F 0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, review of the clinical record, review of facility policy and procedure, and resident,
family and staff interviews, the facility failed to provide the necessary care and services to maintain
personal hygiene for 1(Resident #999) of 3 residents reviewed for activities of daily living.The findings
included:Review of the facility policy Activities of Daily Living (ADLs) implemented 3/1/22 (revised 6/1/25)
documented, A resident who is unable to carry out activities of daily living will receive the necessary
services to maintain grooming, and personal and oral hygiene.Review of the clinical record revealed
Resident #999 had an admission date of 1/25/23 with a re-admission date of 8/22/25. Diagnoses included
displaced intertrochanteric fracture of right femur on 8/22/25, type 2 diabetes mellitus, dementia, anxiety,
and fracture of right femur 2/8/23.Review of the End of Part A stay Minimum Data Set (MDS) (standardized
assessment tool that measures health status in nursing home residents) with an assessment reference
date of 10/24/25 documented Resident #999 required partial to moderate assistance with oral hygiene, and
substantial to maximum assistance with showers/bathing.The MDS noted the resident scored 12 on the
Brief Interview for Mental Status, indicating the resident's cognitive skills for daily decision making were
moderately impaired.Review of the plan of care revealed Resident #999 had an ADL self-care performance
deficit and required assistance of one staff. The interventions included for staff to provide set up, one assist
with extensive assistance for personal hygiene and oral care.On 12/8/25 at 9:00 a.m., Resident #999 was
observed in bed in his room. The room had a very strong, foul odor of urine. The resident was noted to be
unkempt, unshaven with a long scraggly beard and mustache. The bed sheets were soiled with a brown
substance. His hair was matted, greasy and uncombed and extended past his ears.On 12/8/25 at 11:00
a.m., in an interview Resident #999 said he has not been shaved or had a hair cut in a very long time. He
said he would like to be shaved. Resident #999's teeth had black spots and a thick, white coating. His
mouth was dry with foul breath.Review of the clinical record revealed Resident #999's admission photo of a
clean-shaven male with no beard or mustache and neatly trimmed hair.Review of the Certified Nursing
Assistants (CNA) documentation for October 2025, and November 2025 revealed the resident's scheduled
shower days were Mondays and Thursdays on the 7:00 a.m., to 3:00 p.m., shift. There was no
documentation Resident #999 received his scheduled showers on 10/2/25, 10/9/25,10/23/25, 11/3/25,
11/6/25, and 11/10/25.On 12/9/25 at 1:45 p.m., in an interview the [NAME] President of Operations said
Resident #999 was shaved last evening and just received a haircut. The [NAME] President of Operations
said the facility's policy was for staff to shave men two to three times a week or at their preference.On
12/9/25 at 2:40 p.m., in an interview CNA Staff G said men are shaved when they have their shower or if
they ask. The CNA said they brush the residents' teeth. If the residents can brush their own teeth, they get
things ready and are there to help.
Residents Affected - Few
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:
105983
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
105983
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/09/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Harborview Sarasota
4783 Fruitville Road
Sarasota, FL 34232
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 0689
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to
prevent accidents.
Based on observation, record review, review of facility's policies and procedures and staff interviews, the
facility failed to have documentation of fall investigations and failed to implement care planned interventions
to reduce the risk of avoidable accidents for 1 (Resident #999) of 3 residents reviewed with multiple falls at
the facility.The findings included: Review of the facility policy Fall Prevention Program implemented 3/1/22
(revised 1/1/25) revealed, Each resident will be assessed for fall risk and will receive care and services in
accordance with their individualized level of risk to minimize the likelihood of falls.High Risk Protocols:a.
