Health inspection·July 2, 2025

F 0627 Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation. back. She stated this was the first paperwork from the hospital asking for a return. When asked if anyone had received any phone calls requesting the return of the resident, she stated she would have to talk to the Nursing Home Administrator (NHA). Most of the time, the case managers will talk with the NHA about a returning resident. An interview was conducted on 06/18/2025 at 1:44 p.m. with the NHA and Staff E, DON regarding Resident #1. The NHA stated the hospital had not called him, but the hospital had called Representative A, Hospital/Facility Liaison. The NHA stated he did not know when Representative A, Hospital/Facility admission Liaison was called or what the discussion was. The NHA stated, probably one week after the resident was admitted to the hospital, we had a discussion that the resident should come back. The NHA said he had not decided whether or not to take the resident back at the time. He said he did not know if Resident #1 was ready to come back. The NHA said, if the resident wanted to come back, he could come back. Staff E, DON stated she had received clinical paperwork that morning (06/18/2025).On 06/18/2025 at 10:12 a.m., Representative B, Local Hospital Supervising Care Coordinator, was interviewed by phone. He stated when an attempt to return Resident #1 back to the facility was made, the admissions coordinator flat out refused to take the resident back. Representative B, Local Hospital Supervising Care Coordinator stated Resident #1 was still in the hospital, he is alert and oriented. The hospital has been having a difficult time placing the resident. When asked if the facility had requested any additional information from the hospital about the resident's condition to make their determination on whether or not to take the resident back, he said no. The resident had no additional conditions.On 06/18/2025 at 2:10 p.m. Representative B, Local Hospital Supervising Care Coordinator, was interviewed again by phone. He stated Resident #1 was eligible for discharge on [DATE]. He stated one of his discharge planners had reached out to Representative A, Facility/Hospital admission Liaison, who had reportedly given the discharge planner a hard time. So Representative B, Local Hospital Supervising Care Coordinator called Representative A, Facility/Hospital admission Liaison and he told him No. When asked what the situation was, currently, for Resident #1, if the facility had agreed to take the resident back, he stated, we have a system where we can see if a referral has been accepted, no one has accepted the resident as of yet. He stated, it looks as if the facility reached out this morning for clinical paperwork, but no acceptance yet. A phone interview was conducted on 7/1/25 at 2:41p.m with Representative A, Facility/Hospital admission Liaison. He said he handles the admissions from the hospital to the nursing home. He said Resident #1 was hospitalized and quite a while ago the hospital was just keeping him abreast about Resident #1's status through their communication program. He said the hospital did request Resident #1 to be readmitted to the facility. He did not know when they made the request. Representative A, Facility/Hospital admission Liaison, said he told the hospital they would have to talk to the facility's administration because he does not handle readmissions. He said the facility's administration discusses readmissions and he is not involved in the discussion. Representative A, Facility/Hospital admission Liaison said he told the hospital last week sometime the facility would not be accepting Resident #1 back. He said he does not know why the facility didn't accept the resident back. He said he did not know where Resident #1 was at this time. A phone interview was conducted on 7/2/25 at 9:35AM with the NHA. He said Representative A, Facility/Hospital admission Liaison, is a third party contracted personnel who handles the admissions and the readmission back to the facility, the facility does not have an in-house admissions coordinator. The NHA said when a hospital requests a readmission the interdisciplinary team at the facility reviews the hospital documentation to see if the resident is safe for admission. He said Representative A, Facility/Hospital admission Liaison, is the person who informs the hospital of the decisions and the NHA said he includes Representative A, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105409 If continuation sheet Page 2 of 4 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 105409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfview Nursing Center 3636 10th Ave N Saint Petersburg, FL 33713 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 0627 Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation. Facility/Hospital admission Liaison, as part of the interdisciplinary team who reviews the information provided. The NHA confirmed Resident #1 has not been re-admitted back to the facility because he has concerns about Resident #1's weight, although the resident has lost some weight while he's been in the hospital. The NHA said he has talked to the social worker at the hospital, and they said he still weighs over 600 pounds. The NHA said the facility still has not made the decision to accept Resident #1 back or not because of his weight. The NHA said he does not know if Resident #1 is ready for discharge from the hospital. The NHA said he started as the NHA on the day Resident #1 was sent out to the hospital, so he does not know how the facility was providing care to Resident #1 leading up to his discharge to the hospital.A phone interview was conducted on 7/2/25 at 12:11 p.m. with Resident #1. He said he was still at the hospital, but he is feeling better. Resident #1 was asked if he wanted to go back to the facility and he said, I can't go back to the facility because they won't take me back. He said he doesn't know why they won't take him back but it makes me feel bad. He said he never received a discharge notice from the facility. He said he has been ready for discharge for about a month now, but the hospital is having a problem finding a place for him because of his weight. He said the hospital is now looking for facilities outside of Florida. He said most of his family is in Florida. He said the staff at the facility were bringing him food from outside the facility, chicken, shrimp, oxtails, ice cream with caramel sauce. They were feeding my addiction, so I was getting bigger and bigger. Resident #1 said he has lost 65 pounds at the hospital because they put him on a concentrated carbohydrate diet. A phone interview was conducted on 7/2/25 at 12:25 PM with Representative C, Local Hospital's Case Manager. She said she was working on Resident #1's discharge back in May of 2025. She said she spoke to Representative A, Facility/Hospital admission Liaison. He was nasty to me. She said