Inspection·June 17, 2021

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few other side of the bed, where it would not be visible to anyone walking by. When asked what she has been trained to do, Staff A, CNA stated it should be inside a bag for privacy. An interview was conducted with Staff B, LPN unit nurse on 06/16/21 at 09:44 am. Staff B was asked what to expect related to catheter bag storage. Staff B, LPN stated that it should not be exposed, the catheter should be in a bag for dignity reasons. On 06/16/21 03:53 p.m. an interview was conducted with Staff C, CNA. When asked if she has taken care of resident #32's catheter, Staff C stated that she empties it all the time. When asked if she had noticed that it was not stored in a bag, Staff C, CNA said, Yes, and I replaced it this morning and I put it inside a privacy bag. When asked if it should have been in a bag all along, Staff C stated catheters should be covered for privacy. A follow up interview was conducted on 06/16/21 at 08:35 a.m. with the DON (Director of Nursing) who confirmed that she noticed the incident this morning and it was a dignity issue. The DON further stated that the catheter bag should be covered and she asked Staff C, CNA to change the resident's catheter and make sure it is inside a bag for privacy. The DON stated she would start an in-service to remind all staff of the expectation. A review of the facility's assessment tool originally issued October 2017 and recently updated on January 5, 2021, under resident support / care needs revealed that the facility provides Bowel / bladder care and training including bowel and bladder training programs, incontinence prevention and care in order to maintain continence and promote resident dignity. A review of the facility's policy titled, Dignity reviewed on 05/19/20, policy states that each resident has the right to be treated with dignity and respect. Page 2, number 7 of the policy gives examples of treating residents with dignity and respect including but not limited to: refraining from practices demeaning to residents, such as leaving urinary catheter bags uncovered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 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 106025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Sarasota 8104 Tuttle Ave Sarasota, FL 34243 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and staff interviews the facility failed to provide two (#41, #86) of five residents sampled, or their representatives, with a written copy of the notice of transfer when they were transferred to an acute care facility. Findings included: 1) Resident # 41 was admitted to the facility on [DATE] with the principal diagnosis of cerebral palsy, other pertinent diagnoses included hemiplegia, deaf and non-speaking, Barrett's esophagus, dysphagia and gastrostomy status. Resident # 41's comprehensive Minimum Data Set (MDS) dated [DATE] reflected that Resident #41's brief interview for mental status (BIMS) could not be completed, the document also reflected that he had a feeding tube, and was non-verbal. A review of the nurse progress notes revealed an event dated 03/28/21. Shortly before midnight on 03/27/21, it was discovered that Resident # 41 had produced coffee grounds emesis. The record revealed an order from the Physician Assistant to transfer Resident # 41 to an acute care facility for evaluation. The nurse progress note documented that the health care surrogate (HCS) was notified. During an interview with Resident #41's HCS on 06/15/21 at 4:45 p.m., she confirmed that she received a call on 03/28/21 at one in the morning that the Resident had been transferred to the hospital, she stated that she never received a written notification of the transfer. An interview with the Director of Nursing (DON) conducted on 06/17/21 at 2:03 p.m. revealed that the nurse had documented a progress note for the transfer of Resident #41 on 03/28/21, she added that there was no other documentation in the record, and said the transfer packet which is our usual procedure was not completed for this transfer. A review of the facility's transfer packet revealed that it consisted of 1. the facility Bed Hold Policy, 2. AHCA (Agency for Health Care Administration) Form 3120-0002 April 2014 Nursing Home Transfer and Discharge Notice, 3. A Capabilities List (listing of the contact information for staff at the facility who can take off-hours calls related to hospital admissions and the return to the facility) 4. An attachment listing additional services available at the facility 5. Florida Health Care Association's SNF (Skilled Nursing Facility) to Hospital and Hospital to SNF COVID 19 Transfer Communication Tool, 6. Acute Care Transfer Document Checklist. 