Inspection visit
Inspection
11 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 11 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0561
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to and the facility must promote and facilitate resident self-determination through
support of resident choice.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2) During an
interview on 10/30/23 at 9:46 AM, when asked if she was receiving baths or showers as she would like,
Resident #2 stated she was not always getting her showers. When asked why, Resident #2 stated the staff
can't always find the Hoyer lift (a mechanical lift used to transfer a resident from the bed or chair into the
shower chair). When asked how many showers each week she would prefer, Resident #2 stated she
wanted them three times a week. Resident #2 explained there was a schedule, and she was scheduled on
Tuesday, Thursday, and Saturday. When asked about her scheduled dialysis appointments on those same
days, Resident #2 explained when she does get showers, staff give them to her about 7 AM. The resident
explained her dialysis was not until about 10 AM.
Review of the record revealed Resident #2 was admitted to the facility on [DATE]. Review of the current
Minimum Data Set (MDS) assessment dated [DATE] documented the resident had a Brief Interview for
Mental Status (BIMS) score of 15, on a 0 to 15 scale, indicating the resident was cognitively intact. Review
of the recent Annual MDS dated [DATE] documented it was very important for the resident to choose
between a bath and shower.
Review of the Tasks section of the electronic medical record, where the Certified Nursing Assistants
(CNAs) would document the provision of showers, was a section for bathing. Review of the bathing section
lacked any documented evidence of the provision of any showers.
During an interview on 11/02/23 at approximately 1:00 PM, when asked the process for resident showers,
Staff A, CNA, explained there was a shower schedule posted on the inside of each unit's shower room. The
CNA stated they have to follow that schedule. When asked where she documented the provision of
showers, Staff A stated she was unaware of any place to document them, but again stated they have to go
by that posted shower schedule.
Review of the posted shower schedule for the 200 unit revealed Resident #2 was scheduled for a shower
during the 7 AM to 3 PM shift on Tuesday, Thursday, and Saturday.
Based on observation, interview and record review the facility failed to ensure documented evidence of
showers as per schedule and preference for 2 of 4 residents (Resident #2 and Resident #6).
The findings included:
1.) Record review revealed Resident #6 was initially admitted to the facility on [DATE] with re-admission on
[DATE] with diagnosis included Non-Alzheimer's Dementia. The annual minimum data set (MDS)
assessment reference date 08/25/23 recorded a brief interview for mental status (BIMS) score of 12,
(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 18
Event ID:
105804
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0561
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
which indicated Resident #6 was moderately cognitively intact. This MDS revealed that Resident #6
required extensive assistance with bed mobility, dressing and personal hygiene care.
On 10/30/23, started at 10:13 AM Resident #6 was observed lying in bed, lethargic, he stated he was felt
weak. On 10/31/23 at 8:36 AM Resident #6 was observed lying in bed, alert, oriented, and more awake,
there were no signs of lethargic. During that time an interview was started, he stated, he felt much better
today, he was not so lethargic anymore. He then added the staff shaved him this morning, they've cleaned
him up a little. He further stated, The girls asked him if he wanted a shower yesterday, he said no because
he was so lethargic. When asked how often he has received showers? he said every couple of weeks. He
then stated he would like to receive showers more frequently if they can accommodate that for him. During
that time further review of Resident #6's record was conducted, review of the activity of daily living (ADL)
task in the computer system was conducted, there was no shower schedule noted.
On 11/01/23 at 1:52 PM, an interview was conducted with the director of nursing (DON), she revealed the
shower schedule was not recorded under the task tab in the computer system, and the facility has a shower
schedule written on paper that they follow. The DON voiced she would provide the shower schedule and
evidence of providing shower.
On 11/02/23 at 8:33 AM, another interview was held with DON and the regional nurse consultant, the DON
provided the written shower schedule and ADLs report sheet, it was revealed that Resident #6's shower
was scheduled for Mondays, Wednesdays, and Friday on the 3-11 shift. Review of the October 2023 ADLs
report sheet for the 20 days look back period, it was revealed that there was no documented evidence for
ADLs care related to shower.
On 11/02/23 at 1:20 PM, another interview was held with the regional nurse consultant, and a side-by-side
review of Resident #6's ADLs task record was conducted for October 2023, there was no documented
evidence of provided shower for October 2023. The regional nurse consultant agreed with the finding. She
voiced that after the interview with her this morning she had realized that question #3 and #4 have been
deleted for the October ADL task during the transition of changes with the computer system, and she will
have them make changes to it. Question #3 was to record type of bathing: shower or bed bath or tub and
question #4 was to ask about ADL support.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 2 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0565
Honor the resident's right to organize and participate in resident/family groups in the facility.
