Inspection·September 10, 2025

F0000 INITIAL COMMENTS F0000 10/03/2025 An unannounced recertification survey was conducted in conjunction with a complaint investigation for complaint #2025012712 and #2025010804 at Life Care Center of Pensacola, a nursing home in Pensacola, Florida on 09/07/2025 through 09/10/2025. At the time of the survey, the facility was in compliance with Code of Federal Regulations (CFR), Part 483, Subparts B-F, Requirements for Long-Term Care Facilities.

F0880 SS = D Infection Prevention & Control F0880 Infection Prevention & Control 10/27/2025 CFR(S): 483.80(a)(1)(2)(4)(e)(f) $483.80 Infection Control The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. $483.80(a) Infection prevention and control program. The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements: $483.80(a)(1) A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to §483.71 and following accepted national standards; $483.80(a)(2) Written standards, policies, and procedures for the program, which must include, but are not limited to: (I) A system of surveillance designed to identify possible communicable diseases or CFR(S): 483.80(a)(1)(2)(4)(e)(f) On 9/8/2025, Enhanced Barrier Precautions signage and PPE were placed near the room entrance for resident #19. On 9/8/25, the MDS Coordinator/ Designee initiated an audit of facility signage requiring Enhanced Barrier Precautions, to ensure the accuracy of care plans, and that appropriate signage/ PPE were implemented. No additional concerns were identified during the audit. On 9/8/25, the DON/ Designee initiated in-servicing with re-education for licensed nurses, reviewing policies and procedures for Enhanced Barrier Precautions, including care planning and initiation of appropriate signage/ personal protective equipment. The DON/ Designee will conduct ongoing audits, twice weekly, reviewing resident requiring EBP, to ensure that the care sign is accurate, and that the appropriate signage and PPE have been placed near the room entrance as indicated. Audits will be reviewed monthly at the Quality Assurance Performance Improvement Meeting X 3 months, and then as needed as concerns arise. Any deficiency statement ending in an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that | LIFE CARE CENTER OF PENSACOLA | 3291 EAST OLIVE RD., PENSACOLA, Florida, 32514 |

F0880 SS = D Continued from page 1

F0880 Infections before they can spread to other persons in the facility; (iii) When and to whom possible incidents of communicable disease or infections should be reported; (iii) Standard and transmission-based precautions to be followed to prevent spread of infections; (iv)When and how isolation should be used for a resident, including but not limited to: (A) The type and duration of the isolation, depending upon the infectious agent or organism involved; and (B) A requirement that the isolation should be the least restrictive possible for the resident under the circumstances. (v) The circumstances under which the facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease; and (vi)The hand hygiene procedures to be followed by staff involved in direct resident contact. §483.80(a)(4) A system for recording incidents identified under the facility's IPCP and the corrective actions taken by the facility. §483.80(e) Linens. Personnel must handle, store, process, and transport linens so as to prevent the spread of infection. §483.80(f) Annual review. The facility will conduct an annual review of its IPCP and update their program, as necessary. This REQUIREMENT is NOT MET as evidenced by: Based on observations, interviews, and record reviews, the facility failed to implement Enhanced Barrier Precautions (EBP) as an infection control intervention designed to reduce transmission of organisms that employs targeted gown and glove use during high contact resident care activities for 1 of 1 residents observed 106073 09/10/2025 LIFE CARE CENTER OF PENSACOLA 3291 EAST OLIVE RD., PENSACOLA, Florida, 32514 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

