Health inspection·October 20, 2022

F 0585 resident was alert and oriented to person, place, and time. Her memory was noted as ok. Level of Harm - Minimal harm or potential for actual harm 2. On 10/17/22 at 11:55 a.m., Resident #103 stated one night she woke up in a sweat and because her blood sugar was 68 after the nurse checked it. The nurse told her she didn't have snacks and proceeded to look in the resident's drawer for a snack. The nurse found two pieces of candy in her drawer that she could eat. They have never offered her a snack. Resident #103 stated the food was always cold especially the eggs. Residents Affected - Few On 10/18/22 at 9:17 a.m., Resident #103 reported she was not offered a snack yesterday and that scares her. She also stated, the eggs were cold this morning. A review of the admission Record revealed Resident #103 was initially admitted into the facility on [DATE] with a diagnoses that included but was not limited to Type 2 Diabetes. Section C, Cognitive Patterns of the 5-Day Minimum Data Set (MDS), dated [DATE], revealed the resident had a Brief Interview for Mental Status (BIMS) score of 15 out of 15, indicating cognitively intact. A review of the Point of Care (POC) task tab for snacks revealed the following: Snacks were not offered on 09/27-09/29, 10/02-10/07, and 10/09-10/11, No Response 10/13, 10/14, and 10/18. 3. On 10/20/22 at 12:39 p.m., Resident #308 stated she was not getting snacks and did not know they had a refrigerator for residents to get snacks until she heard someone in the hall ask for a snack. She stated she did not know the process of things. A review of the admission Record revealed Resident #308 was initially admitted into the facility on [DATE] with a diagnosis that included but was not limited to Type 2 Diabetes Mellitus Without Complications. Section C Cognitive Patterns, of the admission Minimum Data Set (MDS), dated [DATE], revealed the resident had a BIMS score of 09 out of 15, indicating moderately impaired. On 10/20/22 at 10:26 a.m., the Nursing Home Administrator (NHA) reported snacks are always delivered to each unit by the dietary aides and snacks are always available. CNAs will bring snacks to residents, but they must ask for them. They have bananas, peanut butter and jelly sandwiches, crackers, and oatmeal cream pies available. Snacks are available if a resident requests a snack throughout the night. Resident #103 brought the concern to him about the snacks on a surprised visit on Thursday night. He spoke to the resident about 4:00 a.m. The NHA reported he followed up with her and asked if she had issues with her blood sugar dropping again. He explained to Resident #103 that she could always ask for a snack and there was a refrigerator on the unit. He stated she was very happy and that he personally addressed this issue. He reported the nurse didn't know that snacks were available because she was an agency nurse. The NHA stated he told her to get an aide next time because they are typically more involved with getting snacks. The NHA reported the concern was resolved because she received a snack that night and because she had some snacks of her own in the room. The nurse took a snack out of her drawer that night. He also checked with other residents to see if they had any issues with not receiving snacks. He did not write a grievance because the problem was resolved right then but he would double check to see if there was a grievance. The taking of temperatures of the test trays was an adequate response to the cold food concern stated the NHA. The CDM could have mentioned (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 2 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that they can always reheat the food. They discuss all grievances in Quality Assurance (QA). The NHA reported he would want to see documentation that supports the resolution. The policy states a grievance must be resolved in seven days. On 10/19/22 at 12:00 p.m., the CDM reported snacks are given at 10:00 a.m., 2:00 p.m., and 8:00 p.m. Dietary staff deliver a cart in the par level rooms on each unit. She leaves bananas, oatmeal pies, sandwiches, and sometimes peanut butter and jelly sandwiches The CDM reported a concern about not receiving snacks was brought to her attention by Resident #308. Resident #308 wanted to know how she could get snacks. The concern was brought up in the morning meeting a few weeks ago. Sometimes the snack carts are full when she goes to refill the carts. The cart on Rosewood (200s, 300s, 400s, and 500s) was full most times when she went to refill the cart, but not completely full and the snack cart on the Southway (600s, 700s, and 800s) was always empty. She didn't do a grievance. CNAs are responsible for distributing snacks. She thinks the concern with not keeping the food warm after the food leaves the kitchen was because they have open carts and not warmers. Trays are passed timely on Rosewood but not timely on the Southway Unit. A review of the policy titled, Snacks, revised on 09/2017, revealed the following: 6. Nursing Services is responsible for delivering the individual snacks to the identified residents and for offering evening snacks to all other residents. A review of the policy titled, Complaint/Grievances, with an effective date of 11/30/2014, revealed the following: Procedure Reporting The residence shall permit and respond to oral and written complaints from a source regarding an alleged violation of resident rights, quality of care or other matter without retaliation or the threat of retaliation. Investigation and Resolution The residence shall ensure investigation and resolution of complaints. A staff member will be designated to receive complaints. A log will be kept of all complaints and outcomes. Within 2 business days after the submission of a written complaint, a status report shall be provided by the residence to the complainant, the resident or the residents designated person indicating the steps that will be taken to address the concern. Within 7 days after the submission of a written complaint, the residence will give the complainant and if applicable the designated person a written decision explaining the residence investigation finding and actions to be taken for resolution. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 3 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to present the baseline care plan to the resident and responsible party for one resident (#107) of 37 sampled residents. Findings included: Review of the admission Record revealed Resident #107 was admitted on [DATE]. Diagnoses include but were not limited to chronic inflammatory demyelinating polyneuritis, Guillain-Barre syndrome, weakness, depression, DM (diabetes mellitus), HTN (hypertension), and anemia. Record review of admission Minimum Data Set (MDS), dated [DATE], Section C - Cognitive Patterns showed a Brief Interview for Mental Status (BIMS) score of 15 (cognitively intact). Resident #107 was noted as totally dependent for bed mobility and transfers and required two people to assist. An interview with Resident #107 on 10/17/22 at 11:00 a.m. revealed no one had reviewed his care plan with him since he had been at the facility. On 10/19/22 at 12:55 p.m. Staff A Registered Nurse (RN) MDS stated the admission nurse performs the baseline care plan. The next morning, we have a meeting and update the care plan in the computer. The admission nurse was to review the baseline care plan with the resident and family. The first care planning meeting was to be around day 14-21 depending on the resident's availability and family. The baseline care plan should be signed by the resident / family and the admission nurse. She verified that Resident #107's baseline care plan had not been signed and dated by anyone. On 10/19/22 at 12:55 p.m. Staff B, Licensed Practical Nurse (LPN) MDS stated the care planning meeting should have already been done. She left the room to find documentation regarding the meeting. On 10/19/22 at 12:55 p.m. Staff C, LPN, MDS stated she had a meeting with the resident and therapy yesterday, 10/18/22. She stated the care planning meeting was late. She stated that she will be meeting with the [family member]. Record review of the facility's policy titled, Plans of Care, revised 09/25/2017, showed an individualized person-centered plan of care will be established by the interdisciplinary team (IDT) with the resident and/or representative (s) to the extent practicable and updated in accordance with state and federal regulatory requirements. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 4 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, medical record review, staff interviews and facility policy, the facility did not implement the plan of care for activities for one resident (#38) and failed to develop and implement a nutritional plan of care for one resident (#3) related to weight loss for a sample of 37 sampled residents. Findings included: 1. A medical record review was conducted for Resident #38 on 10/17/2022 which revealed the resident was admitted to the facility on [DATE] with multiple diagnoses but not limited to dementia, cognitive communication deficit and history of falling. On 10/17/22 at 10:00 a.m. the resident was observed in a low bed, hospital gown, and call light within reach. Resident #38 was unable to have a conversation due to her cognitive decline. On 10/17/22 at 2:23 p.m. Resident #38 was observed still in bed. Resident #38 lays in a scooped mattress, low bed, air mattress. The resident was asked if she had eaten, she couldn't remember, her roommate (#79) stated that she is fed, and she did have lunch. The following observations were conducted: Observation: 10/18/22 at 10:06 a.m., Resident #38 was observed this morning with a different gown on, an extra blanket on her bed and a change of clothing and brief on the bed, she is scheduled to have a shower this morning as per the roommate. Roommate reports that she gets her shower on Tuesdays. Resident began to yell and stated that it's too cold for her shower and she wasn't going to take one today. Call light is within reach, bed in the lowest position. No other voiced concerns. Observation: 10/18/22 at 1:20 p.m., Resident #38 was observed in her room sleeping, roommate reports the resident had refused a shower but did receive a bed bath. Observation: 10/19/22 at 11:14 a.m., Resident #38 was in a low bed, with a blanket up to her chin and the call light within reach. Resident does appear groomed and has a different gown on today. Roommate states the resident likes to have many blankets on her bed. The roommate was asked if anyone comes in to offer activities to the resident, she reports the resident is unable to do anything. Roommate was asked if anyone comes in to sit and talk with her or offer any kind of socialization. Roommate confirmed no one comes in to offer her any activities. Resident has been observed randomly throughout the survey lying in bed, she has not left the room or had any visitors. A review of Resident #38's plan of care was conducted for Activities, dated 6/03/2020 with a revision date of 10/17/2022 and a target date of 11/13/2022. The focus area for Resident #38 was she is dependent on staff for activities, and she enjoys socializing with others. She will continue to engage in daily activities that she finds meaningful. Activities will continue to visit for social contact and inform of calendar and events. As an intervention the facility is to provide in room activities of choice as indicated. Included in her Care Plan for the risk of falls related to deconditioning gait and balance problems, the facility should provide diversional activities as needed, with an effective date of 2/9/22, and the resident needs activities that minimize the potential for falls while providing diversion and distraction sitting with resident, therapeutic communication. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 5 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A medical record review was conducted for activity notes and the medical record was silent. There was no progress note to indicate any type of activity was being offered to the resident. An interview was conducted with the Director of Activities on 10/19/2022 at 11:18 a.m., in regard to providing activities or 1:1 activity for the residents. She reported she documents all her 1:1 interaction with residents on her log. A review of the activity log/participation record was conducted which revealed no entries for Resident #38. On 10/19/22 at 12:51 p.m., an interview with the Activities Director (AD) was conducted in regard to activities being provided to Resident #38. She reports Resident #38 doesn't eat ice cream and has been offered the activity packet, but she has not been interested, she has always declined. The AD reports the resident's refusals should be in her care plan for activities and in her progress notes. She was asked to bring in her notes since surveyor was unable to locate any notes in the resident's medical record. On 10/19/22 at 1:44 p.m., an interview with the AD confirmed she had no notes, and the resident did not have any documentation that she was offered activities or the resident declined. A review of the facility's policy titled, Social Activities was conducted, dated 11/30/2014 with a revision date of 3/13/2019, showed, Purpose; To provide opportunities for socialization regardless of one's cognitive limitations. Social activities shall be offered at minimum 2-3 times per day. Attendance and participation shall be documented on the individual's participation record by the Community Life Assistance. 