Average — CMS composite of the measures below.
A standard survey is most likely before around November 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Laurellwood Post- Acute And Rehabilitation Center during CMS and state inspections, most recent first.
Two residents were involved in a sexual abuse incident when a CNA entered a darkened room and found one resident in a wheelchair at the bedside of another, who was lying in a fetal position with her brief pulled down, while the wheelchair-bound resident had a clenched fist against her genital area and his other hand on his exposed penis. The alleged victim had dementia, a BIMS score indicating significantly impaired cognition, and a documented lack of capacity for sexual consent, with a care plan calling for cueing, reorientation, and supervision. Staff and leadership reported that the alleged perpetrator frequently visited other residents’ rooms and masturbated in his shared room, and a prior inappropriate interaction between the same two residents in the dining room had been redirected but not reported. The resident’s representative also reported multiple prior occasions of finding the male resident in the female resident’s room with the door shut and notifying staff, who stated they would separate and monitor them more closely, indicating a failure to adequately identify, assess, and monitor behaviors that could lead to resident-to-resident sexual abuse.
A resident with dementia, behavioral disturbances, and a documented diagnosis of high-risk heterosexual behavior had a care plan addressing depression, dementia, and hypersexual behaviors, including interventions to anticipate needs, protect others, monitor behaviors, and document episodes. However, staff interviews and records showed the plan was not effectively implemented: a CNA discovered the resident in another resident’s room with the other resident’s brief pulled down and the resident’s hand against the other resident’s genital area while the resident’s penis was exposed, and a prior inappropriate interaction between the same two residents in the dining room had gone unreported. The DON, an LPN, and CNAs, including one assigned to 1:1 supervision, were unaware of the hypersexual diagnosis, specific behaviors to monitor, or the reasons for enhanced supervision, and an observation later found the resident in the dining room without continuous 1:1 supervision, contrary to the documented behavioral concerns and facility policy requiring that staff be informed of their care plan responsibilities.
Kitchen sanitation, food storage, and hand hygiene failures were observed in multiple areas. Debris was seen on surfaces above the sink, personal beverages were stored in a refrigerator, the walk-in freezer had ice buildup from a door that was not closing properly, and a nourishment room contained unlabeled resident food items. Dietary staff were also observed touching garbage cans, handling clean items and meal trays without proper hand hygiene or glove changes, wearing dangling bracelets while handling food, and working around a stove with caked-on food and an expired opened bottle in dry storage.
A resident with PTSD, major depressive disorder, generalized anxiety disorder, and psychoactive substance abuse had a prior Level I PASRR that did not lead to a Level II review despite later qualifying mental health diagnoses and ongoing psychotropic medications. The MDS and care plan documented anxiety, trauma-related symptoms, flashbacks, and psychosocial concerns, and the DON confirmed the resident needed a Level II PASRR but did not have one.
Failure to implement fall prevention interventions for a resident with a fall risk score of 15 and a history of falls. The resident’s care plan called for proper footwear and education on wearing appropriate shoes when ambulating, but staff found the resident on the floor during unwitnessed falls while wearing thong slide-on sandals and with the walker unlocked. Interviews confirmed the shoes were not appropriate, and the DON stated the care plan was not reviewed or updated after the falls.
Failure to Provide Scheduled and Requested Showers: A resident with intact cognition and maximal ADL needs reported that staff were not providing requested showers and had refused them. Record review showed multiple scheduled shower dates documented as N/A, and staff confirmed that N/A meant the showers did not occur. The resident’s care plan called for hands-on assistance with bathing, and the DON stated the resident was scheduled for showers twice weekly and could request more.
Failure to Supervise Residents to Prevent Sexual Abuse
Penalty
Summary
The deficiency involves the facility’s failure to adequately supervise residents to prevent resident-to-resident sexual abuse, resulting in an incident between two residents. A CNA reported that during a breakfast tray pass she noticed that one resident’s door, which was usually open, was closed and the room was dark. Upon entering, she observed one resident in a wheelchair at the bedside of another resident, who was lying in bed in a fetal position with her brief pulled down. The CNA saw the wheelchair-bound resident with a clenched fist against the other resident’s vagina and the other hand on his exposed penis. The CNA immediately separated the residents and removed the alleged perpetrator from the room. The resident who was the alleged victim had a history of dementia and significantly impaired cognition, with a BIMS score of 5, and was care planned for impaired cognitive function, dementia, and memory loss. Her care plan included interventions such as cueing, reorientation, supervision as necessary, and maintaining a consistent routine to decrease confusion. A facility assessment of capacity for sexual consent documented that this resident lacked capacity to consent to sexual activity. Progress notes documented that she was found lying in bed with her gown raised in a fetal position, that a head-to-toe skin check revealed no injuries, and that she denied knowing anything had occurred. Psychiatry and medical assessments noted no signs or symptoms of abuse-related distress and that she was confused but at baseline. Prior to the incident, there were indications of ongoing boundary and behavioral concerns that were not effectively addressed. The CNA stated she had worked with both residents many times and knew that the alleged perpetrator frequently went into the alleged victim’s room, appeared very friendly, and needed redirection, but she was unaware of any behavioral diagnoses until after the incident. She also described a previous inappropriate interaction in the dining room months earlier, where the male resident was at the female resident’s table smiling, and the female resident opened her legs and began to open her incontinence brief; the CNA redirected the resident but did not report the incident because she did not know about the male resident’s behaviors and did not think it was serious. The resident’s representative reported having seen the male resident in the female resident’s room with the door shut on three separate occasions, including times when he had his hand on her arm, and stated that each time they informed staff at the entrance, who said they would separate the residents and watch them more closely. Facility leadership and nursing staff reported that they were not aware of the male resident’s hypersexual behavior diagnosis or any significant behavioral issues prior to the incident, despite knowledge that he frequently masturbated in his shared room. These actions and inactions demonstrate a failure to identify, assess, care plan, and monitor residents with behaviors that might lead to conflict or abuse, as required by the facility’s abuse, neglect, and exploitation policy.