The resident may be placed on the facility's Fall Prevention Program.i. Indicate fall risk on care
plan.Implement appropriate interventions.c. Provide interventions that address unique risk factors
measured by the risk assessment tool.d. Provide additional interventions as directed by the resident's
assessment, may include but not limited to:i. Assistive devices.ii. Increased frequency of rounds.iv. Low
bed.8. Interventions will be monitored for effectiveness.Review of the clinical record for Resident #999
revealed an admission date of 1/25/23. Diagnoses included Dementia, generalized anxiety disorder,
difficulty in walking, abnormalities of gait and mobility, and fracture of the right femur.Review of the fall risk
evaluations dated 5/25/25 and 8/17/25 noted Resident #999 was at high risk for falls. Review of the care
plan initiated on 1/27/2023 revealed Resident #999 was very impulsive and will not use call light to ask for
assistance with transfers and will attempt to self-transfer. Resident #999 would tell his family that he was
feeding squirrels through the window in his bedroom and has also shown physical aggression towards staff.
The goal was to monitor the resident daily for his behaviors.The care plan initiated on 5/13/25 noted
Resident #999 displayed behaviors which include hitting during care, playing in feces, shouting, spitting,
tearing things up, yelling out during care, refusing medications and care, and placing self on the floor.The
goal was for the resident not to harm self or others daily. The care plan initiated on 1/31/23 and revised on
8/26/25 revealed Resident #999 was at high risk for falls related to gait/balance problems and medications
that put him at risk.The care plan noted the resident would not use the call light to ask for assistance with
ambulation around his room, to or from the bathroom with or without the use of an assistive device, due to
impaired cognition.The goal for Resident #999 was to Minimize the risk of falls through next review
date.The care plan noted Resident #999 sustained a fall on 5/12/25, 5/25/25, 7/19/25 and 8/17/25.The
interventions included:Bed in lowest locked position. Date initiated: 1/31/23. Revision on 9/30/25.Dycem
(non-slip mat) to wheelchair. Date initiated 5/22/23. Revision on 6/25/24.Offer toileting assistance prior to
meals. Date initiated 5/25/25. Revision on 8/18/25.Perimeter mattress (mattress with raised borders to help
guide the patient back toward the center of the mattress and away from dangerous position near the edge
of the bed). Date initiated 4/24/23. Revision on 8/18/25.Review of the progress notes revealed on 5/26/25 at
12:19 a.m., Unwitnessed fall at 1600 [4:00 p.m.], without severe injury. Abrasions on bilateral legs. Patient
was found in room on [sic] sitting in front of door.On 5/28/25, an interdisciplinary progress note documented
the resident was reviewed related to fall. Resident is identified as a fall risk related to behavior of placing
self on floor, aggression, and unstable gait. Resident is noncompliant with requesting assistance and
requires frequent cueing. Resident will be offered toileting assistance prior to meals in an attempt to reduce
risk of falls.The progress note did not include the root cause of the fall to determine toileting assistance
before meals was an appropriate intervention to prevent further falls.On 7/19/25 at 10:08 p.m., a nursing
progress note documented the Certified Nursing Assistant found Resident #999, with head and upper body
on floor and feet still on bed. Resident alert with confusion cannot explain what happened. No visible
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105983
If continuation sheet
Page 2 of 7
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
105983
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/09/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Harborview Sarasota
4783 Fruitville Road
Sarasota, FL 34232
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 0689
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
hematoma (collection of blood outside of blood vessels), skin tear noted to R (right) leg behind the knee.
