Inspection·April 13, 2023

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 04/12/23 at 11:24 a.m., an interview was conducted with the Regional Clinical Nurse (RNC). She confirmed the resident's PASSAR should have been completed following a new mental health diagnosis. She stated if a resident was admitted with a qualifying diagnosis, they would automatically update the PASSAR. She confirmed if a resident acquired new diagnoses during their stay, a level I PASSAR should be submitted. She stated a Level II PASSAR should be submitted accordingly if the resident had qualifying diagnosis. The RNC stated she would resubmit the resident's PASSAR. Review of facility-provided policy titled 'Pre-admission Screening and Resident Review,' dated 06/06/2019 and revised 10/06/2022 revealed: Policy: The facility will ensure that potential admissions are to be screened for possible serious mental disorders or intellectual disabilities (ID) and related conditions. This initial pre-screening is referred to as PASARR Level I and is completed prior to admission to a nursing facility. A negative Level I screen permits admission to proceed and ends the PASARR process unless a possible serious mental disorder or intellectual disability arises later. A positive Level I screen necessitates an in-depth evaluation of the individual by a state-designated authority, known as PASARR Level II, which must be conducted prior to admission to a nursing facility. 13. Any resident with a newly evident or possible mental disorder, ID or related condition must be referred by the facility to the appropriate state-designated mental health or intellectual disability authority for review. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 2 of 14 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 04/13/2023 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and review of the facility's policy, the facility failed to 1.) ensure the accuracy of a Preadmission Screening and Resident Review (PASARR) Level I for three (Residents #97, #43 and #13) of five residents admitted with mental health diagnoses and sampled for PASARR; and 2.) complete a PASARR Level II within 30 days for one (Resident #20) admitted to the facility under a 'hospital discharge exemption' of five residents sampled for PASARR. Residents Affected - Some Findings include: 1. Review of the clinical record revealed Resident #97 was admitted to the facility on [DATE], and a primary diagnosis of Unspecified Dementia. Review of the admission Minimum Data Set (MDS) dated [DATE], for Resident #97 revealed under Section I, diagnoses that included Non-Alzheimer's Dementia, Anxiety and Psychotic Disorder; and under Section N, antipsychotic and antidepressant medications were received during seven of the past seven days. Review of a PASARR Level I dated 11/28/2022, revealed Section 1A with Depressive Disorder and Psychotic Disorder checked 'yes' and Section II Part 5, 'does the individual have a primary diagnosis of dementia' checked 'no.' The clinical record did not reveal any additional PASARR (Level I nor Level II) assessments. 2. Review of the clinical record revealed Resident #20 was admitted to the facility on [DATE], and a primary diagnosis of Unspecified Dementia. Additional diagnoses included Depression and Psychosis. Review of the annual MDS dated [DATE] for Resident #20 revealed under Section I, diagnoses that included Non-Alzheimer's Dementia, Anxiety Disorder, Depression and Psychotic Disorder (other than schizophrenia); and under Section N, antipsychotic and antidepressant medications were received during seven of the past seven days. Review of a PASARR Level I dated 09/19/2021, revealed Section 1A with Anxiety Disorder checked 'yes' and Section II, Part 3B 'Due to mental illness, the individual has experienced an episode of significant disruption to the normal living situation, for which supportive services were required to maintain functioning at home, or in a residential treatment environment, or which resulted in intervention by housing or law enforcement officials' checked 'yes.' Section II Part 5 'does the individual have a primary diagnosis of dementia' was checked 'yes.' Further review of the PASARR revealed Section III 'hospital discharge exemption' checked 'yes' and 'the individual is being admitted under the 30-day hospital discharge exemption. If the individual's stay is anticipated to exceed 30 days, the NF [nursing facility] must notify the Level I screener on the 25th day of the stay and the Level II evaluation must be completed no later than the 40th day of admission, on or before (date) [blank]' was checked 'yes.' The clinical record did not reveal any additional PASARR (Level I nor Level II) assessments. In an interview with Staff C, Social Services Director (SSD) on 04/12/2023 at 12:30 p.m., she confirmed Resident #20 was admitted under a hospital discharge exemption and a PASARR Level I or Level II was not completed within the 30-day timeframe. Additionally, the SSD confirmed Resident #97 had a primary diagnosis of Dementia checked 'no,' but the resident had a primary diagnosis of Dementia as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 3 of 14 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 04/13/2023 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 0645 per the admission face sheet. Level of Harm - Minimal harm or potential for actual harm Review of facility-provided policy titled 'Pre-admission Screening and Resident Review,' dated 06/06/2019 and revised 10/06/2022 revealed: Residents Affected - Some Policy: The facility will ensure that potential admissions are to be screened for possible serious mental disorders or intellectual disabilities (ID) and related conditions. This initial pre-screening is referred to as PASARR Level I and is completed prior to admission to a nursing facility. A negative Level I screen permits admission to proceed and ends the PASARR process unless a possible serious mental disorder or intellectual disability arises later. A positive Level I screen necessitates an in-depth evaluation of the individual by a state-designated authority, known as PASARR Level II, which must be conducted prior to admission to a nursing facility. 13. Any resident with a newly evident or possible mental disorder, ID or related condition must be referred by the facility to the appropriate state-designated mental health or intellectual disability authority for review. 14. Referral for Level II resident review evaluation is required for individuals previously identified by PASARR to have a mental disorder, intellectual disability, or related condition who experience a significant change. 3. Review of an admission record dated 04/13/23, revealed Resident #43 was admitted to the facility on [DATE]. An admission MDS dated [DATE] showed under Section I active diagnoses, the resident had anxiety disorder, Non-Alzheimer's Dementia, seizure disorder/epilepsy, and depression. A review of a quarterly MDS for Resident #43 dated 03/10/23, showed under Section I active diagnoses, the resident had anxiety disorder, Non-Alzheimer's Dementia, seizure disorder/epilepsy, and depression. A review of Resident #43's level I PASARR dated 05/03/22, showed none of the qualifying diagnosis were checked. Review of a psychiatric progress note for Resident #43 dated 03/26/23, showed the resident was admitted with a psychiatric history of depression for 20 years, the resident attempted suicide in her 30's or 40's and had a documented history of trauma. The record review indicated Resident #43 was not screened for level II PASARR with known qualifying diagnoses, to include a primary diagnosis of dementia. 4. Review of an admission record dated 04/13/23, revealed Resident #13 was re-admitted to the facility on [DATE]. An admission MDS dated [DATE] showed under Section I active diagnoses, the resident was admitted with Non-Alzheimer's Dementia and depression. A review of a quarterly MDS for Resident #13 dated 03/18/23, showed under Section I active diagnoses, the resident had Non-Alzheimer's Dementia and depression. A review of Resident #13's level I PASARR dated 05/01/19, showed an incomplete PASSAR and none of the qualifying diagnosis were checked. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 4 of 14 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 04/13/2023 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 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 04/12/23 at 12:19 p.m., an interview was conducted with Staff C, Social Services Director (SSD). She stated she reviewed all PASARRs upon admission. She looked for errors and alerted the DON (Director of Nursing) if any errors were noted. She stated if a resident did not have a PASARR and they had qualifying diagnoses, she would create a new PASARR upon admission or prior. Staff C stated if a new MDS diagnosis identified the resident had a new diagnosis, she would review the PASARR. Staff C stated they did review PASARRs during care plan meetings for their long-term patients. She stated they were auditing charts to ensure accuracy. Staff C confirmed PASARRs should reflect the resident's current diagnosis and their care plan would be updated. Staff C stated they had started a PIP (Performance Improvement Plan) for PASARRs, and all new admissions had been revised. She stated their goal was to review all their long-term residents. On 04/12/23 at 11:24 a.m., an interview was conducted with the Regional Clinical Nurse (RNC) she confirmed the resident's PASARR should have been completed following a new mental health diagnosis. She stated if a resident was admitted with a qualifying diagnosis, they would automatically update the PASARR. She confirmed if a resident acquired new diagnoses during their stay, a level I PASARR should be submitted. She stated a Level II PASARR should be submitted accordingly if the resident had qualifying diagnosis. The RNC stated she would resubmit the resident's PASARRs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 5 of 14 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 04/13/2023 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 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. Based on observation, interview, medical record review, and policy on Indwelling Urinary Catheter Management, the facility failed to ensure one (Resident #52) of three residents sampled for indwelling urinary catheters was provided timely treatment and care in accordance with professional standards of practice. Findings Included: On 04/11/2023 at 11:01 a.m., an interview was conducted with Resident #52. She