Inspection visit

InspectionDecember 22, 2023

Gainesville Health and RehabilitationCMS #10566418 citations on this visit

18 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 18 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure policies and procedures were implemented for the prevention of abuse, neglect, exploitation of residents and misappropriation of resident property related to training for 1 of 10 employees (the Chef) and reporting allegations immediately, but not later than 2 hours after the allegation was made, to the State Survey Agency and other officials as required for 1 (Resident #23) of 3 residents sampled. Residents Affected - Few Findings include: 1. Review of the Chef's personnel records documented a hire date of 8/28/2023. The personnel records did not contain any documentation since date of hire of education on abuse, neglect, exploitation, and misappropriation of resident property. During an interview on 12/21/2023 at 8:30 AM, the Executive Director (ED) stated that there was no training documented for the Chef for abuse in his personnel file. The ED stated that the Chef had not attended any in-services given for abuse. 2. Review of the progress note for Resident #23 dated 12/15/2023 at 18:47 (6:47 PM) read, [Resident #23's Name] is upset about [aunt's] roommate [Resident #62's Name] requesting [Resident #23's Name] not be allowed in her room. [Resident #23's Name] has family in [Resident #62's room number] and would like to visit her. The Director of Nursing (DON) called and updated on the situation. Police called by nurse. Resident [Resident #23] asked not to go back to room [Resident #62's room]. Monitor. Review of the progress note for Resident #62 dated 12/15/2023 at 19:07 (7:07 PM) read, Resident [Resident #62] sister called and stated that another resident [Resident #23] threatened and cursed at her sister when he came into the room to see his aunt. Sister stated she would call the police if she didn't get a call back to discuss what can be done by the DON and if the resident [Resident #23] came back into her sister's [Resident #62] room. I, [Staff A] called the DON and notified her of the situation and she [DON] stated to call the police if the resident went back into [Resident #62's Name] room and that we could not give sister a call because it is after hours. [Resident #23's Name] was notified he could no longer go in there [Resident #62's room] or that the police would be called, and he went directly to the room and I, [Staff A] called the local law enforcement and am currently awaiting their arrival. Review of the progress note for Resident #23 dated 12/15/2023 at 19:14 (7:19 PM) read, [Resident #23's Name] was told he was not able to go into [Resident #62's Name] room to see his aunt due to claims of threatening and cursing his aunt's roommate [Resident #62's Name] and was told that if he did, the law enforcement would be called. [Resident #23's Name] then went directly to the room to confront [Resident #62's Name] and I [Staff A, Licensed Practical Nurse (LPN)] proceeded to call the (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 14 Event ID: 105664 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few police and I let him [Resident #23] know. He [Resident #23] then called the police as well and then proceeded to make more threats such as stabbing and cutting people. During an interview on 12/19/2023 at 12:03 PM, the Executive Director confirmed he was told of the incident. The Executive Director stated the facility had not completed or submitted federal reports following [Resident #23's Name] verbal abuse incident and, that a report should have been made. During an interview on 12/20/2023 at 9:40 AM, Staff A, LPN, stated that she was passing medications around 6:18 PM and the nurse [Staff B, Registered Nurse, (RN)] for [Resident #23's Name] stated he was upset and had been in [Resident #62's Name's] room. Staff A stated that she went to the 200-hall nursing station to call the DON and [Resident #23's Name] called the police and was overheard stating that if anyone touched him, he would stab and cut their butts. Staff A stated she called the DON to let her know of everything going on between the residents [Residents #23 and #62] and the sister of [Resident #62's Name] and the DON stated she was not able to return the call at that time. Staff A stated she did not know what transpired when the police arrived as her shift was over at 7:00 PM. During an interview on 12/20/2023 at 10:42 AM the DON stated she received a call from the nurse [Staff A] and was informed of the incident. The DON stated she informed the staff to call the police if [Resident #23's Name] went back into [Resident #62's Name] room. Review of the policy and procedures titled Abuse, Neglect and Exploitation, last reviewed on 2/13/2023, read Policy: It is the policy of this facility to provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation and misappropriation of resident property. Definitions: Staff includes employees, the medical director, consultants, contractors, volunteers The components of the facility abuse prohibition plan are discussed herein: II. Employee Training. A. New employees will be educated on abuse, neglect, exploitation, and misappropriation of resident property during the initial orientation. VII. Reporting/Response. A. The facility will have written procedures that include: 1. Reporting of all alleged violations to the Administrator, state agency, adult protective services and to all other required agencies within specific timeframes: a. Immediately, but not later than 2 hours after the altercation is made, if the event that caused the allegation involve abuse or result in serious bodily injury or, b. Not later than 24 hours if the event that cause the allegation do not involve abuse and do not result in serious bodily injury. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 2 of 14 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure the resident assessment accurately reflected the resident's status for 1 resident (Resident #68) of 2 reviewed for dialysis services and 1 resident (Resident #81) of 1 reviewed for restraints. Residents Affected - Few Findings include: Review of Resident #68's physician's order dated 10/19/2021 read, Dialysis is Tues, Thus, Sat, .Seat time 10:25 AM. Review of Resident #68's Minimum Data Set (MDS) Quarterly assessment dated [DATE] reads, Section O-Special Treatments, Procedures, and Programs: Check all of the following treatments, procedures and programs that were performed. Dialysis services were not checked off as special treatments received. During an interview on 12/20/2023 at 2:28 PM the MDS Coordinator stated, [Resident #68's Name] is on my dialysis list and he has not been sent out to the hospital. He should be marked as yes [on the assessment] for dialysis. It was an error. 2. Review of Resident #81's physician's order documented no orders for restraints. Review of Resident #81's MDS Quarterly assessment dated [DATE] read, Section P- Restraints and Alarms documented physical restraints used in chair or out of bed - Trunk restraint - Used less than daily. During an interview on 12/20/2023 at 2:15 PM the Director of Nursing stated, We do not use restraints in the facility. During an interview on 12/20/2023 at 2:26 PM with MDS Coordinator stated, We have no restraints in the building. My assistant is new and is being trained, it was an error. Review of the policy and procedure titled MDS 3.0 Completion with a last review date of 2/13/2023 reads, Policy: Residents are assessed, using a comprehensive assessment process, in order to identify care needs and to develop an interdisciplinary care plan. Policy Explanation and Compliance Guidelines: 1. According to federal regulations, the facility conducts initially and periodically a comprehensive, accurate and standardized assessment of each resident's functional capacity, using the RAI (Resident Assessment Instrument) specified by the State. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 3 of 14 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Based on record review and interview the facility failed to ensure residents that were reviewed for Preadmission Screening and Resident Review (PASARR) with newly evident or possible serious mental disorders were referred to the appropriate state designated authority for review for 3 (#4, #69, #40) of 6 resident reviewed. Findings include: 1.) Record review of Resident #4's most recent PASARR Level II, dated 1/18/2017, revealed Resident #4 was assessed as having mental health diagnoses as follows: Axis I: Depressive Disorder; and Bipolar Disorder. Record review of Resident #4's admission record revealed Resident #4 was subsequently diagnosed with psychotic disorder with hallucinations due to known physiological condition, on set date 8/2/23. Record review of Resident #4's clinical records failed to reveal documentation Resident #4 was identified with a newly evident or possible serious mental disorder and was referred to the appropriate state designated authority for an updated Level II evaluation and determination. 2.) Record review of Resident #69's most recent PASARR Level l, dated 11/29/2023, revealed Resident #69 was assessed as having no mental illness or suspected mental illness diagnoses. Record review of Resident #69's admission record revealed Resident #69 was subsequently diagnosed with brief psychotic disorder, onset 3/17/2023. Record review of Resident #69's clinical records failed to reveal documentation Resident #69 was identified with a newly evident or possible serious mental disorder and was referred to the appropriate state designated authority for a level II resident review. During an interview on 12/20/2023 beginning at 10:35 AM, the Director of Nursing stated she had not been able to locate further information related to [Resident #4's Name and Resident #69's Name] preadmission screening and resident review (PASARR). 