Fairway Oaks Center

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Based on interview and record review the facility failed to ensure the resident representative was notified prior to the resident's transfer for one resident (#2) of three residents reviewed for discharge.Findings Included: Review of Resident #2's Minimum Data Set (MDS), with a target date of 7/23/25, Section C, Cognitive Patterns, showed a Brief Interview for Mental Status (BIMS) score of 00. This BIMS score indicated severe cognitive impairment. The resident's representative was a family member.On 11/20/2025 at 12:51 a.m., an interview was conducted with the Social Service Director (SSD). The SSD stated there is no discharge note or documentation notifying the representative. She said consent was not provided by the representative.On 11/20/2025 at 1:31 p.m., an interview was conducted with the NHA. He confirmed he does not have any paperwork showing the representative gave consent.Review of the Nursing Home Transfer and Discharge Notice with a notice date of 7/21/2025 and an effective date of 8/19/2025, revealed

the form did not list the transfer location for the resident. The notice did not have the signature at the bottom of the page showing that the resident's representative signed before the resident was transferred to another facility.

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 REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Fairway Oaks Center

13806 N 46th St Tampa, FL 33613

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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

previously addressing this with the facility staff, but no one had come to trim them. Resident #7 stated in the past there was someone who came regularly to conduct nail trimming but Resident #7 had not seen them

in a very long time.Review of Resident #7's admission Record revealed the resident was initially admitted to

the facility on [DATE REDACTED] with medical diagnoses of unspecified atrial fibrillation, muscle weakness, muscle wasting and atrophy, and difficulty walking.Review of Resident #7's Quarterly MDS dated [DATE REDACTED], revealed Resident #7 is dependent for toileting hygiene, and requires substantial/max assistance for shower/bathe care.Review of Resident #7's shower sheets for the month of October and November 2025 revealed the following:On 10/18/25, 10/23/25, 10/27/25, and 10/30/25, Resident #7 received a bed bath. There is no documentation of nails being trimmed/cleaned.On 11/3/25, 11/6/25, 11/11/25, 11/13/25, and 11/17/25 Resident #7 received a bed bath. There is no documentation of nails being trimmed/cleaned.An interview was conducted on 11/20/2025, at 12:25 p.m., with Staff D, CNA who stated the residents do not have a specific timeframe to ensure nails are cut due to how fast the residents' nails grow. Staff D stated not everyone's nails grow at the same rate. Staff D stated she bathed the residents that are assigned to them.

Staff D did not address nail care concerns for the residents she bathed.An interview was conducted on 11/20/2025, at 3:40 p.m., with Staff A, Registered Nurse/Unit Manager (RN/UM). She stated the process to trim residents' nails was to consider if the patient was diabetic, which must be done by podiatry, but if they are not diabetic, the staff cuts the residents' nails. Staff A stated the staff members are required to check residents' nails when they are performing care or at least once a week.A review of the facility's policy titled ADL care dated 4/2020 stated their standard was that residents will be provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs).

Guideline that residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Procedure is that residents will be provided with care, treatment and services to ensure that their activities of daily living (ADLs) are met. Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with, including but not limited to: Hygiene (bathing/showers, dressing, grooming, nail care, oral care); mobility( transfer, ambulation, wheelchair, splint/brace); elimination (toileting, catheter, ostomy); dining (meals, hydration, snacks); and communication (speech, language, and any functional communication system).

Event ID:

Facility ID:

If continuation sheet

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Fairway Oaks Center

13806 N 46th St Tampa, FL 33613

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)

Federal health inspectors cited FAIRWAY OAKS CENTER in TAMPA, FL for a deficiency under regulatory tag F-F0842 during a complaint investigation conducted on 2025-11-20.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 3 deficiencies cited during this inspection of FAIRWAY OAKS CENTER.

Correction Status: Deficient, Provider has no plan of correction.