Health inspection·September 8, 2023

F 0700 Level of Harm - Minimal harm or potential for actual harm The Quarterly Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date of 6/21/23 documented Resident #3 required extensive assistance with bed mobility and limited assistance with transfers. The MDS noted Resident #3's cognitive skills for daily decision making were moderately impaired. Residents Affected - Few The clinical record showed a physician order dated 3/16/23 for assist rails on bilateral sides of the bed for mobility. On 9/5/23 at 2:34 p.m., and 9/6/23 at 10:27 a.m., Resident #3 was observed with side rails in the raised position on both sides of the bed. Resident #3 said she did not know how the side rails got there but they had been in place for a long time. 2. Review of the clinical record revealed Resident #27 was admitted on [DATE] with diagnoses including chronic kidney disease stage 3 unspecified, weakness, and unilateral primary osteoarthritis. The Quarterly MDS dated [DATE] documented Resident #27 required supervision with transfers and ambulation. The MDS noted Resident #27's cognitive skills for daily decision making were intact. The clinical record showed a physician order dated 12/1/21 for grab bars as enablers on both sides of the bed for mobility. On 9/5/23 at 2:05 p.m., Resident #27 was observed with side rails raised on both sides of the bed. The resident said she did not ask to have the rails placed on the bed but said she did use them to move in bed. 3. Review of the clinical record revealed Resident #51 was admitted on [DATE] with diagnoses including dementia, history of falls, muscle weakness, anxiety, and depression. The admission MDS with ARD 8/18/23 documented Resident #51 required extensive assistance of 1 with bed mobility and transfers. The MDS noted Resident #51's cognitive skills for daily decision making were severely impaired. The physician order dated 8/19/23 specified assist rails to bilateral bedside for mobility. On 9/5/23 at 3:05 p.m., Resident #51 was observed in bed with side rails in the raised position on both sides of the bed. On 9/6/23 at 11:51 a.m., in an interview the Assistant Director of Nursing (ADON) said the process for side rails was for the therapy department to assess the resident to see if they can benefit from the side rails. The ADON said if the resident qualified to have the side rails placed, then we get a consent form signed by the resident or family. The ADON said once an order is received from the physician, maintenance will come and place the side rails. On 9/6/23 at 12:25 p.m., in an interview the Director of Nursing (DON) said all bed rails in the facility are considered side rails. The DON said the process for side rails was for Occupational Therapist (OT) to complete an assessment to see if they can use the side rail or not. If they can benefit from the side rails to move in bed and transfer then the OT completes the Brief Initial Therapy Eval Review and the nurse obtains an order from the physician. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105790 If continuation sheet Page 2 of 5 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 09/08/2023 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)

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 9/6/23 at 12:39 p.m., in an interview the Therapy Director, said OT completes the side rail evaluations for the residents and determines if they are necessary or not. On 9/6/23 at 12:55 p.m., in an interview the OT said she completes the side rail screens with the Physical Therapist (PT) during treatment. If a resident can turn and use the side rail to reposition themselves then they would benefit from the use of the side rail. The OT said prior to initiating the side rails, we assess the resident for 30 minutes to 70 minutes and sometimes over 1-4 days to see if they benefit from the side rail use. The OT said all the interventions attempted prior to use of the rails were documented in the therapy notes. On 9/6/23 at 1:37 p.m., a review of the OT notes for Residents #3, #27 and #51 revealed no documentation of a side rail assessment or interventions attempted prior to installation of the side rails. On 9/6/23 at 2:26 p.m., the OT confirmed she did not have documentation of the interventions attempted prior to the use of the side rails for Residents #3, #27 and #51. On 9/6/23 at 3:15 p.m., in an interview the Therapy Director said the therapy notes do not document any information regarding side rails or interventions attempted prior to use. The Therapy Director said the therapist completes the Brief Initial Therapy Eval Review for use of the side rails. She said if the residents benefit from it and they can turn, get up and reposition themselves with the side rails then we recommend it. The nurse is responsible for obtaining the physician order and the consent from the resident and or family. The Therapy Director confirmed the form used did not have documentation of interventions attempted or the reason for the side rails. On 9/6/23 at 3:35 p.m., the DON, she said the facility used the Brief Initial Therapy Eval Review form as the assessment for use of the side rails. The DON said we call them side rails not enablers or assist bars. The therapy department determines if the resident should have the side rails or not. It is not used as a restraint; it is used to assist the resident and improve their function and ability. The DON said she was not aware alternate interventions were required before placing the side rails. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105790 If continuation sheet Page 3 of 5 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 09/08/2023 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)

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, review of facility policy and procedures and staff interviews, the facility failed to ensure eye drops and insulin were properly dated when opened and stored 2 of 3 medication carts reviewed. Without an open date on the medication there was no way to know when it would expire. This had the potential for residents to receive medications that could create hazardous health consequences. The findings included: The facility policy Medication Storage in the Facility (revised 1/18) documented Medications and biological's are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. Expiration dates (beyond use date) of dispensed medications shall be determined by the pharmacist at the time of dispensing. When the original seal of a manufacturer's container or vial is initially broken, the container or vial will be dated. The nurse shall place a date opened sticker on the medication and enter the date opened and the new date of expiration. The expiration date of the vial or container will be 30 days unless the manufacturer recommends another date or recommendations/guidelines require different dating. On 9/5/23 at 10:20 a.m., during an observation of medication cart #2 with Licensed Practical Nurse (LPN) Staff A the following was observed: 1. One open Humalog Kwik Pen insulin without a date of when it was opened. The pharmacy label documented to discard after 28 days. Photographic evidence obtained. 2. One open Humalog Kwik Pen insulin with the resident name partially removed from the label. There was no open date on the insulin pen and no open date on the pharmacy bag containing the insulin pen. Photographic evidence obtained. The findings in medication cart #2 were verified by Staff A. On 9/55/23 at 10:43 a.m., during an observation of medication cart #3 with LPN Staff B the following was observed. 3. One Humalog Kwik Pen insulin with no open date on the pharmacy bag or the insulin pen. The pharmacy label specified to discard the medication after 28 days. Photographic evidence obtained. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105790 If continuation sheet Page 4 of 5 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 09/08/2023 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)

F 0761 4. One opened bottle of Dorzolamide 2% eye drops with no open date on the bottle or pharmacy bag. The Pharmacy label specified to discard the eye drops in 60 days. Level of Harm - Minimal harm or potential for actual harm Photographic evidence obtained. Residents Affected - Few The findings in medication cart #3 were verified by LPN Staff B. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105790 If continuation sheet Page 5 of 5