Health inspection·February 2, 2024

F 0584 maintenance issues had 38 items logged. The oldest item was entered in the log 30 days ago. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 2 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Based on record review, review of facility's policies and procedures, resident and staff interviews, the facility failed to protect the residents' rights to be free from neglect. The facility failed to ensure timely evaluation of resident's condition, and immediate physician notification in the presence of an acute change in condition to avoid physical harm for 1 (Resident #98) of 4 residents reviewed for coordination of care. Resident #98 had a diagnosis of Atrial Fibrillation (Type of irregular heartbeat) with long term use of anticoagulant (blood thinner) medication with a potential side effect of bleeding. On 8/28/23 Resident #98 underwent multiple dental extractions, arranged by the facility. The facility had no documentation of coordination with the dentist and medical practitioners related to the use of the blood thinner before and after the dental extractions, and no documentation of timely evaluation and physician notification when Resident #98 experienced significant bleeding from the extraction sites upon return to the facility. On 8/28/23 at approximately 5:30 p.m., Resident #98 was transferred to the hospital with uncontrollable bleeding of the gums status post dental extractions. Resident #98 was critically ill, required a blood transfusion and was admitted to the Intensive Care Unit. The failure of the facility's staff to prevent neglect resulted in the determination of Immediate Jeopardy (IJ) at a scope and severity of isolated (J) starting on 8/28/23. On 2/2/24 at 5:00 p.m., the Administrator was informed of the determination of Immediate Jeopardy and provided the IJ templates. The findings included: Cross reference F684, F835, and F867. The facility's abuse Prevention Program Policy and Procedure with a review date of August 2022 noted neglect is, Failure of the facility, its employees or service providers to provide good and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress . The policy noted the Administrator, DON or designee are responsible for the investigation and reporting of suspected neglect. The Administrator, DON and/or designated individual are responsible for the following: Implementation, ongoing monitoring, investigation, reporting, and tracking and trending. The investigation for Neglect includes initiating an Event Report. The Administrator or designee is notified and will initiate and conclude a complete and thorough investigation within the specified timeframe. The facility will follow Federal regulations and State specific reporting requirements. The resident's physician is notified. Resident #98 was a long term resident of the facility with a reentry date of 9/8/22. Resident #98's diagnoses included Atrial Fibrillation (type of irregular heartbeat). Resident #98's medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 3 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 regimen included Apixaban (Eliquis) (blood thinner) 5 milligrams (mg) twice a day. Level of Harm - Immediate jeopardy to resident health or safety The manufacturer's insert for Eliquis noted under warning and precautions, Bleeding. Eliquis increases the risk of bleeding and can cause serious, potentially fatal, bleeding, and adverse reactions . Get medical help right away if you have any of these signs or symptoms of bleeding when taking Eliquis: . Unexpected bleeding, or bleeding that lasts a long time, such as: Unusual bleeding from the gums . Bleeding that is severe or you cannot control . Residents Affected - Few Review of the care plan revised on 7/18/22 noted Resident #98 was at risk of complications from anticoagulant for Atrial Fibrillation. The interventions included to observe for abnormal bleeding, including bleeding gums when teeth are brushed. If the resident develops minor bleeding (for example a nosebleed or bleeding from the gums that stops within a few minutes) notify the physician. On 7/24/23 at 11:33 a.m., Social Service Director Staff H documented in a progress note she contacted a local dentist's office and arranged a dental appointment for 8/7/23 for Resident #98. The note read, Resident was noted to verbalize the need for appointment due to loose and broken teeth . SW (Social Worker) also provided appointment time and location to charge nurse . Review of the facility's appointment log showed Resident #98 had scheduled appointments with a local dentist on 8/7/23 and 8/28/23. The clinical record lacked documentation the facility followed up with the dentist after the appointment of 8/7/23. There was no documentation that the facility notified the physician of the upcoming 8/28/23 dental appointment for the multiple extractions. Review of the Medication Administration Record revealed the nurse administered the scheduled dose of apixaban on 8/28/23 at 9:00 a.m., to Resident #98 prior to the dentist appointment for the multiple extractions. The clinical record lacked documentation the physician was notified and approved the administration of the blood thinner on the day of the extractions. On 8/28/23 at 3:53 p.m., a nursing progress noted documented, Resident came back from the Dentist Appointment with no hard copies, but order was transferred to [pharmacy name] by the dentist Nurse. The clinical record lacked documentation of a nursing evaluation upon Resident #98's return from the dentist after the multiple extractions. Review of the Medication Administration Record (MAR) showed documentation the nurse administered the scheduled dose of Apixaban 5 mg to the resident on 8/28/23 at 5:00 p.m. On 8/28/23 at 5:37 p.m., a nursing progress note documented, Resident continues to have moderate bleeding of the gum and c/o [complain of] feeling dizzy. PA [Physician Assistant] notified with order to send resident to the ER [Emergency Room] for eval [evaluation]. On 1/30/24 at 11:37 a.m., Resident #98 said he had multiple dental extractions in August 2023. They were supposed to hold the blood thinner for a week but did not. Resident #98 said he ended up in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 4 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 the hospital due to uncontrolled bleeding. Level of Harm - Immediate jeopardy to resident health or safety On 1/30/24 at 4:59 p.m., Social Service Director Staff H said Resident #98 had decay and more than a few teeth to be removed. She verified the lack of documentation, or any paperwork in the clinical record related to coordination with the dentist and the physician related to the use of blood thinner before and after the scheduled dental extractions. Residents Affected - Few On 1/31/24 at 9:19 a.m., in an interview Unit Manager Registered Nurse (RN) Staff D said Social Service Director Staff H was now trying to see why they did not give the order to hold the Eliquis. He said they normally get a clearance from the physician for anyone going to have a procedure. The dentist is supposed to send the paperwork. The physician signs the clearance, and they fax it over to the dentist. On 1/31/24 at 9:47 a.m., in an interview, the Physician Assistant (PA) said he was not aware Resident #98 was having the extractions and did not fill out any forms prior to the extractions. He became aware of the incident when he gave the authorization to send Resident #98 to the hospital when he returned from the dental appointment and was bleeding. On 1/31/24 at 2:07 p.m., in an interview Resident #98 said the morning of the extractions the nurse gave him the blood thinner. He mentioned getting his teeth pulled and thought he should not take the blood thinner. The nurse just told him to take his pills and that is what he did. On 1/31/24 at 4:52 p.m., in an interview the Medical Director said he was not aware Resident #98 was having nine teeth extracted and it was not really discussed. He said he thought there was a good process in place, but some will fall through the cracks. On 2/1/24 at 9:23 a.m., the DON said Resident #98 told Licensed Practical Nurse (LPN) Staff I he was having the dental extractions. She said the facility had no policy addressing outside medical practitioners however she expected the nurse to contact the consulting physician if the resident came back without any documentation from the appointment. The DON verified the lack of documentation Resident #98 was evaluated upon return to the facility after the extractions to promptly address any complication, including bleeding from the extraction sites. On 2/2/24 at 9:06 a.m., in a telephone interview Licensed Practical Nurse (LPN) Staff I said on 8/28/23 she worked the morning shift, did not know Resident #98 was scheduled for dental extractions and administered the Eliquis (Apixaban) at 9:00 a.m., as ordered. She could not recall when Resident #98 returned to the facility. LPN Staff I said, he was doing fine and there was not a lot of blood from the mouth. She said she took the resident's vital signs (Temperature, pulse, respiration, and blood pressure) upon his return to the facility but could not remember what they were or where they documented the vital signs. She verified the lack of documentation she evaluated Resident #98 upon his return. On 2/2/24 at 1:00 p.m., in a telephone interview, Registered Nurse (RN) Staff J said when she came on duty on 8/28/23 at 3:00 p.m., the morning nurse (LPN Staff I) gave her report and left. She did not tell her Resident #98 had the extractions. When she made rounds at 3:00 p.m., Resident #98 was already in the room and was bleeding. She said there was blood everywhere, on the resident's shirt, and his bed. There was blood on the resident's face, he was spitting blood out. RN Staff J said she took the resident's vital signs but could not remember what they were or where she documented them. RN Staff J said she did not immediately call the physician but called the Unit Manager. That's when (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 5 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 the Unit Manager told her Resident #98 had his teeth pulled out that day. Level of Harm - Immediate jeopardy to resident health or safety She said she did not administer the Eliquis on 8/28/23 at 5:00 p.m., despite the documentation on the MAR. Residents Affected - Few The clinical record lacked documentation RN Staff J immediately notified the physician of the significant oral bleeding upon the resident's return to the facility. Review of the Emergency Medical Services (EMS) report showed on 8/28/23 at 5:30 p.m., (approximately two and a half hour after Resident #98 returned to the facility), they received a call and responded to the facility for a hemorrhage. The report noted staff stated the resident had multiple teeth pulled today and has bleeding since. The primary impression was hemorrhage and the chief complaint Hemorrhage from dental work. Pt (patient) takes Eliquis, which was not paused for the dental work. Assessment shows a steady flow of blood from the gums . Review of the hospital record revealed a progress note dated 8/28/23 that read Resident #98 presented to the Emergency Department, for persistent oral bleeding s/p [status post] multiple dental extractions. He has consistent oral bleeding since surgery. Currently feels lightheaded and weak. He received 1 unit of PRBC (packed red blood cells) and LR (Lactated Ringers used to replace water and electrolyte loss in patients with low blood volume or low blood pressure) 1L(liter) prior to his CBC (Complete Blood Count). Oral packing changed every 30 minutes to control the bleeding . Bleeding currently mildly improved to oozing. Estimated loss was around 500 ml (milliliters). Oral cavity hemorrhage s/p multiple dental extractions in the setting of chronic anticoagulation . Hold Eliquis in setting of acute bleed . Patient is critically ill requiring ICU (Intensive Care Unit) admission . After verification of implementation of an acceptable Immediate Jeopardy removal plan, the Immediate Jeopardy was removed as of 2/2/24. The Immediate actions implemented by the facility and verified by the survey team included: 1. Nurse identified in the IJ was immediately suspended pending the outcome of the investigation and the Federal Immediate Report for the allegation of neglect was submitted. Completed 2/2/24. On 2/2/24, the survey team verified through record review and interview with the Administrator. 