Inspection·October 12, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. Resident #14 was readmitted to the facility on [DATE] and has a BIMS score of 13, indicating the resident is cognitively intact. Resident #14 has diagnoses, in part, to include Dysphagia, Chronic Obstructive Pulmonary Disease (COPD), Cerebral Infarction and Atherosclerosis. On 10/09/23 at 12:18 PM, Resident #14 was interviewed. He stated he has not received a shower since his readmission and had only received two showers since his initial admission of 01/25/23. The resident's bathing and shower schedules were reviewed. The documentation revealed the resident was scheduled to have a shower every Tuesday and Friday. The documentation also revealed the resident had not received a shower since his readmission date of 09/18/23. On 10/11/23 at 11:45 AM, the resident was interviewed again concerning his showers. Resident stated he still had not received a shower. When reviewing the shower schedule, the resident was due to have a shower on 10/10/23 and the record revealed he only had a bed bath on 10/10/23. On 10/11/23 at 11:57 AM, Staff D, Licensed Practical Nurse (LPN), observed the surveyor talking to Resident #14. She was informed about the shower schedule and the resident's lack of showers since readmission on [DATE]. She scheduled a shower for the resident to be given on 10/11/23. On 10/11/23 at approximately 3:05 PM, the Director Of Nursing was informed about the findings and due to surveyor intervention, the resident had received a shower on 10/11/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 2 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure accuracy of Minimum Data Set (MDS) assessments for 2 of 5 sampled residents, related to medication use, Residents #54 and #52. Residents Affected - Few The findings included: 1. Review of the Quarterly Minimum Data Set (MDS) assessment, dated 08/04/23, documented Resident #54 received insulin injections 7 of 7 days during the look-back period of 07/29/23 through 08/04/23. Review of the corresponding Medication Administration Records (MARs) for that same look-back period revealed Resident #54 only received the scheduled Lantus insulin on 08/03/23 and 08/04/23. These MARs lacked any other insulin administration. During an interview on 10/12/23 at 1:17 PM, the MDS Coordinator was asked about the Quarterly MDS dated [DATE] with the documented daily insulin injection. As the MDS Coordinator was looking up Resident #54 on the electronic medical record, she stated the resident was on daily scheduled long-acting insulin. Upon review of the August 2023 MAR, the MDS Coordinator realized the insulin had not been administered on 08/01/23 and 08/02/23. Upon review of the July 2023 MAR, the MDS Coordinator agreed with the error in the Quarterly MDS in question. 2. Resident #52 was admitted to the facility on [DATE] with diagnoses, in part, of unspecified complications of Kidney Transplant, Diabetes Mellitus, End Stage Renal Disease, Obesity, Dementia, brief Psychotic Disorder, Iron Deficiency and Atherosclerotic Heart Disease. Review of the record for Resident #52 revealed the MDS is used for assessment and for facilitating care in the facility. The MDS contained different sections for assessment. The assessments are done quarterly or if a resident has a significant change in status. An assessment was completed on 08/04/23 for Resident #52. Section N was reviewed which contained the assessment for medications review. The assessment looked back from 08/04/23 for 7 days and documented the number of days the resident received medication. On 10/11/23 at approximately 11:00 AM, an MDS review was conducted with the MDS Coordinator. The MDS assessment Section N was reviewed for the MDS assessment on 08/04/23, and was compared with the MAR (Medication Administration Record) by the MDS Coordinator. On the MDS assessment, the medication Insulin was documented as being given 5 days and on the [DATE] insulin had been received; Antipsychotics were listed as given 7 days on the MDS assessment and the MAR only documented 4 days as given; Anticoagulants were listed as 7 days being given and only 5 days were documented on the MAR, Diuretics are listed as 5 days being given on the MDS assessment and 0 were documented on the MAR; and Opioids are documented on the MDS assessment as given 7 days and only 6 days are documented on the MAR. The MDS Coordinator agreed with the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 3 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 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 - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure care and services for a Peripherally Inserted Central Catheter (PICC) line dressing change as ordered for 1 of 2 sampled residents with intravenous access, Resident #5. Residents Affected - Few The findings included: Review of the facility's policy, titled, PICC Line or Midline Catheter Dressing Change, with a revised