Health inspection·August 17, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm 2. Review of the clinical record revealed Resident #39 was a [AGE] year-old male admitted to the facility on [DATE]. Diagnoses included impulse disorder, Morbid obesity, Psychosis and Bipolar Disorder. The Annual MDS with a target date of 4/12/23 noted the resident's cognition was intact with a BIMS score of 13. Resident #39 required total physical assistance of one person for bathing. Residents Affected - Some On 8/14/23 at 9:45 a.m., Resident #39 said he would like to have a shower but had not had one in weeks. The resident said he did not know why he was not receiving his scheduled showers. On 8/17/23 at 10:00 a.m., Resident #39 was observed lying in bed in a hospital gown. The room had a strong urine odor. Resident #39 said he was waiting on staff to change his incontinent brief. Review of the shower sheets from 7/22/23 through 8/16/23 showed Resident #39's last documented shower was on 8/5/23. On 8/9/23 and 8/12/23, shower or bed bath were not checked, making it impossible to determine the bathing method for these days. Both forms were incomplete but signed by the nurse and the CNA. On 8/16/23 the shower sheet noted Resident #39 received a bed bath. There was no documentation the resident refused a shower. On 8/17/23 at 10:45 a.m., the DON verified Resident #39 should have at least two scheduled showers weekly without having to request one. 3. Review of the clinical record revealed Resident #28 was a [AGE] year-old female admitted to the facility on [DATE]. Diagnoses included encephalopathy, and anxiety disorder. The Quarterly MDS with a target date of 6/1/23 noted the resident's cognition was severely impaired with a BIMS of 03. Resident #28 was totally dependent on physical assistance of two persons for bathing. Review of the nine shower sheets from 7/21/23 through 8/15/23 revealed Resident #28 received two showers (8/2/23 and 8/7/23). A bed bath was documented for seven shower sheets. On 8/16/23 at 9:00 a.m., the resident's daughter said the facility did not have the staff available to shower her mother two times a week. On 8/17/23 at 10:45 a.m., the DON verified Resident #39 should have at least two scheduled showers each week without having to request one. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 2 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0638 Assure that each resident’s assessment is updated at least once every 3 months. Level of Harm - Minimal harm or potential for actual harm Based on record review and staff interview, the facility failed to ensure completion of the Quarterly Minimum Data Set (MDS) within the required timeframe for 13 (Resident #1, #2, #8, #11, #25, #27, #28, #36, #45, #46, #48, #52 and #54) of 15 residents sampled. This had the potential to delay assessment and revision of the plan of care. Residents Affected - Some The findings included: On 8/17/23, record review for Resident #1 revealed the assessment reference date of the last completed Quarterly MDS was 3/14/23. As of 8/17/23, 133 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 134. On 8/17/23, record review for Resident #2 revealed the assessment reference date of the last completed quarterly MDS was 3/15/23. As of 8/17/23, 152 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 153. On 8/17/23, record review for Resident #8 revealed the assessment reference date of the last completed quarterly MDS was 3/6/23. As of 8/17/23, 160 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 161. On 8/17/23 record review for Resident #11 revealed the assessment reference date of the last completed comprehensive admission MDS was 2/27/23. As of 8/17/23, 164 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 165. On 8/17/23, record review for Resident #25 revealed the assessment reference date of the last completed annual MDS was 3/22/23. As of 8/17/23, 141 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 142. On 8/17/23, record review for Resident #27 revealed the assessment reference date of the last completed quarterly MDS was 2/23/23. As of 8/17/23, 168 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 169. On 8/17/23, record review for Resident #28 revealed the assessment reference date of the last completed quarterly MDS was 3/8/23. As of 8/17/23, 154 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 155. On 8/17/23, record review for Resident #36 revealed the assessment reference date of the last completed comprehensive admission MDS was 3/10/23. As of 8/17/23, 158 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 159. On 8/17/23, record review for Resident #45 revealed the assessment reference date of the last completed quarterly MDS was 2/22/23. As of 8/17/23, 169 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 170. On 8/17/23, record review for Resident #46 revealed the assessment reference date of the last completed quarterly MDS was 3/16/23. As of 8/17/23, 147 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 148. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 3 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0638 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 8/17/23, record review for Resident #48 revealed the assessment reference date of the last completed quarterly MDS was 3/9/23. As of 8/17/23, 154 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 155. On 8/17/23, record review for Resident #52 revealed the assessment reference date of the last completed Quarterly MDS was 3/13/23. As of 8/17/23, 150 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 151. On 8/17/23, record review for Resident #54 revealed the assessment reference date of the last completed quarterly MDS was 3/10/23. As of 8/17/23, 158 days later, the required quarterly MDS was not completed. The quarterly MDS was completed and locked on day 159. During an interview on 8/17/23 at 10:45 a.m., MDS Coordinator, confirmed the required Quarterly MDS assessments for Residents #1, #2, #8, #11, #25, #27, #28, #36, #45, #46, #48, #52 and #54 had not been completed within 92 days of the last assessment as required by regulation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 4 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, resident representative and staff interview, the facility failed to assess, and implement individualized, appropriate interventions to prevent the development and worsening of pressure ulcers for 1 (Resident #28) of 2 sampled residents with in-house acquired pressure ulcers. Residents Affected - Few The findings included: The facility's policy and procedure for Prevention of skin impairments revised in April 2020 noted, The purpose of this procedure is to provide information regarding identification of skin impairments and interventions for specific risk factors . Risk assessment. Assess the resident on admission for existing skin impairments. Repeat the assessment weekly and upon any changes in condition . Nutrition . Conduct nutritional screenings for residents at risk. Conduct a comprehensive nutritional assessment for any resident at risk of pressure injury who is screened to be at risk for malnutrition; and for all adult residents with a pressure injury . The facility's policy and procedure for Pressure Ulcers/Skin Breakdown- Clinical Protocol revised April 2018 noted, Assessment and recognition. The nursing staff and practitioner will assess and document an individual's risk factors for developing pressure ulcers; for example, immobility, recent weight loss, and a history of pressure ulcer(s). In addition, the nurse should describe and document/report the following: full assessment of skin impairment including location, stage, length, width and depth, presence of exudates or necrotic tissue . Review of the clinical record revealed Resident #28 was a [AGE] year-old female admitted to the facility on [DATE]. The Significant Change in Status assessment dated [DATE] noted Resident #28 was receiving hospice care at the facility. On 11/29/22, a hospice revocation of benefit election form noted the resident's power of attorney revoked hospice services and, wants to pursue aggressive physical therapy and occupational therapy. The Quarterly Minimum Data Set (MDS) assessment with a target date of 3/8/23 noted the resident's cognition was severely impaired with a Brief Interview for Mental Status of 05. Resident #28 required extensive physical assistance of two persons for bed mobility (How resident moves to and from lying position, turns side to side, and positions body while in bed). Resident #28 was at risk of developing pressure ulcers but had no unhealed pressure ulcers. The care plan initiated on 9/28/21 with a revision date of 10/17/22 and a target date of 8/17/23 noted Resident #28 was at risk for alteration in skin integrity related to diabetes, impaired mobility, and incontinence. The goal was to decrease/minimize skin breakdown. The interventions included encouraging and assisting the resident to lay down after lunch as tolerated, encouraging to reposition as needed, use assistive devices as needed, use pillows/positioning devices to offload pressure areas. On 4/1/23, a nursing progress note documented the resident's daughter was concerned about the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 5 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0686 resident's knees locked up feels that it is a change and requested X-Rays. Level of Harm - Actual harm On 4/26/23, a skilled nursing progress note documented Resident #28 was noted with purple round shape discoloration to the left inner knee. The skin was intact with no evidence of pain to touch. The resident had a pillow between legs at all times, turned and repositioned side to side every two hours. The Advanced Practice Registered Nurse (APRN) was notified and ordered to place a foam dressing to the left knee pressure point and to continue to keep the pillow between the resident's legs. Residents Affected - Few On 4/27/23 the Director