Health inspection·April 1, 2021

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, resident and staff interview, the facility failed to maintain effective pest control. The failure to maintain effective pest control can lead to infection, bites, allergy exacerbation, and/or anxiety. Residents Affected - Few The findings included: On 3/29/21 at 10:16 a.m. Resident #62 said she had recently been moved and the room was infested with roaches. Resident #62 said she had killed two roaches in the middle of the night. She said she complained to staff about the issue during a resident council meeting. They told her the rooms have been treated for roaches. Resident #62 said she used to work as a pest control technician, and knew her room has not been treated for roaches. At the time of the interview a dead roach was observed on the floor next to Resident #62's bed. **Photographic evidence obtained** On 3/29/21 at 10:30 a.m., a dead roach was observed on the floor in front of Resident #48's bed near the wall. **Photographic evidence obtained** Review of the Resident Council Minutes for the week of 12/28/20 showed staff conducted 1 to 1 room visits with residents. Under the term New Business the documentation read, Bugs in room-wondering about exterminator coming in (entered in pest request book). Review of the Resident Council Minutes for the week of 1/25/21 showed staff conducted 1 to 1 resident meeting at the facility. Under the term Old Business the words pest control were documented without additional information. Under the term New Business it was documented Resident #37 continued to complain of pest. The Resident Council Minutes Dated 3/10/21 showed Resident #62 attended the in-person meeting with other residents and staff. Under the heading New Business the form read, Pest control (comes every other Monday). On 3/30/21, review of the Pest Control Logbook from the first floor showed documentation on 2/18/21 of roaches everywhere in room [ROOM NUMBER]. (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: 106089 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 106089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/01/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Conch Republic Nursing and Rehab 5860 W Junior College Rd Key West, FL 33040 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)