Health inspection·May 11, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of facility's policies and procedures, staff and resident interviews the facility failed to provide care and services in accordance with professional standards of practice for 2 (Resident #37, and #38) of 26 sampled residents. Residents Affected - Few The findings included: Facility policy PL.6-011, revised 12/2020, titled following physician orders stated, a physician order is required for, changes in plan of care, treatment changes and discontinuation of treatments. Facility Policy titled Referrals, Social Services, Revised December 2008 stated Social services personnel shall coordinate most resident referrals with outside agencies. Social Services will collaborate with the nursing staff or other pertinent disciplines to arrange for services that have been ordered by the physician. 1. Resident #38 was admitted on [DATE], with the diagnoses of Acute Disseminated Demyelination, Drug Induced Dyskinesia, (Tardive Dyskinesia), Dysphagia, Muscle Weakness, Peripheral Vascular Disease, Chronic Kidney Disease and Chronic Obstructive Pulmonary Disease. The Quarterly Minimum Data Set, dated [DATE] noted Resident #38's Brief Interview of Mental Status (BIMS) was 13 which indicated intact cognition. Clinical record review noted a physician's order dated 2/22/23 at 8:45 a.m., for Resident #38 to be seen by a Neurologist as soon as possible. On 5/9/23 at 3:29 p.m., the Assistant Director of Nursing (ADON) confirmed an order was written in February for a Neurology Evaluation. On 5/10/23 at 9:50 a.m., the ADON verified the Neurology appointment for Resident #38 had not been scheduled and offered no explanation for the delay. She said she would get it scheduled. On 5/11/23 at 11:21 a.m., Resident #38 said weeks ago he was supposed to see a neurologist for uncontrollable mouth and tongue movements but he had not heard anything about it. He said he's been taking prescribed medications three times a day for the uncontrollable movements but it has not helped at all. On 5/11/23 at 12:20 p.m., Registered Nurse (RN) Staff C stated on 2/22/23 at 9:22 a.m., she placed a check mark on the Medication Administration Record indicating a neurology appointment had been scheduled but was not able to find a corresponding progress note verifying the appointment was scheduled. 2. A review of the clinical record for Resident #37 revealed an admission date of 8/7/21. A quarterly Minimum Data Set assessment completed on 2/15/23 documented Resident #37's cognition was severely impaired. Resident #37 was rarely or never understood. The resident's diagnoses included dementia, and muscle weakness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106022 If continuation sheet Page 2 of 13 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 106022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Palmer Ranch Snf 5111 Palmer Ranch Parkway Sarasota, FL 34238 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm The care plan initiated on 4/11/22 noted Resident #37 was, scratching at self. Skin sleeves/geri-sleeves (skin protective sleeves) to bilateral upper extremities. The Certified Nursing Assistants instructions for Resident care noted to apply the protective geri-sleeves to both upper extremities, Resident scratching at self. Residents Affected - Few On 5/8/23 at 11:40 a.m., 12:20 p.m., and 3:22 p.m., Resident #37 was observed in bed. She was not wearing the geri-sleeves. On 5/9/23 at 9:48 a.m., and 3:40 p.m., Resident #37 was observed in a Broda chair. She was not wearing the protective geri-sleeves. On 5/9/23 at 3:43 p.m., Certified Nursing Assistant (CNA) staff C, stated she was familiar with Resident #37 and verified she was not wearing the protective sleeves on her arms. She said she had not seen the resident wear the sleeves recently. On 5/10/23 at 1:37 p.m., CNA Staff I confirmed resident was not wearing Geri-Sleeves today. He stated he has seen the sleeves but is not sure where they are, I've been so busy today, running around, I haven't had time to look for them. On 5/10/23 at 3:00 p.m., CNA Staff D stated Resident #38 should have the Geri-sleeves on. Review of the Treatment Administration Record for May 2023 showed on 5/8/23 and 5/9/23 the nurses placed a check mark verifying the Geri-sleeves were On in AM (morning), off at HS (bedtime) two times a day. On 5/10/23 at 5:00 p.m., the Director of Nursing (DON) said the task should not be documented on the Treatment Administration Record until it has been completed, and the documentation should not be charted as completed until the task is done. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106022 If continuation sheet Page 3 of 13 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 106022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Palmer Ranch Snf 5111 Palmer Ranch Parkway Sarasota, FL 34238 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on observation, record review, and staff interview, the facility failed to provide appropriate services to maintain highest level of range of motion for 1 (Resident #37) of 3 residents reviewed for limited range of motion and activities of daily living. The findings included: A review of the Clinical Services Policy, Support Activities of Daily living (ADL), effective 4/2022 stated residents should be provided with care, treatment, and services such that their activities of daily living do not diminish unless the circumstances of their clinical condition(s) demonstrate that diminishing ADLS are unavoidable. A review of the clinical record for Resident #37 revealed a Quarterly Minimum Data Set (MDS) assessment completed on 2/15/23 noted Resident #37 had functional limitation in Range of Motion (ROM) on one side of the upper extremities. The resident's cognition was severely impaired. The resident was rarely or never understood. Resident #37's diagnoses included Dementia, Contracture (deformity, rigidity of joint) of the right hand. The physician's orders dated 11/18/22 included the use of a Carrot (device to position the fingers away from the palm to protect from pressure, moisture and nail puncture) to the right hand every shift. Resident #37 care plan revised on 9/5/2021 noted a right hand contracture. The interventions included to use a carrot to the right hand at all times, as tolerated, off twice daily for hand hygiene. On 5/8/23 at 12:12 p.m., 3:22 p.m., and 5/9/23 at 9:48 a.m., Resident #37's right hand was observed tightly closed. The resident was not wearing a carrot or alternative device to prevent the fingernails from pressing into her palm. On 5/9/23 at 3:43 p.m., Certified Nursing Assistant (CNA) Staff E, confirmed the resident was not wearing the carrot to the right hand as ordered. She stated, I know how to do range of motion but there is not anything we do for her now. On 5/9/23 at 3:45 p.m., the Rehabilitation Director stated Resident #37 was not on a restorative program to maintain the current range of motion. The Director said not all residents were provided with restorative services, only those that tend to benefit and may continue to improve over time. On 5/10/23 at 1:37 p.m., CNA Staff I stated the Rehab Director brought a stuffed carrot to place in the resident's hand this morning. He stated he had never seen Resident #37 with a carrot before. On 5/10/23 at 2:53 p.m., the Rehab Director stated, I checked yesterday because I knew she was supposed to have one and realized she didn't have it. I got one for her this morning and gave it to the CNA. She should have it in her hand all the time except when they remove it for hygiene. Review of the documentation on the Treatment Administration Record for May 2023 showed the nurses placed a check mark each shift, including on 5/8/23, and 5/9/23 for, Carrot to right hand every shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106022 If continuation sheet Page 4 of 13 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 106022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Palmer Ranch Snf 5111 Palmer Ranch Parkway Sarasota, FL 34238 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 0688 Level of Harm - Minimal harm or potential for actual harm On 5/10/23 at 5:00 p.m., the Director of Nursing (DON) reviewed the documentation for carrot to right hand being charted from 5/1/23 through 5/10/23 confirming carrot was in place in the resident's hand. The DON confirmed the documentation should not be charted as completed until the task is done. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106022 If continuation sheet Page 5 of 13 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 106022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Palmer Ranch Snf 5111 Palmer Ranch Parkway Sarasota, FL 34238 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interviews and record review the facility failed to ensure 1 (Resident #1) of 5 residents reviewed with an indwelling foley catheter had a valid medical justification for continued use of an indwelling foley catheter (catheter placed in the bladder to drain urine). The facility failed to provide appropriate care and services to 2 (Resident #13 and #203) of 5 sampled residents with a urinary catheter to prevent urinary tract infections. The findings included: 1. On 5/8/23 at 10:18 a.m. Resident #1 was observed connected to an indwelling foley catheter. A review of Resident #1's medical record revealed Resident #1's initial admission was 5/3/22 with a readmission date of 4/27/23. Initial admission diagnoses were acute cystitis with hematuria, atherosclerotic heart disease, hyperlipidemia, anxiety disorder, syncope, and nonrheumatic aortic stenosis. The comprehensive nursing progress note dated 2/7/23 noted Resident #1 as continent of bowel and bladder. A hospital transfer form dated 4/21/22 stated Resident #1 was sent to the emergency room for an evaluation related to a fall. Resident #1 was alert, oriented, and able to follow commands. The functional status section noted Resident #1 did not have an indwelling foley catheter but needed assistance with toileting and Resident #1 was incontinent of the bladder only. The nursing comprehensive note dated 4/28/23 said Resident #1 was readmitted to the facility on [DATE] from the hospital after a fall resulting in a hematoma to her head. The progress note further said Resident #1 was alert and oriented times 3, vital signs were stable, and continent of bowel. The nursing comprehensive note dated 4/30/23 noted Resident #1 was alert and oriented, able to express her needs, and had a pleasant affect. Resident #1 had no complaints of pain and no signs and symptoms of distress. A Physician's order dated 4/28/23 for catheter care for indwelling catheter care every shift and monitoring for redness, irritation, swelling, and sign and symptoms of urinary tract infection was noted. A Physician's progress note dated 4/28/23 at 12:43 p.m. noted the chief complaint as transition of care encounter for readmission to the nursing home on 4/27/23. A review of the physician's progress note revealed no documentation of Resident #1's indwelling foley catheter or a justification for the continued use of the indwelling foley catheter. The Prevention of Catheter Associated Urinary Tract Infection Policy #CS-50-12, dated 1/2009 and last revised 7/2015, stated the purpose of these guidelines was to reduce the risk of urinary tract infection associated with the use of a catheter. Section A said the utilization of a urinary catheter when a resident's clinical condition demonstrated a need, the catheter would be left in place only as long as needed. A catheter could be used for residents with chronic urinary retention or bladder outlet obstruction, to assist in healing a stage 3 or 4 pressure ulcer in incontinent residents, or to improve comfort for end-of-life care if needed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106022 If continuation sheet Page 6 of 13 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 106022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Palmer Ranch Snf 5111 Palmer Ranch Parkway Sarasota, FL 34238 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 5/10/23 at 12:22 p.m. during an interview with the Risk Manager, he said prior to Resident #1 going to the hospital after a fall at the facility Resident #1 was continent of bowel and bladder. He said Resident #1 was readmitted to the facility on [DATE] with an indwelling foley catheter. He confirmed the Prevention of Catheter Associated Urinary Tract Infection policy stated an indwelling foley catheter could be used when a resident has a clinical condition which demonstrated a need for an indwelling foley catheter and the foley catheter should only be left inserted as long as needed. The Risk Manager reviewed Resident #1's medical record, and he said he was unable to find a clinical justification for the continued use of the foley catheter. On 5/10/23 at 3:41 p.m. during an interview with the Interim Director of Nursing (DON), she confirmed their Prevention of Catheter Associated Urinary Tract Infection #CS-50-12 policy stated an indwelling foley catheter could be used when a resident had a clinical condition which demonstrated a need for an indwelling foley catheter and the foley catheter should only be left inserted as long as needed. The interim DON said after she reviewed Resident #1's medical record, she was unable to find documentation related to the clinical justification for the continued use of the foley catheter after Resident #1 was readmitted to the facility on [DATE]. She said they would call Resident #1's primary care physician to determine if Resident #1 needed the foley catheter. On 5/11/23 at 11:04 a.m. the Interim DON said Resident #1's primary care physician said Resident #1 did not need a foley catheter, so they discontinued Resident #1's foley catheter on 5/10/23. 2. Review of Resident #13's admission Minimum Data Set (MDS) dated [DATE] indicated the resident had an indwelling urinary catheter on admission. Resident #13 required extensive assistance of 1-2 staff to move in bed, transfer from bed to chair, wheelchair, standing, and walking. Resident #13's Brief Interview for Mental Status (BIMS) score on admission was 15, indicating intact cognition, and Resident #13 did not reject care. Review of Resident #13's Indwelling Urinary Catheter Care Plan, initiated on 3/29/23, revealed interventions including Catheter Care per policy. Review of the facility policy for Urinary Catheter Care last revised 10/2016, the purpose of this procedure is to prevent infection of the resident's urinary tract. Policy Detail: 9. Be sure the catheter tubing and drainage bag are kept off direct contact with the floor. Review of Resident #13's Certified Nursing Assistant (CNA) Visual/Bedside Kardex Report as of 5/10/23 revealed special instructions for toileting including, The resident requires staff assistance to use toilet. There were no other instructions. On 5/8/23 at 12:41 p.m., observation of Resident #13's urinary catheter drainage bag, within a blue dignity bag lying on the