Health inspection·July 11, 2024

F 0697 comfortable at this time. Level of Harm - Minimal harm or potential for actual harm On 06/19/24 at 1645, Oxycodone 5 mg prn given, medication was ineffective. Per the resident it does not help and follow-up pain was a 9. Residents Affected - Few On 06/19/24 at 1650, Alprazolam 0.5 mg as needed for anxiety was given. It was ineffective. Per the resident, it does not help, my pain is now a 9 On 06/19/24 at 1812, dietary note showed weight down 2 pounds. Resident has pain that can alter po intake. On 06/19/24 at 2035, Oxycodone 15 mg every 12 hours; Awaiting delivery of Oxycodone 15. On 06/19/24 at 2141, Oxycodone 5 mg prn given, follow-up pain was a 5. On 06/20/24 at 0836, Oxycodone 15 mg every 12 hours. Pharmacy is awaiting script from Staff C, PCP/MD. On 06/20/24 at 1508, Tylenol 325 mg x 2 tabs given, ineffective. Follow-up pain was a 8. On 06/20/24 at 2017, Oxycodone 15 mg every 12 hours. Medication unavailable in the Emergency Drug Kit. Staff C, PCP/MD was notified and awaiting new script for medication. Offered resident prn Oxycodone and resident accepted. On 06/21/24 at 0757, Oxycodone 5 mg prn given. Follow-up pain of a 5. On 06/21/24 at 0933, Oxycodone 15 mg every 12 hours. need a new script, Staff C, PCP/MD notified. On 06/21/24 at 2042, Oxycodone 15 mg two times a day, shown given. Individual Resident's Controlled Substance Record showed medication not given until 06/22/24 at 1000. Review of the care plans showed the following: -Resident #3 had chronic pain related to history of a motor vehicle collision. He had a lumbar one fracture, muscle spasms, Polyneuropathy, severe stenosis and had a L3- S1 spinal fusion on 01/18/23. He was alert and oriented x 3 and was able to make his needs known. He had rheumatoid arthritis. He had multiple skin issues including pressure / diabetic / trauma. -He now has Hospice. Care plan initiated on 03/08/2024 and updated on 07/02/2024. Interventions included but not limited to new medication added routine as of 07/10/2024; Administer analgesia as per orders as of 03/08/2024. Anticipate the resident's need for pain relief and respond immediately to any complaint of pain as of 03/08/2024. Medications have been adjusted as of 04/25/2024. Monitor/document for probable cause of each pain episode. Remove/limit causes where possible as of 03/08/2024. Monitor/record/report to Nurse any signs and symptoms of non-verbal pain as of 03/08/2024. Monitor/record/report to nurse loss of appetite, refusal to eat and weight loss as of 03/08/2024. Monitor/record/report to Nurse resident complaints of pain or requests for pain treatment as of 03/08/2024. Notify physician/ Hospice if interventions are unsuccessful or if current complaint is a significant change from residents past experience of pain as of 03/08/2024. Observe and report changes in usual routine, sleep patterns, decrease in functional abilities, decrease ROM, withdrawal or resistance to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106138 If continuation sheet Page 2 of 5 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 106138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgewalk on Harden Health and Rehabilitation, LL 3110 Oakbridge Blvd E Lakeland, FL 33803 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 0697 care as of 03/08/2024. Level of Harm - Minimal harm or potential for actual harm -Care plans showed Resident #3 had an alteration in musculoskeletal status related to motor vehicle collision. He had L1 fracture, severe stenosis and had a L3-S1 spinal fusion on 01/18/2023. He also has rheumatoid arthritis, Rhabdomyolysis, osteopenia, chronic back pain as of 03/04/2024. Interventions included but not limited to give analgesics as ordered by the physician. Monitor an document for side effects and effectiveness as of 03/08/2024. Residents Affected - Few -Care plans showed Resident #3 had rheumatoid arthritis, muscle spasms, spinal stenosis, spondylopathy, compression fractures, osteopenia as of 04/25/2024. Interventions included but not limited to give analgesics as ordered by the physician. Monitor an document for side effects and effectiveness as of 04/25/2024. During an interview and observation on 07/11/2024 at 9:55 a.m. Resident #3 was sitting in bed with the head slightly elevated. He stated he has had no problems with pain or pain medications. He stated he gets them, on schedule and as needed, if he asks for it. During an interview on 07/11/2024 at 10:05 a.m. with Staff A, Licensed Practical Nurse (LPN), Resident #3's nurse for the day. Staff A stated the resident was on Hospice now and