Inspection·February 23, 2023

F 0554 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few an order for a respiratory inhaler, eye drops, or an order allowing the self-administration of medications. The clinical record of the Resident #88 did not indicate the resident had been assessed for the ability to self-administer medications. An observation on 2/22/23 at 10:16 a.m., identified both the bottle of eye drops and inhaler were lying on top of Resident #88's bedside dresser. The resident stated the inhaler was administered twice a day without staff. An interview was conducted on 2/22/23 at 11:59 a.m., with Staff M, agency Licensed Practical Nurse (LPN). The staff member stated the residents are allowed to self-administer if there is a (physician) order for it. Staff N stated the residents are allowed to self-administer after they are assessed and able to return demonstrate. Staff N confirmed Resident #88 did not have an order to self-administer. An observation, on 2/22/23 at 12:04 p.m. was conducted of Resident #88 with Staff N. The resident stated the Albuterol inhaler and eye drops were from an outside pharmacy from the insurance company. The staff member removed the medications from the room and confirmed Resident #88 did not have an order for either medication. A review of Resident #88's facesheet identified the resident was admitted on [DATE] and diagnoses included but not limited to unspecified low back pain, acute pain due to trauma, other specified anxiety disorders, unspecified insomnia, and unspecified depression. The facesheet did not indicate the resident had any respiratory diagnoses. The care plan for Resident #88 did not include any intervention related to the ability to self-medicate and did not indicate the resident had any respiratory issues. The Director of Nursing stated, at 1:19 p.m. on 2/22/23, the residents should be assessed prior to being allowed to self-administer (medications). On 2/22/23 at 2:25 p.m., the Nursing Home Administrator (NHA) stated the facility was unable to locate a self-administration evaluation for Resident #44 and Resident #88 in the computer or the to be filed area. The policy titled, Self-Administration of Medications, revised December 2016, identified the following: Residents have the right to self-administer medications if the interdisciplinary team has determined that it is clinically appropriate and safe for the resident to do so. The policy identified the following: - 1. As part of their overall evaluation, the staff and practitioner will assess each resident's mental and physical abilities to determine whether self-administering medications is clinically appropriate for the resident. - 2. In addition to general evaluation of decision-making capacity, the staff and practitioner will perform a more specific skill assessment, including (but not limited to) the resident's: --a. Ability to read and understand medication labels; --b. Comprehension of the purpose and proper dosage and administration time for his or her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 2 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0554 medications; Level of Harm - Minimal harm or potential for actual harm -- c. Ability to remove medications from a container and to ingest and swallow (or otherwise administer) the medication; and Residents Affected - Few --d. Ability to recognize risks and major adverse consequences of his or her medications. - 5. The staff and practitioner will document their findings and choices of residents who are able to self-administer medications. - 8. Self-administered medications must be stored in a safe and secure place, which is not accessible by other residents. If safe storage is not possible in the resident's room, the medications of residents permitted to self-administer will be stored on a central medication cart or in the medication room. Nursing will transfer the unopened medication to the resident when the resident requests them. - 9. Staff shall identify and give to the Charge Nurse any medication s found at the bedside that are not authorized for self-administration, for return to the family or responsible party. - 13. The staff and practitioner will periodically (for example, during quarterly Minimum Data Set (MDS) reviews) reevaluate a resident's ability to continue to self-administer medications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 3 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. 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 do an ongoing re-evaluation of the need for a restraint for one resident (#43) out of one resident with a restraint. Residents Affected - Few Findings included: An observation was made on 02/20/23 at 10:40 a.m. Resident #43 was observed to be in the common room sitting inside a PVC (lightweight plastic tubing) rolling chair, that wraps completely around the resident's waist and between her legs (known as a merry walker). A review of Resident #43's facesheet revealed she was admitted to the facility on [DATE] with medical diagnoses which include but not limited to unspecified dementia without behavioral disturbances, anxiety disorder due to known physiological condition, unspecified mood disorder, unspecified psychosis not due to a substance or known physiological condition, major depressive disorder, delusional disorder, muscle weakness, abnormalities of gait and mobility, difficulty in walking, unsteadiness on feet, lack of coordination, and a history of falling. A review of Resident #43's physician orders revealed orders with a start date of 12/2/22 check function of merry walker Q [every] shift. Every day. Another order with a start date of 12/2/22 Resident to be OOB [out of bed] in merry walker when awake *monitor resident for sleepiness, place resident to bed when drowsy for a time of Shift A (7:00a.m.-7:00p.m.) every day. A review of Resident #43's Minimum Data Set, section C, which was undated revealed her Brief Interview for Mental Status score was 1 out of 15 indicating severe cognitive impairment. A review of Resident #43's restraint care plan with a start date of 11/23/2022 revealed Restraint: [Resident #43] need to move and loves to walk. She becomes agitated and unhappy when not able to ambulate. She is unsteady and will fall without support the merry walker is used as a solution due to falls and unsteadiness for (the resident's) happiness, quality of life and psychosocial wellbeing and activity. Resident unable to exit the merry walker without assistance. Resident/Representative was involved/informed of this Care Plan. Care Plan Goal: Safe use of restraint/merry walker to enhance ambulation through the review date. Intervention: Check device daily for condition status; Ambulate in hallway with merry walker and to meals daily as desired/required; 1:1 while merry walker is broken and in regular wheelchair due to high galls risk. A review of Resident #43's medical record was conducted and there was no evidence of a quarterly assessment for restraint use. A review of Resident #43's Physical Restraint Record of Informed Consent dated 6/2/21 revealed . After careful consideration of the information provided to me, I hereby: [handwritten] merry walker Give permission for the use of restraints as established in the facility's restraint policies and procedures. .Resident unable to sign consent. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 4 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0604 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Two nurses signed the document and hand written on the document revealed verbal from [family member name and telephone number] was giving consent and aware since she got the merry walker on 10/20/20. An interview was conducted on 02/22/23 at 11:47 a.m. with the Nursing Home Administrator (NHA) she said we talked about it, and we are supposed to have quarterly assessment for her merry walker but our system does not have an assessment for that. We do quarterly assessments with the care plan so I can see if we discussed it with the family and documented it there. An interview was conducted on 02/22/23 at 12:55 p.m. with the Director of Nursing and she confirmed Resident #43's merry walker is a restraint and there should be quarterly reviews related to the merry walker. A review of the facility's Use of Restraints policy revised on April 2017 revealed the following: Policy Statement: Restraints shall only be used for the safety and well-being of the resident(s) and only after other alternatives have been tried unsuccessfully. Restraints shall only be used to treat the resident(s) medical symptom(s) and never for discipline or staff convenience, or for the prevention of falls. When the use of restraints is indicated, the least restrictive alternative will be used for the least amount of time necessary, and the ongoing re-evaluation for the need for restraints will be documented. Policy Interpretation and Implementation 1. physical restraints are defined as any manual method or physical or mechanical device, material or equipment attached or adjacent to the residence body that the individual cannot remove easily, which restricts freedom of movement or restricts normal access to one 's body. 2. The definition of restraint is based on the functional status of the resident and not the device. If the resident cannot remove a device in the same manner in which the staff applied it given that resident's physical condition (i.e., side rails are put back down, rather than climbed over), and this restricts his/her typical ability to change position or place, that device is considered a restraint. .5. Restraints may only be used if/when the resident has s specified medical symptom that cannot be addressed by another less restrictive intervention AND a restrain is required to: a. Treat the medical condition (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 5 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0604 b. Level of Harm - Minimal harm or potential for actual harm Protect the resident's safety; and c. Residents Affected - Few Help the resident attain the highest level of his/her physical or psychological well-being. .9. Restraints shall only be used upon the written order of a physician and after obtaining consent from the resident and/or representative (sponsor). The order shall include the following: a. The specific reason for the restrain (as it related to the resident's medical symptoms); b. How the restrain will be used to benefit the resident's medical symptom; and c. The type of restrain, and period of time for the use of restraint. .11. Reorders are issued only after a review of the resident's condition by his or her physician. .16. Restrained individuals shall be reviewed regularly (at least quarterly) to determine whether they are candidates for restraint reduction, less restrictive methods of restraints, or total restraint elimination . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 6 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews the facility failed to 1) develop a baseline care plan within 48 hours of admission; and 2) provide a written summary of the baseline care plan to the resident/resident representative for two residents (#367 and #214) out of 43 sampled residents. Findings included: The facesheet for Resident #367 indicated the resident was admitted for short term rehabilitative care on 10/1/22 and was discharged on 10/7/22. The facesheet included diagnoses not limited to unspecified osteomyelitis, Type 2 Diabetes with foot ulcer, and personal history of unspecified adult abuse. The progress notes for Resident #367 indicated a note on 10/1/22 at 6:59 p.m., that identified the resident arrived via wheelchair transport with an admitting diagnosis of exostectomy of left foot with wound vacuum (vac). The admission Data Collection Tool was completed at 3:12 p.m. on 10/3/22. The baseline care plan for Resident #367 was not available in either the closed record or the electronic clinical record. The facility provided an undated copy of the Baseline Care Plan that identified the resident was admitted on [DATE]. The care plan indicated in box #62 Signatures of Interdisciplinary Team Members Contributing to Baseline Care Plan was empty, box #63 Written Summary of Baseline Care Plan was empty, box #65 Baseline Care Plan Completion Date was empty, and box #66 Date reviewed with Resident/Representative was written, Resident left to go home 10/7/22. The Comprehensive Care Plan, located in the electronic record, included one care plan description that indicated Resident #367 had a potential for imbalanced nutrition/hydration related to diagnosis of osteomyelitis, anxiety, hypertension, generalized weakness, Diabetes Mellitus, neuropathy, Charcot foot deformity, partial left foot amputation (9/23/22), right foot toe amputation, wound vac in place for healing, often requests alternate meals as desires, multiple sugar free drinks/snacks at bedside, overweight. The care plan identified the resident/representative was involved/informed of this care plan that was started on 10/6/22. On 2/22/23 at 11:04 a.m. the Nursing Home Administrator (NHA) provided the baseline care plan for Resident #367 and indicated they were done on paper. The NHA stated the care plan had been received from Staff P, a sister facility NHA who was in the building assisting. On 2/22/23 at 12:50 p.m., Staff P stated she had obtained the baseline care plan for Resident #367 from Minimum Data Set (MDS) in the to be filed file. The staff member stated the facility had identified issues with baseline care plans and the plans should be completed within 48 hours. The baseline care plan was reviewed with the staff member and identified it did not include a completed date, did not identify who had completed the care plan or if the resident had received a copy. Staff P confirmed the admission Data Tool was completed 2 days after the resident had arrived at the facility. Resident#214 was admitted to the facility on [DATE] with multiple diagnose but not limited to pneumonia with antibiotic treatment. Resident is alert and oriented with a BIMS of 13 indicating cognitively intact. A review of Residnet#214 medical record was conducted which revealed a Baseline Care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 7 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Plan dated 10/5/2022 started at 4:19 PM and completed at 4:21 PM with no input from the resident/family or Interdisciplinary Team (IDT). There was no indication in the medical record the resident or family had received a copy of the summary of the Baseline Care Plan. On 02/22/23 at 12:49 PM. An interview was conducted with the visiting Nursing Home Administrator from the sister facility who stated they realize there is a problem with the facility base line care plans. On 02/22/23 at 1:11 PM an interview was conducted with the Director of Nursing. She was asked to review the Baseline Care Plan and the medical record for Resident #214 for any documented evidence that the resident/family, IDT or physician participated in the Baseline Care Plan. She confirmed she would expect to see documentation in the medical record as to the participants which should include the resident/family and IDT members as well as documentation indicating the resident received a copy of the summary of the Baseline Care Plan. The facility omitted any documentation regarding the participation of the required individuals. A review of the facility policy titled Care Plans- Baseline indicated the following: #4. The resident and their representative will be provided a summary of the baseline care plan FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 8 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews the facility failed to develop and implement care plans for three residents (#69, #55, and #103) of forty-three sampled residents. It was determined care plans were not developed and implemented related to dental/oral status for Resident #69, diabetic diagnosis and care for Resident #55, and smoking/ smoking safety for Resident #103. Findings included: On 2/20/2023 at approximately 2:00 p.m. Resident #69's was observed in the room with a family member. An interview with Resident #69's family member revealed she was the resident's Power of Attorney and makes medical decisions, but Resident #69 could make her daily choice decisions. Resident #69 was observed in her bed, and with head of the bed approximately forty-five degrees and the call light placed within her reach. The resident was observed in a private room, her television on, the over the bed table placed over her, with many personal belongings on it and all within her reach. Resident #69 was not presenting with any behaviors and was pleasant to speak with. Resident #69 allowed an interview and she and her family member explained there had been some dental issues. They stated her partials did not fit right, she had lost some back teeth recently and she had some broken teeth as well. The resident opened her mouth and there were several teeth that appeared broken with sharp edges. The upper partial appeared to be ill fitted, causing discomfort. Resident #69 and her family member both revealed the Dentist came in some time ago (neither could remember exactly how long ago), supplied her with the partials and has not returned. Resident #69's family member believed the Dentist was there maybe two months ago, in 12/2022. Resident #69 indicated her partial did not fit right, due to her losing more teeth since his last visit. She and her family member revealed they had spoken to nurses and aides (no names were provided) many times about getting the Dentist to return. Resident #69 and her family member both revealed staff have not followed up with her yet, and the nurse knows on a daily basis of her mouth discomfort. Resident #69 and her family member could not remember how long ago the Dentist or oral hygienist provided a visit and assessment and care to her. On 2/23/2023 at 7:15 a.m. Resident #69 was noted in room and in bed and dressed for the day. She was awaiting to be assisted to the dialysis center for her routine care. She had no complaints and indicated her pain level was low and staff provided medications per her request. She also revealed she did not have any chewing or tooth pain so far, but still had discomfort from the partial. On 2/23/2023 at 1:50 p.m. another interview with Resident #69 revealed she was not in any pain and did not want to cause any problems with staff. She revealed she feels guilty having to tell staff every day she is in pain and it gets tiring. She did confirm staff do provide her with relief medications when she has pain, but it is just a matter of her being tired of having to tell people every day. She wanted to ensure it was not the staff, but rather her just having a problem of having pain every day and feels she bothers the staff with it too much. The resident did appear during this observation free from any pain, behaviors, and discomfort. Resident #69 confirmed her mouth was in some discomfort, but not in any pain. Her call light was placed within her reach. A review of Resident #69's medical record revealed she was admitted on [DATE]. A review of the advance directives revealed the resident had a decision maker in place who was a family member. A review of the diagnosis sheet revealed diagnoses to include but not limited to: dysphagia, hemodialysis, pain, End Stage Renal Disease. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 9 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 Level of Harm - Minimal harm or potential for actual harm A review of the most current Minimum Data Set (MDS) Quarterly assessment, dated 11/25/2022, revealed: (Cognition/Brief Interview Mental Status or BIMS score - 15 of 15, which indicated the resident was able to speak about her daily choices and decisions); (Activities of Daily Living ADL - EATING = Independent set up only); (ORAL = Checked for swallow disorder); (HEALTH CONDITION = Pain, with assessment should be completed). Residents Affected - Few A review of the assessments revealed the following: : - admission Data Collection dated 9/13/2022 revealed: Does not have any obvious dental concerns during the time of assessment; Number of upper teeth = unable to tell; Number of lower teeth = unable to tell; Does resident wear dentures = No. - Social Service Review dated 11/25/2022 revealed: Comment = Some natural teeth, Referrals needed = Dental. Review of the current care plans with a last review date of 12/17/2022 revealed problem areas to include: - Pain risk for pain and discomfort, with interventions in place as reviewed. However, nothing was documented related to dental or oral pain status. A review of the last dental visits from Dentist and Hygienist dated 10/25/2022, and 12/19/2022 both indicated resident evaluated with sharp tooth but no pain or discomfort and to encourage to notify if any pain and that upper partial is in good condition at this time. Another dental visit dated 2/6/2023 indicated prophylaxis visit and no complaints with regards to her natural teeth and with moderate soft deposits. No other concerns noted. It was determined through the last Dentist assessment/review on 2/6/2023, there were no complaints made by Resident #69 with regards to ill fitted partials. However, since 10/25/2022, it had been evaluated that Resident #69 had sharp teeth. Further, a Social Service note dated 11/25/2022 revealed some natural teeth, and there was a need for a dental referral. This would indicate Resident #69 had a need to be care planned with problem areas, goals, and interventions with relation to Dental/Missing teeth/Oral care. A review of the current care plans revealed no such problem areas, nor any interventions that would accommodate Resident #69's dental needs. On 2/22/2023 at 1:00 p.m. an interview with Staff C, Social Worker Director revealed she has not been notified by the family member or resident to have a dental visit nor gave any indication of pain or discomfort with her teeth or partials. She will follow up immediately and have a visit. On 2/23/2023 at 1:15 p.m. an interview was conducted with the Minimum Data Set (MDS) coordinator. She reviewed Resident #69's medical record and she confirmed there were areas to include past notes and assessments in months 10/2022, 12/2022 and 2/2023 indicating Resident #69 had dental problems, missing teeth and that a care plan should have been developed to specify a dental problem area, with interventions and goals to ensure her mouth partial fitted correctly, to ensure mouth comfort, mouth care, staff monitoring and continued dental visits. The MDS Coordinator Indicated they had been short an MDS employee as of late and it had been difficult trying to catch up with care planning. The MDS coordinator confirmed Resident #69 should have had a Mouth/Dental/Oral care plan since at least 10/2022. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 10 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 2/23/2023 at 3:00 p.m. the Nursing Home Administrator provided the Care Planning - Interdisciplinary Team policy and procedure, with last revision date September 2013, which revealed the following: Policy Statement: Our facility's Care Planning/Interdisciplinary Team is responsible for the development of an individualized comprehensive care plan for each resident. Policy Interpretation and Implementation: 1. A comprehensive care plan for each resident is developed within seven (7) days of completion of the resident (MDS). 2. The care plan is based on the resident's comprehensive assessment and is developed by a Care Planning/Interdisciplinary Team which includes, but is not necessarily limited to the following personnel: (d.) The Social Services Worker responsible for the resident. (g.) Consultants (as appropriate). On 2/23/2023 at 3:00 p.m. the Nursing Home Administrator provided the Using the Care Plan policy and procedure, with last revised date of August 2006, for revealed: Policy Statement: The care plan shall be used in developing the resident's daily care routines and will be available to staff personnel who have responsibility for providing care and services to the resident. Policy Interpretation and Implementation: (1.) Completed care plans are placed in the resident's chart and /or in a 3-ring binder located at the appropriate nurse's station. (2.) The Nurse Supervisor uses the care pan to complete the CNA's daily/weekly work assignment sheets and/or flow sheets. (3.) CNAs are responsible for reporting to the Nurse Supervisor any changes in the resident's condition and care plan goals and objectives that have not been met or expected outcomes that have not been achieved. (4.) Other facility staff noting a change in the resident's condition must also report those changes to the Nurse Supervisor and/or the MDS Assessment Coordinator. A review of Resident #55's facesheet revealed he was admitted to the facility on [DATE] for long term nursing care. He was admitted with diagnosis that include but are not limited Type 2 Diabetes Mellitus with hyperglycemia. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 11 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 A review of Resident #55's physician orders revealed an order to start on 2/3/23 for sliding scale: Level 2-Novolin N Subcutaneous Suspension 100 unit/ML Level of Harm - Minimal harm or potential for actual harm 0-150=No coverage Residents Affected - Few 151-199=1 unit 200-249=2 units 250-299=3 units 300-349=4 units 350 or greater-5 units and call MD [medical doctor] A review of Resident #55's care plans did not reveal a care plan for his diabetes and insulin use. On 2/23/23 at 2:3pm. an interview was conducted with the Nursing Home Administrator (NHA) she confirmed the resident does not have a care plan related to his diabetes diagnosis. An interview was conducted with Resident #103 on 02/20/23 at 9:55 a.m. she said I am a smoker; I sleep with my most important items like my lighters because they keep getting stolen. I keep my important items in my bag and I sleep with it because if you get caught with cigarettes and lighters they will take them away from you. You can go get your smoking stuff from the desk if you want. One night I got caught smoking in my room. They are not happy with me because I was smoking in my room, but I thought I was at home and they told me I can't smoke in the room. An interview was conducted with Resident #103's roommate and she said on 02/20/23 at 9:57 a.m. She smoked in this room with me in it and they caught her and they told her she cannot do that. Neither resident was observed to be on oxygen. A review of Resident #103's facesheet revealed she was readmitted from an acute care hospital on 2/8/2023 with diagnoses that included but are not limited to muscle weakness, difficulty in walking, need for assistance with personal care, encounter for surgical aftercare following surgery, congestive heart failure, chronic kidney disease, acute kidney failure, Type 2 Diabetes Mellitus, Sarcopenia, convulsions, intervertebral disc degeneration, lumbar region, disorders of bone density and structure, benign neoplasm of left adrenal gland, occlusion and stenosis of bilateral carotid arteries, and occlusion and stenosis of left vertebral artery. A review of Resident #103's Minimum Data Set (MDS), section C, dated 12/8/2022 revealed she had a Brief Interview for Mental Status (BIMS) score of 15 out of 15 indicating no cognitive impairment. A review of Resident #103's care plans did not reveal a smoking care plan with appropriate interventions. An interview was conducted on 02/22/23 at 9:47 a.m. with Staff B, Agency Registered Nurse (RN). She said I did hear about her (Resident #103) smoking in her room in report. I think it was last week that I heard about it. Now what day and time that happened I'm not sure. But we had an agreement with her that she needs to return her lighters to us or if we find them, we need to take them from her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 12 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and she would sometimes be good about giving us her lighters. It looks like on December 2nd she went out for a seizure and came back so her smoking assessment was on her original admission stay. She was discharged yesterday. An interview was conducted on 02/22/23 at 10:04 a.m. with Staff N, Assistant Director of Nursing (ADON) she said, I did not know anything about her (Resident #103) smoking. We have a safe smoking assessment that we do upon admission. Therapy will also do an assessment to determine if they are a safe smoker and if they are then they can smoke and if they are not then unfortunately, they cannot smoke. I did not know she was a smoker, we do not have her as a smoker. Staff B, ADON reviewed her safe smoking evaluation and she stated the smoking assessment was from her original admission and it says that she is not a smoker. An interview was conducted on 2/23/23 at 1:11 p.m. with Staff R, Occupational Therapist (OT) she stated when she performs a smoking assessment her role is to conduct orientation questions like if they have oxygen, and if they can manage their oxygen line, do they know to take it off before they smoke, then I asses their fine and gross motor skills, I ask them to show me how to manipulate the lighter and show me how they put it out. I also look at their functional abilities, do they know how to get to the smoking patio safely, self-propel, open the door, get up to the table, lock their breaks. She stated, from there she determines if they are safe to go out on their own to the patio independently or if they are going to need someone to assist in smoking. When Resident #103 was originally here she was not a smoker she did not go out and smoke. On the day she discharged from therapy she was sent out to the hospital either that day or the day after. Then she came back, and we did have her on therapy and we found out that she was going out on the patio and getting cigarettes from the other residents and I was told to go out and do a smoking assessment on her so that's when I did that on the 16th. I did not hear she was smoking in her room. I don't educate them on where to keep their smoking materials that might be a nursing thing, I just assess their abilities to smoke safely and if they are independent or need assistance. It's my understanding that the resident can keep all their smoking materials on them. A review of Resident #103's Safe Smoking Evaluation dated 12/3/2022 revealed Family or Medical Representative informed of smoking policy restrictions-Comment N/A [not applicable] nonsmoker. A review of Resident #103's therapy smoking assessment titled Screening for Smoking Privileges dated 2/16/23 . Assessment Pt [patient] demonstrates good safety measures and judgment; able to safely manipulate smoking materials. Her cognition has improved as she is able to recall safety steps with smoking. Results: smoke independently signed and dated by Staff R, OT On 02/22/23 at 12:55 p.m. an interview was conducted with the Director of Nursing (DON). She said everyone is supposed to get a smoking assessment on admission regardless of if they smoke or not. For smokers, therapy does dexterity assessments to determine safe smoking and then there is a nursing smoking assessment. Nursing is supposed to observe the smoking, make sure they can get to the smoking's area safely and ensure they are safe to smoke. I just learned today Resident #103 smoked in her room. Before she went to the hospital she was not going out to smoke. I'm not sure what happened after she returned from the hospital. The smoking assessment should have been redone when she returned from the hospital. We have liberalized smoking so, the residents are educated on where to smoke, assessed to be a safe smoker and they are able to keep their materials on them. They should also be care planned for smoking as well. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 13 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0660 Plan the resident's discharge to meet the resident's goals and needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility did not ensure 1) a discharge care plan was in place, 2) a discharge summary was completed, and 3) post care discharge plans were documented for two residents (#112 and #113) out of three residents sampled for discharge. Residents Affected - Few Findings included: A review of a document titled, Face Sheet, printed on 2/22/23 showed Resident #112 was admitted to the facility on [DATE] and was discharged on 11/27/22. The document showed under discharge status the resident's return was not anticipated. The document did not indicate where the resident was discharged to. A review of a document titled, Physician Orders List, dated 11/17/22 showed there were no discharge orders for Resident #112. A review of a care plan with a start date of 11/22/22, noted active on discharge, showed Resident #112 did not have discharge planning goals indicated. A review of a document titled, Face Sheet, printed on 2/22/23 showed Resident #113 was admitted to the facility on [DATE] and was discharged on 1/12/23. The document showed under discharge status, the resident's return was not anticipated. The document did not indicate where the resident was discharged to. A review of a document titled, Physician Orders List, dated, 2/2/22 to 2/22/23, showed there were no discharge orders for Resident #113. A review of a care plan with a start date of 7/11/22, status, active on discharge, showed Resident #113 did not have discharge planning goals indicated. On 02/22/23 at 01:14 p.m., an interview was conducted with Staff L, Minimum Data Set (MDS) coordinator. She stated the care plan is completed by nursing, MDS and Social Services Director (SSD). She reviewed Resident #112 and 113's care plans and stated they did not have a discharge plan. Staff L stated the SSD does discharges, care planning goals and discharge summary. On 02/22/23 at 01:36 p.m., an interview was conducted with Staff C, SSD. She stated they start discharge planning upon admission. Staff C stated she finds out the resident's goals through the resident and/or the family and uses that information to initiate discharge planning process. Staff C stated during their stay, she maintains their progress goals in the care plan and continues to work with the resident and/family to make ensure they are meeting the goals. Staff C stated upon discharge, she completes a discharge summary. On 02/22/23 at 02:57 p.m., a follow-up interview was conducted with Staff C, SSD. She stated she did not have a discharge care plan in place for these residents [Resident #112 and #113]. Staff C said, it should have been there. We should be documenting resident's discharge goals from admission, during stay, all the way to the end. Staff C confirmed a discharge summary should have been documented to indicate where the resident went and their aftercare plan. A review of an undated document presented by Staff C,SSD showed, Resident #112 did not have a discharge care plan and was transferred to a hospital. Resident #113 did not have a discharge care plan (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 14 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0660 and was transferred to another skilled nursing facility (SNF). Level of Harm - Minimal harm or potential for actual harm A review of a facility policy titled, discharge summary and plan, dated, December 2016, showed when a resident's discharge is anticipated, and a discharge summary and post discharge plan will be developed to assist the resident to adjust to his or her new living environment. Residents Affected - Few When the facility anticipates a resident's discharged to a private residence, another nursing care facility a discharge summary and a post discharge plan will be developed which will assist the resident to adjust to his or her new living environment. The discharge summary will include recapitulation of the resident's stay at this facility and a final summary of the resident's status at the time of the discharge in accordance with established regulations governing release of resident information and there's permitted by the resident. the discharge summary shall include a description of the residence currents diagnosis, medical history, course of illness, treatment and or therapy since entering the facility; current labs and diagnostic test results, physical and mental functional status, ability to perform activities of daily living, sensory and physical impairments, nutritional status and requirements, special treatments or procedures, mental and psychosocial status, discharge potential, dental condition, activities potential, and rehabilitation potential. a copy of the following will be provided to the resident and receiving facility and a copy will be filed in the residence medical record a. an evaluation of the residents discharge needs. b. the post discharge plan. c. the discharge summary. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 15 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observations, interviews, and record reviews the facility failed to 1) ensure one resident (#103) smoked in the designated smoking area and was adequately assessed for smoking out of three residents sampled for smoking. Findings included: 1) An interview was conducted with Resident #103 on 02/20/23 at 9:55 a.m. she said, I am a smoker; I sleep with my most important items like my lighters because they keep getting stolen. I keep my important items in my bag and I sleep with it because if you get caught with cigarettes and lighters they will take them away from you. You can get your smoking stuff from the desk if you want. One night I got caught smoking in my room. They're not happy with me because I was smoking in my room but I thought I was at home and they told me I can't smoke in the room. An interview was conducted with Resident #103's roommate on 02/20/23 at 9:57 a.m. She stated Resident #103 smoked in the room with me in it and they caught her and they told her she cannot do that. Neither resident was observed to be on oxygen. A review of Resident #103's facesheet revealed she was readmitted from an acute care hospital on 2/8/2023 with diagnoses that included but are not limited to muscle weakness, difficulty in walking, need for assistance with personal care, encounter for surgical aftercare following surgery, congestive heart failure, chronic kidney disease, acute kidney failure, Type 2 Diabetes Mellitus, Sarcopenia, convulsions, intervertebral disc degeneration, lumbar region, disorders of bone density and structure, benign neoplasm of left adrenal gland, occlusion and stenosis of bilateral carotid arteries, and occlusion and stenosis of left vertebral artery. A review of Resident #103's Minimum Data Set (MDS), section C, dated 12/8/2022 revealed she had a Brief Interview of Mental Status (BIMS) score of 15 out of 15 indicating no cognitive impairment. An interview was conducted on 02/22/23 at 9:47 a.m. with Staff B, Agency Registered Nurse (RN). She said, I did hear about her (Resident #103) smoking in her room in report. It was last week that I heard about it. Now what day and time that happened I am not sure. But we had an agreement with her that she needs to return her lighters to us or if we find them we need to take them from her and she would sometimes be good about giving us her lighters. It looks like on December 2nd she went out for a seizure and came back so her smoking assessment was on her original admission stay. She was discharged yesterday. An interview was conducted on 02/22/23 at 10:04 a.m. with Staff N, Assistant Director of Nursing (ADON). She said, I did not know anything about her (resident #103) smoking. We have a safe smoking assessment that we do upon admission. Therapy will also do an assessment to determine if they are a safe smoker and if they are then they can smoke and if they are not then unfortunately they cannot smoke. I did not know she was a smoker, we do not have her as a smoker. Staff B, ADON reviewed her safe smoking evaluation and she stated the smoking assessment was from her original admission and it said that she was not a smoker. An interview was conducted on 2/23/23 at 1:11 p.m. with Staff R, Occupational Therapist (OT) she said when she performs a smoking assessment her role is to conduct orientation questions like, if they (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 16 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 have oxygen, if they can manage their oxygen line, do they know to take it off before they smoke, then she assesses their fine and gross motor skills, she asks them to show her how to manipulate the lighter and show her how they put it out. She stated she also looks at their functional abilities, like do they know how to get to the smoking patio safely, self-propel, open the door, get up to the table, lock their breaks. From there I determine if they are safe to go out on their own to the patio independently or if they are going to need someone to assist in smoking. When Resident #103 was originally here she was not a smoker she did not go out and smoke. On the day she discharged from therapy she was sent out to the hospital either that day or the day after. Then she came back and we did have her on therapy and we found out that she was going out on the patio and getting cigarettes from the other residents and I was told to go out and do a smoking assessment on her so that's when I did that on the 16th. I did not hear she was smoking in her room. I don't educate them on where to keep their smoking materials that might be a nursing thing, I just assess their abilities to smoke safely and if they are independent or need assistance. It's my understanding that the resident can keep all their smoking materials on them. A review of Resident #103's Safe Smoking Evaluation dated 12/3/2022 revealed Family or Medical Representative informed of smoking policy restrictions-Comment N/A [not applicable] nonsmoker. A review of Resident #103's therapy smoking assessment titled Screening for Smoking Privileges dated 2/16/23 . Assessment Pt [patient] demonstrates good safety measures and judgment; able to safely manipulate smoking materials. Her cognition has improved as she is able to recall safety steps with smoking. Results: smoke independently signed and dated by Staff R, OT On 02/22/23 at 12:55 p.m. an interview was conducted with the Director of Nursing (DON). She said, Everyone is supposed to get a smoking assessment on admission regardless of if they smoke or not. For smokers, therapy does dexterity assessments to determine safe smoking and then there is a nursing smoking assessment. Nursing is supposed to observe the smoking, make sure they can get to the smoking's area safely and ensure they are safe to smoke. I just learned today that she (Resident #103) smoked in her room. Before she went to the hospital she was not going out to smoke. I'm not sure what happened after she returned from the hospital. The smoking assessment should have been redone when she returned from the hospital. We have liberalized smoking so, the residents are educated on where to smoke, assessed to be a safe smoker and they are able to keep their materials on them. They should also be care planned for smoking as well. A review of Resident #103's care plans was conducted and there was no evidence Resident #103 had a smoking care plan. A review of the facility's Smoking Policy-Residents Revised January 2020 indicated the following: Policy Statement This facility shall establish and maintain safe resident smoking practices. Policy Interpretation and Implementation .6. The resident will be evaluated on admission to determine if he or she is a smoker or non-smoker. .8. Any smoking-related privileges, restrictions, and concerns (for example, need for close monitoring) shall be noted on the care plan. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 17 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 .11. Residents are permitted to keep cigarettes, e-cigarettes, pipes, tobacco, and other smoking articles in their possession. Only disposable safety lighters are permitted. All other forms of lighters, including matches, are prohibited. 12. Resident are not permitted to give smoking articles to other residents Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 18 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 observations, interviews, and record reviews the facility failed to ensure 1) respiratory care was provided consistent with professional standards of practice related to oxygen levels not set per physician orders for one resident (#72), and 2) respiratory equipment was stored appropriately for four residents (#72, #10, #62 and #73) out of five residents sampled during two of four days of survey. Residents Affected - Few Findings included: Resident #72 was admitted to the facility on [DATE] with diagnosis to include pneumonia unspecified, adult failure to thrive, acute kidney failure and unspecified atrial fibrillation. An undated Minimum Data Set (MDS) for Resident #72 showed the resident is dependent on staff for activities of daily living (ADL) with one-person physical assistance. An observation was conducted on 2/20/23 at 12:15 p.m. of Resident #72 who was observed to be in her watching television. The resident was observed to have a nasal cannula on with her oxygen flow rate set to 5.5 liters per minute (LPM). The resident did not know what the settings of her oxygen should be. The resident stated, this is uncomfortable, pointing to her nasal cannula. Photographic evidence was obtained. On 02/20/23 at 09:45 a.m., Resident #72 was observed in her room, lying in bed. Her nebulizer was noted by bedside, uncovered. On 02/20/23 at 12:15 p.m., Resident #72's nebulizer cannula was observed at bedside, still uncovered. A review of a document titled, Physician Orders List showed oxygen orders with a start date 8/27/22, showing O2 (oxygen) at 2L/Min (liters per minute) via NC (nasal cannula) continuous as tolerated; DX (diagnosis) SOB (shortness of breath)/Cyanosis. The order list also showed, Iprat-[NAME] (Albuterol) 0.5-3 (2.5 MG (Milligrams)/3ML (milliliters) administer 1 vial via nebulizer 4 times daily. Rinse and spit after administered diagnosis COPD (chronic obstructive pulmonary disease). A review of a Medication Administration Record (MAR) for Resident #72, dated February 2023, showed Resident #72 was receiving oxygen at 2L/Min during 7 a.m. - 7 p.m. and 7 p.m. - 7 a.m., contrary to the observation on 2/20/23 and 2/21/23. On 02/21/23 at 09:44 a.m., Resident #72 was observed in her room, sleeping her cannula in her nose. The resident's oxygen was noted set at 5.5 liters. On 02/21/23 at 03:50 p.m., Resident #72's O2 was observed in her room in bed, her oxygen level noted at 2.5L. Photographic evidence was obtained. On 02/21/23 at 04:05 p.m. an interview was conducted with Staff K, Licensed Practical Nurse (LPN)/weekend supervisor. Staff K reviewed Resident #72's orders and stated her orders are to administer Oxygen at 2L/min. She stated it should not be 2.5L/min nor 5L/min. She stated 5L/min is way too high and would be concerning especially if the resident had a diagnosis of COPD. She stated she would address the issue with the DON. Staff K said, the expectation is to follow doctor's orders. There are no parameters here, the order reads 2L/min. that is what it should be. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 19 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 On 02/21/23 at 04:11 p.m., an interview was conducted with the Director of Nursing ( DON). She stated Resident #72's oxygen should be administered as ordered. The DON reviewed the resident's orders and stated her oxygen level should be 2L/min. She stated the nurses should strictly follow physician directions when it comes to administration of oxygen or medications. The DON said, administering oxygen at 5.5L/min when the order reads 2L/min is very concerning. She stated she would follow-up. Residents Affected - Few During a facility tour on 02/20/23 02:09 p.m. and on 02/21/23 at 10:49 a.m., an observation was made of Resident #10's nebulizer machine at bedside, the mask was observed on her nightstand, uncovered, exposed to the elements. Resident #10's oxygen concentrator was observed in her room, set at the corner without tubing, appeared to not be in use. An attempt to interview Resident #10 was unsuccessful. A review of a document titled, Face sheet, showed Resident #10 was admitted to the facility on [DATE] with diagnoses to include pneumonia unspecified, COPD, encephalopathy, and unspecified dementia. An undated MDS for Resident #10 section C, showed a Brief Interview of Mental Status (BIMS) of 3, indicating severe mental impairment. Section D showed Resident #10 is dependent on staff for ADLs with one-person physical assist. A review of a document titled, Physician orders List dated 10/01/22 to 2/23/23, showed, administer oxygen at 2L/minute via nasal cannula, dated 10/23/22. The orders showed Albuterol Sul 2.5 MG/3ML solution administer vial via nebulizer 4 times daily, discontinued 11/15/22. On 02/23/23 at 01:21p.m., an interview was conducted with Staff D, LPN/UM. She stated she had reviewed Resident #10's oxygen orders and MAR which showed the resident was receiving Oxygen daily at 2L/min. Staff D was notified that during 3 of 3 days observations, resident was not observed on oxygen even though it was documented she was receiving continuous oxygen. Staff D confirmed the observation and stated that was why she updated the oxygen orders to PRN. Staff D stated said, I walked into the room and saw the concentrator on the corner of the room, I did not see any tubing or connection to power, to indicate it was in current use. I reviewed her current physician orders and saw she was supposed to be on oxygen 2L continuous. I have not seen her on oxygen. Staff D stated she got new tubing, set up the Oxygen, but the resident did not want it. Staff D said, I checked her O2 sats and reviewed the history of her saturations and noted no concerns with her room air oxygen levels. I called the doctor and received orders to change it to PRN. I do understand concerns related to documentation showing the resident was receiving oxygen 24 hours. I cannot speak of my co-workers observations and documentation, but I know the documentation is not accurate. She stated she and the DON would initiate education and will continue to monitor the resident's O2 saturations An interview was conducted on 02/23/23 at 01:31p.m. with Staff D. She stated she was doing rounds and saw Resident #10's nebulizer by bedside. She said, I saw it was not bagged, I went ahead and bagged it and dated it. I then reviewed the current orders and saw there were no orders for the nebulizer. I removed it from the room. Staff D confirmed the nebulizer should have been bagged or stored in the supply closet if not in current use. A follow up interview was conducted on 02/23/23 at 12:55 p.m. with the NHA and Staff P, NHA from a sister facility. Staff P stated she had reviewed the oxygen orders for Residents #10 and #62 and changed their orders to PRN (as needed) because these residents were not receiving oxygen continuously. She stated they have noted the documentation concern and they will be addressing it. Staff P stated respiratory equipment should be stored appropriately. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 20 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 Residents Affected - Few On 02/20/23 at 10:08 a.m., an observation was made of Resident #62's concentrator was observed by her bedside, oxygen tubing on the floor, her nasal cannula resting on the floor. Photographic evidence was obtained. Resident #62 was observed in the resident lounge with her portable oxygen on, noted receiving oxygen via nasal cannula. A review of a document titled, Face Sheet, showed Resident #62 was admitted to the facility on [DATE] with diagnosis to include pneumonia unspecified. A review of a document titled, Physician Orders List, dated 7/22/22 to 7/23/23, showed resident #62 was to receive O2 at 2L/Min via NC, continuous diagnosis SOB/cyanosis as tolerated. During a facility tour on 02/20/23 at 12:38 p.m., an observation was made of Resident #73's CPAP (Continuous Positive Airway Pressure) machine resting on his bedside table on top of his bed covers. The CPAP face mask was exposed to the elements, and not stored in a bag. Photographic evidence was obtained. Resident #73 was admitted to the facility on [DATE] with diagnoses to include obstructive sleep apnea. A review of a document titled, Physician's Order List showed an order dated, 6/12/22, to apply CPAP mask at bedtime, and an order to remove CPAP and clean, 6/12/22. Resident #73 was not available for an interview. On 02/22/23 at 01:54 p.m., an interview was conducted with Staff D, LPN Unit Manager. Staff D confirmed all respiratory equipment should be stored in a bag after each use. She stated the tubing, masks and cannula's are changed weekly. Staff D said, They should not be on the floor or exposed to germs. On 02/22/23 at 04:59 p.m., an interview was conducted with the DON and the Nursing Home Administrator (NHA). The DON stated oxygen should be administered as ordered. She stated they initiated an audit the day before. She stated she was notified Resident #72's oxygen level was at 2.5L, it was adjusted to 2L should not have been 5.5L. The DON said, Her oxygen levels should not have been at 5.5L, absolutely not. The DON stated their policy is to follow physician orders. The DON stated respiratory equipment should be stored in a bag, nebulizer and oxygen cannula's should be stored in bags and changed out weekly and as needed. A review of a facility policy titled, Oxygen Administration - Nasal Cannula Clinical Practice Guideline, dated 7/25/22, indicated oxygen therapy via nasal cannula is administered as ordered by a physician and includes correct flow rate, mode of delivery and frequency. Humidification of oxygen is used for a flow rate of four liters per minute or greater or if requested by a patient. Guidelines showed to 1. check the resident's medical record to confirm the presence of a complete and appropriate physician's order. 