EMS [Emergency Medical Services] called . The resident was taken to a local hospital via stretcher.On
7/21/25 a progress note documented the resident was reviewed by the Interdisciplinary Team related to
safety. Resident had a fall from the bed on 7/19/25. Resident with diagnosis of confusion and unable to
verbalize cause of fall. Interventions in place at time of fall include bed maintained in lowest position while
occupied with fall recovery matt at bedside in an attempt to prevent injury in the event of a fall, resident is
offered toileting assistance prior to meals, and nonskid footwear is provided. Intervention for this event is
that when staff place resident to bed for HS (bedtime), and HS snack is offered and comfort needs ensured
prior to leaving room .The progress note did not document that the perimeter mattress initiated on 4/24/23
was in place at the time of the fall.On 8/17/25 at 9:46 p.m., a nursing progress noted, Unwitnessed fall, the
patient was found behind his room door seated. Vitals WNL (within normal limits), no injuries noted. Alert to
self.On 8/18/25 a progress note documented the resident was reviewed by the interdisciplinary team for
safety. Resident had an unwitnessed fall on 8/17/25. Current interventions include: resident's bed
maintained in lowest position while occupied, Dycem is in w/c (wheelchair) to prevent slipping, bilateral
assist rails to bed frame to promote independence with bed mobility. Resident provided toileting assistance
prior to meals, and nonskid footwear. Current interventions are providing toileting assistance prior to
returning to bed . Will continue to monitor per facility's guidelines for effectiveness of interventions and need
for additional interventions.The progress notes did not include a root cause of the incident or specify if the
resident was in a wheelchair or the bed with the perimeter mattress in use before the fall.On 8/18/25 a post
fall progress note documented Resident #999 was complaining of pain to the right leg.On 8/19/25 an X-ray
of the right femur documented findings of an acute intertrochanteric right femoral fracture.On 8/19/25,
Resident #999 was transferred to an acute care hospital for evaluation. Resident #999 underwent a surgical
repair of the right femur fracture.On 8/22/25 a nursing progress note documented Resident #999 returned
to the facility. Bilateral rails were in place to promote independence with bed mobility. Perimeter mattress in
place to increase awareness of parameters of bed surface. Ensured a pair of nonskid footwear were in the
room. The call light was placed within reach of the resident and demonstrated usage. Bed was placed in the
lowest position. Staff was reminded that toileting assistance will be offered at bedtime and meals.Review of
the End of Part A Stay Minimum Data Set (MDS) assessment with a reference date of 10/24/25 revealed
Resident #999 scored 12 on the Brief Interview for Mental Status, indicating moderate cognitive
impairment.The MDS noted the resident required partial to moderate assistance to come to a standing
position from sitting in a chair, wheelchair, on the side of the bed, or to get on and off the toilet.On 11/14/25
at 10:30 a.m., a nursing progress note documented the resident was in the television room in his
wheelchair and was trying to reach his shoes, lost his balance and fell on his side, no injuries were noted.
Resident #999 sustained superficial skin tears to his left knee.The fall report documentation dated 11/14/25
at 12:33 p.m. noted Resident #999 was Not oriented to person, place, time or situation.The active
physician's orders included:Bed maintained in lowest position while occupied. Nurse to validate each shift.
Start date 9/5/25.Bilateral enabler bar to standard bed to promote independence with bed mobility. Start
date of 8/25/25. On 12/8/25 review of the Medication Administration Record (MAR) for December 2025
revealed the nurse signed, validating the bed was maintained in the lowest locked position when occupied
on 12/8/25 for the 7:00 a.m., to 3:00 p.m. shift.The nurse also signed, validating that on 12/8/25, the
bilateral enabler bar [sic] was in place to the standard bed to promote independence with bed mobility for
the morning shift.On 12/8/25 at 11:00 a.m., Resident
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105983
If continuation sheet
Page 3 of 7
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
105983
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/09/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Harborview Sarasota
4783 Fruitville Road
Sarasota, FL 34232
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 0689
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
#999 was observed in bed. The fall prevention interventions specified in the care plan and signed by the
nurse in the MAR for 12/8/25 for the morning shift were not in place. The bed was not in the lowest position.
The perimeter mattress was not in place. The bed had no enablers bilaterally. In an interview, Resident
#999 said he remembered falling and breaking his leg but did not remember how it happened.On 12/8/25 at
12:15 p.m., the Director of Nursing (DON) verified through observation that Resident #999's bed was not in
the lowest position and the enablers were not in place. The DON said he was not aware that the resident's
fall interventions in the care plan included a perimeter mattress. The DON verified the nurse documented
on the MAR that the fall prevention interventions were in place when they were not.On 12/8/25 at 12:37
p.m., in an interview the Administrator said she did not have documentation of Resident #999's fall
investigation for 8/17/25 and the right femur fracture identified on 8/19/25.The Administrator said she
initiated an abuse/neglect investigation on 9/23/25 when the resident's responsible party alleged that
Resident #999 was being abused or neglected. The responsible party said his concern was with the fall and
he wanted full side rails on the bed. She said her investigation did not address the fall since the incident
occurred with the former administration. She said she did not know if they investigated the fall and fracture.
