Inspection·October 29, 2020

F 0637 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few elevated from the floor and not in the lowest position to prevent injury to the resident should she attempted to get out of bed or fell out of the bed. On 10/29/20 at 9:25 a.m., in an interview Licensed Practical Nurse (LPN) Staff I verified the bed was not in the lowest position while the resident was in the bed. She stated she was not aware if the bed being in the lowest position was a current fall intervention for Resident #24. Staff I said she did feel the bed should be in the lowest position while the resident was in bed due to her high fall risk. On 10/29/20 keep bed in lowest position at all times was added as an intervention to Resident #24's fall care plan. On 10/29/20 at 10:51 a.m., in an interview the Director of Physical Therapy (DOPT) said after the resident was admitted to the facility, she had improved to stand by assist of one staff prior to her falling on 10/1/20. The DOPT said after the resident was readmitted on [DATE] she lost her ability for mobility and needed two staff members to assist her with transferring and toileting. The DOPT said Resident #24 currently was a two person assist with both transferring and toileting. On 10/29/20 at approximately 11:30 a.m., the MDS Coordinator LPN, Staff E said she should have completed a significant change on Resident #24, but she was waiting to see if she had any improvement with rehabilitation. Staff E verified Resident #24 was a high fall risk and that her current fall interventions needed to be updated due to her recent fall. Staff E said the certified nursing assistant staff were informed verbally by nursing when residents were a high fall risk. After reviewing the form that was provided as the facility's fall policy, Staff E said the facility currently did not have a fall program in place to identify those residents at high risk for falls. On 10/29/20 at 12:30 p.m., Resident #24 was observed sitting in a chair beside her bed. She was observed to be sitting forward in the chair as though she had been attempting to get out of the chair on her own. The resident had one green non-skid sock on her right foot and her left foot was barefoot. There was no other sock observed on the floor near the resident. The resident said staff had not been able to find her other sock and they were looking for it. When asked if she would call for assistance if she needed to get anything she said no. The resident was asked to find her call light. The call light was attached to her wheelchair arm on the left side. The resident was not able to locate the call light at that time. On 10/29/20 at 12:45 p.m., LPN Staff I found a second non-skid green sock in the resident's top dresser drawer. She said she could not explain why Resident #24 did not have a non-skid sock on her left foot. When asked about the resident's tennis shoes observed near the resident, Staff I said the shoes had caused a sore on the resident's left foot. A foam bandage was observed at that time to the resident's left foot. On 10/29/20 at 1:57 p.m., Certified Nursing Assistant (CNA), Staff J said she was assigned to Resident #24 and had worked with her several times. She said if residents were a high fall risk the nurse told the aides in a report. CNA Staff J said staff nursing had not informed her that Resident #24 was a high fall risk. CNA Staff J said Resident #24 would use her call light very infrequently. She said Resident #24 would scoot forward in her chair and attempt to get up on her own. She said she thought the nurse just added an order for Resident #24 to be on fall precautions. On 10/29/20 at 2:20 p.m., the DON verified Resident #24 had had a change in condition on 10/1/20 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106098 If continuation sheet Page 2 of 12 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 106098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hawthorne Center for Rehab & Healing of Sarasota 5381 Desoto Road Sarasota, FL 34235 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 0637 Level of Harm - Minimal harm or potential for actual harm when she fell and fractured her hip at the facility. The DON said they had investigated Resident #24's fall on 10/1/20 and had found the resident thought she had heard her phone ringing and was attempting to reach for her phone. On being readmitted to the facility on [DATE] the intervention to ensure her belongings were within reach was added to her care plan. The DON would not answer why the intervention had not been in place prior to 10/1/20 due to her high risk for falls. Residents Affected - Few Based on record review and interview, the facility failed to complete a significant change Minimum Data Set (MDS) assessment as required by regulation for 2 (Residents #22 and #24) of 6 sampled residents reviewed for hospitalization and falls. This had the potential to delay revision of the resident's plan of care and services. The findings included: According to the Resident Assessment Manual, a significant change was a major decline in a resident's status, determined by a completed assessment of the resident. If the facility deemed the resident had met the guidelines for a major decline, the facility was required to complete a significant change MDS within 14 days of the identification of the major decline. 