Inspection visit

InspectionFebruary 26, 2024

FLORIDA PRESBYTERIAN HOMES INCCMS #10594910 citations on this visit

10 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 10 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure care and services were provided in a dignified manner to one (Resident #1) of twenty six sampled residents. Findings included: A review of Resident #1's medical record revealed Resident #1 was admitted to the facility on [DATE] with diagnoses of congestive heart failure, stage 3 chronic kidney disease, and non-ST-elevation myocardial infarction (NSTEMI). A review of Resident #1's care plan revealed a focus area, initiated 2/23/2024, Resident #1 was at risk for alteration in nutritional status related to significant weight loss and various comorbidities. Interventions included to provide and serve diet as ordered and monitor intake with each meal. An observation was conducted on 2/24/2024 at 12:04 PM of Resident #1 during lunch. Resident #1 was being assisted with the lunch meal by Staff C, Certified Nursing Assistant (CNA) inside of the resident's room. Resident #1 was observed laying in bed with Staff C, CNA providing physical assistance with feeding. Staff C, CNA was observed standing at the bedside during the lunch meal while assisting Resident #1 with the meal. An observation was conducted on 2/25/2024 at 9:54 AM during medication administration with Staff B, Registered Nurse (RN). Staff B, RN prepared an ordered dietary supplement for administration to Resident #1. After preparing the supplement, Staff B, RN knocked on Resident #1's door and introduced herself to the resident. Staff B, RN then administered the dietary supplement to Resident #1. During the observation, a third party nurse with hospice services was observed entering Resident #1's room with a blue colored bag. The nurse did not knock on Resident #1's door before entering and did not introduce herself to the resident or Staff B, RN. The hospice nurse placed her bag on top of several of Resident #1's belongings on a table in the room and removed a stethoscope. The hospice nurse began assessing Resident #1 as Staff B, RN continued to encourage Resident #1 to drink the dietary supplement she had ordered. Staff B, RN handed the dietary supplement to another staff member who entered the room after Resident #1 consumed approximately half of it and exited the room. An observation was conducted on 2/25/2024 at 12:39 PM of Resident #1 during lunch. Resident #1 was being assisted with the lunch meal by Staff D, CNA inside of the resident's room. Resident #1 was observed laying in bed with Staff D, CNA providing physical assistance with feeding. Staff D, CNA was observed standing at the bedside during the lunch meal while assisting Resident #1 with the meal. (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 16 Event ID: 105949 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete An interview was conducted on 2/25/2024 at 3:20 PM with Staff C, CNA. Staff C, CNA stated Resident #1 required assistance with her meals due to having a recent decline in her functioning. Staff C, CNA also stated she stood up to feed the resident during lunch because the resident leans to one side and has an air mattress to her bed and she did not feel safe feeding the resident while seated at the bedside. An interview was conducted on 2/26/2024 at 12:53 PM with the facility's Director of Nursing (DON). The DON stated she would expect staff to assist a resident with cueing or providing physical assistance with meals if the resident experienced a decline. The resident should be positioned appropriately in the bed and the staff member should be seated next to the resident during the meal. The DON stated Resident #1 experienced a recent decline and required assistance with her meals. The DON also stated she would expect nursing staff to reposition the resident if they were leaning during the meal and be positioned in a manner to ensure the resident is chewing and swallowing their food safely. The DON stated she would expect the facility staff to remind any third party staff to ensure they knock on the resident's door before entering their room. Event ID: Facility ID: 105949 If continuation sheet Page 2 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the accuracy of the Resident Assessment Minimum Data Set for one (#9) of five residents reviewed. Residents Affected - Few Findings included: Record review revealed Resident #9 was admitted to the facility on [DATE] with diagnoses that included but not limited to Unspecified Mental Disorder due to known Physiological Disorder, Anxiety, Schizophrenia and Unspecified Dementia according to the Face Sheet. Review of the Medication Administration Record (MAR) for February 2024 showed: -Divalproex 125 milligrams (mg) - 2 capsules orally twice daily for unspecified mental disorder -Quetiapine 50mg orally twice daily for schizophrenia -ABH [Ativan, Lorazepam, Benadryl] Gel 2 milliliters (ml) topically every 8 hours for agitation related to anxiety. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed: -Section C: Brief Interview for Mental Status (BIMS) score 00, indicating severe cognitive impairment. -Section I: Active Diagnosis - none checked. -Section N: Medications administered - Antipsychotic and Antianxiety. During an interview on 02/25/24 at 01:15 PM with Staff A, Registered Nurse (RN), Minimum Data Set Coordinator (MDSC), she confirmed the resident's psychiatric diagnoses were not listed correctly in the MDS assessment and stated she became aware of it today. Review of a facility-provided policy titled 'MDS 3.0 Completion' dated 10/23 revealed: Policy: Residents are assessed, using a comprehensive assessment process, in order to identify care needs and to develop an interdisciplinary care plan. 1. According to federal regulations, the facility conducts initially and periodically a comprehensive, accurate and standardized assessment of each resident's functional capacity, using the RAI [resident assessment instrument] specified by the State. 4.ii Persons completing part of the assessment must attest to the accuracy of the section they completed by signature and indication of the relevant section. Addendum: MDS 3.0 Responsibility by Discipline: Section I - MDSC [minimum data set coordinator] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 3 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based in interview and record review, the facility failed to ensure the accuracy of the Level I Pre-admission Screening and Resident Review (PASSAR) for four (#9, #40, #14 and #198) of five residents reviewed. Findings Included: 1. Record review revealed Resident #9 was admitted to the facility on [DATE] with diagnoses that included but not limited to Unspecified Mental Disorder due to known Physiological Disorder, Anxiety, Schizophrenia and Unspecified Dementia according to the Face Sheet. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed: -Section C: Brief Interview for Mental Status (BIMS) score 00, indicating severe cognitive impairment. -Section I: Active Diagnosis - none checked. -Section N: Medications administered - Antipsychotic and Antianxiety. Review of the Medication Administration Record (MAR) for February 2024 showed: -Divalproex 125 milligrams (mg) - 2 capsules orally twice daily for unspecified mental disorder -Quetiapine 50mg orally twice daily for schizophrenia -ABH [Ativan, Lorazepam, Benadryl] Gel 2 milliliters (ml) topically every 8 hours for agitation related to anxiety Review of the PASSAR Level I, dated 11/26/2019 revealed: -Section IA, no Mental Illness, or suspected Mental Illness checked. -Section II 5 primary diagnosis of Dementia checked no. -Section II 6 secondary diagnoses of Dementia checked no. 2. Record review revealed Resident #40 was admitted to the facility on [DATE] with diagnoses that included but not limited to Parkinson's Disease, Unspecified Dementia, Major Depressive Disorder, and Psychotic Disorder. Review of the quarterly MDS dated [DATE] revealed: -Section C: Brief Interview for Mental Status (BIMS) score 05, indicating severe cognitive impairment. -Section I: Active Diagnosis - depression and psychotic disorder. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 4 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0644 -Section N: Medications administered - Antipsychotic, and Antidepressant Level of Harm - Minimal harm or potential for actual harm Review of the Medication Administration Record (MAR) for February 2024 showed: -Nuplazid 34mg once daily for Parkinson's psychosis Residents Affected - Some -Sertraline 50mg orally daily for MDD [major depressive disorder] -Quetiapine 25mg orally twice daily for psychotic disorder Review of the PASSAR Level I, dated 04/26/2023 revealed: -Section IA, no Mental Illness, or suspected Mental Illness checked. -Section II 5 primary diagnosis of Dementia checked no. -Section II 6 secondary diagnoses of Dementia checked no. 3. Record review revealed Resident #14 was admitted to the facility on [DATE] with diagnoses that included but not limited to Unspecified Dementia, and Major Depressive Disorder. Review of the annual MDS dated [DATE] revealed: -Section C: Brief Interview for Mental Status (BIMS) score 07, indicating moderate cognitive impairment. -Section I: Active Diagnosis - non-Alzheimer's Dementia, and depression -Section N: Medications administered - Antidepressant Review of the Medication Administration Record (MAR) for February 2024 showed: Duloxetine 30mg orally daily for MDD Memantine 10mg PO daily for Unspecified Dementia. Review of the PASSAR Level I, dated 08/05/2021 revealed: -Section IA, no Mental Illness, or suspected Mental Illness checked. -Section II 5 primary diagnosis of Dementia checked no. -Section II 6 secondary diagnoses of Dementia checked