Health inspection·June 8, 2023

F 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the EMR revealed Resident #12 was admitted to the facility on [DATE]. An MDS dated [DATE], showed in section I Resident #12's active diagnoses included non-Alzheimer's dementia, depression and post traumatic stress disorder. A review of a level I PASARR for Resident #12 dated 06/23/22 showed qualifying diagnoses were not checked and a level II was not submitted. Review of the EMR revealed Resident #30 was admitted to the facility on [DATE]. An MDS dated [DATE], showed in section I Resident #30's active neurological diagnoses included aphasia, cerebrovascular accident (CVA), Parkinson's disease and psychiatric diagnoses included depression, psychotic disorder, and schizophrenia. A review of a level I PASARR for Resident #30 dated 12/03/20 showed qualifying diagnoses were not checked and a level II was not submitted. Review of the EMR revealed Resident #60 was admitted to the facility on [DATE]. An MDS dated [DATE], showed in section I Resident #60's active neurological diagnoses included anxiety disorder and depression. A review of a level I PASARR for Resident #60 dated 07/23/21 showed the resident had a diagnosis of dementia indicated. The review revealed qualifying diagnoses were not checked and a level II was not submitted. Review of the EMR revealed Resident #25 was admitted to the facility on [DATE]. An MDS dated [DATE] showed in section I Resident #25's active neurological diagnoses included aphasia, non-Alzheimer's dementia, hemiplegia/hemiparesis and psychiatric diagnoses of anxiety disorder, depression. Psychotic disorder and schizophrenia. A review of a level I PASARR for Resident #25 dated 03/04/21 showed qualifying diagnoses were not checked and a level II was not submitted. Review of the EMR revealed Resident #42 was admitted to the facility on [DATE]. An MDS dated [DATE] showed in section I Resident #42's active neurological diagnoses included cerebrovascular accident (TIA), hemiplegia/hemiparesis and psychiatric diagnoses of anxiety disorder, depression. Psychotic disorder and schizophrenia. A review of a level I PASARR for Resident #42 dated 06/15/21 showed qualifying diagnoses were not checked and a level II was not submitted. On 06/08/23 at 08:16 a.m., an interview was conducted with the Social Services Director (SSD). The SSD stated she was new to the facility. She stated she did not know there were concerns with PASARRs. She stated they should be reviewing them upon admission and if a resident acquired a new psychiatric diagnosis. A follow -up interview was conducted on 06/08/23 at 08:26 a.m. with the Director of Nursing (DON) and the Regional Clinical. The DON stated they had changes in the SSD office. She stated they should be updating PASARRs with any new psychiatric diagnosis. The Regional Clinical stated they would audit all the residents with qualifying diagnosis and update the PASARRs per their policy. A review of an undated facility policy titled, PASARR, showed the facility will ensure each resident in a nursing facility is screened for a mental disorder (MD) if intellectual disability (ID) prior (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 2 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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 0645 Level of Harm - Minimal harm or potential for actual harm to admission and that individuals identified with MD or ID are evaluated and receive care and services in the most integrated setting appropriate to their needs by coordinating with the appropriate state designated authority. The facility will ensure that individuals with a mental disorder or intellectual disabilities continue to receive the care and services they need in the most appropriate setting when a significant change in their status occurs. Residents Affected - Some Under guidelines on preadmission screening, the external liaison, internal admissions staff, or designee will obtain a completed preadmission screen (PASARR level I) on all individuals being admitted to the SNF (Skilled Nursing Facility) prior to admission. If the result of the level one screening indicates that serious mental illness (SMI) and/or intellectual disability (ID) or related condition appears to exist (positive level I screen) and the individual does not meet a provisional or hospital discharge exemption, the individual will be referred for a level 2 screening prior to the individual being accepted for SNF admission. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 3 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure a plan of care was implemented for one (Resident #19) of thirty-six sampled residents. Findings Includes: A review of the admission record for Resident #9, showed the resident was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses to include but not limited to major depressive disorder, paranoid personality disorder, dementia in other disease classified elsewhere, unspecified, mood disorder due to known physiological condition, unspecified, and psychotic disorder with delusions due to known physiological condition. A review of the quarterly Minimum Data Set (MDS) dated [DATE], Section C, Cognitive Patterns, a Brief Interview for Mental Status, BIMS, showed no score was reported. Further review of the quarterly MDS dated [DATE] Section N, Medication, showed Resident #19 received antipsychotic medication on a routine basis only. A review of the physician order dated 8/11/2022, showed the resident received Depakote Oral Tablet Delayed Release 125 MG by month one time a day for Mood Disorder due to known Physiological Condition, Unspecified. A review of the physician order dated 1/24/2023, showed the resident was on Risperidone Tablet 0.25 MG by month at bedtime related to Dementia in Other Disease Classified Elsewhere, unspecified severity, with Other Behavioral Disturbance. A review of the physician order dated 3/27/2023, showed an order for Target Behavior Monitoring for Risperidone: Monitor resident for the following behavior: lashing out physically and verbally, kicking difficult to redirect. A review was conducted of Resident #19's care plan dated 5/2/2023, which showed the resident had a behavioral problem related to a history of threats of self, or harm to others, physically resisting with care at times, wandering, throwing things, tries to hit staff, wanders in and out of other resident's room, will throw communication board in trash, throws clothes in trash, has broken glass and thrown them in trash as well as dentures. A review of the care plan intervention dated 5/2/2023, showed monitor behavior episodes and attempt to determine underlying causes. Further review of the care plan record revealed no documentation of antipsychotic medicine use and no antipsychotic medication interventions documented for Resident #19. 