Inspection·January 29, 2021

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (Cognitively Intact). Review of the Safe Smoking Evaluation dated 12/15/20, revealed that the answer to the question, Is the resident a smoker? was Yes. Review of the resident's care plan with an initial date of 9/28/17 and a revision date of 10/2/20, indicated that the resident, Is a safe smoker. Due to COVID-19 restrictions, she has not been smoking. An interview with Resident #94 on 1/128/21 at 11:22 a.m., revealed that he had not smoked in a while because the facility put a ban on smoking due to COVID-19. Review of Resident #94's record revealed that he was admitted to the facility on [DATE]. A Social Service Evaluation dated 1/8/21 indicated a Brief Interview For Mental Status (BIMS) score of 15 (Cognitively Intact) with tobacco use for many years. Review of the Safe Smoking Evaluation dated 1/14/21 revealed that the answer to the question, Is the resident a smoker? was Yes. Review of the resident's care plan with an initial date of 7/17/19 and a revision date of 1/28/21, revealed that the resident was a safe smoker, But d/t the restrictions of COVID-19 he is not smoking. An interview with resident #68 on 1/28/21 at 11:27 a.m., revealed that she had not been able to smoke due to the facility canceling all smoking due to no one being able to leave their rooms due to COVID-19. She reported that she did not recall getting anything to ease the urge. Review of Resident #68's record revealed that she was initially admitted to the facility on [DATE], with a re-admission date of 8/10/19 and a diagnosis which included Personal History of Nicotine Dependence. A Social Service Evaluation dated 1/5/21, indicated a Brief Interview For Mental Status (BIMS) score of 11 (Moderate cognitive Impairment) and does use tobacco. Review of the Safe Smoking Evaluation dated 4/20/20, revealed that the answer to the question Is the resident a smoker? was Yes. Review of the Safe Smoking Evaluation dated 7/20/20, revealed that the answer to the question Is the resident a smoker? was No. Review of the Safe Smoking Evaluation dated 10/20/20, revealed that the answer to the question Is the resident a smoker? was No. Review of the Safe Smoking Evaluation dated 1/20/20, revealed that the answer to the question Is the resident a smoker? was No. Review of the residents care plan with an initial and created date of 1/28/21, revealed that the resident Has a history of smoking, but d/t the COVID-19 disease all smoking out door has been postponed until further notice. An interview with resident #33 on 1/28/21 at 11:29 a.m., revealed that she was told that due to COVID-19 smoking was not allowed. She reported that they issued her a patch in October to ease the craving, but nothing since. Review of Resident #33's record revealed that she was initially admitted to the facility on [DATE] and re-admitted to the facility on [DATE]. Review of the BIMS dated 12/12/20 revealed a score of 15 (Cognitively Intact). Review of the Safe Smoking Evaluation dated 12/10/20, revealed that the answer to the question, Is the resident a smoker? was Yes. Review of the resident's care plan with an initial date of 12/28/18 and a revision date of 1/29/21, revealed that the resident was a safe smoker, Updated 3/13/20 resident has not been smoking d/t the COVID-19 outbreak. An Interview with resident #38 on 1/28/21 at 11:36 a.m., revealed that he had not smoked because he was told that everyone had to stay in their rooms, and that he had not left his room other than to take a shower since March. Review of Resident #38's record revealed that he was initially admitted to the facility on [DATE] with a re-admission date of 9/24/20. A Social Service Evaluation dated 1/17/21, indicated a Brief (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 2 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview For Mental Status (BIMS) score of 15 (Cognitively Intact) with no tobacco use. Review of the Safe Smoking Evaluation dated 2/4/20, revealed that the answer to the question, Is the resident a smoker? was Yes. Review of the Safe Smoking Evaluation dated 5/5/20, revealed that the answer to the question Is the resident a smoker? was Yes. Review of the Safe Smoking Evaluation dated 8/5/20, revealed that the answer to the question, Is the resident a smoker? was No. Review of the Safe Smoking Evaluation dated 9/11/20, revealed that the answer to the question, Is the resident a smoker? was No. Review of the Safe Smoking Evaluation dated 12/11/20, revealed that the answer to the question, Is the resident a smoker? was No. Review of the residents care plan with an initial date of 7/30/19 with a revision date of 6/2/20, revealed that the resident was a current smoker, 3/13/20 smoking is on hold d/t the COVID-19. An Interview with resident #35 on 1/28/21 at 11:38 a.m. revealed that she had not smoked because of COVID-19. She reported that the facility said that they had to stay in their rooms. Review of Resident #35's record revealed that she was initially admitted to the facility on [DATE] with a re-admission date of 8/25/19. Review of the BIMS dated 1/1/21, revealed a score of 14 (Cognitively Intact). Review of the Safe Smoking Evaluation dated 6/3/20, signed by a nurse on 6/3/20, revealed that the answer to the question, Is the resident a smoker? was No. Review of the Safe Smoking Evaluation dated 6/3/20, signed by a different nurse on 6/4/20, revealed that the answer to the question, Is the resident a smoker? was No. Review of the Safe Smoking Evaluation dated 6/3/20 and signed by the unit manager on 6/8/20, revealed that the answer to the question Is the resident a smoker? was Yes. Review of the Safe Smoking Evaluation dated 12/3/20, revealed that the answer to the question Is the resident a smoker? was No. Review of the resident's care plan with an initial date of 8/2/18 with a revision date of 9/2/20, revealed that the resident is an un-safe smoker. Due to restrictions to COVID-19, resident has not been smoking. Review of the smoking times provided by the facility revealed that scheduled supervised smoking would take place during these times: OPEN 7:00 am-7:30 am CLOSED- 8:00 am-9:00 am -Breakfast OPEN- 9:00 am - 11:30 am CLOSED- 11:30 am - 12:30 pm Lunch OPEN - 12:30 PM - 4:30 PM CLOSED - 4:30 PM - 6:00 PM DINNER OPEN- 6:00 PM- 9:30 PM An interview on 1/28/21 at 2:47 p.m. with the Administrator revealed that all residents who smoked were verbally told that they would not be able to smoke anymore due to COVID as they were to remain in their rooms according to a county official agency. He reported that the residents should have gotten patches but could not be sure. He reported that there was no other written policy which would reflect the facility's current practice and that it was not included in his COVID-19 plan. He reported that he would honor the resident rights and the team would meet to discuss the resident smoking. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 3 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0550 Level of Harm - Minimal harm or potential for actual harm Interview on 1/29/21 at 9:51 a.m. with the Minimum Data Set (MDS) Coordinator revealed that the residents were notified of the changes to the smoking policy back in March and provided this surveyor with a copy of the letter dated 3/11/2020 which indicated that, Structured inside programs as well as outings and trips will be postponed until further notice . The letter did not reflect any information related to smoking. The MDS Coordinator reported that there was no other documentation related to the cancellation of smoking. Residents Affected - Few Review of the facility's policy titled, Smoking with subsection Chapter: Resident Rights with a revised date of 8/29/2018, did not reflect any information related to the postponement or cancellation of smoking. Review of the facility's policy titled Resident Rights, Chapter: Resident Rightswith a revised date of 3/26/2019 revealed, The facility protects and promotes the rights of each resident. The resident has a right to a dignified existence, self determination, and communication with and access to persons and services inside and outside the facility. The resident and /or their representative will be informed both orally and in writing of a change in resident rights and when changes occur in facility rules that govern the resident's conduct or responsibilities. At the time of any changes, another statement of acknowledgement signed by the resident and/or their representative will be placed in the resident's permanent record. 2. On 01/28/21 at 8:33 a.m., Staff A, LPN (Licensed Practical Nurse) gave Resident #4 medication in the communal dining room of the secured unit where other residents were present. Tables in the communal dining room were set up approximately 6 feet apart with one resident per table. Resident #4 was admitted to the facility on [DATE] for diagnoses that included dementia without behavioral disturbance and essential hypertension. The resident had orders that included: Lisinopril 5 mg dated 1/14/2020. In an annual MDS assessment dated [DATE] the resident was assessed to have a BIMS of 5, indicating severe cognitive dysfunction. The resident was care planned to have impaired cognitive function/impaired thought process related to dementia. At 8:44 a.m., Staff A, LPN gave Resident #69 medications in the communal dining room of the secured unit, where other residents were present. During the administration of Resident #69's medications, Staff A said that the normal process for residents in the dementia unit were for them to go into the dining room after they got out of bed and sit one per table so that a CNA (Certified Nursing assistant) could watch over them for safety. She said that this was the normal process for giving medications, that they were given in the dining room. Resident #69 was admitted to the facility on [DATE] for diagnoses that included dementia with behavioral disturbance, paranoid schizophrenia, and hypertension. The resident had orders that included: Ferrous Sulfate Tablet 325 mg give 1 tablet by mouth one time a day for anemia dated 10/1/20 and Hydrochlorothiazide tablet 25MG give 1 tablet by mouth one time a day for HTN (Hypertension) dated 9/22/2020. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 4 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In a quarterly MDS (Minimum Data Set) assessment dated [DATE], the resident was assessed to have a BIMS of 11, indicating the resident had mild cognitive impairment. The resident was care planned to have impaired thought process related to dementia. On 01/28/21 at 11:21 a.m., Resident #19 came out of her room and sat in the hallway next to the medication cart. After exiting another resident's room, Staff E, RN (Registered Nurse) told Resident #19 that she needed to check her blood sugar. At 11:25 a.m., Staff E, RN cleaned and sanitized a glucometer according to facility and manufacturers protocols. She changed her gloves, put a testing strip into the glucometer, and grabbed a single use lancet and an alcohol wipe. She walked to the resident, who was still sitting in the hallway, and checked the resident's blood sugar. The glucometer announced the resident's blood sugar was 199. Staff E, RN then let Resident #19 know that her blood sugar was 199, and the resident said Good. Well, it's not good, but it's better than 500. Resident #19 was admitted to the facility on [DATE] for diagnoses that included acute kidney failure and type 2 diabetes. The resident had orders that included: Accu-check BID (twice a day) for diabetes dated 1/6/2021 and insulin Aspart solution 100 unit/ml as per sliding scale dated 11/22/2020. In an admission MDS dated [DATE] the resident was assessed to have a BIMS of 11, indicating mild cognitive dysfunction. The resident was care planned to have mild cognitive impairment, and to have an altered endocrine system status related to type 2 diabetes. In a policy given by the facility titled Resident Dignity and Personal Privacy dated revised on 4/4/2019, under Fundamental Information it reads Each resident's right to personal privacy includes the confidentiality of his or her personal and clinical affairs. Under procedure, #2 is Examine and treat residents in a manner that maintains their privacy. a. use a closed door, a drawn curtain, or both, to shield the resident during all personal care and treatment procedures. People NOT directly involved in the resident's care will NOT be present without the resident's consent. On 01/29/21 at 10:41 a.m., the ADON (Assistant Director of Nursing) said that she was not sure if there was a policy for giving residents their medication in a common area of the secured unit. She said normally it was her expectation that medication was not given in a communal area, that it should be given in the resident's room for privacy. Regarding the blood sugar taken in the hallway, the ADON was not pleased that the procedure was done in the hallway, and said that it was her expectation that blood sugars be done in private, and that a blood sugar result should not be announced in a communal area where others can hear. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 5 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of resident #89's record revealed that she was admitted to the facility on [DATE] with diagnosis that included End Stage Renal Disease, Dependence on Renal Dialysis, and, Metabolic Encephalopathy. The resident had a Brief Interview For Mental Status (BIMS) dated 12/31/20, with a score of 12 (Moderate Impairment). Review of the residents current physician orders revealed that she had a current order for dialysis on Tuesdays, Thursdays and Saturdays. Review of the resident's electronic records and the hard chart revealed that there was no documentation in the record to reflect any type of communication between the facility and the dialysis center. Interview on 1/29/21 at 9:06 a.m. with Staff F, LPN revealed that the facility tried to send communication paperwork with the resident to dialysis, however since the start of COVID-19 the dialysis center did want to exchange paperwork. She reported that many times the paperwork would come back with no dialysis documentation. She was able to provide one dialysis communication form dated 1/26/21 and reported that this was