Inspection·January 12, 2023

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 observation, interview, and record review, the facility failed to ensure the drugs and biologicals were stored properly. Findings include: During an observation on 1/9/2023 at approximately 12:05 PM, there was a bottle of Tylenol and an inhaler in Resident #45's top drawer of bedside table. During an interview on 1/9/2023 at approximately 12:05 PM, Resident #45 stated that the nurse told her not to keep her medication out in the open but to keep it in her drawer. During an observation on 1/11/2023 at 8:40 AM, there was an unattended medication cup with approximately 10 pills on Resident #45's bedside table. There were a bottle of Tylenol and several loose blister pill-packs in the top drawer of the resident's bedside table. There were no staff members in sight. (Photographic evidence obtained). During an interview on 1/11/2023 at 8:45 AM, Staff C, Registered Nurse (RN), confirmed the medication left unattended at the bedside and in the resident's top drawer. Staff C stated that medications should not be left unattended and that the nurse who administered the medications was new, an orientee. During an interview on 1/11/2023 at 8:45 AM, Staff D, Licensed Practical Nurse (LPN), the orientee, stated that they had no residents currently in the facility that self-administered medication. Review of the facility policy and procedure titled Medication and Medication Supply Storage and Disposal, with an effective date of 11/30/2014 reads, Central storage of medications is required for prescription, prescribed over-the-counter medications and CAM (Complimentary and Alternate Medicine.) Will be kept in a locked area, in their original labeled contained and may not be removed more than 2 hours prior to the scheduled administration. Med will be kept in a medication cart that locks and keys are only accessible to the licensed personnel distributing medication. 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: 105846 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 105846 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Baya Pointe Nursing and Rehabilitation Center 587 SE Ermine Ave Lake City, FL 32025 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)