Level of Harm - Minimal harm
or potential for actual harm
Based on resident interviews, Resident Council meeting minutes, record reviews, and staff interviews, the
facility failed to act upon Resident Council grievances in a timely manner regarding voiced resident
concerns about direct care staff as consistently stated in each Resident Council Meeting Minutes reviewed
from May 2023 to October 2023.
Residents Affected - Few
The findings included:
Policy title Resident and Family Grievances, implemented date 2/15/23; revised date 3/2/23; reviewed by
clinical services. The policy indicated that it is the policy of this facility to support each residents and family
member's right to voice grievances without discrimination, reprisal or fear of discrimination or reprisal.
Prompt efforts to resolve include facility acknowledgment of a complaint/grievance and actively working
toward resolution of that compliant/grievance.
#7 of the policy indicated grievances may be voiced in the following forums: verbal complaint to a staff
member or grievance officer.
#10 procedure: a) the staff member receiving the grievance will record the nature and specifics of the
grievance on the designated grievance form or assist the resident or family member to complete the form.
b) forward the grievance form to the grievance officer as soon as practicable.
c) The grievance officer will take steps to resolve the grievance, and record information about the grievance,
and those actions, on the grievance form.
On 11/01/23 at 2:37 PM, a meeting was held with 8 alert and oriented resident council members whose
Brief Interview for Mental Status (BIMS) was between 9-15 out of 15 (Residents #8 [BIMS 14], #10 [BIMS
10], #35 [BIMS 15], #38 [BIMS 9], #43 [BIMS 15], #50 [BIMS 15], #52 [BIMS 13], and #63 [BIMS 15]).
Each of these resident council members stated, individually, that the Certified Nurse's Aide (CNAs) on the 3
PM - 11 PM are consistently not providing assistance to the residents, speaking Creole, coming into
resident rooms to hide and use their phone, and not treating the residents with respect. They also all
agreed that the aides do not provide water when they request it.
Residents #50, #43, #8, and #10 stated that the Administrator and Director of Nursing (DON) have
attempted to make improvements, and the DON has provided in-service to the staff, but it isn't helping
enough, as the CNAs on the 3 PM - 11 PM shift are still not providing the necessary care to the residents.
Residents #50 and #35 stated that one of the residents yells, Help! all night long. The CNAs ignore her for
the most part saying she's crazy, and they put her call light out of reach.
Residents #8 and #50 stated that there is a German-speaking resident who moans all night long and no
one goes in to take care of her, and there is a Spanish-speaking Dementia resident who wanders the halls
in the evening and has fallen several times.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 3 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0565
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Resident #50 state, A CNA was being very mean to my roommate. I told the Night Nurse on the 11-7 shift,
and the nurse told me I couldn't report it, only the resident getting mistreated can report it. If I see it, why
can't I report it. I did speak to the Administrator about it, and he is taking care of the issue. One of the
surveyors on the team did investigate the claim made by Resident #50 regarding a CNA on the 3 PM -11
PM shift being mean to her roommate. The nurse involved and the roommate were interviewed regarding
the incident. The roommate would not provide any confirmation that such an event occurred either to the
surveyor or to the nurse on duty at the time Resident #50 reported the incident. The roommate is alert and
oriented and able to be interviewed.
Resident #8 stated that CNAs on 3 PM-11 PM shift have left her in her soiled adult brief for 6 hours, and
Resident #43 stated that the 3 PM-11 PM CNAs will tell you they will come back to assist you, but they
never do.
Resident #10 and #63 stated that twice they have had to take a shower with clumps of feces on the shower
floor because the CNAs did not clean it up from a previous resident.
The Residents in the Resident Council meeting stated that all of these grievances have been brought up to
the Administrator. All of the residents agreed that since the new administrator and DON have started
working at the facility, things have gotten better, but they still need improvement. The Resident Council does
recognize that the new Administrator is trying to address the problems, but the problems still exit.
A review of the Resident Council Meeting Minutes for May 2023 through October 2023 revealed:
May 2023 New Business - Residents stated the CNA's in the 3-11 shifts are speaking Creole, gather in
their rooms to have conversations/putting their personal items in their [residents'] rooms.
June 2023 Old Business - CNA concern was passed on to DON, who followed up by providing in-service to
3-11 shift.
June 2023 New Business - Resident stated CNA concerns have improved but could still be improved.
