Inspection·June 30, 2022

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some She said the maintenance staff takes down and washes all the privacy curtains monthly, but they have not been able to do that. The housekeepers are expected to report soiled privacy curtains to her, and she would see that it gets done. She said the facility did not have a written reporting system for items that needed to be cleaned. On 6/30/22 at 10:40 a.m., during a tour of the second floor with the Director of Housekeeping the following was observed: The over bed tables in room [ROOM NUMBER] A and B were dirty with food splatter residue and corrosion. The side chair remained stained. The over bed table in room [ROOM NUMBER] was dirty with food splatter residue. Tube feeding splatter residue remain on the wall and privacy curtain in room [ROOM NUMBER]. The bed frame in room [ROOM NUMBER] was dirty with brown sticky residue. The over bed table was dirty with food splatter residue. The Housekeeping Director verified the resident room furnishings were dirty with residue. She acknowledged the walls, bed frames, over bed table bases were not being cleaned. On 6/27/22 at 9:57 a.m., and 6/28/22 at 3:19 p.m., multiple unlabeled, unbagged hygiene products including toothbrushes, toothpaste, body wash, and lotions were stored on the sink of room [ROOM NUMBER], shared by two residents. Photographic evidence obtained On 6/29/22 at 9:40 a.m., Certified Nursing Assistant (CNA) Staff C verified the personal hygiene items stored on the sink in room [ROOM NUMBER] were not labeled and bagged. She said, That shouldn't be like that. I know I can try to tidy it up and put them into individual baggies with their names on them. CNA Staff C said she wasn't sure which toothbrush belonged to which resident. On 6/30/22 at 11:46 a.m., the Director of Nursing (DON) personal residents' hygiene items, should be separated, either in baggies or drawer. On 6/30/22 at 3:58 p.m., the DON said the facility did not have a policy for labeling or storing personal hygiene items. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 2 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. On 6/27/22 at 12:45 p.m. observed Resident #57 in her bed with her right arm in a sling. Resident #57 said she fell at home, broke her arm and she is here to get better so she can go home. She said since arriving at the facility she doesn't remember anyone going over the plan of care or giving her a copy of her baseline care plan. On 6/29/22 review of Resident #57's medical record revealed she was admitted to the facility on [DATE] with diagnoses not limited to a fracture to the upper end of right humerus, and generalized weakness. Further review of the medical record revealed the Nursing admission Data Collection which contain the Interim Care Plan/Baseline was started on 5/22/22 but was not completed and/or a copy of a completed baseline care was not given to Resident #57 as required. On 6/30/22 at 10:12 a.m., during an interview with the MDS (Minimum Data Set) Nurse, she said Resident #57 was admitted to the facility on [DATE] after a fall at home where she fractured her right humerus. She said the admitting nurse was responsible to start the Nursing admission Data Collection form and nursing was responsible to complete the baseline care plan within 48 to 72 hours. She said the IDT (Interdisciplinary Team) met daily and reviewed the Nursing admission Data Collection form including the Baseline care plan to ensure they were completed as required. The MDS Nurse said after reviewing Resident #57's medical record she was unable to find documentation Resident #57 baseline care plan was completed and Resident #57 had received a copy of her baseline care plan as required. On 6/30/22 at 11:00 a.m., during an interview with the Director of Nursing (DON), she said the admitting nurse was responsible to start the Nursing admission Data Collection form to include the baseline care plan. She said the IDT reviewed each new admission's baseline care plan for completion within 48 to 72 hours of the resident admission date and comprehensive care plans were finalized during the resident's comprehensive care plan meeting with the IDT. After reviewing Resident #57's medical record, the DON confirmed Resident #57's Nursing admission Data Collection and Baseline care plan were not completed, and Resident #57 did not receive a copy of the baseline care plan as required. Based on record review and staff and resident interview, the facility failed to provide the resident and the representative, if applicable, with a written summary of the baseline care plan which included initial goals and a summary of current medications and dietary instructions for 4 (Resident #42, #57, #60, and #417) of 5 residents reviewed for baseline care plans. The findings included: 1. On 6/28/22 at 11:16 a.m., Resident #60's wife said she did not recall receiving a copy of a written summary of the baseline care plan or a summary of medications. On 6/30/22 at 9:50 a.m., record review showed Resident #60's admission date was 5/27/22. The clinical record lacked evidence of a written baseline care plan which included initial goals, and a summary of current medications and dietary instructions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 3 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. On 6/30/22 at 9:51 a.m., Resident #417 record review revealed an admission date of 6/9/22. The clinical record lacked evidence a written summary of the baseline care plan which included initial goals, and a summary of current medications and dietary instructions was provided to the resident or resident representative as required. 