06/07/23 at 3:24 p.m., an interview was conducted with the MDS Coordinator, License Practical Nurse, LPN. She said she developed a care plan during the time of admission, quarterly, and as needed according to changes in the resident's condition. During the admission process, her and the Interdisciplinary Team (IDT) team looked over the resident's clinical chart and reviewed specific areas and diagnosis to ensure the resident had a comprehensive care plan created which included sections that identified if the resident was on any anticoagulant or antipsychotic medication. In addition, if a resident was placed on a drug such as an anticoagulant, antipsychotic, and/or cardiac medication during their stay, she was responsible for revising their care plan to reflect the drug use and added the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 4 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few interventions for those medication. The LPN said in January 2023, Resident #19 was started on anticoagulant and psychotropic medication, but for some reason she missed the chance to develop a care plan and implement interventions that reflected the resident's use of these medications. 06/07/23 at 04:24 p.m., an interview was conducted with the Director of Nursing, DON. The DON stated when a resident was admitted , she expected her clinical staff to thoroughly assess the resident. The admission nurse was responsible for developing the residents a baseline care plan. The MDS nurse was responsible for developing a comprehensive care plan that would identify areas like the resident's ability to perform activities of daily living, cognition, and whether or not the resident was taking any anticoagulants or antipsychotics. The comprehensive care plan should include interventions that both the staff and the resident used. Care plans were also revised in accordance with the resident's condition changes. She stated she was informed that Resident #19's anticoagulant and antipsychotic care plan was not implemented but it was her expectation that a care plan was created to reflect the resident's care needs. A review of the facility policy, revised December 2016 Care Plan, Comprehensive Person -Centered, Policy statement, showed A comprehensive, person- centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychological and functional needs is developed and implemented for each resident. Review of the facility, Care plan, Comprehensive Person- Centered policy interpretation and implementation: 8. The comprehensive, person - centered care plan will: g. Incorporate identified problem areas: h. Incorporate risk factors associated with identified problem. k. Reflect treatment goals, timetable and objectives in measurable outcomes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 5 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to provide proper treatment and assistive devices for two (Resident #60 and #9) of two residents sampled for vision and hearing. Residents Affected - Few Findings included: 1. On 6/6/23 at 8:22 a.m., Resident #60 reported hearing loss in his left ear, and directed this writer to speak towards his right ear. The resident stated about a year and half ago, a woman (unknown) visited and he was supposed to get two hearing aids but had not received them yet. A review of the Audiologic Report, dated 4/6/22, located in Resident #60's clinical record indicated the recommendation, Based on today's testing results patient could benefit from amplification in both ears. Resident would like to pursue amplification to be able to hear more clearly and accurately. The Audiologic report identified the resident had normal-moderate sloping hearing loss in the right ear and mild-moderate sloping hearing loss in the left ear. A review of Resident #60's admission Record indicated he was admitted on [DATE]. The record included diagnoses not limited to Type 2 Diabetes Mellitus without complications, essential (primary) hypertension, moderate single episode major depressive disorder, and generalized anxiety disorder. The quarterly Minimum Data Set (MDS), dated [DATE], indicated the resident had adequate hearing with no difficulty in normal conversation, social interaction, and listening to television (TV). The quarterly comprehensive assessment indicated the resident had a Brief Interview for Mental Status score of 14, which indicated intact cognition. The review of Social Service notes, dated 4/13/22, 7/12/22, and 10/12/22, showed Resident #60 was alert and oriented and able to make (resident) needs known. The notes did not include any information regarding the Audiologic report. A social service note, dated 5/2/23 (thirteen months after the Audiologic report) documented the Social Service Director (SSD) had called the Audiology provider to follow up as resident said he has been waiting on his hearing aids for over a year. The note indicated the SSD had been told there was some miscommunication in their office last year. An additional note on 5/2/23 showed the SSD had faxed over the residents' face sheet to the provider. The care plan for Resident #60 included a potential for alteration in communication related to diagnosis of dementia and instructed staff to observe for changes in hearing, speech, (and) communication; notify physician if noted. 