Residents stated CNAs speak disrespectfully to them, getting annoyed when they ask a question or try to
speak to them [all shifts].
July 2023 Old Business - Residents agreed that improvement has been made but they continue to have
issues with the 3-11 shift.
July 2023 New Business - Follow-up 3-11 shift continue to be disrespectful, talking loudly in the halls while
residents are trying to sleep, using personal cellphones in their [residents'] rooms, personal socialization in
their [residents'] rooms (1 resident stated an aide sat on her chair talking on her cell phone with her foot on
her [resident's] bed, call lights taking too long to answer then being turned off without giving help.
August 2023 Old Business - DON discussed follow-up regarding 3-11 shift issues. She informed the
Committee that the 3-11 shift received in-services/education since last meeting, and it will be on-going.
August 2023 New Business - Residents stated there has been a great change, but there is still room for
improvement.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 4 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0565
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
September 2023 New Business - Call lights are taking too long to answer, at times being turned off without
taking care of the issue, CNAs are hanging out in residents' rooms, socializing or using their phones;
Dinner trays are not taken back to kitchen or taking too long to be picked up after meals for those residents
who choose to eat in their rooms; there are times you cannot find a CNA for assistance.
October 2023 Old Business - Issues with 3-11 shift. Some improvements after in-services but issues
continue to happen and need improvement.
October 2023 New Business - 3-11 shift continue to have the same issues, some CNAs are rude.
On 11/02/23 at approximately 6:00 PM, the ongoing concerns/grievances expressed by the Resident
Council and the fact that these same grievances continue to be unresolved as evidenced from the Resident
Council Minutes from May through October 2023 was discussed with and acknowledged by the
Administrator.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 5 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 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 ensure Minimum Data Set (MDS) assessment
accuracy related to Activities of Daily Living (ADLs), indwelling urinary catheter use, medications, and
hospitalizations for 4 of 16 sampled residents (Resident #19, #28, 39, and #61).
Residents Affected - Few
The findings included:
1) During an observation and interview on 10/31/23 at 9:42 AM, a urinary catheter bag was noted hanging
from the bed of Resident #19. When asked how long she had the catheter, Resident #19 stated she had it
for awhile.
Review of the current orders revealed the use of an indwelling catheter since the admission of Resident
#19 on 09/19/23. Review of the current MDS assessment dated [DATE] lacked the documented use of an
indwelling catheter in section H0100.
2) On 10/31/23 in the afternoon, Resident #28 was observed up in his wheelchair, being pushed by one
staff. During an interview on 11/01/23 at 11:29 AM, when told he was seen yesterday up out of bed,
Resident #28 stated he wanted to get up to go hear the music.
Review of the record revealed Resident #28 was admitted to the facility on [DATE]. Review of the current
MDS assessment dated [DATE] documented Resident #28 needed the assistance of two persons for
locomotion on the unit.
During a side-by-side record review and interview on 11/02/23 at 10:27 AM, the Regional Director of
Clinical Services acknowledged with the inaccurate MDS coding for the number of staff needed to assist
Resident #28 throughout the building.
3) Review of the record revealed Resident #39 was admitted to the facility on [DATE]. Review of the current
MDS assessment dated [DATE] documented the resident only received the high risk medication insulin.
Review of the corresponding Medication Administration Records (MARs) for the look-back period of
09/27/23 through 10/03/23 revealed Resident #39 also received the following high risk medications:
The opioid medication Tramadol was administered four times, daily on 09/27/23 through 09/30/23.
The anticoagulant Lovenox was administered once on 09/27/23.
During a side-by-side review of the record and interview, the Regional Director of Clinical Services agreed
with the inaccurate MDS assessment.
4) Record review revealed Resident #61 was admitted to the facility on [DATE] and was discharged on
08/20/23. Review of the discharged MDS assessment, reference date 08/20/23, revealed Resident #61
entered from acute hospital and was discharged to acute hospital. Review of Physician order dated
08/23/23 revealed May discharge home with HHC and nursing if needed. Review of Progress note dated
08/20/2023 at 10:40 AM indicated Resident #61 was discharged to private home/apt no Home Health. Left
facility via car with Family member. Reason for discharge condition improved. On 11/02/23 at 10:41 AM, a
side-by-side review of Resident #61's record and interview were held with the regional nurse
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 6 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0641
consultant, she agreed with the MDS inaccuracy.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 7 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0644
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Coordinate assessments with the pre-admission screening and resident review program; and referring for
services as needed.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review and interview, the facility failed to ensure completion of a Level 2 PASARR (Preadmission
Screening and Resident Review) for 1 of 2 sampled residents. Resident #9 had a documented Level 1
PASARR dated 04/17/23, and a supplemental review on 11/02/23 that revealed the necessity for a Level 2,
which was not completed.
