Health inspection·April 8, 2022

F 0554 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 4/8/22 at 9:52 a.m. a second observation was made of Resident #62's Restasis eyedrops on her bedside table. The vial was noted unopened. Photographic evidence was obtained. In an immediate interview, Resident #62 stated she would administer the eye drops later. Resident #62 stated the nurse had removed the artificial eye drops from the room and left the Restasis vial. On 4/8/22 at 9:55 a.m. an interview was conducted with Staff X, LPN. Staff X stated the expectation for medication administration is for the nurse to stay with the resident. When asked about eye drops, Staff X stated the expectation was the same, to provide supervision. Staff X stated the nurse should make sure administration is complete before walking away. On 4/8/22 at 10:02 a.m. an interview was conducted with Staff V, Licensed Practical Nurse (LPN). Staff V stated she was assigned to Resident #62 the two days eye drops were left at bedside. Staff V confirmed having left the Resident #62's eye drops on her nightstand. Staff V said, I should not have done that. I thought she had completed the administration. I thought she started to administer. I guess she must have put it down. Staff V stated Resident #62 does not have self-administration orders. Staff V said, she should be supervised. A follow -up interview was conducted with the Director of Nursing (DON) on 4/8/22 at 10:42 a.m. The DON stated residents should be supervised during medication administration by nursing. The DON said, the nurse should stay with the resident. The expectation is the same for oral pills or eye drop. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 2 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 did not ensure respiratory equipment was stored appropriately during three days of four days surveyed, for one floor (second floor) of two floors in the facility, and for nine residents (#56, #28, #52, #51, #102, #213, #313, #314 and #315) of 15 residents receiving respiratory care. Residents Affected - Some Findings included: On 4/5/22 at 1:28 p.m. Resident #56's nebulizer equipment was observed stored on the nightstand, the cannula and tubing were exposed to the air. A review of the admission Record for Resident #56 showed an admission date of 4/25/21 with a diagnosis, to include but not limited to, chronic obstructive pulmonary disease (COPD). The Physician Orders for Resident #56, dated 4/7/21, showed an order for Albuterol Sulfate nebulization solution 2.5 mg (milligrams)/0.5 ml (milliliters), 3 ml inhale orally via nebulizer every 6 hours as needed (PRN) for SOB (shortness of breath) related to COPD. On 4/7/22 at 12:29 p.m. Resident #28's Continuous Positive Airway Pressure (CPAP) machine was observed stored on her bedside, her mask and tubing on her bed. Resident #28 stated she wears her CPAP every night. Resident #28 stated it is always on the bed. The resident did not know how often the tubing and mask were replaced. A review of the admission Record showed Resident #28 was admitted to the facility on [DATE] with a diagnosis of Obstructive Sleep Apnea (OSA). On 4/6/22 at 11:47 a.m. an observation was made of Resident #52's oxygen and nebulizer cannula's on the nightstand not stored in a bag. Resident #52 did not know how often she used either one of them. A review of Physician Orders for Resident #52 showed orders, dated 3/23/22, to administer oxygen at 2 L (liters) via NC (nasal cannula) for oxygen percentage under 90% as needed; Albuterol Sulfate nebulization solution 2.5 mg/3 ml 0.083%, 3 ml inhale orally via nebulizer every 6 hours for wheezing; DuoNeb solution 3 ml inhale orally via nebulizer every 6 hours as needed for SOB; and DuoNeb solution 3 ml inhale orally via nebulizer two times a day for SOB for oxygen percentage under 90%. An observation was made on 4/7/22 at 9:21 a.m. of Resident #51's nebulizer machine stored on the floor, oxygen cannula and tubing were noted on the floor. An immediate interview was conducted with Resident #51. Resident #51 stated she used the nebulizer 2-3 times a day. A review of Resident #51's admission Record showed an admission date of 11/13/21 with a diagnosis of COPD. A review of the Physician Orders for Resident #51 showed orders, dated 2/1/22, for oxygen at 3 liters per nasal cannula continuously for COPD, and an order, dated 4/5/22, for Albuterol Sulfate nebulization solution 2.5 mg/3 ml 0.083%, 3 ml inhale orally via nebulizer every 8 hours as needed for SOB. On 4/7/22 at 12:20 p.m. an observation was made of Resident #102's oxygen tubing and cannula on the floor. Resident #102 stated he is supposed to be on his oxygen. Resident #102 stated the oxygen tubing fell off. A review of Resident #102's admission Record showed an admission date of 3/7/22, with a diagnosis, including but not limited to, chronic respiratory failure and shortness of breath. A review of the Physician Orders showed an order, dated 3/7/22, for oxygen at 3 liters/minute via nasal cannula for SOB / dyspnea. An observation