F0880 SS = D Continued from page 2 for transmission based precautions. (Resident #131) The findings include: Observations performed on 09/07/25 at approximately 12:58 PM and 4:25 PM and 9/08/25 at 8:19 AM discovered that there was no EBP signage posted and no Personnel Protective Equipment (PPE) access outside of the room for Resident #131. (Photographic Evidence Obtained). On 09/07/25 at approximately 12:58 PM, an interview was conducted with Resident #131. She explained that she has been newly admitted to the facility status post c-section and required some surgical scar. On 09/08/25 at approximately 8:19 AM, an additional interview was conducted with Resident #131. She explained that the staff do not wear additional gowns or protective equipment during wound care. On 09/09/25 at approximately 11:25 AM, an interview was conducted with the Director of Nursing (DON) and the Infection Preventionist. They explained that Resident #131 was admitted with a small dehiscence to her surgical scar on 09/02/25. They further indicated that EBP was initiated in her care plan on 09/05/25, however they forgot to place the signage that includes instructions for use of specific PPE to be used and make PPE readily available near the entrance of the room for Resident #131. They acknowledged that between 09/05/25 and 09/08/25, EBP were not followed during high-contact resident care activities, providing opportunities for transfer of organisms. The physician's orders initiated on 09/03/25 for Resident #131 include "cleanse area of dehiscence to proximal end of midline abdominal with wash, loosely pack wound with calcium alginate, cover with small foam dressing". The Care Plan initiated on 09/05/25 for Resident #131 has a focus for break in skin integrity with open area to proximal end of surgical wound, including a goal to minimize risk for symptoms of infection, with an intervention that includes Enhanced Barrier Precautions. The weekly Wound Care progress note dated 09/09/25 reveals proximal end of midline abdominal surgical scar dehiscence present on admission. The Treatment Administration Record (TAR) for September 2005 reveals wound care to the proximal end of midline abdominal surgical scar dehiscence was provided on 09/03/25, 09/06/25 and 09/08/25. A facility policy titled "Enhanced Barrier Precautions (EBP)" (reviewed 07/03/25 and revised 08/19/25) states,

F0880 106073 09/10/2025 LIFE CARE CENTER OF PENSACOLA 3291 EAST OLIVE RD , PENSACOLA, Florida, 32514 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

F0880 SS = D Continued from page 3 "EBP refers to an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employs targeted gown and glove use during high contact resident care activities. Policy for use of EBP as an additional Multidrug-Resistant Organism (MDRO) mitigation strategy for residents that meet the following criteria, during high contact resident care activities, EBP are indicated for residents with the following wounds even if the resident is not known to be infected or colonized with a MDRO Wounds generally include chronic wounds that include, but are not limited to pressure ulcers, diabetic foot ulcers, unhealed surgical wounds, wound care, skin opening requiring a dressing, EBP should be used for any residents who meet the above criteria, wherever they reside in the facility. The facility may choose to post signage on the door or wall outside of the resident room indicating the resident is on EBP. The facility should ensure PPE and alcohol-based hand rub are readily accessible to associates."

F0880 A review of the Center for Disease Control and Prevention website at: https://www.cdc.gov/long-term-care-facilities/hcp/preve nt-mdro/PPE.html#cdc_generic_section_2-enhanced-barrier -precautions-in-nursing-homes-video-posters-pocket-guid e, titled "Implementation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MRDO)", dated 04/02/2024 was reviewed. It reveals that: "when implementing Contact Precautions or Enhanced Barrier Precautions, it is critical to ensure that staff awareness of the facility's expectations about hand hygiene and gown/gloves use, initial and refresher training, and access to appropriate supplies. To accomplish this, post clear signage on the door or wall outside of the resident room indicating the type of Precautions and indications for high contact resident care activities the use of gown and gloves; make PPE available immediately outside of the resident's door". Florida Department of Health LIFE CARE CENTER OF PENSACOLA 3291 EAST OLIVE RD., PENSACOLA, Florida, 32514 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

N0000 INITIAL COMMENTS

N0000 10/03/2025 An unannounced re-licensure survey was conducted in conjunction with a complaint survey for complaint #2025012712 and #2025010604 at Life Care Center of Pensacola in Pensacola, FL on 09/10/2025 through 09/10/2025. At the time of the survey, the facility was in compliance with Florida nursing home regulations. Office of Primary Care and Health Systems Management STATE FORM