all they had. She reported that there was no communication book and that there was no contact person at the dialysis center. Review of the communication form dated 1/26/21 revealed a pre-wt of 68.7; dry wt of 60.5; pre BP 165/57; post BP 172/60; food given None. Closer review of the communication form revealed that there was a hand written note on the side of the form which indicated To much Fluid. Review of Resident #89's medical record revealed that there was no documentation that would indicate that this information was communicated to the Registered Dietician (RD), Physician, or any other team member. Further review of the record revealed that there was no care plan in place that would address the resident's needs related to dialysis treatment. Interview on 1/29/21 at 9:36 a.m. with Staff J, Licensed Practical Nurse (LPN)/Unit Manager and Staff K, Dietetic Technician (DTR) revealed that neither one of them were aware of the dialysis communication form dated 1/26/21. Staff J, LPN/Unit Manager reported that since COVID, the dialysis center did not accept paper and that communication sheets were faxed to the dialysis center and were supposed to be faxed back from the dialysis center. A telephone interview on 1/29/21 at 10:09 a.m. with Staff H, Dialysis Facility Administrator, LPN revealed that the Dialysis company policy was that they do not fill out the Skilled Nursing Facility form, instead they print out their flow sheet and send it home with the resident or it is faxed over to the facility. He reported that on the flow sheet for 1/26/21 the resident's target weight was 60.5 kilograms but arrived to the dialysis center at 68.7 kilograms which was a 8.2 kilogram gain, which was about quadruple the recommendation. He reported that the dialysis center ran the resident's treatment for 4 hours but she was scheduled for 3.45 hours. He reported that the Dialysis center RD would usually call the nursing home facility's RD to notify them that there was too much fluid. He reported that usually she should get 32 oz a day of fluids and weight should be done daily. He reported that if the facility was unsure, they should have called for clarification. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 6 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 1/29/21 at 10:34 a.m., Staff L, MDS Coordinator provided this surveyor with a dialysis care plan which she confirmed that she just created as there was not one in place. Interview on 1/29/21 at 10:56 a.m. with the Assistant Director of Nursing (ADON) revealed that if the dialysis center sends information, that the information should be followed up on. she is unsure if the information related to Too much fluid was followed up on, but that it should have been. Phone interview on 1/29/21 at 10:57 AM with Staff I Dialysis Center RD revealed that she usually will speak to the dietician on call and does remember speaking to facilities dietician this week regarding the resident and was told that the resident was put on fluid restrictions. She reported that the facilities RD does call the dialysis center for weights because the dialysis center weights are probably more reliable. She reported that the residents fluid intake should be monitored. Interview with the ADON and the Regional Nurse on 1/29/21 at 2:ppm., revealed that the Regional Nurse reported that there was currently no process in place to monitor the resident's fluid intake. She reported that resident's weights should be done before and after dialysis treatment. She reported that the dialysis center had not sent the resident's weights to the facility. The ADON reported that the dialysis center no longer sent paperwork to the facility. She said, they would fax it but there was none currently in the record. The Regional Nurse reported that they would have dialysis fax over all the weights now. The ADON and the Regional Nurse both confirmed that it was their responsibility to obtain resident's weights as needed. 3. Review of Resident #175 record revealed that this resident was admitted to the facility on [DATE], with diagnosis that included Encounter for surgical aftercare following surgery on the digestive system, Adult failure to thrive, Anorexia, and abnormal weight loss. The resident had a BIMS dated 1/13/21 with a score of 4 (Severe Impairment). Observations of Resident #175 on 1/27/21 at 10:13 a.m., revealed that the resident appeared small in body size, and was noted that the resident was not eating all her meal. Observations on 1/28/21 at 12:15 p.m., revealed that her meal was on her over bed table, and the resident was not eating her meal. The resident indicated that she was not hungry by rubbing her stomach and shaking her head. Observations on 1/29/21 at 7:30 a.m., revealed the resident with her morning meal on her over bed table. She was observed pushing food around with fork. Observations on 1/29/21 at 8:30 a.m. of the residents completed meal tray revealed that the resident ate 40% of her meal. Review of the resident's physician orders revealed that she has current orders for Ready Care 2.0 tid for weight management, started 1/15/21; Fortified foods with meals for nutrition, started 1/15/21; Regular diet, regular texture. Review of the residents weights revealed that on 1/13/21 the resident's weight was recorded as 114.5 pounds, and on 1/21/21 the residents weight was recorded as 111.0 pounds. A loss of 3.5 pounds in 8 days. Review of the dietary progress note dated 1/22/21 written by Staff K, DTR revealed that Will recommend dietary to speak with resident obtaining meal/snack/supplement preferences to promote PO intakes. Will f/u with weekly weights and PRN. Recommend: 1) Dietary obtain meal/snack/supplement (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 7 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0656 preference as able. Level of Harm - Minimal harm or potential for actual harm Interview on 1/29/21 at 8:44 a.m. with Staff K, revealed that Resident #175 needs cueing, and encouragement. She reported that the resident sometimes needs more extensive assist, and usually did not eat more than 50%. She reported that there was a recommendation for dietary to go in the room to collect the resident's food preferences. She reported that it had been difficult to obtain preferences when the resident was on isolation. Residents Affected - Few Review of Resident #175's Nutritional Evaluation dated 1/14/21, indicated that preferences are to be obtained. Review of Resident #175's Nutritional care plan dated 1/14/21 revealed that the interventions included obtain and provide preferences. Review of the entire record revealed that there was no documentation that would indicate that the resident's food preferences had been obtained. Interview on 1/29/21 at 9:16 a.m. with Staff K, DTR, revealed that she obtained the most recent weight which was taken on 1/27/21. The weight was 108.3 pounds which put the resident at a weight loss of more than 5% in less than 1 month. She reported that the Unit Manager would be calling the husband to obtain preferences. Interview on 1/29/21 at 9:31 a.m. with Staff J, LPN, Unit Manager revealed that she asked the physician today (1/29/21) at 9:05 a.m. to order Megace (appetite stimulant), and tried to contact the resident's husband to obtain preferences. Interview on 1/29/21 at 9:53 a.m. with Staff G, Certified Dietary Manager (CDM) revealed that on the day of admission she went to see the resident to see what she wanted to eat for that day, but did not go back to get the residents preferences. She reported that she did not have documentation for the preferences from the day of admission. She reported that it was not something she keeps. Interview on 1/29/21 at 10:55 a.m. with Staff L, MDS Coordinator, revealed that nutrition was in place in the care plan, but she was not sure if it addressed food preference. The Staff L reviewed the resident's Nutritional care plan and verified that the interventions included, Provide food preferences & substitutions which was initiated on 1/7/21. On 1/29/2021 the facility provided it's Comprehensive Person-Centered Care Plans, with a last revision and review date of 2/18/2019, for review. The Policy read: The facility must develop a comprehensive person-centered care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. Under Fundamental Information section, ii revealed: Be provided by qualified persons in accordance with each resident's written plan of care. The policy also indicated under The comprehensive care plan must describe the following, #3: Develop goals and approaches for each problem and/or concern that is realistic, specific, measurable, and includes interventions/approaches that relate to each stated long or short-term goal, #7 Ensure that interventions specify the frequency of service provide, and #8 Ensure that the care plan specifies the interdisciplinary team member responsible for providing care and services. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 8 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0656 Level of Harm - Minimal harm or potential for actual harm Based on observations, staff interviews and medical record review, the facility failed to ensure care plans were developed and interventions implemented for four (#104, #177, #89, and #175) of 56 sampled residents related to 1. Ensuring fall floor mats were placed appropriately when the resident was in bed, 2. Development of a care plan related to dialysis treatment, and 3. Implementation of interventions related to weight loss. Residents Affected - Few Findings included: 1. On 1/26/2021 at 10:45 a.m. and 1:30 p.m., Resident #104 was observed in her room and lying flat in bed with the call light placed within her reach. It was further observed in the room there was a large gray plastic fall mat placed upright against the bed by the door. Resident #104 was the only one who resided in the room. It was observed that the fall mat was not in place on the floor and there were no fall mats placed on either side of the bed both times observed while in bed. Resident #104 resided in the secured dementia unit. On 1/27/2021 at 1:40 p.m. Resident #104 was observed again in her room and lying in bed and on top of the covers. The call light was placed within her reach and she was not presenting with any behaviors, pain or discomfort. Further observations revealed that the large gray fall floor mat was still placed upright against the wall near the window. There were no fall floor mats on either side of the bed while the resident was observed in bed. On 1/28/2021 at 10:00 a.m., Resident #104 was observed in her room and lying in bed under the covers. Further observations revealed the same fall mat placed up against the wall next to the door bed. There were no fall mats on either side of the floor while the resident was in bed. On 1/28/2021 at 2:00 p.m. Resident #104 was observed in her room and lying in her bed over the covers with the call light placed within her reach. Further observations revealed that this time the gray fall floor mat was positioned on the floor on the resident's left side of the bed. On 1/29/2021 at 7:04 a.m. Resident #104 was observed in her room and lying in bed under the covers and with the call light placed within her reach. The gray fall floor mat was placed upright and leaning against the window wall. There were no fall mats on either side of the bed floor while the resident was in bed. On 1/28/2021 at 10:30 a.m., an interview with Certified Nursing Assistant, Staff C confirmed that the floor mat was not in the proper position on the floor, when the resident was in her room and bed. She revealed that it should have been placed on the floor and was part of the care plan. Staff C revealed that perhaps when Housekeeping came in the room to clean, they lift the floor mat and not place it back on the floor when they are done cleaning. Review of the medical record revealed Resident #104 was admitted to the facility and in the secured/dementia unit on 9/29/2020. Review of the advance directives revealed the resident had a Medical and Financial decision maker in place. Review of the current Minimum Data Set (MDS) Quarterly assessment, dated 1/6/2021 revealed: Cognition/Brief Interview of Mental Status/BIMS score - No score but documented as Short Term/Long Term memory problem and Severely impaired decision making skills, (Falls - History of falls since admission, one since admission. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 9 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0656 Level of Harm - Minimal harm or potential for actual harm Review of the current Physician's Order Sheet for 1/2021 revealed no orders for the use of floor fall mats. Review of the progress notes revealed last actual fall on 10/7/20 and without injury. Review of the current care plans with next review date of 3/31/2021 revealed, History of falls with interventions to include but not limited: Floor mats in place to bilateral sides of bed when resident is in bed. Residents Affected - Few On 1/26/2021 at 10:04 a.m., Resident #177's room was entered and he was observed in his bed and lying flat under the covers. The floor on his right side was observed with a fall mat, which was placed upright between his bed and the window wall. It was not positioned on the floor flat. The other side of the bed did not have a fall mat. A very large gray plastic fall mat was laying upright against the television/dresser area. The other resident who was in the (door) bed was observed in bed and with no fall mats in place. On 1/27/2021 at 7:25 a.m. Resident #177 was in his room and lying in bed flat with the call light placed within his reach. Both fall mats in the room were placed upright and leaning up against the window wall and the middle bed. There were no fall mats on the floor while the resident was in bed. On 1/28/2021 at 7:45 a.m., Resident #177 was observed in his room and in bed. The bed was in the lowest position and with the call light placed within his reach. A large blue fall mat was placed upright against the wall and not poisoned on the floor. Both sides of the bed were observed without floor mats while the resident was in bed. At 10:08 a.m., Resident #177 was again observed in his room and in bed, while under the covers. The bed was in lowest position and with call light placed within his