Inspection·September 1, 2023

F 0600 Review of the progress notes on and about 7/11/2023 did not document a nurses note. Level of Harm - Immediate jeopardy to resident health or safety Review of Resident #13's July 2023 MAR revealed a blood sugar of 424 and a chart code of 9 (other/see nurses notes) was documented on 7/18/2023 at 6:30 AM. Review of the progress notes on and about 7/18/2023 did not document a nurses note. Residents Affected - Some Review of Resident 13's August 2023 MAR revealed a blood sugar of 527 and a chart code of 9 (other/see nurses notes) was documented on 8/2/2023 at 6:30 AM. Review of the progress notes on and about 8/2/2023 did not document a nurses note. Review of Resident #13's August 2023 MAR revealed a blood sugar of 542 and a chart code of 9 (other/see nurses notes) was documented on 8/4/2023 at 6:30 AM. Review of the progress notes on and about 8/4/2023 did not document a nurses note. Review of Resident 13's August 2023 MAR revealed a blood sugar of 531 and a chart code of 9 (other/see nurses notes) was documented on 8/12/2023 at 6:30 AM. Review of the progress notes on and about 8/12/2023 did not document a nurses note. 2. Review of Resident #100's medical record documented diagnoses that included encephalopathy, unspecified visual field defects, type 2 diabetes mellitus without complications, essential primary hypertension, and cerebral infarction (a stroke). Review of the physician orders for Resident #100 dated 4/5/2023 read, Insulin Detemir Solution 100 Unit/ml [milliliter]. Inject 20 units subcutaneously at bedtime for diabetes. Review of the Medication Administration Record (MAR) for Resident #100 for the period of 5/1/2023 through 8/30/2023 revealed on 5/1/2023 at 9:00 PM Staff A, Licensed Practical Nurse (LPN) documented 14 (insulin coverage not needed) for Insulin Detemir 20 units, on 5/2/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) Detemir 20 units, on 5/3/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/4/2023 at 9:00 PM Staff C, LPN documented 4 (held per parameters) for Insulin Detemir 20 units, on 5/9/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/10/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/11/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/16/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/19/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/20/2023 at 9:00 PM Staff B documented 4 (held per parameters) for Detemir 20 units, on 5/21/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/23/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/24/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/25/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/30/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/31/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 6/2/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 6/3/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 6/7/2023 at 9:00 PM, there was no documentation on the MAR for the administration of Detemir 20 units, the box to indicate administration was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 2 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some blank, on 6/13/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 6/18/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 6/22/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 6/30/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/1/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/5/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/12/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/15/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/16/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/18/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/25/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/28/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/29/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/30/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 8/9/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 8/10/2023 at 9:00 PM Staff C LPN documented 14 (insulin not required) for Detemir 20 units, on 8/22/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 8/23/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 8/25/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 8/27/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, and on 8/29/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units. 3. Review Resident #4's medical record documented diagnoses that included cerebral infarction due to occlusion or stenosis of small artery (a stroke), chronic obstructive pulmonary disease, type 2 diabetes mellitus without complications, and end stage renal disease. Review of the physician orders for Resident #4 dated 2/14/2023 read, Insulin Detemir Solution 100 unit/ml, Inject 38 units subcutaneously at bedtime related to type 2 diabetes mellitus without complications. Review of the MAR for Resident #4 for the period of 8/1/2023 through 8/30/2023 revealed on 8/6/2023 at 9:00 PM Staff D, LPN documented 4 (held per parameters) for Detemir 38 units, on 8/8/2023 at 9:00 PM Staff E, LPN documented 4 (held per parameters) for Detemir 38 units, on 8/12/2023 at 9:00 PM Staff E, LPN documented 4 (held per parameters) for Detemir 38 units, on 8/14/2023 at 9:00 PM Staff C, LPN documented 14 (insulin not required) for Detemir 38 units, and on 8/17/2023 at 9:00 PM Staff E, LPN documented 4 (held per parameters) for Detemir 38 units. 4. Review of Resident #5's medical record documented diagnoses that included anoxic brain damage, type 2 diabetes mellitus with diabetic neuropathy, and secondary hypertension. Review of the physician orders for Resident #5 dated 6/22/2023 read, Lantus Solution 100 unit/ml [insulin glargine] inject 15 units subcutaneously two times a day related to type 2 diabetes mellitus without complication. Review of the MAR for Resident #5 for the period of 8/1/2023 through 8/30/2023 revealed on 8/3/2023 at 6:00 AM Staff H, LPN documented 14 (insulin not required) for Lantus Insulin 15 units, on 8/5/2023 at 6:00 AM Staff H, LPN documented 14 (insulin not required) for Lantus 15 units, on 8/8/2023 at 6:00 AM Staff H, LPN documented 14 (insulin not required) for Lantus 15 units, on 8/13/2023 at 9:00 PM Staff G, LPN documented 14 (insulin not required) for Lantus 15 units, on 8/17/2023 at 6:00 AM Staff H, LPN documented 14 (insulin not required) for Lantus 15 units, and on 8/21/2023 at 6:00 AM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 3 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0600 Staff I, LPN documented 4 (held per parameters) for Lantus 15 units. Level of Harm - Immediate jeopardy to resident health or safety During an interview on 8/31/2023 at 10:54 AM, the Medical Director stated, I was not aware that the nurses were holding long-acting insulins. I should be notified when the nurses are holding insulins; long-acting insulin. I should be notified if blood sugars are below 60 or above 400 unless there are different parameters I have set. Long-acting insulin does not have any parameters for holding, so I expect to be called. I do not think that any of my residents have had to be hospitalized due to hyperglycemia. There are concerns with holding insulins, the elderly are not as resilient and can decompensate quickly if they have any underlying illness. I should be notified if insulin is not administered. Nurses should follow orders and call if they have any concerns about giving the insulin. Residents Affected - Some During an interview on 8/31/2023 at 11:50 AM, the Administrator stated, We did meet and discuss the concerns about insulin and have been working on a plan of correction. I guess we should have found this when we looked at the insulin administration. We did not complete an RCA [root cause analysis] to determine if there were any other problems related to insulin administration. I assumed that all insulin was being looked at. We were focusing on the recertification survey, revisit, and complaint surveys. We should have looked at this and found that this was happening during our audits. We should have notified the doctors that the long-acting insulin was not administered. I don't know why; I don't have an answer as to why this was not addressed. Nurses should administer insulin when ordered by the doctor or call if they have any concerns about administering it [the insulin]. During an interview on 8/31/2023 at 11:57 AM, Staff J, Regional Nurse Consultant stated, I did the audits of all the residents on insulin. I did audits for what is documented on the audits, doctors' orders for insulin, orders for hypoglycemia protocol, that nurses can verbalize the signs