Health inspection·June 27, 2023

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to implement policies and procedures for ensuring the reporting of a reasonable suspicion of a crime. This practice involved 1 out of 5 sampled residents (Resident #4). There were 111 residents residing in the facility at the time of the survey. The findings included: During an interview on 6/27/23 at 9:45AM with the Nursing Home Administrator (NHA) it was reported, I started working at this facility on 10/31/22, the former NHA, Staff E was here and the former Director of Nursing (DON) Staff D oversaw the investigation. From my recollection, Resident #4 was alleging that her pain medication was not given to her, an investigation started the nurse involved was called to the facility for investigation. I advised the former NHA, Staff E to report the incident to AHCA (Agency for Health Care Administration). The incident occurred on 10/27/22 and it was reported on 11/1/22 to AHCA, DCF (Department of Children and Family) and the Police Department. The nurse involved License was also reported to the nursing board. The nurse involved was suspended and later resigned from the facility. The resident was able to receive her scheduled pain medications from what we had in stock at the facility. The five-day investigation concluded no physical harm, pain or mental anguish was done to the resident. The complaint allegation of misappropriation of resident property was substantiated, the nurse was terminated and then he resigned. I am aware that the report should have been filed within two (2) hours of the alleged incident. Review of the medical records for Resident #4 revealed, the resident was admitted to the facility on [DATE]. Clinical diagnoses included but were not limited to: Aftercare following Joint replacement and Presence of left artificial knee joint. Resident #4 was discharged on 11/02/2022. Review of the Physician's Orders Sheet for October 2022 revealed, Resident #4 had orders that included but were not limited to: 10/23/22-10/28/22-Oxycodone HCL (Hydrochloride) tablet 5 Milligrams (MG)-Give 1 tablet by mouth every 4 hours as needed for pain. 10/28/22-11/2/22-Tylenol with codeine #3 tablet 300-30MG-Give 1 tablet by mouth every 6 hours as needed for pain. Record review of Resident # 4's Discharge Return not anticipated Minimum Data Set (MDS) dated [DATE] revealed: Section C for Cognitive Patterns documented Brief Interview for Mental Status Score 13 on a 0-15 scale, indicating the resident is cognitively intact. Section J for Health conditions documented, the resident received scheduled pain medications in the last 5 days. Section N for Medications documented, the resident received antidepressants, and antibiotics in the last 7 days. Record review of Resident # 4's Care Plans Dated 10/24/2022 revealed: The resident is at risk for (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: 105641 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 105641 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Kendall 9400 SW 137th Avenue Kendall, FL 33186 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)