Inspection·February 22, 2024

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 policy review, Centers for Disease Control (CDC) recommendation review, observation, interview, and record review, the facility failed to ensure appropriate infection control practices as evidenced by the failure to ensure PPE (personal protective equipment) use during COVID outbreak testing for 2 of 2 sampled residents observed, Residents #1 and #11; failed to fully implement their Enhanced Barrier Precautions (EBP) policy for 3 of 3 sampled residents who were not on EBP (Residents #2, #17, and #138), and 2 additional random residents (Residents #25 and #188); failed to implement appropriate infection prevention practices for eye drop administration and blood glucose monitoring for 3 of 7 sampled residents observed during the medication pass observation, Resident #3, #18 and #28; and failed to assist 11 of 11 residents, who ate independently or with minimal assistance, with hand hygiene prior to meals in the main dining room, that included random residents and sampled residents, Residents #15, #20, and #27. The census at the time of the survey was 30. Residents Affected - Some The findings included: 1. On 02/20/24 at 8:40 AM, observation of medication administration was conducted with Staff A, Registered Nurse (RN) for Resident #28. Resident #28 was sitting in front of her closet picking out clothes to get ready for the day. Staff A approached Resident #28 with her medications in a medicine cup, Staff A asked Resident #28 if she wanted the pills to be poured into her hands as usual. Resident #28 stated yes. Staff A subsequently poured a total of 8 pills into Resident #28's hand without offering her hand hygiene and/or without asking if she had cleaned her hands. The resident had the pills in her left hand and picked the pills with her right hand and put the pills in her mouth. 2. Review of the CDC guideline last updated 04/04/22, indicated that Personnel collecting specimens or working within 6 feet of patients suspected to be infected with SARS-CoV-2 should maintain proper infection control and use recommended personal protective equipment (PPE), which could include an N95 or higher-level respirator (or face mask if a respirator is not available), eye protection, gloves, and a lab coat or gown. On 02/20/24 at 11:44 AM, COVID testing observation was conducted with the Infection Preventionist (IP), License Practical Nurse (LPN). The test was being conducted on Resident #1 and Resident # 11. This test was being conducted related to a COVID outbreak in the facility, whereas the two mentioned residents were exposed with the positive resident during dining. The facility's testing process was as follows: they conducted testing with COVID outbreak on day 1, day 3 and day 5. This testing on 02/20/24 at 11:44 AM was day 3 testing. The IP donned gloves, she had eyeglasses, no mask, and no gown or lab coat. She swabbed Resident #1's nostrils and conducted the test. She said she was going to wait 15 minutes for the result. She sanitized her hands and was waiting in front of the room. Subsequently at 11:49 AM, she voiced she was going to leave the test in the resident room and moved on to Resident #11 to test her. The IP was encouraged to do what she normally does, and to not rush the process for the surveyor. She voiced her normal process was to wait for 15 minutes, and she then encouraged to wait. At 11:50 AM, the IP went to test Resident #11. The IP did not wear PPE (to include mask and gown) while she was testing Resident #11. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 2 of 6 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 02/22/2024 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 0880 Level of Harm - Minimal harm or potential for actual harm On 02/21/24 at 11:50 AM, an interview process was started with the IP, and an inquiry was made regarding the facility's process for doing outbreak testing for COVID. The IP explained when somebody is positive, we contact trace them. The main hall where the residents are, we would do a rapid test, day 1, day 3 and day 5. If any resident tests positive, we isolate them, and contact the Department of Health (DOH), and upload all the negative and positive in the DOH portal. Residents Affected - Some When the surveyor inquired about why she did not wear PPE during the outbreak testing yesterday (2/20), she voiced she did not wear PPE because it was day 3 testing, but with day 1 she would have worn PPE. A side-by-side review of the CDC guideline was conducted with the IP, who agreed she should have worn PPE during the testing. 3. A request of the facility's Policies and Procedures for the facility's Infection Prevention and Control Program was made to the Nursing Home Administrator (NHA). The facility provided a binder which included their policy for the use of Enhanced Barrier Precautions (EBP). During the review of their infection program with the Infection Preventionist (IP), it was revealed that the facility had put into place the use of EBP. Review of the policy, titled, Enhanced Barrier Precautions, dated August 2022, indicated EBPs are used as an infection prevention and control intervention to reduce the spread of multi-drug resistant organisms (MDROs) to residents. 2) EBPs employ targeted gown and glove use during high contact resident care activities when contact precautions do not otherwise apply. 5) EBPs are indicated (when contact precautions do not otherwise apply) for residents with wounds and/or indwelling medical devices regardless of MDROs colonization. 6) EBPs remain in place for the duration of the resident's stay or until resolution of the wound or discontinuation of the indwelling medical device that places them at increased risk. Review of CDC (Centers for Disease Control and prevention) guideline for EBP, last updated 07/12/22, explained that as many as 50% of nursing home residents are infected and or colonized with MDROs that go undetected. Focusing only on residents with active infection fails to address the continued risk of transmission from residents with MDROS colonization, who by definition have no symptoms of illness. MDROS colonization may persists for long periods of time (e.g., months), which contributes to the silent spread of MDROs. Expanded residents for whom EBP applies to include any residents with an indwelling medical device or wound (regardless of MDRO colonization of infection status). Enhanced Barrier Precautions expanded the use of PPE and refer to the use of gown, and goggles during high-contact resident care activities that provide opportunities for transfer of MDROs to the staff hands and clothing. MDROs may be indirectly transferred from resident to resident during these high-contact care activities. Nursing home residents with wounds and indwelling medical devices are at especially high risk of both acquisition of and colonization with MDROs. The use of gown and gloves for high-contact resident care activities is indicated, when contact precautions do not otherwise apply, for nursing home residents with wounds and/or indwelling medical devices regardless of MDRO colonization as well as for residents with MDRO infection or colonization. During the survey process, from 02/19/24 through 02/22/24, there were no residents on EBP. There was no signage or (Personal Protective Equipment) PPE kits in place at the residents doorways. The Infection Preventionist (IP) was asked to provide a list of current residents who had a wound or indwelling device. Review of this list revealed the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 3 of 6 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 02/22/2024 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #2 was admitted to the facility on [DATE], currently had an indwelling urinary catheter, and a pressure injury to the sacrum. The resident was ordered Gentamycin ointment for 14 days as of 01/04/24, for a wound infection. Cloudy urine was observed in the resident's indwelling urinary drainage tube on 02/20/24 at 8:50 AM, and the resident was currently being treated for a Urinary Tract Infection (UTI). Resident #17 was admitted to the facility on [DATE] after hospitalization for a leg fracture. The resident had a metal external immobilizer to her left lower leg with redness observed to the surgical wound. The resident was ordered the antibiotics Cephalexin every 6 hours for 28 days as of 01/30/24 and Doxycycline twice daily for 14 days as of 02/06/24, both as prophylactic measures. Resident #25 was admitted to the facility on [DATE] and had an ostomy (surgical opening) in her abdomen. Resident #138 was admitted to the facility on [DATE] and was being fed via a PEG (percutaneous endoscopic gastrostomy/surgical placement of a feeding tube into the stomach). Resident #188 was admitted to the facility on [DATE] and had an open wound to the heel. These five residents should have been on EBP as per facility policy. During an interview on 02/21/24 at 11:50 AM, the IP confirmed as part of the infection control process, the facility utilized EBP. The IP further explained they only initiate EBP if there was a current resident on an antibiotic and was colonized with an MDRO. During an interview on 02/22/24 in the afternoon, the Director of Nursing (DON) was shown the current CDC guidelines, which was the source of their EBP policy. Upon review of the information, the DON agreed they had not fully implemented their EBP policy to include any resident with an open wound or indwelling device. 6. On 02/19/24 at 12:15 PM, observations were made in the dining room. There were 11 residents being assisted into the main dining room by staff. Of the 11 residents, 8 residents did not need assistance with their meals. There is a second dining room for residents who are totally independent with meals and had 3 residents in that dining room. Further observations were made that the staff did not offer any hand hygiene to the residents prior to their meal. On 02/20/24 at 12:05 PM, residents were observed to be brought into the dining room from the common area/activity area for lunch. Observations made by another surveyor revealed she did not see residents being offered hand sanitizer / hand hygiene prior to being served food. On 02/21/24 at 12:05 PM, residents were observed coming into the dining room with assistance of staff. They were not offered hand hygiene prior to their meal. On 02/22/24 at 12:05 PM, residents were observed coming into dining room from the common area/activity area. There were 8 residents in the main dining room with 5 residents who were independent for eating meals. The surveyor did not observe residents being offered hand hygiene or hand sanitization prior to their meal. In the secondary dining room for independent eating, there were three residents, a staff and private aide sitting at a table. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 4 of 6 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 02/22/2024 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 02/22/24 at 11:38 am, with Staff D, CNA (Certified Nursing Assistant), she stated that she would wash the residents hands before and after eating, and wash them with wash cloth after getting up in morning. She was asked if she hand sanitizes or washes hands of the resident prior to a meal. She stated she will usually wash after eating but not before, During an interview on 02/22/24 at 11:47 AM, with Staff E, Agency Nurse, she stated she makes sure she washes her hands but not residents before meal. During an interview on 02/22/24 at 12:09 PM, with the Dietary Manager (DM), she was asked if staff are supposed to do hand hygiene with the residents prior to having a meal. She stated that the nursing staff is supposed to bring hand wipes prior to a meal. She stated it is her understanding that they had a cart and uses hand sanitizer or with wipes prior to eating but they took it away as one of the residents was taking the wipes. She acknowledged that the staff were not doing hand hygiene with the residents prior to a meal the last three days. She then asked a staff member where the wipes were that are kept in the corner, and they started in the other dining room. The surveyor and dietician walked over to that dining area and did not observe any hand wipes. 4. During a medication pass observation for Resident #18 on 02/21/24 at 4:36 PM, Staff C, Registered Nurse (RN), gathered medications to include an eye drop. The RN went into the resident's room with the medication vial in the labeled box, administered the eye drops, placed the vial of eye drops back into the box, and dropped the box into her lab coat pocket, that was bulging out with other items in it. The RN then went into the resident's bathroom, washed her hands, returned to the medication cart, and placed the now contaminated box into the clean medication cart. During an interview on 02/21/24 at 5:00 PM, when asked about the eye drops in her pocket, the RN questioned, It's a problem even if they are in the box?. When told the box was now contaminated from her pocket and placed into the clean medication cart, the RN stated, Oh yea. 5. Review of the policy, titled, Blood Sampling - Capillary (Finger Sticks), revised September 2014 documented, Steps in the Procedure: . 3. Place blood glucose monitoring device on clean field. 8. Following the manufacturer's instructions, clean and disinfect reusable equipment, parts, and/or devices after each use. 11. Replaced blood glucose monitoring device in storage area after cleaning. During a medication pass observation for Resident #3 on 02/21/24 at 4:44 PM, Staff C, RN, obtained the needed supplies to obtain a blood glucose (sugar) level to include the glucometer (the machine used to obtain the blood sugar level at the bedside). The RN put the supplies in her hand, grabbed a tissue, placed the tissue on the resident's over the bed table placing the lancet, and alcohol wipes on the tissue, and placed the glucometer directly on the over the bed table, that was being used by Resident #3 as evidenced by her personal belonging on the table. Staff C obtained the blood sample and blood sugar level, and returned to the medication cart. The RN properly disposed of the supplies, but placed the glucometer back into the clear plastic storage bag, and placed the bag on top of the medication cart. Staff C proceeded to draw up and provide insulin to Resident #3, returned to the medication cart, and placed the glucometer back into the top drawer of the cart. Staff C provided an additional medication to Resident #3, assisted the resident with dinner set-up, and returned back to the medication cart, stating she was ready to move on to the next resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 5 of 6 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 02/22/2024 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 0880 Level of Harm - Minimal harm or potential for actual harm During the continued observation and interview on 02/21/24 at 5:00 PM, when asked if she had any additional residents who needed a blood sugar level, the RN stated she did not. When prompted if she was done with the glucometer, Staff C, RN, stated No, I need to clean it. I don't know why I put it back in the cart. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105828 If continuation sheet Page 6 of 6