Inspection·October 26, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interviews and medical record review, the facility failed to ensure the accurate nursing skin evaluation and coordination of care between dietary and physician services for nutritional supplements for 1 (Resident #45) of 3 residents reviewed for pressure wounds. Residents Affected - Few The findings included: Review of the Quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #45 had 2 unhealed stage 3 pressure ulcers and was receiving pressure ulcer care at the facility. Review of the admission and discharge record for Resident #45 revealed the resident was discharged from the facility on 10/5/23 and readmitted on [DATE]. Review of the progress note dated 10/5/23 at 5:32 p.m. revealed Resident #45 was sent to the hospital. Review of the progress note dated 10/17/23 at 5:20 a.m. revealed the resident returned to the facility. Review of the admission Nursing Comprehensive Evaluation for Skin completed on 10/17/23 revealed Resident #45's skin was intact and did not include the 2 unhealed stage 3 pressure ulcers. Review of the Medication Administration Record (MARs) revealed Resident #45 was receiving wound care treatments to the right heel and left buttock from 9/8/23 until 10/4/23. On 10/17/23, wound care treatments to the right heel and left buttock were reordered. Review of the MARs revealed Resident #45 was given Prostat 30 milliliters (ml) twice a day (BID) for wound healing from 9/6/23 until 10/5/23, when the resident was discharged to the hospital The nutritional supplement was not restarted after the resident returned from the hospital on [DATE]. On 10/25/23 at 1:17 p.m., Registered Nurse (RN) Unit Manager Staff K confirmed Resident #45 had open wounds to the right heel and left buttock and wound treatments were restarted on 10/17/23 when the resident returned from the hospital. The Unit Manager said she did not know why the nutritional supplement needed for wound healing was not restarted on 10/17/23 when the resident returned from the hospital. On 10/25/23 at 1:21 p.m., during a telephone interview with the Registered Dietician (RD), she confirmed she recommended Prostat 30 mls BID for wound healing due to multiple skin impairments. She said she did not know the resident was discharged on 10/5/23 and returned to the facility on [DATE]. She said she did not know the supplement was not restarted on 10/17/23. She said the facility does not (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: 105522 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 105522 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lehigh Acres Healthcare & Rehab Center 1550 Lee Boulevard Lehigh Acres, FL 33936 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)