Health inspection·January 16, 2025

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident's family interview, staff interviews and record review the facility failed to ensure 1 (Resident #2) of 3 grievances reviewed had documentation of the steps taken to investigate the grievance, a summary of the pertinent findings or conclusion regarding the complainant's concern(s), a statement as to whether the complaint was confirmed or not confirmed, and the complainant was given a summary of the pertinent findings or conclusions regarding their concern(s). The findings included: The facility's Grievance/Concern Policy dated 3/2010 and last revised 5/1/23 stated: 1. Residents, resident representative or other individual on the resident's behalf, have the right to file a grievance with the facility at any time, without fear of discrimination or reprisal. 2. A grievance may include those with respect to care and treatment which has been furnished as well as that which has not been furnished, . and other concerns regarding their stay. 3. Grievance can be filed verbally or in writing, using the Grievance/Concern Form. 4. Grievances can be submitted to the social worker, Executive Director/Residence Director, or any manager/supervisor. The facility will make prompt efforts to resolve grievances including but not limited to grievances from residents and/or family council. 5. Grievances will be routed and tracked by Grievance Officer/social services or designee. 6. The grievance will be responded to within 7 days , and the facility will notify the complainant to provide updates on resolution for the complaint. 7. The manager responsible for investigating and resolving the grievance will complete the Grievance/Concern Form, including a plan for resolution. 8. The complainant will be informed of the final outcome and resolution. All communication will be documented on the Grievance/Concern Form. 9. Individuals not satisfied with the resolution will be directed to the Executive Director or designee who will evaluate the outcome with the concerned party. 10. All forms to be reviewed by the Executive Director. 12. A file for grievances will be maintained by the Grievance Official/social services/Residence Director or designee. 13. Grievance Official will utilize a tracking system of all complaints to ensure proper follow-up. On 1/16/25 a review of Resident #2's medical record revealed the resident was admitted from the hospital on 9/19/24 for short term rehabilitation before returning home. A nursing progress note dated 10/19/24 stated Resident #2 was discharged home accompanied by her husband and daughter. Discharge instructions were given and explained, and they voiced understanding. All belongings were taken, and prescriptions were given to the resident at the time of discharge. No questions or concerns were voiced by the resident and/or family at that time. A nursing progress note written 10/22/24 by Staff A LPN (Licensed Practical Nurse), Nursing (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: 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 01/16/2025 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)