Centre Pointe Health And Rehab Center
CENTRE POINTE HEALTH AND REHAB CENTER in TALLAHASSEE, FL — inspection on January 8, 2026.
Found 6 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
of self-administration of medications prior to allowing the practice for 4 of 25 sampled residents.
room was conducted on 1/5/26 at 11:30 AM, 1/6/26 at 9:46 AM and 2:10 PM, 1/7/26 at 9:30 AM and 12:30 PM, and 1/8/26 at 8:30 AM. A bottle of over-the-counter eye drops was observed to be sitting on the bedside table.An observation of Resident #112's room was conducted on 1/5/26 at 12:30 PM, 1/6/26 at 8:45 AM,1:45 PM and 3:00 PM, 1/7/26 at 9:00 AM and 12:45 PM, and 1/8/26 at 8:20 AM. A bottle of over-the-counter eye drops and a prescription bottle of Ipratropium Bromide 0.06% (nasal spray) were observed sitting on the bedside table.An observation of Resident #67's room was conducted on 1/5/26 at 12:39 PM, 1/6/26 at 9:00 AM and 1:00 PM, and 1/7/26 at 9:15 AM, 12:00 PM, and 4:30 PM. A bottle of throat antiseptic spray, aspirin, ibuprofen and eye drops were observed on the bedside table.An observation of Resident #7's room was conducted on 1/6/26 at 4:30 PM and revealed an inhaler on the bedside table. (Photographic Evidence Obtained of all observations)Record Review:A review of Residents #7, #43, #67 and #112's electronic medical records revealed no physician's order for self-medication administration and no assessments for self-medication.Interviews:An interview was conducted on 1/7/26 at approximately 9:45 AM with Staff A, Licensed Practical Nurse (LPN). LPN A confirmed that there were no residents that were permitted to self-administer medications.Policy review:A review of the facility policy for self-administration of medications by residents revealed each resident who desires to self-administer medications is permitted to do so if the healthcare center's Licensed Nurse and physician have determined that the practice would be safe for the resident.
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
105563 01/08/2026
Centre Pointe Health and Rehab Center 2255 Centerville Road Tallahassee, FL 32308
bed-hold policies.
record review and staff interview, the facility failed to ensure the long term care ombudsman received
findings include:A review of Resident #156's medical record revealed the resident was transferred to the hospital on [DATE]. A review of the Nursing Home Transfer and Discharge Notice dated 11/8/25 revealed the that section the notice indicating the ombudsman received a copy of this transfer was blank. An interview was conducted with the Administrator on 1/7/26 at 4:45 PM. He stated the facility did not have evidence of transfers and discharges being reported to the ombudsman monthly.
The former case manager that was working in the facility would not respond to the facility.
105563 01/08/2026
Centre Pointe Health and Rehab Center 2255 Centerville Road Tallahassee, FL 32308
and Resident Review (PASARR) Level II screening had the evaluation completed for 1 of 1 residents
that the resident had multiple mental disorder diagnosis including Alzheimer's disease, depressive episodes, and cognitive communication deficit.
The facility completed a PASARR Level I evaluation on 6/19/25, which recommended a PASARR Level II screening.
However, the EMR contained no documentation that the facility completed the recommended PASARR Level II screening.On 1/8/26 at approximately 11:52 am, Staff C (Social Services Consultant) was interviewed.
Staff C confirmed that the completed screening was not present in the EMR and had not been completed, Staff C stated that the facility faxed the request for a PASARR Level II screening that morning.A review of the facility's undated policy entitled PASARR Guidance stated: Referral for Level II resident review evaluation is required for individuals previously identified by PASRR to have a mental disorder or intellectual disability, or a related condition who experience a significant change.
105563 01/08/2026
Centre Pointe Health and Rehab Center 2255 Centerville Road Tallahassee, FL 32308
findings include:An interview was conducted with Resident #115's representative on 1/5/2026 at 3:30
daily basis.
She expressed concerns that her mother does not get her teeth brushed daily, she is often in the same clothes for days, she has matted hair to her scalp and is unable to get it untangled.
During this interview, it was observed that Resident #115 was lying in bed with a grey t-shirt on, a brief and a sheet covering her lower extremities.
Her hair was unkempt and matted to the back of her scalp.On 01/06/2026 at 09:30 am, an observation of Resident #115 revealed she was lying in bed, with her eyes closed and oxygen in use.
She was in the same grey t-shirt from yesterday with a stain on the front of her shirt and her hair was unkempt and disheveled. Resident #115's teeth had food particles with a yellowish colored build up around her lower front bottom teeth.At 2:00 pm, an observation was conducted with Resident #115, who was observed lying in bed, continues to be in grey t-shirt with a stain on the front, and only an incontinence brief on her lower half. Resident #115 hair was still unkempt and disheveled.At 4:00 pm Resident #115 was lying in bed eyes with her daughter at her bedside.
The daughter stated she had a bath just a few minutes ago. Resident #115's hair was brushed but it was still matted at the scalp on the back of her head.
She is wearing a new blue t-shirt and has a new incontinence brief on.On 01/07/2026 at 09:15 AM, Resident #115 was lying in her wearing the same navy-blue shirt from yesterday afternoon and an incontinence brief on and her hair was disheveled and appears unkempt.