The Administrator said she spoke with Resident #999 who had no concerns regarding care.Review of the
facility provided incident investigation for an incident date of 9/23/25 revealed an allegation of physical
abuse and neglect. The allegation details noted the resident's responsible party alleged that Resident #999
was being abused or neglected. No other information had been provided at that time. The investigation
noted the representative voiced allegation of neglect regarding the use of full side rails. Resident #999
stated that he had no concerns with care and felt safe at the facility. The investigation noted Resident #999
has had previous falls, care plan reflects noncompliance with fall interventions and Activities of Daily Living
care. The conclusion noted after investigation the facility was not able to verify abuse and neglect due to
care plan interventions followed per individualized plan of care. The investigation noted the resident was not
deemed incapacitated and had a Brief Interview for Mental Status score of 13 (which is indicative of intact
cognition). The resident was able to make his own decisions regarding use of full length side rails.On
12/9/25 at 8:37 a.m., in an interview the Administrator said as part of the fall prevention program, the facility
implemented daily fall and change of shift huddles, walking rounds, and would provide the
documentation.On 12/9/25 at 4:00 p.m., at the time of exit, the Administrator failed to provide
documentation of an investigation for Resident #999's fall on 8/17/25 resulting in fracture of the right femur
and emergency transfer to an acute care hospital.
Event ID:
Facility ID:
105983
If continuation sheet
Page 4 of 7
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
105983
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/09/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Harborview Sarasota
4783 Fruitville Road
Sarasota, FL 34232
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 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
Based on observations, record review and interviews, the facility failed to maintain an effective pest control
program to contain and eradicate common household pests.The findings included:Review of the facilities
Pest Control Program policy (last revised on 3/1/2022) stated, it is the policy of this facility to maintain an
effective pest control program that eradicated and contains common household pests and rodents. The
policy further states effective pest control program is defined as measures to eradicate and contain
common household pests (e.g., bed bugs, lice, roaches, ants, mosquitos, flies, mice and rats).Review of the
facilities Resident Environmental Quality policy (last revised on 3/1/2025) states the facility shall maintain
an effective pest control program so the facility is free from pests and rodents.On 12/8/25 at 9:04 a.m., in
an interview Resident #2 said she has a problem with bugs. She said there were little cockroaches in the
bathroom. She has let everyone know but they were still there. She said there are times she won't take a
shower because of the cockroaches. She said they come up from the shower drain. She said when it rains
they come in as well. She said, I get a couple of brown paper bags and take care of them by squishing
them.On 12/8/25 at 9:14 a.m., in an interview Resident #3 said she has issues with cockroaches. She said
she saw one a couple of days ago.On 12/8/25 at 9:18 a.m., in an interview Resident #4 said, I see the little
roaches crawling around. She said when her family comes in to visit, they have to squish them in the
bathroom.On 12/8/25 at 9:25 a.m., in an interview Resident #5 said there are cockroaches in the bathroom
and they crawl on the walls. She said the cockroaches also come out of the air conditioning vent. She said
she did not know when the last time someone sprayed for cockroaches. During the interview a small brown
bug was observed crawling on the bathroom floor. Photographic evidence obtained.On 12/8/25 at 9:30
a.m., in an interview Resident #6 said she sees cockroaches around her room. She could not recall when
she last saw one but said it was not long ago, they are around. On 12/8/25 at 9:34 a.m., in an interview
Resident #7 said there are cockroaches in his room. He said, I feel them crawling on me at night.
