Inspection·April 23, 2021

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure that one (Resident #29) of three resident's plan of care for fall interventions was followed in a timely manner related to a physical therapy screening. Findings included: On 4/21/2021, the medical record was reviewed for Resident #29 and revealed that the resident was admitted to the facility on [DATE] with multiple diagnoses to include cardiovascular disease, muscle weakness, dementia, and difficult walking. A review of the resident's fall care plan revealed focuses on the resident being at risk for falls related to forgetfulness and ambulating ad lib (as desired) on and off the unit. The care plan indicated that the resident had a fall on 3/15/2021 related to poor balance and unsteady gait. The facility initiated a new intervention for the fall dated 3/15/2021 for a therapy screen. Upon further review, the resident's medical record revealed that a therapy screen was not conducted on 3/15/2021. During a interview on 4/22/2021 at 10:00 a.m. with the Director of Nursing, she confirmed that the resident's medical record did not indicate a follow through with a referral to therapy. During an interview on 4/22/2021 at 10:10 a.m. with the Director of Physical Therapy, he was able to locate a rehabilitation referral dated 3/17/21, signed by a nursing staff member that indicated the resident had safety issues related to falls or fear of falling. The referral indicated that the resident was ambulating in the hallway (heard thump) turned around and noticed [Resident #29] on the floor by the wall. The nurse and CNA monitored the resident. The screening referral under the section, Outcome of Referral was blank and signed by the therapist. 04/23/21 12:08 p.m., an interview with the DON and the Director of Rehabilitation were interviewed regarding the lack of assessment after Resident #29's fall and the timeframe before conducting a referral and screening for rehabilitation. The Director of Rehabilitation reported that there was a delay in picking up the resident because he had a staff member out. The therapist did not conduct an initial evaluation until 3/30/21. The DON concurred that all information regarding a fall should be documented in a resident's medical record. Her expectations were that nursing follow the post fall strategies. The medical record was silent regarding the fall or required post fall assessments according to 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 5 Event ID: 106002 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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)