no. 4. Record review revealed Resident #198 was admitted to the facility on [DATE] with diagnoses that included but not limited to Vascular Dementia, and Major Depressive Disorder. Review of the quarterly MDS dated [DATE] revealed: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 5 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0644 -Section C: Brief Interview for Mental Status (BIMS) score 03, indicating severe cognitive impairment. Level of Harm - Minimal harm or potential for actual harm -Section I: Active Diagnosis - non-Alzheimer's Dementia, and Depression -Section N: Medications administered - Antidepressant and Antianxiety. Residents Affected - Some Review of the Medication Administration Record (MAR) for February 2024 showed: Sertraline 100mg orally daily for MDD Divalproex 125mg orally daily for MDD Buspirone 5mg orally three times daily for MDD Review of the PASSAR Level I, dated 01/08/2023 revealed: -Section IA, no Mental Illness, or suspected Mental Illness checked. -Section II 5 primary diagnosis of Dementia checked no. -Section II 6 secondary diagnoses of Dementia checked no. During an interview on 02/25/24 at 01:22 PM with the Nursing Home Administrator (NHA), she stated the Director of Nursing (DON) reviews the PASSAR forms for accuracy. On 02/25/24 at 01:55 PM an interview was conducted with the NHA and DON. The DON stated she reviews PASARR forms for accuracy when residents are admitted to facility. She stated she has realized the facility had an issue with inaccurate PASARR assessments, and she and the NHA were working on a plan to correct. Review of a facility-provided policy titled; Behavioral Health Services dated 6/2023 revealed: Policy: It is the policy of this facility to ensure all residents receive necessary behavioral health services to assist them in reaching and maintaining their highest level of mental and psychosocial functioning. 7. The facility utilizes the comprehensive assessment process for identifying and assessing a resident's mental and psychosocial status . Staff will: a. Complete PASARR [preadmission screening and resident assessment] screening. A policy related to PASSAR accuracy was requested; however, none was provided by completion of the survey. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 6 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure a baseline and comprehensive care plan was complete for three residents (#148, #150 and #152) related to catheter care (#148), the use of oxygen (#150), and dementia care (#148 and #152) of twenty-five sampled residents. Findings included: 1. On 2/24/24 at 10:12 a.m. an observation revealed Resident #148 sitting in his wheelchair in his room receiving oxygen via a nasal cannula and a droplet precautions sign on his door with personal protective equipment available in a bin. An observation and interview was conducted on 2/25/24 at 1:02 p.m. with Resident #148. He was in a wheelchair in his room receiving oxygen via a nasal cannula and had a [name brand] catheter with the bag covered by a privacy bag. Resident #148 stated he received his medications and could not confirm if he had an infection. He stated he only wears oxygen when he needs it. Review of the Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form, dated 2/7/24, revealed Resident #148 was transferred to the facility with a [brand name] catheter. Review of the medical record for Resident #148 revealed he was admitted on [DATE] with diagnoses to include: sepsis, pneumonia unspecified organism, metabolic encephalopathy and overflow incontinence. Review of the February 2023 Medication Administration Record (MAR) showed a physician order for Memantine HCI Tablet 5 MG (milligrams) - give 1 tablet by mouth two times a day for dementia, start date of 2/17/24. Review of the Minimum Data Set (MDS), dated [DATE], showed in Section H - Bladder and Bowel Appliances that indwelling catheter was checked. Section I - Active Diagnoses showed Resident #148 had medically complex conditions, obstructive uropathy, pneumonia, septicemia, non-Alzheimer's dementia, anxiety disorder, depression, metabolic encephalopathy, overflow incontinence and unspecified dementia, mild, without beh/psych/mood/anx (behavior/psych/mood/anxiety). Section O-Special Treatments, Procedures, and Programs showed Resident #148 received oxygen therapy continuously. An initial review of the care plan on 2/24/24, initiated on 2/8/24, for Resident #148 revealed no care plans developed for catheter care or dementia. An additional review of the care plan revealed a care plan, initiated on 2/25/24, with a focus area as: [Resident #148 name] has an Indwelling Catheter: related to obstructive uropathy. During an interview conducted on 2/26/24 at 10:56 a.m. Staff I, Licensed Practical Nurse (LPN) stated Resident #148 did not have dementia according to his chart. She stated he is here for sepsis, hypotension and