Inspection·September 1, 2022

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Review of the physician order dated 8/21/2022 for Resident #84 reads, IVs: Evaluate site for leakage/ bleeding/ signs of infection every shift. Review of the IV company report dated 8/22/2022 for Resident #84 reads, Reason for Consultation: PICC (non-valved) . Reason for Insertion: Drugs . Post-Insertion Data. Line Insertion: 3 CG PICC. Comments: 4 FR [French] PICC inserted into R [Right] basilic vein successfully . Instructed to order CXR [chest x-ray] for verification of PICC line tip placement prior to use. Review of the radiology report dated 8/22/2022 at 3:12 PM for Resident #84 reads, Conclusion: No acute cardiopulmonary process. Right PICC line tip in the right jugular venous system, recommend repositioning. Review of the IV company report dated 8/23/2022 for Resident #84 reads, Reason for Consultation: PICC (non-valved) . Reason for Insertion: Drugs . Post-Insertion Data. Line Insertion: 3 CG PICC. Reinsertion: Yes. Reinsertion Due To: Malpositioned PICC. Comments: 4 FR PICC inserted into L [left] basilic vein successfully . Instructed to order CXR for verification of PICC line tip placement prior to use. Review of Resident #84's medical record indicated that no chest X-ray was ordered to confirm and verify proper placement prior to administering the medications. Review of Resident #84's medical record indicated that no [NAME] 3CG tip confirmation report (magnetic tracking of the tip of the PICC line that uses ECG (electrocardiogram) was present in the medical report. Review of the Medication Administration Record (MAR) documented that Staff J, Licensed Practical Nurse (LPN), administered Sodium Chloride 0.9% at 75 milliliters per hour on 8/22/2022 at 8:50 AM to Resident #84. Review of the MAR documented that Staff H, LPN, administered Sodium Chloride 0.9% at 75 milliliters per hour 8/23/2022 at 10:14 AM through a peripheral IV to Resident #84. Review of the MAR documented that Staff H, LPN, administered 10 milliliters of Normal Saline IV to Resident #84. Review of the MAR documented that Staff I, LPN, administered 10 milliliters of normal saline flush intravenously on 8/26/2022 at 11:38 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Sodium Chloride solution 0.9% at 75 milliliters per hour on 8/26/2022 at 11:38 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Vancomycin 1000 mg IV on 8/26/2022 at 11:38 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Vancomycin 1000 mg IV on 8/27/2022 at 8:39 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered 10 milliliters of normal saline on 8/27/2022 at 8:40 AM intravenously through a left arm PICC line to Resident #84. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 2 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Review of the MAR documented that Staff I, LPN, administered Sodium Chloride solution 0.9% at 75 ml/hr on 8/27/2022 at 8:40 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Vancomycin 1000 mg IV on 8/28/2022 at 11:08 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered 10 milliliters of normal saline IV on 8/28/2022 at 11:39 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Vancomycin 1000 mg IV on 8/28/2022 at 6:16 PM through a left arm PICC line to Resident #84. Review of the employee file for Staff J, LPN, showed no IV competency or PICC line competency training within the file. Review of the employee file for Staff I, LPN, showed no IV competency or PICC line competency training within the file. Review of the employee file for Staff H, LPN, no IV competency or PICC line competency training within the file. During an interview on 8/31/2022 at 8:40 AM, the Advanced Practice Registered Nurse (APRN) stated, I was not aware that we did not do an X-ray to confirm line placement prior to administering medications. There are possible complications related to infusing medications into any line that is not confirmed. During an interview on 8/31/2022 at 9:15 AM, the Attending Physician stated, I was made aware yesterday we did not complete an X-ray of the PICC line. Since then, we have obtained an X-ray showing the catheter is in place so there is no harm to the patient. I can't speak to harm to the patient as it is properly positioned at this time. I do expect for IV fluids to be administered per my orders and if they don't, they need to call me. During an interview on 8/31/2022 at 12:00 PM, Staff H, LPN, stated, I was the nurse on the day that [Resident #84's name] PICC line was reinserted. The nurse from the IV company came in and inserted it. I helped him with [Resident #84's name] arm. I held it, so he could get the dressing on. He told me that he thought it was in the right place. He did give me the paper that explained that I needed to get an X-ray. It is my signature on the sheet. I didn't know that I needed to get an X-ray. The nurse, he told me he didn't think he would need to come back. I just didn't know. I thought it was okay to use. I just attached it to his PICC line after the IV nurse left. I didn't know that I needed to get a chest X-ray. I should not have hung the IV. I really didn't think I was hanging it. I just connected it to the IV. I am not IV certified. I did not take the IV certification. I know that I can't hang antibiotics. I just didn't think that the normal saline was a problem. I have flushed PICC lines after antibiotics, but I haven't hung them. I just wanted him to get his fluids, so I did hang it. I did hang a new bag to the peripheral IV that the resident had before the PICC line was put in. Once they came to do the PICC, the IV was out and I just connected the normal saline to the PICC line as soon as the IV nurse left. During an interview on 8/31/2022 at 1:45 PM, the Director of Nursing (DON) stated, I was shocked that [Staff H, LPN's name] had done anything related to [Resident #84's name] PICC line. I heard her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 3 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few say that she did not have the IV certification and I was shocked. She was practicing outside her scope as an LPN. I was not aware that this was happening. I do not really know the process for verifying if an LPN is competent to do IVs. I just got here. I literally started the day you arrived for survey. We should have a copy of their 30-hour course when they are hired. We should not allow LPNs to administer IV medications unless we know that they have had the course. During a telephone interview on 8/31/2022 at 2:59 PM Staff I, LPN, stated, I took an 8-hour course many years ago. I guess I did not do the 30-hour IV course, so I guess I am not IV certified. I thought I was okay to do the IVs with what I had done. No one ever asked me for my certification to do IV med administration. I did administer the Vancomycin, flush the PICC line and do the normal saline that was ordered to run continuously to [Resident #84's name]. I wasn't aware that it would be a problem. I wish I had known. I did not do a competency specific to the care of the PICC line dressing when I was hired. During a telephone interview on 8/31/2022 at 3:10 PM, Staff J, LPN, stated, I did administer [Resident #84's name] IV and I hung the normal saline. I have been doing IV medications. I was told that as long as there is an RN [Registered Nurse] in the building that I could do it. I was told that by [Staff C, LPN's name] the unit manager. I am in school to be an RN and I was told that I could do it, so I have. I am aware that as an LPN without IV certification I cannot administer any IV medications because it's against the nurse practice act. But I was told it was okay because I was in nursing school. During an interview on 8/31/2022 at 3:20 PM, the Assistant Director of Nursing (ADON) stated, I was not aware that any LPNs who were not IV certified would be administering IV medications. I would not tell any staff that they could practice outside of the nurse practice act. I am not aware of anyone telling an LPN that it was acceptable to administer meds through a PICC or change dressings if they had not taken the course. During an interview on 8/31/2022 at 3:30 PM, Staff C, LPN, stated, I have not told anyone that they could administer IV medications if they are not IV certified as an LPN. I have not said that it is okay for any LPN to administer IV medications if there is an RN in the building. I know that we as LPNs have to follow our scope of practice and that if we have not had the additional training, we can't administer medications IV. During an interview on 9/1/2022 at 7:35 AM, the Human Resources Director stated, The process of hiring staff starts with the application. We do verify licenses for licensed staff, and we will ask LPNs who tell us they are IV certified. The process used to be for human resources to get all certification nurses have and the DON would know and keep record of any staff competencies for nurse. During a telephone interview on 9/1/2022 at 8:10 AM, the Medical Director stated, I came by yesterday and found out about this problem. I did not know we had LPNs who weren't IV certified, administering IV medications. I would expect nurses to practice within their scope of practice. We plan to implement a solution. I would expect that all nurses practice within their scope of practice. Review of the policy and procedure titled Abuse, Neglect, Exploitation & Misappropriation with an approval date of 8/8/2022 reads, Policy: It is inherent in the nature and dignity of each resident at the center that he/she be afforded basic human rights, including the right to be free from abuse, neglect, mistreatment, exploitation and/or misappropriation of property. The management of the facility recognizes these rights and hereby establishes the following statements, policies and procedures (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 4 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few to protect these rights and to establish a disciplinary policy, which results in the fair and timely treatment of occurrences of resident abuse. Employees of the center are charged with a continuing obligation to treat residents so they are free from abuse, neglect, mistreatment, and/or misappropriation of property. No employee may at any time commit an act of physical, psychological, or emotional abuse, neglect, mistreatment, and/or misappropriation of property against any resident. Violation of this standard will subject employees to disciplinary action, including dismissal, provided herein. Definitions . Neglect is the failure of the center, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. Examples include but are not limited to . Failure to take precautionary measures to protect the health and safety of the resident . Procedure: Acts of abuse directed against residents are absolutely prohibited. Such acts are cause for disciplinary action, including dismissal and possible criminal prosecution. Questions may arise as to what actions constitute abuse of a resident. Any action that may cause or causes actual physical, psychological or emotional harm, which is not caused by simple negligence, constitutes abuse. Review of the policy and procedure titled Administration of Intermittent Infusion with an approval date of 8/8/2022 reads, Guidance . 