2) Resident # 86 was admitted to the facility on [DATE] with the principal diagnosis of fibromyalgia, other pertinent diagnoses included cognitive communication deficit, type II diabetes mellitus with diabetic neuropathy, obesity, and hypertensive heart disease with heart failure. Resident #86's most recent quarterly MDS (minimum data set) dated 05/13/21 reflected a BIMS score of 14, indicating the resident had minimal to no cognitive impairment, the MDS section Q (participation in assessment and goal setting) documented that Resident #86 participated in the assessment and had no other legally authorized representative. A review of the Nursing Home to Hospital Transfer Form dated 05/01/21 at 07:57 a.m. revealed she was transferred to the hospital for evaluation of red swollen and painful bilateral lower extremities. The record included a copy of the facility's bed hold policy effective 11/28/16 signed by Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 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 106025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Sarasota 8104 Tuttle Ave Sarasota, FL 34243 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 0623 # 86 on 5/1/21. Level of Harm - Minimal harm or potential for actual harm An interview was completed on 06/17/21 with the Director of social service Staff I, she confirmed that residents who are their own responsible parties are asked to sign the bed hold policy document when they are transferred to the hospital. Staff I stated that transfer notices are not provided in writing to residents or their representatives, she confirmed that transfer notices in written form are faxed to the office of the State Long-term Care Ombudsman via a batch transfer performed monthly by the medical records department. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 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 106025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Sarasota 8104 Tuttle Ave Sarasota, FL 34243 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 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and staff interviews the facility failed to provide one (#41) of five residents sampled, or their representatives, with a bed hold notice when they were transferred to an acute care facility. Findings included: Resident # 41 was admitted to the facility on [DATE] with the principal diagnosis of cerebral palsy, other pertinent diagnoses included hemiplegia, deaf and non-speaking, Barrett's esophagus, dysphagia and gastrostomy status. Resident # 41's comprehensive Minimum Data Set (MDS) dated [DATE] reflected that Resident #41's brief interview for mental status (BIMS) could not be completed, the document also reflected that he had a feeding tube, and was non-verbal. A review of the nurse progress notes revealed an event dated 03/28/21. Shortly before midnight on 03/27/21, it was discovered that Resident #41 had produced coffee grounds emesis. The record revealed an order from the Physician Assistant to transfer Resident # 41 to an acute care facility for evaluation. The nurse progress note documented that the health care surrogate (HCS) was notified. During an interview with Resident #41's HCS on 06/15/21 at 4:45 p.m. She confirmed that she received a call on 03/28/21 at one in the morning that the Resident had been transferred to the hospital, she stated that she never received a written notification of the transfer and was not given any information on the bed hold policy. An interview with the Director of Nursing (DON) conducted on 06/17/21 at 2:03 p.m. revealed that the nurse had documented a progress note for the transfer of Resident #41 on 03/28/21, she added that there was no other documentation in the record, she added, the transfer packet which is our usual procedure was not completed for this transfer. A review of the facility's transfer packet revealed that it consisted of 1. the facility Bed Hold Policy, 2. AHCA (Agency for Health Care Administration) Form 3120-0002 April 2014 Nursing Home Transfer and Discharge Notice, 3. A Capabilities List (listing of the contact information for staff at the facility who can take off-hours calls related to hospital admissions and the return to the facility) 4. An attachment listing additional services available at the facility 5. Florida Health Care Association's SNF (Skilled Nursing Facility) to Hospital and Hospital to SNF COVID 19 Transfer Communication Tool, 6. Acute Care Transfer Document Checklist. An interview was completed on 06/17/21 with the Director of social service Staff I, she confirmed that residents who are their own responsible parties are asked to sign the bed hold policy document when they are transferred to the hospital, Staff I stated that if their condition is such that they cannot sign it, then we obtain their consent over the phone, or the facility's liaison visits the hospital to obtain the signature when they are able to sign. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 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 106025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Sarasota 8104 Tuttle Ave Sarasota, FL 34243 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** Based on observations, interviews and record review, the facility failed to ensure that nail care was provided for one (#41) of 28 residents sampled as evidenced by the observations of the long fingernails on Resident #41's left hand and documentation from the record and interviews related to the condition of Resident #41's fingernails and toenails. Residents Affected - Few Findings included: Observations of Resident #41 fingernails were done during a facility tour conducted on the University hallway on 06/14/21 at 9:28 a.m. they revealed a right hand with nails trimmed and the left hand with long thin nails with rough edges. Subsequent observations of Resident #41 fingernails on 06/14/21 at 12:30 p.m., and on 06/15/21 at 09:06 a.m. and 1:15 p.m. revealed the same findings; the fingernails of the right hand were trimmed, and the fingernails of the left hand were long thin and with rough edges. Resident #41 was admitted to the facility on [DATE], with diagnoses to include: cerebral palsy, hemiplegia, deaf and non-speaking, left elbow contracture, the need for assistance with personal care, and abnormal posture. A review of the Minimum Data Set (MDS) dated , 04/08/21 Section C (cognitive pattern) revealed a Brief Interview for Mental Status (BIMS) of 99 indicating that Resident #41 was unable to complete the assessment. A review of the care plan for Resident #41 revealed foci that included: initiated on 01/10/2019, The resident is at risk for break in skin integrity related to incontinence, immobility, weakness, contracture and deformity. Left upper extremity pain, percutaneous endoscopic gastrostomy (PEG) tube site, condom catheter. Interventions for this focus directed the certified nurse aide (CNA) to cleanse the left upper extremity and left hand between the skin folds, dry thoroughly, apply moisturizer, and cut nails as needed. Another focus initiated on 07/25/19 indicated: The resident requires ADL (Activity of Daily Living) assistance and therapy services as needed to maintain or attain the highest level of function for this Resident with congenital cerebral palsy, aspiration pneumonia, PEG insertion, pulmonary embolism, long history of dysphagia, Barrett's esophagus, and left hemiplegia. Interventions for this focus directed the nurse and CNA to assist with mobility as needed initiated 01/10/19. Requires extensive assistance with hygiene, oral care every shift initiated 07/25/21. Requires extensive/total assist of one with toileting and hygiene initiated 01/22/19. Transfers with extensive assist 1-2 persons, has left hemiplegia, stands on right lower extremity, left upper extremity contracture, attention to skin care initiated 10/27/19. Turn and reposition every 2 hours and as needed initiated 08/12/19. Uses gestures, interpreter (sister), uses I-pad to communicate needs initiated 01/10/19. During an interview with Resident #41's sister and health care surrogate (HCS) on 06/15/21 at 16:45, she expressed frustration related to the condition of Resident #41's fingernails and toenails, she stated that the nails grow quickly and are not maintained as needed for proper hygiene, she stated that she must remind the facility of this and did so during the most recent care plan meeting on 4/27/21. The HCS stated that when Resident #41 was transferred to the hospital on 3/28/21 she observed his nails, she stated that his fingernails on both hands were very long and jagged, and his toenails were long and thick, so long in fact that they were curling under. She stated that she was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 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 106025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Sarasota 8104 Tuttle Ave Sarasota, FL 34243 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 - Few horrified at the state of his toenails. She stated that Resident #41, . has always been a very clean and neat person, and this upsets him very much. An interview with Staff H, RN was conducted on 06/15/21 at 5:30 p.m. at which time Staff H, RN confirmed that Resident #41's sister had asked her to cut the fingernails of his left hand earlier that day, she stated that she was happy to do it when asked. An interview was conducted on 06/16/21 at 9:30 a.m. with Staff G, CNA in which she confirmed that Resident #41's fingernails are trimmed on Sundays. Staff G, CNA stated that because of the contracture of his left arm she is not comfortable trimming his fingernails, she stated that she would tell the nurse if she observed that his fingernails needed to be trimmed. Staff G, CNA could not recall the most recent time she noticed that Resident 41's fingernails needed trimming. A follow-up interview was conducted with the director of nursing (DON) on 06/16/21 at 3:30 p.m. at which time the DON confirmed that Resident #41's sister had expressed concern that his toenails and fingernails were not being trimmed on a regular basis. She confirmed she was aware that CNAs were not comfortable performing nail care on Resident #41's left hand. The DON stated that the nurse could perform the task instead of the CNA. The DON could not confirm that this directive had been communicated to nursing, including in the form of a revised care plan. An interview was conducted on 06/17/21 at 03:29 p.m. with Staff I who confirmed that she was responsible for scheduling appointments with the podiatrist for Resident #41. Staff I stated that during the care plan meeting on 04/27/21, Resident #41's HCS brought concerns related to his fingernails and toenails that needed trimming, Staff I stated that the nurse present took care of the fingernails at that time. Staff I stated and then provided documentation that Resident #41 was an established patient of (Clinic Name) Podiatry and received services from them on 05/11/21. Staff I could not confirm the prior date that Resident #41 received services from (Clinic Name) Podiatry and did not provide any additional documentation for any additional services prior to our exit on 06/17/21 at 19:30 p.m. Review of the documentation for the services provided to Resident #41 from (Clinic Name) Podiatry Group of Florida on 05/11/21 revealed the following: Patient seen at the request of a representative from the facility . SEE AS EMERGENCY, the document reads under subjective: This [AGE] year old male returns and presents with toe nails that are difficult to cut. The patient is under the care of Dr. (Name). Mycotic Nail Pain: Painful when debriding and pain with palpitation. Objective: There are 10 mycotic