date of August 2023, included: Frequency - Change the dressing in the first 24 hours. After the first 24 hours, the frequency is every 7 days and PRN (as needed) if dressing is loose, damp, or soiled. Record review for Resident #5 revealed the resident was originally admitted to the facility on [DATE] with the most recent readmission date of 08/17/23. The resident's diagnoses included: Type 2 Diabetes Mellitus, Bacterial Infection, and Acquired Absence of Right Leg Below Knee. Review of the Minimum Data Set (MDS) assessment for Resident #5 dated 08/18/23 revealed in Section C a Brief Interview of Mental Status (BIMS) score of 15, indicating an intact cognitive response. Section G revealed for bed mobility the resident had a self-performance of extensive assistance with support of two plus persons assist, for transfers the resident had a self-performance of limited assistance with support of two plus persons assist, for dressing the resident had a self-performance of limited assistance with support of one person assist. Section O revealed for IV (intravenous) medications while not a resident - yes, while a resident - yes. Review of the Physician's Orders for Resident #5 revealed an order dated 08/18/23 for PICC (Peripherally Inserted Central Catheter) Line right arm: Monitor for s/s (signs/symptoms) of infection, swelling, color change, pain, drainage, etc. If abnormalities are observed, stop use of IV (intravenous) site and notify physician every shift and as needed. Review of the Physician's Orders for Resident #5 revealed an order dated 08/26/23 for PICC Line (right arm): Change dressing every 7 days using sterile technique every day shift every Saturday. Review of the Medication Administration Record (MAR) for Resident #5 from 09/01/23 to 10/08/23 revealed the PICC line dressing changes were due to be completed on 09/02/23, 09/09/23, 09/16/23, 09/23/23, 09/30/23, and 10/07/23. Review of the Progress Notes from 09/01/23 to 10/08/23 for Resident #5 revealed Medication Administration Notes dated 09/02/23, 09/16/23, 09/23/23, 09/30/23 and 10/07/23 authored by a Licensed Practical Nurse (LPN) that documented the Registered Nurse (RN) will change the dressing. Review of the Nursing Progress Note dated 09/18/23 revealed: Dressing to RUA (Right Upper Arm) PICC line changed as ordered. This indicated the PICC line dressing was changed once of the 5 times since 09/01/23. There was no documentation of the resident refusing a PICC line dressing change. Review of the Care Plan for Resident #5 with an initiated date of 10/09/23 with a focus on the resident is resistive to care/refusing care, dressing changes and receiving intravenous antibiotic as per doctor's order related to noncompliance. The goal was for the resident to cooperate with care through the next review date. The interventions included: Allow the resident to make decisions about (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 4 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 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 - Minimal harm or potential for actual harm Residents Affected - Few treatment regime, to provide sense of control. Educate resident / family / caregivers of the possible outcome(s) of not complying with treatment or care. Give a clear explanation of all care activities prior to and as they occur during each contact. Praise the resident when behavior is appropriate. During an observation conducted on 10/09/23 at 10:49 AM of Resident #5 sitting in wheelchair in his room with PICC line dressing to his right upper arm with the dressing loose and soiled with edges of the dressing curling up. The PICC line dressing was dated 09/18/23. Photographic Evidence Obtained. During an interview conducted on 10/09/23 at 10:52 AM with Resident #5 who was asked about the PICC line in his right arm, he stated he hasn't had any antibiotic for about 3 weeks. When asked how often they change the PICC line dressing, he said maybe every 2 weeks, but he does not remember when it was changed last. During an interview conducted on 10/09/23 at 10:53 AM with Staff A, LPN, who stated she has been working here for about 4 months and she does not normally work on this unit. When asked how often a PICC line dressing is to be changed, she stated weekly and as needed. When shown the PICC line dressing for Resident #5, she had a look of disbelief on her face. The LPN acknowledged the PICC line dressing was soiled, loose, and dated 09/18/23. She then stated it needs to be changed. An interview was conducted on 10/10/23 at 9:15 AM with Staff B, LPN, who stated she has been working at the facility for about 6 months. When asked about the PICC line dressing changes, she stated LPNs are not allowed to change the PICC line dressings at this facility. When asked if the LPNs can monitor the PICC lines, she said yes. The LPN can do everything for the PICC line such as flush the line, run fluids and antibiotics, but they cannot do the dressing change. When