Above average — CMS composite of the measures below.
A standard survey is most likely before around December 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 Life Care Center Of Sarasota during CMS and state inspections, most recent first.
A deficiency was cited for not ensuring that an area was free from accident hazards and for failing to provide adequate supervision to prevent accidents. The report notes that the environment did not meet safety standards and that oversight was insufficient to protect residents from potential accidents.
A resident with severe cognitive impairment and a history of falls was found on the floor with a hip fracture after an unwitnessed fall. Multiple staff confirmed the fall was not observed, and the cause was unknown. Although the family and physician were notified, the injury of unknown origin was not reported to the appropriate authorities as required by facility policy.
A deficiency was cited when a resident's care plan did not address all of their needs and lacked measurable timetables and specific actions, resulting in incomplete planning and documentation.
A resident did not receive appropriate care to maintain or improve ROM and mobility, and there was no documented medical reason for the decline. The facility failed to ensure necessary interventions were provided to prevent avoidable decline.
Surveyors observed a medication error rate of 13.33%, exceeding the acceptable threshold, due to staff failing to prime insulin pen injectors before administration and administering a discontinued medication. Errors involved multiple residents with diabetes and other chronic conditions, and staff did not consistently follow facility policies for medication preparation and verification.
QAPI failed to fully address deficiencies involving care plan updates and fall prevention. Two residents did not have their care plans revised with appropriate fall interventions, and two residents experienced falls with major injury while another resident had multiple falls. The DON stated the facility’s response focused on orthotics and residents moved from the memory care unit, but staff were not educated on the full scope of F689 and fall prevention.
A resident with physical and cognitive limitations was left unsupervised in a courtyard for about an hour during peak heat, resulting in unresponsiveness and skin damage from sun exposure. Staff interviews indicated a lack of adequate monitoring and hydration, despite care plan interventions and facility policy requiring supervision and periodic checks for residents outdoors. The resident required hospital treatment for heat exposure and related skin injuries.
A resident with physical limitations and a need for assistance was left unsupervised in the courtyard for about an hour during peak heat, resulting in unresponsiveness and significant skin damage from sun/heat exposure. Staff interviews and record reviews showed that required supervision and periodic checks were not performed, and facility policy for monitoring residents outdoors was not followed.
Failure to Maintain Safe Environment and Supervision
Penalty
Summary
A deficiency was identified due to the failure to ensure that a nursing home area was free from accident hazards and that adequate supervision was provided to prevent accidents. The report notes that the environment did not meet safety standards, and there was insufficient oversight to protect residents from potential accidents. Specific details regarding the actions or inactions of staff, the nature of the hazards, or the condition of any residents involved are not provided in the report.
Failure to Report Injury of Unknown Origin
Penalty
Summary
The facility failed to report an injury of unknown origin for a resident who experienced an unwitnessed fall resulting in a hip fracture. Multiple staff interviews confirmed that the fall was not observed, and the resident was found on the floor by staff, complaining of pain. The resident, who had severe cognitive impairment and was dependent on staff for activities of daily living, was later sent to the hospital where imaging confirmed a right femur fracture. Documentation showed that the incident was unwitnessed, and the cause of the fall was unknown. The resident's family and physician were notified, but there was no evidence that the injury of unknown origin was reported to the appropriate authorities as required by facility policy. Review of the facility's policy indicated that all alleged violations, including injuries of unknown origin, should be reported to other agencies or law enforcement authorities. The Director of Nursing acknowledged that a five-day adverse event report should have been completed and that the incident should have been reported. The failure to report the injury of unknown origin constituted a deficiency in the facility's obligation to timely notify proper authorities of suspected abuse, neglect, or injury of unknown origin.
Incomplete Care Plan Development and Implementation
Penalty
Summary
A deficiency was identified due to the facility's failure to develop and implement a complete care plan that addresses all of a resident's needs. The care plan lacked measurable timetables and specific actions, resulting in incomplete documentation and planning for the resident's care requirements. This deficiency was observed through review of the care plan documentation, which did not include all necessary elements to ensure comprehensive care for the resident.
Failure to Provide Care to Maintain or Improve Range of Motion
Penalty
Summary
A deficiency was identified regarding the facility's failure to provide appropriate care to maintain and/or improve a resident's range of motion (ROM), limited ROM, and/or mobility. The report notes that care was not provided as required, and there was no indication that the decline in ROM or mobility was due to a medical reason. This failure resulted in the resident not receiving necessary interventions to prevent avoidable decline in their physical functioning.
