Inspection·January 30, 2025

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 interview and record review the facility failed to ensure adequate supervision to prevent one resident (resident #1) of three residents sampled for falls to prevent multiple falls and major injuries to the resident, multiple falls, a fracture of to the right hip on 11/1/24 for which the resident was hospitalized for surgical intervention, and a fracture to the to the right humorous on 11/17/24. The findings included: Review of facility titled, Falls- Managing, Preventing and Documentation, revised 1/2024, which stated, Based on previous evaluations and current data, the staff will identify interventions related to the resident's specific risks and causes to try to prevent the resident from falling and to try to minimize complications from falling . The staff will implement a resident-centered fall prevention plan to reduce the specific risk factor(s) or with a history of falls .If the resident continues to fall, staff will re-evaluate the situation and whether it is appropriate to continue or change current interventions. As needed, the attending physician will help the staff reconsider possible causes that may not have been previously identified. Resident #1 is an [AGE] year-old male who was admitted to the facility 10/15/24 with a history of Dementia, Post Traumatic Stress Seizures, Delerium, Dysphagia, Encephalopathy, Cirrhosis of the liver, and Stage III kidney disease. Clinical records for Resident #1 were reviewed. The Minimum Data Set (MDS) assessment completed on 10/28/24 documented in Section C Resident #1 had severe cognitive impairment with a brief interview for mental status (BIMS) score of 01. Section J Resident #1 had 2 or more falls since admission. Section GG documented that the resident is dependent on facility staff for ADL (activities of daily living) care including dressing, bathing and toileting needs. The Fall Risk Evaluation completed on 10/15/25, on admission, documented Resident #1 had a Lack of understanding of physical limitations, lack of understanding of cognitive limitations, history of multiple falls, needs assistance with toileting and taking two of the medications identified to increase risk of falls. Resident #1 had a care plan for falls initiated on 10/16/24. The care plan stated the resident is at risk for falls related to cognitive deficit, history of falls, and unsteady gait/ poor balance. The interventions listed on the care plan initiated on 10/16/24 included: Encourage and remind resident to use call bell and to wait for staff assistance with transfers, ambulation, toileting, etc. as indicated. Encourage and assist the resident to wear appropriate FOOTWEAR such as rubber-soled shoes, (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: 106020 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 01/30/2025 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)