Health inspection·September 22, 2022

F 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interviews and record review, the facility failed to provide routine medications to meet the needs of 1 of 7 (#17) residents sampled for medication administration observation. Residents Affected - Few The findings include: On 9/21/22 at approximately 1:50 PM, during a medication administration observation of Nurse A, a Licensed Practical Nurse (LPN), Resident #17 asked Nurse A about his inhaler medication and when it would be available. The nurse responded that the pharmacy stated it would be that evening. On 9/21/22 at approximately 1:50 PM, an interview was conducted with Resident #17 who reported he has not received his inhaler for almost a month now. On 9/21/22 at approximately 1:55 PM, an interview was conducted with Nurse A. Nurse A stated that the medication Incruse Ellipta Aerosol Powder Breath Activated 62.5 MCG/INH (a steroid inhalation medication used to treat Chronic Obstructive Pulmonary Disease) has been out for several days. She further stated that she notified the pharmacy, and when it did not come in, notified the Assistant Director of Nursing (ADON). When asked if the physician had been notified that Resident #17 had been without his medication for several days, Nurse A stated No. On 9/21/22 at approximately 2:00 PM, an interview was conducted with the ADON, a Registered Nurse. The ADON stated that she had called the pharmacy the other day to re-order the medication, and the pharmacy stated it would be delivered that night. She continued that, when it did not arrive, she called the pharmacy again the next day. When asked if the physician had been notified that the medication was out, the ADON stated that the primary nurse would have notified the physician, and confirmed that she had not done so. When asked about the facility's policy on re-ordering medication and notifying the physician, she stated she was not sure and would have to get back to the surveyor later with an answer to the question. A record review was conducted of Resident #17's electronic medical record. Review of the electronic medication administration record (EMAR) revealed that on the following dates, the medication Ellipta Aerosol Powder Breath Activated 62.5 MCG/INH was documented as not given, 9/1/22, 9/3/22, 9/4/22, 9/8/22, 9/9/22, 9/12/22, 9/13/22, 9/14/22, 9/15/22, and 9/17/22. The EMAR revealed that the medication was documented as given on 9/2/22, 9/5/22, 9/6/22, 9/7/22, 9/10/22, 9/11/22, 9/16/22, 9/19/22, and 9/20/22. Review of the progress notes revealed no documentation that the physician was notified that the medication had not been given on 10 days. Further review of progress notes revealed that a progress note entered on 9/21/22 as a late entry for 9/19/22 revealed the pharmacy was notified of the medication not being delivered and the pharmacy reported it would be in that night. The note (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 2 Event ID: 105612 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 105612 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silvercrest Health and Rehabilitation Center 910 Brookmeade Drive Crestview, FL 32539 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)