was made on 4/7/22 at 9:39 a.m. of a CPAP machine/tubing stored inside the bedside drawer, mask not stored in a bag for Resident #213. A review of Resident #213's admission Record showed an admission date of 2/17/22 with a diagnosis, including but not limited to, COPD and acute (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 3 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some respiratory failure. A review of the Physician Orders showed an order, dated 3/24/22, to use CPAP daily at bedtime related to COPD, acute respiratory failure with hypoxia. On 4/5/22 at 11:58 a.m., an observation was made of Resident #313's nebulizer mask on top of a bedside table not stored in a bag. Resident #313 was not interviewable. A review of the admission Record for Resident #313 showed an admission date of 3/14/22. A review of Physician Orders for Resident #313, dated 3/20/22, showed to change nebulizer tubing every night shift and to administer Ipratropium-Albuterol Solution 0.5-2.5 (3 mg / 3 ml), inhale orally every 6 hours as needed for SOB. On 4/7/22 at 12:44 p.m., an observation was made of Resident #314's oxygen tubing and cannula on the floor. Resident #314 did not respond to interview. A review of the admission Record for Resident #314 showed an admission date of 3/28/22. A review of the Physician Orders for Resident #314 showed an order for oxygen at 2 liters as needed dated 3/29/22. An observation was made on 4/7/22 at 12:48 p.m. of Resident #315's CPAP supplies resting on the nightstand mask not stored in a bag. The tubing was observed to be on the floor. Resident #315 stated he wears his CPAP every night. Resident #315 was not aware if his CPAP should be stored in a bag. A review of the admission Record for Resident #315 showed an admission date of 3/31/22 and diagnosis, including but not limited to, COPD. A review of the Physician Orders for Resident #315 showed orders to wear CPAP at bedtime every evening for apnea, dated 4/6/22. On 4/7/22 at 12:57 p.m. an interview was conducted with Staff Q, Licensed Practical Nurse (LPN). Staff Q stated the nebulizer's tubing, CPAP masks, and oxygen cannula's should be stored in a clear bag. Staff Q said, it should be dated and labeled. Staff Q indicated it was third shift nurse's responsibility to place clean bags and tubing. An interview was conducted with Staff R, LPN on 4/7/22 at 1:01 p.m. Staff R stated the nebulizer's should be unplugged when not in use, cleaned, and stored appropriately. Staff R stated appropriate storage means as ordered, covered, and dated. Staff R stated she would conduct an audit of her assigned areas and replace cannula's and masks. On 4/7/22 at 1:08 p.m. an interview was conducted with Staff U, LPN. Staff U stated the nurse administering the respiratory treatment should take responsibility and make sure to clean and store the equipment in a dated bag after each use. An interview was conducted on 4/7/22 at 1:10 p.m. with Staff S, Unit Manager. Staff S said, respiratory equipment should not be on the floor. Staff S reviewed photographic evidence and said, no, that is not appropriate storage. Tubing should not be on the floor. Masks and cannula's should be in a dated bag. Staff S stated some residents refuse to store their units in bags or they remove them. Staff S said, yes ultimately it is our responsibility to ensure sanitary storage. On 4/7/22 at 1:27 p.m., a follow-up was conducted with the Director of nursing (DON). The DON stated respiratory equipment is expected to be in a bag, sometimes it is in a drawer, but it is supposed to be in a bag either way. The DON stated tubing should be changed weekly, on Sundays. The DON said, it should be dated and labeled with the resident's name and room number. The DON stated the expectation is for patients to wear it as ordered and if resident does not follow orders, the physician should be notified. The DON stated equipment is kept on beside table. The DON said, mask should be kept in a bag, placed on the machine and not on the floor. The DON stated if resident refuses appropriate storage, it should be documented, and care planned. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 4 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some An interview was conducted on 4/8/22 at 9:22 a.m. with the DON. The DON confirmed respiratory equipment should be stored and changed per physician order and policy. A review of a facility policy titled, Handheld nebulizer / small volume nebulizer, revised 3/2020, showed (11.) Store nebulizer equipment in a storage bag. Nebulizer tubing should be changed every two weeks or more often if malfunction or visibly contaminated. Clean compressor per manufacturer's recommendation. A review of the facility policy titled, BIPAP CPAP, revised 5/2021, showed (7.) the machine, tubing and masks must be cleaned according to facility policy. A review of a facility policy titled, Oxygen Administration policy and procedure, revised 3/27/2020, showed (11.) all tubing will be changed and dated every two weeks or more if malfunction or visibly soiled. (12.) Oxygen concentrators will be maintained by vendor per facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 5 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record reviews, the facility failed to ensure behavior monitoring was in place for one resident (#59) out of five residents sampled for unnecessary medications. Findings included: A review of the admission Record for Resident #59 indicated the resident was admitted on [DATE] with a diagnoses, including but not limited to, anxiety, dementia in other disease classified elsewhere without behavioral disturbance, and major depressive disorder. A review of Physician Orders for Resident #59 showed the following: Buspirone Hydrochloride tablet 7.5 milligram (mg) give 7.5 mg by mouth two times a day related to anxiety disorder, unspecified. Start date: 4/23/2021 Effexor XR capsule extended release 24-hour 150 mg give one capsule by mouth one time a day related to major depressive disorder, recurrent, unspecified. Start date: 8/12/2021 Gabapentin capsule 400 mg give 1 tablet by mouth three times a day for neuropathy. Start date: 4/21/2021 Norco tablet 5-325 mg give 1 tablet by mouth every 6 hours as needed for pain management. Start date 4/7/2022 A review of the Comprehensive Care Plan for Resident #59 revealed the following: A focus area of Mood Disorder was in place and had interventions, including but not limited to, monitor my mood and behaviors for change and notify psychiatric doctor of any concerns. A focus area of Behavior was in place and had interventions, including but not limited to, observe/document for side effects and effectiveness of medications. A review of the Medication Administration Record (MAR) and the Treatment Administration Record (TAR) for April 2022 revealed no behavior monitoring was in place for Resident #59. An interview was conducted on 4/8/22 at 10:22 a.m. with Staff O, Licensed Practical Nurse (LPN). Staff O looked in Resident # 59's clinical record to check for behavior monitoring for psychotropic medication use. Staff O stated behavior monitoring should be on the MAR and monitoring should be completed every shift by the nurse. Staff O was unable to find any behavior monitoring in Resident #59's clinical record. Staff O opened another resident's record to confirm the location of behavior monitoring and to demonstrate how it should be displayed in the record. Staff O confirmed Resident #59 should have behavior monitoring in place and the monitoring was not present in the record. An interview was conducted on 4/8/22 at 10:50 a.m. with the Director or Nursing (DON). The DON stated if a resident is prescribed psychotropic medication the resident should have a proper diagnosis (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 6 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few for the medication. The DON stated her and the Advanced Registered Nurse Practitioner (ARNP) review the orders and the resident when any resident is prescribed a psychotropic medication. She stated a gradual dose reduction (GDR) is done if needed. The DON stated behavior monitoring and modifications should be completed every shift for residents on psychotropic medications. The DON stated the order for monitoring should be entered into the MAR when the medication order is entered. She confirmed the behavior monitoring would be completed by the nurse and documented in the MAR. A review of the facility policy titled Psychotropic Medication Use, revised 5/2019 was conducted on 4/8/2022. The policy indicated: 3. The facility supports the goals of determining the underlying cause of behavior symptoms so the appropriate treatment of environmental, medical, and/or behavioral interventions, as well as psychopharmacological medications can be utilized to meet the needs of the individual resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 7 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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, interviews and record review, the facility did not ensure medications were inaccessible to unauthorized staff, residents, and visitors for one resident (#70) out of thirty-three residents, and for one (second floor medication cart) of two medications carts observed. Findings included: During a facility tour 4/7/22 at 09:44 a.m. an observation was made of two tablets in a plastic med cup on resident's nightstand. Resident #70 was not in the room at the time. Her roommate stated Resident #70 had gone to the store to pick up some snacks. On 4/7/22 10:02 a.m. an interview was conducted with Staff R, LPN. Staff R stated she had administered Resident #70's medications earlier in the morning. Staff R stated the resident had taken her medications. Staff R walked into the room and observed two tablets in a plastic cup on Resident #70's nightstand. Staff R said, I am surprised. She usually takes her medications. It is my fault. I should have stayed and watched her swallow. Staff R stated she was assisting Resident #70's roommate and had assumed she took her medications. Staff R could not confirm what they were. On 4/7/22 at 10:40 a.m. an interview was conducted with Resident #70 and Staff R. Resident #70 stated she had just returned from the store. Resident #70 said, I got distracted. I didn't have enough water to swallow the pills. I spit them out. I forgot to take my meds. It was not the nurse's fault. It was me. I forgot. I will take them now. Resident #70 stated she usually takes her morning meds between 8 a.m. and 9 a.m. A review of Resident #70's admission Record showed an admission date of 9/11/20 with a primary diagnosis, including but not limited to, neuropathy unspecified. A review of the MDS assessment for Resident #70, dated 2/15/22, showed a BIMS of 14, indicating intact cognition. A review of the Comprehensive Care Plan for Resident #70 revealed a focus area, dated 2/15/21, as ADL self-care deficit related to decline in overall function secondary to illness and hospitalization with an intervention to give Resident #70 medications as ordered. Another focus area in the care plan, initiated on 4/8/22, revealed Mood and Behavior: behaviors include pocketing medications and spitting out meds after administering from nurse with interventions to include nursing staff to monitor and check for pocketing of medications and validate no pills left in mouth with each med pass. An interview was conducted on 4/7/22 at 10:50 a.m. with Staff S, Unit Manager. Staff S confirmed medications should not be left unattended. Staff S stated the expectation is to stay with the resident until they swallow the medications. On 4/7/22 at 10:10 a.m. an observation was made of the medication cart on the second floor, the cart was unlocked and the keys were left on the cart. The nurse was not by her cart. Residents, staff, and families were observed walking by the medication cart. Photographic evidence was obtained. An interview was conducted on 4/7/22 at 10:16 a.m. with Staff V, LPN. Staff V stated the medication cart should be locked all the times. Staff V said, I know, I should have locked the cart and taken the keys with me. It's my fault, I'm sorry. Staff V stated the expectation is not to leave the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 8 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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 medication cart unlocked. Level of Harm - Minimal harm or potential for actual harm An interview was conducted on 4/7/22 at 10:50 a.m. with Staff S, Unit Manager. Staff S confirmed medications should not be left unattended. The medication cart should be locked any time the nurse is walking away. Staff S stated the nurse should have the keys on them. Staff S said, It is for the safety of everyone. Residents Affected - Few On 4/8/22 at 9:55 a.m. an interview was conducted with Staff X, LPN. Staff X stated the expectation for medication administration is for the nurse to stay with the resident and make sure they swallow all their pills. When asked about eye drops, Staff X stated the expectation was the same, to provide supervision. Staff X stated the nurse should make sure administration is complete before walking away. A follow -up interview was conducted with the Director of Nursing (DON) on 4/8/22 at 10:42 a.m. The DON stated residents should be supervised during medication administration. The DON said, the nurse should stay with the resident. The expectation is the same for oral pills or eye drop. A review of a facility policy titled, Medication Storage, revised 3/21, indicated: Policy: for medications and biological's to be stored safely, securely, and properly, following manufacturer's recommendations for the supplier. The medication is accessible only to nursing personnel, pharmacy personnel, or staff members authorized to administer medications. (8.) compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts, and boxes.) containing drugs and biological's shall be locked when not in use, trays or carts used to transport such items shall not be left unattended if open or otherwise potentially available to others. (11.) Only persons authorized to prepare and administer medications shall have access to the medication room, including keys. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 9 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Based on observation, interviews, and record review the facility failed to ensure adequate staffing in the kitchen in order to provide residents with timely meals, during three of four meal services observed on 4/6/2022 and 4/7/2022. It was determined one hundred and nine residents out of one hundred and fourteen residents in the building receive meal trays and meal service. Findings included: On 4/5/2022 at 9:20 a.m. the kitchen was toured with Staff A, Kitchen Manager. During the tour, Staff A pointed out he had two dietary aides, Staff E and Staff Y, in the kitchen as well as himself, a total of three dietary staff members. He confirmed there were one hundred and fourteen residents in the building as of 4/5/2022. Staff A was asked if he had enough staff to prepare, cook