Inspection·July 28, 2022

F 0550 diff) to rule out any process. Resident notified as well. Level of Harm - Minimal harm or potential for actual harm Review of a nursing note, dated 05/19/2022 at 9:07 p.m. (21:07), showed: Note Text: Stool culture for culture and sensitivity (c/s) and c-diff one time only for rule out any process for 2 Days no bowel movement. Residents Affected - Few Review of the Treatment Administration Record for May 2022 revealed a physician ordered stool culture was never obtained. On 07/27/22 at 10:55 a.m. an interview was conducted with Staff C and she said Resident #44 did not have a stool that day. Indicating that was why the stool specimen was never obtained. Staff C did not respond when asked if the physician was notified of the omitted order. On 07/27/22 at 2:56 p.m. a phone interview was conducted with the Medical Director who confirmed she knew Resident #44 and had been her physician since January 2022. She said the resident has moderate cognitive impairment. Stating, She can be very with it sometimes and forgetful about other things. The Medical Director stated, I was never told she wanted to see a GI doctor. She confirmed at that time it was her expectation her orders are followed, and she is notified of the results along with any changes. On 07/27/22 at 4:38 p.m. Staff C, LPN/UM stated, I didn't follow up with the ordered stool culture for [Resident #44]. Review of the facility policy titled, Florida Nursing Home Residents Rights and Responsibilities, dated 03/01/2022 revealed: Section 400.022, Florida Statutes Nursing home facility shall adopt and make public a statement of the rights and responsibilities of the residents and shall treat such resident in accordance with the provisions of that statement. Each resident shall have to right to: 11). Receive adequate and appropriate health care, protective and support services within established and recognized standards. The right to receive adequate and appropriate health care including within the community, and with rules adopted by the agency. 17). Choose Physician The right to freedom of choice in selecting a personal physician. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 2 of 19 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 07/28/2022 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 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and medical record review the facility failed to ensure reasonable accommodations were provided to maintain independence for assistance related to the use of the call light for one resident (#14) out of five residents reviewed for limited range of motion. Residents Affected - Few Findings included: On 07/26/22 at 9:25 a.m. Resident #14 was observed from her doorway entrance sitting up in bed. She stated, I need some water. A table was positioned in front of her that contained her breakfast meal along with two spill proof cups. Both cups where empty and no water was available on the table. Resident #14 stated, yes when asked if she was able to use the call light. The call light was observed attached to the curtain divider. The call light was observed approximately one foot to her right and two feet behind the head of the bed. The resident looked back at the curtain, as she smiled stated, I can't reach that. Resident #14's right hand was noted with a contracture as she pointed back at the curtain. She confirmed and demonstrated the 3rd, 4th or 5th digit were fixated. On 07/26/2022 at 9:35 a.m. an interview was conducted with Staff O, Certified Nursing Assistant (CNA), and was informed Resident #14 requested water. Staff O entered Resident #14's bedroom and at that time confirmed her call light was not within reach. She said the resident has water on her bedside table. She said she moved the water off her table because breakfast tray would not fit. Staff O stated, Oh yes, she can use the call light. But she can't when her braces are on. Staff O said her right brace is removed during her mealtime. She uses her right hand to eat, and she can't use her left hand. Staff O stated, She uses a finger pinch to eat. Staff O added the resident cannot put her braces on without physical assistance. Resident #14 added to the interview and stated out loud, The other fingers don't work. Resident #14's left hand was observed with a therapeutic brace in place. The brace revealed hook and loop fastener straps that held and positioned her thumb, fingers, wrist, and upper arm in place. A medical record review of the admission Record form indicated Resident #14 resided at the facility for one year. The diagnoses information listed; contracture of muscle, multiple sites, generalized muscle weakness, and other symptoms and signs involving the musculoskeletal system. Review of the Quarterly Minimum Data Set, dated [DATE], indicated a Brief Interview for Mental Status (BIMS) score of 13, which was indicative of intact cognitive response. Review of the active physician orders for July 2022 revealed orders for: a Right Resting hand splint for contracture management, dated 05/23/2022, and a Left palm roll splint for contracture management dated 05/23/2022. Review of the active care plan indicated a Focus for Activities of Daily Living (ADL) Self CARE Performance, Interventions; TRIAL and don/doff bilateral upper extremities (BUE) splints for contracture management date initiated: 04/01/2022, and left palm roll resting hand splint as tolerated dated 07/28/2022. Further review of the care plan with a Focus as is at risk for falls AEB (as evidenced by) history of falls with injury, impaired safety awareness, medication, unsteady balance and gait Interventions: assistive devices as needed, and call light and frequency needed items in reach dated 07/30/2021. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 3 of 19 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 07/28/2022 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 07/26/22 1:10 p.m. Resident #14 was observed lying in her bed and opened her eyes to verbal stimuli. She smiled as she picked up her right arm from her chest confirming her right arm brace was not in place. She asked the surveyor can you put it (call light) on? Her call light was attached to the head of her mattress and not within reach. On 07/27/22 at 11:15 a.m. the call light was observed attached to the head of the bed as Resident #14 confirmed she could not reach it. Her right-hand splint was not in place. At that time her roommate stated, If you put it on now, they will just take it off in an hour so she can eat lunch. On 07/27/22 at 11:55 a.m. the Director of Nursing (DON) was informed Resident #14 was not able to utilize or reach her call light. Resident #14's call light was positioned on top of the blanket and her arms were under the blanket. The resident was asked if her right hand brace was on. The resident was observed as she struggled with the weight of the blanket. At that time the DON repositioned the blanket and revealed Resident #14's right hand brace. The brace was observed as identical to her left hand brace as it contained the hook and loop fastener straps that held her thumb, fingers, wrist, and upper arm in place. The DON asked the resident to push the call light button. The resident stated, I can't. The hook and loop fastener strap that held her fingers constricted her ability to push the call button. The DON picked up the call button and placed it on top of the resident over the bedside table. Then asked the resident to push down on the button. The resident used her brace and hit the button twice. On the second contact with the button the light activated. The DON said she would look into replacing her call light. On 07/28/2022 at 10:45 a.m. Resident #14 was observed as she held a fork in her right hand by using her right thumb and index finger. She said she needed her waffles cut up. She was asked if she needed help with eating and she stated no. They fed me before, but they put too much food in my mouth at a time. I can do it myself. A metal hotel service call bell sat on top of the over the bed table. The resident demonstrated the use of the bell by hitting it twice. She began to laugh and stated, No one can hear that. Resident #14's room is located at the end of the hallway, eight rooms from the nursing station. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 4 of 19 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 07/28/2022 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to ensure devices, braces, or splints for contracture prevention were provided as ordered for one resident (#333) out of six sampled residents. Findings included: Multiple observations were conducted of Resident #333. On 07/25/22 at 10:54 a.m. she was observed in her room seated in a wheelchair without any splints or braces on her arms or legs. On 07/25/22 at 12:54 p.m. the resident was observed in her room in a wheelchair with splints on both legs and a splint on her right elbow. On 07/26/22 at 3:36 p.m. the resident was observed in her room seated in a wheelchair without any splints on. Review of the medical record for Resident #333 was conducted. The admission Record revealed diagnoses that included Alzheimer's disease and hemiplegia (partial paralysis) following cerebral infarction (stroke) affecting right dominant side. The Minimum Data Set (MDS) assessment, dated 07/16/22, revealed a Brief Interview for Mental Status (BIMS) score of 7 which meant the resident was cognitively impaired. The MDS revealed she required extensive to total assistance with mobility and ADL (activities of daily living) performance and had functional limitations in range of motion on one side for upper extremity (shoulder, elbow, wrist, hand) and lower extremity (hip, knee, ankle foot). Review of the active physician orders for July 2022 included right elbow splint for contracture management (order date 05/20/22) and bilateral knee braces when up in wheelchair for contracture management, nursing to check skin pre and post splint application (order date 05/23/22). The care plan for Resident #333 revealed a focus area for impaired self-care performance and mobility which included interventions: Nursing to apply right elbow splint for proper positioning during the day, check skin during shift changed .Right knee brace when out of bed. Nursing to check skin under brace daily. The Certified Nursing Assistant (CNA) task list revealed: Application of Bilateral Knee braces when up in wheelchair for contracture management, initiated 06/06/22, and Apply Right elbow extension soft pillow splint after gentle stretch to right elbow when up in chair, initiated 01/28/22. An interview was conducted with Staff E, Licensed Practical Nurse (LPN) on 07/27/22 12:05 p.m. She confirmed she was Resident #333's nurse that day. She said she was employed by a nursing agency and had worked in the facility about three times. She stated she did not know anything about splints for Resident #333 and stated nothing had been communicated about splints in the nurse-to-nurse report when she started her shift. She consulted the Electronic Medical Record (EMR) for the resident during the interview and revealed there was nothing on the Medication Administration Record (MAR) or Treatment Administration Record (TAR) about splints. She revealed the physician orders included orders for splints, but said her process was to check the MAR and TAR and follow what was on it. At this time an observation was conducted with Staff E in Resident #333's room. The resident was seated in a wheelchair in the room without splints. Staff E confirmed the resident did not have splints on. Staff E searched in the drawers of the bedside table and in the closet. She found splints in the closet but stated she wasn't certain if they belonged to the resident or what they were but would find out. An interview was conducted with Staff C, Licensed Practical Nurse/Unit Manager (LPN/UM) on 07/27/22 at 12:22 p.m. She consulted the EMR for Resident #333 and confirmed there were orders for splints and confirmed they were not on the MAR or TAR but stated that was because they were on the CNA task (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 5 of 19 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 07/28/2022 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few list because the CNAs were in charge of putting the splints on the resident. Then Staff C said, I think she's on restorative. Staff C confirmed a nurse was in charge of supervising the CNAs to make sure the splints were properly managed. Regarding Resident #333, Staff C stated the resident needed the splints for contractures, that they were better since using the splints and said, She was more contracted before. At 12:35 p.m. during the interview, Staff C asked Staff F, CNA to put the splints on Resident #333. At 12:41 p.m. an observation of the resident in her room was conducted with Staff C, LPN/UM. The resident was observed seated in a wheelchair without any splints on and the UM confirmed they were not on. Staff F, CNA was not in the room. Staff C went and got Staff F. Staff F told Staff C she had gotten Resident #333 out of bed about 45 minutes ago. Regarding splints, Staff F, CNA said she had not known about them and had only found out just now when Staff C asked her to put them on. Staff F said, I usually don't work on this floor. When asked about using the CNA task list, Staff F did not respond. Staff C, LPN/UM and Staff F, CNA searched the room and found the splints in the resident's closet. At that point Staff C left the room. Staff F was observed until 12:49 p.m. attempting to figure out how the splints worked and how to apply them, including asking the resident how to do it. Staff F confirmed she did not know how to apply the splints. An interview was conducted with Staff C, LPN/UM on 07/27/22 at 1:47 p.m. to inform her that Staff F, CNA had not known how to apply the splints for Resident #333. Staff C stated she thought Staff G, Restorative CNA was in charge of educating the CNAs on how to apply splints. Regarding Staff F, she said, It's her first time on assignment . I think they didn't check the [NAME] (task list) . they are supposed to check the [NAME]. An interview was conducted with Staff G, Restorative CNA on 07/27/22 at 2:16 p.m. She confirmed she was a CNA and said, I guess I am the most senior in charge person [of restorative program]. Regarding Resident #333, she said, She has right soft pillow splint and bilateral splints on the legs to prevent contracture on the knees and the elbow. She confirmed the floor staff were in charge of making sure the splints were on the resident as ordered and said, I'm trying to help like put it on because they've moved the task for the CNAs. Then stated it was the facility therapists who educated her how to apply the splints and said, It's usually the therapist that educates the CNAs .I did not educate the CNAs. Staff G confirmed she was not in charge of providing education to nurses or CNAs on how to apply splints. She stated the therapists were in charge of that and said, The therapist would write like how to put what splints they have on, and it has spot for signatures of staff who are trained. Regarding Resident #333 she said, Today I was there this morning to see if she was up and she wasn't up yet .then I was in the dining room and was about to go there and then [Staff C] said you were asking about it. Staff G stated she had gone to check on the status of the splints for Resident #333 that day after Staff C told her about the inquiry and said what she had found was, Both leg braces had been applied incorrectly below the knee .supposed to be covering the knee .I fixed it. Regarding ensuring proper application of splints Staff G said, Me, as a CNA, if I wasn't trained or don't know how to do something I would ask my supervisor and maybe if I know it comes from therapy I can go around and ask therapy but my main would be to ask my supervising nurse .it can be a problem to put them (splints) on wrong. An interview was conducted with Staff H, Physical Therapist (PT) on 07/27/22 at 2:34 p.m. She confirmed the resident had been discharged from PT on 05/23/22 with bilateral knee splints and discharged from Occupational Therapy (OT) on 04/01/22 with a right elbow splint. She said the knee splints were for when she's up to increase knee extension because she has contracture so to prevent further contraction, and stated preventing further contraction and maintaining knee extension would allow for the resident to continue being able to sit in a chair. She confirmed the therapists provided education to restorative and floor CNAs on how to apply splints at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 6 of 19 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 07/28/2022 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few discharge. She said, Supposedly, should be documentation of the in-service, and stated the Director of Rehabilitation (DOR) might have those documents. Regarding whom was in charge of splint management for Resident #333 currently, she confirmed therapy was not in charge of it, and it was nursing's responsibility. Regarding correct application of the knee splints for Resident #333 she said, Brace should be applied so part is on the upper part of the leg and part on the lower and the kneecap in between. She stated proper application of a splint was important so it does what it's supposed to do .this is why we have to monitor. An interview was conducted with the Director of Nursing (DON) and the DOR on 07/27/22 at 4:22 p.m. They confirmed splint management for Resident #333 was to be managed by the floor nursing staff. The in-service documentation for Resident #333's splints provided by the therapy team was reviewed during the interview. The in-service for the knee splints was dated 05/02/22. The in-service for the elbow splint was dated 03/29/22. Neither had signatures of the nursing staff caring for the resident on 07/27/22. The DOR and DON confirmed there were no additional education records and no process for ensuring in-service to floor staff was continuous. The DON stated nursing staff should know a resident had splints from nurse-to-nurse reporting, CNA rounding, and the CNA task list. The DON said, My expectation (for CNA) would be if on [NAME] (task list) or in the room and you are questioning how to put them on you ask. She stated the CNA should ask the nurse, the unit manager, or a therapist. The DON said, CNAs have been educated to refer to the [NAME] (task list), and stated her expectation was they check it at the start of every shift. Regarding the splints being applied to Resident #333 incorrectly by the CNA on 07/27/22, the DON said, It's nursing, housekeeping, everyone 101 to ask if you don't know what to do. Review of facility policy titled, Body Positioning, reviewed 08/29/17, revealed: Positioning is done to protect the resident from secondary medical complications related to muscles, joint, or skin involvement which can include muscle imbalances, pressure ulcers, nerve damage, exacerbation of synergies, and tone, which can lead to deformities. Improved positioning may enhance the resident's ability to perform functional activities. Positioning techniques should be used with residents with stroke and other neurological impairments for the following reasons: .Increase range of motion and decrease tendency toward deformities . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 7 of 19 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 07/28/2022 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure care and services were in place for an indwelling catheter for one resident (#236) out of four residents with indwelling catheters. Findings included: On 7/25/22 at 8:00 a.m. Resident #236 was observed in his room seated in the bed. The resident was observed with an indwelling catheter hanging on the bed frame. On 7/25/22 at 11:00 a.m. a review of the medical record for Resident #236 revealed the resident was admitted to the facility on [DATE] with diagnoses, including but not limited to, benign prostatic hypertrophy, and obstructive and reflex uropathy. A review of the AHCA (Agency for Health Care Administration) Form 5000-3008 indicated the resident was transferred from an acute care hospital to the facility with an indwelling catheter. A review of the admission data set dated [DATE] revealed Resident #236 was admitted to the facility with an indwelling catheter in place. A review of the Order Summary Report on 7/25/22 did not reveal any orders for care and services related to the indwelling catheter for Resident #236. A review of the Treatment Administration Record (TAR) dated July 2022 revealed no treatment orders in place for an indwelling catheter as of 7/25/22. On 7/28/22 at 11:02 a.m. an interview was conducted with Staff K, Registered Nurse (RN) and Staff L, Licensed Practical Nurse/Unit Manager (LPN/UM). The Staff K, RN stated Resident #236 was admitted on [DATE] with a indwelling catheter and oxygen therapy in place from an acute care hospital. Staff K accessed the TAR and confirmed the indwelling catheter order was not entered for Resident #236 as required by the admitting nurse. Staff K stated the orders did not get entered to provide care and services for the indwelling catheter until 7/26/22. Staff K was unable to confirm if care and services had been provided for the indwelling catheter between 7/21 /22 and 7/26/22. Staff K stated it is the responsibility of the admitting nurse to get orders for care and implement them upon admission to the facility from the provider. Staff L, LPN/UM verified the process for nurses to obtain orders for care and services upon admission of the residents. Staff L, LPN/ UM could not confirm care and services were provided to Resident #236 for the indwelling catheter from 7/21/22 to 7/26/22. On 7/28/22 at 1:06 p.m. an interview was conducted with the Director of Nursing (DON). The DON stated the admission nurse and the unit managers are required to obtain all care orders for indwelling catheters present on admission for the residents. She confirmed Resident #236 should have had orders for care and treatment since admission. An indwelling catheter policy was requested from the facility but was not provided prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 8 of 19 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 07/28/2022 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, and interviews, the facility failed to ensure physician orders were followed related to fluid restrictions for one resident (#129) out of nine sampled residents. Residents Affected - Few Findings included: A review of the admission Record indicated Resident #129 was admitted into the facility on [DATE] with diagnoses that included end stage renal disease, calculus of kidney, and dependence on renal dialysis. Section C Cognitive Patterns of the admission Minimum Data Set (MDS), dated [DATE], showed Resident #129 had a Brief Interview for Mental Status (BIMS) score of 13 out of 15, indicating cognitively intact. In Section O Special Treatments, Procedures and Programs, yes was checked indicating Resident #129 received dialysis while a resident. A review of the Order Summary Report with active physician orders as of 07/28/22 at 12:43 p.m. revealed the following: Dietary- Breakfast: 360 ml (milliliters) Lunch: 180 ml and Dinner 160 ml, order date 7/11/22, Nursing- Day: 120 ml, evening: 120 ml, night 60 ml, order date 7/11/22. A review of the Medication Administration Record (MAR) for July 2022 revealed the following: Nursing- day: 120 ml, evening: 120 ml, night 60 ml every shift for fluid restriction with a start date of 07/11/2022. There were check marks in each box for each shift from July 11th-July 28th indicating administered per the chart code. A review of the Certified Nursing Assistant (CNA) [NAME] indicated the resident was on fluid restrictions. Fluids offered per nurse instructions. No white foam cups at bedside resident was on fluid restrictions was written in all caps. A review of the CNA Task form revealed no white foam cups due to resident being on fluid restrictions. On 07/27/22 at 12:52 p.m., two white foam cups of water were observed next to Resident #129's bed. One was sitting next to the bed on a small dresser, and one was sitting on the bedside table. Both cups were full. One cup was dated 07/26 with the resident's room number and bed number and the other cup was dated 07/27 with the resident's room number and bed number written in a black marker (Photographic Evidence Obtained). A review of the active care plan related to nutritional status and dehydration, initiated on 07/06/22, indicated to follow fluid restrictions as ordered. A review of the progress notes and care plan did not indicate Resident #129 refused to follow the order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 9 of 19 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 07/28/2022 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 07/27/22 at 12:45 p.m., Staff N, Certified Nursing Assistant (CNA), stated she passed water cups to the residents and Resident #129 was not on a fluid restriction that she was aware of. Staff N reported she was Resident #129's assigned CNA for today. On 07/27/22 at 12:46 p.m., Staff J, Registered Nurse (RN)/Unit Manager stated she thinks he's (Resident #129) on a fluid restriction, but she would have to look it up. Residents don't get a water cup if they are on fluid restrictions. On 07/27/22 at 12:54 p.m., Staff M, Licensed Practical Nurse (LPN) reported she knows how much fluid Resident #129 was supposed to get because it was on the MAR (Medication Administration Record). They are supposed to only get fluids from the kitchen. When asked why the CNA didn't know the resident was on fluid restriction, Staff M, LPN, reported it was probably because the CNA had not been employed by the facility for very long. Staff M, LPN stated she did not know how the CNAs were tracking how much fluid they were giving to Resident #129 but she knows what she gives