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. Page 1 of 3 105790 105790 12/16/2021 Solaris Senior Living North Naples 10949 Parnu Street Naples, FL 34109

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 12/14/2021 at 2:40 p.m., the MDS coordinator verified the lack of a bladder patterning to assess Resident #4's incontinence and develop individualized interventions to maintain or improve Resident #4's bladder continence. She said residents were to be evaluated for continence on admission and a monitoring record in place to assess elimination patterns. All incontinent residents were re-assessed on a quarterly basis using the Incontinence Reassessment form to determine if residents qualify for a toileting plan. Individualized plans and goals were developed based on the results of the assessment. Each resident on the monitoring program will have individual plans and goals established by the care plan team to assist the resident in acquiring lost functions or to maintain present function. On 12/14/21 at 2:35 p.m., CNA Staff A said Resident #4 will alert staff when she needs to urinate, but sometimes has already urinated in her brief when she gets to her. On 12/14/21 at 3:00 p.m., in a telephone interview, Resident #4's daughter said her mother is now incontinent, but it was not always that way. She said she visits twice a week on Wednesday and Saturday and spends two hours at the facility. Daughter said she used the call light during visits and witnessed that it takes a while for staff to answer the call bell. She said she has had to seek out staff herself so they would assist with toileting. Resident #4's daughter recalled that her mother once contacted her at 2:00 a.m. upset that staff would not come to assist her with toileting after she pressed her call bell. On 12/16/21, the Director of Nursing (DON) confirmed resident #4 was not on a toileting program based on voiding pattern and the interventions were not individualized to assist staff (licensed nurses and certified nursing assistants) to maintain and promote continence. The DON confirmed the facility failed to implement a tailored approach to improve and maintain resident's urinary function. 105790 Page 2 of 3 105790 12/16/2021 Solaris Senior Living North Naples 10949 Parnu Street Naples, FL 34109

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, staff and resident interviews, the facility failed to ensure medications were secured and remained under direct observation during medication administration for 1 (Resident #16) of 1 resident observed with unsecured medications at the bedside. The failure to properly secure medications has the potential to lead to inaccurate amount of medication taken by the resident or possible ingestion of the medication by another resident. The findings included: On 12/13/21 at 9:55 a.m., seven unidentified pills were observed on a napkin on Resident #16's over the bed table. There was also a paper cup with a prescription bottle of Atrovent nasal spray inside a plastic bag. Resident #16 said it took her a while to get the pills down so the nurse left the pills with her. During the Resident's interview Licensed Practical Nurse (LPN) Staff C walked into Resident #16's room to collect the bottle of Atrovent nasal spray. The resident told her she hadn't used it yet. Staff C left the nasal spray with the resident and left the room. Photographic evidence obtained On 12/14/21 at 11:30 a.m., in an interview, the Assistant Director of Nursing (ADON) said the facility currently did not have any resident who were allowed to self-medicate. She said when the nurses are doing medication pass, they are supposed to stay at bedside with the resident until all the medications are administered. Upon seeing the photographic evidence of the medications left at the bedside, the ADON said this was not part of facility practice. She said the nurse was new and she would reeducate her. On 12/14/21 at 2:15 p.m., in an interview the Director of Nursing verified there were no residents in the facility self-medicating and the nurses were not allowed to leave any medication unattended at bedside. On 12/15/21 at 9:50 a.m., in an interview LPN Staff C said she didn't know she couldn't leave medications unattended at the bedside for the residents. She said she was reeducated and would not leave medications at bedside anymore. 105790 Page 3 of 3