Inspection·January 25, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on clinical records review, resident and staff interviews the facility failed to develop and implement an individualized care plan to meet the needs of 2 (Residents #25, and #83) of 32 sampled residents. Residents Affected - Few The findings included: 1. Review of Resident #25's clinical records revealed an admission date of 7/8/15. Diagnoses included Cerebral Palsy (congenital disorder of movement, muscle tone and posture), and a history of intestinal obstruction. Review of the Significant Change Minimum Data Set (MDS) assessment with a target date of 10/26/23 noted Resident #25 received 500 milliliters or more of fluids daily through a feeding tube (tube inserted into the stomach for nutrition and/or hydration). The clinical record lacked documentation of an individualized care plan, with goals and interventions related to the use of a feeding tube. On 1/25/24, at 2:30 p.m., in an interview the Director of Nursing verified the lack of a care plan addressing the use of the feeding tube for Resident #25. On 1/25/24, at 2:45 p.m., in an interview the MDS Coordinator verified no care plan related to the use of the tube feeding was developed for Resident #25. 2. Review of clinical record for Resident #83 revealed an admission date of 10/13/23. The admission MDS with a target date of 10/16/23 noted the resident's primary language was Spanish and he needed an interpreter to communicate with the physician and healthcare staff. Resident #83 scored a 15 on the Brief Interview for Mental Status, indicating intact cognition. The triggered care areas in the Care Area Assessment Summary and Care Planning did not include communication. Resident #83's care plan did not address the limited English proficiency and the communication needs of the resident. On 1/22/24 at 11:46 a.m., Resident #83 was interviewed using the facility's Spanish speaking Medical Record Staff as a translator. A monthly activity calendar was observed posted on the wall, in the resident's room. The calendar was written in English. Resident #83 said he spoke very little English and could not read English. On 1/23/24 at 8:52 a.m., in an interview the Activity Coordinator verified there was not activity calendar available in Spanish for the Spanish speaking residents. On 1/23/24 at 4:04 p.m., in an interview, Registered Nurse Staff W said she was contracted from an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 2 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 outside nursing agency and did not speak Spanish. She said the facility has not told her who she could use as a translator. Staff W said she sometimes is able to find a Certified Nursing Assistant who speaks Spanish to communicate with Spanish speaking residents. On 1/23/24 at 4:15 p.m., in an interview the MDS Coordinator verified the lack of care plan to address Resident #83's language and communication needs. On 1/23/24 at 4:25 p.m., in an interview the Dietary Manager said residents' menu were not available in Spanish. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 3 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 8. Review of the clinical record revealed Resident #83 had an admission date of 10/13/23. The Quarterly MDS assessment with a target date of 1/16/24. Resident #83's cognition was intact with a Brief Interview for Mental Status score of 13. Resident #83 was dependent on staff for showers. Residents Affected - Some On 1/22/24 at 11:46 a.m., Resident #83 was interviewed with the assistance of the facility's Medical Record Staff translating in Spanish, the resident's native language. Resident #83 said he had been at the facility for approximately six months and has not had a shower for at least three months. Resident #83 was unshaven with medium facial hair growth. A brown substance was observed underneath his fingernails. Review of the shower schedule showed Resident #83's showers were scheduled on Mondays, Wednesdays, and Fridays on the evening shift (3:00 p.m., to 11:00 p.m.). Review of the shower documentation for October 2023, November 2023, December 2023, and January 2024 revealed Resident #83 received two of the 44 scheduled showers (12/29/23 and 1/12/24). N/A (not applicable) was entered on October 13, October 15, October 17, October 18, October 23, October 25, November 1, November 3, November 6, November 8, November 10, November 13, November 24, and December 8, 2023. A Full Bed Bath was documented for November 17, November 29, December 10, and December 15. A sponge bath was documented On October 14, October 16, October 19, October 27, November 22, November 29, December 1, December 4, and December 13, 2023. Resident unavailable was documented on November 20, November 27, November 29, December 27, January 3, and January 15. There was no explanation documented in the clinical record for the bed baths, sponge baths, the not applicable, and the unavailable entries on the scheduled shower days. Based on observation, record review, review of facility policy and procedure, resident and staff interviews, the facility failed to provide the necessary care and services to maintain hygiene, for 8 (Residents #26, #37, #8, #45, #83, #85, 103 and #366) of 8 dependent residents reviewed for activities of daily living. The findings included: The facility policy Activities of Daily Living (ADLs), Supporting (revised 2018) documented Residents will provided with care, treatment and services as appropriate to maintain or improve their ability to carry out activities of daily living . Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene . If residents with cognitive impairment or dementia resist care, staff will attempt to identify the underlying cause of the problem and not just assume the resident is refusing care. Approaching the resident in a different way or at a different time or having another (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 4 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0677 staff member speak with the resident may be appropriate . Level of Harm - Minimal harm or potential for actual harm 1. Review of the clinical record revealed Resident #45 had an admission date of 12/13/23 with diagnoses including depression and dementia. Residents Affected - Some The admission Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date of 12/20/23 documented N/A (not applicable) for bathing assistance and supervision/touching for personal hygiene. The MDS noted Resident #45's cognitive skills for daily decision making were severely impaired with a Brief Interview for Mental Status score of 03. Review of the plan of care initiated on 12/26/23 noted Resident #45 had an ADL self-care deficit. The interventions included to, Encourage and assist with all ADL tasks as indicated, as tolerated by resident, including locomotion/ambulation, bathing, bed mobility, transfers, toileting tasks, meals, personal/oral hygiene, etc. On 1/22/24 at 2:42 p.m., Resident #45 was observed in his wheelchair in the hallway of the memory care unit. The resident had approximately seven days of facial hair growth. Resident #45 said he wanted a shave, shower, and a haircut. His hair was uncombed, looked greasy and extending past his jaw line. On 1/23/24 at 8:48 a.m., Resident #45 was observed in the dining room and remained unshaven and appeared unkempt. Review of the shower schedule revealed Resident #45 was scheduled for showers on Tuesdays, Thursdays, and Saturdays during the 3:00 p.m., to 11:00 p.m., shift. Review of the Certified Nursing Assistant (CNA) documentation for 1/1/24 to 1/23/24 showed Resident #45 received four of the 10 scheduled showers. On 1/9/24 the CNA noted the resident refused the shower. On 1/11/24 and 1/13/24 the CNA documented a sponge bath was provided. On 1/18/24 N/A (Not applicable) was entered for the scheduled shower. Review of the December 2023 CNA charting revealed Resident #45 received a sponge bath in place of the scheduled shower on 12/14/23, 12/16/23 and 12/29/23 No shower was documented on 12/19/23. Not applicable was documented on 12/21/23, and 12/23/23. The CNA documented the scheduled shower was refused 12/26/23. The clinical record lacked an explanation for the showers that were not given as per the schedule. 2. Review of the clinical record revealed Resident #85 had an admission date of 11/6/23 with diagnoses including, hemiplegia (paralysis of one side of the body) and hemiparesis (weakness of one side of the body) affecting his left side, vascular dementia and depression. Review of the admission MDS with a target date of 11/19/23 documented Resident #85 was dependent on staff for bathing, dressing and personal hygiene. The MDS noted Resident #85's cognitive skills for daily decision making were moderately impaired with a Brief Interview for Mental Status of 10. Review of the plan of care initiated on 11/19/23, showed Resident #85 had an ADL self-care deficit (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 5 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0677 due to chronic medical conditions. The Interventions included to encourage and assist with all ADL tasks as indicated, as tolerated by resident, Level of Harm - Minimal harm or potential for actual harm including locomotion/ambulation, bathing, bed mobility, transfers, toileting tasks, Residents Affected - Some meals, and personal/oral hygiene. On 1/22/24 at 2:26 p.m., Resident #85 was observed in bed with approximately seven days of facial hair growth. The resident said, they do not take good care of me here. They don't change me until the afternoon, they don't shower me or shave me. I don't get anyone to shave me, I ask but they don't do it. On 1/23/24 at 10:17 a.m., Resident #85 was observed out of bed in a high back wheelchair in the bathroom with CNA Staff E. In an interview, CNA Staff E verified Resident #85 approximately seven days of facial hair growth and needed to be shaved. Review of the shower schedule revealed Resident #85's showers were scheduled on Tuesdays, Thursdays, and Saturdays was scheduled on the 7:00 a.m., to 3:00 p.m., shift. Review of the CNA documentation for December 2023 documented Resident #85 received a sponge bath on 12/2/23, 12/28/23 and 12/30/23. The CNA documented the resident was unavailable for a shower on 12/7/23. A full bed bath was provided on 12/9/23, 12/12/23 and 12/14/23 in place of the scheduled showers. Review of the CNA