2. The Risk Management Consultant completed a 30 day look back of residents with external appointments as well as internal podiatry & dental appointments who are also taking anticoagulants and no concerns or adverse incidents were identified. Additionally, the Risk Management Consultant completed a review of residents currently taking anticoagulants who have upcoming external appointments as well as internal podiatry & dental service appointments and their providers were notified of the residents' anticoagulant status. Completed 2/2/24. On 2/2/24 the survey team verified through record review and interview with the Administrator and Director of Nursing. 3. Resident evaluated, remains in the facility with no change in condition or signs of distress. On 2/2/24 the survey team verified through record review. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 6 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 - Few 4. The Risk Management consultant completed education to the Administrator, Director of Nursing and Interdisciplinary Team on the following topics: a. The facility's Abuse, Neglect and Exploitation Prevention Program with a focus on the prevention of neglect. Completed 2/1/24. b. Event Management process to ensure root cause is established for events and interventions implemented are based on the root cause. Completed 2/1/24. On 2/2/24, the survey team verified through review of the completed education, and interview with the Administrator, and the Director of Nursing. They both were able to verbalize understanding of the content of the education provided. 5. The facility Director of Nursing, Staff Development Coordinator and Assistant Director of Nursing conducted education on the facility's Abuse, Neglect and Exploitation Prevention Program. Facility staff education currently at 96% to total and all remaining staff will be removed from the schedule until education occurs. On 2/2/24 the survey team interviewed six Licensed Nurses on the North and South Units. All six Licensed Nurses interviewed were able to verbalize the facility's abuse, neglect, and exploitation prevention program. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 7 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 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 Based on observation, clinical record review, and staff interviews, the facility failed to provide the necessary care and services to maintain personal hygiene for 2 (Resident #31 and #184) of 5 dependent residents reviewed for Activities of Daily Living (ADLs). Residents Affected - Few The findings included: 1. Review of the clinical record revealed Resident #31 had a readmission date of 8/22/23. Diagnoses included fracture of the left femur, dementia, muscle wasting, and history of falling. The Quarterly Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date (ARD) of 12/13/23 documented Resident #31 required assistance of one for transfer to and from bed and was dependent on staff for personal hygiene and bathing. The MDS noted Resident #31's cognitive skills for daily decision making were moderately impaired with a Brief Interview for Mental Status (BIMS) score of 10. On 1/29/24 at 11:00 a.m., Resident #31 was observed in bed. His fingernails extended approximately half an inch from the nail beds with an accumulation of brown substance under the nails. The resident had approximately four days of facial hair growth. Resident #31 was not able to respond appropriately to any questions regarding his personal hygiene and bathing. On 1/30/24 at 1:32 p.m., Resident #31 was observed in bed wearing a neon green, long-sleeved shirt. The resident remained unshaven and the fingernails remained long with a dark brown substance under the nails. On 1/31/24 at 10:29 a.m., and 12:22 p.m., during random observations Resident #31 was observed in bed wearing the same long sleeved, neon green shirt as the previous day. The front of the shirt now had multiple food stains. Resident #31 had approximately five days of facial hair growth. His fingernails remained long with black/brown substance under the nails. On 1/31/24 at 10:24 a.m., in an interview Certified Nursing Assistant (CNA) Staff C said Resident #31 was dependent for bathing and all ADLs and only able to feed himself after set up. He did not refuse or resist care and was not combative. The CNA said, if a resident refused care, she would notify the nurse. The CNA said the process for the showers was to check the assignment book and it provides the name of the resident to be showered on that day and then the CNA signs it when completed. On 1/31/24 at 2:04 p.m., in a joint observation, Licensed Practical Nurse (LPN) Staff G verified Resident #31's fingernails extended approximately half an inch from the nail bed and had an accumulation of black and brown substance under the nails. Staff G also verified Resident #31 wore the same stained neon green shirt from the previous day and was not shaved. Staff G said, ok and left the room. A review of the facility shower schedule revealed Resident #31 was scheduled for showers on Mondays, Wednesdays, and Fridays on the 7:00 a.m., to 3:00 p.m., shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 8 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 Review of the CNA documentation for December 2023, and January 2024 revealed Resident #31 received eight of 27 scheduled showers. Resident #31 received a bed bath on 12/1/23, 12/6/23, 12/8/23, 12/13/23, 12/15/23, 12/18/23, 12/20/23, 12/22/23, 12/27/23, 12/29/23, 1/1/24, 1/3/24, 1/10/24, 1/12/24, 1/15/24, 1/17/24, 1/19/24. Residents Affected - Few There was no documentation Resident #31 refused the scheduled showers. 2. Review of the clinical record revealed Resident #184 had an admission date of 1/3/24. Diagnoses included Parkinson's disease, anxiety, and depression. The admission MDS with an ARD of 1/9/24 documented Resident #184 required extensive to maximum assistance with showers and moderate assistance of one for personal hygiene. The MDS noted the resident's cognitive skills for daily decision making were moderately impaired with a BIMS score of 12. During random observations on 1/29/24 at 10:45 p.m., and 1/30/24 at 9:15 a.m., Resident #184 was observed in his bed, he was unshaven with approximately four days of facial hair growth. The resident's fingernails extended approximately half an inch from the nail bed with an accumulation of brown/black substance under the nails. Resident #184 did not respond appropriately to interview questions. On 1/31/24 at 10:57 a.m., Resident #184 was observed in bed sleeping, dressed in a hospital gown. He appeared unkempt, unshaven, with approximately five days of facial hair growth. On 1/31/24 at 2:06 p.m., in a joint observation, LPN Staff E, confirmed Resident #184 had approximately five days of facial hair growth, and his nails extended approximately half an inch from the nail bed with black and brown substance under the nails. LPN Staff E asked Resident #184 if he'd like to be shaved. He said, That would be nice, I could use a shave. Review of the CNA documentation from admission date of 1/3/24 to 1/30/24 showed documentation Resident #184 received three of the 12 scheduled showers. Resident #184 received a bed bath on 1/4/24, 1/6/24, 1/13/24, 1/16/24 and 1/25/24. Resident #184 received a partial bed bath on 1/9/24, 1/23/24 and 1/30/24. The clinical record had no documentation Resident #184 refused his scheduled showers. On 1/31/24 at 4:39 p.m., in an interview the Director of Nursing (DON), said the expectation for showers and personal hygiene was for the showers to be given as scheduled. If the resident refuses, then a bed bath is given. The CNA should let the nurse know the resident refused the shower. For shaving it is up to the individual, some residents may not want to be shaved every day and some resident's family members may want them shaved daily or not shaved at all, so it is up to the individual and the family. On 1/31/24 at 5:12 p.m., in an interview CNA Staff A, said there are no razors, it is very hard to find any. I told the nurse I needed razors to shave, and she said to wait because she is busy. The razors they have are not good quality and it takes three razors sometimes to shave one resident. I have spoken with the DON about it, but I still can't get a razor when I want to shave someone. CNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 9 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 Staff A said, The men need to be shaved every day if they want it. Level of Harm - Minimal harm or potential for actual harm On 1/31/24 at 4:25 p.m., in an interview, the DON said the facility had no policy on ADL care for residents. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 10 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of policies and procedures, and staff interviews, the facility failed to implement an activity program to meet the needs of 3 (Resident #112, #114, and #136) of 3 sampled residents dependent on staff for physical, mental, and psychosocial well-being. Residents Affected - Some The findings included: The Policy Activities Overview effective October of 2021 reads, Activities Department employees will provide activities that include sensitivity and an understanding of each individual resident's needs and requirements including medical, emotional, spiritual, therapeutic, and recreational needs. The Activity Programs will reflect individual needs and provide/promote the following: Stimulation or solace Physical, cognitive, and/or emotional health Enhancement, to the extent practicable, of each resident is physical and mental status. Resident Self-respect by providing activities that support self-expression, social and personal responsibility, and choice . Programs will be designed to meet the residents at their level of functioning. Support activities-for residents who may be severely impaired or unable to tolerate the stimulation of the group. Maintenance Activities-schedule events that promote the highest level of physical, emotional, cognitive, psychosocial, and spiritual well-being. 1. Review of the clinical record revealed Resident #112 was admitted to the facility on [DATE]. Diagnoses included Alzheimer's Disease, Dementia, and Depression. The admission Minimum Data Set (MDS) assessment with a target date of 1/8/24 showed it was very important to the resident to be able to read, listen to music, be around pets, go outside for fresh air, and attend religious activities. Resident #112's cognitive abilities for daily decision making were severely impaired with a Brief Interview for Mental Status (BIMS) score of 07. Resident #112's activities care plan noted she required staff assistance with involvement in activities related to cognitive deficits, including staff assistance to and from activities. The resident activity goal was to participate in activity of her choice. The interventions included: Encourage to participate with activities of choice. Prefers/would benefit from: In Room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 11 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 0679 Prefers/would benefit from: Passive Active Room Activity. Level of Harm - Minimal harm or potential for actual harm Prefers/would benefit from: Small Group. The resident needs assistance/escort to/and from activity functions. Residents Affected - Some Thank the resident for attendance at activity function. On 1/30/24 at 9:55 a.m., and 1:40 p.m., Resident #112 was observed sitting her wheelchair in the main living area of the memory care unit in front of the television. On 2/2/24 at 9:49 a.m., Resident #112 was observed sitting in front of the television on the memory care unit. On 2/2/24 at 10:30 a.m., Resident #112 remained in her wheelchair in front of the television with 17 other memory care residents. The movie observed playing on the television was Ground Hog's Day. There were no activity staff observed in the memory care unit. On 2/2/24 at 3:30 p.m., Resident #112 was observed in the dining room area of the memory care unit. Thirteen other residents were observed in the living area in front of the television. There were no activity staff noted in the memory care unit. Review of the electronic documentation of activity participation showed Resident #112 attended three group activities since 1/4/24. One group activity was marked N/A (not applicable.) 