Inspection·December 5, 2024

F 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to complete comprehensive assessments for the admission Minimum Data Set (MDS) for 4 of 9 residents reviewed, Residents #41, #57, #112, and #176. Findings include: 1) Review of Resident #41's admission record documented an admission date of 11/21/2024. Review of Resident #41's MDS Entry assessment dated [DATE] documented a status of accepted. There was no documentation of a completed or accepted Medicare 5-day assessment. Review of Resident #176's admission record documented an admission date of 11/19/2024. Review of Resident #176's MDS Entry assessment dated [DATE] documented a status of accepted. There was no documentation of a completed or accepted Medicare 5-day assessment. Review of Resident #112's admission record showed the resident was admitted on [DATE] and discharged home on 8/16/2024. Review of Resident #112's electronic medical records showed no discharge MDS completed. During an interview on 12/5/2024 at 10:00 AM, the Regional MDS Coordinator stated, The admission assessment should be opened between days one and eight. It was opened this morning. It should be completed by day 14. When asked if Resident #41 and Resident #176's admission assessments were in compliance with date requirements, the MDS Coordinator stated, It was not opened between days one and eight, so no. The Regional MDS Coordinator confirmed that discharge MDS assessment was not completed for Resident #112 and stated, We have 21 days after discharge to complete the Discharge MDS.2) Review of Resident #57's progress notes showed the resident was discharged home with his daughter on 8/20/2024. Review of Resident #57's electronic medical records showed no discharge MDS completed for the discharge on [DATE]. During an interview on 12/5/2024 at 10:22 AM, the Regional MDS Coordinator stated, [Resident #57's name] does not have a discharge [MDS Assessment] for 8/20 [2024], but he should have one. 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 5 Event ID: 106149 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 106149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Ridge Health and Rehabilitation Center 6517 NW 39th Avenue Gainesville, FL 32606 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)