Inspection·November 2, 2023

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with the Director of Social Services (DSS) on 11/02/2023 at 12:53 pm revealed, she does not remember any grievance filed on behalf of resident #1. She went to look for Resident #1's chart and came back a few minutes later and stated she remembers this resident, he was a total care patient, alert and oriented to self with memory deficit, his daughter was the responsible party. They scheduled him for discharge, and she found out he passed away here days before his planned discharge. The DSS stated, she called the family to offer her condolences and stated the daughter never complained about anything. The DSS reported, there was no grievance about missing personal property ever voiced by the family or resident. When asked about the facility's process if a resident or family voices a concern about anything, the DSS stated, they will start the grievance process and it goes to the Department Manager. If the concern is about missing items, they would go back to the laundry because the clothing might not be labeled. The ADSS reported, the facility has a policy in place to label it and put everything brought into the facility on the inventory sheet, but if the family brings items and they do not stop at the desk with the item, there is no way to have it labeled and put on the inventory sheet. The DSS stated, this facility has the labeling machine in the laundry room and when the residents are admitted with belongings, everything goes to the laundry room. If residents bring no belongings, they will be provided with donated clothing and they will label the clothing for them. In a further interview with the DSS on 11/02/2023 at 03:35 pm revealed, the facility's policies and procedures on grievances are in place in any case resident and/or family voice a concern with anything. The DSS, was asked if she received information about Resident #1's family's concern with missing personal property to include a blue robe and two blankets, the DSS stated she did not. The DSS reported, if she had been told about the missing items, she would have gone to the Housekeeping Department to search for the items and would have called the family if the items were found. The DSS reported, if they were not found she would have called the family to follow up on the grievance procedure. The SSD reported, she went to look for the items in the laundry and did not find anything. Interview with the Assistant Director of Nursing (ADON) on 11/02/2023 at 03:30pm revealed, she received the 24 hours report on the the day Resident #1 passed away and she provided a copy of the 24-hours Report and it shows no documentation on Resident #1's family's concern about missing personal property. Interview with the Staff B, Registered Nurse (RN)/Nurse Supervisor on 11/02/2023 at 3:45 pm revealed, she is the supervisor for the day shift, and stated when she entered the facility on the day Resident #1 passed, she recalls the nurse told her the family came and picked Resident #1's belongings. When she went to express her condolences, they were already gone. She received the 24-Hour Report, but she did not remember whether missing personal property was documented, but anything put in that report, they would follow up. Staff B stated if there would have been any report on missing property, they would follow up. Record review of facility's Policy and Procedures on Grievances dated 03/01/2022 revealed: INTENT: It is the policy of the facility to have a Grievance Process in accordance with State and Federal regulations. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105513 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 105513 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Claridge House Nursing and Rehabilitation Center 13900 NE 3rd Court North Miami, FL 33161 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 0585 PROCEDURE: Level of Harm - Minimal harm or potential for actual harm 1. The facility will have a grievance procedure available to its residents and their families. The grievance procedure must include: Residents Affected - Few a. An explanation of how to pursue/redress of a grievance. b. The names, job titles, and telephone numbers of the employees responsible for implementing the facility's grievance procedure. The list must include the address and the toll-free telephone numbers of the Ombudsman and the agency. d. A procedure for providing assistance to residents who cannot prepare a written grievance without help. f. Each facility must respond to a grievance within a reasonable time after its submission. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105513 If continuation sheet Page 3 of 3