and symptoms of hypoglycemia and that the MAR reflects appropriate administration. I don't recall seeing documentation for holding long-acting insulin. I don't recall whether I saw this or not. We did training with staff about insulin administration and that did include types of insulin. I was not aware that we still have staff not administering the long-acting insulin. I really can't say if I looked at the long-acting insulin or just that the accuchecks [an easy way to measure blood sugar] were being called if they were documenting them correctly. I don't know exactly how the education was completed. What exactly they went over. We did not document whether or not we looked at the long-acting insulin when we did the PIP [performance improvement plan]. I was not involved in the PIP, and I can't say. We should have identified it as a problem [long-acting insulin administration] and evaluated whether the staff were administering it per orders. Long-acting insulin does not have parameters for holding them. Nurses should have called the doctor if they had concerns about administering the insulin and documented that they called the doctor. Review of the PIP with the Regional Nurse Consultant, the PIP did not document identification of long-acting insulin not being administered. During a telephone interview on 8/31/2023 at 4:35 PM, Staff H, LPN stated, I did hold the insulin. It was long-acting insulin. The blood sugar was below 150. I always hold the Lantus when that happens. I did not call the doctor or text him. I thought that I was doing the right thing. I was not following doctors' orders for that administration. There are no parameters in the order to hold the insulin. If I was concerned, I should have called the doctor. During a telephone interview on 9/1/2023 at 8:06 AM, Staff I, LPN stated, I did hold the insulin. I guess I wasn't understanding that I needed to give it. I did not receive training prior to last night for insulin. We talked about calling and documenting accuchecks. I know I should not hold (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 4 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0600 long-acting insulin without parameters now. I should not have held the insulin and not let the doctor know. Level of Harm - Immediate jeopardy to resident health or safety During a telephone interview on 9/1/2023 at 8:16 AM, Staff B, LPN stated, So, I guess I had a misunderstanding of what long-acting insulin does and I would hold this for the sliding scale parameters. I didn't understand that I shouldn't or that I wasn't following doctors' orders. I should have given the insulin. Residents Affected - Some During an interview on 9/1/2023 at 8:26 AM, Staff K, Regional Nurse Consultant stated, I do not have any evidence for the dates the insulin was not administered that the doctor was notified, no texts and no progress notes. During an interview on 9/1/2023 at 11:10 AM, Staff D, LPN stated, I did hold insulin based on the short acting insulin scale and I shouldn't have. I should have either given the insulin or called the doctor if I was concerned about the resident's blood sugars. I just thought I was doing the right thing for the resident. I really should have called the doctor. Review of the policy and procedure titled P&P ANE [Abuse, Neglect, Exploitation] and Investigation issued on 4/1/2022 read, It will be the policy of this facility to honor resident rights and to address with employees the seven (7) components regarding mistreatment, abuse, neglect, sexual misconduct, injuries of unknown source, involuntary seclusion, corporeal punishment, misappropriation of residents property or funds or use of physical or chemical restraint not required to treat the resident's symptoms in accordance with Federal Law. Definitions: Neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. Procedure . 3. Prevention: Staff, residents and resident representatives will be instructed of how to identify and report concerns, events, & grievances. The facility will monitor reported events to determine any pattern, trend, or frequency exists to attempt to minimize the occurrence of injury. All events will be addressed at the monthly Quality Assurance Performance Improvement (QAPI) meeting. 5. Investigation: The facility will conduct their own internal investigation including but not limited to staff (work history and background screening), resident, and family/resident representative interviews, medical record reviews, 24-hour reports reviews, full body skin exam, etc. The resident's representative and physician should be notified that there is an on-going investigation regarding the alleged incident. The Immediate Jeopardy was removed on site on 9/1/2023 after the receipt of an acceptable immediate jeopardy removal plan. The survey team verified the facility's action for removal of the immediate jeopardy to prevent the likelihood of harm and/or possible death as evidenced by the following: On 8/31/2023 the facility assessed all residents involved in the IJ situation and conducted a facility wide audit of all residents receiving insulin to identify possible harm, side effects or injury due to holding the insulin. The facility held an Ad Hoc QAPI meeting to discuss staff holding long-acting insulin without parameters and conducted a root cause analysis. On 8/31/2023 and 9/1/2023 the Regional Nurse Consultant provided education to the licensed nursing staff on long and short acting insulin administration, medication errors, following physician orders, changes in condition and abuse and neglect for 39 out of 41 licensed staff. On 8/31/2023 the Regional Nurse Consultant provided education and training to the facility administration on QAPI/QAA policy and abuse and neglect policy. On 8/31/2023 and 9/1/2023 interviews were conducted with eight licensed nursing staff who verified training was provided for abuse and neglect, long and short acting insulin administration, following physician orders, medication errors, and change in condition notification. Interview with the Administrator on 9/1/2023 verified that training on abuse and neglect and on quality assurance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 5 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 - Immediate jeopardy to resident health or safety Based on interviews and record reviews, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice by failing to notify the physician of changes in condition for 1 of 5 residents, Resident #13, and failed to follow physicians' orders for the administration of long-acting insulins for 3 of 5 residents, Residents #100, #4, and #5. Residents Affected - Some The body must have insulin working 24 hours a day. If there is no glargine [Lantus/Detemir] and you have not given rapid acting insulin within the past 3-4 hours, it is likely that your body will make ketones and is at risk of developing life-threatening diabetic ketoacidosis (DKA) or Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHS) which as similar symptoms, causes, and treatments of DKA. DKA is caused by an overload of ketones present in your blood. When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic. HHS is a potentially fatal condition that can develop when diabetic medications are not administered as directed causing sever hyperglycemia and extreme dehydration leading to coma and death. Findings include: 1. Review of Resident #13's medical record documented the resident was admitted to the facility with the following diagnoses: acute on chronic systolic congestive heart failure, benign prostatic hyperplasia without lower urinary tract symptoms, chronic kidney disease stage 3, acquired absence of left leg above knee, personal history of transient ischemic attack and cerebral infarction, cerebral infarction, subacute osteomyelitis left ankle and foot, depression, anemia, type 2 diabetes mellitus with diabetic polyneuropathy, secondary hypertension, hyperlipidemia, pressure ulcer unstageable, and pressure ulcer of sacral region. Review of Resident #13's physician orders dated 7/3/2023 read, Humalog Kwik-pen 100 units/ml [milliliter] solution pen-injector, Inject as per sliding scale: if BS [blood sugar] under 60 call MD [medical doctor], 0-150 = 0 units, 151-200 = 2 units, 201-250 = 4 units, 251-300 = 6 units, 301-350 = 8 units, 351-400 = 10 units, if BS > 400 call MD. Review of Resident #13's July 2023 Medication Administrator Record (MAR) revealed on 7/4/2023 at 11:30 AM no information was documented for blood sugar, and on 7/11/2023 at 6:30 AM blood sugar of 461 was documented with a chart code of 9 (other/see nurses notes). Review of the progress notes on and about 7/11/2023 did not document