pneumonia. On 2/26/24 at 12:32 p.m. Staff A, Registered Nurse/MDS Coordinator (RN/MDS) confirmed Resident #148 had a diagnosis of dementia. She confirmed he did not have a care plan for dementia and should have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 7 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0655 had one. Level of Harm - Minimal harm or potential for actual harm 2. A review of the admission Record for Resident #150 revealed an admission date of 2/7/24 with diagnoses to include chronic obstructive pulmonary disease and cognitive communication deficit. Residents Affected - Some Review of the Order Summary Report, active as of 2/26/24, revealed a physician order as: O2 (oxygen) 2 L (liters) via nasal cannula continuous every shift, start date of 2/7/24. Review of the Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form, dated 2/7/24, revealed Resident #150 was receiving oxygen liters at two percent. Review of the active care plan for Resident #150 revealed there was no care plan or intervention related to oxygen therapy. An observation of Resident #150 on 2/25/24 at 3:35 p.m. revealed the resident was lying in bed receiving oxygen via a nasal cannula. During an interview with Staff H, Licensed Practical Nurse (LPN) she reviewed the order for Resident #150 and that she was to be receiving 2 liters. Staff H confirmed the resident is compliant with care and would not change the oxygen. An immediate observation was conducted with Staff H and Staff H confirmed the oxygen for Resident #150 was set at 3 liters. She stated she would turn it down to 2 liters. On 2/26/24 at 12:28 p.m. Staff A, Registered Nurse/MDS Coordinator (RN/MDS) confirmed Resident #150 did not have a care plan for oxygen and should have had one. Staff A stated the process for creating a baseline care plan is the day after admission, we go through the orders (physician) with the IDT (interdisciplinary) team and everybody would put information in. 3. Review of the admission Record revealed Resident #152 was admitted to the facility on [DATE] with medical diagnoses to include anxiety disorder, major depressive disorder and unspecified dementia, mild with anxiety. An interview and observation was conducted on 2/24/24 at 1:03 p.m. with Resident #152. Resident #152 was in bed visiting with family and confirmed she was being administered her medications with no concerns. She confirmed she was admitted approximately two weeks ago. Review of the Minimum Data Set (MDS), dated [DATE], revealed in Section C - Cognitive Patterns a Brief Interview for Mental Status score of 13 out of 15, indicating intact cognition. Section I - Active Diagnosis included non-Alzheimer's dementia, anxiety disorder and depression. Review of Resident #152's Medication Administration Record (MAR) for February 2024 revealed a physician order for Memantine HCI tablet 10 mg (milligrams) - give 1 tablet by mouth one time a day for dementia, start date 2/6/24. Review of the baseline care plan, initiated on 2/8/24, revealed it was silent of a focus area, goal or interventions for dementia. During an interview on 2/26/24 at 12:23 p.m. Staff A, RN/MDS stated Resident #152 has a dementia diagnosis and confirmed there was not a care plan initiated for it. She also confirmed there was no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 8 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0655 care plan related to the diagnosis of anxiety and there should be. Level of Harm - Minimal harm or potential for actual harm A review of the facility's policy titled, Comprehensive Care Plans, revised 7/23, revealed: Policy: It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment. Residents Affected - Some Policy Explanation and Compliance Guidelines: .2. The comprehensive care plan will be developed within 7 days after the completion of the comprehensive MDS assessment. All Care Assessment Areas (CAAs) triggered by the MDS will be considered in developing the plan of care. Other factors identified by the interdisciplinary team, or in accordance with the resident's preferences, will also be addressed in the plan of care. The facility's rationale for deciding whether to proceed with care planning will be evidenced in the clinical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 9 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On 2/24/2024 at 9:45 am Resident #6 was observed sitting in a chair in her room wearing a nasal cannula attached to an oxygen concentrator set at 2 liters. An additional observation of the residents door and surrounding area showed an oxygen in use sign was absent. Residents Affected - Few A review of Resident #6 admission record on 2/25/2024 revealed the resident was admitted on [DATE] with a primary diagnosis of acute on chronic systolic (congestive) heart failure. A review of Resident #6 physician orders on 2/25/2024 included an order, dated 2/13/2024, for continuous oxygen at 2 liters per minute. A review of the facility's policy titled, Oxygen Administration, revised 6/23 showed, Oxygen is administered to residents who need it, consistent with professional standards of practice, the comprehensive person-centered care plans, and the resident's goals and preferences. The Policy Explanation and Compliance Guidelines showed: 1. Oxygen is administered under orders of a physician, except in the case of an emergency . 