Health inspection·March 15, 2024

F 0578 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few dated by Resident #1 on [DATE] and signed by the physician on [DATE] directing that CPR be withheld or withdrawn. On [DATE] at 5:16 p.m., Registered Nurse (RN) Staff A documented in a progress note upon rounds at 11:40 a.m., Resident #1 was identified unresponsive, without pulse, no spontaneous respirations noted. Code blue called. The nurse went to retrieve the crash cart. CPR initiated. Emergency Medical Services were called. The resident was then noted to be a DNR and CPR was terminated. Resident #1 did not regain pulse or respirations. Review of the facility's investigation showed that on [DATE] at approximately 11:40 a.m., Resident #1 was found without pulse or respiration. RN Staff A did not verify Resident #1's advance directives for code status and administered cardiopulmonary resuscitation (CPR) against the resident's documented wishes to withhold CPR in the event of cardiac or respiratory arrest. After approximately four minutes of CPR being administered, the Director of Nursing (DON) realized Resident #1 was DNR and permission was received from Resident #1's daughter to cease CPR. Resident #1 expired. During an interview on [DATE] at 11:47 a.m., Licensed Practical Nurse (LPN) Staff B said she was upstairs and heard the code blue. When she got to the resident's room, the first thing she did was to ask if the resident was a full code or DNRO. She said she was told she was a full code. When she walked in the room she saw CPR being performed. Certified Nursing Assistant (CNA) Staff C was doing the compressions. The Weekend Supervisor was next to him and they were rotating. They had Staff B do the ambu bag (medical tool to force air into lungs) and give her the two breaths. Somebody came in and said to stop doing CPR as the resident was a DNR. During an interview on [DATE] at 1:13 p.m., LPN Staff D said she heard the code blue. She was downstairs and came up. She went to grab the crash cart, but it was gone. She went to the resident's room. The weekend supervisor was doing CPR. The CNAs were standing in the room and trying to assemble the ambu bag. After that, one CNA took over the CPR compressions, and the other nurse. LPN Staff B grabbed the ambu bag. The Weekend Supervisor left the room to make calls. CPR was still going and someone in hall said the resident was a DNR. Everything stopped. Emergency Medical Services (EMS) stopped coming off the elevator when they heard she was DNR and left back down elevator. The resident's daughter eventually came. During an interview on [DATE] at 1:58 p.m., CNA staff C said he heard the code blue. The Weekend Supervisor said the resident was a full code, then she did CPR. When she stopped she asked CNA Staff C to take over. He said he had CPR training and he took over the compressions. CNA Staff C said it was the first time he was doing CPR on anyone. He said the crash cart was there. He said he did not know how long CPR lasted but between two to five minutes. Then he heard someone say to stop doing CPR she's passed away. The Weekend Supervisor said to stop. Afterward, he heard the weekend supervisor spoke to the family. The DON asked him (Staff C) for his CPR certification and made a copy of it. He said when he checked the facility's electronic medical record, it showed the resident was a DNR. On [DATE] at 2:08 p.m., in an interview the DON said facility policy is to follow the Residents' Advanced Directive wishes. The DON explained the proper process if found unresponsive would be to go to the hall and yell code blue for assistance. At that time, all staff respond and check Electronic Health Record to confirm code status so they know what to do next. If a person is identified as DNR they do not start compressions. If the Resident was not DNR status they would start compressions. The DON confirmed RN Staff A did not follow facility's policy by failing to verify Resident #1's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 2 of 10 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 03/15/2024 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 0578 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Advance Directives and initiated CPR against the resident's wishes. She said RN Staff A was no longer employed at the facility. During an interview on [DATE] at 2:30 p.m., CNA Staff E said she was working and Resident #1 was her patient. She said the Weekend Supervisor found Resident #1 unresponsive. When the code blue was called she went to the room. Her CPR certification had expired, she helped move everything in the room to make room for the crash cart and EMS. She said the Weekend Supervisor started CPR until the DON found the resident was a DNR, then CPR was stopped. The immediate actions implemented by the facility and verified by the survey team on [DATE] included: As of [DATE], Resident #1 no longer resides in the facility. On [DATE] an investigation was initiated that included obtaining statements from staff involved and placing staff involved on suspension by the Director of Nursing and Administrator. On [DATE], the surveyor reviewed and verified the investigation was complete. On [DATE] staff members involved were given 1:1 (one on one) education on the advance directive process by the Director of Nursing. On [DATE], the surveyors verified all nurses completed the training on [DATE]. On [DATE] five of five nurses interviewed verified receipt of the training and able to verbalize process to verify advance directives. On [DATE] a root cause analysis was conducted by the DON, Risk Manager, RNC (Registered Nurse Consultant) and NHA (Nursing Home Administrator). On [DATE], the survey reviewed and verified the root cause analysis was complete. On [DATE] current residents had their advance directives audited to ensure accuracy by the Social Services Director. No new concerns were identified. On [DATE], the Social Services Director was interviewed and explained that every Morning Meeting the IDT team discuss each new admission from the prior day and verify when they have obtained the code status. She further explained that each Monday morning she or her back-up brings the code book to Morning Meeting and all new admissions from the prior week are reviewed for code status and verified the status is in the book. On [DATE], the surveyor verified the advanced directives were accurate through record review and reviewed Morning Meeting minutes to verify Code Status is discussed. On [DATE] a timeline was completed by the Director of Nursing. On [DATE] the surveyor verified the timeline and interviewed the Director of Nurses. On [DATE] through [DATE] current licensed nurses were educated on the advanced directive process (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 3 of 10 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 03/15/2024 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 0578 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few with an emphasis on ensuring FL Yellow DNR form for those who wish for CPR to be withheld completed and in electronic medical record, orders accurately reflect current resident's code status in the electronic medical record, code status binder process and accuracy of care plans reflect individualized code status wishes, abuse/neglect, and resident's rights education by the Director of Nursing. On [DATE] the surveyors verified the nurses were trained and the code status book were complete and accurate. Code status books observed on the first and the second floor at the nurse's station and on the crash carts. 15 Total licensed nurses including one contracted nurse. On [DATE] 9 out of 15 nurses completed the education, 60% of nurses. On [DATE] the surveyors verified the nurses were trained through record review. On [DATE] 6 out of 15 nurses completed the education, 40% of nurses for a total of 100% of nurses educated. On [DATE] the surveyors verified through record review the nurses, including the contracted nurse were trained. Any contracted nurses who are placed at the facility on assignment will receive the above education prior to starting their shift through an agency orientation packet. On [DATE] the surveyors interviewed the Director of nurses and reviewed the Agency Nurses training packet. Ad Hoc (unplanned) QAPI (Quality Assurance and Performance Improvement) on [DATE] completed with Medical Director, Administrator, Director of Nursing and remaining IDT members on the advance directive process including following policy and procedures in accordance with advance directives and a review of the root cause analysis. A Palm Vista Specific Code Process was developed. On [DATE] the surveyors interviewed the Director of nurses and verified the QAPI committee had reviewed all audits. On [DATE], the Registered Nurse (who did not verify the code status) was terminated and reported to the Board of Nursing. On [DATE], the surveyor verified through record review the Registered Nurse was terminated and reviewed the referral to the Board of Nursing. As part of the ongoing QAA (Quality Assessment and Assurance) process, an ad hoc QAPI was conducted on [DATE] that included the Medical Director, Administrator, Director of Nursing and remaining IDT (Interdisciplinary Team) members to review the plan viability on the advance directives process, code process, code status binder process and results of ongoing audits from [DATE] until [DATE]. No discrepancies or concerns were noted from the reviewed information and no changes to the plan were made. On [DATE] the surveyors verified through interview with the Director of nursing and verified the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 4 of 10 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 03/15/2024 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 0578 QAPI committee had reviewed all audits. Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 5 of 10 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 03/15/2024 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 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, the facility failed to implement their policies and procedures by failing to verify code status and administering cardiopulmonary resuscitation (CPR) to 1 (Resident #1) of 2 sampled residents found without pulse or respiration, against the resident's documented wishes and physician's order for DNR (Do not resuscitate). On [DATE] at approximately 11:40 a.m., Resident #1 was found without a pulse or respiration. Staff did not verify Resident #1's code status and administered cardiopulmonary resuscitation (CPR) against the resident's documented wishes, and the physician's orders to withhold CPR in the event of cardiac or respiratory arrest. The failure to follow the facility's CPR policies and procedures placed residents who had established advance directives at a likelihood that they would be resuscitated against their wishes and resulted in the determination of Immediate Jeopardy (IJ) at a scope and severity of isolated (J) starting on [DATE]. CPR may result in major physical trauma including broken ribs, lungs bruising, damage to the airway and internal organs, and internal bleeding. On [DATE] at 4:49 p.m., the Administrator was notified of the determination of Immediate Jeopardy and provided the IJ templates. The findings of Immediate Jeopardy were determined to be corrected on [DATE]. The findings included: The facility's policy and procedure titled, Advanced Directives Code Status issued 01/2024 noted, Do Not Resuscitate (DNR)- A DNR code status would indicate that the person would not want CPR performed and would be allowed to die naturally if their heart stops beating and/or they stop breathing . Review of the clinical record for Resident #1 revealed an admission date of [DATE]. The admission Minimum Data Set (MDS) assessment with a target date of [DATE]. The MDS noted the resident's cognition was intact with a Brief Interview for Mental Status score of 15. Review of the State of Florida Do Not Resuscitate Order form showed a patient statement signed and dated by Resident #1 on [DATE] noting to withhold or withdraw CPR based upon informed consent. On [DATE] the physician signed the form directing the withholding or withdrawing of cardiopulmonary resuscitation from Resident #1 in case of cardiac or respiratory arrest. On [DATE] at 5:16 p.m., Registered Nurse (RN) Staff A documented in a progress note upon rounds at 11:40 a.m., Resident #1 was identified unresponsive, without pulse, no spontaneous respirations noted. Code blue called. The nurse went to retrieve the crash cart. CPR initiated. Emergency Medical Services were called. The resident was then noted to be a DNR and CPR was terminated. Resident #1 did not regain pulse or respirations. Review of the facility's investigation showed that on [DATE] at approximately 11:00 a.m., Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 6 of 10 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 03/15/2024 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 0678 Level of Harm - Immediate jeopardy to resident health or safety #1 was found without pulse or respiration. Staff A Registered Nurse (RN) did not verify Resident #1's advance directives for code status and administered cardiopulmonary resuscitation (CPR) against the resident's documented wishes to withhold CPR in the event of cardiac or respiratory arrest. After approximately four minutes of CPR being administered, the Director of Nursing (DON) discovered Resident #1 was DNR and permission was received from Resident #1's daughter to cease CPR and resident expired. Residents Affected - Few During an interview on [DATE] at 11:47 a.m., Licensed Practical Nurse (LPN) Staff B said she was upstairs and heard the code blue. When she got to the resident's room, the first thing she did was to ask if the resident was a full code or DNRO. She said she was told she was a full code. When she walked in the room she saw CPR being performed. Certified Nursing Assistant (CNA) Staff C was doing the compressions. The Weekend Supervisor was next to him and they were rotating. They had Staff B do the ambu bag (medical tool to force air into lungs) and give her the two breaths. Somebody came in and said to stop doing CPR as the resident was a DNR. During an interview on [DATE] at 1:13 p.m., LPN Staff D said she heard the code blue. She was downstairs and came up. She went to grab the crash cart, but it was gone. She went to the resident's room. The weekend supervisor was doing CPR. The CNAs were standing in the room and trying to assemble the Ambu bag. After that, one CNA took over the CPR compressions, and the other nurse. LPN Staff B grabbed the Ambu bag. The Weekend Supervisor left the room to make calls. CPR was still going and someone in hall said the resident was a DNR. Everything stopped. Emergency Medical Services (EMS) stopped coming off the elevator when they heard she was DNR and left back down elevator. The resident's daughter eventually came. During an interview on [DATE] at 1:58 p.m., CNA staff C said he heard the code blue. The Weekend Supervisor said the resident was a full code, then she did CPR. When she stopped she asked him (CNA Staff C) to take over. He said he had CPR training and he took over the compressions. CNA Staff C said it was the first time he was doing CPR on anyone. He said the crash cart was there. He said he did not know how long CPR lasted but between two to five minutes. Then he heard someone say to stop doing CPR she's passed away. The Weekend Supervisor said to stop. Afterward, he heard the weekend supervisor spoke to the family. The DON asked him (Staff C) for his CPR certification and made a copy of it. He said when he checked the facility's electronic medical record, it showed the resident was a DNR. On [DATE] at 2:08 p.m., in an interview the DON said on the day of the event, she was in the dining room, heard the code blue called, and went to the room. She said Staff A (RN) was actively doing CPR. The DON said Staff A asked her to get paperwork to prepare for transfer. When she went to the nurse's station, the DON saw the DNR order on the Electronic Health Record. She said at that time Staff A had switched out compressions with another staff member and was coming up the hall. The DON said she told Staff A that Resident #1 was DNR at which time Staff A opened Resident #1's chart and saw the yellow DNR form. RN Staff A was on the phone with Resident #1's daughter who advised to stop CPR. The DON said facility policy is to follow the Residents Advanced Directive wishes. DON explained the proper process if found unresponsive would be to go to the hall and yell code blue for assistance. At that time, all staff respond and check the Electronic Health Record to confirm code status in order to determine what to do next. If a person is identified as DNR, they do not start compressions. If the Resident does not have a DNR status, they would start compressions. the DON said Staff A (RN) did not follow facility policy and was no longer employed at the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 7 of 10 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 03/15/2024 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 0678 Level of Harm - Immediate jeopardy to resident health or safety During an interview on [DATE] at 2:30 p.m., CNA Staff E said she was working and Resident #1 was her patient. She said the Weekend Supervisor found Resident #1 unresponsive. When the code blue was called she went to the room. Her CPR certification had expired, she helped move everything in the room to make room for the crash cart and EMS. She said the Weekend Supervisor started CPR until the DON found the resident was a DNR, then CPR was stopped. Residents Affected - Few The immediate actions implemented by the facility and verified by the survey team on [DATE] included: As of [DATE], Resident #1 no longer resides in the facility. On [DATE] an investigation was initiated that included obtaining statements from staff involved and placing staff involved on suspension by the Director of Nursing and Administrator. On [DATE], the surveyors reviewed and verified the investigation was complete. On [DATE] The Director of Nursing and the Nursing Home Administrator were educated by the Regional Nurse Consultant on the procedure for performing cardio-pulmonary resuscitation and double validation process of code status. On [DATE], the surveyors verified the training of Director of Nursing and Nursing Home Administrator. On [DATE] staff members involved were given 1:1 (one on one) education on regarding providing basic life support, including CPR, related to physician's orders and the resident's advanced directives by the Director of Nursing. On [DATE], the surveyors verified the training of all nurses was completed on [DATE] and interviewed five of five nurses present. On [DATE] a root cause analysis was conducted by the DON, Risk Manager, RNC (Registered Nurse Consultant and NHA (Nursing Home Administrator). On [DATE], the surveyors reviewed and verified the root cause analysis was complete. On [DATE] the Human Resources Director completed an audit of licensed nurse's CPR certification to ensure they were up to date including staff involved. On [DATE], the surveyor verified CPR was current for all nursing staff. On [DATE] a timeline was completed by the Director of Nursing. On [DATE] the surveyor verified the timeline through record review and interview with the Director of Nursing. The surveyors also verified the audit for nurses' CPR certification. On [DATE] through [DATE] current licensed nurses were educated on providing basic life support, including CPR, related to physician's orders, code blue process, verifying code status, the resident's advance directives, abuse/neglect, and resident's rights education by the Director of Nursing. 