Chipola Health and Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Chipola Health and Rehabilitation Center, in the surveyor’s own words.

• No harm, potential for more than minimal, isolatedF584May 29, 2025

  Based on observations and interviews, the facility failed to provide an environment that is clean and in good condition in 3 of 50 occupied rooms. (Rooms 106B, 107A, 108A/B) The findings include: A tour of the 100 hall was conducted with the Environmental Services Director (EVS Director) on 5/29/25 at 12:20 PM. The following issues were observed: Resident room [ROOM NUMBER]B's privacy curtain had a reddish-brown smear with a quarter sized clump of what appeared to be reddish black crusted matter. Resident room [ROOM NUMBER]'s privacy curtains had multiple brownish red droplet stains. Resident 108A's privacy curtains had numerous grey stains with flecks of brown substance and a grey stain along the bottom portion of the curtain. […]

• No harm, potential for more than minimal, isolatedF641May 29, 2025

  Based on interviews, records reviews, and review of the faciity's policy and porcedure, the facility failed to conduct an accurate assessment by not assigning the proper code to the Minimum Data Set (MDS) that corresponds to the appropriate aspect of the resident care in 2 out of 6 residents. (Resident #24 and #7) The findings include: Resident #24 On 05/28/2025 at approximately 09:10 AM, a record review was performed for Resident #24 that was admitted with a past medical history including cerebrovascular disease, Diabetes-type 2 with neuropathy, Peripheral Vascular Disease, Hypertension, Alzheimer's disease, and Gastrointestinal hemorrhage. The 4/25/25 MDS section for skin documented that the resident did not have a diabetic foot ulcer. […]

• No harm, potential for more than minimal, isolatedF692May 29, 2025

  Based on observations, interviews, records and policy review, the facility failed to maintain acceptable parameters of nutritional status and electrolyte balance for 1 out of 2 enteral feeding residents by not following physician orders for enteral fluid hydration. (Resident #45) The findings include: On 05/28/25 at approximately 1:15 PM an observation was made with Nurse B with Resident #45 for her scheduled enteral feeding. After checking the placement of the percutaneous endoscopic gastrostomy tube (PEG tube) (a tube to provide nutrition directly into the stomach), Nurse B proceeded with 120cc of water via a syringe to the PEG tube, then administrated 1 carton of Jevity 1.5 per order and completed with another 120cc of water. […]

• No harm, potential for more than minimal, isolatedF755May 29, 2025

  Based upon observations and record reviews, the facility failed to ensure adequate documentation of narcotic sheets on 2 out of 3 medication carts. The findings include: On 5/28/25 at 08:00 AM, while observing medication administration and reviewing medications, an observation was made of the narcotic signage sheet for each shift to confirm accurate count of controlled drugs. It was observed that the narcotic control sheet was not signed on 4/22/25, 4/24/25, 5/2/25, 5/13/25, and 5/15/25 on the medication cart for the 100 unit. On the 300 unit, the narcotic count sheet was lacking signatures for 4/8/25, 4/12/25, 12/27/24. 12/28/24, and 1/3/25. On 5/28/25 at 08:20 AM, an interview with Nurse B was conducted. […]

• No harm, potential for more than minimal, isolatedF761May 29, 2025

  Based on observations, interviews, and policy review, the facility failed to facilitate consideration of precautions and safe administration of medication for 2 out of 6 residents as evidenced by 2 expired insulin pens present in the medication cart. The findings include: On [DATE] at approximately 08:55AM, an observation was made during medication administration and overview of the medication cart. An expired insulin pen for Basaglar 100unit/ML KWIKPEN was opened on [DATE] with a discard date of [DATE] (after 28 days) for Resident #7 and an expired insulin Novolin R 100unit/ML Flexpen opened on [DATE] with a discard date of [DATE] (after 28 days) for Resident #24 was found on the top drawer of the medication cart. […]