Health inspection·October 2, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete AM, Staff F, a Licensed Practical Nurse (LPN), stated: During rounds, if I notice a resident's shirt is on incorrectly, I go back to the room and change the shirt or assist the resident if they can change it on their own.On 10/02/2025 at 11:52 AM, Staff R, a Certified Nursing Assistant, revealed, I am responsible for ensuring the residents wear their clothes properly. When we pass out meal trays, we should serve everyone at the same time, including those in their rooms. [Resident #159] requires assistance with meals, and on Monday, the lady working left the tray on the cart and should have waited before serving the roommate. The surveyor asked Staff R, CNA, about the facility's policy and terminology for residents that are dependent on staff during mealtime. Staff R, CNA, admitted she had made a mistake and clarified the correct terminology: Resident requires assistance with meals. Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to provide an advance directive for one (Resident #151) out of seven residents sampled; as evidence by: Resident #151 did not have an advance directive care plan or acknowledgement form in his chart. There were 160 residents residing in the facility at the time of the survey.During observation and record review on 09/30/2025 1:51 PM the residents advance directives was not located in the electronic chart.On 10/02/2025 03:00 PM, an advance directive care plan was unable to be located electronically.On 10/02/2025 03:20 PM, the facility's Social Services Director presents an advanced directive acknowledgement form with the signature of the resident, dated 10/01/2025. Review of the medical records for Resident #151 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to Cerebral infarction due to embolism of left posterior cerebral artery.Review of Resident #151's Physician's Orders Sheet for August 2025 revealed an order dated 08/13/2025 for Full Resuscitation.Record review of Resident #151 's Significant Change Minimum Data Set (MDS) dated [DATE] revealed: Section C for Cognitive Patterns documented Brief Interview for Mental Status Score is 15 indicating functional cognitive abilities. Section GG for Functional Abilities documented impairment on one side for upper and lower extremities, set up assistance for eating, substantial assistance for toileting and sit to lying, partial assistance for showering, upper and lower body dressing. Record review of Resident #151's Care Plans revealed no care plan for advance directives was done upon admission. Interview on 10/02/2025 at 02:42 PM the Social Services Director stated I have only been working here for five months. Advance directive paperwork should be completed at the time of intake. This includes obtaining documentation such as power of attorney, a living will, and the resident's code status (Do Not Resuscitate or Full Code). Advance directives are admission documents that should be signed upon admission by the resident or their representative. If they are not signed at that time, I have to follow up to obtain the signature. The admissions department is responsible for ensuring these documents are completed. I have discussed with the MDS nurse the importance of including advanced directives in care plans, and each resident should have an advanced directive care plan. At this time, I am unsure of the exact timeframe required to have advance directives signed. Care plan meetings are conducted twice a weekRecord Review of the facility policy and procedure titled Advanced Medical Directives August 2025 indicate: At the time of admission, Admissions shall furnish residents, family members, and / or the resident representatives) with information regarding Advanced Medical Directives.The resident and / or resident representative shall be asked to provide Social Services with a copy of the resident's current Advanced Medical Directives. Social Services will place the Advanced Medical Directives in the resident's medical record and ensure that the presence, or absence, of Advanced Medical Directives is documented in the resident record.Completion of an Advanced Medical Directive is not a requirement for admission or continued stay in the facility. After admission to the facility, the Director of Social Services will assist in providing further guidance and / or information on Health Care Advanced Directives as required or requested.1. Verify that information about Advanced Medical Directives was provided to the resident and / or family / resident representative at the time of admission. Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to provide appropriate notices for one (Resident #175) out of three residents reviewed for beneficiary notices. The resident received the notice after they were discharged from the facility. There were 160 residents residing in the facility at the time of this survey.The findings included:Record review of the Beneficiary Notice Initiative Notice of Medicare Non-Coverage (NOMNC) Policy and Procedure effective May 2012 documented: 4) When to Deliver the NOMNC: A. Must give an advance, completed copy of the Notice of Medicare Non-Coverage (NOMNC to Medicare beneficiaries/Medicare Advantage enrollees receiving covered skilled services no later than two days before the termination of services.Review of the Demographic Face Sheet for Resident #175 documented the resident was admitted on [DATE] with a diagnosis of diabetes mellitus, hypertension, epilepsy, anxiety disorder, bipolar disorder and hyperlipidemia. The resident was discharged from the facility on 8/19/2025 to an assisted living facility (ALF).Review of the Beneficiary Notification Review for Resident #175 documented the Medicare Part A Skilled Services Start date was 8/07/25 and the last covered day of Part A service was 9/17/25. The Notice of Medicare Non-Coverage (NOMNC CMS Form 10123) was provided on 9/17/25 and a verbal consent was received from the resident on 9/17/2025. The resident was discharged from the facility on 8/19/25.Review of the Minimum Data Set (MDS) admission Assessment for Resident #175 dated 8/18/2025 documented the resident's Mental Status (BIMS) Summary Score had a BIMS Summary Score of 11 out of 15 indicating cognitive impairment and the resident required partial to moderate assistance for ADLs (Activities Daily Living).Review of the Physician's Order Sheet (POS) for August 2025 for Resident #175 documented the resident was discharged to an ALF on 8/19/2025.On 10/02/25 at 2:38 PM, interview with the Social Services Director. She stated, The resident had several discharges. I would need to check on them. She refused to acknowledge that the form was filled out after the resident was discharged on 8/19/25. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews facility failed to submit a [NAME] II Preadmission Screening and Resident Review (PASRR) for a one (Resident #121) out of one sampled resident with a serious mental disorder as evidenced by a record review of a Level I PASRR indicating a Level II to be completed and no Level II was done. There were 161 residents residing in the facility at the time of survey.The findings included: On 9/29/25 at 10:42 AM Resident#121 observed seated in a wheelchair near bed. No apparent distress noted.Record review of a demographic sheet for Resident #121 revealed an admission date of - 6/26/23 with diagnosis that included: Bipolar disorder, Anxiety and Major depressive disorder.Record review of an Annual Minimum Data Set reference dated 7/3/25 revealed Residet#121 was not considered by the state level II Preadmission Screening and Resident Review (PASRR) process to have serious mental illness and/or intellectual disability or a related condition, had diagnosis that included: Anxiety disorder, Depression, Bipolar Disorder, was taking Antipsychotic and Antidepressant medication and received 0 minutes of Psychological Therapy in the last 7 days- 0.Record review of Care Plan started on 8/19/25 revealed Resident #121 was receiving psychotropic medications, had a goal to have minimal side effects and interventions included: Psychological services per order and as needed (PRN). Record review of Resident#121's physician's order sheet revealed orders dated 8/19/25 for Effexor Oral Capsule Extended Release 24 Hour 150 milligram (MG) directions: Give one capsule by mouth one time a day for Depression and 9/6/25 Abilify Oral Tablet 10 MG directions: Give one tablet by mouth at bedtime related to bipolar disorder.Record review of the medical record revealed Resident #121 was evaluated by a psychiatrist on 9/16/25. Record review of a Policy titled, PASRR - Requirements for Completion effective August 2025 revealed Pre-admission Screening & Resident Review (PASRR) Preadmission screening will be conducted prior to admission as the PASRR process is a federally mandated pre-admission screening program (see 42 CFR S 483.100) required to be performed on all individuals prior to admission to a Nursing Home. The screening is reviewed by Admissions for suspicion of serious mental illness and intellectual disability to ensure appropriate placement in the least restrictive environment and to identify the need to provide applicants with needed specialized services. PASRR screening applies to all new admissions into a Medicaid certified nursing facility and includes private pay, Medicare, and Medicaid admissions regardless of payer source. This screening is typically done by discharge planners & hospital staff as a step in the discharge process. It is separate from a medical needs assessment, which most often occurs after a person applies for Medicaid, and is a required step to qualify for Medicaid long-term care assistance. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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, record review and interviews, the facility failed to ensure proper positioning to prevent choking and aspiration for one (Resident #108) out of three sampled residents observed during dining; as evidenced by Resident #108 who has a diagnosis of Dysphagia Oropharyngeal Phase (difficulty swallowing) was noted in bed lying flat eating his lunch meal increasing the risk of food or liquid entering his airway leading to complications that include but not limited to aspiration pneumonia. The findings include: Observation on 09/30/2025 at 12:36 PM revealed Resident #108 lying flat in bed eating in his lunch meal.On 09/30/2025 at 12:37 PM Staff I, Certified Nursing Assistant, entered the room and the surveyor asked about Resident #108's position while eating his meal. Staff I, C N A reported the meal tray and set up was done by another staff and stated: This resident is a [requires assistants with eating], and we usually feed him. He like when [Staff P] feeds him. Staff I, CN A attempted to assist the resident without positioning the resident appropriately and the surveyor intervened. Staff I, CNA stated she will ask Staff P, CNA to assist the resident.On 09/30/2025 at 12:40 PM, the Assistant Director of Nursing (ADON) was shown Resident #108 lying flat in bed eating. The ADON stated, The resident should be elevated to prevent aspiration.On 09/30/2025 at 12:41 PM, during the observation and interview with the ADON the Unit Manager entered the room and stated: He always refuses to sit up.On 09/30/2025 at 12:42PM revealed Staff P, Certified Nursing Assistant, entered the room and assisted Resident #108 with his meal, the resident was noted compliant.Review of Resident # 108's clinical records revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses include but not limited to: Dysphagia oropharyngeal, and dementia related to other diseases, focusing on unspecified severity and the absence of behavioral, psychotic, mood disturbances, and anxiety and cognitive communication deficit .There isn't information on Resident #108's Dietary Order Summary for September 2025 in the entities.The Dietary Order Summary for Resident #108 in September 2025 noted an active order dated 03/28/2025, specifying a no added salt diet with regular texture and thin consistency fortified foods.Review of Quarterly Minimum Data Set (MDS) submitted 09/29/2025 revealed Resident # 108 is cognitively intact; functional abilities documented for eating the resident requires setting up for meals and clean-up assistance required.The Sections for Behavior related to Rejection of Care - Presence and Frequency noted: Behavior not exhibitedOther Health Conditions noted: Shortness of breath or trouble breathing when lying flat-Checked (Yes)On 09/30/2025 at 2:01PM, Staff I, CNA revealed, He like to lay flat to eat but I should make sure I position him up in the bed to eat.Review of the policy and procedure provided indicate:Policy Topic: Free of Accidents and Hazards Supervision/ Devices indicate the facility shall ensure patient centered care and services are provided to residents in accordance with each resident's preferences and goals and in accordance with professional standards of practice that meet each resident's physical mental and psychosocial needs.Procedure: 1. The facility shall ensure that: b. Each resident receives supervision and assistance to prevent accidents to the extent possible Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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 - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation records reviewed and interviews, the facility's staff failed to ensure a safe environment free of potential accidents and hazards for two out of three sampled residents, as evidenced by observation a knife in Resident #15's room on the windowsill and Resident #21 in possession of cigarettes. This deficiency increases the risk of negative outcomes that could affect all occupants in the facility. The findings include. Observation on 09/29/2025 at 9:40 AM, Resident #21 noted seated in an electric wheelchair in his room, with cigarettes visible in an open accessory bag (photographic evidence). Certified Nursing Assistant (CNA) Staff Q revealed that the resident goes out on pass and returns with the cigarettes. At 10:30 AM, the Assistant Director of Nursing (ADON) was shown the cigarettes in the open accessory attached to the right side of the wheelchair. The ADON immediately acknowledged the concern and informed the resident that he is not allowed to have cigarettes in his possession. The facility admitted Resident #21 on 06/07/2025 with clinical diagnoses including but not limited to Paraplegia unspecified, Neuromuscular Dysfunction of Bladder, Polyneuropathy, and type 2 Diabetes. The Nursing Home Administrator (NHA) revealed during an interview at 4:12 PM that law enforcement was called, and the resident refused to sign the behavioral note. Staff confiscated the cigarettes and implemented a 1:1 monitoring. The resident will remain on 1:1 monitoring, and nurses will be