F 0732
Post nurse staffing information every day.
Level of Harm - Minimal harm
or potential for actual harm
Based on observations and staff interviews, the facility failed to post the total number, and the actual hours
worked of the direct care staff for the benefit of the facility residents and the public on 04/05/21 through
04/07/21 as evidenced by the position and location of the clipboard that was identified by the Staffing
Coordinator as the posting location.
Residents Affected - Few
Findings included
Upon entry to the facility at approximately 09:00 am on Monday 04/05/21 surveyors did not observe the
information required by statutes concerning the posting for the nurse staffing information.
The nurse posting information was not available for viewing until the last day of the survey, 04/08/21, when
the staffing coordinator stated that the information was on a clipboard at one of the nursing stations. The
staffing coordinator identified the location as being on the wall to the right of the skilled step-down unit
(SSU). The observed clipboard was not identified as holding the staffing information and hung in a manner
that did not allow viewing for visitors or any other passerby unless they knew to take it off the wall and turn
the clipboard over. This clipboard was observed in this position during the four days of the survey
(photographic evidence was obtained). This clipboard was not accessible to visitors who did not come to
this particular unit and the staffing coordinator stated that she had been posting the information in this way
for months. The Nursing Home Administrator stated that she was not aware of the posting requirements
prior to our interview on 04/08/21, but that the posting would be available for prominent viewing by all the
residents and their visitors at the reception counter from now on.
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:
105786
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
105786
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/08/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Bayonet Point Health Center by Harborview
8132 Hudson Avenue
Hudson, FL 34667
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.
Based on observations, interviews and record review the facility did not ensure that Controlled substances
were locked and stored in a permanently affixed compartment in two of two medication storage rooms
sampled.
Findings included:
On 04/07/21 at 10:28 a.m. during the performance of the medication storage and labeling task the locked
medication room on the Skilled Subacute Unit (SSU) inspection of the refrigerator in the same medication
room at 10:30 a.m. accessed by Staff A, LPN, revealed a locked box. The box was not secured or
maintained in a permanently affixed compartment in the refrigerator. Staff A, LPN unlocked the box, which
revealed two clear plastic cases. The clear plastic cases were sealed with a green tamper proof seal and
the contents could be seen through the plastic. Each plastic case contained three, 2mg/ml vials of the
controlled substance lorazepam (photographic evidence was obtained).
An interview with Staff A, LPN. He stated that he was not aware that the box containing control substances
lorazepam had to be secured in a permanently affixed compartment.
At 10:35 a.m. in an Interview with the Regional Nurse providing Clinical Services, she confirmed that the
box should have been secured to a permanently affixed compartment in the refrigerator, but she thought it
did not apply to Schedule II controlled substances.
An inspection of the medication room located on the Geriatric Nursing Restorative (GNR) unit at 10:48 a.m.
with Staff B, LPN, revealed a locked box in the refrigerator. The locked box was not secured or maintained
in a permanently affixed compartment in the refrigerator. The locked box was accessed and opened by
Staff B, LPN, which revealed two individual bags of the controlled substance Lorazepam 2mg/ml labeled
with residents' name. One bag contains 10 vials and the other bag contains 8 vials. In-addition there were
two clear plastic cases sealed with a green tamper proof seal. The contents could be seen through the
clear plastic. Each plastic case contained three, 2mg/ml vials of the controlled substance lorazepam
(photographic evidence obtained).
In an interview with Staff B, LPN, she stated that she was not aware that the box containing control
substances lorazepam should have been maintained in a permanently affixed compartment.
On 4/7/21 11:40 a.m. in an interview with the Nurse Home Administrator, she concurred that the
medications should have been maintained in a separately locked, permanently affixed compartment.
A review of the facility policy Titled Long Term Care (LTC) Facility's Pharmacy Services and Procedure
Manual revised 10/28/2019, under the subheading General Storage Procedures 3.1.1 It reads: Store all
drugs and biologicals in locked compartments, including the storage of Schedule II-V medications in
separate locked, permanently affixed compartments .
Under the subheading Control Substances Storage13.3 it reads: Facility should ensure that all II-V
controlled substances are only stored in a manner that maintains their integrity and security.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105786
If continuation sheet
Page 2 of 2