The findings included:
Review of the record revealed Resident #9 was admitted to the facility on [DATE], and had five
hospitalizations since admission. A Level 1 PASARR was completed on 04/17/23 by the previous Nursing
Home Administrator (NHA), who was also a Medical Social Worker. This Level 1 screening indicated in
Section II, there was an indication the individual has or may have had a disorder resulting in functional
limitations in major life activities that would otherwise be appropriate for the individual's developmental
stage. The instructions on this Level 1 PASARR documented the need for the Level 2 assessment. A
supplemental letter to Resident #9 from the previous NHA, informed the resident of the need for a Level 2
assessment.
The record lacked the Level 2 assessment.
During a side-by-side record review and interview on 11/01/23 at 5:27 PM, the Social Services Director
(SSD) was asked to locate and provide the Level 2 PASARR assessment for Resident #9. The SSD agreed
a request was made in April 2023, but was unable to locate any results. The SSD logged into the Kepro
website and found a letter dated 04/18/23 that documented the review was closed due to an incomplete
referral packet.
A second Resident Review (RR) - Evaluation Request was completed by the Acting Director of Nursing
(DON) on 11/02/23, with Section II: Significant Change documenting a change in behavior, psychiatric, or
mood suggestive of a suspicion of SMI (Serious Mental Illness), with an onset date of 04/17/23.
During a supplemental interview on 11/02/23 at 8:43 AM, the SSD stated she was unable to locate any
additional information, and had requested the Level 2 review, after surveyor intervention.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 8 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0645
PASARR screening for Mental disorders or Intellectual Disabilities
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review and interview, the facility failed to ensure Level 1 PASARR (Preadmission Screening and
Record Review) screening was completed for 1 of 2 sampled residents prior to or upon admission
(Resident #19).
Residents Affected - Few
The findings included:
Review of the record revealed Resident #19 was admitted to the facility on [DATE] for a Hospice respite,
and subsequently admitted for long term care as of 09/24/23. Review of the record lacked any Level 1
PASARR screening.
During a side-by-side record review and interview, the Social Services Director (SSD) was asked to locate
and provide a Level 1 PASARR screening, and she was unable to find one. The SSD volunteered that the
Hospice staff refused to complete the PASARR screening. When asked if she completed it upon admission
to the facility, the SSD stated she had not.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 9 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0657
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed,
and revised by a team of health professionals.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to update the comprehensive care plans and or
ensure resident representative participation in the care needs for 3 of 16 sampled residents, after changes
in condition were identified. Resident #23 had a decline in eating ability with facility failure to update the
care plan. Resident #28 required two person assistance for transferred that was not reflected in the current
care plan. Resident #39 had a decline in eating ability and the facility failed to update the care plan. The
resident representative for Resident #39 had requested a consult for upper dentures and was not informed
of the findings of the dentist.
The findings included:
1) During an observation on 10/31/23 at 12:12 PM, Resident #23 was in the main dining room awaiting
lunch. The resident was served her lunch meal, took a few bites independently, and then was fed the rest of
the meal by Staff D, Certified Nursing Assistant (CNA).
Review of the record revealed Resident #23 was admitted to the facility on [DATE]. Review of the current
Minimum Data Set (MDS) assessment documented the resident needed the limited assistance of one
person for eating. Review of the current care plan dated 12/24/19, with no documented revision date,
documented Resident #23 required the assistance of 1 to 2 persons with mobility, and Activities of Daily
Living (ADL) tasks, except self feeding, which she could do independently after set up.
Further review of previous MDS assessments revealed the following:
Resident #23 needed the limited assistance of one person for eating as of 09/22/23.
Resident #23 needed the extensive assistance of one person for eating as of 06/22/23 and 03/22/23.
Resident #23 needed supervision from one staff for eating as of 12/20/22.
Resident #23 was independent for eating after set up as of 09/21/22. The facility failed to update the care
plan since this date.
Review of the quarterly dietary review dated 09/27/23 revealed Resident #23 ate 50 to 100% with
assistance from one staff as needed.
During a side-by-side record review and interview on 11/02/23 at 10:15 AM, the Regional Director of
Clinical Services agreed the current care plan was not representative of the resident's current needs for
assistance in eating.
