Inspection·November 15, 2022

F 0656 practices.' Level of Harm - Minimal harm or potential for actual harm It was documented that Resident #12's care plans were reviewed on 10/27/22, with the participation of required IDT (Interdisciplinary Team) members. Further review of Resident #12's records lacked any documented evidence of care plans specific for activity. Residents Affected - Few On 11/14/22 at 12:07 PM, a side-by-side review of Resident #12's records and interview were held with the MDS coordinator, who acknowledged there were no care plans initiated for activities. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 2 of 14 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 105828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waters Edge Health and Rehabilitation 1500 SW Capri St Palm City, FL 34990 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interviews, the facility failed to ensure ongoing activities were provided for 1 of 3 sampled residents, Resident#24, reviewed for activities. Residents Affected - Few The findings included: Review of Resident #24 records revealed an admission to the facility on [DATE] with diagnoses to include Parkinson's Disease, Atrial Fibrillation, Coronary Heart Disease, Major Depressive Disorder, Short of Breath, Marasmic Kwashiorkor, and Dementia. Resident #24 was currently on Hospice care. Review of her comprehensive MDS (Minimum Data Set), dated 11/25/22, revealed a Brief Interview for Mental Status (BIMs) Score of 99, indicating her cognition was severely impaired. Further review of her section F: Activity Preferences documented: Very Important: Listening to music is very important to her; Books, newspapers, and magazines to read; be around animals such as pets, to do favorite activities; and go outside and get fresh air is somewhat important to her. Review of her care plans revealed she did not have an activities' care plan. Observations of Resident #24 were made throughout the survey process on 11/07/22, 11/08/22, 11/14/22 and 11/15/22. Resident #24 was always observed in her bed or in her high back wheelchair in her room. The resident was never observed in activities, nor was she observed with activity staff coming to see her, during the survey. Throughout the 4-day survey, activities were observed going on in the activities room, but Resident #24 was not observed in attendance at these activities. Review of the Resident #24's activity progress notes documented the following four notes: On 07/30/22, Staff M documented the resident is alert to self with one-word answers. Enjoys listening to 40's big band music on her tv. likes to look at picture magazines especially animals. On 11/03/22, the Social Service Director documented the resident is verbal but unable to follow conversational exchanges; Resident displays some mood issues as evidenced by appearing tired, sleeping more, and problems with conversation; on hospice; and will attend group activities and listen/watch tv in her room. On 11/14/22, during the survey process, it was brought to the Activities Director's attention that the surveyor was reviewing activities for this resident. The Activities Director was home on this day and imputed the following note: 'On 11/14/22, Resident #24 continues to be a Long-Term Care resident, alert to self with confusion, forget fullness and hallucinations. Family is very supportive and visit regularly. Daughter takes her outside for fresh air when she visits. Staff visits daily for friendly visits. She attends group activities to be around others. She likes music programs and socials. Staff takes her to and from groups. She is under hospice care. She has been sleeping more. Staff will continue to visit with her and bring her to groups of interest.' On 11/14/22 at 2:58 PM: 'a 1:1 visitation provided by activities' assistant to Resident#24 this afternoon. She was in her broda chair by her bedside. I spoke with here and read today's [NAME] she mumbled some words and opened her eyes. I asked if she would like to hear some music. She mumbled what sounded like a yes before leaving I put the television on 'sounds of the season'.' (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 3 of 14 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 105828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waters Edge Health and Rehabilitation 1500 SW Capri St Palm City, FL 34990 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 0679 Review of the Daily Activities Log that was inputted into the Kiosk by activities' staff documented the following: Level of Harm - Minimal harm or potential for actual harm 08/02/22, family under individual activity Residents Affected - Few 09/04/22, family under individual activity Family outside 10/30/22, Family 11/13/22, Family 11/14/22, 1:1. During an interview on 11/07/22 at 11:53 AM, with the resident's family member, she stated she was not sure if [the resident] goes to activities but she would benefit from it, and she cannot participate but she can sit and listen. During an interview on 11/14/22 at 9:45 AM with Staff L, Activities Assistant, she stated Resident #24 does not come to activities, she likes to be inside her room, we will go in and see her and the Certified Nursing Assistants (CNAs) will bring her out in her chair. She was asked