Inspection·May 12, 2023

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm Based on observations, interview, and record review, the facility failed to ensure medications stored at the bedside were assessed for safe administration for one (Resident #336) of twenty-five sampled residents. Residents Affected - Few Findings Included: On 05/08/2023 at 09:41 a.m., Resident #336 was observed lying in his bed and was receptive to an interview. When he spoke, his speech was soft toned and garbled at times. His son was present and assisted with the interview. Resident #336 appeared comfortable and denied any discomfort when asked. On his over the bedside table an inhaler was present. Resident #336 stated, it's for my Parkinson's and confirmed he took it on his own as needed. On 05/09/2023 at 2:45 p.m., Resident #336 was lying in his bed with his eyes closed and appeared comfortable. His son was present at the time and confirmed his inhaler remained in his bedroom. Resident #336 remained with his eyes closed and stated softly I used it last night. Medical record review of Resident #336's admission Record form was reviewed and indicated he was geriatric in age and had resided at the facility for less than a month. His primary diagnosis was listed as Parkinson's disease. A review of Resident #336's physician orders included an order for Inbrija Inhaler Capsule 42 MG (Levodopa) 1 capsule inhale orally as need for Parkinson related to PARKINSON'S DISEASE dated 04/19/2023. A review of the Medication Administration Record (MAR) for May 2023 revealed Inbrija Inhaler was not administered in the month of May 2023. Further review of the medical record failed to reflect a physician order to self-administer Inbrija inhaler at the bedside. On 05/09/2023 at 3:04 p.m., an interview was conducted with Staff C, Licensed Practical Nurse. She confirmed she was caring for Resident #336. When asked about his Inbrija inhaler she stated, I think he has this one in his room. If he needs it right away, we can't get back there quick enough, so he takes it himself. Staff C stated, He does not tell me when he takes it. She confirmed she was unaware of the frequency Resident #336 was self-administering his inhaler. HOW TO USE INBRIJA: Use INBRIJA when Parkinson's symptoms start to return. (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 8 Event ID: 105866 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 105866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plaza West 912 American Eagle Blvd Sun City Center, FL 33573 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)