Health inspection·January 18, 2024

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, interview, and facility policy review, the facility failed to ensure the resident care plan for one (Resident #1) of three residents reviewed for falls, was revised to reflect new interventions for risk of injury due to recent falls. Failing to revise care plans places the residents at risk of not receiving appropriate care. The findings include: A review of Resident #1's medical record revealed she was admitted to the facility on [DATE] with a re-entry on 12/5/23 with diagnoses of muscle wasting, unsteadiness on feet, unspecified dementia, and Parkinson's disease. Further review of Resident #1's medical record revealed she had falls in the facility on 11/8/23, 11/19/23, 12/4/23, and 1/9/24. A review of Resident #1's care plan initiated on 8/30/22 revealed she was at risk for falls with a goal to minimize risk for injury related to falls with interventions in place. However, interventions were noted to remain the same, and no documentation was found to support the facility had revised the resident's care plan, for effectiveness, following her falls on 11/8/23, 11/19/23, 12/4/23, and 1/9/24. (Photographic evidence obtained) On 1/18/24 at 2:22 PM, an interview was conducted with the MDS Coordinator, in the presence of the administrator. She was asked if Resident #1's care plan should have been updated or reviewed after the residents multiple falls in the facility due to her at risk for falls. The MDS Coordinator confirmed that although interventions were in place and the resident was appropriately assessed following each fall, the care plan did not reflect this. A review of the facility's policy titled, Care Plans, Development Baseline and Comprehensive issued on 11/2001, (revised on 5/2023) revealed: Comprehensive Care Plan 13. Assessments of residents are ongoing and care plans are revised as information about the residents' conditions change. (Photographic evidence obtained) A review of the facility's polity titled, Falls and Falls Risk, Managing issued in 2001, (revised on 3/2018) revealed: (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 2 Event ID: 105402 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 105402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeview Center 350 S Ridgewood Avenue Ormond Beach, FL 32174 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)