Crossbreeze Care Center

F-F600.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 19 105774 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105774 B. Wing 05/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Indian Beach Nursing and Rehab Center 1755 18th St Sarasota, FL 34230

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 0835 Review of the Administrator's job description signed and dated 9/1/23 revealed, The primary purpose of the Executive Director (Administrator) is to direct the day-to-day functions of the facility in accordance with Level of Harm - Immediate current federal, state, and local standards, guidelines and regulations that govern nursing facilities to ensure jeopardy to resident health or that the highest degree of quality care can be provided to our residents at all times .Duties and safety Responsibilities . Ensure a safe, clean and comfortable environment for residents . Resident Rights . Review resident complaints and grievances and make written reports of action taken. Discuss such actions with Residents Affected - Some residents and family as appropriate .

Review of the Director of Nursing's job description signed and dated 9/28/23 revealed, As the company Director of Nursing, you are entrusted with the responsibility of caring for our residents . The primary purpose of your job position is to plan, organize, develop and direct the overall operation of our Nursing Service Department in accordance with current federal, state, and local standards, guidelines, and regulations that govern our facility, and as may be directed by the Executive Director to ensure that the highest degree of quality care is maintained at all times . Job functions . You will assume the primary role in ensuring the delivery of high quality, efficient nursing care .

Review of the Resident Council Minutes from January 2025 through April 2025 revealed:

On 1/23/25, Temperature [sic] in [NAME] wing need replacing was documented under Old business.

Heat and temps are not 71 or higher and being addressed today .

On 2/20/25, Heat and temps being addressed was documented under old business, and AC unit being fixed under New Business.

On 3/20/25, there was no update documented about the AC unit being fixed under old business. Under New business, 500 hall needs AC compressor but hallway is comfortable temps was documented.

On 4/17/25, Temps: Regulation temps 71-81 degrees. Working on AC units on 500 and [NAME] halls.

On 5/20/25 at approximately 9:30 a.m., during an initial tour of the facility, the hallways felt excessively warm.

On 5/20/25 at 10:14 a.m., room [ROOM NUMBER]'s temperature was 82.0 Fahrenheit (F).

On 5/20/25 at 10:25 a.m., in an interview, the Administrator said the central air conditioning unit in the 500 hallway has been down since early April. He said they installed air conditioning window units to the residents' rooms to keep the temperature between 76.0 degrees F and 77.0 degrees F. He said the central air conditioning unit of the 400 hallway went down early this morning. He said both units needed either a new compressor or needed to be replaced.

On 5/20/25 at 11:15 a.m., Resident #2 was observed in her room on the 400 hallway. In an interview, Resident #2 said her room was a bit hot. Resident #2 said, Last night was terrible, I was cooking (indication of body heat), it felt like I showered. It's been hot like this for a few days. The room temperature obtained

during the interview was 82.2 F.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 19 105774 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105774 B. Wing 05/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Indian Beach Nursing and Rehab Center 1755 18th St Sarasota, FL 34230

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 0835 On 5/20/25 at 11:34 a.m., Resident #3 was observed in his room on the 400 hallway. In an interview, Resident #3 said, It's hot, it's hot, I am sweating. I had to come in the hallway to cool off. I stayed by the fan, Level of Harm - Immediate not moving around. I thought the hallway would be cooler but it's not. It was hot yesterday, I sweated my ass jeopardy to resident health or off all day and all night. Resident #3's room felt warm. The temperature obtained during the interview was 82. safety 4 F.

Residents Affected - Some On 5/20/25 at 11:40 a.m., Resident #4's room temperature was 82.0 F.

On 5/20/25 at 11:42 a.m., room [ROOM NUMBER]'s temperature (with a window air conditioning unit) was 81.6 F.

On 5/20/25 at 1:59 p.m., in an interview, the Food Service Director said he helps in the maintenance department with translation. He said 9 window units were purchased and will be installed in residents' rooms

on the 400 hallway in the afternoon. He said, Long term we have 3 new units approved by the corporate office. They are ordered, waiting to be delivered, I don't know the exact day.

