Inspection·February 13, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure timely housekeeping and maintenance in 2 of 4 (100 and 300) resident hallways, affecting Resident #224, #42, #23, and #66; and failed to maintain ceiling vents and common area walls on all four resident units and in the central common area. The findings included: 1. The following environmental and housekeeping concerns were observed during the survey: a) On 02/10/25 at 10:24 AM, Resident #224 stated the window air conditioner in her room was broken, and had been since her admission on [DATE]. The panel on the air conditioning unit showed a code of E3, indicating an error, and no air was blowing. b) On 02/10/25 at 11:09 AM, the privacy curtains for Resident #42 were noted to be stained on both sides. Photographic Evidence Obtained. There was also a urine odor noted upon entering the room. On 02/11/25 at 10:35 AM and on 02/12/25 at 9:29 AM, the urine odor remained. An observation of the resident's mattress at this time lacked any obvious signs of previous incontinent episodes and during a skin check at this time, the resident's skin lacked any skin impairment which would indicate a lack of incontinence care. Upon further investigation, the privacy curtain had an urine odor as well as the room itself. The baseboard on the wall behind the bed had also pulled away from wall several inches and the laminate trim from the footboard of the bed was missing. The floors were visibly dirty with debris and darkened stains. Photographic Evidence Obtained. c) On 02/10/25 at 11:19 AM, the over-the-bed table for Resident #23 had an open rusted square area on the leg and the headrest area of the recliner had a worn off, and could no longer be effectively cleaned. Photographic Evidence Obtained. d) On 02/10/25 at 10:35 AM, an area of white plaster, approximately 2 feet by 3 feet, was noted on the yellow wall located behind the bed of Resident #66. During a supplemental interview on 02/11/25 at 9:42 AM, the resident stated it had been there ever since she could remember. When asked if it bothered her, the resident stated, Well it's not pretty. During an interview on 02/13/25 at approximately 10:00 AM, when asked the process for ensuring clean privacy curtains, the Housekeeping Director stated the curtains are taken down and replaced monthly when each room is deep cleaned. When asked specifically about the deep cleaning schedule, the Housekeeping Director stated he makes out a monthly calendar and ensures each room and all common areas are deep cleaned monthly. The Housekeeping Director also identified two target rooms that are completed weekly due to urine odors, but did not include the room of Resident #42. When asked if the staff did any type of rounds to identify new areas of concern, the Housekeeping Director stated managers do daily angel rounds and should be reporting any concerns during their morning meetings. An additional observation was made at this time and the Housekeeping Director agreed with the concerns for Residents #42 and #23. During an interview and tour on 02/13/25 at 11:12 AM, when asked the process for repairs, the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 2 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Maintenance Director stated they had a maintenance book to log needed repairs, and many staff just tell him of needed repairs. The Maintenance Director stated, Remember, I'm the only maintenance person, so I can't always get to things right away. And I do life safety as well. Review of the 100 unit Maintenance Book lacked any entries for 2025. During an observation of the plaster wall in Resident #66's room, with the Maintenance Director, he stated the repair of that wall had been done back in November or December (of 2024), and that he hadn't had a chance to get back and paint the area or the wall. Observation of Resident #244's room revealed a temporary air conditioner. The Maintenance Director stated he had just heard about the issue that morning. When told it had not been working since the resident's admission, the Maintenance Director stated he just heard of the issue that day. 2. Observation of the common area and four hallways on 02/13/25 beginning at approximately 11:30 AM, with Photographic Evidence obtained, revealed the following: a) On the 100 hall, 5 of 6 ceiling vents had a rust-like substance and or were dirty. b) On the 200 hall, 6 of 6 ceiling vents had a rust-like substance and or were dirty. c) On the 300 hall, 6 of 6 ceiling vents had a rust-like substance and or were dirty. There were multiple areas of bubbling and or pealing paint on the walls. d) On the 400 hall, 4 of 6 ceiling vents had a rust-like substance and or were dirty. The walls had areas of bubbling paint. e) In the common central area, 6 of 8 ceiling vents had a rust-like substance and or were dust laden. During an interview on 02/13/25 at approximately 1:00 PM, the Maintenance Director agreed with the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 3 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 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 policy review, observation, interviews, and record review, the facility failed to ensure timely fingernail care for 2 of 5 sampled residents, Residents #6 and #61, reviewed for activities of daily living (ADLs) care. Residents Affected - Few The findings included: Review of the policy, titled, Nail Care, dated 09/01/23, documented in part, . 