2. A medical record review was conducted for Resident #3. The admission Record showed Resident #3 was admitted to the facility on [DATE] with a re-admission date of 1/04/2022. Resident #3 had multiple diagnoses but not limited to Parkinson Disease, dysphagia, difficulty walking and feeding difficulties. A dietary review note dated 9/30/22 showed, weight loss note- triggered for a -5% change (comparison weight 9/7/22, 156.8 lbs (pounds) -6.0%, -9.4 lbs.) Diet is regular diet. Dysphagia advanced texture. Nectar thickened fluids consistency. Receiving Add large entrée, starch, veg (vegetable) portions all meals. History of weight loss. Possibly due to disease progression. Current nutritional supplement is fortified foods, receives insulin. Dependent dinner eats 50-100% of meals. Recommend health shake BID (two times a day) and weekly weights. Review of a dietary note on 3/4/22 showed, .Will continue to monitor PO (taken by mouth) Intake, weekly weights, RD (Registered Dietician) to f/u (follow up) PRN (as needed). Review of a dietary note on 9/9/22 showed, .Recommend fortified foods and weekly weights. The medical record for Resident #3 indicated the following weights taken: 9/19/22 - 155 pounds 9/09/22 - 161 pounds 9/07/22 - 156 pounds (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 6 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 0656 8/03/22 - 172 pounds Level of Harm - Minimal harm or potential for actual harm 7/01/22-177 pounds 6/06/22 - 182 pounds Residents Affected - Few 4/08/22 - 178 pounds 3/14/22 - 175 pounds 3/08/22 - 172 pounds 3/02/22 - 172 pounds No weekly weights were taken after 3/14/22 and with no explanation documented in the medical record . Resident #3 lost 11.43 lbs. in six months. Review of the plan of care with a focus area for nutritional problems, with an effective date 10/11/2021 and revision date of 9/30/22, had an intervention that read: weights as available/tolerated. The recommendation of weekly weights by the Registered Dietician, on 3/4/22, was not developed as a focus for a care plan or an intervention. On 10/20/22 at 10:49 a.m., an interview was conducted with the Director of Nursing and the Regional Director of Clinical Services. They reported the Registered Dietician at the time had not brought forward the recommendation for the weekly weights onto Resident #3's plan of care. The facility policy for Weighing the Resident, with a revision date of 10/4/2021 was obtained. Under the heading Procedures showed: Weights will be completed as indicated and documented in the clinical record and Consult with the Director of Dietary Services and/or dietician and notify the interdisciplinary team in order to update the plan of care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 7 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. A medical record review was conducted for Resident #38 on 10/17/2022 which revealed the resident was admitted to the facility on [DATE] with multiple diagnoses but not limited to dementia, cognitive communication deficit and history of falling. Residents Affected - Few On 10/17/22 at 10:00 a.m. the resident was observed in a low bed, hospital gown, and call light within reach. Resident #38 was unable to have a conversation due to her cognitive decline. On 10/17/22 at 2:23 p.m. Resident #38 was observed still in bed. Resident #38 lays in a scooped mattress, low bed, air mattress. The resident was asked if she had eaten, she couldn't remember, her roommate (#79) stated that she is fed, and she did have lunch. The following observations were conducted: Observation: 10/18/22 at 10:06 a.m., Resident #38 was observed this morning with a different gown on, an extra blanket on her bed and a change of clothing and brief on the bed, she is scheduled to have a shower this morning as per the roommate. Roommate reports that she gets her shower on Tuesdays. Resident began to yell and stated that it's too cold for her shower and she wasn't going to take one today. Call light is within reach, bed in the lowest position. No other voiced concerns. Observation: 10/18/22 at 1:20 p.m., Resident #38 was observed in her room sleeping, roommate reports the resident had refused a shower but did receive a bed bath. Observation: 10/19/22 at 11:14 a.m., Resident #38 was in a low bed, with a blanket up to her chin and the call light within reach. Resident does appear groomed and has a different gown on today. Roommate states the resident likes to have many blankets on her bed. The roommate was asked if anyone comes in to offer activities to the resident, she reports the resident is unable to do anything. Roommate was asked if anyone comes in to sit and talk with her or offer any kind of socialization. Roommate confirmed no one comes in to offer her any activities. Resident has been observed randomly throughout the survey lying in bed, she has not left the room or had any visitors. A medical record review was conducted for activity notes and the medical record was silent. There was no progress note to indicate any type of activity was being offered to the resident. An interview was conducted with the Director of Activities on 10/19/2022 at 11:18 a.m., in regard to providing activities or 1:1 activity for the residents. She reported she documents all her 1:1 interaction with residents on her log. A review of the activity log/participation record was conducted which revealed no entries for Resident #38. On 10/19/22 at 12:51 p.m., an interview with the Activities Director (AD) was conducted in regard to activities being provided to Resident #38. She reports Resident #38 doesn't eat ice cream and has been offered the activity packet, but she has not been interested, she has always declined. The AD reports the resident's refusals should be in her care plan for activities and in her progress notes. She was asked to bring in her notes since surveyor was unable to locate any notes in the resident's medical record. On 10/19/22 at 1:44 p.m., an interview with the AD confirmed she had no notes, and the resident did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 8 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 not have any documentation that she was offered activities or the resident declined. Level of Harm - Minimal harm or potential for actual harm A review of the facility's policy titled, Social Activities was conducted, dated 11/30/2014 with a revision date of 3/13/2019, showed, Purpose; To provide opportunities for socialization regardless of one's cognitive limitations. Social activities shall be offered at minimum 2-3 times per