of Nursing assessed the resident's left inner knee and documented a dark brown to light purple area measuring 2.0 centimeters (cm) by 3.0 cm, with red halo surrounding the discoloration. On 4/27/23 Physical Therapy documented in a progress note, Patient will be positioned in bed using a knee abductor pillow wedge placed between feet/ankles for 8 hours in order to reduce pressure and decrease risks of wounds, facilitate skin integrity, improve skin integrity and hygiene, achieve proper joint alignment, reduce redness, decrease pain, decrease discomfort and promote adequate hygiene. The clinical record lacked documentation of a physician' s order for a knee abductor pillow wedge. On 7/12/23 a physician's order was noted to have pillows between Resident #28 knees at all times as tolerated. Review of the physician's orders from 12/8/22 through 8/16/23 noted the following orders related to the resident's left inner knee: 4/26/23: Left medial aspect of knee: apply skin prep and foam dressing as needed. 5/1/23: Left medial aspect of knee preventive care: apply skin prep (protective barrier wipes to help preserve skin integrity) and foam dressing (provides cushioning effect) every evening shift every 3 days for preventive. Review of the Treatment Administration Record for 5/2023, and 6/2023 revealed the treatment to the left medial knee was done on 5/2/23, and 5/5/23. There was no treatment to the left knee documented from 5/6/23 until 6/4/23. The clinical record lacked documentation of physician or nursing assessment of the resident's impaired skin integrity to the left inner knee to assess the effectiveness of the treatment from 4/27/23 through 6/6/23. The clinical record lacked documentation of a comprehensive nutritional assessment to assess the resident's nutritional needs to aid in wound healing. The last nutritional assessment was completed on 12/09/22. On 6/7/23, a weekly wound evaluation noted Resident #23 had a skin tear to the front of the left lower leg. On 6/7/23, the physician issued an order to apply collagen powder (stimulate new tissue growth) to the wound bed (tissue within a wound) of the left medial aspect of the knee and cover with foam (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 6 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0686 dressing. Level of Harm - Actual harm On 6/28/23 a wound care physician progress note documented an initial evaluation of Resident #28's wounds. Residents Affected - Few The wound care physician documented a full thickness unstageable wound measuring 4.0 cm in length by 4.0 cm in width, with 76 to 100% eschar (dry dead skin) and 1 to 25% slough (dead tissue). On 7/12/23 the wound care physician documented he performed a surgical debridement (removal of dead tissue) of the resident's wound. The physician's orders for 7/12/23 included to cleanse the wound to the left lower extremity daily with Dakins ½ strength (broad spectrum antimicrobial cleanser), apply Santyl (debriding agent), medi honey (debriding agent) and cover with foam dressing. Review of the Treatment Administration Record for 8/2023 showed staff daily cleansing of the wound with Dakin's solution ½ strength as ordered. On 8/15/23 at 4:30 p.m., Licensed Practical Nurse (LPN) Staff E was observed changing the dressing to the resident's left inner knee. The wound was approximately the size of dime with 10% yellow slough in the wound bed. She cleansed the wound with Dakins solution ¼ strength, instead of Dakins ½ strength as per the physician's order. Staff E said ½ strength Dakin's solution was not available, so she used what was available (1/4 strength Dakins solution) without the benefit of a physician's order. On 8/16/23 at 10:00 a.m., the Director of Nursing said Resident #28 developed a pressure ulcer on the left inner aspect of her knee from staff turning the resident on her side when she was in the bed. He said on 8/11/23 he identified Resident #28 would pull the pillows out from between her legs. There was no documentation in the clinical record of Resident #28 pulling the pillows between her legs. There was no documentation of interventions to address the resident pulling the pillows between her legs to prevent additional pressure from the resident's knees pressed against each other. On 8/17/23 at 2:00 p.m., the MDS Coordinator said the resident's left inner knee was not documented as a pressure ulcer until the wound care physician assessed the wound on 6/28/23. On 8/17/23 at 2:30 p.m., a meeting was held with the Administrator, the Director of Nursing. The Administrator said in May 2023 staff was handwriting on the TAR when the electronic record was not working but could not find documentation of handwritten TARs for Resident #28. On 8/18/23 at 1:31 p.m., the observation of LPN Staff E not following the physician's order for the Dakin's solution to cleanse Resident #28's wound was shared with the DON. He said he would clarify the wound care orders today. A request was made to provide any additional documentation related to the prevention, development and worsening of pressure ulcers for Resident #28. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 7 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0686 Level of Harm - Actual harm On 8/18/23 at 2:29 p.m., the Medical Director who is also Resident #28's primary care physician said the facility notified him of the resident's pressure ulcer a month ago. The physician said the wound was probably unavoidable, but it should have never worsened to that stage. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 8 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 - Some 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 interview and record review the facility failed to provide care and services to maintain and prevent avoidable decline in range of motion for 1 (Resident #48) of 2 sampled residents with limited range of motion. The findings included: Review of the clinical record revealed Resident #48 was an [AGE] year-old male admitted to the facility on [DATE]. Diagnoses included history of Cerebral Vascular Accident (CVA) with right sided weakness. The Quarterly Minimum Data Set (MDS) assessment with a target date of 3/9/23 noted the resident's cognition was intact with a Brief Interview for Mental Status (BIMS) score of 15. The MDS noted impaired functional limitation in range of motion on one side of the upper and lower extremities. The resident was totally dependent on the physical assistance of two people for transfers, and walking had not occurred during the assessment period. On 8/14/21 at 8:50 a.m., Resident #48 was observed in the bed. The resident's hand was flaccid, and the arm flexed at the elbow. Resident #48 said he was scheduled to get up on Mondays, Wednesdays, and Fridays, but he had not been out of bed for more than a month. Resident #48 said staff told him several times there was not enough staff to get him out of bed. Resident #48 said he did not have a splint for his hand and was not receiving any services to maintain the range of motion to the right hand. The resident said he used to have a ball to exercise the right hand but did not know what happened to it. He stated he had a leg brace, but he left it in California. He said the therapy department had not given him an exercise program for his right leg and arm. On 8/16/23 at 9:00 a.m., Certified Nursing Assistant Staff C said at one time, Resident #48 had an exercise ball at one time, but therapy may have the ball. On 8/16/23 at 10:43 a.m., the Director of Physical Therapy said Resident #48 was a long-term patient with a history of stroke and had not received any therapy for over 90 days. He said an Occupational Therapy screen was scheduled today for Resident #48. She said when therapy stops, Resident #48 refuses to get out of bed. The Physical Therapy Director said in February 2022, Resident #48 was ambulating with a walker, and a brace to his right leg. Resident #48 went home and came back without the brace and had not been able to walk since then. The Physical Therapy Director said the facility did not provide restorative services. She verified Resident #48 did not have a splint for his right hand and did not know if he had an exercise ball. On 8/17/23 at 2:30 p.m., the Director of Nursing said the facility was working on starting restorative services at the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 9 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, resident, family and staff interviews, the facility failed to ensure the availability of sufficient nursing staffing to meet the needs of 4 (Residents #48, #39, #28, #119, and #7) of 22 sampled residents. The failure to ensure sufficient nursing staffing to provide timely care and services could prevent residents from attaining, or maintaining their highest practicable physical, mental, and psychosocial well-being. The findings included: The facility's assessment with a date reviewed by the Quality Assurance and Performance Improvement committee on June 21, 2023, noted, Staff Assignments . meets this requirement by considering census, individual and overall unit acuity, routine/consistent staffing assignments per unit for both licensed nurses and CNAs (Certified Nursing Assistants), and resident preferences for staff assignments . The facility assessment noted the monthly average of residents requiring assistance of 1-2 staff with activities of daily living was 60% (dressing), 75% (Bathing), 55% (Transfer), 15% (Eating), 55% (Toileting). 