Inspection·April 29, 2026

K0000 05/06/2026 Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See reverse for further instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: 1E4043-L2 Facility ID: 35961023 If continuation sheet Page 1 of 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES PRINTED: 05/06/2026 CENTERS FOR MEDICARE & MEDICAID SERVICES FORM APPROVED OMB NO. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 106081 (X2) MULTIPLE CONSTRUCTION A. BUILDING B. WING (X3) DATE SURVEY COMPLETED 04/29/2026 NAME OF PROVIDER OR SUPPLIER ARABELLA HEALTH & WELLNESS OF CARRABELLE STREET ADDRESS, CITY, STATE, ZIP CODE 239 CROOKED RIVER ROAD, CARRABELLE, Florida, 32322 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETION DATE

E0000 Initial Comments E0000 05/06/2026 During the revisit survey conducted on 04/29/2026 at Arabella Health and Wellness of Carrabelle, a nursing home in Carrabelle, Florida, the Emergency Preparedness Program (EP) was reviewed. Arabella Health and Wellness of Carrabelle complies with the Emergency Preparedness rule per Code of Federal Regulations (CFR) 42, Part 483.73. Requirement for Long-Term Care Facilities Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See reverse for further instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: 1E4043-L2 Facility ID: 35961023 If continuation sheet Page 1 of 1