Inspection·February 2, 2023

F 0677 Focus (1/13/21, last revised 10/21/21) Self-Care Performance Deficit related to cognitive deficit, right femur fracture, impaired judgement/decision making, impaired mobility. Level of Harm - Minimal harm or potential for actual harm Goal: Customer will be assisted with ADLs daily by staff through next review. Residents Affected - Few Interventions: Assist as needed with daily dressing and grooming. Ensure neat and clean appearance daily. 2. On 01/30/2023 at 12:20 PM, Resident #65 was observed in her room, sitting up in a wheelchair, dressed in day clothing. She was nonverbal aside from some nonsensical mumbling. All of her fingernails were elongated with brown debris observed under each nail. On 01/31/2023 at 2:06 PM, Resident #65 was observed in her room, sitting up in a wheelchair, dressed in day clothing. She was nonverbal aside from some nonsensical mumbling. All of her fingernails were elongated with brown debris observed under each nail. On 02/01/2023 at 8:45 AM, Resident #65 was observed in her room, sitting up in a wheelchair, dressed for the day. She was nonverbal. All of her fingernails were elongated with brown debris under each nail. On 02/01/2023 at 3:00 PM, Resident #65 was observed in her room, sitting up in a wheelchair, dressed for the day. She was nonverbal. All of her fingernails were elongated with brown debris under each nail. A medical record review for Resident #65 revealed diagnoses ubcluding dementia, history of falling, polyosteoarthritis, major depressive disorder, and blindness in one eye. A review of the MDS annual assessment, dated 10/25/22 for Resident #65 revealed: Section C: Brief Interview for Mental Status (BIMS) score was 02 out of a opssible 15 points, indicating severe cognitive impairment. Section E: Behaviors exhibited: None; Rejection of Care: Behavior not exhibited. Section G: Personal Hygiene: Eextensive staff assist/one person physical assist provided. The Care Plan for Resident #65 was reviewed and revealed: Focus (8/8/14, last revised 2/8/21) Resident has a Self-Care Performance Deficit related to dementia, impaired judgement/decision making. Goal: (revised 1/25/23) Resident will complete and/or maintain self-care tasks with moderate assistance through next review. Interventions: Ensure neat and clean appearance daily. 3. On 01/31/2023 at 10:00 AM, Resident #37 was observed lying in bed, awake, conversant, and pleasant. She was asked if staff had assisted her with her activities of daily living this morning. She stated yes. Her fingernails were elongated with debris under each nail. She was asked if staff cared (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 2 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few for her fingernails. She stated. Sometimes, but not recently. I need to get them repainted. She was asked if she could trim and clean her fingernails herself. She stated, No, I can't do that myself. I've had a stroke; I can't manage things like that with my hands. On 02/01/2023 at 8:45 AM, Resident #37 was observed in her room, lying in bed, awake, and eating breakfast. Her fingernails were elongated with brown debris under each nail. A medical record review for Resident #37 revealed diagnoses including COPD (Chronic Obstructive Pulmonary Disease), type II diabetes, CVA (Cerebral Vascular Accident), and glaucoma. A review of the MDS quarterly assessment, dated 12/18/2022 for Resident #37 revealed: Section C: Brief Interview for Mental Status score was 11 out of a possible 15 points, indicating moderate cognitive impairment. Section E: Behaviors exhibited: None; Rejection of Care: Behavior not exhibited. Section G: Personal Hygiene: Extensive staff assist/one person physical assist provided. The Care Plan for Resident #37 was reviewed and revealed: Focus: (6/10/22) Resident requires assistance with ADL functions. Goal: Resident will maintain current level of function til next review. Interventions: Grooming: someone must assist the resident to groom self. Grooming: The resident depends entirely upon someone else for grooming needs. On 02/02/2023 at 11:50 AM, in an interview with Certified Nursing Assistant (CNA) U, she was asked if she was caring for Residents #37, #65, and #115 today. She stated, I have [Residents #65 and #115] on my assignment today, but I have cared for [Resident #37] before too. This is usually my unit to work, so I've cared for most of the residents over here. She was asked who cleaned and trimmed the residents' fingernails. She stated, We do, if they let us. Not the diabetics, though, only the nurses trim the diabetics' nails. She was asked if CNAs could clean under the diabetics' fingernails. She stated, I think so, yes, we can clean them, we just can't trim them. She was asked when residents' fingernails were cleaned and trimmed. She stated, Anytime, just with their ADL care. It's not something that's scheduled. We just clean them when they need to be cleaned, if they let us. She was asked what she did if a resident refused to have their fingernails trimmed and cleaned. She stated, I'll try to ask them again later, and then I let my nurse know if they still refuse. She was asked if she was able to chart anywhere if a resident refused care. She stated, Yes, we chart on the computer and we can put in refusals. She was asked who cleaned and trimmed the residents' toenails. She stated, That would be the foot doctor. We don't touch their toenails. She was asked what she did if she observed a resident's toenails to be elongated or in need of cleaning. She stated, I'll let my nurse know so they can get them a foot doctor appointment. They come into the facility to see the residents. On 02/02/2023 at 12:00 PM, Licensed Practical Nurse (LPN) E was asked who cleaned and trimmed the residents' fingernails. She stated, The activities staff does that as an activity. They clean and trim them and give manicures, and they'll paint their nails. She was asked who trimmed fingernails for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 3 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few diabetic residents. She stated, Oh the nurses do that. We do the the trimming for the diabetic residents. She was asked how often fingernails for diabetic residents were cleaned and trimmed. She stated, I'm not sure. I think there's a schedule. She was asked how often she cleaned and trimmed her diabetic residents' nails. She replied, If I see they need it done or if one of the CNAs let me know it needs to be done. On 02/02/2023 at 12:10 PM, the Director of Nursing (DON) was asked who cleaned and trimmed the residents' fingernails. She stated, Activity staff cleans, trims and paints residents' nails, but if a resident is a diabetic, only nurses can trim those nails. She was asked if CNAs provided fingernail care. She stated, Yes, as long as they are not a diabetic. She was asked if there was a schedule for fingernail care. She stated, No, they just do it when it needs to be done, or if the CNA lets the nurse know that a diabetic needs their nails trimmed. She was asked if CNAs and activities staff cleaned under all residents' nails, including diabetics. She stated, Yes, they can soak their nails and use an orange stick to clean under them. She was asked when this should be done. She stated, As needed, usually on shower days or in-between if it's needed, as long as a resident is agreeable and doesn't refuse the care. She was asked what the procedure was if a resident refused to have their fingernails trimmed and cleaned. She stated, The staff would reapproach them again later, and if they still refused, they would chart the refusal of care. A review of the facility's policy for Activities of Daily Living (ADLs) revealed: Policy statement: Residents will be provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out ADLs. Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Policy Interpretation and Implementation: 2. Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: a. Hygiene (bathing, dressing, grooming, nail care, and oral care). 4. On 01/30/2023 at 2:00 PM, Resident #98 was observed with facial hair and stated she would like to be shaved. On 01/31/2023 at 10:12 AM, Resident #98 was observed and appeared as she did on 01/30/2023 at 2:00 PM, with facial hair. On 02/01/2023 at 2:22 PM, Resident #98 was observed with a shaved chin, but she still had hair above her upper lip. She stated, They shaved me yesterday. A review of Resident #98's medical record revealed an admission date of 8/6/2022, and a re-entry on 10/25/2022. Resident #98's diagnoses included encephalopathy, major depressive disorder, fracture of upper end of left humerus, subsequent encounter for fracture with routine healing, confusion, psychosis, and cataract extraction status, unspecified eye. A review of the resident's quarterly MDS, dated [DATE], indicated Resident #98 had a BIMS score of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 4 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 7 out of a possible 15 points, indicating severe cognitive impairment. Resident #98 had no behaviors , and required limited assistance with bed mobility, transfers, walking in room, locomotion on unit and corridor, limited assistance with dressing, supervision while eating, and she was totally dependent for bathing. A review of the Care Plan, dated 10/18/2022, revealed that Resident #98 had an ADL Self-Care Deficit related to chronic medical conditions. Goal: Resident will maintain and/or improve ADL functioning through next review date. Resident will not have a decline in ADL functioning through next review date. Interventions: Assistive devices as ordered/indicated. Encourage and assist with all ADL tasks as indicated, as tolerated by resident, including locomotion/ambulation, bathing, bed mobility, transfers, toileting tasks, meals, personal/oral hygiene, etc. On 01/30/2023 at 10:18 AM, an interview was conducted with CNA P. He stated female residents had their facial hair removed during their shower day, which for resident #98, was every Friday during the day shift. On 01/31/2022 at 2:18 PM, an interview was conducted with CNA Q. She stated some female residents refused facial hair removal, but they provided the service on shower days. A review of the facility's policy and procedure for Activities of Daily Living (ADL) (effective 2001, revised in March 2018) revealed: Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. 5. On 01/31/2023 (Tuesday) at 11:45 AM, Resident #70 stated he hadn't been shaved in over a week, maybe more, and had a heavy growth of facial hair forming into a beard and mustache. The resident stated most of the time he didn't receive a shower or a full bath, he was just wiped off while in bed. He stated before his illness, he showered everyday and he would like to receive a shower more frequently. On 02/01/2023 (Wednesday) at 10:02 AM, Resident #70 was observed lying in bed on his back, resting with his eyes closed. There were no changes to his facial hair. He had not been shaved. On 02/01/2023 at 12:00 PM, Resident #70 was observed sitting up in bed, alert and oriented. He stated he asked a CNA this morning (couldn't recall name) if they could shave him, and he was told they would check with the CNA who normally shaved him. A review of the medical record revealed that Resident #70 was admitted to the facility on [DATE] with diagnoses including traumatic intracranial hemorrhage, hemiplegia affecting the non-dominant left side, and seizure disorder. A review of the ADL Task List revealed: Bathing/Shower/Bath schedule weekly variable/evenings, on Tuesdays, Thursdays, and Saturdays. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 5 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of the quarterly MDS assessment, dated 1/10/2023, revealed that the resident had a BIMS score of 12 out of a possible 15 points, indicating mild to moderate cognitive impairment. He required extensive assistance with personal hygiene (included shaving and bathing). A review of the Care Plan (dated 11/13/2022) indicated the resident had an ADL Self-Care Deficit related to chronic medical conditions. Interventions included: Encourage and assist with ADL tasks as indicated, as tolerated by resident including locomotion/ambulation, bathing, bed mobility, transfers, toileting tasks, meals. personal/oral hygiene, etc. Observe resident for changes in ADL capabilities. On 02/02/2023 (Thursday) at 10:00 AM, Resident #70 was observed in bed. There were no changes to his facial hair. He was still unshaven. He stated he asked a CNA again this morning if someone could shave him, but they hadn't returned to do it yet. In an interview on 02/02/2023 at 11:00 AM with CNA K, she stated she was assigned to Resident #70. She confirmed that the resident had asked her to shave him and she had not gotten to it yet. She added that residents were supposed to be shaved during their shower days. Resident #70 was scheduled to receive showers in the evenings, and therefore, she could not explain why the evening staff had not done it. She added that she would shave him before the end of the shift. In an interview with LPN A on 02/02/2023 at 11:28 AM, she stated CNAs were expected to shave the residents during showers. If a resident refused a shower, the nurse should be notified. At least three attempts should be made at different times before documenting that the resident refused. When asked about Resident #70, she stated she was not aware of whether he refused showers. She added that this resident received showers in the evening, and she worked in the morning. She said she would ensure he was shaved. A review of the facility's policy for Activities of Daily Living (Revised March 2018) revealed: Policy Statement: Residents will be provided with care, treatment and services as appropriate to maintain or improve their ability to carry out ADLs. Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Policy Interpretation and Implementation: Line 1. Resident will be provided with care, treatment and services to ensure that their activities of daily living (ADLs) do not diminish unless the circumstances of their clinical condition(s) demonstrate that diminishing ADL's are unavoidable. Line 2. Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with; a. Hygiene (bathing, dressing, grooming and oral care). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 6 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0677 Level of Harm - Minimal harm or potential for actual harm Page 2, Line 6. read: Interventions to improve or minimize a resident's functional abilities will be in accordance with the resident's assessed needs, preferences, stated goals and recognized standards of practice. . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 7 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, record reviews, and policy and procedure reviews, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices, by failing to 1) Carry out physician's orders for consultations for Resident #30, and 2) Promptly identify and intervene for a change in condition (dehydration), report low blood pressures (hypotension) to the physician, consult the physician about low blood pressures prior to the administration of blood pressure medications for a resident with hypotension, and follow physician's orders for laboratory tests, for Resident #517, two residents reviewed from a total sample of 55 residents. Residents Affected - Few The findings include: 1. On 1/31/22 at 10:00 AM, Resident #30 was observed lying in bed. He stated he had spoken to his physician multiple times related to his pain and vision. He had pain in his left lower back that radiated to his left foot. He stated when he told the nursing staff about his pain, they only gave him Tylenol and it did not help. He further stated he was worried about losing his vision, and would also like to see a dentist. When asked if the facility staff were aware of this, he said he had spoken to the staff. I have told the nurses over and over again and they ignore me. I just stopped telling them because they don't seem to care. A review of the resident's Electronic Medical Record (EMR) revealed that Resident#30 was admitted to the facility on [DATE] and had a re-entry on 12/15/22. His admitting diagnoses included hemiplegia, hemiparesis, diabetes mellitus, retinopathy, and peripheral neuropathy. A review of the active physician's orders revealed the following: Cardiology consult dated 12/16/22. Pain consult dated 12/30/22. Ophthalmology consult dated 1/27/23. A review of the resident's Care Plan, with a review date of 2/3/23, revealed that the resident had pain and/or was at risk for pain related to chronic pain and physical disability. Interventions included administration of analgesia (pain medication) as ordered and review pain medication as needed. The care plan also indicated that the resident had oral/dental health problems related poor hygiene, missing teeth, and the facility would assist with arrangements for dental care. He was also at risk for altered respiratory status/difficulty breathing related shortness of breath (SOB). A review of the Medicare 5-Day Minimum Data Set (MDS) assessment, dated 12/21/22, revealed that the resident had adequate vision and no corrective lenses. The Brief Interview for Mental Status (BIMS) score was recorded as 14 out of 15 possible points, indicating intact cognition. He required extensive assistance for bed mobility and toilet use, and limited assistance for transfers. He was independent for eating. He had no broken or loosely fitting full or partial dentures and no mouth discomfort or difficulty chewing. The assessment further indicated that the resident was not on any scheduled or as needed (PRN) pain management, and reported that he experienced pain almost constantly. Pain was described as severe. The resident was also noted as experiencing shortness of breath (SOB). A Physician's Progress Note, dated 12/16/22, indicated the resident had poor dentition, and an electrocardiogram (EKG) performed at the acute care facility was reflective of stable ischemic cardiomyopathy. The resident was at risk for sickle cell disease (SCD). The plan included an in-house cardio consult and weekly weights. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 8 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0684 Level of Harm - Minimal harm or potential for actual harm A Nursing Progress Note, dated 1/1/23, indicated that the resident was in minimum pain but refused pain relief. (A review of the active physician's orders as of 02/02/23, revealed current orders for pain medication.) A review of the Optometry Consult form, dated 11/03/22, revealed the resident was not examined due to COVID isolation. (Copy obtained) Residents Affected - Few On 2/1/23 at 12:00 PM, Resident #30 was observed seated in a wheelchair in the hallway. He again stated he had requested pain medication and the nurse gave him Tylenol, which did not help. When he was asked his level of pain on a scale of 1-10, 10 being the most severe pain, he replied that his pain level was a 10. He touched his left lower back and added that he also had nerve pain down through his left leg. He mentioned that he previously received stronger pain medication, but he was no longer offered that. He confirmed that he had not seen anyone about his dental concerns, pain or cardiology concerns. In an interview on 2/2/23 at 11:28 AM, Licensed Practical Nurse (LPN) A stated if a resident was in pain, the nurse should complete a pain assessment and administer pain medication. If a resident did not have pain medication ordered, the nurse should call the physician and obtain an order. She stated medication should not be given without an order. She added that when an order was received, the facility had a medication bank where nurses could obtain medication while awaiting delivery from the pharmacy. When asked about consultation orders, she stated the nurse receiving the orders should contact the necessary department related to the consult. He/she should then fax the orders, and place the referral to the appropriate binder located at the nurses' station. She added that communication for follow up was also done during change-of-shift report. When asked about Resident #30's ordered consultations, she confirmed the resident had orders for cardiology, pain and ophthalmology consults, and there was no evidence that these orders were carried out. She stated she would follow up with the unit manager. A review of the Pain Management binder, which was kept at the nurses' station, revealed all the residents' names under pain management as of 11/16/22. Resident #30 was on the list. A review of the Cardiology binder, which was at the nurses' station, revealed that the consults had not been updated since 2019. In an interview on 2/2/23 at 12:07 PM, LPN B confirmed that Resident #30 had no pain medication and was not under pain management. She reviewed the orders and stated the resident was previously on Norco (narcotic pain medication), 5/325 milligrams every 6 hours as needed (PRN) for pain, and the medication was discontinued on 11/3/22 when Resident #30 was transferred to an acute care facility. She also confirmed that the orders for the cardiology, pain and ophthalmology consultations were not carried out. In an interview with LPN C/Assistant Director of Nursing (ADON) on 2/2/23 at 12:30 PM, she stated the facility should keep a list of residents who were receiving cardiology and/or pain consultations. She confirmed that the facility failed to maintain a list of residents who were on pain management or cardiology and therefore, she could not confirm whether Resident #30 was on the case load. She further stated there were no visit notes, so most likely, the resident was not on case load for either the cardiology or pain physicians. 2. A review of Resident #517's medical record revealed that the resident was admitted to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 9 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility on [DATE], with diagnoses including metabolic encephalopathy, adult failure to thrive, severe protein-calorie malnutrition, and dementia. On 12/12/2022, Resident #517 was discharged to the hospital for dehydration and acute kidney failure. A review of the Medicare 5-Day MDS (Minimum Data Set) assessment, dated 11/14/2022, revealed that Resident #517 had a Brief Interview for Mental Status (BIMS) score of 9 out of a possible 15 points, indicating moderate cognitive impairment. She required extensive assistance with bed mobility and locomotion, limited assistance with transfers, and she was totally dependent on two staff members for bathing. Resident #517 was frequently incontinent of urine and always incontinent of bowel. A review of the Care Plan, dated 12/1/2022, revealed that the resident was at Risk for Alteration in Nutrition/Hydration r/t overweight status, therapeutic diet, advanced age, adult failure to thrive (AFTT), malnutrition, dementia, hypertension (HTN - high blood pressure), gastroesophageal reflux disease (GERD), and anemia. A review of the Physician's Orders revealed: 11/10/2022 Carvedilol tablet 6.25 mg (milligrams), give 1 tablet by mouth two times a day for HTN. 11/10/2022 Valsartan Tablet 80 mg, give 1 tablet by mouth at bedtime for HTN. 12/2/2022 Pink Bismuth Suspension 262 mg/15ml (milligrams per milliliter) (Bismuth Subsalicylate), give 30 ml by mouth every 4 hours as needed for diarrhea. 