Health inspection·September 25, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on observation, interview, and record review, the facility failed to ensure the comprehensive care plans were implemented for 2 of 4 residents reviewed for positioning, Residents #73 and #74. Residents Affected - Few Findings include: 1) During an observation on 9/23/2024 at 9:59 AM, Resident #74 was resting with her eyes closed. The resident's feet were not offloaded while in bed. There was a yellow pillow with white cover on top of the wheelchair. During an observation on 9/23/2024 at 12:14 PM, Resident #74 was lying in bed with her eyes closed. The resident's feet were not offloaded while in bed. During an observation on 9/23/2024 at 12:53 PM, Resident #74 was lying in bed with her eyes closed. The resident's feet were not offloaded while in bed. During an observation on 9/24/2024 at 7:45 AM, Resident #74 was lying in bed with her eyes closed. The resident's feet were not offloaded while in bed. There was a yellow pillow with white cover on top of the wheelchair. During an observation on 9/24/2024 at 8:40 AM, Resident #74 was sitting up in bed with breakfast tray in front of her. The resident's feet were not offloaded. There was a yellow pillow with white cover on top of the wheelchair. During an observation on 9/24/2024 at 11:06 AM, Resident #74 was resting with her eyes closed. The resident's feet were not offloaded while in bed. There was a yellow pillow with white cover on top of the wheelchair. Review of Resident #74's care plan dated 7/12/2024 showed it read, Approaches. Float heels when in bed. 2) During an observation on 9/23/2024 at 10:00 AM, Resident #73 was lying in bed, with the bed being at the lowest position. The resident's feet were not offloaded while lying in bed. During an observation on 9/23/2024 at 12:15 PM, Resident #73 was lying in bed, with the bed at being the lowest position. The resident's feet were not offloaded while lying in bed. During an observation on 9/24/2024 at 7:46 AM, Resident #73 was resting with her eyes closed. The (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 4 Event ID: 105796 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 105796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edgewater at Waterman Village 300 Brookfield Ave Mount Dora, FL 32757 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)