2. On 06/06/23 at 11:48 a.m., Resident #9 was observed in his room. The resident did not respond to the greeting/interview. Resident #9's roommate stated the resident was hard of hearing. The roommate said, you have to speak loudly. He can't hear you. A review of Resident #9's admission record revealed the resident was admitted to the facility on [DATE] with diagnoses to include dementia, cognitive communicative disorder, and need for assistance with personal care. A review of current physician orders for Resident #9 dated 06/08/23, showed hearing aids to be placed in medication cart at HS (hours of sleep), initiated 03/12/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 6 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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 0685 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An admission nursing comprehensive evaluation for Resident #9 dated 01/27/22 showed the resident used bilateral hearing [device]. A care plan for Resident #9 initiated 01/28/22 showed a focus indicating the resident has an alteration in communication ability related to bilateral hearing [device]. Resident is hard of hearing responds only to simple direct communication due to diagnosis of dementia. The goal indicated the resident will maintain current level of communication ability through the next review date. Care plan interventions included to ensure the hearing appliance is in place. Assist in application/removal and maintenance/storage of device. Face resident when speaking and speaking clear direct tones. Repeat/rephrase messages as needed if resident misses part of intended message. Speak to residents in simple direct terms. Ask resident yes/no questions. Allow resident adequate time to respond, provide cues as needed if resident displays difficulty finding words. As president repeat verbalization and validate as needed. Keep calm light within reach and respond to communicated needs as needed. SLP to screen is needed. Observe changes in hearing, speech, communication and notify physician as needed. On 06/08/23 at 10:26 a.m., an interview was conducted with Staff K, Staff L and Staff M, all CNA's (Certified Nursing Assistants). They confirmed they had worked with Resident #9 and had taken care of him recently. Staff K stated she had worked with this resident a long time, over one year. She stated she did not know the resident was supposed to be wearing hearing aids. Staff L stated she did not know he had hearing devices. Staff M stated she knew she had to speak louder, but thought it was related to his dementia diagnosis. Staff M stated she did not know the resident required assistive hearing devices. On 06/08/23 at 11:38 a.m., an interview was conducted with Staff D, Licensed Practical Nurse (LPN ). She stated she did not have the hearing devices for Resident #9 in the medication cart. Staff D opened all the drawers and searched for the hearing devices and could not locate them. Staff D said, I did not know this resident wore hearing [devices]. On 06/08/23 at 11:49 a.m., an interview was conducted with Staff C, LPN, Unit Manager (UM). She stated the resident had hearing devices and two years ago he had dropped them. She said, I believe the [family member] said not to replace it. Do not quote me on that. We should have revised his care plan and educated staff on how to interact with him. Staff C stated everyone knew had to speak loudly. Staff C stated they had forgotten about the hearing devices because it had been two years. An interview was conducted on 06/08/23 at 2:02 p.m. with the Social Services Director (SSD). She stated she had contacted the resident's family member and she [family member] asked her [Social Services Director] to schedule an audiology exam. The SSD stated she had sent a referral and the resident would be seen the following week. The SSD said, someone should have followed up and referred him to an audiologist. The SSD stated she was new to the position and did not know the resident had trouble hearing. The policy, Care of Hearing-Impaired Resident, revised February 2018, showed that the staff would assist hearing-impaired residents to maintain effective communication with clinicians, caregivers, other residents, and visitors. The policy showed, Staff will assist the resident (or representative) with locating available resources, scheduling appointments and arranging transportation to obtain needed services. The implementation showed that staff were to determine the resident's awareness of and adaptation to hearing loss, and to evaluate and address avoidable obstacles to effective communication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 7 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility did not ensure a resident with a history of trauma received timely services related to evaluation and assessment for changes in behavior for one (Resident #29) of three residents Findings included: On 06/05/23 at 8:40 a.m., Resident #29 was observed in his room and stated he did not know why he was at the facility. Resident #29 said, I want to go home to check on my wife. Someone stole my car. On 06/05/23 at 12:58 p.m., an interview was conducted with Resident #29's family member. She stated she had noticed the resident was more confused than usual. The family member said, last night he wanted to go to the garage. He was looking for his car. He thought someone had broken in. The staff called me. The family member stated she did not know if the resident was receiving psychiatry services. She stated he had a history of trauma having served in the [name of] war. The family member stated she had noted a change in the last month. Review of the electronic medical record (EMR) revealed Resident #29 was admitted to the facility on [DATE] with diagnoses to include Parkinson's disease, major depressive disorder, vascular dementia, Dementia in other diseases, major depressive disorder, unspecified mood disorder, generalized anxiety disorder, post-traumatic stress disorder and hemiplegia and hemiparesis following cerebral infarction affecting right dominant side. A review of current physician orders for Resident #29 dated 06/08/23 showed the resident had orders for psychological/psychiatric evaluation and treatment as needed effective 03/20/23. A review of a care plan for Resident #29 showed a focus indicating the resident had potential for re-traumatization related to diagnosis