reach. The large blue fall mat was placed on the floor on his left side of the bed and there was a dark gray smaller fall mat placed upright and leaning up against the middle bed. Review of Resident #17's medical record revealed he was admitted to the facility and on to the secured unit on 2/14/2019. Review of the advance directives revealed he had a Medical and Financial decision maker in place. Review of the MDS 5 day assessment dated [DATE], revealed, Cognition/BIMS - 6 of 15 low cognitive function. Resident #177 was not able to be interviewed. Review of the current care plans with the next review date 2/23/2021 revealed the following but not limited problem areas: Risk for falls and fall related injuries related to impaired cognition and mobility and weakness with interventions to include: Floor mats to both sides of the bed while resident is in bed On 1/29/2021 at 10:00 a.m., an interview with the CNA, Staff B confirmed that the fall floor mat for Resident #177 was not in place while he was in bed. She indicated that sometimes the residents will pick them up, or housekeeping will pick them up and place them back. She continued to say that they try to do their best to monitor and place the mats back in place when the residents are in bed. She said that sometimes the residents get in and out from bed on their own so many times throughout the day and its hard to keep up with making sure the mats are in the right place. On 1/29/2021 at 2:00 p.m. an interview with the Assistant Director of Nursing (ADON) confirmed that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 10 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0656 Level of Harm - Minimal harm or potential for actual harm anytime a resident is in bed and is care planned for use of fall mats while in bed, staff were to ensure the fall mats were placed on the floor as part of interventions. She further revealed that it was staff to include aides, nurses and herself to monitor the unit and rooms when residents were in bed and for those who were care planned for fall risks. She continued to say that fall mats must be placed appropriately on the floor when the residents were in bed. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 11 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, interview, and record review the facility failed to ensure an accident free environment for one (Resident #97) of eight residents sampled. The facility failed to ensure the area surrounding Resident #97's bed was clear of tripping hazards related to floor mats being placed to both sides of Resident #97's bed, and the floor mats were placed without objects stored on top of them. Findings included: Resident #97's admission Record revealed an initial admission date of 12/13/19, and an admission date of 07/13/20 with medical diagnoses of dementia with behavioral disturbance, cerebral infraction, traumatic subdural hemorrhage without loss of consciousness, muscle weakness, need for assistance with personal care, difficulty in walking, and cognitive communication deficit. His Minimum Date Set (MDS), dated 12/19/20, Section G: Functional Status revealed Resident #97 required extensive assistance with two-people for personal hygiene and toilet use. Resident #97 required limited assistance with two-people. A review of the Progress Notes, dated 12/27/20, revealed Resident #97 was . observed on floor by his bed, with laceration noted above right eye. At 0450 am the CNA called the writer the patient is on the floor, patient has a moderate laceration that was bleeding, the writer called MD [Medical Director] with no response, called tele health with no response, the resident was still bleeding without control, the writer called 911 . Resident #97's Progress Notes, dated 12/31/20, revealed . arrived from [Hospital Name] Via stretcher, he is alert to self only . readmission who was sent to the hospital for a recent fall that resulted in a subdural hematoma . no complaints of pain or discomfort at this time A review of [Hospital Name] Progress Notes- Physician, dated 12/27/20, page 9 revealed . Was called about this elderly . male. He suffered ecchymosis over the right eyebrow consistent with a facial fracture and was brought to the hospital and evaluated. A CT [computed tomography] demonstrated a very small 5 mm traumatic subdural hematoma of no clinical consequence. The patient was alert but clearly confused, unable to answer questions or stay focused. He is not a surgical candidate. Repeating CT scan is of no clinical value A review of Resident #97's Care Plan, with an initiation date of 12/16/19, revealed the Resident is at risk for falls due to impaired balance, medication side effects, and a history of falling. Interventions for the focus area included assisting with early rising in the morning (initiated 7/13/20), assisting the resident with toileting upon early rising (initiated 11/11/20), placing floor mats to both sides of the bed (initiated 6/29/20), and keeping personal items within reach (initiated 12/27/20). A review of Fall Risk Evaluation, dated 11/11/20, revealed Resident #97 is at high risk for falls due to intermittent confusion, having 1-2 falls within the past 3 months, and a balance problem while walking and standing with decreased muscular coordination. During an observation on 01/27/21 at 1:29 p.m., Resident #97 was lying in bed under the covers with a floor mat in place on the right side of the bed with a wheelchair stored on top of the mat. On (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 12 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the left side of the bed, no floor mat was observed with a metal legged tray stand stored directly next to the bed. If the Resident were to roll off the left side of the bed, his legs would hit the wheelchair. If the Resident were to roll off the right side of the bed, he would fall onto the metal legged tray stand. During an observation on 01/28/21 at 10:14 a.m., Resident #97 was lying in bed with a floor mat in place on the right side of the bed. A blue mat was stored leaning against the Resident's bed on the left side of the bed, not on the ground. A metal legged tray stand was stored on top of the right floor mat. If the Resident rolled off the right side of the bed, he would fall onto the metal legged tray stand. Next to the Resident's bed on the right side, stored by the end of the bed where the Resident's head was resting on a pillow, was a wooden nightstand. The nightstand was approximately a foot away from the Resident's bed. During an interview on 1/28/21 at 12:49 a.m., Staff M, Certified Nursing Assistant (CNA) stated a resident determined to be a high risk for falls will usually have floor mats next to their bed and are placed on 30-minute checks for safety. A follow-up observation of Staff M, CNA on 1/28/21 at 2:23 p.m. revealed the CNA inside Resident #97's room placing a blue mat onto the left side of the Resident's bed. After placing the floor mat onto the ground, the CNA exited the Resident's room. Upon observation inside of the Resident's room, the metal legged tray stand was still stored directly on the right floor mat next to the Resident's bed. During