Health inspection·January 26, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 1/25/2023 at 12:28 PM, the Caring Way Unit Manager said the DON and Unit Managers ensured preference documentation was completed so CNAs were aware of the resident's care choices. The Unit Manager stated care plan updates were imported to the CNA [NAME] where everything about the resident was noted. She explained the [NAME] was important, especially when an agency CNA wasn't familiar with the resident and had been assigned. The Unit Manager acknowledged resident #66's preferred schedule and routines were not included in the [NAME] for CNAs to see. She explained it was important for a resident to have choices as the facility was their home, and not accommodating them negatively affected mood and energy. On 1/26/2023 at 9:43 AM, CNA M said not all CNAs knew resident #66 wanted to get up and dressed early. On 1/26/2023 at 10:01 AM, Licensed Practical Nurse (LPN) I stated she was aware resident #66 liked to get out of bed and wanted to be up and dressed early. LPN I said CNAs only knew of residents preferences as indicated in their software documentation, familiarity with the resident, or by receiving verbal communication from other staff. On 1/26/23 at 10:26 AM, the MDS Coordinator said residents were interviewed for specific preferences and they were discussed at care plan meetings. She stated resident #66's last care plan meeting was 11/1/2022. The MDS Coordinator explained the Interdisciplinary Team (IDT) updated care plans and MDS was ultimately responsible. On 1/26/23 at 10:45 AM, the Social Services Assistant said nurses were responsible for entering resident preferences to the medical record software for CNAs to be aware. She explained resident #66 was an early riser, and it was important for the resident to, be up and dressed as early as 7:30 AM. The facility's welcome packet, pages 20-21, titled Attachment 3 read, (a)(1) A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident, and (c) (3) (iii) Incorporate the resident's personal and cultural preferences in developing goals of care. The Facility assessment dated [DATE], page 6, titled, Other 1.7, read, The Facility's Lifestyles Director meets with the resident upon admission to obtain the individualized daily living preferences to ensure they can continue life on their own schedule while residing in the facility as much as the facility can . we are flexible with resident schedules. , page 8, Part 2, Find out what resident's preferences and routines are; what makes a good day for the resident; what upsets him/her and incorporate this information into the care planning process. Make sure staff caring for the resident have this information. Record and discuss treatment and care preferences. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105673 If continuation sheet Page 2 of 8 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 105673 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Indian River Center 7201 Greenboro Dr West Melbourne, FL 32904 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide adequate personal hygiene related to nail care for 1 of 4 dependent residents reviewed for Activities of Daily Living (ADLs) of a total sample of 55 residents, (#91). Residents Affected - Few Findings: Review of resident #91's medical record revealed he was admitted to the facility on [DATE] with diagnoses that included type 2 diabetes, congestive heart failure, atrial fibrillation, glaucoma, hearing loss, and dementia. Review of resident #91's quarterly Minimum Data Set (MDS) assessment with Assessment Reference Date of 11/15/22 revealed he had a Brief Interview for Mental Status score of 12 which indicated he had moderate cognitive impairment. The MDS showed resident #91 required extensive assistance on staff for dressing, and personal hygiene. The assessment noted no rejection of care necessary to obtain goals for his health and well-being. Review of the admission readmission Nursing Packet dated 8/9/22 included a Skin Assessment. The assessment revealed thickening and extremely long fingernails. On 1/23/23 at 11:53 AM, during a medication pass observation with Licensed Practical Nurse (LPN) H, resident #91 showed his fingernails and asked the nurse when his nails were going to be trimmed. All fingernails were long, thick, and curved with light brown substance underneath the nails. She responded by informing the resident that the podiatrist had to trim his fingernails. On 1/24/23 at 5:36 PM, resident #91 showed his long fingernails and stated the podiatrist saw him today. He explained the podiatrist cut his toenails and told him he could not touch him from the knees up. He indicated the facility had not found anyone who could trim his fingernails. On 1/25/23 at 5:48 PM, Certified Nursing Assistant (CNA) G stated most of her assigned residents needed assistance with their ADLs. She indicated resident #91 refused showers occasionally but she provided a head-to-toe bed bath. She stated she was aware his fingernails were long, and this had been addressed with management. On 1/25/23 at 5:55 PM, the Unit Manager (UM) for the East Coast Unit explained shortly after resident #91 was admitted to the facility, a podiatrist trimmed his fingernails. She stated a second podiatrist examined resident #91 yesterday and said he could not trim his fingernails. She stated CNAs had tried to file them, but tissue was growing under them, and they did not want to cause bleeding. On 1/26/23 at 10:03 AM, the UM explained she spent time interacting with the residents in her unit to better know them and their needs. She stated they had discussed resident #91 fingernails issue multiple times during the Interdisciplinary Team (IDT) meetings and the facility was seeking a referral to address it. She shared there were many discussions about the nail care he required. She indicated a podiatrist had seen resident #91 on 8/27/22 and provided nail care. She stated his fingernails had looked the same ever since he was admitted to the facility. She indicated this had been a continuous concern for this resident. The UM could not provide any evidence of the IDT discussions or contacts made for outside resources. She reviewed his medical record for progress notes and could not find any regarding nail care. She indicated CNAs could provide nail care but not if the resident was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105673 If continuation sheet Page 3 of 8 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 105673 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Indian River Center 7201 Greenboro Dr West Melbourne, FL 32904 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few diabetic. The UM stated it was within the CNAs' scope of practice to keep resident #91's nails cleaned. She stated CNAs could not trim them because his fingernails were very thick. The UM stated she and her staff were aware of his need, but unaware which physician could provide the services resident #91 needed. On 1/26/23 at 4:14 PM, the Director of Nursing (DON) stated she spoke with the podiatrist on Tuesday 1/24/23 after he saw resident #91. She explained the physician told her resident #91 had a medical condition called onychomycosis with onychogryphosis and it was not safe for anyone in the facility to trim his nails. She mentioned the physician told her resident #91 needed to see a hand specialist. She indicated the previous podiatrist who had seen resident #91 back in August 2022 filed them. The DON stated this was the first time she had encountered a situation like this one. She explained they did not pursue anything in August because the physician made no recommendations and the long fingernails did not affect the resident in any way, and he continued getting his ADLs. Review of resident #91's nursing care plan for ADLs initiated on 8/09/22 revealed he required assistance with ADL functions due to chronic conditions which included history of stroke, diabetes, and risk for injury. The care plan interventions listed grooming: someone must assist the resident to groom himself. Review of the Certified Nursing Assistant job description, dated 8/15/19, responsibilities included, Attend the individual needs of residents which may include assistance with grooming, bathing . or other needs in keeping with the individuals' care requirement, and scope of practice. Review of the Activities of Daily Support, Support policy and procedure not dated read, Resident who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. The policy revealed, Appropriate care and services will be provided for resident who are unable to carry out ADLs independently . including appropriate support and assistance with: Hygiene (bathing, dressing, grooming, nail care and oral care). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105673 If continuation sheet Page 4 of 8 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 105673 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Indian River Center 7201 Greenboro Dr West Melbourne, FL 32904 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide services and treatments to prevent further decrease in range of motion for 1 of 5 residents reviewed for positioning and mobility of a total sample of 55 residents, (#112). Findings: Resident #112 was admitted to the facility on [DATE] with diagnosis of hemiplegia and hemiparesis following cerebral infarction, contracture of right ankle, contracture of left ankle and contracture of muscles of left hand. Review of the Minimum Data Set (MDS) quarterly assessment with assessment reference date (ARD) of 12/16/22 revealed resident #112 had short-term and long-term memory problems and severely impaired cognitive skills for daily decision making. She required extensive to total assistance with Activities of Daily Living (ADLs) and did not resist care. The assessment revealed she had limited range of motion (ROM) to one side of her body for upper extremities and both sides of her body for lower extremities. A care plan for ADL assistance required was initiated 9/19/22 and revised on 9/21/22. The care plan revealed resident #112 required assistance due to multiple factors which included contractures of both legs, right knee and left hand. Interventions included left hand splint as ordered. Review of resident #112's medical record revealed a physician order dated 12/06/22 for left wrist splint to be applied in the morning and removed in the afternoon as tolerated. Review of the Medication Administration Record (MAR) and Treatment Administration Record (TAR) for December 2022 and January 2023 revealed no nursing documentation to validate resident #112's left hand splint was applied as ordered. Review of the progress notes revealed no documentation related to resident #112's left hand splint. On 1/23/23 at 11:06 AM, 1/24/23 at 9:25 AM, 1/25/23 at 10:14 AM and 1/25/23 at 2:59 PM, resident #112 was observed in bed. She did not have a splint on her left hand. A left-hand splint was noted to be on the nightstand next to resident #112's bed during the observations. On 1/25/23 at 10:27 AM, Certified Nursing Assistant (CNA) C stated she was familiar with resident #112. She reported the resident required assistance with ADLs. She explained she provided ROM as part of ADL care but did not apply the splint. CNA C clarified therapy applied splints. On 1/25/23 at 2:54 PM, the Therapy Director reported resident #112 was not currently on caseload. She clarified therapy did not don and doff the splint once the resident was discharged from therapy. She stated if a resident discharged from therapy with a splint, therapy educated the CNA on how to don and doff the splint and when it should be worn. She explained the resident would also be referred to restorative nursing therapy. The Therapy Director reviewed the record for resident #112 and confirmed she should have a left wrist splint put on in the morning and removed in the afternoon. On 1/25/23 at 3:01 PM, the Restorative Nurse stated she had just started in the position recently. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105673 If continuation sheet Page 5 of 8 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 105673 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Indian River Center 7201 Greenboro Dr West Melbourne, FL 32904 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few She explained she had a meeting with the Director of Nursing (DON) and Therapy Director on 1/19/23 about getting the restorative program up and running again. She was unable to identify who performed ROM or application of splints. On 1/25/23 at 3:03 PM, the MDS Coordinator stated she and the Restorative Nurse were new to the facility and had started recently. She recalled the DON approached her after the Restorative Nurse started. The DON informed her she wanted to get the whole restorative program up and running. The MDS Coordinator stated she did not know whether or not part of the program was in place. She reviewed the physician orders for resident #112 and confirmed the order for a left wrist splint. The MDS Coordinator was unable to provide documentation showing application of the splint. On 1/25/23 at 3:26 PM, the Regional Nurse Consultant (RNC) confirmed a meeting was held on 1/19/23 to discuss the restorative program. She stated she was unsure how long the restorative program had not been functional but believed that some residents received ROM and splinting by CNAs. She stated the nurses documented on the MAR if the splint was applied. On 1/25/23 at 4:25 PM, Licensed Practical Nurse (LPN) A confirmed resident #112 was on her assignment. She stated she was familiar with the resident and had worked with her previously. She explained she had never put on or removed resident #112's splint. LPN A clarified therapy took care of the splints. She stated splint applications were signed on either the MAR or TAR. On 1/25/23 at 4:42 PM, the LPN Nurse Supervisor reviewed the physician orders for resident #112 and confirmed the order for a left wrist splint dated 12/06/22. She reviewed the MAR and TAR for January 2023 and acknowledged the order was not on either. The LPN Nurse Supervisor then checked the order type on the physician order and explained the order was coded as Other orders (no documentation required). She stated each physician order entered into the electronic record would be placed into an order type which would determine whether the order appeared on the MAR or