3). Review of Resident #40's most recent PASARR Level l, dated 10/4/17, documented No diagnosis or suspicion of Serious Mental Illness or Intellectual Disability indicated. Level II PASARR evaluation not required. Review of Resident #40's admission record documented a diagnosis of paranoid schizophrenia, onset date 6/22/23. Record review of Resident #40's clinical records failed to reveal documentation Resident #40 was identified with a newly evident or possible serious mental disorder and was referred to the appropriate state designated authority for a referral for a Level II evaluation and determination. During an interview on 12/20/2023 at 1:50 PM, The Director Of Nursing stated the facility did not have any documentation related to [Resident #40's Name] preadmission screening and resident review. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 4 of 14 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure residents received a PASARR (Pre-admission Screening and Resident Review) for possible serious mental disorders, intellectual disabilities, and related conditions prior to admission for 1 (#25) of 6 residents reviewed. Residents Affected - Few Findings Include: Review of Resident #25's admission record documented a diagnosis of paranoid schizophrenia, onset date 4/25/23. Review of the psychiatry note dated 4/25/23 read, chief complaint depression, insomnia, and schizophrenia. Plan of Action: continue medication Abilify for schizophrenia, Divalproex for mood and Trazodone for depression. Review of the hospital note dated 9/04/23 read, discharge summary. discharge diagnosis: bi-polar disorder. Review of the clinical record revealed no documented PASARR screening. During an interview on 12/19/23 at 11:17 AM, the Director of Nursing (DON) stated that with the diagnosis of schizophrenia, bi-polar, and depression, a PASARR should have been completed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 5 of 14 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to provide nutritional services with adequate nutritional interventions to maintain acceptable parameters of nutritional status for 1 (Resident #19) of 7 residents reviewed nutrition. Residents Affected - Few Findings include: Review of Resident #19's admission record documented diagnoses that included other forms of systemic lupus erythematosus, dysphagia, folate deficiency anemia, and vitamin D deficiency. Review of Resident #19's care plan, revised 4/19/2023, documented a nutritional problem or potential nutritional problem related to diagnoses of congestive heart failure, hypertension, anxiety, and chronic pain with interventions that include provide and server diet as ordered and RD (registered dietitian) to evaluate and make diet change recommendations. Review of Resident #19's complete blood count with differential lab results, collection date 11/25/2023, documented results that included hemoglobin at 9.6, reference range 12.0 - 16.0, and albumin at 2.7, reference range 3.5 - 5.7. Review of Resident #19's quarterly dietary profile, dated 11/6/2023, documented the current diet order as a no added salt mechanical soft texture, thin consistency diet. The dietary profile documented food dislikes as eggs. Review of the weight record on 10/05/2023, Resident #19 weighed 95.2 pounds and 11/06/2023, Resident #19 weighed 90.8 pounds which was a 4.62 % loss. Review of the weight record showed on 06/12/2023, Resident #19 weighed 107.4 pounds and on 11/06/2023, Resident #19 weighed 90.8 pounds which was a 15.46 % loss. During an interview on 12/18/2023 at 9:30 AM, Resident #19 stated that the facility did not provide her enough food. She stated she had lost weight, and the portions were small. She stated she wanted to eat but the facility did not give her enough food. On 12/19/2023 at 8:25 AM, Resident #19 was observed during the morning meal. Resident #19 had been served buttered wheat toast and grits. Resident #19 had not been served protein with her morning meal. On 12/20/2023 at 8:36 AM, Resident #19 was observed during the morning meal. There was one pancake with syrup and butter, mechanical soft sausage, and a bowl of oatmeal. During an interview on 12/20/2023 beginning at 8:36 AM, Resident #19 complained of only receiving 1 pancake for the morning meal. Review of Resident #19's breakfast meal ticket, dated 12/20/2023, showed Resident #19 should have received 2 pancakes softened with butter and syrup. Continued observation with Staff C, Certified Nursing Assistant, on 12/20/2023 beginning at 8:36 AM, revealed there was a second halved pancake placed under the upper rim of Resident #19's plate. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 6 of 14 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Staff C lifted the halved pancake from underneath the plate rim and tapped the halved pancake on the bedside table resulting in an audible noise. Staff C advised Resident #19 that the second pancake was too hard for her to eat and could result in a choking episode. Staff C offered to get Resident #19 a second pancake that Resident #19 would be able to eat safely. During interview on 12/20/2023 beginning at 8:59 AM, the Certified Dietary Manager stated the tray card system was supposed to automatically generate a protein for meals. She added that the pancake probably got overcooked and agreed the pancake should not have been served to [Resident #19's Name] or any other resident but should have been discarded. During a follow up interview on 12/20/2023 beginning at 10:09 AM, the Certified Dietary Manager reported the alternate menu item for eggs and bacon was scrambled eggs. She reported [Resident #19's Name] had said she did not like eggs, but she had not yet entered a protein alternate for Resident #19 into the tray card system. During an interview on 12/20/2023 beginning at 8:59 AM, the Registered Dietician stated that a weight loss alert should have been triggered but it was not. The Registered Dietician stated, to be honest, in the transition, I was trying to catch it all up. The Registered Dietician confirmed that no added salt was [Resident #19's Name] only dietary restriction. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 7 of 14 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to ensure that residents received respiratory care services consistent with professional standards of practice for 1 (Resident #13) of 2 residents receiving respiratory services. Residents Affected - Few Findings include: During an observation on 12/18/2023 at 10:30 AM, Oxygen Concentrator at bedside. Resident was not currently using oxygen. Oxygen tubing was dated 11/30/2023. The nasal canula was on the floor. A nebulizer mask was observed not bagged. (photo evidence obtained). During an observation on 12/19/2023 at 8:43 AM, the nebulizer mask was under a telephone receiver with no bag. (photo evidence obtained) During an interview on 12/18/2023 at 10:30 AM, Resident #13 said, I am not currently using the oxygen concentrator. During an interview on 12/21/2023 at 8:26 AM the Director of Nursing, stated oxygen tubing is changed every 7 days, and the oxygen tubing was overdue for being changed. She also stated, when a nebulizer is not in use it should be bagged. Review of the admission record for Resident #13 documented the most recent admission date of 11/01/2023, included diagnoses of Parkinson's disease without dyskinesia, acute and chronic respiratory failure unspecified whether with hypoxia or hypercapnia, and chronic obstructive pulmonary disease, unspecified. Review of the physician's order for Resident #13 dated 11/01/2023 read, Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML (milligram/3milliliter) 1 vial inhale orally every 8 hours as needed for Wheezing. Review of the physician's order for Resident #13 dated 11/02/2023 read, Change 02 (oxygen) tubing label and date tubing) and bag cover every week, every night shift every Wed. Review of the physician's order for Resident #13 dated 12/18/2023 read, Oxygen at 2 liters/min (minute) via nasal cannula as needed for O2. Review of policy and procedure titled Oxygen Administration last reviewed 02/13/2023 read, Policy Explanation and Compliance Guidelines: 5. Staff shall perform hand hygiene and don gloves when administering oxygen or when in contact with oxygen equipment. Other infection control measures include: b. Change oxygen tubing and mask/cannula weekly and as needed if it becomes soiled or contaminated., e. keep delivery devices covered in plastic bag when not in use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 8 of 14 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure the drugs and biologicals used in the facility were stored and labeled in accordance with currently accepted professional principle for 3 of 4 medication carts. Findings include: During an observation on [DATE] at 9:09 AM of station #1 medication cart #1 with Staff D, Registered Nurse, (RN), there was one expired insulin vial with an expiration date of [DATE], one expired Novolog insulin pen with expiration date of [DATE], one unopened Novolog pen with a blue label which read refrigerate until opened, one open Novolin pen with no open or expired date, two open Lantus Solostar insulin pen with no open or expired date, and one open Novolog flexpen with no open or expired date, two medication cups with pre-poured medications, and one opened Advair Diskus with no open or expired date. During an interview on [DATE] at 9:15 AM, Staff D, RN, stated, The insulin pen is not opened, the insulin will be used tonight, it