documentation for 1/1/24 to 1/24/23 showed Resident # 85 refused showers on 1/2/24, 1/18/24 and 1/20/24. He received sponge bath on 1/13/24, and a full bed bath on 1/16/24 and 1/23/24. The clinical record lacked an explanation for the showers not provided as scheduled. On 1/24/24 at 12:03 p.m., in an interview CNA Staff F said the said she follows the unit shower schedule and if a resident refused, she would tell the nurse so she could document it. 3. Review of the clinical record revealed Resident #103 had an admission date of 11/21/23 with diagnoses including acute kidney failure, dementia, psychotic mood disorder and depression. Review of the admission MDS with a target date of 11/27/23 documented Resident #103 was dependent on staff for bathing, dressing and personal hygiene. The MDS noted Resident #103's cognitive skills for daily decision making were severely impaired. On 1/22/24 at 2:20 p.m., Resident #103 was observed with approximately seven days of facial hair growth. During the observation, Resident #103's wife said she was concerned the staff were not shaving or bathing her husband. She said she did not know if he had been showered since he arrived at the facility several weeks ago. The spouse was observed running her fingers through the resident's uncombed hair. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 6 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the memory care unit shower schedule revealed Resident #103 was scheduled for showers on Mondays, Wednesdays, and Friday on the 3:00 p.m., to 11:00 p.m., shift. Review of the CNA documentation showed Resident #103 received no scheduled showers from 1/1/24 to 1/23/24. He received a sponge bath on 1/1/24, 1/3/24, 1/8/24, 1/10/24, 1/15/24, 1/17/24, and 1/22/24. The documentation showed on 1/19/24 Resident #103 refused his shower. On 1/5/24 he received a full bed bath in place of the scheduled shower. The CNA documentation for December 2023 showed no scheduled showers were provided to Resident #103. The documentation showed not applicable on 12/1/23. refused his shower on 12/8/23 and 12/22/23. He received a sponge bath on 12/4/23, 12/6/23, 12/11/23, 12/13/23,12/15/23, 12/18/23, 12/20/23, 12/25/23, 12/27/23 and 12/29/23 in place of the scheduled showers. The clinical record failed to show documentation why the showers were not provided as scheduled. On 1/23/24 at 10:30 a.m., in an interview Unit Manager Registered Nurse Staff B said the men residing on the memory care unit are to be shaved daily and during showers. Staff B said you have to remember where you are, this is a dementia unit and they can refuse care if they want. The expectation is to provide a shave daily. If they refuse the CNA tells the nurse and it is documented. On 1/25/24 at 2:36 p.m., in an interview the Director of Nursing (DON) said the expectation was the scheduled showers were to be given and that applied to the residents on the memory care unit as well. On 1/25/24 at 6:45 p.m., the DON failed to provide documentation showing the residents received the scheduled showers. 4. The facility Standards and Guidelines for Call lights Issued on 3/2018 and revised 1/2024 stated Resident will have a call light to summon facility personnel to ensure the resident's needs will be met. The guidelines were Resident's call light is to be within reach and answered promptly by facility personnel. Answer call light promptly. All facility personnel are expected to respond to call lights; turn off call light; Listen to residents' requests. Do NOT make residents feel that you are too busy; Offer services before leaving the room; Respond to the resident's request, if unable to assist, notify the nurse. Return to the resident promptly with a reply. Clinical record review showed Resident #8 was admitted to the facility on [DATE]. The Annual MDS assessment with a target date of 12/19/23 noted the resident's cognition was moderately impaired with a Brief Interview for Mental Status score of 08. Resident #8 required substantial to maximal assistance for activities of daily living, including, transferring, and toileting. On 1/24/24 at 12:45 p.m., observed Resident #8 call light flashing. Unit Manager Registered Nurse Staff J and three other staff members were observed distributing lunch trays to residents on the hallway. They did not respond to the resident's call light. RN Staff J walked into Resident #8's room with a lunch tray and walked out of the room without addressing the call light. On 1/24/24 at 12:55 p.m., in an interview Resident #8 said he turned on the call light 30 minutes ago to request assistance to go to the bathroom. On 1/24/24 at 1:10 p.m., the call light was still on. In an interview RN Staff J said she did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 7 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some notice the call light on when she delivered Resident #8's lunch tray to his room, and the resident did not say he needed assistance. Staff J said it was important to hand out lunch trays to prevent the food to be cold. On 1/25/2024 at 11:00 a.m., Resident #8 was observed dressed and sitting up at bedside in his wheelchair. He said he'd like to receive at least one shower a week but has not had one in at least two weeks. Resident #8 said when he asks for a shower they always tell him tomorrow, but tomorrow never comes. Review of the shower schedule provided by the Director of Nursing showed Resident #8's scheduled shower days were Mondays, Wednesdays, and Fridays. Review of the shower documentation for January 1, 2024, through January 24, 2024, showed Resident #8 received two of the nine scheduled showers. The CNA documentation was left blank on 1/3/24, 1/8/24, 1/10/24, 1/12/24, 1/15/24, 1/17/24, and 1/22/24, making it impossible to determine if the resident received the scheduled shower. 