West Volusia Healthcare and Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at West Volusia Healthcare and Rehabilitation Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF600Aug 5, 2021

  Based on medical record reviews, staff interviews and a review of the facility's Abuse and Neglect Policy and Procedure, the facility failed to provide vulnerable residents protection from sexual abuse for one (Resident #1) of five vulnerable residents reviewed. The facility failed to implement adequate interventions for one (Resident #1) of five residents reviewed with known wandering behaviors and a potential to suffer physical and/or sexual abuse. On [DATE] at 4:30 p.m., Resident #1, who was severely cognitively impaired, was found in Resident #2's room, sitting on his bed with her head in his lap, performing oral sex. Resident #2 was holding his underwear. Resident #1 was not able to consent to sexual activity due to a diagnosis [MEDICAL RECORD OR PHYSICIAN ORDER] . […]

• No harm, potential for more than minimal, widespreadF812Jan 30, 2025

  Based on observations and staff interviews, the facility failed to follow proper sanitation and food handling practices to prevent foodborne illness by failing to ensure: (1) Opened refrigerated foods were labeled and dated; (2) Canned goods received from the vendor and intended for resident consumption were within the manufacturer's expiration date; and (3) Food was prepared and served from a clean, sanitary kitchen. Unsafe food handling and sanitation practices present a potential source of pathogen exposure which could result in foodborne illness. This had the potential to affect all residents who consumed foods from the facility's kitchen. […]

• No harm, potential for more than minimal, widespreadF880Jan 30, 2025

  Based on facility record review, staff interview, and facility policy and procedure review, the facility failed to develop and implement a comprehensive water management program for the purpose of reducing the risk of growth and spread of Legionella and other opportunistic pathogens in the facility water system. Residents of nursing homes who may suffer from a weakened immune system, chronic lung disease, or other underlying medical conditions such as immunosuppression, are at risk for Legionnaires' Disease (type of pneumonia) if exposed to Legionella bacteria. This had the potential to affect all residents residing in the facility. […]

• No harm, potential for more than minimal, widespreadF732Feb 23, 2023

  Based on observations and interview, the facility failed to post the nurse staffing data specified in paragraph (g)(1) of this section [ (i) Facility name. (ii) The current date. (iii) The total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift: (A) Registered nurses. (B) Licensed practical nurses or licensed vocational nurses (as defined under State law). (C) Certified nurse aides. (iv) Resident census.] on a daily basis at the beginning of each shift for 2 of 2 days observed. The findings include: On 2/20/2023 at 10:10 AM, the daily nurse staffing data had not been updated for the current date. The data posted reflected the census and nurse staffing data for 2/16/2023. […]

• No harm, potential for more than minimal, widespreadF812Feb 23, 2023

  Based on kitchen food service observations, staff interviews, facility document review, and facility policy and procedure review, the facility failed to follow proper sanitation and food handling practices to prevent the outbreak of foodborne illness, with the potential to affect all residents who consumed foods from the facility's kitchen, by failing to date mark numerous open food packages in the refrigerator and the freezer. Food handling and sanitation is important in health care settings serving nursing home residents. Unsafe food handling practices represent a potential source of pathogen exposure. The findings include: A tour of the kitchen was conducted on 2/19/2023 at 11:45 AM. […]