2. Review of the clinical record revealed Resident #114 was admitted to the facility on [DATE]. Diagnoses included Alzheimer's Disease with early onset, Dementia with psychotic disturbance. Resident #114 had a history of Cerebral Infarction, Dysphagia, Alzheimer's Disease with early onset, Dementia with Psychotic Disturbance, Hemiplegia and Hemiparesis, Bi-Polar Disorder, and Obsessive-Compulsive Disorder. The Annual MDS with a target date of 11/18/23 showed Resident #114's cognitive abilities for decision making were severely impaired with a BIMS score of 05. The Annual MDS with a target of 11/18/23 noted the following activities were very important to Resident #114: Reading, listening to music, being around pets, keeping up with the news, having group activities, attending religious services, and doing her favorite activity. Resident #114's care plan showed she required staff to assist her with involvement in activities related to cognitive deficits. The activity's goal for Resident #114 was to participate in activities of choice and answer simple questions. The interventions for Resident #114 were the same as Resident #112, and included: Encourage to participate with activities of choice. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 12 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 0679 Prefers/would benefit from: In Room. Level of Harm - Minimal harm or potential for actual harm Prefers/would benefit from: Passive Active Room Activity. Prefers/would benefit from: Small Group. Residents Affected - Some The resident needs assistance/escort to/and from activity functions. Thank the resident for attendance at activity function. Review of the activity participation showed Resident #114 attended five group activities in the last 30 days. Three other group activities were marked not applicable. On 1/29/24 at 11:01 a.m., Resident #114 was observed sleeping in her bed. Multiple random residents on the memory care unit were observed in front of the television. No activity staff was noted in the memory care unit at the time of the observation. On 2/2/24 at 9:49 a.m. Resident #114 was observed sitting in front of the television on the memory care unit. The activity listed on the calendar for 2/2/24 at 10:00 a.m., was Grove to the music. On 2/2/24 observation from 10:00 a.m., to 10:30 a.m., showed Resident #114 remained sitting in front of the television with 17 other memory care residents. The movie observed playing on the television was Ground Hog's Day. There were no activity staff observed in the memory care area. The activity listed on calendar for 2/2/24 at 3:30 p.m., listed Vantage Time. On 2/2/24 at 3:30 p.m., Resident #114 was observed in her bedroom on the memory care unit without any activity. Thirteen other residents were observed in the living area in front of the television. There were no activity staff noted in the memory unit at that time. 3. Review of the clinical record for Resident #136 showed an admission date of 8/27/21. Diagnoses included Anoxic (lack of oxygen) Brain Damage, Bi-Polar (Episodes disorder and Post Traumatic Stress Disorder. The Annual MDS with a target date of 9/5/23 showed Resident #136 was able to answer questions regarding activity preferences. The Annual MDS assessment showed reading, music, being around pets, and doing her favorite activity were very important to the resident. The Quarterly MDS with a target date of 12/6/23 showed Resident #136's cognitive abilities for decision making were moderately impaired with a BIMS score of 08. The activity care plan listed the same interventions as Resident #112 and #114 which included: Encourage to participate with activities of choice. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 13 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 0679 Prefers/would benefit from: In Room. Level of Harm - Minimal harm or potential for actual harm Prefers/would benefit from: Passive Active Room Activity. Prefers/would benefit from: Small Group. Residents Affected - Some The resident needs assistance/escort to/and from activity functions. Thank the resident for attendance at activity function. Review of the electronic activity participation over the last 30 days showed Resident #136 attended three group activities. Six activities were marked not applicable. On 1/29/24 at 11:10 a.m., Resident #136 was observed in bed in her room on the memory care unit. On 2/2/24 at 9:49 a.m., Resident #136 was observed wandering from the living area to her bedroom on the memory care unit. Staff were observed redirecting the resident to her bedroom at times. On 2/2/24 at 10:30 a.m., Resident #136 was observed wandering from her bedroom to the living room area of the memory care unit. A movie (Ground Hog's Day) was observed playing on the television. No activity staff was observed in the memory care area. On 2/2/24 at 3:30 p.m., Resident #136 was observed sitting in front of the television in the living room area of the memory care unit. Thirteen other residents were observed in the living area in front of the television. There were no activity staff noted in the memory unit. Ground Hogs Day was playing on the television. Review of the facility assessment dated [DATE] showed the facility has a capacity of 240 residents. The facility assessment showed one Activities person and one activities assistant were adequate to provide individualized activities for residents. On 1/27/24 the census was 197 residents. On 2/2/24 at 11:30 a.m., the Activity Director (AD) said they did not have enough staff to do one-to-one activities with the residents. The AD said the activity department consisted of two activity staff for all the residents. When asked about Residents #112, #114, and #136's lack of group activities the AD said she did not have time to document the activities being completed. She said the activity staff did not transport residents to group activities. On 2/2/24 at 3:39 p.m. Registered Nurse, Staff L was asked about activities on the memory care unit. She stated she worked on Fridays and Saturdays and her shift started at 3:00 p.m. She stated when she arrived on the memory care unit there were no activities being provided. She stated by 3:00 p.m. all activities at the memory care unit were completed on Fridays and Saturdays. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 14 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 0679 Level of Harm - Minimal harm or potential for actual harm Review of the memory care unit activity calendar for February of 2024 showed three to four activities listed daily. One to two of the daily activities listed were for residents to watch television, and included: Game Show, Vintage movie, Let's Make A Deal, Church on TV, I love [NAME], and Superbowl. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 15 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. Review of the clinical record revealed Resident's #110 was admitted to the facility on [DATE]. Diagnoses included Congestive Heart Failure, muscle wasting and atrophy. Residents Affected - Few The physician's order as of 1/9/24 included to monitor the blood sugar four times a day via fingerstick, before meals and at bedtime. The physician's order did not include parameters for physician notification for the blood sugar. The admission Minimum Data Set (MDS) assessment with a target date of 1/11/24 did not list a diagnosis for the blood sugar monitoring. The hospital Discharge summary dated [DATE] did not list a diabetic medication. Resident #110's diet was for a regular mechanical soft diet. On 2/2/23 at 10:38 a.m., in an interview the MDS Coordinator said, I don't see a diagnosis of Diabetes. The resident is not on steroids, which can elevate blood sugar levels. She is not on insulin or on a hypoglycemic agent. On 2/2/24 at 11:05 a.m., in an interview the Physician Assistant (PA) he said he would have to look into it. On 2/2/24 at 11:41 a.m., in an interview, the PA said, we will stop the Accu Checks (finger sticks) for now. He said he would order blood test used to diagnose Diabetes and decide when he gets the results. On 2/2/24 at 1:10 p.m., in an interview Resident #110 said she did not know why they started doing the finger sticks to monitor her blood sugar. She said they just told her they had to do it. She said the doctor came in earlier, stopped the finger sticks and said he would order some lab work. On 2/2/24 at 4:50 p.m., in an interview Resident #110's spouse said he did not know why they were doing the finger sticks. He said his spouse has never had an issue with her blood sugar. After verification of implementation of an acceptable Immediate Jeopardy removal plan, the Immediate Jeopardy was removed as of 2/2/24. The immediate actions implemented by the facility and verified by the survey team included: The nurse involved in the IJ was immediately suspended pending the outcome of the investigation and the Federal Immediate Report for the allegation of neglect was submitted. The survey team verified through record review and interview with the Administrator. Resident evaluated, remains in the facility with no change in condition or signs of distress. On 2/2/24 the survey team verified through observation and interview with Resident #98. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 16 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 The Risk Management Consultant completed a 30 day look back of residents with external appointments as well as internal podiatry and dental appointments who are also taking anticoagulants and no concerns or adverse incidents were identified. On 2/2/24 the survey team verified through review of the completed look back of residents with external appointments, as well as internal podiatry and dental appointments. Residents Affected - Few Additionally, the Risk Management Consultant completed a review of residents currently taking anticoagulants who have upcoming external appointments as well as internal podiatry and dental service appointments and their providers were notified of the residents' anticoagulant status. On 2/2/24 the survey team verified through review of documentation the physicians were notified of the current residents taking anticoagulants who have upcoming external appointments as well as internal podiatry and dental services appointments. The Risk Management consultant completed education to the Director of Nursing, Staff Development Coordinator, and Assistant Director of Nursing on the following topics: a. Anticoagulant therapy including monitoring for side effects. Completed 2/1/24. b. Ensure communication with medical provider prior to procedures if resident is taking anticoagulents. Completed 2/1/24. c. Ensuring follow-up documentation is received and addressed following external appointments and coordination of care to meet the resident's physical, mental, and psychosocial needs. Completed 2/1/24. The survey team verified through record review of the education, and interview with the Director of Nursing, and Assistant Director of Nursing. The facility DON, Staff Development Coordinator, and Assistant Director of Nursing (ADON) educated all licensed nurses on the following topics: a. Anticoagulant therapy, including monitoring for signs and symptoms of side effects. Completed 2/1/24. b. Ensure communication with medical provider prior to procedures if resident is taking anticoagulents. Completed 2/1/24. c. Ensure follow-up documentation is received and addressed following external appointments and coordination of care to meet the resident's physical, mental, and psychosocial needs. Completed 2/1/24. On 2/2/24 the survey team interviewed six Licensed Nurses on the North and South Units. All six Licensed Nurses interviewed were able to verbalize anticoagulent therapy monitoring for signs and symptoms of side effects. All six Licensed Nurses were able to verbalize the process for timely evaluation of residents, appropriate interventions, and notification of physician to meet each resident's needs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 17 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 The Risk Management consultant educated the facility Social Services Director on the coordination of care, following up with internal and external referrals to ensure documentation is reviewed and assessed to meet the resident's physical, mental, and psychosocial needs. Completed 2/2/24. On 2/2/24 the survey team verified through review of the education, interview with the Director of Nursing, Assistant Director of Nursing, Staff Development Coordinator, and the Social Services Director. Residents Affected - Few 2. On 2/1/24 review of Resident #9's medical record revealed a re-admission date of 12/05/23 with diagnoses of secondary Parkinsonism, unspecified dementia, dysphagia, cognitive communication deficit, psoriasis, chronic kidney disease and adult failure to thrive. On 12/14/23 a consent for hospice services was signed by the primary caregiver and hospice staff representative. Review of Resident #9's medical record revealed a Physician's Order, dated 12/18/23, for Terminal Diagnosis: The resident is diagnosed with a terminal condition and is at risk for loss of dignity during dying process related to the terminal diagnosis of Parkinson's disease. Review of Resident #9's plan of care for nutrition, Parkinson's disease, discharge planning, cognition, advance directives, activity of daily living, and wound risk revealed the care plans were updated and revised on 12/15/23. The care plans stated the facility would collaborate care with Hospice. On 12/18/23 an invitation to the Care Plan meeting was extended to the Hospice representative. The attendees sign-in sheet for the care plan meeting noted that Hospice had been invited to the meeting, but the Hospice representative did not attend the Care Plan meeting. Review of Resident #9's medical record revealed it did not contain a record of the Hospice plan of care for Resident #9 and/or documentation related to the collaboration of care between Hospice services and the facility in the development of Resident #9's plan of care. 3. On 2/1/24 review of Resident #99's medical record revealed a re-admission date of 12/07/23 with a primary diagnosis of cerebral infarction to thrombosis of right cerebral artery, hemiplegia affecting left side, contracture of right and left knees, dysphagia, and adult failure to thrive. Review of Resident #99's Physician's Order, revealed an order dated 12/11/23 for Terminal Diagnosis: The resident is diagnosed with a terminal condition and is at risk for loss of dignity during dying process related to the Terminal diagnosis of: CVA (cardiovascular accident). Review of Resident #99's plan of care for nutrition, dental, discharge planning, cognition, advance directives, activity of daily living, and pain care plans were updated and revised on 12/15/23. The care plans stated the facility would collaborate care with Hospice. On 12/26/23, an invitation to the Care Plan meeting was extended to the Hospice representative. The attendees sign-in sheet for the Care Plan meeting noted it stated that Hospice was invited to the meeting, but the Hospice representative did not attend the care plan meeting. Review of Resident #99's medical record revealed it did not contain a record of the Hospice plan of care for Resident #99 and/or documentation related to the collaboration of care between Hospice (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 18 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 services and the facility in the development of Resident #99's plan of care. Level of Harm - Immediate jeopardy to resident health or safety On 2/1/24 at 5:09 p.m., during an interview with the Clinical Reimbursement Director (CRD), she said she was responsible for the development and creation of each resident's plan of care while at the facility. She said Resident #9 had a Physician's Order for Hospice services dated 12/18/23 and Resident #99 had a Physician's Order for Hospice services on 12/11/23. She confirmed both Residents #9 and #99 plan of care stated the facility and Hospice would collaborate in the development of each resident's plan of care. She further stated neither medical record had a copy of each resident's plan of care developed by Hospice services. Residents Affected - Few She said the Hospice representatives were invited to Resident #9 and #99's plan of care meetings but did not attend their Care Plan meetings. She further said the facility did not have documentation the facility and Hospice had collaborated in the development and implementation of Resident #9 and #99's Care Plans to ensure that each resident received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices. Based on record review, review of facility's policies and procedures, residents and staff interviews, the facility failed to implement processes to ensure effective coordination between staff, physicians, and outside medical providers in accordance to professional standards of care to meet the needs of 4 (Residents #98, #9, #99, and #110) of 4 residents reviewed. Resident #98 had a diagnosis of Atrial Fibrillation (Type of irregular heartbeat) with long term use of anticoagulant (blood thinner) medication with a potential side effect of bleeding. The facility arranged an appointment for multiple dental extractions for Resident #98. The facility did not ensure coordination between facility staff, the dentist, or the attending physician related to the use of anticoagulant (Eliquis) before and after the dental extractions. On 8/28/23 Resident #98 underwent nine extractions and returned to the facility around 3:00 p.m. There was no documentation Resident #98 was evaluated upon return to the facility. On 8/28/23 at approximately 5:25 p.m., Resident #98 was transferred to the hospital with uncontrollable bleeding of the gums status post (s/p) dental extractions. Resident #98 was critically ill, required a blood transfusion and was admitted to the Intensive Care Unit. The facility failure to develop and implement resident care policies to ensure ongoing collaboration and communication processes resulted in noncompliance at the Immediate Jeopardy (IJ) at a scope and severity of isolated (J) starting on 8/28/23. On 2/2/24 at 5:00 p.m., the Administrator was notified of the determination of Immediate Jeopardy and provided the IJ templates. There were 38 residents receiving anticoagulant medications. The findings included: Cross reference F600, F835, and F867. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 19 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 - Few 1. The facility's policy and procedure for referral services with an effective date of February 2021 noted, . The Director of Social Services or designee works with the interdisciplinary team to identify needs, evaluate resources, and coordinate community resources to meet the needs of the resident . Referral services may include, but are not limited to Dental Services . Follow up on the referrals to community services as appropriate and document the outcome of referrals in the resident/patient chart . Resident #98 had a reentry date of 9/8/22. Diagnoses included Atrial Fibrillation, anxiety disorder, and depression. Resident #98's medication regimen included Apixaban (Eliquis) (blood thinner) 5 milligrams (mg) twice a day. The manufacturer's insert for Eliquis noted under warning and precautions, Bleeding. Eliquis increases the risk of bleeding and can cause serious, potentially fatal, bleeding, and adverse reactions . Get medical help right away if you have any of these signs or symptoms of bleeding when taking Eliquis: . Unexpected bleeding, or bleeding that lasts a long time, such as: Unusual bleeding from the gums . Bleeding that is severe or you cannot control . counseling information . To tell their physicians and dentists they are taking Eliquis, and/or any other product known to affect bleeding . before any surgery or medical or dental procedure is scheduled . Review of the care plan revised on 7/18/22 noted Resident #98 was at risk of complications from anticoagulant for Atrial Fibrillation. The interventions included to observe for abnormal bleeding, including bleeding gums when teeth are brushed. If the resident develop minor bleeding (for example a nosebleed or bleeding from the gums that stops within a few minutes) notify the physician. The care plan did not include coordination with the physician or dentist to address the use of the blood thinner (anticoagulant) before any surgery, medical or dental procedure is scheduled. On 7/24/23 at 11:33 a.m., Social Service Director Staff H documented in a progress note she contacted a local dentist's office and arranged a dental appointment for 8/7/23 for Resident #98. The note read, Resident was noted to verbalize the need for appointment due to loose and broken teeth . SW (Social Worker) also provided appointment time and location to charge nurse . The clinical record lacked documentation of the outcome of dentist's visit for 8/7/23. The facility's appointment log showed Resident #98 had a second dental appointment scheduled for 8/28/23. The clinical record lacked documentation of the reason for the dental appointment, or coordination with the dentist and the physician to address the use of the blood thinner in the event Resident #98 required a dental procedure such as an extraction. On 8/28/23 at 3:53 p.m., a nursing progress noted documented, Resident came back from the Dentist Appointment with no hard copies, but order was transferred to [pharmacy name] by the dentist Nurse. The clinical record lacked documentation of a nursing evaluation upon Resident #98's return from the dentist. On 8/28/23 at 5:37 p.m., a nursing progress note documented, Resident continues to have moderate bleeding of the gum and c/o [complain of] feeling dizzy. PA [Physician Assistant] notified with order (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 20 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 to send resident to the ER [Emergency Room] for eval [evaluation]. Level of Harm - Immediate jeopardy to resident health or safety Review of the hospital record revealed a progress note dated 8/28/23 that read Resident #98 presented to the Emergency Department, for persistent oral bleeding s/p multiple dental extractions . He has consistent oral bleeding since surgery . Currently feels lightheaded and weak . He received 1 unit of PRBC (packed red blood cells) and LR (Lactated Ringers) 1L(liter) prior to his CBC (Complete Blood Count) . Oral packing changed every 30 minutes to control the bleeding . Bleeding currently mildly improved to oozing. Estimated loss was around 500 ml (milliliters) . Oral cavity hemorrhage s/p multiple dental extractions in the setting of chronic anticoagulation . Hold Eliquis in setting of acute bleed . Patient is critically ill requiring ICU (Intensive Care Unit) admission . Residents Affected - Few On 1/30/24 