of PTSD (Post Traumatic Stress Disorder) initiated on 02/03/2023. The goal indicated the resident will remain free of episodes of retraumatizing and will have minimal triggers. Interventions included administering medications as ordered. Observe for effectiveness and for side effects. Nursing to Establish a relationship of trust with the resident. Therapy to encourage participation in activities of choice . Encourage social interactions with staff and peers. Provide a calming and reassuring environment. Allow resident to make decisions related to daily cares/routine. Educate of unsafe choices as needed. Use a calm approach. Explain action during cares. Encourage resident to express emotions in a safe, private environment and to provide reassurance and reorientation to facility. A care plan focus dated 02/02/23 showed the resident had potential for adverse effects related to the use of psychotropic medications. Interventions included observing side effects related to psychotropic medication use and report to physician if any changes were noted. Psychotropic review for dose reduction as able. Psychiatry services /psychology services as ordered and to observe changes in mood/behavior to physician if noted. During facility tours on 06/05/23, 06/06/23, 06/07/23 and 06/08/23, Resident #29 was observed in his room, door closed, and not engaging in any activities, or interacting with others. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 8 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 06/08/23 08:09 a.m., Resident #29 was observed sitting on the edge of his bed having breakfast. The resident did not engage in the conversation. He presented withdrawn and avoiding eye contact. On 06/08/23 at 8:18 a.m., an interview was conducted with Staff J, LPN (Licensed Practical Nurse). She stated she thought the resident was stable, but she had noticed he was sleepier. She said, the only change I can speak of is that he is a lot sleepier in the mornings for at least the last one month. He says he is okay. The nurses have not told me anything about him wanting to go outside to check on his car. I would have noted it. He is taking medications for depression. Staff J stated Resident #29 used to go out to smoke in the mornings after breakfast, but he has not done so in the last one month. Staff J confirmed such concerns or changes in routine should be discussed with the physician. A review of the EMR showed the incident described by the family member was not documented in the record. The review further showed concerns with changes in behavior, increased confusion, and excessive sleeping were not documented. On 06/08/23 at 8:16 a.m., an interview was conducted with the Social Services Director (SSD). She stated the resident was followed by psychiatry, but she would have to obtain the records from them. She stated she was not aware the resident had a change in condition, and she would have to review the record. On 06/08/23 at 8:26 a.m., an interview was conducted with the Director of Nursing (DON). The DON stated the resident was on psych medications, and he should be on the list of residents to be seen regularly. She stated the resident had diagnosis of depression, dementia, anxiety, PTSD. She stated they normally have a psych meeting where they discuss medications and changes in behaviors. She stated the nursing staff should have reported the resident was sleeping a lot more. The DON said, Yes, we should have addressed the restlessness at night and sleeping in the morning, not going out to smoke. He is not doing what he used to do. He will be seen on Monday. The DON stated she was not notified of the incident when the resident was trying to get out to confront someone breaking into his car. The DON stated that kind of behavior should be reported, given the resident's diagnosis. On 06/08/23 at 08:45 a.m., the DON (Director of Nursing) and this surveyor observed Resident #29 lying in bed, curled, and covered up with a sheet from head to toe. The DON said, I have seen him like that. I just did not zero in on the behavior. He is isolating himself. A review of the facility policy titled, Changes in a Resident's Condition or Status dated May 2017, showed the facility shall promptly notify the resident, his or her attending physician, and or representative Sponsor) of changes in the resident's medical/mental condition and/or status (e.g., changes in level of care .) Under policy interpretation and implementation, the nurse will notify the resident's attending physician or physician on call when there has been a significant change in the resident's physical/emotional/mental condition. A significant change of condition is a major decline or improvement in the resident's status that will not normally resolve itself without intervention by staff or by implementing standard disease related clinical interventions, impacts more than one area of the resident's health status, requires interdisciplinary review and/or revision to the care plan and ultimately is based on clinical staff and the guidelines outlined in the Resident Assessment Instrument (RAI). The nurse will record in the resident's medical record information relative to changes in the resident's medical/mental condition or status. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 9 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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. Based on observations, record reviews, and interviews, the facility failed to ensure the reconciliation of a controlled substance was reviewed and monitored for one (Resident #52) of five residents sampled for unnecessary medications. Findings included: On 6/7/23 at 1:05 p.m., Resident #52 was observed with a Fentanyl patch dated 6/7/23 on his upper left chest. On 6/7/23 at 3:47 p.m , the resident was observed lying in bed and reported being administered a Fentanyl patch at the facility for the last 2 months, staff change (the patch) every 3 days, and had not gone without one. A review of the admission Record for Resident #52 revealed an admission date of 8/24/21 and included diagnoses not limited to Type 2 Diabetes Mellitus without complications, left knee contracture, left shoulder