floor. Resident #13 was in bed waiting for lunch. CNA Staff N walked into the resident's room with the lunch tray. Staff N approached the bed and the staff's foot bumped the urinary catheter collection bag that was on the floor. Staff N set down the lunch tray but left the urine drainage bag on the floor. Staff N walked out of the room. On 5/8/23 at 2:17 p.m., observed Resident #13 in bed, urinary catheter drainage bag lying on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106022 If continuation sheet Page 7 of 13 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 106022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Palmer Ranch Snf 5111 Palmer Ranch Parkway Sarasota, FL 34238 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 0690 floor. Level of Harm - Minimal harm or potential for actual harm On several additional observations of Resident #13 in bed on 5/9/23 at 8:50 a.m., 5/9/23 at 1:24 p.m., 5/9/23 at 3:00 p.m., and 5/10/23 at 8:55 a.m., the urinary drainage bag was lying on the floor. Residents Affected - Few On 5/10/23 at 9:29 a.m., CNA Staff M said Resident #13 cannot get out of bed by himself and needs staff to help him out of and back into bed. On 5/10/23 at 10:09 a.m., Physical Therapist (PT) Staff L confirmed Resident #13 needs staff to assist him out of and back into bed. 3. Review of Resident #203's admission MDS with an Assessment Reference Date (ARD) of 5/10/23 revealed resident did not reject care, had a BIMS score of 15, meaning cognitively intact, required to staff to move in bed, transfer to chair and wheelchair, and had not walked in his room. The MDS also revealed the presence of indwelling urinary catheter. Review of Resident #203's Care Plan for Indwelling Urinary Catheter initiated on 5/4/23 revealed interventions including Catheter Care per policy. Review of the CNA Visual/Bedside Kardex Report as of 5/10/23 with special instructions for bladder and bowel revealed Resident #203's urinary catheter bag and tubing to be positioned below the level of the bladder. There were no other instructions. Review of Resident #203's Order Summery Report dated 5/10/23 did not reveal instructions for the urine drainage bag. On 5/08/23 at 9:20 a.m. and 5/9/23 at 9:00 a.m., Resident #203 observed in bed, urinary catheter drainage bag laying on the floor. On 5/10/23 at 9:11 a.m., the Interim Director of Nursing (DON) and the newly appointed DON were, and the Infection Preventionist, Licensed Practical Nurse (LPN) Staff F agreed it was not an acceptable standard of practice to store urinary catheter bags on the floor. On 5/11/23 at 1:15 p.m., CNA Staff N confirmed she cared for Residents #13 and #203 on 5/8/23 and 5/9/23. Staff N said she thought if the urine drainage bag was in a dignity bag it was okay to be on the floor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106022 If continuation sheet Page 8 of 13 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 106022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Palmer Ranch Snf 5111 Palmer Ranch Parkway Sarasota, FL 34238 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. Based on record review, observation and staff interview the facility failed to ensure all drugs and biologicals were labeled or stored in a locked compartment for 2 (Residents #32 and #39) of 2 residents reviewed for medication storage. The findings included: Facility Policy and Procedure for Resident Self-Administration of Medications-MED-4, revised on 3/19 states It is the policy of Brookdale that those residents who desire to self-administer medications may do so if the review determines the resident is capable: 1) If the resident desires to self-administer medications, the charge nurse will review the resident's mental and physical abilities in conjunction with a Self-Administration of Medication Data Collection; 2) This skills review is conducted as part of the care plan process including (but not limited to) the resident's: ability to read and understand medication labels, comprehension of the purpose and proper dosage and administration times of the medications, ability to remove medications from the package and, in case of nonsolid dosage forms such as an inhaler, to verbalize the steps in administration, ability to recognize risks and adverse reactions of the medications . 5) Obtain health care provider's order that the resident may self-administer . 7) Self-administered medications must be stored in a safe and secure place, which is not accessible to other residents. If safe storage is not possible in the resident's room, the medication will be stored in the medication cart and returned to resident upon request . 9) The charge nurse/Interdisciplinary team (IDT) should review the resident's capability quarterly, and as needed, for the appropriateness of continued participation in self-administration of medications, and update the care plan when indicated. 