5. Review of the clinical record for Resident #26 revealed an admission date of 2/3/15. The Quarterly MDS assessment with a target date of 12/28/23 showed the resident's cognition was intact with a Brief Interview for Mental Status score of 15. The resident was frequently incontinent of bowel and bladder. Resident #26 was dependent on staff for all activities of daily living, including toileting. The care plan revised on 8/17/23 noted to encourage and assist Resident #26 with activities of daily living tasks as indicated and tolerated by resident, including toileting tasks. The care plan noted the resident required two staff assistance for transfer with the use of a mechanical lift. On 1/22/24 at 9:40 a.m., in an interview Resident #26 said he felt the facility was short staffed as it frequently takes staff two hours to respond to his call light requests for assistance with toileting. On 1/25/24 at 11:30 a.m., Resident #26 was lying in bed and said he needed to be changed. He said staff just turned off the call light, and said they'll be back with help. Resident #26 said, Now I'll have to wait another two hours to be changed. On 1/25/24 at 2:00 p.m., in an interview Resident #26 said being wet or worse is uncomfortable and humiliating. Review of the ADL care documentation for January 1,2024 through January 25, 2024 failed to show documentation Resident #26 received assistance with ADL care, including toileting and personal hygiene on 1/1/24, and 1/22/24 (all three shifts), on 1/4/24, 1/10/24, 1/11/24, 1/15/24, 1/16/24, 1/18/24, 1/19/24, 1/20/24, 1/22/24, 1/23/24 or 1/24/24 (Morning shift), on 1/2/24, 1/5/24, 1/13/24, 1/17/24, 1/18/24, 1/19/24, 1/20/24, 1/21/24, 1/22/24, and 1/124/24 (Evening shift), on 1/2/24, 1/8/24, 1/11/24, 1/12/24, 1/14/24, and 1/22/24 (Night shift). 6. Review of the clinical record revealed Resident #37 was admitted on [DATE]. The Quarterly MDS assessment with a target date of 11/25/23 noted a Brief Interview for Mental Status score of 12, indicative of moderately impaired cognition. The MDS showed the resident was frequently incontinent of urine. Resident #37 was dependent on staff for toileting hygiene. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 8 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 1/23/24 at 10:32 a.m., Resident #37 said staff changed her incontinent brief maybe once a shift. Resident #37 said she felt the facility did not have enough staff as it took a while, usually 30 to 45 minutes to answer the call lights. On 1/24/24 at 11:20 a.m., in an interview Resident #37 said the average wait time to answer the call light was about 30 minutes. She said then staff comes in, turn it off come back later. Review of the CNA ADL documentation flowsheets for January 1, 2024, through January 25, 2024, failed to show documentation Resident #37 received assistance with toileting on 1/4/24 and 1/22/24 (all three shifts), on 1/1/24, 1/2/24, 1/3/24,1/4/24, 1/8/24, 1/12/24, 1/13/24, 1/14/24, and 1/22/24 (morning shift), on 1/4/24, and 1/22/24 (evening shift), on 1/1/24, 1/2/24, 1/4/24, 1/6/24, 1/7/24, 1/8/24, 1/9/24, 1/11/24, 1/12/24, 1/13/24, 1/18/24, 1/19/24, 1/20/24, and 1/22/24 (night shift). 7. Review of the clinical record revealed Resident #366 had an admission date of 1/16/24. The 5-day MDS assessment with a target date of 1/21/24 noted the resident was cognitively intact with a Brief Interview for Mental Status score of 15. The care plan initiated on 1/17/24 noted the resident needed assistance with ADL care related to multiple factors, including weakness, decreased mobility status post recent hospitalization, illnesses including arthritis, pneumonia, and flu. The interventions included encouraging and assisting the resident with all ADL tasks as indicated and as tolerated by resident, including personal hygiene. On 1/22/24 at 10:20 a.m., in an interview Resident #366, she has been here since last Tuesday (1/22/24). The resident said she was recently hospitalized for pneumonia and flu and needed assistance for showers and hygiene. Resident #366 said she was supposed to get a shower on Mondays, Wednesdays, and Fridays but to date has not received one despite her daily requests for shower. Resident #366 was in bed, dressed in a nightgown. She said she had a wipe off bath yesterday and has only brushed her teeth one time. Review of Resident #366's CNA shower record for January 16, 2024, through January 25, 2024, failed to show documentation the resident received the scheduled showers. On 1/17/24, 1/18/24, 1/21/24, and 1/24/24, sb (sponge bath) was entered with no explanation for the missed showers. On 1/25/24 at 