Further observations at 12:30 pm and 4:30 pm revealed no change in the situation. An additional observation on 1/8/26 at 8:15 AM revealed no changes.On 1/8/2026 at 09:00 AM an interview was conducted with Staff Member E (Certified Nursing Assistant), who stated that Resident #115 is totally dependent on staff assistance for eating, bathing, changing, and dressing and that she is incontinent of bowel and bladder.
Staff E stated that there are times she will become combative when providing care for her.
When asked if she has any training with residents who are combative with care, Staff Member E stated that they have not had any training or in-services on how to deal with combative residents during care. On 1/6/2026 at 10:00 am, a record review was conducted for activities of daily living for Resident #115.
Her shower days are scheduled for every Tuesday, Thursday, and Saturday. A thirty-day look back period for showers noted Resident #115 only received 5 showers and 1 bed bath.Resident #115's plan of care reveals she has an activities of daily living self-care deficit related to impaired functional mobility, generalized weakness, and decreased endurance with the goal that she will have needs met and that she will be clean, and well groomed.
Interventions include assist as needed to reposition, face her when speaking, provide diet as ordered, encourage her to participate to the fullest extent possible, encourage the use of call light, and explain all procedures.
105563 01/08/2026
Centre Pointe Health and Rehab Center 2255 Centerville Road Tallahassee, FL 32308
resident sampled for wound care. (Resident #122)The findings include:On 1/5/26 at approximately
dressing on the resident's left shin which had lifted along the bottom edge and was dripping a dark red fluid.
The dark red fluid drained from beneath the dressing, ran in a thin stream down the resident's leg, and dripped onto the floor. An approximate silver dollar sized pool, with several smaller drops of the dark red fluid, had formed on the floor beneath the resident's feet. At 3:45 PM, an additional observation of Resident #122 noted that staff had applied a new bandage dated with the current date.On 1/6/26, Resident #122's electronic medical record (EMR) was reviewed.
The EMR contained no documentation regarding the dressing on the resident's left shin and no skin care orders for treatment to the area.On 1/6/26 at approximately 4:45 PM, Staff D, Licensed Practical Nurse (LPN), was interviewed.
Staff D confirmed that she was Resident #122's nurse.
She was asked why Resident #122 had a dressing on her lower left leg and whether it was related to a wound or a skin condition.
Staff D stated that she was not aware of any dressing on the resident's left leg.
Staff D was asked to show documentation in the EMR explaining why the resident's leg was draining and required a dressing.
Staff D stated that the EMR contained no documentation regarding the dressing.On 1/6/26 at approximately 5:00PM the facility's Director of Nursing (DON) was asked whether the EMR contained documentation of a draining wound or skin condition requiring a dressing on Resident #122's left shin.
The DON stated that the resident had a pressure ulcer to her coccyx with treatment orders; however, the DON found no documentation in the EMR of a draining skin condition or wound on the left shin requiring dressing.
The DON stated that skin assessments for long term care residents were documented on paper and may not have been scanned into the EMR.On 1/7/26, a skin sweep (an assessment used to document areas of compromised skin integrity) was completed for Resident #122.
The skin sweep contained no documentation of a skin condition or wound to Resident #122's left leg.
The resident's most recent quarterly Care Plan included interventions for skin inspection, including observing for redness, open areas, scratches, cuts, bruises and report changes to the nurse.On 1/8/26 at approximately 9:30 AM, the DON confirmed that the facility had no documentation of any skin condition or wound to Resident #122's left shin.The facility's undated policy entitled Weekly & (as needed) PRN Skin Check.
The policy stated: 1.
The skin check should be documented on the Weekly & PRN Skin Check. If a new area is identified the appropriate Change in Condition should be initiated. 4. If there are any new areas identified: a.
Complete a Change in Condition 5.
Maintain in resident Electronic Medical Record.
105563 01/08/2026
Centre Pointe Health and Rehab Center 2255 Centerville Road Tallahassee, FL 32308
information from each unit at least once per week, initiate a resident specific infection surveillance
document on the appropriate month on the annual infection rate summary, calculate incidence rates
control prevention tea meeting, develop conclusions, recommendations, actions, and follow ups, report to risk manager / quality improvement committee as needed, provide staff training, and review and revise action plan as needed. Resident #7 On 1/7/26 at approximately 2:05 PM, Staff B, Licensed Practical Nurse (LPN), was observed administering Resident #7's scheduled intravenous (IV) antibiotics.
Staff B was observed performing all steps in the administration of Resident #7's IV medication. At no time after entering the resident's room did Staff D remove her gloves, perform hand hygiene, and don a new pair of gloves, even though she was observed touching the resident's waste basket and bedside table.
At approximately 2:10 PM, Staff B was asked about the facility's infection control policy and asked whether she should perform hand hygiene after touching the resident's bedside table and waste basket.
Staff B stated that she should have washed her hands and put on a new pair of gloves after touching those things.
At approximately 2:20 PM, the facility's Director of Nursing (DON) was asked about the expectations when nurses administer IV medications to the residents.
The DON stated that she expects all nurses to follow the infection control policy and use aseptic [clean] technique when administering IV medications.
The facility's undated policy entitled Infection Prevention - Hand Hygiene stated: The facility requires personnel to wash hands thoroughly to remove dirt, organic material, and transient microorganisms.
Hand hygiene to occur including but not limited to the following activities: Contact with contaminated items or surfaces.
Initiating/completing a clean [aseptic] procedure.