muscle contracture, left hand muscle contracture, hemiplegia affecting unspecified side, and malignant neoplasm of prostate. The quarterly Comprehensive Assessment, dated 5/18/23, showed that Resident #52 scored 15 out of 15 in a Brief Interview of Mental Status (BIMS) which indicated intact cognition. The resident reported occasional pain over the 5 days of the assessment, rating the worst pain felt was 4 out of 10. The Order Summary Report for Resident #52 identified a physician order, started on 3/23/23, for Fentanyl Patch 72 hour 25 microgram/hour (mcg/hr) - Apply 1 patch transdermally every night shift every 3 day(s) for nonacute pain, Rotate site. A review of Resident #52's March, April, May, and June 2023 Medication Administration Records (MAR) indicated that the residents' Fentanyl patch was to administered anytime during the night shift every 3 days. The MAR did not include an area to document the location where the residents patch was applied. The April MAR for Resident #52 showed a Fentanyl patch was applied on 4/1/23 and 4/4/23, the corresponding Control Drug Disposition Record (CDDR) showed a patch was applied on 4/1/23 at 10:00 p.m., a patch was applied sometime after 3:00 a.m. on 4/5/23, and did not show that a patch was applied on 4/4/23. The MAR did not indicate that a patch had been applied on 4/5/23 as documented on the CDDR. Further review of the April MAR and CDDR indicated that a Fentanyl patch was applied on 4/7/23 at 6:00 p.m. (66 hours after the patch was applied on 4/5/23). The April MAR showed that on 4/10/23, staff applied the resident's Fentanyl patch at 9:00 p.m., 75 hours after the patch on 4/7/23 was applied. The MAR showed that a patch was applied on 4/25/23, the CDDR indicated that no patch was applied on 4/25/23, but one was applied at 9:00 p.m. on 4/26/23. The CDDR showed that the next patch was applied on 4/28/23 at 9:00 p.m., 48 hours (2 days) after the last patch was applied on 4/26/23. The review of a CDDR showed the facility obtained 6 Fentanyl patches for Resident #52 on 4/19/23. The CDDR indicated that the fifth patch was applied on 5/2/23 at 0000 (midnight) and the sixth patch was applied at 9:00 p.m. on 5/5/23. The MAR showed that a patch was applied on 5/1/23 and the next was applied on 5/4/23. The MAR did not show that a patch was applied on either 5/2/23 or on 5/5/23 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 10 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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 which was indicated on the CDDR. Level of Harm - Minimal harm or potential for actual harm The May and June MAR's for Resident #52 showed that a Fentanyl patch was applied to the resident on 5/7/23 (2 days after the CDDR indicated that the sixth patch was applied on 5/5/23), 5/10, 5/13, 5/16, 5/19, 5/22, 5/25, 5/28, 5/31, and 6/3/23. The facility was unable to locate the disposition record for Resident #52's Fentanyl patches from 5/7 to 6/1/23. A review of a CDDR showed 5 patches were received on 5/31/23, and the first patch of the five was applied at 6:00 a.m. on 6/4/23. Residents Affected - Few On 6/7/23 at 1:42 p.m., during an interview with the Director of Nurses (DON), she stated the process for controlled substance accounting was that she received the empty package and the CDDR that was matched against the MAR to make sure there was no diversion. The DON the pharmacy would be contacted to obtain CDDR records for the period from 5/8 to 6/3/23 as they were missing. On 6/7/23 at 3:15 p.m., the DON reported not remembering getting or not getting any empty Fentanyl boxes from Resident #52 and that the pharmacist was assisting in looking for the two missing Fentanyl reconciliation records for the resident. On 6/8/23 at 8:50 a.m., the DON stated that she had tore boxes apart and still was unable to locate the reconciliation (Fentanyl) reports. The DON reported, at approximately 4:00 p.m. on 6/8/23, because the resident's Fentanyl was scheduled to administered on the night shift, staff were able to document the application anytime during the shift. The policy, Controlled Substances, revised April 2019, revealed that The facility complies with all laws, regulations, and other requirements related to handling, storage, disposal, and documentation of controlled medications. The implementation of the policy indicated that the upon administration the nurse administering the medication was responsible for recording time of administration. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 11 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews, the facility failed to monitor the behaviors of one (Resident #53) of one resident sampled for mood and behaviors associated with the use of psychotropic medications. Findings included A review of Resident #53's admission Record indicated the resident was admitted on [DATE] and on 5/23/23. The record included diagnoses not limited to moderate depressed current episode bipolar disorder, moderate recurrent major depressive disorder, post-traumatic stress disorder, and generalized anxiety disorder. On 6/6/23 at 1:20 p.m., Resident #53 was observed in the activity room and moving between other residents. She appeared to be happy and smiling with staff and other residents. A review of Resident #53's Physician Order Summary Report, active as of 6/8/23 at 2:57 p.m., showed the resident was to receive 10 milligram (mg) of the antidepressant Escitalopram one time a day for depression and 0.5 mg of the antipsychotic Risperidone two times a day for schizophrenia. These orders were ordered on 5/23/23 (day of the resident's readmission). The physician orders did not include an order instructing staff to monitor the resident for any behaviors. The May 2023 Medication Administration Record (MAR) for Resident #53 showed the resident received Escitalopram 10 mg one time a day for depression, ordered 2/10/23 and discontinued on 5/17/23, and 0.5 mg of Risperidone two times a day related to bipolar disorder, ordered on 5/8/23, discontinued on 5/17/23. The MAR indicated behaviors related to the administration of Escitalopram was monitored on the day and night shifts then discontinued on 5/17/23. The behavior related