an interview on 1/28/21 at 2:41 p.m., Staff O, CNA revealed the facility provided educational in-servicing upon hire related to high fall risk residents and interventions related to preventing fall with injuries. Staff O stated residents that are deemed high risk usually have floor mats in place with their beds in the lowest positions. Staff O confirmed nothing should be on top of the floor mats, . in case they fall and hit their heads they won't hurt themselves . Staff O stated Resident #97 required additional supervision due to his tendencies of attempting to get out of bed. Resident #97 required floor mats to both sides of his bed because he had weaknesses on both sides and so if he attempts to get out of bed and falls, he would fall onto the floor mats. Staff O entered into Resident #97's room and confirmed the metal legged tray stand on-top of the Resident's right floor mat. The CNA confirmed the stand should not be stored there and immediately removed the tray stand. Staff O stated she did not recall the Resident having any recent falls or hospitalizations. An interview was conducted on 1/28/21 at 3:16 p.m. with the Nursing Home Administrator (NHA) and the Director of Nursing (DON). The DON was included in the interview over the phone due to her not being physically present in the facility. The NHA stated Resident #97 was . a gentleman who regularly gets up and won't put his light [call light] on. He is pretty mobile . but unstable. The NHA stated the purpose of the floor mats were to minimize injury should a resident fall onto the floor. Related to the Resident's fall on 12/27/20, the NHA stated Resident #97 slipped when he was trying to transfer and hit his head. Both the NHA and the DON confirmed that during their root-cause analysis for the event, the most likely cause of the head laceration was that Resident #97 hit his head against the wooden nightstand table. Both the NHA and DON confirmed Resident #97 was impulsive with poor safety awareness. During the interdisciplinary team discussions after the Resident's fall on 12/27/20, the DON said, Part of the discussions was moving the dresser . it was something that was implemented was moving the dresser further away from the bed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 13 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0689 Level of Harm - Minimal harm or potential for actual harm Further review of Resident #97's Care Plan, revealed no intervention related to ensuring the dresser is not next to the Resident's bed. Further review of Resident #97's Progress Notes, since November 2020 revealed no mention, or indication, of discussions related to nightstand removal or relocation. Residents Affected - Few During the interview on 1/28/21 at 3:16 p.m. the NHA stated he has not been back to Resident #97's room in the past few days to check [that the dresser was not next to Resident #97's bed] . but that is easily something that could get moved back. The DON stated she would update the Resident's Care Plan to remind staff that Resident #97's dresser should be pushed away from the bed. During an observation and interview on 1/28/21 at 4:26 p.m., the NHA stated he observed Resident #97's nightstand and stated what seems like what happened was the Resident's bed was pushed closer to the wall when the room was being cleaned as his bed was not completely centered. He stated they also want to ensure the nightstand isn't too far as to keep his personal items within reach. During an interview on 1/29/21 at 1:58 p.m., the Regional Nurse Consultant stated they do not have a policy directly related to fall prevention or accident prevention; however, the facility had procedures written related to fall management. A procedure review of Fall Management, dated July 2015, page 2, revealed Milestones, which include nursing management will review program material, and complete the follow-up to ensure the resident's care plan is updated, and individualized prevention measures are in-place. A policy review of Comprehensive Person-Centered Care Plans, revised 2/18/19, revealed The facility must develop a comprehensive person-centered care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, mental, and psychosocial needs that are identified in the comprehensive assessment . The comprehensive plan of care must describe the following . reflect treatment goals with measurable objectives . include interventions to prevent avoidable decline in function or functional level FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 14 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure that each dialysis resident received dialysis services consistent with standards of practice for one (Resident #89) of three residents related to communication and follow up between the facility and the dialysis center. Residents Affected - Few Findings included: Review of resident #89's record revealed that she was admitted to the facility on [DATE] with diagnosis that included End Stage Renal Disease, Dependence on Renal Dialysis, and, Metabolic Encephalopathy. The resident had a Brief Interview For Mental Status (BIMS) dated 12/31/20, with a score of 12 (Moderate Impairment). Review of the residents current physician orders revealed that she had a current order for dialysis on Tuesdays, Thursdays and Saturdays. Review of the resident's electronic records and the hard chart revealed that there was no documentation in the record to reflect any type of communication between the facility and the dialysis center. Interview on 1/29/21 at 9:06 a.m. with Staff F, LPN revealed that the facility tried to send communication paperwork with the resident to dialysis, however since the start of COVID-19 the dialysis center did want to exchange paperwork. She reported that many times the paperwork would come back with no dialysis documentation. She was able to provide one dialysis communication form dated 1/26/21 and reported that this was all they had. She reported that there was no communication book and that there was no contact person at the dialysis center. Review of the communication form dated 1/26/21 revealed a pre-wt of 68.7; dry wt of 60.5; pre BP 165/57; post BP 172/60; food given None. Closer review of the communication form revealed that there was a hand written note on the side of the form which indicated To much Fluid. Review of Resident #89's medical record revealed that there was no documentation that would indicate that this information was communicated to the Registered Dietician (RD), Physician, or any other team member. Further review of the record revealed that there was no care plan in place that would address the resident's needs related to dialysis treatment. Interview on 1/29/21 at 9:36 a.m. with Staff J, Licensed Practical Nurse (LPN)/Unit Manager and Staff K, Dietetic Technician (DTR) revealed that neither one of them were aware of the dialysis communication form dated 1/26/21. Staff J, LPN/Unit Manager reported that since COVID, the dialysis center did not accept paper and that communication sheets were faxed to the dialysis center and were supposed to be faxed back from the dialysis center. A telephone interview on 1/29/21 at 10:09 