Health inspection·September 5, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some care plan for Resident #7 initiated on 5/29/25 noted that the resident is at risk and/or have actual impaired cognitive function/impaired thought processes related to BIMS less than or equal 12 and diagnosis of dementia. The resident is at risk for altered respiratory status/difficulty breathing related COPD-Interventions included to Administer OXYGEN as ordered. Monitor O2 saturations as ordered/PRN. Change tubing per MD order and PRN. Notify MD as indicated. Resident #7 was not care planned for smoking. (Copy obtained) A review of the smoking assessment for Resident #7 dated 5/23/25 indicated that the resident did not smoke. (Copy obtained)Review of the interdisciplinary care plan meeting sheet dated 5/26/25 indicated that Resident #7 was educated on not taking oxygen outside to the smoking area due to risk of injury. Resident agreed to leave wheelchair and oxygen in the building. (Copy obtained) A smoking contract/policy was signed by the resident on the same day.2. A clinical record review for Resident #8 indicated he was admitted to the facility on [DATE] with re-entry on 5/10/25. His diagnoses included Sequelae of Cerebral Infarction, Moderate Protein-Calorie Malnutrition, gastrostomy status, iliotibial band syndrome, low back pain, critical illness myopathy, Vascular Dementia, Mild, With Anxiety, Unspecified Convulsions, Nontraumatic Subdural Hemorrhage, Unspecified and muscle weakness.Review of the physician orders for Resident #8 dated 5/10/25 revealed the following:Risperidone 1 mg by mouth two times a day for paranoia.Levetiracetam (Keppra) 100mg/ml. Give 5 ml via PEG tube every morning and at bedtime for seizure control.Valproic acid oral solution. Give 1000mg via G- tube at bedtime and 250 mg in the morning for mood disorder/ agitation.Review of the care plan for Resident #8 initiated on 11/25/24 indicated that the resident was at risk for complications related to chronic tobacco use. Nicotine dependence Encourage/remind resident to maintain smoking materials, including lighters, matches, etc. at the designated facility location. Offer and encourage the resident to utilize a smoking apron. Resident refused to utilize a smoking apron. Resident has a history of exhibiting the following behaviors: noncomplaint with smoking apron, throwing things around including metal ashtray and calling residents by racial slurs. Revised care plan dated 3/15/25 indicated that the resident has a potential for activities of Daily Living ( ADL) self-care deficit related to ADL needs and participation vary, fatigue, chronic medical condition, dementia, impaired balance, history of cardiovascular accident (CVA).The Quarterly MDS with an ARD of 5/28/25 revealed that the resident had a BIMS score of 09 out of 15, indicating moderate cognitive impairment. Review of the smoking assessment for Resident #8 dated 5/10/25 section B (Mental and physical factors) noted that the resident had cognitive impairment and had dexterity/mobility limitations, therefore smoking supervision was required (Copy obtained).During an interview on 8/05/25 at 10:30 am, Resident #8 was observed in the hallway. He confirmed that he smoked unsupervised. He acknowledged that he had cigarettes in his pocket. However, he declined to answer if he had a lighter with him and self-propelled himself away.During a follow up interview on 08/05/25 at 11:16 am with the DON, she stated that residents are assessed on admission and quarterly. She said, All smoker are supposed to be safe smokers and do not require supervision. She mentioned that there were no designated smoking times, and smokers are supposed to give their smoking paraphernalia to the nurse after the smoking session. When asked how the nurses tracked the resident smoking paraphernalia's, she stated that the residents were educated to hand the over to the nurse after they were done smoking. She added that some residents were buying the smoking paraphrenias when they go out on LOA. She confirmed that there was no system in place to ensure that the residents do not possess them. She said, It's hard to track them since we cannot search them when they go out, it's their right, but we can revoke the smoking privilege if they don't follow the policy.On 8/5/25 at 1:05 pm, Certified Nursing Assistant (CNA) A was observed at the designated smoking area. She stated that she was asked to monitor residents as they (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105402 If