12/3/2022 CBC & BMP (laboratory tests) one time only for 1 day. 12/3/2022 Vital signs every shift for 10 days. 12/11/2022 Dextrose-NaCl Solution 5-0.9% (Dextrose-Sodium Chloride), 60 ml/hour intravenously every shift for dehydration for 3 days. 12/11/2022 CBC&CMP (laboratory tests) one time only for dehydration. 12/12/2022 20:04 (8:04 PM) Send to ER (emergency room) for critical lab results STAT (immediately). A review of Vital Signs forms for December 2022 revealed: 12/5/2022 17:14 (5:14 PM) blood pressure 82/53 mmHg (millimeters of mercury) 12/6/2022 16:44 (4:44 PM) blood pressure 94/68 mmHg 12/6/2022 20:03 (8:03 PM) blood pressure 90/70 mmHg (Copies obtained) A review of the medical record revealed that on the 5th and 6th of December 2022, the records contained no documentation of physician notification about the resident's hypotension or the withholding/provision of blood pressure medication during those times. A review of the electronic Medication Administration Record (eMAR) for December 2022, revealed no blood pressure (BP) or pulse (P) recorded for the medication Valsartan (blood pressure medication), (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 10 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few nor was it administered on 12/05/2022 at 20:00 (8:00 PM). Code 4 outside parameter was documented, however, no parameters were indicated on the eMAR. On 12/6/2022 at 20:00 (8:00 PM), a BP of 90/70 and a P of 70 were recorded on the MAR under the medication Valsartan, and the medication was signed by the nurse as having been administered. Further review of the eMAR for December 2022, revealed a BP of 82/53 and a P of 91 recorded for the medication Carvedilol (blood pressure medication) at 4:00 PM on 12/5/22. The medication was withheld and Code 4 outside parameter was documented, however, no parameters were indicated on the eMAR. On 12/6/22 at 8:30 AM, no BP or P were recorded for Carvedilol and the medication was administered. At 4:00 PM, a BP of 94/68 and a P of 70 were recorded for Carvedilol and the medication was administered. Pink Bismuth Suspension (diarrhea medication), ordered as needed every 4 hours on 12/2/22 for diarhhea and discontinued on 12/19/22, was never administered. Dextrose-NaCl Solution 5-0.9%, 60 ml/hr intravenously every shift x3 days for dehydration, starting on the night shift on 12/11 and to be administered through the evening shift on 12/14, was not signed off by the assigned nurse as having been administered at all on 12/13, or during the day shift or evening shifts on 12/14/22. (Copies obtained) A review of the Laboratory Results reported on 12/13/2022 at 12:43 PM and reviewed by Registered Nurse (RN) W on 12/13/2022 at 5:38 PM, revealed critical high levels of Blood Urea Nitrogen (BUN) - 134 mg/dL (milligrams per deciliter) with a normal range of 7 to 25 mg/dL, and Creatinine - 9.17 mh/dL with a normal range of 0.60 to 1.20 mg/dL, indicating increased renal insufficiency. There was no documentation on the form to indicate that the resident's physician was notified. (Copy obtained) A review of the Laboratory Results (BMP and CBC) reported on 12/15/2022 at 11:51 AM, and reviewed by the Assistant Director of Nursing (ADON)/LPN C on 12/15/2022 at 1:14 PM, revealed a collection date of 12/05/2022 at 5:20 AM, a received date of 12/05/2022 at 16:27 (4:27 PM), and a reported date of 12/15/2022 at 11:51 AM: Status invalid. Tests not performed. There was no documentation on the form to indicate that the resident's physician was notified. (Copy obtained) Further review of Resident #517's medical record revealed that between 12/05/2022 and 12/12/2022 (Resident #517's discharge date ), the record contained no documentation of the facility having followed up on the resident's status invalid - tests not performed laboratory results. A review of the resident's physician's Cardiology Progress Note, dated 11/11/2022, revealed the following recommendations for the resident: Monitor vital signs, avoid overcorrection of blood pressure, plan to check laboratory tests. A review of the Progress Note dated 12/02/2022, revealed that the resident's family was concerned that she was lethargic and her appetite had not improved. The family was also concerned about diarrhea, and staff not cleaning her, dressing her, or or putting her hearing aids in. A review of the Progress Note dated 12/11/2022, revealed that the resident had not been taking fluids or eating, and her blood pressure (BP) was 90/60. A review of the Progress Note dated 12/12/2022, showed that the resident's chief complaint was low blood pressure (hypotension). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 11 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0684 Level of Harm - Minimal harm or potential for actual harm On 2/1/23 at 2:00 PM, an interview was conducted with LPN O. He stated after sending a sample from the resident to the laboratory for tests like a CMP (complete metabolic panel) and/or a CBC (complete blood count), it usually took one to two days to receive results. After two days, if no results were received, the nurse should call the laboratory to inquire about results. LPN O stated he would not give Valsartan or Carvedilol to the resident with a blood pressure of 82/53, 94/68, or 90/70 mmHg. Residents Affected - Few On 2/1/23 at 2:11 PM, an interview was conducted with LPN B. She stated the results from the laboratory usually came at 4:00 AM, 5:00 AM, or in the afternoon or evening time. She would call the laboratory if no results had been received within two days. If a resident's blood pressure was 82/53, 94/68, or 90/70, for a systolic blood pressure of 90 or less, she would not administer Valsartan or Carvedilol, and she would call the physician. On 2/2/23 at 1:28 PM, an interview was conducted with the Director of Nursing (DON). She was asked to explain the process for following up on laboratory test results and who was responsible for the follow up. She stated a nurse was responsible (or a unit manager) for follow up calls to the laboratory. She stated if there were no blood pressure parameters in the MAR for blood pressure medications Valsartan and Carvedilol, she would call the physician for blood pressures of 82/53, 94/68, and 90/70 before administering those medications. The DON was asked to explain and show evidence that the facility followed up on the aforementioned laboratory results for Resident #517. She stated she needed time to investigate the problem. No explanation was provided before the survey exit. A review of the facility's policy and procedure for Administering Medications (effective 2001 and revised in December 2022) revealed: If medication has been identified as having potential adverse consequences for the resident or is associated with adverse consequences, the person administering the medication will contact the prescriber. Notify physician of changes in resident/patient. (Copies obtained) A review of the facility's policy and procedure for Change in a Resident's Condition or Status (effective 2001 and revised in May 2017) revealed: The nurse will notify the resident's attending physician or physician on call when there has been an adverse reaction to medication or a significant change in the resident's physical condition. (Copies obtained) A review of the facility's policy and procedure for Laboratory Services (effective 2005 and revised in September 2012) revealed: A nurse will review all results. Before contacting the physician/designee, the nurse will gather and organize information and coordinate any telephone communications with physician and/or designee. (Copies obtained) A review of the National Kidney Foundation at kidney.org (Accessed 2/2/23 at 3:00 PM) revealed: What causes acute kidney injury (AKI)? Acute kidney injury can have many different causes. AKI can be caused by the following: Decreased blood flow. Some diseases and conditions can slow blood flow to your kidneys and cause AKI. These diseases and conditions include: Low blood pressure (called hypotension) or shock, and blood or fluid loss (such as bleeding or severe diarrhea). . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 12 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm Based on observations, staff and resident interviews, medical record review, and policy and procedure review, the facility failed to ensure that two (Residents #37 and #74) of a total sample of 55 residents were provided with foot care consistent with professional standards of practice, including assisting residents in making necessary appointments with qualified healthcare providers such as podiatrists. Residents Affected - Few The findings include: 1. On 01/31/23 at 10:00 AM, Resident #37 was observed lying in bed, awake and conversant. The resident stated she had not seen a podiatrist. She pulled back her covers and both feet were observed to have significantly thickened toenails, which were elongated and curled. She stated her left great toe hurt. She was asked when she had last seen a podiatrist. She stated, I don't know, but I haven't seen one since I've been here. She was asked if staff trimmed or cleaned her toenails. She stated, No. I don't think they will, because I'm a diabetic. She was asked if she had asked staff for a podiatry appointment. She replied, Yes, I've asked more than once. I haven't heard anything. On 02/01/23 at 8:45 AM, Resident #37 was observed in her room, lying in bed, awake, eating breakfast. She was asked if her left great toe was still painful. She stated, Yes. I haven't heard a thing about the foot doctor. Can you put a fire under them? A medical record review for Resident #37 revealed diagnoses including type II diabetes and Cerebral Vascular Accident (CVA). A review of her quarterly Minimum Data Set (MDS) assessment, dated 12/18/22, revealed: Section C: (Brief Interview for Mental Status) BIMS score of 11 out of 15 possible points, indicating moderate cognitive impairment. Section E: Behaviors: None exhibited. Rejection of care: Not exhibited Section G: Personal hygiene: Extensive assist/1-person assist A review of Resident #37's Physician's Orders revealed that no order (current, past, or discontinued) was found for podiatry care/visit/referral. A review of the comprehensive person-based Care Plan revealed: Focus Area: 6/10/22 (revised 10/11/22) Resident has potential for complications including hypo/hyperglycemia related to diabetes mellitus. Goal: Resident will have no complications related to diabetes through the review date. Interventions: (10/11/22) Refer to podiatrist/foot care nurse to monitor/document foot care needs and to cut long toenails. Focus Area: 6/10/22 Resident requires assistance with Activities of Daily Living (ADL) functions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 13 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0687 Goal: Resident will show improvement in ADLs through next review. Level of Harm - Minimal harm or potential for actual harm Interventions: Grooming: resident depends entirely upon someone else for grooming needs. Further review of the medical record revealed no notes/consults from a podiatrist. Residents Affected - Few 2. On 02/01/23 at 9:30 AM, Resident #74 was observed in her room. Licensed Practical Nurse (LPN) D pulled back the resident's bed covers to apply lotion to her legs. Her toenails were elongated and curled. The resident stated, I wish I had some nail clippers to cut my toenails. She was asked if she was diabetic. She stated yes. She was asked if she had seen a podiatrist. She stated no. LPN D stated, We'll have to get a foot doctor for you. A medical record review for Resident #74 revealed diagnoses including type II diabetes and Cerebral Vascular Accident (CVA). A review of her annual MDS assessment, dated 11/14/22, revealed: Section C: BIMS score of 11 out of 15 possible points, indicating moderate cognitive impairment. Section E: No behaviors exhibited. Rejection of care: Not exhibited. Section G: Personal hygiene: Extensive assistance/1-person assist. A review of the Physician's Orders revealed that no order (current, past, or discontinued) was found for podiatry care/visit/referral. A review of the comprehensive person-based Care Plan revealed: Focus Area: (3/1/219) Resident is at risk for alteration in skin integrity related to diabetes mellitus. Goal: Resident will receive appropriate services and treatments to minimize potential skin breakdown, and will implement interventions to minimize the risk of skin impairment through the next review. Interventions: (revision 5/9/21) Dry skin well between toes and other surfaces where skin rubs together. File/trim nails. Podiatry consult as indicated/ordered. In an interview with the Administrator on 02/02/23 at 8:40 AM, she was asked who provided podiatry services for the residents. She stated, We use a service called [name of provider]. They come to the facility. She was asked how the residents were seen by podiatry. She stated, A podiatrist comes here about every 6-8 weeks; they have struggled with getting a doctor here. Residents are added to the list to be seen. We will send over a referral so they know who needs to be seen. She was asked if she could provide any foot care notes from podiatry for Resident #37. She stated, She was just seen yesterday. She was asked if this resident had been seen by a podiatrist any other time since her admission date of 6/10/22. She stated, No she hadn't. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 14 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0687 She was asked if this resident had a diagnosis of diabetes. She stated yes. Level of Harm - Minimal harm or potential for actual harm She was asked how often a diabetic resident should be seen by a podiatrist. She stated, I would say as needed, but I'm a social worker by trade, so that may be a more clinical question. Residents Affected - Few She was asked if Resident #74 been seen by a podiatrist. She stated yes, and provided podiatry notes from 8/22/22 and 11/18/21. She was asked if these were the only times this resident had been seen by a podiatrist. She stated, Yes, that's all we have for documentation. She was asked if this resident was diabetic. She stated, Yes she is. In an interview with Certified Nursing Assistant (CNA) U on 2/2/23 at 11:50 AM, she was asked who cleaned and trimmed the residents' toenails. She stated, We don't do that. They have a podiatrist do that. She was asked how the podiatrist knew which residents needed their toenails trimmed. She stated, We'll tell the nurse, or the nurse will see them and the nurse adds them to a list, I guess. In an interview with LPN E on 2/2/23 at 12:00 PM, she was asked who cleaned and trimmed the residents' toenails. She stated, The foot doctor does that. Especially if they're a diabetic, but I think they do all the toenails for all