Health inspection·November 19, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (End date: 11/27/2025)- Start Vistaril 50 mg PO every 8 hours PRN for 14 days (End date: 11/27/2025)Continue Buspirone 10 mg PO BID for anxiety.11/17/25, Resident denies any pain or discomfort. Resident is resting in bed with eyes closed. Safety measures in place. Call light and bed control within reach of the left hand. I will continue to monitor. Review of the Trauma Informed Care on 11/11/25 showed --Has the resident ever been diagnosed with PTSD (Post Traumatic Stress Disorder) had a life altering event or life changing event? Yes. --If yes, what type of event? Had a life altering event. --Is there a smell, sound, touch, taste, sight or other sensation that causes a flashback or trigger? No.--Is the resident being seen by any of the following: psychologist and psychiatrist--Does he attend support groups? No. --Care Plan Update:Trauma Informed CareGoal: staff will assist in managing the resident's response to the trigger; staff will make efforts to avoid the flashback or trigger; the frequency or severity of my trauma related signs and symptoms will not increase.Interventions: coordinate psychology or psychiatric services on admission and as needed; coordinate support groups as requested; encourage to express feeling, concerns and thoughts; know what triggers are and minimize expose if possible; observe for reported symptoms of a trigger; provide with meaningful activities. Review of the PHQ-9 dated 1/11/15 showed minimal depression Little interest or pleasure in doing things-symptoms presence: Yes.Little interest our pleasure in doing thingssymptom frequency. two to six days Feeling down, depressed, or hopeless - symptom present. Yes Feeling down, depressed or hopeless - symptom frequency. 2 to 6 days. Trouble falling or staying asleep, or sleeping too much- symptom present. Yes Trouble falling or staying asleep, or sleeping too much - symptom frequency. 7 to 11 days Review of the care plans showed:Trauma Informed Care-Had a life altering event. Interventions included but not limited to: coordinate psychology or psychiatric services on admission and as needed, encourage to express feeling, concerns and thoughts, observe for reported symptoms of a trigger. Resident #3 uses psychotropic medications related to anxiety. Interventions included but not limited to psychological services per order and prn, psychiatry services per order / prn/ protocol, use of psychotropic medications will be reviewed at least quarterly with the IDT/MD to review continued need for the medication and ensure lowest dose. Resident #3 uses psychotropic medications related to depression. Interventions included but not limited to monitor for psychotropic side effects, administer medications as ordered and observe/document for side effects and effectiveness. Activities of Daily Living (ADL): The Resident has an ADL Self Care Performance Deficit. Interventions included but not limited to: BED MOBILITY: Assist of x 2 to turn and/or reposition. During an interview on 11/19/25 at 11:00 a.m. Resident #3 was lying in bed with a brief in place and blankets. Resident #3 was able to put his bed up and down. Resident #3 had difficulty speaking. He nodded his head yes to the following questions: does the staff answers your call light; do you feel safe at the facility; does the staff treat you well; do they keep you dry? When asked if anyone else had verbally or physically abused him, he nodded no. He typed on his phone the following: Staff C, Certified Nursing Assistant (CNA) when told her to get my phone and call light she didn't and told me to get it myself and she closed the door, when I was yelling for the nurse she said see if you get any food, get it yourself and she knew I could not lift my right arm and then I was very scared because I didn't know what she was capable of because when she was trying to turn me she was yelling at me, you're not gonna break my fckn back and she rolled me with no assistance and I have pads underneath my bum because I have a bone spur on my tailbone and she never put that back I felt helpless and humiliated because I'm here for therapy and she knows that. Resident #3 stated the Nursing Home Administrator (NHA) and Director of Nursing (DON) spoke with him. He stated he feels safe here. He stated all the other staff was great. He stated he just started sleeping all night after the incident. He was sleeping before (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105299 If continuation sheet Page 2 of 5 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 105299 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Oaks 1514 E Chelsea St Tampa, FL 33610 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 - Minimal harm or potential for actual harm Residents Affected - Few the incident. He stated he was just getting back to his normal self. During an interview on 11/19/25 at 12:45 p.m. Staff C, CNA via phone conversation stated she