1. Record review of the resident's hospitalizations revealed Resident #22 had five hospital admissions with returns to the facility between 2/14/20 and 7/24/20. Record review of Resident #22's MDS admission and quarterly assessments between 3/4/20 and 9/2/20, revealed Resident #22 had multiple physical declines that required an increase in staff assistance and services. On 10/29/20 at 12:00 p.m., facility MDS Coordinator Licensed Practical Nurse (LPN) Staff E acknowledged there should have been a significant change MDS done for Resident #22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106098 If continuation sheet Page 3 of 12 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 106098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hawthorne Center for Rehab & Healing of Sarasota 5381 Desoto Road Sarasota, FL 34235 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, policy and procedure review, interview, the facility failed to provide a Restorative Nursing program as ordered by the physician to prevent decline in ambulation for 1 (Resident #29) of 1 resident reviewed for Activities of Daily Living. Residents Affected - Few The findings included: The facility's Restorative Nursing/Nursing Rehabilitation program's primary focus was Nursing interventions to promote the resident's ability to attain or maintain his or her maximum functional potential. On 10/27/20 at 9:05 a.m., Resident #29 was observed sitting in her wheelchair, propelling herself with her feet. Resident #29 said she fell a long time ago and tried to walk but it hurts her legs and knees. Resident #29's clinical record indicated she had a fall on 8/11/20, went to the hospital and was re-admitted to the facility on [DATE]. The resident received skilled Physical Therapy (PT) from 8/17/20 through 9/18/20. The resident was ambulating 50 feet using an assistive device with stand by assistance (SBA) upon discharge from therapy. There was no referral for a Restorative Nursing program. The clinical record also included a physician's order for Restorative Nursing Program; active range of motion exercise in sitting/standing all planes; Gait training as tolerated using the wheelchair to push with SBA and cues; 3 times a week for 90 days as of 6/29/20 and 10/14/20. The Activities of Daily Living (ADL) Restorative nursing records for Resident #29 were reviewed from 6/29/20 through 10/27/20. Under the area of how many feet did the resident walk on 10/19/20 the resident walked 15 feet and on 10/23/20 walked 12 feet. There was no other documentation of the resident walking as per the Restorative Nursing program. On 10/27/20 at 1:54 p.m., in an interview Certified Nursing Assistant (CNA) Staff F said Resident #29 was walking about 30 feet with stand by assist pushing her wheelchair before she broke her hip. Since then she was not able to walk. CNA Staff F said the resident was no on any restorative program. In 10/27/20 at 2:21 p.m., in an interview Licensed Practical Nurse (LPN) Staff G said before Resident #29 broke her hip, she was able to get up and walk a short distance. LPN Staff G said the resident has been up walking in her room but was not aware of any ambulation program. LPN Staff G checked the restorative book and said there was no restorative program for Resident #29. On 10/27/20 at 2:53 p.m., in an interview Restorative CNA Staff H said Resident #29 was on an active range of motion program to her upper and lower extremities but no ambulation or gait training program. Restorative CNA Staff H said the resident was walking about 20 to 30 feet before the last fall where she broke her hip. On 10/27/20 at 3:09 p.m., in an interview the Director of Rehabilitation said when Resident #29 was discharged from skilled therapy, she was walking 50 feet. He said the resident had been on case load previously and was discharged to nursing restorative on 6/29/20. The Director of Rehabilitation (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106098 If continuation sheet Page 4 of 12 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 106098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hawthorne Center for Rehab & Healing of Sarasota 5381 Desoto Road Sarasota, FL 34235 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 confirmed he did not make any new referral to restorative when the resident was discharged on 9/19/20. Level of Harm - Minimal harm or potential for actual harm On 10/28/20 at 12:52 p.m., in an interview Registered Nurse (RN) Staff D said she never received any referral from therapy for a restorative ambulation program for Resident #29. She confirmed there was a physician's order to ambulate the resident 3 time as week and there was no documentation of it being done as ordered. RN Staff D said she sent a request for therapy to determine her current level of ambulation to see if she was still able to walk 50 feet. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106098 If continuation sheet Page 5 of 12 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 106098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hawthorne Center for Rehab & Healing of Sarasota 5381 Desoto Road Sarasota, FL 34235 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** Based on observation, interview, and record review, the facility failed to provide an activities program to meet the residents choices and encourage both group and independent activities by failing to assess the residents activity choices and care planning and structured group and individual activities for 3 (Resident #24, #127, and #19) of 4 residents sampled resulting in decreased physical and psychosocial stimulants for the residents which a potential to cause a decline in both physical and mental abilities of the residents. Residents Affected - Few The findings included: Review of the facility Policy NO: 10.01 for activities showed the policy was adopted 1/81, and was revised on 2/20/18, and, 10/23/19. The policy stated The facility will provide an ongoing program to support residents in their choices of activities, both group and independent, designed to meet the interests of, and support the physical, mental, and psychosocial wellbeing of each resident, encouraging both independence and interaction. Under the Procedure heading the policy lists the following interventions: 1. Residents shall be assessed at the time of admission for individual activity interests, hobbies and cultural preferences, which will be incorporated into the resident's plan of care. 2. An activity calendar shall be developed to create opportunities for each resident to enhance his/her sense of wellbeing . 1. Resident #24 was an [AGE] year-old resident who was admitted to the facility on [DATE] with a fractured left wrist and radius. She was assessed by the facility to have a brief interview for mental status score (BIMS) of 12 which idicates resident has good cognition. On 10/27/20 at 9:02 a.m., in an interview when Resident #24 was asked about her activities at the facility, she stated, All I do is watch TV and wiggle my toes. She said she never left her room and staff did not bring her any activities. The resident said she liked puzzle books. She said staff would come in and talk with her for about five minutes, but they had never brought her books or puzzle books. On 10/27/20 at 3:15 p.m., in an interview the Activities Director (AD) said he would have to locate Resident #24's activity visits documentation. The AD said residents have been encouraged to stay in their rooms since March of 2020. He said he had two activity staff members who made visits with the residents daily. They documented when they visited each resident. The AD said he would assess the resident for their activity's preferences 5 to 7 days after they were admitted because he liked to wait for the social services assessment to be completed prior to doing his assessment so he could compare their findings with his. On 10/27/20 at 3:45 p.m., in an interview Activities Assistant Staff K said the AD did not provide an activities program for each resident. She said she would go in and ask the resident what they liked to do and spent 5 to 10 minutes with each resident talking or playing music. She said they had a cart with books and activities that they brought around to residents on some days and they sometimes brought a snack cart around to the residents. Staff K said a confused resident like Resident #24 would be asked to fold towels. She said Resident #24 would fold one or two towels before stopping. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106098 If continuation sheet Page 6 of 12 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 106098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hawthorne Center for Rehab & Healing of Sarasota 5381 Desoto Road Sarasota, FL 34235 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 On 10/27/20 at 4:00 p.m., in an interview the AD verified he could not find documentation of the initial activities observation he had completed for Resident #24. Review of the Activity Charting-Restricted Activities showed documentation of daily room visits. Activities documented provided for Resident #24 were resting, watching tv, snack cart, and folding towels. Residents Affected - Few On 10/28/20 at approximately 11:00 a.m., in an interview the Director of Nursing and Administrator verified they were not aware of the Memorandum provided by Centers for Medicare and Medicaid dated 9/17/20 that allowed for communal activities of residents with social distancing, hand washing and face coverings. The Administrator said she had just started working at the facility and had not yet had time to review the activities program. On 10/29/20 at 12:30 p.m., in an interview Resident #24 said they still had not brought her any puzzle books. She said she did not read because of her eye site. She said she had some reading glasses but was not able to locate them at that time. On 10/29/20 at 2:30 p.m., in and interview the AD verified there were no structured activities for Resident #24. He said he was working on putting together group activities for the residents at this time. 2. Resident #127 was an [AGE] year-old male who was admitted to the facility on [DATE]. Review of Resident #127's BIMS from his 5-day assessment shows his score as 00. This would show him to be severely confused. On 10/26/20 at 8:40 a.m., Resident #127 was observed sleeping in a recliner next to his bed. On 10/28/20 at 10:40 a.m., Resident #127 was observed in a recliner next to his bed. He was alert but unable to answer yes and no questions due to confusion. On 10/28/20 at 1:00 p.m., in an interview the AD verified he could not find documentation that he had completed an observation of activities for Resident #127. On 10/28/20 at 2:00 p.m., in an interview the AD said he had completed the activities observation on 10/28/20 by asking Resident #127 his likes and dislikes. He verified at that time resident #127 had a BIMS of 00. On 10/28/20 at 2:28 p.m., in an interview Activities Assistant, Staff L said she visited the resident daily for 5 to 10 minutes and he colored with crayons, listened to music, and did puzzles. Staff L verified she had not documented these activities with Resident #127. Review of Resident #127's care plans showed no care plan for activities. On 10/29/20 at 2:00 p.m., in an interview the AD verified Resident #127 did not have a care plan for activities. 