Failure to Implement Care Plan for Resident With Hypersexual Behaviors
Penalty
Summary
The deficiency involves the facility’s failure to implement care plan interventions related to a resident’s known hypersexual behaviors. The resident was admitted with dementia, behavioral disturbances, psychotic and mood disturbances, and was later diagnosed with high-risk heterosexual behavior. The resident’s care plan, initiated on 01/05/2026, identified a focus on potential behaviors related to depression, dementia, and hypersexual behaviors, with a goal of no evidence of behavior problems. Interventions included anticipating and meeting needs, assisting with appropriate coping and interaction, encouraging appropriate expression of feelings, providing opportunities for positive interaction, intervening to protect the rights and safety of others, removing the resident from situations as needed, monitoring behavior episodes to determine underlying causes, and documenting behaviors and potential causes. Despite these identified interventions, staff interviews and record review showed that the care plan was not effectively implemented. A physician note documented that over a weekend, staff observed the resident attempting to touch a female resident, and the resident was described as non-verbal with a history of impulsive behaviors. A psychiatry note indicated ongoing behavioral concerns involving inappropriate gestures toward staff and other residents, with the resident demonstrating limited awareness of their behavior. A CNA reported witnessing an incident during breakfast tray pass where the resident was found in another resident’s darkened room, with that resident lying in a fetal position with their brief pulled down, while the resident had a clenched fist against the other resident’s vagina and their other hand on their exposed penis. The CNA separated the residents and removed the resident from the room. The same CNA also described a prior unreported inappropriate interaction between the same two residents in the dining room months earlier, where the other resident opened their legs and incontinence brief toward the resident, and the CNA redirected but did not report the incident. Multiple staff interviews revealed a lack of awareness and implementation of the care plan and the resident’s hypersexual diagnosis. The DON stated she had not read the treatment plan and was unaware of the hypersexual behavior diagnosis. An LPN who had cared for the resident did not know of the hypersexuality diagnosis or behaviors, although they knew the resident frequently masturbated in a shared room. A CNA assigned to one-to-one supervision for the resident reported not knowing what specific behaviors to watch for or the reason for the one-to-one assignment. Observation in the dining area showed the resident and the other involved resident seated in the same room without staff at their tables and without continuous one-to-one supervision for several minutes, until a CNA returned with a behavior monitoring form. The Nursing Home Administrator also reported being unaware of the resident’s hypersexual behavior diagnosis and not being concerned about behavioral issues, despite the facility’s policy requiring that qualified staff responsible for carrying out care plan interventions be notified of their roles and responsibilities.
Kitchen sanitation, food storage, and hand hygiene failures
Penalty
Summary
Food service safety standards were not followed in the kitchen and in one nourishment room. During a kitchen tour, kitchen items including pans, pots, and a long grater were hanging above the three-compartment sink, and the top part of the window where they were stored had multiple black particles and debris. A circular kitchen item with sharp metal pieces inside, which appeared to be for chopping food, also had dust particles on its surface. The CDM stated the item had never been used and directed a dietary assistant to clean the area. In the walk-in refrigerator, a 20-ounce Gatorade bottle was observed on the top shelf behind a box of bananas. The CDM confirmed the bottle did not belong there and stated personal items should not be stored in the refrigerator. In the walk-in freezer, ice buildup was observed along the top and sides of the door and on top of boxes containing food items, with a small mound of ice on the floor near the door. The CDM stated a work order had been submitted and said she believed the door did not close properly. The top of the freezer door latch was observed to be off center compared with the refrigerator door, and a work order dated 7/31/25 documented that the freezer door was not closing properly and was leading to ice buildup around the door frame. In a nourishment room refrigerator, a 12-ounce plant-based protein shake was observed without a resident name or date label. In the freezer, a pint of vanilla ice cream, a frozen plastic water bottle, and a 20-ounce Gatorade bottle were observed. The CDM stated the CNA should have labeled the items with the resident’s name and that unlabeled or undated items should be discarded. During lunch tray line observations, dietary staff were seen touching garbage can lids and then handling clean items or putting on gloves without hand hygiene between tasks. One dietary assistant was observed touching his cheek and forehead while working with meal trays and beverages, and another staff member was observed wearing dangling bracelets while handling food and moving between tasks without hand hygiene and glove changes. The stove also had food caked on its sides and on the floor around it, and an opened half-full lemon juice bottle was found in dry storage without an open date and with an expiration date of 6/27/25.