asked if a resident is due to have the PICC line dressing changed on her shift, what she would do, she stated she would let one of the Registered Nurses (RNs) know the dressing needs to be changed, and the RN would perform the dressing change. When asked about the documentation for the dressing change, she said the LPN would mark the code 'other' on the MAR and then write a note that they let an RN know the dressing needed to be changed. When asked if she identified which RN did the dressing change, she stated 'no, she does not document the specific RN'. When asked if she follows up with the RN, she said they just do the dressing change. An interview was conducted on 10/10/23 at 2:30 PM with the Director of Nursing (DON) who stated she has been with the facility for 1 year and a couple of months. When asked if the LPNs monitor peripherally inserted central catheters (PICCs), she stated yes, and they document this daily on the MAR. When asked what is involved with monitoring PICC dressing, she stated the nurse would check the dressing site for any swelling, color change, drainage, and pain. When asked if the nurse would monitor if the dressing was loose or take note of the date on the dressing, she said the nurse should. When asked if LPNs perform dressing changes for PICCs, she stated the facility has the RNs perform those types of dressing changes, an LPN may only perform those types of dressing changes only if they have had specialized training for central line dressing changes and provide to the facility a training certificate for the same. When asked if they have any LPNs that have provided a training certificate for central catheter dressing changes, she said they may have 1 LPN. When asked if a resident is due for a PICC dressing change and is assigned an LPN that day, what happens. She stated the LPN would get an RN to change the dressing. The LPN would document in the MAR for that resident 'other' and make a note that an RN would change the dressing. When asked if the LPN needs to document which RN is to do the dressing change, she stated no. When asked if the RN who does the dressing change needs to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 5 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 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 - Minimal harm or potential for actual harm document that they have performed the dressing change, the DON stated the RN would do a follow up or general progress note to document the dressing was changed. When asked if the LPN does any follow up to ensure the dressing was changed, she said the LPN will receive a verbal report from the RN that the dressing change was completed. When the DON was asked when the PICC dressing change was last completed for Resident #5, she said it had been documented as completed on 10/07/23. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 6 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to obtain a physician order for oxygen use for 1 of 3 sampled residents reviewed for respiratory issues, Resident #38; and failed to post 'oxygen in use' signage for 2 of 3 sampled residents reviewed for respiratory issues, Residents #38 and #6. Residents Affected - Few The findings included: Review of the facility's policy, titled, Oxygen Administration, with a revised date of October 2010, included: the purpose of this procedure is to provide guidelines for safe oxygen administration. Verify there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. Review of the facility's policy, titled, Oxygen In Use Signage, with a revised date of 03/08/17, revealed it is the policy of the facility that wherever oxygen is in use a sign must be posted at the location. 1. Record review for Resident #38 revealed the resident was originally admitted to the facility on [DATE] with the most recent readmission on [DATE]. The diagnoses included Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure with Hypoxia, Type 2 Diabetes Mellitus, Morbid (Severe) Obesity with Alveolar Hypoventilation, and Hemiplegia and Hemiparesis following Cerebral Infarction Affecting Left Non-Dominant Side. Review of the Minimum Data Set (MDS) assessment for Resident #38 dated 08/04/23 revealed in Section C a Brief Interview of Mental Status (BIMS) score of 15, indicating an intact cognitive response. Section G revealed for bed mobility, toilet use, and personal hygiene the resident had a self-performance of extensive assistance with support of 2 plus persons assist, for transfers the resident had a self-performance of activity occurred only once or twice with support of 2 plus persons assist. Section O under oxygen while a resident - yes. Review of the Physician's orders for Resident #38 revealed no active order for oxygen. Review of the Physician's orders for Resident #38 revealed order dated 01/25/22 for O2 (Oxygen) at 2L/min (2 liters per minute) via NC (nasal canula) continuously, every shift for SOB (Shortness of Breath) and discontinued on 02/14/22. Review of the Physician's orders for Resident #38 revealed an order dated 12/31/21 for O2 at 3 L/min via NC continuously, every shift for SOB and discontinued 01/25/22. Review of the Care Plan for Resident #38 dated 12/31/21 with a revised date of 07/24/22 with a focus on the resident has altered respiratory status/difficulty breathing related to respiratory failure, COPD (Chronic Obstructive Pulmonary Disease) and history of PNA (Pulmonary Nodular Amyloidosis). The goal was to have no complications related to SOB though the review date. The interventions included: 'Change oxygen cannula / tubing as ordered. Encourage and assist resident to wear oxygen per physician's orders. Follow up with pulmonology as ordered. Monitor for signs/symptoms of respiratory distress and report to physician as needed: Increased Respirations; Decreased Pulse oximetry; Increased heart rate (Tachycardia); Restlessness; Diaphoresis; Headaches; Lethargy; Confusion; Hemoptysis; Cough; Pleuritic pain; Accessory muscle usage; Skin color changes to blue/grey.' (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 7 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 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 Level of Harm - Minimal harm or potential for actual harm On 10/09/23 at 10:10 AM, an observation was made of Resident #38 lying in bed wearing oxygen. There was no oxygen sign on the entrance to the resident's room. On 10/09/23 at 2:14 PM, an observation was made of Resident #38 lying in bed wearing oxygen. There was no oxygen sign on the entrance to the resident's room. Residents Affected - Few On 10/10/23 at 9:10 AM, an observation was made of Resident #38 lying in bed wearing oxygen. There was no oxygen sign on the entrance to the resident's room. On 10/10/23 at 1:15 AM, an observation was made of Resident #38 lying in bed wearing oxygen. There was an oxygen sign on the entrance to the resident's room. An interview was conducted 10/09/23 at 2:14 PM with Resident #38 who was asked if she uses oxygen all the time or as needed. She said she uses oxygen all of the time, day, and night. When asked how long she has been using oxygen, she stated she has been using it for years. An interview was conducted on 10/10/23 at 3:10 PM with the Director of Nursing (DON) who stated she has been with the facility for 1 year and a couple of months. When asked if all residents who use oxygen need a physician's order, she stated yes. She stated in an emergency situation, we would administer the oxygen and then notify the physician to obtain an order. When asked if oxygen is being used by a resident, did the facility place oxygen-in-use signs, she stated she would have to look into that. When asked if Resident #38 uses oxygen, she said yes. When asked if Resident #38 had an active order for oxygen, she looked at the electronic medical and acknowledged Resident #38 did not have an order for oxygen. 2. Record review for Resident #6 revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Chronic Obstructive Pulmonary Disease, Acute Respiratory Failure with Hypoxia, Human Immunodeficiency Virus Disease, and Type 2 Diabetes Mellitus. Review of the Minimum Data Set (MDS) assessment for Resident #6 dated 07/05/23 revealed in Section C, a BIMS score of 15 indicating an intact cognitive response. Section O revealed for oxygen: While not a resident - yes; While a Resident - yes. Review of the Physician's orders for Resident #6 revealed an order dated 06/30/23 for Respiratory-Oxygen: Nasal Canula (NC)/Mask Continuous. Encourage and assist resident to use O2 (Oxygen) at 2 Liters via NC continuously for COPD (Chronic Obstructive Pulmonary Disease) every shift. Review of the Physician's Orders for Resident #6 revealed an order dated 06/30/23 to clean O2 Concentrator Filter once weekly on Wednesday during the 11-7 (11:00 PM- 7:00 AM) shift and PRN (as needed) at bedtime every Wednesday and as needed. Review of the Care Plan for Resident #6 dated 06/29/23 with a focus on the resident is at risk for altered respiratory status / difficulty breathing related to CHF (Congestive Heart Failure), COPD, Sleep Apnea, respiratory failure, pulmonary nodule. The goal was for the resident to maintain normal breathing pattern as evidenced by normal respirations, normal skin color, and regular respiratory rate/pattern through the review date. The interventions included: Encourage adequate rest periods in between tasks/activities. Encourage and assist resident to elevate the head of bed to facilitate breathing as tolerated. Monitor for signs/symptoms of respiratory distress and report to physician as needed: Increased Respirations; Decreased Pulse oximetry; Increased heart rate (Tachycardia); (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 8 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Restlessness; Diaphoresis; Headaches; Lethargy; Confusion; Hemoptysis; Cough; Pleuritic pain; Accessory muscle usage; Skin color changes to blue/grey. Administer