a nurses note. Review of Resident #13's July 2023 MAR revealed a blood sugar of 424 and a chart code of 9 (other/see nurses notes) was documented on 7/18/2023 at 6:30 AM. Review of the progress notes on and about 7/18/2023 did not document a nurses note. Review of Resident 13's August 2023 MAR revealed a blood sugar of 527 and a chart code of 9 (other/see nurses notes) was documented on 8/2/2023 at 6:30 AM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 6 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 Review of the progress notes on and about 8/2/2023 did not document a nurses note. Level of Harm - Immediate jeopardy to resident health or safety Review of Resident #13's August 2023 MAR revealed a blood sugar of 542 and a chart code of 9 (other/see nurses notes) was documented on 8/4/2023 at 6:30 AM. Review of the progress notes on and about 8/4/2023 did not document a nurses note. Residents Affected - Some Review of Resident 13's August 2023 MAR revealed a blood sugar of 531 and a chart code of 9 (other/see nurses notes) was documented on 8/12/2023 at 6:30 AM. Review of the progress notes on and about 8/12/2023 did not document a nurses note. 2. Review of Resident #100's medical record documented diagnoses that included encephalopathy, unspecified visual field defects, type 2 diabetes mellitus without complications, essential primary hypertension, and cerebral infarction (a stroke). Review of the physician orders for Resident #100 dated 4/5/2023 read, Insulin Detemir Solution 100 Unit/ml [milliliter]. Inject 20 units subcutaneously at bedtime for diabetes. Review of the Medication Administration Record (MAR) for Resident #100 for the period of 5/1/2023 through 8/30/2023 revealed on 5/1/2023 at 9:00 PM Staff A, Licensed Practical Nurse (LPN) documented 14 (insulin coverage not needed) for Insulin Detemir 20 units, on 5/2/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) Detemir 20 units, on 5/3/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/4/2023 at 9:00 PM Staff C, LPN documented 4 (held per parameters) for Insulin Detemir 20 units, on 5/9/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/10/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/11/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/16/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/19/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/20/2023 at 9:00 PM Staff B documented 4 (held per parameters) for Detemir 20 units, on 5/21/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/23/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/24/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/25/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/30/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 5/31/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 6/2/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 6/3/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 6/7/2023 at 9:00 PM, there was no documentation on the MAR for the administration of Detemir 20 units, the box to indicate administration was blank, on 6/13/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 6/18/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 6/22/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 6/30/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/1/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/5/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/12/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/15/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/16/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/18/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/25/2023 at 9:00 PM Staff B, LPN documented 4 (held (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 7 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 - Immediate jeopardy to resident health or safety Residents Affected - Some per parameters) for Detemir 20 units, on 7/28/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/29/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 7/30/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 8/9/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 8/10/2023 at 9:00 PM Staff C LPN documented 14 (insulin not required) for Detemir 20 units, on 8/22/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 8/23/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 8/25/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, on 8/27/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units, and on 8/29/2023 at 9:00 PM Staff B, LPN documented 4 (held per parameters) for Detemir 20 units. 3. Review Resident #4's medical record documented diagnoses that included cerebral infarction due to occlusion or stenosis of small artery (a stroke), chronic obstructive pulmonary disease, type 2 diabetes mellitus without complications, and end stage renal disease. Review of the physician orders for Resident #4 dated 2/14/2023 read, Insulin Detemir Solution 100 unit/ml, Inject 38 units subcutaneously at bedtime related to type 2 diabetes mellitus without complications. Review of the MAR for Resident #4 for the period of 8/1/2023 through 8/30/2023 revealed on 8/6/2023 at 9:00 PM Staff D, LPN documented 4 (held per parameters) for Detemir 38 units, on 8/8/2023 at 9:00 PM Staff E, LPN documented 4 (held per parameters) for Detemir 38 units, on 8/12/2023 at 9:00 PM Staff E, LPN documented 4 (held per parameters) for Detemir 38 units, on 8/14/2023 at 9:00 PM Staff C, LPN documented 14 (insulin not required) for Detemir 38 units, and on 8/17/2023 at 9:00 PM Staff E, LPN documented 4 (held per parameters) for Detemir 38 units. 4. Review of Resident #5's medical record documented diagnoses that included anoxic brain damage, type 2 diabetes mellitus with diabetic neuropathy, and secondary hypertension. Review of the physician orders for Resident #5 dated 6/22/2023 read, Lantus Solution 100 unit/ml [insulin glargine] inject 15 units subcutaneously two times a day related to type 2 diabetes mellitus without complication. Review of the MAR for Resident #5 for the period of 8/1/2023 through 8/30/2023 revealed on 8/3/2023 at 6:00 AM Staff H, LPN documented 14 (insulin not required) for Lantus Insulin 15 units, on 8/5/2023 at 6:00 AM Staff H, LPN documented 14 (insulin not required) for Lantus 15 units, on 8/8/2023 at 6:00 AM Staff H, LPN documented 14 (insulin not required) for Lantus 15 units, on 8/13/2023 at 9:00 PM Staff G, LPN documented 14 (insulin not required) for Lantus 15 units, on 8/17/2023 at 6:00 AM Staff H, LPN documented 14 (insulin not required) for Lantus 15 units, and on 8/21/2023 at 6:00 AM Staff I, LPN documented 4 (held per parameters) for Lantus 15 units. During an interview on 8/31/2023 at 10:54 AM, the Medical Director stated, I was not aware that the nurses were holding long-acting insulins. I should be notified when the nurses are holding insulins; long-acting insulin. I should be notified if blood sugars are below 60 or above 400 unless there are different parameters I have set. Long-acting insulin does not have any parameters for holding, so I expect to be called. I do not think that any of my residents have had to be hospitalized due to hyperglycemia. There are concerns with holding insulins, the elderly are not as resilient and can decompensate quickly if they have any underlying illness. I should be notified if insulin is not administered. Nurses should follow orders and call if they have any concerns about giving the insulin. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 8 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 - Immediate jeopardy to resident health or safety Residents Affected - Some During an interview on 8/31/2023 at 11:50 AM, the Administrator stated, We did meet and discuss the concerns about insulin and have been working on a plan of correction. I guess we should have found this when we looked at the insulin administration. We did not complete an RCA [root cause analysis] to determine if there were any other problems related to insulin administration. I assumed that all insulin was being looked at. We were focusing on the recertification survey, revisit, and complaint surveys. We should have looked at this and found that this was happening during our audits. We should have notified the doctors that the long-acting insulin was not administered. I don't know why; I don't have an answer as to why this was not addressed. Nurses should administer insulin when ordered by the doctor or call if they have any concerns about administering it [the insulin]. During an interview on 8/31/2023 at 11:57 AM, Staff J, Regional Nurse Consultant stated, Each time 4 or 14 is documented the medication was not given per the doctors' order. The nurses did not administer the long-acting insulin. Reviewing the orders, I see that there are no parameters to hold the medication and the insulin should have been administered. They were not following doctors' orders. They were not following the policies for medication administration and holding medications. They should have called the doctor if they were concerned about administering the medications. I have no idea why they would have held the insulin. I just don't know why they did this. Long-acting insulin does not have parameters for holding them. Nurses should have called the doctor if they had concerns about administering the insulin and documented that they called the doctor. The nurses were not following our policies for medication administration, notifying doctors of changes in condition. They should have called the doctor if they had any concerns at all. I don't know why they did not administer the insulin. I have not asked them or investigated why they did not give it. I was not aware that long-acting insulin wasn't being given. During a telephone interview on 8/31/2023 at 4:35 PM, Staff H, LPN stated, I did hold the insulin. It was long-acting insulin. The blood sugar was below 150. I always hold the Lantus when that happens. I did not call the doctor or text him. I thought that I was doing the right thing. I was not following doctors' orders for that administration. There are no parameters in the order to hold the insulin. If I was concerned, I should have called the doctor. During a telephone interview on 9/1/2023 at 8:06 AM, Staff I, LPN stated, I did hold the insulin. I guess I wasn't understanding that I needed to give it. I should not have held the insulin. I should have let the doctor know I was holding the insulin. I was not following doctor's orders when I held the long-acting insulin. During a telephone interview on 9/1/2023 at 8:16 AM, Staff B, LPN stated, So, I guess I had a misunderstanding of what long-acting insulin does and I would hold this for the sliding scale parameters. I didn't understand that I shouldn't or that I wasn't following doctors' orders. I should have given the insulin. I was not following the policies for medication administration; I was not following the doctor orders when I held the insulin. There are no parameters to hold long-acting insulin. During an interview on 9/1/2023 at 8:26 AM, Staff K, Regional Nurse Consultant stated, I do not have any evidence for the dates the insulin was not administered that the doctor was notified, no texts and no progress notes. During an interview on 9/1/2023 at 11:10 AM, Staff D, LPN stated, I did hold insulin based on the short acting insulin scale and I shouldn't have. I should have either given the insulin or called the doctor if I was concerned about the resident's blood sugars. I just thought I was doing the right thing for the resident. I really should have called the doctor. I did not follow the doctor's orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 9 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 - Immediate jeopardy to resident health or safety Residents Affected - Some I was not following our policies for calling the doctor or administering medications. I did not receive any training related to long-acting insulin. Today we discussed long term insulin administration and that we don't ever hold the insulin unless we call the doctor and they just put in new parameters that say below 80 call the doctor. During an interview on 9/1/2023 at 1:30 PM, Staff N, LPN stated, I was not trained on long- acting insulin until today. I just was given the information about long-acting insulin today. I was not trained on this two weeks ago. During an interview on 9/1/2023 at 1:45 PM, Staff O, LPN stated, Two weeks ago I did not get any training on the types of insulin or when they peak. We just got that today along with long- acting insulin that it doesn't get held. That we need to call doctors if we hold insulin or if it's high and on neglect. I do understand that I shouldn't hold long-acting insulin and that I have to follow doctors' orders when it comes to insulin. During an interview on 9/1/2023 at 2:15 PM, Staff P, RN stated, I was not given insulin administration education information before today. They did not talk to use about long-acting insulin until today. I did get training on neglect, change of condition, following doctors' orders, the new orders to call a doctor if blood glucose is less than eighty today. I do understand how long-acting insulin works and that I shouldn't hold it. During an interview on 9/1/2023 at 2:25 PM, Staff Q, LPN stated, We got some training like two weeks ago making sure orders were in if they had blood sugars below 60 and what to do, like give glucagon. I was not trained on the types of insulin until today. We went over a printout that had the types of insulin, when they begin to work, that we don't have parameters on Lantus and Levemir insulins only the short acting ones. That we don't hold long-acting insulin, they also talked about following doctors' orders, calling doctors when we need to report things like blood sugars to them. Review of the policy and procedure titled P&P Diabetes/Hypo/Hyperglycemia issued on 4/1/2022 read, Policy: It will be the policy of this facility to provide appropriate care to residents with diabetes mellitus. Nursing measures and physician orders will be implemented to minimize risk of hypo/hyperglycemia. Procedure: 1. Residents diagnosed with diabetes mellitus (or other condition requiring blood glucose monitoring and control) will receive insulin, oral hypoglycemic medications and/or an individually prescribed diet according to physician order . 5. Staff will provide glucose monitoring, medication administration, laboratory testing and diet per physician orders. 13 . Report noncompliance with physician orders to the physician and/or resident representative, if applicable. 14. Document pertinent information, regarding medication administration, changes in condition, education, or interventions in clinical record. Review of the policy and procedure titled P&P Medication Errors issued on 4/1/2022 read, Policy: It will be the policy of this facility that the staff and practitioner shall try to prevent medication errors and adverse medication consequences and shall strive to identify and manage them appropriately when they occur. Procedure: 1. The staff and practitioner shall strive to minimize adverse consequences by: a. Following relevant clinical guidelines and manufacturers specifications for use, dose, administration, duration, and monitoring of the medication. b. Defining appropriate indications for use. 2. The staff shall report clinically significant adverse medication consequences to the resident's physician, governing agencies, and resident representative, if applicable . 4. Staff will document appropriately detailed accounts of any incidents/events on an appropriate report form or electronic database system for quality assurance. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 10 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 - Immediate jeopardy to resident health or safety Residents Affected - Some Review of the policy and procedure titled Medication Administration issued on 4/1/2022 read, Policy: It will be the policy of this facility to administer medications in a timely manner and as prescribed by the physician, unless otherwise clinically indicated or necessitated by other circumstances such as lack of availability of medication or refusals of medication by the resident. Procedure . 2. The Director of Nursing is responsible for the supervision and direction of all personnel with medication administration duties and functions. 3. Medications shall be administered in a timely manner and in accordance with the physician's orders . 5. Should a dose seem excessive considering the residents age and medical condition, or medication order seems to be unrelated to the resident's current diagnosis or medical condition, the person preparing/administering the medication shall contact the resident's physician or the facility's Medical Director . 12. Should a drug be withheld, refused, or given other than the scheduled time, the individual administering the medication will document this in the clinical record. Review of the policy and procedure titled P&P Change in Condition issued on 4/1/2022 read, Policy: It will be the policy of this facility to notify the physician, family, resident, and/or responsible party/resident representative (as is applicable) of significant changes in condition and providing treatment(s) according to resident wishes and physician's orders . 