was assigned to Resident #3. She stated she fed him breakfast and lunch. She stated he said he did not want any more food that he was full. She stated no incident happened when turning him. She stated she talked about the resident with the NHA, and the Risk Manager and my union representative. She stated she knew Resident #3 was a little upset because he was staying in bed too long and the nurse and therapist talked to him about getting out of bed. Staff D, Licensed Practical Nurse (LPN), the nurse, and the resident were having a conversation about that. Staff C stated the resident used a urinal, so she checked on him and he was fine. Staff C stated she could not recall if she turned him or not. Staff C hung up during the interview phone call. During an interview on 11/19/25 at 1:08 p.m. Staff D, LPN stated she had worked at the facility for about a year. She was made aware of the incident (with Resident #3) after it happened. Staff D stated she was not aware of it on the day of the incident. She stated the resident told a staff member in therapy about the incident the next day. Staff D stated Resident #3 had not told her he was not sleeping at night. She stated she talks to the resident all the time. She stated the resident was a very soft-spoken person. She stated the resident had not shown any signs of increased anxiety or depression that she had seen. Staff D stated she did not hear any hollering on the day of the incident. She stated the only time she remembers the resident's door being closed was around 2 p.m. Which would have been the time the aides were doing their final rounds before shift change to provide care. She stated she has not seen any changes in the resident since the incident. Staff D stated the resident was buying more food but had no mood changes. She stated she was not involved (in the incident) and administration spoke with her only briefly. During an interview on 11/19/25 at 1:18 p.m. Staff E, CNA stated he provides care for the resident. He changes the resident, assists the resident with eating, cleans the resident up. He used to shower the resident but now he gets his showers in the afternoons. It takes 2 persons to turn the resident and two person for Hoyer into wheelchair. He stated the resident gets up in a wheelchair 3 x week. Staff E stated the resident has not had any mood changes that he was aware of. The resident had not expressed any concerns or complaints to him. During an interview on 11/19/25 at 1:32 p.m. with Staff F, Social Service (SS) which was over the 300 and 400 hallways. She stated she makes rounds and sees the resident daily or every other day. She stated she did a Trauma Informed Care evaluation on the resident on 11/11/25. Staff F stated the resident did not want any further counseling for the incident. Staff F stated the resident had not reported increased anxiety, depression or sleeplessness to her. She stated she asks the resident those exact questions. The resident stated he had no concerns. She stated she tries to encourage him. She stated she does not provide him any counseling. During an interview on 11/19/25 at 2:08 p.m. NHA, DON, and Risk Manager (RM) stated they were notified on 11/06/25 at 13:13 p.m. that Resident #3 had something he possibly wanted to report. Staff G, CNA came into her office, activities office, and reported the conversation to Staff H the Activity Director. Staff H reported it to the NHA. They stated the NHA, RM, and the DON went down to Resident 3's. The resident was not there, he was out and about. The DON stated she first approached him and he gave her permission to discuss the incident. She stated they went to a private area. The DON stated she asked Resident #3 how he was doing? He stated, okay. The DON asked him if he felt bad? Having any pain? The DON asked him if he was afraid? He stated, no. The DON stated she asked the resident did he have anything he wanted to share? The DON told the resident he could stop the interview at any time. The DON state the resident was a functional quad, and not able to verbal totally audible. The DON stated the resident can communicate with his phone. The DON stated the resident expressed to me, that he was mistreated. The DON stated the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105299 If continuation sheet Page 3 of 5 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 105299 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Oaks 1514 E Chelsea St Tampa, FL 33610 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 - Minimal harm or potential for actual harm Residents Affected - Few resident described what happened, both verbally and on the phone. He told me that someone, Staff C, CNA, used vulgar language. The DON stated Resident #3 stated, they literally threatened him, he said if you don't do this then I am going to do XYZ. The resident stated Staff C stated she was not going to give him his call bell or phone. The resident showed where he keeps his phone tucked on his side. The