day. Attendance and participation shall be documented on the individual's participation record by the Community Life Assistance. Residents Affected - Few Based on observations, record reviews and interviews the facility failed to ensure activities met the interest and needs of two residents (#63, and #38) out of the sample of thirty-seven residents. Findings included: 1. Resident #63 was observed and interviewed on 10/17/22 at 11:19 a.m., the resident stated, Don't know of any (activities) they only come sometimes, only sometimes. An activity calendar was posted on the wall, approximately 3 feet from the resident's bed and mid-torso to the resident. The resident identified she was unable to read the calendar that was printed on the 8.5 x 11 inch sheet of paper. Resident #63 reported getting out of bed on certain days then the facility parks her wherever they want. The care plan for Resident #63, initiated on 11/14/18 and revised on 9/7/22, identified the resident was dependent on staff for her activities needs, she can make her needs known, enjoys visits from her [family member] and enjoys watching TV, also likes to socialize when she's up. Activities will continue to visit for social contact and inform of calendars of events, and cognitive deficits. The interventions included: - Ensure that the activities the resident is attending are: Compatible with physical and mental capabilities; Compatible with known interests and preferences; Adapted as needed (such as large print holders if resident lacks hard strength, task segmentation), Compatible with individual needs and abilities; and Age appropriate. - Invite the resident to scheduled activities. On 10/18/22 at 1:51 p.m., Resident #63 was observed sitting in a wheelchair, outside of the activity room at the end of the 800-hall, across from the nursing station by herself. A review of the 1:1 Activities Binder identified Resident #63 had received visits from the Activity department eight times, August 11th and 25th, September 1st, 8th, 16th, and 29th, and October 5th and 12th in eighty-one days (approximately 12 weeks). The 1:1 log identified the resident attended one church service in those 12 weeks. On 10/19/22 at 1:24 p.m., Resident #63 reported just sitting by the nursing station yesterday (10/18/22). Resident #63 stated, didn't go anywhere or do anything, just sat there. An interview was conducted on 10/19/22 at 9:47 a.m., with the Activity Director (AD). The AD explained the department passed out activities packets which contained a newsletter with trivia and history, a coloring page, and sometimes a crossword or a word search puzzle. She stated for bedridden residents we have a bubble machine that they really like, and also have an [Brand Name] oven that the ingredients are taken into the resident room and mixed together approximately once a month. The AD (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 9 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated room visits are done on Fridays, sometimes on Wednesdays or Thursdays, an ice cream cart every Tuesday from 2-3 p.m. and a popcorn cart every Wednesday. The AD explained residents are told about activities when the calendars are handed out at the beginning of the month, and when we do assessments. Assessments are completed on admission, annually and when there was a change in condition. She reported Staff A, Activity Assistant (AA) passed out activity packets today, and when they had extra time they did manicures, reporting they did two manicures yesterday. The AD reported there were two activity staff who worked Monday - Friday, on the weekends activity packets were left at the nursing stations and staff passed them out. A review of the activity calendar identified Shopping for Residents was scheduled for 10:00 a.m. twice a month on Fridays. The other activity available on those Fridays was at 9:00 a.m., Activity Packet and Bingo # (a game in which a Bingo letter and number for that day is written on the board in each resident's room. Then the resident's would mark it on their card). The AD stated the residents are unable to go shopping due to the facility van being in the shop and the activity staff ask residents if they need anything from a big-box store and the staff go shopping for them. She stated about once a week she takes some residents next door to the big-box pharmacy store. An observation was conducted of the activity room on the 700-800 hall with the AD. Staff M, Activity Assistant was observed doing the nails of the one female in the room with a male resident sitting at the table. The AD indicated Staff M had handed out Thursday's activity packet instead of Wednesday's. Staff M stated she would pass out today's (Wednesday) also. Staff M reported she prints out 30 activity packets a day. The facility census was 116 on 10/17/22. A review of the October 2022 Activity Calendar identified every day at 9:00 a.m. an activity packet and a bingo # were passed out, an assortment of 10:00 a.m. activities during the weekday and the last resident activity started at 2:00 p.m. The calendar identified activity packets were passed out on Saturday and Sundays, 10:00 a.m. on Saturdays were Self-directed Activities and 10:00 a.m. Sunday activity was TV Church Service. The calendar did not identify any other activities on Saturday or Sunday and the latest activity during the current week was on 10/20/22 at 3:00 p.m., and was a food council meeting. In an additional interview the AD confirmed on 10/19/22 at 10:59 a.m., the Shopping for Residents twice a month on Fridays was not an activity for the residents, and the Saturday activities were self-directed after staff passed out the activity packets, and the Sunday 10:00 a.m. church service could be watched on their TVs. She stated the facility did not have a van available since before she got to the facility in July 2022 due to being in the shop waiting for a special part. The AD confirmed there was no outside music programs and that a pastor comes twice a month on Thursdays. The AD stated, on 10/19/22 at 1:41 p.m , Staff M visited Resident #63 once a week and admitted the resident wasn't someone that she saw very often and did not know what (type of activity) the resident liked to do. On 10/20/20 at 9:39 a.m., the AD did not know if Staff M documented when she visited Resident #63 to socialize. The AD stated Resident #63 did not come out of her room for activities. On 10/20/22 at 9:43 a.m., Staff M, AA stated she visits Resident #63 maybe once every couple of weeks. She stated the visits are approximately 10 minutes and she converses with resident. The AA reported the resident doesn't get out of bed that often, says she wants to stay in the hallway, and does not want to stay out of bed very