Observation of the resident's room and bathroom revealed 3 black bugs crawling in the bathroom above
and below the resident's toilet. On 12/8/25 at 9:38 a.m., in an interview Resident #15 said he has a problem
with ants. He said the ants come from the detached baseboard. He said the staff tape the baseboard, but it
never stays.Observation of the resident's floor revealed the baseboard was detached from the wall and
laying on the resident's floor. Photographic evidence obtained.On 12/8/25 at 9:49 a.m., in an interview
Resident #8 said she saw a cockroach the day before in her room and another one a few days ago. She
said, they are baby roaches. They are everywhere. She said she used to tell the staff but it didn't help so
now she squishes them herself.On 12/8/25 at 9:43 a.m., in an interview Resident #9 said, I had a roach in
my bed a month ago crawling on me. She said the nurse aide found the cockroach on her while changing
her brief. She said when the nurse aid took the brief off, the roach came crawling out from inside her
brief.On 12/9/25 at 11:12 a.m., a small brown bug was observed crawling in Resident #10's room.
Photographic evidence obtained.On 12/8/25 at 1:04 p.m., in an interview Resident #13 said they have a
problem with cockroaches. Resident #13 said when her family comes to visit, they have to open the
drawers and kill all of the roaches. She said, It is embarrassing. During the interview a small brown bug was
observed on the floor. Photographic evidence obtained.On 12/8/25 at 9:22 a.m., in an interview Licensed
Practical Nurse (LPN) Staff C said, We have a problem with roaches. Staff C said if there is a pest sighting,
it goes in the pest logbook. Staff C said, They are never going to fully fix the problem. On 12/8/25 at 9:22
a.m., in an interview LPN Staff D said, I see roaches around here but not today. Staff D said she lets
maintenance know when she sees one.On 12/8/25 at 9:47 a.m., in an interview LPN Staff E said, I've seen
big roaches
Residents Affected - Some
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105983
If continuation sheet
Page 5 of 7
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
105983
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/09/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Harborview Sarasota
4783 Fruitville Road
Sarasota, FL 34232
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 0925
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
around here. Staff E said when she sees one, she kills it, throws it away and then let maintenance know.On
12/8/25 at 12:08 p.m., review of the facility provided Pest Sighting Log showed on 12/1/25 Resident #16
reported roaches in dresser drawer. This sighting was not listed as treated. On 11/19/25, Resident #11
reported roaches around bed, bathroom and soap dispenser. The sighting was marked as treated by the
pest control company. On 11/6/25, the activities department reported roaches, activity room cabinets. The
sighting was marked as treated by the contracted pest control company.Review of the Resident Council
Minutes reviewed for 11/12/25 revealed, Resident #11 talked about having roaches in her room and
needing someone to come and take care of them.On 12/8/25 at 12:10 p.m., in an interview Resident #11
said she reported the roaches a month ago and there has been no change. Resident #11 said the roaches
are in the bathroom, by her bed, they climb up and down the wall, behind the television and are behind the
soap dispenser. Resident #11 said she just saw a cockroach last night go behind her television. Resident
#11 said she also saw a cockroach in the bathroom this morning on the ceiling while showering. She said
she let the Nursing Assistants know. A small brown bug was observed crawling on the floor next to the
resident's bed. A small brown bug was observed on the bathroom wall. Photographic evidence obtained.On
12/8/25 at approximately 12:15 p.m., Staff F was observed removing the cover of the soap dispenser
affixed to the bathroom wall. Multiple brown bugs were observed scurrying from behind the soap dispenser.