2. Documentation of central vascular access device (CVAD) tip location must be included in the medical record prior to administration of medications. Maintain catheter patency per flushing/locking protocol while awaiting confirmation. Documentation may include: 2.1. Copy of chest X-ray results reporting location of tip, or fluoroscopy report. Review of the policy and procedure titled Continuous infusion of Medications and Solutions with an approval date of 8/8/2022 reads, To be Performed by: Licensed nurses according to state law and facility policy. The nurse is responsible and accountable for obtaining and maintaining competence with infusion therapy within his or her scope of practice. Competency validation is documented in accordance with organizational policy . Guidance . 2. Documentation of central vascular access tip location must be included in the medical record prior to administration of medications. Maintain catheter patency per flushing/locking protocol while awaiting tip confirmation. Documentation may include: 2.1. Copy of chest x-ray or fluoroscopy report; 2.2. Telephone order from radiologist stating location of tip (e.g. cavoatrial junction, IVC); 2.3. Copy of ECG technology insertion report. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 5 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 the residents received care and services for central venous access devices in accordance with professional standards of practice for 2 of 2 residents with a central venous access device, Residents #84 and #86, in a total sample of 36 residents. Residents Affected - Some Findings include: 1. During an observation on 8/28/2022 at 11:16 AM, Resident #84 was observed resting in bed with the head of the bed elevated. There was an IV (intravenous) pump with a 1000 milliliter (ml) bag of 0.9% normal saline infusing into a left arm single lumen PICC (peripherally inserted central catheter) line. The PICC line was wrapped with gauze that had a yellow tan substance on the gauze that was dried. The transparent dressing was lifting on all four edges exposing the insertion site to air. During an interview on 8/28/2022 at 12:10 PM, Staff C, Licensed Practical Nurse (LPN), confirmed that the left PICC line dressing was wrapped in gauze that was stained, the dressing edges were lifting and not adhering to the resident's skin and there was gauze covering the insertion site. During an observation on 8/28/2022 at approximately 12:15 PM, Staff C, LPN, proceeded to change the PICC line dressing for Resident #84. Staff C donned gloves without performing hand hygiene, removed the old dressing, gauze and silver impregnated patch. Staff C removed gloves, opened the dressing kit, and placed them on the resident's bed. Staff C donned the sterile gloves in the package without performing hand hygiene, cleaned the insertion site for 2 seconds, and applied the transparent dressing. Staff C removed gloves and exited the resident's room. Staff did not measure the arm circumference or external catheter length. During an interview on 8/28/2022 at 12:25 PM, Staff C, LPN, stated, I should have checked to arm and catheter length when I changed the dressing. I should have washed my hands before I put on gloves, and I should have cleaned the site longer. Oh, I should have put a face mask on the patient or asked him to turn his head before I did the dressing. Review of Resident #84's records revealed the resident was admitted to the facility on [DATE] with the diagnoses including atherosclerotic heart disease of native coronary artery (heart disease) with angina pectoris (chest pain), acquired absence of left leg below knee, acquired absence of right leg below knee, hyperlipidemia (high cholesterol), hypertension, local infection of the skin, major depressive disorder, pressure ulcer right buttock stage 3, and pressure ulcer left buttock stage 3. Review of the physician order dated 8/21/2022 for Resident #84 reads, Sodium Chloride Injection Solution 0.9% (Sodium Chloride), Use 75 ml [milliliter]/hr [hour] intravenously every shift related to encounter for other specified prophylactic measures (Z29.8) for 14 days. IV [intravenous] NS [normal saline] to run continuously until IV ABT [antibiotic] completed. Review of the physician order dated 8/28/2022 for Resident #84 reads, Vancomycin HCl in Dextrose Intravenous Solution 1-5 GM [grams]/200 (milliliters)-% (Vancomycin HCl- Dextrose) Use 1000 mg [milligrams] intravenously in the evening for wound for 14 days. Pharmacy to dose. Review of the physician order dated 8/21/2022 for Resident #84 reads, Change dressing on admission or 24 hours after insertion and weekly thereafter and PRN [as needed]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 6 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the physician order dated 8/21/2022 for Resident #84 reads, PICC or midline: Measure upper arm circumference and external catheter length on admission, with each dressing change and PRN. Review of the physician order dated 8/21/2022 for Resident #84 reads, IVs: Type of Access PICC. Review of the physician order dated 8/21/2022 for Resident #84 reads, IVs: Evaluate site for leakage/ bleeding/ signs of infection every shift. Review of the IV company report dated 8/22/2022 for Resident #84 reads, Reason for Consultation: PICC (non-valved) . Reason for Insertion: Drugs . Post-Insertion Data. Line Insertion: 3 CG PICC. Comments: 4 FR [French] PICC inserted into R [Right] basilic vein successfully . Instructed to order CXR [chest x-ray] for verification of PICC line tip placement prior to use. Review of the radiology report dated 8/22/2022 at 3:12 PM for Resident #84 reads, Conclusion: No acute cardiopulmonary process. Right PICC line tip in the right jugular venous system, recommend repositioning. Review of the IV company report dated 8/23/2022 for Resident #84 reads, Reason for Consultation: PICC (non-valved) . Reason for Insertion: Drugs . Post-Insertion Data. Line Insertion: 3 CG PICC. Reinsertion: Yes. Reinsertion Due To: Malpositioned PICC. Comments: 4 FR PICC inserted into L [left] basilic vein successfully . Instructed to order CXR for verification of PICC line tip placement prior to use. Review of the radiology reports indicated no CXR was completed for Resident #84. Review of the physician orders indicated no order for CXR for Resident #84. During an interview on 8/30/2022 at 11:50 AM, the Director of Nursing (DON) stated, All PICC lines should be verified with Chest X ray for placement before we use them. I did not know that he did not have X ray confirmation of his PICC line when it needed to be reinserted. We should not have used the line until we did. I see that was his second PICC line. I expect that all staff understand this and follow the orders for PICC line and care. We have batch orders that should be entered when a PICC line goes in. This is a problem. All PICC line dressings should be changed 24 hours after they are inserted and whenever they are soiled or compromised. I expect nurses to follow physician orders. During an interview on 8/31/2022 at 8:40 AM, the Advanced Practice Registered Nurse (APRN) stated, I was not aware that we did not do an X ray to confirm line placement prior to administering medications. There are possible complications related to infusing medications, but truly I am not familiar enough with the nursing home process. I would expect that the nurses will do arm circumference measurements to make sure there is no clot or infections process being completed. During an interview on 8/31/2022 at 9:15 AM, the Attending Physician stated, I do expect staff to safely administer IV fluids per my orders and to complete my orders and if they don't they need to call me. 2. During an observation on 8/31/2022 at 9:04 AM, Resident #86 was resting in bed with a left single lumen PICC line. The transparent dressing was dated 8/28/2022 with a 2x2 gauze under the transparent dressing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 7 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident #86's records revealed the resident was admitted to the facility on [DATE] with the diagnoses including chronic osteomyelitis right thigh, infection of amputation stump, left lower extremity chronic venous insufficiency, hypertension, and anemia in chronic kidney disease. Review of the physician order dated 8/28/2022 for Resident #86 reads, Change dressing on admission or 24 hours after insertion and weekly thereafter and PRN. Every day shift every Sun [Sunday]. Review of the physician orders dated 8/10/2022 for Resident #86 reads, PICC or midline: Measure upper arm circumference and external catheter length on admission, with each dressing change and prn, every night shift every Thu [Thursday]. Review of Resident #86's Medication Administration Record (MAR) revealed NA was documented for arm circumference and length on 8/11/2022, 3 was documented for arm circumference and length on 8/18/2022, and NA was documented for arm circumference and length on 8/25/2022. During an interview on 8/31/2022 at 10:11 AM, the DON stated, I do expect the nurses to follow physicians' orders for measuring arm circumference. It is a standard to change dressings every 48 hours if they have gauze under them. I don't know why the staff is documenting NA. NA would mean not applicable and that they did not do it. They should have followed the physician orders. Review of the policy and procedure titled Central Vascular Access Device (CVAD) Dressing Change with an approval date of 8/8/2022 reads, Considerations: 1. Central vascular access devices (CVADs) include: 1.1 Peripherally inserted central catheter (PICC) . 