continuation sheet Page 2 of 3 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 105402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeview Center 350 S Ridgewood Avenue Ormond Beach, FL 32174 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete smoke today. She mentioned that she had been in the facility for almost a year and residents were not supervised during smoking until today. She confirmed that Residents #7 and #8 were smoking cigarettes. She stated that she was not asked to take the smoking paraphernalia.A review of the facility's smoking policy tilted Smoking/vaping contract acknowledgement: updated on 1/27/2025 revealed the following:PURPOSE: To provide residents with the privilege of smoking/vaping and/or use of electronic smoking devices while maintaining their safety and the safety of others. Facility Policies:Resident smoking, vaping and/or use of electronic smoking devices is permitted only in the designated smoking area. All other areas of facility property are smoke free.2. All residents who smoke/vape and/or use electronic smoking devices will be assessed upon admission or at the start at such activity and as their cognitive and/or physical status mandates.3. Residents who require supervision will only use tobacco products and/or nicotine with supervision at the appointed smoking times (this includes electronic cigarettes). Residents who use tobacco products and/or nicotine with an electronic smoking/vaping device will have a care plan. 4. If determined the resident is unsafe when smoking and/or vaping, they will have supervision during such activity.5. Residents are to only smoke/vape the products that are purchased specifically for them. There is no borrowing or sharing of tobacco/nicotine products between Residents or Staff. If a Resident does not have tobacco products/nicotine they cannot smoke/vape.6. Tobacco products will be dispensed one at a time per resident request, with a limit of two cigarettes per supervised smoking break. Electronic smoking/vaping devices will be dispensed with prefilled cartridge.7. Absolutely no tobacco paraphernalia and/or tobacco products are to be kept in resident rooms. Electronic cigarettes, vaping devices including prefilled cartridges, nicotine, batteries, and/or charging elements for such devices are not permitted in a resident's room.8. If at any time, a resident is found with tobacco, nicotine and/or smoking/vaping materials (including lighters, matches, electronic cigarettes, prefilled cartridges, etc.) in his/her room or is found smoking, vaping, and or using an electronic smoking device (i.e. e-cig) in the room or inside the facility, such articles will be removed, smoking/vaping privileges will be revoked, and could result in Resident discharge from the facility. 9. If at any time this policy/contract is violated, smoking/vaping and/or tobacco/nicotine usage privileges will be revoked.10.Tobacco/Nicotine and smoking/vaping privileges may be revoked or limited at any time at the discretion of the facility administration.11. No resident may smoke/vape and/or use an electronic smoking device while on oxygen. 12. Smoking/Vaping paraphernalia for all residents will be secured by staff and labeled with individual resident names. 13. E-Cigarettes/Electronic Smoking Devices/Vaping Devices are considered the same as cigarettes and are subject to the same policies. 14. Any resident witnessed using/obtaining/storing illegal smoking/vaping materials and/or paraphernalia on facility property is subject to a 30-day discharge notice. Local Law Enforcement will be notified. PROCEDURE: A licensed nurse will evaluate residents who smoke, vape, or use electronic smoking devices upon admission or at the start of such activity and as cognitive or physical status changes warrant 2. Residents who smoke, vape, use electronic smoking devices are only permitted to do such activity in the designated smoking area. Residents will periodically be reviewed to reassess their ability to smoke/vape or use tobacco/nicotine safely.Residents will be offered and encouraged to use smoking aprons. I, ---------------------have reviewed and agree to the above smoking/vaping policy and procedure contract and further agree to abide by these guidelines in order to continue smoking/vaping privileges. I further acknowledge that my room or personal belongings may be searched for by facility staff at any time if I am suspected of violating any aspect of this smoking agreement. Event ID: Facility ID: 105402 If continuation sheet Page 3 of 3