Bentley Care Center
875 Retreat Drive, Naples, FL 34110 · Collier County · 84 certified beds · avg 75 residents/day · certified since Dec 2, 2004
Part of chain: VI LIVING (9 facilities, chain avg rating 4.4★)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★☆☆☆2/5 · CMS overall rating: 3/5
The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.
All citations in the current public record (17)
CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.
| Date | Severity | What the facility was cited for |
|---|---|---|
| Nov 21, 2024 | F · Potential for harm, facility-wide | The facility did not have enough support staff to safely and effectively run its food and nutrition service. |
| Nov 21, 2024 | F · Potential for harm, facility-wide | The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. |
| Nov 21, 2024 | F · Potential for harm, facility-wide | The facility did not dispose of garbage and refuse properly. |
| Nov 21, 2024 | F · Potential for harm, facility-wide | The facility was not managed in a way that uses its money, staff, and resources effectively and efficiently to care for residents. |
| Nov 21, 2024 | E · Potential for harm, repeated | The facility did not keep residents' personal and medical information private and confidential. |
| Nov 21, 2024 | D · Potential for harm, one-off | The facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights. |
| Nov 21, 2024 | D · Potential for harm, one-off | The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow. |
| Nov 21, 2024 | D · Potential for harm, one-off | The facility allowed residents to lose the ability to do daily activities — like bathing, dressing, and eating — when there was no medical reason for the decline. Good care helps residents keep the abilities they have. |
| Nov 21, 2024 | D · Potential for harm, one-off | The facility did not provide enough food and fluids to keep residents healthy, such as preventing unplanned weight loss or dehydration. |
| Nov 21, 2024 | D · Potential for harm, one-off | The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. |
| Nov 21, 2024 | D · Potential for harm, one-off | The facility did not try to gradually reduce doses of mood- and mind-altering medications or use non-drug approaches first, as required, or used 'as needed' psychiatric drugs without proper limits. |
| Nov 21, 2024 | D · Potential for harm, one-off | The facility did not make sure special medical diets — like low-sodium or diabetic diets — were properly ordered by the resident's doctor or managed by a qualified dietitian as state law allows. |
| Nov 21, 2024 | D · Potential for harm, one-off | The facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards. |
| Nov 21, 2024 | D · Potential for harm, one-off | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. |
| Nov 21, 2024 | D · Potential for harm, one-off | The facility did not have a working call system — the button or cord residents use to summon help — in each resident's bathroom and bathing area. |
| Mar 2, 2023 | D · Potential for harm, one-off | The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own. |
| Mar 2, 2023 | D · Potential for harm, one-off | The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving. |
Inspection trend by year
Citations from standard inspections increased between the last two inspection cycles (2 → 15).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 2 | 0 | D |
| 2024 | 15 | 0 | F |
Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.
Fines and enforcement (last 3 years)
No fines or payment denials in the published 3-year window.
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | Florida avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 6.59 | 4.03 | 3.95 | top 1% in Florida; top 2% in the U.S. |
| Registered Nurse hours | 1.94 | 0.76 | 0.69 | top 2% in Florida; top 2% in the U.S. |
| Weekend total nurse staffing | 5.96 | 3.68 | 3.50 | top 1% in Florida; top 2% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 1.36 | 0.53 | 0.48 | top 2% in Florida; top 2% in the U.S. |
| Total nursing staff turnover (%) | 31.1 | 41.4 | 45.8 | top 25% in Florida; top 16% in the U.S. |
| RN turnover (%) | 43.9 | 46.0 | 42.9 | top 46% in Florida; bottom 46% in the U.S. |
Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 6.45, RN 1.90, weekend 5.84. Staffing rating: 5/5.
Self-reported quality measures
Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.
