Inspection·October 25, 2023

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical and administrative record review and staff interview, the facility must ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive care plan, and the resident's choices, related to pain management. This is evidenced by the facility failure to follow the physician order for pain management for 1 of 3 sampled residents reviewed for pain management, Resident # 1. Residents Affected - Few The findings included: Review of the clinical record for Resident #1 revealed the resident was admitted to the facility on [DATE] with diagnoses that included Aftercare following Joint Replacement surgery, unilateral primary Osteoarthritis, left hip, Multiple Sclerosis, Takotsubo Syndrome, Chronic Pain Syndrome, and Muscle Spasm. Review of the 09/27/23 Minimum Data Set Assessment (MDS) documented Resident #1's Pain Assessment identifed the resident has had pain or hurting anytime in the last 5 days. The resident frequently experienced pain or hurting over the last 5 days and the pain has limited her day to day activities. The resident rated her pain level over the past five days at seven (7) on the pain scale of 0-10, with zero being no pain and ten being as the worst pain. The facility identified a problem, initiated 09/21/23, that the resident has acute/chronic pain related to recent left total hip replacement, muscle spasms an chronic pain syndrome. She is at risk for constipation due to decreased mobility, use of narcotic medication, and history of constipation. The interventions included Analgesics as ordered; Discuss with resident the need to request pain medications before pain becomes severe; Evaluate characteristics of pain: location, severity on a scale of 0-10, and frequency; Monitor for side effects of pain medication; Note any change in usual activity attendance patterns or refusal to attend activities related to sign and symptoms or complaints of pain/discomfort; and Observe for signs of relief/effectiveness with interventions. Further review of the physician orders and the Medication Administration Record (MAR) revealed the staff failed to follow the physician orders regarding the resident's pain medication. The physician prescribed for the resident to receive Oxycontin ER (Extended Release) 20 mg every 12 hours routinely. The physician's order was transcribed as every 12 hours as needed. The resident was also prescribed Oxycodone 10 mg i. r. (Immediate Release) give 2 tablets every 4 hours as needed for severe pain. The facility failed to administer the Extended-release medication as prescribed, as follows: In September 2023, the resident should have received 19 doses from September 21 - September 30. The resident received 10 doses of the routinely prescribed medications which were documented as removed (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 3 Event ID: 105831 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 105831 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm City Nursing & Rehab Center 2505 SW Martin Hwy Palm City, FL 34990 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)