3. 10/26/20 at 9:24 a.m., in interview Resident #19 said she feels that it has been too long with being made to stay in the rooms. she said that it has been over 8 months. It seems like a person can go crazy in the room. She said, I use to go out on to the patio and just enjoy the sunshine and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106098 If continuation sheet Page 7 of 12 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 106098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hawthorne Center for Rehab & Healing of Sarasota 5381 Desoto Road Sarasota, FL 34235 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 - Few fresh air, now they will not let us go out. She said she did not feel that it should be a problem with us going out there. there are not many things to help life be interesting we have to stay in our rooms for so many months. She said she lays in bed all day, eats in her room and there are very few things to make life interesting anymore. On 10/27/20 at 10:38 a.m., observed Resident #19 laying in her bed appeared to be sleeping. Dressed appropriate for the day. On 10/27/20 at 1:49 p.m., in interview Certified Nursing Assistant (CNA) Staff N she said the managers say the residents must stay in their rooms. On 10/27/20 at 2:17 p.m., in an interview RN Staff M, said that the residents were encouraged to stay in their room and were not allowed out on the porch or outside. She said they pretty much did not have any activities and they just stay in their rooms and watch television, read, or sleep. On 10/28/20 at 2:24 p.m., observed Resident #19 in her room laying in her bed in her room. Review of Resident #19's activity care plan dated 3/17/20, documented the resident would have a current focus of programming including independent activities due to temporary group activity being prohibited related to COVID-19 virus. Approaches: 1. resident will keep in touch with family. 2. provide resident with independent activity supplies. 3. provide room visits and socialization. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106098 If continuation sheet Page 8 of 12 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 106098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hawthorne Center for Rehab & Healing of Sarasota 5381 Desoto Road Sarasota, FL 34235 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to assess, evaluate, and plan care to provide individualized approaches to restore as much normal elimination function as possible for 1 (Resident #29) of 1 resident with the identified problem of a decline in bladder incontinence. The findings included: The facility's policy Incontinence (Bowel and Bladder) revised on 7/2005; indicated residents were to be evaluated for continence on admission and a monitoring record in place to assess elimination patterns. Each resident on the monitoring program would have individual plans and goals established by the care plan team to assist the resident in acquiring lost functions or to maintain present function. All incontinent residents would be further re-assessed on a quarterly basis using the Incontinence Re-assessment form. Licensed staff would review the last full incontinence assessment at that time. If there were no changes and current bladder plan of care was effective, continued current plan. If there were changes that did affect resident's plan of care, a new 3-day tracking and incontinence assessment would be completed. Then individualized plans and goals would be developed. Resident #29's clinical record revealed a diagnosis of Dementia, Depression, osteoporosis, and history falls with fracture. An Annual Minimum Data Set 3.0 (MDS) assessment dated [DATE], indicated the resident was always continent of bladder and required staff assistance with toileting. A Quarterly MDS dated [DATE], indicated the resident was occasionally incontinent of bladder. On 8/21/20 a quarterly MDS was completed and indicated the resident was now always incontinent of bladder and required extensive assist from staff with toileting. An Incontinence Assessment was completed on 6/3/20 and 8/16/20. The assessments indicated Resident #29 was continent at least once a day and no interventions to promote continence were in place (prompted voiding, scheduled voiding, adaptive equipment, habit training, etc.). The certified nursing assistant documentation for bladder function was reviewed from 7/26/20 through 10/27/20 and there was no evidence of any tracking being done to establish a pattern of continence/incontinence to include time of episode, and how many times the resident was continent or incontinent during the shift. On 10/27/20 at 9:05 a.m., in an interview Resident #29 said regarding toileting she didn't drink anymore so she didn't have to go to the bathroom. On 10/27/20 at 1:54 p.m., in an interview Certified Nursing Assistant (CNA) Staff F said Resident #29 was usually incontinent of bladder since she broke her hip a couple months ago. Staff F thought the resident was aware of the need to urinate, but when Staff F found her in the bathroom already, she had been incontinent. Staff F said the resident used to love coffee but no longer drinks it. The resident was not on any toileting program but tried to take her after meals. On 10/27/20 at 2:21 p.m., in an interview Licensed Practical Nurse Staff G said since Resident #29 was incontinent at times, had some control of bladder but was not on any toileting program that he knew of. On 10/28/20, Resident #29's