6. Contact the primary physician to update/him/her to the change in condition. In the event the primary physician cannot be notified, attempt to contact the facility's medical director. The Immediate Jeopardy was removed on site on 9/1/2023 after the receipt of an acceptable immediate jeopardy removal plan. The survey team verified the facility's action for removal of the immediate jeopardy to prevent the likelihood of harm and/or possible death as evidenced by the following: On 8/31/2023 the facility assessed all residents involved in the IJ situation and conducted a facility wide audit of all residents receiving insulin to identify possible harm, side effects or injury due to holding the insulin. The facility held an Ad Hoc QAPI meeting to discuss staff holding long-acting insulin without parameters and conducted a root cause analysis. On 8/31/2023 and 9/1/2023 the Regional Nurse Consultant provided education to the licensed nursing staff on long and short acting insulin administration, medication errors, following physician orders, changes in condition and abuse and neglect for 39 out of 41 licensed staff. On 8/31/2023 the Regional Nurse Consultant provided education and training to the facility administration on QAPI/QAA policy and abuse and neglect policy. On 8/31/2023 and 9/1/2023 interviews were conducted with eight licensed nursing staff who verified training was provided for abuse and neglect, long and short acting insulin administration, following physician orders, medication errors, abuse, and change in condition notification. Interview with the Administrator on 9/1/2023 verified training on abuse and neglect and on quality assurance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 11 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0773 Level of Harm - Minimal harm or potential for actual harm Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. Based on record reviews and interviews, the facility failed to ensure the physician was notified of a change in condition for 1 of 3 residents, Resident #1. Residents Affected - Few Findings include: Review of Resident #1's medical record documented the resident was admitted to the facility with the following diagnoses: Non-ST elevation myocardial infarction (a heart attack), cellulitis of left lower leg, chronic obstructive pulmonary disease unspecified, type 2 diabetes mellitus with diabetic neuropathy, bladder disorder, and essential primary hypertension. Review of the physician order dated 8/10/2023 read, U/A [urinalysis] with C&S [culture and sensitivity] one time only for UTI [urinary tract infection] until 8/10/2023 23:59 [11:59 PM]. Review of the physician order dated 8/11/2023 read, Cipro oral tablet 500 mg [milligrams] give 1 tablet by mouth two times a day for infection. Review of the Lab Results titled Urine Culture Report dated 8/12/2023 at 12:15 PM read, Report information: Collection Date: 08/10/2023 03:36 [3:36 AM], Received date: 08/10/2023 16:15 [4:15 PM], Reported date: 08/12/2023 12:15 [PM]. Final Report: Result > 100,000 CFU [colony forming unit]/ml [per milliliter]. Gram negative rods. Escherichia Coli. This isolate is extended spectrum beta-lactamase [ESBL]. Sensitivity analysis: Ciprofloxacin > = 4 R [R = resistant]. Review of the progress notes dated 8/12/2023 at 11:29 AM read, Critical lab called by [laboratory's name] for pt. [patient] positive for ESBL in the urine, MD [medical doctor] notified via phone. No new orders at this time pending sensitivity results per MD. Review of the progress notes for Resident #1 for the period on and about 8/12/2023 did not provide for documentation the doctor was notified of the sensitivity analysis results. Review of the August Medication Administration Record (MAR) for Resident #1 documented Cipro oral tablet 500 mg one tablet was administered on 8/12/2023 at 9:00 PM, 8/13/2023 at 9:00 AM and 9:00 PM and on 8/14/2023 at 9:00 AM. During an interview on 8/14/2023 at 9:55 AM, the Director of Nursing (DON) stated, I was not aware that he was taking Cipro for his urinary tract infection, and this [infection] was not sensitive to Cipro. I don't see a note that has the staff calling [physician's name] after the initial note that states the sensitivities are pending. It looks like we had the lab report about 45 minutes after they called [the doctor], so I'm not sure why we didn't call him back. We should have called back and gotten the correct antibiotic ordered for him. He did receive this medication and it will not treat his UTI. I don't know why the infection control nurse didn't see this. We did not follow the McGeer criteria [used to meet the criteria for definitive infection] for antibiotics. This should have been followed up on and the correct antibiotic should have been administered. During an interview on 8/14/2023 at 11:30 AM, the Medical Doctor stated, I was called and told about the ESBL in his urine culture, but there were no sensitivities back when I was notified so I wouldn't have changed the antibiotic until the sensitivities were back. I was not called when (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 12 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few sensitivities were back. I was not aware the Ciprofloxacin was resistant. I would have changed the antibiotic sooner had I received a call. It would be necessary to change the antibiotic to treat the infection. During a telephone interview on 8/14/2023 at 3:30 PM, Staff B, Registered Nurse (RN) stated, I did call [doctor's name] about the critical lab after I got called by the lab. I did not have the sensitivities when I called him. I did not call him back when the sensitivities came back. I should have but I don't remember seeing them. Review of the policy and procedure titled P&P Change in Condition issued on 4/1/2022 read, Policy: It will be the policy of this facility to notify the physician, family, resident, and/or responsible party/resident representative (as is applicable) of significant changes in condition and providing treatment(s) according to resident wishes and physician's orders. 6. Contact the primary physician to update/him/her to the change in condition. In the event the primary physician cannot be notified, attempt to contact the facility's medical director. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 13 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Immediate jeopardy to resident health or safety Based on interviews and record reviews, the facility administration failed to use its resources effectively and efficiently to attain or maintain the highest practicable physical wellbeing of each resident when not assuming full responsibility for the day-to-day operations of the facility and failing to effectively implement a QAPI/QAA plan. The administration failed to identify medication errors for residents who were not administered long-acting insulin as ordered by the physician and failed to ensure physician notification when medication orders were not followed and residents had change of condition for 4 of 7 residents, Resident #13, #100, #4, and #5. Residents Affected - Some The body must have insulin working 24 hours a day. If there is no glargine [Lantus/Detemir] and you have not given rapid acting insulin within the past 3-4 hours, it is likely that your body will make ketones and is at risk of developing life-threatening diabetic ketoacidosis (DKA) or Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHS) which as similar symptoms, causes, and treatments of DKA. DKA is caused by an overload of ketones present in your blood. When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic. HHS is a potentially fatal condition that can develop when diabetic medications are not administered as directed causing severe hyperglycemia and extreme dehydration leading to coma and death. Findings include: Cross Reference to F867- QAPI/QAA (Quality Assurance and Performance Improvement/Quality Assessment and Assurance) Improvement Activities under survey event RQJA12. Review of the job description for the Administrator read, Purpose of your job position: The primary purpose of your position is to direct the day-to-day functions of the facility in accordance with current federal, state, and local standards, guidelines, and regulations that govern nursing facilities to assure that the highest degree of quality care can be provided to our residents at all times. Duties and Responsibilities: Administrative functions: Develop and maintain written policies and procedures and professional standards of practice that govern the operation of the Facility. Assist department directors in the development, use, and implementation of departmental policies