long. Staff M stated visits to the resident do not get documented all the time. Staff J, Licensed Practical Nurse (LPN) stated, on 10/20/22 at 11:09 a.m., the resident will stay (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 10 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few out of bed for about for 3 - 3 1/2 hours and does not usually ask to go back to bed. If something was going on we will take her in (activities) and the resident does not refuse group activities I haven't heard her refuse. The policy titled, Social Activities, effective 11/30/2014 and revised 3/13/2019, indicated, The social activities are modified to meet the basic needs of love and belonging in residents who experience deficits in judgment, reasoning, and perception. The activities focus on acceptance of the individual and the stimulation of learned social responses. The procedure identified the following: - 1. Social Activities shall be offered at minimum 2-3 times per day. - 2. Social Activities shall be offered in a variety of settings and locations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 11 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 observations, interview and record review the facility failed to perform accurate skin assessments for one resident (#43) of 37 sampled residents. Residents Affected - Few Findings included: An observation on 10/17/22 at 1:40 p.m. showed Resident #43 lying in bed. The hospice nurse was assessing the resident. It was noted he had multiple reddened skin areas on his right arm. He appeared to be reaching for items in the sky and trying to take his clothes off. He was observed again on 10/18/22 at 12:55 p.m. and he was being fed by an aide. He had oxygen in place via a nasal cannula. He was continuing to try to remove his clothes. Five reddened/abrasions were noted on his right arm. One above his elbow, one below his elbow, one above his wrist and two between the elbow and wrist. They were not bleeding nor were they covered. Review of the admission Record showed Resident #43 was admitted on [DATE] and readmitted on [DATE]. The review showed diagnoses included but were not limited to cerebral atherosclerosis, diabetes, hypertension, dementia, mood disorder, depression schizophrenia, psychosis and pain. Review of the Quarterly Minimum Data Set, dated [DATE], showed a Brief Interview of Mental Status (BIMS) score of 05 (severely impaired). Section M, Skin Conditions showed no skin issues. Review of the Weekly Skin Integrity Sheets dated 10/18/22, 10/3/22, 9/26/22, 9/19/22, 9/15/22 and 9/8/22 showed he had areas on his right arm. Review of a Standard of Care meeting on 09/26/22 showed an Interdisciplinary Team Meeting was held to discuss unavoidable wounds, that he was a hospice resident, and continues with wound care to his right heel and sacrum area. Review of the physician note dated 10/18/22 showed the resident was total care with unavoidable wounds. Review of care plans showed has potential/actual impairment to skin related to fragile skin: sacrum wound and right heel blister. Interventions included but not limited to administer treatment per MD order, air mattress, keep skin clean and dry, use caution during transfers and bed mobility to prevent striking arms, legs and hands against any sharp or hard surface as of 09/01/22 During an interview with the Director of Nursing (DON) on 10/18/22 at 1:45 p.m. she stated if an incident occurred, they would fill out an incident report and put an intervention into place and it would be documented in the progress notes. She stated if they should find an abrasion or bruising it should be documented on the Weekly Skin Sheets. The DON observed the 5 areas on his right arm and verified they were reddened areas. She stated the resident was a hospice resident and it was expected for him to have areas on his skin. She stated hospice should be documenting the areas on their notes. When asked if the facility was also responsible for the resident, she stated Yes, I see what you are saying, it should be documented somewhere. She reviewed the chart and was unable to find any documentation. A second interview with the DON on 10/19/22 at 9:40 a.m. revealed she had not found any (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 12 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 documentation about his reddened skin areas. Level of Harm - Minimal harm or potential for actual harm Record review of the facility's policy titled, Clinical Guideline Skin and Wound, dated 0401/2017, revealed on admission/readmission the resident's skin will be evaluated for baseline skin condition and documented in the medical record. Licensed nurse to document presence of skin impairment/new skin impairment when observed and weekly until resolved. Licensed Nurse to report changes in skin integrity to the physician/practitioner and resident/responsible party and document in the medical record. Develop individualized goals and interventions and document on the care plan and the CNA [NAME]. Monitor resident's response to treatment and modify treatment as indicate. Evaluate the effectiveness of interventions, and progress toward goals during the care management meeting as needed. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 13 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to 1.) provide adequate supervision to related to falls with an injury for one (#49) of two sampled residents and 2.) ensure the mattresses fit the beds properly for one (#63) of eight affected residents for a facility with a census of 116 residents. Findings included: 1. An interview on 10/18/22 at 2:18 p.m. with Resident #49 revealed he had fallen out of bed last Friday, 10/14/22. He was turned on his left side, his lower extremities, knees, and lower legs were hanging off the bed. The resident was in a semi-fetal position. He stated he fell out of bed after the aide left him too close to the right side of the bed and he slid off the bed. He stated the aide was changing his brief and she said he was bleeding. She left to go get the nurse and he slid off. He fell on the floor and hit his head and left shoulder. He stated the bandage on his left forehead was from the fall. The bed was in a normal position and no floor mats were beside the bed. The TV was on and the call light within reach. He had fluids and snacks on his bedside table. A second interview and observation with Resident #49 was conducted on 10/18/22 at 3:00 p.m. He stated the facility had not changed his dressing since he came back from the hospital. He went to the dermatologist yesterday and they changed the dressing. He said he thought two people were moving him in the bed before the fall, but he was not sure. There were no floor mats noted. An observation of Resident #49 conducted on 10/20/22 at 1:30 p.m. revealed he was lying in bed. There were no floor mats at the bedside. An observation of Resident #49 was conducted on 10/20/22 at 3:00 p.m. with the Director of Nursing (DON). The resident was lying on his left side. He had floor mats at his bedside and the dressing was removed from his forehead. Review of the clinical record revealed Resident #49 was admitted on [DATE] and readmitted on [DATE]. Diagnoses included but were not limited to low back pain, low back pain, aphasia, Cerebrovascular Accident (CVA) with hemiplegia, diabetes, occlusion and stenosis of bilateral carotids, stage III pressure ulcers of sacral, depression, seizures, stiffness of left hip and left knee, gastrostomy, and hypertension. Review of the quarterly Minimum Data Set (MDS) dated [DATE] showed a Brief Interview Mental Status (BIMS) score of 15 (cognitively intact). He required extensive assistance of two persons for bed mobility. Review of the nursing care plan and aide Kardex showed the resident had a bariatric bed and required assistance of 2 with bed mobility. Review of the care plans showed Resident #49 was at risk for falls related to deconditioning. Interventions included but were not limited to bilateral floor mats while in bed as of 02/09/2022; ensure that resident was in the middle of the bed; reposition as needed as of 10/14/22; low bed in lowest position at all times, except for care as of 06/25/21; Send to ER [emergency room] for evaluation/ treatment, returned the same day neuro-checks as of 10/14/22 ADL [activities of daily living] self-care plan showed a performance deficit related to CVA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 14 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 0689 Level of Harm - Actual harm Residents Affected - Few [cerebral; vascular accident] with limitation of movements to lower extremities showed intervention included but not limited to the resident had a bariatric bed and required assistance of 2 with bed mobility as of 09/25/2020. Record review of the Bed Mobility ADL task showed 26 out of 59 bed mobilities were performed with one person assist and 33 out of 59 were performed with two persons assist. Review of a Fall Report dated 10/14/22 showed nursing was notified that the patient fell on the floor. The resident was assessed. Vitals were within normal limits. Skin tear to left shoulder, left buttock, forehead. Normal Saline, pat dry, and cover with dressing. Resident stated he had pain of 2/10. He denied pain medication. Asked him how he fell three plus times. Resident was anxious and repeated he is sorry and did not know how he fell. He was helped back into bed with the assist of the resident's aide on shift and the other hall nurse. No injuries were observed at time of incident. He was oriented to person, place, time, and situation. No witness found. Attending physician was notified on 10/14/22 at 8:01 a.m. Completed by Staff G, Licensed Practical Nurse (LPN) Review of a Change in Condition dated 10/14/22 at 7:10 a.m. showed wound care and vitals were performed. The resident was on anticoagulant. His blood pressure was 115/72 on 10/14/22 at 7:19 a.m. He had a skin abrasion. He was not having any pain. Neurological evaluation was not clinically applicable to the change in condition being reported. Nursing was notified by the Certified Nursing Assistant (CNA) that the resident was on the floor. Assessed vitals and head-to-toe assessment. the vitals were within normal limit. Pain was 2/10. Resident stated he hit head. He had a 2 x 3 cm abrasion to the middle of his forehead. It was cleaned and dressed. Completed by Staff G, LPN Review of Neurological checks showed they were performed on 10/14/22 at 5:30 a.m., 5:45 a.m., 6:00 a.m., 6:15 a.m. performed by Staff G, LPN Review of the Hospital Transfer form filled out on 10/14/22 at 8:56 a.m. showed resident fell this morning, hematoma noted to his right forehead. Attending physician notified and order received to send resident to the hospital for evaluation. Called POA, and phone not in service. Completed by Staff H, Registered Nurse, Unit Manager (RN) (UM) Record review of the progress notes showed: On 10/14/22 at 7:27 a.m. Staff G, LPN showed was notified by the aide that the resident was found on the floor. Vitals were taken and within normal limits. His pain was 2/10 reported from resident. Resident was helped back into bed with help of other hall nurse and CNA with Hoyer lift. He had a wound to his bottom, his left hip, his left shoulder, and forehead. Cleansed his wounds with normal saline, pat dry with gauze and covered with dry sterile dressing. The Advanced Registered Nurse Practitioner (ARNP) was called. The report was passed on to the oncoming nurse. Completed by Staff G, LPN On 10/14/22 at 9:48 a.m. the family was called for notification of fall and transfer to hospital. No answer for three different family members. Per Staff H, RN, UM Review of physician orders show a lack of orders for wound care for left forehead. Record review revealed no Skin Sheets were documented showing description of skin and wounds. An interview with Staff H, Registered Nurse (RN), Unit Manager (UM) on 10/18/22 at 2:40 p.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 15 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 0689 Level of Harm - Actual harm Residents Affected - Few revealed he had fallen, and she filled out the paperwork to send with him to the hospital. She was working the 7-3 shift and he fell on the 11-7 shift. Staff I, Certified Nursing Assistant (CNA) which was an agency aide, went to dress the resident. Staff G, LPN had told her in report he had fallen, and he had a bruise on his head. Staff H, RN called the physician and he said to send him to the hospital for evaluation. Staff H stated the nurse left the facility. She did not try to call Staff G, LPN for more information about the fall. An interview with Staff I, CNA involved in fall on 10/19/22 at 10:01 a.m. revealed that Resident #49 fell last Friday. She said she went in to change his brief, she did not remember what time it was. He was facing the window, or on his left side; he always wanted to be on his left side. She rolled him over to his right side, to change him. She noticed he did not have a dressing on his bottom. She pulled him over to the middle of the bed. and went to get the nurse. As she was walking down the hall to get the nurse, the Nursing Home Administrator (NHA) came out of the room, from the hall. He said, hey, where you at. The resident is on the floor. Staff I and the two floor nurses ran in to get him up. We put the Hoyer pad under him and lifted him back in bed. She stated, He had a little scrape on his