Inspection·December 4, 2023

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. 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 1 of 5 residents was assessed for self-administration of medications of a total sample of 5 residents, (#1). Residents Affected - Few Findings: Resident #1 was admitted to the facility on [DATE] with diagnoses of multiple sclerosis, dermatitis, rosacea, post mastectomy lymphedema syndrome, and anxiety disorder. On 12/04/23 at 12:24 PM, resident #1 sat in her wheelchair at the side of her bed. On the resident's bedside table was a plastic bag, with label that read Ketoconazole Cre 2%. The plastic bag contained Metronidazole gel 1%, and tube of Clindamycin Phosphate gel 1%. On the bedside table was a vial of Thera Tears and a vial of Ivizia eye drops. Resident #1 stated she used the gels herself but had not used them in two to three days, because they were not doing anything. She stated the eye drops were given to her by her eye doctor and she used the drops daily. Resident #1 could not say if she was assessed for self-administration of medications. She stated she last used the medications approximately two or three days ago. Metronidazole topical gel is used to treat inflammatory lesions (pimples and red bumps) caused by rosacea. (Retrieved from www.nhs.uk>medicines 12/12/23). Clindamycin is an antibiotic which works by stopping the growth of bacteria. (Retrieved from webmd.com 12/12/23). Thera Tears and Ivizia eye drops are used for relief of dry eyes and eye irritation. Review of the resident's physician orders revealed an order dated 8/16/23 for Clindamycin Phosphate gel 1% apply to red area on nose cheeks and forehead 4 times daily at 9 AM, 1 PM, 5 PM, 9 PM. The order noted the medication was discontinued on 8/21/23. A physician order on 9/28/23 read Metronidazole gel 1% apply topical daily to face for rosacea for 7 days. Documentation indicated the medication was discontinued on 10/02/23A. A physician's order for self-administration of the medications was not identified. On 12/04/23 at 12:59 PM, the South Wing Licensed Practical Nurse/Unit Manager (LPN/UM) stated the facility did not allow residents to administer their own medications. She said if a resident was admitted with medications from home, the medications would be kept in the medication cart, and would be administered by the nurse. On 12/04/23 at 1:41 PM, the Director of Nursing (DON) stated there were not any residents in the facility that were assessed for self-administration of medication. She verbalized that a physician order must be obtained for residents to take their own medications. She added that a care plan would be (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: 105839 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 105839 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Terrace of Kissimmee, The 221 Park Place Blvd Kissimmee, FL 34741 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)