3. On 6/30/22 at 9:53 a.m., Resident #42 record review revealed an admission date of 5/11/22. The clinical record lacked evidence a written summary of the baseline care plan which included initial goals, and a summary of current medications and dietary instructions was provided to the resident or resident representative as required. On 6/30/22 at 9:55 a.m., interview with Staff R (MDS Coordinator) verified a written baseline care plan summary was not completed for Resident #42, #60 or #417. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 4 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff and resident interviews and record review the facility failed to develop and implement a comprehensive resident-centered care plan for 1 (Residents #57) of 3 residents reviewed for specialized rehabilitation services. The failure to develop and implement a resident-centered care plan could lead to a decline and/or failure to meet the resident's highest practicable physical, mental, and psychosocial well-being. The findings included: On [DATE] at 12:45 p.m., observed Resident #57 in her bed with her right arm in a sling. Resident #57 said she fell at home, broke her arm and she was here to get better so she can go home. She said since arriving at the facility she doesn't remember anyone going over their plan of care in getting her strong enough so she can go home. On [DATE] review of Resident #57's medical record revealed she was admitted to the facility on [DATE] with diagnoses not limited to a fracture to the upper end of right humerus, and generalized weakness. Further review of the medical record revealed the Nursing admission Data Collection which contain the Interim Care Plan/Baseline was started on [DATE] but was not completed. Review of Resident #57's comprehensive plan of care revealed she had care plans with goals and interventions for; no CPR (comprehensive pulmonary respiration), risk for injury with hot liquids, nutritional problem or potential nutritional problem, and discharge planning. Resident #57's medical record did not reveal a comprehensive person-centered plan of care for Resident #57's fractured right humerus with measurable objectives and interventions which meets the resident's medical, nursing, and mental and psychosocial needs. On [DATE] at 9:31 a.m., in an interview with the Director of Therapy (DOT), she said Resident #57 was admitted to the facility on [DATE]. Physical and Occupational therapists conducted evaluations on [DATE] and the protocol for a proximal humerus and greater tuberosity fractures the resident was to wear a sling for 4 weeks and was non-weight bearing of the upper extremity for 4 weeks. The DOT said after reviewing Resident #57's medical record she was unable to find physician orders stating Resident #57 was non-weight bearing to her upper extremity and was unable to find a comprehensive person-centered plan of care related to Resident #57's fractured right humerus with measurable objectives and interventions to include the use of the right arm sling. On [DATE] at 10:12 a.m., during an interview with the MDS (Minimum Data Set) Nurse, she said Resident #57 was admitted to the facility on [DATE] after a fall at home where she fractured her right humerus. She said the admitting nurse was responsible to start the Nursing admission Data Collection form and nursing was responsible to complete the baseline care plan within 48 to 72 hours. She said the IDT (Interdisciplinary Team) met daily and reviewed the Nursing admission Data Collection form including the Baseline care plan to ensure they were completed as required. She said Resident #57's comprehensive care plan meeting was held on [DATE] but she was unable to determine who attend the comprehensive care plan meeting. She confirmed Resident #57 only had a comprehensive care plan for no CPR (comprehensive pulmonary respiration), risk for injury with hot liquids, nutritional problem or potential nutritional problem, and discharge planning with interventions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 5 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The MDS Nurse said after reviewing Resident #57's medical record, a comprehensive person-centered plan of care was not created or implemented addressing Resident #57's fractured right humerus with measurable objectives and interventions to include the use of the right arm sling. On [DATE] at 11:00 a.m., during an interview with the Director of Nursing (DON), she said the admitting nurse was responsible to start the Nursing admission Data Collection form to include the baseline care plan. She said the IDT reviewed each new admission's baseline care plan for completion within 48 to 72 hours of the resident admission date and the comprehensive care plans were finalized during the resident's comprehensive care plan meeting with the IDT. The DON confirmed after reviewing Resident #57's medical record, Resident #57's comprehensive care plan meeting was held on [DATE]. The DON said the facility did not complete the Nursing admission Data Collection form, or initiate a baseline care plan, and did not create and implement a comprehensive person-centered plan of care related to Resident #57's fractured right humerus with measurable objectives and interventions which met the resident's medical, nursing, and mental and psychosocial needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 6 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on observations, record review, and staff interviews, the facility failed to