to the administration of Risperidone was on the night shift of 5/15/23 and the day shift on 5/16/23. The monitoring on night shift of 5/16 indicated that the resident was hospitalized . The MAR did not include monitoring of behaviors or side effects after the resident was readmitted on [DATE]. The June 2023 MAR for Resident #53 showed the resident had received 10 mg of Escitalopram daily for depression from 6/1 through 6/8/23 and Risperidone 0.5 mg two times daily for schizophrenia related to bipolar disorder from 6/1 through 6/8/23. The MAR did not include staff documentation of the residents' behaviors or any side effects. The Psychology note, dated 5/23/23, showed staff had reported the [resident's] behavior as restless and nervous. The note summary indicated Resident #53's mood was anxious and depressed, continued to try and help others, restless and has been walking around facility aimless. A review of Resident #53's care plan showed the resident had an alteration or potential in mood as evidence by (AEB) complaints of (c/o) or displays the following: feeling down, depressed or hopeless due to an abusive home relationship. The interventions indicated staff were to administer medications as ordered, observe for effectiveness, and for adverse side effects (SE's). The care plan indicated that the resident had the potential for adverse side effects related to the use of psychotropic medications: antidepressant for treatment (tx) of depression. The interventions instructed staff to observe for effectiveness of psychotropic medications and to observe for adverse side effects related (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 12 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to psychotropic med use, report to physician if note and to observe for changes in mood/behavior report to physician if noted. The care plan indicated that the resident had potential for self-directed violence related to verbalizations of hurting self, would be better off dead. The interventions instructed staff to observe for decline in mood and for attempts of self-harm. The policy, Intervention and Monitoring Behavioral Assessment, revised December 2016, indicated that Behavioral symptoms will be identified using facilty-approved behavioral screening tool and the comprehensive assessment. The facilty will comply with regulatory requirements related to the use of medications to manage behavioral changes. The policy identified that the following: - nursing staff will identify, document, and inform the physician about specific details regarding changes in an individual's mental status, behavior, and cognition, including: onset, duration, intensity, and frequency of behavioral symptoms. - New onset or changes in behavior will be documented regardless of the degree of risk or others. - The Interdisciplinary Team (IDT) will monitor the progress of individuals with impaired cognition and behavior until stable. New or emergent symptoms will be documented and reported. - The nursing staff and the physician will monitor for side effects and complications related to psychoactive medications; for example, lethargy, abnormal involuntary movements, anorexia, or recurrent falling. - If antipsychotic medications are used to treat behavioral symptoms, the IDT will monitor their indication and implement a gradual dose reduction, or document why this cannot or should not be done (for example, recurrence of psychotic symptoms after several previous attempts to taper medications. The Director of Nursing (DON) reviewed, on 6/8/23 at 2:50 p.m., Resident #53's May and June MAR and confirmed behavior monitoring was not done. She stated the resident went to the hospital and they (staff) probably did not add the batch orders which included behavior monitoring when the resident came back. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 13 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure the medication error rate was less than 5.00%. Twenty six medication administration opportunities were observed, and two errors were identified for one (Resident #423) of three residents observed. These errors constituted a 7.62% medication error rate. Residents Affected - Few Findings include: On 06/06/23 at 08:00 a.m., medication administration was observed with Staff A, Licensed Practical Nurse (LPN), for Resident #423. Staff A reviewed the Medication Administration Record (MAR) and prepared and administered by mouth the following medications. Eliquis 2.5 milligrams Metoprolol 25 milligrams Potassium Chloride 10 milliequivalent [NAME] Sulfate 325 milligrams Two medications, Omega-3 fatty acids 1000 milligrams and Cholecalciferol 25 milligrams, were ordered but Staff A was unable to locate the medications in the medication cart and they were not administered during the observation. On 06/06/23 at 10:15 a.m. medication reconciliation was conducted of MAR and revealed no documentation that the Omega-3 fatty acids and the Cholecalciferol were administered or held. Review of the MAR on the next day, 6/7/23 indicated the Omega 3 fatty acid and Cholecalciferol 25 milligrams were administered on 6/6/23. The Director of Nursing (DON) was interviewed on 06/07/23 at 4:46 p.m. The DON reviewed Resident #423's MAR that documented the medications were administered on 6/6/23 at 3:18 p.m. The DON explained the policy to administer medications was one hour before or after the prescribed time and this was an error. Review of facility policy Administering Medications revised April 2019 states: Policy Statement Medications are administered in a safe timely manner, as prescribed. Policy interpretation and implementation 4. Medications are administered in accordance with prescriber orders, including any required time frame. 5. Medication administration times are determined by resident need and benefit, not staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 14 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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 0759 convenience. Level of Harm - Minimal harm or potential for actual harm 6. Medication errors are documented, reported, and reviewed by the QAPI committee to inform process changes and or the need for additional staffing. Residents Affected - Few 7. Medications are administered within one (1) hour of their prescribed time, unless otherwise specified (for example, before and after meal orders). 