Health inspection·September 15, 2022

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 1. On 9/12/22 at 11:02 a.m., 2:00 p.m., and 3:15 p.m., Resident #6 was observed in her bed wearing a hospital gown and not involved in an activity. Further observation noted the television (TV) was not on nor was there a radio playing music for Resident #6. On 9/15/22 review of Resident #6's medical record revealed she was admitted to the facility on [DATE]. The activity plan of care initiated on 7/29/19 and last revised on 4/5/22 stated Resident #6 had needs for daily activities of choice. The resident would maintain involvement in cognitive stimulation, and social activities as desired. The last documented activity assessment for Resident #6 was a quarterly activity assessment completed on 8/4/21 by the Activity Director. The Activity Director wrote when Resident #6 is up in her wheelchair, she would occasionally attend group activities as desired, and Resident #6 continued to enjoy socializing, reminiscing with staff and other residents, and spending time up in her wheelchair in the hallway. There was no documentation Resident #6's activity care plan had been reviewed and/or revised based on an activity quarterly assessment completed by the Activity Director or their designee to reflect her current activity of choice. 2. On 9/12/22 at 11:12 a.m. and 3:21 p.m., Resident #22 was observed in his bedroom sitting on his bed, not involved in an activity. Further observation noted the TV was not on nor was there a radio playing music for Resident #22. On 9/13/22 at 10:06 a.m., Resident #22 was observed in his bedroom sleeping and not involved in an activity. Further observation on 9/13/22 at 11:59 a.m. and 2:13 p.m., Resident #22 was observed in his bedroom sitting on his bed not involved in an activity. The TV was not on nor was there a radio playing music for Resident #22. On 9/15/22 review of Resident #22's medical record revealed he was admitted to the facility on [DATE]. The activity plan of care initiated on 10/24/19 and last revised on 3/11/22 stated Resident #22 would attend/participate in activities of choice by the next review date. The last documented activity assessment for Resident #22 was an quarterly assessment dated [DATE] completed by the Activity Director. The Activity Director wrote they interviewed Resident #22 utilizing a translator because Resident #22 is Spanish speaking only. Resident #22 enjoyed going outside for fresh air and watching people and socializing with other Spanish-speaking residents. He enjoyed playing dominoes and listening to Cuban music. There was no documentation Resident #22's activity care plan had been reviewed and/or revised based on an activity quarterly assessment completed by the Activity Director or their designee to reflect his current activity of choice. On 9/15/22 review of the facility Activities policy dated March 2022 and reviewed/revised in September 2022, noted the facility would provide an ongoing activity program to support residents in their choice of activities based on the resident comprehensive assessments, care plan, and preferences. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 2 of 8 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 106089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Conch Republic Nursing and Rehab 5860 W Junior College Rd Key West, FL 33040 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 0657 Each resident's interests and needs would be assessed on a routine basis. Level of Harm - Minimal harm or potential for actual harm On 9/15/22 review of the Activity Director's job description, in section Major Duties and Responsibilities stated the Activity Director was responsible to review and evaluate each resident response to their activity program to determine if the activity program met the needs of the resident. Residents Affected - Some On 9/15/22 at 11:41 a.m., interview with Staff C, an Assistant Activity Aid said she had been working at the facility since May 2021 as an activity assistant. She said all admission, quarterly and annual assessment are completed by the Activity Director who was currently out on medical leave. Staff C said as an activity assistant she would visit the residents daily and gets to know what each resident likes to do for their activity choice. She said she did not know when the Activity Director last reviewed and/or updated each resident's activity plan of care to determine their likes and dislikes. Staff C said Resident #6 tended to stay in her room and did not get out of bed. She said Resident #22 did not speak English and she didn't know enough Spanish to communicate with Resident #22. She said when she brought Resident #22 to an activity program he would wander off. She said she did not know if the Activity Director had completed the quarterly activity plan of care updates to determine Resident #6 and #22 activity likes and dislikes. On 9/15/22 at 3:50 p.m., during an interview with the Administrator, he said the facility's Activity Director was currently out on medical leave. The Administrator confirmed the facility Activity policy dated March 2022 stated the Activity Director would provide an ongoing comprehensive assessment of each resident's interests and needs on a routine basis. He also confirmed the Activity Director's job description stated they were required to review and evaluate each resident's response to their activity program to determine if the activity program met their needs. The Administrator reviewed Resident #6 and Resident #22's medical records. The Administrator confirmed the last activity assessment documentation for Resident #6 was dated 8/4/21 and the last activity assessment for Resident #22 was dated 4/6/21. The Administrator said they were unable to find documentation Resident #6's and #22's activity care plan had been reviewed and/or revised based on an activity quarterly assessment completed by the Activity Director or their designee to reflect each resident's activity of choice. 3. The facility's policy titled, Hemodialysis with an implementation date of March 2022 noted, . Compliance guidelines . The nurse will ensure that the dialysis access site (. Shunt or graft) is checked before and after dialysis treatments and every shift for patency by auscultating for a bruit (swooshing sound) and palpating for a thrill (Vibration felt on the overlying skin). If absent, the nurse will immediately notify the attending physician, dialysis facility and/or nephrologist. Review of the clinical record for Resident #23 showed a care plan initiated on 7/5/21 and revised on 3/23/22 noting the resident had a diagnosis of chronic kidney disease and received hemodialysis (treatment to filter wastes and water from the blood) three times a week at a dialysis center. The goal was to have no infection at the site or adverse side effects of dialysis. The care plan noted Resident #23 had two dialysis access sites, a dialysis port to the right side of the chest and a left arm shunt (Surgical connection between an artery and a vein). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 3 of 8 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 106089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Conch Republic Nursing and Rehab 5860 W Junior College Rd Key West, FL 33040 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some The interventions included to assess the dialysis port to the right side of the chest for signs and symptoms of infection, protect shunt site from injury, provide dialysis communication with pre and post dialysis assessment done on dialysis days. The Care plan showed no interventions to assess the shunt to the left arm for a bruit and thrill, indicating the shunt is functioning. for assessing the access site for signs of infection or for There was no documented revision of the care plan to include accessing the shunt for infections after the site became infected on 7/22/2022. Review of the dialysis communication tool dated 7/22/22 showed Resident #23's left Arteriovenous Fistula (dialysis access site) was warm, red, and swollen The nurse documented Resident #23 had blood cultures and was started on antibiotics because of the signs of infection. There was no documentation the care plan was updated to reflect the left arm dialysis access site infection or monitoring for signs and symptoms of infection. On 9/14/22 at 3:30 p.m., Licensed Practical Nurse, Staff E said the pre-dialysis treatment assessment consisted of taking the resident's vital signs and sending her on her way. Staff E said when the resident returned from treatments, the post treatment assessment was to take her vital signs again. On 9/14/22 at 4:00 p.m., Unit Manager, Staff D said the bruit and the thrill was supposed to be checked before and after the resident's dialysis treatment and the site was supposed to be assessed for redness. Staff D verified there was no documentation on the Medication Administration Record or the Treatment Administration Record the resident's access site to the left arm was being monitored before and after treatments. Based on observation, record review and interview, the facility failed to reassess the effectiveness of interventions and review and revise care plans to meet resident needs for 3 (#22, #6, #23) of 21 residents reviewed. The findings included: FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 4 of 8 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 106089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Conch Republic Nursing and Rehab 5860 W Junior College Rd Key West, FL 33040 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 observations, record review and interview, the facility failed to provide appropriate care and services to prevent urinary tract infections to the extent possible for 1 (Resident #69) of 2 residents reviewed for urinary catheter care. The findings included: The Healthcare Infection Control Practices Advisory Committee, guideline for Prevention of Catheter-Associated Urinary Tract Infection 2009 with a last update of June 6, 2019, noted the proper techniques