Solaris Healthcare Lake Zephyr

In the surveyor’s words

From the most serious findings on record at Solaris Healthcare Lake Zephyr, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF656Jul 30, 2024

  Based on observations, interviews, and record review, the facility failed to implement care plan interventions related to oxygen administration for four residents (#42, #56, #60, and #71) out of 4 residents reviewed for oxygen administration. Findings include: 1. During an observation 07/15/24 at 09:38 AM, Resident #42 was lying in bed with a nasal cannula in place and the oxygen concentrator running at 1.5 liters per minute (LPM). During an observation on 7/15/24 at 1:30 PM Resident #42 was lying in bed with a nasal cannula in place and the oxygen concentrator running at 1.5 liters per minute. During an interview on 7/15/24 at 1:30 PM Resident #42 stated, I think my oxygen should be running on 3, but the nurse is the one who usually checks it. […]

• No harm, potential for more than minimal, patternF880Jul 30, 2024

  Based on observations, interviews, and record review. the facility 1) failed to adhere to infection control practice standards for personal protective equipment (PPE) while providing direct care for two residents (#98 and #319) out of eight residents on enhanced barrier precautions (EBP), and 2) failed to perform hand hygiene during medication administration during 3 out of 9 observations of medication administration. Findings included: 1. Review of the medical record showed Resident #98 was admitted on [DATE] with diagnoses including pressure ulcer of sacral region (unstageable), Peripheral Vascular Disease, Paroxysmal Atrial Fibrillation, Acute Kidney Failure, Chronic Kidney Disease (Stage 3B), and Sepsis. […]

• No harm, potential for more than minimal, patternF885Aug 18, 2022

  Based on observation, interview, and policy review, the facility failed to ensure residents, resident representatives, and visitors were notified of the COVID-19 status. Findings included: On 8/15/22 at approximately 9:00 a.m., the Nursing Home Administrator identified that there was COVID-19 positive residents in the building. A review of the facilities website on 8/18/22 at 9:35 a.m. (https://www.adventhealth.com/skilled-nursing/adventhealth-care-center-zephyrhills-south) instructed residents/representatives and potential visitors of the following for Important COVID-19 Updates: Extra Safety Measures for Your Protection Your health and safety have always been our top priority and we have expanded our policies, procedures and products to protect you and our caregivers. […]

• No harm, potential for more than minimal, patternF800Apr 2, 2021

  Based on observation, record reviews, and interviews, the facility failed to ensure that hot foods were held at 135 degrees Fahrenheit or higher on the steam table in one of one kitchen. Findings included: On 04/01/21 at 11:16 a.m., the main cook took the temperatures of the foods being served for lunch. The tuna melt was at 119 degrees Fahrenheit. The main cook reported to the Certified Dietary Manager (CDM) that the temperature of the tuna melt was at 119 degrees Fahrenheit. The CDM stated that the temperature was ok and that the recipe stated to grill cheese until melted and she continued making more tuna melts on the stove. […]

• No harm, potential for more than minimal, isolatedF585Nov 24, 2025

  Based on interviews and record review the facility failed to ensure a grievance process was followed for one resident (#5) of three residents sampled for grievances.Findings Included: Review of Resident #5's medical record revealed the resident was re-admitted to the facility on [DATE]. The medical diagnosis of the resident included: concussion with loss of consciousness status unknown, subsequent encounter trauma fall with laceration 3 centimeters with hematoma, major depressive disorder, recurrent, moderate, and adjustment disorder with anxiety. Review of Resident #5's Minimum Data Set (MDS), revealed the resident had a Brief Interview Mental Status (BIMS), score of 13 out of 15, indicating the resident's cognition was intact. During an interview at 9:54 a.m. […]