Health inspection·May 22, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observations, interviews, and record review, the facility failed to maintain a safe environment for two (Resident #20 and #44) of six residents reviewed for smoking safety. Specifically, cigarette lighters were found in the residents' rooms, in violation of the facility's smoking policy, which prohibits residents from possessing smoking materials in their personal living spaces, placing residents at risk for fire and smoke related injuries. The findings include: 1. A review of Resident #20's medical record revealed an admission date of 01/30/24 and diagnoses including atherosclerotic heart disease, chronic congestive heart failure, use of a cardiac pacemaker, major depressive disorder, cognitive/communication deficit, and anxiety disorder. Resident #20's smoking evaluation, dated 01/13/25, revealed that Resident #20 was permitted to smoke unsupervised in designated smoking areas. Resident must request smoking material from staff. (Photographic evidence obtained) Resident #20 was care planned on 05/06/25 with a focus area for Smoker/Tobacco User. The goal was to smoke safely at designated areas through the next review. Interventions included: Instruct resident about smoking/tobacco use risks and hazards and about smoking/tobacco use cessation aids that are available. Instruct resident about the facility's policy on smoking: locations, times, safety concerns. Notify charge nurse immediately if it is suspected resident has violated facility's smoking policy. The resident can smoke unsupervised, and the resident's smoking supplies are stored in nurses' cart or nurses' station. (Photographic evidence obtained) A smoking observation and interview was conducted on 05/21/25 at 9:30 AM with Residents #20 and #44 while in the facility's designated smoking area. Resident #20 stated she was permitted to keep her smoking materials in her room. Resident #44 stated she kept her lighter and cigarettes in her red bag on her wheelchair in her room. An interview was conducted on 05/21/25 at 10:46 AM with Certified Nursing Assistant (CNA) C who stated residents were assessed for safe smoking during admission. Residents were then permitted to smoke independently. Smoking material was locked in the medication carts and residents were not permitted to keep cigarettes or lighters in their rooms. On 05/21/25 at 10:51 AM, a gray cigarette lighter was observed in Resident #20's room in a flower colored pouch. (Photographic evidence obtained) (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 2 Event ID: 106065 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 106065 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Isle Healthcare & Rehabilitation Center 1125 Fleming Plantation Blvd Orange Park, FL 32003 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)