medication / inhalers / nebulizers as ordered. Administer oxygen as ordered. Monitor O2 saturations as ordered/PRN. Change tubing per facility protocol/MD order and PRN. Notify MD as indicated. Review of the Treatment Administration Record (TAR) for Resident #6 from 09/01/23 to 10/09/23 documented the resident was receiving oxygen every shift. During an observation conducted on 10/09/23 at 10:43 AM of Resident #6 was wearing oxygen via nasal canula. There was no oxygen sign on door. Photographic Evidence Obtained. During an observation conducted on 10/09/23 at 2:00 PM of Resident #6 wearing oxygen via nasal canula. There was no oxygen sign on door During an observation conducted on 10/09/23 at 3:20 PM, Resident #6 was wearing oxygen via nasal canula. There was no oxygen sign on door During an observation conducted on 10/10/23 at 8:50 AM, Resident #6 was wearing oxygen via nasal canula. An Oxygen sign was noted on the door. An interview was conducted on 10/10/23 at 8:50 AM with Resident #6 who was asked how long he has been at the facility, who stated a couple of months. When asked how often he wears oxygen, he stated he wears it all of the time, except when it hurts his nose, he will take it off. When asked how long he has been using oxygen, he stated for a while, and when he was at the other facility before he came here. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 9 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure blood sugar monitoring, failed to follow blood pressure parameters with medication administration, and failed to ensure consistent and appropriate monitoring of medication side effects, all as per physician orders, for 3 of 5 sampled residents, Residents #36, #46, and #54. Residents Affected - Few The findings included: 1. Review of the record revealed Resident #36 was admitted to the facility on [DATE]. Review of the current physician orders documented to administer 25 milligrams of Metoprolol twice daily, withhold parameters if the systolic (upper number) blood pressure reading was less than 100, the diastolic (lower number) blood pressure reading was less than 60, or the heart rate was less than 60. Review of the September 2023 Medication Administration Record (MAR) revealed the following: On 09//19/23 at 5:00 PM, the nurse administered the Metoprolol with a documented blood pressure reading of 109/57. On 09/22/23 at 9:00 AM, the nurse administered the Metoprolol with a documented blood pressure reading of 96/63. On 10/03/23 at 9:00 AM, the nurse held the Metoprolol with a documented blood pressure reading of 100/62. On 10/03/23 at 5:00 PM, the nurse held the Metoprolol with a documented bleed pressure reading of 100/70. During an interview on 10/12/23 at 11:54 AM, the A Wing Unit Manager agreed with the documented parameters and failure to ensure they were followed by the nurses. Continued review of the current orders revealed the nurses were to monitor for antidepressant medication side effects. This order dated 07/26/23 instructed the nurse to document a Y if monitored and no side effects were observed, and to document a N if monitored and side effects were observed. This order then instructed to document the behavior in the progress note. Review of the September 2023 and October 2023 MARs simply documented a checkmark for each shift, each day, thus it was unknown if Resident #36 was having any side effects to the medication. During the continued interview on 10/12/23 at 11:16 AM, the A Wing Unit Manager reviewed the monitoring for medication side effects order, reviewed the nurse's documentation, and stated it was a poorly worded batch order that was not consistently being followed. 2. During an interview on 10/09/23 at 9:33 AM, Resident #46 stated she is a brittle diabetic and has bottomed out a few times. Review of the record revealed Resident #46 was admitted to the facility on [DATE]. Review of the current orders dated 03/08/23 revealed the following related to blood sugar levels: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 10 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 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 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Monitor for signs and symptoms of hypo/hyperglycemia [low or high blood sugars]. If blood glucose (sugar) is less than 60, initiate PRN (as needed) hypoglycemia protocol. Glucose Gel 15 GM (grams)/32 ML (milliliters). Give 15 gram orally as needed for Hypoglycemia. Administer to a responsive resident only with blood glucose less than 70. Squeeze into mouth and encourage resident to swallow. Recheck blood glucose in 15 minutes. If blood sugar remains below 70, may repeat X 1 dose. Notify MD of results. Glucagon Solution Inject 1 mg (milligram) subcutaneously as needed for Hypoglycemia Recheck blood glucose in 15 minutes. If blood sugar remains below 70, may repeat x 1 dose and recheck. Notify MD of results. Review of the October 2023 MAR revealed a documented blood sugar of 50 on 10/03/23 at 6:30 AM. The record lacked any documented provision of glucose or any follow up interventions. Further review of the current orders revealed the nurses were to monitor for antidepressant and pain medication side effects. This order dated 03/08/23 instructed the nurse to document a Y if monitored and no side effects were observed, and to document a N if monitored and side effects were observed. This order then instructed to document the behavior in the progress note. Review of the September 2023 and October 2023 MARs documented mostly N with no corresponding behavior or side effect. 