Inspection·January 10, 2020

F 0689 Level of Harm - Minimal harm or potential for actual harm station/common areas for close observation, redirect as needed (start date: 12/30/19). Anti-roll backs to wheelchair (start date: 1/2/20). Provide 1:1 as needed (start date: 1/8/20). ADL (Activities of Daily Living) deficit: assist with toileting and transfers, provide ADL care to ensure daily needs met. Communication deficit: interventions: anticipate and meet the needs per physical/non-verbal indicators of discomfort/distress. Behavioral: address wandering; redirect from inappropriate areas. Residents Affected - Few Review of a Nursing Progress note dated 12/27/19 at 7 p.m. revealed: Resident's daughter and son in law with resident on admission. Daughter reports She has been very confused and trying to get out of bed constantly. Her bed had to be put in front of the nurse's station because she won't stay in bed. Resident's room placed across from the nurse's station at this facility .Family says, She will fall here, just so you know. Resident doesn't know where she is, she is impulsive with no safety awareness, and she is not able to call for assistance or verbalize her needs due to poor cognition. One family member stays with her at all times because she will get out of bed in a second. Family left facility at 7:15 p.m., at 7:17 p.m. she was out of the bed and did not know why. Frequent observation every 5 minutes. Resident found on the floor by the dresser less than one minute after being toileted and put back to bed. Family and physician were notified. Family says, Of course she fell, we said she would. No injuries. Resident is attended to by one to one staff. This note also reflected that the family requested side rails for bed mobility and the use of restraints. A Nursing progress note written on 12/28/19 at 4:17 a.m. indicated that Resident #226 was found on the floor by a Certified Nursing Assistant (CNA). Patient observed on floor past foot of the bed between wheelchair and tall dresser in room; on right side of buttocks on floor, and right side of head leaning against the wall; no injuries observed; neuro checks initiated. MD (medical doctor) notified, POA (Power of Attorney) daughter notified. Daughter stated, I told you so. Daughter informed that labs would be drawn in the morning, and that Resident #226 would be on 1:1 supervision for the rest of the 3-11 p.m. CNA shift; and that on the 11 p.m. to 7 a.m. shift the resident would be by the nurse's station near the nurses and CNAs. Observations of Resident #226 were conducted over a few days. These observations revealed the following: 1/7/20 at 10:00 a.m.: Resident #226 was lying in bed, and a CNA was getting ready to provide morning care to the resident. Her room was directly across from the nursing station in the 400's hall. 1/8/20 at 2 p.m.: resident was lying in bed. after lunch. One of the CNA's had just provided incontinence care and helped her back into bed. 1/9/20 at 1 p.m.: resident was sitting at bedside in wheelchair; with an empty lunch tray on the bedside table in front of her. Her grandson was in the room with her. 1/10/20 at 11 a.m.: Resident #226 was lying in bed, eyes closed. A Registered Nurse (RN), Staff N , was sitting in a chair at the bedside. Staff N said, I am working as a sitter today. This resident is on 1:1 supervision, and so I will be her sitter until the replacement comes at 1 p.m. This is my first time as her sitter, but I have functioned as her nurse before, about a week ago. An interview was conducted on 1/10/20 at 11:15 a.m. with the Rehab Director, Staff M. Staff M said, Yes, the resident had a decline in her mobility. Side rail evaluations are done by the nurses. However, I can tell you that the side rails are to aide with bed mobility, but that is only if the resident is cognitively aware enough to use them. In her case, I do not think it would have been of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 2 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 benefit to her. Also, side rails do not prevent falls. She needed constant redirection as she was very impulsive. A progress note was written on 12/31/19 at 1:02 p.m. by an Advanced Registered Nurse Practitioner (ARNP). The ARNP's note revealed: Review of Systems: Neurologic: Alert and oriented x 1 only. Assessment: Acute Urinary Tract Infection (UTI) . and Advanced Dementia His note also revealed: Travel to an outpatient office setting for care/treatment could not be accomplished without taxing effort from the patient and care staff. Patient suffers from acute and chronic debilitating medical conditions and requires close follow-up and treatment to avoid unnecessary re-hospitalizations. Review of labs and diagnostics completed in December 2019 revealed that the urinalysis test was negative, and the x-rays of both hips were also unremarkable. A neurological evaluation flow sheet was completed over 72 hours for the resident. An interview was conducted on 1/10/2020 at 12:00 p.m. with the Social Services Director, (SSD), Staff K. Staff K said, Yes, I did know the Resident, and I knew her to be confused on admission. I remember that the family was encouraged from the beginning to have 1:1 care. The resident had to be kept right by the nurse's station because she kept getting up from the wheelchair and tried to walk around. I did write that note on 12/31/19, and I let the family know that there were other options. An interview was conducted on 1/10/20 at 12:10 p.m. with the Weekend Nursing Supervisor, Staff L . Staff L said, Yes, I am very familiar with the resident. I was here when she was admitted . Her family was here. But they made it seem like the resident was more confused than her normal baseline. We weren't sure of how much of a fall risk she was, until a few hours had passed. But yes, the family did tell us that she had siderails and restraints in the hospital. We don't use restraints at this facility. I felt that the resident should be on frequent checks, so that is what I directed the staff to do. After the first fall, then I put her on one to one supervision, but it wasn't documented in the record as one to one. Then there were a few minutes, when the resident was left alone, because I had to attend to something, and she fell again. I know when someone is on 1:1 supervision, that you have to get another staff member to watch the resident while you are out of the room, and I didn't do that. An interview was conducted on 1/10/20 at 1:30 p.m. with the Nursing Home Administrator (NHA), who functioned as the Risk Manager. The