Inspection·July 18, 2024

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interviews, record review and facility policy review, the facility failed to ensure an injury of an unknown source resulting in physical injury and subsequent death, were reported to the proper authorities within the prescribed timeframes for 1 (#1) of 3 residents reviewed. Findings included: Resident #1 was admitted to the facility on [DATE] and discharged on 06/13/24. Review of a progress note for Resident #1 dated 06/13/24 showed: Resident noted sitting up, leaning over in bed and was unresponsive. Hematoma and laceration noted to back of head. Wheelchair next to bed in locked position and blood noted on leg rest area of wheelchair. Resident appears to have had unwitnessed fall. MD [Medical Doctor] notified, and EMS [Emergency Medical Service] called to send resident to [name of Hospital] emergency room for evaluation and treatment. Resident's [Healthcare Surrogate] was notified of resident's status and transfer to hospital. Review of a progress note for Resident #1 dated 06/13/24 showed a progress note documented by Staff A, Licensed Practical Nurse (LPN) assigned to Resident #1. It read: Received a call from resident's [family member stating they were at a local hospital trauma center and were asking if Resident #1 had any advanced directives in her chart. Resident's [family member] stated, We aren't really sure if she does, but we think she might. This nurse checked chart and located HCS (Health Care Surrogate). Staff A, LPN confirmed with social services that there were no other Advanced Directives. Staff A inquired about the resident's status and resident's [family member] stated The doctor said she has a very big brain bleed, and the brain has shifted. The doctor said she is not going to come out of this. Resident's [family member stated, I don't know what she hit her head on this time, it must have been something very hard. Resident's [family member] stated .they need to have her HCS sign paperwork to remove her from a ventilator. Review of the facility's adverse and incident report log dated April 2024 to July 2024 showed the facility had not had any reportable incidents. Review of a quarterly MDS (Minimum Data Set) dated 04/04/24, showed in section GG: for chair/bed-to-chair transfer meaning the ability to transfer to and from a bed to a chair (or wheelchair). The resident required partial/moderate assistance. Helper does LESS THAN HALF the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. The assessment confirmed Resident #1 was not independent to self-transfer after a presumed unwitnessed fall. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 105045 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 07/18/2024 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)