3. Review of the record revealed Resident #54 was admitted to the facility on [DATE]. Review of the current order dated 02/04/23 documented to administer 20 units of the long acting insulin Lantus every morning at 6:00 AM. This order lacked any parameters for holding the insulin. Review of the September 2023 and October 2023 MARs revealed the nurses held the Lantus insulin on 31 of 41 days with no documented parameters, rationale, or notification to the physician. Further review of the current order dated 07/31/23 instructed the nurses to obtain a blood sugar level twice daily, and to notify the physician if less than 60 or greater than 300. Review of the September 2023 and October 2023 MARs documented a checkmark that it was completed, but lacked any documented blood sugar levels. Review of the Blood Sugar Summary report for Resident #54 revealed only 10 of 81 ordered levels at 6:00 AM and 4:00 PM. Review of the progress notes for September 2023 and October 2023 documented 28 of the 81 blood sugar readings. The nurses failed to obtain the blood sugars on 43 of 81 opportunities. Further review of the current orders revealed the nurses were to monitor for psychotropic medication side effects. This order dated 02/02/23 instructed the nurse to document a Y if monitored and no side effects were observed, and to document a N if monitored and side effects were observed. This order then instructed to document the behavior in the progress note. Review of the September 2023 and October 2023 MARs documented mostly N with no corresponding behavior or side effect. During an interview on 10/12/23 at 11:16 AM, the A Wing Unit Manager agreed with the lack of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 11 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 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 0757 Level of Harm - Minimal harm or potential for actual harm consistent blood sugar monitoring as per the physician orders. When asked if she was made aware of the numerous occasions the nurses held the insulin at 6:00 AM, the Unit Manager stated she had not been aware and further stated we generally do not hold long acting insulin. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 12 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and policy review, the facility failed to ensure accuracy of medical records related to the administration of wound care and the provision of a Central Venous Catheter dressing change, for 2 of 2 sampled residents reviewed for wound care, Residents #15 and #52, and for 1 of 2 sampled residents with intravenous access, Resident #5. The findings included: Review of the facility's policy, titled, Central Venous Catheter Dressing Changes with a revised date of April 2016, included under Section Purpose: The purpose of this procedure is to prevent catheter related infections that are associated with contaminated, loosened, soiled, or wet dressings. Included under the Section Documentation: 1. The following information should be recorded in the resident's medical record: a) Date and time dressing was changed. b) Location and objective description of insertion site. c) Any complications, interventions that were done. d) Condition of sutures (if present). e) Any questions, education given to resident, resident's statement regarding IV therapy and response to procedure. f) Signature and title of the person recording the data. 1. Review of the record revealed Resident #15 was admitted to the facility on [DATE]. Review of the current order initiated on 08/31/23 revealed wound care to the stage 4 pressure injury of Resident #15 was to be completed once daily on the day shift. Review of the corresponding Treatment Administration Records (TARs) for September 2023 and October 2023 documented the wound care was completed by the wound care nurse only 4 of 40 days. Review of the Punch Report (time clock report) and assignments for the Wound Care Nurse from 09/01/23 through 10/10/23 revealed the Wound Care Nurse was assigned to complete the wound care on 14 of her 21 days working during the review period. During an interview on 10/10/23 at 1:26 PM, when asked if she was responsible to complete all the wound care in the facility, the Wound Care Nurse stated she was unless she was not working or was pulled to one of the units to pass medications. When asked if she signs off on the TARs when she completes a wound treatment, the Wound Care Nurse hesitated and said yes. When asked if she had been doing the wound care for Resident #15, the Wound Care Nurse stated yes. When asked why she had not signed off on the TAR that she had completed the wound care, but that the nurses had been signing off, the Wound Care Nurse stated she had been on vacation and this was her first day back. The Wound Care Nurse confirmed she had completed the wound care for Resident #15 on that same day. Review of the TAR revealed Staff F, Licensed Practical Nurse (LPN), had signed off on the TAR for the completion of the wound care for that day. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 13 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 10/10/23 at 1:33 PM, Staff F, LPN, confirmed they had a Wound Care Nurse who completed the wound care on most day, unless she was off or working on a unit. When asked if she did the wound care today, the LPN stated the Wound Care Nurse had done it. When asked why she signed off as completing the wound care treatment today, the LPN stated, Because (name of Wound Care Nurse) told me to. The LPN stated it depended upon the wound care nurse. In the past some signed off the care themselves while others would tell her to signed it off. When asked if it was acceptable to sign off for care that she did not provide, the LPN stated it was not. During an interview on 10/10/23 at 1:46 PM, when asked who should sign off on the TAR for each resident's wound care, the A Wing Unit Manager stated whoever does the care should sign it off. 2. Resident #52 was admitted to the facility on [DATE] with diagnoses, in part, of unspecified complications of Kidney Transplant, Diabetes Mellitus, End Stage Renal Disease, Obesity, Dementia, brief Psychotic Disorder, Iron Deficiency and Atherosclerotic Heart Disease. On 09/27/23, the wound care physician's documentation revealed the resident had an unstageable pressure injury of the right heel; with measurements of 6.6 cm length, 1.5 cm with and no measurable depth; and the injury was facility acquired. On 09/27/23, physician orders were given to cleanse the wound with normal saline, apply Medi honey, apply calcium alginate and cover with a silicone bordered foam dressing daily and as needed. The order was discontinued on 10/02/23. A new order was given on 10/03/23 for the right heel wound. The order was documented as cleanse with Dakins pat dry, apply Santyl, apply calcium alginate and cover with silicone bordered foam dressing daily and as needed. On 10/04/23, the wound care physician documented the pressure injury status as no change. A review of Resident #52 wound care was completed. On 09/29/23, 10/06/23 and 10/07/23, no documentation was found for wound care being completed on those days as ordered. On 10/11/23 at approximately 3:05 PM, the Director of Nursing (DON) was informed of the findings. 3. Review of the facility's policy, titled, PICC Line or Midline Catheter Dressing Change, with a revised date of August 2023, included: Frequency - Change the dressing in the first 24 hours. After the first 24 hours, the frequency is every 7 days and PRN (as needed) if dressing is loose, damp, or soiled. Record review for Resident #5 revealed the resident was originally admitted to the facility on [DATE] with the most recent readmission date of 08/17/23. The resident's diagnoses included: Type 2 Diabetes Mellitus, Bacterial Infection, and Acquired Absence of Right Leg Below Knee. Review of the Minimum Data Set (MDS) for Resident #5 dated 08/18/23 revealed in Section C a Brief Interview of Mental Status score of 15, indicating an intact cognitive response. Section G revealed for bed mobility the resident had a self-performance of extensive assistance with support of two plus persons assist, for transfers the resident had a self-performance of limited assistance with support of two plus persons assist, for dressing the resident had a self-performance of limited assistance with support of one person assist. Section O revealed for IV (intravenous) medications while not a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 14 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 resident - yes, while a resident - yes. Level of Harm - Minimal harm or potential for actual harm Review of the Physician's orders for Resident #5 revealed an order dated 08/18/23 for PICC (Peripherally Inserted Central Catheter) Line right arm: Monitor for s/s (signs/symptoms) of infection, swelling, color change, pain, drainage, etc. If abnormalities are observed, stop use of IV (intravenous) site and notify physician every shift and as needed. Residents Affected - Few Review of the Physician's orders for Resident #5 revealed an order dated 08/18/23 for PICC Line right arm: Change injection caps on all lumens every 7 Days and PRN (as needed) with dressing changes every day shift every 7 day(s). Review of the Physician's orders for Resident #5 revealed an order dated 08/18/23 