Inspection·October 8, 2024

F 000 A complaint survey for complaint numbers 2024011752 and 2024008757 was conducted on 10/8/24 at Rosewood Healthcare and Rehabilitation, a nursing home in Pensacola, FL. The facility was in compliance with Code of Federal Regulations (CFR) 42, Part 483, Subparts B-F, Requirements for Long-Term Care Facilities. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE Electronically Signed TITLE 10/21/2024 (X6) DATE 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: TUQZ11 Facility ID: 11704 If continuation sheet Page 1 of 1 Agency for Health Care Administration PRINTED: 10/25/2024 FORM APPROVED 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 10/08/2024 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 SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY)

N 000 INITIAL COMMENTS N 000 A complaint investigation for complaint numbers 2024011752 and 2024008757 was conducted at Rosewood Healthcare and Rehabilitation in Pensacola, FL on 10/8/24. The provider had no deficiencies at the time of the visit. AHCA Form 3020-0001 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Electronically Signed 10/21/24 STATE FORM 8899 TUQZ11 If continuation sheet 1 of 1