Staff F dropped the soap dispenser, brushed off and washed her hands. Black bio growth was also
observed inside of the soap dispenser. Photographic evidence obtained.On 12/8/25 at 12:22 p.m., in an
interview the Housekeeping Supervisor said the soap dispensers are changed monthly and, That soap has
not been changed for a while.On 12/8/25 at 12:30 p.m., in an interview Resident #12 said there were
cockroaches in her dresser drawers. Resident #12 said she let the staff know but the roaches were still
there. With Resident #12's permission, the dresser drawers were observed. Upon opening the top drawer, a
large brown bug was observed scurrying deeper into the dresser. Resident #12 said, There is roach poop in
the drawer. Black bio growth observed in the Resident #12's drawer which contained medical equipment,
soap, ear plugs and deodorant. Resident #12 said she was extremely embarrassed that anyone had to see
the condition of her drawer. Multiple brown bugs observed stuck to a sticky mat trap on the ground next to
the resident's toilet. Photographic evidence obtained.On 12/8/25 at 1:17 p.m., a kitchen tour was conducted
with the [NAME] Supervisor. In an interview the [NAME] Supervisor said the pest company bombed the
kitchen and food storage area last week due to roaches. The [NAME] Supervisor was unable to give a
timeline for how long the pest problem had been going on. Dead brown bug observed outside of the kitchen
door. Multiple dead brown bugs observed in the food storage area.On 12/8/25 at 2:20 p.m., the activities
room was observed with the cabinets open and emptied. The items in the cabinet were observed on the
table in the center of the room. In an interview the Activities Director said her assistant reported a roach on
her desk and sent a picture of it. The Activities Director said they are in the process of removing things out
of the cabinet and a family member volunteered to take things home to wash them.Review of the contracted
pest control company log revealed:On 7/16/25 the pest control technician noted under Cockroach program
that Only had one room ready for me when arrived. Rooms were to be ready by 10 am.On 8/20/25 the pest
control technician noted under Cockroach problem that No rooms were fogged today. They did not have any
rooms ready.On 8/27/25 the pest control technician noted under Cockroach problem that Arrived at location
it's 1020. No rooms were ready. An email was sent on Monday and there was notes at the nurses station
but no rooms were ready.On 9/17/25 the pest control technician noted under Cockroach problem that I am
stopping my weekly visits. Any structural or sanitation issues that have been marked down have not been
addressed yet. It has been a few months. Will resume
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105983
If continuation sheet
Page 6 of 7
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
105983
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/09/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Harborview Sarasota
4783 Fruitville Road
Sarasota, FL 34232
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 0925
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
after structural issues have been resolved and sanitation.On 12/4/25 the pest control technician noted,
Some of the rooms still had personal belongings in the drawers, so it's not able to fog nightstand.On
12/8/25 at 2:48 p.m., in a telephone interview the pest control technician said he serviced the building but, I
won't get into too much detail. He said he was going to the facility weekly at one point. He said that he
stopped coming weekly because the rooms were not ready when he arrived.On 12/8/25 at 3:30 p.m., in an
interview the Maintenance Director said there is a pest sighting logbook at every nurse's station. The
Maintenance Director said the pest control company sprays weekly. Upon reviewing the pesto control
documentation showing the weekly visits had stopped on 9/17/25, the Maintenance Director said weekly
visits started again last week. When asked about the pest control technician documentation that rooms
were not ready to be treated multiple times when he arrived, causing him to stop the weekly visits, the
Maintenance Director said they were working on it. The Maintenance Director said his expectation is if
rooms need to be ready, they should be ready for the pest control technician. When asked about the live
crawling insects observed behind the soap dispenser in Resident #11's room, the Maintenance Director
said, I did not know to look behind the soap dispenser. The Maintenance Director said the photographic
evidence of Resident #11's drawer looked like pest droppings. The observation of the live crawling insect in
Residents' drawers was shared with the Maintenance Director. He said the expectation was to document on
the log to be treated during the weekly pest control visits on Thursdays. On 12/9/25 at 12:40 p.m., an
interview was held with the Nursing Home Administrator related to the lack of an effective pest control
program. The Administrator said if there is a pest sighting, it is to be put in the log immediately. The Nursing
Home Administrator confirmed the pest control company came out to service the facility on 9/17/25,
10/16/25, 11/21/25 and 12/4/25. The pest control recommendations were not completed when the
technician arrived. The Administrator said the facility resumed the weekly visits last week.Review of the
facility's provided documentation revealed the pest control company has been providing services to the
facility since 10/4/24. Review of the contracted pest control company's website revealed, Cockroaches can
carry diseases such as Salmonellosis (Salmonella food poisoning), Staphylococcus infections
(gastrointestinal illness), Escherichia coli (bacterial infection), Typhoid fever (life-threatening illness that can
multiply and spread into the bloodstream) and Gastroenteritis (inflammation of the stomach, small and
large intestines).
Event ID:
Facility ID:
105983
If continuation sheet
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