Inspection·April 24, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of an order dated 04/23/25, instructed staff to cleanse area to right lateral leg with normal saline, pat dry, apply xeroform and cover with bordered gauze dressing. An observation on 04/24/25 at 9:51 AM revealed Resident #102 sitting in the wheelchair with his right leg elevated. There was rolled gauze on his right leg secured with tape and dated 04/24/25. When asked if the nurse just did wound care to his right leg, Resident #102 stated, Yes. During an interview on 04/24/25 at 10:16 AM, when asked, are you the nurse who performed the wound care on Resident #102, Staff E, LPN, stated Yes, this morning. The wound was bleeding, because he scratches. When asked, did you remove the same type of dressing from Resident #102's right leg that you reapplied Staff E stated, Yes. 3. Record review for Resident #517 revealed the resident was admitted to the facility on [DATE] with a diagnosis that included right ankle fracture requiring surgical repair. Review of the Hospital History and Physical dated 04/13/25 documented, in part, that Resident #517 landed on knees and left elbow .with severe pain in his right ankle. Review of the admission MDS assessment, which was in progress, documented Resident #517 had a BIMS score of 15, indicating the resident was cognitively intact. Review of the admission Skin assessment dated [DATE] documented a skin tear to the left elbow. Review of the Skin Observation documentation on the Certified Nursing Assistant (CNA) task list from 04/18/25 at 2:01 PM revealed Resident #517 had a scratch and skin tear. Review of the physician's orders did not include an order for the left elbow dressing for the resident. During an observation conducted on 04/22/25 at 10:00 AM, the resident was sitting in a wheelchair, awake and alert and oriented. It was noted that the left elbow was covered with a dry and intact dressing dated 4/18. During an observation conducted on 04/23/25 at 12:17 PM, Resident #517 was sitting in room, awake, alert and oriented. The resident had a new dry and intact dressing on his left elbow dated 4/23 7a/7p. When the resident was asked what happened to his elbow, he stated that happened when I fell two weeks ago. It's nothing really. When asked who applied the dressing to his left elbow, the resident replied, someone here and they put something on it but the resident was unable to provide a name of the caregiver. During an interview on 04/23/25 at 3:30 PM, Staff D, LPN, stated she did not have to perform any dressing changes today for any of her assigned residents. She stated, it was all already done today. An interview conducted on 04/23/25 at 3:38 PM with the Wound Care Nurse (WCN) who stated that she did not do wound care for Resident #517. The WCN stated the nurses do wound care dressing on Monday's, Wednesday's and Friday's. During a side-by-side review of the record and interview on 04/23/25 at 4:00 PM with the Seaway Unit Manager (UM), she confirmed the lack of a physician order for left elbow wound care dressing changes. The UM reviewed the skin assessment documentation on 04/21/25 which identified a left elbow tear (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105592 If continuation sheet Page 2 of 12 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 105592 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of Vero Beach 1755 37th Street Vero Beach, FL 32960 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 0684 and agreed that there should be an order. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, and interview, the facility failed to ensure timely and appropriate quality of care for 3 of 11 sampled residents reviewed for medications and wounds, as evidenced by the failure to timely obtain and administer eye drops and antibiotics for Resident #24, failure to treat a wound per physician order for Resident#102, and failure to obtain a physician order for wound care prior to treatment for Resident #517. Residents Affected - Few The findings included: 1. Record review revealed Resident #24 was admitted to the facility on [DATE]. Review of the current Minimum Data Set (MDS) assessment dated [DATE] documented the resident had a Brief Interview for Mental Status (BIMS) score of 15, on a 0 to 15 scaled, indicating the resident was cognitively intact. During an interview on 04/21/25 Resident #24 stated she missed a dose of antibiotics and had trouble getting her eye drops upon admission to the facility. Review of physician orders revealed the following: a) As of 03/18/25, the resident was ordered the eye drop Lumigan at bedtime for glaucoma. b) As of 03/18/25, the resident was ordered the eye drop Pilocarpine four times daily for glaucoma. c) As of 03/21/25, the resident was ordered the eye drop Dorzolamide twice daily for glaucoma. d) As of 03/18/25, the resident was ordered the antibiotic Ceftriaxone 2 grams intravenously (IV) daily for Osteomyelitis. Review of the March 2025 Medication Administration Record (MAR) revealed the following: a) The Lumigan eye drop was not administered until 03/20/25 as staff were awaiting delivery, thus missing two doses. During an interview on 04/24/25 at 11:23 AM, the Unit Manager stated the eye drop was delivered to the facility on [DATE] and that she did not know why it was not administered timely. b) The Pilocarpine eye drop was not administered until 03/20/25 as staff were awaiting delivery, thus missing five doses. The Unit Manager stated this eye drop was also delivered to the facility on [DATE] and that she did not know why it was not administered timely. c) The Dorzolamide eye drop was documented as administered as of 03/20/25 in the morning, related to awaiting delivery, which would indicate the resident missed three doses. But during the continued interview, the Unit Manager stated the Dorzolamide was not delivered to the facility until 03/23/25. d) The Ceftriaxone IV antibiotic was administered as ordered on 03/19/25, but was not administered on 03/20/25, as the medication was on order. The Unit Manager confirmed this antibiotic was available in their emergency stock and should have been administered. Review of the April 2025 MAR revealed the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105592 If continuation sheet Page 3 of 12 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 105592 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of Vero Beach 1755 37th Street Vero Beach, FL 32960 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 0684 Level of Harm - Minimal harm or potential for actual harm e) The Dorzolamide eye drops were not administered on 04/13/25 and 04/14/25, as evidenced by a blank in the MAR, with no explanation provided. f) The IV Ceftriaxone was not provided on 04/11/25, as it was on order. During the continued interview, the Unit Manager confirmed the IV antibiotic had been available in the emergency supply. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105592 If continuation sheet Page 4 of 12 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 105592 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of Vero Beach 1755 37th Street Vero Beach, FL 32960 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to physicians' order were followed to avoid wearing socks to allow the wound to air dry; failed to provide guidance and education regarding the risk of using socks in the affected area; and failed to follow infection control practices, as evidenced by using items placed on the floor, for 1 of 5 sampled residents reviewed for wound care and management, Resident #100. Residents Affected - Few The findings included: Clinical record review revealed Resident #100 was admitted to the facility on [DATE] and again on 02/25/25, with diagnoses that included Hypertension. The admission Minimum Data Set (MDS) assessment, referenced on 02/04/25, recorded a Brief Interview for Mental Status (BIMS) score of 11, indicating Resident #100 was moderately cognitively impaired. This MDS indicated no mood, or behavior concerns and documented the resident was dependent on assistance for lower body dressing and putting on or taking off footwear. Review of the care plan, revised on 02/04/25, noted Resident #100 had a pressure injury on the left heel. Interventions on the care plan included floating the heels while in bed as tolerated by the resident and treatments as ordered. Review of Certified Nursing Assistants (CNA) tasks revealed no sock on the left foot. An additional review of the clinical record indicated a physician order dated 04/08/25 to apply Betadine to the left heel every Tuesday, Thursday, and Friday, allowing it to air dry for wound care management. The order specifically stated, no sock to left foot; float heels. Review of the doctor's wound care evaluation dated 04/22/25 included the following recommendations: off-load wounds and float heels in bed. Additionally, place a heel elevator or 2-3 pillows behind the knees (posterior to the popliteal fossa) to elevate the heels from making contact with the bed surface. On 04/22/25 at 10:33 AM, an observation was conducted on Resident #100. She was found lying in bed with her heels positioned directly on the bed, not offloading. Her heel-protector boots were on the floor beneath the bed, and she stated, My heels hurt. On 04/23/25, at 11:56 AM, Resident #100 was observed sitting at the edge of her bed, wearing socks and placing her feet directly on the floor, not offloading them. She was talking to her visitor, who was beside her, labeling new socks that had been brought in. Two heel-protector boots were on the floor next to the bed. On 04/23/25 at noon, Staff A, Wound Care Nurse (WCN), conducted care for the left heel wound, applying Betadine to the open area. Staff A assessed the resident for pain, and the resident expressed that her heels hurt. After the wound care, Staff A asked if Resident #100 wanted to wear the new socks her friend had brought in. The resident responded, Yes. Staff A then applied the socks to the resident's feet and retrieved the heel protector boots from the floor, putting them on the resident's feet. This practice did not follow the physician's order to allow the wound to air dry. Staff A also failed to provide guidance or education regarding the risks of wearing socks in the affected area and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105592 If continuation sheet Page 5 of 12 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 105592 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of Vero Beach 1755 37th Street Vero Beach, FL 32960 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 0686 the importance of allowing the wound to air dry. Level of Harm - Minimal harm or potential for actual harm At 12:14 PM, the surveyor overheard the visitor telling Resident #100, The socks are not good for the bad foot; you should take them off. Residents Affected - Few At 12:32 PM, another observation was conducted, and Resident #100 was still wearing the socks and the boots. On 04/23/25 at 12:20 PM, Staff C, the assigned CNA, was interviewed. She stated that when she came in, she observed Resident #100 wearing socks and commented, Maybe the previous shift put them on. On 04/23/25 at 1:13 PM, Resident #100 was sitting in bed, still wearing socks and the heel-protector boots. On 04/23/25 at 2:02 PM, an interview with Staff A (WCN) revealed that when asked why she put socks on the resident's feet after the wound care, she stated the resident preferred to have them on. When the surveyor pointed out that the physician's order specifically indicated no sock on the left foot, Staff A agreed upon seeing the order and acknowledged the wound care doctor preferred the socks not to be applied. The surveyor then asked why she had not provided guidance or education to the resident about the risks of wearing socks. Staff A agreed that she should have done so. After the surveyor's intervention, Staff A spoke to the resident, stating, Remember how the socks stick to the wound. The doctor does not want them on. The resident complied and allowed the nurse to remove the socks. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105592 If continuation sheet Page 6 of 12 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 105592 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of Vero Beach 1755 37th Street Vero Beach, FL 32960 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure appropriate care and services for 2 of 3 sampled residents, Residents #162 and #11, who had indwelling catheters and a history of Urinary Tract Infections (UTIs). The findings included: 1. Review of the record revealed Resident #162 was admitted to the facility on [DATE]. Review of the current physicians' orders documented the resident had an indwelling catheter and staff were to flush the catheter as needed. Review of the current care plan initiated on 03/31/25 documented the resident was at risk for complications related to the use of an indwelling catheter. Interventions included to anchor the catheter and to irrigate it as ordered. Review of a urinalysis report revealed urine was collected on 03/31/25 for the test. The results of a positive UTI were reported to the facility on [DATE] with the completed culture on 04/03/25 indicating appropriate antibiotics to use. The urinalysis was not reviewed until 04/06/25 at which time an antibiotic was ordered. An observation on 04/22/25 at 11:26 AM revealed the indwelling catheter bag hanging on the bedside. Cloudy urine was noted in the tubing. During a subsequent observation on 04/23/25 at 9:15 AM, catheter care was observed with Staff G and Staff H, both Certified Nursing Assistants (CNA). Observation of the catheter tubing revealed continued cloudy urine. Photographic Evidence Obtained. During the care, a catheter anchor was noted on the resident's thigh, but the tubing was not secure. When staff turned the resident onto her right side, with the catheter bag on her left side, the tubing was pulled tightly. After the care, when asked the use of the anchor, Staff H stated it was to keep the tubing from pulling. Staff G attempted to hook the catheter into the anchor at the junction, in order to secure it, but Staff H told Staff G that was not correct, and put it back as it was, leaving the catheter loose and freely moving. During an observation on 04/23/25 at 3:43 PM, Staff I, Licensed Practical Nurse (LPN), was unaware of how to utilize the anchor, but agreed the catheter tubing was not secured. When asked if she had assessed the indwelling catheter that day, the LPN stated she had and the urine was cloudy that morning, and agreed it still was. When asked what she should do if the urine was cloudy, the LPN stated she should notify the physician but had not done so. During an interview on 04/24/25 at 9:58 AM, when asked what she would expect a nurse to do if a resident's indwelling catheter had cloudy urine, the Unit Manager stated the nurse should try to flush the catheter, encourage fluids, and call the physician if it persists. The Unit Manager stated she did receive an order for a urinalysis after the surveyor had asked the nurse about the cloudy urine the previous afternoon. When asked the process for reviewing the results, the Unit Manager stated the labs are uploaded by the lab into their electronic medical record and the lab will call the facility with any critical results. The Unit Manager explained that both the nurses and physician or nurse practitioner are responsible for reviewing the labs. During a side-by-side review of the record, the Unit Manager was made aware of the urinalysis of 03/31/25 and delay of antibiotic. The Unit Manager had no reason for the delay. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105592 If continuation sheet Page 7 of 12 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 105592 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of Vero Beach 1755 37th Street Vero Beach, FL 32960 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. Clinical record review revealed Resident #11 was admitted to the facility on [DATE] with diagnoses that included non-Alzheimer's Dementia. The quarterly Minimum Data Set (MDS) assessment reference date was 02/23/25, documented a Brief Interview for Mental Status (BIMS) score of 06, indicating Resident #11 was severely cognitively impaired. This MDS did not record any mood or behavior concerns. It was documented that she was dependent and required assistance with toileting hygiene, personal hygiene, and toilet transfers. and was frequently incontinent of urine, indicating a loss of bladder control. The records included a care plan added to the revised plan dated 02/23/25. This care plan documented Resident #11 had incontinence related to impaired mobility, with her incontinent status potentially varying due to her diagnosis of dementia. It also noted that she was frequently incontinent of urine and had the potential for complications secondary to the UTI. On 04/10/25, a urine sample was collected, and the urinalysis results showed a positive urinary tract infection (UTI), which was reported to the facility by the lab on the same day. Further recollection of urine was suggested. On 04/15/25, the facility was able to straight catheterize the resident after several attempts due to her resistance. The results from this urine collection were reported on 04/18/25, confirming the presence of a UTI. On 04/19/25, a physician order for the antibiotic, Macrobid 100 mg to be taken orally twice a day for seven days, was initiated. On 04/24/25 at 11:03 AM, perineal care was initiated by Staff B, Certified Nursing Assistant (CNA). Staff B placed a large towel in the bathroom sink, allowed the water to run until the towel was saturated, and then applied soap. After retrieving the wet towel and squeezing some water out, she approached the resident and brusquely instructed her to open her legs. She then poured water from the towel onto the resident's private area and used wet wipes to clean the groin area and the top of the pubic bone, but did not provide care to the external genital structures. Staff B repeated the process, squeezing more water from the towel onto the pubic area and cleaning it with wet wipes. She then instructed the resident to turn, which the resident did without resistance. Staff B squeezed water from the towel onto the resident's buttocks and wiped them with the wet towel, then used wet wipes for additional cleaning. Without drying the perineal area, she applied protective zinc oxide cream to the buttocks and groin area, then put on a new adult incontinent brief and secured it. The care was completed at 11:09 AM, and Staff B stated, She was done. Later, at 11:56 AM on 04/24/25, the Director of Nursing (DON) and the Infection Control Preventionist were interviewed regarding how the care was provided to resident #11. The surveyor demonstrated the process Staff B had used during the care. The DON and the Infection Control Preventionist agreed that the process was improperly executed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105592 If continuation sheet Page 8 of 12 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 105592 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of Vero Beach 1755 37th Street Vero Beach, FL 32960 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure they followed physicians' orders that were recommended by the pharmacy, as evidenced by not discontinuing orders for Resident #48. Residents Affected - Few The findings included: Record review revealed Resident #48 was admitted to the facility on [DATE]. Review of the current Minimum Data Sheet (MDS) assessment dated [DATE], documented the resident had a Brief Interview for Mental Status score of 15, on a 0-15 scale indicating no cognitive impairment. A pharmacy consultation report dated 11/23/24 recommended that Lactobacillus (medication to promote growth of good bacteria in the gut) and Pyridoxine (a vitamin that is important for normal brain functioning) be discontinued. On 11/27/24, the physician accepted the pharmacy recommendation by signing the consultation. Photographic Evidence Obtained. Review of the current active orders for Resident #48 revealed the resident was still ordered to take lactobacillus and pyridoxine. Review of April 2025's Medication Administration Record (MAR) for Resident #48 revealed staff had also administered the lactobacillus and pyridoxine to Resident #48 on 04/23/25. Further review of the physician orders and MARs from 11/2024 through 04/2025 revealed the supplements had not been discontinued. During an interview on 04/23/25 at 4:10 PM, when asked who was responsible for making changes to the resident's orders after the doctor accepts or declines the pharmacy recommendation, the DON stated, the Unit Manager. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105592 If continuation sheet Page 9 of 12 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 105592 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of Vero Beach 1755 37th Street Vero Beach, FL 32960 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. Record review revealed Resident #129 was admitted to the facility on [DATE] with Diagnosis that included, in part: Chronic Obstructive Pulmonary Disease (COPD), unspecified injury at C3 cervical spinal cord, atrial fibrillation (AFib), chronic pain syndrome, dependence on wheelchair and urinary tract infections (UTIs). Residents Affected - Few On 04/17/25, the facility received a urine analysis results for Resident #129. The urine results indicated the resident had ESBL (Extended Spectrum Beta Lactamases) in their urine. The diagnosis of ESBL makes bacterial infections harder to treat with antibiotics. ESBL producing bacteria can spread from person to person. It can be contacted by simply touching an infected person or touching soiled objects that have not been cleaned thoroughly. By review of the facility policy, a resident who has the diagnosis of ESBL should be on contact precautions. When a resident has any type of precautions in the facility, a sign is to be posted on the door of the resident's room to indicate which type of precautions are to be followed. On 04/21/25 at 9:00 AM, a tour was conducted of the facility. Resident #129's door was observed, and the door did not have any posting for contact precautions. During an interview, on 04/21/25 at 11:02 AM, the Infection Preventionist stated that she had not completed rounds from the previous weekend to determine additional precautions for residents. Based on policy review, observation, interview, and record review, the facility failed to implement effective infection control practices by failing to promptly initiate Enhanced Barrier Precautions (EBP) and Transmission-Based Precautions (TBP); and failed to provide appropriate education or ensure competency following facility-acquired urinary tract infections (UTIs) for 4 of 9 sampled residents who should have been on EBP and TBP, involving Residents #129, #80, #31, and #6. The findings included: The policy, titled, Enhanced Barrier Precautions, with implemented date of 08/16/22, documented it is the policy of this facility to implement enhanced barrier precautions [EBP] for the prevention of transmission of multidrug-resistant organisms (MDROs). Enhanced barrier precautions refer to the use of gown and gloves for the use during high-contact resident care activities for residents known to be colonized or infected with MDRO acquisition (e.g., residents with wounds or indwelling medical devices). The policy documented clear signage will be posted on the door or wall outside of the resident room indicating the type of precautions, required personal protective equipment (PPE), and the high-contact resident care activities that require the use of gown and gloves. Nursing staff may place residents with certain conditions or devices on enhanced barrier precautions empirically while awaiting physician orders. An order for enhanced barrier precautions will be obtained for residents with of the following: wounds (e.g., chronic wounds such as pressure ulcers, diabetic foot ulcers, unhealed surgical wounds, and chronic venous stasis ulcers) and/or indwelling medical devices (e.g., central lines, hemodialysis catheters, urinary catheters, feeding tubes, tracheostomy/ventilator tubes) even if the resident is not known to be infected or colonized with a MDRO. Examples of targeted and epidemiologically important MDROs include but are not limited to: Enterobacterales, pseudomonas, Acinetobacter baumannii, candida auris, methicillin-resistant staphylococcus (MRSA), ESBL-producing Enterobacterales, Vancomycin-resistant enterococci (VRE), drug-resistant streptococcus pneumoniae. The policy, titled, transmission-based precautions, dated September 2019, documented (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105592 If continuation sheet Page 10 of 12 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 105592 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of