where they document the resident had activities. Staff L stated we will document on the screen on the wall. She was then asked if she could show documentation of activities for or with this resident, and she acknowledged she had never documented on the resident coming to activities. During an interview on 11/14/22 at 1:40 PM with the Activities Director, she stated Resident #24 is up in morning; she comes to things for socialization; she doesn't participate; and likes music, exercise program. She stated the Activities Assistants put in a note and which resident went to activities for the day. During an interview on 11/15/22 at 1:51 PM with Staff M, Activities Assistant, Staff M stated Resident #24 will come out sometimes in morning or when we do activities in the atrium; if she is up, I will include her in group; I will bring her into activities; and we document on the kiosk in the hallway. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 4 of 14 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 105828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waters Edge Health and Rehabilitation 1500 SW Capri St Palm City, FL 34990 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 ensure care and services for residents with limited range of motion (ROM) was provided for 2 of 2 sampled residents reviewed, Residents #14 and #18. The findings included: 1. Record review revealed Resident #14 was admitted to the facility on [DATE] with diagnoses that included: Non-traumatic Brain Dysfunction and Alzheimer's disease. The quarterly minimum data set (MDS) assessment, reference date 08/18/22, revealed there was no Brief Interview for Mental Status (BIMS) score, indicating Resident #14 was rarely/never understood. There were no behaviors recorded in this MDS. The MDS recorded Resident #14 required total assistance by staff for activity of daily living (ADLs) care. Review of care plan, effective date of 10/18/22, documented Resident #14 had stiffness to bilateral hands. The intervention included: Resident #14 was to have palm guards in place daily, may remove for skin checks and hygiene. On 11/07/22 at 1:50 PM, Resident #14 was observed lying in bed, her hands were tightly closed and there was no splint or palm guard in place. On 11/08/22 at 10:35 AM, Resident #14 was observed lying in bed with no splint or palm guard in place. On 11/08/22 at 11:44 AM, Resident #14 was observed sitting in her wheelchair in her room, both hands were tightly closed, and there was no splint or palm guard in place. On 11/08/22 at 12:30 PM, Resident #14 was observed sitting in her wheelchair in her room, both hands were tightly closed and there was no splint or palm guard in place. On 11/14/22 at 10:33 AM, Resident #14 was observed sitting in her wheelchair in room by herself, she had just received morning care, her hands tightly closed and there was no splint or palm guard noted in place. On 11/14/22 at 11:21 AM, an observation was made of Resident #14 accompanied with the Director Of Nursing (DON), who acknowledged that Resident #14's hands were tightly closed and there was no splint or palm guard in place. She voiced there should be palm guard or rolls in her hands. She added she was going to find out what happened to the palm guards. On 11/14/22 at 1:01 PM, Resident #14 was observed being assisted with feeding by Staff D, Certified Nursing Assistant (CNA). During this time, Resident #14 was observed with palm guards applied to both hands. During an interview with Staff D, she stated she failed to apply the palm guards to the resident's hands this morning. 2. Record review revealed Resident #18 was admitted to the facility on [DATE] with diagnoses that included: Non-traumatic Brain Dysfunction, Arthritis, Alzheimer's Disease, and Dementia. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 5 of 14 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 105828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waters Edge Health and Rehabilitation 1500 SW Capri St Palm City, FL 34990 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 The annual MDS assessment, reference date 09/15/22, revealed no documented BIMS score, inidcating Resident #18 is rarely/never understood. There were no behaviors recorded in this MDS. This MDS further revealed Resident #18 required total assistance by staff with ADLs care. Review of care plans, revision date 09/29/22, documented Resident #18 had tightness to left hand, BL knee and right ankle. Resident #18 was immobile and needed assistance with range of motion (ROM). Intervention included: ensure resident was wearing resting hand splint to the left hand daily as tolerated. On 11/07/22 at 9:29 AM, Resident #18 was observed sitting in wheelchair. She had a private aide who revealed 'she was a paid companion;' and she is here every day with Resident #18. Resident #18 was observed with both hands tightly closed. The left hand was tighter than the right hand. When inquired about hand splint or palm guard, the aide showed demonstration of the hands being able to open. She stated I usually apply the palm guard to her hands, but I've been trying to keep her nails nice. At the time, there was no hand splints or palm guard in place. On 11/07/22 At 1:57 PM, Resident #18 was observed lying in bed, both hands were tightly closed, no splint in place. On 11/08/22 at 10:08 AM, Resident #18 was observed in room, sitting in her wheelchair accompanied by the private aide. Resident #18 kept both hands tightly closed, and agian she was not wearing hand splint. The private aide showed that Resident #18 could open her hands with assistance, otherwise, she kept her hands tightly closed. On 11/08/22 at 12:27 PM, Resident #18 was observed sitting in the room by herself, both hands kept tightly closed and there were no splints in place to the hands. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 6 of 14 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 105828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waters Edge Health and Rehabilitation 1500 SW Capri St Palm City, FL 34990 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure proper positioning of a catheter bag and tubing for 1 of 1 sampled resident reviewed with a history of urinary tract infection (UTI), Resident #1. The findings included: On 11/14/22 at 10:17 AM, Resident #1 was observed lying in bed, the bed was at low position, and the catheter bag at the bedside was observed with scant hematuria (bloody urine). The catheter bag and tubing were observed touching the floor. When Resident #1 was asked if she had lowered the bed to low position, she stated, 'no, they did' (referring to the staff). On 11/15/22 at 09:07 AM, Resident #1 was observed lying in bed, and the catheter bag was positioned on the floor without protection. Record review revealed Resident #1 was admitted to the facility on [DATE] with diagnosis that included: Neurogenic Bladder (a urinary condition due to lack of bladder control). The significant change minimum data set (MDS) assessment, reference date 09/11/22, recorded a Brief Interview for Mental Status (BIMS) score of 14, indicating Resident #1 was cognitively intact. There were no behaviors recorded in this MDS. This MDS revealed Resident #1 required extensive assistance by staff with activity of daily living (ADLs) care. Review of Physician orders, dated 02/21/20, revealed: Cephalexin 500 mg by mouth every 6 hours for Urinary Tract Infection (UTI), which ended 02/24/20; and on 03/24/20, Cephalexin 500 mg by mouth every four times daily for UTI, which ended 03/25/20. Review of care plan, revision date 09/29/22, documented Resident #1 had an infection of the urinary tract. She was at risk for recurrent infection due to use of a suprapubic catheter (SPC) being in place. She goes out to a urologist biweekly for a catheter change. Review of progress notes revealed the following: On 08/19/22 at 7:37 AM, Resident #1 'was noted with increased confusion on this shift. Resident #1 also had hematuria noted in Supra Pubic catheter bag; Medical doctor was notified; Laboratory was due on 08/22/22 were drawn today with a urinalysis, culture and sensitivity (UA, C&S) per the medical doctor to rule out UTI; The laboratory was called to pick up the urine and the laboratory tech was in to pick up the urine.' On 08/19/22 at 7:38 AM, the laboratory was contacted at 7 AM to request labs results to be faxed to the facility; The laboratory results were faxed over promptly; The nurse sent the labs over to the medical doctor who stated that urinalysis showed chronic bacteriuria, and he will wait for the C&S before any further instructions. On 08/20/22 at 8:38 PM, First dose of Cipro (antibiotic) was administered [to Resident #1] for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 7 of 14 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 105828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waters Edge Health and Rehabilitation 1500 SW Capri St Palm City, FL 34990 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 0690 bacteremia (presence of bacteria in the urine). Level of Harm - Minimal harm or potential for actual harm On 10/06/22 at 1:33 PM, a noted indicated Resident #1 was started on antibiotic therapy by mouth for bacteriuria on prior shift. Residents Affected - Few On 11/14/22 at 7:02 PM, a note revealed Resident #1 suprapubic catheter noted with gross hematuria output of 200cc this AM. On 11/14/22, beginning at 11:29 AM, an interview was held with the Director Of Nursing (DON) and she was made aware of concern related to catheter bag and tubing observed on the floor. Photographic Evidence had been Obtained. The photographic evidence was shown to the DON. On 11/15/22, beginning at 9:43 AM, another interview was held with the DON; she was made aware again that the catheter bag was observed on the floor today (11/15/22) at 9:06 AM. On 11/15/22 at 09:49 AM, an interview was held with the infection control (IC) nurse. Photographic Evidence had been Obtained. The photographic evidence of the catheter bag being on the floor was shown to the IC nurse, who acknowledged the finding. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 8 of 14 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 105828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waters Edge Health and Rehabilitation 1500 SW Capri St Palm City, FL 34990 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to act upon a decline in eating ability, ensure consistent meal intake information, and failed to assist and encourage 1 of 1 sampled resident reviewed for weight loss (Resident #16). Residents Affected - Few The findings included: Review of the record revealed Resident #16 was admitted to the facility on [DATE]. Review of the current Minimum Data Set (MDS) assessment dated [DATE] documented Resident #16 had a Brief Interview for Mental Status (BIMS) score of 4 on a 0 to 15 scale, indicating the resident was severely cognitively impaired. Further review of this assessment revealed the resident needed the limited assist of one person for eating. Review of the previous MDS dated [DATE] revealed Resident #16 needed only supervision and set up of meals, indicating a decline in ability to feed herself. Review of the current care plans for Resident #16 revealed the following: Effective 02/20/21 to present, the resident had a noted functional decline in self-care, to include feeding. Interventions included to encourage the resident to do as much as able and to promote independence by encouraging active participation. This care plan also instructed staff to use verbal cues to provide instructions. Effective 02/27/21 to present, cognitive skills for daily decision making are impaired - decisions poor; cues/supervision required. Interventions included to remind, redirect, and reorient as needed. Repeat instructions as necessary. Effective 02/21/21 to present, the resident was at nutritional risk related to multiple comorbidities to include dementia. This care plan lacked any intervention related to providing direction or encouragement. An observation on 11/07/22 at 12:11 PM revealed Resident #16 sitting in her room with a lunch tray on an over-the-bed table located to the resident's left side, and not in front of her. The resident was just sitting there, staring at her tray, which was unopened and untouched. When asked if she was going to eat, the resident stated, when they come help me. At 12:16 PM the resident was seen standing in her doorway. The Social Services Director (SSD) assisted the resident into the common area. On 11/07/22 at 12:26 PM, Resident #16 was observed going back into her room for a few minutes, the lunch tray still untouched, then back out into the hall, and headed back to the common area. As a dietary staff passed by, the staff asked the resident about her lunch, and then told the resident she had some ice cream in there (referring back to her room). Resident #16 continued out of her room and went back to common area. The dietary staff asked if she wanted coffee and the resident stated yes. On 11/07/22 at 12:32 PM, Resident #16 went into the main dining room, just off the common area, with the empty coffee cup, and sat down at a table. Her lunch tray remained in her room. At 12:35 PM, Resident #16 was given chocolate ice cream. At 12:37 PM, Staff K, a Certified Nursing Assistant (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 9 of 14 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 105828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waters Edge Health and Rehabilitation 1500 SW Capri St Palm City, FL 34990 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (CNA), noticed the lunch tray in the resident's room, found the resident in the main dining room, and brought the tray to Resident #16, who started eating. On 11/07/22 at 12:44 PM, Resident #16 was no longer in the dining room and the lunch tray had been removed. When asked how much lunch Resident #16 consumed, the Registered Dietician stated she ate about 40% of the lunch. Documentation provided during the survey, and reviewed after the survey, revealed Staff K documented Resident #16 at 75% of the lunch meal on 11/07/22. An observation on 11/08/22 at 12:35 PM revealed the lunch tray for Resident #16 was taken to her room. Resident #16 self-propelled to the main dining room and staff brought her the lunch tray. Staff D, CNA, uncovered the lunch plate and questioned, Are you gonna eat your sandwich? Resident #16 pointed to the soup, and the CNA asked the resident if she wanted her to uncover it. Resident #16 reached over to the soup, started to uncover it, then covered it back up. Staff did not assist nor stay at the table. At 12:40 PM, the resident picked up the covered ice cream and returned it to the tray, then looked at the soup again, picking up the covered dish. Resident #16 then took her sandwich, dipped it into her coffee, and took one bite, putting the sandwich back on the plate. At 12:42 PM, Resident #16 tried to get the attention of dietary staff, who looked her way and kept going, leaving the dining room. Resident #16 put her mask back up over her mouth, which had remained hooked to her ears and just barely below her mouth the entire meal, and just sat back and looked at her tray. At 12:44 PM Staff D, Registered Nurse (RN)/the MDS Coordinator, walked over to the resident and stated, You're not eating; what is going on. Do you want something different. A dietary aide went back to the table and stated she just wanted the ice cream today. Staff D opened the magic cup ice cream, encouraged her to eat it, which the resident did independently. The RN left and the resident continued eating. At 12:50 PM, Staff D returned and asked the resident if she was good. Resident #16 stated, I'm not eating much of this. Observation revealed the soup and cookie remain covered. Resident #16 continued eating, her mask barely below her mouth the entire meal. Staff, including the MDS Coordinator, dietary staff, and the RD, did not assist or encourage her to remove the mask. On 11/14/22 at 12:11 PM, Staff E, CNA, set up the lunch tray for Resident #16, who was sitting in her recliner in her room. The CNA unwrapped the main plate and uncovered the soup. The CNA put a spoon into the soup and left the room. The surveyor remained in the hallway within view of the resident's room. Observations of Resident #16 in her room at 12:14 PM, 12:20 PM, and at 12:43 PM revealed the resident had pushed the over-the-bed table away from herself, and she was sitting back in the recliner chair with her eyes closed. At 12:55 PM, Staff H, Occupational Therapist (OT), went into the resident's room, and took Resident #16 across the hall to therapy. When asked if the resident said anything about lunch, the OT stated, No she didn't say anything about lunch. When asked if she asked Resident #16 if she was finished with lunch, the OT stated she did ask, and the resident stated she was done. The resident's lunch tray remained in her room, untouched. Photographic Evidence Obtained. On 11/14/22 at 1:00 PM, Staff E noticed the resident's room light was off. The CNA went into room, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 10 of 14 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 105828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waters Edge Health and Rehabilitation 1500 SW Capri St Palm City, FL 34990 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few turning on the light, and stated, Are you OK looking for the resident. The CNA left the room not finding the resident, turned off the light, and went back to gathering finished lunch trays from other residents. At 1:28 PM, Staff G, CNA, took the uneaten lunch tray from the room, put it in the dining cart, and removed the cart from the unit. Review of the meal intake for 11/14/22 lacked any documented amount of consumption. On 11/15/22 at 8:16 AM, Resident #16 was observed sitting up in her recliner chair with the breakfast tray on her lap. The resident's eyes were closed, and she had not eaten anything. As per the meal schedule and the RD, breakfast trays were usually delivered at 7:10 AM. At 8:23 AM, the resident's tray had been taken from her room and identified on the dirty food cart. Resident #16 ate less than a half of a slice of toast. Photographic Evidence Obtained. Review of documented weights for Resident #16 revealed a weight of 142.8 pounds on 03/02/22, and a weight of 120.8 pounds on 04/01/22, indicating a loss of 15.41% during that 30-day period. At that time, the magic cup nutritional supplement was added and more frequent weights for one month were obtained by staff. The documented weight for Resident #16 on 11/03/22 was 123.6 pounds. On 11/15/22 at 8:53 AM, the surveyor requested staff to obtain a current weight for Resident #16. The weight obtained at this time was 117.0 pounds, indicating a weight loss of 5.34% in twelve days. The most current nutritional assessment and or nutritional note for Resident #16 was dated 10/21/22. This note documented a 1.18% weight gain in 30 days, a 2.40% gain in 90 days, and a 6.13% gain in 6 months, with a weight of 128.2 pounds as of 10/01/22. During an interview on 11/15/22 at 10:35 AM, the RD explained Resident #16 has Dementia, goes back and forth from her room to the dining room, has multiple supplements in place, and likes to sit in the common area in the evening and have snacks. When asked the process for obtaining weights related to the frequency, the RD explained a new resident was weighed at least weekly the first month, and that all residents were weighed at minimum monthly. The RD explained she uses the weights, the intake records, her observations, and any voiced concerns as a guide if weights are needed more often than monthly. When asked what interventions besides the nutritional supplements have been tried for Resident #16, the RD stated she has asked the resident her preferences. The RD further explained if the resident is not eating well, her staff will ask the resident if she wants something different. The RD stated the staff always check on her and she can have whatever she wants. When asked if they have tried sitting with the resident and encouraging her, the RD stated she believes they have tried that in the past but didn't think it worked. The RD confirmed there was no current restorative program at the facility, which would be used to encourage meal consumption for those that needed extra guidance. During an interview on 11/15/22 at 1:39 PM, Staff H, OT, explained Resident #16 was being seen for a decline in dressing, toileting, and bathing. The OT stated the resident was not currently being seen related to a decline in eating. The OT stated in the past they determined the resident could feed herself but had more of a motivation and cognition problem. When asked about encouraging the resident to eat, the OT stated sometimes the encouragement helped. When asked if she had been told Resident #16 wasn't eating recently, the OT stated she had not been told. During an interview on 11/15/22 at 1:44 PM, the Speech Therapist (ST) confirmed Resident #16 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 11 of 14 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 105828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waters Edge Health and Rehabilitation 1500 SW Capri St Palm City, FL 34990 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 0692 Level of Harm - Minimal harm or potential for actual harm currently on caseload for cognition issues, not for eating problems. The ST stated when she was on caseload a while back related to possible swallowing issues, the resident could tolerate a regular diet with thin liquids, but needed encouragement. When asked if she was encouraged now, would the resident understand, and the ST stated she would, but she also sometimes says no and will hold on to her no answer. Residents Affected - Few Review of the meal intake record from 11/01/22 through 11/14/22 revealed a lack of documented meal consumption percentages for 13 of 42 meals. Of the documented meal intakes, the resident refused four meals, ate only 'bites' for one meal, ate 25% for 10 meals, 50% for 9 meals, 75% for 4 meals (one of which was observed as inaccurate during the survey), and 100% of one meal. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 12 of 14 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 105828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waters Edge Health and Rehabilitation 1500 SW Capri St Palm City, FL 34990 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 - Few 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** 2. An observation of wound care was made on 11/14/22 beginning at 10:55 AM with Staff F, Licensed Practical Nurse (LPN). Staff F took supplies into the room of Resident #5, and provided the wound care, leaving the locked cart near the room in the Magnolia Hall. Staff F finished care at about 11:05 AM, cleaned up the area, disposed of the trash, hand sanitized and returned to her cart to document the care. Staff F then went to the treatment cart, which was now located at the entrance of the Gardenia Hall (the other unit), and noticed it was unlocked and unattended. Staff F stated she had locked the cart and left it outside of Resident #5's room, and that someone must have moved it. An observation by another surveyor on 11/14/22 at 10:56 AM revealed the treatment cart at the entrance of the Gardenia Hall, unlocked and unattended. During an interview on 11/14/22 at 11:14 AM, Staff J (LPN) and the only other direct care nurse in the facility, confirmed she had moved the treatment cart from the Magnolia Hall and brought it to the current location at the entrance of the Gardenia Hall, to stock the cart. When asked if there was a reason, she had left it open, Staff J stated, not really . but I was having problems with my contact lenses. Resident #16, who is cognitively impaired and was observed multiple times during the survey, self-propelling from her room on the Gardenia unit to the common area, passed the area where the unlock cart was located. Based on policy review, observation and interview, the facility failed to ensure proper storage of medications in 1 of 2 medication carts observed on the Gardenia Hall and 1 of 1 treatment carts observed on the Gardenia Hall. The findings included: 1. The Policy, Storage of Medications, revised November 2020, indicated the facility stores all drugs and biologicals in a safe, secure, and orderly manner. Under policy interpretation and implementation, #6 revealed compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts, and boxes) containing drugs and biologicals are locked when not in use. Unlocked medication carts are not left unattended. On 11/07/22 at 9:13 AM, while standing at the Gardenia unit, the medication cart was observed left opened, and unlock, while unattended. Several staff walked by the medication cart without acknowledging it. At that time, the attending nurse, Staff B, Registered Nurse (RN) was in room [ROOM NUMBER]. The medication cart was facing forward located between rooms [ROOM NUMBERS], and it was not positioned in a place where the nurse could have been able to monitor it. At 9:18 AM, a housekeeping staff walked by without acknowledging the opened medication cart. At 9:19 AM, a Certified Nursing Assistance (CNA) walked by the opened medication cart without acknowledging it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 13 of 14 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 105828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waters Edge Health and Rehabilitation 1500 SW Capri St Palm City, FL 34990 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 At 9:21 AM, Staff B returned to the hallway and attended to the medication cart. Level of Harm - Minimal harm or potential for actual harm At 9:22 AM, an interview was conducted with Staff B and he confirmed the cart was left opened and unlock and shouldn't have been. Residents Affected - Few On 11/14/22 at 10:56 AM, while at the Gardenia unit, the treatment cart was noted unlock and unattended. On 11/14/22 at 11:24 AM, an interview was held with the Director Of Nursing (DON). Photographic Evidence had been Obtained of the medication cart which was left unlock and opened. The photographic evidence was shown to the DON who acknowledged the finding, stating, she would be doing in-services with the staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 14 of 14