revise, and update the resident's care plan to accurately reflect the resident's condition and needs for 1 (Resident #49) of 3 residents reviewed with pressure ulcers. The findings included: The facility Pressure Injury Prevention and Management Policy provided by the facility (undated) page 3 under the Risk Assessments heading number 4 reads: Findings from the pressure ulcer/injury risk assessment will be incorporated into the resident's plan of care. On 6/28/2022 at 11:15 a.m., Licensed Practical Nurse Staff L was observed, cleaning and changing the dressings to Resident #49's wound to the right heel and right lateral malleolus (bone segment that forms the ankle). No wound was observed to the sacrum. Review of the Advanced Practice Registered Nurse (APRN) wound report dated 5/5/22 showed Resident #49 had a pressure wound to the right heel and the right lateral malleolus which were facility acquired. Review of the clinical record for Resident #49 revealed a care plan for skin integrity revised on 2/28/22 noting the resident had a stage 3 (Full thickness skin loss) pressure ulcer to the sacrum (Bone just below the lumbar vertebrae). The care plan was not updated to reflect the current pressure ulcers to the right heel and the right lateral malleolus. On 6/30/2022 at 2:15 p.m., Registered Nurse (RN) Staff R, MDS (Minimum Data Set) Coordinator verified Resident #49's care plan was not updated to include the wounds to the right heel and right ankle. She said tries to make changes to the care plan as soon as she finds out about them. She said no one notified her to update care plans regarding pressure ulcers. She finds it randomly on the computer. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 7 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, and staff interview, the facility failed to provide care and services to maintain or improve ability to carry out activities of daily living for 1 (Resident #47) of 3 residents reviewed for functional abilities. Residents Affected - Few The findings included: Review of record for Resident #47 revealed she was admitted to facility on 8/7/20 with diagnoses including hemiplegia (Paralysis of one side of the body) and hemiparesis (weakness or partial paralysis of one side of the body) following Cerebral Infarction affecting Right Dominant side, aphasia (disorder affecting ability to communicate), and diabetes mellitus without complications. Review of the list provided by the facility showed Resident #47 was included in a Functional Maintenance Program (program designed to maintain performance after discharge from therapy). On 6/27/22 at 10:00 a.m., 6/28/22 at 9:40 a.m., and 11:15 a.m.,6/29/22 at 9:31 a.m., and 6/30/22 at 10:00 a.m., Resident #47 was observed in bed, sleeping. On 6/27/22 at 12:00 p.m., and 2:58 p.m., Resident #47 was observed in bed watching television. Resident #47 was not observed participating in a functional maintenance program during the survey. On 6/29/22 at 1:24 p.m., Certified Nursing Assistance (CNA) Staff S said she has been out on leave since March 25, 2022, and returned to work on June 4, 2022. She said no one has done the functional maintenance program since March 25, 2022. She said since her return to work on 6/4/22, she has been working an assignment on the floor and has not done the Functional Maintenance Program. On 6/30/22 at 10:00 a.m., the Director of Therapy, confirmed Resident #47 was on their Functional Maintenance Program, and had not received the services. She said the CNA in charge of the program had just returned from medical leave and had been pulled to the floor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 8 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. On 6/27/22, Resident #18 was observed lying in bed all day in night clothes. Residents Affected - Some On 6/28/22 at 01:05 p.m., during observation throughout the day, Resident #18 was not observed out of bed or involved in any activity participation. On 6/29/22 at 12:00 p.m., in an interview, the Activities Director said she has not been able to have many group activities. She said Resident #18 moved to a new room due to the need for isolation of her roommate and Resident #18 has not been getting out of bed. The Activities Director said she has not been documenting activities participation. There was no record of group activity attendance or one-to-one activity encounters for Resident #18. On 6/29/22 at 2:02 p.m., the Activities Assistant said she has not been working with Resident #18 but was going to try to have a one-to-one activity this day. On 6/30/22 at 1:48 p.m., the Activities Director said Resident #18 has been very tired and sleeping a lot lately. She said the activities staff have been putting notes in 'General Progress Notes'. The Activities Director said the Activities Assistant made a note yesterday about providing coloring materials for Resident #18. A review of the Progress Notes finds the last prior Activities note was documented on 7/23/20. 