should have been kept in the refrigerator. Medication should be labeled once we open them. The pre-poured medication is stored in the cart because I was going to give it to the residents, and they were not available. During an observation on [DATE] at 9:25 AM of station #1 medication cart 2 with Staff E, License Practical Nurse, (LPN), there was one open artificial lubricant eye drops with no open or expired date and one open Brimonidine Sol 0.2% OP eye drops with no open or expired date. During an interview on [DATE] at 9:27 AM, Staff E, LPN, stated, Eye drops should be labeled once we open them, they are good for 30 days after opening. During an observation on [DATE] at 9:42 AM of station 2 medication cart 2 with Staff F, LPN, there was one open Basaglar insulin pen with no open or expired date, one unopened Humalog pen, two open artificial eye drop bottles with no open or expired date, one open expired Advair Diskus with open date of [DATE], one open expired Breo Ellipta with an open date of [DATE], two expired Advair Diskus with open date [DATE] and open date [DATE]. During an interview on [DATE] at 9:50 AM, Staff F, LPN, stated, Medication should be labeled once opened. All expired medication should be removed from the cart and new medication ordered. If the insulin is not open, it should be stored in the refrigerator until ready to use. During an interview on [DATE] at 12:09 PM the Director of Nursing stated, Medication should be labeled for the security of the medication. Insulin not opened should be stored in the refrigerator. The protocol for expired medication should be reordered and not used. The medication should be removed from the medication cart. Review of the policy and procedure titled Medication Storage, last reviewed [DATE] reads, Policy: It is the policy of this facility to ensure all medications housed on our premises will be stored in the pharmacy and/or medication rooms according to the manufacturer's recommendations and sufficient (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 9 of 14 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to ensure proper sanitation, temperature, light, ventilation, moisture control, segregation, and security. Policy Explanation and Compliance Guidelines. 6a. All medications requiring refrigeration are stored in refrigerators located in the pharmacy and at each medication room. Review of Polaris Pharmacy Services Medication Storage information sheet, updated 5/2023, reads, Advair Diskus, storage-room temperature (opened-remove from foil), expiration date-30 days. Breo Ellipta, storage-room temperature (opened-removed from foil), expiration date-6 weeks. Eye Drops (OTC) (over the counter), storage-room temperature (opened) unless otherwise indicated, expiration date-30 days. Brimonidine, storage-room temperature (opened), expiration date-28 days. Review of the policy and procedure titled Labeling of Medications and Biologicals, last reviewed [DATE], reads, Policy: All medications and biologicals used in the facility will be labeled in accordance with current state and federal regulations to facilitate consideration of precautions and safe administration of medications. 6. Labels for each floor/unit's stock medications must include: c. The expiration date when applicable. 7. Labels for over the counter (OTC) medications must include: c. The expiration date when applicable. 8. Labels for multi-use vials must include: a. the date the vial was initially open or accessed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 10 of 14 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure resident records were complete and accurately documented for 2 of 4 residents reviewed for intravenous catheters (Residents #81, #40). Findings include: 1. During an observation on 12/18/2023 at 11:00 AM, Resident #81 was lying in bed with no intravenous (IV) catheter noted on the resident's arms. During an interview on 12/19/2023 at 1:10 PM, Resident #81 stated, I do not have an IV at this moment. They had to take it out about three days ago. Review of Resident #81's physician order dated 12/11/2023 reads, Discontinue peripheral IV per MD [Medical Doctor]. Review of Resident #81's physician order dated 12/8/2023 reads, Give 2 liters of normal saline @ [at] 75 cc/hr x 2 liters [75 milliliters per hour times 2 liters] one time a day for labs until complete. Review of Resident #81's Medication Administration Record for December 2023 showed that 2 liters of normal saline was administered from 12/11/2023 to 12/20/2023. Review of Resident #81's progress note dated 12/10/2023 reads, IV fluids stopped d/t [due to] fluids leaking from IV site. Resident denies pain or discomfort to area. Call placed to IV nurse to replace line. During an interview on 12/21/2023 at 8:18 AM, the Director of Nursing stated, Nursing should not have been checking as given. Nurses should be documenting