care plan was reviewed. Under the problem Urinary Incontinence, dated 8/17/20, the goal was to keep the resident clean and dry to prevent skin damage. The approaches were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106098 If continuation sheet Page 9 of 12 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 106098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hawthorne Center for Rehab & Healing of Sarasota 5381 Desoto Road Sarasota, FL 34235 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete to check frequently and provide care after each incontinent episode. No care plan had been developed to include a measurable goal and approaches to help the resident maintain her highest level of continence and to prevent decline. There were no interventions in place for CNA staff to use to assist the resident in being continent to include a scheduled or prompted toileting plan based on the resident's voiding pattern. On 10/28/20 at 12:52 p.m., in an interview Registered Nurse Staff D confirmed there had been no care plan developed to address Resident #29's decline in continence to include a specific goal and individualized approaches to improve or maintain the resident's urinary function. Event ID: Facility ID: 106098 If continuation sheet Page 10 of 12 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 106098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hawthorne Center for Rehab & Healing of Sarasota 5381 Desoto Road Sarasota, FL 34235 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 Residents Affected - Many 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 store and serve food in a sanitary manner to prevent potential contamination. This failure had the potential to cause food borne illness in residents receiving an oral diet. The findings included: 1. On 10/26/20 at 7:15 a.m., during an initial tour of the kitchen, the door to the walk-in freezer was noted to be slightly ajar. There was a large area of semi-solid ice was noted along the edge of the door frame to the walk-in freezer and extended out about an inch away from the frame on each side and along the top. The plastic protective curtain strips were coated with partially frozen condensation; the floor to the left of the entrance around the wheel of the food storage cart had a large pile of snow-like condensation; and there was a large area of frozen condensation extending along the top of the ceiling in front of the fans with large droplets hanging down. On 10/26/20 at 7:30 a.m., in an interview Dietary Staff A said the condensation in the walk-in freezer had been like that for many months. On 10/29/20 at 9:46 a.m., a second tour of the walk-in freezer was conducted along with the Food Services Supervisor (FSS). The condensation was still present with more accumulation present on the floor and walls just inside the entrance. The frozen condensation droplets along the ceiling were still present. Discussed condensation on ceiling of freezer had potential to contaminate food with door being left open or so heavily coated with frost cannot close properly. This potentially could cause food to partially thaw with warming of freezer and then refreeze. The FSS acknowledged the concern and confirmed this problem had been going on for months. On 10/29/20 at 10:45 a.m., in an interview the Director of Maintenance said he had someone out to install a new door closer on 6/15/20 for this and fix a threshold screw on 10/9/20. He said there was nothing wrong with the seals of the door and condensation was from staff not closing the door properly and leaving it ajar. 2. On 10/26/20 at 7:15 a.m., during an initial tour of the kitchen, the following observations were made: the front of the stove was heavily coated with a large area of grease drippage going into a metal pan on the floor; the metal vent grates over the stove were heavily soiled with a brown grease like substance; the front, ides, and top of the dish machine was heavily coated with dried residue from water creating a thick crust along the top and edges; and all 3 hand sinks were soiled/stained with rust and drippage along the inside and outside of the metal frames. On 10/26/20 at 7:50 a.m., a tour of the kitchenettes on Independence Place revealed the inside glass door of the microwave was damaged and the interior was stained brown along the top and sides. On 10/26/20 at 8:15 a.m., a tour of the Bounce Back Lane kitchenette revealed a corroded and heavily stained microwave; and the ceiling above the drink and ice machines were heavily stained brown. On 10/29/20 at 9:46 a.m., a second tour of the kitchen was conducted along with the FSS. The areas previously identified were still present. The FSS said the grease drippage on the front of the stove had been like that for about a year and was probably a broken trap. The grates over the stove were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106098 If continuation sheet Page 11 of 12 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 106098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hawthorne Center for Rehab & Healing of Sarasota 5381 Desoto Road Sarasota, FL 34235 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 cleaned by Maintenance and she acknowledged they appeared to be soiled with grease. The FSS confirmed the hand sink in the dish room had rusted areas and the dish machine was heavily soiled with crusted white residue creating uncleanable surfaces. **photographic evidence obtained** Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106098 If continuation sheet Page 12 of 12