Adviniacare Waterview Villas, Llc

F 0689 Level of Harm - Actual harm Residents Affected - Few

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

results were reviewed by the physician, and the resident was sent to the emergency department due to the risk for bone necrosis (death of tissue due to restricted blood supply) related to the type of fractures s/he sustained.Record review of a hospital Discharge summary dated [DATE REDACTED] revealed the resident would be returning to the nursing home on that day and revealed that the resident presented to the emergency department after s/he was found to have a left femoral neck fracture and pelvic fracture after a fall.

Additionally, it revealed that the resident was ambulatory with a walker prior to the fall and now requires a wheelchair. Further review of the hospital document revealed that the resident was in pain with the movement of the leg and could not provide further history due to dementia. Furthermore, imaging was ordered and revealed an acute comminuted fracture of the left femur (a type of bone fracture where the bone breaks into multiple pieces that occurs suddenly and is typically caused by a traumatic event, such as

a fall) and the resident was then admitted for surgery. During a surveyor observation on 11/10/2025 at approximately 11:30 AM, the resident was noted to be seated in a wheelchair. S/he was unable to stand effectively, complained of pain, and was being assisted by two staff members utilizing a gait belt.During a surveyor interview on 11/10/2025 at 11:50 AM with Licensed Practical Nurse, Staff B, she revealed that

after the resident's fall on 10/27/2025, s/he was complaining of increased pain with care and was no longer using his/her walker. She further revealed that she requested an order for an X-ray from the physician on 11/1/2025 due to concerns of the resident's increased pain and a significant decrease in ADLs. Staff B further revealed that the X-ray was not completed until 11/3/2025.During a surveyor interview on 11/10/2025 at 3:51 PM with the DNS, she could provide evidence the resident received the X-ray prior to 11/3/2025.During a surveyor interview on 11/17/2025 at approximately 5:00 PM with the DNS, she revealed that the resident had rolled out of bed on 10/27/2025. Additionally, she acknowledged at the time of the fall

the bed rails were not put in place. During a surveyor interview on 11/17/2025 at approximately 3:20 PM with Nursing Assistant (NA), Staff C, he revealed that he was the resident's NA that night. He indicated that

the resident fell out of bed because s/he did not have any side rails on his/her bed. During a surveyor

interview on 11/18/2025 at 12:23 PM with Licensed Practical Nurse, Staff D, she revealed that Staff C reported to her that the resident had fallen out of bed. Additionally, she revealed that when she went into

the room, she found the resident on the floor in between the two beds. She further revealed that the resident was unable to walk and that she and Staff C pivoted the resident and assisted him/her back to the bed. The facility's failure to ensure that staff update and implement proper safety measures, including the use of bed rails, resulted in the resident sustaining a significant fracture that required surgery and a significant decline from his/her prior level of function due to a preventable fall.

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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

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Adviniacare Waterview Villas, LLC

1275 South Broadway East Providence, RI 02914

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 0814

Dispose of garbage and refuse properly.

Level of Harm - Minimal harm or potential for actual harm

Based on surveyor observation, record review and staff interview, it has been determined that the facility failed to ensure that garbage is properly disposed of in accordance with professional standards for food safety, relative to refuse being left outside the dumpster, potentially harboring and feeding pests. Findings are as follows:Review of the 2022 Food and Drug Administration (FDA) Food Code, Section 5-501.112 Outside Storage Prohibitions states in part, (A) Except as specified in (B) of this section, REFUSE receptacles not meeting the requirements specified under 5-501.13(A) such as receptacles that are not rodent-resistant, unprotected plastic bags and paper bags, or baled units that contain materials with FOOD residue may not be stored outside .Review of the 2022 FDA Food Code, Section 5-502.11 Frequency states in part, REFUSE, recyclables, and returnable shall be removed from the PREMISES at a frequency that will minimize the development of objectionable odors and other conditions that attract or harbor insects and rodents .Record review of a community report complaint submitted to the Rhode Island Department of Health on 10/10/2025 alleges that overflowing garbage at the facility was attracting pests and was creating

a risk of disease for both residents and staff.Record review of an undated photograph provided by the complainant revealed multiple garbage bags accumulated next to the dumpsters. Record review of an email authored by the facility Administrator revealed that he had contacted his supervisors on 10/6/2025 and 10/7/2025 to inform them that the waste management company had placed a hold on the account due to nonpayment. It further revealed that trash bags were accumulating in the parking lot and that the company was requesting proof of payment to remove the hold.During a surveyor interview on 11/17/2025 at 11:08 PM with the Administrator he acknowledged that there were issues with the trash removal company at the beginning of October 2025 as they have stopped trash pickup without notice due to nonpayment.

Additionally, he acknowledged that the garbage was accumulating in the parking lot.

Residents Affected - Many

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

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If continuation sheet