accurately what is being administered. Review of the policy and procedure titled Documentation in Medical Record, last reviewed 2/13/2023 reads, Policy: Each resident's medical record shall contain an accurate representation of the actual experiences of the resident and include enough information to provide a picture of the resident's progress through complete, accurate, and timely documentation. Policy Explanation and Compliance Guidelines: 3. Principles of documentation include, but are not limited to: a. Documentation shall be factual, objective, and resident centered. i. False information shall not be documented. B. Documentation shall be accurate, relevant, and complete, containing sufficient details about the resident's care and/or responses to care. 2. Review of the admission record for Resident #40 showed the resident was admitted to the facility on [DATE] with a diagnosis of, but not limited to, contracture of the right hand, cerebral ischemia, diffuse traumatic brain injury, brainstem stroke syndrome, hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting right dominant side, unspecified protein calorie malnutrition, vitamin D deficiency, vitamin B-12 deficiency, anemia, other symptoms and signs involving cognitive functions and awareness. Review of Resident #40's weight record showed on 12/6/2023, the resident weighed 129.4 pounds, with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 11 of 14 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0842 an ideal body weight listed at 148 pounds. Resident #40 is 14% below his ideal body weight. Level of Harm - Minimal harm or potential for actual harm Review of Resident #40's physician's active order dated 7/27/2022 reads, Ensure [nutritional supplement] three times a day for nutritional needs Offer TID [Three times daily]. Document amount consumed. Residents Affected - Few Review of Resident #40's care plan dated 4/27/2023 revealed the resident was at risk for protein-calorie malnutrition, monitor intake and record every meal. Review of Resident #40's percentage of meal eaten data/nutrition task documentation dated 11/21/2023 through 12/19/2023 showed the percentage of meal intake was not recorded for all meals on 14 out of 30 days reviewed. 11/22/23, 11/24/23, 11/26/23, 11/27/23, 11/28/23, 11/30/23, 12/4/23, 12/7/23, 12/11/23, 12/13/23, 12/14/23, 12/15/23, and 12/18/23. During an interview on 12/20/2023 at 2:15 PM, the Director of Nursing confirmed the meal percentage intakes were not consistently recorded daily for Resident #40. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 12 of 14 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure staff performed hand hygiene during medication administration to help prevent the development and transmission of communicable diseases and infections. Residents Affected - Few Findings include: During an observation on 12/20/2023 at 8:28 AM, Staff G, License Practical Nurse (LPN), started preparing medications for Resident #56 after using hand sanitizer. The medication blister pack fell on the floor and Staff G picked it up from the floor. Without performing hand hygiene, Staff G continued to pour medication in individualized medication cups. Staff G began to crush the medication and placed them back into the individualized medication cups. Staff G donned gloves and opened a capsule and poured the medication in the medication cup and then removed gloves. Staff G entered Resident #56's room and donned gloves and administered medications via the gastric tube. Staff G did not perform hand hygiene. During an interview on 12/20/2023 at 8:59 AM, Staff G, LPN, stated, I should have done hand hygiene after picking up the blister pack from the floor. During an interview on 12/21/2023 at 12:12 PM, the Director of Nursing stated, If there is a break in the clean technique, the staff should hand sanitize before proceeding and putting on gloves. Review of the facility policy and procedure titled Hand Hygiene with the last review date of 2/13/2023 reads, Policy: Staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. This applies to staff working in all locations within the facility . Policy Explanation and Compliance Guidelines . 6. Additional considerations: a. The use of gloves does not replace hand hygiene. If your task requires gloves, perform hand hygiene prior to donning gloves, and immediately after removing gloves. Review of the facility document titled Hand Hygiene Table revealed the requirement to perform hand hygiene either with soap and water or alcohol based hand rub after handling contaminated objects. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 13 of 14 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 105664 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Health and Rehabilitation 4000 SW 20th Ave Gainesville, FL 32607 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)

