Health inspection·June 27, 2023

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on record review and interview, the facility failed to resolve grievances related to response to call lights in a timely manner for 4 (Residents #1, #4, #5, and #6) of 4 residents reviewed requiring assistance with activities of daily living (ADLs). The findings included: Record review of the facility's Quality Assurance Service Recovery Trending Log provided by Social Services revealed there had been six grievances filed in May 2023 related to timely call light response. 1. Record review of Resident #1's care plan indicated he was unable to self-toilet and required the assistance of one. It also indicated he was at risk for falls as related to history of multiple falls related to incontinence. During an interview on 6/26/23 at 12:57 p.m., Resident #1 said when he uses his call bell, sometimes he has to wait. He said he doesn't wear a watch, so he doesn't know how long but it was long enough to make him wonder. He said he had a couple of falls trying to get to the bathroom when no one responded to his call. 2. Record review of Resident #4's care plan indicated she requires extensive staff assistance with the majority of ADLs. Record review of Resident council minutes for March of 2023 indicated Resident #4 had voiced concerns regarding call bell response times. During an interview on 6/26/23 at 1:00 p.m., Resident #4 said there are times you can wait up to an hour for someone to respond to the call bell. She said the staff was running around doing a lot of work. She said it was especially at night. She said she hadn't been incontinent from it, because she would get herself on the toilet and then hope they come to get her off. 3. Record review of Resident #5's care plan indicated she had impaired toileting with decreased mobility, strength, endurance, transfers, ambulation and balance. During an interview on 6/26/23 at 2:03 p.m., Resident #5 said she has complained about call bell response time. She said sometimes it was hours before someone came. She said she hadn't been incontinent due to it because she holds it, but it was uncomfortable. She said nothing had improved since she complained. 4. Record review of Resident #6's care plan indicated she required extensive to total assist with (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 2 Event ID: 105859 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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)