Inspection·February 8, 2024

F 0689 utilizing fall precautions/interventions through next review date. Level of Harm - Actual harm The interventions included to, Encourage and remind resident to use call bell and wait for staff assistance with transfer, ambulation, toileting, etc., as indicated. Residents Affected - Few The clinical record showed documentation Resident #999 sustained five falls since admission to the facility on [DATE]. On 2/8/24, review of the falls with the Director of Nursing (DON) since 1/7/24 revealed: Fall #1. On 1/9/24 at 3:30 p.m., an incident investigation showed Resident #999 had a fall. The nursing progress note dated 1/9/24 at 4:09 p.m. documented Resident #999 stood out of the wheelchair and fell forward hitting the left side of her head and face, sustaining a laceration above the left eyebrow. Resident #999 was transferred to the hospital via 911. On 1/9/24 at 10:30 p.m., the progress note documented the Resident returned to facility with three sutures to the left eyebrow. The care plan was not updated with new interventions after Resident #999 sustained a fall with injury. On 2/8/24 at 1:15 p.m., in an interview the DON said she the Resident's care plan was updated but it would only show on her computer. On 2/8/24 at 1:45 p.m., the DON returned with a new care plan documenting on 1/9/24 the care plan was updated with the intervention, Resident to use drop seat in wheelchair (w/c) and dycem (non-slip mat) as tolerated. The instructions for the drop seat and dycem were not added to the Certified Nursing Assistant (CNA) [NAME] (Provides instructions for care). The DON said the instructions were not placed on the CNA Care [NAME] because it was a therapy thing. Therapy educates the staff; they bring the chair and show the CNAs how to do it. The DON said the root cause of the fall was the resident was trying to stand up but leaned forward and fell. The DON said, we can't stand beside her all day, even if we had a one on one sitter it would not hold her in the chair. She is in a highly visible area and when they see her stand, they run to her but they don't reach her in time to stop her from falling and the resident's cognition does not let her understand. Fall #2. On 1/18/24 at 5:38 p.m., an incident investigation showed Resident #999 had a fall. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 2 of 4 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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)

F 0689 The incident investigation specified that the resident was observed in the hallway and fell forward out of the w/c. Resident #999 did not sustain any injuries from the fall. Level of Harm - Actual harm Residents Affected - Few The DON said the root cause of the fall was positioning, she always looks like she is leaning forward and to the right side. The DON said on 1/19/24 therapy did an evaluation and said it was an issue with her position in the w/c. A high back w/c was initiated with a drop seat, dycem and a ½ tray table. Fall #3. On 2/1/24 at 2:00 p.m., Resident #999 was found on the floor. A nurse's progress note dated 2/1/24 at 4:42 p.m., documented the resident was discovered on the floor in the hallway. The resident had multiple skin tears to the arms and left hand. The resident also had stiches (sutures) to her left forehead that were bleeding. The progress note dated 2/1/24 at 4:06 p.m., noted the resident was discovered on the floor in the hallway on the unit, the stiches from the previous event (fall) were open and bleeding. The incident investigation revealed Resident #999 was at the nurse's station. A delivery person was at the desk talking to the nurse. He then pointed to the resident. The nurse stood up, looked and the resident was on the floor. Resident #999 was sent to the local emergency department for treatment. Resident #999 returned to the facility with three sutures above the left eyebrow. On 2/2/24 the care plan was updated with the intervention Use antiroll back to wheelchair as resident tolerates. On 2/8/24 at 11:30 a.m., in an interview Unit Manager, Registered Nurse (RN) Staff A said Resident #999, sits at the front of the nurse's station, and I will watch her up there. She is alert but doesn't comprehend a lot of speech. She used to have a small table in front of her on the wheelchair. We tried everything, activities, keeping her occupied and therapy but she does not comprehend. On 2/1/24 she was sitting in her high back wheelchair. I had a delivery representative with me at the station and he pointed to her. I was sitting down so I stood up to look and she was face down on the floor. She landed on the same spot where she recently had sutures from a fall. Her foot was tangled in the footrest. We got her untangled and got her up. It took several of us to get her up. We took her vital signs and got orders to send her back out to the emergency room. She hit her face pretty hard on the floor. She split open where she just had split open before and had stiches, in the same spot. On 2/8/24 at 11:45 a.m., in an interview CNA Staff B said, the resident is on my usual assignment. When I come in, I get her up in the morning, she is always sleeping and tries to get up and walk and we watch her. I watch her a lot because she tries to walk around. She is always asleep; her eyes are closed, and I tell her to open her eyes. When she tries to walk her eyes are open. I was not working anytime she fell. On 2/8/24 at 1:51 p.m., in an interview the Director of Rehab said, the resident was always a one (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 3 of 4 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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)

F 0689 Level of Harm - Actual harm Residents Affected - Few person assist. She could walk 300 feet with us one day and the next minute she had no interaction with us. Her cognitive status was just up and down, always changing. We have staff at different intervals so she could be seen at different times if she was not interactive with us. She has been on case load five times a week for Physical Therapy and Occupation Therapy since her admission. She was seen almost daily; I stagger the staff assignments. We had worked on three to four different wheelchairs for her. We tried a drop seat to change her seating position, so she was seated back more. We tried a breakaway lap tray. She was receiving Speech Therapy to find things to keep her engaged cognitively. She had single step commands more tactile like place the walker in front of her and help her to stand and walk. I would say less than 50% of the time she was engaging to commands. For her safety 24 hours one to one supervision would be ideal. On 2/8/24 at 3:00 p.m., in an interview, the DON said the root cause of fall #3 was, the residents advanced dementia, cognitive loss and she is impulsive. She has a sleep disorder. On 2/8/24 at 3:15 p.m., in an interview the Administrator said, the care plan interventions were effective because she had a decrease in injuries, and we tried something different every time. This will be her fourth chair. Requested any additional documents, and information related to each of the resident's falls. On 2/8/24 at 5:45 p.m., the DON and the Administrator did not provide any additional documentation at the end of the survey. On 2/9/24 the facility provided Enhanced Supervision Worksheets that were not provided during the survey. The three Enhanced Supervision Worksheets dated 1/9/24 documented on 1/9/24 Resident #999 was checked at 3:00 p.m., and 3:30 p.m. (Fall #1 was at 3:30 p.m.). Two of the forms had 1 (In room lying in bed) entered in the behavior code on 1/9/24 at 3:30 p.m., 3:45 p.m., and 4:00 p.m., at the time of the resident's fall from the wheelchair. The Enhanced Supervision Worksheets for 1/9/24 noted Resident #999 was supervised every 15 minutes from 3:30 p.m., to 10:30 p.m., when Resident #999 was at the hospital. The Enhanced Supervision Worksheets dated 1/18/24 documented Resident #999 was placed on 15-minute checks beginning at 5:45 p.m., after fall #2 had occurred. The enhanced monitoring form dated 2/2/24 documented the resident was placed on 15 minute checks after her return from the emergency room from fall #3. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 4 of 4