the residents. She was asked how residents were seen for foot care. She stated, I think there's a list, and the list gets sent to the foot doctor. I think they come in once a month to see residents. In an interview with the Director of Nursing on 2/2/23 at 12:10 PM, she was asked how often podiatry services were provided for the residents. She stated, We have a company called [name of provider]that comes in; I think they come in monthly. They have a schedule, but social services also deals with that and makes the appointments. They were here yesterday and saw seven residents. She was asked if there was a set schedule for diabetics to be seen by podiatry. She stated, I don't know how often they are seen, but if we see any needs for a foot doctor, then we can call over to the podiatry service and they will add the resident to their schedule for their next visit. She was asked who trimmed the residents' toenails. She stated, The podiatrist. She was asked how often diabetics' toenails were assessed. She stated, Nursing should be assessing them on shower days. The CNAs will let them know if there is anything that needs to be looked at, and they have weekly skin checks that the nurses do. A review of the facility's Policy and procedure for Foot Care (revised 3/2018) revealed: Policy Statement: Residents will receive appropriate care and treatment in order to maintain mobility and foot health. 1. Residents will be provided with foot care and treatment in accordance with professional standards of practice. 2. Overall foot care will include the care and treatment of medical conditions associated with foot complications (i.e.: diabetes, PVD (peripheral vascular disease) etc.) 3. Residents will be assisted in making transportation appointments to and from specialists as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 15 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0687 needed. Level of Harm - Minimal harm or potential for actual harm 4. Trained staff may provide routine foot care (eg: toenail clipping) within professional standards of practice for residents without complicating disease processes. Residents with foot disorders or medical conditions associated with foot complications will be referred to qualified professionals. Residents Affected - Few . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 16 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 observations, staff and resident interviews, and facility policy review, the facility did not ensure the resident environment remained as free of accident hazards as is possible for one (Resident #106) of a total sample of 55 residents. The facility, which is responsible for resident safety, had no protocol for verifying the safety of individual resident refrigerators and/or maintaining safe temperatures inside to ensure foodborne illness did not result from temperatures that were too warm to keep foods properly cooled. The findings include: On 1/30/23 at 12:15 PM, Resident #106 was observed lying in bed, dressed in day clothes. A personal refrigerator was observed in her room beside her bed. No temperature log was observed in the area. The resident was asked what she kept inside the refrigerator. She stated, Usually leftovers if I get some take out food. She was asked permission to look inside the refrigerator. She agreed. Three coffee creamers were observed, and a thermometer which read 48 degrees. On 1/31/23 at 10:49 AM, Resident #106 was not observed in her room. Her personal refrigerator was observed. Three creamers were observed inside the refrigerator. No temperature log was observed in the area. The thermometer inside indicated the temperature was 47 degrees Fahrenheit (F). (Photographic evidence obtained). On 2/1/23 at 11:46 AM, Resident #106 was observed lying in bed, awake. She was asked if she had any food in her personal refrigerator. She stated, No, not right now. She was asked what type of food she kept in there. She stated, Sometimes my family will bring me some fried chicken, and I put drinks and sodas in there. My family will bring me other stuff, too, and I'll put the leftovers in there. She was asked how often she kept food in her refrigerator. She stated, Oh, a couple times a week, sometimes more, sometimes less. She was asked permission to look inside the refrigerator. She agreed. Three creamers were observed, and the thermometer read 47 degrees F. (Photographic evidence obtained) No temperature log was observed in the room. The resident was asked if staff checked the temperature of her refrigerator daily or at any time. She stated, No, no one checks it. On 2/1/23 at 4:00 PM, during an interview with the Administrator, and after requesting a facility policy for personal refrigerators kept in residents' rooms, she stated the facility did not have a policy. On 2/2/23 at 8:39 AM, in an interview with the Administrator, she was asked at what temperature a resident's refrigerator should be kept to safely store food. She stated, We don't monitor the temps, so it's what the resident deems safe. She was asked if temperatures were monitored by staff and recorded for residents' personal refrigerators to ensure safe food storage. She stated, No, if the resident is alert and oriented, we'll check the fridge and we educate the resident on what they should and shouldn't keep inside the fridges. The resident or their family has to be able to maintain their personal fridge and the temperature. She was asked what if the resident is not alert and oriented. She stated, Well, we try to keep an eye on the residents and make sure they are still competent to take care of the fridge themselves. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 17 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 She was asked who monitored and cleaned the refrigerators to ensure safety. She stated, Housekeeping checks them to clean them, but not to monitor the temps. She was asked if any temperature logs were maintained by staff, resident, or families for the personal refrigerators. She stated no. Residents Affected - Few On 2/2/23 at 9:37 AM, during an interview with Resident #106 with the Administrator present, the resident was asked permission to look inside her refrigerator. She agreed. The thermometer inside read 48 degrees F. Three creamers were observed inside. The Administrator asked the resident if she kept food inside her refrigerator. The resident said yes. The Administrator asked the resident what type of food she kept inside. The resident stated, Oh, cookies, chicken, drinks, whatever my family brings in for me. On 2/2/23 at 12:10 PM, during an interview with the Director of Nursing (DON), she was asked who monitored the temperatures and cleaned the residents' personal refrigerators. She stated, They or their families have to be able to clean them themselves. She was asked what a safe temperature for a personal refrigerator was. She stated, I suppose the same temperature as your fridge at home, but we don't monitor the temps here because it's their fridge. We actually didn't even know anyone had a personal fridge until you told us. We're not allowing personal fridges; we're going to remove them. A review of the facility's policy for Food Brought in by Family/Visitors (revised 10/2017), revealed: Policy statement: Food brought in by family/visitors is permitted. Facility staff will strive to balance resident choice and a homelike environment with the nutritional and safety needs of the resident. A review of the facility's policy for Refrigerators and Freezers (revised 12/2014), revealed: Policy statement: This facility will ensure safe refrigerator and freezer maintenance, temperatures, and sanitation, and will observe food expiration guidelines. Policy interpretation and implementation: 1. Acceptable temperature ranges are 35 degrees F to 40 degrees F and less than 0 degrees for freezers. 