him. On 07/28/22 at 10:53 a.m., the Director of Nursing (DON) stated a nurse could find out if a resident was on fluid restrictions from the nurse to nurse report. She stated the CNAs get a report and it's on their [NAME] also. Once it's on the care plan, it gets pulled over to the [NAME]. Dietary sends a certain amount and nurses knows what amount they should have. The [NAME] shows the resident shouldn't have any white foam cups at bedside stated the DON. A review of the policy provided by the facility titled, Dialysis, revised on 06/23/2015 revealed the following: Diet Monitor Fluid restrictions as ordered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 10 of 19 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 07/28/2022 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, medical record reviews, and policy review the facility failed to ensure 1. respiratory care and services was consistent with professional standards of practice for two residents (#99 and #111) out of two residents with tracheostomies, and 2. failed to ensure care and services were in place for oxygen therapy for one resident (#236) out of ten residents receiving oxygen therapy in the facility. Residents Affected - Few Findings included: 1. On 07/25/22 at 10:27 a.m. Resident #99 was observed lying in bed and presented with a tracheostomy that was attached to a ventilation machine. The head of his bed was positioned at a 20-degree angle as his face revealed a moderate amount of perspiration. The bedside table contained a full box of inner cannulas. Staff A, Licensed Practical Nurse (LPN) was in the room and disconnected Resident #99's gastroesophageal tubing (G-Tube). Staff A stated, At this time is when I normally provide his trach care. Staff A, LPN opened a trach cleaning kit and while attempting to don the sterile glove onto the left hand it ripped. Both gloves were then disposed of, and a new pair were donned. She opened a container of sterile water and poured it inside of the kit/tray submerging two cotton tipped applicators. Staff A then proceeded to use the cotton applicators in a back-and-forth motion around the outer cannula. The outer cannula was noted with a moderate amount of brown colored residual. After the applicators were disposed of Staff A immediately removed the gauze pad from under the flange. The pad was noted with a minimal amount of clear mucus as the resident began coughing. Staff A placed a clean gauze in the sterile water and cleaned under the flange. After the cleaning was performed a dry gauze dressing was placed under the flange. The trach ties appeared old as the right side of the tie curled under and no longer laid flat to his neck. From disconnecting the G-tube to providing care to the tracheostomy site no hand hygiene was performed. On 07/26/22 at 9:20 a.m. Resident #99 was observed with the head of bed at a 20-degree angle His eyes were closed as he opened them momentarily to verbal stimuli. He was non-verbal as he presented with a moderate amount of perspiration to his face. His respirations were normal and even. On 07/26/22 at 9:38 a.m. an interview was conducted with Staff C, LPN/Unit Manager (UM) she confirmed Resident #99's head of bed (HOB) should be higher. She raised the head of the bed at that time. Review of Resident #99's admission Record indicated he had resided at the facility for close to two years. The diagnoses information listed aphasia following nontraumatic intracerebral hemorrhage, chronic respiratory failure, independence of supplemental oxygen, and tracheostomy status. Medical record review for Resident #99 revealed a physician order as Trach care every shift and as needed respiratory therapist (RT) to change trach monthly and as needed and was discontinued on 5/10/2022. New orders dated 05/10/2022 Trach care every shift and as needed every shift. Elevate head of bed (HOB) at least 45 degrees at all times every shift for shortness of breath (SOB)/Wheezing, dated 03/29/2022. On 07/28/22 at 11:35 a.m. an interview was conducted with Staff A, LPN and she stated, His orders do not say to change the inner cannula. So, I don't change it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 11 of 19 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 07/28/2022 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 07/28/22 at 11:40 a.m. an interview was conducted with Staff B, LPN who said Resident #99's trach care every shift indicated to make sure it's clean and the gauze is changed. She said the inner cannula is not changed on the day shift. On 07/28/22 at 11:50 a.m. an interview was conducted with Staff C, LPN/UM she stated, The inner cannula is changed when needed. They can change it. She then restated, The inner cannula change and dressing changes are performed every shift. That's how it's supposed to be. Review of progress notes for a look back period of 30 days did not reveal documentation that indicated the inner cannula was changed. Review of Resident #99's active care plan revealed a Focus as: Is trach dependent D/T (due to) resp (respiratory) failure. Goal: will remain free of complications related to ventilator dependence, Target date 08/15/2022. Interventions included: Routine trach change by respiratory care. 2. On 07/28/2022 at 11:55 a.m. Resident #111 was observed lying in bed with her head of bed up at 30 degrees. She appeared comfortable with her eyes closed. On 07/28/22 at 12:05 p.m. an interview was conducted with Staff D, LPN and she stated, I changed [Resident #111's] inner cannula and collar today. I just change it every couple of days. But am not here daily. I change it to make sure it's being done. Medical record review for Resident #111 indicated she had resided at the facility for close to five years. Diagnoses listed traumatic subdural hemorrhage, respiratory failure, dependance on supplemental oxygen and tracheostomy status. Review of the active physician orders for Resident #111 revealed: Trach care every shift and as needed every shift for prophylaxis, dated 2/16/2022 and Change trach and or trach collar as needed size 6DCFN as needed, dated 09/03/2019. Review of the Treatment Administration Record for July 2022 was noted with omitted documentation the trach or the trach collar had been changed. On 07/28/2022 at 12:10 p.m. an interview was conducted with the Director of Nursing (DON) and the Corporate Infection Control Preventionist (ICP), at that time they indicated they were unaware of the licensed staff members interpretation of the order for trach care every shift. The DON confirmed it was her expectation the facility policy is followed. Review of the facility policy titled, Tracheostomy Care, dated 04/24/2018, revealed: PURPOSE: 1. To maintain patency of the airway. 