Inspection·February 5, 2026

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to provide needed tracheostomy supplies for 1 of 1 residents reviewed for tracheostomy care. (Resident #28)The findings include:An observation of Resident #28 was conducted on 02/03/2026 at 09:00 AM. The resident was in bed with tracheostomy in place (tracheostomy is a surgical procedure creating an opening (stoma) in the neck into the trachea to establish an airway, facilitate mechanical ventilation, or remove lung secretions). No extra tracheostomy inner cannula and obturator was observed at bedside (tracheostomy inner cannula and obturator are components of a tracheostomy tube system). Additional observations were made on 02/03/2026 at 12:45 PM, on 02/03/2026 at 02:35 PM, and on 02/04/2026 at 09:00 AM. No extra tracheostomy inner cannula and obturator was at the bedside at any of these times.A review of Resident #28's current comprehensive care plan indicates that Resident #28 has tracheostomy and is at increased risk for infection/complications. The care plan's interventions included to keep extra trach tube and obturator at bedside if tube is coughed out.An interview was conducted with Staff A, a licensed practical nurse, on 02/04/2026 at 09:45 AM. Staff A stated that a spare tracheostomy inner cannula and obturator is usually at bedside. Staff A looked through the resident's room and verified that Resident #28 did not have the spare equipment. Staff A stated that residents with a tracheostomy should always have spare tracheostomy inner cannula and obturator at bedside. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105624 If continuation sheet Page 2 of 4 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 105624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/05/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bonifay Nursing and Rehab Center 306 West Brock Avenue Bonifay, FL 32425 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, medical record review and facility policy review, the facility failed to provide protective measures for 1 of 1 resident sampled for neutropenic precautions. (Resident #12)The findings include:On 2/03/2026 at 8:38 AM, Resident #12 was observed. Signage on the door stated, Neutropenic precautions: clean hands before entering and when leaving room. Avoid raw or undercooked fruits or vegetables: raw or undercooked eggs or shellfish. No live flowers or plants. Do not enter if you feel unwell. There was a second sign at door stating, Personal Protective Equipment: per standard precautions. Signage stated room cleaning: use facility policy for neutropenic precautions. However, there was no protective equipment (mask, gown, gloves) observed outside the room.On 2/03/2026 at 8:47 AM, Staff D, Certified Nurse Assistant (CNA), was observed exiting the resident's room with a tray. She was asked about the resident's signage. Staff D stated she was aware that Resident #12 was on neutropenic precautions. Staff D, CNA, was asked to explain what neutropenic precautions meant when entering the room. She explained it meant to wash hands before and after entering room. She stated she did not wear gloves, gowns or mask when she entered Resident #12's room. She further stated she had been instructed to wash hands but she did not have to wear a mask or any other protective equipment.On 2/03/2026 at 11:54 AM, an interview was conducted with the Director of Nursing (DON). She stated the facility did not have a policy for neutropenic precautions. She further stated the facility's protocol for a resident with neutropenic precautions was for staff to perform hand washing before having contact with patient, when touching resident, or when touching resident's belongings. The DON clarified that staff did not wear a mask because the resident was the one with a weakened immune system. The DON further stated if the resident came out the room, then the resident will wear a mask.A review of Resident #12's medical record was conducted. Resident #12 was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses including myelophthisis (a severe form of bone marrow failure), neutropenia (a condition with low levels of neutrophils, a type of white blood cell that fights infection), thrombocytopenia (a condition with an abnormally low number of platelets in the blood, leading to easy bruising and bleeding) and pancytopenia (a serious blood disorder characterized by a reduction in all three blood cell types -red cells white cells and platelets, leading to symptoms like fatigue, infections and easy bleeding). An active physician order dated 9/30/25 stated Neutropenic Precautions DX: Myelophthesis. A review of the facility provided in-service/education dated 2/2/26 was conducted. In-service education documentation titled Neutropenic precautions states Use standard precautions and wear a mask when entering the room. On 2/04/2026 at 9:05 AM, an interview was conducted with the DON. She was asked to explain the meaning of standard precautions. The DON stated standard precautions meant hand washing alone, did not involve any type of protective equipment. On 2/04/2026 at 2:20 PM, an interview was conducted with Staff C, Medical Doctor (MD) and Resident #12's primary doctor. He was asked to explain the meaning of neutropenic precautions. He stated neutropenic precautions were protective measures. He was asked the expectations in regards of neutropenic precautions for Resident #12. Staff C, MD stated he expected staff to wash their hands, and at minimum, to wear a mask when entering the room. He further stated a gown and gloves were very essential when providing care.A review of facility policy titled Standard Precautions, revised 8/2023, was conducted. The policy stated Standard precautions are used in the care of all residents regardless of their diagnoses or suspected or confirmed infection status. All employees are to practice standard precautions to reduce the risk of transmitting infections and the likelihood of exposure. Use of standard precautions applies to all resident care contacts. Under procedures, policy stated masks, eye protection, face shields: mask and eye Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105624 If continuation sheet Page 3 of 4 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 105624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/05/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bonifay Nursing and Rehab Center 306 West Brock Avenue Bonifay, FL 32425 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm protection or a face shield are worn to protect mucous membranes of the eyes, nose and mouth during procedures and resident-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105624 If continuation sheet Page 4 of 4