2. Monthly tracking sheets for all refrigerators and freezers will be posted to record temperatures. 3. Monthly tracking sheets will include: temperature, initials, and action taken. The last column will only be completed if temperatures are not acceptable. . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 18 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of one resident (#35) who required blood pressure and pain medication, out of four residents reviewed for unnecessary medication, from a total sample of 55 residents. The findings include: A medical record review revealed that Resident #35 was admitted to the facility on [DATE] with a primary diagnosis of pneumonia. Secondary diagnoses included anxiety and pulmonary hypertension. A review of a Physician's Order, dated 3/4/22, revealed Tramadol 50 milligrams (mg) every 6 hours for non-acute pain, Lisinopril 2.5 mg, give 2 tablets one time a day for hypertension (high blood pressure). A review of the electronic Medication Administration Record (eMAR) for January 2023, revealed that on 1/30/23 and 1/31/23 lisinopril was not administered. The eMAR notes indicated that the drug was on order. Tramadol was not administered on the following days: 1/10/23, 1/16/23, 1/17/23, 1/19/23, 1/20/23, 1/21/23, or 1/29/23. eMAR notes indicated that the medication was on order. (Copies obtained) On 1/25/23, the resident's blood pressure was 113/47 mm Hg (millimeters of mercury) and her Lisinopril was held. An eMAR note, dated 1/25/23, read, Medication was held due to low BP of 113/47. There was no indication that the physician was contacted. (Copies obtained) A review of the Care Plan dated 11/13/22, revealed that the resident had a potential for Altered Cardiovascular Status related to hypertension. Interventions included observation for side effects such as orthostatic hypotension. The Care Plan further indicated that the resident had a potential for generalized pain related to immobility. A review of the quarterly Minimum Data Set (MDS) assessment, dated 12/11/22, revealed that the resident had a Brief Interview for Mental Status (BIMS) score of 5 out of a possible 15 points, indicating severe cognitive impairment. The assessment also indicated that the resident required limited assistance with bed mobility; extensive assistance for transfers and toilet use; supervision for eating; and was receiving scheduled pain medication. In an interview on 2/2/23 at 11:28 AM, Licensed Practical Nurse (LPN) A stated if a resident was in pain, nurses should complete a pain assessment and then administer pain medication. She added that if medication was not available in the medication cart, the facility had a medication bank where nurses could obtain medication while awaiting delivery from the pharmacy. In an interview on 2/2/23 at 12:30 PM, LPN C/Assistant Director of Nursing (ADON), was asked about the missed medication doses. She stated nurses had access to the medication bank, and they should check there to see whether the medication was available. She added that nurses should re-order medications when there were at least three days worth of medications left. Additionally, they should also contact the pharmacy if medication was not available, because medications were delivered to the facility twice daily and there was no reason the residents should miss medications for two consecutive days. When she was asked to explain the facility's protocol for administering blood pressure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 19 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0755 Level of Harm - Minimal harm or potential for actual harm medication, she stated her expectation was that nurses should obtain the resident's blood pressure before administering any blood pressure medication (with or without parameters), hold the medication if the blood pressure was below 110/50 millimeters of mercury (mm Hg), and notify the physician. When asked about Resident #35, LPN C confirmed that that blood pressure was low, the medication should have been held, and the physician should have been notified. Residents Affected - Few A review of the facility's policy and procedure for Pharmacy Services Overview (revised in April 2019), revealed: The facility shall accurately and safely provide or obtain pharmaceutical services, including the provision of routine and emergency medication and biologicals and the services of a licensed consultant pharmacist. Policy interpretation and implementation: 3. Pharmacy services are available to residents 24 hours a day, seven days a week. 4. Residents have sufficient supply of their prescribed medication and receive medications (routine, emergency or as needed) in a timely manner. 5. Nursing staff communicate prescriber orders to the pharmacy and are responsible for contacting the pharmacy if a resident's medication is not available for administration. A review of the facility's policy and procedure titled Administering Medication (revised April 2020), revealed: Policy interpretation and implementation: 5) If a dosage is believed to be inappropriate or excessive for a resident, or medication has been identified as having potentially adverse consequences for the resident or is suspected of being associated with adverse consequences, the person preparing or administering the medication will contact the prescriber, the attending physician or the facility's Medical Director to discuss the concerns. 10) The following information is checked/verified for each resident prior to administering medication: a. Allergies to medications; and b. Vital signs, if necessary. According to Mayoclinic. org 2023 (https://www.mayoclinic.org/diseases-conditions/low-blood-pressure/symptoms-causes/syc-20355465 accessed on 2/3/23 at 4:00 PM), Low blood pressure is generally considered a blood pressure reading lower than 90 millimeters of mercury (mm Hg) for the top number (systolic) or 60 mm Hg for the bottom number (diastolic). Extreme low blood pressure can lead to a condition known as shock. . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 20 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 facility policy review, the facility failed to provide separately locked, permanently affixed compartments for storage of controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976 and other drugs subject to abuse. The findings include: On 2/2/23 at 9:20 AM, Licensed Practical Nurse (LPN) N was observed retrieving a Clonidine 0.1 mg (milligram) tablet from the Emergency Medication Supply Machine (Medbank). The Medbank was observed located in the hallway of the Beachside Unit. The Medbank was observed to be self-standing in the common area hallway, not enclosed or within a medication room. No secondary locking system was observed. The nurse was asked if narcotic medications were also contained in the machine. She stated, Yes, all the back-up medications are kept there, including narcotics. (Photographic evidence obtained) A list of all current medications kept in the Medbank was requested, as well as the facility's policy for storage of controlled narcotic medications. A review of the policy for Storage of Medications (last revision 4/2019), revealed: The facility stores all drugs and biologicals in a safe, secure, and orderly manner. Policy Interpretation and Implementation: 13. Schedule II-IV controlled medications are stored in separately locked, permanently affixed compartments. Security access to controlled medications is separate