Inspection·April 11, 2024

F 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to complete and submit the discharge minimum data set for 4 of 5 sampled discharged residents. (Resident #27, #50, #53, and #67) The findings include: A review of Resident #27's electronic medical record revealed the resident was admitted to the facility on [DATE]. The resident was discharged on 12/9/23 to a hospital emergency room. The record revealed the discharge minimum data set was not completed and submitted. A review of Resident #50's electronic medical record revealed the resident was admitted to the facility on [DATE]. The resident was discharged home on [DATE]. The record revealed the discharge minimum data set was in progress but not complete or submitted. A review of Resident #53's electronic medical record revealed the resident was admitted to the facility on [DATE]. The resident was discharged home on [DATE]. The record revealed the discharge minimum data set was not completed or submitted. A review of Resident #67's electronic medical record revealed the resident was admitted to the facility on [DATE]. The resident was discharged home on [DATE]. The record revealed the discharge minimum data set was not completed and submitted. An interview was conducted with employee C (Registered Nurse Case Mix Director) on 4/11/24 at 10:16 AM. Employee C confirmed the discharge minimum data set was not completed or submitted for these residents. She stated the records system did not alert the facility staff or corporate staff that the assessments were not complete. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106140 If continuation sheet Page 2 of 4 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 106140 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pruitthealth - Southwood 2301 Bluff Oak Way Tallahassee, FL 32311 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on observations, record review, staff interview, and policy review, the facility failed to provide appropriate quality care and treatment for 1 of 1 residents with a skin tear (Resident #14) and 1 of 1 residents reviewed for edema (Resident #18). Residents Affected - Few The findings include: Resident #14: Observations of Resident #14 were conducted on 4/8/24 at 2:21 PM and 4/9/24 at 3:13 PM. During these observations, the resident was in bed and had an undated dressing on her left middle forearm. On 4/8/24 at 2:21 PM, her husband was at her side and stated he was not sure what happened to her arm. A review of the electronic medical record revealed no current physician's orders for the dressing on the left arm or documentation of a skin issue to the left arm. A skin observation note dated 4/9/24, completed by Employee A (licensed practical nurse (LPN)), indicated the resident had no skin impairments. A telephone interview was conducted with Employee A on 4/10/24 at 9:38 AM. She stated she completed a skin observation on Resident #14 on 4/9/24. She stated the resident had a skin tear under the pink dressing on her left arm. She thought the wound care nurse placed the dressing on the resident's arm, but she did not ask the wound care nurse to confirm this. She stated she forgot to document the dressing on the skin observation on 4/9/24. On 4/10/24 at 9:45 AM, Resident #14 was observed in the presence of the Director of Nursing (DON). The DON observed the pink dressing on the resident's left arm and confirmed it was not dated. The DON removed the dressing and stated the area under the dressing was a scabbed skin tear. She stated there should have been an order for the dressing in the electronic medical record. An interview was conducted with Employee B (licensed practical nurse, wound care) on 4/10/24 at 10:33 AM. She stated she had no knowledge of the pink dressing or a skin tear on Resident #14's arm. A review of the facility policy for Documentation of Skin and Wound Care (PruittHealth 2014) revealed it is the policy of the Healthcare center to complete documentation that reflects the current resident status as related to skin/wound care. Documentation will provide current and timely documentation on resident's condition related to skin/wound care, accurate information on the resident's status as it pertains to skin/wound care, record care rendered and interventions in place and provide a detailed history of the wound assessments that have occurred in the healthcare center. Resident #18: On 04/09/24 at 02:45 PM, Resident #18 was observed to be semi reclined in bed with bilateral (both) lower extremities (BLE) elevated on pillows and wearing non-skid socks. The skin of the lower extremities was noted to be red and scaley with swelling present on both lower extremities. Resident #18 was observed on 04/10/2024 on three separate occasions (11:25am, 12:51pm and 1:50pm) while in his room and in the dining area. For all observations, Resident #18 had no Thrombo-embolic deterrent (TED) hose applied to his lower extremities. A review of the electronic medical record revealed the medical diagnosis of lymphedema, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106140 If continuation sheet Page 3 of 4 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 106140 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pruitthealth - Southwood 2301 Bluff Oak Way Tallahassee, FL 32311 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Non-pressure chronic ulcer of right ankle, Localized edema and Muscle wasting and atrophy, multiple sites. There was an order dated 3/29/2024 at 03:45 pm to Apply TED hose on BLE for 12 hours, start time 09:00 AM, remove at 09:00 PM daily per Verbal Order (VO). On 04/10/24 at 02:12 PM, an interview with Staff E, a Certified Nursing Assistant, was performed. She stated that she had nothing in her tasks that indicated that Resident #18 was to have TED hose, but that the nurse would be responsible for applying and removing any TED hose. During an interview with Nurse G, a LPN, it was reported that this resident had refused TED application on several occasions. She stated she had located some TED hose in the facility that were size Large and had attempted to apply them on her shift but they were very tight and she had had to remove them, that's probably why he refused them. When asked who would be responsible to measure patient for appropriate size she responded that's a good question, I don't know. Probably the nurse manager but [Nurse K] must know because she is the only one that documented that resident needed a size 2XL on the Medication Administration Record (MAR). On 04/10/2024 at approximately 3:00 PM, an interview was conducted with Nurse H, a Registered Nurse, and Nurse F, a LPN, who reviewed residents record and confirmed the orders for Compression stockings. After reviewing the record, Nurse F stated that, following Resident #18's appointment with the Dermatologist, they had recommended that the patient be referred to the lymphedema clinic. Nurse H stated that the clinic had declined to see the resident due to the amount of skin lesions and Resident #18's physical limitations. Per Nurse F, the lymphedema service recommended that the facility apply TED hose on BLE for 12 hours on and off for 12 hours then they will see if the resident will tolerate any form of compression. Nurse H informed Resident #18's attending physician of the recommendation and was given a verbal order for TED hose to BLE for 12 hours per day per the recommendation. When asked who and how they determine what size compression hose are needed, they could not provide an answer. Observation of the facility's stock of knee-high TED hose revealed two boxes of TED hose. One box revealed measurement instructions on the box and in one box measurement instructions were on each individual pack. (Photographic evidence obtained.) Nurse F agreed that the order had not been implemented in a timely manner and confirmed that Resident #18 had not been appropriately measured. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106140 If continuation sheet Page 4 of 4