1. Review of the clinical record for Resident #32 revealed an admission date of 10/15/22. The Quarterly Minimum Data Set (MDS) assessment with a target date of 5/11/23 revealed Resident #39 scored a 14 on the Brief Interview for Mental Status, indicating cognitive intact. There was no self-administration assessment or a physician order to keep medications, including inhalers at bedside. On 5/8/23 at 9:56 a.m., Resident #32 was observed lying in bed. Resident #39 had an inhaler stored on his bedside table. Resident #32 said the inhaler medication belonged to him. On 5/9/23 at 11:00 a.m., Resident #32 was observed sleeping in bed. The inhaler remained stored on top of his bedside table. On 5/9/23 at 11:47 a.m., the Assistant Director of Nursing (ADON) and Infection Control Preventionist (ICP), verified the inhaler medication was stored unsecured on Resident #32's bedside table, and said it should be in a locked box. On 5/11/23 at 12:29 p.m., the Infection Control Preventionist (ICP) said Resident #32 did not have a self-administration assessment or an order to keep medication at bedside. 2. On 5/8/2023 at 1:30 p.m., observed a bottle of antacids on Resident #39's bedside table. Resident #39 said he takes them when he gets an upset stomach. There was also a white unlabeled bottle of pills with an orange lid with green gel pills stored on the bedside table. The resident said they were pills to help him sleep. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106022 If continuation sheet Page 9 of 13 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 106022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Palmer Ranch Snf 5111 Palmer Ranch Parkway Sarasota, FL 34238 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 On 5/9/2023 at 10:30 a.m., the administrator verified there should not be unsecured medications at residents' bedside and started a performance improvement plan to address unsecured medications at the bedside. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106022 If continuation sheet Page 10 of 13 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 106022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Palmer Ranch Snf 5111 Palmer Ranch Parkway Sarasota, FL 34238 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 Based on observation, interview, record review, staff and resident interview the facility failed to provide timely dental care services to meet the needs of 1 (Resident #38) of 1 resident reviewed for dental services. Residents Affected - Few The findings included: The facility policy titled Oral Health Care and Dental Services-CS-110-2, revised 11/2017, stated Oral health care and dental services will be provided to each resident. The nursing associates will conduct oral health evaluations on admission and at least quarterly (through the MDS) process. The charge nurse or designee will request a consultation if needed. Social Services or designee will be responsible for making necessary dental appointments. Review of the clinical record for Resident #38 revealed an admission date of 7/21/22. The Quarterly Minimum Data Set with an ARD of 2/26/23 indicated the resident's cognition was intact. No oral concern were noted. Clinical record review noted resident #38 had an order for a dental consult for dentures related to eating/diet on 1/6/2023. On 5/8/23 at 3:27 p.m., Resident #38 was observed in his room. He stated he has no teeth, and it makes it hard for him to eat. He stated he does not have pain. He stated he has been waiting to see the dentist to get dentures, they made that appointment today. On 5/9/23 at 2:34 p.m., the Social Service Director (SSD) said she has been employed at the facility since August 30, 22. She said she became aware of the request to see the dentist in late March. Resident #38 was referred to the facility dentist on 3/27/23 but was not seen because of Resident #38's payor source. They had to refer to an outside dentist. On 5/8/23 a dentist appointment was obtained and scheduled for 5/22/23. She said nursing did not inform her of the request to see the dentist. On 5/9/23 at 3:29 p.m., the Assistant Director of Nursing verified the dental order was written on January 6,2023 for resident #38. She was unable to locate any documentation explaining the delay in arranging dental services for Resident #38. On 5/10/23 at 10:54 a.m., the Speech and Language Pathologist said teeth would be beneficial to be able to get to a regular diet and prevent the resident from food getting stuck in his cheeks and gums. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106022 If continuation sheet Page 11 of 13 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 106022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Palmer Ranch Snf 5111 Palmer Ranch Parkway Sarasota, FL 34238 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 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on record review, and staff interviews the facility failed to ensure the Dietary Manager was qualified per the regulation. The failure could potentially lead to therapeutic menus not being followed, portion sizes not being followed, and clinical indicators of nutritional deficits not being addressed in a timely manner. The findings included: The facility job description, POL 147; revised 9/12/2018 stated the primary responsibility was to organize and coordinate the Food and Nutrition Services Department's clinical program. The facility job description stated the Registered Diet Technician has completed a 2 year degree program and passed the exam. A minimum of 1 year of dietary management experience, preferably in a health care setting, is required. The Dietary Manager orientation guide dated 10/28/22 revealed section G was not completed. Section G included a review of local/state/federal regulations and the food code. On 5/9/23 at 3:01 p.m., the Registered Dietician (RD) stated she was contracted to work 18 hours per week. The RD was required to complete quarterly notes, consultations, new admission assessments, annual assessments, and reviews high risk residents. She said her role in the kitchen was to perform monthly and quarterly sanitation audits. The RD verified residents may choose multiple entrees to be served for each meal. On 5/10/23 at 12:10 p.m., the Dietary Manager stated he was hired 4/11/22 as a Certified Nursing Assistant (CNA). He stated his past employment experience has been as a CNA. He stated he has not had prior food service or dietary experience. He stated he was responsible for all dietary services of the nursing and assisted living facility. On 5/10/23 at 12:56 p.m., the Administrator verified the Dietary Manager did not have the requirements, and was not qualified to be a Dietary Manager. On 5/11/23 at 9:16 a.m., the Dietary Manager stated he was hired by the facility with the knowledge he was not certified and did not have prior experience in food services. He stated he was told it was acceptable if he enrolled in school. On 5/11/23 at 10:00 a.m., the RD stated the facility was aware of the regulation related to dietary management staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106022 If continuation sheet Page 12 of 13 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 106022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Palmer Ranch Snf 5111 Palmer Ranch Parkway Sarasota, FL 34238 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, record review, and interview, the facility failed to store and serve food in accordance with professional standards for food service and safety and ensure food was handled in a sanitary manner that prevented cross contamination. The findings included: Cross-contamination means the transfer of harmful substances or disease-causing microorganisms to food by hands, food contact surfaces, sponges, cloth towels, or utensils which are not cleaned after touching raw food, and then touch ready-to-eat foods. Cross-contamination can also occur when raw food touches or drips onto cooked or ready-to-eat foods. This had the potential to affect all 55 residents who reside in the facility and receive food from the kitchen. Facility policy titled, Storage of Perishable Food-DS-04.014; effective 2005 stated: Perishable food must be refrigerated in a manner that optimizes food safety, nutrient retentions, and aesthetic quality. Perishable foods include fruits, vegetables, meats, daily etc. All pre-dished items must be covered, labeled, and dated to prevent off-flavors, drying, or cross-contamination while refrigerated. On 5/8/23 at 9:26 a.m., during an initial tour of the kitchen two trays of fish were observed uncovered and undated in the refrigerator. On a separate rack chicken was observed in marinade, not dated. Chopped green peppers were open, not dated and brown lettuce with a use by date of 5/7/23 was observed. The Executive Chef verified these items were not stored in a safe and sanitary manner and stated it would be corrected. On 5/9/23 at 8:58 a.m., during a follow up tour to the kitchen with the Dietary Manager, lima beans were found open, and desert was plated. Both were not dated and uncovered. The Dietary Manager stated he would ensure it was corrected. Observation of the facility refrigerator noted Pepsi and skittles. The Dietary Manager said they belonged to the staff. He removed them and stated they should not be stored there. On 5/9/23 at 11:39 a.m., during tray line observation with the Dietary Manager and Registered Dietician, staff N, facility cook was noted plating raw shrimp, lettuce and tomatoes, with gloved hands. On multiple occasions he was observed wiping his gloved hands on his apron, entering the refrigerator to restock salad items, and touching meal tickets without changing his gloves or washing his hands. The Dietary Manager and Dietician instructed him to use tongs to plate the cold food items. He proceeded to use the tongs to pick up the shrimp and tomatoes, placed them in his hand prior to placing them on the plate. The dietary manager and Registered Dietician stated they would begin education and in-service after lunch service was completed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106022 If continuation sheet Page 13 of 13