and send out food to all the residents in the building in timely manner. He indicated he works up to seventy hours a week to ensure appropriate staffing in the kitchen. He did not offer any information as to why he had to work so much. Staff A confirmed the kitchen staff is contracted and there have been new hires recently but they don't stay. He was asked what number of kitchen staff would be appropriate in the kitchen and he could not answer. Staff A did confirm he could use more help and does not know if his agency is trying to hire new staff or not. Staff A revealed he had been working at the facility for about five months now and has had a large staff turnover. He also confirmed he works seven days a week. At 9:25 a.m. an interview was conducted with Staff E, Dietary Aide and Staff Y, Dietary Aide, neither staff member would answer if they felt the kitchen was short staffed. They did, however, reveal they do the best that they can with what they have. Staff members A, E and Y were asked if meal trays were being sent out to the floor and dining room late on a routine basis. None wanted to answer the question with a clear yes or no. On 4/5/2022 at 9:45 a.m. both the first floor and second floor hallways were still observed with meal tray carts and with staff picking up completed meal trays from resident rooms. Interviews with Certified Nursing Assistants (CNAs) Staff I, J, K, L, and M all revealed meals generally come out late in the mornings and they try to pass the meal trays to residents as quickly as they can, when the cart arrives. None of the aides interviewed were able to say why the meal tray carts come out late from the kitchen. Staff I and K stated they felt the Kitchen was short on staff. On 4/5/2022 at 11:00 a.m. the Kitchen Manager, Staff A provided the Tray Meal Service times document for review. The breakfast meal service times revealed the following: Cart 1 Rooms 134 - 132 7:15 a.m. Cart 2 Rooms 111 - 121 7:30 a.m. Cart 3 Rooms 101 - 110 7:40 a.m. Cart 4 Rooms 223 - 232 7:50 a.m. Cart 5 Rooms 211 - 222 8:00 a.m. Cart 6 Rooms 201 - 209 9:00 a.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 10 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During tour of the facility on 4/5/2022 from 11:30 a.m. through to 1:00 p.m. random interviews with Residents #94, #38, #17, #101, #49, #86, #11, and #34 all revealed they typically eat all three meals in their rooms and confirmed the kitchen is routinely late sending out food. The residents revealed breakfast meals are typically the main meal that is sent out late. They were all aware of when they are supposed to receive their tray and further revealed they typically receive their trays in their room about thirty to forty minutes later than what is posted. On 4/6/2022 the facility was entered at 7:08 a.m. to observe the breakfast meal service. There were three dietary aides working in the kitchen, Staff Y, E, and Z. Staff Z stated she was asked to come in from her regular working facility to help out. Staff Z was not listed as an employee at the facility. The Kitchen Manager, Staff A was not in the kitchen at the time of the observation. An interview was conducted with Staff Y, and E. They stated they did not know where Staff A was. An observation of the breakfast meal was conducted on 4/6/22, the meal trays made it out to the floor during the following times: a. Cart for rooms 101 - 110 arrived on the floor at 8:46 a.m. A review of the meal service time sheet revealed the cart was supposed to arrive on the floor at 7:40 a.m. It was found the cart arrived on the floor one hour and six minutes late. b. Cart for rooms 111 - 121 arrived on the floor at 8:36 a.m. A review of the meal service time sheet revealed the cart was supposed to arrive on the floor at 7:30 a.m. It was found the cart arrived on the floor one hour and six minutes and one hour and sixteen minutes late. c. Cart for rooms 132 - 134 arrived on the floor at 8:26 a.m. A review of the meal service time sheet revealed the cart was supposed to arrive on the floor at 7:15 a.m. It was found the cart arrived on the floor one hour and eleven minutes late. d. Cart for rooms 223 - 232 arrived on the floor at 8:20 a.m. A review of the meal service time sheet revealed the cart was supposed to arrive on the floor at 7:50 a.m. It was found the cart arrived on the floor thirty minutes late. An observation of the breakfast meal was conducted on 4/7/22, the meal trays made it out to the floor during the following times: e. Cart for rooms 101 - 110 arrived on the floor at 8:24 a.m. A review of the meal service time sheet revealed the cart was supposed to arrive on the floor at 7:40 a.m. It was found the cart arrived on the floor one hour and nine minutes late. f. Cart for rooms 111 - 121 arrived on the floor at 8:05 a.m. A review of the meal service time sheet revealed the cart was supposed to arrive on the floor at 7:30 a.m. It was found the carts arrived on the floor thirty-five minutes late. g. Carts 132 - 134 arrived on the floor at 8:30 a.m. A review of the meal