Health inspection·January 21, 2022

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 1/20/2022 at 10:15 AM, Staff H, Licensed Practical Nurse (LPN) stated, I really don't know what his dressing orders are. I know he has a wound on his coccyx. I don't know when the wound care doctor saw him. We should do dressings as they are ordered by the doctor. There is no date on his dressing. I would have to look up when it was changed. During an interview on 1/21/2022 at 9:10 AM, the DON stated, I expect staff to complete physician orders for care for wounds. It looks like the wound dressing wasn't done. I'm not sure why the wound care order didn't get ordered. It is a standard to complete doctor's orders and follow recommendations. During an interview on 1/21/2022 at 10:50 AM, the Medical Doctor (MD) stated, I did recommend dressing changes when I completed his initial consult on 1/14/2022. I made wound care recommendations on that day, and I was not aware that they were not followed. I expect that when I make recommendations for wound care, they are followed. I assessed his wound today and feel that he may have an underlying infectious process brewing. His wound has deteriorated to unstageable from a stage 2 when I saw it on the 14th. I have added antibiotics and Bactroban ointment to his wound care and increased his dressing changes to twice a day. I was not aware that he was not getting his dressing changed according to my recommendations. I have added an air mattress also. Review of the facility policy and procedure titled Wound Care, with an approval date of 1/6/2022, read, Purpose: The purpose of this procedure is to provide guidelines for the care of wounds to promote healing . Documentation: The following information should be recorded in the resident's medical record: 1. The type of wound care given. 2. The date and time the wound care was given. 2. Review of Resident #69's records revealed the resident was admitted on [DATE] with diagnoses to include chronic kidney disease, cellulitis of right lower limb, diabetes mellitus, severe protein calorie malnutrition, congestive heart failure, lymphedema, and dementia. During an interview on 1/18/2022 at 9:34 AM, Resident #69 stated, The swelling in my legs gets worse during the day and this has been occurring for a long time. My legs get a dressing sometimes by the nurses. On 1/18/2022 at 9:34 AM, both legs of Resident #69 were observed to be swollen and red. The left leg had oozing of clear fluid on the resident's skin, with no dressing covering the leg. On 1/19/2022 at 8:34 AM, both legs of Resident #69 were observed to be red and swollen, and the lower left leg had oozing clear fluids, with no dressing on the leg. Review of the physician orders dated 12/1/2021 read, LLE [Left Lower Extremity): Cleanse skin tear with NSS/ wound cleanser, apply Bactroban ointment to wound bed, wrap bilateral lower extremities with unna boots from knee-to-toes, cover with tubigrip twice weekly and additionally as needed. During an interview on 1/20/2022 at 2:59 PM, Staff G, LPN, stated that Resident #69's dressings were changed daily if she could find the time to do them. She verified that the dressing was not on the resident. During an interview on 1/21/2022 at 11:14 AM, the DON stated that nursing staff on the assigned units should complete the wound care as ordered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 2 of 6 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 106046 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Terrace Healthcare & Rehabilitation Center 7207 SW 24th Ave Gainesville, FL 32608 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure that a resident who needed respiratory care received such care consistent with professional standards of practice for 1 of 3 residents reviewed for respiratory care, Resident #63, in a total sample of 54 residents. Residents Affected - Few Findings: Review of Resident #63's records revealed the resident was admitted with diagnoses to include rhabdomyolysis (breakdown of skeletal muscle), history of pulmonary embolism (a blood clot in the lung), asthma, and bell's palsy (weakness or paralysis of the muscles in the face). During an observation on 1/18/2022 at 11:00 AM, Resident #63's respiratory pattern and speech were labored, and the resident required breathing periods between words. An oxygen concentrator was sitting in the corner of the room, not in use. An oxygen tank was sitting on the floor at the end of the resident's bed. The oxygen tank regulator read empty and was not in use. During an interview on 1/18/2022 at 11:00 AM, Resident #63 stated, I was given an oxygen concentrator that began to make noise and not work properly, so it was turned off and I was given an oxygen tank. The oxygen tank is empty, and the staff have not brought me a new one yet. I have told the nurse, when she brings my medications, and the aides, when they come in, that the oxygen tank is empty. I am supposed to always have oxygen but have not had it for two days. I get very short of breath when I try to move around too much. Review of Resident #63's physician orders dated 7/1/2021 read, Oxygen at two liters/minute via NC [Nasal Canula] every shift. On 1/18/2022 at 12:50 PM, Resident #63 was observed sitting up in bed with no oxygen in use. An oxygen concentrator was sitting in the corner of her room, not in use. An oxygen tank was sitting on the floor at the foot of the bed, with the oxygen regulator reading empty. During an interview on 1/18/2022 at 12:50 PM, Staff A, Licensed Practical Nurse (LPN), stated Resident #63 had an order for continuous oxygen, and