Inspection·April 1, 2024

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure medications were labeled and stored in accordance with professional standards of practice in 6 of 6 medication carts reviewed for medication storage. Findings include: During an observation of Medication Cart #1 on 4/1/2024 at 8:40 AM with Staff A, Licensed Practical Nurse (LPN), there were one opened Humalog insulin with no date opened or expiration date, one opened Lispro insulin with no date opened or expiration date, two unopened Aspart insulin with pharmacy instructions to refrigerate until opened, one opened bottle of olopatadine eye drops with no date opened or expiration date, one opened bottle of Prednisolone eye drops without the original pharmacy packaging and no date opened or expiration date, and two opened bottles of artificial tears with no dates opened or expiration dates. During an observation of Medication Cart #2 on 4/1/2024 at 8:51 AM with Staff A, LPN, there were one opened Humalog insulin with no date opened or expiration date, one opened Lantus insulin with no date opened or expiration date, and one opened Humulin N insulin with date opened of 2/10/2024 with pharmacy instructions to discard after 42 days. During an interview on 4/1/2024 at 8:52 AM, Staff A, LPN, stated, Eye drops and insulin should have labels and dates when opened or when they should expire. Expired insulin should not be on the cart. During an observation of Medication Cart #3 on 4/1/2024 at 8:58 AM with Staff B, LPN, there were one opened Latanoprost eye drops with no date opened or expiration date, one unopened latanoprost eye drops with pharmacy instructions to refrigerate until opened, and one opened Lispro insulin with no date opened or expiration date. During an observation of Medication Cart #4 on 4/1/2024 at 9:05 AM with Staff B, LPN, there were two unopened Humalog insulin with pharmacy instructions to refrigerate, two opened Latanoprost eye drops with no dates opened or expiration dates, one opened Timolol eye drops with no date opened or expiration date, and one opened Brimonidine eye drops with no date opened or expiration date. During an interview on 4/1/2024 at 9:07 AM, Staff B, LPN, stated, We do label all insulin and eye drops with the date we open them, and any medications should be thrown out if they are expired. Insulin should stay in the refrigerator until it is opened. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 106003 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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)