NHA said, I will refer you to my Director of Nursing (DON) for the actual details of the investigation; she is actually the spearhead for the investigations. An interview was then conducted with the DON on 1/10/20 at 1:45 p.m. The DON said, Yes, I did investigate her falls. She had a fall on the 12/28 and 12/29/19. When she was made aware that the fall log and progress notes indicated falls on 12/27 and 12/28/19, the DON stated she needed to go and verify the actual dates. The DON said, I didn't bring all my investigative notes with me, I just have the event reports for the falls on 12/27/19 and on 12/29/19. I will have to go get the rest of the information. The DON was asked about her process for investigation of falls. The DON said, After a fall, there should be an incident report filled out, with witness statements of what happened/was observed, and what immediate interventions were done. This immediate report should be done by the nurse on the floor that is assigned to that resident. This report gets reviewed by the DON, and Assistant Director of Nursing (ADON) during Stand-up meeting in the morning. Physician orders should be reviewed, and all interventions initiated. If there was a major injury, an Immediate Report should be filed to the state. But she had no injuries. Then the DON, and ADON meet with the unit manager to complete the root cause analysis and determine if interventions were appropriate. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 3 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 Again, I don't have all the information, on witnesses, all staff involved, and who met for the Standup, etc. I will have to go and get that information. The DON returned and a short while later and confirmed with a member of the surveyor team that her investigations of Resident #226's falls were incomplete, and she could not provide any further information on her investigations. Review of Fall #1's Event Report referred to by the DON in the preceding paragraph revealed: Description: Fall No Injury. Date and Time of the Event: 12/27/19 at 7:35 p.m. Location of Injury: none. Doctor Notified: 12/27/19 at 7:40 p.m. Doctor's Response: admission labs in a.m. Family notified: 12/27/19 at 7:50 p.m. Was fall witnessed? : No. What was resident doing just prior to fall? : resting in bed. Describe measures taken: neuro checks initiated; 1:1 with CNA, during the night 1:1 with nurses at the nurse's station. Care plan reviewed and revised: Yes. Orders: Monitor for 72 hours for bruising, change in mental status/condition, pain, or other injuries related to fall. Physical therapy consult ordered. Evaluation notes: Resident a new admission with confusion and right hip fracture; very fidgety and restless being in new facility. Bed in lowest position; will continue to monitor. Fall prevention program initiated: No. Review of the 5 Why's Root Cause Analysis Worksheet revealed: Define the problem: Fall 12/28/19. Why is it happening? Resident is a new admission to a new facility. Why is that? Right hip fracture, dementia. Why is that? Confused and fall risk. Why is that? Bed in lowest position. Review of Fall #2's Event Report created on 12/29/19 revealed: Description: Fall event. Date and Time of the Event: 12/29/19 at 11:20 a.m. Resident Evaluation: Location of Injury: no new injuries noted/observed at current time. Doctor notified: 12/29/19 02:20 Doctor's response: (blank). Family notified: 12/29/19 12:00 Was fall witnessed? : No What was resident doing just prior to fall? : resting in low bed position. Care plan reviewed and revised as needed: Yes. Treatments: Initiate Fall Prevention program: ordered 12/29/19, discontinued 12/30/19. Fall with Suspected head trauma: neuro checks every 15 minutes x 4, then every hour x 2, then every 2 hours x 2, then every 4 hours x 2, then every shift x 3. Evaluation: Resident alert and confused with poor safety awareness. Resident continues to get up out of chair constantly, attempts to ambulate and transfer without assistance. Resident's family and physician aware. No apparent injuries noted. Resident to be redirected as needed and to be kept closer to nurse's station and common areas for closer supervision. Fall prevention program initiated: No. Review of the 5 Why's Root Cause Analysis Worksheet revealed: Define the problem: Fall 12/29/19. Why is it happening? Resident observed on floor in her room. Why is that? Resident has dementia with poor safety awareness. Why is that? Attempts to transfer/ambulate without assistance. Observed to be very fidgety. Why is that? New orders for hip x-rays. Resident on 1:1 for rest of the shift. Labs completed with no new orders. Review of the facility's policy titled, Falls, revised on 11/6/19, revealed: Policy Statement: It is the intent of this facility to provide residents with assistance and supervision to minimize the risk of falls and fall related injuries. Guidelines; 1) All residents will have a comprehensive fall risk assessment on admission/readmission .Appropriate care plan interventions will be implemented (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 4 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 FORM CMS-2567 (02/99) Previous Versions Obsolete and evaluated as indicated by the assessment. 2) The care plan will be reviewed following each fall; interventions are to be revised as indicated by the assessment. 3) If a fall occurs, the following actions will be taken: f) Document the evaluation, pertinent facts, and incident in the Electronic Medical Record (EMR). g) Begin investigation. h) Interdisciplinary Team (IDT) and DON reviews during At Risk Meeting: a. Identify additional referrals, consults, and interventions. b. Document resident response to intervention. c. Document At Risk review in the EMR (electronic medical record). Event ID: Facility ID: 105529 If continuation sheet Page 5 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** During interview on 01/08/20 at 5:55 p.m., Staff H, Licensed Practical Nurse (LPN) said that, Resident #333 should get Xanax at bedtime, but the prescription is not available for the Resident. Staff H said that if the prescription is not in from the pharmacy, they should pull it from the emergency drug kit (EDK). Residents Affected - Some During an interview with the Director of Nursing (DON) on 01/09/20 at 9:31 a.m., the DON said that staff are expected to call pharmacy, check with the physician, and get a code to fill medication. Upon review of the Medication Administration History, the DON acknowledged that Resident #333 had not received her pain