Health inspection·June 7, 2023

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview conducted on 6/5/2023 at 2:30 PM the Director of Nursing (DON), stated, The Resident [Resident #18] needs the ace wraps on and the orders need to be followed. 2) Review Resident #274's medical record documented the resident was admitted on [DATE] with medical diagnosis to include nontraumatic ischemic infraction of muscle of the left lower leg, methicillin staph aureus infection, local infection of the skin inside the Canadian tissue (a study first in Canada to characterize the incidence of skin and soft tissue infections), unspecified open wound of the left lower leg, peripheral vascular disease, and type 2 diabetes. Review of the physician order dated 6/1/2023 for Resident #274 documented, Cleanse left Achilles with ns [normal saline] apply sorbact gauze and cover with bordered drsg [dressing] Tuesdays and Fridays and prn [as needed] for Sx [signs and symptoms] wound. Cleanse left and right shin with ns [normal saline] apply Medi honey cover with bordered drsg [dressing] daily and prn [as needed] every day shift for Trauma. During an observation on 6/4/2023 at 10:10 AM Resident #274's left and right legs were wrapped in gauze and dated 5/31/2023, a Wednesday. (Photographic evidence obtained) During an interview on 6/4/2023 at 10:10 AM Resident #274 stated, They have not changed my dressing. During an observation on 6/5/2023 at 1:25 PM Resident #274's left, and right legs were wrapped in gauze dressings dated 5/31/2023. During an interview conducted on 6/5/2023 at 1:25 PM Resident #274 stated, The dressing changes have not been done. During an interview on 6/5/2023 at 1:45 PM Staff C, LPN (Licensed Practical Nurse) stated, The dressing has not been changed since 5/31/2023. During an interview on 6/5/2023 at 2:31 PM the DON stated, The dressing changes for [Resident #274's name] were not done and should not have been charted that they had been completed. 3) Review of Resident #80's medical record documented the resident was admitted [DATE] with medical diagnosis to include hemiplegia and hemiparesis (paralysis) left non dominant side, dysphasia (difficulty swallowing), chronic obstructive pulmonary disease (difficulty breathing), respiratory failure , acute congestive heart failure, cognitive social or emotional deficiency following cerebral infraction, muscle weakness, weakness, unspecified protein calorie malnutrition, major depressive disorder, hypothyroidism, gastric esophageal reflux disease. Review of the physician order dated 8/9/2022 for Resident #80 documented Multi podus boots while in bed every shift. Review of TAR for Resident #80 did not document the multi podus boots while in bed every shift was conducted on June 5, 2023. During an observation on 6/4/2023 at 9:48 AM Resident #80 was lying in bed and podus boots were not on the resident's feet. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 2 of 11 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 06/07/2023 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 0684 During an interview on 6/4/2023 at 9:48 AM Resident #80 stated, I don't have boots on my feet. Level of Harm - Minimal harm or potential for actual harm During an observation on 6/5/2023 at 8:37 AM Resident #80 was lying in bed and podus boots were not on the resident's feet. Residents Affected - Some During an observation on 6/5/2023 at 1:44 PM Resident #80 was lying in bed and podus boots were not on the resident's feet. During an interview on 6/5/2023 at 1:46 PM Staff S, RN stated, I don't remember [Resident #80's name] ever having boots on. They could be in laundry services. During an interview on 6/5/2023 at 2:31 PM the DON stated, The multi podus boots should be on resident when she is in the bed. Even if they were sent to the laundry they come back by the next day. 4) Review of Resident #113's medical record documented the resident was admitted [DATE] with medical diagnosis to include pain syndrome, COPD (chronic obstructive pulmonary disease), heart failure, hyperlipidemia, sleep apnea, morbid obesity, muscle weakness, unspecified abnormalities of gait and mobility, and hypertension. Review of the physician order dated 5/9/2023 for Resident #113 documented, Compression stockings in the morning on during the day off at night. During an observation on 6/4/2023 at 10:40 AM Resident #113 was sitting in a recliner with her legs prompted up; there were no compression stockings on her legs. During an observation on 6/5/2023 at 12:22 AM Resident #113 was sitting in a recliner at bed side with her feet prompted up. Compression stockings were not on the resident's legs. During an interview on 6/5/2023 at 12:22 AM Resident stated I never wear the compression socks they are in the cabinet, but no one assists me to put them on. I can't reach down there and do it myself. I've not had my compression stockings on. During an interview conducted on 6/5/2023 at 1:15 PM Staff C, LPN, confirmed Resident #113 was not wearing compression stockings and should be. During an interview on 6/5/2023 at 2:30 PM the DON stated, The resident needs her compression stocking on. Review of the policy and procedure titled, Wound Care issued 4/1/2022 read, Policy: It will be the policy of this facility to provide assessment and identification of residents at risk of developing pressure injuries, other wounds and the treatment of skin impairment. 6.Wound care procedures and treatments should be performed according to physician orders. 7. Wound care treatment should maintain proper technique, as is indicated by the type of wound and physician orders. 8. Preventative measures such as barrier creams, can be employed to help maintain skin integrity as well as utilization of pressure relieving surfaces, floating heels, protective boots and use of positioning devices. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 3 of 11 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 06/07/2023 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure respiratory care services were provided consistent with professional standards of practice for oxygen administration for 3 of 7 residents, Residents #12, #80, and #113, reviewed for respiratory services Residents Affected - Few Findings include: 1) Review of Resident #12 medical record documented the resident was re-admitted into the facility on 5/12/2023 with diagnosis to include pneumonia, emphysema, chronic obstructive pulmonary disease, respiratory failure, diabetes, abnormal finding of lung field, hypertension, anemia. During an observation on 6/4/2023 at 11:33 AM Resident #12 was being administered oxygen via nasal cannula at 2 liters per minute. During an interview on 6/4/2023 at 11:33 AM Resident #12 stated, My oxygen is set at 3. During an observation on 6/5/23 at 11:59 AM Resident #12 was sitting in a wheelchair. Oxygen was being administered at 3 liters per minute via nasal cannula. Review of Resident #12's physician's orders did not document an order for oxygen. During an interview on 6/5/2023 at 1:48 PM Staff A, RN (Registered Nurse) stated, There are no oxygen orders for the resident [Resident #12] the oxygen order was discontinued on 5/11/2023. 2) Review of Resident #80's medical record documented the resident was admitted into the facility on 8/8/2022 with diagnosis to include hemiplegia and hemiparesis (paralysis) left non dominant side, dysphasia (difficulty swallowing), chronic obstructive pulmonary disease (difficulty breathing), respiratory failure, and acute congestive heart failure. Review of the physician order dated 10/18/2022 for Resident #80 read, Change oxygen tubing weekly and PRN [as needed] ensure to label date and time. During an observation on 6/4/2023 at 9:48 AM Resident #80 was lying in bed. Oxygen was being administered at 2 liters per minute via nasal cannula, the tubing was not labeled with the date and time. During an observation on 6/5/2023 at 8:37 AM Resident #80 was being administered oxygen at 2 liters per minute via nasal cannula. The oxygen tubing was not labeled with the date and time. 3) Review of Resident #113's medical record documented the resident was admitted on [DATE] with diagnosis to include pain syndrome, chronic obstructive pulmonary disease, heart failure, sleep apnea, morbid obesity, muscle weakness, and hypertension. Review of the physician's order dated 3/16/2024 for Resident #113 read, Change oxygen tubing weekly and PRN every night shift every Thursday. During an observation on 6/4/2023 at 10:40 AM of Resident #113 the oxygen concentrator at the bedside was administering oxygen at 2 liters per minute and was being humidified with water to Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 4 of 11 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 06/07/2023 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 Level of Harm - Minimal harm or potential for actual harm #113 via nasal cannula. The nasal cannula tubing and the water utilized for humidification was not labeled or dated of when the tubing was changed. During an observation on 6/5/2023 at 12:22 PM Resident #113's oxygen tubing and water utilized for humidification was not labeled or dated. Residents Affected - Few During an interview on 6/5/2023 at 1:15 PM Staff C, Licensed Practical Nurse stated, [Resident #113's name] oxygen tubing is not dated. During an interview on 6/5/2023 at 1:22 PM Staff D, Medical Record stated, They are supposed to be changed [oxygen tubing] and dated on night shift. During an interview on 6/5/2023 at 02:30 PM the Director of Nursing stated, It is my expectation that physician orders are followed, oxygen tubing is changed out on Thursday nights or as needed and is dated. During an interview on 6/6/2023 at 10:22 AM the Assistant Director of Nursing/Infection Preventionist stated, It is my expectation that oxygen tubing is changed out on Thursday nights and are dated at that time. Review of the policy and procedure titled, Oxygen Administration issued 4/1/2022 read, Policy: It is the policy of this facility to provide guidelines for safe oxygen administration. Procedure: 1. Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. 7. Weekly oxygen tubing changes can be documented in the medical record as a reminder to the staff but is only required to have tubing dated appropriately demonstrating that the tubing was changed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 5 of 11 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 06/07/2023 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 - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation and interview, the facility failed to store medications under proper temperature for 1 of 4 medication carts. Findings include: During an observation on 6/6/23 at 3:15 p.m. of the medication cart for the 300 Hall, a bag of intravenous bag of Vancomycin 1.75 GM/500 ML D5W [1.75 grams/500 milliliters dextrose 5% water] dated 6/4/23. a use by date of 6/13/23, labeled for Resident #44 was located in the bottom drawer of the medication cart. The solution was at room temperature. There was no condensation on the bag. There was no indication the bag had been refrigerated. There was no date or time on the bag indicating when the bag was removed from the refrigerator. During an interview on 6/6/23 at 3:15 p.m. Staff F stated, I gave the 8:00 a.m. dose of Vancomycin. I don't know where this bag came from. I had not noticed it in the cart until just now. Vancomycin must be refrigerated. I did not take that bag out. I don't know how long it has been in the cart. During an interview on 6/7/23 at 8:17 a.m. the Consultant Pharmacist stated, Vancomycin is always refrigerated. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 6 of 11 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 06/07/2023 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 observations, interviews, and policy review, the facility failed to ensure stored food is labeled and dated, thawed according to professional standards, and that food is distributed in a safe manner. Residents Affected - Some Findings Include: During a walk-through tour of the kitchen on 6/04/23 at 09:16 AM with the morning cook, an observation was made in the walk-in cooler in the kitchen of a large pan of what appeared to be diced chicken; the food item was not labeled identifying the content or dated and a quart size container with what appeared to be gravy or sauce that was not labeled identifying the contents or dated. An interview was conducted with the morning cook on 6/04/2023 at 9:20 AM. The cook stated, That is a large pan of chicken, and the quart container was breakfast gravy, and both items should have had a label and date. An observation was made on 6/04/23 at 9:25 AM of four 5# (pound) rolls of raw ground beef being thawed in a prep sink of 12 of standing water. An interview was conducted with the Dietary Manager (DM) on 06/04/2023 at 10:00 AM regarding thawing of frozen foods. The DM stated, Foods should always be thawed under running water. Review of a document provided, with no date, titled Food Preparation read, 5. The Dining Services Director/Cook(s) is responsible to ensure that proper practice is utilized in thawing frozen foods. Completely submerged under cold water that is running fast enough to agitate and float off loose ice particles. An observation of the food carts being transported to seven various hallways for delivery was conducted on 6/04/23 at 12:30 PM. Observations of the tray delivery showed food trays included pork loin, seasoned potatoes, buttered zucchini, roll, and a dessert of a piece of chocolate cream pie. An observation was made of the food trays being removed from the food cart located at one end of each hallway, drinks being added from a drink cart and then being transported by a staff member down the hall and delivered to the resident rooms. An observation was made of the trays without any covering or lid on the dessert on all the room trays that were being delivered throughout the entire length of each hallway. An interview was conducted with the DM on 06/04/2023 regarding covering food items during transport. The DM confirmed all drinks and food should be covered during transporting to the residents' rooms and not be delivered uncovered in the hallways. Review of a document provided, dated October 2019, and titled Meal Distribution read, 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 7 of 11 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 06/07/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on record review and interview, the facility failed to ensure residents' medical records were complete and accurately documented for 7 of 12 residents, Residents #44, #54, #18, #274, #80, #85, and #113. Residents Affected - Some Findings Include: 1) Review of the Health Status Note dated 5/16/23 at 11:09 PM [eINTERACT form] for Resident #54 read, At approximately 2200 [10:00 PM] this writer was notified by the CNA [Certified Nursing Assistant] that resident was not responding. On arrival to the residents room resident was noted laying on the bed with eyes closed and mouth breathing. Resident was not wearing her O2 [oxygen] as ordered. Pulse ox noted to be 76. B/P [blood pressure] noted to be 179/78 with HR [heart rate] at 104. Or [sic] at 5L [liters] via non-rebreather mask was applied O2 noted to increase to 91%. Resident remained unresponsive. Accu check was performed and noted to be 25. Glucagon injection administered and 911 called. Resident transported to [Hospital's name] for further eval. Review of Resident #54's Nursing Home to Hospital Transfer Form dated 5/16/2023 at 11:17 PM read, Key Clinical Information. Reason(s) for transfer: Other -- planned surgery. During an interview on 6/5/23 at 3:50 p.m., the Director of Nursing (DON) stated, The eINTERACT form was not filled out correctly on the 16th. The form populates information from previous forms, and it looks like that information is from a previous form. This was not a planned hospitalization. I would expect the nurse completing the form, to provide the correct information on the form prior to transfer. 2) Review of the physician's order for Resident #44 dated 5/30/23 read, Anasept Antimicrobial External Gel 0.057%. Apply to buttocks and sacrum topically every day shift for wound. Review of the Treatment Administration Record (TAR) for Resident #44 did not document wound care on 6/3/23 or 6/4/23. Review of the physician's order for Resident #44 dated 5/2/23 read, Anasept Antimicrobial External Gel 0.057%. Apply to coccyx R & L [right and left] buttocks topically every day shift for wound. Review of TAR for Resident #44 did not document wound care on 5/6/23, 5/13/23, 5/14/23, 5/17/23, 5/18/23, 5/22/23, 5/24/23, 5/26/23, and 5/29/23. Review of the physician's order for Resident #44 dated 5/2/23 read, Cleanse coccyx wound with ns [normal saline], skin prep periwound, apply moistened gauze with Anasept gel cover with bordered drsg [dressing] daily and prn [as needed] every day for wound. Review of the TAR for Resident #44 did not document wound care on 5/6/23, 5/13/23, 5/14/23, 5/17/23, 5/18/23, 5/19/23, 5/20/23, 5/22/23, 5/24/23, 5/26/23, 5/29/23, 6/3/23, and 6/4/23. Review of the physician's order for Resident #44 dated 5/2/23 read, Cleanse left buttock wound with ns, skin prep periwound, apply moistened gauze with Anasept gel cover with bordered drsg daily and prn every day shift for wound. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 8 of 11 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 06/07/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the TAR for Resident #44 did not document wound care on 5/6/23, 5/13/23, 5/14/23, 5/17/23, 5/18/23, 5/19/23, 5/20/23, 5/22/23, 5/24/23, 5/26/23, 5/29/23, 6/3/23, and 6/4/23. Review of the physician's order for Resident #44 dated 5/2/23 read, Cleanse left lat [lateral] foot wound with ns, skin prep periwound apply medihoney on ca [calcium] alaginate, cover with bordered drsg daily, and prn every day for wound. Review of the TAR Resident #44 did not document wound care on 5/6/23, 5/13/23, 5/14/23, 5/17/23, 5/18/23, 5/19/23, 5/20/23, 5/22/23, 5/24/23, 5/26/23, 5/29/23, 6/3/23, and 6/4/23. Review of the physician's order for Resident #44 dated 5/2/23 read, Cleanse right buttock wound with ns skin prep periwound, apply moistened gauze with Anasept gel cover with bordered drsg daily and prn every day shift for wound. Review of the TAR for Resident #44 did not document wound care on 5/6/23, 5/13/23, 5/14/23, 5/17/23, 5/18/23, 5/19/23, 5/20/23, 5/22/23, 5/24/23, 5/26/23, 5/29/23, 6/3/23, and 6/4/23. Review of the physician's order for Resident #44 dated 5/2/23 read, Cleanse right heel wound with ns, skin prep periwound, apply medihoney on ca alginate cover with bordered drsg daily and prn every day shift for wound. Review of the TAR for Resident #44 did not document wound care on 5/6/23, 5/13/23, 5/14/23, 5/17/23, 5/18/23, 5/19/23, 5/20/23, 5/22/23, 5/24/23, 5/26/23, 5/29/23, 6/3/23, and 6/4/23. Review of the physician's order for Resident #44 dated 5/2/23 read, Cleanse right inner thigh wound with ns, skin prep periwound, apply medihoney on ca alginate cover with bordered drsg daily and prn every day shift for wound. Review of the TAR for Resident #44 did not document wound care on 5/6/23, 5/13/23, 5/14/23, 5/17/23, 5/18/23, 5/19/23, 5/20/23, 5/22/23, 5/24/23, 5/26/23, 5/29/23, 6/3/23, and 6/4/23. Review of the physician's order for Resident #44 dated 5/2/23 read, Cleanse right lat calf wound with ns, skin prep periwound apply medihoney on ca alginate cover with bordered drsg daily and prn every day for wound care. Review of the TAR for Resident #44 did not document wound care on 5/6/23, 5/13/23, 5/14/23, 5/17/23, 5/18/23, 5/19/23, 5/20/23, 5/22/23, 5/24/23, 5/26/23, 5/29/23, 6/3/23, and 6/4/23. Review of the physician's order for Resident #44 dated 5/2/23 read, Cleanse right lat foot wound with ns, skin prep periwound apply medihoney on ca alginate cover with bordered drsg daily and prn every day shift for wound. Review of the TAR for Resident #44 did not document wound care on 5/6/23, 5/13/23, 5/14/23, 5/17/23, 5/18/23, 5/19/23, 5/20/23, 5/22/23, 5/24/23, 5/26/23, 5/29/23, 6/3/23, and 6/4/23. 3) Review of the physician's order for Resident #18 dated 4/13/2023 documented, Apply ace wrap to bilateral lower extremity every day shift for chronic edema. Dated 4/13/2023, Cleanse wound with wound cleanser, pat dry, apply calcium alginate, and cover with dry dressing every day shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 9 of 11 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 06/07/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident #18's TAR did not document wound care on 4/7/23, 4/9/23, 4/13/23, 4/14/23, 4/16/23, 5/3/23, 5/10/23, 5/17/23, 5/19/23, 5/23/23, 5/27/23, 6/2/23 and 6/5/23. 4) Review of the physician's order dated 6/1/2023 for Resident #274 documented, Cleanse left Achilles with ns, apply sorbact gauze and cover with bordered drsg Tuesdays and Fridays and prn as needed for Sx [signs and symptoms] wound. Cleanse left and right shin with ns apply Medi honey cover with bordered drsg daily and prn every day shift for trauma. Cleanse left heel wound with ns, apply medi honey on calcium alginate cover with bordered drsg daily and prn as needed for wound. Review of Resident #274's TAR did not document wound care for the left Achilles on 5/19/23, 5/23/23, and 5/27/2023 and did not document wound care to the left heel and left shin wounds on 5/18/23, 5/19/23, 5/20/23, 5/21/23, 5/22/23, 5/23/23, 5/24/23, 5/25/23, 5/26/23, and 6/2/23. 