5. On 6/27/22 during multiple observations from 10:10 a.m. to 3:00 p.m., Resident #9 was observed in her room wearing a hospital gown not involved in an organized activity program. On 6/28/22 during multiple observations from 9:00 a.m. to 4:00 p.m., Resident #9 was observed in her room wearing a hospital gown not involved in an organized activity program. On 6/28/22 review of Resident #9's medical record, an activity plan of care stating Resident #9's was dependent on staff for meeting physical, and social needs related to cognitive deficits, Resident #9 would participate in 1:1 activities of choice weekly, staff would assist Resident to and from all locations of interest and break activities into simple and easy-to-follow steps. Further review of Resident #9's medical record revealed no documentation Resident #9 had attended any activities of her choice in 2022. On 6/29/22 at 1:20 p.m., during an interview with the MDS (Minimum Data Set) Nurse, she said Resident #9 was admitted to the facility on [DATE] and her last quarterly care plan meeting was conducted on 3/14/22. She confirmed Resident #9's activity plan of care stated Resident #9's was dependent on staff for meeting physical, and social needs related to cognitive deficits, Resident #9 would participate in 1:1 activities of choice weekly, staff would assist Resident to and from all locations of interest and break activities into simple and easy-to-follow steps. The MDS Nurse said the Activity Director was responsible to ensure Resident 9's activity plan of care was followed and documented in the medical record. The MDS Nurse said after reviewing Resident #9's medical record she was unable to find documentation of Resident #9 attending activity programs and the Activity Director completed the mandatory quarterly activity assessment progress notes in 2022. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 9 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 6/29/22 at 4:09 p.m., interview with the Activity Director said she was an activity assistant and became the Activity Director in September 2021. She attended each resident's care plan meetings and was responsible to complete the MDS section for activity and complete the quarterly activity assessment for each resident. She confirmed Resident #9's activity plan of care stated Resident #9's was dependent on staff for meeting physical, and social needs related to cognitive deficits, Resident #9 would participate in 1:1 activities of choice weekly, staff would assist Resident to and from all locations of interest and break activities into simple and easy-to-follow steps. The Activity Director said after reviewing Resident #9's medical record she did not have any documentation Resident #9 had attended any activity programs in 2022. She further said she was unable to find documentation she had completed Resident #9's quarterly activity assessment as required. 6. On 6/27/22 during multiple observations from 9:00 a.m. to 4:00 p.m., Resident #52 was observed in his room wearing a hospital gown not involved in an organized activity program. On 6/28/22 during multiple observations from 10:00 a.m. to 3:00 p.m., Resident #52 was observed in his room wearing a hospital gown not involved in an organized activity program. On 6/28/22 review of Resident #52's medical record, noted the activity plan of care stated Resident #52 was dependent on staff for meeting physical, and social needs related to cognitive deficits, aphasia, and physical limitations and Resident #52 would attend and participate in activities of his choice on a weekly basis. Further review of Resident 52's medical record revealed no activity progress notes for Resident #52 since 2/24/21 and no documentation Resident #52 had attended any activities of choice in 2022. On 6/29/22 at 2:00 PM, in an interview with the MDS Nurse, she said Resident #52 was admitted to the facility on [DATE]. She confirmed Resident #52's activity plan of care stated Resident #52 was dependent on staff for meeting physical, and social needs related to cognitive deficits, aphasia, and physical limitations. The plan of care further stated Resident #52 would attend and participate in activities of his choice on a weekly basis. The MDS Nurse said after reviewing Resident #52's medical record she was unable to find documentation of Resident #52 attending activity programs and the Activity Director completed the mandatory quarterly activity assessment progress notes in 2022. On 6/29/22 at 4:33 p.m., during an interview with the Activity Director, she confirmed Resident #52 was admitted to the facility on [DATE]. She confirmed Resident #52's activity plan of care stated Resident #52 was dependent on staff for meeting physical, and social needs related to cognitive deficits, aphasia, and physical limitations and Resident #52 would attend and participate in activities of his choice on a weekly basis. The Activity Director said after reviewing Resident #52's medical record she did not have documentation Resident #52 had attended any activity programs in 2022. She further said she was unable to find documentation she had completed Resident #52's quarterly activity assessment as required. 7. On 6/27/22 at 10:05 a.m., Resident #36 was observed lying in bed no TV on, 12:15 p.m. sitting up in eating lunch, and 2:58 p.m., observed lying in bed sleeping. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 10 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 6/28/22 at 9:40 a.m., observation revealed Resident #36 sitting up in bed drinking a shake. On 6/28/22 at 11:15 a.m. Resident #36 was observed sitting up in bed sleeping, and on 6/28/22 at 2:59 p.m., Resident #36 was observed lying in bed. There was no evidence of activity participation occurring with Resident #36 at the time of the observations. On 6/29/22 at 9:31 a.m., observation revealed Resident #36 sitting up in bed eating breakfast. On 6/29/22 at 12:00 p.m., Resident #36 was observed lying in bed sleeping, there was no evidence of an activity program being conducted at either time. Review of Resident #36's clinical record revealed no documentation of activity participation for the last 30 days. On 6/29/22 at 3:10 p.m., in an interview, the Activity Director confirmed they had not completed any documentation under activities for Resident #36. Based on observations, interviews, records review and facility policy review the facility failed to ensure an ongoing activities program for 7 (Residents, # 9, #52, #18, 36, #15, #55 and #61) of 9 residents reviewed for activities. The findings included: Review of the facility policy titled, Resident Activities, revised May 16, 2022, which said Purpose: To ensure residents are offered activities that are compatible with the resident's individual physical and mental capabilities. 