nails located on L1, L2, L3, L4, L5, R1, R2, R3, R4, R5, long, thick, discolored, +odor, +subungual debries, painful and long toenails, incurvated, painful on palpation. Assessment: .Tinea unguium, .Pain in right toe(s), .Pain in left toe(s) Plan: .Sharply debrided 1-10 symptomatic dystrophic nails by manual debridement with the use of nail nippers to decrease pain, as required by medical necessity .Sharply debrided 6-10 symptomatic nails. Manual debridement by use of nail nippers to debride all fungal nails in order to decrease pain and risk as required by medical necessity. Review of the Facility's policy for Activities of Daily Living (ADLs) with a revised date of 5/5/2020 revealed the following: Purpose, to ensure facilities identify and provide needed care and services that are patient centered ., Policy, the resident will receive assistance as needed to complete ADLs. Any change in the ability to perform ADLs will be documented and reported to the licensed nurse .A resident who is unable to carry out activities of daily living receives the necessary services to maintain .grooming, and personal and oral hygiene .Procedure, for fingernail care, the following procedure will be followed: 1. Ensure fingernails are clean and trimmed to avoid injury and infection. 2. Explain the importance of fingernail care to the resident ., 5. Report any abnormalities to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 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 106025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Sarasota 8104 Tuttle Ave Sarasota, FL 34243 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 nurse. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 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 106025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Sarasota 8104 Tuttle Ave Sarasota, FL 34243 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure that a mechanically altered therapeutic diet was provided according to orders for one (Resident #97) out of eight sampled residents. Residents Affected - Few Findings included: An observation was made on 06/16/21 at 9:43 a.m. in Resident #97's room. There were signs printed with large print and taped on his closet door that read: Please wait after each bite for the patient to finish swallowing before you give him another bite. Feed the patient small bites and small sips. Staff J, Certified Nursing Assistant (CNA) was interviewed following this observation. She confirmed she was Resident #97's CNA and said he needed to be fed. Staff K, Registered Nurse (RN) was interviewed. She confirmed she was his RN and said the resident was very confused, was dependent for mobility and care, and had to be fed. She said that his wife usually visited and fed him lunch. Photographic evidence obtained. On 06/16/21 at 12:53 p.m. Resident #97 was observed in bed. His wife was present, standing at bedside, attempting to feed him lunch. She said that she thought that the food on his tray wasn't right and said, he can't eat that. The tray and meal ticket were observed. The meal ticket was printed with Mech-Soft. The plate had a whole breadstick, noodles, ground meat, and whole steamed vegetables that included whole green beans, large broccoli florets, and pieces of red pepper. There was an unopened dish of fruit chunks also on the tray. His wife said he had accepted a little of the meat and some of his nutritional shake. The resident was observed not accepting bites of food that were offered, keeping his mouth closed and shaking his head. Photographic evidence obtained. At 5:40 p.m. on 06/16/21 Resident #97 was observed in bed in his room. There was no dinner tray present. At 5:45 p.m. Staff K took his dinner tray into the room and set it on the tray table against the wall on his side of the room and left the room. At 5:59 p.m. Staff K was observed entering the room, setting up the dinner tray, and preparing to feed the resident. The meal ticket was printed with Mech-Soft and the plate contained a bowl of refried beans and a soft tortilla shell with coarsely chopped tomatoes, ground meat, and lettuce inside. There was also a covered plate with two whole cookies on the tray. Observation continued until the resident would not accept more food. He only accepted a few bites of the refried beans and then proceeded to accept some of his fortified shake, after which the tray was removed. Photographic evidence obtained. Review of Resident #97's medical record revealed that he was admitted to the facility on [DATE] with diagnoses that included dementia and dysphagia (difficulty swallowing). The Minimum Data Set (MDS) dated [DATE] revealed that he had severely impaired cognitive skills and required extensive assistance of one person providing physical assistance for eating. Physician orders revealed an order for regular diet with mechanical soft texture, order date 06/09/21. A Speech Language Pathology (SLP) evaluation completed 06/10/21 revealed that the resident was admitted to the facility on a mechanical soft diet and that recommendation for diet remained for mechanical soft textures for all solid foods. An observation of breakfast was made on 06/17/21 at 8:15 a.m. Resident #97 was being assisted by a nursing student who was seated at bedside. The meal ticket read Mech-Soft, and the plate had scrambled eggs and pancakes on it. On 06/17/21 at 8:51 a.m. Staff L, SLP was interviewed. She confirmed that she was providing therapy (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 