11:10 a.m., in an interview Resident #366 said she did not receive any shower since her admission date of 1/16/24. She said she'll shower when she's discharged home. On 1/25/24 at 1:20 p.m., in an interview the Director of Nursing said the expectation was for residents to receive their showers on the scheduled days. She said there was no expectation to answer the call lights. She said staff could be busy and not able to answer the call lights. She said staff at the desk should get up and answer the call lights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 9 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Based on observation, record review, residents, resident representative and staff interviews, the facility failed to ensure sufficient nursing staffing to meet the needs of 8 (Residents #26, #37, #8, #45, #83, #85, 103 and #366) of 8 dependent residents. The failure to meet the residents' needs could lead to the residents not receiving services timely and not attaining or maintaining their highest practicable physical, mental and psychosocial well-being. The findings included: 1. On 1/22/24 at 2:42 p.m., Resident #45 was observed in a wheelchair in the hallway of the memory care unit. The resident's hair was uncombed, looked greasy and extended past his jaw line. Resident 345 had approximately seven days of facial hair growth. Resident #45 said he wanted a shave, shower, and a hair cut. On 1/23/24 at 8:48 a.m., Resident #45 was observed in the dining room. He remained unshaven and appeared unkept. Review of the Certified Nursing Assistants (CNAs) documentation for 1/1/24 to 1/23/24 showed Resident #45 received four of the 10 scheduled showers with no explanation for the missed showers or the sponge baths provided instead of the shower. 2. On 1/22/24 at 2:26 p.m., Resident #85 was observed in bed with approximately seven days of facial hair growth. The resident said, they do not take good care of me here. They don't change me until the afternoon, they don't shower me or shave me. I don't get anyone to shave me, I ask but they don't do it. On 1/23/24 at 10:17 a.m., Resident #85 was observed out of bed in a high back wheelchair in the bathroom with CNA Staff E. In an interview, CNA Staff E verified Resident #85 approximately seven days of facial hair growth and needed to be shaved. Review of the CNA documentation failed to reveal Resident #85 received all the scheduled showers. There was no explanation documented for the missed showers. 3. On 1/22/24 at 2:20 p.m., Resident #103 was observed with approximately seven days of facial hair growth. During the observation, Resident #103's wife said she was concerned the staff were not shaving or bathing her husband. She said she did not know if he had been showered since he arrived at the facility several weeks ago. The spouse was observed running her fingers through the resident's uncombed hair. The CNA documentation showed Resident #103 refused a shower on 12/8/23, 12/22/23, and 1/19/24. There was no explanation for the sponge baths provided instead of the showers on the days Resident #103 was scheduled for a shower and did not refuse. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 10 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0725 Level of Harm - Minimal harm or potential for actual harm On 1/23/24 at 10:30 a.m., in an interview Unit Manager Registered Nurse Staff B said the men residing on the memory care unit are to be shaved daily and during showers. On 1/25/24 at 2:36 p.m., in an interview the Director of Nursing (DON) said the expectation was the scheduled showers were to be given and that applied to the residents on the memory care unit as well. Residents Affected - Some 4. On 1/24/24 at 12:45 p.m., Resident #8 call light flashing. Unit Manager Registered Nurse Staff J and three other staff members were observed distributing lunch trays to residents on the hallway. They did not respond to the resident's call light. RN Staff J walked into Resident #8's room with a lunch tray and walked out of the room without addressing the call light. On 1/24/24 at 12:55 p.m., in an interview Resident #8 said he turned on the call light 30 minutes ago to request assistance to go to the bathroom. On 1/24/24 at 1:10 p.m., the call light was still on. In an interview RN Staff J said it was important to hand out lunch trays to prevent the food to be cold. On 1/25/2024 at 11:00 a.m., Resident #8 said he'd like to receive at least one shower a week but has not had one in at least two weeks. Resident #8 said when he asks for a shower they always tell him tomorrow, but tomorrow never comes. Review of the shower documentation for January 1, 2024, through January 24, 2024, showed Resident #8 received two of the nine scheduled showers. The CNA documentation was left blank on 1/3/24, 1/8/24, 1/10/24, 1/12/24, 1/15/24, 1/17/24, and 1/22/24, making it impossible to determine if the resident received the scheduled shower. 