Inspection·August 25, 2022

F 0684 Level of Harm - Minimal harm or potential for actual harm On 8/23/22 at 2:09 p.m., the Director of Nursing (DON) said she was aware of a concern regarding someone's PICC at the facility. She confirmed to reduce risk of infection, the policy and standard is to change the dressing every seven days. She said the nurse should have obtained an order from the physician to change the PICC dressing every seven days. She said it was a facility error. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105155 If continuation sheet Page 2 of 4 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 105155 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sarasota Health and Rehabilitation Center 1524 East Avenue South Sarasota, FL 34239 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 record review, review of policies and procedures, observation, and staff interviews, the facility failed to provide oxygen therapy in accordance with physician's orders for 2 (Resident #82 and #94) of 4 residents reviewed for oxygen administration. Failure to follow prescribed oxygen therapy may result in inadequate oxygen treatment or increased risk of side effects and complications. Residents Affected - Some The findings included: The facility's Oxygen Therapy policy (SMS O 2 ED 2013) documented, Initiation of oxygen. Verify physician order . Apply device to the patient with appropriate liter flow. The Oxygen concentrator policy (undated) noted to, Verify and understand the physician's order, know the flow rate and duration of use . Adjust the flow meter control knob to the flow setting prescribed by the physician. The graduated line of the meter should be aligned with the center of the floating ball. 1. Review of the clinical record revealed an admission Minimum Data Set (MDS) assessment dated [DATE], noting resident#82 was receiving oxygen therapy. The assessment also noted Resident #82's scored 3 on the brief interview mental status (BIMS), indicating severe cognitive impairment. The diagnoses included acute respiratory failure with hypoxia (low level of oxygen in body tissues). Resident #82 was totally dependent on one person's physical assistance for locomotion (If in wheelchair, self-sufficiency once in chair). The Physician's order dated 7/23/22 included to administer oxygen at 2 liters per minute (LPM) via nasal cannula as needed every 23 hours as needed for shortness of breath. The care plan initiated on 7/25/22 noted the resident was receiving oxygen therapy related to pneumonitis, pleural effusion and heart failure. The goal was for Resident #82 to have no sign or symptom of poor oxygen absorption. The interventions included to administer oxygen as ordered, monitor for changes in or development of signs and symptoms of breathing difficulty, and report shortness of breath, cough, fever, chills, difficulty speaking, bluish skin color, changes in cognition. On 8/22/22 at 11:55 a.m., 8/23/22 at 10:27 a.m., and 8/23/22 at 1:00 p.m., Resident #82 was observed in a wheelchair receiving oxygen therapy via nasal cannula. The oxygen concentrator was observed behind the wheelchair against the wall and set at 1.5 LPM. On 8/23/22 at 1:17 p.m., the Assistant Director of Nursing (ADON) verified Resident #82's oxygen was set to 1.5 LPM. She said staff decreased the liter flow to 1.5 LPM to wean the resident from the oxygen so she can return to the assisted living facility. She said nursing staff was checking the oxygen saturation rate. The Treatment Administration Record for August 2022 did not have documentation of signs or symptoms warranting the use of the oxygen, including the oxygen saturation rate. The clinical record did not include a physician's order to decrease the oxygen to 1.5 LPM or wean Resident #82 from the oxygen. 2. Review of the clinical record for Resident #94 revealed a physician's order dated 7/14/22 to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105155 If continuation sheet Page 3 of 4 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 105155 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sarasota Health and Rehabilitation Center 1524 East Avenue South Sarasota, FL 34239 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 - Some administer oxygen at 2 LPM continuously via nasal cannula or BiPAP (machine that delivers higher air pressure when you breathe in) for shortness of breath. The care plan revised o 4/5/22 noted Resident #94 required the use of oxygen and monitoring for potential complications related to obesity hypoventilation syndrome (condition in which severely overweight people fail to breathe rapidly or deeply enough resulting in low blood oxygen level and high carbon dioxide level). The interventions included to provide oxygen as ordered. The Quarterly MDS dated [DATE] noted Resident #94 required extensive physical assistance of two persons for bed mobility (How resident moves to and from lying position, turns side to side, and positions body while in bed). On 8/23/22 at 9:04 a.m., and 8/23/22 at 1:15 p.m., Resident #94 was observed lying flat on her back, receiving oxygen via nasal cannula. The cannula was connected to an oxygen concentrator set at 3.5 LPM. The Medication Administration Record (MAR) for August 2022 showed the nurses placed their initials each day, including on 8/23/22 indicating Resident #94 was receiving oxygen at 2 LPM in accordance with the physician's order. On 8/23/22 at 1:15 p.m., the Assistant Director of Nursing (ADON) verified the oxygen concentrator was set at 3.5 LPM. She said it was an error and decreased the flow on the concentrator to 2 LPM. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105155 If continuation sheet Page 4 of 4