Inspection·June 30, 2025

N0000 INITIAL COMMENTS N0000

N0040 SS = D Facility Policies Required N0040 CFR(s): 59A-4.106( ) FAC (2) Each nursing home licensee must adopt, implement, and maintain written policies and procedures governing all services provided in the facility. (3) All policies and procedures must be reviewed at least annually and revised as needed with input from the facility Administrator, Medical Director, and Director of Nursing. This LICENSURE REQUIREMENT is NOT MET as evidenced by: Based on observations, record reviews and interviews, the facility failed to follow resident care policies that are consistent with current professional standards of practice for three residents (#8, #9 and #7) of four sampled residents. Findings included: Review of a facility policy titled care, Version 1.2, showed the following: The purpose of this procedure is to provide guidelines for the care to promote healing... Steps in the Procedure-13) ...Mark tape with initials, time, and date and apply to 1. On at 9:15 AM during an interview and observation, while lying in bed, Resident #8 said he was admitted to the facility for care. An occlusive and was not dated. was observed on his left Office of Primary Care and Health Systems Management Florida Department of Health TRINITY REGIONAL REHAB CENTER 2144 WELBILT BLVD, TRINITY, Florida, 34655 --- | --- | --- | --- | ---

N0040 SS = D | Continued from page 1 | N0040 | | | | Review of Resident #8's admission record showed he was admitted on of the left lower and left and. | | | | | Review of Resident #8's "Order Summary Report" showed an order to "cleanse to left with cleanser, dry Apply , then cover with dry shift" every day (QD) and as needed (PRN), night shift. | | | | | 2. On at 12:20 PM Resident #9 was observed in the second-floor hallway with three undated on the right lower extremity. | | | | | Review of Resident #9's admission record showed he was admitted on with diagnoses to include and . | | | | | Review of Resident #9's Treatment Administration Record (TAR) dated Petroleum showed an order for Xeroform extremities at bedtime for ...apply to lower (ABD) pads and wrap with [gauze] start date at 8:00 PM. | | | | | 3. Review of the "Admission Record" for Resident #7 showed she was admitted to the facility on with diagnoses including but not limited to . and type 2 . . with | | | | | On at 9:45 AM Resident #7 was observed participating in restorative , located in the media lounge. Resident #7 had a on his lower left lateral with no date, time, or initials. | | | | | During an interview on at 11:42 AM Staff K, Licensed Practical Nurse (LPN), said after are changed "label with date and initials." | | | | | During an interview on at 2:30 PM, Staff O, LPN, Unit Manager (UM) said after are expected to follow a resident's care orders and the facility | | | | Florida State Department of Health |---|---|---|---| |---|---|---|---|---| | N0040 SS = D | Continued from page 2 policies. During an interview on at 6:10 PM during an in-person interview with the Director of Nursing (DON) and a phone interview with the Nursing Home Administrator (NHA). The DON said staff are expected to date and initial the bandage when care is completed. Class III | N0040 | | | 106079 TRINITY REGIONAL REHAB CENTER 2144 WELBILT BLVD, TRINITY, Florida, 34655 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

F0000 INITIAL COMMENTS

F0000 An unannounced complaint survey for complaint numbers 2025007123 and 2025008689 were conducted in conjunction with a revisit survey (Event ID: 4EQ12) at Trinity Regional Rehab Center on compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities.