Health inspection·May 30, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few explained that when residents are on antibiotics nurses should be monitoring the side effects and effectiveness of the medication. She stated that the Minimum Data Set (MDS) nurse was responsible for updating residents' care plans. On 5/30/25 at 1:29 PM, an interview was conducted with Registered Nurse (RN) D, MDS Coordinator. She stated care plan focus areas information is obtained from MDS assessment, nursing assessments, physician orders and tasks. She explained that this information is generated through reports and/or communication during clinical meetings. When asked about the care plan for Resident #85, she confirmed that the care plan for use of antibiotics and/or infection was not initiated. 2. During and interview with Resident #1 on 5/27/25 at 2:40 PM, he stated that his wife had requested side rails be placed on his bed to help him with mobility and positioning in bed. He stated his wife spoke with the unit nurse approximately 3 weeks ago, but did not know which one. He explained that no one had notified him of the status of the rails and they had not been placed on his bed. A review of the clinical record revealed that Resident #1 was admitted on [DATE]. His diagnoses included unspecified dislocation of left shoulder joint, subsequent encounter; muscle weakness (generalized); muscle wasting and atrophy not elsewhere classified, erosive (osteo)arthritis; age-related osteoporosis without current pathological fracture. A review of quarterly MDS with and ARD of 3/15/25 revealed that the resident had a BIMS score of 14/15, indicating cognitively intact. He was assessed to have functional impairment of upper extremity on one side, and required maximum assistance of personal hygiene, bed mobility and bed to chair transfer. A review of Resident #1's physician's orders revealed an order for side rails - half bilaterally for bed mobility (order dated 4/29/25). On 12/31/24- weight bearing to shoulder as tolerated. A review of the care plan revised on 1/25/25 revealed that the resident had activities of daily living (ADL) self-care performance deficit related to left shoulder dislocation, muscle wasting/atrophy/weakness, osteoporosis, osteoarthritis. Interventions included half side rail to right side of bed for bed mobility. (Copy obtained) Review of a nursing interdisciplinary team (IDT) note dated 4/29/25 indicated that the resident was educated on the risks versus benefits such as safety, security, mobility assistance and potential risks and negative outcomes that relate to use of bed rails. The use of bed rail(s) can present a hazard or involve potential risks to certain individuals, particularly those residents with physical limitations or altered mental status, such as delirium or dementia. Potential risks may include getting caught within the rail, getting caught between mattress and rail, strangulation, suffocation, bruising and/or skin tears caused by hitting against rail(s), crawling over the rail(s) and falling from greater heights increasing risk for serious injury or death. Other potential negative outcomes may include, but are not limited to, decline in muscle functioning, skin integrity issues, may alter resident's self-esteem, induces agitation or anxiety, feelings of isolation, decline in other areas of activities of daily living and reduced physical mobility. (Copy obtained) In an interview on 5/30/25 at 2:05 PM, the Certified Nursing Assistant (CNA) B stated that she was assigned to Resident #1. She explained that the resident required moderate assistance with bed positioning and used to be more mobile (requiring minimum assistance) with getting out of his bed when his side rail was in place. She stated she believed his rail was removed around three weeks ago, but (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105533 If continuation sheet Page 2 of 5 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Jacksonville 8700 A C Skinner Parkway Jacksonville, FL 32256 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 0656 was not totally sure of the exact date. Level of Harm - Minimal harm or potential for actual harm During the interview on 5/30/25 at 2:13 PM, RN C Unit Manager stated that she was not aware that resident's side rail was missing, but was made aware by therapy services on 5/28/25. She stated that she spoke with other unit staff who stated that there was an issue with the resident's bed and his new bed would not accommodate the rails currently in maintenance stock. She stated that maintenance was to order new rails for the resident's current bed. She was unsure of the status of the order and could not produce written documentation related to the order when requested. Residents Affected - Few A review of the facility's policy and procedures titled Comprehensive care plans revised on 1/2025 was conducted. The policy read, It is the policy of this facility to develop and implement a comprehensive person-centered care plan of each resident, consistent with resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs and ALL services that are identified in the resident's comprehensive assessment and meet professional standards of quality. Policy Explanation and Compliance Guidelines: 1. The care planning process will include an assessment of the resident's strengths and needs and will incorporate the resident's personal and cultural preferences in developing goals of care. All services provided or arranged by the facility, as outlined by the comprehensive care plan, must meet professional standards of quality, and incorporate culturally competent and trauma-informed care as indicated. 2. The comprehensive care plan will be developed within 7 days after the completion of the comprehensive MDS assessment. All Care Assessment Areas (CAAs) triggered by the MDS will be considered in developing the plan of care. Other factors identified by the interdisciplinary team, or in accordance with the resident's preferences, will also be addressed in the care plan. The facility's rationale for deciding whether to proceed with care planning will be evidenced in the clinical record. . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105533 If continuation sheet Page 3 of 5 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Jacksonville 8700 A C Skinner Parkway Jacksonville, FL 32256 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 observation, interview and record review, the facility failed to administer oxygen at the ordered flow rate for one (Resident #155) of two residents reviewed for respiratory care, from a total of 43 sampled residents. Residents Affected - Few The findings include: On 05/27/25 at 2:15 PM, Resident #155 was observed resting in bed with eyes closed and with respirations. Observation of the flow rate meter ball revealed it was between 2.5 and 3 liters. (Photographic evidence obtained) On 05/28/25 at 12:05 PM, Resident #155 was observed resting in bed with eyes closed and with respirations. Observation of the flow rate meter ball revealed it was was between 2.5 and 3 liters. (Photographic evidence obtained) On 05/30/25 at 9:33 AM, Resident #155 was observed resting in bed with eyes closed and with respirations. Observation of the flow rate meter ball revealed it was between 2.5 and 3 liters. (Photographic evidence obtained) A review of the clinical record revealed Resident #155 was an [AGE] year old male admitted on [DATE] with diagnoses including dependence on supplemental oxygen, chronic ischemic heart disease, unspecified, and heart disease, unspecified. A review of Resident #155's current physician's orders revealed the resident was prescribed oxygen (O2) at 2 liters/per minute (min.) via nasal cannula for diagnosis of shortness of breath (SOB), every shift for SOB. A review of the baseline care plan for Resident #155, dated 05/21/25, documented the resident was not oriented to person, place, time or situation. Additional review of Resident #155's baseline care plan documented a focus of: the resident is at risk for respiratory complications. The baseline care plan goal noted that the resident will have a minimized risk of respiratory distress through review date. Interventions included: administer oxygen as ordered (Refer to medication administration record for current order). Medicate as ordered and monitor for effectiveness and observe for signs and symptoms of side effects. Report to MD as indicated. Observe for signs or symptoms of respiratory complication. Notify MD of abnormal findings. Observe O2 saturation levels via pulse oximetry as ordered and report as needed. On 05/30/25 at 9:37 AM, an interview was conducted with Employee A, LPN, who reported she has worked at the facility for 3 1/2 years. Observation of Resident #155's room at that time with Employee A revealed that the oxygen (O2) flow rate was set at 3 liters (L) per minute (min). Employee A reviewed the resident's oxygen order in Point Click Care (PCC) and stated that Resident #155's oxygen order was written on 05/27/25, and the order was 2L/min. She explained that she checks resident oxygen flow rates throughout her shift. The process for ensuring residents receive the correct amount of oxygen includes making sure the O2 concentrator is set at the correct liter flow rate, make sure the nasal cannula (NC) is properly placed, and take resident oxygen saturation levels. She explained that she began her shift today at 7:00 AM, and checked Resident #155's oxygen this morning and thought that the order for the resident's oxygen was 3 L/min. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105533 If continuation sheet Page 4 of 5 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Jacksonville 8700 A C Skinner Parkway Jacksonville, FL 32256 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 Review of the facility's policy titled Oxygen Administration, Date Implemented: 11/2020, Date Reviewed/Revised: 01/2025 and Reviewed/Revised: Clinical Services, documented Policy Explanation and Compliance Guidelines: 1. Oxygen is administered under orders of a physician, except in the case of an emergency 3. Staff shall document the initial and ongoing assessment of the resident's condition warranting oxygen and the response to oxygen therapy, page 1 of 2. Residents Affected - Few . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105533 If continuation sheet Page 5 of 5