8. If a dosage is believed to be inappropriate or excessive for a resident, or a medication has been identified as having potential 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 resident's Attending physician or the facility's Medical Director to discuss the concerns. 9. The individual administering medications verifies the resident's identity before giving the resident his/her medications. Methods of identifying the resident include: a. Checking the identification band; b. Checking photograph attached to the medical record; and c. If necessary, verifying resident identification with other facility personnel. 10. The individual administering the medication checks the label THREE (3) times to verify the right resident, right medication, right dosage, right time, and right method (route) of administration before giving the medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 15 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, and interviews, the facility failed to maintain an effective pest control program related to rodent activity in two (East and North) of five hallways. Residents Affected - Some Finding included: On 6/07/23 at 4:29 pm, an interview was conducted with the resident in room [ROOM NUMBER]-A (North Hall) who stated, there's a rat or mouse in here. The resident stated a rodent was in her room (North Hall) approximately three weeks ago. The resident said she shared her concern with environmental and nursing services. On 6/07/23 at 4:45 pm, an interview with the Staffing Coordinator was conducted. The Staffing Coordinator stated there was a logbook that was used by the staff when a pest/rodent issue was seen or if a resident voiced a concern to the staff. The Pest Sighting logbook was in the front by the main entrance. On 6/08/23 at 8:23 am, an interview was conducted with Staff F and staff G of Environmental Services (housekeeping) in the Activity room. Staff F stated, There are no housekeeping services for the night shift. Staff F stated, If rodent droppings are found I would bleach the area and notify their supervisor(s). Staff F stated, I think the bug service comes weekly. On 6/08/23 at 8:37 am, an interview was conducted with the resident in room [ROOM NUMBER]-A (East Hall). The resident denied seeing rats but claimed the resident in room [ROOM NUMBER]-A (East Hall) across from her room was yelling out to staff about a rat in his room. The resident in 24-A could not recall a timeframe but stated, It was recent. A record review of the Pest Sighting Log showed an entry dated April 29, 2023, at 4:40 p.m., and May 1, 2023 at 12:00 p.m. for room [ROOM NUMBER]-A (East Hall) related to [rodent] sightings. On 6/08/23 at 9:23 a.m., an interview was conducted with the Director of Maintenance (DOM). The DOM stated communication from the facility to the pest control service was done through a logbook at the front desk. Any concerns regarding pests or rodents were logged in the book and the pest control company would review and treat the concern(s). Communication from the pest control company to the facility was done as an electronic service inventory sheet to the Nursing Home Administrator (NHA). Based off the inventory sheet from the pest control company, the DOM and his team would address any maintenance concerns. Maintenance repairs were logged into an electronic work log. An observation was made with the DOM of a completed work repair based on a concern for potential rodent entrance into resident room [ROOM NUMBER]-A, North Hall. On 6/08/23 at approximately 10:30 am, an observation with the DOM was made in resident room [ROOM NUMBER]-A. The resident in 41-A was not present in the room during this observation. The DOM pointed to a metal mesh over a current hole by the drain under the sink. On 6/08/23 at 10:48 am, an interview with the NHA was conducted. The NHA stated a former pest control service company was released of their duties on March 22, 2023. The NHA stated [name of the pest control service company] did not appropriately address the situation and more rat traps should have been utilized. The NHA presented a receipt from a company hired to professionally repair the outside (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 16 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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 0925 Level of Harm - Minimal harm or potential for actual harm perimeter of the facility including ninety-three holes repaired at that time of service (end of March 2023 to beginning of April 2023). The NHA stated with the new pest control company improvements had occurred regarding concerns for rodents. The NHA presented the Pest Sighting log for the months of April 2023 to May 2023 but was unable to account for the months of January 2023 through March of 2023 from the previous pest control company. Residents Affected - Some A record review of the Service Inspection Reports from January 2023 -March 2023 showed: Pest Control Company #1 *01/05/2023 Call back request for reported rodent activity, met with NHA who reported rodent activity in the kitchen and rooms 6 & 37. Inspect and found droppings in the kitchen pantry where activity chase runs into the building. Placed several snap traps in the pantry to eliminate activity. Inspected 37 & 6 and found that rodents chewed through the drywall to enlarge the gaps around plumbing pipes. Set large rodent snap traps in both rooms and sealed holes with exclusion foam and cloth. *01/12/2023 Arrived at location checked in NHA and walked the kitchen reset rodent traps in pantry and treated the drains on the exterior served rodent stations and applied liquid residual around perimeter of building for pest prevention. *01/19/2023 checked traps in pantry and checked rodent stations bait was still good. *01/26/2023 Rounds with DOM maintenance-all exterior bates cleaned and replaced with fresh bait- no evidence of feeding at this time-Found rodent entry points all around exterior and showed maintenance and explained