Aspire At Evans

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

Based on record review, and staff interviews, the facility failed to ensure a licensed nurse was designated to serve as charge nurse on all shifts. This failure resulted in the inability of nursing staff to know who would provide oversite for patient care, ensure safety and compliance and serve as a leader to support staff on

the evening shifts.The findings included:On 9/4/25 a review of the daily assignment sheets from 8/31/25 to 9/3/25 on the three nursing units revealed no documented Charge Nurse was assigned on the 3:00 p.m., to 11:00 p.m., or 11:00 p.m., to 7:00 a.m. shifts. On 9/5/25 at 8:45 a.m., in an interview the Director of Nursing (DON) said there is no charge nurse at night, all the nurses are in charge and work together. There is an assigned Weekend Supervisor here 12 hours each weekend day. There is not an assigned charge nurse at night. On 9/5/25 at 8:55 a.m., in an interview the Assistant Director of Nursing (ADON) said I spoke with the Administrator, and he wanted me to tell you when a Registered Nurse (RN) is on duty at night, they are automatically the Supervisor for the night, and it is written on the assignment sheet. On 9/5/25 at 9:50 a.m.,

in an interview Licensed Practical Nurse (LPN) Staff I said she did not know who the evening or night supervisor was. She said it should be in the schedule. I know there is a Unit Manager during the day and a weekend supervisor, but I honestly don't know how you would know who the supervisor is. On 9/5/25 at 9:56 a.m., in an interview LPN Staff J said she did not know of a night supervisor. I know there is a weekend supervisor, but at night, I don't know how to know that. On 9/5/25 at 10:04 a.m., in an interview

the Administrator said the Supervisor is listed on the daily assignment sheets. This writer showed him the daily assignment sheets from the three nursing units that did not document who was in charge on any unit.

He said, I would have to ask the Director of Nursing (DON). On 9/5/25 at 10:10 a.m., in an interview the DON said going forward we will put a C next to the nurse assigned to be a charge nurse. The DON confirmed there was currently not a licensed nurse assigned to be the supervisor on the evening shifts.

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

Event ID:

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aspire at Evans

3735 Evans Ave Fort Myers, FL 33901

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)

F 0925

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, review of facility policy and procedures, resident and staff interviews, the facility failed to maintain an effective pest control program to ensure an environment free from pests for 2, (Resident #400 and #500), of 97 residents residing in the skilled nursing facility.The findings included:The facility Policy and Procedure, HL-200 (11/30/14) specified the facility will maintain a pest control program which includes inspection, reporting and prevention.Procedure: Treatment will be rendered as required to control insects and vermin. Any unusual occurrence or sighting of insects should be reported immediately to the Supervisor. Proper action will be taken. On 9/4/25 at 9:04 a.m., during an initial tour of the facility two brown bugs were observed crawling up the wall in the bathroom of an occupied resident room. Licensed Practical Nurse (LPN) Staff J noted the observation and left the room. Certified Nursing Assistant (CNA) Staff A was present and said, All the time, they are everywhere, all the time. You tell them and they are spray, and they are still here. On 9/4/25 at 9:20 a.m., in an interview Resident #400 said, I see roaches here every night.

I've been telling everyone there is a problem here. Last night one crawled on my bedside table during the meal, it came right on up. On 9/4/25 at 9:30 a.m., in an interview Registered Nurse (RN) Staff E said, Oh yeah bugs are everywhere in here, real bad. But the Administrator said he got someone to come and spray last week. On 9/4/25 at 9:44 a.m., in an interview Resident #500 said, I told the management here and I've asked to be transferred to another facility, but they are trying to talk me into staying. I have been here three weeks, and I see roaches all over the floor, they run under the bed. I saw three last night and I had to stomp

on one with my foot.On 9/4/25 at 10:08 a.m., in an interview CNA Staff D said, There are a lot of bugs and roaches in this whole building. They mostly are in the resident drawers, and they come out from the air-conditioning units. I have seen that. On 9/4/25 at 10:12 a.m., in an interview the Maintenance Assistant said, Yes I have seen roaches in here, but they come and spray every Tuesday. Review of the facility Pest Sighting Log located on each of the three nursing units documented:On the 300 unit the following was reported: 6/16/25 roaches, staff breakroom. 8/6/25 roaches in rooms.On the 100 unit the following was reported: Roaches observed on 7/24/25, 8/1/25, 8/2/25, 8/6/25, 8/19/25, 8/21/25, 9/1/25, 9/2/25 in resident rooms.On the 200 unit the following was reported: 7/16/25 ants in bed, 7/28/25 ants in Director of Nursing office, 8/11/25 ants in bed, 8/14/25 roaches in rehab gym, 8/16/25 roaches in rooms, 8/18/25 roaches in rooms, 8/19/25 roaches in activity room and on my desk and coming out of each table in the C wing dining room. On 9/2/25 ants in rooms crawling on the beds and in drawers. On 9/4/25 ants and roaches seen in rooms. Review of the pest control logs from [NAME] Exterminators:On 9/2/25- Exterior rodent station, roof rats-gnawing. Rodent droppings were found. Interior of the building documented no activity for roaches and ants.On 8/11/25- Bed bug treatment for room on B Wing. The exterminator provided a Bed bug Customer Preparation Checklist. A service agreement was signed on 8/4/25 to treat bed bugs in Wing B.On 8/5/25 the interior of the facility was treated for roaches with no activity noted.On 7/31/25 documented Having issues with roaches and fruit flies in kitchen. On 9/4/25 at 12:04 p.m., in an interview with the Maintenance Director, he said he was aware of the bug problem and pest control comes every other Tuesday and he reports it. He was informed of the bugs observed during the tour of the facility today. He said, I have the staff write down in the pest log when and where they see them and the pest control will check the logs. I check them daily but there is nothing I can do; we have nothing to spray them with. If I call the pest control,

they will come if they can, sometimes they are booked up and can't come.

Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet