Health inspection·July 12, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Review of the policy Management of C. Difficile Infection, implementation date is blank, states under section 5, General principles related to contact precautions for C. Difficile: All staff are to wear gloves and a gown upon entry into the resident's room and while providing care for the resident with C. difficile infection. Hand hygiene shall be performed by handwashing with soap and water in accordance with facility policy for hand hygiene. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105438 If continuation sheet Page 2 of 5 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 105438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aspire at Ridge Haven 4927 Voorhees Rd New Port Richey, FL 34653 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 observation, record review, staff interview, and policy review, the facility failed to ensure staff followed appropriate isolation precautions during the provision of resident care for one (Resident #12) of three sampled residents on transmission-based precautions. Residents Affected - Some Findings included: On 7/11/23 at approximately 10:55 AM., an observation was made of the speech therapist performing a swallowing evaluation with resident #12. The resident was in her room and there was a three drawer isolation cart noted at the entrance to the room with a sign that had two red STOP signs that stated Enhanced Barrier Precaution's. EVERYONE MUST: Clean their hands, including before entering and when leaving the room. Providers and staff must also: wear gloves and gown for the following high-contact resident care activities. Dressing, bathing/showering, transferring, changing linens, providing hygiene, changing brief or assisting with toileting, device care or use, wound care. The speech therapist entered the isolation room, sanitized her hands but did not don an isolation gown or put on gloves. She was observed talking to Resident #12 and offering yogurt. At 10:58 AM., the speech therapist was observed walking around the room without Personal Protective Equipment (PPE), no gown, no gloves, no mask. She was heard to report to the resident that she had not been feeling well yesterday (7/10/23) and instructed the resident on proper swallowing technique to include how to move her tongue side to side. At 11:17 AM, the speech therapist was observed to used hand sanitizer as she exited the resident's room. Photographic evidence obtained. On 7/11/23 at approximately 11:18 AM, an interview was conducted with Staff A, Speech Therapist who reported Resident #12 was on isolation for C-diff (Clostridium difficile colitis). She stated she had not been providing care to the resident as she was only doing oral motor exercises. She reported she only touched the bed to elevate the head, did not feed the resident or touch her mouth. She stated she had been educated by the facility on isolation but since she did not provide care she was not required to gown up and alcohol-based hand rub was appropriate to sanitize her hands after she exited the room. On 7/11/23 at approximately 12:33 PM., an observation of Resident #12 revealed, upon entering the room, no trash bin for discarded Personal Protective Equipment (PPE) was noted. At this time, a staff member standing close to the outside of the room was asked where the discarded PPE should be placed. A Certified Nursing Assistant (CNA) provided a small waste basket and placed it by the door. At this time an Occupational Therapist (OT), staff member C, entered the room and stated she was there to feed the resident. She entered the room, introduced herself to the resident, exited the room and pulled a lunch tray from a cart in the hallway. She returned to the room, raised the head of the resident's bed and set the tray on the bedside table to assist the resident with eating. She was not noted to don PPE of any kind during this observation. On 7/11/23 at approximately 12:35 PM, the Director of Nursing (DON) was asked to observe the OT staff member in the room with Resident #12. The DON confirmed the resident was on isolation for C-diff and that all staff should have on a gown, gloves, and mask when in the resident's room. She observed the OT staff member in the resident's room, confirmed she was wearing gloves but no other PPE. She verified the staff member should have on PPE and that it was required. She then stated that the bin outside the door clearly stated what staff should do and wear in the patient's room. She stated that therapy staff are contracted staff but the facility was responsible for offering education to them. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105438 If continuation sheet Page 3 of 5 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 105438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aspire at Ridge Haven 4927 Voorhees Rd New Port Richey, FL 34653 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 On 7/11/23 at approximately 1:12 PM, an interview was conducted with the Staff C, OT who had been observed working with resident #12. She stated she felt the observation of her not wearing PPE reflected poorly on the therapy department. She stated she saw the isolation sign but was very focused on what she was there to do and just wanted to feed the resident. She had been here for 10 months and stated she was sure she had education on isolation precautions. Residents Affected - Some On 7/11/23 at approximately 3:18 PM, an observation was made of Resident #12's room which revealed the trash can was no longer at door and two staff members were in the room providing wound care, Staff D and B, both Licensed Practical Nurses (LPNs). Staff B, LPN was not wearing PPE. She was assisting Staff D, who was wearing full PPE to include gown, gloves and mask. Staff B, LPN was obtaining and handing Staff D wound care supplies from the wound care cart that was located outside the resident's room. The small trash can that had been by the door earlier was observed next to Staff D, LPN, who was providing the wound care. At the completion of the wound care Staff B was observed to move the trash can back to the door of the room with ungloved hands. The discarded PPE from the surveyor observation from earlier was in the can and no other PPE or trash was observed. Staff B was observed to exit Resident #12's room and walk down the hall to retrieve a bag for Staff D to put wound care scissors in. Staff B returned and handed Staff D, an opaque, whitish trash bag into which Staff D placed the scissors. Staff B was then noted to walk down the hall again to retrieve red trash bags from the isolation station outside another resident's room. She handed the red bag to Staff D who used it to discard her PPE. At no time was the Staff B observed to perform hand hygiene. At this time, Staff B was interviewed during which she stated she knew resident had c-diff. She stated she was new to the facility and had been there about a week. She stated she was sort of still on orientation and had just been observing the wound care and not providing care. She confirmed she had infection control training as part of her orientation but since she was not performing care and only observing she did not need to wear PPE but now thinks she should have. On 7/12/23 at approximately 12:00 PM, an interview was conducted with Staff E, LPN, who stated that when a resident had C-diff they were on contact isolation and gloves were required when entering the resident's room. You would only need a mask and a gown if you were going to have contact with the resident. She stated that if she was touching the patient or his bed would gown up but to just take in a tray I would just wear gloves. At this time she was asked where discarded PPE was put since there is no noted trash bin in the room, she stated the Assistant Director of Nursing (ADON) is supposed to be getting us a bin. She stated that alcohol-based hand sanitizer is fine to use when leaving the resident's room, after any care and clarified, No need for soap and water. On 7/12/23 at approximately 12:15 PM, an interview was conducted with Staff F, CNA who offered that with C-diff if you were only delivering a food tray there was no need to wear an isolation gown or a mask. You really only need to wear PPE when providing direct care such as bathing. On 7/12/23 at approximately 12:25 PM, an interview was conducted with the Infection Preventionist who was also the ADON. She stated currently there are three cases of C-diff in the building. Her expectation for staff entering these rooms is that they would follow the sign posted on the isolation cart outside the room. All staff should put on gloves and a gown when they enter the resident's room. She explained that currently they use the contact isolation sign because the facility does not have enteric isolation signs and contact is the closest one they have. She stated that she has done in-services with staff in the past related to isolation and the requirement to wear PPE in the rooms however she has identified that some of the staff only speak Spanish and realized they were not able to read the isolation signs to know what to do and she is working on getting signs in Spanish but it will be a few weeks before this is done. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105438 If continuation sheet Page 4 of 5 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 105438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aspire at Ridge Haven 4927 Voorhees Rd New Port Richey, FL 34653 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 Residents Affected - Some A record review was conducted for Resident #12 which revealed she was admitted to the facility on [DATE] with diagnoses to include diabetes type 2, Chronic Obstructive Pulmonary Disease (COPD), pulmonary fibrosis, Congestive Heart Failure (CHF), Encephalopathy, Cardiomyopathy and was on isolation for Extended-spectrum Beta-Lactamase (ESBL) in her urine and C-diff. The resident was incontinent of bowel and bladder and total care. She was on antibiotics Cefdinir 300 mg (milligrams) twice daily for 10 days and Azithromycin 500 mg daily for 5 days. On 7/4/23 the orders included Enhanced precautions every shift until 7/15/23. Review of the task sheet for bowel stated the resident had three episodes of loose/diarrhea in last 24 hours (7/12/23). Review of the resident's plan of care (POC) revealed the resident was at risk for complications due to being incontinent of urine and bowel. Had dementia and limited independent mobility. Risk for falls related to cognitive loss/decline, difficulty in walking, hx of falls and impaired mobility. Active infection Urinary Tract Infection (UTI) + H. interventions include administer medications as ordered, assess need for dietary modifications, encourage good clean hygiene to avoid cross contamination, monitor for side effects relate to ABT (antibiotic) therapy, observe facility policies for infection control. There is no mention of C-diff or isolation precautions on the POC. Review of the facility provided training documents include a Center for Disease Control and Prevention (CDC) document titled Clostridioides Difficile formerly Clostridium difficile states, Clostridioides Difficile (also known as C. diff) is a bacterium that causes diarrhea and colitis (an inflammation of the colon). C. diff infection can be life-threatening. One in 11 people over 65 diagnosed with a healthcare-associated C. diff infection die within a month. Healthcare professionals can help prevent c. diff by wearing gloves and gowns when treating patients with C. diff - and remembering that hand sanitizer doesn't kill C. diff. Review of the policy Management of C. Difficile Infection, implementation date is blank, states under section 5, General principles related to contact precautions for C. Difficile: All staff are to wear gloves and a gown upon entry into the resident's room and while providing care for the resident with C. difficile infection. Hand hygiene shall be performed by handwashing with soap and water in accordance with facility policy for hand hygiene. Review of the policy Transmission-Based (Isolation) Precautions implemented 1/2022 and revised on 1/2022. States, It is our policy to take appropriate precautions to prevent transmission of pathogens, based on the pathogens' modes of transmission. The policy offers that high touched objects or environmental surfaces include bed rails, over-bed tables, bedside commode, lavatory surfaces in residents bathrooms. Item 9. Contact Precautions states intended to prevent transmission of pathogens that are spread by direct or indirect contact with the resident or the resident's environment. Item C. Healthcare personnel caring for residents on Contact Precautions wear a gown and gloves for all interactions that may involve contact with the resident or potentially contaminated areas in the resident's environment. D. Donning personal protective equipment (PPE) upon room entry and discarding before exiting the room is done to contain pathogens, especially those that have been implicated in transmission through environmental contamination (e.g. VRE, C. difficile, noroviruses and other intestinal tract pathogens, RSV). The policy includes a section titled Recommendations for Personal Protective equipment (PPE) and states for Contact isolation gloves should be worn whenever touching the patient's intact skin or surfaces and articles in close proximity to the patient (e.g. medical equipment, bed rails). [NAME] gloves upon entry into the room or cubicle. Gowns whenever anticipating that clothing will have direct contact with the patient or potentially contaminated environmental surfaces or equipment in close proximity to the patient. [NAME] gown upon entry into the room or cubicle. Type and Duration of Transmission-Based Precautions Recommended for Selected Infections and Conditions for C-diff states Hand hygiene with soap and water. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105438 If continuation sheet Page 5 of 5