Medication Error Rate Exceeds Acceptable Threshold Due to Insulin Pen and Order Verification Failures
Penalty
Summary
The facility failed to maintain a medication error rate below 5%, as required, with surveyors observing a 13.33% error rate during medication administration. Thirty medication opportunities were observed, and four errors were identified involving residents with complex medical histories, including diabetes, anemia, and vitamin D deficiency. Specific deficiencies included staff failing to prime insulin pen injectors before administration, as observed with multiple residents receiving insulin. In one instance, a registered nurse administered insulin without priming the pen, stating, "I don't do that" when questioned. In another case, an LPN also failed to prime the insulin pen for two different residents, later admitting to forgetting this step. These actions were in direct violation of the facility's insulin pen administration policy, which requires priming prior to each use to prevent air collection in the reservoir. Additionally, a medication was administered to a resident after the order for that medication had been discontinued, as confirmed by review of the medication administration record and facility orders. The facility's policies require staff to verify medication, dose, route, rate, time, and resident identity prior to administration, but these procedures were not consistently followed. The Director of Nursing acknowledged awareness of the errors and confirmed that staff had recently received training on insulin administration, which included the requirement to prime pens, but staff did not adhere to this protocol during observed medication passes.
QAPI Plan Failed to Address Falls and Care Plan Deficiencies
Penalty
Summary
The facility’s QAPI program failed to implement an effective plan of correction for deficiencies identified during the recertification survey. The report states that the facility did not ensure updated care plan interventions were in place for two sampled residents, Resident #2 and Resident #10, related to falls. The revisit survey and complaint surveys found that the same deficiency remained out of compliance because the residents’ care plans had not been updated or revised with appropriate interventions. The report also states that the facility failed to prevent a fall with major injury for two residents, Resident #1 and Resident #2, and failed to prevent multiple falls for Resident #10. These findings were identified during the revisit survey conducted to verify compliance with F689. The interview with the NHA, DON, and RNC documented that the facility’s corrective action had focused on orthotics and residents transferred out of the memory care unit, rather than addressing the broader fall prevention and supervision issues identified in the survey findings. The facility’s own QAPI policy states that the program is to be ongoing and comprehensive and address all systems of care and management practices. However, the report indicates that the plan of correction did not address the full scope of the deficient practices related to care plan updates, fall prevention, and supervision needs for the affected residents. The DON stated that staff education had been provided on orthotics and that the facility had looked at supervision needs for residents who fell, but the report notes that the facility did not educate staff on the entirety of F689 and fall prevention.
Deficient Supervision Leads to Resident's Heat Exposure and Hospitalization
Penalty
Summary
A deficiency occurred when a resident was left unsupervised in the facility's courtyard for approximately one hour during the hottest part of the day, from 2:45 p.m. to 3:45 p.m. The resident, who had a history of physical limitations, difficulty walking, and required assistance with personal care, was found unresponsive and had to be transferred to a hospital for treatment related to sun and heat exposure. The resident's care plan included interventions to avoid exposure to extreme heat and to observe for symptoms such as sweating, tremor, and lack of coordination, but these interventions were not effectively implemented. Multiple staff interviews revealed that the resident was last seen in the activity room eating ice cream before going outside. Staff responsible for monitoring residents outside, including activities staff and CNAs, did not provide adequate supervision or hydration during the resident's time outdoors. The resident was discovered by another staff member who noticed he was unresponsive and not at his usual baseline. Upon assessment, the resident was found to be very warm to the touch and unable to respond appropriately, prompting emergency services to be called. Medical records and hospital documentation confirmed that the resident suffered from heat exposure and developed skin damage, including redness and fluid-filled blisters on areas exposed to the sun. The facility's policy required periodic monitoring, hydration, and appropriate supervision for residents outdoors, especially those with moderate to severe impairments. However, these procedures were not followed, resulting in the resident's adverse health event.
Plan Of Correction
This plan of correction is submitted as required under Federal and State regulations and statutes applicable to long term care providers. This plan of correction does not constitute an admission of liability on the part of the facility, and such liability is hereby specifically denied. The submission of this plan does not constitute agreement by the facility that the surveyors' findings or conclusions are accurate, that the findings constitute a deficiency, or that the scope of severity regarding any of these deficiencies cited are correctly applied. In order to ensure that the services provided at Life Care Center of Sarasota meet the professional standards of quality, the team has initiated the following plan of correction: Resident #1 was discharged from the facility. Residents who enjoy outdoor activities have the potential to be affected by not providing adequate supervision to prevent exposure to the sun/heat. The facility revised and implemented a new process for the courtyard that includes designated times in which the courtyards will be open and supervised pending inclement weather. The Executive Director and or designee will educate the facility staff on the courtyard process, courtyard hours, communication, supervision, and sign-out process for residents who enjoy outdoor activities. The Executive Director and or designee will complete 5 random audits per week on the facility courtyard process, which will include communication and supervision. The results of the audits will be tracked, trended, and reported to the monthly Quality Assurance and Performance Improvement meeting for a period of three months or until sustained compliance is achieved.