for Urinary Catheter Maintenance included to keep the collecting bag below the level of the bladder at all times and not to rest the bag on the floor. https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-guidelines-H.pdf Review of Resident #69's clinical record revealed a care plan dated 8/16/22 with a focus for an indwelling catheter (Catheter placed in the bladder to drain urine). On 9/12/22 at 10:24 a.m., 11:30 a.m., and 2:38 p.m., Resident #69's urinary catheter drainage bag was observed hooked to the lowest portion of the bed frame. The bottom of the urinary drainage bag was resting on the floor. On 9/13/22 at 9:47 a.m., and 9/14/22 at 8:44 a.m., the urinary catheter drainage bag remained hanging off the side of the bed with the bottom of the bag resting on the floor. On 9/14/22 at 8:47 a.m., Licensed Practical Nurse (LPN) Staff A said she did not think the catheter bag should be on the floor. On 9/14/22 at 8:55 a.m., Certified Nursing Assistant (CNA) Staff B said they were trained about catheter care and the catheter drainage bag was not supposed to touch the floor. If it had to touch the floor, there was supposed to be a barrier. The Facility's policy titled Catheter Care; last reviewed/revised September 2022 noted the policy of the facility was to ensure that residents with indwelling catheter receive appropriate catheter care. The policy did not address keeping the catheter drainage bag off the floor. On 9/14/22 at 9:27 a.m., the Director of Nursing (DON) said urinary catheter drainage bags should never touch the floor. She said the bag should be hung on the higher level of the bed frame, so it doesn't touch the floor. She said if it touched the floor, it increased the potential for infection. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 5 of 8 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 106089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Conch Republic Nursing and Rehab 5860 W Junior College Rd Key West, FL 33040 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 Based on observation, interview, and record review the facility failed to maintain documentation of ongoing coordination with the dialysis center related to assessment of resident status, including dialysis access site before, during, and after each dialysis treatment for 1 (Resident #23) of 1 sampled resident receiving outpatient dialysis treatment. Residents Affected - Few The findings included: Review of the Long Term Care Outpatient Dialysis Services Coordination Agreement signed and dated by a facility and dialysis treatment representative on 6/22/21 read, . Interchange of Information. The Long Term Care Facility shall provide the interchange of information useful or necessary for the care of the ESRD (end stage renal disease) Residents . Review of the facility policy Hemodialysis implemented 3/2022 and revised on 9/14/22 read, This facility will provide necessary care and treatment, consistent with professional standards of practice, physician's orders, the comprehensive person-centered care plan, and the resident's goals and preferences, to meet the special medical, nursing, and psychosocial needs of residents receiving hemodialysis .The Nurse will monitor and document the status of the resident's access site(s) upon return from the dialysis treatment to observe for bleeding or other complications . The nurse will ensure that the dialysis access site (. shunt, or graft) is checked before and after dialysis treatments and every shift for patency by auscultating for a bruit (swooshing sound) and palpating a thrill (Vibration felt on the overlying skin). If absent, the nurse will immediately notify the attending physician, dialysis facility and/or nephrologist . Review of Resident #23's clinical record revealed an admission date of 10/2/20. The care plan initiated on 7/5/21 and revised on 3/23/22 noted the resident had a diagnosis of chronic kidney disease and received hemodialysis (treatment to filter wastes and water from the blood) three times a week at a dialysis center. The goal was to have no infection at the site or adverse side effects of dialysis. The care plan documented Resident #23 had two dialysis access sites, a dialysis port to the right side of the chest and a left arm shunt (Surgical connection between an artery and a vein). The interventions included to assess the dialysis port to the right side of the chest for signs and symptoms of infection, protect the shunt site from injury, provide dialysis communication with pre and post dialysis assessment done on dialysis days. The care plan had no intervention to assess the left arm shunt before and after treatment and every shift per facility policy. Review of the Medication Administration Record and Treatment Administration Record showed no documentation of assessment of the resident's left arm shunt for bruit and thrill. Observation on 9/13/22 at 3:25 p.m., showed Resident #23 had two dialysis access sites, an external catheter to the right side of her chest and a shunt to her left inner arm. Resident #23 said the