Inspection·September 12, 2024

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview, record review, and policy review, the facility failed to ensure the interdisciplinary team (IDT) assessed and determined if a resident was capable of self-administration of medications prior to allowing 1 of 37 sampled residents to self-administer medications. (Resident #171) Residents Affected - Few The findings include: An observation of Resident #171 was conducted on 9/10/24 at 2:39 PM. Resident #171 nodded yes when asked if he was completing his own tracheostomy care. He then pointed to a tube of mupirocin ointment that was not secured and was laying on the sink. (Photographic evidence was obtained) An interview was conducted with Employee H (registered nurse) on 9/10/24 at 2:35 PM. She stated Resident #171 performed his own tracheostomy care. A review of Resident #171's record revealed no assessment to determine if the resident was capable of self-administering his own medications and treatments. A review of the progress notes for September 2024 revealed that on 9/10/24, 9/9/24, 9/5/24, 9/4/24, 9/2/24, and 9/1/24, the resident declined tracheostomy care from staff and provided his own tracheostomy care. An interview was conducted with the Director of Nursing (DON) on 9/10/24 at 3:30 PM. She stated the facility has a process to assess the resident before allowing them to self-administer medications. She stated this resident refused to allow the nursing staff to perform the tracheostomy care. The DON stated she would have the nursing staff complete an assessment for him to self-administer the medication and treatment. A review of the facility policy Self-Administration of Medications (revised February 2021) revealed, .residents have the right to self-administer medications if the interdisciplinary team has determined that it is clinically appropriate and safe for the resident to do so. As part of the evaluation comprehensive assessment, the IDT assesses each resident's cognitive abilities to determine whether self-administering medications is safe and clinically appropriate for the resident. If it is deemed safe and appropriate for a resident to self-administer medications, this is documented in the medical record and the care plan. 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: 106051 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 106051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Bay at Pensacola, LLC 600 W Gregory St Pensacola, FL 32502 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)