vigilant when he goes out on pass. Staff reminded all smokers and the assigned staff that cigarettes must be kept in the smoking cart and locked. The resident signed a compliance agreement upon admission and was educated and reminded of the consequences for noncompliance. He refused to sign the behavioral notes, and a Psych consult was done on 09/30/25. Resident #21's Smoking Care Plan indicates that he is a current smoker. The plan includes measures to ensure the resident remains safe while smoking, informs of the Facility Smoking Policy, designated smoking areas and times, the need to turn off oxygen, and the use of ash trays and smoking aprons. Smoking materials are kept by facility staff, and smoking is supervised as indicated. The Quarterly Minimum Data Set (MDS) submitted on 09/27/2025 shows Resident #21 scored 14 out of 15 on the Brief Interview for Mental Status (BIMS), indicating cognitive intactness. He is dependent on staff for activities of daily living, according to the functional status section. The facility's policy and procedure effective August 2024 titled Smoking/Tobacco Use: 4. Staff should label smoking/tobacco materials with the resident's name and maintain them in a secure location. Residents may not keep combustible smoking materials in their room. Residents are not allowed to retain lighters, matches, cigarettes, e-cigarettes, ignitable tobacco products, or other smoking materials in their personal possession. 5. Staff will inform the resident, family, or visitors of the designated smoking/tobacco use area and times. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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 - Few 6. Staff will maintain cigarette/tobacco counts for each smoker. They will add cigarettes/tobacco brought into the facility to individualized inventory sheets and reconcile throughout the day as cigarettes are consumed and reconcile at the end of each day. If counts do not reconcile, the employee smoking attendant will notify the supervisor. Observation on 9/29/2025 at 11:10 AM in Resident #15's room a knife was noted on the windowsill. Staff A, Registered Nurse (RN), unit manager, was notified about identified concern and removed knife. Staff was interviewed about facility protocol and stated and stated, The knife should not be there. On 9/29/2025 at 11:15 AM Staff B, Licensed Practical Nurse (LPN) was interviewed and stated, I did not see the knife when I did rounds. Record review of a demographic sheet revealed Resident#15 was admitted on [DATE] with diagnosis that included: Sequelae of cerebral infarction, Heart failure and gastronomy status. Record review revealed the Annual Minimum Data set (MDS) reference dated 9/6/25 revealed Resident#15 Brief Interview of Mental Status score was undetermined and was dependent for eating. Record review of a Anticoagulation care plan initiated on 9/6/25 revealed Resident#15 had on anticoagulant/antiplatelet therapy medication) related to History of Stroke, had a goal to Will be free from discomfort or adverse reactions related to use through the review date and the interventions included: Provide safe environment: Assist with transfers/ mobility as needed, protect extremities from trauma to lessen the possibility of bleeding/ injury. Record review of a June 2025 physician's order sheet revealed Resident#15 had an order for Aspirin 81 Oral Tablet Chewable Directions: Give one tablet via Tube one time a day for cardiovascular disease, monitor for signs and symptoms (S/S) of bleeding during each nursing shift. Notify prescriber if resident experiences any of the following: S/S of dark/discolored urine, black tarry stools, nosebleed, vomiting. Review of the facility's Policy and Procedure effective September 2025 indicate: TOPIC-Free of Accident Hazards/Supervision/Devices POLICY- The facility shall ensure that patient-centered care and services are provided to residents in accordance with each resident's preferences and goals, and in accordance with professional standards of practice that meet each resident's physical, mental, and psychosocial needs. PROCEDURE 1. The facility shall ensure that: a. The resident environment remains free of accident hazards to the extent possible. b. Each resident receives supervision and assistance to prevent accidents to the extent possible. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on observations, records reviewed and interviews, the facility staff did not properly position an indwelling urinary tubing to facilitate the flow of urine for one (Resident #21) out of two sampled residents with an indwelling urinary catheter. As evidenced by; Resident #21's indwelling catheter tubing was positioned above the bladder and kinked. This improper practice prevented urine from freely flowing and increasing the risk for catheter-associated urinary tract infections and other serious medical issues. At the time of this survey, eleven residents with indwelling urinary catheters resided in the facility.The findings include. On 09/29/2025 at 9:32 AM, staff completed Resident #21's morning care, the indwelling catheter tubing was noted coiled on the bed. At 9:38 AM, Certified Nursing Assistants (CNAs) Staff Q and M used a mechanical lift to transfer Resident #21 from the bed to an electric wheelchair, positioning the indwelling catheter's tubing curled between the resident's legs.Record review revealed the facility admitted Resident #21 on 06/07/2025 with clinical diagnoses including but not limited to Paraplegia unspecified, Neuromuscular Dysfunction of Bladder, Polyneuropathy, and type 2 Diabetes.Review of the Physician Order Summary for September 2025 included an active order dated 06/07/2025 for Urinary Catheter care daily and PRN (as needed) for preventative measures. An active order dated 06/18/2025 required urinary catheter to drainage bag for DX (Diagnosis) Neurogenic Bladder, with a Urinary Catheter size #20 FR with balloon, and observation every shift.On 09/29/2025 at 9:42 AM when asked about the policy for catheter's tubing position, Staff M, CNA, stated that it was acceptable if the bag remained below the bladder. Observation on 09/29/2025 at 10:20 AM, Resident #21 was seated in a reclined electric wheelchair watching television in the activities/dining area. The indwelling urinary catheter tubing was noted curled and kinked; the urine appeared cloudy and was not flowing freely.On 09/29/2025 at 10:30 AM, the surveyor showed the Assistant Director of Nursing (ADON) and the Unit Manager that Resident #21's indwelling catheter tubing was curled and kinked. Both the Unit Manager and the ADON acknowledged the concern and noted that they would change the drainage bag.Review of the Urinary Catheter Care Plan for Resident #21 began on 9/7/2025 and aimed for completion on 9/15/2025. The plan included providing catheter care daily and as needed, educating the resident and family about catheterization and minimizing complications, observing for signs and symptoms of discomfort during urination and frequency, documenting pain or discomfort due to the catheter, keeping the catheter tubing free of kinks, and ensuring the drainage bag stayed below the level of the bladder.Review of the Quarterly Minimum Data Set (MDS) submitted 09/27/2025, Resident #21 scored 14 out of 15 on the Brief Interview for Mental Status (BIMS), indicating cognitive intactness. The functional status section revealed the resident is dependent on staff for activities of daily living. The Bladder and Bowel section noted the use of an indwelling catheter and frequent bowel incontinence, with no current toileting program in place to manage the resident's bowel continence.On 10/01/2025 Staff G, Licensed Practical Nurse (LPN) revealed the catheter tubing should not be kept straight to allow drainage and prevent backflow.On 10/01/2025 at 2:05 PM, Staff I, CNA revealed the catheter bag should be below the bed and the tubing straight. Review of the facility's Policy and Procedure effective September 2025 Topic titledQuality of Care indicate:POLICY:It is the policy of the facility to ensure that each resident receives the necessary care and services to attain and maintain the highest practicable physical, mental, and psychosocial well-being in accordance with State and Federal Regulations.PROCEDURE:1. The facility shall ensure that the resident obtains optimal improvement or does not deteriorate within the limits of a resident's right to refuse treatment and within the limits of recognized pathology and the normal aging process.2. Quality of care and services shall (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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 0690 Level of Harm - Minimal harm or potential for actual harm be provided to the resident in accordance with professional standards of care to the extent possible, including but not limited to:a.) assistive devices,e.) incontinence care and management,h.) activities of daily living, Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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, interviews, and record reviews, the facility failed to ensure their medication error rate were 5% or lower as evidenced by an error rate of 64.29 % out of 28 opportunities. There were 160 residents residing in the facility at the time of survey.The findings included:On 09/30/25 at 10:27 AM, a medication observation was completed with Staff F, RN on the Section 4 medication cart #1 for Resident #108. Staff F, RN revealed Resident #108 takes medicine by mouth in a whole form. Staff F, RN performed hand hygiene and verified each medication according to the physician's order and placed the following medications into a cup:1. Amlodipine 5 mg, po, 1 tab, once a day2. Lisinopril 10 mg, 1 tab, daily, po3. Procardia 90 mg xl, po, once daily, 1 tab4. Metformin 500 mg, po, 1 tab, twice a day 5 Multivitamin, 1 tab, po, once a day6. Lactulose 30 ml, liquid, po, twice a day7. Juven 