Inspection·June 27, 2023

N 000 AHCA Form 3020-0001 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE Electronically Signed TITLE (X8) DATE 07/17/23 STATE FORM 6809 YSY411 If continuation sheet 1 of 1 PRINTED: 08/01/2023 FORM APPROVED Agency for Health Care Administration STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 11704 (X2) MULTIPLE CONSTRUCTION A. BUILDING: ________ B. WING ________ (X3) DATE SURVEY COMPLETED C 06/27/2023 NAME OF PROVIDER OR SUPPLIER ROSEWOOD HEALTHCARE AND REHABILITATION CI STREET ADDRESS, CITY, STATE, ZIP CODE 3107 NORTH H STREET PENSACOLA, FL 32501 (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) (X6) COMPLETE DATE

N 000 INITIAL COMMENTS

N 000 On June 27, 2023 an unannounced complaint survey for complaint numbers 2023008131 and 2023008755 was conducted at Rosewood Healthcare and Rehabilitation Center in Pensacola, FL. A revisit survey was conducted in conjunction. The facility had no deficiences at the time of the investigation. AHCA Form 3020-0001 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE Electronically Signed TITLE (X8) DATE 07/17/23 STATE FORM Y5Y411 If continuation sheet 1 of 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES PRINTED: 08/01/2023 CENTERS FOR MEDICARE & MEDICAID SERVICES FORM APPROVED OMB NO. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION A. BUILDING ______ B. WING ______ (X3) DATE SURVEY COMPLETED C 105747 06/27/2023 NAME OF PROVIDER OR SUPPLIER 3107 NORTH H STREET PENSACOLA, FL 32501 ROSEWOOD HEALTHCARE AND REHABILITATION CENTER (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

F 000 INITIAL COMMENTS F 000 On June 27, 2023 an unannounced complaint survey for complaint numbers 2023008131 and 2023008755 was conducted at Rosewood Healthcare and Rehabilitation Center in Pensacola, Fl. A revisit survey was conducted in conjunction. The facility was found to be in compliance with 42 CFR 483. Requirements for Long Term Care Facilities, at the time of survey visit. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Electronically Signed 07/17/2023 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 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. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: Y5Y411 Facility ID: 11704 If continuation sheet Page 1 of 1