Inspection·February 10, 2022

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 review of policy and procedure, it was determined that the facility failed to ensure that it secured medications for Resident #37, during a Medication Pass Observation and properly disposed of over-the-counter (OTC) medication for Resident #13, during an observational room tour. The findings included: 1) On 02/07/22 at 9:50 AM during a Medication Administration Observation, it was noted that there were three (3) unidentified, loose pills---one (1) orange and two (2) pink on Resident #37's floor, one (1) near the doorway and two (2), near her bedside table, unsecured and accessible to other residents, staff and visitors. Resident #37 was originally admitted to the facility on [DATE] with diagnoses which included Dementia, Osteoarthritis, Major Depressive Disorders and History of Falling. She had a Brief Interview Mental Status (BIM) score of 6 (severely impaired). Photographic evidence obtained of the three (3) loose, unidentified pills located on the floor in Resident #37's room. On 02/07/22 at 9:52 AM an interview was conducted with Staff A, a Registered Nurse (RN), in which she acknowledged that the pills should not have been there and should have been discarded. 2) During an observational room tour conducted on 02/07/22 at 11:15 AM of Resident #13's room, it was noted that there was a container of (OTC) vaporizing Chest rub sitting on Resident #13's bedside table; the container had no expiration date on it. And, in Resident #13's bathroom located on the over-sink shelf, it was noted that there was a one-half (1/2) used bottle of (OTC) Sore Throat Spray with an expiration date of 07/23, also unsecured and accessible to other residents, staff and visitors. Resident #13 was re-admitted to the facility on [DATE] with diagnoses which included Chronic Obstructive Pulmonary Disease, Asthma, Shortness of Breath, Emphysema, Diabetes Mellitus and Obesity. Resident #13 is currently out of the facility since 02/02/22 after transfer to Hospital with a determined diagnosis of Renal Failure. She had a Brief Interview Mental Status (BIM) score of 13 (cognitively intact). Photographic evidence obtained of the container of (OTC) Chest rub on the resident's bedside table and (OTC) Sore Throat Spray in the resident's bathroom. On 02/07/22 at 12:47 PM it was still noted that there was a container of vaporizing Chest rub sitting on Resident #13's bedside table and it was also still noted on the over-sink shelf, that there was a one-half (1/2) used bottle of Sore Throat Spray. On 02/07/22 04:08 PM it was still noted that there was a container of vaporizing Chest rub sitting on Resident #13's bedside table and it was also still noted on the over-sink shelf, that there was a (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 4 Event ID: 105686 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 105686 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Springtree Rehabilitation & Health Care Center 4251 Springtree Drive Sunrise, FL 33351 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)