F 0732
Post nurse staffing information every day.
Level of Harm - Minimal harm
or potential for actual harm
Based on observations, record reviews, and interviews, the facility failed to accurately post the required
daily staffing information.
Residents Affected - Few
Findings included:
On 08/15/2022 at 9:02 a.m., upon entry into the facility, an observation of the bulletin board located on the
1st floor next to the Nurse's station, revealed there was no current Daily Staffing Sheet, a document that
provided information of the number of residents and the total hours of nursing staff working all on three
shifts for that day.
On 08/15/2022 at 3:13 p.m., an observation revealed no Daily Staffing Sheet posted for the current day.
On 08/16/2022 at 7:35 a.m., while touring the 1st floor nursing unit, an observation revealed no Daily
Staffing Sheet posted for the day.
On 08/16/2022 at 10:15 a.m., during an interview with the Director of Nursing (DON), the Daily Staffing
Sheets for the current week to include Sunday
08/14/2022 through Thursday 08/18/2022 was requested.
On 08/16/2022 at 12:20 p.m., the DON delivered copies of the requested information regarding the Daily
Staffing Sheets
On 08/16/2022 at 3:05 p.m., an observation was made of the Daily Staffing Sheet posted for the day with
the following information:
Census:45, Certified Nursing Assistants (CNA): 120.25 hours, Licensed Practical Nurses (LPN): 48.0
hours, Registered Nurses (RN): 12.0 hours, RN/DON: 8.0 hours, RN with administrative duties: 10.0 hours
On 08/17/2022 at 12:35 p.m., an observation revealed the Daily Staffing Sheet was dated 08/16/2022.
On 08/17/2022 at 3:05 p.m., an observation revealed the posted Daily Staffing Sheet was still showing
information from 08/16/2022.
On 08/18/2022 at 8:38 a.m., an observation revealed the Daily Staffing Sheet was still showing
(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:
105732
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
105732
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/18/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
The Cedar at Mease Life
910 New York Ave
Dunedin, FL 34698
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 0732
information from 08/16/2022.
Level of Harm - Minimal harm
or potential for actual harm
On 08/18/2022 at 8:42 a.m., an interview was conducted with the Staffing Coordinator. She stated the
census was: 52 for Sunday 08/14/2022, 52 for Monday 08/15/2022, 51 for Tuesday 08/16/2022, and 52 for
Wednesday 08/17/2022. She said she received the census numbers from the admissions office and did the
calculations. The information was then given to the DON for her to post.
Residents Affected - Few
On 08/18/2022 at 9:46 a.m., during an interview with the DON, she stated she was responsible for posting
the Daily Staffing Sheet. She showed a current copy of the Daily Staffing Sheet for Thursday 08/18/2022
and said she was in the process of posting it. She also stated she forgot to post the Daily Staffing Sheet on
Wednesday 08/17/2022.
On 08/18/2022 at 10:26 a.m., an interview was conducted with the Nursing Home Administrator (NHA). She
explained in their morning meeting, the census was discussed as of midnight the previous day. Changes
were made if a resident was sent out and a discussion was conducted related to any potential new admits.
The staffing numbers were then created or adjusted by the DON and the hours were calculated by the
Staffing Coordinator. She said the DON completed the staffing sheet and would post it on the bulletin
board, which is located next to the first unit Nurse's Station. The NHA was shown the Daily Staffing Sheets
which were received from the DON on Tuesday 08/16/2022. The first was dated for Sunday 08/14/2022, the
second was for Monday 08/15/2022, and the third was for Tuesday 08/16/2022. All three sheets showed a
total census of 45. The NHA was made aware that during an interview with the Staffing Coordinator, she
stated the census for Sunday was 52, Monday was 52 and Tuesday was 51. The NHA stated, I honestly
cannot give a good reason why the numbers are different, we screwed up and no one caught it or corrected
it. I will investigate it and see what happened.
A review of the policy titled, Posting Direct Care Staffing Numbers, revised July 2016 revealed:
Policy Statement
Our facility will post on a daily basis for each shift the number of nursing personnel responsible for providing
direct care to residents.
Policy Interpretation and Implementation:
1. Within two (2) hours of the beginning of each shift, the number of Licensed Nurses (RNs, LPNs, and
LVNs) and the number of unlicensed nursing personnel (CNAs) directly responsible for resident care will be
posted in a prominent location (accessible to resident and visitors) in a clear and readable format.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105732
If continuation sheet
Page 2 of 2
