Health inspection·October 21, 2025

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews, the facility failed to implement an effective pest control program related to live pests found in two rooms (210 and 350) located in two halls (200 and 300) out of 4 halls observed.Findings included: An observation of room [ROOM NUMBER] on 10/21/2025 at 9:40 A.M. revealed several roaches on the wall behind Bed 2's nightstand and under and around the floor of Bed 3's armoire/closet. An observation of the outside of the maintenance area on 10/21/2025 at 11:20 A.M. revealed a resident nightstand. The Housekeeping Supervisor (HS) was spraying the nightstand with a red can of ant and roach pesticide. The nightstand had three drawers that were partially pulled out and each drawer contained personal resident items. A record review of the pest sighting logbooks on each nursing station revealed an entry dated 10/20/2025 and read, 200 Nurse Cart Roach. The entry was made by the Nursing Home Administrator (NHA). A record review of the exterminators invoice dated 10/10/2025 read, No activity was reported today. I need to note that out pest sighting logbooks are not being utilized by the nurses. None of the stations reported any activity for this week's treatment. Please ask the nurses to use the logbook correctly to help record and monitor pest activity. An interview was conducted on 10/21/2025 at 9:34 A.M. with Staff A, Housekeeping. Staff A said she always saw roaches in room [ROOM NUMBER]. She said the roaches are behind bed 2's nightstand and the roaches are under bed 3's armoire/closet. Staff A said the exterminators spray the room and outside the room, but they always come back. She said she thinks the roaches are living inside the wall. Staff A said she tells the maintenance department. She said she doesn't write anything in the pest sighting logbooks. An interview was conducted on 10/21/2025 at 9:46 A.M with the resident in room [ROOM NUMBER]. There were several flies in the room and a food tray sitting on the resident's bed. The resident (#2) said once the facility started construction he saw several roaches in his room and hallways. The resident said he asked for maintenance to come and no one from maintenance or housekeeping had come to the room to see the pests. The resident said he had talked to the staff about the pests, but the staff always say they were working on it. An interview was conducted on 10/21/2025 at 10:50 A.M. with Staff E, Van Driver/Maintenance assistant. Staff E said she helps with maintenance often. Staff E said the pest control company comes to the facility twice per month. Staff E said if the staff see pests inside, she will spray them with the red can of ant and roach pesticide. Staff E said when pests are seen in the facility, staff should be writing the sighting in the pest sighting logbooks at each nursing station. An interview was conducted on 10/21/2025 at 11:21 A.M with the Housekeeping Supervisor (HS). The HS said he had pulled the nightstand out of room [ROOM NUMBER]-2 and sprayed it with the red can of ant and roach pesticide. The HS said he would put it back in room [ROOM NUMBER]-2 later in the day. An interview was conducted on 10/21/2025 at 11:35 A.M. with the Director of Maintenance (DOM). The DOM said the staff do not spray for pests; the facility uses a pest control company. The DOM said if there are pests inside the furniture, that furniture should be pulled out of the Residents Affected - Few (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: 105891 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 105891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ybor City Center for Rehabilitation and Healing 1709 Taliaferro Ave Tampa, FL 33602 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)