forehead, like a carpet burn, it was not leaking, it looked like a flesh wound. Staff G, LPN, checked him. She stated she put the brief back on. Staff G left the room after she put a band-aid on his head. Staff I stated one of his shoulders had a bruise on it. She did not know if the bruise had been there before the fall or not. At close of shift she went to the 7-3 aide and gave a report. She stated she let her know he was to have vital signs taken every 15 minutes. He did not tell her anything was hurting. She stated she was the only one in the room turning him. He helped her a little bit and kept grabbing at the enabler. She stated he clinched the enabler on the right side of the bed. She stated she had worked with him a while back. He was able to be moved with one person. Staff I, CNA stated that everyone moved him with one person assist, he was a one person assist. An interview with the Director of Nursing (DON) on 10/19/22 at 12:18 p.m. revealed they were to perform Interdisciplinary Team (IDT) meetings post falls. The DON was unable to find any documentation regarding an IDT meeting. She verified the care plan showed that bed mobility required 2 persons for Resident #49, and it was not always performed with two persons. She stated she spoke with Staff G, LPN and Staff I CNA. The aide was agency and was placed on the Do Not Return list. The DON stated she was not aware if they reported the incident to any regulatory agencies, she would have to check with the Risk Manager which was the NHA. When asked about documentation regarding the description of the head and shoulder wound, assessment performed, description of how resident was found, environmental elements, etc. the DON stated she would investigate. Record review of the facility's policy, Fall Management, revised on 07/29/2019 showed residents are evaluated for fall risk. Patient centered interventions are initiated, based on resident risk. Purpose: is to identify residents at risk for falls and establish / modify interventions to decrease the risk of a future fall (s) and minimize the potential for a resulting injury. B. Fall Mitigation Strategies: 1. Develop resident centered interventions based on resident risk factors; w. Update the resident's care plan with interventions. C. Post Fall Strategies: 1. Resident will be evaluated, and post fall care provided; 2. Initiate neurological checks as per policy or as directed by physician order. 3. Notify the physician and resident representative. 4. Re-evaluate fall risk utilizing the Post Fall Evaluation; 5. Update care plan with intervention (s). 6. Initiate post fall documentation within 72 hours. 7 Interdisciplinary Team to review fall documentation. 8. Review resident within 7 days. D. QAPI: 1. review fall trends monthly during QAPI. Record review of the facility's Action Sheet, Resident Safety, not dated showed Establish a resident fall program that includes .prompt medical attention for residents who are injured from falls. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 16 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 0689 Level of Harm - Actual harm Residents Affected - Few Notification of staff, residents' family and physician regarding falls and any changes in resident condition. Implementation of preventative measures. Ongoing monitoring of resident falls. Ongoing monitoring of staff response to resident call system. Documentation of facts related falls in resident care records, such as: time resident found. Location of fall. Nursing assessment of resident's injury from fall. Medical care given after fall. Implementation of preventative measures. 2. An observation was conducted on 10/17/22 at 3:59 p.m. of a nine (9) inch gap between the headboard and the mattress of Resident #63's bed. Immediately following the observation, the Maintenance Director confirmed the findings and removed 2 4-5 inch bolsters from the head of bed under the bed frame. He stated that measurements for spacing between the mattresses and headboard/footboard were done annually then he changed it to quarterly. On 10/17/22 at 4:07 p.m., the Nursing Home Administrator (NHA) observed the gap between Resident #63's mattress and headboard. The Maintenance Director notified the NHA that bolsters were found under the bed frame. The NHA stated, at 4:14 p.m. on 10/17/22, that the bolsters had been put at the top and the bottom of the residents mattress and had fixed the issue. The NHA provided on 10/18/22 at 9:00 a.m., a full house audit of mattress and headboard/footboard placements. He identified three findings , however after reviewing the audit, it indicated that 8 beds were found to have issues with gaps between mattresses and headboard and/or footboards. On 10/18/22 at 9:20 a.m., the NHA stated the Food and Drug Administration (FDA) had not documented a certain measurement between mattress and head/foot board. The Maintenance Director stated on 10/18/22 at 9:23 a.m. that the x's on the audit were the ones that had needed to be adjusted as many were that the mattresses had slid down. The NHA stated ultimately they (the beds) had all been fixed. A Guide for Modifying Bed Systems and Using Accessories to Reduce the Risk of Entrapment, June 21, 2006, identified that the space between the mattress and headboard was an unmeasured zone but to be used in reference for the reporting of entrapment incidents. The illustrations included with the guidance showed how a human head could become entrapped in the space between mattress and headboard. This information was located at: https://www.fda.gov/medical-devices/hospital-beds/guide-modifying-bed-systems-and-using-accessories-reduce-risk-entrap According to Reference.com (https://www.reference.com/science/average-size-human-head-62364d028e431bf3), the average human head measures 6-7 inches in width. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 17 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, and interviews, the facility failed to ensure one resident (#101) was assessed and monitored appropriately after dialysis of six residents receiving dialysis. Residents Affected - Few Findings included: A review of the admission Record for Resident #101 revealed he was initially admitted into the facility on [DATE] with diagnoses that included but was not limited to end stage renal disease and dependence on renal dialysis. Section C Cognitive Patterns of the Quarterly Minimum Data Set (MDS), dated [DATE], revealed Resident #101 had a Brief Interview for Mental Status (BIMS) score of 04 out of 15 indicating severe impairment. Section O Special Treatments, Procedures, and Programs indicated dialysis was performed while a resident. A review of the Order Recap Report for the dates of 08/01/22 to 10/31/22 revealed the following orders related to dialysis: Hemodialysis- Monday, Wednesday, and Friday. There were no orders related to assessing for bruit and thrill. A review of the Medication Administration Records and Treatment Administration Records for the months of August 2022 to October 2022 revealed no documentation related to assessing for bruit and thrill. A review of the progress notes from August 2022 to October 2022 only revealed two notes related to assessing and monitoring the bruit and thrill: 09/09/22 at 23:36 (11:30 p.m.) - Continues on dialysis. Left port is clean, dry, intact, no swelling, no redness noted. No adverse reactions noted. 