Solaris Senior Living North Naples

In the surveyor’s words

From the most serious findings on record at Solaris Senior Living North Naples, in the surveyor’s own words.

• Actual harm, isolatedF686Nov 1, 2022

  Based on observation, interview and record review, the facility failed to provide care consistent with professional standards to prevent the development of pressure ulcers for 1 (#1) of 3 Residents admitted to the facility without pressure ulcers but at risk for developing pressure ulcers. The lack of interventions resulted in the resident developing a stage 4 full thickness coccyx pressure wound with bone visible. The findings included: Review of the facility Policy Pressure injury(s)/Skin Breakdown - Clinical Protocol revised on 1/7/20, Assessment and Recognition #4 . The physician will assist the staff to determine the etiology and characteristics of the skin alteration . […]

• No harm, potential for more than minimal, patternF689Apr 24, 2025

  Based on observations, interviews and record review, facility failed to follow care plan interventions to prevent further falls for 1 (Resident #26) of 1 resident sampled for accidents. The findings included: Review of the facility's policy titled Care Plans-Comprehensive, revised on 12/10/24, showed the following: Each Resident's comprehensive care plan is designed to: a. Incorporate identified problem areas. b. Incorporate risk factors associated with identified problems. c. Build on the residents' strengths. d. Reflect on the residents' expressed wishes regarding care and treatment goals. e. Reflect treatment goals, timetables, and objectives in measurable outcomes. f. Identify the professional services responsible for each element of care.' g. […]

• No harm, potential for more than minimal, isolatedF558Apr 24, 2025

  Based on observations, interviews and record review, the facility failed to ensure that the call light was within reach for 1 (Resident #26) of 1 resident sampled for accommodation of needs. The findings included: A record review showed Resident #26 was readmitted to the facility on [DATE] with diagnoses of Vascular Dementia, Depressive Disorder, and Hyperlipidemia. The Quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #26 had a Brief Interview of Mental Status (BIMS) score of 07, which is severely cognitively impaired. A progress note dated 3/18/25 showed Resident #26 on the floor between the bed and the nightstand in his room. He was unable to explain what happened and said he was trying to grab something off the table. […]

• No harm, potential for more than minimal, isolatedF656Apr 24, 2025

  Based on observations, interviews, and record review the facility failed develop and implement a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 1 out of 1 resident with a Percutaneous Endoscopic Gastrostomy (PEG) tube (Resident # 56) and 1 out of 1 resident on Transmission Based Precautions (Resident #37). The findings included: Review of the facility's policy titled, Care Plans - Comprehensive with a revised date of 12/10/24 included in part the following: Our facility's Care Planning/Interdisciplinary Team, in coordination with the resident. […]

• No harm, potential for more than minimal, isolatedF690Apr 24, 2025

  Based on record review, observations and interviews, the facility failed to ensure facility staff performed urinary indwelling catheter care technique consistent with accepted standards of practice and failed to follow the facility's policy titled, Catheter Care, Urinary as observed during indwelling urinary catheter care for 1 (Resident #22) of 1 resident sampled for urinary catheter. The findings included: Review of the facility's policy titled, Catheter Care, Urinary with a review date of 12/10/24 included in part the following: The purpose of this procedure is to prevent catheter-associated urinary tract infections. Check the resident frequently to be sure he or she is not lying on the catheter and to keep the catheter tubing free of kinks. […]