3. routine cleaning and inspection of nails will be provided during ADL care on an ongoing basis. 4. Routine nail care, to include trimming and filing, will be provided on a regular schedule. Nail care will be provided between scheduled occasions as the need arises. 7. d. If trimming is allowed, clip nails using nail clippers straight across and even with tops of the fingers. 1. Review of the record revealed Resident #6 was admitted to the facility on [DATE]. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] documented the resident had a Brief Interview for Mental Status (BIMS) score of 9, on a 0 to 15 scale, indicating severe cognitive impairment. This MDS also documented the resident needed substantial to maximum assistance for personal hygiene. Review of the current care plan initiated on 02/28/24, and revised on 07/11/24, documented Resident #6 had an ADL [Activities of Daily Living] self-care deficit, and instructed staff to check nail length, trim, and clean on bath day, and as necessary. A second care plan initiated on 02/22/22, and revised on 02/04/25, documented, in part, to avoid scratching and keep fingernails short. Review of the most current weekly skin assessment, dated 02/05/25, documented the resident's nails were cleaned and trimmed. Observations on 02/10/25 at 2:46 PM and on 02/11/25 at 12:59 PM revealed Resident #6 was in bed and noted to have excessively long fingernails that had red-brown substance under the nail beds, extending approximately 0.5 cm beyond the fingertips. On 02/11/25 at 12:59 PM, the resident was observed scratching an open area on her left facial cheek using her fingernails and blood was present on her face. During an interview on 02/11/25 at 3:00 PM, when asked who was responsible for nail care, Staff D, Certified Nursing Assistant (CNA), stated another CNA, Staff B, who speaks Spanish the resident's primary language, does the resident's nails. On 02/11/25 at 3:10 PM, Staff B stated that nails were cleaned as part of bathing, but not trimmed, because all nail trimming was done by the activity department. During an interview on 02/12/25 at 11:36 AM, when asked who was responsible for nail care, the Activities Director stated a restorative CNA does nail care that includes trimming, filing, and polishing fingernails for the residents. An interview was conducted on 02/12/25 at 1:57 PM, with Staff C, Registered Nurse (RN), who stated the fingernails of Resident #6 were a little long. Observation at this time revealed the resident's fingernails appeared shorter than the previous day but still remained long and beyond the end of the fingers. During this interview, Staff B stated she had trimmed the resident's nails that morning. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 4 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 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 2. Record review revealed Resident #61 was admitted to the facility on [DATE]. Review of the Quarterly Minimum Data Set (MDS) assessment, dated 12/09/24, documented the resident had a Brief Interview for Mental Status (BIMS) score of 5, on a 0 to 15 scale, indicating severe cognitive impairment. This MDS also documented the resident needed partial to moderate assistance with personal hygiene. Review of the current care plan initiated on 06/27/24, and revised on 08/02/24, documented Resident #61 had an ADL self-care deficit and instructed staff to check the nail length, trim and clean on bath day, and as necessary. An interview and observation conducted on 02/10/25 at 12:46 PM revealed Resident #61 was sitting in his chair digging under his fingernails. His lunch tray with the remainder of bar-b-que chicken and sauce were on the over-the-bed table. Nine of the ten nails on both hands were long, extending beyond the fingertips, with reddish-brown substance under the nails. Resident #61 requested a napkin to clean under his nails. The fingernails of Resident #61 extended approximately 1cm beyond his fingertip line and were curled under, making it more difficult to remove the debris under his nails. When asked if he likes his nails that length, the resident stated, No. Resident #61 expressed that he was waiting for a staff member to trim his nails, and that it had been several weeks. On 02/12/25 at 10:06 AM, the resident's nails remained long with some residual substance under the nails. On 02/13/25 at 12:07 PM, the resident's nails were trimmed and cleaned. Resident #61 stated, They were just done. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 5 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, observation, interview, and record review, the facility failed to ensure wound dressing changes were completed per physician order for 1 of 2 sampled residents, Resident #61, reviewed for wound care. Residents Affected - Few The findings included: Review of the policy, titled, Wound Treatment Management, revised 09/01/24, documented in part, 1. Wound treatments will be provided in accordance with physician orders 7. Treatments will be documented on the Treatment Administration Record. Review of the record revealed Resident #61 was admitted to the facility on [DATE]. Review of the Quarterly Minimum Data Set (MDS) assessment, dated 12/09/24, documented the resident had a Brief Interview for Mental Status (BIMS) score of 5, on a 0 to 15 scale, indicating severe cognitive impairment. Review of the current orders documented as of 02/04/25 that staff were to provide daily wound care to the right heel. An order dated 02/13/25 instructed nurses to provide daily care to the resident's right leg. An additional order dated 02/10/25 instructed staff to offload Resident #61 right heel while in bed. An observation on 02/10/25 at 3:35 PM revealed Resident #61 in bed with two dressings on his right lower leg. The resident's right heel was directly on the mattress, with no offloading. There were two right leg dressings: one on the calf area and one around the heel and ankle. Written on both dressings was the date 02/10/25 with the initials of the nurse who completed the care. On 02/11/25 at 3:17 PM, an observation revealed the same date and initials as the previous day. On 02/11/25 at 3:26 PM, Staff E, Unit Manager, confirmed that the nurse did not change the dressing as ordered, as the initials on the dressing were by the nurse who had worked two days prior. Review of the corresponding Treatment Administration Record (TAR) for February 2025, documented the dressing had been completed, when it had not been done, as confirmed with the Unit Manager. Staff E was observed doing the dressing change on 02/11/25 at 3:42 PM. When the dressing was removed, there was a moderate amount of drainage on the dressing that had seeped through the outermost layer and it was malodorous. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 6 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 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 0697 Provide safe, appropriate pain management for a resident who requires such services. 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 effectively communicate the resident's complaint of pain, failed to evaluate the effectiveness of pain interventions, and failed to appropriately treat pain for 1 of 5 sampled residents, Resident #42, reviewed for pain management. Residents Affected - Few The findings included: Review of the record revealed Resident #42 was admitted to the facility on [DATE]. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] documented the resident had a Brief Interview for Mental Status (BIMS) score of 3, on a 0 to 15 scale, indicating severe cognitive impairment. This MDS documented the resident needed maximum to dependent assistance for Activities of Daily Living (ADL). Review of the care plan, initiated on 11/28/22 and revised on 10/11/23, documented the resident had chronic pain related to a stroke, neuropathy (nerve pain), back pain, and left shoulder pain. This care plan instructed staff to evaluate the effectiveness of pain interventions as needed. It documented to review for compliance, alleviating symptoms, dosing schedules and resident satisfaction with results, impact on functional ability, and impact on cognition. Staff instructed to monitor, record, and report to the nurse any signs and symptoms of non-verbal pain, such as changes in breathing (noisy, deep / shallow, labored, fast/slow); Vocalizations (grunting, moans, yelling out, silence); Mood/behavior (changes, more irritable, restless, aggressive, squirmy, constant motion); Eyes (wide open/narrow slits/shut, glazed, tearing, no focus); Face (sad, crying, worried, scared, clenched teeth, grimacing) Body (tense, rigid, rocking, curled up, thrashing). Review of physician progress notes dated 03/30/23 revealed in part that a significant contracture was present in the left arm and shoulder with significant spasticity consistent with prior history of stroke. The record lacked any