Baya Pointe Nursing And Rehabilitation Center
BAYA POINTE NURSING AND REHABILITATION CENTER in LAKE CITY, FL — inspection on May 26, 2026.
Found 2 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
(injury/decline/room, etc.) that affect the resident.
record review and interview, the facility failed to maintain accurate and complete records for 1
dated [DATE] documented the discharge location name and address as Resident #1's home address/his Responsible Party/Daughter's home address.
There was no documentation of Resident #1's name or that of his Responsible Party/daughter in the section designated for Resident/Representative Acknowledgement.Review of Resident #1's social worker progress note dated 4/23/2026 read, Resident stated that he would like to discharge home to address [an address not listed on Resident #1's admission record] on 4/23/26.
Resident stated that brother [name of brother] will be picking him up from the facility.
During an interview on 5/26/2026 at 12:54 PM, the Director of Social Work stated, He [Resident #1] wanted to leave and he didn't trust his daughter. I opened the discharge assessment [Discharge Summary] and put the address [of where the resident is going after discharge].
During an interview on 5/26/2026 at 2:02 PM, Staff A, Licensed Practical Nurse (LPN) Unit Manager, stated, He [Resident #1] left with his brother on 4/24 [2026]. I do not remember the brother's name. I think it's on the discharge summary. I remember asking his address. I remember cross-referencing the address on the facesheet with [Resident #1's name]. I couldn't tell you which brother he left with.
During an interview on 5/26/2026 at 2:26 PM, the Director of Nursing (DON) stated, It should have been documented where he [Resident #1] went [when he was discharged ].
Knowing where a resident is being discharged is required for a safe discharge and is expected to be accurately documented on the Discharge Summary.
Review of the facility policy and procedure titled Transfers and Discharges issue in 5/2020 read, Standard: The facility will develop and implement an effective discharge process that focuses on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care.
Procedure: 3.
The resident and/or representative (sponsor) will be notified in writing of the following information: c.
The location to which the resident is being transferred or discharged .
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 TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE
105846 05/26/2026
Baya Pointe Nursing and Rehabilitation Center 587 SE Ermine Ave Lake City, FL 32025
During an interview on 5/26/2026 at 2:02 PM Staff A, LPN (Licensed Practical Nurse) - Unit Manager stated, He (Resident #1) left with his brother on 4/24 [2026]. I do not remember the brother's name, I think it's on the discharge summary. I remember asking his address. I remember cross-referencing the address on the facesheet with [Resident #1's name]. I couldn't tell you which brother he left with.
During an interview on 5/26/2026 at 2:26 the DON (Director of Nursing) stated, It should have been documented where he [Resident #1] went [when he was discharged ].
The DON stated that knowing where a resident is being discharged is required for a safe discharge and is expected to be accurately documented on the Discharge Summary.
During an interview on 5/26/2026 at 3:45 PM APRN (Advanced Practice Registered Nurse) #2 stated that she remembered Resident #1, and knew his daughter was coming in frequently to visit him. He was a heavy drinker when he was home.
She was not in the facility when he left. It was the facility's responsibility to confirm where the resident was being discharged and to ensure everything was safe at home [a safe environment for discharge].
Review of Resident #1's Census Data revealed he was admitted on [DATE] with medical diagnoses that included other sequelae of cerebral infarction; alcohol dependence with alcohol-induced persisting dementia; presence of other vascular implants and grafts; difficulty in walking, not elsewhere classified Review of Resident #1's most recent MDS (Minimum Data Set) Assessment, a Medicare 5-day assessment dated [DATE] documented his BIMS (Brief Inventory of Mental Status) Score as 7 out of 15 which indicated he had cognitive impairment. A Social Worker Progress Note dated 4/24/2026 read, Writer attempted to call [name of Resident #1's brother] in regard to resident being discharged .
Writer was unable to reach him.
Writer will inform resident. A Social Worker Progress Note dated 4/23/2026 read, Resident stated that he would like to discharge home to address [an address not listed on Resident #1's facesheet] on 4/23/26.
Resident stated that brother [name of brother] will be picking him up from the facility.
Resident declined home health and equipment.
Writer attempted to called POA [Resident #1's daughter's name] to inform her of the discharge and was unable to reach her.
Review of Resident #1's Discharge summary dated [DATE] documented the discharge location name and address as Resident #1's home address/his Responsible Party/daughter's home address.
There was no documentation of Resident #1's name or that of his Responsible Party/daughter in the section designated for Resident/Representative Acknowledgement.
Review of Resident #1's Progress notes from 4/23/2026 through 4/25/2026 revealed there was no documentation of the specific date or time Resident #1 left the facility or any details of his discharge disposition.
Review of the policy and procedure titled Transfers and Discharges, with an issue date of 5/2020 read, Standard: The facility will develop and implement an effective discharge process that focuses on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care.
Procedure: 3.
The resident and/or representative (sponsor) will be notified in writing of the following information: c.
The location to which the resident is being transferred or discharged
Frequently Asked Questions
More Reports
Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.