Quality measures rating: 3/5 · long-stay residents: 4/5 · short-stay residents: 3/5
Who owns this facility
For profit - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Margot and Tom Pritzker Foundation | Organization | 5% or Greater Indirect Ownership Interest | 10% | 05/22/2025 |
| P. G. - Daniel Trust | Organization | 5% or Greater Indirect Ownership Interest | 5% | 01/01/2012 |
| P. G. - Don #3 Trust | Organization | 5% or Greater Indirect Ownership Interest | 5% | 01/01/2012 |
| P. G. - Jim Trust | Organization | 5% or Greater Indirect Ownership Interest | 5% | 01/01/2012 |
| P. G. - Johnny Trust | Organization | 5% or Greater Indirect Ownership Interest | 5% | 01/01/2012 |
| P. G. - Karen Trust | Organization | 5% or Greater Indirect Ownership Interest | 9% | 01/01/2012 |
| P. G. - Linda Trust | Organization | 5% or Greater Indirect Ownership Interest | 5% | 01/01/2012 |
| P. G. - Nicholas Trust | Organization | 5% or Greater Indirect Ownership Interest | 6% | 01/01/2012 |
| P. G. - Tony Trust | Organization | 5% or Greater Indirect Ownership Interest | 5% | 01/01/2012 |
| Pritzker Pucker Family Foundation No. 2 | Organization | 5% or Greater Indirect Ownership Interest | 9% | 05/22/2025 |
| Allison, Pamela | Individual | Operational/Managerial Control | NOT APPLICABLE | 07/21/2025 |
| Allison, Pamela | Individual | ADP of the SNF | NOT APPLICABLE | 07/21/2025 |
| Classic Residence Management Limited Partnership | Organization | Operational/Managerial Control | NOT APPLICABLE | 12/11/1990 |
| Classic Residence Management Limited Partnership | Organization | ADP of the SNF | NOT APPLICABLE | 10/18/2025 |
| Conzelman, Tina | Individual | Operational/Managerial Control | NOT APPLICABLE | 06/09/2025 |
| Conzelman, Tina | Individual | ADP of the SNF | NOT APPLICABLE | 06/09/2025 |
| Cope, Tara | Individual | Corporate Officer | NOT APPLICABLE | 06/01/2018 |
| Cope, Tara | Individual | ADP of the SNF | NOT APPLICABLE | 06/01/2018 |
| Elterman, Frank | Individual | Operational/Managerial Control | NOT APPLICABLE | 07/01/2023 |
| Elterman, Frank | Individual | ADP of the SNF | NOT APPLICABLE | 07/01/2023 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "How is your kitchen staffed, and have meals ever been delayed because of staffing?"
- "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
- "Can I see where garbage is stored and how often it's removed?"
- "What were the findings behind this administration citation, and what has leadership changed since?"
- "How do you protect residents' privacy, both in their medical records and in day-to-day care?"
- "Can you give me examples of how your staff protect residents' dignity in everyday care, like bathing and dressing?"
- "Can you tell me what this citation involved and what steps you took to bring care back up to standard?"
- "How do you help residents maintain their daily living skills, and how do you measure whether it's working?"
- "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
- "Can I see the results and plan of correction from your most recent state inspection?"
Nearby facilities (within 20 miles)
| Facility | Distance | City | Overall | Inspection | Flags |
|---|---|---|---|---|---|
| Solaris Healthcare Imperial | 1.2 mi | Naples, FL | ★★★☆☆ | 2/5 | |
| Solaris Senior Living North Naples | 2.9 mi | Naples, FL | ★★★☆☆ | 2/5 | |
| Renaissance at the Terraces | 3.3 mi | Bonita Springs, FL | ★★★★☆ | 3/5 | |
| Adviniacare at Naples | 5.1 mi | Naples, FL | ★☆☆☆☆ | 1/5 | |
| Premier Place at the Glenview | 6.1 mi | Naples, FL | ★★★★★ | 5/5 | |
| Chateau at Moorings Park, the | 7.1 mi | Naples, FL | ★★★★★ | 4/5 | |
| Life Care Center of Estero | 7.9 mi | Estero, FL | ★★★★★ | 4/5 | |
| Naples Health and Rehabilitation Center | 8.7 mi | Naples, FL | ★☆☆☆☆ | 1/5 | abuseSFF |
| Gardens at Terracina Health & Rehabilitation | 12.6 mi | Naples, FL | ★★★★★ | 4/5 | |
| Woodside Health and Rehabilitation Center | 13.5 mi | Naples, FL | ★☆☆☆☆ | 1/5 | abuse |
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Facility data as of CMS processing date 2026-08-01. CCN 106062.