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 106025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Sarasota 8104 Tuttle Ave Sarasota, FL 34243 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few for Resident #97 related to eating. She said she was consulted because of his dysphagia and confirmed he was on a mechanical soft texture diet. Staff L defined a mechanical soft diet as, things that are easy to chew .ground meat, steamed vegetables, pasta, food you can put gravy on .things you can make softer and easier to swallow. She said if feeding foods such as full-size cooked green bean, the bean should be cut into four parts before feeding. She said she would not consider lettuce, tomatoes, or a flour tortilla to be mechanical soft items. Staff M, SLP was interviewed on 06/17/21 at 9:33 a.m. She said that in order to be considered mechanical soft, meat should be processed into tiny pieces hamburger consistency, potatoes should be mashed not baked, canned fruit was allowed but not fresh, salads must be chopped, but no tomatoes, no cucumbers. Observation was made of the lunch meal on 06/17/21 at 12:39 p.m. Resident #97 was observed in bed being fed lunch by Staff L who was seated at bedside. Staff L confirmed it was a therapy session to work on the goal of educating his wife on proper technique to safely feed the resident. The meal ticket read, Mech-Soft and the tray contained a whole dinner roll, steamed carrots that had been further chopped/mashed, ground meat with gravy, mashed potatoes with gravy, and a whole piece of cake. Photographic evidence obtained. An interview was conducted with Staff N, Registered Dietician (RD) on 06/17/21 at 01:17 p.m. Because the facility's Certified Dietary Manager (CDM) had quit prior to the survey, Staff N was assisting to supervise and manage kitchen operations during the survey period. Staff N said that morning before the breakfast tray line started she had re-educated the kitchen staff on textures. She said she had done that because yesterday a resident on mechanical soft in the dining room was served a regular tray .she started eating the vegetable and I walked over and I asked if I could exchange her plate. Staff N confirmed she had replaced the resident's food with mechanical soft textured foods. She said she had also counseled the dietary aide responsible for confirming tickets with trays on the line that day and he said he was in a hurry. Regarding that staff member, Staff N said, he's already put his notice in for July .he's just going through the motions. Staff N confirmed that it was expected that the kitchen check each tray before it was served to ensure it had items on it that matched any therapeutic diet texture that was listed on the meal ticket. She explained the process: before tray is made a person at start of line reads off the ticket, then the food gets put on the tray, and then the person at the end of the line is supposed to check and match the ticket with the tray. She said, it is important because that could be someone's life if they are having difficulty swallowing. Staff N revealed that she had conducted an in-service with the kitchen staff on 05/11/21 that included reading tray tickets to ensure correct food textures and said she had done that because I was coming across myself that diet textures were being missed. The photographic evidence of Resident #97's lunch and dinner trays from 06/16/21 were revealed to Staff N and she identified that the only items on his lunch and dinner plates that were considered mechanical soft were the ground meat and the refried beans. She said that compliant texture foods were defined by the facility's corporation and revealed a printed list. She said for example that certain kinds of soft breads were allowed, and vegetables must be cooked very well and soft enough to mash up. She said that nursing staff was also supposed to be educated on recognizing correct textures. A follow up interview was conducted on 06/17/21 at 2:11 with Staff L and Staff M. They viewed the photographic evidence from Resident #97's lunch and dinner from 06/16/21 and confirmed that neither tray should have been served as they both contained foods that were not considered mechanical soft: tortilla, green beans, tomato, lettuce and maybe the breadstick. On 06/17/21 at 3:51 p.m. the facility Director of Nursing (DON) was interviewed. She said that when (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 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 106025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Sarasota 8104 Tuttle Ave Sarasota, FL 34243 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few serving meals to residents, nursing staff were expected to look at the meal ticket, check to make sure the tray had what was listed, and if it did not match they were expected to return the tray to the kitchen and get a correct tray before serving to the resident. Regarding training, the DON said that during orientation they go over diets. She said, as diets change there is communication that happens between speech [SLP] and nurses generally. In response to observations made regarding Resident #97 she said, there's probably more training opportunity .it's been a crazy six months for us. On 06/17/21 at 4:05 p.m. Staff N followed up and reported there was no corporate or facility policy on checking trays for therapeutic diets. She provided documentation of the in-service she gave on 05/11/21. Review revealed that