service time sheet revealed the cart was supposed to arrive on the floor at 7:15 a.m. It was found the cart arrived on the floor one hour and fifteen minutes late. Interviews conducted on 4/7/22, during the meal observation, with Staff F, Licensed Practical Nurse (LPN), Staff K, CNA, and Staff M, CNA, all confirmed the meals are still getting out late and they (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 11 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many felt there was not enough staff in the kitchen to prepare and get meals out in a timely manner. Staff F, K, and M stated residents continually ask where their breakfast is and all they (staff) can do is to serve them coffee and hydration. On 4/8/2022 at 6:30 a.m. the building was entered to review 11-7 shift staffing for both nursing staff and the kitchen staff and also meet with the Staffing Coordinator. She confirmed she completes daily staffing for direct care and does not handle staffing for the kitchen, as they are contracted. She revealed sometimes the facility will pull activities staff during meal service to assist with meal tray pass and to get tray carts from the kitchen. The Staffing Coordinator confirmed there used to be sufficient staffing in the kitchen prior to the contracted company taking over and she does not know why kitchen staffing at this time constantly has turn over. The Staffing Coordinator did not have any further information to provide with relation to appropriate staffing in the kitchen. On 4/8/2022 an interview with the Kitchen Manager, Staff A, the other new Dietary Manager Staff B, and the Regional Dietary Manager, all revealed they believed they had sufficient kitchen staffing numbers in the kitchen during the lunch and dinner meal service but confirmed they could have more kitchen staff during the breakfast meal service. They confirmed having more staff in the kitchen could have ensured breakfast tray carts getting out from the kitchen and to the floor in a timelier manner, and in a manner with following the meal tray service times sheet. They were aware meals were brought out from the kitchen in an untimely manner, resulting in residents receiving their meals late. The Kitchen Manager, the Director of Nursing and the Regional Dietary Manager revealed the facility did not have a specific Kitchen Staffing policy and procedure. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 12 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** The facility failed to ensure food preferences and meal choices were honored for one resident (#94) out of two residents investigated for choices, during two meals observed on 4/5/2022 and 4/7/2022. It was determined Resident #94 had expressed his food preferences related to not receiving eggs during the breakfast meal to multiple staff members and he continued to receive eggs on a routine basis. Findings included: On 4/5/2022 at 9:30 a.m. Resident #94 was visited in his room and interviewed with permission. The resident was observed seated in his wheelchair next to his bed and had his over the bed table placed in front of him. He still had his breakfast meal tray placed in front of him on the table. The lid was still in place as if he did not eat anything. Resident #94 was observed dressed for the day and pleasant to speak with. Resident #94 expressed he routinely receives food items he hates and he has spoken with the Dietary Manager, Staff A about his choices. Resident #94 indicated he hates eggs and gets them almost every morning. Resident #94 pointed to the wall next to the bathroom door and said to look at the menu sheet. Upon review of weekly menu sheet, the word eggs was penned out and with large bold letters all over the sheet, indicating NO EGGS. Photographic evidence was taken. Resident #94 stated he has spoken to his care aides as well when they drop off the tray. He continued to state staff drop off the tray so fast and leave before he can lift the lid off and see if he had eggs or not. Resident #94 was asked about the meal tray in front of him and he lifted the lid. An egg omelet was observed on his plate. Resident #94 did not touch or eat anything due to the fact he does not like the sight of eggs. He stated he was hungry and would eat something if they brought him something else. However, it was 9:30 a.m. and staff were observed in the hallways picking up trays for residents who have already eaten. There was a meal slip/ticket on his meal tray and it had documentation printed light in color and not clear to read. Most of the ticket was unreadable. It appeared that the printer where this ticket was printed was either out of ink or almost out of ink. No preferences were able to be seen. On 4/5/2022 at 11:00 a.m. the Kitchen Manager Staff A confirmed he was aware Resident #94 did not like eggs and they have tried to accommodate the resident by not providing eggs. Staff A stated the tray ticket system only indicates food allergies and does not indicate food likes and dislikes. Staff A was asked how he and his dietary line staff would