1. Resident #48 was an [AGE] year-old male admitted to the facility on [DATE]. Diagnoses included history of Cerebral Vascular Accident (CVA) with right sided weakness. The Quarterly Minimum Data Set (MDS) assessment with a target date of 3/9/23 noted the resident's cognition was intact with a Brief Interview for Mental Status (BIMS) score of 15. The MDS noted impaired functional limitation in range of motion on one side of the upper and lower extremities. The resident was totally dependent on the physical assistance of two people for transfers, and walking had not occurred during the assessment period. On 8/14/21 at 8:50 a.m., Resident #48 was observed in bed lying on his back. He said he had been waiting since 4:00 a.m. for assistance. He said, They give you excuses. His right hand was flaccid with the arm flexed at the elbow. Resident #48 said he did not have a splint for his hand and was not receiving any services to maintain the range of motion to the right hand. Resident #48 said he was scheduled to get up on Mondays, Wednesdays, and Fridays, and receive a shower but he had not been out of bed for more than a month. Resident #48 said staff told him several times there was not enough staff to get him out of bed or help him with a shower. Review of the Certified Nursing Assistants (CNAs) documentation from 7/24/23 through 8/14/23 showed the last documented shower was 7/28/23. There was no documentation in the clinical record Resident #48 refused showers. On 8/14/23 at 2:00 p.m., Resident #48 remained in bed, in the same position, on his back. On 8/16/23 at 10:43 a.m., the Director of Physical Therapy said the facility did not have a restorative nursing program. On 8/17/23 at 10:30 a.m., the Director of Nursing said Resident #48 was scheduled to have at least (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 10 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0725 Level of Harm - Minimal harm or potential for actual harm two showers weekly. He said the resident should not have to ask for a shower on the days he was scheduled to receive one, and if they request a shower, they should receive one. On 8/17/23 at 2:30 p.m., the Director of Nursing verified the facility did not have a restorative nursing program. Residents Affected - Some 2. On 8/16/23 at 9:00 a.m., Resident #48 was observed in bed, on his back. The resident said he has been waiting since 7:30 a.m., for the Certified Nursing Assistant (CNA) to change his incontinent brief. He said he told the CNA at 7:30 a.m., when she brought him breakfast. Resident #48 said he would be happy if staff answered the call light within 30 minutes. Resident #48 said last night the night shift changed his brief and the sheets were wet. Staff just threw a blanket on the wet sheets instead of changing the bed. They told him the morning shift would have to change his sheets. On 8/16/23 at 9:02 a.m., the call light was activated. Resident #48 said, you might be waiting a while. On 8/16/23 at 9:12 a.m., CNA Staff C answered the call light. She verified Resident #48 asked her to change his incontinent brief at 7:30 a.m., when she brought him breakfast. She said she told Resident #48 she would be back because she was busy changing another resident. She said the nurse was right outside the door and she was not the only one responsible to answer call lights. 3. Review of the clinical record revealed Resident #39 was a [AGE] year-old male admitted to the facility on [DATE]. Diagnoses included impulse disorder, Morbid obesity, Psychosis and Bipolar Disorder. The Annual MDS with a target date of 4/12/23 noted the resident's cognition was intact with a BIMS score of 13. Resident #39 required total physical assistance of one person for bathing. On 8/14/23 at 9:45 a.m., Resident #39 said he would like to have a shower but had not had one in weeks. The resident said he did not know why he was not receiving his scheduled showers. On 8/17/23 at 10:00 a.m., Resident #39 was observed lying in bed in a hospital gown. The room had a strong urine odor. Resident #39 said he was waiting on staff to change his incontinent brief. Review of the shower sheets from 7/22/23 through 8/16/23 showed Resident #39's last documented shower was on 8/5/23. On 8/9/23 and 8/12/23, shower or bed bath were not checked, making it impossible to determine the bathing method for these days. Both forms were incomplete but signed by the nurse and the CNA. On 8/16/23 the shower sheet noted Resident #39 received a bed bath. There was no documentation that the resident refused a shower. On 8/17/23 at 10:45 a.m., the DON verified Resident #39 should have at least two scheduled showers weekly without having to request one. 4. On 8/17/23 at 10:00 a.m., Resident #39 was observed lying in the bed in a hospital gown. While interviewing Resident #39 a strong odor of urine was noted in the resident room. The resident verified he was incontinent and had been waiting on staff to change and assist him to get up so he could go and smoke at 10:00 a.m. The call light was pinned to the left side of the bed at the head of the bed out of the resident's reach. The resident verified he could not reach his call light to call for assistance. With the resident's permission the call light was activated. Five minutes after the call (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 11 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0725 Level of Harm - Minimal harm or potential for actual harm light was activated, CNA Staff C came in the room. She said she was not assigned to the resident and did not help him. She said she would let his assigned CNA know he needed to be changed. 