1. On 6/27/22 at 9:57 a.m., Resident # 61 was observed wandering in hall repeatedly pacing back and forth the length of the unit. On 6/27/22 at 1:21 p.m., Resident #61 observed again wandering in hall, repeatedly pacing back and forth the length of the unit occasionally attempting to enter rooms not assigned to Resident #61. Redirected by staff when attempting to enter rooms not assigned to Resident #61. On 6/28/22 at 8:22 a.m., Resident # 61 observed doing the same wandering behavior on unit. On 6/28/22 at 3:45 p.m., Resident # 61 observed again walking back and forth in hall. During several observations activities staff did not engage or attempt to engage Resident #61. On 6/29/22 at 11:25 a.m., interviewed Activities Director and Activities Assistant, Staff I, about activities for Resident #61. Activities Director replied, She likes to walk, and her daughter used to bring her dog up for visits. She loves coming downstairs when we have singing and dancing. Resident #61 really likes music, she likes snacks. We do activities like one to one with her. Asked to see documentation of Resident #61 participating in activities. Activities Director said We recently just started doing progress notes but unfortunately, I am not seeing any for Resident #61 There was no evidence of documentation in the Point of Care (POC) for activities. Activities Director said, I did not even know we were supposed to document there. 2. On 6/27/22 at 10:29 a.m., observed Resident # 15 in bed asleep. Room quiet, no music or television observed and currently no roommate in room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 11 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 6/28/22 10:22 a.m., Resident #15 in bed awake in bed with television playing in room. During observations of resident no staff from the activities department entered resident's room. On 6/29/22 record review of Resident #15 revealed no evidence of participation in activities in the POC. On 6/29/22 at 11:48 a.m., in an interview, the Activities Director said You would think it would have been done especially since she has been here since 2018. 3. On 6/27/22 at 9:45 a.m., Resident #55 observed in bed watching TV. Asked how she was doing. Resident #55 replied, I am okay. On 6/28/22 at 11:05 a.m., Resident #55 observed in bed. Asked about going to activities and replied, Sometimes I do stuff but not really too much. There isn't a lot to do. During observations of resident, no staff from the activities department entered resident's room. On 6/29/22 at 12:03 p.m., interviewed Activities Director about activities for Resident #55. Activities Director said, She stays mostly in her room and in bed. Record review for Resident #55 revealed no documentation in POC for activities on 30 days look back. On 6/29/22 at 1:35 p.m., in an interview, the Facility Administrator said the expectation for Activities Director and Activities Assistant is to perform the activities that are needed and document that they are done. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 12 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0680 Ensure the activities program is directed by a qualified professional. Level of Harm - Minimal harm or potential for actual harm Based on review of the employee file, and staff interview, the facility failed to ensure the activities program was directed by a professional with the required qualifications. This has the potential to affect all current residents at the facility. Residents Affected - Some The findings included: On 6/29/22 at 11:25 a.m., the Activities Director said she was currently working on her Activities Professional Certification. The Activities Director said she has not worked within the last five years in a social or recreational program and had no experience in long term care. She said the past eight years she was watching her grandchildren. On 6/30/22 at 4:48 p.m., review of the Activity Director with the Administrator verified the Activities Director did not have the qualifications to develop and supervise the activity program. the Administrator said, No she does not have the training. We have paid for her training, and she is working on it. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 13 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, record review, staff, and resident interviews the facility failed to provide supervision during smoking for 1 (Resident #47) of 1 resident reviewed for smoking. This places the resident at risk for injuries. The findings included: Record review for Resident #47 revealed a smoking assessment done on 9/10/20, indicating Pt need to be supervised by staff while smoking. Pt needs an apron while smoking. Further review revealed a Smoking assessment done on 5/28/21, section D Smoking Habit Evaluation #4: someone to light/extinguishing cigarette. Care plan for smoking cigarettes under interventions indicates The Resident requires supervision while smoking. On 6/28/22 at 3:41 p.m., Resident #47 was observed in the smoking area with no staff supervision, and she