Inspection·February 26, 2026

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident and staff interview the facility failed to ensure 3 (Residents #1, #4 and #6) of 4 residents reviewed with Baseline Care Plans, had those Care Plans developed and completed appropriately to include instructions needed to provide effective and person-centered care within 48 hours of the residents being admitted to the facility. The findings included: The facility's Plan of Care Policy and Procedures N-1015 dated 11/30/14, with a revision date of 9/25/17, stated the facility would develop and implement an Individualized Person-Centered Baseline Plan of Care within 48 hours of admission that included, but not limited to, initial goals based on the admission Orders, Physician Orders, Dietary Orders, Therapy Services, Social Services if applicable, and other areas needed to provide effective care of the resident that meets professional standards of care to ensure that the resident's needs were met appropriately until the Comprehensive Plan of Care was completed. 1. On 2/25/26 a review of Resident #1's medical record revealed he was admitted to the facility on [DATE] for rehabilitation services after a fall at home. Review of Resident #1's Baseline Care Plan revealed it was blank except for Resident #1's wife signature on page 4. The Baseline Care Plan did not contain the initial goals and instructions to provide effective care, to ensure Resident #1's needs were met prior to the completion of the comprehensive plan of care. The baseline care plan did not address his history of falls or identify goals and interventions to prevent further falls.2. On 2/26/26 a review of Resident #4's medical record revealed he was admitted to the facility on [DATE] from the hospital with a discharge diagnosis of chest pain and transferred to a skilled nursing facility for rehabilitation services. Review of Resident #4's Baseline Plan of Care, dated 1/26/26, revealed page 1 was not completed, and the goal for falls/safety was circled but the interventions for that goal were not identified required. 3. On 2/26/26 a review of Resident #6's medical record revealed she was admitted to the facility 2/06/26 from the hospital with a discharge diagnosis of acute respiratory failures with hypoxia and was transferred to a skilled nursing facility for rehabilitation services. Review of Resident #4's Baseline Plan of Care dated 2/06/26 revealed page 1 was not completed, and the goals for falls/safety, oral/dental, pain, and anticoagulant use were circled but the interventions for those goals were not identified as required. On 2/26/26 at 11:01 a.m. in an interview with Staff A Unit Manager, she said when a resident was admitted to the facility, the admitting nurse was required to complete a Comprehensive Assessment to include a personalized Baseline Care Plan at that time. The next day she would review all resident(s) admitted the day prior to ensure the residents' Physician Orders were completed and in the computer, the admission Assessment was completed, and the Baseline Care Plan was completed to include the goals and personalized interventions for each goal as required. Staff A reviewed Residents #1, #4 and #6's admission Baseline Care Plan and confirmed their Baseline Care Plans were not completed appropriately with goals and interventions to ensure each goal was addressed as required. On 2/26/26 at 1:10 p.m. in an interview with the Director (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 3 Event ID: 106000 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 106000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aspire at Evans 3735 Evans Ave Fort Myers, FL 33901 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)