Inspection·June 21, 2023

F 0687 Provide appropriate foot care. 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 show effective coordination to ensure 4 (Residents #6, #7, #8, and #9) of 5 residents reviewed for podiatry services received the necessary services to maintain good foot health. Residents Affected - Some The findings included: Review of facility policy titled, Nail Grooming reviewed 7/24/18 which stated, Regular fingernail care will promote cleanliness and prevent infection. The nursing staff will provide observation and care of nails for all residents daily and as necessary. Note Care of toenails will be performed by a licensed nurse or podiatrist, if the resident has a diagnosis of Diabetes or circulatory disease. On 6/21/23 at 2:30 p.m., the facility administrator said the policy was in effect until November 1, 2022, when the facility changed ownership. She said the new company did not have a policy specific to nail care or ancillary services for the facility. They had a hard time establishing a new podiatrist who would come to the facility until January 2023. On 6/21/23 at 3:00 p.m., Registered Nurse (RN), Staff C said, Toenails are addressed by podiatry. On 6/21/23 at 3:30 p.m., the Social Services Director, (SSD) provided a list of 21 long term care residents who were not seen with the new podiatry company. The SSD said, I now have them on the list to be seen 6/30/23. The SSD had no explanation why the residents on the list had not been seen since the new podiatry service started in January of 2023. A review of a sample of the residents from the list provided by the Social Service Director revealed the following: 1. Clinical records review for resident #6 revealed an initial admission to the facility on 3/29/2021. Diagnoses included Dementia, Hypertension, and hip fracture. The Quarterly Minimum Data Set (MDS) assessment dated [DATE] noted the resident was totally dependent on the physical assistance of staff for personal hygiene. Resident #6's functional range of motion was impaired on both lower extremities. The clinical record showed the last podiatry visit was dated 9/10/22. The podiatrist documented the resident was seen for routine medically necessary foot care. The podiatric assessment noted a diagnosis of clinical peripheral vascular disease unspecified and atherosclerosis (thickening or hardening) of the native arteries. (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 3 Event ID: 105387 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 105387 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ambassador Healthcare at College Park 13755 Golf Club Pkwy Fort Myers, FL 33919 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)