K 000 INITIAL COMMENTS K 000
An unannounced Fire & Life Safety re-licensure
survey was conducted on 08/19/2024 at
Rosewood Healthcare & Rehabilitation Center, a
nursing home in Pensacola, Florida, in
accordance with the standards of National Fire
Protection Association (NFPA) 1 and 101 (2021
edition) and all applicable requirements of the
Florida State Fire Marshal's Rules and
Regulations, Florida Administrative Code (F.A.C.)
69A-3, F.A.C. 69A-53, F.A.C. 59A-4, and Florida
Statutes (F. S.) 400 Part II, and F.S. 633.0215,
adopting National Fire Protection Association
(NFPA) 1 and 101 (2021 edition) standards,
collectively known as the Florida Fire Prevention
Code, and all NFPA referenced standards and
requirements adopted per NFPA 101, Chapter 2.
The facility was found to be in compliance at the
time of this survey.
AHCA Form 3020-0001
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X8) DATE
Electronically Signed 08/29/24
STATE FORM
6809 GWVD21 If continuation sheet 1 of 1
DEPARTMENT OF HEALTH AND HUMAN SERVICES
PRINTED: 09/19/2024
CENTERS FOR MEDICARE & MEDICAID SERVICES
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
(X2) MULTIPLE CONSTRUCTION
IDENTIFICATION NUMBER:
A. BUILDING 01 - MAIN FED
(X3) DATE SURVEY
COMPLETED
105747
B. WING
08/19/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
ROSEWOOD HEALTHCARE AND REHABILITATION CENTER
3107 NORTH H STREET
PENSACOLA, FL 32501
(X4) ID
SUMMARY STATEMENT OF DEFICIENCIES
ID
(X5)
PREFIX
TAG
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
PREFIX
TAG
PROVIDER'S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS-REFERENCED TO THE APPROPRIATE
DEFICIENCY)
COMPLETION
DATE
K 000 INITIAL COMMENTS
K 000
An unannounced Fire & Life Safety recertification
survey was conducted on 08/19/2024 at
Rosewood Healthcare & Rehabilitation Center, a
nursing home in Pensacola, Florida.
The facility is in compliance with Code of Federal
Regulations (CFR) 42, Part 483.90, Requirement
for Long Term Care Facilities: Physical
Environment and National Fire Protection
Association (NFPA) 101 (2012 edition) and NFPA
99 (2012) requirements for nursing homes.
The facility was found to be in compliance at the
time of this survey.
Initial Plan Review: 1963
Existing
NFPA 220 Construction Type: II (222)
Number of beds: 155
Census: 139
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
Electronically Signed
08/29/2024
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 of survey these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued
program participation.
FORM CMS-2567(02-99) Previous Versions Obsolete
Event ID: 6WDV21
Facility ID: 11704
If continuation sheet Page 1 of 1