5) Review of the physician's order dated 4/21/2023 for Resident #85 documented, Nystatin triamcinolone cream 100000-0.1 unit gram %, apply to left palm topically two times a day for dermatitis for 14 days start. Dated 5/24/2023 Eucerin Eczema Relief External Cream 2% colloidal oatmeal, apply to left palm topically three times a day for eczema for 30 days. Review of the TAR for Resident #85 did not document wound care of the Nystatin triamcinolone cream on 4/24/23, 4/25/23, 4/28/23, 4/29/23, 4/30/23, 5/1/23 and 5/2/23 at 5:00 PM, and on 4/29/23 at 9:00 AM. Review of the TAR did not document wound care of Eucerin Eczema Relief External Cream 2% colloidal oatmeal on 5/27/23 at 9:00 AM, 1:00 PM, and 9:00 PM, and on 6/2/23 at 9:00 PM. 6) Review of the physician's order for Resident #80 dated 8/9/2022 read, Multi podus boots while in bed every shift. Review of the TAR for Resident #80 did not document care and treatment for the multi use podus boots on 4/2/23, 4/8/23, 4/14/23, 4/28/23 night shift, 4/8/23, 4/15/23, 4/27/23 day shift, 4/23/23 evening shift, 5/3/23, 5/11/23, 5/16/23, 5/27/23, 5/31/23, 6/2/23, 6/5/23, 6/6/23 day shift, 6/5/23, and 6/6/23 evening shift. 7) Review of the physician's order for Resident #113 dated 5/9/2023 read, Compression stockings in the morning on during the day off at night. Review of the TAR for Resident #113 did not document care and treatment for compression stockings on 5/20/23, 5/25/23, 5/27/23 and 6/1/23. During an interview on 6/6/23 at 9:45 a. m. Staff J, LPN Wound Care Nurse stated, If it was a weekend or holiday, I may not have been here to do it. We know if it wasn't documented, it isn't done. But, when I come back on Mondays or after being gone, the dressings have been changed. The dressings were always labeled and I'm sure they were done because I check the date on the actual dressing. It is a documentation problem. The care was given. There is a way for them to chart it even if it is done later. But they didn't do that. Maybe they got busy, but it wasn't charted. Review of policy and procedure titled, P & P Charting and Documentation dated 4/1/22 read, Policy: It is the policy of this facility that services provided to the resident or any changes in the resident's medical or mental condition, shall be documented in the resident's clinical record as needed. Procedure: 1. Observations, medications administered, services performed, etc., should be documented in the resident's clinical records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 10 of 11 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 06/07/2023 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to prevent the possible spread of infection for 1 of 3 residents reviewed, Resident #1. Residents Affected - Few Findings include: During an observation conducted on 06/04/23 at 11:10 AM, Resident #1's catheter bag was lying on the floor next to the bed without a protective barrier between it and the floor. Review of Resident #1's clinical record documented Resident #1 was admitted to the facility on [DATE] with diagnoses to include osteomyelitis of vertebra, sacral and sacrococcygeal, sepsis, pulmonary embolism, type II diabetes mellitus, protein calorie malnutrition, and neuromuscular dysfunction of bladder. Review of Resident #1's physician orders dated 6/5/23 read, insert/maintain indwelling catheter (14 French), change indwelling catheter for leakage or blockage as needed, catheter care every shift and as needed for soiling or leakage. Review of Resident #1's care plan dated 4/24/23 read, Focus: Resident has a urinary catheter with interventions including resident has a urinary catheter in place and needs the following care: keep the drainage bag below bladder level, cover the bag for dignity, give catheter care as ordered . During an interview conducted on 06/04/23 at 11:13 AM Staff N, Licensed Practical Nurse, confirmed Resident #1's catheter bag was on the floor with no barrier between it and the floor and stated, that should not be on the floor. Review of the policy and procedure (P & P) titled, P & P Indwelling Catheters, dated 4/1/22 read, Policy: It will be the policy of this facility to provide appropriate documentation for use and care for indwelling catheters of the resident's [sic] that have the indication for use beyond 14 days. Procedure: 8. Staff will provide daily catheter care or as ordered by the physician and or needed. Catheter care should be provided in a manner that promotes infection control and maintenance of the insertion site. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106046 If continuation sheet Page 11 of 11