at 11:37 a.m., Resident #98 said he had multiple dental extractions in August 2023. They were supposed to hold the blood thinner for a week but did not. Resident #98 said he ended up in the hospital due to uncontrolled bleeding. On 1/30/24 at 4:59 p.m., Social Service Director Staff H said Resident #98 had decay and more than a few teeth to be removed. She verified the lack of documentation in the clinical record of coordination with the dentist and medical practitioners (Physician, Physician Assistant, Advanced Practice Registered Nurse) related to the use of blood thinner before and after the scheduled dental extractions. On 1/31/24 at 9:19 a.m., in an interview Unit Manager Registered Nurse (RN) Staff D said they normally get a clearance from the physician for anyone going to have a procedure. The physician signs the clearance, and they fax it over to the dentist. The Unit Manager verified the lack of documentation Resident #98's physician was notified of the multiple dental extractions and cleared the resident for the dental procedure. On 1/31/24 at 9:47 a.m., in an interview, the Physician Assistant (PA) said he was not aware Resident #98 was having the extractions and did not fill out any forms prior to the extractions. He became aware of the incident when he gave the authorization to send Resident #98 to the hospital when he returned from the dental appointment and was bleeding. In collaboration with the dentist, they determine whether to hold the blood thinner. He said if the cardiologist saw him, the cardiologist would have done the clearance, especially for advanced procedures. Review of the progress notes showed on 8/24/23 the Advanced Practice Registered Nurse (APRN) documented in a follow up cardiology note, Patient is somewhat a limited historian, therefore most information regarding past cardiac medical history has been gained from available records at facility . Patient was previously maintained on coumadin (blood thinner) prior to a hospital admission in 2022, when he developed a severe upper GIB (Gastrointestinal bleed). He was transitioned off coumadin (anticoagulant) to Eliquis . There was no documentation the facility informed the APRN of the upcoming appointment for the multiple extractions scheduled for 8/28/23. On 1/31/24 at 1:45 p.m., the Regional Nurse Consultant said they completed an incident report when Resident #98 was transferred to the hospital. She said they were following the physician's orders. The Regional Nurse Consultant said she realized Resident #98 was sent out to the hospital and received the packed cells (blood transfusion) but, really it all turned out well for the resident. He was back in less than 36 hours. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 21 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 - Few On 1/31/24 at 2:07 p.m., Resident #98 said the morning of the extractions the nurse gave him all his pills, including the blood thinner. He mentioned getting the teeth pulled and thought he should not take the blood thinner. The nurse just told him to take his pills and that is what he did. He said he was at the dentist for a while, they drilled and pulled and drilled and pulled. He said they pulled all of his teeth, and he needed stitches after the extractions. On 1/31/24 at 3:01 p.m., in a telephone interview, a representative of the dental office said there was no medical clearance, or a complete medication list in the chart of Resident #98 for the dental extractions done on 8/28/23. On 1/31/24 at 4:52 p.m., in an interview the Medical Director said he was not aware Resident #98 was having nine teeth extracted and it was not really discussed. He said he thought there was a good process in place, but some will fall through the cracks. The Medical Director said it would be good to know of any type of procedures in high risk patients. He said he would not have stopped the Eliquis due to the risk of a cerebrovascular accident if the blood thinner is stopped. On 2/1/14 at 8:55 a.m., during a joint interview with the Director of Nursing (DON), and the Administrator, the DON said Resident #98 specifically told the Social Service Director he was going to have teeth removed. The Administrator said the Social Service Director arranged the dental services. The DON verified the lack of documentation of coordination with the dentist and the attending physician prior to the dental extractions. On 2/1/24 at 9:06 a.m., in an interview Social Service Director Staff H said at the end of July, Resident #98 came to her and said he wanted some teeth extracted. He said he had broken teeth and wanted to be seen by a dentist. She said she made the initial appointment on 8/7/23. She said the facility did not receive any paperwork from the dentist. She verified the lack of documentation the facility followed up on the dental appointment on 8/7/23 or coordination with the dentist for the upcoming 8/28/23 appointment for the multiple dental extractions. On 2/1/24 at 9:23 a.m., the DON said Resident #98 was not really able to take care of himself. She said on 8/28/23 Resident #98 told Licensed Practical Nurse (LPN) Staff I he was having the dental extractions. She said when residents go out for appointments, the physician may not be aware of procedures done such as a wound debridement (Removal of dead tissue) prior to the appointment. She said the facility had no policy addressing outside medical providers however she expected the nurse to contact the consulting physician if the resident came back without any documentation from the appointment. On 2/1/24 at 9:35 a.m., the DON said Resident #98 was sent out within two hours of coming back from the dental appointment. The DON said the facility did not think the incident represented a safety risk and did not put anything in place other than what they currently do for outside medical providers' appointments. On 2/2/24 at 9:06 a.m., in a telephone interview Licensed Practical Nurse (LPN) Staff I said she did not know Resident #98 was scheduled for dental extractions, and on 8/28/23 at 9:00 a.m., she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 22 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 - Few administered the Eliquis as ordered. She could not recall when Resident #98 returned to the facility and verified the lack of documentation she evaluated Resident #98 upon his return. LPN Staff I said, he was doing fine and there was not a lot of blood from the mouth. Review of the Medication Administration Record (MAR) showed on 8/28/23 at 5:00 p.m., Registered Nurse (RN) Staff J documented she administered the scheduled dose of Apixaban (Eliquis) 5 milligrams to Resident #98. On 2/2/24 at 1:00 p.m., in a telephone interview, RN Staff J said when she came on duty on 8/28/23 at 3:00 p.m., the morning nurse (LPN Staff I) gave her report and left. She did not tell her Resident #98 had the extractions. When she made rounds at 3:00 p.m., Resident #98 was already in the room and was bleeding. She said there was blood everywhere, on the resident's shirt, and his bed. There was blood on the resident's face, he was spitting blood out. She said she called Unit Manager RN Staff D and informed him the resident refused to get changed. That's when the Unit Manager told her Resident #98 had his teeth pulled out that day. RN Staff J said the anticoagulant should have been held the week prior to the extractions and it wasn't. She verified she did not document her evaluation. RN Staff J said she took the resident's vital signs (Temperature, pulse, respiration, and blood pressure) but could not remember what they were or where she documented them. She said she did not administer the Eliquis on 8/28/23 at 5:00 p.m., despite the documentation on the MAR. The clinical record lacked documentation the physician was immediately notified of the significant oral bleeding upon the resident's return to the facility. Review of the Emergency Medical Services (EMS) report showed on 8/28/23 at 5:30 p.m., they received a call and responded to the facility for a hemorrhage. The report noted staff stated the resident had multiple teeth pulled today and has bleeding since. The primary impression was hemorrhage and the chief complaint Hemorrhage from dental work. Pt (patient) takes Eliquis, which was not paused for the dental work. Assessment shows a steady flow of blood from the gums . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 23 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record review and staff and resident interview, the facility failed to provide the appropriate monitoring and application of splints for 1(Resident #24) of 1 resident reviewed with a limitation in range of motion (ROM). This had the potential to cause pain and worsening of the contracture. The findings included: Review of the clinical record revealed Resident #24 was [AGE] years old with an admission date of 10/12/18. The residents' diagnoses included hemiparesis and hemiplegia affecting the left side, dementia, schizoaffective disorder, muscle wasting, contracture of left elbow, left wrist, and left hand. Review of the activities of daily living care plan, initiated 4/19/22, specified palm guard to left hand on in am for 8 hours - may remove for skin checks and care - refuses to wear most days. Review of the physician order dated 10/13/20 documented Patient to wear Palm Guard for up to 8 hours per day to reduce risk of skin breakdown and contracture of left hand, every day and evening shift. Check skin integrity pre and post application. On 1/29/24 at 11:14 a.m., resident #24 was observed seated in her wheelchair, her left hand was noted to be in a tight fist, and she said she was not able to straighten her fingers. There was a splint on the dresser, and she said sometimes the staff put it on for her. On 1/30/24 at 9:53 a.m., Resident #24 had been out of bed for 2 hours and no splint was observed in the left hand. The splint was observed on the table next to the television. On 1/31/24 at 5:02 p.m., Resident #24's left hand splint was observed on the table near the television., Photographic evidence obtained. On 2/1/24 at 1:20 p.m., in an interview the Director of Nursing (DON) said the nursing staff were to apply the splints. She said she was not aware Resident #24 did not have the splint on and said, I will see if she has an order for it. On 2/1/24 at 1:22 p.m., in an interview Certified Nursing Assistant (CNA) Staff C said the resident has the contracture and when she is assigned to the resident she will try and put the splint on for her but she refuses a lot of the time. The CNA said if the resident refused to wear the splint then she would tell the nurse so it could be documented. On 2/1/24 at 4:34 p.m., in an interview with Occupational Therapist (OT) Staff K said the resident had recently come off services for the hand splint. At the time of her discharge, she was wearing the splint 4-5 hours. The resident can remove the splint. The OT said the resident does have a history of refusing care, but she never refused for me. She would say I don't want to wear it today and I was able to talk with her and she eventually agrees. On 2/1/24 at 4:50 p.m., in an interview the Rehab Director said we do splint audits every 6 months (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 24 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 0688 Level of Harm - Minimal harm or potential for actual harm to ensure the splints are still appropriate, do they need a different device, is the splint still fitting the resident. The audits are to be done every 6 months but right now we are a year behind. When we discharge a resident from any therapy with a device, we provide an in-service to the CNA and the nurse. We demonstrate how to apply the device and they demonstrate back to us that they can apply the device. We teach them to check the resident's skin before and after applying the splint. Residents Affected - Few Review of the therapy notes received from the Rehab