Health inspection·November 16, 2023

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure minimum data set assessments were accurate for 1 of 2 residents reviewed for dental services, Resident #75, and 1 of 4 residents reviewed for discharge, Resident #93. Residents Affected - Few Findings include: 1. During an observation on 11/13/2023 at 10:34 AM, Resident #75 was sitting up in bed. Resident #75 had missing teeth on the top and bottom gums. During an interview on 11/13/2023 at 10:34 AM, Resident #75 stated, I am missing teeth, which makes it difficult for me to chew. Review of Resident #75's physician order dated 9/28/2023 reads, Regular diet pureed texture, thin consistency, pt [patient] is vegan, no milk product, no meat, nutritional fruit drink in cup with meals tid [three times a day]. Review of Resident #75's Nutrition Risk Evaluation dated 9/27/2023 reads, 07. Physical/Mental Function: A. Physical and Mental Functioning: b. Out of bed with assistance, motor agitation (tremors, wandering), limited feeding assistance, supervision while eating, chewing or swallowing problems, teeth in poor repair, ill-fitting dentures or refusal to wear dentures, edentulous, taste and sensory changes, unable to communicate needs . Summary: Res [Resident] states she is vegan. States she does not eat any animal products or any food containing animal products such as milk. Res states she avoids regular bread because it is made with milk. Res refused most of lunch due to her belief that the rice and vegetables contained foods she could not eat. Spoke with ST [Speech Therapist] and CDM [Certified Dietary Manager] regarding Res c/o [complain of] not being able to chew well and regarding her refusal of foods. Res difficult to communicate with due to being HOH [hard of hearing]. Dietary and ST to work together to get list of foods Res may eat. Started on Nutritional Fruit Drink in cup for encourage Res to drink supplement. Res would not drink any other supplement due to most contain milk-based protein sources. Has severe loss of subcutaneous fat and muscle wasting. Has hx [history] of low weight and BMI [Body Mass Index]. No routine medications. Will cont [continue] with fruit drink in cup tid with meals. Will recommend MVI [multivitamin] daily. Review of Resident #75's care plan initiated on 9/27/2023 reads, Focus: [Resident #75's name] is at risk for an alteration in nutrition and /or hydration r/t: [related to:] has a chewing problem, receives mechanically altered diet, has variable PO [oral] intake, Strict vegan, Refuses foods made with animal products such a bread, cereals, severe loss of subcutaneous fat tissue and muscle wasting, hx of low wight and BMI, hx small appetite. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 9 Event ID: 105196 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lodge Healthcare and Rehabilitation Center 635 SE 17th Street Ocala, FL 34471 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)