10 minutes after CNA Staff C left the room, Licensed Practical Nurse Staff D came in and verified there was a strong odor of urine in the room. Resident #39 said yes when the nurse asked if this was the first time the CNA had come to his room. Residents Affected - Some 5. Review of the clinical record revealed Resident #28 was a [AGE] year-old female admitted to the facility on [DATE]. Diagnoses included encephalopathy, and anxiety disorder. The Quarterly MDS with a target date of 6/1/23 noted Resident #28 was totally dependent on physical assistance of two persons for bathing. On 8/16/23 at 9:00 a.m., the resident's daughter said the facility did not have the staff available to shower her mother two times a week. Review of the nine shower sheets from 7/21/23 through 8/15/23 revealed Resident #28 received two showers (8/2/23 and 8/7/23). A bed bath was documented for seven shower sheets. On 8/17/23 at 10:45 a.m., the DON verified Resident #28 should have at least two scheduled showers each week without having to request one. 6. On 8/15/23 at 1:08 p.m., during a resident council meeting, Resident#119 said staff do not respond to call lights in a timely manner at night and weekends. He said it can take 20 to 30 minutes for staff to answer his call light. He said he has to wait for staff to assist him to the bathroom because he has a history of falls. 7. Resident #7 who attended the meeting said he has to wait for long periods of time for staff to answer his call light. He said eventually gets up and go to the rest room on his own. He said staff do not respond to his call light at night and especially on weekends. Residents #119 and #7 said they had complained about the call light response time at the last resident council meeting and had received no response from administration. Review of the Resident Council meeting minutes from 3/9/23 through 8/9/23 showed call light response was a concern on 3/9/23, 4/6/23, 6/1/23, and 6/16/23. On 8/3/23 the meeting minutes noted, Call light issue (Better). Review of the grievance log showed on 8/10/23 Resident #39 requested a snack around 9:00 to 9:30 p.m., and it took a long time for staff to answer the call light. The grievance form noted the facility resolved the grievance by giving Resident #39 snacks to keep at the bedside but did not address the timeliness of the call light response. 8/16/23 at 1:00 p.m., the Administrator said they had been auditing call lights, and provided documentation of call light audits for five rooms between 8/15/23 through 8/17/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 12 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observations, record reviews, interviews, and facility policy review, the facility failed to ensure the medication error rate was less than 5%. This was evidenced by three medication errors out of 27 opportunities, resulting in a medication error rate of 11.11%. Residents Affected - Few The findings included: A review of facility policy titled, Administering Oral Medications, revised October 2010, indicated, verify that there is a physician's medication order for the procedure. Check the label on the medication and confirm the medication name and dose with the Medication administration record (MAR). Prepare the correct dose. 1. On 8/16/23 at 8:02 a.m., observation of Registered Nurse (RN) staff A preparing to give medications to Resident #69, including an injection of Depo-Medrol (steroid) 40 milligrams. The label specified the Physician Assistant to administer. The nurse informed the resident the injection was for pain. Resident #69 said she thought the doctor was supposed to come in and inject a steroid in the shoulder joint for pain. RN staff A asked the resident if she wanted the injection in her arm or hip. The surveyor intervened and asked RN staff A to read the directions on the label. On 8/16/23 at 8:12 a.m., RN Staff A acknowledged the directions specified the Physician Assistant (PA) to give the injection. On 8/16/23 at 8:23 a.m., the Director of Nursing (DON) reviewed the physician's order and said the order was written poorly and the nurse should not have given it. The DON stated the nurse should slow down and read the medication directions more carefully. 