Inspection·May 11, 2023

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 observation, interview and record review, the facility failed to provide accurate Minimum Data Set (MDS) Resident Assessments on 3 of 5 residents sampled. (Residents #21, #64, and #71) Residents Affected - Few The findings include: Resident #21 A record review for Resident #21 was completed on 5/10/2023 at approximately 2:30 PM. This review noted an admission diagnosis of Schizophrenia dated 1/27/2023 and Anxiety Disorder dated 1/30/2023. A record review of the admission Annual MDS Assessment for Resident #21, dated 2/3/2023, noted no documentation in Section A1500 that acknowledged a Level II Preadmission Screening and Resident Review (PASARR) was completed for the diagnosis of Schizophrenia. Section A1510 of the MDS did not list the mental health conditions. A record review noted a positive Level II Screen for Resident #21 that was dated 2/8/2023 and a consent from Resident #21 for a Level II evaluation. A record review noted the Level II determination for Resident #21 was received on 2/17/2023. An interview was performed on 05/11/23 at approximately 11:42 AM with Staff A, a MDS Registered Nurse (MDS-RN) and Staff B, another MDS-RN. They agreed that the MDS had not been updated to reflect that a Level II MDS screening was submitted for the resident. They said his Level II assessment was done after admission and the MDS had already been submitted and they had not yet updated the change in MDS. Resident #64 A record review for Resident #64 was completed on 5/10/2023 at approximately 3:30 PM. The record noted a secondary admission diagnosis of Paranoid Schizophrenia and Antisocial Personality Disorder dated 5/17/2021 and an added diagnosis of Unspecified dementia - unspecified severity with agitation added on 10/18/2022 and Major Depressive Disorder added on 11/28/2022. A record review of the Annual MDS Assessment for Resident #64 dated 5/25/2023 noted no documentation in Section A1500 that acknowledged a Level II PASARR screening was completed for the mental illness diagnoses. Section A1510 did not list the mental illness conditions. A record review for Resident #64 noted an updated PASARR was completed on 11/21/2022 which noted (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: 105747 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 105747 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Healthcare and Rehabilitation Center 3107 North H Street Pensacola, FL 32501 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)