Health inspection·September 5, 2024

F 0552 Ensure that residents are fully informed and understand their health status, care and treatments. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure one resident (# 14) of eight residents sampled, was provided the opportunity to participate in care planning. Residents Affected - Few Findings included: On 09/03/24 at 11:00 a.m., Resident #14 was observed lying down in bed with her call light in reach. She presented well-groomed with no signs of distress. She stated she was happy at this facility. She was the new council president, and the residents were very pleased with the staff. She stated she had been at the facility for a year and had never been invited to a care plan meeting. She said she would like to be informed and a part of her plan of care. On 09/04/2024 at 10: 00 a.m., Resident #14 was observed lying down in bed with her call light within reach. She was observed with no signs of distress. Review of an admission Record dated 09/05/2024, showed Resident # 14 was admitted to the facility with diagnoses to include but not limited to myasthenia gravis with (acute) exacerbation, multiple sclerosis, and major depressive disorder, recurrent, unspecified. Review of an quarterly Minimum Data Set, (MDS) dated [DATE], showed a Brief Interview for Mental Status ( BIMS) score of 14, which indicated intact cognition. On 09/05/2024 at 1:00 pm., an interview was conducted with Staff A, the Minimum Data Set (MDS) Director. Staff A stated they invited residents or their family to care plan meetings quarterly. If the resident or the family did not want to come to the meeting, she asked them if there was anything they would like to address with the team. There was a letter that was sent out to the families or residents quarterly. The letter was scanned in the Electronic Medical Record. She said [Resident #14's] last meeting would have been in July or beginning of August. I don't see a letter for the month of July or August. She stated, come to think of it she had never seen Resident # 14 attend any of her care plan meetings. The facility did not have a care plan policy to provide for this citation. Review of resident handbook provided by facility revealed on page 5 section Care Conference/Care Plan. It showed A care plan conference is held on each resident. The care conference consists of representatives from each department and meets to discuss the resident's plan of care. Care conferences are held no later than the 21st day of admission. Resident and resident representative will be given advance notice of the scheduled care conference and will be invited to attend. If you cannot attend (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 7 Event ID: 105959 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 105959 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Addington Place at College Harbor 4600 54th Ave S Saint Petersburg, FL 33711 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)