Director revealed on 11/28/23 OT Staff K provided an in-service to 2 registered nurses and, 1 licensed practical nurse and 1 CNA regarding the application of the splint. Review of the OT progress and discharge summary note revealed the start date of care for Resident #24 was 8/8/23 and end of date of her therapy was 1/6/24. The summary documented the diagnosis for the therapy was hemiplegia following a cerebral vascular accident affecting the left side. The goal for the resident specified that the patient will wear functional position splint for 4-6 hours according to wear schedule with 90% accuracy as applied by trained caregivers. On 2/1/24 at 6:00 p.m., in an interview the DON, said the resident was able to remove the splint, I just spoke with her, and she did not want to put it on. The DON said she updated the plan of care to document the resident's refusal of the splint. The DON said, the expectation is the CNA puts it on and if the resident refuses it should be documented. The DON said the application of the splint was documented by the nurse on the medication administration record (MAR). Review of the MAR documented a physician order dated 10/13/20 specified Patient to wear Palm Guard for up to 8 hours per day to reduce risk of skin breakdown and contracture of left hand. The MAR showed from 1/25/24 to 1/31/24 the splint was documented as off. There was no documentation as to why the splint was off when it should have been on. On 2/2/24 at 3:10 p.m., in an interview the DON said the facility had no policy for the application of splints. She said staff are educated on the device by therapy. The DON said we document it on the MAR if it is on or off and said the resident refuses to wear it at times and it is care planned. The DON confirmed there was no documentation the staff attempted to apply the splint and no documentation the resident refused it or removed it. Without documentation there was no way to know how long the splint was on for, or if the resident refused to wear it. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 25 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, review of facility policy and procedure, and staff interview, the facility failed to store respiratory equipment in a sanitary manner for 1(Resident #489) of 2 residents reviewed for respiratory care. This had the potential to cause respiratory infections in compromised residents. Residents Affected - Few The findings included: The facility policy Medication Administration via Nebulizer 1/2020, documented Store the dry nebulizer (administers medication directly into the lungs) in a storage bag labeled with resident name and date. Review of Resident #489's clinical record revealed an admission date of 1/23/24 with diagnoses including chronic obstructive pulmonary disease (COPD), and a history of lung cancer. The physician's order dated 1/25/24 included to administer Pulmicort Inhalation Suspension 0.25 milligram/2 milliliters (Budesonide (Inhalation)) 1 vial inhale orally via nebulizer two times a day for COPD. On 1/30/24 at 9:55 a.m., and 5:50 p.m., Resident #489 was observed to have a nebulizer on the nightstand. The handheld pipe mouthpiece was stored uncovered and touching other items on the cluttered nightstand. During random observations on 1/31/24 at 10:07 a.m., and on 2/2/24 at 9:00 a.m., Resident #489 's nebulizer machine with the pipe mouthpiece was stored uncovered on top of the portable cooling unit in the room. A second nebulizer machine was observed on the bedside nightstand. The handheld pipe mouthpiece was stored uncovered on the nightstand. The resident did not answer questions appropriately. Photographic evidence obtained. On 2/2/24 8:16 at a.m., in an interview Licensed Practical Nurse (LPN) Staff B said the nebulizer is to be stored in a plastic bag when not in use to keep it clean. The mouthpiece is to be washed and dried after use. On 2/2/24 at 9:26 a.m., in an interview Registered Nurse (RN) Supervisor Staff D said the nebulizer machines should be covered when not in use and placed on the nightstand. Staff D observed, and confirmed both nebulizer machines and pipe mouthpiece were not covered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 26 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 record review, resident and staff interview the facility administration failed to use its resources effectively to protect residents' rights to be free from neglect, in that they failed to show effective coordination of care to ensure 1 (Resident #98) of 4 sampled residents received care and services in accordance with professional standards of care. Residents Affected - Few Resident #98 had a diagnosis of Atrial Fibrillation (abnormal heart rhythm) with long term use of anticoagulant (blood thinner) medication. On 8/28/23 Resident #98 underwent multiple dental extractions, arranged by the facility. There was no documentation of coordination with the dentist and the physician related to the use of the blood thinner before and after the dental extractions. On 8/28/23 at approximately 5:25 p.m., Resident #98 was transferred to the hospital with uncontrollable bleeding of the gums status post dental extractions. Resident #98 was critically ill, required a blood transfusion and was admitted to the Intensive Care Unit. The failure of the facility's administration to prevent neglect and ensure timely assessment of the resident and coordination of care with the physicians resulted in the determination of Immediate Jeopardy (IJ) at a scope and severity of isolated (J) starting on 8/28/23. The Administrator was notified of the Immediate Jeopardy on 2/2/24 at 5:00 p.m. and provided the IJ templates. The findings included: Cross reference F600, F684, and F867. Review of the Nursing Home Administrator's job description signed and dated 8/11/23 showed the essential duties and responsibilities included, Enacts, implements, and enforces the facility policies regarding the management and operation of the facility. Analyzes . quality of care, compliance, regulatory and other management reports to determine the appropriate management interventions needed then implements the interventions resulting in improved outcomes . Identifies facility needs or issues and obtains consulting assistance, as needed, in the root-cause analysis, recommendation for improvement, education assistance or monitoring . Review of the Director of Nursing's job description signed and dated 10/9/20 noted, The Director of Nursing is responsible for developing, organizing, evaluating, and administering patient care programs and services of the Center. Has twenty four (24) hour responsibility for overall delivery of nursing services and ensures the implementation of all clinical policies and procedures . Accountable for adherence by staff to policies, procedures, and standards; delivery and proper documentation of patient care . Supervises nursing staff whether directly or indirectly in accordance with company policies and procedures . The facility's abuse Prevention Program Policy and Procedure with a review date of August 2022 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 27 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 - Few noted neglect is, Failure of the facility, its employees or service providers to provide good and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress . The facility's policy and procedure for referral services with an effective date of February 2021 noted, . The Director of Social Services or designee works with the interdisciplinary team to identify needs, evaluate resources, and coordinate community resources to meet the needs of the resident . Referral services may include, but are not limited to Dental Services . Follow up on the referrals to community services as appropriate and document the outcome of referrals in the resident/patient chart . Resident #98 was a long term vulnerable resident of the facility with a reentry date of 9/8/22. Resident #98's diagnoses included Atrial Fibrillation (type of irregular heartbeat). Resident #98's medication regimen included Apixaban (Eliquis) (blood thinner) 5 milligrams (mg) twice a day. The manufacturer's insert for Eliquis noted under warning and precautions, Bleeding. Eliquis increases the risk of bleeding and can cause serious, potentially fatal, bleeding, and adverse reactions . Get medical help right away if you have any of these signs or symptoms of bleeding when taking Eliquis: . Unexpected bleeding, or bleeding that lasts a long time, such as: Unusual bleeding from the gums . Bleeding that is severe or you cannot control . Review of the care plan revised on 7/18/22 noted Resident #98 was at risk of complications from anticoagulant for Atrial Fibrillation. The interventions included to observe for abnormal bleeding, including bleeding gums when teeth are brushed. If the resident develop minor bleeding (for example a nosebleed or bleeding from the gums that stops within a few minutes) notify the physician. The care plan did not include coordination with the physician or outside providers to address the use of the blood thinner (anticoagulant) before any invasive procedure. Review of the facility's appointment log showed Resident #98 had scheduled appointments with a local dentist on 8/7/23 and 8/28/23. On 7/24/23 at 11:33 a.m., Social Service Director Staff H documented in a progress note she contacted a local dentist's office and arranged a dental appointment for 8/7/23 for Resident #98. The note read, Resident was noted to verbalize the need for appointment due to loose and broken teeth . SW (Social Worker) also provided appointment time and location to charge nurse . The clinical record lacked documentation of follow up on the 8/7/23 visit to the dentist, follow up care needed, and the scheduled 8/28/23 appointment for multiple dental extractions. The clinical record lacked documentation of coordination with the dentist, or the attending physician related to the use of the blood thinner before and after the scheduled dental extractions. On 8/28/23 at 3:53 p.m., a nursing progress noted documented, Resident came back from the Dentist Appointment with no hard copies, but order was transferred to [pharmacy name] by the dentist Nurse. The clinical record lacked documentation of a nursing evaluation upon Resident #98's return from the dentist. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 28 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 - Few On 8/28/23 at 5:37 p.m., a nursing progress note documented, Resident continues to have moderate bleeding of the gum and c/o [complain of] feeling dizzy. PA [Physician Assistant] notified with order to send resident to the ER [Emergency Room] for eval [evaluation]. Review of the hospital record revealed a progress note dated 8/28/23 that read Resident #98 presented to the Emergency Department, for persistent oral bleeding s/p multiple dental extractions. He has consistent oral bleeding since surgery. Currently feels lightheaded and weak. He received 1 unit of PRBC (packed red blood cells) and LR (Lactated Ringers used to replace water and electrolyte loss in patients with low blood volume or low blood pressue) 1L(liter) prior to his CBC (Complete Blood Count). Oral packing changed every 30 minutes to control the bleeding . Bleeding currently mildly improved to oozing. Estimated loss was around 500 ml (milliliters). Oral cavity hemorrhage s/p (status post) multiple dental extractions in the setting of chronic anticoagulation . Hold Eliquis in setting of acute bleed . Patient is critically ill requiring ICU (Intensive Care Unit) admission. On 1/30/24 at 11:37 a.m., Resident #98 said he had multiple dental extractions in August 2023. They were supposed to hold the blood thinner for a week but did not. Resident #98 said he ended up in the hospital due to uncontrolled bleeding. On 1/30/24 at 4:59 p.m., Social Service Director Staff H said Resident #98 had decay and more than a few teeth to be removed. She verified the lack of documentation, or any paperwork in the clinical record related to coordination with the dentist and the physician related to the use of blood thinner before and after the scheduled dental extractions. On 1/31/24 at 9:19 a.m., in an interview Unit Manager Registered Nurse (RN) Staff D said Social Service Director Staff H was now trying to see why they did not give the order to hold the Eliquis. He said they normally get a clearance from the physician for anyone going to have a procedure. The dentist is supposed to send the paperwork. The physician signs the clearance, and they fax it over to the dentist. On 1/31/24 at 9:47 a.m., in an interview, the Physician Assistant (PA) said he was not aware Resident #98 was having the extractions and did not fill out any forms prior to the extractions. He became aware of the incident when he gave the authorization to send Resident #98 to the hospital when he returned from the dental appointment and was bleeding. On 1/31/24 at 1:45 p.m., the Regional Nurse Consultant said they completed an incident report when Resident #98 was transferred to the hospital. She said they were following the physician's orders. The Regional Nurse Consultant said she realized Resident #98 was sent out to the hospital and received the packed cells (blood transfusion) but, really it all turned out well for the resident. He was back in less than 36 hours. On 1/31/24 at 3:01 p.m., in a telephone interview, a representative of the dental office said there was no medical clearance, or a complete medication list in the chart of Resident #98 for the dental extractions done on 8/28/23. On 1/31/24 at 4:52 p.m., in an interview the Medical Director said he has been caring for Resident #98 for approximately two years. He was not aware the resident was having nine teeth extracted and it was not really discussed. He said he thought there was a good process in place, but some will fall through the cracks. The Medical Director said it would be good to know of any type of procedures in high risk patients. He said he would not have stopped the Eliquis due to the risk of a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 29 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 cerebrovascular accident if the blood thinner is stopped. Level of Harm - Immediate jeopardy to resident health or safety On 2/1/14 at 8:55 a.m., in an interview the Director of Nursing (DON) said Resident #98 specifically told the Social Service Director he was going to have teeth removed. The Administrator present during the interview said the Social Service Director arranged the dental services. The DON verified the lack of documentation of coordination with the dentist and the attending physician prior to the dental extractions. Residents Affected - Few On 2/1/24 at 9:06 p.m., in an interview Social Service Director Staff H said at the end of July, Resident #98 came to her and said he wanted some teeth extracted. He said he had broken teeth and wanted to be seen by a dentist. She said she made the initial appointment on 8/7/23. She spoke with the resident and asked him how the appointment went. Resident #98 said the appointment went ok. The resident did not tell her he had a follow up appointment, he set up the follow up appointment himself. She said the facility did not receive any paperwork from the dentist. She verified the lack of documentation of the content of the dental appointment on 8/7/23 or coordination with the dentist for the upcoming 8/28/23 appointment for the multiple dental extractions. On 2/1/24 at 9:23 a.m., the DON said the facility investigation from 8/28/23 through 8/30/23 showed Resident #98 knew he was getting the extraction and communicated that to Licensed Practical Nurse (LPN) Staff I. She said Resident #98 was not really able to take care of himself. She said when residents go out for appointments, the physician may not be aware of procedures done such as a wound debridement (Removal of dead tissue) prior to the appointment. She said on 8/28/23 the resident told his nurse he was having the extractions. The DON verified the facility had no documentation related to the resident's dental appointments. She said the facility had no policy addressing third party providers however she expected the nurse to contact the consulting physician if the resident came back without any documentation from the appointment. The facility provided a document with a nursing incident description dated 8/28/23 at 5:26 p.m., which noted Resident #98 had, Uncontrollable bleeding of the gums s/p (status post) tooth extraction. The Physician Assistant was notified and issued an order to send the resident to the emergency room for evaluation. The facility lacked documentation of an investigation of the incident, including statements of all staff involved in the resident's care, a root-cause analysis, or recommendation for improvement. On 1/31/24 at 1:26 p.m., in an interview the Administrator said he started employment at the facility in August 2023, and was the risk manager for the facility. He said they do discuss any return to hospital. He said he did not remember the incident involving Resident #98 as a reportable event, or an adverse incident. On 2/01/24 at 8:55 a.m., a meeting was held with the Administrator, the DON and the Social Service Director. The DON said when someone is sent out each morning they go over the events of the prior day, The interdisciplinary team talks about it in Quality Assurance. The NHA said the Social Service Director arranged the dental services. He said the incident involving Resident #98 was not reported in Quality Assurance because it did not meet criteria for an adverse incident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 30 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 On 2/1/24 at 9:35 a.m., the DON said Resident #98 was sent out within two hours of coming back from the dental appointment. The DON said the facility did not think the incident represented a safety risk and did not put anything in place other than what they currently do for outside providers' appointments. After verification of implementation of an acceptable Immediate Jeopardy removal plan, the Immediate Jeopardy was removed as of 2/2/24. Residents Affected - Few The immediate actions implemented by the facility and verified by the survey team included: Resident evaluated, remains in the facility with no change in condition or signs of distress. On 2/2/24 the survey team verified through observation and interview with Resident #98. The Risk Management Consultant completed a 30 day look back of 38 residents with external appointments as well as internal podiatry and dental appointments who are also taking anticoagulants and no concerns or adverse incidents were identified. On 2/2/24 the survey team verified through review of the completed look back of 38 residents with external appointments, as well as internal podiatry and dental appointments. Additionally, the Risk Management Consultant completed a review of residents currently taking anticoagulants who have upcoming external appointments as well as internal podiatry and dental service appointments and their providers were notified of the residents' anticoagulant status. On 2/2/24 the survey team verified through review of documentation the physicians were notified of the 38 current residents taking anticoagulants who have upcoming external appointments as well as internal podiatry and dental services appointments. The Risk Management consultant completed education to the Administrator. Director of Nursing and Interdisciplinary team on the following topics: a. The facility's Abuse, Neglect and Exploitation Prevention Program with a focus on the prevention of neglect. Completed 2/1/24. b. Timely evaluation of patients. Completed 2/1/24. c. Appropriate Interventions. Completed 2/2/24. d. Notification of physician to meet each resident's needs. Completed 2/2/24. On 2/2/24 the survey team verified through review of the education, interview with the Administrator and the Director of Nursing. On 2/2/24 the survey team interviewed six Licensed Nurses on the North and South Units. All six Licensed Nurses interviewed were able to verbalized the Abuse, Neglect and Exploitation Prevention Program with a focus on prevention of neglect. All six Licensed Nurses were able to verbalize process for timely evaluation of residents, appropriate interventions, and notification of physician to meet each resident's needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 31 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 0867 Level of Harm - Immediate jeopardy to resident health or safety Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on record review, resident and staff interview, the facility failed to maintain an effective Quality Assurance and Performance Improvement (QAPI) program that recognize quality deficiencies in the areas of neglect and effective coordination of care related to the use of anticoagulant (blood thinner). Residents Affected - Few Resident #98's medication regimen included long term use of Eliquis (anticoagulant). On 8/28/23 the facility arranged for multiple dental extractions for Resident #98 without documentation of coordination with the dentist or the attending physician related to the use of anticoagulant before and after the extractions. Resident #98 experienced uncontrollable bleeding from the extractions resulting in a transfer to an acute care hospital. Resident #98 was critically ill, required a blood transfusion and was admitted to the Intensive Care Unit. The facility failure to recognize, systematically analyze quality deficiencies and implement corrective actions resulted in the determination of Immediate Jeopardy (IJ) at a scope and severity of isolated (J) starting on 8/28/23. On 2/2/24 at 5:00 p.m., the Administrator was notified of the determination of Immediate Jeopardy and provided the IJ templates. There were 38 residents receiving anticoagulant medications. The findings included: Cross reference F600, F684 and F835. The facility's Policy and Procedure related to the Quality Assurance Performance Improvement (QAPI) Plan with an effective date of October 2017 noted, The facility will develop a QAPI plan to . identify and prioritize deviations for performance and other problems and issues; systematically investigate and analyze to determine underlying causes of systemic problems and adverse events; develop and implement corrective actions or performance improvement activities; monitor/evaluate the effects of corrective actions/performance activities . The facility's abuse Prevention Program Policy and Procedure with a review date of August 2022 noted the Administrator, DON or designee are responsible for the investigation and reporting of suspected neglect. The Administrator, DON and/or designated individual are responsible for the following: Implementation, ongoing monitoring, investigation, reporting, and tracking and trending. The investigation for Neglect includes initiating an Event Report. The Administrator or designee is notified and will initiate and conclude a complete and thorough investigation within the specified timeframe. The facility will follow Federal regulations and State specific reporting requirements. The resident's physician is notified. The Nursing Home Administrator's job description signed and dated 8/11/23 noted the Administrator is responsible and accountable for the Facility Quality Assurance Performance Improvement for all aspects of the facility including but not limited to establishing and implementing policies and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 32 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 0867 procedures, quality of care and regulatory compliance. Level of Harm - Immediate jeopardy to resident health or safety Review of the clinical record for Resident #98 revealed a reentry date of 9/8/22. Resident #98's medication regimen