Tag 0880 · Severity E
Provide and implement an infection prevention and control program.
Infection Control Deficiencies · Deficient, Provider has date of correction 2025-05-07| Ownership | For profit - Limited Liability company | Certified beds | 60 |
|---|---|---|---|
| Estimated occupancy | 91.2% | Latest inspection | 2025-04-02 |
| Metric | Facility | County | Florida |
|---|---|---|---|
| Overall rating | 5 of 5 | 4 of 5 | 3 of 5 |
| Health-inspection score | 20.0 points | 18.0 points | 38.5 points |
| Total nurse staffing | 3.72 hours/day | 3.56 hours/day | 3.63 hours/day |
| RN staffing | 0.71 hours/day | 0.50 hours/day | 0.62 hours/day |
| Staff turnover | 56.8% | 48.8% | 41.8% |
| Latest health deficiencies | 4 deficiencies | 2 deficiencies | 6 deficiencies |
Comparisons describe CMS data; they are not recommendations.
Immediate-jeopardy citations: 0
Provide and implement an infection prevention and control program.
Infection Control Deficiencies · Deficient, Provider has date of correction 2025-05-07PASARR screening for Mental disorders or Intellectual Disabilities
Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction 2025-05-07Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction 2025-05-07Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies · Deficient, Provider has date of correction 2025-05-07Immediate-jeopardy citations: 0
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction 2023-07-17Provide safe and appropriate respiratory care for a resident when needed.
Quality of Life and Care Deficiencies · Deficient, Provider has date of correction 2023-07-22Immediate-jeopardy citations: 0
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Quality of Life and Care Deficiencies · Deficient, Provider has date of correction 2021-10-23Ensure each resident’s drug regimen must be free from unnecessary drugs.
Pharmacy Service Deficiencies · Deficient, Provider has date of correction 2021-10-23Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Pharmacy Service Deficiencies · Deficient, Provider has date of correction 2021-10-23Reported averages, not a real-time staffing schedule.
These group measures do not predict an individual resident’s experience.
What is driving staff turnover, and what is being done to retain nurses and aides?
Suggested because of: staff turnoverWhat fall-prevention program is used, and how are families notified after a fall?
Suggested because of: falls major injuryHow will the care plan be developed, reviewed, and shared with our family?
Suggested because of: general care planning| Reported measure | Value |
|---|---|
| Nurse aide hours | 2.13603 |
| Lpn hours | 0.86728 |
| Rn hours | 0.71489 |
| Reported total hours | 3.71819 |
| Weekend total hours | 3.31046 |
| Weekend rn hours | 0.61773 |
| Adjusted total hours | 3.83995 |
| Total turnover percent | 56.8 |
| Rn turnover percent | 66.7 |
| Administrators left | 1 |
Hours are per resident per day; turnover values are percentages. Missing values are not zero.
No matching penalties in the supplied CMS records.
Totals reflect the supplied CMS records, not a lifetime total.
Health counts describe the latest rating cycle. Fire counts cover supplied fire-safety records.
FL counts scope/severity G–L as serious deficiencies. Immediate jeopardy is J–L; these are not interchangeable.
0
| Name | Role | Share |
|---|---|---|
| DELAND FL HOLDCO, LLC | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% |
| BIGGEST ROCK SNF IRREVOCABLE TRUST | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| BP DELAND AND DAYTONA OPCO LP | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 100% |
| CAMDEN WV LLC | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| HEALTHCARE INVESTMENT HOLDINGS LLC | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| THE ADAM SASOUNESS FAMILY TRUST | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| THE DANA SASOUNESS FAMILY TRUST | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| JS FAMILY TRUST | INDIRECT OWNERSHIP INTEREST | NOT APPLICABLE |
| ALVAREZ, NORMA | MANAGING CONTROL - GOVERNING BODY | NOT APPLICABLE |
| FRIED, BINYOMIN | MANAGING CONTROL - GOVERNING BODY | NOT APPLICABLE |
| FRIED, BINYOMIN | CORPORATE OFFICER | NOT APPLICABLE |
| PINNACLE HEALTHCARE SOLUTIONS INC | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| ALVAREZ, NORMA | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| BECKMAN, ROBERT | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| FRIED, BINYOMIN | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| NURIEL, GABRIEL | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| BIGGEST ROCK SNF IRREVOCABLE TRUST | ADP OF THE SNF | NOT APPLICABLE |
| BP DELAND AND DAYTONA GENERAL PARTNER LLC | ADP OF THE SNF | NOT APPLICABLE |
| BREDLEGS HOLDINGS LLC | ADP OF THE SNF | NOT APPLICABLE |
| CAMDEN WV LLC | ADP OF THE SNF | NOT APPLICABLE |
| HEALTHCARE INVESTMENT HOLDINGS LLC | ADP OF THE SNF | NOT APPLICABLE |
| JS FAMILY TRUST | ADP OF THE SNF | NOT APPLICABLE |
| PINNACLE HEALTHCARE SOLUTIONS INC | ADP OF THE SNF | NOT APPLICABLE |
| THE ADAM SASOUNESS FAMILY TRUST | ADP OF THE SNF | NOT APPLICABLE |
| THE DANA SASOUNESS FAMILY TRUST | ADP OF THE SNF | NOT APPLICABLE |
| ALVAREZ, NORMA | ADP OF THE SNF | NOT APPLICABLE |
| BECKMAN, ROBERT | ADP OF THE SNF | NOT APPLICABLE |
| FRIED, BINYOMIN | ADP OF THE SNF | NOT APPLICABLE |
| NURIEL, GABRIEL | ADP OF THE SNF | NOT APPLICABLE |
| STURM, JOSHUA | ADP OF THE SNF | NOT APPLICABLE |
Educational information, not medical or legal advice. Data & methodology