2. The catheter insertion site is a potential entry site for bacteria that may cause a catheter-related infection . Guidance . 2. When a transparent dressing is applied over a sterile gauze dressing it is considered a gauze dressing and is changed . 2.2. Every 2 days, 2.3. If the integrity of the dressing has been compromised (wet, loose, or soiled) . 9. Length of external catheter is obtained . 9.2. During dressing changes . 10. For PICC's, upper arm circumference (10 cm [centimeters] above the antecubital fossa) is obtained . 10.2. Upon admission if no insertion measurement available, then weekly . Procedure: 1. Verify prescriber order . 4. Perform hand hygiene . 7. [NAME] masks and clean gloves . 9. Remove old dressing/securement device, being careful not to disturb catheter . 11. Remove gloves. Perform hand hygiene at bedside using appropriate hand sanitizer. 12. [NAME] sterile gloves. 13. Vigorously cleanse around catheter insertion site with antimicrobial solution, according to the manufacturer's instructions. Allow to air dry. Review of the policy and procedure titled Administration of Intermittent Infusion with an approval date of 8/8/2022 reads, Guidance . 2. Documentation of central vascular access device (CVAD) tip location must be included in the medical record prior to administration of medications. Maintain catheter patency per flushing/locking protocol while awaiting confirmation. Documentation may include: 2.1. Copy of chest X-ray results reporting location of tip, or fluoroscopy report. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 8 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 residents received care consistent with professional standards of practice to prevent worsening of pressure sores for 1 of 3 residents observed for pressure ulcers, Resident #31, in a total sample of 36 residents. Residents Affected - Few Findings include: During an observation on 8/30/2022 at 10:00 AM, Resident #31 was sitting in bed with the head elevated. There was a wound vac (vacuum assisted closure device) that was not alarming, and the machine was set at -120 mm (millimeters) hg (mercury). There was no alarm ringing from the wound vac machine. Resident #31 lifted her blankets and there was a large amount of serosanguinous drainage noted on a large pad that was positioned under the resident's right above the knee amputation. During an interview on 8/30/2022 at 10:00 AM, Resident #31 stated, There is something wrong with this [wound vac]. It isn't suctioning like it should be. I have told them last night and this morning. The nurses know that I need to have a new dressing and pad. They have known since they came in. I told a nurse last night, too. During an observation of Resident #31's wound conducted on 8/30/2022 with Staff B, Licensed Practical Nurse (LPN), Staff B assisted the resident to position on her side. There was a transparent dressing that was rolling up at the edges. The black Granufoam was not set within the wound edges and the transparent dressing was not adhering to the skin and there was no suction being applied to the wound. The wound vac machine was not alarming during this observation. There was a large amount of serous drainage that was dripping down the sides of the transparent dressing. Resident #31's right upper leg and thigh both front and back were reddened. During an interview on 8/30/2022 at 10:15 AM, Staff B, LPN, stated, I know that her wound vac is not working, but I have to finish med [medication] pass and then I will do it. The resident told me about it earlier, maybe 30-45 minutes ago. Review of Resident #31's medical record revealed that the resident was admitted to the facility on [DATE] , transferred to the hospital and returned to the facility on 7/27/2022 with the diagnoses including necrotizing fasciitis (a serious bacterial infection that destroys tissue under the skin), pressure ulcer of sacral region stage 2, pressure ulcer of right hip stage 3, major depressive disorder, lumbar spina bifida (a birth defect in which the spinal cord fails to develop properly), anemia in other diseases, hyperlipidemia (high cholesterol), hypertension, acquired absence of right leg above the knee, and acquired absence of left leg above the knee. Review of the physician order dated 8/15/2022 for Resident #31 reads, Wound vac to back of right thigh. Review of Resident #31's admission/readmission data dated 7/27/2022 reads, Right thigh rear: unstageable wound no measurements, Sacrum: open area, other: amputee left and right BKA [below the knee amputation], other scab thigh right/front. Review of Resident #31's weekly skin sweep dated 8/29/2022 reads, 23) Coccyx red, 35) Right thigh (rear) open wound, wound vac in place. There are no wound measurements documented. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 9 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #31's weekly skin sweep dated 8/23/2022 reads, 23) Coccyx raw, no openings, 38) Left knee (front) scab on stump, 35) Right thigh (rear) open wound, wound vac in place. There were no wound measurements documented. Review of Resident #31's weekly skin sweep dated 8/17/2022 reads, 2. Skin Intact: no. 3. Notes: see wound care assessment. There was no wound care assessment documented in the medical record. Review of Resident #31's weekly skin sweep dated 8/10/2022 reads, 2. Skin Intact: no. 3. Notes: see wound care assessment. There was no wound care assessment documented in the medical record. Review of Resident #31's weekly skin sweep dated 8/3/2022 reads, 2. Skin Intact: no. 3. Notes: see wound care notes for skin assessment. wound vac intact and in use. There were no wound measurements documented. Review of the Wound Care documentation from Healogics dated 8/24/2022 reads, Wound #1 status is healed, wound #2 status is healed. History of present illness reads: 8-3: went to hospital, upper leg was debrided and wound vac placed, will look to see if following up with surgeon, if not will follow the wound. There was no documentation of wound measurement for the right leg wound. Review of the Wound Care documentation from Healogics dated 8/17/2022 reads, History of present illness 8-3: went to hospital, upper leg was debrided and wound vac placed, will look to see if following up with surgeon, if not will follow the wound. There was no documentation of wound measurement for the right leg wound. Review of the Wound Care documentation from Healogics dated 8/10/2022 reads, History of present illness 8-3: went to hospital, upper leg was debrided and wound vac placed, will look to see if following up with surgeon, if not will follow the wound. There was no documentation of wound measurement for the right leg wound. Review of the Wound Care documentation from Healogics dated 8/3/2022 reads, History of present illness 8-3: went to hospital, upper leg was debrided, and wound vac placed, will look to see if following up with surgeon, if not will follow the wound. There were no documentation of wound measurement for the right leg wound. During an observation of wound care conducted on 8/30/2022 at 10:45 AM, Resident #31 was repositioned on her side. Staff B, LPN, assembled supplies, entered the room and cleaned the overbed table and placed wound care supplies on the overbed table. Staff B donned gloves without performing hand hygiene, opened 3 packages of 4x4 gauze and a 100 ml (milliliter) bottle of normal saline. Staff B removed the old dressing of a 4x4 gauze and cleaned the wound bed from the top of the wound to the bottom using the gauze 2 times and discarded it. Staff B then picked up the bottle of normal saline and moistened another 4x4 gauze and cleaned the wound from the top to the bottom using the 4x4 twice before discarding. Staff B picked up the 4x4 gauze and poured normal saline on the gauze and cleaned the wound once from the top to the bottom. Staff B removed gloves and donned a new pair without performing hand hygiene. Staff B pulled a pair of scissors from her uniform pocket and began to cut the transparent dressing, placing the scissors on the overbed table. Staff B took the opened package of 4x4 gauze and used the measurements on the side of the package to measure the wound length, width and depth, touching the wound bed during the measurements. After measurements were completed, Staff B began placing the transparent dressing on the skin surrounding the wound bed. Staff B used the scissors to open the package of wound care supplies, placing the scissors back on the overbed table. Staff B (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 10 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0686 Level of Harm - Minimal harm or potential for actual harm then picked up the black Granufoam dressing and cut the foam to the shape of the wound, and then placed the foam on the wound bed. Staff B covered the Granufoam with the transparent dressing, cut a 1/2-centimeter hole with the scissors in the transparent dressing, placed the sensor tubing over the hole and attached the tube to the wound vac machine and verified that the setting was -120 mm hg. Staff B removed her gloves and exited the room without performing hand hygiene. Residents Affected - Few During an interview on 8/30/2022 at 11:00 AM, Staff C, LPN, stated, Residents get weekly wound measurements done and documented. They are documented on the wound forms. Usually the wound care nurse practitioner does the measurements every week. During an interview on 8/30/2022 at 11:20 AM, Staff B, LPN, stated, Wound measurements are usually done by Healogics and we don't measure them. I did not know that they weren't being done. The length, width and depth should be measured when they are admitted and when the weekly wound care see them. I should have used hand sanitizer before I put on my gloves. I thought that I had placed my scissors on the field that I cleaned and that would be okay to do that. During an interview on 8/31/2022 at 8:20 AM, the Director of Nursing stated, I don't know why the wound nurse practitioner was not seeing this resident. They should have been. The surgeon was not seeing the patient every week. We should have called the wound care nurse and had them take over the care of the resident. There are no wound measurements documented since she came back to the facility. Review of the policy and procedure titled Pressure Injury Record with an approval date of 8/8/2022 reads, Policy: To document the presence of skin impairment/ new skin impairment related to pressure when first observed and weekly thereafter until the site is resolved. One site will be recorded per page. Procedure: 1. Residents will have a Pressure Injury Record completed for each skin impairment that is related to pressure . 4. Enter the stage of the pressure injury. 5. Enter the size of the pressure injury- length x width x depth in centimeters. 6. Enter the tissue type and color. 7. Enter the wound edges and drainage. 8. Enter the per-wound information. Review of the policy and procedure titled Dressing Change with an approval date of 8/8/2022 reads, Policy: A clean dressing will applied [Sic.] by a nurse to a wound as ordered to promote healing. Sterile dressing will be used only if specifically ordered. Procedure . Perform hand hygiene; Apply gloves; Remove and dispose of soiled dressing; Remove gloves; Perform hand hygiene; Apply gloves; Evaluate wound for type, color, amount of drainage; Cleanse wound as ordered, dispose of gauze; Remove gloves and perform hand hygiene; Apply treatment as ordered and clean dressing; Discard gloves and perform hand hygiene. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 11 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. During an observation on 8/28/2022 at 9:55 AM, Resident #84 was resting in bed with the head of his bed elevated 45 degrees with oxygen infusing via nasal cannula. The oxygen concentrator was set at 4 liters per minute. Residents Affected - Some During an observation on 8/29/2022 at 9:40 AM, Resident #84 was resting in bed with the head of the bed elevated with oxygen infusing via nasal cannula. The oxygen concentrator was set at 4 liters per minute. Review of Resident #84's records revealed the resident was admitted to the facility on [DATE] with the diagnoses including atherosclerotic heart disease of native coronary artery (heart disease) with angina pectoris (chest pain), acquired absence of left leg below knee, acquired absence of right leg below knee, hyperlipidemia (high cholesterol), hypertension, local infection of the skin, major depressive disorder, pressure ulcer right buttock stage 3, and pressure ulcer left buttock stage 3. Review of the physician order dated 8/27/2022 for Resident #84 reads, Oxygen at 2 L [liters] as needed PRN if O2 [oxygen] drops less than 90%. During an interview on 8/29/2022 at 9:40 AM, Staff D, Registered Nurse (RN), stated, I don't know why his oxygen is at 4 liters. His order is for 2 liters. There is no way that he can change it himself. He cannot reach it. We should check the oxygen when we administer medications. I would not go above 2 liters of oxygen. 4. During an observation on 8/28/2022 at 2:32 PM, Resident #201 was observed resting in bed with oxygen infusing via nasal cannula. The oxygen concentrator was set at 4 liters per minute. Review of Resident #201's medical record revealed the resident was admitted to the facility on [DATE] with the diagnoses including COVID-19, hypertensive heart disease with heart failure, type 2 diabetes mellitus, chronic kidney disease, hypertension, hyperlipidemia, and major depressive disorder. Review of the physician orders dated 8/18/2022 for Resident #201 reads, Respiratory: Oxygen Continuous 2 L/NC [nasal cannula]. During an observation on 8/29/2022 at 12:03 PM, Resident #201 was resting in bed with oxygen infusing via nasal cannula. The oxygen concentrator was set a 4 liters per minute. During an interview on 8/29/2022 at 12:45 PM, Staff E, RN, stated, His oxygen is running at 4 liters on the concentrator. If we have any concerns, we would start oxygen and call the physician to get an order. If any resident had any decompensation, we should document it in the progress notes. His order is for 2 liters, and it shouldn't be at 4 liters. During an interview conducted on 8/30/2022 at 1:35 PM, the Director of Nursing stated, I would expect the staff to follow the doctors' orders for oxygen and check at least daily what the settings are. Review of the policy and procedure titled Oxygen Therapy with an approval date of 8/8/2022 reads, Policy: Oxygen therapy is the administration of a FiO2 [Fraction of Inspired Oxygen] greater than 21% by means of various administration devices to . to decrease work of breathing; to reverse and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 12 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some prevent tissue hypoxia, and/or; to decrease myocardial work . Procedure: Physician's order for oxygen therapy shall include: Administration modality; FiO2, or liter flow; continuous or PRN [as needed]; PRN orders must include specific guidelines as to when the resident is to use oxygen . Review physician's order. 2. Review of Resident #95's clinical record revealed the resident was admitted to the facility on [DATE]with the diagnoses including other specified myoneural disorders; COVID-19; influenza due to other identified influenza virus with other respiratory manifestations; fibromyalgia; unspecified dementia without behavioral disturbance; urinary tract infection, site not specified; atherosclerotic heart disease of native coronary artery without angina pectoris; mixed hyperlipemia; other urethral stricture, male, meatal; muscle weakness (generalized); difficulty in walking, not elsewhere classified; need for assistance with personal care; other lack of coordination; gastro-esophageal reflux disease without esophagitis; presence of urogenital implants; old myocardial infarction; and essential (primary) hypertension. Review of Resident #95's most recent Minimum Data Set (MDS) assessment, completed on 8/14/2022, reads, Should brief interview for mental status (C0200-C0500) be conducted? 0. No (resident is rarely/never understood.) Review of Resident #95's physician orders did not reveal an active order for the administration of oxygen. During an observation on 8/28/2022 at 11:07 AM, Resident #95 was lying in his bed in his room. There was an oxygen concentrator located on the floor at the left side of his bed. The oxygen concentrator was running and was set to 2 liters per minute. The tubing from the oxygen concentrator was in the resident's bed, tangled up in the resident's sheets. The resident was not wearing his nasal cannula. During an observation on 8/29/2022 at 9:26 AM, Resident #95 was observed lying in his bed. The resident was being administered oxygen via a nasal cannula attached to the tubing that was connected to the oxygen concentrator. The oxygen concentrator was set at 2 liters per minute. (Photographic evidence obtained.) During an observation on 8/29/2022 at 11:27 AM, Resident #95 was observed lying in his bed. The resident was being administered oxygen via a nasal cannula. The oxygen concentrator was set at 2 liters per minute. (Photographic evidence obtained.) During an interview on 8/30/2022 at 9:40 AM, Staff A, Registered Nurse (RN), Unit 2 Manager, confirmed that Resident #95 had been receiving oxygen. After reviewing Resident #95's clinical record, Staff A confirmed the resident had an order for continuous oxygen at 2 liters per minute that was discontinued on 8/24/2022. Staff A stated, On 8/27/22 at approximately 6:30 PM, I checked all the residents on Unit 2. [Resident #95's name] oxygen concentrator was off, and he was not wearing the nasal cannula. Another nurse must have checked on the resident later, saw the oxygen concentrator in the resident's room, turned it on, and put the nasal cannula on the resident, thinking that the resident was supposed to be receiving oxygen. During an interview on 8/30/2022 at 3:15 PM, the Director of Nursing stated it was her expectation that the nurses should be aware of what each resident's physician orders were and the nurses should be monitoring the residents who were on oxygen administration. The Director of Nursing confirmed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 13 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 that Resident #95 did not have an active physician order for oxygen administration on 8/29/2022. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure residents received respiratory care services consistent with professional standards of practice for 4 of 5 residents reviewed for respiratory care services, Residents #80, #84, #95, and #201, in a total sample of 36 residents. Residents Affected - Some Findings include: 1. During an observation on 8/28/2022 at 12:00 PM, Resident #80 was sitting in her bed with oxygen being administered via nasal cannula (N/C). Oxygen concentrator was set at 3.75 liters per minute. During an observation on 8/28/2022 at 3:30 PM, Resident #80 was receiving oxygen via N/C. Oxygen concentrator was set at 3.75 liters per minute. During an observation on 8/29/2022 at 9:00 AM, Resident #80 was receiving oxygen via N/C. Oxygen concentrator was set at 3.75 liters per minute. Review of Resident #80's medical record revealed the resident was admitted to the facility on [DATE] with the diagnoses including hemiplegia (paralysis of one side of the body) and hemiparesis (muscle weakness or partial paralysis on one side of the body) following cerebral infraction (stroke), pericardial effusion (fluid buildup), pleural effusion (a buildup of fluid between the tissues that line the lungs and the chest), chronic obstructive pulmonary disease with (acute) exacerbation, (a condition involving constriction of the airways and difficulty or discomfort in breathing). Review of the physician order dated 8/8/2022 for Resident #80 reads, Respiratory: Oxygen-continuous 2 liter via N/C. During an interview on 8/31/2022 at 9:30 AM, Staff F, Licensed Practical Nurse (LPN), stated, It is supposed to on 2 liters. Oh, I was not aware it was on 3.75 liters. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 14 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure licensed nurses had appropriate competencies and skills sets to provide nursing and related services to residents by allowing unqualified facility staff to work outside of their scope of practice, administering intravenous (IV) medications via a peripherally inserted central catheter (PICC) line for 1 of 2 residents, Resident #84, without certification of education, training, and validation of competency for IV medication administration. IV infusion without IV certification and validation of competency could result in the likelihood of serious harm and/or death for residents who are administered IV medication infusions. This can result in an increased risk of infection, damage to veins and injection sites, an air embolism, phlebitis, and blood clots, which can occur from a poorly administered IV infusion. Phlebitis can cause blood clots, which can block important blood vessels, causing tissue damage or even be life-threatening. Lack of proper training and verification to assess IV patency (the line is open and not blocked allowing the treatment to flow directly into the patient's vein) can increase the spread of infection. Lack of training and verified competency to assess the insertion site for signs and symptoms of phlebitis or infection, fluid leaking (resulting in the treatment not being administered as ordered), redness, pain, tenderness, and swelling can result in the likelihood of increased risk of serious harm and/or death. Proper placement of the PICC through X-ray or ultrasound is required prior to the administration of medication; this knowledge is provided through training and education as part of the certification process. Findings include: Review of Resident #84's records revealed the resident was admitted to the facility on [DATE] with the diagnoses including atherosclerotic heart disease of native coronary artery (heart disease) with angina pectoris (chest pain), acquired absence of left leg below knee, acquired absence of right leg below knee, hyperlipidemia (high cholesterol), hypertension, local infection of the skin, major depressive disorder, pressure ulcer right buttock stage 3, and pressure ulcer left buttock stage 3. Review of the physician order dated 8/21/2022 for Resident #84 reads, Sodium Chloride Injection Solution 0.9% (Sodium Chloride), Use 75 ml [milliliter]/hr [hour] intravenously every shift related to encounter for other specified prophylactic measures (Z29.8) for 14 days. IV [intravenous] NS [normal saline] to run continuously until IV ABT [antibiotic] completed. Review of the physician order dated 8/28/2022 for Resident #84 reads, Vancomycin HCl in Dextrose Intravenous Solution 1-5 GM [grams]/200 (milliliters)-% (Vancomycin HCl- Dextrose) Use 1000 mg [milligrams] intravenously in the evening for wound for 14 days. Pharmacy to dose. Review of the physician order dated 8/21/2022 for Resident #84 reads, IVs: Type of Access PICC. Review of the physician order dated 8/21/2022 for Resident #84 reads, IVs: Evaluate site for leakage/ bleeding/ signs of infection every shift. Review of the IV company report dated 8/22/2022 for Resident #84 reads, Reason for Consultation: PICC (non-valved) . Reason for Insertion: Drugs . Post-Insertion Data. Line Insertion: 3 CG PICC. Comments: 4 FR [French] PICC inserted into R [Right] basilic vein successfully . Instructed to order CXR [chest x-ray] for verification of PICC line tip placement prior to use. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 15 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Review of the radiology report dated 8/22/2022 at 3:12 PM for Resident #84 reads, Conclusion: No acute cardiopulmonary process. Right PICC line tip in the right jugular venous system, recommend repositioning. Review of the IV company report dated 8/23/2022 for Resident #84 reads, Reason for Consultation: PICC (non-valved) . Reason for Insertion: Drugs . Post-Insertion Data. Line Insertion: 3 CG PICC. Reinsertion: Yes. Reinsertion Due To: Malpositioned PICC. Comments: 4 FR PICC inserted into L [left] basilic vein successfully . Instructed to order CXR for verification of PICC line tip placement prior to use. Review of Resident #84's medical record indicated that no chest X-ray was ordered to confirm and verify proper placement prior to administering the medications. Review of Resident #84's medical record indicated that no [NAME] 3CG tip confirmation report (magnetic tracking of the tip of the PICC line that uses ECG (electrocardiogram) was present in the medical report. Review of the Medication Administration Record (MAR) documented that Staff J, Licensed Practical Nurse (LPN), administered Sodium Chloride 0.9% at 75 milliliters per hour on 8/22/2022 at 8:50 AM to Resident #84. Review of the MAR documented that Staff H, LPN, administered Sodium Chloride 0.9% at 75 milliliters per hour 8/23/2022 at 10:14 AM through a peripheral IV to Resident #84. Review of the MAR documented that Staff H, LPN, administered 10 milliliters of Normal Saline IV to Resident #84. Review of the MAR documented that Staff I, LPN, administered 10 milliliters of normal saline flush intravenously on 8/26/2022 at 11:38 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Sodium Chloride solution 0.9% at 75 milliliters per hour on 8/26/2022 at 11:38 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Vancomycin 1000 mg IV on 8/26/2022 at 11:38 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Vancomycin 1000 mg IV on 8/27/2022 at 8:39 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered 10 milliliters of normal saline on 8/27/2022 at 8:40 AM intravenously through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Sodium Chloride solution 0.9% at 75 ml/hr on 8/27/2022 at 8:40 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Vancomycin 1000 mg IV on 8/28/2022 at 11:08 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered 10 milliliters of normal saline IV on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 16 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0726 8/28/2022 at 11:39 AM through a left arm PICC line to Resident #84. Level of Harm - Immediate jeopardy to resident health or safety Review of the MAR documented that Staff I, LPN, administered Vancomycin 1000 mg IV on 8/28/2022 at 6:16 PM through a left arm PICC line to Resident #84. Residents Affected - Few Review of the employee file for Staff J, LPN, showed no IV competency or PICC line competency training within the file. Review of the employee file for Staff I, LPN, showed no IV competency or PICC line competency training within the file. Review of the employee file for Staff H, LPN, no IV competency or PICC line competency training within the file. During an interview on 8/31/2022 at 8:40 AM, the Advanced Practice Registered Nurse (APRN) stated, I was not aware that we did not do an X-ray to confirm line placement prior to administering medications. There are possible complications related to infusing medications into any line that is not confirmed. During an interview on 8/31/2022 at 9:15 AM, the Attending Physician stated, I was made aware yesterday we did not complete an X-ray of the PICC line. Since then, we have obtained an X-ray showing the catheter is in place so there is no harm to the patient. I can't speak to harm to the patient as it is properly positioned at this time. I do expect for IV fluids to be administered per my orders and if they don't, they need to call me. During an interview on 8/31/2022 at 12:00 PM, Staff H, LPN, stated, I was the nurse on the day that [Resident #84's name] PICC line was reinserted. The nurse from the IV company came in and inserted it. I helped him with [Resident #84's name] arm. I held it, so he could get the dressing on. He told me that he thought it was in the right place. He did give me the paper that explained that I needed to get an X-ray. It is my signature on the sheet. I didn't know that I needed to get an X-ray. The nurse, he told me he didn't think he would need to come back. I just didn't know. I thought it was okay to use. I just attached it to his PICC line after the IV nurse left. I didn't know that I needed to get a chest X-ray. I should not have hung the IV. I really didn't think I was hanging it. I just connected it to the IV. I am not IV certified. I did not take the IV certification. I know that I can't hang antibiotics. I just didn't think that the normal saline was a problem. I have flushed PICC lines after antibiotics, but I haven't hung them. I just wanted him to get his fluids, so I did hang it. I did hang a new bag to the peripheral IV that the resident had before the PICC line was put in. Once they came to do the PICC, the IV was out and I just connected the normal saline to the PICC line as soon as the IV nurse left. During an interview on 8/31/2022 at 1:45 PM, the Director of Nursing (DON) stated, I was shocked that [Staff H, LPN's name] had done anything related to [Resident #84's name] PICC line. I heard her say that she did not have the IV certification and I was shocked. She was practicing outside her scope as an LPN. I was not aware that this was happening. I do not really know the process for verifying if an LPN is competent to do IVs. I just got here. I literally started the day you arrived for survey. We should have a copy of their 30-hour course when they are hired. We should not allow LPNs to administer IV medications unless we know that they have had the course. During a telephone interview on 8/31/2022 at 2:59 PM Staff I, LPN, stated, I took an 8-hour course (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 17 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few many years ago. I guess I did not do the 30-hour IV course, so I guess I am not IV certified. I thought I was okay to do the IVs with what I had done. No one ever asked me for my certification to do IV med administration. I did administer the Vancomycin, flush the PICC line and do the normal saline that was ordered to run continuously to [Resident #84's name]. I wasn't aware that it would be a problem. I wish I had known. I did not do a competency specific to the care of the PICC line dressing when I was hired. During a telephone interview on 8/31/2022 at 3:10 PM, Staff J, LPN, stated, I did administer [Resident #84's name] IV and I hung the normal saline. I have been doing IV medications. I was told that as long as there is an RN [Registered Nurse] in the building that I could do it. I was told that by [Staff C, LPN's name] the unit manager. I am in school to be an RN and I was told that I could do it, so I have. I am aware that as an LPN without IV certification I cannot administer any IV medications because it's against the nurse practice act. But I was told it was okay because I was in nursing school. During an interview on 8/31/2022 at 3:20 PM, the Assistant Director of Nursing (ADON) stated, I was not aware that any LPNs who were not IV certified would be administering IV medications. I would not tell any staff that they could practice outside of the nurse practice act. I am not aware of anyone telling an LPN that it was acceptable to administer meds through a PICC or change dressings if they had not taken the course. During an interview on 8/31/2022 at 3:30 PM, Staff C, LPN, stated, I have not told anyone that they could administer IV medications if they are not IV certified as an LPN. I have not said that it is okay for any LPN to administer IV medications if there is an RN in the building. I know that we as LPNs have to follow our scope of practice and that if we have not had the additional training, we can't administer medications IV. During an interview on 9/1/2022 at 7:35 AM, the Human Resources Director stated, The process of hiring staff starts with the application. We do verify licenses for licensed staff, and we will ask LPNs who tell us they are IV certified. The process used to be for human resources to get all certification nurses have and the DON would know and keep record of any staff competencies for nurse. During a telephone interview on 9/1/2022 at 8:10 AM, the Medical Director stated, I came by yesterday and found out about this problem. I did not know we had LPNs who weren't IV certified, administering IV medications. I would expect nurses to practice within their scope of practice. We plan to implement a solution. I would expect that all nurses practice within their scope of practice. Review of the policy and procedure titled Administration of Intermittent Infusion with an approval date of 8/8/2022 reads, Guidance . 