Health inspection·October 13, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on record review and interview, the facility failed to notify the resident representative when there was a change in condition for 1 of 3 residents reviewed for wound care, Resident #2. Residents Affected - Few Findings include: Review of Resident #2's physician order dated 1/13/2023 reads, Mupirocin External Ointment 2% (Mupirocin) apply to g-tube [gastrostomy tube] site topically every shift for infected g-tube site applied to g-tube site after cleaning water and soap and pat dry then applied t-sponge. Review of Resident #2's physician order dated 2/27/2023 reads, Triple Antibiotic External Ointment (Neomycin-Bacitracin-Polymyxin) apply to g-tube site topically three times a day for infection of site with foam dressing. Review of Resident #2's physician order dated 2/27/2023 reads, Contact isolation precautions x [times] 10 days for ESBL (Extended Spectrum Beta-Lactamase) e-coli [Escherichia Coli] around G-tube every shift for infection control and resolution for 10 days. Review of Resident #2's physician order dated 2/27/2023 reads, Invanz Injection Solution Reconstituted 1 GM [gram] (Ertapenem Sodium) Inject 1 gram intramuscularly one time a day for g-tube infection for 7 days. Review of Resident #2's physician order dated 2/27/2023 reads, Levaquin Oral Tablet 500 MG [milligrams] (Levofloxacin) Give 1 tablet via G-Tube one time a day for g-tube infection for 7 days. Review of Resident #2's progress note dated 2/27/2023 reads, [Advanced Practice Registered Nurse's Name] aware of wound culture results. Resident on contact isolation. Review of Resident #2's progress note dated 2/21/2023 reads, Optum APRN [Advanced Practice Registered Nurse] [APRN's name] notified of G tube site draining pus, greenish color. She ordered to do wound culture. Stat CBC [Complete Blood Count] and BMP [Basic Metabolic Panel]. Continue Nystatin to armpit for another 5 days. She will come and see her. Review of Resident Infection Report dated 2/28/2023 for Resident #2 reads, Infection site: G-tube site infection, pus present at a wound, skin, or soft tissue site (green pus) . Evaluation . Healthcare acquired: Symptoms were not present at the time of admission and resident meets McGeer's criteria for LTC [Long Term Care] infections . Comments: Resident has chronic g-tube site infections. Culture was positive for e-coli (ESBL) and pseudomonas aeruginosa. Resident has been placed on contact (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: 105717 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 105717 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Timberridge Nursing & Rehabilitation Center 9848 SW 110th St Ocala, FL 34481 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)