6. Oxygen warning signs must be placed on the door of the resident's room where oxygen is in use. Photographic evidence obtained. 2. During an interview and observation on 2/24/24 at 1:29 p.m. Resident #150 was in bed receiving oxygen via a nasal cannula visiting with family. The family member stated she received 3 liters of oxygen and only at night when she is at home, but here they have her (Resident #150) on it more to assist. There was no sign observed on the door upon entrance to Resident #150's room to indicate she was on oxygen. A review of the admission Record for Resident #150 revealed an admission date of 2/7/24 with diagnoses to include chronic obstructive pulmonary disease and cognitive communication deficit. Review of the Order Summary Report, active as of 2/26/24, revealed a physician order as: O2 (oxygen) 2 L (liters) via nasal cannula continuous every shift, start date of 2/7/24. Review of the Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form, dated 2/7/24, revealed Resident #150 was receiving oxygen liters at two percent. Review of the active care plan for Resident #150 revealed there was no care plan or intervention related to oxygen therapy. An observation of Resident #150 on 2/25/24 at 3:35 p.m. revealed the resident was lying in bed receiving oxygen via a nasal cannula. During an interview on 2/25/24 at 3:36 p.m. Staff G, Certified Nursing Assistant (CNA) observed the setting for the oxygen and confirmed the oxygen was set at 3 liters. She then assisted the resident with straightening the nasal cannula. The resident at this time was unable to remember who set the oxygen to 3 liters. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 10 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview with Staff H, Licensed Practical Nurse (LPN) she reviewed the order for Resident #150 and that she was to be receiving 2 liters. Staff H confirmed the resident is compliant with care and would not change the oxygen. An immediate observation was conducted with Staff H and Staff H confirmed the oxygen for Resident #150 was set at 3 liters. She stated she would turn it down to 2 liters. Based on observations and interviews, the facility failed to ensure respiratory care and services were provided in accordance with professional standards for two (Resident #1 and Resident #150) of three residents sampled for oxygen therapy and failed to ensure oxygen warning signs were posted outside of resident rooms when oxygen was in use for three (Resident #1, Resident #150, and Resident #6) of three residents sampled for oxygen therapy. Findings included: A review of Resident #1's medical record revealed Resident #1 was admitted to the facility on [DATE] with diagnoses of congestive heart failure, stage 3 chronic kidney disease, and non-ST-elevation myocardial infarction (NSTEMI). A review of Resident #1's physician's orders revealed an order, dated 1/23/2024, for continuous oxygen at 2 liters per minute (lpm) via nasal cannula (NC). Resident #1's physician's orders also revealed an order, dated 2/18/2024, to check and maintain the oxygen concentrator setting at 2 lpm every shift. An observation was conducted on 2/24/2024 at 12:04 PM of Resident #1. Resident #1 was observed resting in bed and wearing a nasal cannula with oxygen flowing from an oxygen concentrator. An observation of the oxygen concentrator revealed Resident #1's oxygen flow was set to 1 lpm. An observation outside of Resident #1's room did not reveal signage to indicate oxygen was in use in the resident's room. An interview was conducted on 2/26/2024 at 1:01 PM with the facility's Director of Nursing (DON). The DON stated she would expect nursing staff to check the resident's oxygen concentrator and ensure the nasal cannula is properly placed. The DON also stated signage should be posted outside of the resident's room to indicate oxygen is in use in that room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 11 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure recommendations during medication regimen review were addressed and acted upon by the primary care provider for one (Resident #37) of six residents sampled for medication regimen review. Findings included: A review of Resident #37's medical record revealed Resident #37 was admitted to the facility on [DATE] with diagnoses of dementia with agitation and cognitive communication deficit. A review of Resident #37's physician's orders revealed an order, dated 