Failure to Update PASARR for Resident With PTSD and Other Mental Health Diagnoses
Penalty
Summary
The facility failed to complete and update PASARR screening for a resident with mental health diagnoses after qualifying diagnoses were present in the medical record. Resident #4 had an admission history that included psychoactive substance abuse, primary insomnia, PTSD, major depressive disorder, and generalized anxiety disorder, and active orders included antianxiety, antidepressant, sedative/hypnotic medications, and zolpidem for difficulty sleeping. The resident’s prior Level I PASRR from 2020 identified anxiety disorder and depressive disorder, but the Section IV PASRR screen was marked as having no diagnosis or suspicion of serious mental illness or intellectual disability, and no Level II PASRR evaluation was completed. The resident’s quarterly MDS documented antianxiety, hypnotic, and opioid medications, and the care plan described trauma-related symptoms, anxiety attacks, flashbacks, feeling that things are unreal, memory problems, and triggers such as arguing, loud noises, and nightmares. The psychosocial care plan also identified potential alteration in psychosocial well-being related to major depressive disorder and anxiety disorder. During interview, the DON stated she was responsible for comparing diagnoses with PASRRs, that a resident review is completed when there is a change of condition, and that PTSD would have qualified the resident for a Level II PASRR; she confirmed the resident did not have a Level II PASRR and said she had not recognized that PTSD was not on the PASRR.
Failure to Implement Fall Prevention Care Plan Interventions
Penalty
Summary
The facility failed to implement care plan interventions related to falls for a resident with diagnoses including schizoaffective disorder, bipolar type, major depressive disorder, muscle weakness, unsteadiness on feet, and essential hypertension. The resident’s annual MDS showed a BIMS of 12 and indicated the resident could walk at least 150 feet independently. The resident also had a fall risk evaluation showing a fall risk score of 15, with prior falls listed on 08/16, 08/05, and 03/12 of 2025. The resident’s care plan had a fall prevention focus initiated on 08/05/2022 and revised on 03/26/2025, with a goal that the resident would not experience injury from falls through the next review date. Interventions included wearing prior footwear and educating the resident to have proper shoes on when ambulating. The record showed the resident was on antipsychotropic medications daily, and physician orders included Depakote, trazodone, and furosemide for edema. Progress notes and interviews showed the resident had falls while wearing thong slide-on sandals. One note documented the resident sitting on the floor in the dining room between a table and wall with the walker unlocked and the resident’s back against the wall; another note documented the resident sitting on the floor in front of a sink with the walker behind the resident and unlocked. Staff interviews confirmed the resident was found on the floor with thong shoes on, that proper shoes were closed-toed shoes like sneakers, and that thong sandals were not appropriate for the resident. The DON stated the resident had two falls, one unwitnessed, had lower back pain, and that a change of condition was not completed for one fall. The DON also stated an IDT meeting was not completed and the care plan interventions were not reviewed or updated after the falls.
Failure to Provide Scheduled and Requested Showers
Penalty
Summary
The facility failed to ensure a resident received ADL care related to showers. Resident #16 stated during interview that showers were not being provided by facility staff, even though the resident wanted and requested showers and staff refused to provide them. The resident’s record showed a CNA Kardex indicating the resident’s preferred bathing type, and for 07/30, 08/06, 08/10, and 08/13 of 2025 the chart reflected "N/A" for showers. Staff interviews confirmed that "N/A" meant the showers did not occur, and the shower logs for those dates could not be found. Resident #16 was re-admitted with diagnoses including muscle weakness, need for assistance with personal care, contracture of the right hand, and sequelae of cerebral infarctions. The quarterly MDS showed a BIMS score of 14 out of 15 and indicated the resident required maximal assistance with ADLs, including washing, rinsing, and drying self. The care plan identified self-care deficits related to bathing, dressing, grooming, and toileting, and included interventions for hands-on assistance with bathing as needed. The DON stated the resident was scheduled for showers on Sundays and Wednesdays, that residents could request additional showers, and that if a shower was not documented anywhere, it could not be stated that it occurred.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Saint Petersburg
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Abbey Rehabilitation And Nursing Center | 2 mi | ★★★★★ | 16 | 0 |
| Vivo Healthcare Gateway | 2.1 mi | ★★★★★ | 1 | 0 |
| Vivo Healthcare St Petersburg | 2.3 mi | ★★★★★ | 0 | 0 |
| Pinellas Park Fl Opco, Llc | 2.4 mi | ★★★★★ | 4 | 3 |
| Golfview Nursing Center | 2.9 mi | ★★★★★ | 2 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.