Health inspection·February 7, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the clinical record, resident, resident representative and staff interviews, the facility failed to provide the necessary care and services to maintain personal hygiene for 3 (Residents #999, #900, and #899) of 4 residents reviewed for Activities of Daily Living (ADL). Residents Affected - Some The findings included: The facility policy, Nursing-Activities of Daily Living (ADL's) documented, The facility shall ensure a resident is given appropriate treatment and services to maintain or improve his or her ability to carry out the activities of daily living . A resident who is unable to carry out activities of daily living shall receive the necessary services to maintain good nutrition, grooming and personal and oral hygiene . 1. Review of the clinical record revealed Resident #999 was 82 had an admission date of 1/11/24, with diagnoses including Parkinson's disease, sepsis, muscle weakness and need for assistance with personal care. The admission Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date (ARD) of 1/18/24 documented Resident #999 required maximum assistance of one for showers/bathing. The MDS noted Resident #999's cognitive skills for daily decision making was intact with a Brief Interview for Mental Status (BIMS) score of 13. Review of the Certified Nursing Assistant (CNA) documentation for January 2024 revealed that Resident #999 preferred showers on the 3:00 p.m., to 11:00 p.m., shift on Mondays and Thursdays. The record showed a shower was documented on 1/18/24. No other showers were documented from admission on [DATE] through discharge 1/22/24. One bed bath was documented on 1/19/24. The clinical record did not document a reason for the missed scheduled showers on 1/11/24, 1/15/24 and 1/22/24. On 2/7/24 at 9:00 a.m., the Director of Nursing (DON) confirmed the CNA documentation documented only one shower was provided to Resident #999 during the 12 days he resided at the facility. 2. Review of the clinical record revealed Resident #900 had an admission date of 11/28/23, with diagnoses including rheumatoid arthritis, muscle weakness and need for assistance with personal care. The admission Minimum Data Set (MDS) with an ARD of 12/5/23 documented Resident #900 required maximum assistance of 1 for showers/bathing. The MDS noted the residents cognitive skills for daily (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 6 Event ID: 105363 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 105363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Charlotte Bay Rehab and Care Center 4033 Beaver Lane Port Charlotte, FL 33952 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)