2. Determine appropriate oxygen source and need for humidification. Under guidance for best practice 14. Replace the entire setup every 7 days. Date and store in treatment bag when not in use. A review of facility policy titled, Respiratory Muscle Trainer Clinical Practice Guideline, dated, 7/25/22, showed: 24. Rinse the nebulizer after the treatment and allow it to air dry. 25. Conclude treatment and store circuit in treatment bag. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 21 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 reviews, and interviews the facility failed to ensure insulin administration was adequately and appropriately monitored for two residents (#74 and #55) out of 7 resident reviewed for unnecessary medications and insulin administration. Residents Affected - Few Findings included: 1) A review of Resident #74's facesheet identified the resident was admitted on [DATE]. The facesheet included diagnoses not limited to Type 2 Diabetes Mellitus. A review of Resident #74's physician orders for 2/2023 included an order for Insulin Lispro 100 unit/milliliter (mL) pen (interchange). Inject subcutaneously (sub-q) per sliding scale three times daily, 70-140=0 units, 141-180= 1 unit, 181-200= 2 units, 221-260= 3 units, 261-300= 4 units, greater than 400= call MD (Medical Doctor) . The order did not identify how much insulin Resident #74 should be administered for a blood glucose of 201-220 or if the residents blood glucose level was between 301 - 399. A review of Resident #74's Medication Administration Record (MAR) identified the residents blood sugar was not documented during the 6:30 a.m. monitoring on 2/3, 2/5-2/9, 2/15, 2/29, and 2/23/23 and during the 4:30 p.m. monitoring on 2/6/23. The MAR indicated the resident was administered insulin outside the parameters on 2/7 at 4:30 p.m. for a blood glucose of 103, on 2/11 at 11:30 a.m. for a blood glucose of 120, and on 2/13 at 4:30 p.m. for a blood glucose of 101. The MAR did not identify how much insulin had been administered twenty-seven out of twenty-seven administrations. The care plan for Resident #74 identified the resident had Diabetes Mellitus (Type 2): uncontrolled blood sugar levels and included interventions not limited to obtain blood sugars as ordered. A review of the policy titled Insulin Administration, copyrighted 2001 and revised September 2014, indicated the purpose was To provide guidelines for the safe administration of insulin to residents with diabetes. The policy identified the following: - The type of insulin, dosage requirements, strength, and method of administration must be verified before administration, to assure that it corresponds with the order on the medication sheet and the physician's order. - The nurse shall notify the Director of Nursing Services and Attending Physician of any discrepancies, before giving the insulin. The procedure portion of the policy instructed staff to Check blood glucose per physician order or facility protocol., Check the order for the amount of insulin., and Double check the order for the amount of insulin. The policy for documenting insulin administration include The resident's blood glucose result, as ordered.2) A review of Resident #55's facesheet revealed he was admitted to the facility on [DATE] for long term nursing care. He was admitted with diagnoses that include but are not limited to dementia with agitation, vascular dementia with agitation, and Type 2 Diabetes Mellitus with hyperglycemia. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 22 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 A review of Resident #55's physician orders revealed an order to start on 2/3/23 for sliding scale: Level 2-Novolin N Subcutaneous Suspension 100unit/ML Level of Harm - Minimal harm or potential for actual harm 0-150=No coverage Residents Affected - Few 151-199=1 unit 200-249=2 units 250-299=3 units 300-349=4 units 350 or greater-5 units and call MD [medical doctor] A review of Resident #55's MAR for the month of February 2023 did not reveal the amount of Novolin administered according to the sliding scale for all administered doses and did not reveal the blood sugar reading which determines the amount the Novolin to be administered according to the sliding scale for all administered doses. A further review of the MAR and administration record notes revealed the following: 2/3/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/4/23 at 6:00 a.m. no documentation indicating the medication was administered or not. 2/4/23 at 8:00a.m. the medication was documented as not administered --> Review of the administration record note .scheduled for 2/4/23 8:00 AM was not administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/4/23 at 11:30 a.m. the medication was documented as administered. The administration record note revealed . scheduled for 2/4/23 11:30 AM was administered. BS [blood sugar] 155. No documentation of how much insulin was administered. 2/4/23 at 4:30 p.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/4/23 4:30 PM was not administered -other BS 159, awaiting arrival from pharmacy 2/4/23 at 9:00p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/5/23 at 6:00a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/5/23 at 8:00 a.m. there was no documentation for the medication. There was no evidence of the blood sugar reading. 2/5/23 at 11:30 a.m. the medication was documented as administered. There was no evidence of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 23 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 blood sugar reading or the amount of Novolin administered. Level of Harm - Minimal harm or potential for actual harm 2/5/23 at 4:30 p.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/5/23 4:30 PM was held There was no evidence of the blood sugar reading. Residents Affected - Few 2/5/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/6/23 at 6:00 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/6/23 at 8:00 a.m. there was no documentation for the medication. There was no evidence of the blood sugar reading. 2/6/23 at 11:30 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/6/23 at 4:30 p.m. the medication was documented as not administered. There was no evidence of the blood sugar reading. 2/6/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/7/23 at 6:00 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/7/23 at 8:00 a.m. there was no documentation for the medication. There was no evidence of the blood sugar reading. 2/7/23 at 11:30 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/7/23 at 4:30 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/7/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/8/23 at 6:00 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/8/23 at 8:00 a.m. there was no documentation for the medication. There was no evidence of the blood sugar reading. 2/8/23 at 11:30 a.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/8/23 11:30 AM, 11:30 AM was held. There was no evidence of the blood sugar reading. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 24 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2/8/23 at 4:30 p.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/8/23 4:30 PM was held. There was no evidence of the blood sugar reading. 2/8/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/9/23 at 6:00 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/9/23 at 8:00 a.m. there was no documentation for the medication. There was no evidence of the blood sugar reading. 2/9/23 at 11:30 a.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/9/23 11:30 AM insulin coverage not needed There was no evidence of the blood sugar reading. 2/9/23 at 4:30 p.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/9/23 4:30 PM no insulin required 144 2/9/23 at 9:00 p.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/9/23 9:00 PM BS 121. No coverage needed. 2/10/23 at 6:00 a.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/10/23 6:00 AM was not administered- other Blood sugar 111. 2/10/23 at 8:00 a.m. there was no documentation for the medication. There was no evidence of the blood sugar reading. 2/10/23 at 11:30 a.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/10/23 11:30 AM was held. There was no evidence of the blood sugar reading. 2/10/23 at 4:30 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/10/23 at 9:00 p.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/10/23 9:00 PM BS 127 2/11/23 at 6:00 a.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/11/23 6:00 AM was refused by resident. There was no evidence the physician was notified of the refusal. 2/11/23 at 8:00 a.m. there was no documentation for the scheduled dose. 2/11/23 at 11:30 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/11/23 at 4:30 p.m. the medication was documented as administered. There was no evidence of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 25 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 blood sugar reading or the amount of Novolin administered. Level of Harm - Minimal harm or potential for actual harm 2/11/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. Residents Affected - Few 2/12/23 at 6:00 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/12/23 at 8:00 a.m. there was no documentation for the scheduled medication. 2/12/23 at 11:30 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/12/23 at 4:30 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/12/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/13/23 at 6:00 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/13/23 at 8:00 a.m. there was no documentation for the scheduled medication. 2/13/23 at 11:30 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/13/23 at 4:30 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/13/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/14/23 at 6:00 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/14/23 at 8:00 a.m. there was no documentation for the scheduled medication. 2/14/23 at 11:30 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/14/23 at 4:30 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/14/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/15/23 at 6:00 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 26 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 2/1/23 at 8:00 a.m. there was no documentation for the scheduled medication. Level of Harm - Minimal harm or potential for actual harm 2/15/23 at 11:30 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. Residents Affected - Few 2/15/23 at 4:30 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/15/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/16/23 at 6:00 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/16/23 at 8:00 a.m. there was no documentation for the scheduled medication. 2/16/23 at 11:30 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/16/23 at 4:30 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/16/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/17/23 at 6:00 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/17/23 at 8:00 a.m. there was no documentation for the scheduled medication. 2/17/23 at 11:30 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/17/23 at 4:30 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/17/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/18/23 at 6:00 a.m. the medication was documented as administered. Review of the administration record note revealed .scheduled for 2/18/23 6:00 AM was held.' There was no evidence of the blood sugar reading. 2/18/23 at 8:00 a.m. there was no documentation for the scheduled medication. 2/18/23 at 11:30 a.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/18/23 11:30 AM was not administered- other BS 137, coverage not needed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 27 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2/18/23 at 4:30 p.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/18/23 4:30 PM BS 144, no coverage needed. 2/18/23 at 9:00 p.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/18/23 9:00 PM was held. There was no evidence of the blood sugar reading. 2/19/23 at 6:00 a.m. the medication was documented as not administered. There was no evidence of the blood sugar reading. 2/19/23 at 8:00 a.m. there was no documentation for the scheduled medication. 2/19/23 at 11:30 a.m. the medication was documented as not administered. Review of the administration record note revealed .scheduled for 2/19/23 11:30 AM was administered. BS 165. There was no indication of how many units were administered. 2/19/23 at 4:30 p.m. the medication was documented as administered. Review of the administration record note revealed .scheduled for 2/19/23 4:30 PM was administered. BS 157. There was no documentation on how much insulin was administered. 2/19/23 at 9:00 p.m. the medication was documented as not administered. There was no evidence of the blood sugar reading. 2/20/23 at 6:00 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/20/23 at 8:00 a.m. there was no documentation for the ordered medication. 2/20/23 at 11:30 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/20/23 at 4:30 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/20/23 at 9:00 p.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/21/23 at 6:00 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. 2/21/23 at 8:00 a.m. there was no documentation for the scheduled medication. 2/21/23 at 11:30 a.m. the medication was documented as administered. There was no evidence of the blood sugar reading or the amount of Novolin administered. On 2/23/23 at 2:23p.m. an interview was conducted with the Nursing Home Administrator (NHA) she confirmed the resident did not have a care plan related to his diabetes diagnosis and she stated the facility had not completed a February pharmacy review. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 28 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete On 2/23/23 at 2:31p.m. an interview was conducted with the facility's Consultant Pharmacist. He said, I have not done February reviews yet. Related to insulins, I make sure they are getting their blood glucose checked and that they are getting their Hemoglobin A1C's completed. I do not question the type of insulin they are on because insulin is so patient specific. and if I review a patient and they don't have blood glucose documented that is something I would write up and if I see 50 units being administered that is something I am going to write up. I mostly look at psychotropic's unless something jumps out at me. Event ID: Facility ID: 105616 If continuation sheet Page 29 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews the facility failed to ensure behavioral/side effect monitoring was conducted for psychotropic medications for one resident (#74) out of five residents sampled for unnecessary medications administration. Findings included: An observation, on 2/22/23 at 11:45 a.m., identified Resident #74 was lying in bed with eyes closed. A review of Resident #74's facesheet indicated the resident was admitted on [DATE] for short term skilled nursing and rehabilitative care. The facesheet identified diagnoses that included but not limited to Type 2 Diabetes Mellitus, unspecified anxiety disorder, other seizures, and unspecified single episode major depressive disorder. A review of the active Physician Orders for Resident #74 indicated the resident received the following psychotropic medication: - Lorazepam 0.5 milligram (mg) orally three times a day. - Venlafaxine extended release 225 mg orally daily - trazodone 50 mg at bedtime - Divalproex 250 mg every morning and bedtime Resident #74's Medication Administration Record (MAR) for February 2023 identified the resident received the above medications as ordered. The MAR did not include documentation the resident exhibited any behaviors or that staff had monitored the possible side effects related to the use of psychotropic medications. A review of Resident #74's care plan identified the resident was at risk for side effects (related to) psychotropic/seizure/supplement medication use and the goal was no injury related to medication usage/side effects. The interventions instructed staff to Monitor patterns of target behaviors (and) monitor ability to sleep and to Assess for adverse side effects, document, and report. The care plan for Resident #74, Behavior: verbally aggressive behavior, declines to get out of bed frequently, and declines showers at times indicated staff were to Monitor and document target behaviors. The policy, Use of Psychotropic Medication, copyrighted 2022, identified Residents are not given psychotropic drugs unless the medication is necessary to treat specific condition, as diagnosed and documented in the clinical record, and the medication is beneficial to the resident, as demonstrated by monitoring, and documentation of the resident's response to the medication(s). The effects of psychotropic medications on a resident's physical, mental, and psychosocial well-being will be evaluated on an ongoing basis which identified In accordance with nurse assessments and medication monitoring parameters consistent with clinical standards of practice, manufacturer's specifications, and the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 30 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0758 resident's comprehensive plan of care. Level of Harm - Minimal harm or potential for actual harm On 2/22/23 at 11:45 a.m., Staff M, Licensed Practical Nurse (LPN), stated behaviors are documented on the computer. Staff M reviewed Resident #74's orders and stated the behaviors had already been done this shift and was included with the MAR's. The staff member reviewed the MAR then asked another nurse sitting at the nursing station, Staff O, LPN to review the MAR. Staff N, Registered Nurse (RN) reviewed the orders and stated there was not an order for behavior monitoring for Resident #74 and confirmed if the resident was on psychotropic medications there should be an order for monitoring of Side Effects and Behaviors. Residents Affected - Few The Director of Nursing (DON) stated on 2/22/23 at 1:17 p.m., behaviors and side effects should be monitored for residents with psychotropic medications ordered. On 2/23/23 at 2:36 p.m., the Consultant Pharmacist reported that a behavior monitoring record should be filled out, with an appropriate diagnosis, and if runs into more than one psychotic medication, a note is written. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 31 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record reviews, the facility failed to ensure the medication error rate was less than 5.00%. Twenty-eight medication administration opportunities were observed with four errors identified for two residents (#51 and #17) of seven residents observed. These errors constituted a 14.29% medication error rate. Residents Affected - Few Findings Include: 1. On 02/21/23 at 07:27 AM Staff F, Licensed Practical Nurse (LPN) was observed administering Tylenol 650 milligrams (mg) by mouth for pain to Resident #51. A review of the Medication Administration Record (MAR) did not show medication was administered. A follow up interview with Staff F was conducted on 02/21/23 at 11:48 AM. Staff F, LPN stated she didn't know why the medication was not documented. Staff F was not able to produce documentation of the medication from the morning but was able to provide a nursing note written at 11:15 AM assessing the effectiveness of the medication. Staff F stated, The original administration time may not show up except as medication follow up assessment. 2. Staff G, LPN prepared the following medications for administration to Resident #17 on 02/21/23 at 09:56 AM. Cranberry supplement 1 tablet Symbicort inhaler 160/4.5 mg Aspirin 81 mg chewable 1 tablet Wellbutrin SR 200 mg 1 tablet Bumex 0.5 mg 1 tablet On entering the room Staff G took vital signs for Resident #15, oxygen Saturation 92%, blood pressure 98/69 and pulse 113. Staff G did not administer Bumex because of low blood pressure. Staff G was observed administering the Cranberry tablet, Aspirin, Wellbutrin. Staff G then handed the resident the Symbicort inhaler who then took two puffs from the device. Medication reconciliation with the electronic medical record revealed the Bumex was held but no provider notification was present in the medical record. The order for Symbicort was for one puff and for the resident to rinse mouth with water after administration. A follow up interview was conducted with Staff G on 02/21/23 at 02:20 PM. Staff G confirmed Resident #17 likes to self-administer her inhaler and took two puffs. Staff G, LPN stated, The resident won't let anyone tell her what to do with it. She will not rinse after using it because she will not drink water. The only thing she drinks is soda and she will not rinse with water. When asked about holding the Bumex, Staff G stated she was trained blood pressure medications with a systolic under a hundred to hold the medications. She stated Resident #17 refuses to drink water and is tachycardic and hypotensive. She stated I am afraid that if I give her the medicine she will pass out getting up. We've been working on her BP medicine for a while and just last week we discontinued her metoprolol. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 32 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The Director of Nursing (DON) was interviewed on 02/22/23 at 01:51 PM. The DON was informed of medication error observations and stated she expects nurses to use their judgement and hold medications when they feel is appropriate, but they should notify the provider when medications are held and she expects nurses to document medications at the time they are given. The DON said she expects nurses to follow medical orders and instruct residents on using medication devices like inhalers. The DON said she would ask to have the order to rinse after the inhaler changed by the provider or address the behavior in resident care plan. During an interview with Consultant Pharmacist on 02/23/23 at 02:55 PM the medication findings were shared. The Consultant Pharmacist confirmed the observations as medication administration errors. A review of facility policy Administering Medications (Revised April 2019) indicated the following: 1. Only persons licensed or permitted by this state to prepare, administer, and document the administration of medications may do so. 2. The Director of Nursing Services supervises and directs personnel who administer medication and/or have related functions. 3. Medications are administered in accordance with prescriber orders, including any required time frame. 15. If a drug is withheld, refused, or given at a time other than the scheduled time, the individual administering the medication shall initial and circle the Medication Administration Record (MAR) space provided for that drug and dose. 21. Residents may self-administer their own medications only if the Attending Physician, in conjunction with the Interdisciplinary Care Planning Team, has determined that they have the decision-making capacity to do so safely. A review of policy Documentation of Medication Administration (Revised April 2007) indicated the following: 1. A Nurse or Certified Medication Aide (where applicable) shall document all medications administered to each resident on the residents MAR. 2. Administration of medication must be documented immediately after (never before) it is given. 3. Documentation must include, as a minimum: a. Name and strength of the drug; b. Dosage; c. Method of administration (e.g., oral, injection (and site), etc.); d. Date and time of administration; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 33 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0759 e. Reason(s) why a medication was withheld, not administered, or refused (as applicable); Level of Harm - Minimal harm or potential for actual harm f. Signature and title of the person administering the medication: and g. Resident response to the medication, if applicable (e.g., PRN, pain medication, etc.). Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 34 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews the facility failed to ensure 1) expired supplements and medications were discarded from three of the six medication carts, and 2) medications were stored appropriately for three residents (#50, #10, and #52) out of 43 sampled residents. Findings included: An observation was conducted, on [DATE] at 10:22 a.m., with Staff O, Licensed Practical Nurse (LPN) of the One Center medication cart. The observation revealed an opened bottle of Prostat Liquid Protein with 11/14 written on it. The staff member turned the bottle over and stated it was not expired until May. Staff O confirmed the manufacturer label instructed to discard the bottle 3 months after opening and it should have been discarded a few days ago. An observation on [DATE] at 10:32 a.m., was conducted with Staff M, LPN, of the One [NAME] medication cart. The observation revealed the following: - Levemir insulin pen, with no pharmacy label. A label was located under the pen on the bottom of the drawer which did not include a name of the one resident it was prescribed to. - An opened bottle of Novolog which did not identify an opened date. Staff M read the pharmacy label and stated that the bottle had been received on [DATE]. - One opened bottle, opened on [DATE], which was to be discard after 28 days. The bottle of insulin should have been discarded on [DATE]. - An open bottle of Semglee insulin, opened on 1/24 and to be discarded after 28 days. The bottle should have been discarded on [DATE]. - An Lispro insulin Kwikpen, opened on 1/24 and to discard after 28 days. The pen expired on [DATE]. - An opened bottle of ProStat Liquid Protein, labeled as opened on 11/14. Staff M confirmed that the bottle stated to discard after 60 days. A review of the policy titled Storage of Medications, copyrighted 2001 and revised [DATE], indicated the following: The facility stores all drugs and biologicals in a safe, secure, and orderly manner. The policy identified the following: - Drug containers that have missing, incomplete, improper, or incorrect labels are returned to the pharmacy for proper labeling before storing. - Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 35 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On [DATE] at 2:36 p.m., the Consultant Pharmacist was made aware of the concerns found with the medication carts. The consultant reported during a review of a facility medication carts 6 insulin pens were found without pharmacy labels. During a facility tour on [DATE] at 10:01 a.m., a round white tablet was found on the floor between Resident #50's bed and his roommate's. The tablet was found next to a clear plastic medicine cup, laying on the floor. Photographic evidence was obtained. On [DATE] at 10:06 a.m., an interview was conducted with Staff J, LPN. Staff J was notified there was a white, round tablet on the floor next to Resident #50's bed. Staff J looked at the tablet and stated it looked like a Magnesium tablet for Resident #50. Staff J retrieved the tablet from the floor, placed it in a plastic cup and stated she would follow-up with the nurse. She stated they would review to see when it was dropped. Staff J confirmed resident's medications should not be on the floor. On [DATE] at 09:49 a.m., an interview was conducted with Staff D, LPN/ UM (Unit Manager). She stated she followed up with the nurse on shift, and the nurse had stated the tablet belonged to Resident #50 but did not match his morning medications. Staff D said, it looked like it was from the night shift. The resident may have spit it out of his mouth. She stated she would educate the nurses on the expectation to supervise residents during medication administration. On [DATE] at 12:34 p.m. an observation was made of two bottles of medicated shampoo, Ketoconazole 2% in the bathroom shared by Resident #50 and his roommate. The two bottles were noted with prescription information and Resident's #50's name transcribed on them. In an interview with Resident #50, he stated the staff use the shampoo to wash his hair because he has a problem with dandruff. Photographic evidence was obtained. A review of a document titled, Face sheet, showed resident #50 was admitted to the facility on [DATE] with diagnoses to include Diabetes Mellitus, mood disorder, Multiple Sclerosis, dermatitis, and vitamin deficiency. A review of a Minimum Data Set (MDS) printed [DATE], showed Resident #50 has a Brief Interview for Mental Status (BIMS) score of 14, indicating intact cognition. Section G-Functional status showed Resident #50 was totally dependent on staff for bathing, with one-person physical assist. A review of an active physician orders list for Resident #50 showed the medicated shampoo was not listed. A review of a Medication Administration Record (MAR) for Resident #50 for the month of February 2023, showed an order for Ketoconazole 2% shampoo scalp, face, and ears. Shampoo and lather for minutes then rinse daily at night shift; diagnosis seborrheic dermatitis, order date [DATE], discontinued [DATE]. On [DATE] at 9:53 a.m., an observation was made of a prescription bottle labeled Nyamyc by Resident #10's bedside table. The small white bottle was noted with the resident's name, instructions for external use only, and an expiration date of [DATE]. An attempt to interview Resident #10 was unsuccessful. Photographic evidence was obtained. A review of active orders for Resident #10 showed there were no current orders for Nyamyc powder. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 36 of 37 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 105616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Bay Center for Rehabilitation and Healing 10501 Roosevelt Blvd N Saint Petersburg, FL 33716 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of a document titled physician orders list', dated [DATE] to [DATE], showed an order for Nyamyc 100,000 unit/gm (gram) Apply to affected areas topically every morning, order date [DATE] and stop date [DATE]. On [DATE] at 01:38 p.m., an interview was conducted with Staff D. She stated Resident #10 did not have current orders for the Nyamyc powder. Staff D said, either way, it should not have been stored in the room. All medications should be secured. A review of a document titled, Face sheet, showed Resident #10 was admitted to the facility on [DATE] with diagnoses to include pneumonia unspecified, COPD, encephalopathy, and unspecified dementia. An undated MDS for Resident #10 section C, showed a BIMS of 3, indicating severe mental impairment. Section G showed Resident #10 is dependent on staff for ADLs with one-person physical assist. On [DATE] at 04:59 p.m., an interview was conducted with the DON and NHA. The DON stated if she found medication on the floor, she would identify what it is and then discard it. She stated the expectation is to not leave the resident alone during medication administration. The DON said, the nurse should always provide supervision, wait until the resident swallows. The DON stated anything that has a physician order should be considered a medication and should be secured. The DON confirmed a medicated shampoo should be secured and only brought out for use as ordered by the physician. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105616 If continuation sheet Page 37 of 37