was holding a lit cigarette with her left hand. No other residents smoking at the time, she was noted in this area by herself. On 6/29/22 at 3:45 p.m., Resident #47 was observed smoking outside the window of admission office, no one was in that office, she was smoking unsupervised. At 3:50 p.m., she rolled herself back inside and asked receptionist for one more cigarette, rolled herself back out, lit the cigarette, smoked it, and then threw the lit cigarette on the ground. Staff T (receptionist) confirmed that Resident #47 was not smoking in the designated area and was not supervised. On 6/30/22 at 11:55 a.m., in an interview, the Assistant Director of Nursing (ADON), verified that Resident #47 goes out to smoke by herself, and she is not supervised. On 6/30/22 at 3:30 p.m., Resident #47 was observed in the smoking area with no staff supervision, and she was holding the cigarette with her left hand. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 14 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on staff interviews and staff record reviews, the facility failed to ensure 3 (Staff B, C, and D) of 3 nursing assistant employee records reviewed had a performance review completed at least once every 12 months/yearly. The facility failure to conduct a 12-month/yearly performance review could lead to the nursing staff not receiving the required in-service education to address areas of weakness identified in their yearly performance review. Residents Affected - Some The findings included: On 6/30/2022, a review of Certified Nursing Assistant (CNA) Staff B's employee file revealed they were hired 8/28/19. There was no documentation Staff B's employee performance review was completed in 2021 with in-service education to address any areas of weakness identified. On 6/30/2022, a review of CNA Staff C's employee file revealed they were hired 9/23/2019. There was no documentation Staff C's employee performance review was completed in 2021 with in-service education to address any areas of weakness identified. On 6/30/2022, a review of CNA Staff D's employee file revealed they were hired 7/30/2020. There was no documentation Staff D's employee performance review was completed in 2021 with in-service education to address any areas of weakness identified. On 6/30/2022 at 12:48 p.m., the Human Resources Director (HRD) said after a review of Staff B, C and D's employee files she was unable to find documentation they had completed their mandatory staff education every 12 months and the facility had completed a yearly performance review with education based on the outcome of their yearly performance review. On 6/30/2022 at 2:04 p.m., the Administrator and Director of Nursing said the facility did not have a written policy related to completing the required staff yearly performance reviews. The Administrator said they followed the Federal regulation stating the facility must complete a performance review of every nurse aide at least once every 12 months and provide regular in-service education based on the outcome of their performance review. The Administrator and Director of Nursing said they reviewed Staff B, Staff C and Staff D employee files and were unable to find documentation the facility had completed each employee's yearly performance review in 2021 and the employee had received in-services education based on the outcome of their performance review as required per Federal regulation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 15 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, facility policy review, and staff interviews, the facility failed to establish a system of record of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation. The findings included: Review of facility policy titled, Controlled Substance Storage dated August 2019 stated, Accountability records for discontinued controlled substances are maintained with the unused supply until it is destroyed or disposed of. On 6/29/22 at 12:44 p.m., interviewed the Director of Nursing (DON) about the process for management of controlled substances after medication is discontinued or resident is discharged . The DON said, After resident discharged or the controlled substance is discontinued, the nurse brings the controlled substance and log paper to me. We both verify the log is accurate and number listed on log matches the number of medications being turned in. The nurse signs the log and I store the controlled substances in the locked file cabinet in my locked office until I can meet with the pharmacist and do the destruction. The DON said she does not sign the controlled substance count when receiving the medication from the floor nurse. She said, I probably should but I have only been signing at the time of destruction. She said she has not been keeping a log of the controlled substances waiting to be destroyed since she started her employment as the DON at the facility in March 2022. She said the procedure was to keep a log but she has not done so. Observation during the interview of the file cabinet where the DON said she stored the controlled substances to be destroyed showed the drawer filled to capacity with controlled substances waiting to be destroyed. The DON said the last destruction of narcotics (controlled substances) at the facility was done on February 3, 2022, before she became the DON. The DON said, I have no idea what controlled substances are in the drawer at this time. The DON said, I can't say what is in the drawer and would not know if something had gone missing. It is my failure is not getting the log done. I need to get this log up to date