Health inspection·March 21, 2024

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm Based on observation, interviews and record review, the facility failed to ensure the interdisciplinary team assessed and determined a resident was capable of self-administration of medications prior to allowing 1 of 28 sampled residents to self-administer medications. (Resident #80) Residents Affected - Few The findings include: On 3/18/24 at approximately 1:08 PM, an observation of Resident #80 was conducted. A 30-milliliter medicine cup containing three pills, a small drinking cup containing a cloudy liquid with a plastic spoon, and a 30-milliliter cup containing a clear salve were observed on the over the bed table. The resident indicated she fell asleep and forgot to take her pills and confirmed the nurse left the medications for her to self-administer. The resident also indicated the nurse leaves the medications on occasion if the resident is not ready to take the medications or if the resident is sleeping. On 3/18/24 at approximately 1:15 PM, an interview was conducted with Staff B, a Licensed Practical Nurse (LPN). The LPN indicated she did not know where the medications came from. She indicated she administered and watched the resident take her medications this morning and could not recall a specific time. The LPN indicated she thought perhaps the overnight shift left the medications. She indicated she did not notice the medications this morning on the resident's over the bed table. The LPN is not sure if Resident #80 has been evaluated to self-administer her medications. She confirmed the facility does not allow nurses to leave medications unlocked at the bedside. On 3/18/24, a review of the resident's electronic medical record did not reveal a physician order for the resident to self-administer her medications. A review of the resident's medication administration record for 3/17/24 revealed no medications were administered during the overnight shift. A review of the admission minimum data set with an assessment date of 9/12/23 reveals the resident has a BIMS (brief interview of mental status) of 15 indicating she is cognitively intact. There was no documentation to verify if self-administration of medications had been reviewed and/or approved. On 3/19/24 at approximately 10:12 AM, an interview was conducted with the Director of Nursing (DON) regarding nurses leaving medications at the bedside for residents to self-administer. The DON was shown the photo of the medications left on the over the bed table. The DON indicated, per facility policy, the nurse should have watched the resident take the medications and should have applied any topical medications as ordered. 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 4 Event ID: 105561 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 105561 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Pensacola 8475 University Parkway Pensacola, FL 32514 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)