Inspection·September 16, 2021

F 0578 Level of Harm - Minimal harm or potential for actual harm 2. During a resident's admission and/or stay, Facility should ask about and document a resident's choices regarding CPR [cardiopulmonary resuscitation], with two witnesses signing off on same. Faciilty should seek to obtain a physician order reflecting the resident's CPR choice as soon as possible, and place in the resident's medical record, wherever that record is maintained. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 2 of 7 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 09/16/2021 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, record reviews, and review of facility policy, the facility failed to notify the Office of the State Long-Term Care (LTC) Ombudsman of a facility initiated transfer for one resident (#41) of two residents sampled for hospitalizations. Findings included: A review of Resident #41's Resident Face Sheet revealed that Resident #41 was admitted to the facility on [DATE], with a readmission to the facility on [DATE], with diagnoses of bilateral primary osteoarthritis of knee, acute pyelonephritis, and sepsis. Resident #41's Resident Face Sheet also revealed Resident #41 was her own responsible party. A review of Resident #41's Progress Notes revealed a note, dated 07/24/2021 at 5:38 p.m., which documented Resident #41 was transferred to the hospital due to complaints of abdominal pain and decreased bowel sounds. A review of Resident #41's Progress Notes also revealed a note, dated 07/24/2021 at 11:20 p.m., which documented Resident #41 was admitted to the hospital with diagnoses of urinary tract infection and pyelonephritis. An interview was conducted on 09/15/2021 at 3:17 p.m. with the facility's Nursing Home Administrator (NHA). The NHA stated that the LTC Ombudsman was not notified of Resident #41's transfer to the hospital on [DATE] and that the notification should have been made by the facility's Social Services Director (SSD). An interview was conducted on 09/15/2021 at 3:34 p.m. with Resident #41. Resident #41 stated she was recently admitted to the hospital due to a urinary tract infection that bothered her kidneys and that she was in the hospital for a couple of days. Resident #41 stated that she was her own responsible party and that she made her own health care decisions. An interview was conducted on 09/16/2021 at 11:08 a.m. with the SSD. The SSD stated they were not sending notification of transfers to the LTC Ombudsman but they were working on putting a plan in place to make sure the notifications were being completed. A review of the facility policy titled, Discharge or Transfer Summary, last reviewed on 06/28/2018, revealed under the section titled Guideline, that prior to a resident transfer or discharge, the facility will notify the resident and/or the resident's representative of the transfer or discharge and the reason for the move in writing and in a language and manner they understand and the facility will send a copy of the notice to a representative of the Office of the State LTC Ombudsman. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 3 of 7 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 09/16/2021 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 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Resident #72 was admitted to the facility with a diagnosis of Alzheimer's, according to the Resident Face Sheet in the medical record. Review of the MDS assessment dated [DATE] reflected a Brief Interview for Mental Status (BIMS) score of 0, indicating severe cognitive impairment. Review of the physician orders revealed an order dated 7/4/21, send patient to ED (emergency department) for evaluation and treatment for sob (shortness of breath). Review of the resident's medical record reflected there wasn't a bed hold policy on file for the date of the transfer (7/4/21). An interview with the NHA on 9/15/21 at 3:11 p.m. was conducted. She said the admission paperwork has the bed hold policy in it. He went out on July 4th. We don't have a copy of the bed hold policy. We don't know if it was sent or not. The NHA also said there is a whole packet that is provided when they go out to the hospital. Based on interviews, record reviews, and review of facility policy, the facility failed to provide written notice of bed hold upon a facility initiated transfer for two residents (#41 and #72) of two residents sampled for hospitalizations. Findings included: A review of Resident #41's Resident Face Sheet revealed that Resident #41 was admitted to the facility on [DATE], with a readmission to the facility on [DATE], with diagnoses of bilateral primary osteoarthritis of knee, acute pyelonephritis, and sepsis. Resident #41's Resident Face Sheet also revealed Resident #41 was her own responsible party. A review of Resident #41's Progress Notes revealed a note, dated 07/24/2021 at 5:38 p.m., which documented Resident #41 was transferred to the hospital due to complaints of abdominal pain and decreased bowel sounds. A review of Resident #41's Progress Notes also revealed a note, dated 07/24/2021 at 11:20 p.m., which documented Resident #41 was admitted to the hospital with diagnoses of urinary tract infection and pyelonephritis. An interview was conducted on 09/15/2021 at 3:17 p.m. with the facility's Nursing Home Administrator (NHA). The NHA stated that a notice of bed hold document was not sent in the transfer paperwork upon Resident #41's transfer to the hospital on [DATE], that the transfer paperwork was probably dropped. The NHA also stated Resident #41 was her own responsible party and that she made her own health care decisions. An interview was conducted on 09/15/2021 at 3:34 p.m. with Resident #41. Resident #41 stated she was recently admitted to the hospital due to a urinary tract infection that bothered her kidneys and that she was in the hospital for a couple of days. Resident #41 also stated that she did not remember signing any documentation related to the facility bed hold notice and did not remember receiving the notice at all during her time in the hospital. Resident #41 stated that she was her own (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 4 of 7 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 09/16/2021 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 0625 responsible party and that she made her own health care decisions. Level of Harm - Minimal harm or potential for actual harm A review of Resident #41's Minimum Data Set (MDS) Assessment, dated on 07/31/2021, revealed under Section C - Cognitive Patterns a Brief Interview for Mental Status (BIMS) score of 12, which indicated that Resident #41 was cognitively intact. Residents Affected - Few A review of the facility policy titled, Facility Bedhold, last revised on 11/12/2018, revealed under the section titled Policy Statement, that the facility will notify the resident/responsible party of the facility's bed hold and re-admission policies at admission and anytime a resident is transferred to the hospital or goes out on therapeutic leave. The facility policy also revealed, under the section titled Guideline, that the facility's Bedhold and re-admission policies will be discussed with the resident/responsible party and the facility will provide written notice of the bed hold and re-admission policies at the time of admission and before a resident's transfer to the hospital or for overnight therapeutic leave, included in the resident's transfer packet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 5 of 7 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 09/16/2021 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews, and policy review, the facility did not ensure the consultant pharmacist's recommendations were acted upon for one resident (#26) of five residents sampled for unnecessary medications. Findings included: Resident #26 was admitted to the facility with a diagnosis of dementia without behavior disturbance, according to the face sheet in the admission record. Review of the Minimum Data Set (MDS) assessment dated [DATE] reflected a Brief Interview for Mental Status (BIMS) score of 5, indicating cognitive impairment. Further review of the assessment indicated Resident #26 did not have any mood or behavior symptoms at the time of the assessment. A review of the Physician Order Report dated 6/27/21 - 9/15/21 in the medical record revealed the following medications: 6/27/21 Seroquel 25 mg (milligram) give 1/2 tablet (12.5 mg) by mouth at bedtime, with a discontinue date of 6/28/21 6/28/21 Seroquel 25 mg give 1/2 tablet (12.5 mg) by mouth at bedtime Additional review of physician orders revealed an order was received to discontinue Seroquel on 6/27/21 with a discontinue date of 6/28/21 and signed by the resident's attending physician. A review of the 7/10/21 MRR (medical record review) from the consultant pharmacist revealed a recommendation as: Federal Guidelines for long-term care facilities require an evaluation of antipsychotic usage within two weeks of admission. This resident (#124) was recently admitted with an order for Seroquel 12.5 mg QHS (bedtime) to treat Major Depressive Disorder. Please consider a trial dose reduction to assess continued need for treatment and check one of the following: ()Medication to be continued as ordered. Discontinuation of therapy likely will be harmful to resident and/or others or it will interfere significantly with the provision of care for others. ()Reduce the current order as indicated below. ()Evaluation of the antipsychotic medication was completed by Psych. See Psych progress notes dated ___. The section for the physician/prescriber response was blank. None of the boxes were checked off as Agree, Disagree, or Other, nor was there a signature indicating the physician received/reviewed the recommendation. Review of the Medication Administration Records (MAR) for the months of July, August, and September 2021 revealed the Seroquel 12.5 mg continued to be administered. On 9/15/21 at 10:38 a.m. an interview was conducted with the Admissions Nurse Liaison. She said the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 6 of 7 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 09/16/2021 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 0756 unit managers fax the recommendations to the physicians. Level of Harm - Minimal harm or potential for actual harm On 9/15/21 at 11:09 a.m. an interview was conducted with the Regional Nurse. She said the pharmacist may have reviewed the medications before it (Seroquel) was discontinued. She confirmed the physician signed a discontinue order on 6/27 for Seroquel and that it was being administered for the months of July, August, and September 2021. Residents Affected - Few On 9/16/21 at 10:39 a.m. a telephone interview was conducted with the Consultant Pharmacist. She said when the facility receives her recommendations they put them in the practitioner's folders, or it may go to the behavior meeting for psychiatric services to review. On 9/16/21 at 1:10 p.m. a follow up interview was conducted with the Regional Nurse. She said the pharmacist sends the recommendations to the DON (Director of Nursing). The DON disperses them to the unit managers and they get them to the doctors. On 9/16/21 at 1:12 p.m. an interview was conducted with the Nursing Home Administrator (NHA). She said she prints off the recommendations and gives them to the unit manager. They also go to the ADON (Assistant Director of Nursing). Sometimes they come to herself too. She doesn't know where they go after that; that's nursing. Review of the policy, Psychotropic Medications, revised 9/5/18, reflected the following: Policy Statement Physicians and mid-level providers will use psychotropic medications appropriately working with the interdisciplinary team to ensure appropriate use, evaluation, and monitoring. Guideline: 7. If a clinical contraindication for a gradual dose reduction (GDR)/tapering has been indicated, it must be properly and fully documented on the physician order sheet and care plan. Primary Care Physician, Physician Assistant (PA) or advanced nurse practitioner (APRN) 8. If contraindicated, the prescriber will document in the medical record the clinical rationale why the attempt would likely impair the resident's function or cause instability. 11. Review reports from the consultant pharmacist and documents in the medial record the identified irregularity has been reviewed and what, if any, action has been taken to address the irregularity. If the physician determines there is to be no change in the medication; the physician will document the rationale in the resident's medical record. Pharmacist and/or consulting pharmacist 4. The consultant pharmacist and the nursing care center follow up on the recommendations to verify appropriate action has been taken. Recommendations shall be acted upon within 30 calendar days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105529 If continuation sheet Page 7 of 7