dialysis center had been using the shunt in her left arm for dialysis (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 6 of 8 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 106089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Conch Republic Nursing and Rehab 5860 W Junior College Rd Key West, FL 33040 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 treatments for a couple of months. Level of Harm - Minimal harm or potential for actual harm On 9/14/22 at 3:46 p.m., Staff Nurse #1 from the Dialysis Unit said Resident #23 had had the left arm shunt in place for several months, but due to complications with the shunt they had not been able to discontinue the external catheter. Staff #1 said the resident left arm shunt site was infected this past July and received antibiotics. Staff #1 said on 9/14/22 the access site to the left arm was red and swollen. Staff #1 said the pressure dressing from the previous treatment was kept on too long, causing the irritation. She said this had been a problem in the past as well and the dialysis center spoke to the facility staff about not leaving the pressure bandage on too long. Residents Affected - Few The facility provided documentation of post treatment assessments of dialysis access sites completed on six treatment days: On 7/22/22 Licensed Practical Nurse, Staff D documented on the pre-treatment assessment the Shunt/Fistula Site had no pain. There was no documentation of the bruit or the thrill. The Dialysis Staff nurse documented on the communication form after the resident's treatment the Left Arteriovenous Fistula was red, warm, and swollen blood cultures were drawn and resident #23 was given one gram of Vancomycin. On 8/15/22 There was no documented assessment of the left arm access site pre-dialysis treatment. The facility nurse documented there was no pain at the site. No bruit or thrill was noted. On 9/2/22 The facility nurse documented vital signs from 9/1/22 at 10:48 p.m., for pre-treatment vital signs. There was no documentation of a bruit or thrill before or after the treatment documented. There was no documentation of a bruit of thrill before or after the dialysis treatment on 9/9/22. On 9/12/22, the vital signs documented were from 9/7/22. The resident's weight documented was dated 9/4/22. There was no assessment of the resident's left arm access site prior to the dialysis treatment. There was no documented assessment of a bruit or thrill before the dialysis treatment on 9/14/22. On 9/14/22 at 3:30 p.m., Licensed Practical Nurse, Staff E said the pre-dialysis and post dialysis treatment assessment consisted of taking the resident's vital signs. On 9/14/22 at 4:00 p.m., Unit Manager, Staff D said the bruit and the thrill was supposed to be checked before and after the resident's dialysis treatment and the site was supposed to be assessed for redness. Staff D verified there was no documentation on the MAR or TAR the resident's access site was being assessed before and after treatments and every shift. On 9/15/22 at 11:00 a.m., the Director of Nursing verified the facility only had six post communications documented by the Dialysis unit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 7 of 8 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 106089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Conch Republic Nursing and Rehab 5860 W Junior College Rd Key West, FL 33040 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. Based on observation, record review and interview, the facility failed to review the risks and benefits of bed rails with the resident or resident representative and obtain informed consent prior to installation of bed rails for 3 (Residents #80, #68, and #289) of 5 residents reviewed for bed rails. The findings included: The facility's policy titled Proper Use of Side Rails reviewed/Revised in September 2022 noted to obtain informed consent from the resident, or the resident representative for the use of bed rails, prior to installation/use. On 9/12/22 at 2:05 p.m., Resident #80's bed was observed to have bed rails. On 9/15/22 at 10:10 a.m., Resident #80 said he liked having the bed rails, they helped him move about in bed and get out of bed. The clinical record did not include documentation of informed consent for the use of bed rails. On 9/13/22 at 9:39 a.m., Resident #68's bed was observed to have bed rails. Review of Resident #68's clinical record revealed no documentation of informed consent for the use of bed rails. On 9/12/22 at 11:06 a.m., Resident #289's bed was observed to have bed rails. On 9/15/22 at 10:00 a.m., Resident #289 said he liked having the bed rails, they help him move about. Review of Resident #289's clinical record revealed no documentation of informed consent for the use of bed rails. On 9/15/22 at 11:50 a.m., the Regional Nurse reviewed the clinical records for Residents #80, #68, and #289. He verified there were no informed consent for the use of the bed rails in the respective clinical records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 8 of 8