Inspection·August 6, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on record review and interview, the facility failed to inform the resident representative of an accident that required physician intervention for 1 of 3 residents reviewed for falls (Resident #2). Findings include: During an interview on 8/6/2025 at 10:10 AM, Resident #2 stated that she had fallen, getting in bed and her knee got stuck, and she had to have x-rays. Review of Resident #2's nursing progress notes dated 7/10/2025 read, Note Text: This nurse entered resident's room to administer PM [afternoon] medication when resident stated that she was hurting from a fall that occurred earlier in the day. Resident stated that her right leg gave out when the CNA [Certified Nursing Assistant] was attempting to put her back in bed which resulted in her right leg twisting and going under the bed. Roommate states she witnessed said incident. This nurse palpated hip area down to her lower extremity. Resident showed signs of pain with facial grimacing and screaming for me to stop. Xray ordered for rule out. Scheduled pain medication administered at that time. Review of Resident #2's records showed no notification of the resident representative regarding the incident documented on 7/10/2025. During an interview on 8/6/2025 at 5:33 PM, the Director of Nursing (DON) stated, The expectation for a fall, whether reported or witnessed, is to complete an incident report and to complete a change in condition report, assess the resident, notify the PCP [primary care physician] and the family. There was no notification to family regarding a fall. Review of the facility policy and procedure titled Nursing- Change in Condition with an effective date of 4/1/2022, and a revision date of 4/4/2023 read, Purpose: To identify and communicate changes in condition to the physician and other employees to implement interventions to prevent further deterioration and possibly prevent hospitalization. Procedure. 7. The resident's family/legal representative/health care agent should be notified about the change in condition as required. Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 105613 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 105613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Live Oak Healthcare and Rehabilitation Center 1620 Helvenston St SE Live Oak, FL 32064 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)