2. A review of Resident #28 Order Summary Report noted to administer Lasix 20 mg, one tablet once a day at 9:00 a.m., for Congestive Heart failure (CHF) and to instill Glycerin-Hypromellose-PEG 400 Ophthalmic solution 0.2-2-1% one drop in both eyes twice a day. On 8/16/23 at 8:32 a.m., Licensed Practical Nurse (LPN) staff B was observed preparing medications to administer to Resident #28. LPN staff B did not administer the Lasix 20 mg and did not instill the eye drops to the resident's eyes. On 8/16/23 at 10:05 a.m., LPN staff B verified she did not administer the Lasix and the eye drops as ordered. She said she thought she gave the Lasix, and acknowledged she did not give Resident #28 her eye drops. On 8/16/23 at 10:07 a.m., the DON said LPN staff B should slow down and make sure they she gives all the medication. The DON acknowledged that LPN staff B did not give the medication, and did not follow the physician's orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 13 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interview, the facility failed to follow the physician's orders repeatedly and regularly for 4 (Residents #902, #12, #905 and #906) of 4 residents reviewed for blood pressure medications with parameters. Residents Affected - Some The findings included: 1. On 10/10/23 at 8:50 a.m., Licensed Practical Nurse (LPN) Staff B was observed preparing to administer medications to Resident #902, including Midodrine(a medication to increase blood pressure(bp). Staff B placed all of the medications in a medicine cup including the Midodrine. The Medication Administration record (MAR) order dated 9/13/23 read: Midodrine HCL Oral Tablet 5 mg (milligrams), give 1 tablet by mouth two times a day for low blood pressure for systolic (top number) bp below 110. Staff B entered Resident #902's room to administer the medication. When asked about the resident's blood pressure, Staff B said, Oh yeah, I have to check that. Staff B checked the blood pressure which was 140/68. Staff B handed the medication cup to the resident, including the Midodrine. Staff B was asked to check the physician's order before administering the Midodrine. Upon reading the physician's orders, Staff B removed the Midodrine from the medication cup. On 10/10/23 at 1:41 p.m., Staff B verified the physician's orders for the Midodrine specified to only administer if the systolic bp was less than 110. Review of the Medication Administration Record (MAR) from 9/18/23 through 10/9/23 revealed Resident #902 received Midodrine 5 mg twice a day at 9:00 a.m., and 5:00 p.m. The MAR did not list a blood pressure prior to each dose administered. On 10/11/23 at 9:37 a.m., Resident #902's physician said if there was a parameter on a medication it should be followed. The parameter means it should be checked. If a medication was given outside parameter, it could cause hypertension beyond baseline, could become hypertensive. For example, if Midodrine was given with a BP of 180 systolic, it could drive the systolic over 200 which would be of concern. 2. Clinical Record review for Resident #12's revealed a physician's order for Midodrine HCL 5 mg, give 1 tablet by mouth with meals for hypotension (low blood pressure). The order specified to hold the Midodrine for systolic blood pressure of 110 or higher. The medication was scheduled for 6:30 a.m., 12:00 p.m., and 5:00 p.m. Review of the MAR from September 18 through October 10, 2023, revealed on 10 different occasions, the resident was administered the Midodrine when the systolic blood pressure was higher than 110 as follows: 10/10/23 at 6:30 a.m.: BP of 131/70, 10/9/23 at 5:00 p.m.: BP of 138/74, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 14 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0760 10/3/23 at 12:00 p.m.: BP of 112/70 Level of Harm - Minimal harm or potential for actual harm 10/1/23 at 5:00 p.m.: BP of 132/74 9/30/23 at 5:00 p.m.: BP of 116/62 Residents Affected - Some 9/29/23: BP of 118/59 (12:00 p.m.), BP of 142/64 (5:00 p.m.) 9/27/23: BP of 124/78 (124/78) 9/25/23: BP of 165/55 (165/55) 9/23/23: BP of 121/62 (6:30 a.m.) and BP of 124/58 (5:00 p.m.) 9/22/23: BP of 136/78 (6:30 a.m.) and BP of 122/58 (5:00 p.m.) 9/19/23: BP of 128/69 (6:30 a.m.) and BP of 128/69 (5:00 p.m.) 9/16/23 with a recorded BP of 115/62. On 10/11/23 at 11:02 p.m., the DON said he had been doing medication audits. He said he audited Resident #12's chart on 10/6/23 but he just did a spot check for that day. He said did a weekly random audit for just that day. He said he must not have noticed Resident #12's medication had been being given beyond parameters on the other days since he didn't put any correction. 3. Record review of Resident #906's chart revealed she was admitted [DATE] and was prescribed Labetalol HCL tablet 100 mg give 1 tablet by mouth two times a day for hypertension (high blood pressure). The order specified to hold the Labetalol if systolic blood pressure was below 110 or the heart rate (HR) was below 60. This order had a start date of 10/4/23 and a discontinuation date of 10/10/23 at 3:35 p.m. Review of Resident #906's MAR for October 2023 revealed the Labetalol had been given twice a day, every day from 10/4 at 5:00 p.m. through 10/10/23 at 9:00 a.m., with no recorded blood pressure or heart rate check prior to each dose administered. 