2) During an interview on 10/30/23 at 11:40 AM, Resident #28 explained that he was transferred from the
bed via a Hoyer lift (mechanical transfer) utilizing two staff for assistance.
Review of the record revealed Resident #28 was admitted to the facility on [DATE]. Review of the current
MDS assessment documented the resident had a Brief Interview for Mental Status (BIMS) score of 15, on a
0 to 15 scale, indicating the resident was cognitively intact. Further review of this MDS revealed the resident
was totally dependent upon two staff for transfers.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 10 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0657
Level of Harm - Minimal harm
or potential for actual harm
Review of the current care plan initiated on 01/11/22, with no revision date, documented the resident
required the assistance of one staff for transfers.
During an interview on 11/01/23 at 11:37 AM, Staff F, Certified Nursing Assistant (CNA), confirmed the
need for two staff for the transfer of Resident #28.
Residents Affected - Few
During a side-by-side record review and interview, the Regional Director of Clinical Services agreed with
the inaccurate care plan.
3) Review of the record revealed Resident #39 was admitted to the facility on [DATE]. The resident
sustained a fracture on 09/10/23, and had a significant decline in functioning, and was admitted to Hospice
as of 09/26/23.
During an interview on 11/01/23 at 2:32 PM, when asked if Resident #39 was able to feed herself, Staff B,
CNA, explained that prior to her fracture she was able to feed her self with occasional cuing, but now has to
be fed. An interview on 11/01/23 at 2:57 PM with Staff C, Registered Nurse (RN), revealed prior to her
fracture, Resident #39 would sometimes eat independently, and sometimes needed to be fed.
Review of the current care plan initiated on 03/09/21, and revised on 10/30/23, documented Resident #39
was able to feed herself after setting up the meal, with occasional cueing needed.
Further review of the current care plan for activities initiated on 12/27/21, with no revision date, documented
Resident #39 needed reminders and directions to promote attendance to activities. The goal was that the
resident would participate in cognitively stimulating activities on a daily bases. During the survey week of
10/30/23 through 11/02/23, Resident #39 was observed only in her bed, except for 11/01/23, when she
went out for a medical appointment.
During an interview on 11/01/23 at 3:41 PM, when asked the current activity participation for Resident #39,
the Activity Director stated that since the resident's fracture, she has remained in bed nearly everyday and
receives in room visits. When shown the current activity care plan, the Activity Director confirmed it did not
represent the current status of the resident for activities.
4) During a phone interview on 10/30/23 at 10:29 AM, when asked if he had any concerns regarding the
care and services of Resident #39, the resident representative stated he had been asking about an upper
set of dentures for some time, had been told the resident had dental insurance, but had not heard anything
since.
Review of the record revealed Resident #39 was admitted to the facility on [DATE]. Further review of the
record lacked any evidence of dental services.
During an interview on 11/01/23 at 5:02 PM, when asked if she was aware of any dental or denture
concerns for Resident #39, the Social Services Director (SSD) stated that during a recent care planning
meeting on 10/10/23, the resident representative asked about the upper dentures and was told he would be
added to the dental list. When asked if the concern had been discussed previously, the SSD was unsure as
this was her first care plan meeting for Resident #39, as she was a fairly new employee.
On 11/02/23 at 10:57 AM, the SSD stated she reached out to the dental service and they provided
evidence of a dental visit from 08/11/23. Review of this visit revealed Resident #39 was not a
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 11 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0657
candidate for dentures. The SSD agreed that the resident representative was unaware of that visit as he
was still questioning it with the October care plan meeting.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 12 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
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 wound care, and accurately document
the provision of dressing changes, as per physician order for 2 of 3 sampled residents with wounds
(Residents #19 and #28).
Residents Affected - Few
The findings included:
1) During an interview and observation on 10/30/23 at 3:00 PM, a gauze dressing with the date 10/27 was
noted to the upper left arm of Resident #19. When asked how often the dressing was to be changed,
Resident #19 was unsure.
Review of the record revealed Resident #19 was admitted to the facility on [DATE]. Review of current orders
revealed an order dated 10/09/23 for the dressing to the resident's left arm exposed hardware was to be
cleaned with normal saline, with the application of calcium alginate, collagen and a clean dry dressing,
every Monday, Wednesday, and Friday. This order was changed to daily as of 10/26/23. This dressing
change was scheduled for the evening shift nurses to complete.
Review of the October 2023 Medication Administration Record (MAR) documented the dressing was
changed by Staff G, Licensed Practical Nurse (LPN) on 10/27/23. This MAR documented the dressing was
changed by another LPN on 10/28/23 and 10/29/23.