9/18/2023 for lorazepam 0.5 milligrams (mg) by mouth every 8 hours as needed for agitation. The order did not include a duration of use or end date. A review of Resident #37's progress notes, dated 9/18/2023 at 3:52 AM revealed Resident #37 displayed increased agitation and restlessness over several days. Resident #37's primary care provider (PCP) was notified and ordered lorazepam 0.5 mg by mouth every 8 hours as needed for agitation. A review of Resident #37's Medication Regimen Review (MRR) report, dated 9/30/2023, revealed a recommendation to evaluate Resident #37 for the appropriateness use of lorazepam 0.5 mg and to document a rationale and duration for use in Resident #37's medical record due to orders for psychotropic drugs being limited to 14 days, except when the attending physician or prescribing practitioner believes that it is appropriate for the as needed order to be extended beyond 14 days. The recommendation also requested for the PCP to provide a re-assessment date and clinical rationale for the continued use of the medication. The section of the MRR titled Re-Assessment Date had an entry of 10/24/2023. The section of the MRR titled Clinical rationale was left blank. The MRR was signed by Resident #37's PCP, but was not dated. A review of Resident #37's medical record did not reveal an evaluation by the PCP related to use of lorazepam 0.5 mg or rationale for the use of the medication on an as needed basis on 10/24/2023. An interview was conducted on 2/26/2024 at 11:03 AM with the facility's Director of Nursing (DON). The DON stated when a recommendation is received from the consultant pharmacist, the facility calls the resident's physician to inform them or the nursing staff will place the recommendation in the physician's inbox to review when they come to the facility. The DON also stated Resident #37 had the lorazepam 0.5 mg ordered for a long time due to the resident's behaviors. The DON stated Resident #37's initial order lorazepam 0.5 mg should have been for 14 days and the resident should have been re-evaluated by the PCP to determine if the resident still needed the medication on an as needed basis. The DON also stated the medication should have an end date to indicate a duration of use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 12 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of the admission Record revealed Resident #152 was admitted to the facility on [DATE] with medical diagnoses to include anxiety disorder, major depressive disorder and unspecified dementia, mild with anxiety. An interview and observation was conducted on 2/24/24 at 1:03 p.m. with Resident #152. Resident #152 was in bed visiting with family and confirmed she was being administered her medications with no concerns. She confirmed she was admitted approximately two weeks ago. Review of the Minimum Data Set (MDS), dated [DATE], revealed in Section C - Cognitive Patterns a Brief Interview for Mental Status score of 13 out of 15, indicating intact cognition. Section D - Mood revealed a symptom presence for Feeling down, depressed, or hopeless. Section E - Behavior revealed no behaviors noted. Review of Resident #152's February 2023 physician orders revealed an order with a start date of 2/5/24 and no end date for Lorazepam Oral Tablet 0.5 MG (milligrams) - give 1 tablet by mouth every 8 hours as needed for anxiety with no end date. Review of Resident #152's Medication Administration Record (MAR) for February 2024 revealed the Lorazepam was not limited to 14 days and the resident received the medication 7 times since the medication was ordered on 2/5/24. Further medical record review was conducted for Resident #152 and there was no evidence to support the continuation of Lorazepam longer than 14 days. During an interview on 2/26/24 at 11:09 a.m. Staff E, Licensed Practical Nurse (LPN) confirmed there was no end date for the Lorazepam, and there should be for the as needed medication. She stated Resident #152 let's them know when she needs the medication. During an interview on 2/26/24 at 11:15 a.m. Staff F, Registered Nurse/Unit Manager confirmed there was no end date in the medical record for the Lorazepam for Resident #152. A review of the facility policy titled Use of Psychotropic Medication, last revised in June 2023, revealed under the section titled Policy residents are not given psychotropic drugs unless the medication is necessary to treat a specific condition, as diagnosed and documented in the clinical record, and the medication is beneficial to the resident, as demonstrated by monitoring and documentation of the resident's response to the medication. The policy also revealed under the section titled Policy Explanation and Compliance Guidelines the attending physician will assume leadership in medication management by developing, monitoring, and modifying the medication regimen in collaboration with residents, their