On 5/20/25 at 3:09 p.m., Resident #4 was observed in his room (with a window air conditioning unit). In an interview, Resident #4 complained about the heat. He said, It's too hot. It's been hot for about two weeks. At night it's bad, it's hard to sleep. The resident's room temperature obtained during the interview was 83.5 F.

On 5/20/25 at 3:18 p.m., the temperature was 83.4 F in the activity area of the Memory Care Unit.

Random temperatures obtained on 5/20/25 after 3:00 p.m., revealed:

On 5/20/25 at 3:24 p.m., room [ROOM NUMBER]'s temperature was 84.0 F.

On 5/20/25 at 3:25 p.m., room [ROOM NUMBER]'s temperature was 84.3 F.

On 5/20/25 at 3:28 p.m., Resident #3's room temperature was 83.4 F.

On 5/20/25 at 3:32 p.m., Resident #1's room temperature was 81.3 F. The room had an air conditioning window unit. Resident #1's roommate was observed in bed and was not able to answer to interview questions.

On 5/20/25 at 3:34 p.m., room [ROOM NUMBER]'s temperature was 82.2 F.

On 5/20/25 at 3:37 p.m., the temperature was 82.7 F in the television room of the 500 hallway.

On 5/20/25 at approximately 3:45 p.m., in an interview, the Director of Nursing (DON) discussed measures implemented to ensure each resident's comfort and minimize the risk of complications from prolonged heat exposure.

The DON said she just implemented a safety plan, today at 3:30 p.m. as the temperatures were never as high as they have been today.

Review of the document titled, Safety Plan Elevated Temperatures-Heat provided by the DON revealed,

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 19 105774 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105774 B. Wing 05/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Indian Beach Nursing and Rehab Center 1755 18th St Sarasota, FL 34230

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 0835 1. Dedicated staff member to pass ice/water/cool cloths throughout the day/night. Please be sure staff are staying hydrated as well. Level of Harm - Immediate jeopardy to resident health or 2. Offer popsicles, ice cream etc. safety 3. Nursing: Please take VS (Vital Signs) to include temperature every four hours. Residents Affected - Some 4. Any resident who shows any change in condition or s/s (signs and symptoms) of being overheated send to

the hospital.

5. Record ambient temperatures in various areas of the bld. (building), and resident rooms. Be sure to keep

a record. If resident rooms are above 81 degrees, please move to a cool zone or cooler area of the facility.

6. Keep blinds closed to help keep the area as cool as possible.

The DON said she did not have documentation verifying that the temperatures in the residents' rooms have not been as high as they have been today. She verified the interventions listed in the facility's Safety Plan Elevated Temperatures-Heat were not implemented until 5/20/25 at 3:30 p.m.

On 5/20/25 at 5:05 p.m., in an interview, Resident #5 said she has been the Resident Council President for

the past six months and the temperature has been an issue for the past six months. She said, A gamut of issues was raised in the meetings. The temperature was always a concern. She said, If it wasn't too hot, it was too cold. It was never tempered, never. Resident #5 said, Who can sleep when all you want to do is strip naked and get in ice. The temperature has never been regulated here, ever. It's been coming up every month in the meetings. They don't really do anything, it's never comfortable.

Resident #5's room temperature was 81.6 F. The room felt warm. Resident #5 said the room always feels warm. She said it was not a comfortable temperature for her, It's hot for a very small space, with the bathroom door closed, the hallway door opened and the blinds closed at all times. She said, If I open the blinds, it would be worse than a sauna.

On 5/21/25 at 4:20 p.m., the Administrator provided a document titled, Indian Beach Center A/C (Air Conditioning) Timeline. In an interview the Administrator said they noticed the 500 AC unit was not working

on 4/10/25. Facility maintenance was able to repair it at that time and it worked for about 2.5 weeks. On 4/28/25 both the 500 unit and 700 unit went down. Maintenance was unable to repair either of those units.

On 4/28 window units were placed in the 500 hall rooms. In the 700 hall each of the residents' rooms was on

a separate unit so the rooms stayed cool. On 5/20/25 the 400 hall central unit stopped working and maintenance was unable to fix. Window units were installed in the rooms. He said they had received a quote from an outside vendor to repair/replace with an anticipated start date of 6/2/25.