An observation on 10/31/23 at 9:43 AM revealed a new dressing to the left arm, indicating the dressing was
changed on the previous evening shift on 10/30/23. Further review of the MAR documented the dressing
was again changed by Staff G, LPN.
During an interview on 11/01/23 at 4:15 PM, Staff G, LPN, confirmed he had changed the left arm dressing
of Resident #19 on both 10/27/23 and 10/30/23. When asked if he noticed the dressing he removed on
10/30/23 was the dressing he had applied on 10/27/23, the LPN stated he had and confirmed the order
was for daily dressing changes. When asked if he had reported his finding of the old dressing to anyone,
Staff G stated he passed it on during change of shift report, to the night nurse. When asked if he reported
his finding to a supervisor, he stated he had not. Staff G stated he was fairly new and was not sure of the
chain of command during his shift.
On 11/01/23 at 4:21 PM, during a side-by-side review of the record, the Director of Nursing (DON) was told
of the surveyor's observation of the left arm dressing dated 10/27/23, on the afternoon of 10/30/23. When
asked if she was aware that an evening nurse was signing off a dressing change that was not completed,
the DON stated she was not.
2) During an interview and observation on 10/30/23 at 11:40 AM, Resident #28 explained that he had
lymphedema, and there were supposed to be Ace wraps on his legs. The resident asked the surveyor to
look at his legs, and gauze wrapped legs were noted with a date of 10/25 handwritten on the tape. Resident
#28 confirmed the leg dressings, including the provision of Ace wraps, don't always get completed on the
evening shift, and that he had not had the Ace wraps for multiple days.
On 10/31/23 in the morning, Resident #28 saw the surveyor outside of his door, and stated, Come here and
look. Resident #28 had Ace wraps on both legs and explained they were applied early that morning.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 13 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0684
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Review of the record revealed Resident #28 was admitted to the facility on [DATE]. Review of the current
Minimum Data Set (MDS) assessment dated [DATE] documented Resident #28 had a Brief Interview for
Mental Status (BIMS) score of 15, on a 0 to 15 scale, indicating the resident was cognitively intact. This
same MDS documented the resident had three venous and / or arterial ulcers.
Review of the current orders revealed multiple wound care orders initiated 10/09/23 for care to bilateral leg
ulcers and provision of bilateral leg UNNA boots (a specific wrap that ends with an Ace wrap on the outer
layer), every Monday, Wednesday, and Friday. These orders were scheduled to be completed on the night
shift. Review of the October 2023 Treatment Administration Record (TAR) documented the bilateral leg care
was provided on Wednesday 10/25/23. This TAR documented the care was also provided by the same night
nurse on 10/27/23.
On 11/01/23 at 4:21 PM, during the continued side-by-side review of the record, the DON was told of the
surveyor's observation of the leg wrapped dressing dated 10/25/23, on the morning of 10/30/23. When
asked if she was aware that a night nurse was signing off a dressing change that was not completed, the
DON stated she was not.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 14 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0690
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate
catheter care, and appropriate care to prevent urinary tract infections.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
policy, observation, interview, and record review, the facility failed to ensure proper peri-care for 1 of 1
sampled resident who had a urinary tract infection (UTI), (Resident #4).
The findings included:
Review of Policy and Procedure: title perineal care. Date implemented: 01/2023. The Policy revealed it is
the practice of this facility to provide perineal care to all incontinent residents during routine bath and as
needed in order to promote cleanliness and comfort, prevent infection to the extent possible, and to prevent
and assess for skin breakdown. Definition: perineal care refers to the care of the external genitalia and the
anal area. #9 of the policy revealed to change gloves if soiled and continue with perineal care.
Record Review revealed Resident #4 was initially admitted to the facility on [DATE] with re-admission on
[DATE] with diagnosis included non-Alzheimer's dementia. The annual minimum data set (MDS)
assessment, reference date 08/08/23 recorded a brief interview for mental status (BIMS) score of 03,
indicated Resident #4 was cognitively impaired.
Review of laboratory results dated [DATE] revealed Resident #4 was positive for UTI. Review of physician
order dated 10/28/23 indicated an order of Nitrofurantoin (antibiotic) 100 MG give 1 capsule by mouth two
times a day for UTI for 5 Days.
