Health inspection·November 25, 2024

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of facility policies and procedures, resident and staff interviews the facility failed to follow the established plan of care for safe transfer, resulting in an avoidable fall and fall related major injury for 1 (Resident #3) of 3 residents reviewed. The findings included: Review of the clinical record for Resident #3 revealed an admission date of 7/4/24. Diagnoses included morbid obesity and left artificial knee joint. The 5-day scheduled Minimum Data Set (MDS) assessment with a target date of 9/2/24 noted Resident #3 was dependent (Helper does all of the effort. Resident does none of the effort to complete the activity) for toilet transfer (Ability to safely get on and off a toilet or commode). Resident #3's cognition was intact with a Brief Interview for Mental Status score of 15. The care plan initiated on 7/5/24 noted the resident had Activities of Daily Living (ADL) Deficit with a goal to improve ADLs. The interventions included and specified the use of a full body mechanical lift with assistance of two for transfers. Resident #3 received Physical and Occupational Therapy. Review of Occupational Therapy Discharge summary dated [DATE] noted Resident #3 required substantial/maximal assistance with toilet transfer. The Physical Therapy Discharge summary dated [DATE] noted Resident #3 required partial/moderate assistance with toilet transfer. On 10/20/24 at 6:31 p.m., an incident progress note documented on 10/20/24 at approximately 4:45 p.m., the nurse was at the nurses station. Certified Nursing Assistant (CNA) Staff A came to the nurses station and said, Quick help. The nurse followed the CNA to Resident #3's room and observed the resident sitting on her buttocks on the floor in front of the toilet. The resident's right lower extremity was in abnormal alignment with the right foot externally rotated. Resident #3 complained of right foot pain and denied hitting her head. Resident #3 stated, It's my fault, I told her (CNA Staff A) I could do it with just her. The nurse immediately called 911 and prepared transfer paperwork as a Registered Nurse stayed with the resident to monitor. EMS (Emergency Medical Services) arrived and transferred Resident #3 to a local hospital. (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: 105995 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 105995 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Adviniacare at Naples 7801 Airport Pulling Road N 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)