Health inspection·November 16, 2023

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 observation, interviews, record review, and facility policy review, the facility failed to accurately transcribe medication orders upon admission for 1 (Resident #118) of 6 residents reviewed for physicians orders. Residents Affected - Few The findings included: Review of the facility policy titled admission Orders dated 5/2022, revealed specification: 1) The facility will receive a medication list/reconciliation and required documentation prior to/or upon arrival of the resident to the facility. 2) A licensed nurse will review the medication reconciliation with the designated Primary Physician and /or Practitioner via telephone or verbally via face-to-face encounter. 3) The licensed nurse will document all correspondence and new orders in the Electronic Health Record (EHR). 4) The licensed nurse will transcribe all physician and/or practitioner's orders in the EHR. Review of Resident #118 clinical record revealed an admission date of 11/9/23 from an Assisted Living Facility (ALF). Diagnoses included malignant lung cancer, metastasis (spread to) bone and liver. Resident #118 was receiving hospice services. The admitting Physician's orders from the ALF dated 11/7/23 included to administer oxycodone 10 milligrams (mg) routinely every 4 hours for pain. On 11/13/23 at 9:20 a.m., in an interview Resident #118 said her pain medications were messed up over the weekend on admission. She said she did not receive the oxycodone 10 mg routinely every four hours. A review of Resident #118 Medication Administration Record (MAR) for November 2023 noted a physician's order for oxycodone 5 mg give two tablets (10 mg) by mouth every 4 hours as needed for pain. The MAR did not list the oxycodone 10 mg every four hours noted in the admitting orders. On 11/15/23 at 10:50 a.m., in an interview the hospice nurse said the admitting orders were transcribed incorrectly upon admission to the skilled nursing facility. She said Resident #118 should have been given oxycodone 10 mg every four hours around the clock, and not as needed. (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: 106137 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 106137 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Preserve 14750 Hope Center Loop 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)