1 packet, powder mix in 240 ml water, po, twice a dayThe nurse locks the cart and screen, performs hand hygiene, and dons gloves and gown.Vital signs: BP 120/62, HR 105.The nurse disinfects the blood pressure cuff with wipes and administers prescribed medications. The resident refuses lactulose and Juven, which are poured down the sink, and related trash is discarded. The bedside table is cleaned.The nurse then removes Personal Protective Equipment (PPE), completes hand hygiene, and signs off on medication administration.On 10/01/25 at 10:22 AM a medication observation was completed with Staff G, LPN on the Section 4 medication cart #1 for Resident #80. Staff G, LPN revealed Resident #80 takes medicine by mouth in a whole form. Staff G, LPN performed hand hygiene and verified each medication according to the physician's order and placed the following medications into a cup:Propranolol 10 mg, 1 tab, po, every 8 hours prn 2. Risperdal 2 mg, po, every morning and at bedtime 3. Artificial tears 1 %, 1 drop, 1 drop in both eyes 4. Divalproex 250 mg, po, 1 tab, twice a day 5. Duloxetine 20 mg, 1 cap, po, once a day 6. Gabapentin 600 mg, po, 3 times a day, 1 tab7. Methocarbamol 750 mg, 1 tab, po 3 times a day 8. Sertraline 25 mg, po, 1 tab, once a day 9. Meclizine 12.5 mg, 1 tab, po, once a day 10. Percocet 5-325 mg, po, 1 tab, every 4 hours as neededThe nurse signs the narcotic book after administering as needed narcotics, then locks the cart and screen. After knocking on the door, the nurse applies gloves and administers oral medications. Eye drops are instilled in both eyes, followed by wiping with tissue. Hand hygiene is performed, and the eye drops are returned to storage. The nurse signs off on medication administration in the computer. On 10/01/25 at 10:41 AM a medication observation was completed with Staff G, LPN on the Section 4 medication cart #1 for Resident #48. Staff G, LPN revealed Resident #48 takes medicine by mouth in a whole form. Staff G, LPN performed hand hygiene and verified each medication according to the physician's order and placed the following medications into a cup:Ibuprofen 800 mg, 1 tab, po, every 8 hours prn 2. Finasteride 5 mg, po, 1 tab, once a day 3. Gabapentin 300 mg, one tab, po, 3 times a day Vital signs: 101/53, HR:76 The nurse locks the cart and screen, obtains the resident's vital signs, and ensures privacy. Medications are administered, with blood pressure medication held due to low blood pressure. The blood pressure machine is disinfected, and the unadministered medication is discarded in the pill buster. Hand hygiene is performed. A note is written to the physician, and medications are signed off in the computer.On 09/30/2025 at 3:25 PM a narcotic count for Section 5 cart with Staff E, RN revealed no loose pills or expired medications observed in the medication cart. Staff E, RN documented signing off on ClonazePAM Oral Tablet 0.5 mg (Clonazepam), a controlled substance, for administration of 1 tablet by mouth once daily for anxiety. The medication was signed at 3:10 PM, though it was scheduled for 9:00 AM, for Resident #49. When questioned, the nurse stated her pen had run out earlier and she forgot to obtain a new one to complete the signature.Record review of a policy titled, Medication Administration, 09/18 stated 1. Medications are administered within 60 minutes of scheduled time, except before or after meal orders, which Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete are administered based on mealtimes. Unless otherwise specified by the prescriber, routine medications are administered according to the established medication administration schedule for the nursing care center. Medications should not be given at mealtimes or in the dining room unless specifically ordered with meal.Interview on 10/02/2025 at 06:26 PM with Director of Nursing (DON) stated Nurses are required to sign the narcotic book immediately upon administration of medications and should not wait hours after giving the medication. A medication is considered late if it is administered more than one hour past the scheduled time. The acceptable time frame for giving medications is within one hour before or after the scheduled time. Penalties for late administration may include verbal or written warnings. Medication tracking is performed by checking every other day and conducting a weekly review on Thursdays, which includes reviewing the Electronic Medication Administration Record (EMAR) and narcotic books. Nurses receive education on medication storage, and the medication pass annually and as needed, provided by the Assistant Director of Nursing (ADON), unit manager, or myself. Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations, record reviews, interviews, the facility failed to ensure medications and biologicals are stored in accordance with professional standards in keep the unit one medication storage room and three medications: as evidence by twelve expired Nutritional Supplement in the medication storage room on unit one and expired insulin on medication cart three. There were 160 residents that resided in the facility at the time of survey.The findings include: On 09/29/2025 at 02:45 PM, the medication storage room in unit 1 was observed with the Assistant Director of Nursing (ADON). It was revealed that the medication log was signed for daytime on 09/29/25. Twelve Nutritional Supplement feedings were found to be expired, with an expiration date of 05/01/2025 (photo evidence available). Termite and rodent droppings were observed in the cabinets. Interview with the Director of Nursing on 10/02/2025 at 06:26 PM stated Expired medications should never be present in the medication carts or medication storage rooms. On 9/29/25 at 3:50 PM, during a medication storage check on the Station 3, back medication cart with Staff C, Licensed Practical Nurse (LPN), an observation was made of an expired bottle of insulin labeled open date 8/30/25 and expiration date 9/28/25 and an unopened bottle of insulin (photo evidence). On 9/29/25 at 4:05 pm Staff C, Licensed Practical Nurse (LPN) was interviewed about the facility's protocol for medication storage and stated: When the insulin is unopened it is kept in the fridge and any expired insulin bottles are discarded. Interview on 10/01/25 at 10:48 AM, Staff A, Registered Nurse (RN) unit manager, about the identified concern. The Unit manager stated, I check the med carts and treatment carts in section 3 once a week on Fridays. I educate the nurses to check all meds for expiration dates. Record review of The Facility's policy titled, Medication Storage 9/18 4.1 STORAGE OF MEDICATION POLICY revealed Medications and biologicals are stored properly, following manufacturers or provider pharmacy recommendations, to maintain their integrity and to support safe effective drug administration. The medication supply shall be accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on observations interview and record review, the facility failed to their Quality Assurance Performance Improvement policy and demonstrate effective plan of actions were implemented to correct identified quality deficiencies in the problem area as evidenced by repeated deficient practices for

F550-Resident Rights/Exercise of Rights and F761- Labeling of Drugs and Biologicals, F689 Free of Accident Hazards/Supervision/Devices, F880 Infection Prevention and Control and F867 QAPI/QAA Improvement Activities. The findings included: Review of the facility's survey history revealed, during a recertification survey with exit dated 07/24/2024 deficient practice was identified for F550-Resident Rights/Exercise of Rights and F761- Labeling of Drugs and Biologicals, F689 Free of Accident Hazards/Supervision/Devices, F880 Infection Prevention and Control and F867 QAPI/QAA Improvement Activities. During this survey with exit date of 10/02/2025, the facility was cited for F550-Resident Rights/Exercise of Rights and F761- Labeling of Drugs and Biologicals, F689 Free of Accident Hazards/Supervision/Devices, F880 Infection Prevention and Control and F867 QAPI/QAA Improvement Activities.On 10/02/2025 at 4:37 PM a Quality Assurance and Performance Improvement (QAPI) overview was conducted with the Nursing Home Administrator, (NHA) the Travelling Nursing Home Administrator and the Director of Nursing (DON).The NHA revealed the meeting are held on the last Thursday of each month. The committee member include the Medical Director, NHA, Corporate representatives, DON, ADON, Admissions, Department Heads. The committee is always focusing on prior tags with ongoing systems in place to maintain compliance and identifying any areas for improvement. Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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 0880 Provide and implement an infection prevention and control program. 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 infection control standards were followed as evidenced by nebulizer mask noted uncovered, dirty call light on Resident#15's bed, nebulizer machine on the floor, Resident #5's indwelling urinary catheter drainage bag inside a trash. There were 160 residents residing in the facility at the time of the survey Residents Affected - Some During observation on 09/29/2025 at 09:25 AM, a respiratory mask as noted at Resident # 120's bedside observed without a storage bag. Photographic evidence attached. On 09/30/2025 11:21 AM Resident seated in wheelchair at doorway, alert and watching TV with no distress observed. Liquid within reach. Nebulizer mask not visible at bedside. On 10/01/2025 10:58 AM Resident sleeping in wheelchair near doorway, no distress observed. Liquid at bedside, privacy curtain in place. Empty urinal noted at bedside. Nebulizer mask not visible. Review of the medical records for Resident #120 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to Hypoxic Ischemic Encephalopathy, Unspecified. Review of