said she
empties the drainage bag into a container and takes it to the bathroom and pours it into the toilet. If it does
not look right, I tell the nurse if I see bleeding.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105497
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
105497
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/21/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Venice Health and Rehabilitation Center
1240 Pinebrook Road
Venice, FL 34292
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 0690
Level of Harm - Minimal harm
or potential for actual harm
On 3/21/24 at 2:00 p.m., the Administrator said she initiated a Performance Improvement Plan (PIP) on
1/12/24 to address infection control. The PIP action steps included to ensure catheter drainage bags were
off the floor and dignity bags were in place. The target date for the PIP was 2/10/24.
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105497
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
105497
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/21/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Venice Health and Rehabilitation Center
1240 Pinebrook Road
Venice, FL 34292
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
Based on observation, facility policy and procedures review, record review and staff interviews, the facility
failed to store nebulizer inhalation equipment and bilevel positive air pressure (BiPAP) machine in a sanitary
manner for 1(Resident #21) of 1 resident reviewed for respiratory care.
Residents Affected - Few
The findings included:
The facility policy CPAP/BIPAP Cleaning documented It is the policy of this facility to clean CPAP/BIPAP
equipment in accordance with current Centers for Disease Control (CDC) guidelines and manufacturer
recommendations in order to prevent the occurrence or spread of infection. Clean mask frame daily after
use with CPAP cleaning wipe or soap and water. Dry well. Cover with plastic bag or completely enclosed in
machine storage when not in use.
The facility policy Nebulizer Therapy implemented 11/2020 (revised 12/23/22) documented It is the policy of
this facility for nebulizer treatments, once ordered, to be administered by nursing staff as directed using
proper technique and standard precautions. Care of the equipment specified to clean after each use. Rinse
the nebulizer cup and mouthpiece with water. Once completely dry, store the nebulizer cup and mouthpiece
in a plastic storage bag.
Review of the clinical record revealed Resident #21 had an readmission date of 11/6/23 with diagnoses
including emphysema, former smoker, chronic obstructive pulmonary disease (COPD) and chronic
respiratory failure.
The quarterly MDS with an assessment reference date of 1/17/24 documented Resident #21's cognitive
skills for daily decision making were moderately impaired.
On 3/18/24 at 10:04 a.m., during an interview and observation Resident #21 had oxygen in use. She said
she uses a bilevel positive air pressure (BiPAP) machine (delivers positive air pressure when you breath in
and out to help with breathing) at night and receives nebulizer treatments because she gets short of breath.
The BiPAP machine and mask were stored on top of a container next to the nightstand and had items
stored under it and a plastic cabinet next to it. The BiPAP machine and mask were not covered. The
nebulizer and mask were on top of the nightstand, uncovered.
Photographic evidence obtained.
Review of the care plan identified the resident was at risk of respiratory complications related to COPD,
emphysema, chronic respiratory failure, and sleep apnea. The care plan instructed to administer oxygen
and medications as ordered and Bi-PAP settings as ordered.
Review of the physician orders specified to clean BiPAP face mask frame daily after use with soap and
water on the day shift.
On 3/19/24 at 8:31 a.m., in an interview Resident #21 said she used to smoke and quit 10 years ago. I have
COPD so I am always short of breath, the oxygen helps. I sleep with the BiPAP on. The BiPAP mask and
machine remained uncovered and in the same location. The nebulizer mask was uncovered and lying on
the nightstand.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105497
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
105497
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/21/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Venice Health and Rehabilitation Center
1240 Pinebrook Road
Venice, FL 34292
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
On 3/20/24 at 9:53 a.m., in an interview and observation Licensed Practical Nurse Staff D, confirmed the
BiPAP and nebulizer masks were on top of the nightstand and said they should be covered when not in
use. The LPN said, I know she uses the nebulizer during the day, I don't know about the BiPAP because I
am not here at night. Resident #21 said she uses the BiPAP at night. The LPN said, there are plastic bags
right here and placed the masks into the plastic bags.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105497
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
105497
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/21/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Venice Health and Rehabilitation Center
1240 Pinebrook Road
Venice, FL 34292
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 0698
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review, and staff interview, the facility failed to ensure ongoing communication and collaboration with
the dialysis center related to assessment of the resident before, during and after each dialysis treatment for
1 (Resident #84) of 1 resident reviewed for dialysis.
