Inspection·November 20, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide activities of daily living (ADLs) related to grooming and personal hygiene care for three dependent residents (#4, #6, and #7) out of three sampled residents. Findings included:Review of Resident #4 admission Record revealed an admission to the facility on [DATE] with medical diagnoses of bullous pemphigoid, dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, anxiety, adult failure to thrive, muscle weakness and other reduced mobility.An interview was conducted on 11/20/2025 at 9:50 am via telephone with Resident #4's family member (fm). The fm stated having raised concerns and spoke with staff at the facility about Resident #4's overgrown fingernails and residents' nails not being cut down. A grievance was filed by Resident #4's family member 7/7/2025 with the facility regarding concerns with ADL care and Resident #4's nails. The facility noted in the grievance follow-up that nails and shower were done on 7/8/25.Review of Resident # 4's Quarterly Minimum Data Set (MDS) dated [DATE], section titled, Cognitive Patterns revealed resident was rarely understood. The assessment revealed Resident #4 was severely impaired. Resident #4 was dependent for toileting hygiene, and shower/bathe care.Review of Resident #4's care plan revealed no documentation for Resident #4 needing assistance with nail trimming/care. The care plan revealed Resident #4 was dependent on staff for bathing needs.On 11/20/2025, at 3:15 p.m., an interview was conducted with Staff B, Certified Nursing Assistant (CNA). Staff B stated they did not cut the residents' nails, but they cleaned them. Staff B stated CNAs are not allowed to trim resident's nails. Staff B stated that CNAs document showers and nail care on the specific resident's shower sheet. Staff B stated the residents are showered at least twice a week. Staff B stated if an unplanned event occurred and the resident requires a shower on a non-shower day, then the resident would be showered.2. During an observation and interview on 11/20/2025, at 10:40 a.m., Resident #6 was observed lying in bed on clean bed linen and wearing a clean gown, disheveled in appearance and overgrown fingernails. Resident #6 stated, concern about overgrown fingernails. Resident #6 stated preferring short fingernails. Resident #6 stated previously addressing this with staff but that no one had come to trim them down. Resident #6's fingernails were observed to be long, with dirt underneath the nails.Review of Resident #6's admission Record revealed resident was admitted to the facility on [DATE] with medical diagnoses of osteomyelitis of vertebra, lumbar region, muscle weakness, muscle wasting and atrophy, intraspinal abscess and granuloma, repeated falls.Review of Resident #6's Quarterly MDS dated [DATE], Section GG revealed Resident #6 is dependent for toileting hygiene and requires substantial/max assistance for shower/bathe care.Review of Resident #6's care plan did not reveal documentation of the resident needing assistance for nail care. An interview was conducted on 11/20/2025, at 2:50 p.m., with Staff C, CNA. Staff C stated they trim residents' nails once a week on bath days. Staff C stated they usually bathe residents two to three times a week at residents' request. She stated the nails are trimmed/cleaned during shower days.Review of Resident #6's shower sheets for the month of November 2025 revealed the following:On 11/6/25 Resident #6 did not receive a shower. There is no documentation of nails being trimmed/cleaned. Resident #6 received a bed bath. Under nails being trimmed/cleaned, it was documented the resident refused.On 11/13/25 Resident #6 did not receive a shower. There is no documentation of nails being trimmed/cleaned.3. During an observation and interview on 11/20/2025, at 11:07 a.m., Resident #7 was observed lying in bed, disheveled in appearance and overgrown fingernails. Resident #7 stated concerns about having overgrown fingernails and that preferred to have nails that are a lot shorter. The fingernails were observed to be long and with dirt underneath the nails. Resident #7 stated having Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105305 If continuation sheet Page 2 of 6 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 105305 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fairway Oaks Center 13806 N 46th St Tampa, FL 33613 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete previously addressing this with the facility staff, but no one had come to trim them. Resident #7 stated in the past there was someone who came regularly to conduct nail trimming but Resident #7 had not seen them in a very long time.Review of Resident #7's admission Record revealed the resident was initially admitted to the facility on [DATE] with medical diagnoses of unspecified atrial fibrillation, muscle weakness, muscle wasting and atrophy, and difficulty walking.Review of Resident #7's Quarterly MDS dated [DATE], revealed Resident #7 is dependent for toileting hygiene, and requires substantial/max assistance for shower/bathe care.Review of Resident #7's shower sheets for the month of October and November 2025 revealed the following:On 10/18/25, 10/23/25, 10/27/25, and 10/30/25, Resident #7 received a bed bath. There is no documentation of nails being trimmed/cleaned.On 11/3/25, 11/6/25, 11/11/25, 11/13/25, and 11/17/25 Resident #7 received a bed bath. There is no documentation of nails being trimmed/cleaned.An interview was conducted on 11/20/2025, at 12:25 p.m., with Staff D, CNA who stated the residents do not have