On 11/01/23 at 9:39 AM peri care observation was conducted on Resident #4 with Staff B, and Staff E,
Certified Nursing Assistant (CNA). Staff B was actively doing the peri care and Staff E was assisting. Before
the care, Staff B washed her hands, and donned gloves. She gathered water in a basin and placed it on the
bedside table. Then at 9:42 AM while Staff B had her gloves on, she touched the door knob to close the
door, she drew the curtain to close it, she touched the bed remote to bring the bed up, and touched bed
linens to uncover the resident, she touched the resident's skin (to turn her to apply barrier pad) all the while
she had gloves on. She then proceeded to provide the peri-care without changing her gloves. During the
care Resident #4 had a bowel movement, Staff B removed the soiled brief. With the same gloves Staff B
continued the peri care. At 9:50 AM, an interview was held with Staff B she acknowledged the findings. On
11/01/23 at 9:54 AM, an interview was conducted with the Director of Nursing (DON), the surveyor
explained the manner of which Staff B conducted the peri care. The DON acknowledged the improper
peri-care.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 15 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in
accordance with accepted professional standards.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review, interview, and policy review, the facility failed to ensure accurate documentation related to
Medication Administration Records (MARs), physician consults, and orders for 3 of 16 sampled residents.
The record for Resident #39 lacked the provided dental consult, an order for Hospice services, and
contained multiple blank areas in the MAR. The records for Residents #52 and #53 contained numerous
blank areas in the MARs.
The findings included:
Review of the policy Documentation in Medical Record revised 08/25/22 documented, Policy Explanation
and Compliance Guidelines: 1. Licensed staff and interdisciplinary team members shall document all
assessments, observation, and services provided in the resident's medical record in accordance with state
law and facility policy. 2. Documentation shall be completed at the time of service, but no later than the shift
in which the assessment, observation, or care service occurred. 3. Principles of documentation include, but
are not limited to: a. documentation shall be factual, objective, and resident centered. i. False information
shall not be documented. b. documentation shall be accurate, relevant, and complete, containing sufficient
details about the resident's care and/or responses to care.
1a) During a phone interview on 10/30/23 at 10:29 AM, when asked if he had any concerns regarding the
care and services of Resident #39, the resident representative stated he had been asking about an upper
set of dentures for some time, had been told the resident had dental insurance, but had not heard anything
since.
Review of the record revealed Resident #39 was admitted to the facility on [DATE]. Further review of the
record lacked any evidence of dental services.
During an interview on 11/01/23 at 5:02 PM, the Social Services Director (SSD) explained she had just
heard about the request for dentures for Resident #39 during the recent care plan meeting. The SSD
confirmed the resident was now set up with the in-house dental service.
On 11/02/23 at 10:57 AM, the SSD provided evidence of a dental visit dated 08/11/23, by the in-house
dental service. When asked where she located the documented visit, the SSD stated she had reached out
to the dental service and they had provided it to her. When asked why the documented dental visit was not
in the medical record, the SSD explained the dental service had been sending the documented completed
visits to the email of the previous Director of Nursing (DON). The SSD stated the previous DON had
departed on 10/05/23, and confirmed she didn't have any documented dental visits since that date.
1b) Review of the census information and signed Hospice consent form for Resident #39 revealed she
began receiving services as of 10/26/23. Review of the current orders lacked any documented order to
admit Resident #39 to Hospice services. No order was found in the paper record either.
During an interview on 11/02/23 at 11:16 AM, the Weekend Supervisor was asked to locate and provide the
facility's physician order to admit Resident #38 to Hospice services. The Weekend Supervisor found a
progress note for a Hospice consult on 09/26/23, but was unable to locate a facility order.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 16 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0842
The Weekend Supervisor stated there should be a physician order in the electronic medical record.
Level of Harm - Minimal harm
or potential for actual harm
1c) Review of the October 2023 MAR for Resident #39 revealed the following:
Residents Affected - Few
The night shift dressing change for the feeding tube was not signed off as completed on 10/11/23 and
10/31/23.
Levemir insulin, scheduled for 4:30 PM, was not signed off as provided on 10/06/23 and 10/31/23.
Simvastatin, a medication for high cholesterol, scheduled for 8 PM, was not signed off as provided on
10/31/23.
Glipizide, a diabetic medication, scheduled at 5 PM, was not signed off as provided on 10/31/23.
Miralax, a laxative, scheduled at 9 PM, was not signed off as provided on 10/31/23.
Tramadol, a pain medication, scheduled at 8 PM, was not signed off as provided on 10/31/23.
Tylenol, scheduled three times daily for pain, was not signed off as provided on 10/07/23 at 2 PM and on
10/31/23 at 10 PM.