included long term use of Eliquis (anticoagulant) 5 milligrams twice a day for Atrial Fibrillation (Type of irregular heartbeat). Residents Affected - Few On 8/28/23 at 3:53 p.m., a nursing progress noted documented, Resident came back from the Dentist Appointment with no hard copies, but order was transferred to [pharmacy name] by the dentist Nurse. On 8/28/23 at 5:37 p.m., a nursing progress note documented, Resident continues to have moderate bleeding of the gum and c/o [complain of] feeling dizzy. PA [Physician Assistant] notified with order to send resident to the ER [Emergency Room] for eval [evaluation]. Review of the hospital record revealed a progress note dated 8/28/23 that read Resident #98 presented to the Emergency Department, for persistent oral bleeding s/p (status post) multiple dental extractions . Oral cavity hemorrhage s/p multiple dental extractions in the setting of chronic anticoagulation . Hold Eliquis in setting of acute bleed . Patient is critically ill requiring ICU (Intensive Care Unit) admission. On 1/30/24 at 11:37 a.m., Resident #98 said he had multiple dental extractions in August 2023. They were supposed to hold the blood thinner for a week but did not. Resident #98 said he ended up in the hospital due to uncontrolled bleeding. Review of the Medication Administration (MAR) for August 2023, showed Resident #98 received the Apixaban (Eliquis) 5 mg twice a day, every day in August 2023, including before, and after the dental appointment for the multiple extractions on 8/28/23. The manufacturer's insert for Eliquis noted, Bleeding. Eliquis increases the risk of bleeding and can cause serious, potentially fatal, bleeding, and adverse reactions . The clinical record lacked documentation of coordination with the dentist or the physician for instructions related to the anticoagulant before and after the scheduled multiple dental extractions. On 1/30/24 at 4:59 p.m., Social Service Director Staff H said Resident #98 had decay and more than a few teeth to be removed. She verified the lack of documentation, or any paperwork in the clinical record related to coordination with the dentist and the physician related to the use of blood thinner before and after the scheduled dental extractions. On 1/31/24 at 9:47 a.m., in an interview, the Physician Assistant (PA) said he was not aware Resident #98 was having the extractions and did not fill out any forms prior to the extractions. On 1/31/24 at 1:45 p.m., the Regional Nurse Consultant said they completed an incident report when Resident #98 was transferred to the hospital. She said they were following the physician's orders. The Regional Nurse Consultant said she realized Resident #98 was sent out to the hospital and received the packed cells (blood transfusion) but, really it all turned out well for the resident. He was back in less than 36 hours. On 1/31/24 at 3:01 p.m., in a telephone interview, a representative of the dental office said there was no medical clearance, or a complete medication list in the chart of Resident #98 for the dental (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 33 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 0867 extractions done on 8/28/23. Level of Harm - Immediate jeopardy to resident health or safety On 1/31/24 at 4:52 p.m., in an interview the Medical Director who is Resident #98's attending physician said he was not aware the resident was having nine teeth extracted and it was not really discussed. He said he thought there was a good process in place, but some will fall through the cracks. The Medical Director said it would be good to know of any type of procedures in high risk patients. He said he would not have stopped the Eliquis due to the risk of a cerebrovascular accident if the blood thinner is stopped. Residents Affected - Few On 2/1/24, the Director of Nursing (DON) provided a document which she said was the investigation related to Resident #98's uncontrollable bleeding after the nine dental extractions and transfer to the hospital. The document consisted of a nursing incident description dated 8/28/23 at 5:26 p.m., which noted Resident #98 had, Uncontrollable bleeding of the gums s/p (status post) tooth extraction. No injuries observed at time of incident. Immediate action taken. Description: PA (Physician Assistant) notified, and order received to send resident to the ER (Emergency Room) for eval (evaluation). A handwritten statement from Unit Manager, Registered Nurse (RN) Staff D noted, The nurse came and asked me to do an evaluation on the resident (Resident #98) because he was complaining of lightheaded, and he also had gum bleeding. I notified the PA and he gave an order [sic] send resident to the ER. Resident refused to chew on the gauze that he was provided with by the dentist, stating it was not helping. The facility investigation did not include a thorough review of the clinical record to include a timeline, review of the MAR which showed Eliquis was administered to the resident on 8/28/23 at 5:00 p.m., statements of all staff involved in the resident's care, a root-cause analysis, or recommendation for improvement. The investigation did not consider the lack of coordination between staff, the dentist, and the physician. On 2/1/24 at 9:00 a.m., a joint interview was conducted with the Administrator and the Director of Nursing (DON). The DON said the incident involving Resident #98 was reviewed by the Interdisciplinary team (IDT) the next morning, and an event report filed. The DON said the event was locked on 8/30/23 which meant the event had been reviewed and concluded. Both the Administrator and the DON said the consensus of the IDT team was the investigation did not yield any reason to investigate further or implement any interventions. The Administrator said the incident was not discussed in QAPI since it did not meet criteria for adverse incidents. On 2/2/24 at 9:06 a.m., in a telephone interview Licensed Practical Nurse (LPN) Staff I said she did not know Resident #98 was scheduled for dental extractions on 8/28/23 and administered the Eliquis as ordered. She said if she had known the resident was getting his teeth pulled she would not have given him the blood thinner as it would cause Resident #98 to bleed more. She could not recall when Resident #98 returned to the facility and verified the lack of documentation she evaluated Resident #98 upon his return. LPN Staff I said, he was doing fine and there was not a lot of blood from the mouth. On 2/2/24 at 1:00 p.m., in a telephone interview, RN Staff J said when she came on duty on 8/28/23 at 3:00 p.m., the morning nurse gave her report and left. She did not tell her Resident #98 had the extractions. When she made rounds at 3:00 p.m., Resident #98 was already in the room and was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 34 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 0867 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few bleeding. She said there was blood everywhere, on the resident's shirt, and his bed. There was blood on the resident's face, he was spitting blood out. She said she called Unit Manager Staff D and informed him the resident refused to get changed. That's when the Unit Manager told her Resident #98 had his teeth pulled out that day. RN Staff J said the anticoagulant should have been held the week prior to the extractions and it wasn't. She verified she did not document her evaluation. RN Staff J said she took the resident's vital signs (Temperature, pulse, respiration, and blood pressure) but could not remember what they were or where she documented them. She said she did not administer the Eliquis on 8/28/23 at 5:00 p.m., despite the documentation on the MAR. Review of the Emergency Medical Service (EMS) report showed the facility called EMS on 8/28/23 at 5:30 p.m., two and a half hours after the resident was observed to be bleeding. EMS noted they responded to the facility, Pt (patient) has bleeding from the mouth. Staff states pt had multiple teeth pulled today and has been bleeding since. Pt takes Eliquis, which was not paused for the dental work. Assessment shows a steady flow of blood from the gums . After verification of implementation of an acceptable Immediate Jeopardy removal plan, the Immediate Jeopardy was removed as of 2/2/24. The immediate actions implemented by the facility and verified by the survey team included: Resident evaluated, remains in the facility with no change in condition or signs of distress. On 2/2/24 the survey team verified through observation and interview with Resident #98. The Risk Management Consultant completed a 30 day look back of 38 residents with external appointments as well as internal podiatry and dental appointments who are also taking anticoagulants and no concerns or adverse incidents were identified. On 2/2/24 the survey team verified through review of the completed look back of 38 residents with external appointments, as well as internal podiatry and dental appointments. Additionally, the Risk Management Consultant completed a review of residents currently taking anticoagulants who have upcoming external appointments as well as internal podiatry and dental service appointments and their providers were notified of the residents' anticoagulant status. On 2/2/24 the survey team verified through review of documentation the physicians were notified of the 38 current residents taking anticoagulants who have upcoming external appointments as well as internal podiatry and dental services appointments. The Regional Risk Consultant completed education to the Administrator and Director of Nursing on implementing an effective Quality Assurance and QAPI program as verified on 2/2/24 by the survey team through review of signed completed education and interviews with the Administrator and DON. The Regional Nursing Consultant completed education to the facility Interdisciplinary Team on ensuring follow-up documentation is received and addressed following external appointments and coordination of care. On 2/2/24 the survey team verified through review of signed completed education and verbal acknowledgement by the DON and Administrator who are members of IDT team. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 35 of 36 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 105327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and staff interviews, the facility failed to ensure a functioning call light system on 2 (room [ROOM NUMBER] and #277) of 32 rooms observed. Residents Affected - Some The findings included: On 1/29/24 at 12:19 p.m., Resident #78 said she turned on her call light for assistance, but no one had answered it. The call light did not turn on when activated. Licensed Practical Nurse (LPN) Staff O present during the observation verified the call light was not functioning. LPN Staff O said, it must have a short in it. On 1/31/24 at 10:36 a.m. Resident #78 said staff did not answer her call light since it did not alarm at the nurse's station. On 1/31/24 at 11:00 a.m., the call light of room [ROOM NUMBER] was turned on. It did not ring at the call light box located the nurse's station to alert the staff of the resident's call for assistance. Six of the rooms on the call light box were missing the top cap that identified the room number. On 2/2/24 at 2:00 p.m., the Maintenance Director said the facility utilizes an electronic system to report maintenance issues. He said he was not aware of the non-functioning call light system on the South Unit. On 2/2/24 at 2:08 p.m., the Maintenance Director was observed turning on the call light in room [ROOM NUMBER]. The call light did not light up or alarmed at the nurse's station. On 2/2/24 at 2:15 p.m., Certified Nursing Assistant, Staff M said approximately a month ago, a company came out a month ago to work on the call light system. It has not been working correctly since then. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105327 If continuation sheet Page 36 of 36