or anxiety medications on multiple days. The DON acknowledged that the resident had not received anything for pain management during the night of 01/06/20 until the following morning at 5:00 a.m. when the Resident was provided with Tylenol. The DON acknowledged that the (Pharmacy Supplier) Shipping Manifest revealed that Resident #333's prescriptions were sent from the (Pharmacy Supplier) on 01/07/20 at 10:18 a.m. and would not have arrived until around 1:00 p.m. on 01/07/20 with Xanax not listed as one of the medications. Policy review of Medication Administration General Guidelines dated 9/18 revealed on page 3, Section: Medication Administration 1. Medications are administered in accordance with written orders of the prescriber. If a dose seems excessive considering the resident's age and condition, or a medication order seems to be unrelated to the resident's current diagnosis or condition, the nurse calls the provider pharmacy for clarification prior to the administration of the medication. If necessary, the nurse contacts the prescriber for clarification. This interaction with the pharmacy and the resulting order clarification are documented in the nursing notes and elsewhere in the medical record as appropriate. 14. Medications are administered within 60 minutes of scheduled time, . Based on observations, interviews, record review, and policy review, the facility failed to provide admission medications related to pain, anxiety, and antibiotics for a urinary tract infection (UTI), after transfer from the hospital for one (Resident #333) of three residents sampled. Findings included: During an interview with Resident #333 on 01/07/20 at 11:30 a.m. she revealed she was admitted on [DATE] at 2:58 p.m. The resident stated that she did not receive any of her medications during the evening of her admission as directed by her physician. Also, prior to arriving to the facility from the hospital, she was taken off injectable pain medication. As the evening progressed at the facility, she began experiencing pain due to back spasms. Resident # 333 requested her medication during the evening due to increasing anxiety and pain. However, the facility did not have her medication and no relief came until midnight. Around midnight, the nurse provided her with something which helped ease the pain. The resident did not think it was her prescribed medication. Record review of the Medical Certification for Medicaid Long-Term Services and Patient Transfer Form revealed that Resident #333 was transferred to facility with a primary diagnosis (DX) of left knee pain with additional DX of severe osteoarthritis, rheumatoid arthritis, and a UTI (Urinary Tract Infection). The record also revealed that the resident was alert, oriented, and followed instructions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 6 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 0760 Review of Resident #333's medical record showed a Physician Order Report with the following information: Level of Harm - Minimal harm or potential for actual harm admission date and time: 1/6/2020, 14:58 (2:58 p.m.) Medications with a start date of 01/06/20 included: Residents Affected - Some Acetaminophen (Tylenol) for mild pain. Instructions: 325 MG (milligrams), 2 tablets, orally every 6 hours as needed. Alprazolam. (Xanax) for anxiety disorder. Instructions: 0.5MG tablet orally once a day HS (at bedtime) Amoxicillin for UTI. Instructions: 500MG, 1 tablet orally for 7 days, 3 times a day. Baclofen for muscle spasms. Instructions: 10 MG tablet orally 3 times a day. Meloxicam 15 mg for osteoporosis. Instructions: 1, 15 mg tablet orally Once per day. Restasis (cyclosporine) for dry eye syndrome. Instructions: install 1 drop into each eye every 12 hours. Record Review of the (Pharmacy Supplier) Inventory Summary (inventory present in the EDK Emergency Drug Kit) revealed that since 11/11/19 medications available for residents if their prescriptions are not filled by pharmacy in a timely manner included: amoxicillin 250 MG tablets, Xanax 0.25 MG tablets, and meloxicam 7.5 MG tablets. Review of Resident #333's Medication Administration History showed that none of the prescribed or as needed medications were administered on 1/6/2020. The following entries were found in the medication administration record: Xanax at bedtime, not administered on 1/6/20 due to drug unavailable, resident new admission. Xanax at bedtime, not administered on 1/7/20 due to unavailable, awaiting pharmacy delivery Amoxicillin 500 mg, not administered on 01/06/20 due to late charting, New Admission. Baclofen 10 mg, not administered on 01/06/20 due to late admission. Baclofen 10 mg, not administered on the morning of 01/07/20 due to unavailability, pharmacy notified. Meloxicam not administered on 01/06/20 due to late charting. Restasis not administered on 01/06/20 due to new admission status. Restasis not administered on the morning of 01/07/20 due to unavailability. Tylenol 325 mg two tablets were given on 01/07/20 at 5:16 a.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 7 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of the Care Plan dated 01/07/20 revealed additional DX of unspecified pain, anxiety disorder due to a known physiological condition, and muscle spasms. Care plan goals related to required medications include: 1) Resident will have relief or reduction in pain intensity within 1 hour after receiving interventions over the next 30 days. Actions to achieve this goal include administering pain medications per physicians' orders and observing effectiveness of pain medications. 2) Resident will be free from signs and symptoms of infection by 01/13/20. Actions to achieve this goal include administering medications per physicians' orders and observing for adverse reactions to medications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 8 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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** 5. On 01/07/20 at 1:48 p.m., Resident #58 was observed sitting in her wheelchair with oxygen cannulas in her nostrils, with the oxygen concentrator turned on. Upon entering the room, the resident was oriented and able to communicate. A nebulizer mask was observed on the nightstand desk behind her. The nebulizer mask was placed directly on the nightstand without protective bagging. The nightstand was also used to store the resident's personal items to include food products, tissues, and a lotion bottle. (Photographic Evidence Obtained) During the observation and interview, the Assistant Activities Director (AAD) entered the room to take the resident to bingo. At 2:00 p.m., the resident was observed being wheeled by the AAD with the catheter bag under the resident's wheelchair being dragged along the floor down the hallway. Residents Affected - Some Record review of Resident 58's care plan with a start date of 12/16/19 and edited on 12/18/19 revealed, Resident is at risk for complications related to current indwelling urinary catheter R/T (related to) recent hospitalization for bladder obstruction. Requires assists with toileting, transfers and cath care. The goal was documented as, Resident will have catheter care managed appropriately . An observation on 01/08/20 at 2:51 p.m. revealed Resident #58 to be sitting up in a wheelchair with a water cup in front of her as she watched television. Resident #58 was wearing oxygen cannulas with the oxygen concentrator turned on. The nebulizer mask was observed to be placed directly on the nightstand without protective covering. The catheter bag was observed to be underneath the resident's wheelchair in contact with the floor. Staff I, CNA said during an interview on 01/09/20 at 2:47 p.m. that while providing care to the resident related to the catheter, they look for any sediment around it and that the urine is clear. They verify that the resident is not complaining of pain. Staff I said that if the catheter bag is touching the floor; then staff can maneuver the bag, so the tubing and the bag are lifted off the floor. Staff I said if she saw the bag touching the floor, she would probably change it out. She stated that the nurse is responsible for the nebulizer. However, if she sees that the resident has finished her nebulizer treatment, and the nurse is busy, Staff I would remove it from the resident. Staff I said that once the mask is removed from the resident, it should be placed into a bag on the table. An interview was conducted with the DON on 01/10/20 at 8:52 a.m. in the company of another surveyor. The DON said that the catheter bag should never touch the floor and if it does, the bag should be changed. Record review of the Physician Order Report dated 12/9/19 - 1/9/20 revealed that Resident #58 was prescribed albuterol sulfate solution for nebulization inhalation as needed for a diagnosis of shortness of breath. A review of Resident #54's medical record revealed an admission date of 8/29/19. The face sheet showed diagnoses included unspecified dementia without behavioral disturbance and urinary tract infection (UTI). A record review of the Quarterly MDS, dated [DATE], showed a BIMS score of 09 (moderately impaired cognition). Further review of the MDS for Section H, Bowel and Bladder, revealed Bowel was coded as frequently incontinent. Urinary continence was coded as, Resident has a catheter. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 9 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 On 01/07/20 at 12:30 p.m., Resident #54's catheter was observed with the catheter tubing dragging on the floor of the dining room during the lunch meal. On 01/09/20 at 12:53 p.m., Resident #54 was observed at mealtime in the dining room and the catheter bag was dragging on the floor. The Registered Nurse was in the process of coming into the dining room and placed a pillow case over the catheter. 01/10/20 at 10:11 a.m., Resident #54 was observed seated in the hallway in a wheelchair with a pillow case covering the catheter and the tubing was dragging on the floor. Staff D, LPN asked the assigned Certified Nursing Assistant, Staff B, to fix the tubing. A review of Resident #54's physician's orders on the Physician Order Report dated, 12/10/19 - 1/10/2020 revealed orders, all dated 1/1/2020, for Cipro 500 mg (milligram) tablet twice a day for x7 days for Urinary Tract Infection, site not specified on 1/7/2020, Change suprapubic catheter 18 FR (French) every month on the 15th - once a day on the 15th of month, Cleanse suprapubic catheter site with soap and water; pat dry, apply drain sponge daily - once a day, Follow -up with (Urologist) as needed, Irrigate catheter with 60 ml of 1/4 strength white vinegar and sterile water daily- once a day, (Indwelling catheter)/Supra-pubic catheter care every shift- every shift day night. A review of Resident #54's care plan, dated 8/29/19, revealed a problem of Indwelling Catheter, Resident has a supra pubic cath (catheter) urinary catheter long standing according to hospital record, dx urinary obstruction. The interventions included, flush per current order (12/11/2019). Keep catheter tubing free of kinks and drainage bag below level of bladder (9/11/2019). Prevent tension on urinary meatus from catheter (9/11/2019). Provide catheter care per policy (9/11/2019). An interview was conducted on 01/10/20 at 9:06 a.m. with the Director of Nursing. She stated and verified catheter bags and tubing should never touch the floor and staff should change bag when that occurs. On 01/10/20 at 10:12 a.m., an interview was conducted with Staff B, CNA. He stated, Start by going in to give peri care, drain the catheter, alcohol wipe- clean thoroughly, and wash hands. He stated a resident should have a privacy bag and not be in plain view. The bag should be placed under the bladder, not touching the floor, seat resident at 45-degree angle. He stated he has had in-services on catheter care, hand washing, standard precautions, and customer care. An interview was conducted on 01/10/20 at 2:01 p.m. with Staff D, LPN on catheter care. She stated, The CNA takes care of it when the resident is having a shower. You do good peri-care to clean every shift. The nurse wipes with normal saline, drain dressing every day and unless it is soiled. She stated the resident should have a blue covering on the catheter bag. She stated, The bag should be pulled up and placed under wheelchair so it does not drag on the floor and they (the CNAs) should put the catheter bag in a blue cover. On 01/10/20 at 2:09 p.m., an interview as conducted with Staff J, CNA. She stated, The catheter is put in a dignity bag. You must put the bag up and make sure it does not kink up and fixed, so it does not splatter. This is making sure the resident does not have a spasm and a back-up does not occur. She stated if she saw a pillow case covering the catheter bag and it was dragging, she would look for a blue privacy bag and then tie up the ends off the floor. Based on observations, interviews, record review, policy review, and CDC (Center for Disease (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 10 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 Control and Prevention) guidelines, the facility did not ensure 1. appropriate infection control measures were implemented for one resident (#184) of two residents related to contact precautions, and 2. medication was administered in a sanitary manner for one resident (#45) of six residents, and 3. the facility did not ensure pressure ulcer care was done according to practice standards for one resident (#42) of two residents, and 4. the facility did not ensure catheter bags were maintained off the floor for three residents (#54, #58, and #64) of three residents, and 5. the facility did not ensure a nebulizer mask was appropriately bagged for one resident (#58) of two residents reviewed for respiratory care. Findings included: 1. An initial tour of the facility was conducted on 1/07/20 at 9:31 a.m. on the 100 hallway. There were no isolation kits observed or any signage indicating any of the residents were on any precautions. Resident #184 was readmitted to the facility after a hospitalization, on 1/3/20 with a diagnosis of infection of amputation stump, according to the face sheet was documented in the admission record. On 1/07/20 at 3:36 p.m. an interview was conducted with Resident #184 in his bedroom. He said he has an infection in his surgical site where they amputated his right leg. He said they are changing the wound vac dressing regularly and they are doing a good job. He said after the leg was amputated; he came here and had been here a couple days when the nurse came and looked at it, and said he needed to go the hospital immediately. It was draining and had an odor. There was no isolation kit observed on his door or in his room, or any signage indicating any precautions were necessary at that time. Review of the Medical Certification for Medicaid Long Term Care Services and Patient Transfer Form (3008) dated 1/3/20 reflected the primary diagnosis was right stump infection. Under Section F. Infection Control Issues, Associated Infections/resistant organisms, the box was checked for MRSA (Methicillin-Resistant Staphylococcus Aureus) , and the site indicated was nares and blood. A review of the Minimum Data Set (MDS) assessment dated [DATE] indicated Resident #184 had a Brief Interview for Mental Status (BIMS) score of 10 which indicated moderately impaired . Section G, Functional Status, showed Resident #184 required extensive assistance of one person for bed mobility, dressing, toileting, personal hygiene, and bathing, with bilateral lower extremity impairment. A review of the January 2020 physician's orders in the electronic medical record revealed a physician's order dated 1/3/20 for contact precautions for MRSA of the blood and nares. Review of nursing notes in the electronic medical record revealed nursing staff were aware of the contact precautions, as indicated in notes. The 1/3/20 progress note showed Resident #184 was readmitted after right surgical site was debrided, and a wound vac was ordered. Contact isolation for MRSA to blood/nares. Review of the 1/5/20 nursing progress note reflected that Resident #184 remains on [NAME] (antibiotics) for MRSA of wound. On 1/08/20 at 12:37 p.m. an observation was conducted of Resident #184's bedroom. There was no signage on the door indicating contact precautions, and no isolation kit available with PPE (personal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 11 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 protection equipment) near his bedroom. Level of Harm - Minimal harm or potential for actual harm On 1/08/20 at 6:29 p.m. an interview was conducted with Staff D, Licensed Practical Nurse (LPN). She said she saw the order, but she didn't get any information in report that Resident #184 was on contact precautions, so she told the aides to just make sure they were washing their hands real good. Staff D, LPN said she wasn't here when Resident #184 returned from the hospital, so she didn't do his orders. Staff D, LPN confirmed there was an order for contact precautions. She said usually if there is an order for contact precautions a kit would be placed outside the door. The precautions would also be documented on the treatment records. Residents Affected - Some On 1/09/20 at 8:50 a.m. an observation was conducted of Resident #184's entryway to his bedroom. There was not an isolation or PPE kit available for staff to use, neither at the entryway or in the resident's room. There was also no signage indicating Resident #184 was on contact precautions. On 1/09/20 at 8:53 a.m. in an interview with Staff B, Certified Nursing Assistant (CNA), he said he has cared for Resident #184 before. He said he has not seen any isolation precautions in the month he has been employed at the facility. He also said he had not been advised that Resident #184 had MRSA. He said contact precautions for MRSA would include use of gloves and a gown. On 1/09/20 at 8:55 a.m. an interview was conducted with Staff C, CNA. She said no one has been on any precautions. She was observed exiting Resident #184's room after delivering a breakfast tray to his roommate. She was not observed to be wearing a gown or gloves while she was in the room. On 1/09/20 at 10:17 a.m. an interview was conducted with the Staff O, Registered Nurse (RN). She said she does infection control at the facility. The surveyor asked if any precautions were necessary if a resident came to the facility with MRSA of the blood and nares. She said, Contact, unless its contained, its universal or standard precautions. Yes, she was aware he had MRSA of the nares, blood, and stump. She said that it is contained. He has a wound vac. The blood is associated with the stump. He is not bleeding from any orifices, so it would be contained by the vac. I have to see if they did a nasal swab to see if the nares were cleared. She said the doctor determines if they need to be on precautions. She confirmed there was an order for contact precautions and she read it; Contact precautions every shift day and night from the doctor. She said she would have clarified it. Yes, if she saw that order she would initiate it. Usually it would be in the MAR (medication administration record) with a check off for it, or in the progress note. They can write verbiage in relations to it. Yes, PPE should be available somewhere. It's allocated for the level of precaution needed. It should be at the resident's room. The storage room and central supply has the overflow. The nurse who receives the order should initiate the precaution upon receiving the order. She said she does participate in the meetings. She can't