Inspection·November 30, 2023

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to conduct a thorough investigation for a bruise of unknown origin for 1 of 6 residents reviewed for accidents, out of a total sample of 39 residents, (#50). Residents Affected - Few Findings: Resident #50 was admitted to the facility on [DATE] with diagnoses to include Alzheimer's Disease, dementia, mixed anxiety disorders, long-term use of anticoagulants and cognitive communication deficit. Review of the Minimum Data Set (MDS) quarterly assessment with Assessment Reference Date (ARD) of 10/12/23 revealed resident #50 had a Brief Interview for Mental Status (BIMS) score of 04 which indicated she had severe cognitive impairment. Resident required assistance with activities of daily living and used a wheelchair for mobility. A weekly skin assessment dated [DATE] indicated resident #50 had a discoloration on her left wrist. Review of resident #50's electronic medical record revealed a nursing progress note dated 12/30/22 which indicated resident #50 had a discolored area to her left wrist. The area was approximately 6 centimeters by 4 centimeters with no swelling. Resident #50 was noted to be alert and oriented to self with increased confusion and agitation. The note was entered by the Risk Manager. On 11/30/23 at 2:13 PM, the Risk Manager verified she was responsible for reviewing incidents and accidents. She explained she reviewed documentation and conducted interviews to determine the cause or possible cause for any incident or accident. The Risk Manager recalled she was informed resident #50 had a bruise and went to assess. She stated she observed a discolored area to resident #50's left wrist. She explained the resident did not say what happened. The Risk Manager stated from interviews and her own observation, resident #50 had increased confusion and agitation days before due to an infection and was on antibiotic therapy. She explained resident #50 took an anticoagulant and had anemia. She stated the cause of the bruise was determined to be from resident #50 being agitated and hitting on top of her overbed table which was witnessed by other staff members and herself. The Risk Manager reviewed resident #50's Electronic Medical Record (EMR) and verified there was no documentation in the record regarding resident #50's behaviors other than her own note from the investigation. The Risk Manager acknowledged she did not have any witness statements from staff contained in her investigation. She confirmed obtaining witness statements was part of the investigation process and could not explain why she did her own documentation and did not obtain any statements from staff. On 11/30/23 at 3:00 PM, the Administrator stated she had participated in the investigation but did (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 11 Event ID: 105967 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 105967 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Bennet Center for Rehabilitation & Healing 1091 Kelton Ave Ocoee, FL 34761 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)