as soon as possible. It's a priority unfortunately that has been kicked back in the past with so much to do otherwise. On 6/29/22 at 1:10 p.m., interviewed clinical pharmacist. The Pharmacist confirmed the last narcotic destruction was done in February 2022. The Pharmacist said, We try to schedule destruction the DON and I, but it can be as needed. March 2022 and April 2022 were not planned for destruction but May 20, 2022, was rescheduled since the DON said she had not had time to enter all controlled substances which needed destruction into the Polaris system. The Pharmacist said We have a triple check system. The DON and nurse check the dates and the counts when meds are given to the DON. Then the DON scans into Polaris for destruction portal, and finally the pharmacist and DON confirm the list with the actual controlled substances at time of destruction. The pharmacist said there were no controlled substances awaiting destruction scanned into the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 16 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0755 Level of Harm - Minimal harm or potential for actual harm system. The pharmacist verified he would not know if any controlled substance was missing since they were not counted and entered in the system. He said, I agree it is a concern to have so many controlled substances not logged as waiting for destruction without anyone knowing for sure what is there. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 17 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0790 Provide routine and 24-hour emergency dental care for each resident. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to assist 1 (Resident #39) of 1 resident reviewed in obtaining routine dental care for missing dentures. Residents Affected - Few The findings included: On 6/27/22 at 11:31 a.m., Resident #39 said earlier in the year he went out to the hospital for a pacemaker and his front teeth went missing. The resident said he was told the dentist could replace them, but he does not know what going on. He said he wants permanent front teeth. On 6/29/22 at 12:15 p.m., Unit Manager Staff P said she was not aware of the Resident #39's teeth issue. She did not realize the teeth were missing nor did she know the resident wanted them replaced. On 6/29/22 at 1:58 p.m., the Social Services Director said the facility has a designated dentist who will come to the facility within 48 hours of making an appointment. The Social Services Director said she was not aware of Resident #39's dental needs. She said the resident had not expressed a need for dental care. She said she will get a consult. The Social Services Director said the resident has his own dentist and said months ago he wanted implants. The Social Services Director said she had not followed up on the dental care request. On 6/29/22 at 3:25 p.m., the Minimum Data Set (MDS) Coordinator said she did not have a record of Resident 39's missing teeth. The MDS Coordinator said she was the one who completed the last Annual MDS assessment in August 2021. The MDS Coordinator confirmed there was no mention of broken or missing teeth or dentures. She reviewed the Progress Notes and found notes about oral surgery. She said during the assessment she didn't notice that he was missing dentures. She said the other day she noticed there was something different about him but could not figure it out. She said she didn't know when the dentures went missing. A review of a physician's progress note dated 8/13/2021 at 11:00 p.m., noted, Patient seen today for continued evaluation and treatment. At our last visit patient was maximizing his therapy plan to continue improving his condition. At today's visit patient relates that his oral surgery is occurring soon and that after a brief rehab he is again going to plan for his discharge to return back to his home. We will support his wish when it occurs. There are no further comments regarding dental care or scheduling of oral surgery for implants in the resident's medical record. On 6/29/22 at 3:47 p.m., Resident #39 said he fell at home and broke out his teeth. He said when he was admitted to the nursing home, he was told he would have oral surgery. He has not heard anything further. On 6/30/22 at 12:00 p.m., the administrator said he was aware the resident came back from the hospital without his partial denture. He said he contacted the hospital to see if they had located the denture. The hospital did not find the denture. He said the resident was getting his dental care from an outside dentist, and no one has been working on getting the resident the dental care. On 6/30/22 at 1:20 p.m., Scheduler Staff Q said she is responsible for making outside provider's appointments for the residents. She said she was not aware Resident #39 had an issue with his teeth (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 18 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0790 and has not scheduled any dental appointments for him. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 19 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 and interview the facility failed to maintain cooking equipment, storage racks and physical facilities in a sanitary manner. Residents Affected - Many The findings included: On 6/27/22 at 9:24 a.m., during an initial tour of the kitchen the cooking oven, range, hood, prep tables, utility carts, and storage racks were observed dirty with grease, grimy residue, and debris. Photographic evidence obtained The wall in the dish room had large patches of missing tiles and the floor has broken and missing tiles. Photographic evidence obtained The grease trap on the griddle was full of grease and unable to be removed. The drip pan on the range had a large accumulation of grease and debris. A large amount of liquid grease was observed under the foil liner on the drip pan. Photographic evidence obtained The Utility carts were dirty with grime and debris. Photographic evidence obtained The storage rack holding clean baking sheets and cooking pans has collected grease, lint, and other debris. Photographic evidence obtained Shelves below and above preparation tables are dirty with grime and debris. On 6/29/22 at 7:11 a.m., during observation of the breakfast service the utility carts remained dirty with grime and debris. The storage rack for the clean cooking pans was still dirty with lint and grime. There was no improvement to the wall in the dish room. On 6/29/22 at 3:06 p.m., the Dietary Manager acknowledged the kitchen was not as clean as it should be. He confirmed the storage racks were dirty with grime and lint, and the steam table wells had scaling and burnt-on residue. Photographic evidence obtained (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 20 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 He said he did not have the staff to keep the kitchen clean. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 21 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview the facility failed to properly contain and dispose of garbage and refuse. Residents Affected - Many The findings included: On 6/27/22 9:10 a.m., the two dumpsters were observed to be full of bags of refuse and cardboard boxes. One of the dumpsters was overflowing. The lids were not closed over the garbage. There were bags of refuse on the ground around the dumpsters and litter around the area. There was a container the size of a dumpster constructed of a steel frame and chain link fencing filled with construction debris and cardboard boxes. Observation of the dumpsters on 6/29/22 at 7:45 a.m. found the garbage was still not properly contained. The dumpsters were overflowing and uncovered. On 6/30/22 at 12:01 p.m., the administrator said he was aware the garbage was not properly contained in the dumpsters. He said he was not sure when the last pick up was made but the pick-up schedule with the waste company was for Mondays, Wednesdays and Fridays. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 22 of 23 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 106092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at the Keys Nursing and Rehab 48 High Point Road Tavernier, FL 33070 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 0825 Provide or get specialized rehabilitative services as required for a resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, resident and staff interview, the facility failed to obtain or provide Therapy Services for 2 (Resident #42 and #417) of 2 residents reviewed for Rehabilitation Services. This has the potential to inhibit the progress in ambulation and Activities of Daily Living. Residents Affected - Few The findings included: 1. Review of the clinical record for Resident #42 revealed he was admitted to the facility on [DATE] with a diagnosis of hemiplegia (paralysis of one side of the body) and hemiparesis (weakness of one side of the body) following cerebral infarction affecting left non-dominant side. The clinical record contained a physician's order dated 5/18/22 for Physical, and Occupational Therapy evaluation and treatment. On 6/28/22 at 12:15 p.m., Resident #42 stated he needed to get stronger to go home but he was not getting therapy. He tried to do exercises on his own to be active and move to an Assisted Living Facility. On 6/30/22 at 10:10 a.m., the Director of Rehabilitation reviewed Resident #42's clinical record for his admission of 5/11/22 and confirmed the physician's order for Physical and Occupational Therapy evaluation and treatment. The Director of Rehabilitation said Resident #42 was not evaluated by Physical or Occupational Therapy due to his payor source. 2. On 6/29/22, review of the clinical record for Resident #417 revealed he was admitted to the facility from an acute care hospital on 6/15/22 with a diagnosis of hemiplegia and hemiparesis following cerebral infarction affecting right dominant side. The Therapy Screen form dated 6/10/22 noted Resident #417 had, Profoundly decreased ability to participate in therapeutic tasks at this time secondary to extreme lethargy [lacking energy] and confusion. Patient was max [maximum] assist with CNA [Certified Nursing Assistant] to transfer. Did not follow any directions to assist with movement. Patient would benefit from therapy when able to follow directions to participate . The form noted Physical, Occupational and Speech therapy was indicated. The clinical record lacked documentation of a therapy re-screen or evaluation after 6/10/22. On 6/27/22 at 10:10 a.m., 11:13 a.m., 6/28/22 at 9:41 a.m., and 6/29/22 at 12:00 p.m., Resident #417 was observed in bed, sleeping. On 6/28/22 at 3:01 p.m. and 6/29/22 at 9:32 a.m., Resident #417 was observed in bed watching television. On 6/29/22 at 12:37 p.m., the Rehab Director verified Resident #417 was a new stroke, and would benefit from Physical, Occupational and Speech Therapy. She said due to his payor source; however, the facility Administrator would have to approve therapy services. She said she had not requested permission from the Administrator to provide the needed therapy services to Resident #417. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106092 If continuation sheet Page 23 of 23