recall if Resident #184 was discussed. They go over all the new admissions and new orders. The kit should be right outside the room before you enter. I would have called to clarify it. To me, it is contained. Ideally nares should have contact. But it is contained with the wound vac. If the nurse changes the vac she should wear PPE (personal protective equipment). I think he goes out for his wound vac, I am not sure. I use the policy to determine precautions. I think the policy came from CDC, I would have to check. The surveyor asked if the MRSA infection would be logged on a surveillance log. She said, Yes, it would go on the infection control log. The infection, the antibiotic, the resident, the room number, the day it was started, the duration, the organism, and the physician. The nurse who admits should have admitting orders and diagnosis. She would initiate the precautions. There should be a sign on the door that indicates do not enter and tells people to see the nurse before going in. Usually, the unit managers would know they have precautions on their unit and would communicate it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 12 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 Review of the TAR (treatment administration record) in the electronic medical record reflected the physician's order, Contact precautions for MRSA blood/nares. It had been signed every shift beginning 1/4/20 to the day shift of 1/9/20, indicating nurses were aware of the necessary precautions. On 1/09/20 at 12:35 p.m. a follow up interview was conducted with Staff O, RN. She said Resident #184 went to the hospital for an infected wound stump last month. He was swabbed at the hospital on admission. They gave him an order for Bacitracin. He completed it on the 1st. When he returned to the facility on the third, prior to returning they tested his stump and it was positive for MRSA. She said, We don't initiate contact precautions if it's contained. Our policy is to use standard precautions. The admitting nurse should have clarified it. We have initiated education with staff. And we are going to implement a process for reviewing orders. There was a breach of communication. The nurse should have communicated with the unit manager, who should have communicated that with the doctor. Obviously, there was a lack of communication. They would utilize standard precautions regardless, gloves. They shouldn't be touching his sheets without gloves. Staff O, RN also said the facility does not document surveillance. On 1/10/20 at 8:52 a.m. an interview was conducted with the Director of Nursing (DON). She said, We do not repeat any testing and they would remain on standard precautions. We follow our own policy. It's on a case by case basis. We look at containment of fluids, secretions. We would clarify that order with the admitting physician here. The med (medication) reconciliation form would include any orders. The nurse did not clarify the order. She put the order in and did not set up the precautions that go with it. She put the order in and didn't follow through with the rest of the process. The surveyor asked if there was an order for contact precautions, should staff have implemented them. She said, No, I would have clarified it based on our policy on admission. He is contained. He was on Bacitracin at the hospital. I assumed he received nasal irrigation during surgery at the hospital. The stump is contained. Any drainage is contained in the wound vac. My determine was made based on our policy. She said, No, she did not use a CDC resource to make that determination. On 1/10/20 at 11:10 a.m. an observation was conducted of Resident #184. He was dressed and clean and awake, sitting in his bed with a wound vac hanging from the foot of the bed. The tubing was extending from his right leg contained serosanguainous drainage. There was not an isolation kit observed in the entryway of his bedroom, or any signage indicating contact precautions were necessary. Review of the policy titled, Infection Control, revised October 2018, reflected the following information: Policy Statement This facility's infection control policies and practices are intended to facilitate maintaining a safe, sanitary and comfortable environment and to help prevent and mange transmission of diseases and infections. Policy Interpretation and Implementation 1. This facility's infection control policies and practices apply equally to all personnel, consultants, contractors, residents, visitors, volunteer workers, and the general public alike, regardless of creed, nationality origin, religion, age, sex, handicap, marital or veteran status, or payor source. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 13 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 2. The objectives of our infection control policies and practices are to: Level of Harm - Minimal harm or potential for actual harm a. Prevent, detect, investigate, and control infections in the facility; Residents Affected - Some b. Maintain a safe, sanitary and comfortable environment for personnel, residents, visitors, and the general PUBLIC; c. Establish guidelines for implementing Isolation Precautions, including Standard and Transmission based precautions; d. Establish guidelines for the availability and accessibility of supplies and equipment necessary for Standard and Transmission-based Precautions. e. Maintain records of incidents and corrective actions related to infections; and f. Provide guidelines for the safe cleaning and reprocessing of reusable resident-care equipment. 3. The Quality Assurance and Performance Improvement Committee, through th infection Control Committee, shall establish, review, and revise infection control policies and practices, and help department heads and managers ensure that they are implemented and followed. 4. All personnel will be trained on our infection control policies and practices upon hire and periodically thereafter, including where and how to find and use pertinent procedures and equipment related to infection control. The depth of employee training shall be appropriate to the degree of direct resident contact and job responsibilities. 