a.m. with Staff H, Dialysis Facility Administrator, LPN revealed that the Dialysis company policy was that they do not fill out the Skilled Nursing Facility form, instead they print out their flow sheet and send it home with the resident or it is faxed over to the facility. He reported that on the flow sheet for 1/26/21 the resident's target weight was 60.5 kilograms but arrived to the dialysis center at 68.7 kilograms which was a 8.2 kilogram gain, which was about quadruple the recommendation. He reported that the dialysis center ran the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 15 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few treatment for 4 hours but she was scheduled for 3.45 hours. He reported that the Dialysis center RD would usually call the nursing home facility's RD to notify them that there was too much fluid. He reported that usually she should get 32 oz a day of fluids and weight should be done daily. He reported that if the facility was unsure, they should have called for clarification. On 1/29/21 at 10:34 a.m., Staff L, MDS Coordinator provided this surveyor with a dialysis care plan which she confirmed that she just created as there was not one in place. Interview on 1/29/21 at 10:56 a.m. with the Assistant Director of Nursing (ADON) revealed that if the dialysis center sends information, that the information should be followed up on. she is unsure if the information related to Too much fluid was followed up on, but that it should have been. Phone interview on 1/29/21 at 10:57 AM with Staff I Dialysis Center RD revealed that she usually will speak to the dietician on call and does remember speaking to facilities dietician this week regarding the resident and was told that the resident was put on fluid restrictions. She reported that the facilities RD does call the dialysis center for weights because the dialysis center weights are probably more reliable. She reported that the residents fluid intake should be monitored. Interview with the ADON and the Regional Nurse on 1/29/21 at 2:ppm., revealed that the Regional Nurse reported that there was currently no process in place to monitor the resident's fluid intake. She reported that resident's weights should be done before and after dialysis treatment. She reported that the dialysis center had not sent the resident's weights to the facility. The ADON reported that the dialysis center no longer sent paperwork to the facility. She said, they would fax it but there was none currently in the record. The Regional Nurse reported that they would have dialysis fax over all the weights now. The ADON and the Regional Nurse both confirmed that it was their responsibility to obtain resident's weights as needed. Review of the facilities policy titled Dialysis Chapter Genitourinary with a revision date of 6/23/15 revealed that under the sub-heading Fluid Overload Ensure resident weights and labs are completed either at facility or dialysis. If transported by stretcher weigh resident at facility prior to treatment and when returns from treatment. Under the sub-heading Continuity of Care and Communication: Send Dialysis Communication Form (SHC 215-26) with resident for every treatment. Coordinate care plans with dialysis clinic to assure continuity of care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 16 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations, staff interview and record review, the facility failed to ensure medications were stored appropriately and supervised as given for one (Resident #17) of fifty-six sampled residents as evidence by nursing staff leaving cup with pills/tablets on the resident's over the bed table without ensuring that the resident took the medication. Findings included: On 1/26/2021 at 12:40 p.m., the room for resident #17 was observed. After knocking and announcing and upon entering the room, it was determined that the resident was out of the room and was seated in the dining room. This room and the dining room were on the secured unit which had residents who wandered and had need for constant supervision. Observation of the room revealed the over the bed table for resident #17 was positioned between her bed and the middle bed, and was observed with several opened snacks, several unopened drinks, a plastic hydration cup and a small clear mediation cup with two white in color round tablets. The cup of medications were observed within reach to anyone who came in the room. It was observed that several residents on this unit go in and out and wander into rooms frequently. On 1/27/2021 at 12:45 p.m., the floor nurse, Staff A was interviewed. She was asked if she was the only nurse on the floor and she confirmed that she was. She was asked if she passed medications to residents this morning and she confirmed that she did. Staff A was brought to resident #17's room and was asked about the cup of medications that was on the over the bed table. She said, Oh those are gone now. Staff A was asked why the cup of medications were left on Resident 17's over the bed table. She stated, I usually bring in medications and the resident would take them immediately and I supervise them taking or not taking the medications. She was asked why the medications were left there. Staff A explained that the resident was sleeping. She thought she would come back and give them to her but she must have forgotten. She explained that the medication pass for that resident was around just after breakfast. Staff A confirmed that resident #17 did not self administer medications without supervision and that the medications should not have been left unattended. Staff A confirmed that leaving medications unattended was not part of medication pass practice. Staff A confirmed the cup of medications was left in the room unsupervised for at least one hour. Review of Resident #17's medical record revealed she was admitted to the facility for long term care on 11/17/2020. Review of the current Minimum Data Set (MDS) assessment, dated 11/25/2020, revealed the resident had a Brief Interview for Mental Status (BIMS) score of 6 of 15, meaning low cognitive function. The resident was not able to answer any questions related to her care and services. A review of the current Physician's Order Sheet for the month of 1/2021, progress notes dated from 11/2020 through to current 1/29/2021, the current care plans did not indicate that resident #17 was able to self administers medications and also did not indicate that medications could be left at bedside without nurse supervision. On 1/29/2021 at approximately 2:00 p.m,. an interview with the Assistant Director of Nursing (ADON), who was also the unit manager for the secured dementia unit, revealed that there were no residents in that unit who could self administer medications unsupervised and that Staff A should not have left the medications in the resident's room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 17 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0761 Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility did not ensure that 3 out of 4 medication carts inspected were clean, sanitary and free of debris; and that 1 (Resident #17) out of 55 residents did not have medications left unattended at the bedside. Findings included: Residents Affected - Few On 1/27/21 at 9:30 a.m. the 3 East cart was inspected with Staff D, RN (Registered Nurse). The second large drawer on the right side of the cart had a sticky debris at the bottom of the drawer. Bottles of medications were stuck to the bottom of the drawer which left markings of the container on the bottom of the drawer. Staff D said that the medication carts were cleaned on the inside weekly every Sunday night. Staff D was not sure how long the drawers had looked like that, because it was not their normal cart.