Review of the document titled, Indian Beach Center A/C (Air Conditioning) Timeline revealed,

4/28/2025: Both 500 Central AC unit and 700 Day room Central AC unit stopped working.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 19 105774 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105774 B. Wing 05/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Indian Beach Nursing and Rehab Center 1755 18th St Sarasota, FL 34230

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 0835 4/28/2025: (Outside company) called for service. They were unable to repair either unit. Their recommendation was to replace the 500 Central AC unit and replace the compressor for the 700 unit. Level of Harm - Immediate jeopardy to resident health or 4/28/2025: Room air temps on the 700 unit are in range in the mid-70s F. Appropriate Temperatures for the safety unit maintained as the residents' rooms units are working and keeping the whole unit cool. Day room temperatures are In the Mid 70' F range. Residents Affected - Some Resident Rooms 501, 502, 503, 504 and 505 require window Acs. Each room has a window AC placed in the window. Proper room temperatures are maintained.

4/28/2025: The center received a quote and approval from (outside AC company) for new Central AC unit for 500 unit and New Compressor for 700 unit. Estimated start Date for project is contingent on delivery of the Units.

5/16/2025: (Outside AC company) sent confirmation the project for 500 Unit and 700 unit will begin on/or about 6/2/2025.

5/20/2025: 400 Central Unit stopped working. Center staff was unable to resolve. The issue appears to be

the compressor will require replacement. The Affected rooms are rooms 401, 402, 403, 404, 406, and 408.

The center purchased and placed window ACs in residents' rooms 401, 402, 403, 404, 406 and 408. The center also rented two large Portable AC units. One was placed in the 400 Hallway. The second was placed

in the 700 Unit Hallway.

Review of the temperature monitoring logs for January 2025 through May 2025 revealed the temperature was documented twice a day (morning and afternoon), two times a month in the following areas:

The 300, 400, 600, 700, and 800 hallways.

The Main Dining Room, the Therapy gym, the Activities room, the East, and [NAME] Nurses Stations, East and [NAME] Day Rooms.

The temperature range was 71.0 F to 80.0 F.

The most recent temperatures were on May 1, 2025, and ranged from 74.0 F to 80.0 F.

The log did not include temperature in residents' rooms.

On 5/22/25 at 11:55 a.m., in an interview, the Administrator said he thought they were doing temperature logs twice a week. He said the routine schedule for the temperatures was supposed to be Mondays and Thursdays. When asked about taking residents' rooms temperature to ensure they were at a safe and comfortable level, the Administrator said, If there is a high temperature out in the hallway, then they know to go check in the residents rooms. The Administrator said he attends Resident Council meetings with an agenda and talks to the residents about the maintenance issues they are working on. The Administrator said, I know my residents extremely well, none of those meetings I've been to have the residents brought up the temperature.

30525

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 19 105774 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105774 B. Wing 05/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Indian Beach Nursing and Rehab Center 1755 18th St Sarasota, FL 34230

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 0835 The immediate actions implemented by the facility and verified by the survey team on 5/24/25 included:

Level of Harm - Immediate On 5/24/25 verified through observation that the facility placed portable air conditioners and chillers jeopardy to resident health or throughout the facility to maintain temperatures between 71 and 81 degrees. safety

On 5/24/25, verified through resident interviews that the residents feel the temperature is now comfortable Residents Affected - Some throughout the facility including in the resident rooms.

On 5/24/25 at 10:30 a.m., temperatures were taken throughout the facility and verified to be within the temperature range of between 71 and 81 degrees.

On 5/24/25 at 1:00 p.m., temperatures were taken throughout the facility and verified to be within the temperature range of between 71 and 81 degrees.

On 5/24/25 at 5:00 p.m., temperatures were taken throughout the facility and verified to be within the temperature range of between 71 and 81 degrees.

The facility is and will continue to maintain hourly temperature logs until all air conditioner units are repaired.

On 5/24/25, verified that on 5/20/2025 education was completed with the Administrator and Director of Nursing (DON) by the [NAME] President of Clinical Operations. The education included their responsibility to implement the facility excessive heat emergency plan r/t broken air conditioning units. The education also included the monitoring process and notification procedure to the Chief Executive Officer/Chief Nursing Officer and to ensure residents are provided with a clean, comfortable environment.