other documentation related to spasms or cramps. Review of the recent daily skilled nursing notes documented inconsistency with the location of leg pain, documenting on 02/09/25 right leg pain, on 02/06/25 left leg pain, on 02/05/25 left leg pain level 5, on 01/28/25 leg pain, on 01/27/25 right leg pain, on 01/26/25 right leg pain, and on 01/24/25 right leg pain. Further review of the record documented an order dated 07/07/24 for Gabapentin (a medication for seizures and nerve pain) but lacked any medication order for cramps or muscle spasms. An observation of personal care by Staff B, Certified Nursing Assistant (CNA), was made on 02/12/25 at approximately 9:45 AM for Resident #42. During the care, Resident #42 experienced left leg rigidity and extension, with the left leg involuntarily pulling inward and crossing over right leg, with the resident expressing pain and calling it a cramp. The CNA gave verbal instructions to relax and on breathing exercises. The CNA was unable to provide care for about 1 to 2 minutes during the event. Interview and observation with the resident were conducted on 02/12/25 at 11:17 AM, who stated he would like to get up in a chair, but the chair was a problem because his whole body hurts while sitting in the chair. The resident stated he has cramps all the time in his left leg, and that is why he is more comfortable in bed. During this interview, the resident started to have pain and stated it was his left leg cramping. He squirmed in the bed holding the bedrail with his right hand and pulling up in bed, and his left leg was in full extension. He started moaning and had facial grimacing, stating that it was still hurting for 2 to 3 minutes. Resident #42 then pushed the call bell at 11:20 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 7 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few AM. Staff C, Registered Nurse (RN) came in at 11:22 AM, and he stated he had a cramp to his left leg, at which time she repositioned his left leg. During an interview on 02/12/25 at 2:50 PM with Staff B, CNA, when asked how often Resident #42 has spasms or cramps, and what body part was involved, Staff B stated he complained of left leg pain and called it a cramp. The CNA stated he pushes the call bell several times a day and says his left leg is cramping. She stated she repositions him and places a pillow under his leg. When asked what she does next, Staff B stated she reports the complaint of pain to the nurse. An interview was conducted on 02/12/25 at 3:15 PM with Staff C, RN, who was asked if she had ever seen Resident #42 have a left leg spasm, she stated, No and added the resident has a diagnosis of Neuropathy and gets Gabapentin for it. Staff C, RN, stated today was the first time she had ever heard the resident's pain described as a cramp. After surveyor intervention, an order for Flexeril, a muscle relaxant, was added on 02/12/25 at 3:39 PM by Staff C, RN. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 8 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 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 policy review, interview, and record review, the facility failed to ensure adequate monitoring of side effects and behaviors for residents receiving psychotropic medications, for 1 of 5 sampled residents reviewed for unnecessary meds, Resident #16. Residents Affected - Few The findings included: Review of the policy, titled, Use of Psychotropic Medication, dated 09/01/23, indicated Residents are not given psychotropic drugs unless the medication is necessary to treat a 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). A psychotropic drug is any drug that affects brain activities associated with mental processes and behavior. Psychotropic drugs include but are not limited to the following categories: Antipsychotics, antidepressants, anti-anxiety, and hypnotics. The resident's response to the medication (s), including progress towards goals and presence/absence of adverse consequences, shall be documented in the resident's medical record. Clincial record review revealed Resident #16 was admitted to the facility on [DATE], and again on 04/29/23, with diagnoses that included Non-Alzheimer's Dementia, and a psychotic disorder. Review of the physician orders, dated 12/20/23, revealed Seroquel 25 mg was prescribed to be administered orally at bedtime to address psychosis. Another order, dated 12/05/23, outlined behavior monitoring for the antipsychotic with a specific behavior code system: - 0: None - 1: Mania/agitation - 2: Paranoia/hallucinations/delusions - 3: Screaming/yelling - 4: Biting/kicking/hitting/pinching - 5: Danger to self/others - 6: Smearing feces/ Extreme fear - 7: non-pharmacological interventions were to be recorded with a specific code system included: -0: None -1: Activities -2:1:1 -3: Redirection (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 9 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 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 -4: Repositioning Level of Harm - Minimal harm or potential for actual harm -5: food/fluids -6: rest period Residents Affected - Few -7: quite environment -8: Medication -9: PN Intervention Outcome: I=Improvement S=Same W=Worsen N/A=Not Applicable. On 12/05/23, another physician ordered monitoring for antipsychotic side effects, and to place a number corresponding with the side effects, if other-document nurse's note. Outlined monitoring for the antipsychotic with a specific side effect code system: - 0: None - 1: Stiffness/lack of movement - 2: Tardive Dyskinesia - 3: Sedation - 4: Hypotension - 5: Weight gain - 6: Dizziness - 7: Seizures - 8: Constipation - 9: Restlessness - 10: Urinary retention - 11: Dry mouth - 12: Vision changes - 13: Other. Review of the care plan, revised on 12/31/24, indicated Resident #16 utilized antipsychotic medication for psychosis and dementia. Interventions included monitor, document and reporting any adverse effects from the medication, such as unsteady gait, tardive dyskinesia, extrapyramidal (EPS) symptoms, falls, refusal to eat, weight loss, difficulty swallowing, nausea, vomiting, social isolation, fatigue, blurred vision, loss of appetite, dry mouth, depression, suicidal ideations, muscle cramps, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 10 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 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 weight loss, any symptoms not usual to the resident. Level of Harm - Minimal harm or potential for actual harm Additionally, it documented to monitor and record occurrence for targeted behaviors that included: delusions, combativeness, and any verbal or physical aggression toward others. Residents Affected - Few Review of the February 2025 Medication Administration Record (MAR) indicated that behavior monitoring was recorded three times daily from February 1 to February 12, 2025. The documentation did not include specific codes as mandated to indicate observed behaviors; instead, they were noted by check marks. On 02/13/25 at 8:36 AM, an interview with the Director of Nursing (DON) who clarified that behavior monitoring should include coding entries as directed. The DON stated that Resident #16 had not exhibited any concerning behaviors. When asked about using check marks, the DON affirmed that nurses should record a zero if no exhibited behaviors were noted, emphasizing that check marks do not effectively communicate the required information. Upon reviewing the MARs, the DON acknowledged the presence of check marks for behavior monitoring and confirmed the necessity of adhering to the documented coding system. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 11 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, the facility failed to ensure a clean and sanitary kitchen and failed to maintain food that was not past it's use-by or expired date. This could potentially affect 72 of 75 residents who consume an oral diet. The findings included: An observation of the kitchen was made on 02/10/25 beginning at 8:54 AM with the Kitchen Manager / Certified Dietary Manager (CDM). Upon entering the kitchen, the breakfast service was completed, the kitchen had been cleaned after the meal, and staff were in the process of doing the breakfast dishes. The following concerns were noted and confirmed by managerial staff, with Photographic Evidence Obtained: a) A table in the food preparation area had peeling paint on all the legs and shelf. b) A table in the food preparation area had legs and shelves with rust-like surfaces. c) Pitchers filled with juice to be used that day had leftover sticker debris that had not been cleaned off. d) A plastic serving cart with two shelves was marred, scratched, and with grey-black staining. e) The floor around the cooking appliances was visibly soiled with debris and a black liquid-like substance. f) The plate warmer had visible dried brown substance or corrosion. g) The dispensing hose and nozzle to the juice bin was lying directly on the floor. h) A plastic bin with individual syrup containers was visibly soiled with a sticky substance. i) The oven handle was slippery and greasy with dried debris and a carbon build-up. j) The walk in refridgerator had a brownish-black debris around the frame where the seal meets the frame. k) A plastic bin with clean utensils stored in it was on a large utility cart with dirty items. The plastic bin was visibly dirty with debris. l) Water was pooling on the floor, appoximately 10 to 12 inches from the wall, along the entire wall that contained the ovens and steamer. The following expired items, as evidenced by the best-by-dates, use-by-dates, and or expired dates marked on the item, were identified in the dry storage area: m) Twelve large cans of chicken and dumplings expired July 2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 12 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 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 0812 n) Twelve large cans of chili expired 01/22/25. Level of Harm - Minimal harm or potential for actual harm o) A case of jelly expired on 03/16/24. p) A six pound can of beef stew expired 10/13/24. It had been delivered on 11/10/22. Residents Affected - Some q) A large can of chili con carne expired 10/10/224. It had been delivered on 11/10/22. r) A large jar of Skippy peanut butter expired 04/15/24. s) A case of butterscotch pudding, a case of pinto beans, a case of carrots, and a case of peanut butter, all dated as delivered in January of 2023 and unable to read the used by dates. t) Four packages of walnuts with hand written dates that were not able to be read and lacked use-by-dates. The CDM was asked to provide the use-by-dates by the lot number, but failed to do so. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 13 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 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 observation, interview, record review, and policy review, the facility failed to use appropriate hand hygiene practices and personal protective equipment (PPE) when providing incontinence and wound care for 2 of 3 sampled residents observed for direct care, Residents #65 and #61. Residents Affected - Few The findings included: Review of the policy, titled, Enhanced Barrier Precautions (EBP), implemented on 04/01/24 documented, in part, Definitions: 'Enhanced barrier precautions' refers to the use of gown and gloves for use during high-contact resident care activities for residents known to be colonized or infected with a multidrug-resistant organism (MDRO) as well as those at increased risk of MDRO acquisition (e.g., residents with wounds or indwelling medical devices.) . Policy Explanation and Compliance Guidelines: . 1.b) Clear signage will be posted on the door or wall outside of the resident room indicating the type of precaution, required (PPE), and the high contact resident care activities that require the use of gown and gloves . 2. Initiation of Enhanced Barrier Precautions b.) An order for enhanced barrier precautions will be obtained for residents with any of the following: i.) Wounds (e.g., chronic wounds such as pressure ulcers, diabetic foot ulcers, unhealed surgical wounds, and chronic venous statis ulcers) and/or indwelling medical devices (e.g., central lines, hemodialysis catheters, urinary catheters, feeding tubes, tracheostomy/ventilator tubes) even if the resident is not known to be infected or colonized with a MDRO . 4.) High-contact resident care activities include: a.) Dressing b.) Bathing c.) Transferring d.) Providing hygiene e.) changing linens f.) changing briefs or assisting with toileting g.) Device care or use: central lines, urinary catheters, feeding tubes, tracheostomy/ventilator tubes h.) Wound care . 7. Enhanced barrier precautions should be used for the duration of the affected resident's stay in the facility or until the wound heals or indwelling medical device is removed for the high-risk residents. 1. Record review revealed Resident #65 was admitted to the facility 10/05/24, with a primary diagnosis of atherosclerosis of native arteries of extremities with gangrene of the right leg (an accumulation of cholesterol plaque in the walls of the arteries causing obstruction to blood flow leading to dead tissue.). Other diagnoses included: acquired absence of right leg below knee, acquired absence of left leg below knee, Type 2 Diabetes Mellitus with Diabetic Neuropathy and need for assistance with personal care. Review of the current Minimum Data Set (MDS) assessment dated [DATE] documented Resident #65 had a Brief Interview for Mental Status (BIMS) score of 15, on a 0 to 15 scale, indicating intact cognition. This same MDS also documented the resident had an unhealed Stage 3 Pressure Ulcer and was receiving dialysis. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 14 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the active orders revealed there were no Enhanced barrier precaution orders from 02/10/2025 02/12/25. An interview was conducted on 02/12/25 at 9:05 AM with Resident #65, who when asked if the staff usually wore a gown and gloves when care was provided, the resident stated he had never seen them wear a gown. The resident was asked what type of dialysis site he had and stated he had both a right upper chest port, (also known as a central venous catheter / CVC, a tube inserted into a vein in the neck, chest or groin to provide access for dialysis) and a arteriovenous fistula (AV fistula) to his left arm that was still maturing (a surgical connection between an artery and a vein that allows patients to receive dialysis treatments). At the time this interview was conducted, there was no (EBP) sign and no PPE was observed outside or inside the resident's room. An incontinence care observation was conducted on 02/12/25 at 10:15 AM on Resident #65 with Staff A, CNA. Before the care, Staff A washed her hands, gathered water in a basin and placed it on the bedside table and donned gloves; no PPE was used. With her gloved hands, Staff A pulled the curtain and provided privacy. She cleansed the upper body first and continued to the lower half. She then proceeded to provide perineum care and discovered the resident was soiled when she observed feces on the washcloth. While using the same gloves, Staff A turned the resident to their side to cleanse his bottom. She removed the soiled brief and continued with perineum care without changing her gloves. When Staff A proceeded to dress Resident #65, she changed out her gloves without performing hand hygiene. Staff A stated, I am going to find the lift to transfer the resident to the chair. She was observed to remove her gloves and again not perform any hand hygiene as she left the room. When Staff A walked out of the resident's room, an interview was conducted at10:50 AM with the aide. Staff A was made aware of her hand hygiene and incontinence care practices, and stated she did not even notice she had not performed hand hygiene or changed her gloves during and after the care was provided. Staff A stated, I did wash my hands in the beginning. She acknowledged the importance of hygienic performance. When asked if the resident was on any precautions or if they usually used gowns when care was provided, she stated the resident was not on any precautions and if there was no sign on the door they didn't have to wear a gown. On 02/13/25 at 12:14 PM, an interview was conducted with the Director of Nursing (DON) regarding the (EBP) and incontinence care observation findings with Staff A. The DON stated, It breaks my heart to hear that because we just did an in-service training last week about handwashing and her signature is on it. She agreed incontinence care should not have been performed that way and stated Staff A was nervous. The DON admitted she misunderstood the guidelines and criteria regarding the residents that should have been placed on (EBP). The DON stated, I take full accountability, and we are currently working on fixing it by placing the orders and precautions back in place for those residents. 2. Record review revealed Resident #61 was admitted to the facility on [DATE]. Review of the current physician's wound order, dated 02/04/25, documented for daily care to the open area of the resident's right heel. A physician's order, dated 02/13/25, documented for daily wound care to the open area of the resident's right leg. The record lacked any order or care plan related to Enhanced Barrier Precautions (EBP). During the initial pool process on 02/10/25, there was no EBP signage on or at the door or in the room of Resident #61. There was no PPE set up on or at the resident's door, as observed on the doors (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 15 of 16 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 105804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare Fort Pierce 700 S 29th Street Fort Pierce, FL 34947 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 of the other residents who were on EBP. Level of Harm - Minimal harm or potential for actual harm An observation of wound care was done on 02/11/25 at 3:42 PM with Staff E, Unit Manager. Staff E did not wear a protective gown during the dressing change. Staff E completed care on both open wounds. Residents Affected - Few An interview was conducted on 02/13/25 at 10:12 AM with Staff E, who when asked of her understanding of EBP, the Unit Manager stated she did not understand the implementation of EBP until this week. The Unit Manager confirmed she did not wear a gown during the dressing change that she had completed for Resident #61 on 02/11/25. An interview was conducted on 02/13/25 at 8:50 AM with the Director of Nursing (DON) that revealed she misunderstood EBP. She stated she thought it was for Multi-Drug Resistant Organisms (MDROs), Foley (urinary) catheters, and wound Vacs. She stated that she instructed the staff to remove all EBP signs on other room doors. The DON stated she had reread the Centers for Disease Control and Prevention (CDC) recommendations last night and stated she was wrong. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105804 If continuation sheet Page 16 of 16