Inspection visit
Inspection
3 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 3 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation and staff interviews, the facility failed to provide housekeeping and maintenance services to
ensure a clean environment for 7 (rooms 135, 139, 138, 126, 205, 203 and 207) of 20 rooms observed on
the Memory care and the North unit. The findings included:Review of the facility's Environmental General
Cleaning policy (last updated 01/2024) revealed, it is the policy of this facility to provide a clean, safe,
orderly, comfortable and attractive homelike environment . Accepted practices and procedures are used to
keep the facility free from odors, accumulations of dirt, dust and safety hazards.
On 8/17/2025 at 10:14 a.m., observation of room [ROOM NUMBER] revealed the front air conditioning
vents were coated with multiple spots of a black substance.
Photographic evidence obtained.
On 8/17/2025 at 11:55 a.m., the front air conditioning vents of room [ROOM NUMBER] were observed
coated with multiple spots of a black substance.
On 8/18/2025 at 10:45 a.m., the air conditioning vents in room [ROOM NUMBER] were observed coated
with multiple spots of a black substance.
Photographic evidence obtained.
On 8/20/25 at 9:27 a.m., the observation of the multiple spots of black substance on the air conditioning
vents of rooms 203, 204 and 207 was shared with the Director of Environmental Services. In an interview
he said he was the one responsible to clean the air conditioning vents.
On 8/20/25 at approximately 9:35 a.m., the Director of Environmental Services observed the black
substance on the air conditioning vents of room [ROOM NUMBER] and said it should not look like that.
On 8/17/25 between 10:00 a.m., and 11:00 a.m., the following observations were made during a tour of the
memory care unit:
room [ROOM NUMBER]: Floor tile missing. The caulking around the toilet was cracked and discolored.
Photographic evidence obtained.
room [ROOM NUMBER]: Peeling wallpaper with orange discoloration on the wall under the wallpaper,
water damage to the wall, molding and floor in the bathroom.
(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 4
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
08/21/2025
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)
F 0584
Photographic evidence obtained.
Level of Harm - Minimal harm
or potential for actual harm
room [ROOM NUMBER]: Bathroom floor tiles stained and cracked. The caulk around the toilet was
discolored and cracked.
Residents Affected - Some
Photographic evidence obtained.
room [ROOM NUMBER]: Large gap in tiles, the wall by the air conditioning was cracked, embedded dirt in
tiles, cracked, discolored caulking around the toilet.
Photographic evidence obtained.
On 8/20/25 at 2:30 p.m., the observations, and photographic evidence of the environmental concerns in the
memory care unit were shared with the Director of Environmental Services. The Director of Environmental
Services said he was aware of the concerns, and they have been slowly trying to work their way through
the unit to address identified environmental issues.
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
08/21/2025
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)
F 0636
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every
12 months.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review the facility failed to complete a Comprehensive Minimum Data Set (MDS)
Assessment within 14 calendar days of admission for 1 (Resident #70) of 45 reviewed.The findings
included:Review of medical records revealed Resident #70 was admitted to the facility on [DATE].
Diagnoses muscle wasting and atrophy, Type II Diabetes Mellitus and pulmonary disease.Review of the
admission Minimum Data Set (MDS) assessment revealed a completion date of 3/27/25, 21 days after
admission.On 8/20/2025 at 4:33 p.m., in an interview MDS coordinators, Registered Nurse (RN) Staff C
and Licensed Practical Nurse (LPN) Staff D verified Resident #70 was admitted to the facility on [DATE]
and the MDS admission Assessment was not completed until 3/27/25, 21 days after admission. LPN Staff
D said the MDS admission Assessment should have been completed by 3/20/25 and was not sure why the
admission MDS assessment was not completed within 14 days of admission as required. LPN Staff D said
they follow the instructions on the Resident Assessment Instrument (RAI) manual specifying that the
admission MDS assessment must be completed within 14 days of admission.
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
08/21/2025
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)
F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
Based on record review and staff interviews, the facility failed to provide care and services in accordance
with professional standards of practice by failing to communicate a significant weight loss to the physician
for 1 (Resident #10) of 2 residents reviewed for nutrition.The findings included:On 8/18/25, review of the
clinical record for Resident #10 experienced a significant weight loss. The documented weights
were:2/10/25: 185.0 pounds (lbs.)3/05/25: 187.8 lbs.4/04/25: 186.0 lbs.4/24/25: 182.5 lbs.4/29/25: 183.0
lbs.5/06/25: 185.6 lbs.6/03/25: 181.0 lbs.7/03/25: 171.4 lbs.8/05/25: 168.0 lbs.8/13/25: 161.4 lbs.Review of
the physician's orders revealed a dietary order dated 5/6/25 for Regular diet, large portions for weight
loss.On 7/31/25, a Registered Dietitian progress note documented the resident's weight was 171.4 lbs.
negative 5% change over 30 days.On 8/17/25 a Dietary progress note indicated Resident #10 was having
an evaluation for significant weight change. Resident #10's usual body weight was in the 180s with a 13%
weight loss (24 lbs.) over 180 days. Resident #10 was not receiving supplements. Dietary interventions
were large portions. The resident's usual meals intake were 51% to 75%, 76% to 100%. The resident was
tolerating oral diet with good appetite. Recent medication changes: Donepezil and Memantine (medications
to treat Alzheimer's/dementia) associated with weight change may be contributing factor.The progress note
specified: Defer to MD (physician). The clinical record lacked documentation the physician/provider was
notified of the resident's significant weight loss.Review of the progress notes revealed on 7/2/25, 7/8/25,
7/10/25, 7/15/25, 7/17/25, 7/22/25, 7/24/25, 7/29/25, 7/31/25, 8/5/25, 8/8/25, 8/12/25, 8/15/25 and 8/18/25,
the provider documented, His weight is stable. Review of System: Constitutional: (-) weight loss.On 8/19/25
at 3:07 p.m., in an interview the Regional Dietitian (RD) said when a dietary progress note is entered, there
is a box that is checked for a physician/nursing communication report, and the doctor would have to review
it. The Regional Dietitian reviewed the dietary progress notes. She said the box was checked on dietary
progress note for 7/31/25 but had not been checked on the dietary progress note for 8/17/25. The RD said
she could not explain why the physician's progress notes continued to say negative for weight loss.On
8/20/25 at 9:30 a.m., in an interview Licensed Practical Nurse (LPN) Staff E said she was Resident #10's
nurse. She said the resident ate and did not refuse food.On 8/20/25 at 11:15 a.m., in an interview the
Advanced Practice Registered Nurse (APRN) said she had been off for a week. She said she was looking
through the system this morning and noticed the weight difference. She noticed a 10.0 lbs., then a 3.0 lbs.
weight loss., then another weight. She said she asked staff to reweigh the resident as one of the weight
was obtained standing and others were sitting.On 8/20/25 at 3:51 p.m., in a follow up interview the RD said
there was no way to verify that the physician reviewed the communication reports. There was no place to
sign off or acknowledge the physician had seen the communication report. The RD said she was not aware
of any policy addressing the communication reports.
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
106020
If continuation sheet
Page 4 of 4
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Back to topCitations
3 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
F636 - Resident Assessment
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
FAQ · About this visit
Common questions about this visit
What happened during the August 21, 2025 survey of EAGLERIDGE HEALTH AND REHABILITATION CENTER?
This was a inspection survey of EAGLERIDGE HEALTH AND REHABILITATION CENTER on August 21, 2025. The surveyor cited 3 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at EAGLERIDGE HEALTH AND REHABILITATION CENTER on August 21, 2025?
Yes, 3 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receivin..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.