Inspection·January 16, 2020

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to provide vision services in a timely manner for 1 (Resident #22) of 1 resident sampled for vision. Residents Affected - Few The findings included: During the initial screening process, on 1/13/20 at 10:37 a.m., Resident #22 revealed, he did not have his glasses, and he did not have money to go to an eye doctor. He said he had told everybody he had blurry vision and stated, I'm not going to say who I told. On 1/15/20 at 4:31 p.m., during an interview with Resident #22 he said he had no trouble seeing the television but, he needed glasses for reading. He said he had left eye cataract surgery years ago but couldn't recall how long ago he had the surgery. He said he never went back for treatment for the right eye because of cost. Resident #22 said his sight was blurred because he had fallen many times and hit his head. Observed a pair of reading glasses in a case on his bedside table. He said the glasses were given to him by the facility staff. He said the glasses helped him a little, but he still couldn't see clearly with them, and still had blurry vision. When asked if staff knew he was having trouble with his vision, he said he thought he told the Social Worker, but he didn't want to discuss further. In an interview on 1/15/20 at 4:34 p.m., the Social Worker said she was not aware the patient had blurry vision and needed prescription glasses but would discuss that with him to arrange services. In an interview conducted on 1/15/20 at 4:41 p.m., Speech Language Pathologist, (SLP), Staff B revealed Resident #22 received services two times per week. She also said she discussed the patient vision issue with the Rehabilitation Manager (RM). Staff B also said she had done the initial assessment of Resident #22. She provided copies of Speech Therapist (SP) Treatment Note records that detailed the patient's visual limitations. In an interview conducted on 1/15/20 at 5:00 p.m., the RM, said she personally discussed Resident #22 blurry vision with the Interdisciplinary Team, (IDT) during a meeting on 12/5/19. She said she believed the Medical Director (MD), spoke with resident regarding his vision issue. The RM said she thought this issue was resolved and the resident was capable of reading and signing forms. The resident was offered vision reading glasses on 12/13/19, but she did not have a record of the outcome. Record review revealed, from the SLP Preadmission Screening Form dated on 12/04/19, Resident #22 reported blurry vision and listed for impaired vision. Record review from the SP Daily Treatment Note dated on 12/10/19. The resident could read a medium (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: 106122 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 106122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Coast Medical Center Skilled Nursing Unit 13960 Plantation Road 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)