4. Record review of Resident #905's chart revealed he was admitted [DATE] and prescribed Midodrine HCL oral tablet 10 mg, give 1 tablet by mouth one time a day every Monday, Wednesday, Friday on dialysis days (SBP less than 110). Review of the MAR revealed Resident #905 was administered the Midodrine on 10/9/23 without recorded blood pressure prior to administration. On 10/11/23 at 9:11 a.m., the Administrator said they had done in-servicing on medications after the last survey. She said she will have the DON pull all residents with medication orders with parameters and go through them to clarify. On 10/11/23 at 11:18 a.m., Regional Director of Clinical Services provided policy: 1.0 dispensing system as medication policy. When asked about policy mentioned in previous citation titled Administering Oral Medications she said what she gave me was the policy. Administrator was present at the time and said the company switches policies all the time. Under bullet Item I: policy stated: If necessary, obtain vital signs before medication administration. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 15 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, staff interviews, and facility policy and record review, the facility failed to store food in a manner to prevent possible contamination from dirty ceiling tiles and air vents and to monitor refrigeration logs and three compartment sink sanitizer check logs. The findings included: The Kitchen Operations Sanitization Policy revised July 2023 provided by the facility states the food service area shall be maintained in a clean and sanitary manner. Number 16 of the policy state kitchen and dining room surfaces not in contact with food shall be cleaned on a regular schedule and frequently enough to prevent accumulation of grime . the Food Service Manager will be responsible for scheduling staff for regular cleaning of kitchen and dining areas. The Food Receiving and Storage Policy revised July 2023 states Foods shall be received and stored in a manner that complies with safe food handling practices. Functioning of the refrigeration and food temperatures will be monitored at designated intervals throughout the day be the food and nutrition services manager or designee and documented according to state-specific requirements. On 8/14/23 at 7:25 a.m., the initial tour of the kitchen was conducted. The 3 Compartments utility sink log and reach in refrigerator log were not up to date. The grease filter cleaning log for kitchen hood was last signed off on 5/11/2023. The air conditioning vents and intake vent over steam table were dirty with dust, grease, grime, and condensation build up. Photographic evidence obtained. The hood vents over the cooking surfaces were greasy and grimy. Photographic Evidence Obtained. On 8/14/23 at 8:45 a.m. in an interview with the Certified Dietary Manager, (CDM), she said she has only been employed at the facility for two weeks. The CDM said she was working on a cleaning schedule for the kitchen, but she had yet to complete it. She was unaware if a prior cleaning schedule existed. She verified the dirty air conditioning vents in the kitchen over the steam table, and said she was aware of the dirty vents and had shown them to the maintenance director to address. She said the Maintenance Director came in last Tuesday and said he would take care of it. On 8/16/2023 at 10:00 a.m., in a follow up tour of kitchen with the CDM and the Regional Dietitian, the Regional Dietitian provided a Performance Improvement Plan (PIP) addressing the refrigerator temperature logs initiated 8/9/2023 with a goal to ensure temperature logs for the refrigerator/freezer are logged and guidelines are being met. Also, ensure Daily temperature audits completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 16 of 17 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 105389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Health and Rehabilitation Center 3250 12th St Sarasota, FL 34237 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 0812 Level of Harm - Minimal harm or potential for actual harm On 8/16/2023 at 10:40 a.m., In an interview with the Maintenance Director, he has been employed at the facility for one week. He said there were no maintenance records for cleaning/addressing the air conditioning intakes and vents prior to his coming to the facility. The intake vent is now clean. He said he cleaned it yesterday. He said the air conditioning vents have to be taken down and cleaned, sanded, repainted and put back up. Residents Affected - Many On 8/16/2023 at 11:20 a.m. tray line was observed. The Regional Dietitian was also present. She was shown a photograph of the air conditioning vent over the steam table which had dust and grime build-up and condensation dripping. She said it was being addressed now through a performance improvement plan. On 8/17/2023 at 3:45 p.m., the Administrator said she was aware of the issues in the kitchen. The Administrator reviewed the photographic evidence of the dirty air conditioning vents over the steam table and the dirty hood vents and said they were concerning and disturbing and would be taken care of this week. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105389 If continuation sheet Page 17 of 17