The Chief Nursing officer educated the Administrator and DON on their job descriptions 5/20/2025. The Administrator and DON understand they are responsible to ensure proper temperatures in the center are maintained and residents reside in a safe, comfortable environment.

On 5/24/25, reviewed the agenda and staff sign in page for the Quality Assurance and Performance Improvement (QAPI) meeting held 5/23/25. The agenda included a review of the effected regulations and implementation of the facilities Excessive Heat Emergency Plan.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 19 105774

F-F835.

Review of the facility's policy and procedure titled, Abuse, Neglect, Exploitation and Misappropriation with a revision date of 11/28/2017 revealed, Neglect is the failure of the center, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress. Examples include but are not limited to . Failure to take precautionary measures to protect the health and safety of the resident .Prevention. The center is committed to the prevention of . neglect . The following systems have been implemented: Resident Council .

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 7 of 19 105774 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105774 B. Wing 05/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Indian Beach Nursing and Rehab Center 1755 18th St Sarasota, FL 34230

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 0600 Review of the Resident Council Minutes from January 2025 through April 2025 revealed:

Level of Harm - Immediate On 1/23/25, Old business.Temperature [sic] in [NAME] wing need replacing was documented. jeopardy to resident health or safety Heat and temps are not 71 or higher and being addressed today .

Residents Affected - Some On 2/20/25, Old business. Heat and temps being addressed and New Business . AC (Air Conditioning) unit being fixed.

On 3/20/25, there was no update documented about the AC unit being fixed under old business. New business. 500 hall needs AC compressor but hallway is comfortable temps.

On 4/17/25, Temps: Regulation temps 71-81 degrees. Working on AC units on 500 and [NAME] halls.

On 5/20/25 at approximately 9:30 a.m., during an initial tour of the facility, the hallways felt excessively warm.

A hygrometer (measures temperature and humidity) was used to take the temperature in residents' rooms and common areas several times throughout the day.

On 5/20/25 at 10:14 a.m., room [ROOM NUMBER]'s temperature was 82.0 Fahrenheit (F).

On 5/20/25 at 10:25 a.m., in an interview, the Administrator said the central air conditioning unit in the 500 hallway has been down since early April. He said they installed air conditioning window units to the residents' rooms to keep the temperature between 76.0 degrees F and 77.0 degrees F. He said the central air conditioning unit of the 400 hallway went down early this morning. He said both units needed either a new compressor or needed to be replaced. The Administrator said they took temperatures twice a month and provided a temperature monitoring log for January 2025, February 2025, March 2025, April 2025 and May 1, 2025.

Review of the temperature monitoring logs for January 2025 through May 2025 revealed each log included a column for temperature in the morning and a column for temperature in the evening. the temperature was documented twice a day (morning and afternoon), two times a month in the following areas:

The 300, 400, 600, 700, and 800 hallways.

The Main Dining Room, the Therapy gym, the Activities room, the East, and [NAME] Nurses Stations, East and [NAME] Day Rooms.

For January 2025 the log noted, Date: Jan-2025 1-10.

[DATE REDACTED]-24 was written above the temperature obtained in the morning from 8:00 a.m. to 8:50 a.m. The temperature ranged from 72.0 F to 80.0 F.

[DATE REDACTED]-31 was written above the temperature obtained in the afternoon from 5:00 p.m. to 5:20 p.m. The temperature ranged from 72.0 F to 80.0 F.

For February 2025 the log noted, Date: 2-3-2025.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 19 105774 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105774 B. Wing 05/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Indian Beach Nursing and Rehab Center 1755 18th St Sarasota, FL 34230

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 0600 2-3-25 2-14 was written above the the column for the temperature documented for 8:00 a.m. The temperature ranged from 71.0 F to 80.0 F. Level of Harm - Immediate jeopardy to resident health or 2-17 2-28-25 was written above the column for the temperature documented for 8:00 p.m. The temperature safety ranged from 71.0 F to 80.0 F.

Residents Affected - Some For March 2025 the log noted, Date: 3/1/2025.

3-2- 3/14/25 was written above the column for the temperature documented at 8:00 a.m. The temperature ranged from 72.0 F to 80.0 F.