2. Documentation of central vascular access device (CVAD) tip location must be included in the medical record prior to administration of medications. Maintain catheter patency per flushing/locking protocol while awaiting confirmation. Documentation may include: 2.1. Copy of chest X-ray results reporting location of tip, or fluoroscopy report. Review of the policy and procedure titled Continuous infusion of Medications and Solutions with an approval date of 8/8/2022 reads, To be Performed by: Licensed nurses according to state law and facility policy. The nurse is responsible and accountable for obtaining and maintaining competence with infusion therapy within his or her scope of practice. Competency validation is documented in accordance with organizational policy . Guidance . 2. Documentation of central vascular access tip location must be included in the medical record prior to administration of medications. Maintain catheter (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 18 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0726 Level of Harm - Immediate jeopardy to resident health or safety patency per flushing/locking protocol while awaiting tip confirmation. Documentation may include: 2.1. Copy of chest x-ray or fluoroscopy report; 2.2. Telephone order from radiologist stating location of tip (e.g. cavoatrial junction, IVC); 2.3. Copy of ECG technology insertion report. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 19 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure food was prepared and stored in a safe and sanitary manner. Findings include: During an initial observation of the main kitchen with Staff G, Cook, on 8/28/2022 beginning at 10:15 AM, there were open items inside the cooler with no opening date including [NAME] El Whole Eggs, a ceramic bowl of purple jelly-like substance, Sysco Imperial Thickened Dairy Drink and a clear bag of approximately four cups of sliced lemons. In the freezer on the floor under the racks, there were pieces of paper trash, small milk cartons. In the dry storage area, there was one container of food wrapped in foil, which was not labeled or dated. On the shelf in the dry storage area, there was an area approximately 8 inches of what appears to be spilled white sugar. The door to the dry storage area was propped open with three large dented cans. In a free-standing cooler, there was a black substance on the door frame. The gasket on the door was cracked and split. In prep area, there was breakfast eggs sitting out on counter with utensils sitting inside, one gallon of milk sitting out on counter. The slicer has old food debris build up on the blade. There were personal items (cell phone) out on prep table area. The oven had brown buildup substance around edges. The cups and saucers were sitting on a tray in an upright position (photographic evidence obtained). During an interview on 8/28/2022 at approximately 10:25 AM, Staff G, Cook, stated, I have been here only one week and the oven is not used to cook only to hold items. Staff G acknowledged the undated items in the cooler. During an interview on 8/29/2022 at approximately 11:15 AM, the Certified Dietary Manager stated that she had not finished training Staff G, and she was not aware of the concerns with gasket being cracked and split. Review of the policy and procedure titled Food Storage: Cold revised in May 2014 reads, Policy Statement: It is the center policy to insure all Time/Temperature Control for Safety (TCS), frozen and refrigerated food items, will be appropriately stored in accordance with guidelines of the USDA Food Code. Action Steps: 1. The Food Services Director is responsible for storing all items 6 inches above the floor and 18 inches below sprinkler unit . 5. The Food Service Director/ Cook(s) insures that all food items are stored properly in covered containers, labeled and dated, and arranged in a manner to prevent cross contamination. Review of the policy and procedure titled Food Storage- Dry Goods revised in May 2014 reads, Policy Statement: It is the center policy to insure all dry goods will be appropriately stored in accordance with guidelines of the USDA Food Code. Action Steps: Dry Storage: 1. The Food Services Director or designee is responsible to store all items 6 inches above the floor on shelves, racks, dollies or other surfaces which facilitate thorough cleaning. Items may not be stored within 18 [inches] of the sprinkler unit . 3. The Food Services Director or designee ensures that all packaged and canned food items shall be kept clean dry, and properly sealed. Review of the policy and procedure titled Equipment revised in May 2014 reads, Policy Statement: It is the center policy that all foodservice equipment is clean, sanitary, and in proper working (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 20 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 - Many FORM CMS-2567 (02/99) Previous Versions Obsolete order. Action Steps: 1. The Food Services Director will ensure that all equipment is routinely cleaned and maintained in accordance to [Sic.] manufacturer directions and training materials. 2. The Food Services Director will ensure that all staff members are properly trained in the cleaning and maintenance of all equipment. 3. The Food Services Director will ensure that all food contact equipment is cleaned and sanitized after every use . 5. The Food Services Director will ensure that all submit requests for maintenance or repairs to the Administrator and /or Maintenance Director as needed. Event ID: Facility ID: 105996 If continuation sheet Page 21 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility administration failed to effectively and efficiently attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident by not assuming full responsibility for the day to day operations of the facility by allowing unqualified facility staff to work outside of their scope of practice, administering intravenous (IV) medications via a peripherally inserted central catheter (PICC) line for 1 of 2 residents, Resident #84, without certification of education, training, and validation of competency for IV medication administration. IV infusion without IV certification and validation of competency could result in the likelihood of serious harm and/or death for residents who are administered IV medication infusions. This can result in an increased risk of infection, damage to veins and injection sites, an air embolism, phlebitis, and blood clots, which can occur from a poorly administered IV infusion. Phlebitis can cause blood clots, which can block important blood vessels, causing tissue damage or even be life-threatening. Lack of proper training and verification to assess IV patency (the line is open and not blocked allowing the treatment to flow directly into the patient's vein) can increase the spread of infection. Lack of training and verified competency to assess the insertion site for signs and symptoms of phlebitis or infection, fluid leaking (resulting in the treatment not being administered as ordered), redness, pain, tenderness, and swelling can result in the likelihood of increased risk of serious harm and/or death. Proper placement of the PICC through X-ray or ultrasound is required prior to the administration of medication; this knowledge is provided through training and education as part of the certification process. Residents Affected - Few Findings include: Review of the job description for the Executive Director 1, with an effective date of 8/8/2022, reads, Purpose of Your Job Position: The Executive Director 1 is responsible for management of the facility in a manner which exemplifies Consulate Health Care's standard of operational excellence, to include but not limited to creating an environment in which employees demonstrate Compassion, Honesty, Integrity and Respect for one another and everyone they come into contact with, and business practices are conducted with Passion. The primary purpose of the Executive Director is to direct the day-to-day functions of the facility in accordance with current federal, state, and local standards, guidelines, and regulations that govern nursing facilities to ensure that the highest degree of quality care can be provided to our residents at all times. You are entrusted to provide innovative, responsible healthcare with the creation and implementation of new ideas and concepts that continually improve systems and processes to achieve superior results. Review of the job description for Director of Clinical Services I, with an effective date of 8/22/2022, reads, Purpose of Your Job Position: As a Consulate Health Care Director of Clinical Services, you are entrusted with the responsibility of caring for our residents, families, co-workers, visitors, and all others; as well as demonstrating in all interactions, Consulate Health Care's five core values of Compassion, Honesty, Integrity, Respect, and Passion. The primary purpose of your job position is to plan, organize, develop, and direct the overall operation of our Nursing Service Department in accordance with current federal, state, and local standards, guidelines, and regulations that govern our facility, and as may be directed by the Executive Director to ensure that the highest degree of quality care is maintained at all times. You are entrusted to provide innovative, responsible healthcare with creation and implementation of new ideas and concepts that continually improve systems and processes to achieve superior results . Duties and Responsibilities . 