F 0943 Level of Harm - Minimal harm or potential for actual harm Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. Based on record review and interview, the facility failed to ensure the training program on abuse and neglect was completed for 1 of 10 employees, the Chef. Residents Affected - Few Findings include: Review of personnel records for the Chef, hired on 8/26/2023, revealed no training on abuse, neglect, and exploitation during the orientation training. Review of the in-service on abuse, neglect, and exploitation on 12/18/2023 showed the Chef did not attend the in-service. During an interview on 12/21/2023 at 11:50 AM, the Executive Director (ED) confirmed that the Chef had an orientation training and the training did not include abuse, neglect, and exploitation. The ED also confirmed that the Chef had not attended any in-services on abuse, neglect, and exploitation since her hire date of 8/26/2023. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105664 If continuation sheet Page 14 of 14

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Citations

18 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0918GeneralS&S Epotential for harm
F918 - Bathroom Facilities
Have generator or other power source capable of supplying service within 10 seconds.
0920GeneralS&S Epotential for harm
F920 - Dining and Resident Activities
Ensure proper usage of power strips and extension cords.
0607GeneralS&S Dpotential for harm
F607 - The facility must develop and implement written policies and procedures that:
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
0641GeneralS&S Dpotential for harm
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
0644GeneralS&S Dpotential for harm
F644 - Coordination
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
0645GeneralS&S Dpotential for harm
F645 - Preadmission Screening for individuals with a mental disorder and individuals
PASARR screening for Mental disorders or Intellectual Disabilities
0692GeneralS&S Dpotential for harm
F692 - Assisted nutrition and hydration
Provide enough food/fluids to maintain a resident's health.
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0761GeneralS&S Dpotential for harm
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
0842GeneralS&S Dpotential for harm
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
0880GeneralS&S Dpotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0943GeneralS&S Dpotential for harm
F943 - Abuse, neglect, and exploitation
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
0211GeneralS&S Epotential for harm
Keep aisles, corridors, and exits free of obstruction in case of emergency.
0324GeneralS&S Epotential for harm
Provide properly protected cooking facilities.
0345GeneralS&S Epotential for harm
Have approved installation, maintenance and testing program for fire alarm systems.
0355GeneralS&S Dpotential for harm
Properly select, install, inspect, or maintain portable fire extinguishes.
0372GeneralS&S Epotential for harm
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
0741GeneralS&S Dpotential for harm
F741 - The facility must have sufficient staff who provide direct services to
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.

FAQ · About this visit

Common questions about this visit

What happened during the December 22, 2023 survey of Gainesville Health and Rehabilitation?

This was a inspection survey of Gainesville Health and Rehabilitation on December 22, 2023. The surveyor cited 18 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at Gainesville Health and Rehabilitation on December 22, 2023?

Yes, 18 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Have generator or other power source capable of supplying service within 10 seconds."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

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Data from CMS Care Compare public records. Dataset last refreshed June 8, 2026. If you believe any information is inaccurate, report it here.

Inspection·December 22, 2023