said her catheter was for urinary retention. She said she was a nurse for many years and knew about retention. She said she was not able to void, and nothing was coming out. She said she could feel distention in her bladder so she went to the hospital. Resident #52 stated, they straight cathed me and removed 4000 cubic centimeter (cc) of urine. They had performed tests at the hospital and found I had a cord compression to my spine. The compression was causing retention to my bladder. I had the surgery performed and went home with the catheter. She said after being at home, she recalled being dizzy when standing and fell. She said, I broke my hip and here for rehabilitation. Resident #52 denied any attempted voiding trials performed at the facility. She stated, I cant wait unit they remove it. I do Kegel exercises all the time. A Trial Without Catheter (TWOC) is when the catheter (the tube inserted into your bladder to drain urine) is removed from your bladder for a trial period to determine whether you can pass urine without it. Mayo Clinic Kegel exercises can prevent or control urinary incontinence and other pelvic floor problems. https://www.mayoclinic.org > in-depth > art-20045283. Review of the admission Record form revealed she had resided at the facility for close to a month. The form listed diagnoses of periprosthetic fracture around internal prosthetic right hip joint, urinary tract infection, and retention of urine. Review of Physician notes dated 04/10/2023 revealed Endnotes: unspecified cord compression, spondylosis. Review of the hospital admission orders revealed an order for Augmentin oral tablet 500-124 mg (Amoxicillin & pot Clavulante) Give one tablet by mouth three times a day for urinary tract infection (UTI) for 7 days dated, 03/14/2023. Review of the medication administration record (MAR) reflected on 03/14/2023, the scheduled 2:00 p.m. (1400) and 9:00 p.m. (2100) doses documented with a number 10. Review of the Chart Codes revealed number 10= Other /See Progress Note. Review of progress notes dated 03/14/2023 at 4:55 p.m. (16:55) revealed, Orders - Administration Note, Note Text: Augmentin Oral Tablet 500-125 MG Give 1 tablet by mouth three times a day for UTI for 7 Days dose not available. On 03/14/2023 at 9:05 p.m. (21:05) Orders - Administration Note, Note Text: Augmentin Oral Tablet 500-125 MG Give 1 tablet by mouth three times a day for UTI for 7 Days (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 6 of 14 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 04/13/2023 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 0690 Awaiting from pharmacy. Level of Harm - Minimal harm or potential for actual harm Review of the hospital Discharge Summary print date 03/14/2023, Pending Results Culture urine ordered on 03/11/2023 at 1:22 p.m. (13:22) Microbiology Identification and susceptibility to follow. The discharge paper work did not reflect the urine culture sensitivity results that would indicate which antibiotic would be appropriate to treat the urinary tract infection. Residents Affected - Few Review of Physician orders Bactrim DS oral tablet 800-160 mg -SULFAMETHOZONE;-Trimethoprim give on tablet by mouth two times a day for UTI order dated, 04/08/2023 at 2:50 p.m. (1450). Review of the MAR reflected Bactrim DS was first administered on 04/10/2023 at 0900, which indicated a 43 hour delay in starting the antibiotic. Review of the treatment administration record revealed,change catheter bag as needed for infection, obstruction or when the closed system is compromised dated 03/14/2023. No documentation was located in the medical record that reflected the catheter bag was changed after an infection was identified on 04/08/2023. Review of physician orders dated, 04/04/2023 revealed, UA & C&S Point-of-care Test Device: none. No documentation was located in the medical record that indicated how the urine specimen was obtained. Further review of the medical record reflected Resident #52's indwelling urinary catheter was placed sometime prior to her admission. On 04/12/2023 at 3:30 p.m., an interview was conducted with the Director of Nursing (DON). She said, Typically the cath bag is changed on an as needed bases. And we don't change the catheter for new urinary specimen like we did before, that had changed. The DON indicated she was unaware Resident #52's catheter bag was not changed after an infection was identified. She stated, I'll have it changed out. The DON was unaware Resident #52 admission orders for Augmentin were not provided as ordered. She reviewed the medical record and stated typically they would call the MD and get an extension of the dose. When asked about Resident #52's second ordered antibiotic/Bactrim that was ordered on 04/08/2023 and not administered until 04/10/2023, she confirmed it was her expectation the medication was started in a timely manner. The DON went on to say she was aware the resident had a voiding trial while in the hospital but it had failed. She said I think she might have had one here, but am not sure I will have to check. The DON added, If the trial [removing the catheter] doesn't ' work we will set her up to be seen by a urologist. On 04/13/2023 at 9:24 a.m., the DON stated she had left a message for the physician related to the delay in starting the Bactrim, and they were okay with the delay. The DON confirmed it was the first time the physician had been notified of the delay. She added, [Resident #52] is set up to start a voiding trial today, 04/13/2023. On 04/13/2023 at 11:52 a.m., an interview was conducted with the Minimum Data Set Coordinator (MDSC) and the Infection Control Preventionist (ICP). The MDSC indicated he was the ICP just last month, and CP had worked the position for one month. The MDSC said part of the process for the Antibiotic Stewardship program was that he would follow an order for a urinary specimen. He spoke about ensuring the correct antibiotic was ordered by reviewing the laboratory results for the organism and its (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 7 of 14 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 04/13/2023 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few sensitivity. He would review the physician's antibiotic order for the correct duration and discontinue date. The MDSC confirmed he would check the MAR to ensure the antibiotic was given as ordered. The ICP confirmed she followed the same process that included reviewing the MAR. She reviewed the medical record for Resident #52 and confirmed the Augmentin received reflected two doses of omission. She then stated, I missed it. When asked about new admissions on antibiotics, the MDSC stated, I would reach out to Medical Records for the culture and sensitivity results. Typically the antibiotic the resident was on would have the culture and sensitivity results in the paper work. He said he had not encountered new admissions with pending culture and sensitivity. When asked about a new admission with an indwelling urinary catheter, the MDSC and ICF both stated it is removed as soon as possible. Review of Resident #52 Care Plan revealed, Focus: The resident has an indwelling urinary Catheter: Urinary Retention related to (r/t) Urinary Retention obstructive uropathy, Goal: Will have no complications r/t indwelling catheter use. Date Initiated: 03/15/2023. A second care plan was reviewed with the Focus: The resident has a Urinary Tract Infection r/t indwelling cath date initiated: 03/15/2023, Revision on: 04/10/2023, Goal: The resident urinary tract infection will resolve without complications by the review date Target Date 07/09/2023. Review of the policy titled Surveillance of Infections revised: 12/13/2021 Surveillance Definitions for Urinary Tract Infections (UTI) B. For residents with an indwelling catheter. 2. Comments: Urinary catheter specimens for culture should be collected following replacement of the catheter (if current catheter has been in place for greater than (>)14 d). Review of policy titled Indwelling Urinary Catheter (Foley) Management Revised : 08/22/2022 Policy: The facility will ensure that residents admitted with a urinary catheter, or determined to need a urinary catheter for a medical indication will have the following areas addressed; 1. Documentation for the involvement of the resident in the discussion of the risks and benefits of the use of a catheter, removal of the catheter when criteria or indication for use is no longer present, and the right to decline the use of the catheter; 3. Identification and documentation of the clinical indications for the use of a catheter; as well as criteria for the discontinuance of the catheter when the indication for use is no longer present; 4. Insertion, ongoing care and catheter removal protocols that adhere to professional standards of practice and infection prevention and control procedures; 5. Response of the resident during the use of the catheter; and 6. On going monitoring for changes in condition related to potential CAUTI's, recognizing response and addressing such changes. General Urinary Catheter Maintenance Guidelines: 5. Changing indwelling catheters or drainage bags at routine, fixed intervals is not recommended. Rather, it is suggested to change catheters and drainage bags base on clinical indication such as infection. Centers for Disease Control and Prevention. Healthcare-Associated Infections (HAIs)Catheter-associated Urinary Tract Infections (CAUTI) A urinary tract infection (UTI) is an infection involving any part of the urinary system, including urethra, bladder, ureters, and kidney. UTIs are the most common type of healthcare-associated infection reported to the National Healthcare Safety Network (NHSN). Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. Between 15-25% of hospitalized patients receive urinary (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 8 of 14 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 04/13/2023 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 0690 Level of Harm - Minimal harm or potential for actual harm catheters during their hospital stay. The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed. https://www.cdc.gov/hai/ca_uti/uti.html. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 9 of 14 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 04/13/2023 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure pre and post dialysis care was provided for one (Resident #68) of four dialysis residents. Residents Affected - Few Findings included: Review of the admission record dated 04/13/23, showed Resident #68 was admitted to the facility on [DATE] with diagnoses to include acute kidney failure and severe chronic kidney disease, stage 4, and dependence on renal dialysis. Review of active physician orders for Resident #68 showed: Dialysis patient receives dialysis at [name of facility] on Tuesday, Thursday, and Saturday at 10:30 a.m., start date 01/19/23. Check right chest dialysis port for bleeding or signs and symptoms of infection, every shift, start date 12/27/22. Liberal renal diet, Regular texture, thin consistency, start date 12/24/22. Medication orders around dialysis, at least 2 hours prior to or after return, start date 12/24/22. Review of a care plan with a revision date of 12/27/22 showed a focus on Dialysis- hemodialysis related to end stage renal disease. The goal showed the resident will have no signs/symptoms of complications from dialysis. Interventions included to check vital signs daily, dialysis treatments as ordered, dry weights obtained from dialysis center, encourage resident to attend dialysis, labs, and report to doctor, observed for bleeding at dialysis access site, observe for dry skin. Observe /report signs/symptoms of bleeding, hemorrhage, and provide therapeutic diet as ordered. Review of Resident #58's dialysis book dates 01/19/23 to 04/11/23 showed missing documentation for pre and post care. The document titled pre/post dialysis communication showed the following expectation: Pre dialysis (to be completed by SNF- [skilled nursing facility]): obtain vital signs, obtain weight, check lung sounds, assess condition of access/site, document if the resident is on antibiotic and diagnosis of the antibiotic use, check for bruit and thrill, indicate if the resident is to be given medications at the center, and if meal is to be given at the center. Post dialysis (to be completed by SNF): obtain vital signs, obtain weight, assess condition of access/site, check for bruit and thrill, and to indicate if there was change of site. Review of documents titled, pre/post dialysis communication showed: On 4/11/23 pre and post dialysis care was not documented as completed. On 3/23/23 post dialysis care was not documented as completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 10 of 14 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 04/13/2023 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 0698 On 3/14/23 pre and post dialysis care was not documented as completed. Level of Harm - Minimal harm or potential for actual harm On 3/9/23 post dialysis care was not documented as completed. On 3/7/23 post dialysis care was not documented as completed. Residents Affected - Few On 2/28/23 pre and post dialysis care was not documented as completed. On 2/25/23 pre and post dialysis care was not documented as completed. On 2/16/23 post dialysis care was not documented as completed. On 2/2/23 and 2/4/23: dialysis center section noted blank. On 1/28/23 pre and post dialysis care was not documented as completed. On 1/26/23 pre and post dialysis care was not documented as completed. On 1/24/23 pre and post dialysis care was not documented as completed. On 1/17/23 post dialysis care was not documented as completed. On 1/12/23 post dialysis care was not documented as completed. Two undated pages were also noted with no pre/post care documented as completed. On 04/12/23 at 09:23 a.m., an interview was conducted with Staff D, LPN (Licensed Practical Nurse). She stated she was assigned to the resident today and that she worked with him quite often. Staff D stated she prepared the resident for dialysis. Staff D said, Yes, the expectation is to make sure we are checking the bruit and thrill prior to sending the resident out. Makes sure the port is in place, no bleeding and obtain vitals. She stated she made sure the resident had taken their medications and they had lunch to take with them. Staff D confirmed the nurses should complete the dialysis communication documentation. On 04/12/23 10:29 a.m., an interview was conducted with Staff E, LPN. She stated the nurse assigned to the resident was responsible for completing the care pre and post dialysis. She stated they were expected to obtain vitals, check the site for bleeding, and document findings. She stated they review what the dialysis facility sent back to see if there were any care concerns. Staff E stated the nurse on duty should be reviewing the dialysis book and the Unit Manager (UM) should monitor the accuracy of the dialysis communication books. On 04/13/23 11:31 a.m., an interview was conducted with the Regional Clinical Nurse (RCN). She confirmed the documentation was missing. She stated the nurses were expected to complete the pre and post dialysis communication log. The RCN stated they should be monitoring the resident's vitals and port site as expected. On 04/13/23 11:33 a.m., an interview was conducted with the DON (Director of Nursing). She stated she would be educating the UM about monitoring documentation and addressing missed records. She stated she had reviewed Resident #68's record and noted the missed documentation. She stated she was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 11 of 14 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 04/13/2023 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 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few concerned they would not be able to verify if the resident received the care, or if it was a documentation problem. She stated they reviewed all the other dialysis residents without concerns. The DON said, It was that one unit. We will be in-servicing staff to ensure post and pre dialysis care is completed and accurately documented. We should ensure any concerns are documented with appropriate notifications. A review of a facility policy revised 08/18/22 showed the facility assures that each resident receives care and services for the provision of hemodialysis and/or peritoneal dialysis consistent with professional standards of practice including the; on-going assessment of the resident's condition and monitoring for complications before and after dialysis treatments received at a certified dialysis facility and on-going communication and collaboration with the dialysis facility regarding dialysis care and services. Under procedure: the resident receiving dialysis shall receive consistent care pre and post dialysis. The vascular access site shall be checked daily with physician notification for any known or suspected problem. Under general guidelines: Assess for any signs/symptoms of infection, such as redness or edema at the vascular access site. Observe fluid restriction as ordered by physician. Assess vascular access site for signs of clotting or bleeding every shift. Monitor for any complaints of pain or discomfort at vascular access site. Notify the physician of any change in mental status or physical status. Document in the clinical nursing record, dialysis treatment completed, order changes, condition of shunt site, complaints from resident (if applicable). Pre dialysis: initiate pre/post dialysis communication form to be sent to the dialysis clinic with the resident. Post dialysis: obtain vital signs of resident upon return from dialysis and complete the pre/post dialysis communication form. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 12 of 14 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 04/13/2023 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 record review and interview, the facility failed to provide rationale for long term use or limit the use of as needed antianxiety medications to less than 14 days for two (Residents #29 and #91) of five residents surveyed for unnecessary medications. Findings include: 1. Resident #29 was originally admitted to the facility on [DATE]. While conducting a record review, an order was identified for Ativan 0.5 milligrams (mg) by mouth every 4 hours as needed for anxiety/agitation/shortness of breath. The order was written on 3/16/23 and did not have an expiration date or rationale for long term use. Further record review revealed on 3/22/23, a Medication Regimen Review was conducted by the Consultant Pharmacist with the following documentation: Recommendation: Please discontinue as needed Ativan, tapering as necessary. If the medication cannot be discontinued at this time, please document the indication for use, the extended duration of therapy, and the rationale for the extended time period. Rationale for Recommendation: Centers for Medicare & Medicaid Services (CMS) requires that as needed orders for non-antipsychotic psychotropic drugs be limited to 14 days unless the prescriber documents the diagnosed specific condition being treated, the rationale for the extended time period, and the duration for the as needed order. (photo evidence obtained). 2. Resident #91 was admitted to this facility on 8/31/22. While conducting a record review, two orders were identified for as needed anti-anxiety medication written on 12/1/22 with no expiration dates or rationale for long term use. The medications were as follows: Ativan Tablet 0.5 mg. Give 1 tablet by mouth every 6 hours as needed for moderate anxiety/agitation/shortness of breath. May dissolve in 2 drops of water. Ativan Tablet 0.5 mg. Give 2 tablets by mouth every 6 hours as needed for severe anxiety, restlessness, or insomnia. The Director of Nursing (DON) was interviewed on 04/13/23 at 12:20 p.m. During the interview, the DON said both residents were on hospice and the medication was required for end of life care. She said she had contacted the provider and asked them to enter rationale for extended as needed orders. Review of facility policy Psychotropic Medication Use revision date 10/24/22 revealed: Policy 8. As needed psychotropic medications should be ordered for no more than 14 days. Each Resident who (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106025 If continuation sheet Page 13 of 14 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 04/13/2023 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 FORM CMS-2567 (02/99) Previous Versions Obsolete is taking an as needed psychotropic drug will have his or her prescription reviewed by the physician or prescribing practitioner every 14 days and also by a pharmacist every month. 9. For psychotropic medications, excluding antipsychotics, that the attending physician believes an as needed order for longer than 14 days is appropriate, the attending physician can extend the prescription beyond 14 days for the resident by documenting their rationale in the resident's medical record. Event ID: Facility ID: 106025 If continuation sheet Page 14 of 14