5. On 1/22/24 at 9:40 a.m., in an interview Resident #26 said he felt the facility was short staffed as it frequently takes staff two hours to respond to his call light requests for assistance with toileting. On 1/25/24 at 2:00 p.m., in an interview Resident #26 said being wet or worse is uncomfortable and humiliating. Review of the ADL care documentation for January 1,2024 through January 25, 2024 failed to show documentation Resident #26 received assistance with ADL care, including toileting and personal hygiene on 1/1/24, and 1/22/24 (all three shifts), on 1/4/24, 1/10/24, 1/11/24, 1/15/24, 1/16/24, 1/18/24, 1/19/24, 1/20/24, 1/22/24, 1/23/24 or 1/24/24 (Morning shift), on 1/2/24, 1/5/24, 1/13/24, 1/17/24, 1/18/24, 1/19/24, 1/20/24, 1/21/24, 1/22/24, and 1/124/24 (Evening shift), on 1/2/24, 1/8/24, 1/11/24, 1/12/24, 1/14/24, and 1/22/24 (Night shift). 6. On 1/23/24 at 10:32 a.m., Resident #37 said staff changed her incontinent brief maybe once a shift. Resident #37 said she felt the facility did not have enough staff as it took a while, usually 30 to 45 minutes to answer the call lights. On 1/24/24 at 11:20 a.m., in an interview Resident #37 said the average wait time to answer the call light was about 30 minutes. She said then staff comes in, turn it off come back later. Review of the CNA ADL documentation flowsheets for January 1, 2024, through January 25, 2024, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 11 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some failed to show documentation Resident #37 received assistance with toileting on 1/4/24 and 1/22/24 (all three shifts), on 1/1/24, 1/2/24, 1/3/24,1/4/24, 1/8/24, 1/12/24, 1/13/24, 1/14/24, and 1/22/24 (morning shift), on 1/4/24, and 1/22/24 (evening shift), on 1/1/24, 1/2/24, 1/4/24, 1/6/24, 1/7/24, 1/8/24, 1/9/24, 1/11/24, 1/12/24, 1/13/24, 1/18/24, 1/19/24, 1/20/24, and 1/22/24 (night shift). 7. On 1/22/24 at 10:20 a.m., in an interview Resident #366, she has been here since last Tuesday (1/22/24). Resident #366 said she was supposed to get a shower on Mondays, Wednesdays, and Fridays but to date has not received one despite her daily requests for shower. She said she had a wipe off bath yesterday and has only brushed her teeth one time. Review of Resident #366's CNA shower record for January 16, 2024, through January 25, 2024, failed to show documentation the resident received the scheduled showers. On 1/17/24, 1/18/24, 1/21/24, and 1/24/24, sb (sponge bath) was entered with no explanation for the missed showers. 8. On 1/22/24 at 11:46 a.m., Resident #83 was interviewed with the assistance of the facility's Medical Record Staff translating in Spanish, the resident's native language. Resident #83 said he had been at the facility for approximately six months and has not had a shower for at least three months. Resident #83 was unshaven with medium facial hair growth. A brown substance was observed underneath his fingernails. Review of the shower documentation for October 2023, November 2023, December 2023, and January 2024 revealed Resident #83 received two of the 44 scheduled showers (12/29/23 and 1/12/24). There was no explanation for the missed showers or the sponge baths, full bed baths and not applicable documented on the day of the scheduled showers. 9. On 1/22/24 at 8:34 a.m., Resident #45, and four other residents were observed in a wheelchair at the nurse's station of the secured unit. Registered Nurse (RN) Staff I was next to Resident #45 yelling, I need someone to babysit these people, I have to give medications. RN Staff I walked down the hall looking for staff as she kept yelling out loud, I need someone to babysit these people, I have to give medications. Three residents were observed in the hallway. 10. On 1/25/24 at 1:20 p.m., in an interview the Director of Nursing said the expectation was for residents to receive their showers on the scheduled days. She said there was no expectation to answer the call lights. She said staff could be busy and not able to answer the call lights. She said staff at the desk should get up and answer the call lights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 12 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0732 Post nurse staffing information every day. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review and staff interview, the facility failed to post the federal staffing hours daily at the beginning of each shift. Residents Affected - Few The findings included: On 1/22/24 at 7:30 a.m., upon entrance, the daily staffing information displayed in the main lobby was dated 1/19/24. No staffing information was observed for 1/20/24, 1/21/24, or 1/22/24. On 1/25/24 at 2:53 p.m., the Director of Nursing verified the staffing information was not displayed on 1/20/24, 1/21/24, or 1/22/24 for the morning shift. She said the staffing information should be displayed daily, including weekends. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 13 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on record review, review of facility's policy and procedure, resident and staff, the facility failed to implement processes to ensure timely acquiring and receiving of physician's ordered medications to meet the needs of 1 (Resident #367) of 7 newly admitted residents reviewed. The findings included: The Standards and Guidelines for Medication Reconciliation Admission/re-admission Issued 7/2017 and revised 2/2023 standard stated, The purpose of this procedure is to ensure medication safety by accurately accounting for the resident's medications, routes, and dosages upon admission or readmission to the facility. Review of the clinical record for Resident #367 revealed an admission date of 1/17/24. Diagnoses included acute respiratory failure with hypoxia (lack of sufficient oxygen in the blood), Emphysema (type of lung disease), pneumonia and anxiety. The admitting physician's orders dated 1/17/24 included Albuterol inhaler (used to prevent and treat difficulty breathing) every four hours as needed for wheezing, and Xanax 2 milligrams every 12 hours as needed for anxiety. Resident #367's care plan initiated on 1/17/24 noted the resident uses anti-anxiety medications related to Anxiety disorder. The interventions included to administer the anti-anxiety medications as ordered by the physician. The care plan also noted the resident was at risk for altered respiratory status and difficulty breathing due to Chronic Obstructive Pulmonary Disease (COPD), Emphysema and Pneumonia. The interventions included to administer medication, inhalers and nebulizers as ordered. On 1/22/24 at 11:00 a.m., in an interview Resident #367 said she uses an Albuterol inhaler every four hours and had the inhaler with her when she arrived at the facility on 1/17/24. She said the staff took the inhaler from her and she hasn't had her Albuterol inhaler since 1/17/24. Resident #367 said it made her anxious not to have her inhaler available in case she needed it for her shortness of breath. On 1/23/24 at 10:25 a.m., Resident #367 complained she still had not received her Albuterol inhaler or her Xanax since 1/17/24. She said she's asked for the Albuterol and the Xanax every day and still has not received them. Resident #367 said she did not sleep at all the night before since she did not have her Xanax (anti-anxiety) that she usually takes twice a day. On 1/23/24 at 3:30 p.m., in an interview Unit Manager Registered Nurse (RN) Staff J verified the Albuterol and the Xanax have not been available to administer to the resident since her admission date of 1/17/24. She said it should not take more than 24 hours to obtain a medication for a new resident. Upon reviewing the clinical record, Staff J said the Albuterol order was entered incorrectly in their system therefore the pharmacy did not fill the prescription. On 1/24/24 at 9:45 a.m., in an interview the Director of Nursing (DON) said if the Physician wrote the order for a medication on 1/17/24, it should be at the facility by 1/19/2024 at the latest. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 14 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The physician's orders for the Albuterol inhaler and the Xanax 2 milligrams every 12 hours as needed for anxiety specified a start date of 1/17/24. On 1/24/24 at 12:10 p.m., in an interview the DON said the pharmacy missed the order and they have been calling nightly to get the medication. The DON was not able to provide documentation of the nightly calls to the pharmacy. Review of the Medication Administration Record (MAR) for 1/17/24 through 1/23/24 failed to show documentation Resident #367 received the physician's ordered Albuterol or Xanax since the admission date of 1/17/24. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 15 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on review of the clinical record, and staff interviews, the facility failed to act upon the consultant pharmacist's recommendation for behavior monitoring for 1 (Resident #85) of 5 residents sampled for unnecessary medications review. The findings included: Review of the clinical record for Resident #85 revealed a physician order dated 11/8/23 to administer Quetiapine Fumarate 12.5 milligrams by mouth at bedtime for psychosis. Review of the Pharmacy Consultant medication review dated 11/29/23, documented Please consider adding an order to monitor behaviors r/t (related to) the Quetiapine use. On 11/30/23, the physician agreed with the recommendation and documented, agree, please write order. Review of the Medication Administration Record (MAR) for December 2023, and January 2024 showed no documentation of behavior monitoring. On 1/25/24 at 12:07 p.m., the DON confirmed there was no documentation of behavior monitoring as ordered by the physician on 11/30/23 for Resident #85. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 16 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of facility policy and procedures and staff interviews, the facility failed to ensure insulin was properly dated when opened and failed to dispose of expired insulin stored in 1 of 1 medication cart observed on the secured unit of the facility. The findings included: The facility policy Storage of Medications (revised 11/20) documented, The expiration/beyond use date on the medication label is checked prior to administering. When opening a multi-dose container, the date opened is recorded on the container. On [DATE] at 8:30 a.m., during an observation of the memory unit medication cart with Registered Nurse Staff I the following was observed: 1. Resident #85 had one open bottle of Humalog sliding scale insulin date opened was [DATE] with the expiration date [DATE]. There was an additional opened bottle of Humalog insulin without a date of when it was opened. Photographic evidence obtained. 2. Resident #45 had one open bottle of Lispro/Humalog with expiration an expiration of date [DATE]. There was an additional opened bottle of Humalog insulin for Resident #45 without a date of when it was opened. Photographic evidence obtained. 3. Resident #43 had two opened bottles of Humalog insulin without a date of when they were opened. Photographic evidence obtained. Staff I verified the findings of the expired and undated insulin's stored in the medication cart. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 17 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of facility's policy and procedure, staff, resident and resident representative interviews, the facility failed to document a grievance and ensure prompt efforts to replace lost dentures for 1 (Resident #8) of 3 residents sampled for grievance resolution. Residents Affected - Few The findings included: The facility Standards and Guidelines for Grievances - Resident Rights issued 4/2017 and revised 6/2023 states Residents and their representatives have the right to file grievances, either orally or in writing, to the facility staff or to the agency designated to hear grievances. The Guideline states the Administrator and staff will make prompt efforts to resolve grievances to the satisfaction of the resident and/or representative. Review of the clinical record for Resident #8 revealed an admission date of 12/16/21. The Annual Minimum Data Set (MDS) assessment with a target date of 12/19/23 noted the resident's cognition was moderately impaired with a Brief Interview for Mental Status score of 08. Review of the Nutritional assessment dated [DATE] noted Resident #8 will be seeing a dentist to have his bottom denture replaced. On 1/22/2024 at 9:00 a.m., in a telephone interview Resident #8's Power of Attorney said Resident #8's got new lower dentures around October 2023 and they went missing at the facility three days later. She said she reported the missing dentures multiple times to the Administrator, and the Director of Social Services. They have offered no resolution; the dentures were still missing. On 1/22/24 at 10:00 a.m., in an interview Resident #8 said his bottom dentures went missing months ago. The facility has not done anything to replace them. Resident #8 was not observed with bottom dentures at the time of the interview. The grievance log from August 2023 until present was reviewed. There were no grievances documented regarding Resident #8's missing dentures. On 1/24/2023 at 3:30 p.m., in an interview the Social Service Assistant Staff L said she remembers Resident #8 getting new dentures but could not recall the dentures going missing. The Director of Social services present during the interview said she remembered something about the resident's dentures missing but could not recall any details. The Social Services Director did not offer any documentation or action taken related to the resident's missing dentures. She said normally a grievance would be filed. On 1/25/2024 at 10:55 a.m., in an interview Social Service Assistant Staff L verified the resident's bottom dentures were missing, and no grievance was filed. She said she arranged for the resident to get new dentures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 18 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0840 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide an active dialysis contract for 1 (Residents #46) of 1 resident reviewed for dialysis. The findings included: Resident #46 was admitted to the facility on [DATE] with a diagnosis of end stage renal disease (ESRD). Review of the clinical record revealed Resident #46 received dialysis on Mondays, Wednesdays, and Fridays at a local dialysis center as per the physician's order dated 6/14/23. The dialysis contract provided by the facility was dated 12/1/15, and was from the previous facility's owner. On 1/25/24 at 10:30 a.m., in an interview the Administrator confirmed there was no current contract with the dialysis center. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 19 of 20 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 106020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagleridge Health and Rehabilitation Center 13881 Eagle Ridge Drive Fort Myers, FL 33912 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 0849 Level of Harm - Minimal harm or potential for actual harm Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. Based on record review and interviews, the facility failed to provide an active Hospice contract for 6 (Residents #1, #11, #21, #24 #38, and #71) of 6 residents receiving Hospice services. Residents Affected - Some The findings included: Review of the facility's matrix on 1/22/24 revealed Residents #1, #11, #21, #24 #38, and #71 were currently receiving hospice services. The hospice contract provided by the facility was dated 4/25/17, and was from the facility's previous owner. On 1/24/24 at 4:00 p.m., in an interview the Administrator verified the contract provided was from the previous ownership. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106020 If continuation sheet Page 20 of 20