all need sealed ASAP, he had been trying to seal interior holes first, directed him to seal exterior first, there are rodent droppings in kitchen under equipment and behind equipment , in pantry under storage racks, this needs daily cleaning until activity is under control. No sight logs found at nurse's stations need 2. *2/9/2023 Arrived on property and checked in with front desk- checked both nurses stations no sight found for our logbook. Spoke with NHA. Inspected from 12 for 3 pests and found no activity at this time. Inspected room [ROOM NUMBER] and 37B for mice. I found no activity at this time - NHA would like mouse traps and rodent stations added to outside perimeter. There are still plenty of vents around the upper perimeter needing seal up. I inspected and treated all doors ways for help and preventing pest issues. Rat baits cleaned and rebaited- no feedings noted. *2/22/2023 There are still exclusion areas on top of roof, holes on left side of entire wall of building, AC conduits all need sealed rodents entire building hole in wall in kitchen area near cooler. *2/28/2023- NHA requested 2 rat glue boards in kitchen storage room, Missing logbooks x 2 - NHA to locate. Outside exclusion still needed to be completed. *3/7/2023 Checked both logbooks nothing in both books. Spoke with NHA. Inspected food pantry and found rat droppings. Set up 2 t [NAME] baited and 4 large glueboards. Reset another rat trap already there. Holes in walls-around entire left side and back of building soffit areas have evidence of rodents entering, hole in exterior wall ac conduits all need sealed rodents entering building, holes in walls in kitchen area by walk in cooler from rodents, holes in walls in pantry area by ac lines. *3/14/2023 Scanned both logbooks with no recorded activity. Found rat in glueboard in kitchen. Rodent station 1-4 with moderate rodent activity. Traps rebated. High Severity level to the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 17 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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 0925 continues for outside and kitchen potential rodent entry access. Level of Harm - Minimal harm or potential for actual harm *3/21/2023 Kitchen staff reported rat activity with rat caught in trap by pantry. Additional rat trap added by pantry since one trap did not setting. Additional 2 glueboards added to pantry for a total of 4. High Severity level to the facility continue for outside and kitchen potential rodent entry access. Residents Affected - Some A record review of the Service Inspection Reports from March 2023 -May 2023 showed for Pest Control Company #2: *3/23/2023 Inspection of outside perimeter with additional stations added. All stations cleaned and rebaited. *3/24/2023 reinspected traps in ceiling - no activity. Placed 2 cameras above the 1 through 10 room hall to monitor any activity. Removed 3 dead rodents caught on snap traps in the kitchen. Re set all snap traps and placed them back out. No Pest Service documentation was provided from facility from 3/25/2023-4/10/2023. *4/11/2023 inspected and serviced conference room, for rodent activity *4/13/2023 Inspected and serviced 14 rodent stations no activity was found. Inspected and serviced conference room, for rodent activity. Set up snap traps and glue boards at attic. Inspected and serviced room [ROOM NUMBER] and 12, for rodent activity. room [ROOM NUMBER] wall needs to be fix on the bottom by the base bore rodent shoot through the wall. See pictures attachment *4/20/2023 Inspected and serviced unit 6 and 10 for rodent activity *4/21/2023 Inspected and serviced dining, physical therapy and conference room at the ceiling tile for rodent activity. New glueboard and reset traps. *4/26/2023 Inspected and serviced unit 3,4,5,6,11,20,29,30 and 33 for rodent activity. In unit 6 and 5 hole under the sink need to be fixed. Inspected and serviced conference room and hallway for rodent activity. *5/4/2023 Inspected and serviced units 29,31,35 and 39 for rodent activity. No activity found. *5/11/2023 Inspected and serviced all hatches towards the attic for rodent activity death or life. No activity was found. Inspected and serviced units 34,35,38 and 41, for rodent activity, In unit 41 found under the sink need to be repair to prevent rodent getting inside the rooms. See pictures attachment *5/15/2023 Re(regarding) inspected Attic areas for rodent activity. Placed multiple glue boards throughout each wings attic areas, Removed dead squirrel today and disposed of. *5/24/2023 Inspected and serviced 13 rodent station no activity was found. Check all books no request. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105159 If continuation sheet Page 18 of 19 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Healthcare Rehabilitation and Nursing C 210 21st Ave W Bradenton, FL 34205 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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete On 6/08/23 at 11:23 am, an interview was conducted with the pest control company representative who was providing service this day. The pest control service representative stated service started in April of 2023 with every other week visits. A review of the pest sighting logbook for the month of May 2023 showed six complaints of rodent and or rodent droppings. A review of the last logged complaint entry showed a rodent concern in room [ROOM NUMBER]-A (East Hall) for rat activity. An observation was made following this interview with the pest control service representative of room [ROOM NUMBER]-A. The resident who resides in the A bed was not present in the room, but the resident who resides in B bed was in bed at this time. The resident denied seeing any rodent activity nor hearing of any rodent activity. An observation was made of the room and rodent droppings were noted next to the wall and the closest for the resident in bed A. (Photographic Evidence Obtained). The rodent droppings were observed and confirmed by the pest control service representative. The pest control service representative brought these findings to the attention of the DOM. Event ID: Facility ID: 105159 If continuation sheet Page 19 of 19