Vero Beach 1755 37th Street Vero Beach, FL 32960 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 - Few transmission-based precautions are used when the route of transmission is not completely interrupted using standard precautions alone and the pathogen may have multiple routes of transmission. Transmission based precautions [TBP] are divided into: contact precautions, droplet precautions and airborne precautions. Contact precautions: wear PPE [Personnel Protective Equipment], gown and gloves for all interactions that may involve contact with the resident or potentially contaminated areas in the resident environment. See nurse sign posting will be on resident rooms alerting health care workers, resident and visitors that they must see the nurse before entering room. The reverse side of the sign will note the type of precaution, method of acceptable hand disinfection and PPE to be utilized. 1. Review of the clinical record revealed Resident #80 was admitted to the facility on [DATE] with a diagnosis that included Cirrhosis. The records indicated that on 04/15/25, a urine sample was collected for urinalysis, culture, and sensitivity (C&S) testing. The results were reported to the facility on [DATE], indicating the presence of extended-spectrum beta-lactamase (ESBL). On 04/19/25, the resident was prescribed 1 gram of Ertapenem (antibiotic/ATB) to be administered intramuscularly in the afternoon for 7 days to treat symptomatic bacteremia. The TBP initiation was noted to have been delayed by 4 days. Additionally, a physician's order for contact precautions related to the ESBL was documented on 04/22/25. The care plan, also dated 04/22/25, stated that Resident #80 was experiencing symptomatic bacteremia. 2. Review of the clinical record revealed Resident #31 was admitted to the facility on [DATE] with a diagnosis that included End-Stage Renal Disease (ESRD). Documentation indicated that on 04/18/25, a urine sample was collected for urinalysis, culture, and sensitivity testing. The results, reported to the facility on [DATE], showed the presence of extended-spectrum beta-lactamase (ESBL). The initiation of transmission-based precautions (TBP) was delayed by one day. Additionally, a physician's order for contact precautions related to the ESBL was documented on 04/21/25. The care plan, dated 04/22/25, noted that Resident #31 had a urinary tract infection (UTI) with ESBL and received antibiotics. 3. Review of the clinical record revealed Resident #6 was admitted to the facility on [DATE], with a diagnosis that included Neurogenic Bladder. On 04/16/25, a urine sample was collected for urinalysis, culture, and sensitivity testing. The results, reported to the facility on [DATE], revealed the presence of extended-spectrum beta-lactamase (ESBL). On the same day, the resident was prescribed 1 gram of Ertapenem {ATB] to be administered intramuscularly at bedtime for 7 days to treat a urinary tract infection. However, initiating enhanced barrier precautions (EBP) was delayed by 2 days. Additionally, a physician's order for EBP related to the Foley catheter and ESBL was documented on 04/22/2025. 4. The Infection by Unit Report from April 1 to April 30, 2025, documented seven UTIs, that included four confirmed as facility-acquired infections for Residents #129, #80, #31, and #6. On 04/24/25 at 12:07 PM, an interview was conducted with the Infection Control Preventionist (ICP) and the Director of Nursing (DON). When asked about the Transmission-Based Precautions (TBP) and Enhanced Barrier Precautions (EBP) that should have been implemented for Residents #129, # 80, 31, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105592 If continuation sheet Page 11 of 12 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 105592 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of Vero Beach 1755 37th Street Vero Beach, FL 32960 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete #6, the ICP acknowledged that these precautions were initiated late. The ICP indicated that the nurses did not begin these precautions. She revealed the facility had identified the issue on Monday, April 21, 2025, which coincided with the arrival of the survey team at the facility. The ICP stated the facility had been experiencing increasing facility-acquired UTIs. The surveyor inquired about the actions taken in response and whether education or competency assessments had been provided to the Certified Nursing Assistants. The surveyor requested documented evidence of such education or competency training. The ICP stated she walks around and speaks with the staff regarding infection control, reminding them to maintain good perineal care and practice proper hand hygiene while emphasizing caution. Notably, the ICP pointed out that she typically does not require staff to sign in-service documentation, indicating a lack of documented competency assessments or in-service training related to UTIs. Event ID: Facility ID: 105592 If continuation sheet Page 12 of 12