Inspection·August 1, 2025

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents' preference for shower date and time was honored for 1 of 4 residents reviewed (Resident #107). Findings include: During an observation on 7/30/2025 at 8:50 AM, the communication board in Resident #107's room showed that the resident was scheduled to have two showers weekly on Wednesday and Sundays. During an interview on 7/30/2025 at 8:45 AM, Resident #107 stated that her usual shower days were Sundays and Wednesdays. This past Sunday (7/27/2025), she requested a shower, and the aide informed her that she could not have a shower, only a bed bath. The resident informed the aide that she did not want a bed bath, she wanted a shower, but the aide refused and informed her she would give a bed bath. The resident stated that she was never given a bed bath or a shower on 7/27/2025. During an interview on 7/30/2025 at 12:23 PM, Staff A, Certified Nursing Assistant (CNA), stated that she was the aide providing care for Resident #107 on the evening of 7/27/2025. Staff A stated, It was [Resident #107's name]'s shower day, but by the time I got to her, she said it was too late, and to just put her to bed, so I did. [Resident #107's name] asked to have her peri-area washed, and did not want her gown changed, as it was still clean. I asked if she was sure, but she said just wash my peri area. This occurred around 8:00 PM. She likes to shower right after dinner. If I remember right, we only had two CNAs that night. Normally, we have three, so it took longer for me to get to her. During an interview on 7/31/2025 at 9:08 AM, the Director of Nursing (DON) stated, I interviewed [Resident #107's name] and [Staff A, CNA's name]. [Staff A's name] should have documented the bed bath for [Resident #107's name] as refused if the bed bath was not completed. During an interview on 7/31/2025 at 10:10 AM, Staff B, Registered Nurse (RN), stated, I was the nurse on shift for [Resident #107's name] on the evening of 7/27/25. I review and sign the shower sheets at the end of the shift. [Staff A, CNA's name] never informed me that [Resident #107's name] refused a shower or a bed bath. I expect the CNAs to inform me when a resident refuses a shower or bed bath. Review of Resident #107's ADL (Activities of Daily Living) task records showed the resident preferred Wednesdays and Sundays at 3-11 shift for bathing. Review of Resident #107's Minimum Data Set (MDS) assessment dated [DATE] showed the resident was dependent for showering and bathing under Section GG- Functional Status. Review of Resident #107's care plan dated 5/22/2025 read, Focus: Resident has specific preferences r/t [related to] day to day activities. Goal: Staff need to be aware of resident preferences and incorporate them into daily care. Review of the facility policy and procedure titled Activities of Daily Living (ADL), Supporting with the last review date of 12/10/2024 read, Policy Statement: Residents will be provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs). Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming, and personal and oral hygiene. 2. Appropriate care and services will be provided for residents (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: 106119 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 106119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Waterman 4501 Waterman Way Tavares, FL 32778 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)