TAR for documentation. She then reviewed the CNA tasks and [NAME] for resident #112 and confirmed the application of the splint was not located on either. The LPN Nurse Supervisor acknowledged there was no documentation to show the splint had been applied as ordered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105673 If continuation sheet Page 6 of 8 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 105673 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Indian River Center 7201 Greenboro Dr West Melbourne, FL 32904 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide appropriate care and services for oxygen therapy for 1 of 1 resident reviewed for respiratory care of a total sample of 55 residents, (#105). Residents Affected - Few Findings: Resident #105 was admitted to the facility on [DATE] and most recently re-admitted on [DATE]. Her diagnoses included cerebrovascular disease, diabetes mellitus type 2, hypertension, coronary artery disease and congestive heart failure. Review of the admission Minimum Data Set (MDS) assessment with assessment reference date 11/23/22 revealed resident #105 was cognitively intact, and had physical or verbal behaviors towards herself or others. Resident #105 was assessed as needing extensive assistance from at least two staff for bed mobility, transfers from surface to surface and dressing. She required extensive assistance from one staff for eating and personal hygiene. Resident #105 was noted to require use of oxygen and received hospice care. Resident #105 had a care plan for altered cardiovascular status related to diagnoses of anemia, arrythmia, heart failure and other heart related diagnoses. Interventions included staff to administer oxygen (O2) per physician's orders. Review of resident #105's medical record revealed no other care plans related to oxygen use. On 1/24/23 at 10:05 AM, resident #105 was observed in her room, alert and oriented to person, place and time. She was wearing a nasal cannula connected to an oxygen concentrator with an attached humidifier operating. The oxygen concentrator was set at 3 liters of oxygen per minute (LPM). Resident #105 stated she was not sure who was supposed to fill the humidifier with water, but said her husband did it when the water would get low, usually every other day. Review of the Medication Review Report dated 01/24/23 revealed a physician's order for Respiratory-Oxygen nasal cannula/mask continuous. Encourage and assist resident to use O2 at 2 LPM via nasal cannula continuously for hypoxemia every shift dated 11/16/22. Additional orders were in place to change O2 tubing/mask/bag every week on Sundays and as needed dated 11/16/22. There were no orders for oxygen humidification found. On 1/24/23 at approximately 5:30 PM, Licensed Practical Nurse (LPN) A observed resident #105 in her room and confirmed resident #105's O2 concentrator was set at 3 LPM with the humidifier in place. LPN A returned to the nurse's station and reviewed the physician orders. She confirmed resident #105 did not have orders for the humidification and acknowledged the order was for 2 LPM not 3. When asked why she had not noticed resident #105's oxygen was set on 3 LPM or why there was no order for the humidification she stated resident #105 came over from the rehabilitation unit with the humidification and O2 concentrator set at 3 LPM. On 1/24/23 at approximately 5:35 PM, the Key [NAME] Unit Manager explained the resident needed to have an order for oxygen with humidity, and the nurse was responsible to change or refill the water in the canister. She was unable to say why resident #105 did not have an order for the humidified oxygen nor why the concentrator was set at 3 LPM instead of the ordered 2 LPM. She stated she would clarify the order with the physician and Hospice. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105673 If continuation sheet Page 7 of 8 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 105673 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Indian River Center 7201 Greenboro Dr West Melbourne, FL 32904 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 FORM CMS-2567 (02/99) Previous Versions Obsolete On 1/26/23 at 9:58 AM, the Director of Nursing stated if the physician determined the resident needed oxygen she expected the staff to follow those orders. She stated she did not believe the facility had a protocol for the humidification of oxygen, but stated she thought if there was no order the staff should follow the care plan instead. Review of the Oxygen Administration policy with revision date October 2010 revealed the purpose to provide guidelines for oxygen administration. The guidelines indicated oxygen therapy was administered per physician's orders and/or facility protocol. Event ID: Facility ID: 105673 If continuation sheet Page 8 of 8