families and/or representatives, other professionals, and the interdisciplinary team. PRN (as needed) orders for all psychotropic shall be used only when the medication is necessary to treat a diagnosed specific condition that is documented in the clinical record, and for a limited duration (i.e. 14 days). If the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she shall document their rationale in the resident's medical record and indicate the duration for the PRN order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 13 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0758 Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record reviews, the facility failed to ensure use of psychotropic meds on an as needed basis was limited to 14 days without rationale for continuation for two (Resident #37 and Resident #152) of six residents sampled for psychotropic medication use. Findings included: Residents Affected - Few A review of Resident #37's medical record revealed Resident #37 was admitted to the facility on [DATE] with diagnoses of dementia with agitation and cognitive communication deficit. A review of Resident #37's physician's orders revealed an order, dated 9/18/2023 for lorazepam 0.5 milligrams (mg) by mouth every 8 hours as needed for agitation. The order did not include a duration of use or end date. A review of Resident #37's progress notes, dated 9/18/2023 at 3:52 AM revealed Resident #37 displayed increased agitation and restlessness over several days. Resident #37's primary care provider (PCP) was notified and ordered lorazepam 0.5 mg by mouth every 8 hours as needed for agitation. A review of Resident #37's Medication Regimen Review (MRR) report, dated 9/30/2023, revealed a recommendation to evaluate Resident #37 for the appropriateness use of lorazepam 0.5 mg and to document a rationale and duration for use in Resident #37's medical record due to orders for psychotropic drugs being limited to 14 days, except when the attending physician or prescribing practitioner believes that it is appropriate for the as needed order to be extended beyond 14 days. The recommendation also requested for the PCP to provide a re-assessment date and clinical rationale for the continued use of the medication. The section of the MRR titled Re-Assessment Date had an entry of 10/24/2023. The section of the MRR titled Clinical rationale was left blank. The MRR was signed by Resident #37's PCP, but was not dated. A review of Resident #37's medical record did not reveal an evaluation by the PCP related to use of lorazepam 0.5 mg or rationale for the use of the medication on an as needed basis on 10/24/2023. An interview was conducted on 2/26/2024 at 11:03 AM with the facility's Director of Nursing (DON). The DON stated when a recommendation is received from the consultant pharmacist, the facility calls the resident's physician to inform them or the nursing staff will place the recommendation in the physician's inbox to review when they come to the facility. The DON also stated Resident #37 had the lorazepam 0.5 mg ordered for a long time due to the resident's behaviors. The DON stated Resident #37's initial order lorazepam 0.5 mg should have been for 14 days and the resident should have been re-evaluated by the PCP to determine if the resident still needed the medication on an as needed basis. The DON also stated the medication should have an end date to indicate a duration of use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 14 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0759 Ensure medication error rates are not 5 percent or greater. 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 maintain a medication error rate of less than 5%. A total of 30 medication administration opportunities were observed with 5 medication errors for one (#34) of five residents sampled for medication administration, which resulted in a medication administration error rate of 16.67%. Residents Affected - Some Findings included: A review of Resident #34's medical record revealed Resident #34 was admitted to the facility on [DATE] with diagnoses of vascular dementia, hypertension, major depressive disorder, and cognitive communication deficit. A review of Resident #34's physician's orders revealed the following orders: - An order, dated 1/3/2024, for escitalopram 10 milligrams (mg) by mouth one time daily at 9:00 AM. - An order, dated 1/3/2024, for gabapentin 100 mg by mouth three times a day at 8:00 AM, 2:00 PM, and 8:00 PM. - An order, dated 1/3/2024, for losartan 100 mg by mouth one time daily at 9:00 AM. - An order, dated 1/3/2024, for methocarbamol 500 mg by mouth two times daily at 9:00 AM and 9:00 PM. - An order, dated 1/3/2024, for metoprolol succinate 25 mg, one half tablet, by mouth two times daily at 9:00 AM and 9:00 PM. An observation of medication administration was conducted on 2/25/2024 at 10:00 AM with Staff B, Registered Nurse (RN). Staff B, RN gathered the following medications for administration to Resident #34: - Gabapentin 100 mg, 1 tablet. - Escitalopram 10 mg, 1 tablet. - Losartan 100 mg, 1 tablet. - Methocarbamol 500 mg, 1 tablet. - Metoprolol Succinate 25 mg, 1/2 tablet. After gathering the medications for Resident #34, Staff B, RN crushed the medications and put them in a small amount of applesauce to prepare for administration. Staff B, RN administered the five medications to Resident #34 at 10:05 AM without difficulty. An interview was conducted following the observation with Staff B, RN. Staff B, RN stated all of Resident #34's medications were administered late and they must be administered within one hour before or after the ordered time. Staff B, RN displayed her laptop screen to reveal the medication administration record (MAR) for the unit. The MAR (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 15 of 16 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 105949 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florida Presbyterian Homes Inc 909 Lakeside Ave Lakeland, FL 33803 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)

F 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some revealed 13 resident names highlighted in red. Staff B, RN stated the red highlight indicates the resident's medications are late. Staff B, RN also stated if a medication is administered late, she continues with the medication pass without notifying anyone because she had over 30 residents on her floor and she was the only nurse working on the unit. An interview was conducted on 2/26/2024 at 1:03 PM with the facility's Director of Nursing (DON). The DON stated she would expect nursing staff to follow the five rights of medication administration when administering medications to residents, including the right time, right dose, right patient, right route, and right medication. The DON also stated if the five right are not followed, it would result in a medication error. The DON stated she would expect the nursing staff to notify the resident's physician if a medication is going to be administered later than the ordered time and the physician should be notified before the medication is administered. The DON stated nursing staff have between an hour before to an hour after the ordered medication time to administer the medication. A review of the facility policy titled Medication Administration, last revised July 2023, revealed under the section titled Policy medications are administered by licensed nurses, or other staff who are legally authorized to do so, as ordered by the physician and in accordance with professional standards of practice. The policy also revealed under the section titled Policy Explanation and Compliance Guidelines staff are to compare the medication source with the MAR to verify resident name, medication name, form, dose, route, and time and the medication is to be administered within 60 minutes prior to or after the scheduled time unless otherwise ordered by the physician. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105949 If continuation sheet Page 16 of 16

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Citations

10 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0550GeneralS&S Dpotential for harm
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
0641GeneralS&S Dpotential for harm
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
0644GeneralS&S Epotential for harm
F644 - Coordination
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
0655GeneralS&S Epotential for harm
F655 - Comprehensive Person-Centered Care Planning
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0756GeneralS&S Dpotential for harm
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
0758GeneralS&S Dpotential for harm
F758 - Medication Errors
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
0759GeneralS&S Epotential for harm
F759 - Medication Errors
Ensure medication error rates are not 5 percent or greater.
0211GeneralS&S Dpotential for harm
Keep aisles, corridors, and exits free of obstruction in case of emergency.
0353GeneralS&S Dpotential for harm
Inspect, test, and maintain automatic sprinkler systems.

FAQ · About this visit

Common questions about this visit

What happened during the February 26, 2024 survey of FLORIDA PRESBYTERIAN HOMES INC?

This was a inspection survey of FLORIDA PRESBYTERIAN HOMES INC on February 26, 2024. The surveyor cited 10 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at FLORIDA PRESBYTERIAN HOMES INC on February 26, 2024?

Yes, 10 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her right..."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

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Data from CMS Care Compare public records. Dataset last refreshed June 15, 2026. If you believe any information is inaccurate, report it here.

Inspection·February 26, 2024