Inspection·September 10, 2021

F 0550 Level of Harm - Minimal harm or potential for actual harm On 9/09/21 at 7:54 AM an interview with the Director of Nursing (DON) revealed if residents are exposed staff are to offer help and ensure privacy. On 9/09/21 at 8:07 AM an Interview with the DON revealed all staff are to intervene timely to protect all resident's dignity and offer help. she stated she will speak to all staff regarding resident privacy and dignity. Residents Affected - Few Review of Resident #30's record revealed a Minimum Data Set (MDS) for a 5-day admission dated 8/2/21, which indicated that the resident has a Brief Review for Mental Status (BIMS) score of 14 (cognitively intact); feels that it is very important to choose what to wear and very important to take care of her personal belongings. 2. Observations on 9/10/21 at 8:08 AM revealed that while seated in the work area room which was in the front of the building adjacent to the lobby a transport vehicle was observed to pull in front of the building and the driver came into the building and requested a resident. On 9/10/21 at 8:11 AM while in the work area Staff A, CNA was heard talking loud in the lobby and indicated that Resident #39 can't come now she's on the toilet she's got diarrhea, he has to wait. The lobby area instantly became quiet, Staff A then passed the door to the work area and stated, Oh I'm sorry. On 9/10/21 at 8:13 AM an interview with the DON revealed she was present when Staff A was speaking loudly about Resident #39, and she has already spoken to her. She reported that all the residents should be protected, and resident conditions should be reported to the nurse in a manner to protect privacy. Review of the Resident #39's record revealed a Quarterly MDS dated [DATE] which indicate that she has a BIMS score of 13 (Cognitively intact) 3. Review of the facility policy titled Promoting/Maintaining Resident Dignity with a review date of 10/14/2020 revealed that It is the practice of this facility to protect and promote resident rights and treat each resident with respect and dignity as well as care for each resident in a manner and in an environment, that maintains or enhances resident's quality of life by recognizing each resident's individuality. Continued review of the policy found that under the sub-section titled Compliance Guidelines: included the following: 1. All staff members are involved in providing care to residents to promote and maintain resident dignity and respect resident rights. 10. Speak respectfully to residents; avoid discussions about residents that may be overheard. 12. Maintain resident privacy. Review of the facility policy titled Confidentiality of Personal and Medical Records with an effective date of October 13, 2019 revealed that Employees should not discuss resident information in public or semi-public areas. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105849 If continuation sheet Page 2 of 4 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wrights Healthcare and Rehabilitation Center 11300 110th Ave N Seminole, FL 33778 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 observation, interview and record review, the facility failed to ensure wound care orders and consistent treatment were in place for one Resident (#40) of three residents reviewed. Residents Affected - Few Findings Included: During an interview and observation of Resident #40 on 9/8/21 at 10:52 a.m. she stated she had a fall recently and sustained a skin tear to the left arm and left lower leg. The resident stated someone changed the dressing and pulled up her left sleeve which revealed an oval shaped white dressing with illegible writing on her left arm and left leg. During an interview with Staff Member E, Licensed Practical Nurse (LPN) on 9/9/21 at 3:49 p.m. she stated the resident had a fall a few weeks ago and scraped her left arm and left leg. [NAME] said a dressing was applied for pressure and protection as the scrapes were scabbed over. Staff Member E, LPN stated she did not document what the wounds looked like and called them 'scabs.' Staff Member E, LPN stated she did not get an order for wound care as she probably had an order before and could not say where the dressings were documented as changed and when she last changed them. During observation of Resident #40 on 9/9/21 at 4:29 p.m. with Staff Member E, LPN and Staff member C, Registered Nurse (RN), Staff Member C, RN removed the resident's left lower leg dressing. The wound was observed with slough, redness and slightly swollen with drainage. Staff Member E, LPN conveyed the wounds were from the August fall to Staff member C, RN. Staff member C, RN stated the wound was moist from the scab falling off and stated the wound was red but did not appear infected. The resident pulled up her sleeve to look at her left arm. The left arm did not reveal a dressing, blood was observed on the resident's sweater and a skin tear was observed on the left arm. Staff Member E, LPN stated she did have a dressing on the residents left arm and was not sure what happened to it. She confirmed it was bleeding and said they would clean and dress the wounds and obtain a physician's order for wound care on the left arm and left leg. A review of a health status note dated 9/9/21 at 5:28 p.m. included the resident had a skin tear to left lower extremity that scab had come off. Dressing was removed, small amount of serosanguineous drainage on dressing. Also noted skin tear to left forearm with moderate amount of serosanguineous drainage noted. Both skin tears documented as occurring during a prior fall. Nurse Practitioner notified. Skin tear cleansed with normal saline, triple antibiotic ointment applied and covered dressing. Treatment orders placed on the Medication Administration Record (MAR). A review of an Infection Note dated 8/22/21 at 5:02 a.m. included, Dressing remains intact, clean, and dry to left arm and left leg. A review of an Infection Note dated 8/10/21 at 4:23 p.m. included skin tear to left top forearm. A review of an Infection note dated 8/10/21 at 2:54 p.m. included Resident received two skin tears. Physician notified. A continued review of the health status note dated 8/9/21 at 7:50 p.m. revealed the resident was found on the floor in front of her wheelchair and next to the sink. Large skin tear found on left lateral lower leg and one large skin tear on left forearm. Nurse applied adaptic, steristrips, pads and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105849 If continuation sheet Page 3 of 4 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wrights Healthcare and Rehabilitation Center 11300 110th Ave N Seminole, FL 33778 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 kerlex to both skin tears. Physician called. Level of Harm - Minimal harm or potential for actual harm Review of physician orders documented skin check by licensed nurse every Saturday on evening shift ordered on 5/19/21. Residents Affected - Few Review of the care plan revealed a focus area for risk of skin tears initiated on 3/13/18 included interventions to maintain clutter free environment, moisturize skin implemented 3/13/18. Focus area risk for infection related to arthritis initiated 9/29/17. Interventions included monitor resident for any signs and symptoms of infection and notify physician as indicated, initiated on 9/29/17. Review of the treatment administration record (TAR) included skin check by licensed nurse every Saturday on evening shift. Start date 5/25/19 last completed on 9/4/21. Review of the wound/skin evaluation dated 9/4/21 included cellulitis to lower extremities on antibiotics. No dressing medically required. Review of the Minimum Data Set (MDS) revealed a Brief interview for mental status (BIMS) of 13, no cognitive impairment dated 8/12/21. During an interview with the Director of Nursing (DON) on 9/9/21 at 3:56 p.m. she stated that anytime a dressing is in place there should be a treatment ordered, skin sheets should be charted, and orders should be obtained. Review of facility policy for wound management dated 6/10/18, two pages, revealed: 5. Weekly during the scheduled weekly skin evaluation the nurse responsible for that week's evaluation will document the wounds on the weekly skin check. When there is noted deterioration in the wound the nurse will notify the physician and consult for additional treatment orders. The nurse will notify the resident's responsible party regarding the change in condition, and this will be documented in the resident's record. This process will continue weekly until the wound is healed. Review of facility policy for wound prevention dated 6/10/18, two pages, revealed: The purpose of this program is to assist the facility in the care, services and documentation related to the occurrence, treatment, and prevention of pressure as well as, non-pressure related wounds. Review of facility policy for skin integrity dated 6/10/18 page one revealed: It is the policy of the facility to ensure that the residents receive care and services to prevent the development and promote the healing of pressure sores, in accordance with State and Federal Regulations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105849 If continuation sheet Page 4 of 4