the resident should have oxygen always running at two liters/minute via nasal cannula. Staff A verified the resident was not currently receiving oxygen. Staff A stated, [Resident #63's name] told me that the oxygen concentrator provided to her does not work and her oxygen tank is empty. I don't know how long she has gone without oxygen. During an interview on 1/18/2022 at 1:05 PM, the Director of Nursing (DON) stated it was her expectation that the nursing staff would follow all physician orders. She further stated if a resident was ordered to receive oxygen by her physician, that resident should receive the oxygen as ordered. Review of the facility policy and procedure titled, Oxygen Administration, with an approval date of 1/6/2022 read, Purpose: The purpose of this procedure is to provide guidelines for safe oxygen administration Preparation: 1. Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. 2. Review the resident's care plan to assess for any special needs of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 3 of 6 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 106046 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Terrace Healthcare & Rehabilitation Center 7207 SW 24th Ave Gainesville, FL 32608 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 - Many 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 observation, interview, and record review, the facility failed to ensure the drugs and biologicals used in the facility were stored and labeled in accordance with currently accepted professional principles, and included the expiration date when applicable, in 6 of 7 medication carts. Findings: On 1/18/2022 at 9:05 AM, the surveyor observed Medication Cart #1 with Staff A, Licensed Practical Nurse (LPN), and found one opened bottle of Humalog insulin with an opened date of 11/29/2021, one opened bottle of Levemir insulin with an opened date of 11/29/2021, one opened Levemir insulin pen with no opened or expiration dates, one opened Aspart insulin pen with an opened date of 12/13/2021, one opened Levemir pen with an opened date of 12/2/2021, one opened Lantus insulin with an opened date of 12/5/2021, one opened Lantus insulin with an opened date of 12/10/2021, four opened Basaglar insulin pens with no opened or expiration dates, one opened Lantus insulin pen with no opened or expiration dates, one opened bottle of Polymyxin-trimethoprim eye drops with no opened or expiration dates, one opened Admelog Insulin pen with no opened or expiration dates, one opened bottle of Tobramycin eye drops with no opened or expiration dates, and two opened bottles of artificial tears with no opened or expiration dates. During an interview on 1/18/2022 at 9:15 AM, Staff A, LPN, stated, Insulin is only good for 30 days and the insulins are expired and should not be on the cart. All eye drops and insulin should be labeled with the date they are opened and date they expire, and these are not labeled at all. On 1/18/2022 at 9:20 AM, the surveyor observed Medication Cart #2 with Staff B, LPN, and found two opened Lantus insulins with no opened or expiration dates, one Novolog insulin with an opened date of 12/8/2021 and an expiration date of 1/7/2022, one opened Glargine insulin with no opened or expiration dates, one opened Aspart insulin with no opened or expiration dates, one opened Humalog insulin with no opened or expiration dates, one opened bottle of Latanoprost eye drops with an opened date of 12/9/2021 and pharmacy instructions to discard 42 days after opening, three opened bottles of Brimonidine eye drops with no opened or expiration dates, and one bottle of Dorzolamide 2% eye drops with an opened date of 9/4/2021. During an interview on 1/18/2022 at 9:30 AM, Staff B, LPN, stated, These insulins and eye drops are expired. Insulin is only good for 30 days and the eye drops are expired. All eye drops and insulin should have a label when they are opened or when they expire. I don't know why these expired medications are in the cart. On 1/18/2022 at 9:35 AM, the surveyor observed Medication Cart #3 with Staff F, LPN, and found three opened Aspart insulin pens with no opened or expiration dates, one opened Victoza pen with no opened or expiration dates, two opened Glargine insulin pens with no opened or expiration dates, one open Humulin R insulin with no opened or expiration dates, one opened Humulin N insulin with no opened or expiration dates, one opened bottle of Dorzolamide/Timolol eye drops with an opened date of 12/13/2021 and pharmacy instructions to discard 28 days after opening, one opened bottle of Moxifloxacin eye drops with no opened or expiration dates, one opened bottle of Brimonidine eye drops with an opened date of 12/13/2021 and pharmacy instructions to discard after 28 days, and one opened bottle of Latanoprost eye drops with no opened or expiration dates. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 4 of 6 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 106046 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Terrace Healthcare & Rehabilitation Center 7207 SW 24th Ave Gainesville, FL 32608 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 - Many During an interview on 1/18/2022 at 9:45 AM, Staff F, LPN, stated, These insulins and eye drops should be labeled when they are opened and when they expire, and they aren't. Most insulin is only good for one month and eye drops should have been reordered when they expired. Both of the eye drops that are labeled have expired and shouldn't be on the cart. On 1/18/2022 at 9:50 AM, the surveyor observed Medication Cart #4 with Staff E, LPN, and found two opened bottles of Artificial tears with no resident identifiers and no opened or expiration dates, two opened bottles of Latanoprost eye drops with no opened or expiration dates, one opened bottle of Dorzolamide eye drops with an opened date of 12/3/2021 and pharmacy instructions to discard after 28 days, one opened bottle of Dorzolamide eye drops with no opened or expiration dates, two opened bottles of Brimonidine eye drops with no opened or expiration dates, one opened bottle of Polymyxin trimethoprim eye drops with no opened or expiration dates, one opened bottle of Lantus insulin with an opened date of 12/20/2021 and pharmacy instructions to discard after 28 days, one opened Glargine insulin pen with no opened or expiration dates, one Humalog insulin pen with no opened or expiration dates, one opened bottle of NovoLog insulin with an opened date of 11/22/2021, one Levemir insulin with an opened date of 11/21/2021, one opened Humulin R insulin with an opened date of 12/3/2021 and pharmacy instructions to discard after 28 days, one opened Humulin R insulin with no opened or expiration dates, one Lantus insulin pen with no opened or expiration dates, and one opened Levemir insulin pen with an opened date of 12/2/2021 and pharmacy instructions to discard after 42 days. During an interview on 1/18/2022 at 10:00 AM, Staff E, LPN, stated, Insulin is only good for 28 or 42 days and should be labeled when it is opened and discarded and reordered when needed. All insulin and eye drops should be labeled when they are opened. I'm not sure how long eye drops are good for. On 1/18/2022 at 10:05 AM, the surveyor observed Medication Cart #5 with Staff C, LPN, and found two opened bottles of Latanoprost eye drops with no opened or expiration dates, and one opened Lantus pen with no opened or expiration dates. During an interview on 1/18/2022 at 10:10 AM, Staff C, LPN, stated, All insulin and eye drops should be dated when they are opened, and these are not. On 1/18/2022 at 10:15 AM, the surveyor observed Medication Cart #6 with Staff D, LPN, and found two Basalagar insulin pens with no opened or expiration dates, one Novolog insulin with an opened date of 12/10/2021, one Novolog insulin with an opened date of 12/16/2021, one Admelog insulin with an opened date of 12/19/2021, and one opened bottle of Pred Forte eye drops with an expiration date of 12/4/2021 on the packaging. During an interview on 1/18/2022 at 10:20 AM, Staff D, LPN, stated, I'm not sure why they didn't label the insulins. All the insulins are expired and should be thrown out. All insulin and eye drops should have the dates on them. Review of the facility policy and procedure titled, Storage of Medication, with an approval date of 1/6/2022 read, Policy Statement: The facility stores all drugs and biologicals in a safe, secure, and orderly manner. Policy Interpretation and Implementation . 5. Discontinued, outdated, or deteriorated drugs and biologicals are returned to the dispensing pharmacy or destroyed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 5 of 6 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 106046 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Terrace Healthcare & Rehabilitation Center 7207 SW 24th Ave Gainesville, FL 32608 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure food was stored, distributed and served in accordance with professional standards for food service. Residents Affected - Many Findings: 1. During the initial tour of the kitchen on 1/18/2022 beginning at 9:20 AM, an observation of the walk-in freezer showed an opened and unlabeled bag of English style battered cod exposed to the air sitting in a box on a shelf, an opened and unlabeled bag of frozen meat on an open wire shelf, and an opened and unlabeled box of frozen hash brown patties exposed to the air. During an interview on 1/18/2022 at 9:35 AM, the Kitchen Manager stated the frozen fish bag should have been sealed, the hash brown patties should have been closed in a bag, and both in addition to the bag of frozen meat should have been labeled with identification of product and an opened date. Review of the facility policy and procedure titled, Food Storage: Cold, dated October 2019 and reviewed on 1/6/2022, read, Policy Statement: It is the center policy to insure all Time/ Temperature Control for Safety (TCS), frozen and refrigerated food items, will be appropriately stored in accordance with guidelines of the FDA Food Code . Action Steps . 5. The Dining Services Director/ [NAME] insures that all food items are stored properly in covered containers, labeled and dated and arranged in a manner to prevent cross contamination. 2. On 1/18/2022 at 1:01 PM, an observation of the meal trays being distributed on the 500 Hall showed the cornbread portions on trays in the cart were uncovered. The trays were being removed from the cart and carried down the hall to the resident rooms (Photographic evidence obtained). During an interview on 1/18/2022 at 1:06 PM, the Kitchen Manager stated that all food items should be covered when being delivered to the resident rooms. Review of the facility policy and procedure titled, Meal Distribution, dated October 2019 and reviewed on 1/6/2022 read, Policy Statement: It is the center policy that meals are transported to the dining locations in a manner that insures proper temperature maintenance, protects against contamination, and are delivered in a timely and accurate manner . Action Steps . 3. All foods that are transported to dining areas that are not adjacent to the kitchen will be covered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 6 of 6