2. To keep tracheostomy tube and the surrounding area clean 3. To prevent infection of the airway and the area around the tracheostomy tube and 3. To prevent excoriation of the area around the tracheostomy tube. PROCEDURE: 1. Obtain a physician's order. 5. Wash hands 6. Gather supplies 9. Open sterile kit and put on sterile gloves using sterile technique 10. Suction tracheostomy tube. 11. Wash hands 12. Put on clean gloves. 13. Remove soiled dressing and inner cannula. Discard dressing into waste bag (discard inner cannula only if the disposable type). 14. Remove gloves, discard in waste bag, and wash hands. 24. Of using a disposable inner cannula, with sterile hand, place a new inner cannula inside tracheostomy tube and lock into place. 3. On 7/25/22 at 8:00 a.m. Resident #236 was observed in his room seated in the bed. The resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 12 of 19 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 07/28/2022 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was observed with an oxygen concentrator present and running in the room via a nasal cannula to the resident at 2 liters/minute. On 7/25/22 at 11:00 a.m. a review of the medical record for Resident #236 revealed the resident was admitted to the facility on [DATE] with diagnoses, including but not limited to, chronic obstructive pulmonary disease (COPD), respiratory failure, malignant neoplasm of bronchus or lung, atelectasis, and dependence on supplemental oxygen. A review of the AHCA (Agency for Health Care Administration) Form 5000-3008 indicated the resident was transferred from an acute care hospital to the facility with oxygen therapy at 2 liters per nasal cannula. A review of the admission data set dated [DATE] revealed Resident #236 was admitted to the facility with oxygen therapy at 2 liters/minute via nasal cannula. A review of the Order Summary Report on 7/25/22 did not reveal any orders for care and services related to oxygen therapy for Resident #236. A review of the Treatment Administration Record dated July 2022 revealed no treatment orders in place related to oxygen therapy. On 7/28/22 at 11:02 a.m. an interview was conducted with Staff K, RN (Registered Nurse) and Staff L, Licensed Practical Nurse, Unit Manager(LPN/UM). Staff K stated Resident #236 was admitted on [DATE] with oxygen therapy in place from an acute care hospital. Staff K accessed the TAR and confirmed the oxygen therapy order was not entered for Resident #236 as required by the admitting nurse. Staff K stated the orders did not get entered to provide care and services for oxygen therapy until 7/26/22. Staff K was unable to confirm if care and services had been provided for the oxygen therapy between 7/21/22 and 7/26/22. Staff K stated it is the responsibility of the admitting nurse to get orders for care and implement them upon admission to the facility from the provider. Staff L, LPN/UM verified the process for nurses to obtain orders for care and services upon admission of the residents. Staff L, LPN/UM could not confirm care and services were provided to Resident #236 for the oxygen therapy from 7/21/22 to 7/26/22. On 7/28/22 at 1:06 p.m. an interview was conducted with the DON. The DON stated the admission nurse and the unit managers are required to obtain all care orders for oxygen therapy present on admission for the residents. She confirmed Resident #236 should have had orders for care and treatment since admission. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 13 of 19 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 07/28/2022 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 observation, record review, and interviews, the facility failed to complete Dialysis Communication forms for one resident ( #129) out of the sampled five residents. Residents Affected - Few Findings included: A review of the admission Record indicated Resident #129 was admitted into the facility on [DATE] with diagnoses that included to end stage renal disease and dependence on renal dialysis. Section C Cognitive Patterns of the admission Minimum Data Set (MDS), dated [DATE], indicated Resident #129 had a Brief Interview for Mental Status (BIMS) score of 13 out of 15 indicating cognitively intact. In Section O Special Treatments, Procedures and Programs, yes was checked indicating that Resident #129 received dialysis while a resident. A review of the Order Summary Report with active physician orders as of 07/28/22 revealed the following: Dialysis Chair Time: 6:50 AM, order date 7/5/22, Dialysis Days: One time a day every Monday, Wednesday, and Friday for ESRD (End Stage Renal Disease), order date 7/5/22. A review of the Medication Administration Record (MAR) for July 2022 revealed Resident #129 was transported to dialysis per orders. A review of the To Be Completed By Sending Facility section of the Dialysis Communication Forms was blank and/or missing documentation on the following days: 07/06, 07/08, 07/11, 07/13, 07/17, 07/20, 07/22, 07/25, and 07/27. This section required the following information to be completed: Appetite, Bowel Function, Nausea/Vomiting, S/S (signs/symptoms) of Infection, Blood Loss, B/P (blood pressure) Today, Non-Dialysis Day B/P, Temp (temperature) this a.m., Fluid Restrictions, office appointments/MD (medical doctor) consults scheduled and Significant Clinical, Events/Changes and Signature. This section also indicated to attach a copy of the monthly physician's orders (1st visit of month). On 07/28/22 at 10:50 a.m., Staff M, Licensed Practical Nurse (LPN) stated the night nurse was responsible for completing the communication sheets prior to the resident going to dialysis. On 07/28/22 at 10:53 a.m., the Director of Nursing (DON) stated the top portion of the Dialysis Communication Forms should be completed by nursing staff prior to the resident going to dialysis. The DON confirmed the forms for the following days 07/06, 07/08, 07/11, 07/13, 07/17, 07/20, 07/22, 07/25, and 07/27 were not complete. A review of the policy provided by the facility title, Dialysis, revised on 06/23/2015, revealed the following: Continuity of Care and Communication: Send Dialysis Communication Form with resident for every treatment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 14 of 19 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 07/28/2022 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 0732 Post nurse staffing information every day. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews and record review, the facility failed to post current an accurate nurse staffing data at the beginning of each shift for two days (7/23/22 and 7/24/22) of three days. Residents Affected - Few Findings included: During the initial facility tour on 7/25/22 at 7:07 a.m., an observation was made of the posted nurse staffing data at the reception desk. The posting showed a census of 137 and a date of July 22, 2022 (Photographic Evidence Obtained). An interview was conducted on 7/28/22 at 12:12 p.m. with the Staffing Coordinator. The Staffing Coordinator stated she updates the daily staffing posting. The Staffing Coordinator stated the posting is posted in the front at the reception area. The Staffing Coordinator stated the days that were missed were Saturday (7/23/22) and Sunday (7/24/22), and she did not work weekends. The Staffing Coordinator stated on weekends, the weekend supervisor updated the posting. The Staffing Coordinator stated the weekend supervisor is expected to ensure the posting is correct to include the date, census, and staffing numbers. A follow -up was conducted on 7/28/22 at 12:35 p.m. with the Nursing Home Administrator (NHA). The NHA stated the staffing posting should be updated daily. The NHA stated on the weekends it should be completed by the weekend supervisor. The NHA stated the expectation is for the posting to be updated daily regardless of the day of the week. Review of a facility policy titled, Nursing Scheduling/Staffing /Posting, revised, 7/26/2016, showed scheduling is the responsibility of the nursing department in order to provide appropriate staffing to deliver resident care. Under posted nurse staffing information and retention showed: (a.) Data requirements: The facility must post the following information on a daily basis (2.) The current date. (b.) Posting requirements: The facility must post the nurses staffing data specified above on a daily basis at the beginning of each shift. Public access to posted nurse staffing data. The facility data retention requirements. The facility must maintain the posted daily nurse staffing data . as required. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 15 of 19 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 07/28/2022 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure behavioral and side effect monitoring was conducted with the use of psychotropic medications for two residents (#233 and #84) of five residents sampled for unnecessary medications. Findings included: 1. On 7/25/22 at 9:50 a.m. Resident #233 was observed in his room lying in the bed. The resident was not able to answer questions related to his care. The resident appeared confused as to why he was in the facility and was asking what was going on. The resident had a wandering bracelet on his ankle. A review of the admission Record revealed Resident #233 was admitted to the facility on [DATE] with diagnoses including but not limited to Parkinson's Disease, dementia, Alzheimer's Disease, restlessness, and agitation. A review of the Order Summary Report dated July 2022 revealed medication orders as follows: Deplin 15 capsule 15-90.314 milligrams give one capsule by mouth one time a day for depression, to start on 7/13/22. Namzaric capsule extended release 24 hour 28-10 milligrams give one capsule by mouth in the evening for dementia, to start on 7/13/22. Sertraline hydrochloride tablet 100 milligrams give one tablet by mouth one time a day for depression, to start on 7/14/22. A review of the Medication Administration Record (MAR), dated July 2022, revealed the medications were administered as ordered and no behavior or side effect monitoring was being conducted for the psychotropic medications ordered for Resident #233. A review of the care plan for Resident #233 revealed the following: Focus area: Resident #233 uses antidepressant medication related to depression (initiated 7/20/22). Goal: Resident will be free from discomfort or adverse reactions related to antidepressant therapy through the review date. Interventions: Anti-depressant medications as ordered; Monitor ongoing signs and symptoms of depression unaltered by antidepressant meds (medications) . On 7/28/22 at 9:59 a.m. an interview was conducted with Staff K, Registered Nurse (RN). The nurse stated the resident was on psychotropic medications and should be monitored for behaviors and side effects. She stated there is a behavior tab that comes up when the nurse gives a medication, but it was not available for Resident #233. She stated the behaviors and side effects are usually triggered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 16 of 19 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 07/28/2022 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few by the nurse when the order for psychotropic medications are entered for a resident. The nurse stated the unit manager enters the behavior and side effect monitoring for psychotropic medications and she was unable to state why this was not completed for Resident #233. She stated the monitoring was not being done for Resident #233 and she would correct this right away. 2. On 7/27/22 at 9:48 a.m., Resident #84 was observed in her room in a secured unit with a relative visiting. Resident #84 was crying. Resident #84's relative stated to Resident #84, You just took your medications, they will kick-in in a minute. Resident #84 stated she was in pain. Resident #84's relative stated she was very confused, and she cries a lot. Review of Resident #84's admission Record showed Resident #84 was admitted to the facility on [DATE] with diagnoses to include unspecified dementia without behavioral disturbance, depression, anxiety disorder and major depressive disorder. The Minimum Data Set for Resident #84, dated 6/16/22, Section C Cognitive Patterns showed a Brief Interview for Mental Status (BIMS) score of 04, indicating severe impairment. A review of a care plan for Resident #84 showed a Focus, initiated on 6/20/22, as [Resident #84] uses anti-anxiety medications related to anxiety disorder. Interventions included to administer medications as ordered, obtain consent from resident or responsible party. The medications are associated with an increased risk of confusion, amnesia loss of balance, and cognitive impairment that looks like dementia, falls, broken hips, and legs. A second Focus indicated [Resident #84] is at risk for adverse drug reaction related to polypharmacy. Interventions included to evaluate for duplicate medications, proper dosage and times, adverse interactions and supporting diagnosis. The care plan did not show an expectation for side effects and behavioral monitoring. A review of the active physician orders for Resident #84 dated, 7/26/22, showed the following orders: Buspirone HCI 15 mg, (milligrams) Give 1 tablet by mouth three times a day for anxiety. Depakote tablet delayed release 125 mg tab give 1 tablet by mouth two times a day for mood stabilizer. Lexapro tablet 5mg (Escitalopram oxalate) give 1 tablet a day related to anxiety disorder, major depressive disorder. Memantine HCI ER (extended release) give 1 capsule by mouth one time a day for dementia. Review of the orders did not show an expectation to monitor behaviors and medications side effects. Review of the Medication Administration Record (MAR) for Resident #84 dated 6/1/22 - 6/30/22 showed Resident #84 received Clonazepam tablet 0.5mg give 1 tablet at bedtime for anxiety, Seroquel tablet 25mg (quetiapine fumarate) and Buspirone HCI tablet 10mg, give 1 tablet by mouth three times a day for mood and paranoia. The administration did not show behavior and side effect monitoring. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 17 of 19 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 07/28/2022 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 0758 Level of Harm - Minimal harm or potential for actual harm Review of the MAR for Resident #84 for the dates of 7/1/22 - 7/31/22 showed Resident #84 received Clonazepam 0.5 mg give 1 tablet by mouth at bedtime for anxiety, Lexapro tablet 5 mg give 1 tablet by mouth one time a day related to anxiety disorder unspecified, Depakote tablet delayed release 125mg give 1 tablet by mouth two times a day for mood stabilizer, Seroquel tablet 25mg (quetiapine fumarate) give two times a day for mood and paranoia. The MAR did not show behavior and side effect monitoring. Residents Affected - Few On 7/27/22 at 12:26 p.m., an interview was conducted with Staff I, Licensed Practical Nurse (LPN). Staff I stated the medication monitoring comes up when she clicks on the medication to be administered. Staff I stated the question pops up if it is an antipsychotic, the response box comes up and I enter the response related to the behavior observed. Staff I reviewed the MAR for Resident #84 and restated she thought the box to check the behavior monitoring should automatically come up. Staff I stated she did not know why the monitoring orders would not be in place. An interview was conducted on 7/27/22 at 12:28 p.m. with Staff J, Registered Nurse (RN)/Unit Manager. Staff J stated the orders for medication monitoring are entered electronically. Staff J stated there is no other place to look. Staff J stated there is a box that should pop during med (medication) administration. Staff J stated Resident #84 should be monitored for use of antipsychotics. Staff J stated she did not know how to look back on the MAR but would speak to the DON (Director of Nursing). On 07/27/22 at 12:35 p.m., an interview was conducted with the Assistant Director of Nursing (ADON). The ADON stated the monitoring orders are entered when the new medication orders are added to the system, either upon admission or when a new psychotropic medication order is received. The ADON reviewed Resident #84's medication orders and stated, This order was entered wrong. The nurse did not check the monitoring part. The ADON stated there is a supplementary section that should be checked to include behavior monitoring or side effects. The ADON confirmed the monitoring section was not checked. The ADON stated this means the nurse administering the medication would not see the pop-up option to document behavior or side effects monitoring. The ADON stated the nurse who entered the orders did not do it right. The ADON stated she will review all the resident's orders to make sure they are correct. A follow -up interview was conducted with the DON on 7/27/22 at 1:05 p.m. The DON stated the nurses should be monitoring resident's pain, side effects and should document behaviors if noted, per physician orders. The DON stated the nurse who entered the orders for Resident #84 is new and she did not push the monitoring part. The DON was notified Resident #84 was missing monitoring orders for the month of June and July 2022. The DON stated the monitoring was definitely missed. The DON said, Obviously we can't fix the past. We will review orders and make sure the orders are up to date. A telephonic interview was conducted on 7/28/22 at 1:48 p.m. with the facility's Pharmacy Consultant. The Pharmacy Consultant stated the expectation is for daily monitoring, per shift or per orders. The Pharmacy Consultant stated the monitoring should be for each specific behavior. It should show why the medication was prescribed and identify any side effects or behaviors presented. The consultant stated the nurse should document the behaviors being observed prior to administering the medications and monitor if the medication was a relief. The Pharmacy Consultant said, Yes, they should definitely be monitoring psychotropic and antipsychotic medications as ordered. Review of a facility policy titled, Psychotropic Medication Assessment & Monitoring, revised 10/30/2018, showed an expectation to administer and monitor the effects of psychotropic medications. Under (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105045 If continuation sheet Page 18 of 19 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 07/28/2022 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Procedure (c.) The interdisciplinary team assesses and monitors the appropriateness, effectiveness and side effects associated with psychotropic medications for each resident via the MDS process. The consultant pharmacist reviews the use of the psychotropic medication order as part of each drug regimen review and monitors . if there is a change in behavior or clinical status. (d.) monitoring of residents receiving antipsychotic medication will be completed by a licensed nurse as per acceptable standard of practice using the behavior monitoring record. Under Documentation, (2.) record the approaches and interventions taken for behavior problems. (4.) Record behavior, interventions and the effectiveness of the intervention taken in the behavior monitoring record. Event ID: Facility ID: 105045 If continuation sheet Page 19 of 19