5. The Administrator or Governing Board, through Quality Assurance and Performance Improvement and the Infection Control Committees, has adopted the infection control policies and practices. Inquiries concerning our infection control polices and facility practices should be referred to the Infection Preventionist or Director of Nursing Services. Multidrug-Resistant Organisms Policy Statement Appropriate precautions will be taken when caring for individuals known or suspected to have infection with a multidrug resistant organism. (Note: Infection means that the organism is present and is causing illness. Colonization means that the organism is present in or on the body but is not causing illness.) Policy Interpretation and Implementation General Guidelines 1. Multidrug-resistant organism (MDROs) are bacteria and other microorganisms that have developed resistance to one or more classes of antimicrobial drugs. a. Common examples of MDROs in long-term care facilities include MRSA (methicillin/oxacillin resistant Staphylococcus Aureus) and VRE (Vancomycin resistant Enterococci). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 14 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 2. Persons who have Staphylococcus Aureus resistant to nafcillin, oxacillin, or methicillin are considered to have MRSA, no matter what other antibiotic sensitivities are identified for the organism. Level of Harm - Minimal harm or potential for actual harm Standard Precautions Residents Affected - Some 1. Staff will use standard precautions as the primary approach to preventing transmission of MDROs. Contact Precautions 1. The staff and practitioner will evaluate each individual known or suspected to have infection with a multi-drug resistant organism for room placement and initiation of contact precautions on a case-by-case basis. Standard precautions will be adequate for some. 2. The infection prevention and control committee or medical director may implement or consider the following to determine the need for contact precautions and/or room placement: a. individual's ability to contain infected/colonized body fluids or body site; b. Personal hygiene of the resident c. Risks for transmission including uncontrolled secretions. stool incontinence, draining wounds, diarrhea, total dependence for activities of daily living or behaviors that may increase the risk of transmission. 3. Should a resident be placed on contact precautions, implement the facility's contact precautions policy. Discontinuing Contact Precautions 1. Residents who are placed on Contact Precautions will remain so until a clear culture report has been obtained or until it is determined that they are no longer present a risk of transmission. a. If a resident is symptomatic and a has a positive culture he or she is considered colonized and does not require precautions. b. If resident is symptomatic and has a positive culture, a case by case decision will be made on whether precautions are needed. c. If resident is considered colonized but there are other factors such as behaviors that increase the risk of transmission, precautions may be continued. 2. Contact Precautions shall not be discontinued until the infection preventionist/designee reviews there situation and the attending physician approves the discontinuation. Environmental Precautions 1. In general, healthy visitors and volunteers will be encouraged to wear disposable gloves during visitation. If refused, visitors will be asked to perform hand hygiene before leaving the room and will be requested to not visit with other residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 15 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 For residents with colonization or infection with MDROs, non-critical resident care items will be dedicated for individual use or decontaminated prior to sue with another resident. Level of Harm - Minimal harm or potential for actual harm Surveillance and Reporting Residents Affected - Some 1. Ongoing surveillance of MDROs will be conducted by the infection preventionist. Communication 1. The nursing staff and/or infection preventionist will ensure that staff are aware of a resident with a MDRO infection so that appropriate transmission based precautions can be utilized. 3. Physicians and other healthcare personnel who provide care for the resident will be notified of confirmed or suspected infections/colonization with a MDRO. Implementation of Personal Protective Equipment in Nursing Homes to Prevent Spread of Novel or Targeted Multidrug-resistant Organisms (MDROs) Implementation of Contact Precautions, as described in the CDC Guideline for Isolation Precautions (https://www.cdc.gov/infectioncontrol/guidelines/isolation/), is perceived to create challenges for nursing homes trying to balance the use of personal protective equipment (PPE) and room restriction to prevent MDRO transmission with residents ' quality of life. Thus, current practice in many nursing homes is to implement Contact Precautions only when residents are infected with an MDRO and on treatment. Focusing only on residents with active infection fails to address the continued risk of transmission from residents with MDRO colonization, which can persist for long periods of time (e.g., months), and result in the silent spread of MDROs. With the need for an effective response to the detection of serious antibiotic resistance threats, there is growing evidence that current implementation of Contact Precautions in nursing homes is not adequate for prevention of MDRO transmission. This document is intended to provide guidance for PPE use and room restriction in nursing homes for preventing transmission of novel or targeted MDROs, including as part of a public health containment response (https://www.cdc.gov/hai/containment/index.html). This guidance introduces a new approach called Enhanced Barrier Precautions, which falls between Standard and Contact Precautions, and requires gown and glove use for certain residents during specific high-contact resident care activities,3 that have been found to increase risk for MDRO transmission. This document is not intended for use in acute care or long-term acute care hospitals and does not replace existing guidance regarding use of Contact Precautions for other pathogens (e.g., Clostridioides difficile, norovirus) in nursing homes. Contact Precautions is one type of Transmission-Based Precaution that are used when pathogen transmission is not completely interrupted by Standard Precautions alone. Contact Precautions are intended to prevent transmission of infectious agents, like MDROs, that are spread by direct or indirect contact with the resident or the resident ' s environment. Contact Precautions requires the use of gown and gloves on every entry into a resident ' s room. The resident is given dedicated equipment (e.g., stethoscope and blood pressure cuff) and is placed into a private room. When private rooms are not available, some