Residents Affected - Few
The findings included:
The facility policy titled Hemodialysis revised on 11/28/2022 stated, This facility will provide the necessary
care and treatment, consistent with professional standards of practice, physician orders, the comprehensive
person-centered care plan, and the resident's goals and preferences, to meet the special medical, nursing,
mental, and psychosocial needs of residents receiving hemodialysis . This will include: ongoing assessment
of the resident's condition and monitoring for complications before and after dialysis treatments received at
a certified dialysis facility. Ongoing assessment and oversight of the resident before, during and after
dialysis treatments, including monitoring of the resident's condition during treatments, monitoring for
complications, implementation of appropriate interventions, and using appropriate infection control
practices: and ongoing communication and collaboration with the dialysis facility regarding dialysis care and
services . The licensed nurse will communicate to the dialysis facility via telephonic communication or
written format, such as a dialysis communication form or other form . The facility will communicate with the
dialysis facility, attending physician and /or nephrologist and significant weight changes, nutritional
concerns, medication administration or withholding of certain medications prior to the dialysis treatment
and document such orders.
Review of the admission Record indicated Resident #84 was admitted to the facility on [DATE]. Diagnoses
included acute kidney failure and dependence on renal dialysis.
Review of Resident #84's clinical record showed the facility utilized Hemodialysis communication Record
forms to ensure ongoing communication and collaboration with the dialysis facility regarding dialysis care
and services.
The form consisted of three sections:
The first section to be completed by the licensed nurse prior to the dialysis treatment, including an
evaluation of the access site, blood pressure, temperature, pulse, last meal, diet, and the resident's general
condition.
The second section to be completed by the dialysis center following dialysis treatment included an
evaluation of the access site, pre and post dialysis weight, new orders, significant change in condition
during dialysis.
The third section to be completed by the facility's receiving licensed nurse post-dialysis treatment included
an evaluation of the access site, and any new orders from the dialysis center.
The forms are kept in a dialysis book.
Review of the care plan showed Resident #84 received hemodialysis at a local dialysis center on Tuesdays,
Thursdays, and Saturdays.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105497
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
105497
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/21/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Venice Health and Rehabilitation Center
1240 Pinebrook Road
Venice, FL 34292
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 0698
Review of Resident #84's dialysis book revealed three Hemodialysis communication Record forms.
Level of Harm - Minimal harm
or potential for actual harm
The Hemodialysis Communication Record form dated 3/16/24 had a line drawn through the date, and
3/19/24 written underneath. The section to be completed by the dialysis center was blank.
Residents Affected - Few
The hemodialysis communication record form dated 3/19/24 was missing the post-hemodialysis information
from the dialysis center, including blood pressure, pre and post weight, medications given during
hemodialysis, any new orders, or significant change in condition.
No hemodialysis communication form was found for 3/12/24, or 3/14/24.
On 3/20/24 at 10:22 a.m., in an interview Licensed Practical Nurse (LPN) Unit Manager Staff (J), said she
did not know if the nurses have been filling out the Dialysis communication Record. She noticed Resident
#84's dialysis book was not leaving the resident's bag after he returned from his treatment. Staff J said she
was unable to find the missing dialysis communication forms from treatment dates of 3/12/24 and 3/14/24.
Unit Manager, Staff J said the nurse needs to make a phone call to the dialysis center if the post treatment
section is not filled out. Unit Manager Staff J said she was the nurse who received Resident #84 after
dialysis treatment on 3/19/24 and did not make a phone call to get a verbal report of post-hemodialysis
care from the dialysis center.
On 3/21/24 at 9:27 a.m., in an interview the Director of Nursing (DON) verified the pre and post dialysis
sections of the hemodialysis communication forms were not being consistently completed.
On 3/21/24 at 10:35 a.m., in an interview the DON said the purpose of monitoring the blood pressure pulse
and temperature before and after dialysis was to make sure there was no infection, fever wise, hypotension
(low blood pressure) or hypertension (high blood pressure). The DON stated, There is a lack of
communication between the facility and the dialysis center.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105497
If continuation sheet
Page 9 of 9
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Back to topCitations
4 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.
F644 - Coordination
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
F698 - Dialysis
Provide safe, appropriate dialysis care/services for a resident who requires such services.
FAQ · About this visit
Common questions about this visit
What happened during the March 21, 2024 survey of VENICE HEALTH AND REHABILITATION CENTER?
This was a inspection survey of VENICE HEALTH AND REHABILITATION CENTER on March 21, 2024. The surveyor cited 4 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at VENICE HEALTH AND REHABILITATION CENTER on March 21, 2024?
Yes, 4 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Coordinate assessments with the pre-admission screening and resident review program; and referring for services as neede..."
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.