Resident #120's Physician's Orders Sheet for September 2025 revealed an order dated 09/25/2025 for Levalbuterol HCl Inhalation Nebulization Solution 1.25 MG/3ML (Levalbuterol HCl) 1.25 mg inhale orally via nebulizer every 8 hours as needed for Shortness of Breath. Record review of Resident #120's Significant Change Minimum Data Set (MDS) dated [DATE] revealed: Section C for Cognitive Patterns documented Brief Interview for Mental Status Score is 10 indicating some cognitive impairment. Section GG for Functional Abilities documented no impairment for upper body extremities and impairment on both sides for lower extremities, independent for eating, partial assistance for toileting and sit to lying, showering, upper and lower body dressing. Section J for Health Conditions documented the resident receives scheduled pain medication regimen. Section O for Special Treatments, Procedures, and Programs documented the resident did not receive the influenza, pneumococcal or covid19 vaccine. Record review of Resident #120's Care Plans revealed the resident has Oxygen Therapy related to (r/t) shortness of breath (SOB), Chronic obstructive pulmonary disease (COPD). Interventions include Administer Oxygen as ordered. Give medications as ordered by physician. Monitor/document side effects and effectiveness. Promote lung expansion and improve air exchange by positioning with proper body alignment. Interview on 10/02/2025 at 04:28 PM with Staff D, LPN stated After the nebulizer treatment is finished, the device should be placed in a bag and changed weekly or as needed. It should not be left lying uncovered on the dresser. The resident receives nebulizer treatments every 12 hours and as needed. Staff receive infection control training monthly, provided by the ADON. Record Review of the facility policy and procedure titled Infection Prevention and Control Program (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105408 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 105408 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treasure Isle Care Center 1735 N Treasure Drive North Bay Village, FL 33141 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 0880 Level of Harm - Minimal harm or potential for actual harm October 2021 indicate: The Infection Prevention and Control Program is comprehensive program that addresses detection, prevention and control of infections and communicable diseases among residents, visitors, volunteers, those individuals providing services under contractual agreement and personnel. d. Identify and correct problems relating to infection control and prevention practices. Residents Affected - Some 1) On 9/29/25 at 10:23 AM An observation was made of a nebulizer machine on the floor in a resident's room in Section 3 (photo evidence). On 9/29/25 at 10:27 AM Staff A, Registered Nurse (RN) Unit manager was notified about the identified concern. The unit manager picked up the nebulizer machine, placed it in a plastic bag and removed it from the room. On 9/29/25 at 11:07 AM Staff B, Licensed Practical Nurse (LPN) was interviewed about the identified concern and stated, I did round this morning and I didn't notice the nebulizer machine on the floor, or I would have picked it up. 2) On 9/29/25 at 11:10 AM An observation was made of a dirty call light on the bed of a Resident#15 (photo evidence). On 9/29/25 at 11:15 AM Staff A, RN Unit manager was notified and stated, It looks like milk. I will clean it. On 9/29/25 at 11:20 AM Staff C, LPN was interviewed about the identified concern and stated, I did not notice the call light was dirty. 3) On 10/01/25 at 1:30pm an observation was made of Resident #5's indwelling urinary catheter drainage bag inside a trash can next to bed (photo evidence). On 10/01/25 at 1:35 pm Staff A, RN unit manager was notified stated, Earlier in the around 12:30 PM the catheter was properly placed on the side of the bed. Staff A, RN unit manager entered room with surveyor and observed the drainage bag inside the trash can while still connected to resident. and stated, I don't know why it's in the garbage and I will change it. Record review of a quarterly minimum data set reference dated 9/10/25 revealed Resident#5 had a Brief interview of mental status score of 12 indicated moderate cognitive impairment, required substantial/maximal assistance for toileting hygiene and had an indwelling catheter. Record review of a care plan started on 9/10/25 revealed Resident #5 had an indwelling Catheter with interventions that included: observe/document/report to doctor for signs and symptoms of Urinary tract infection. Record review of a September 2025 physicians' order sheet for Resident#5 revealed an order for Suprapubic Catheter: Suprapubic catheter to drainage bag for Neurogenic Bladder. Suprapubic catheter size # 14 French with 10 Cubic centimeter (cc) Balloon. Observe every shift. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105408 If continuation sheet Page 16 of 16