Health inspection·December 16, 2021

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of facility's policy and procedure and staff interview, the facility failed to assess, evaluate, and plan care to provide individualized approaches to restore as much normal elimination function as possible for 1 (Resident #4) of 6 residents reviewed with bladder incontinence. The findings included: The facility's Activities of Daily Living (ADL), supporting Policy Statement revised on 1/7/20 read, . Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with . Elimination (toileting) . Interventions to improve . a resident's functional abilities will be in accordance with the resident's assessed needs, preferences, stated goals, and recognized standards of practice . On 12/13/21 at 2:00 p.m., in an interview Resident #4 said when she presses the call light, she waits too long for staff to come and ends up having accidents and wets herself in her adult brief. Review of the Quarterly Minimum Data Set (MDS) dated [DATE] showed Resident #4 had a Brief Interview for Mental Status (BIMS) score of 9 (moderate cognitive impairment), was frequently incontinent of urine and required staff assistance with toileting. The quarterly MDS with a target date of 12/8/21 showed Resident #4 had a BIMS score of 10 (moderate cognitive impairment), was frequently incontinent of urine and required limited physical assistance of one person with toileting. Review of the facility Observation Detail List Reports completed on 9/15/21 and 12/13/21 showed a completed a bladder screen noting Resident #4's urinary pattern was upon arising, before meals, after meals and before going to bed. Each screen documented Resident #4 was a candidate for scheduled/prompted toileting. The Certified Nursing Assistant (CNA) documentation for bladder function for September and December 2021 failed to show documentation of tracking over several days to establish the urinary pattern. The care plan with a start date of 9/21/21 noted Resident #4 had episodes of bladder incontinence. The goal was to report a decrease in episodes of incontinence when asked and remain clean and comfortable daily. The approaches included to assist to the toilet upon rising, before and after meals, prior to sleep and as needed and desired. (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: 105790 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 105790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/16/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Senior Living North Naples 10949 Parnu Street Naples, FL 34109 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)