Life Care Center Of Port Saint Lucie

F-F550). These residents stated there was not enough staff to care for the needs of residents and that the care they did receive was often in an undignified manner.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 24 106012 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 106012 B. Wing 08/08/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Port Saint Lucie 3720 SE Jennings Rd Port Saint Lucie, FL 34952

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 0761 Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately Level of Harm - Minimal harm or locked, compartments for controlled drugs. potential for actual harm 39142 Residents Affected - Few Based on interview, record review and observation, the facility failed to keep medications secured as evidenced by an observation of dispensed and open medications at the bedside for 1 of 1 sampled residents (Resident #55) and failed to ensure medication carts were free of expired medications in 1 of 3 medication carts with the potential to negatively affect 1 resident (Resident #314), who was prescribed Ferrex 150 MG, which was expired.

The findings included:

The facility's Pharmacy Services and Procedure Manual, last revised 08/07/23, under the Procedure section has requirements listed in numerical sequence. Item #2 is worded as follows:

Facility should ensure that medications and biologics are stored in an orderly manner in cabinets, drawers, carts, refrigerators/freezers of sufficient size to prevent crowding.

Item 3.3 is worded as follows:

Facility should ensure all medications and biologicals, including treatment items, are securely stored in a locked cabinet/cart or locked medication room that inaccessible by residents and visitors.

Item 4 is worded as follows:

Facility should ensure that medications and biologics that: (1) have an expired date on the label; (2) have been retained longer than recommended by the manufacturer or supplier guidelines; or (3) have been contaminated or deteriorated , are stored separate from other medications until destroyed or returned to the pharmacy or supplier.

Item 5 is worded as follows:

Once any medication or biologic package is opened, Facility should follow manufacturer/supplier guidelines with respect to expiration dates for opened medications. Facility staff should record the date opened on the primary medication container (vial, bottle, inhaler) when the medication has a shortened expiration date once opened or opened.

1) Record review revealed Resident #55 has a Brief Interview for Mental Status (BIMS) score of 14/15, which is considered cognitively intact.

Resident #55 has medications administered by mouth in the mornings. The following is a list of medications which is not inclusive of all medications:

- Metoprolol Tartrate Oral Tablet 25 MG Give 1 tablet by mouth two times a day for HTN (Hypertension) Hold for SBP (Systolic Blood Pressure)<110, HR (Heart Rate)<60 (Active)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 22 of 24 106012 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 106012 B. Wing 08/08/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Port Saint Lucie 3720 SE Jennings Rd Port Saint Lucie, FL 34952

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 0761 - Methadone HCl Oral Tablet 10 MG Give 1 tablet by mouth two times a day for pain (Active)

Level of Harm - Minimal harm or - Metformin HCl Oral Tablet 500 MG Give 1 tablet by mouth two times a day for Hypoglycemia (Active) potential for actual harm - Lactobacillus Oral Capsule Give 1 capsule by mouth one time a day for supplement (Active) Residents Affected - Few - Apixaban Oral Tablet 5 MG Give 1 tablet by mouth every 12 hours for AFIB (Atrial Fibrillation) (Active)

- Amlodipine Besylate Oral Tablet 5 MG Give 5 mg by mouth one time a day for HTN hold for SBP <110; HR <60 (Active)

On 08/6/2024 at 9:59 AM, while interviewing Resident #55, it was noted that the resident had medications laying on a napkin. The resident explained he was waiting for the nurse to come back with a medicine cup so

he could take the medications. Resident # 55 explained he had poured his medications onto a napkin because he was suspicious that one of the medications was not one he was taking before. Resident #55 stated the nurse took away the medicine cup after he poured the medications out. The nurse came into the room, while the surveyor was present, and showed Resident #55 the medication cards for the medications given to Resident #55. Resident #55 was satisfied with the nurse's explanation and took his medications at that time in the presence of the nurse.

Photographic Evidence Obtained

39167

2) On 08/07/24 at 2:13 PM the medication storage review process was started at the Ocean Unit, medication cart #2 was audited (this cart had medications for Residents in rooms 213-226). There were 3 bottles of expired medications found in the cart included: 2 bottles of Ferrex (iron) 150 mg which was open and a bottle of Ibuprofen 200 mg which was open, the medications were expired in July 2024. At 2:15 PM the Ocean Unit Manager was asked to print out a list of residents who were on those medications. It was revealed Resident #314 was on Ferrex 150 mg. Clinical record review for Resident #314 showed evidence he received Ferrex 150 mg on 08/06/24 and 08/07/24 at 8 AM.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 23 of 24 106012 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 106012 B. Wing 08/08/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Port Saint Lucie 3720 SE Jennings Rd Port Saint Lucie, FL 34952

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 0803 Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Level of Harm - Minimal harm or potential for actual harm 25404

Residents Affected - Few Based on menu and recipe review, observation, and interview, the facility failed to ensure an adequate protein portion for all residents eating the regular meal for lunch on 08/07/24. Upon entrance there were 108 residents in the facility with the potential to affect the 70 residents who consume a regular diet, including sampled Residents #77, #164, #49, #34, #54, #57, #53, #74, #76, #3, #12, and #55.

The findings included:

Review of the menu for Week 2 revealed the lunch for Wednesday 08/07/24 included kielbasa with peppers and onions. The kielbasa was the meat protein for that meal. Review of the diet spread sheet for the meal documented the serving size to be 4 ounces of kielbasa with 2 ounces of the peppers and onions. Review of

the production recipe instructed to serve 4 ounces of sausage (kielbasa) with 3 ounces of vegetables.

An observation of the lunch line service on 08/07/24 beginning at 11:20 AM revealed a large pan on the steam table containing sliced kielbasa mixed with onions and green peppers. Staff D, the cook for that day, used a 4-ounce ladle to portion out and serve the kielbasa and vegetables for each resident. Observations were made of the entire first and second carts that serviced the restorative and main dining room. Each portion of kielbasa and vegetables had about 6 slices of the kielbasa, give or take one slice.

At the end of the service on 08/07/24 at approximately 12:50 PM, the cook was asked to weigh 6 slices of

the kielbasa, the protein served for the regular diet. The cook agreed that was the average number of slices provided to each resident. The weight of the kielbasa was 2.4 ounces (Photographic Evidence Obtained).

During a side-by-side review of the diet spread sheet and recipe, both the cook and CDM (Certified Dietary Manager) agreed an inadequate protein portion was served.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 24 of 24 106012