Blood sugar levels with supplemental insulin was not signed off as completed on 10/06/23 at 4:30 PM,
10/07/23 at 11:30 AM, 10/15/23 at 6 AM, 10/31/23 at 4:30 PM, and 10/31/23 at 8 PM.
2) Resident #52 was admitted to the facility on [DATE] with diagnoses which included Cognitive
Communication Deficit, Altered Mental Status, Protein-Calorie Malnutrition, Dementia with Behaviors, Major
Depressive Disorder, Vitamin B12 Deficiency Anemia, and Vitamin D deficiency.
A review of the electronic Medication Administration Record (eMAR) for October 2023 showed no nursing
initials indicating the following medications were provided on the date and times indicated, as per physician
order, for Resident #52:
10/22/23 at 9:00 PM - Aricept 10 mg each evening at bedtime for Dementia;
10/22/23 at 9:00 PM - Trazodone HCI 50 mg each evening at bedtime for depression;
10/22/23 at 9:00 PM - Folic Acid 1 mg twice daily (9:00 AM and 9:00 PM) for supplement;
10/22/23 at 9:00 PM - Thiamine 100 mg twice daily (9:00 AM and 9:00 PM) for supplement.
On 10/02/23 and 10/10/23 during the day shift, the monitoring for Resident #52's Wanderguard was not
initialed as being checked, as per order.
3) Record review for Resident #52 revealed she was admitted to the facility on [DATE] with diagnoses
including coronary artery disease, hyperlipidemia, Parkinson, depression, and Schizophrenia. The quarterly
MDS assessment, reference date 08/31/23 recorded a BIMS score of 13, indicated Resident #13 was
cognitively intact.
Review of physician order revealed the following orders: 05/24/23 Senna (stool softer) 8.6 mg give
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 17 of 18
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
105804
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/02/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vivo Healthcare Fort Pierce
700 S 29th Street
Fort Pierce, FL 34947
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 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
one table by mouth in the evening for constipation scheduled for 5 PM. 05/24/23 Colace (stool softener)
give 100 mg by mouth two times a day for constipation scheduled for 9 AM and 5 PM. 05/24/23 atorvastatin
oral tablet 20 MG give 1 tablet by mouth one time a day at bedtime for hyperlipidemia scheduled for 8 PM.
07/24/23 Sinemet 25-100 mg give one tablet by mouth three times a day for tremors scheduled for 9 AM, 1
PM and 5 PM. 07/26/23 Lamictal 200 mg give one tablet by mouth two times a day for schizoaffective
disorder scheduled for 9 AM and 9 PM. 09/27/23 trazodone 100 mg give 2.5 tablet by mouth at bedtime for
depression scheduled for 9 PM.
Review of the October 2023 medication administration records lacked documented evidence to account for
medication administration on October 12 of the following medications included: Atorvastatin oral tablet 20
MG at 8 PM, Senna 8.6 mg at 5 PM, Trazodone 100 mg at 9 PM, Colace 100 mg at 5 PM, Lamictal 200 mg
at 9 PM, and Sinemet 25-100 mg at 5 PM.
On 11/01/23 at 1:55 PM, an interview with held the DON. She was made aware of the lack of documented
evidence for medication administration on October 12, 2023, she acknowledged the finding. On 11/02/23 at
10:48 AM another interview was conducted with the DON, she revealed that she did speak with the nurse
who worked that evening on October 12, and the nurse informed her that Resident # 13 did receive all the
scheduled medications that evening, but because the computer system was down, there was confusion
with signing out the medications.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105804
If continuation sheet
Page 18 of 18
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
11 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F561 - Self-determination
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
F565 - The resident has a right to organize and participate in resident groups in the
Honor the resident's right to organize and participate in resident/family groups in the facility.
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
F644 - Coordination
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
F645 - Preadmission Screening for individuals with a mental disorder and individuals
PASARR screening for Mental disorders or Intellectual Disabilities
F657 - Comprehensive Care Plans
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
- 0353GeneralS&S Dpotential for harm
Inspect, test, and maintain automatic sprinkler systems.
- 0900GeneralS&S Dpotential for harm
Meet Health Care Facilities Code mechanical requirements.
FAQ · About this visit
Common questions about this visit
What happened during the November 2, 2023 survey of VIVO HEALTHCARE FORT PIERCE?
This was a inspection survey of VIVO HEALTHCARE FORT PIERCE on November 2, 2023. The surveyor cited 11 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at VIVO HEALTHCARE FORT PIERCE on November 2, 2023?
Yes, 11 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to and the facility must promote and facilitate resident self-determination through support o..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.