from access to non-controlled medications. A review of the inventory for all on-hand medications contained in Medbank storage, revealed that the following Schedule II-IV medications were housed inside the Medbank, and were not in separately locked, permanently affixed compartments: Xanax 0.25 mg (milligrams) (15 tablets) APAP/Codeine 300-30 mg (10 tablets) Klonopin 0.5 mg (7 tablets) Valium 5.0 mg (10 tablets) Fentanyl Patch 25 mcg (micrograms) (2 patches) Fentanyl Patch 50 mcg (2 patches) Hydrocodone/APAP 5/325 mg (12 tablets) Hydrocodone/APAP 10/325 mg (11 tablets) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 21 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 Dilaudid 2 mg (10 tablets) Level of Harm - Minimal harm or potential for actual harm Ativan 0.5 mg (15 tablets) Methadone 5 mg (10 tablets) Residents Affected - Few Morphine Sulfate IR 15 mg (20 tablets) Morphine Sulfate ER 15 mg (20 tablets) Morphine Sulfate 10 mg/0.5 ml (milliliters) (10 vials) Oxycodone/APAP 10/325 mg (18 tablets) Oxycodone/APAP 5/325 mg (19 tablets) Oxycodone/APAP 7.5/325 mg (14 tablets) Oxycodone ER 10 mg (10 tablets) Oxycodone 5.0 mg (15 tablets) Ultram 50 mg (14 tablets) Temazepam 7.5 mg (7 capsules) Ambien 5 mg (10 tablets) . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 22 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On 01/31/2023 at 12:57 PM, Resident #104 reported the food was cold. Resident #104 was admitted on [DATE]. His quarterly Minimum Data Set (MDS) assessment, dated 01/11/2023, reported a Brief Interview for Mental Status (BIMS) score of 15 out of a possible 15 points, indicating intact cognition. Residents Affected - Many On 01/31/2023 at 10:20 AM, Resident #31 reported, The food is often cold because they leave the doors to the food cart open and don't use hot plates. The resident's medical record was reviewed and noted an MDS assessment, dated 12/10/2022, with a BIMS score of 15 out of a possible 15 points. On 02/02/2023 at 1:16 PM, an interview was conducted with Resident #184. He reported that the food was not hot. He stated, The food is usually warm to cool but not hot. It sits on the cart too long. Resident #184 was admitted on [DATE]. His quarterly MDS assessment, dated 11/10/2022, reported a BIMS score of 12 out of a possible 15 points, indicating mild to moderate cognitive impairment. An observation of the kitchen was conducted on 02/01/2023. At 11:28 AM, an observation of the tray line was conducted and food temperatures were obtained by the cook. The temperatures were as follows: Enchilada: 135 °F, pureed enchilada: 135°F. The Regional Certified Dietary Manager (CDM) confirmed that 135°F was adequate, even though the tray line had just started service. At 12:50 PM on 02/01/2023, a full food cart was observed with no plastic bottoms for plates to match the plastic doomed tops. The CDM confirmed they had run out of plastic bottoms at this time. A test tray of regular diet was requested to be put on the last lunch cart to be served. The test tray was removed from the food delivery cart after residents' trays from same cart were served. The food was taste tested and it was noted with a luke warm enchilada with warm rice and warm corn. The foods were not hot. The test tray was noted as having no plastic bottom to match the plastic domed top to help keep the food warm. Based on interviews, record review, and policy and procedure review, the facility failed to ensure that resident meals were served at a safe and appetizing temperature, for five (Residents #478, #467, #104, #31, and #184) out of 55 sampled residents. Failure to provide palatable, attractive, and appetizing food in accordance with professional standards for food service, can decrease the amount of food all residents eat and drink. Residents at nutritional and hydration risk could be affected, potentially impacting their ability to heal, and possibly resulting in an overall health status decline. The findings include: During a facility tour on 1/30/23 at 12:50 PM, Resident #468, who had a Brief Interview for Mental Status (BIMS) score of 15 (intact cognition), reported, The food is always cold. The food sits in the hallway for 30 minutes before being served. On 2/1/23 at 2:00 PM, Resident #467, with a BIMS score of 10 out of a possible 15 points (moderate cogntive impairment) reported, Today the food was cold all the way through. When asked if she requested that her tray be warmed, she replied no, she had never requested that staff warm her food. When asked if she requested an alternate meal, she replied No, I didn't feel like eating after that. On 2/2/23 at 11:50 AM, a food cart holding lunch trays for the 100 hallways was observed in front of the nursing station. Twenty-nine minutes later at 12:19 PM, Certified Nursing Assistant (CNA) T, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 23 of 24 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 105135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many assigned to rooms 114-122, arrived on the nursing unit and began passing lunch trays from the food cart in front of the nursing station to her residents on the 100 hallways. On 2/2/23 at 12:32 PM, CNA T was asked what time the lunch meals were delivered to the 100 hallways. She replied, sometime between 12:00 PM and 12:30 PM. When asked if she had received any complaints from the residents in rooms 114-122 related to cold food, she replied no. She stated, If a resident complained of cold food I would warm the food, but that has never happened. If a resident did not want a meal they received, they could request an alternate meal. On 2/2/23 at 1:20 PM, Dietary Director V confirmed that the lunch meal cart for the Beachwalk Nursing Unit (rooms 114-122) was scheduled to arrive from the kitchen between 12:15 PM and 12:40 PM. She confirmed that the tray line finished early, so the Beachwalk Nursing Unit received their lunch food cart earlier today, between 11:30 AM and 11:45 AM. A review of Resident Council minutes, dated 1/16/2023, revealed food trays had not been not passed timely upon arrival at the nursing units. A review of the In-Service Education Roster, dated 1/18/2023, revealed the Topic: Resident Council, 1. Please pass trays timely. A review of the Resident Council minutes dated 11/21/2022, revealed trays were not passed timely, so an in-service training was provided by Dietary Director V. A review of the Food Committee Form dated 11/21/2022, revealed the coffee was served cold. A review of the Resident Council minutes dated 11/7/2022, revealed in the discussion of Old Business: Would like trays delivered timely. Meeting facilitated by [Dietary Director V]. Ad hoc meeting on tray delivery timeliness - staff in-serviced. A review of the Food Committee Form dated 11/7/2022, revealed eggs were served cold, but the rest of the food was hot. A review of the Resident Council minutes dated 10/3/2022, revealed in the discussion of New Business: Resident stated food carts get to the unit, but are not passed out right away and visual cues are not provided. Resolutions/Need for Assistance - New Business revealed: Would like food trays passed promptly and appropriate notifications given. Meeting facilitated by [Dietary Director V]. Team members in-serviced. A review of the facility's policy and procedure for Food Preparation and Handling, dated: 1/15/2021, revealed: To ensure that all food served by the facility is of good quality and safe for consumption, all food will be prepared and handled according to the current Federal and State Food Codes and HACCP guidelines. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105135 If continuation sheet Page 24 of 24