kitchen staff had attended and received training on Importance of accurately reading tray tickets, this includes diet textures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 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 106025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Sarasota 8104 Tuttle Ave Sarasota, FL 34243 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure that orders and implementation for behavior monitoring were in place for psychotropic medications for one (Resident #10) out of five sampled residents. Findings included: Multiple observations were made of Resident #10 between the hours of 8 a.m. and 5 p.m. from 06/14/21 to 06/17/21. The Resident was always observed in bed, was awake and alert, engaged freely, and was confused. During an observation on 06/16/21 at 9:45 a.m., there was a person seated at the bedside who identified herself as a sitter hired through an agency. She said she was hired to sit with him during the day from 9:00 a.m. to 2:00 p.m. Staff K, Registered Nurse (RN) confirmed that the sitter was hired by the resident's family. Staff K was interviewed again on 06/16/21 at 2:48 p.m. She was seated at her medication cart just outside of Resident #10's open doorway. During the interview, the resident kept his eyes on Staff K. She confirmed that the sitter had left for the day so that was why she was positioned there in his view. She said he's calm, not agitated and as long as he can see you're there he's fine but said if she walked away out of his view he would try and get up which would cause him to fall. Review of Resident #10's medical record revealed that he was admitted to the facility on [DATE]. The resident's diagnoses included dementia, anxiety, and depression. The Minimum Data Set (MDS) dated [DATE] revealed a Brief Inventory of Mental Status (BIMS) score of 3 which meant the resident had severe cognitive impairment. The MDS revealed that the resident required extensive to total assist with all mobility and activities of daily living (ADL) and had mood disturbance that included little interest in doing things and lethargy or restlessness. Review of the Medication Administration Record (MAR) and Treatment Administration Record (TAR) for April 2021 revealed orders for buspirone HCL tablet 10mg two times a day for anxiety and duloxetine HCl capsule delayed release particles 40mg one time a day for depression. The medications were documented administered and there was no behavior monitoring. The MAR and TAR for May 2021 revealed orders for buspirone HCL tablet 10mg two times a day for anxiety and duloxetine HCl capsule delayed release particles 40mg one time a day for depression. The medications were documented administered and there was no behavior monitoring. The MAR and TAR for June 2021 revealed orders for revealed orders for buspirone HCL tablet 10mg two times a day for anxiety and duloxetine HCl capsule delayed release particles 40mg one time a day for depression. The medications were documented administered and there was no behavior monitoring. The most recent psychiatry note dated 06/04/21 revealed the following plan and recommendations: Continue monitoring for response/potential adverse reactions .monitor mood, behavior, and appetite. An interview was conducted with the facility Director of Nursing (DON) on 06/17/21 at 3:07 p.m. She consulted the Electronic Health Record (EHR) for Resident #10 and confirmed that there were no orders for behavior monitoring in place related to psychotropic use and no behavior monitoring was documented. She confirmed it had never been ordered or monitored since the resident's admission in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 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 106025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Sarasota 8104 Tuttle Ave Sarasota, FL 34243 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few September 2020. Regarding how it got missed she said, we audit every morning in clinical .we go through the list of recent orders that come through and I either give to the unit manager to check or follow up myself .I think this one just got missed .I'm going to put it in right now. A telephone interview was conducted on 06/17/21 at 6:10 p.m. with the facility's consulting pharmacist. She said she was new to the facility and had been assigned there for about a month. She said the only review she had completed at the facility so far was for May 2021. She confirmed that her review process included reviewing behavior monitoring. She said that if she found it to be missing, she would make a recommendation to put in place. She confirmed that she reviewed Resident #10 in her May 2021 review and did not note that behavior monitoring was missing and did not make any recommendations. The facility policy titled Psychotropic Medication Use revised 11/28/16 was reviewed. The procedure section revealed, Facility should comply with the Psychopharmacologic Dosage Guidelines created by the Centers for Medicare and Medicaid Services . and Facility staff should monitor the resident's behavior pursuant to Facility policy using a behavioral monitoring chart or behavioral assessment record for residents receiving psychotropic medication .Facility staff should monitor behavioral triggers, episodes, and symptoms. Facility staff should document the number and/or intensity of symptoms and the resident's response to staff interventions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 13 of 13