a specific timeframe to ensure nails are cut due to how fast the residents' nails grow. Staff D stated not everyone's nails grow at the same rate. Staff D stated she bathed the residents that are assigned to them. Staff D did not address nail care concerns for the residents she bathed.An interview was conducted on 11/20/2025, at 3:40 p.m., with Staff A, Registered Nurse/Unit Manager (RN/UM). She stated the process to trim residents' nails was to consider if the patient was diabetic, which must be done by podiatry, but if they are not diabetic, the staff cuts the residents' nails. Staff A stated the staff members are required to check residents' nails when they are performing care or at least once a week.A review of the facility's policy titled ADL care dated 4/2020 stated their standard was that residents will be provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs). Guideline that residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Procedure is that residents will be provided with care, treatment and services to ensure that their activities of daily living (ADLs) are met. Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with, including but not limited to: Hygiene (bathing/showers, dressing, grooming, nail care, oral care); mobility( transfer, ambulation, wheelchair, splint/brace); elimination (toileting, catheter, ostomy); dining (meals, hydration, snacks); and communication (speech, language, and any functional communication system). Event ID: Facility ID: 105305 If continuation sheet Page 3 of 6 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 105305 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fairway Oaks Center 13806 N 46th St Tampa, FL 33613 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, and interviews the facility failed to maintain complete clinical records for one resident (#5) of five sampled residents which were accurately documented, readily accessible, and systematically organized.Findings included:Review of Resident #5's admission Record showed the resident was admitted on [DATE]. The record included diagnoses not limited to hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, aphasia following cerebral infarction, unspecified systemic lupus erythematosus, not having achieved remission myeloid leukemia, and need for assistance with personal care. The record showed the resident's family member was an emergency contact proxy.Review of Resident #5's 5-day Minimum Data Set (MDS), dated [DATE], showed the resident scored 3 of 15 on a Brief Interview of Mental Status (BIMS) indicating a severe cognitive impairment.Review of the facility incident log showed Resident #5 had falls on 10/15/25 at 11:30 a.m. and 10/22/25 at 4:00 a.m.A record review of Resident #5 revealed the resident was discharged to the community with a family member on 11/3/25.Review of Resident #5's Situation, Background, Appearance, and Review/Notify (SBAR) summary effective 10/15/25 at 12:47 p.m. showed the resident had suffered a fall with no changes observed in mental status and functional status was fall. The nursing observations, evaluation, and recommendation were Patient was observed on the floor. The recommendation from the primary care provider was to Initiate Neuro Checks and monitor for further changes. The note did not reveal any further information on the resident's fall or if the family member had been notified of the incident.Review of Resident #5's progress notes for 10/15/25 included:- Advance Directive follow up note, effective 10/15/25 at 1:29 p.m. revealed pt was observed on the floor. no new injury noted will continue to monitor. No note did not contain any further documentation.- Fall Evaluation, effective 10/15/25 at 1:30 p.m. revealed the resident was re-oriented to the call light and the fall risk evaluation was reviewed, and education was provided with the resident. The outcome of the education provided was unsuccessful.- A late entry SBAR effective 10/15/25 at 5:31 p.m. revealed the resident had a fall and did not show either the primary care provider or family member was notified.- No progress note on 10/15/25 showed the emergency contact or proxy of Resident #5 had been notified of the fall.Review of Resident #5's electronic record did not include documentation of the neuro checks recommended by the physician after the resident's fall on 10/15/25.Review of an Interdisciplinary note (IDT), effective 10/16/25 at 9:45 a.m. showed Resident #5's fall was reviewed with the IDT. The facility-initiated use of a communication board due to expressive aphasia and slurred speech. The note did not contain any other information regarding where the resident fell, was the fall witnessed or unwitnessed, who found the resident, or how the resident was found.Review of Resident #5's change in condition progress note, effective 10/22/25, at 6:51 a.m. showed the change in condition was Falls. The blood pressure, pulse, respiration rate, temperature, and pulse oximetry was taken on 10/22/25, at 4:00 a.m. The nursing observations, evaluation, and recommendations were Patient able to communexpesionicate with body and facial expression. The note showed the physician was called with no answer and a message was left. The note did not show the emergency contact/proxy was notified of the fall.Review of Resident #5's SBAR evaluation showed a fall had occurred on 10/22/25 and the condition, symptom, or sign had not occurred before. The evaluation showed the physician was notified on 10/22/25, at 6:45 a.m. with other recommendations which did not describe other. The nursing note for additional information was