5. Set and monitor (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 22 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few achievement of goals and objectives for the nursing department consistent with established philosophy and standard of practice. 6. Recruit and hire a sufficient number of qualified nursing staff to deliver efficient resident care in accordance with the established staffing plan. 7. Establish, implement, and continually update competency/ skills checklists for nursing staff . 9. Maintain and guide the implementation of current policies and procedures, which reflect adherence to corporate and external regulatory guidelines . 11. Establish and monitor compliance with an effective medical record documentation system . 14. Actively participate in the quality improvement process for the facility . 15. Participate in and/or provide in-service education sessions. Review of Resident #84's records revealed the resident was admitted to the facility on [DATE] with the diagnoses including atherosclerotic heart disease of native coronary artery (heart disease) with angina pectoris (chest pain), acquired absence of left leg below knee, acquired absence of right leg below knee, hyperlipidemia (high cholesterol), hypertension, local infection of the skin, major depressive disorder, pressure ulcer right buttock stage 3, and pressure ulcer left buttock stage 3. Review of the physician order dated 8/21/2022 for Resident #84 reads, Sodium Chloride Injection Solution 0.9% (Sodium Chloride), Use 75 ml [milliliter]/hr [hour] intravenously every shift related to encounter for other specified prophylactic measures (Z29.8) for 14 days. IV [intravenous] NS [normal saline] to run continuously until IV ABT [antibiotic] completed. Review of the physician order dated 8/28/2022 for Resident #84 reads, Vancomycin HCl in Dextrose Intravenous Solution 1-5 GM [grams]/200 (milliliters)-% (Vancomycin HCl- Dextrose) Use 1000 mg [milligrams] intravenously in the evening for wound for 14 days. Pharmacy to dose. Review of the physician order dated 8/21/2022 for Resident #84 reads, IVs: Type of Access PICC. Review of the physician order dated 8/21/2022 for Resident #84 reads, IVs: Evaluate site for leakage/ bleeding/ signs of infection every shift. Review of the IV company report dated 8/22/2022 for Resident #84 reads, Reason for Consultation: PICC (non-valved) . Reason for Insertion: Drugs . Post-Insertion Data. Line Insertion: 3 CG PICC. Comments: 4 FR [French] PICC inserted into R [Right] basilic vein successfully . Instructed to order CXR [chest x-ray] for verification of PICC line tip placement prior to use. Review of the radiology report dated 8/22/2022 at 3:12 PM for Resident #84 reads, Conclusion: No acute cardiopulmonary process. Right PICC line tip in the right jugular venous system, recommend repositioning. Review of the IV company report dated 8/23/2022 for Resident #84 reads, Reason for Consultation: PICC (non-valved) . Reason for Insertion: Drugs . Post-Insertion Data. Line Insertion: 3 CG PICC. Reinsertion: Yes. Reinsertion Due To: Malpositioned PICC. Comments: 4 FR PICC inserted into L [left] basilic vein successfully . Instructed to order CXR for verification of PICC line tip placement prior to use. Review of the medical record indicated that no Chest X ray was ordered to confirm and verify proper placement prior to administering medications. Review of the medical record indicated that no [NAME] 3CG tip confirmation report (magnetic tracking of the tip of the PICC line that uses ECG (electrocardiogram) was present in the medical report. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 23 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Review of the Medication Administration Record (MAR) documented that Staff J, Licensed Practical Nurse (LPN), administered Sodium Chloride 0.9% at 75 milliliters per hour on 8/22/2022 at 8:50 AM to Resident #84. Review of the MAR documented that Staff H, LPN, administered Sodium Chloride 0.9% at 75 milliliters per hour 8/23/2022 at 10:14 AM through a peripheral IV to Resident #84. Residents Affected - Few Review of the MAR documented that Staff H, LPN, administered 10 milliliters of Normal Saline IV to Resident #84. Review of the MAR documented that Staff I, LPN, administered 10 milliliters of normal saline flush intravenously on 8/26/2022 at 11:38 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Sodium Chloride solution 0.9% at 75 milliliters per hour on 8/26/2022 at 11:38 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Vancomycin 1000 mg IV on 8/26/2022 at 11:38 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Vancomycin 1000 mg IV on 8/27/2022 at 8:39 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered 10 milliliters of normal saline on 8/27/2022 at 8:40 AM intravenously through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Sodium Chloride solution 0.9% at 75 ml/hr on 8/27/2022 at 8:40 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Vancomycin 1000 mg IV on 8/28/2022 at 11:08 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered 10 milliliters of normal saline IV on 8/28/2022 at 11:39 AM through a left arm PICC line to Resident #84. Review of the MAR documented that Staff I, LPN, administered Vancomycin 1000 mg IV on 8/28/2022 at 6:16 PM through a left arm PICC line to Resident #84. Review of the employee file for Staff J, LPN, showed no IV competency or PICC line competency training within the file. Review of the employee file for Staff I, LPN, showed no IV competency or PICC line competency training within the file. Review of the employee file for Staff H, LPN, no IV competency or PICC line competency training within the file. During an interview on 8/31/2022 at 8:40 AM, the Advanced Practice Registered Nurse (APRN) stated, I was not aware that we did not do an X ray to confirm line placement prior to administering medications. There are possible complications related to infusing medications into any line that is not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 24 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0835 confirmed. Level of Harm - Immediate jeopardy to resident health or safety During an interview on 8/31/2022 at 9:15 AM, the Attending Physician stated, I was made aware yesterday we did not complete an x-ray of the PICC line. Since then, we have obtained an x-ray showing the catheter is in place so there is no harm to the patient. I can't speak to harm to the patient as it is properly positioned at this time. I do expect for IV fluids to be administered per my orders and if they don't, they need to call me. Residents Affected - Few During an interview on 8/31/2022 at 12:00 PM, Staff H, LPN, stated, I was the nurse on the day that [Resident #84's name] PICC line was reinserted. The nurse from the IV company came in and inserted it. I helped him with [Resident #84's name] arm. I held it, so he could get the dressing on. He told me that he thought it was in the right place. He did give me the paper that explained that I needed to get an X-ray. It is my signature on the sheet. I didn't know that I needed to get an X-ray. The nurse, he told me he didn't think he would need to come back. I just didn't know. I thought it was okay to use. I just attached it to his PICC line after the IV nurse left. I didn't know that I needed to get a chest X-ray. I should not have hung the IV. I really didn't think I was hanging it. I just connected it to the IV. I am not IV certified. I did not take the IV certification. I know that I can't hang antibiotics. I just didn't think that the normal saline was a problem. I have flushed PICC lines after antibiotics, but I haven't hung them. I just wanted him to get his fluids, so I did hang it. I did hang a new bag to the peripheral IV that the resident had before the PICC line was put in. Once they came to do the PICC, the IV was out and I just connected the normal saline to the PICC line as soon as the IV nurse left. During an interview on 8/31/2022 at 1:45 PM, the Director of Nursing (DON) stated, I was shocked that [Staff H, LPN's name] had done anything related to [Resident #84's name] PICC line. I heard her say that she did not have the IV certification and I was shocked. She was practicing outside her scope as an LPN. I was not aware that this was happening. I do not really know the process for verifying if an LPN is competent to do IVs. I just got here. I literally started the day you arrived for survey. We should have a copy of their 30-hour course when they are hired. We should not allow LPNs to administer IV medications unless we know that they have had the course. During a telephone interview on 8/31/2022 at 2:59 PM, Staff I, LPN, stated, I took an 8-hour course many years ago. I guess I did not do the 30-hour IV course, so I guess I am not IV certified. I thought I was okay to do the IVs with what I had done. No one ever asked me for my certification to do IV med administration. I did administer the Vancomycin, flush the PICC line and do the normal saline that was ordered to run continuously to [Resident #84's name]. I wasn't aware that it would be a problem. I wish I had known. I did not do a competency specific to the care of the PICC line dressing when I was hired. During a telephone interview on 8/31/2022 at 3:10 PM, Staff J, LPN, stated, I did administer [Resident #84's name] IV and I hung the normal saline. I have been doing IV medications. I was told that as long as there is an RN [Registered Nurse] in the building that I could do it. I was told that by [Staff C, LPN's name] the unit manager. I am in school to be an RN and I was told that I could do it, so I have. I am aware that as an LPN without IV certification I cannot administer any IV medications because it's against the nurse practice act. But I was told it was okay because I was in nursing school. During an