residents (e.g., residents with the same pathogen) may be cohorted, or grouped together. Residents on Contact Precautions should be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 16 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 restricted to their rooms except for medically necessary care and restricted from participation in group activities. Because Contact Precautions require room restriction, they are generally intended to be time limited and, when implemented, should include a plan for discontinuation or de-escalation. Residents Affected - Some Description of New Precautions: Enhanced Barrier Precautions expands the use of PPE beyond situations in which exposure to blood and body fluids is anticipated, refers to the use of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDROs to staff hands and clothing 2,3. Examples of high-contact resident care activities requiring gown and glove use for Enhanced Barrier Precautions include: Dressing Bathing/showering Transferring Providing hygiene Changing linens Changing briefs or assisting with toileting Device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator Wound care: any skin opening requiring a dressing Gown and gloves would not be required for resident care activities other than those listed above, unless otherwise necessary for adherence to Standard Precautions. Residents are not restricted to their rooms or limited from participation in group activities. Implementation: When implementing Contact Precautions or Enhanced Barrier Precautions, it is critical to ensure that staff have awareness of the facility ' s expectations about hand hygiene and gown/glove use, initial and refresher training, and access to appropriate supplies. To accomplish this: Post clear signage on the door or wall outside of the resident room indicating the type of Precautions and required PPE (e.g., gown and gloves). o For Enhanced Barrier Precautions, signage should also clearly indicate the high-contact resident care activities that require the use of gown and gloves. See Enhanced Barrier Precautions - Example Sign [PDF - 1 page] (https://www.cdc.gov/hai/pdfs/containment/enhanced-barrier-precautions-sign-P.pdf) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 17 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 Make PPE, including gowns and gloves available immediately outside of the resident room Level of Harm - Minimal harm or potential for actual harm Ensure access to alcohol-based hand rub in every resident room (ideally both inside and outside of the room) Residents Affected - Some Position a trash can inside the resident room and near the exit for discarding PPE after removal, prior to exit of the room or before providing care for another resident in the same room Incorporate periodic monitoring and assessment of adherence to determine the need for additional training and education Provide education to residents and visitors Note: Prevention of MDRO transmission in nursing homes requires more than just proper use of PPE and room restriction. Guidance on implementing other recommended infection prevention practices (e.g., hand hygiene, environmental cleaning, proper handling of wounds, indwelling medical devices, and resident care equipment) are available in CDC ' s free online course - The Nursing Home Infection Preventionist Training (https://www.train.org/cdctrain/training_plan/3814). Nursing homes are encouraged to have staff review relevant modules and to use the resources provided in the training (e.g., policy and procedure templates, checklists) to assess and improve practices in their facility. 2. Resident #45 was admitted to the facility with a diagnosis of dysphagia following cerebral infarction, according to the face sheet in the admission record. On 1/09/20 at 9:27 a.m. an observation was conducted during medication administration for Resident #45, with Staff A, Registered Nurse (RN). Staff A, RN poured Resident #45's pills in individual medication cups. Then Staff A, RN poured each pill into a medication pouch and crushed each one individually. Next Staff A, RN took a narcotic book binder and placed each cup on it. After announcing herself, Staff A, RN placed the binder on Resident #45's bedside table. Then Staff A, RN went into the bathroom where she washed her hands in the sink. She exited the bathroom and put on a pair of gloves. Then she took the syringe off the pump next to the resident's bed and placed it on the bedside table next to the binder. Then Staff A, RN took a Styrofoam cup off the bedside table, and went to the bathroom with it, where she turned on the faucet and filled it with tap water. She returned the cup to the bedside table, removed her gloves, and put on a new pair. Next, Staff A, RN poured 5 milliliters (ml) into each medication cup containing the crushed pills. Then Staff A, RN removed the syringe from the bag and connected it to Resident #45's gastrostomy tube. She unclamped his tube and poured 60 ml of the water into it. Then Staff A, RN poured each medication one at a time into the syringe and flushed with 5 ml of water after each. When Staff A, RN finished pouring the medications, she clamped the tube, and retrieved the Styrofoam cup. She returned to the bathroom sink and refilled the cup with tap water. She returned the cup to the bedside table and removed her gloves. Then Staff A, RN returned to the bathroom and washed her hands in the sink. Next, Staff A, RN put on another pair of gloves and returned to the bedside. She unclamped the tube and poured 60 ml of tap water into it. Then Staff A, RN reclamped the gastrostomy tube. She removed her gloves, put on new gloves, and returned the syringe to the bag. She returned the bag to the iv pole. Staff A, RN disposed of the remaining supplies and gloves in the trash can. Then Staff A, RN retrieved the narcotic binder from the bedside table, exited the room with it, and returned it to the top of the medication cart. Staff A, RN did not clean the binder and she did not perform hand hygiene. Staff A, RN opened the computer on top of the medication cart and started using it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 18 of 19 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 105529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Health Center by Harborview 2302 59th St W Bradenton, FL 34209 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 On 1/10/20 at 8:52 a.m. an interview was conducted with the DON. She said they have the Styrofoam trays for c[TRUNCATED] Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 19 of 19