Deficiency Due to Lack of Supervision Resulting in Resident's Sun/Heat Exposure
Penalty
Summary
A deficiency occurred when a resident was left unsupervised in the facility's courtyard for approximately one hour during the hottest part of the day, from 2:45 p.m. to 3:45 p.m. The resident, who had a history of physical limitations, difficulty walking, and required assistance with personal care, was found unresponsive and had to be transferred to a higher level of care for treatment related to sun and heat exposure. The resident subsequently developed skin damage, including redness and fluid-filled blisters on the arms and thighs, as documented in medical records and provider notes. Staff interviews revealed that the resident was last seen by the activities assistant around 2:30 p.m. in the activity room eating ice cream, after which the resident went outside. Multiple staff members, including the DON and activities staff, stated that residents who are alert and oriented are allowed to go outside, but are supposed to be checked on periodically and offered hydration and sunscreen. However, on the day of the incident, no staff were present in the courtyard to supervise or monitor the resident, and it was not clear how long the resident had been outside before being found unresponsive by another staff member who happened to be passing by. The facility's policy required periodic monitoring of residents in outdoor areas, especially in warmer weather, and specified that residents with moderate to severe impairments should be attended by staff or a visitor when outside. Despite these policies, the resident was left unattended, and staff were unable to account for the resident's whereabouts or provide documentation of supervision during the critical period. The lack of adequate supervision and failure to follow established procedures directly led to the resident's exposure to hazardous conditions and subsequent medical complications.
Plan Of Correction
This plan of correction is submitted as required under Federal and State regulations and statutes applicable to long term care providers. This plan of correction does not constitute an admission of liability on the part of the facility, and such liability is hereby specifically denied. The submission of this plan does not constitute agreement by the facility that the surveyors' findings or conclusions are accurate, that the findings constitute a deficiency, or that the scope of severity regarding any of these deficiencies cited are correctly applied. In order to ensure that the services provided at Life Care Center of Sarasota meet the professional standards of quality, the team had initiated the following plan of correction: Resident #1 was discharged from the facility. Residents who enjoy outdoor activities have the potential to be affected by not providing adequate supervision to prevent exposure to the sun/heat. The facility revised and implemented a new process for the courtyard that includes designated times in which the courtyards will be open and supervised pending inclement weather. The Executive Director and or designee will educate the facility staff on the courtyard process, courtyard hours, communication, supervision, and sign-out process for residents who enjoy outdoor activities. The Executive Director and or designee will complete 5 random audits per week on the facility courtyard process which will include communication and supervision. The results of the audits will be tracked, trended, and reported to the monthly Quality Assurance and Performance Improvement meeting for a period of three months or until sustained compliance is achieved. F 689 F 689 F 689 F 689 F 689 F 689 F 689
Removal Plan
- Courtyards were rounded on hourly, all who chose to go outside offered hydration, sunscreen and encouraged to wear sunblock.
- Courtyard re-opened with checks conducted by the Activities Director, Executive Director and/or designee.
- 100% of staff provided education as to inclement weather policy and facility procedures for facility courtyards.
- Current facility practice of communication ensures nursing is made aware of residents leaving unit to participate in an outdoor activity.
- Care plans updated as appropriate.
- Courtyard closed for renovations.
- At the recommendation of the Ad Hoc QAPI committee, education regarding upcoming courtyard process change, sign in and sign-out process for front desk.
- Education regarding new courtyard process sent to residents/families, front desk/receptionist staff.
- Met informally with resident council president to discuss courtyard process.
- Courtyard re-opened with distinct opportunities to utilize with 100% supervision. All dependent upon inclement weather policy.
What surveyors are citing around you — mapped
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What surveyors actually found near you
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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 Sarasota
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Siesta Key Health And Rehabilitation Center | 1.9 mi | ★★★★★ | 1 | 0 |
| Hawthorne Center For Rehab & Healing Of Sarasota | 3.1 mi | ★★★★★ | 0 | 0 |
| Indian Beach Nursing And Rehab Center | 3.3 mi | ★★★★★ | 5 | 0 |
| Birchwood Health And Rehabilitation Center | 3.4 mi | ★★★★★ | 8 | 0 |
| Pines Of Sarasota | 3.5 mi | ★★★★★ | 2 | 0 |
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