when she asked him if the facility was going to readmit Resident #1, he told me Yea well we're not. She asked what that meant and he told her No. She said her supervisor, Representative B, Local Hospital Supervising Care Coordinator, called Representative A, Facility/Hospital admission Liaison on 5/26/25 and wrote a note on 5/26/25 at 12:15 p.m. which said Consult to escalate. Patient is long term care of [Facility] since April of 2022. [Representative A, Facility/Hospital admission Liaison] is refusing, adamantly refusing, to accept the patient back. He said the patient was confused when he left the facility, so they called the POA [Power of Attorney] who refused to sign the bed hold so they do not have to take the patient back. [Representative A, Facility/Hospital admission Liaison] continues stating patient is bariatric, over 700 pounds, eats/orders whatever he wants, difficult to turn, has bed sores and no longer able to meet his needs. Since the POA refused to sign the bed hold he is under no obligation to take the patient back. [Representative A, Facility/Hospital admission Liaison] informed me no 30-day notice was provided but he is well within his right to refuse the patient because the bed hold was never signed. Representative C, Local Hospital's Case Manager said Resident #1 has lost a lot of weight since he has been at the hospital and as of today, he weighs 656 pounds and the day after he came into hospital, he was 709.5 pounds. She said Resident #1's discharge case has been escalated up to the complex discharge social worker at the hospital. A phone interview was conducted on 7/2/25 at 12:46PM with Representative D, Local Hospital Complex Discharge Social Worker. She said her job is to coordinate a discharge location for patients who are difficult to find a facility for. She said Representative B, Local Hospital Supervising Care Coordinator, reached out to Representative A, Facility/Hospital admission Liaison, on 5/26/25 to see if the facility was going to accept Resident #1 back and he said they were not going to accept Resident #1 back. She said within the last two weeks she had been talking to the NHA, and he said he has been fighting with the owner of the facility to readmit Resident #1. She said she followed up (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105409 If continuation sheet Page 3 of 4 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 105409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfview Nursing Center 3636 10th Ave N Saint Petersburg, FL 33713 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 0627 Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation. FORM CMS-2567 (02/99) Previous Versions Obsolete with the NHA daily and he kept saying he was working on it. Then, she was informed through the communication tab of the referral system on 6/27/25 the owner of the facility is not taking the patient back. Representative D, Local Hospital Complex Discharge Social Worker said since then she has not had communications with the facility. She requested 474 providers to review the referral to accept Resident #1 into their facility's, and they have all denied him. She said she is looking outside of the state of Florida now and she has not had any confirmations yet and Resident #1 is still at the hospital waiting for placement. A phone interview was conducted on 7/2/24 at 1:14 PM with Resident #1's Family. She said she does not have official Power of Attorney paperwork written up. She said she is just his next of kin for the facility. She said the facility called her when Resident #1 was being transferred out and they said he was having trouble breathing, and she asked how they were going to transfer him, and they said the fire department was handling it. She said the facility told her they would hold his bed for 24 hours and she could pay an additional fee to hold it longer, but she said she does not have access to Resident #1's funds so she told the facility she could not do that. She said she did not understand why he had not returned to the facility. An interview was conducted with Staff F, DON on 7/2/25 at 1:48p.m. She said she started working at the facility on Monday 6/30/25. She said she receives the admission request documentation, reviews the documents, and makes a determination whether or not the facility can meet the resident's needs. She said she has not been involved in a readmission request for Resident #1. She said she was just informed Resident #1 had not come back after he was transferred to the hospital. She said Resident #1 transferred to the hospital prior to her becoming the DON. She said she was made aware Resident #1 was a patient of the facility and from her understanding he remains their resident, and he should be brought back to the facility. She said for someone who is around 650 pounds, for a new patient, they would probably not accept that resident but since Resident #1 was their resident before they should accept him back into the facility and from what she had been told he gained weight while he was admitted at the facility. Staff F, DON said the facility can have a bed available for Resident #1 and they just need to come up with a plan to get the dietitian and physical therapy involved to help him lose weight and come up with a plan with the paramedic company if he needs transfer out. Review of the facility's policy Admission, Transfer & Discharge -Permitting Resident to Return to Facility, undated, revealed the following:Intent: It is the policy of the facility to permit the resident to return to facility [sic] according to state and federal regulations. PROCEDURE:1. A facility will establish and follow a written policy on permitting residents to return to the facility after they are hospitalized or placed on therapeutic leave. 2. The policy will provide for the following: a. A resident, whose hospitalization or therapeutic leave exceeds the bed-hold period under the State plan, returns to the facility to their previous room if available or immediately upon the first availability of a bed in a semi-private room if the resident: i. Requires the services provided by facility; and ii. Is eligible for Medicare skilled nursing facility services or Medicaid nursing facility services.b. If the facility that determines that a resident who was transferred with an expectation of returning to the facility, cannot return to the facility, the facility must comply with the requirement of paragraph (c) as they apply to discharges. When the facility to which a resident returns is a composite distinct part ., the resident must be permitted to return to an available bed in the particular location of the composite distinct part in which he or she resided previously. If a bed is not available in that location at the time of return, the resident must be given the option to return to that location upon the first availability of a bed there. Event ID: Facility ID: 105409 If continuation sheet Page 4 of 4