09/09/22 at 09:00 (9:00 a.m.) - Dialysis status is hemodialysis. Bruit and thrill present. Left port is clean, dry, intact, no swelling and no redness noted at this time. Currently Leave of Absence (LOA) to dialysis at this time. A review of the care plans revealed a care plan, initiated on 7/4/22, for hemodialysis related to renal failure. Interventions included but were not limited to monitor, document, and report as needed any signs and symptoms of infection to access site. On 10/20/22 at 9:00 a.m., Staff Q, Licensed Practical Nurse (LPN), stated she checks the bruit and thrill every day and they did not have to document anything because it was a standard in nursing. She stated they must check it because it can clog up and get infected. Staff Q, LPN, touched the site on the left arm with her fingers and stated you can feel it here. A dressing was on the left arm. She stated she was going to remove the dressing today. Staff Q stated, as a nurse, she knew she had to assess the site. On 10/20/22 at 11:52 a.m., the Director of Nursing (DON) stated if a resident had a bruit and thrill, they have to assess the site. She would not expect to see an order in place to check the bruit and thrill because it was a standard. The DON stated the assessments were documented on the dialysis (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 18 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete sheets, but she wanted to check to make sure. Her expectation was for nurses to check the bruit and thrill and document this on the dialysis communication sheets. When asked about assessing the site the other four days the resident did not have dialysis, the DON did not respond. She then stated she would check on this and follow up. On 10/20/22 at 1:51 p.m., the DON reported there was an order in place, but the order fell off when Resident #101 went to the hospital in July (2022). Event ID: Facility ID: 106002 If continuation sheet Page 19 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews, the facility failed to ensure one (#28) out of five residents sampled for unnecessary medications was administered pain medication per the parameters ordered by the physician. Residents Affected - Few Findings included: Resident #28 was admitted on [DATE]. The admission Record included diagnoses not limited to pain in left knee, idiopathic progressive neuropathy, and lumbar region radiculopathy. A review of Resident #28's October Medication Administration Record (MAR) identified the following physician orders: - Acetaminophen Extended Release (ER) 650 milligram (mg) - Give 1 tablet by mouth every 6 hours as needed for pain levels 1-6, started 8/25/22, discontinued on 10/7/22. - Acetaminophen Extended Release (ER) 650 milligram (mg) - Give 1 tablet by mouth every 6 hours as needed for pain levels 1-6, started 10/7/22. - Percocet Tablet 5-325 mg (Oxycodone-Acetaminophen) - Give 1 tablet by mouth every 6 hours as needed for pain, start date 8/25/22 and discontinued 10/7/22. - Percocet Tablet 5-325 mg (Oxycodone-Acetaminophen) - Give 1 tablet by mouth every 6 hours as needed for pain levels 7-10, start date 10/7/22. The October Medication Administration Record (MAR) for Resident #28 indicated that Acetaminophen ER had not been administered. The MAR identified the resident had been administered Percocet for the following pain levels: one time for a pain level of 1, one time for a pain level of 3, six times for a pain level of 4, 10 times for pain level of 5, and twice for a pain level of 6. A recommendation, dated 7/8/22, indicated the Consultant Pharmacist identified that Resident #28's as needed order for Percocet was to be administered for a pain level of 7 to 10 and had been given 34 times for a pain level of less than 7 in June. Resident #28's care plan indicated that the resident had chronic back pain due to spinal stenosis, arthritis, radiculopathy, and bilateral knee and hip pain. The interventions included: administer analgesia as per orders. On 10/20/22 at 11:15 a.m., during an interview with Staff Member J, Licensed Practical Nurse (LPN), she stated Resident #28 hated when the staff member was not at the facility because she made sure the resident got pain meds on time. In an interview with the Director of Nursing (DON) on 10/20/22 at 2:10 p.m., she said she would expect staff to reach out to the physician regarding pain management and knew the patient insisted on getting Percocet instead of Tylenol. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 20 of 21 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 106002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Healthcare and Rehabilitation Center 1010 Carpenters Way Lakeland, FL 33809 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on record review, staff interview and policy review the facility failed to have all required members participate in two monthly Quality Assurance Committee meetings (1/30/22 and 5/26/22) of nine monthly Quality Assurance Committee meetings. Residents Affected - Few Findings included: The facility provided their policy titled, Performance Improvement Committee (Quality Assurance). The policy showed the committee will meet to review, recommend and act upon activities of the facility, performance improvement teams and/or departmental activities. The procedure showed, #6.The committee will maintain a record of attendees and a description of the topics discussed. During the Quality Assurance review meeting held with the Nursing Home Administrator (NHA) on 10/20/2020 at 1:00 p.m. it was confirmed the committee met once a month. In review of the sign in sheet it was revealed the Medical Director, a required key member, did not participate on the Quality Assurance meetings for January 30, 2022, and May 26, 2022. Additional review of the signature sheets revealed no documented evidence that a Quality Assurance meeting was held on May 2021, June 2021, November 2021, and December 2021. The facility failed to provide documented evidence (signature sheets). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106002 If continuation sheet Page 21 of 21