Inspection·February 10, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow the comprehensive person-centered care plan for three (#2, #4, #5) of three sampled residents related to bed mobility and transfers. Findings included: 1. Resident #2 was admitted on [DATE] and readmitted on [DATE]. Review of the admission Record showed diagnoses included but not limited to traumatic subarachnoid hemorrhage without loss of consciousness on 08/18/2021; orthostatic hypotension, intervertebral disc displacement, lumbar region; other specified disorders of the brain; diabetes; anemia; adult failure to thrive; unspecified dementia severe; Cognitive Communication Deficit; stage 3 chronic kidney disease; Chronic Obstructive Pulmonary Disease, tremor, low back pain, hypertensive chronic kidney disease and spondylosis. Review of the Care Plans showed: ADL (Activities of Daily Living) Self-Care and/or mobility deficit. Resident #2 was at risk of developing complications associated with decreased ADL self-performance related to: weakness, tremors, often chooses to not get out of bed as of 08/19/2021 and revised 02/03/2025. Interventions included but not limited to: Bed Mobility are total assist of 2 related to air mattress; Transfers are total assist of 2 with the mechanical lift; Bathing was total assist of 2; Toileting was total assist of 2 as of 10/05/2023. Review of the ADL Tasks dated 01/12/2025 to 01/31/2025 Bed Mobility-how resident moves to and from a lying position, turns side to side, and positions body while in bed: Bed Mobility required total dependence assistance for 34 out of 44 opportunities Bed Mobility required extensive assistance for 6 out of 44 opportunities Bed Mobility required limited assistance for 2 out of 44 opportunities Bed Mobility required resident not available for 1 out of 44 opportunities Bed Mobility is not applicable for 1 out of 44 opportunities (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 5 Event ID: 105574 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 105574 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of Largo 10500 Starkey Rd Largo, FL 33777 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)