Sabal Palms Health & Rehabilitation

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

hours after formulating the suspicion if the resident suffers serious bodily harm, or no later than 24 hours

after forming the suspicion if the resident does not suffer serious bodily harm. IV Prevention of Abuse, Neglect, Exploitation of Residents, and Misappropriation of Resident PropertyThe facility will utilize the following techniques for prevention of abuse, neglect, exploitation of residents, and misappropriation of resident property: Train staff in appropriate interventions to deal with aggressive and/or catastrophic reactions by residents.recognize signs of burnout, frustration and stress in employees that may lead to abuse.React to all allegations or questions from residents, family members, employees or visitors. Take appropriate actions when abuse, neglect, exploitation or misappropriation is suspected. Provide feedback to residents, staff and family members who voice grievances. Provide instructions to staff on care needs of residents. Supervise staff to identify inappropriate behaviors, such as using derogatory language, rough handling, ignoring residents while giving care, . Assess, monitor and develop appropriate plans of care for residents with needs and behaviors which might lead to conflict or neglect.VII Response and reporting of Abuse, Neglect, Exploitation, and MisappropriationAnyone with knowledge or concerns about the care of a resident int eh facility must report suspected abuse to the Facility Administrator, abuse agency hotline or file

a complaint with the state agency and adult protective services.immediately (but not alter than 2 hours after

an allegation is made if the events that lead to the allegation involve abuse or results in serious bodily injury) or not later than 24 hours if the events that lead to the allegation do not involve abuse and do not result in serious bodily injury. Reporting and investigation should be in accordance with state law/regulation.

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Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sabal Palms Health & Rehabilitation

499 Alternate Keene Rd NE Largo, FL 33771

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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

admission assessment to determine the resident's level of fall risk and initiate interventions on the resident's baseline care plan, in accordance with the resident's level of risk and individual needs.The nurse will refer to the facility's High Risk or Low/Moderate Risk protocols when determining primary interventions.High Risk Protocols i. Indicate fall risk on care plan. ii. Implement interventions from Low/ Moderate Risk Protocols. iii. Provide interventions that address unique risk factors measured by the risk assessment tool: medications, psychological, cognitive status, or recent change in functional status. iv.

Provide additional interventions as directed by the resident's admission, quarterly or significant change assessment. v. Appropriate interventions will be individualized to the safety needs of the resident.b. Low, Moderate Risk Protocols:i. Implement universal environmental interventions that decrease the risk of resident falling, including, but not limited to:1. A clear pathway to the bathroom and bedroom doors.2. Bed is locked and lowered to a level that allows the resident's feet to be flat on the floor when the resident is sitting on the edge of the bee3. Call light and frequently used items are within reach.4. Adequate lighting.5.

Wheelchairs and assistive devices are in good repair.6. Implement routine rounding schedule.7. Monitor-for changes in resident's cognition, gait, ability to rise/sit, and balance.8. Encourage residents to wear shoes or slippers with non-slip soles when ambulating.9. Ensure eyeglasses, if applicable, are clean and the resident wears them when ambulating.10. Monitor-vital signs in accordance with facility policy.11. Complete a fall risk assessment every 90days. Update care plan interventions as needed as resident's condition changes.Each resident's risk factors, and environmental hazards will be evaluated when developing the resident's comprehensive plan of care. a. Interventions will be monitored for effectiveness.b. The-plan of care will be revised as needed.When any resident experiences a fall, the facility will:Assess the resident.Complete-a-Post-Fall Incident-report.Place the resident on the Falling Star program for a period of 30 days or longer if determined.Notify physician and family.Review the resident's care plan and update as indicated.Document all assessments and actions.Obtain witness statements in the case of injury.Review of

a facility policy titled, Post Fall assessment policy, reviewed on 10/14/24 showed the following:Policy: All residents will be assessed immediately who fall to identify causative factors that may be related to the fall.

Upon this assessment, actions will be taken to decrease the potential for future falls.Procedure:The nurse will respond to the resident sustaining a fall.The nurse will perform a head-to-toe assessment and notify the physician as needed.The nurse will document in the medical record.The family will be notified.The DON or Supervisor on duty will be notified should there be a severe injury enough to require transportation to the hospital.The nurse will initiate an incident/accident report.All falls will be reviewed by the Interdisciplinary team who will make additional recommendations as needed for the resident's safety and document in the medical records. Changes as appropriate will be made on the resident's care plan and communicated to

the nursing staff.Nursing will implement the recommendations and monitor that preventive measures are consistently followed.

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If continuation sheet