and procedures and professional standards of practice. Review deficiencies noted during the exit conference. Assist in developing plans of correction for cited deficiencies. Ensure such plans incorporate timetables and methods of monitoring to ensure such deficiencies do not recur. Committee functions: Serve on various committees of the facility (i.e., Infection control, Quality Assurance & Assessment, etc ., assist the Quality Assurance and Assessment Committee in developing and implementing appropriate plans of action to correct identified quality deficiencies, evaluate and implement recommendations from the facility's committees as necessary. Safety and Sanitation: Review accident and incident reports (e.g., falls, injuries of unknown source, abuse, etc.) Monitor to determine effectiveness of facility's risk management program. Review of the Job description for the Director of Nursing Services read, Purpose of your Job Position: The primary purpose of your position is to plan, organize, develop, and direct the overall operation of our Nursing Services Department in accordance with current federal, state, and local (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 14 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some standards, guidelines, and regulations that govern our facility and as may be directed by the Administrator to ensure the highest degree of quality care is maintained at all times. Delegation of Authority: You are charged with carrying out the resident care policies established by this facility. Administrative functions: Plan, develop, organize, evaluate, and direct the nursing service department, as well as its programs and activities, in accordance with current rules, regulations, and guidelines that govern nursing care facilities. Develop, maintain, and periodically update written policies and procedures that govern the day-to-day function of the nursing service department. Make written and oral recommendations to the administrator concerning the operation of the nursing service department. Develop, implement, and maintain an ongoing quality assurance program for the nursing service department. Assist in developing and implementing appropriate plans of action to correct identified deficiencies. Monitor the facility's QI [Quality Improvement], QM [Quality Management], and survey reports. Assist in developing plans of action to correct potential or identified problem areas. Committee functions: Serve on, participate in, and attend various committees of the facility as appointed by the administrator. Evaluate and implement recommendations from established committees as they may pertain to nursing services. Staff Development: Develop and participate in the planning, conducting, and scheduling of timely in-service training classes that provide instructions on how to do the job, and ensure a well-educated nursing service department. Develop, implement, and maintain an effective orientation program that orients new employees to the department, its policies and procedures, and to his/her job position and title. Review of the contractual agreement for the Medical Director read, The responsibilities of the Medical Director shall be without limitation, to perform the following duties, such duties to be solely administrative in nature and not including any direct medical services: Coordinate medical care in the facility, provide clinical guidance and oversight regarding the implementation of patient care policies and make good faith efforts to assure adequate medical care for patients. Coordinate and collaborate with facility leadership, staff, other practitioners, and consultants, including any other facility medical directors to help develop, implement and evaluate patient care policies and procedures that reflect current standards of practice and regarding administrative requests and patient care initiatives as specified in the agreement. Assist facility to identify, evaluate, address, resolve medical and clinical concerns and issues that affect patient care, medical care or quality of life or are related to the provision of services by physicians and other licensed healthcare practitioners including medical care consistent with applicable current standards of care and monitoring of the performance and practices of healthcare practitioners generally. Provide clinical leadership through active participation in the facilities quality assurance committee and quality assurance program and participate in all other activities which may be designated by the executive director of the facility from time to time to facilitate the cost-effective delivery of services at the facility. Assurance of and participation in the delivery of regular in-service training sessions for all facility staff. Participate in such case management and risk management activities and programs as the executive director of the facility may request from time to time. 1. Review of Resident #13's medical record documented the resident was admitted to the facility with the following diagnoses: acute on chronic systolic congestive heart failure, benign prostatic hyperplasia without lower urinary tract symptoms, chronic kidney disease stage 3, acquired absence of left leg above knee, personal history of transient ischemic attack and cerebral infarction, cerebral infarction, subacute osteomyelitis left ankle and foot, depression, anemia, type 2 diabetes mellitus with diabetic polyneuropathy, secondary hypertension, hyperlipidemia, pressure ulcer unstageable, and pressure ulcer of sacral region. Review of Resident #13's physician orders dated 7/3/2023 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 15 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some read, Humalog Kwik-pen 100 units/ml [milliliter] solution pen-injector, Inject as per sliding scale: if BS [blood sugar] under 60 call MD [medical doctor], 0-150 = 0 units, 151-200 = 2 units, 201-250 = 4 units, 251-300 = 6 units, 301-350 = 8 units, 351-400 = 10 units, if BS > 400 call MD. Review of Resident #13's July 2023 Medication Administrator Record (MAR) revealed on 7/4/2023 at 11:30 AM no information was documented for blood sugar, and on 7/11/2023 at 6:30 AM blood sugar of 461 was documented with a chart code of 9 (other/see nurses notes). Review of the progress notes on and about 7/11/2023 did not document a nurses note. Review of Resident #13's July 2023 MAR revealed a blood sugar of 424 and a chart code of 9 (other/see nurses notes) was documented on 7/18/2023 at 6:30 AM. Review of the progress notes on and about 7/18/2023 did not document a nurses note. Review of Resident 13's August 2023 MAR revealed a blood sugar of 527 and a chart code of 9 (other/see nurses notes) was documented on 8/2/2023 at 6:30 AM. Review of the progress notes on and about 8/2/2023 did not document a nurses note. Review of Resident #13's August 2023 MAR revealed a blood sugar of 542 and a chart code of 9 (other/see nurses notes) was documented on 8/4/2023 at 6:30 AM. Review of the progress notes on and about 8/4/2023 did not document a nurses note. Review of Resident 13's August 2023 MAR revealed a blood sugar of 531 and a chart code of 9 (other/see nurses notes) was documented on 8/12/2023 at 6:30 AM. Review of the progress notes on and about 8/12/2023 did not document a nurses note. 2. Review of Resident #100's medical record documented diagnoses that included encephalopathy, unspecified visual field defects, type 2 diabetes mellitus without complications, essential primary hypertension, and cerebral infarction (a stroke). Review of the physician orders for Resident #100 dated 4/5/2023 read, Insulin Detemir Solution 100 Unit/ml [milliliter]. Inject 20 units subcutaneously at bedtime for diabetes. Review of the Medication Administration Record (MAR) for Resident #100 for the period of 5/1/2023 through 5/31/2023 revealed the licensed nursing staff documented 4 (held per parameters) on 16 days. Review of the Medication Administration Record (MAR) for Resident #100 for the period of 6/1/2023 through 6/30/2023 revealed the licensed nursing staff documented 4 (held per parameters) on 7 days. Review of the Medication Administration Record (MAR) for Resident #100 for the period of 7/1/2023 through 7/31/2023 revealed the licensed nursing staff documented 4 (held per parameters) on 10 days. Review of the Medication Administration Record (MAR) for Resident #100 for the period of 8/1/2023 through 8/30/2023 revealed the licensed nursing staff documented 4 (held per parameters) on 7 days. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 16 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0835 Cross Reference to F884- Quality of Care. Level of Harm - Immediate jeopardy to resident health or safety 3. Review Resident #4's medical record documented diagnoses that included cerebral infarction due to occlusion or stenosis of small artery (a stroke), chronic obstructive pulmonary disease, type 2 diabetes mellitus without complications, and end stage renal disease. Residents Affected - Some Review of the physician orders for Resident #4 dated 2/14/2023 read, Insulin Detemir Solution 100 unit/ml, Inject 38 units subcutaneously at bedtime related to type 2 diabetes mellitus without complications. Review of the MAR for Resident #4 for the period of 8/1/2023 through 8/30/2023 revealed the licensed nursing staff documented 4 (held per parameters) on 5 days. Cross Reference to F884- Quality of Care. 4. Review of Resident #5's medical record documented diagnoses that included anoxic brain damage, type 2 diabetes mellitus with diabetic neuropathy, and secondary hypertension. Review of the physician orders for Resident #5 dated 6/22/2023 read, Lantus Solution 100 unit/ml [insulin glargine] inject 15 units subcutaneously two times a day related to type 2 diabetes mellitus without complication. Review of the MAR for Resident #5 for the period of 8/1/2023 through 8/30/2023 revealed the licensed nursing staff documented 4 (held per parameters) on 6 days. Cross Reference to F884- Quality of Care. During an interview on 8/31/2023 at 9:55 AM, Staff J, Regional Nurse Consultant stated, We have done a PIP [performance improvement plan] for insulin administration. We did this about a week ago and we have been auditing. We did a whole house audit of all residents who are being administered insulin. I will get that for you. During an interview on 8/31/2023 at 10:54 AM, the Medical Director stated, I was not aware that the nurses were holding long-acting insulins. I should be notified when the nurses are holding insulin, long-acting insulin. I should be notified if blood sugars are below 60 or above 400 unless there are different parameters I have set. Long-acting insulin does not have any parameters for holding, so I expect to be called. I do not think that any of my residents have had to be hospitalized due to hyperglycemia. There are concerns with holding insulins, the elderly are not as resilient and can decompensate quickly if they have any underlying illness. I should be notified if insulin is not administered. Nurses should follow orders and call if they have any concerns about giving the insulin. During an interview on 8/31/2023 at 11:50 AM, the Administrator stated, We did meet and discuss the concerns about insulin and have been working on a plan of correction. I guess we should have found this when we looked at the insulin administration. We did not complete an RCA [root cause analysis] to determine if there were any other problems related to insulin administration. I assumed that all insulin was being looked at. We were focusing on the recertification survey, revisit, and complaint surveys. We should have looked at this and found that this was happening during our audits. We should have notified the doctors that the long-acting insulin was not administered. I don't know why; I don't have an answer as to why this was not addressed. Nurses should administer insulin when ordered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 17 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0835 by the doctor or call if they have any concerns about administering it [the insulin]. Level of Harm - Immediate jeopardy to resident health or safety During an interview on 8/31/2023 at 11:57 AM, Staff J, Regional Nurse Consultant stated, Each time 4 or 14 is documented the medication was not given per the doctors' order. The nurses did not administer the long-acting insulin. Reviewing the orders, I see that there are no parameters to hold the medication and the insulin should have been administered. They were not following doctors' orders. They were not following the policies for medication administration and holding medications. They should have called the doctor if they were concerned about administering the medications. I have no idea why they would have held the insulin. I just don't know why they did this. Long-acting insulin does not have parameters for holding them. Nurses should have called the doctor if they had concerns about administering the insulin and documented that they called the doctor. The nurses were not following our policies for medication administration, notifying doctors of changes in condition. They should have called the doctor if they had any concerns at all. I don't know why they did not administer the insulin. I have not asked them or investigated why they did not give it. I was not aware that long-acting insulin wasn't being given. I don't know what the DON [Director of Nursing] knew or investigated. I did the audits of all the residents on insulin. I did audits for what is documented on the audits, doctors' orders for insulin, orders for hypoglycemia protocol, that nurses can verbalize the signs and symptoms of hypoglycemia and that the MARs reflect appropriate administration. I don't recall seeing documentation for holding long-acting insulin. I don't recall whether I saw this or not. We did training with staff about insulin administration and that did include types of insulin. I was not aware that we still have staff not administering the long-acting insulin. I really can't say if I looked at the long-acting insulin or just that the accuchecks [an easy way to measure blood sugar] were being called and if they were documenting them correctly. I don't know exactly how the education was completed. What exactly they went over. We did not document whether or not we looked at the long-acting insulin when we did the PIP. I was not involved in the PIP, and I can't say. We should have identified it as a problem [long-acting insulin administration] and evaluated whether the staff were administering it per orders. Long-acting insulin does not have parameters for holding them. Nurses should have called the doctor if they had concerns about administering the insulin and documented that they called the doctor. Residents Affected - Some Review of a Full House audit titled Diabetes Insulin dated 8/23/23 was completed and included: 1. MD [Medical Doctor] order with dx [diagnosis] for insulin. **** Sliding scale orders should include instructions such as MD notification for BG [blood glucose] > 400 or < 70. 2. MD order for hypoglycemia emergency response. 3. Nurse assigned to patient can verbalize the s/s [signs and symptoms] of hypoglycemia. 4. MAR documentation supports appropriate administration. (i.e., . MD notified for BG > 400 or < 70). [Long-acting insulins were not included in this audit]. Review of the document titled Performance Improvement Plan dated 8/23/23 read, Objective and goal: Insulin administration/following physician orders. The facility will respond with the development of a charter PIP as well as an investigation. Initiative: 1. Immediate corrections to ensure safety of affected resident(s). 2. Identification of any other residents who may be affected or at risk. 3: Interventions put into place to prevent the incident from occurring again. 4. Plan for future follow up to ensure that interventions are working. Action Steps: During a quality system review, it was identified that physician's orders, as it pertains to insulin administration were not followed at times or action taken related to variation from physician orders were not documented in the clinical record. A comprehensive audit of active residents in the facility with orders for insulin administration was conducted to identify concerns related to insulin administration in accordance with physician orders 30 days no concerns. Responsible person(s): DNS/designee. Target date: 8/23/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 18 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0835 Status: Completed. Level of Harm - Immediate jeopardy to resident health or safety Review of the PIP with the Regional Nurse Consultant, the PIP did not document identification of long-acting insulin not being administered. Residents Affected - Some During an interview on 9/1/2023 at 8:26 AM, Staff K, Regional Nurse Consultant stated, I do not have any evidence for the dates the insulin was not administered that the doctor was notified, no texts and no progress notes. Review of the policy and procedure titled P&P Diabetes/Hypo/Hyperglycemia issued on 4/1/2022 read, Policy: It will be the policy of this facility to provide appropriate care to residents with diabetes mellitus. Nursing measures and physician orders will be implemented to minimize risk of hypo/hyperglycemia. Procedure: 1. Residents diagnosed with diabetes mellitus (or other condition requiring blood glucose monitoring and control) will receive insulin, oral hypoglycemic medications and/or an individually prescribed diet according to physician order . 