3-16-3-30 was written above the column for the temperature documented for 8:00 p.m. The temperature ranged from 73.0 F to 80.0 F.

For April 2025 the log noted, Date: 4/1/2025.

4-1-12 was written above the column for the temperature documented for 8:00 a.m. The temperature ranged from 73.0 F to 80.0 F.

4-13-30 was written above the column for the temperature documented for 8:00 p.m. The temperature ranged from 71.0 F to 80.0 F.

For May 2025, the log noted, Date: 5-1-2025.

5-1-2025 was written above the column for the temperature documented for 8:00 a.m. the temperature ranged from 74.0 F to 80.0 F.

No date range or time was documented above the second column for the temperature range of 74.0 F to 80. 0 F.

The log did not include the temperature in residents' rooms.

On 5/20/25 at 11:15 a.m., Resident #2 was observed in her room on the 400 hallway. In an interview, Resident #2 said her room was a bit hot. Resident #2 said, Last night was terrible, I was cooking (indication of body heat) , it felt like I showered. It's been hot like this for a few days. The room temperature obtained

during the interview was 82.2 F.

On 5/20/25 at 11:34 a.m., Resident #3 was observed in his room on the 400 hallway. In an interview, Resident #3 said, It's hot, it's hot, I am sweating. I had to come in the hallway to cool off. I stayed by the fan, not moving around. I thought the hallway would be cooler but it's not. It was hot yesterday, I sweated my ass off all day and all night. The temperature obtained during the interview was 82.4 F.

On 5/20/25 at 11:40 a.m., Resident #4's room temperature was 82.0 F.

On 5/20/25 at 11:42 a.m., room [ROOM NUMBER]'s temperature (with a window air conditioning unit) was 81.6 F.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 19 105774 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105774 B. Wing 05/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Indian Beach Nursing and Rehab Center 1755 18th St Sarasota, FL 34230

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 0600 On 5/20/25 at 1:01 p.m., in an interview, the Administrator said it was an old building with 20 different central units that were all aged, except one that was installed last fall. He said monitoring temperature levels has Level of Harm - Immediate been ongoing. He said they had complaints regarding issues with the air conditioning in the 500 hall. They jeopardy to resident health or rectified it right away with window units so room temperatures were comfortable. safety

On 5/20/25 at 3:09 p.m., Resident #4 was observed in his room (with a window air conditioning unit). The Residents Affected - Some room temperature was 83.5 F. Resident #4 complained about the heat. He said, It's too hot. It's been hot for about two weeks. At night it's bad, it's hard to sleep.

On 5/20/25 at 3:18 p.m., the temperature was 83.4 F in the activity area of the Memory Care Unit.

On 5/20/25 at 3:21 p.m., in an interview, the Administrator said the new Maintenance Director knows air conditioning. They try to refurbish the air conditioning units instead of replacing them. He said they did routine maintenance of the air conditioning units and when they catch an issue, they address it.

Review of the Work Order Tracking Log revealed on 4/28/25 the central Air Conditioning of the 500 central unit and the 700 Main Hall were Down. Unable to repair was written under repair date.

The log noted on 4/28/25 window units were placed in each resident's room. The facility had no documentation the residents' room temperature levels were monitored to ensure the window air conditioning units maintained a safe temperature level between 71.0 F to 81.0 F.

The Administrator provided estimates from an outside heating and cooling company dated April 28, 2025, and May 16, 2025, to remove and replace the 700 hall compressor and replace the 500 hall unit.

On May 16, 2025, the estimate noted the project was approved with an anticipated start date of 6/2/25.

Random temperatures obtained on 5/20/25 after 3:00 p.m., revealed:

On 5/20/25 at 3:24 p.m., room [ROOM NUMBER]'s temperature was 84.0 F.

On 5/20/25 at 3:25 p.m., room [ROOM NUMBER]'s temperature was 84.3 F.

On 5/20/25 at 3:28 p.m., Resident #3's room temperature was 83.4 F.

On 5/20/25 at 3:32 p.m., Resident #1's room temperature was 81.3 F. The room had an air conditioning window unit. Resident #1's roommate was observed in bed and was not able to answer to interview questions.

On 5/20/25 at 3:34 p.m., room [ROOM NUMBER]'s temperature was 82.2 F.

On 5/20/25 at 3:37 p.m., the temperature was 82.7 F in the television room of the 500 hallway.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 19 105774 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105774 B. Wing 05/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Indian Beach Nursing and Rehab Center 1755 18th St Sarasota, FL 34230

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 0600 On 5/20/25 at approximately 3:45 p.m., in an interview, the Director of Nursing (DON) discussed measures implemented to prevent the neglect of residents, ensure each resident's comfort and minimize the risk of Level of Harm - Immediate complications from prolonged heat exposure. jeopardy to resident health or safety The DON said she just implemented the safety plan, today at 3:30 p.m. as the temperatures were never as high as they have been today. Residents Affected - Some

The DON said she did not have documentation the residents' rooms temperature levels were monitored and had not been as high as they have been today. She verified the interventions listed in the facility's Safety Plan Elevated Temperatures-Heat were not implemented until 5/20/25 at 3:30 p.m.

The DON provided a document titled, Safety Plan Elevated Temperatures-Heat.

Review of the Safety Plan Elevated Temperatures-Heat documents revealed:

1. Dedicated staff member to pass ice/water/cool cloths throughout the day/night. Please be sure staff are staying hydrated as well.

2. Offer popsicles, ice cream etc.

3. Nursing: Please take VS (Vital Signs) to include temperature every four hours.

4. Any resident who shows any change in condition or s/s (signs and symptoms) of being overheated send to

the hospital.

5. Record ambient temperatures in various areas of the bld. (building), and resident rooms. Be sure to keep

a record. If resident rooms are above 81 degrees, please move to a cool zone or cooler area of the facility.

6. Keep blinds closed to help keep the area as cool as possible.

On 5/20/25 at 5:05 p.m., in an interview, Resident #5 said she has been the Resident Council President for

the past six months and the temperature has been an issue for the past six months. She said, A gamut of issues was raised in the meetings. The temperature was always a concern. She said, If it wasn't too hot, it was too cold. It was never tempered, never. Resident #5 said, Who can sleep when all you want to do is strip naked and get in ice. The temperature has never been regulated here, ever. It's been coming up every month in the meetings. They don't really do anything, it's never comfortable.

During the interview, Resident #5's room temperature was 81.6 F. The room felt warm. Resident #5 said the room always feels warm. She said it was not a comfortable temperature for her, It's hot for a very small space, with the bathroom door closed, the hallway door opened and the blinds closed at all times. She said, If I open the blinds, it would be worse than a sauna.

On 5/21/25, the Administrator provided a document titled, Indian Beach Center A/C (Air Conditioning) Timeline that included:

4/28/2025: Both 500 Central AC unit and 700 Day room Central AC unit stopped working.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 19 105774 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105774 B. Wing 05/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Indian Beach Nursing and Rehab Center 1755 18th St Sarasota, FL 34230

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 0600 4/28/2025: (Outside company) called for service. They were unable to repair either unit. Their recommendation was to replace the 500 Central AC unit and replace the compressor for the 700 unit. Level of Harm - Immediate jeopardy to resident health or 4/28/2025: Room air temps on the 700 unit are in range in the mid-70s F. Appropriate Temperatures for the safety unit maintained as the residents' rooms units are working and keeping the whole unit cool. Day room temperatures are In the Mid 70' F range. Residents Affected - Some Resident Rooms 501, 502, 503, 504 and 505 require window Acs. Each room has a window AC placed in the window. Proper room temperatures are maintained.

4/28/2025: The center received a quote and approval from (outside AC company) for new Central AC unit for 500 unit and New Compressor for 700 unit. Estimated start Date for project is contingent on delivery of the Units.

5/16/2025: (Outside AC company) sent confirmation the project for 500 Unit and 700 unit will begin on/or about 6/2/2025.

5/20/2025: 400 Central Unit stopped working. Center staff was unable to resolve. The issue appears to be

the compressor will require replacement. The Affected rooms are rooms 401, 402, 403, 404, 406, and 408.