resident told the DON, they did it deliberately, she (Staff C) verbalized, if you don't turn then I am not going to give it back because I am not going to break my fing back. The DON stated Resident #3 asked her if they were they allowed to do that? The DON stated the resident informed them how it made him feel. The DON stated Resident #3 stated, he felt humiliated. The DON stated the resident did not want his family to know. His POA had recently changed from one family member to another. The DON stated the resident finally gave permission to tell his family. The DON stated that Law Enforcement was called and came to the facility and opened an investigation. The DON stated the resident stated Staff C did not touch him in anyway, she just made threats. The DON stated she informed the resident of the investigation process. The DON stated she informed the resident Staff C would not be caring for him anymore. The DON stated they performed a skin assessment on the resident. The RM stated they interviewed residents on the 200 hallway because she was prior assigned to that area. The RM stated only 2 residents on the 200 hall knew Staff C, CNA and said her tone could be poor at times, occasionally. The NHA stated Staff C, CNA came into the facility on [DATE] (Saturday) and wrote a statement. The statement showed Staff D, LPN stated the resident needed to get up and get out of bed and go to therapy. The RM stated she called Staff C, CNA on 11/10/25 with specific questions. The RM stated she asked Staff C, What care did you provide the resident? Staff C stated, ADL and feeding assistance.The RM asked, Was there any conversations? Staff C stated, None other than to help turn.The RM asked, How did you ask him? Staff C, stated, Can you please come toward me.The RM asked, Did you use any explanative? Staff C, denied. The RM asked, Did you remove his cell phone while providing care? Staff C, stated, It was on the tray table, did not move the tray table. The RM asked, Did you replace the call bell? Staff C stated, It was on the left side of his head. The RM asked, Did you at any point did you say, there was nothing you could do about it regarding cell phone and call light. Staff C stated, Why would I do that. That would be a dignity issue. Abuse. The RM aske, Did you shut the door while in room? Staff C stated, Pulled the curtain while providing care. The RM asked, While providing care did he try to alert you anything was wrong? Staff C, stated, Not that I remember. The RM asked, Did he cry out for help? She stated, No. The DON stated SS did a new PhQ-9, psychosocial evaluation on the resident to see how he was doing since the incident. The DON stated the resident was having some tearfulness due to this incident initially. The DON stated the resident was affected by the incident They stated he stated he was humiliated. The DON stated since the incident the resident has not expressed any symptoms. Review of the facility's policy, Abuse Prevention Program, revised August 2022 showed the facility has designated and implemented processes, which strive to reduce the risk of abuse, neglect, exploitation, mistreatment and misappropriation of resident's property. These policies guide the Identification, management and reporting of suspected, or alleged, abuse, neglect, mistreatment and exploitation. It is expected that these policies will assist the facility with reducing their risk of abuse, neglect, exploitation and misappropriation of resident's property through education of staff and residents, as well as early identification of staff burnout, or resident behavior which may increase the likelihood of such events. Verbal abuse: oral, written, or gestured language that includes despairingly and derogatory terms to the residents or their families to describe the resident within their hearing distance, regardless of their age and / or ability to comprehend or disability. Mental emotional abuse: includes, but is not limited to humiliation, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105299 If continuation sheet Page 4 of 5 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 105299 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Oaks 1514 E Chelsea St Tampa, FL 33610 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 - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete harassment, and threats of punishment or deprivation. Whether mental abuse has occurred is determined by a reasonable person standard and does not require a specific response from the resident. Prevention: Facility leadership will identify situations in which abuse, neglect, mistreatment, exploitation, misappropriation may be more likely to occur, such as: residents with needs / behaviors which might lead to conflict or abuse / neglect staff burnoutanalyze the occurrences to determine what changes are needed, if any, to policies and procedures and education to prevent further occurrences. Event ID: Facility ID: 105299 If continuation sheet Page 5 of 5