Health inspection·March 10, 2022

F 0756 Level of Harm - Minimal harm or potential for actual harm Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on interviews and record reviews, the facility failed to ensure a monthly Medication Regimen Review (MRR) for 2 (#24 and #61) of 5 residents reviewed. Residents Affected - Few The findings included: The facility Policy for Medication Regimen Review (MRR) with an effective date of 12/1/07 noted, The Consultant Pharmacist will conduct MMRs if required under a Pharmacy Consultant Agreement . The facility should maintain copies of MRRs on file in the facility, either as part of the resident's permanent medical record or in a special file, in accordance with applicable law. Review of the clinical records showed Resident's #24 and #61 were admitted to the facility respectively on 6/12/20 and 3/19/21. The clinical records lacked documentation of a medication regimen review for September 2021. Review of the Consultant Pharmacy Reports for September 2021 showed MRRs were conducted for 17 residents without recommendation and for two residents with recommendations. Residents #24 and #61 were not included in the MMRs. Review of the facility Detailed Census Report for September 2021 showed there were between 84 and 93 residents at the facility during the month of September 2021. On 3/9/22 at 11:17 a.m., in an interview the Assistant Director of Nursing (ADON) confirmed there was no MRR for September 2021 for Residents #24 and #61. The ADON also confirmed there were Consultant Pharmacy MMRs conducted for only 19 residents during September 2021. The ADON said she discovered the problem in October 2021 and contacted the Consultant Pharmacist. The Consultant Pharmacist's reply was they were missed. On 3/9/22 at 03:22 p.m., in a telephone interview, the Consultant Pharmacy Supervisor confirmed MRRs were not conducted for Resident #24 and #61 in September 2021. 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 3 Event ID: 105538 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 105538 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harbour Health Center 23013 Westchester Blvd Port Charlotte, FL 33980 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)