blank and did not describe the resident's fall. The evaluation showed the emergency contact/proxy was notified 10/29/25, at 6:43 a.m. (7 days after the incident).Review of Resident #5's IDT note, 10/22/25 at 9:18 a.m. showed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105305 If continuation sheet Page 4 of 6 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 105305 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fairway Oaks Center 13806 N 46th St Tampa, FL 33613 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the resident's fall was reviewed and no injury was noted. The resident was to be assisted with toileting upon rising, before and after meals, and at bedtime. The note did not reveal any specific details on the resident's fall.Review of Resident #5's progress notes showed on 10/22/25 at 2:46 p.m. the nurse called the emergency contact regarding of a clinical situation. The notes showed on 10/22/25 at 1:47 p.m. a Certified Nursing Assistant (CNA) had called the nurse to the resident's room to alarm the nurse of a bruise on right hip and due to facial expression of minor distress x-ray of right hip was ordered.An interview was conducted with the Director of Nursing (DON) on 11/20/25 at 12:35 p.m. The DON stated the facility did not have hard (physical) charts, everything was uploaded unless the document was in Medical Records waiting to be uploaded. The interview was in response to the request for Resident #5's neuro check evaluations from 10/15/25.An interview and observation was conducted on 11/20/25, at 1:05 p.m. with the Nursing Home Administrator (NHA) of the Medical Records office. The NHA reported Medical Records clerk works from 5 p.m. to 9 p.m. The observation showed multiple stacks of resident(s) documentation on file cabinets, boxes, and desks. The stacks ranged from a couple of inches in height, to approximately 18 inches. The NHA acknowledged the multitude stacks of documentation inside the Medical Records office, and the documents need to be uploaded to specific resident(s) accordingly.An interview was conducted with the DON and Assistant DON (ADON) on 11/20/25, at 3:18 p.m. The DON acknowledged Resident #5 had a few falls which were discussed in the Utilization Review meeting. The DON stated staff were to document a change in condition note (regarding fall) and notify the physician and family. The note should include what happened and where the resident was found. The DON reviewed the progress notes from 10/15/25 and confirmed family had not been notified of the fall and the change in condition note described the resident had been found on floor. The DON reported on 10/22/25 the resident had been found unclothed on floor in room. The DON reviewed progress notes and confirmed the note did not reveal any of the information regarding the fall nor that the family had been notified. The DON stated she had the neuro check evaluations (from 10/15 fall) on her desk. A request was made to receive the neuro check evaluations. An interview was conducted with the NHA on 11/20/25 at approximately 5:30 p.m. The NHA stated they were looking for Resident #5's neuro check evaluations in the Medical Record office, and the writer knew the condition of the office. The NHA stated it looked like a paper tornado in the medical records office. The facility was unable to produce the neuro check evaluations as requested prior to the survey exit.Review of the policy titled Change in Resident Condition or Status-Resident Rights, revised 6/2023, revealed: Facility shall notify the resident, his or her attending physician, and representative of changes in the residence medical/ mental condition and/ or status (e.g. changes in level of care, billing/payments, resident rights, etc.). Guideline: To Ensure the facility provides timely notification in accordance with State and Federal Regulations as it pertains to residents' rights. Procedure: . 5. The nurse will record in the resident's medical record information relative to changes in the resident's medical/mental condition or status.Review of the policy titled Documentation, revised 1/2024, revealed: Guideline: Services provided to the resident shall be documented in the residence medical record. The medical record shall facilitate communication between the interdisciplinary team regarding the residence condition and response to care. Procedure: . 2. The following information was to be documented in the resident medical record: a. Objective observations; b. Medications administered; c. Treatments or services performed; d. Changes in the resident's condition; . 4. Documentation in the medical record will be objective (not opinionated or speculative), complete, and accurate. 8. Documentation of procedures and treatments will include care-specific details, including: a. The date and time of procedure/ treatment was provided; b. The name and title of the individual(s) who provided the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105305 If continuation sheet Page 5 of 6 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 105305 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fairway Oaks Center 13806 N 46th St Tampa, FL 33613 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 0842 Level of Harm - Minimal harm or potential for actual harm care; c. The assessment data and/ or any unusual findings obtained during the procedure/ treatment; d. Whether the resident refused the procedure/ treatment; e. Notification of family, physician, or other staff, if indicated; . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105305 If continuation sheet Page 6 of 6