interview on 8/31/2022 at 3:20 PM, the Assistant Director of Nursing (ADON) stated, I was not aware that any LPNs who were not IV certified would be administering IV medications. I would (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 25 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few not tell any staff that they could practice outside of the nurse practice act. I am not aware of anyone telling an LPN that it was acceptable to administer meds through a PICC or change dressings if they had not taken the course. During an interview on 8/31/2022 at 3:30 PM, Staff C, LPN, stated, I have not told anyone that they could administer IV medications if they are not IV certified as an LPN. I have not said that it is okay for any LPN to administer IV medications if there is an RN in the building. I know that we as LPNs have to follow our scope of practice and that if we have not had the additional training, we can't administer medications IV. During an interview on 9/1/2022 at 7:15 AM, the Administrator stated, I am ultimately responsible for all that occurs in the building, and I had asked about whether all the LPNs were IV certified and knew that there were several LPNs needing the course. We had not arranged the course yet because I was waiting for the new director of nursing to get here. During the onboarding process, we should be verifying whether LPNs are IV certified and keeping record of this within their employee files. This should have been done and I can't tell you why it has not been. During an interview on 9/1/2022 at 7:35 AM, the Human Resources Director stated, The process of hiring staff starts with the application. We do verify licenses for licensed staff, and we will ask LPNs who tell us they are IV certified. The process used to be for human resources to get all certification nurses have and the DON would know and keep record of any staff competencies for nurse. During a telephone interview on 9/1/2022 at 8:10 AM, the Medical Director stated, I came by yesterday and found out about this problem. I did not know we had LPNs who weren't IV certified, administering IV medications. I would expect nurses to practice within their scope of practice. We plan to implement a solution. I would expect that all nurses practice within their scope of practice. Review of the policy and procedure titled Administration of Intermittent Infusion with an approval date of 8/8/2022 reads, Guidance . 2. Documentation of central vascular access device (CVAD) tip location must be included in the medical record prior to administration of medications. Maintain catheter patency per flushing/locking protocol while awaiting confirmation. Documentation may include: 2.1. Copy of chest X-ray results reporting location of tip, or fluoroscopy report. Review of the policy and procedure titled Continuous infusion of Medications and Solutions with an approval date of 8/8/2022 reads, To be Performed by: Licensed nurses according to state law and facility policy. The nurse is responsible and accountable for obtaining and maintaining competence with infusion therapy within his or her scope of practice. Competency validation is documented in accordance with organizational policy . Guidance . 2. Documentation of central vascular access tip location must be included in the medical record prior to administration of medications. Maintain catheter patency per flushing/locking protocol while awaiting tip confirmation. Documentation may include: 2.1. Copy of chest x-ray or fluoroscopy report; 2.2. Telephone order from radiologist stating location of tip (e.g. cavoatrial junction, IVC); 2.3. Copy of ECG technology insertion report. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 26 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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, and record review, the facility failed to maintain an infection prevention and control program to prevent the possible development and transmission of communicable diseases and infections. The facility failed to ensure the staff performed hand hygiene during wound care in one of three wound care observations. Residents Affected - Few Findings include: During an observation on 8/30/2022 at 10:00 AM, Resident #31 was sitting in bed with the head elevated. There was a wound vac (vacuum assisted closure device) that was not alarming, and the machine was set at -120 mm (millimeters) hg (mercury). There was no alarm ringing from the wound vac machine. Resident #31 lifted her blankets and there was a large amount of serosanguinous drainage noted on a large pad that was positioned under the resident's right above the knee amputation. During an interview on 8/30/2022 at 10:00 AM, Resident #31 stated, There is something wrong with this [wound vac]. It isn't suctioning like it should be. I have told them last night and this morning. The nurses know that I need to have a new dressing and pad. They have known since they came in. I told a nurse last night, too. During an observation of Resident #31's wound conducted on 8/30/2022 with Staff B, Licensed Practical Nurse (LPN), Staff B assisted the resident to position on her side. There was a transparent dressing that was rolling up at the edges. The black Granufoam was not set within the wound edges and the transparent dressing was not adhering to the skin and there was no suction being applied to the wound. The wound vac machine was not alarming during this observation. There was a large amount of serous drainage that was dripping down the sides of the transparent dressing. Resident #31's right upper leg and thigh both front and back were reddened. During an interview on 8/30/2022 at 10:15 AM, Staff B, LPN, stated, I know that her wound vac is not working, but I have to finish med [medication] pass and then I will do it. The resident told me about it earlier, maybe 30-45 minutes ago. Review of Resident #31's medical record revealed that the resident was admitted to the facility on [DATE] , transferred to the hospital and returned to the facility on 7/27/2022 with the diagnoses including necrotizing fasciitis (a serious bacterial infection that destroys tissue under the skin), pressure ulcer of sacral region stage 2, pressure ulcer of right hip stage 3, major depressive disorder, lumbar spina bifida (a birth defect in which the spinal cord fails to develop properly), anemia in other diseases, hyperlipidemia (high cholesterol), hypertension, acquired absence of right leg above the knee, and acquired absence of left leg above the knee. Review of the physician order dated 8/15/2022 for Resident #31 reads, Wound vac to back of right thigh. Review of Resident #31's admission/readmission data dated 7/27/2022 reads, Right thigh rear: unstageable wound no measurements, Sacrum: open area, other: amputee left and right BKA [below the knee amputation], other scab thigh right/front. During an observation of wound care conducted on 8/30/2022 at 10:45 AM, Resident #31 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 27 of 28 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 repositioned on her side. Staff B, LPN, assembled supplies, entered the room and cleaned the overbed table and placed wound care supplies on the overbed table. Staff B donned gloves without performing hand hygiene, opened 3 packages of 4x4 gauze and a 100 ml (milliliter) bottle of normal saline. Staff B removed the old dressing of a 4x4 gauze and cleaned the wound bed from the top of the wound to the bottom using the gauze 2 times and discarded it. Staff B then picked up the bottle of normal saline and moistened another 4x4 gauze and cleaned the wound from the top to the bottom using the 4x4 twice before discarding. Staff B picked up the 4x4 gauze and poured normal saline on the gauze and cleaned the wound once from the top to the bottom. Staff B removed gloves and donned a new pair without performing hand hygiene. Staff B pulled a pair of scissors from her uniform pocket and began to cut the transparent dressing, placing the scissors on the overbed table. Staff B took the opened package of 4x4 gauze and used the measurements on the side of the package to measure the wound length, width and depth, touching the wound bed during the measurements. After measurements were completed, Staff B began placing the transparent dressing on the skin surrounding the wound bed. Staff B used the scissors to open the package of wound care supplies, placing the scissors back on the overbed table. Staff B then picked up the black Granufoam dressing and cut the foam to the shape of the wound, and then placed the foam on the wound bed. Staff B covered the Granufoam with the transparent dressing, cut a 1/2-centimeter hole with the scissors in the transparent dressing, placed the sensor tubing over the hole and attached the tube to the wound vac machine and verified that the setting was -120 mm hg. Staff B removed her gloves and exited the room without performing hand hygiene. During an interview on 8/30/2022 at 11:20 AM, Staff B, LPN, stated, I should have used hand sanitizer before I put on my gloves. I thought that I had placed my scissors on the field that I cleaned and that would be okay to do that. Review of the policy and procedure titled Dressing Change with an approval date of 8/8/2022 reads, Policy: A clean dressing will applied [Sic.] by a nurse to a wound as ordered to promote healing. Sterile dressing will be used only if specifically ordered. Procedure . Perform hand hygiene; Apply gloves; Remove and dispose of soiled dressing; Remove gloves; Perform hand hygiene; Apply gloves; Evaluate wound for type, color, amount of drainage; Cleanse wound as ordered, dispose of gauze; Remove gloves and perform hand hygiene; Apply treatment as ordered and clean dressing; Discard gloves and perform hand hygiene. Review of the policy and procedure titled Hand Hygiene with an approval date of 8/8/2022 reads, Overview: The CDC [Centers for Disease Control and Prevention] defines hand hygiene as cleaning your hands by using either handwashing (washing with soap and water), antiseptic hand wash, or antiseptic hand rubs (i.e. alcohol-based sanitizer including foam or gel). Purpose: To reduce the spread of germs in the healthcare setting. Process: Hand hygiene should be performed . After contact with blood, body fluids, or excretions, mucous membranes, non-intact skin, or wound dressings . After glove removal. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 28 of 28