15 Total licensed nurses including one contracted nurse received education. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 8 of 10 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 03/15/2024 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 0678 On [DATE] 9 out of 15 nurses completed the education, 60% of nurses. Level of Harm - Immediate jeopardy to resident health or safety On [DATE] 6 out of 15 nurses completed the education, 40% of nurses for a total of 100% of nurses educated. Residents Affected - Few On [DATE] the surveyors verified through record review the nurses were trained and the code status book were complete and accurate. One contracted licensed nurse is on staff. On [DATE] the surveyors verified the contracted nurse was trained through record review and interview with the contracted nurse. Any contracted nurses who are placed at the facility on assignment will receive the above education prior to starting their shift through an agency orientation packet. On [DATE] the surveyors verified through interview with the Director of nursing and review of the Agency Nurses training packet. On [DATE] current residents had their advance directives audited to ensure accuracy by the Social Services Director. No new concerns were identified. On [DATE], the Social Services Director was interviewed and explained that every Morning Meeting the IDT team discuss each new admission from the prior day and verify when they have obtained the code status. She further explained that each Monday morning she or her back-up brings the code book to Morning Meeting and all new admissions from the prior week are reviewed for code status and verified the status is in the book. On [DATE], the surveyor verified the advanced directives were accurate through record review and reviewed Morning Meeting minutes to verify Code Status is discussed. On [DATE] mock code drills including verification of resident code status were conducted with nursing staff by the Director of Nursing/Designee daily through [DATE] and then additional drills for a total of 10 mock code drills. Director of Nursing/Designee conducted five drills on day shift and five drills on night shift with a variety of DNR and Full Code scenarios addressed. On [DATE] six out of 15 nurses completed a mock code drill, 40% of nurses. On [DATE] seven out of 15 nurses completed a mock code drill, 47% of nurses. On [DATE] eight out of 15 nurses completed a mock code drill, 53% of nurses. On [DATE] 12 out of 15 nurses completed a mock code drill, 80% of nurses. Two licensed nurses to participate in a mock code drill prior to the next shift work. One total contracted licensed nurse is on staff. This was completed by [DATE] when they returned from leave to make 100% of licensed nurses (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 9 of 10 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 03/15/2024 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 0678 participated in the mock code drill. Level of Harm - Immediate jeopardy to resident health or safety On [DATE] the surveyor verified through review of the drills that all licensed nurses, including the contracted nurse participated in at least one mock drill by [DATE]. Residents Affected - Few Ad Hoc (unplanned) QAPI on [DATE] completed with Medical Director, Administrator, Director of Nursing and remaining IDT (Interdisciplinary Team) members on the Advance Directives process including verifying code status prior to providing CPR related to the resident's wishes, code blue process, code status binder and a review of the root cause analysis. A Palm Vista Specific Code Process was developed. On [DATE] the surveyors verified through record review the nurses were trained, the code status book were complete and accurate and the policy covered the procedure. On [DATE] the surveyors verified the nurses were trained and the code status book were complete and accurate. Code status books observed on the first and the second floor at the nurse's station and on the crash carts. On [DATE], RN Staff A was terminated and reported to the Florida Board of Nursing. On [DATE], the surveyor verified the nurse was terminated and reviewed the referral to the Board of Nursing. As part of the ongoing QAA (Quality Assessment and Assurance) process, an ad hoc QAPI was conducted on [DATE] that included the Medical Director, Administrator, Director of Nursing and remaining IDT members to review the plan viability on the advance directives process, code process, code status binder process and results of ongoing audits including mock code drills conducted from [DATE] until [DATE]. No discrepancies or concerns were noted from the reviewed information and no changes to the plan were made. On [DATE] the surveyors interviewed the Director of nurses and verified the QAPI committee had reviewed all audits. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106089 If continuation sheet Page 10 of 10