5. Staff will provide glucose monitoring, medication administration, laboratory testing and diet per physician orders. 13 . Report noncompliance with physician orders to the physician and/or resident representative, if applicable. 14. Document pertinent information, regarding medication administration, changes in condition, education, or interventions in clinical record. Review of the policy and procedure titled P&P Medication Errors issued on 4/1/2022 read, Policy: It will be the policy of this facility that the staff and practitioner shall try to prevent medication errors and adverse medication consequences and shall strive to identify and manage them appropriately when they occur. Procedure: 1. The staff and practitioner shall strive to minimize adverse consequences by: a. Following relevant clinical guidelines and manufacturers specifications for use, dose, administration, duration, and monitoring of the medication. b. Defining appropriate indications for use. 2. The staff shall report clinically significant adverse medication consequences to the resident's physician, governing agencies, and resident representative, if applicable . 4. Staff will document appropriately detailed accounts of any incidents/events on an appropriate report form or electronic database system for quality assurance. Review of the policy and procedure titled Medication Administration issued on 4/1/2022 read, Policy: It will be the policy of this facility to administer medications in a timely manner and as prescribed by the physician, unless otherwise clinically indicated or necessitated by other circumstances such as lack of availability of medication or refusals of medication by the resident. Procedure . 2. The Director of Nursing is responsible for the supervision and direction of all personnel with medication administration duties and functions. 3. Medications shall be administered in a timely manner and in accordance with the physician's orders . 5. Should a dose seem excessive considering the residents age and medical condition, or medication order seems to be unrelated to the resident's current diagnosis or medical condition, the person preparing/administering the medication shall contact the resident's physician or the facility's Medical Director . 12. Should a drug be withheld, refused, or given other than the scheduled time, the individual administering the medication will document this in the clinical record. Review of the policy and procedure titled P&P Change in Condition issued on 4/1/2022 read, Policy: It will be the policy of this facility to notify the physician, family, resident, and/or responsible party/resident representative (as is applicable) of significant changes in condition and providing treatment(s) according to resident wishes and physician's orders . 6. Contact the primary physician to update/him/her to the change in condition. In the event the primary physician cannot be notified, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 19 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0835 attempt to contact the facility's medical director. Level of Harm - Immediate jeopardy to resident health or safety Review of the policy and procedure titled P&P Quality Assurance and Performance Improvement (QAPI) Program issued on 4/1/2022 read, Policy: It will be the policy of this facility, including a facility that is part of a multiunit chain, will develop, implement, and maintain an effective, comprehensive, data driven QAPI program that focuses on indicators of the outcomes of care and quality of life. Procedure: 1. The facility shall maintain and demonstrate evidence of its ongoing QAPI program. This may include but is not limited to systems and reports demonstrating systemic identification, reporting, investigation, analysis, and prevention of adverse events; and documentation demonstrating the development, implementation, and evaluation of corrective actions or performance improvement activities . 4. The facility shall design its QAPI program to be ongoing, comprehensive, and to address the range of care and services provided by the facility: address all systems of care and management practices, include clinical care, quality of life, and resident choice; utilize the best available evidence to define and measure indicators of quality and facility goals that reflect processes of care and facility operations; reflect the complexities, unique care, and services that the facility provides. 5. The governing body and/or executive leadership (or organized group or individual who assumes full authority and responsibility for operation of the facility) is responsible and accountable for ensuring that: An ongoing QAPI program is defined, implemented, and maintained and addresses identified priorities. The QAPI program identifies and prioritizes problems and opportunities that reflect organizational process, functions, and services provided to residents based on performance indicator data, and resident and staff input, and other information; corrective actions address gaps in systems and are evaluated for effectiveness. Residents Affected - Some Review of the policy and procedure titled P&P ANE [Abuse, Neglect, Exploitation] and Investigation issued on 4/1/2022 read, It will be the policy of this facility to honor resident rights and to address with employees the seven (7) components regarding mistreatment, abuse, neglect, sexual misconduct, injuries of unknown source, involuntary seclusion, corporeal punishment, misappropriation of residents property or funds or use of physical or chemical restraint not required to treat the resident's symptoms in accordance with Federal Law. Definitions: Neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. Procedure . 3. Prevention: Staff, residents and resident representatives will be instructed of how to identify and report concerns, events, & grievances. The facility will monitor reported events to determine any pattern, trend, or frequency exists to attempt to minimize the occurrence of injury. All events will be addressed at the monthly Quality Assurance Performance Improvement (QAPI) meeting. 5. Investigation: The facility will conduct their own internal investigation including but not limited to staff (work history and background screening), resident, and family/resident representative interviews, medical record reviews, 24-hour reports reviews, full body skin exam, etc. The resident's representative and physician should be notified that there is an on-going investigation regarding the alleged incident. The Immediate Jeopardy was removed on site on 9/1/2023 after the receipt of an acceptable immediate jeopardy removal plan. The survey team verified the facility's action for removal of the immediate jeopardy to prevent the likelihood of harm and/or possible death as evidenced by the following: On 8/31/2023 the facility assessed all residents involved in the IJ situation and conducted a facility wide audit of all residents receiving insulin to identify possible harm, side effects or injury due to holding the insulin. The facility held an Ad Hoc QAPI meeting to discuss staff holding long-acting insulin without parameters and conducted a root cause analysis. On 8/31/2023 and 9/1/2023 the Regional Nurse Consultant provided education to the licensed nursing staff on long and short acting insulin (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105193 If continuation sheet Page 20 of 21 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 105193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Meadows Healthcare & Rehabilitation Center 3250 SW 41st Place Gainesville, FL 32608 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete administration, medication errors, following physician orders, changes in condition and abuse and neglect for 39 out of 41 licensed staff. On 8/31/2023 the Regional Nurse Consultant provided education and training to the facility administration on QAPI/QAA policy and abuse and neglect policy. On 8/31/2023 and 9/1/2023 interviews were conducted with eight licensed nursing staff who verified training was provided for abuse and neglect, long and short acting insulin administration, following physician orders, medication errors, and change in condition notification. Interview with the Administrator on 9/1/2023 verified that training on abuse and neglect and on quality assurance. Event ID: Facility ID: 105193 If continuation sheet Page 21 of 21