The center purchased and placed window ACs in residents' rooms 401, 402, 403, 404, 406 and 408. The center also rented two large Portable AC units. One was placed in the 400 Hallway. The second was placed

in the 700 Unit Hallway.

5/20/25: The center implemented the emergency weather Plan. The center initiated hourly Temperature checks throughout the center.

On 5/22/25 at 11:55 a.m., in an interview, the Administrator said he thought they were doing temperature logs twice a week. He said the routine schedule for the temperatures was supposed to be Mondays and Thursdays.

When asked about taking residents' rooms temperature to ensure they were at a safe and comfortable level,

the Administrator said, If there is a high temperature out in the hallway, then they know to go check in the residents rooms.

30525

The immediate actions implemented by the facility and verified by the survey team on 5/24/25 included:

On 5/24/25 verified through observation that the facility placed portable air conditioners and chillers throughout the facility to maintain temperatures between 71 and 81 degrees.

On 5/24/25, verified through resident interviews that the residents feel the temperature is now comfortable throughout the facility including in the resident rooms.

On 5/24/25 at 10:30 a.m., temperatures were taken throughout the facility and verified to be within the temperature range of between 71 and 81 degrees.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 19 105774 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105774 B. Wing 05/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Indian Beach Nursing and Rehab Center 1755 18th St Sarasota, FL 34230

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 0600 On 5/24/25 at 1:00 p.m., temperatures were taken throughout the facility and verified to be within the temperature range of between 71 and 81 degrees. Level of Harm - Immediate jeopardy to resident health or On 5/24/25 at 5:00 p.m., temperatures were taken throughout the facility and verified to be within the safety temperature range of between 71 and 81 degrees.

Residents Affected - Some The facility is and will continue to maintain hourly temperature logs until all air conditioner units are repaired.

On 5/24/25, facility wide staff abuse/neglect education verified through staff interview and record review of post-test results. All staff interviewed were able to explain the education. No staff will be permitted to work until they are reeducated on Abuse and Neglect policies. The education included not immediately reporting to the Administrator when a resident's room is at or above 81 degrees is considered Neglect. Education included a written competency test to include who and when to notify when a resident room is at or above 81 degrees. It also included information on where the cool zones are located, and failure to report is considered neglect.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 19 105774 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 105774 B. Wing 05/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Indian Beach Nursing and Rehab Center 1755 18th St Sarasota, FL 34230

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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently.

Level of Harm - Immediate **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 37256 jeopardy to resident health or safety Based on observation, record review, residents and staff interview, the facility Administration failed to utilize its resources effectively and efficiently to protect the residents' right to be free from neglect by failing to take Residents Affected - Some immediate and appropriate actions to maintain a safe and comfortable temperature level throughout the facility and in residents' rooms when the central air conditioning units of the 400 hall, the 500 hall and the 700 hall common area broke.

Review of the resident council meeting minutes from January through April 2025 noted concerns with the temperature and the air conditioning units not working. Each month the meeting minutes noted the concerns were being addressed.

On 4/28/25 the facility administration was aware the central air conditioning unit for the 500 hall broke and

the common area of the 700 hall broke.

On 5/19/25 the facility administration was aware the central air conditioning of the 400 hall broke.

The facility administration contracted with an outside company to make the necessary repairs but failed to implement immediate and effective measures to maintain a safe and comfortable temperature until the air conditioning units could be repaired or replaced on June 2, 2025.

On 5/20/25 at multiple times throughout the day, the temperature in random residents' rooms in the 400 hall, 500 hall (with window air conditioning units), room [ROOM NUMBER] and the common area of the 700 hall measured between 81.3 degrees to 84.3 degrees Fahrenheit (F).

On 5/20/25 during interviews, Residents #2, #3, #4, and #5 complained the excessive heat has been ongoing for weeks and the facility has not addressed their concerns.

The facility administration failure to address residents' concerns and the failure to utilize resources effectively to ensure a safe and comfortable temperature for all residents created a likelihood of serious harm, or death of residents due to prolonged exposure to excessive heat and resulted in the determination of Immediate Jeopardy.

On 5/23/25 at 9:30 a.m., the Administrator was notified of the Immediate Jeopardy (IJ).

The findings included:

Cross reference