they were controlling his pain medications. He had multiple wounds and was seen by the wound care doctor. He has wounds on his bottom, left and right hip, and feet. She stated she had seen his wounds, and they were getting better. He had chronic pain and Hospice was caring for that. She stated he was on scheduled pain medications, and he can ask for his prn pain meds. Staff A also stated he was on meds for anxiety. She stated the resident will use the call light or yell when he wants his prn pain meds. Staff A, LPN stated he had been out of his pain medications once. She stated the doctor was called for a script and the doctor has to send a script to the pharmacy. Staff A, stated, they call the pharmacy to follow-up. 2. Resident #6 was admitted on [DATE]. Review of the admission record showed diagnoses included but were not limited to Multiple Sclerosis, dorsalgia, muscle weakness, sacral pressure ulcers, pain. Review of the quarterly MDS dated [DATE] showed a BIMs score of 12 (cognitively intact). Section GG, Functional Abilities and Goals showed the resident was dependent for toileting and bathing. Section J, Health Conditions showed the resident had occasional pain. Rated 5 on the scale of 1 to 10. Section N, Medications showed resident was on antianxiety, antidepressant, anticoagulant and Opioid. Review of the physician orders, Individual Resident's Controlled Substance Record and June 2024 Medication Administration Record (MAR) showed: Fentanyl Transdermal Patch 72 hours 100 mcg/hr, apply patch transdermally every 72 hours related to Multiple Sclerosis as of 11/29/2023. The last Fentanyl patch was applied on 06/14/2024 at 1000. Fentanyl patch was not applied on 06/17/24 at 1000. It was not applied until 06/20/2024 at 1010. Review of the Progress notes showed On 06/17/2024 at 1004, Fentanyl patch 72-hour 100 mcg/hour. Staff C, PCP/MD notified to send script to pharmacy. Staff C, PCP/MD notified that pharmacy is in need of a new script. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106138 If continuation sheet Page 3 of 5 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 106138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgewalk on Harden Health and Rehabilitation, LL 3110 Oakbridge Blvd E Lakeland, FL 33803 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the care plans showed Resident #6 had chronic pain, dorsalgia and multiple sclerosis as of 11/27/2023 and was updated on 05/23/2024. The goal was for the resident to not have discomfort related to side effects of analgesia and will not have an interruption in normal activities. Interventions included but were not limited to administer analgesia as per orders as of 11/27/2023. Anticipate the resident's need for pain relief and respond immediately to any complaint of pain as of 11/27/2023. Monitor/document for side effects of pain medication. Report occurrences to the physician as of 11/27/2023. Monitor/record pain characteristics and PRN revised on 11/27/2023. Monitor/record/report to Nurse any signs and symptoms of non-verbal pain as of 11/27/2023. Monitor/record/report to nurse any complaints of pain or requests for pain treatment as of 11/27/2023. Notify physician if interventions are unsuccessful or if current complaint is a significant change from residents past experience of pain as of 11/2/2023. During an interview and observation on 07/11/2024 at 3:55 p.m. Resident #6 was lying in bed. He was difficult to understand during the interview. He stated he was in pain, his head and neck. He had pain medication at 1408 per his floor nurse. The nurse stated the Hospice nurse had been there last night and was addressing the resident's pain. An interview occurred on 07/11/2024 at 3:00 p.m. with the Director of Nursing (DON) and the Nursing Home Administrator (NHA). The DON stated it was the process to perform a narcotic audit every Wednesday for the need to renew prescriptions. The DON also reviewed narcotics that had 7 pills or less left and asked for refills for those also. The DON stated the pharmacy will let them know if they need a new prescription, or if the prescription had been filled and was to go out for delivery. The DON stated if they need a script, they will call the physician. The DON stated they will ask the physician if there was something they can give the resident in the meantime. The DON stated Resident #3 had Oxycodone 5 mg prn. The DON stated she as well as other staff members reached out to Staff C PCP/MD about Resident #3's need for a pain prescription. The DON stated they reached out to Staff C PCP/MDs PA (Physician Assistant) and APRN and was told by them that they cannot write narcotic scripts, that it had to be Staff C, PCP/MD. The DON stated that she spoke with Staff C, PCP/MDs PA on 06/19/2024 regarding the prescription need for Resident #3. The DON stated a nurse reached out to Staff C, PCP/MD on 06/16/2024 at 11:33 p.m. regarding Resident #3. The DON stated another nurse contacted Staff C, PCP/MD on 06/18/2024 at 9:07 a.m. regarding Resident #3. The DON stated on 06/20/24 at 9:33 a.m. another contacted Staff C, PCP/MD for Resident #3 and it was sent as a priority. Staff C, PCP/MD replied, I signed one last week, where is it?. (Staff C, PCP/MD wrote for Oxycodone and needed Oxytocin). The DON stated she sent texts on 06/19/2024 at 11:56 a.m. and on 06/20/2024 at 2:30 p.m. and again on 06/20/2024 at 5:47 p.m. and Staff C, PCP/MDs APRN responded on 06/20/2024 at 7:03 p.m. and stated I messaged our office manager and Staff C, PCP/MD again, I'm sorry, it looks like they were having trouble with our system. I stressed how urgent this was to them. The DON and NHA stated the Medical Director of the facility was Staff C, PCP/MD, Resident #3 and #6's physician. The DON stated the Oxycodone 15 mg was not found in the Emergency Drug Kit. The DON stated she had a conversation with Staff C, PCP/MD on 07/21/2024 and that they had several scripts that needed signing. It was the coming into the weekend. Staff C, PCP/MD was informed he filled out the scripts last week, but it was incorrect for Resident #3. She explained again about the Oxycodone vs. Oxycontin. Staff C, PCP/MD stated he would look into it and wrote scripts we needed that day. The NHA and DON stated they were unaware of Resident #6 lack of pain medication. The DON stated she was not aware of this incident. She stated she needed to look at the tablet (regarding communication with Staff C, PCP/MD) and talk to her Staff B, Unit Manager of that floor. The DON stated she should have been informed, she needed to be aware because it was a delay in care. On 06/19/2024 a text was sent to Staff C, PCP/MD stating Resident #6 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106138 If continuation sheet Page 4 of 5 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 106138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgewalk on Harden Health and Rehabilitation, LL 3110 Oakbridge Blvd E Lakeland, FL 33803 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 0697 needed a new script for his Fentanyl patches. Level of Harm - Minimal harm or potential for actual harm Staff B, UM came into the interview at 3:31 p.m. and stated she was unaware of Resident #6's patch (Fentanyl) being out. Staff B, M stated a script was sent to the physician showing they needed it signed. The script showed not to order prior to 06/13/2024. Staff B, UM stated she does not know what happened. Staff B, UM stated Staff C, PCP/MD does not always return calls timely. Staff B, UM stated she has called Staff C, PCP/MD and he has returned the call the next day after she was in bed. The DON stated that Staff C, PCP/MD was not actually called regarding either of these residents' needs. The NHA stated that the resident's physician was also the Medical Director. The NHA stated they would have to discuss the situation with the Staff C, PCP/MD and come to another plan. The DON stated she had not discussed the situation with Staff C, PCP/MD. Residents Affected - Few Review of the facility's policy, Medication Orders, effective 2019 showed Controlled Substance Prescriptions: Policy: Before a controlled drug can be dispensed, the pharmacy must be in receipt of a clear, complete, and signed written prescription from a person lawfully authorized to prescribe. Therefore, the prescriber issuing the chart order must also provide the pharmacist with a valid prescription. Controlled substance prescription from physician assistants and nurse practitioners who are authorized to prescribe controlled drugs are valid only if they comply with state law, requirements listed below, and with applicable formularies or prescribing protocols that have been provided to the facility by the responsible physician. Procedures: 2. Schedule II controlled medications prescribed for a specific resident are delivered in the facility only if a signed prescription by a physician has been received by the pharmacy prior to dispensing or as required by state law. A signed prescription for a Schedule II drug may be faxed to the provider pharmacy in accordance with the state laws by the prescriber or his/her agent. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106138 If continuation sheet Page 5 of 5