Health inspection·April 23, 2025

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff and resident interviews, medical record review, and facility policy review, the facility failed to appropriately store resident's medication by leaving medication at bedside for one (Resident #4) of three residents sampled for unsecured medication. Resident #4 who had not been assessed for self-administration of medication was observed taking medications that had been left on his overbed table. These medications were also accessible to other residents who should not have access to them. The findings include: During an interview with Resident #4 on 04/23/2025 at 10:22 AM, the resident picked up a medicine cup from his overbed table containing multiple pills in it. When asked if the pills were his morning medications he stated, yes and then took them. A medical record review for Resident #4 indicated he was admitted to the facility on [DATE] and had a Brief Interview for Mental Status (BIMS) score of 13/15, indicating intact cognition. A review of medication to be given to Resident #4 at 9:00 AM included the following: Aspirin 81mg tab; Atorvastatin 20 mg tablet; Clopidogrel Bisulfate 75 mg tablet; Glipizide 25 mg tablet; Jardiance 25 mg tablet; Meloxicam 7.5 mg tablet; and Sodium Chloride tablet 1gm. A review of physician's orders for Resident #4 revealed no order for the resident to self-administer medications. On 04/23/2025 at 11:42 AM, a follow interview was conducted with Resident #4. The resident was asked how often medications were being left for him to take later. He stated, It happens sometimes but not very often. A review of the electronic chart for Resident #4 revealed no assessment for the resident to self-administer medications. A review of the care plan for Resident #4 revealed no care plan initiated for self-administering medications. On 04/23/2025 at 11:55 AM, the Director of Nursing (DON) was asked if medications should be left in residents' rooms. She stated that the nurse that left the medication at the bedside was immediately taken off the cart. The medication administration policy was reviewed with her and she will 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: 105930 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 105930 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Healthcare & Rehabilitation Center 120 Chipola Ave Deland, FL 32720 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)