know and honor resident food preferences, and he indicated he does not have a good tracking system for preferences. On 4/7/2022 at 8:20 a.m. Resident #94 was observed in his room and seated in a wheelchair next to his bed. He was observed with the over the bed table placed in front of him and with his breakfast meal tray placed on the table. The lid was on and the resident appeared to be upset. He shook his head in a no manner and revealed, they did it again. He pointed to his breakfast tray and lifted the lid. The meal he was provided was a double portion of scrambled eggs, one round sausage patty, and one Danish. The tray also included one bowl of hot oatmeal, a glass of juice, and a carton of 2% milk with an empty glass. Photographic evidence was obtained. Resident #94 expressed he was not going to touch anything on his plate because he hates eggs and further expressed the staff were completely aware of his likes and dislikes, especially eggs. The meal ticket placed on the meal tray was reviewed and indicated: 4/7/22 Regular diet, apple juice, assorted Danish, hot coffee, creamer, low fat fruited yogurt. Photographic evidence was taken. Resident #94 placed the lid back on the plate and stated staff just placed it on his table and left before he could lift the lid and see what he got. He (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 13 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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 0806 stated he was hungry and wanted to eat but would not eat what was provided on the plate. Level of Harm - Minimal harm or potential for actual harm On 4/7/22 at 8:25 a.m. the floor nurse, Staff F stated she was not aware if Resident #94 liked or disliked eggs until she heard him call out he did not want eggs during the breakfast meal service on 4/5/2022. She stated she floats to different floor assignments and does not know the resident well. She did express she would follow up with the resident. Residents Affected - Few On 4/7/2022 at 8:33 a.m. the Certified Nursing Assistant (CNA) Staff I, who had Resident #94 on her work assignment, stated she knew the resident and also knew he did not like eggs. Staff I, CNA stated she did not serve him his meal this a.m. and didn't know who did. She stated Resident #94 does receive eggs and when she sees this she will tell the kitchen and get another tray. She confirmed she has seen Resident #94 receive eggs often. A review of Resident #94's medical record revealed he was admitted to the facility on [DATE] and readmitted on [DATE]. A review of the Advance Directives revealed Resident #94 was his own responsible party. A review of the current Minimum Data Set (MDS) quarterly assessment, dated 3/7/2022, revealed: In Section C-Cognition, a Brief Interview of Mental Status (BIMS) score of 13, which indicated Resident #94 was able to speak on behalf of himself and his care and services. In Section G-Functional Abilities, Activities of Daily Living indicated Resident #94 was able to eat independently with set up only and was on a regular diet. A review of the Physician's Order sheet for the month 4/2022, revealed a diet order to include: Regular Diet, Regular texture, thin liquid consistency. A review of the Progress Notes revealed, dietary notes dated from 1/2022 through 4/7/2022, did not indicate any food likes/dislikes or food preference documented for Resident #94. A note dated 4/7/22 at 9:54 a.m. was added to the record and indicated, Resident food preference updated by Kitchen Staff/Management and tray cards have been updated. Will continue to monitor and follow up with needs as needed. A review of the Comprehensive Care Plan for Resident #94 revealed the following: Focus: Potential for nutrition decline: (last revised on 3/7/2022) with interventions, to include but not limited to, Registered Dietician to evaluate and make diet change recommendations. An interview with the Interim Certified Dietary Manager, Staff B, confirmed Resident #94 does not like eggs and they are going to update the tray slip to show his dislikes. She revealed she had spoken to some staff to include dietary and nursing, and the staff had confirmed Resident #94 does not like to receive eggs. She indicated she was just hired on as the manager of this facility and her first observation indicated the kitchen did not have a good ticket tracker and food preference identification system. On 4/7/2022 at 11:00 a.m. an interview with the Director of Nursing (DON), Staff A, and Staff B was conducted. They stated they did not have specific policies and procedures with relation to food (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 14 of 15 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 105525 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatee Springs Rehabilitation and Nursing Center 5627 9th St E Bradenton, FL 34203 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 0806 preferences and or food likes/dislikes. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105525 If continuation sheet Page 15 of 15