(photographic evidence taken). On 1/28/21 at 8:33 a.m. the 4 East Cart was inspected with Staff A, LPN (Licensed Practical Nurse). The second large drawer on the right side of the cart had granulated debris in the bottom of the drawer, and areas that appeared sticky. Staff A said that the night shift would clean out the medication carts about once a week, which did include wiping down the bottom of each drawer. (Photographic evidence taken) On 1/28/21 at 11:30 a.m. the 3 west cart was inspected with Staff E, RN. The second large drawer on the right side of the cart was dirty with granulated debris in the bottom of the drawer. She said that the 11:00 p.m.-7:00 p.m. shift was supposed to clean it out every Sunday. Staff E wiped the bottom with a bleach wipe. (Photographic evidence taken.) On 01/29/21 at 10:38 AM the ADON (Assistant Director of Nursing) said that she and the unit manager wound randomly select a medication cart and go through it to make sure it was clean. The ADON said that it was her expectation that if a nurse spilt something in the cart that it was cleaned up immediately. In a policy given by the facility titled Medication Pass Guidelines dated revised on 4/25/2017, under Purpose it reads To assure the most complete and accurate implementation of physicians' medication orders and to optimize dug therapy for each resident by providing for administration of drugs in an accurate, safe, timely and sanitary manner Under Procedure #9 reads Follow the guidelines for medication storage. In a policy given by the facility titled Drug and Biological Storage dated revised on 5/22/2018 there was no guidance for keeping the medication cart clean. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 18 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, staff interview and facility record review, the facility failed to ensure kitchen equipment to include one of one walk in freezer maintained and free from heavy ice crystallization and ice build up. It was determined that large chunks of ice were forming in and around where food was stored. Findings included: On 1/26/2021 at 9:20 a.m. a brief kitchen tour was conducted with the Certified Dietary Manager (CDM). During tour the walk in freezer was observed with an internal temperature at around 13 degrees F. , which was below the required freezing temperature. Inside the freezer and up against the back wall, the motor housing and metal and foam insulated piping leading from the motor housing were observed with heavy ice crystallization and build up. The left corner of the motor housing and copper pipe was observed with a very large built up ice formation approximately two and a half feet long, two feet wide and approximately twelve inches thick at its thickest point. Further, there was ice build up and ice drops all over packaged food on the left side shelves to include ice cream and other packaged frozen food. Ice was also formed on the floor and ceiling of the freezer. Photographic evidence was taken. Interview with the CDM revealed that the freezer is probably going through a defrost stage. However, she did not have an exact date when the defrost stage starts and stops. She indicated that Maintenance handles that and they have had to pick away ice off the shelves and pipes recently. She did not know when the current large ice formation began. She said, she had put in a work order with Maintenance and that they had been working on it. The CDM was not sure how long ago that was, but was going to have the Maintenance Director follow up with that. On 1/26/2021 at approximately 11:15 a.m., the Maintenance Director provided information related to the maintenance history of the freezer. He indicated that he did defrost the freezer but did not have a schedule of when it is defrosted. He did not have any documentation to support the last time the freezer had a defrost cycle. He confirmed that ice builds up on the motor housing and other areas in the freezer. The Maintenance Director revealed when he asked the CDM about it, she indicated that sometimes her staff will not latch the door all the way. However, interview with both the Maintenance Director and the CDM both confirmed that the ice build up of that magnitude and where the ice is built up, would not have been from the door not being latched all the way. There was no ice observed on or surrounding the door rubber seal/gaskets. The Maintenance Director indicated that he had two companies fix and/or repair the motor and provided documentation to support this. Review of the repair company work order/receipt dated 9/3/2020. revealed, looked at walk in freezer not keeping temp, clean condenser coil with water, adjust setting on cut in cut out and monitor system. This work order was completed on 9/3/2020. The second repair work order from a different repair company, dated 9/17/2020, revealed, Replaced fuses in outside condenser and for walk in freezer; Apparently some one put metal screws. This work order was completed on 9/17/2020. According to the documentation, after the first repair on 9/3/2020, the walk in freezer broke again and another repair company came out on 9/17/2020. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 19 of 20 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 105045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Braden River Rehabilitation Center LLC 2010 Manatee Ave E Bradenton, FL 34208 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 0812 Level of Harm - Minimal harm or potential for actual harm On 1/29/2021 at 9:15 a.m., the kitchen was toured for a comprehensive inspection. During the inspection with the CDM, the walk in freezer was observed. The inside of the freezer was again observed with ice build up and ice drops on and in a box of individual packaged ice cream cups and on a box of packaged frozen food. The floor of the unit was again observed with ice build up in several spots. The Maintenance Director and CDM did not have information on how to maintain the walk in freezer related to heavy ice build up. Residents Affected - Few On 1/29/2021 at 12:30 p.m., the Nursing Home Administrator revealed he was not aware of the ice build up in the walk in freezer in the kitchen. He revealed he remembered there were issues with the freezer a few months ago but had not been made aware that it was not working properly as of recent. The Nursing Home Administrator did not have a policy or procedure related to kitchen equipment, to include walk in freezer maintenance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 20 of 20