Inspection·April 10, 2025

F 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interviews the facility failed to protect residents' right to be free from physical restraint for 1 (Resident #1) of 1 resident reviewed for restraints. Residents Affected - Few The findings included: Review of the clinical record revealed Resident #1 was re-admitted to the facility on [DATE]. Diagnoses included Traumatic Subdural Hemorrhage (bleeding in the brain), Aphasia (language disorder affecting ability to speak) following Cerebral Infarction, and muscle weakness. The admission Minimum Data Set (MDS) assessment with a target date of 11/12/24 noted the resident's cognition was severely impaired with a Brief Interview for Mental Status score of 05. Review of the facility's incident investigations revealed on 11/25/24 at 7:45 a.m., the Director of Rehab reported to the Administrator when the Certified Occupational Therapist Assistant (COTA) went to get Resident #1 for therapy, she found the resident in his room, in his wheelchair with a sitter. The resident had a gait belt around his abdomen and secured to the back of the wheelchair. The resident was assessed and there were no injuries. The investigation noted Resident #1's sitter said in an interview that she was assigned to provide one to one supervision to Resident #1 during the alleged incident. She said she had been assigned to the resident for a double shift starting at 10:00 p.m. She said Resident #1 for up at around 5:00 a.m. Resident #1 kept getting up. The therapist came by and said she would be right back to bring the resident to therapy. The sitter said she put the gait belt on because Resident #1 kept getting up. She said she was holding onto the gait belt with the resident in the wheelchair waiting for the therapist to return. It was only a few seconds and she did not attach the gait belt to the wheelchair. The investigation noted the COTA said when she went to get the resident for therapy, she saw the gait belt around the resident's abdomen and attached to the wheelchair. It wasn't tight to cause injury but secured to keep the resident in the chair. The facility's conclusion noted Resident #1 kept getting up and the sitter used the gait belt to keep the resident from getting up until therapy returned. On 4/10/2025 at 10:50 a.m., in an interview the Social Services Director said he has been at employed at the facility for about three years. He could not remember exactly what the resident said but he assisted in conducting interviews with other residents. He said all staff were educated on abuse (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: 105439 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 105439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Naples Health and Rehabilitation Center 2900 12th Street N Naples, FL 34103 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)