for PICC Line right arm: Flush line all lumens with 10ml of Normal Saline every shift and before and after each medication administration. Review of the Physician's orders for Resident #5 revealed an order dated 08/18/23 for IV Tubing: Change IV tubing every 24 hours on the day shift and as needed. Review of the Physician's orders for Resident #5 revealed an order dated 08/26/23 for PICC Line (right arm): Change dressing every 7 days using sterile technique every day shift every Saturday. Review of the Medication Administration Record (MAR) for Resident #5 from 09/01/23 to 10/08/23 revealed the PICC line dressing changes were due on 09/02/23 (signed off as 'other' by Staff B LPN), 09/09/23 (signed off as 'completed' by Staff C RN), 09/16/23 (signed off as 'other' by Staff B LPN), 09/23/23 (signed off as other by Staff B LPN), 09/30/23 (signed off as other by Staff B LPN),10/07/23 (signed off as other by Staff B LPN). Review of the Progress Notes from 09/01/23 to 10/08/23 for Resident #5 revealed Medication Administration Notes dated 09/02/23, 09/16/23, 09/23/23, 09/30/23 and 10/07/23 authored by the LPN that documented RN will change dressing. Nursing Progress Note dated 09/18/23 revealed Dressing to RUA (Right Upper Arm) PICC line changed as ordered. This indicated the PICC line dressing was changed once out of 5 times since 09/01/23. There was no documentation of the resident refusing a PICC line dressing change. Review of the Care Plan for Resident #5 with an initiated date of 10/09/23 with a focus on the resident is resistive to care/refusing care dressing changes and receiving intravenous antibiotic as per doctor's order related to noncompliance. The goal was for the resident to cooperate with care through the next review date. The interventions included: Allow the resident to make decisions about treatment regime, to provide sense of control. Educate resident/family/caregivers of the possible outcome(s) of not complying with treatment or care. Give a clear explanation of all care activities prior to and as they occur during each contact. Praise the resident when behavior is appropriate. An observation was conducted on 10/09/23 at 10:49 AM of Resident #5 sitting in wheelchair in his room with PICC line dressing to his right upper arm with the dressing loose and soiled with edges of the dressing curling up. The PICC line dressing was dated 09/18. Photographic Evidence Obtained. An interview was conducted on 10/09/23 at 10:52 AM with Resident #5, who was asked about the PICC line in his right arm. He stated he hasn't had any antibiotic for about 3 weeks. When asked how often they change the PICC line dressing, he said maybe every 2 weeks, but he does not remember when it (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 15 of 16 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 105399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Breeze Rehab and Nursing Center 3663 15th Ave Vero Beach, FL 32960 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 was changed last. He stated it is supposed to be removed tomorrow. Level of Harm - Minimal harm or potential for actual harm An interview was conducted on 10/09/23 at 10:53 AM with Staff A, (LPN), who stated dressing changes for a PICC line are changed weekly and as needed. When shown the PICC line dressing for Resident #5, she had a look of disbelief on her face. The LPN acknowledged the PICC line dressing was soiled, loose, and dated 09/18. She then stated it needed to be changed. Residents Affected - Few An interview was conducted on 10/10/23 at 9:15 AM with Staff B, LPN, who stated, when asked about the documentation for the dressing change, that the LPN would mark the code for other on the MAR and then write a note that they let an RN know the dressing needed to be changed. When asked if she has to identify which RN, she informed to do the dressing change she said no she does not document the specific RN. When asked if she follows up with the RN, she said they just do the dressing change. An interview was conducted on 10/10/23 at 2:30 PM with the Director of Nursing, who stated the LPN would document in the MAR for that resident, 'other' and make a note that an RN will change the dressing. When asked if the LPN needs to document which RN is to do the dressing change, she stated no. When asked if the RN who does the dressing change needs to document that they have performed the dressing change, the DON stated the RN would do a follow up or general progress note to document the dressing was changed. When asked if the LPN does any follow up to ensure the dressing was changed, she said the LPN will receive a verbal report from the RN that the dressing change was completed. When the DON was asked about when the PICC dressing change was last completed for Resident #5 she said it was documented on the MAR that it should have been done on 10/07/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105399 If continuation sheet Page 16 of 16