Vivo Healthcare Gandy

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

personal control over choices and cultural preference. 'Culture' is the conceptual system that structures the way that people view the world-it is the particular set of beliefs, norms, and values that influence ideas about the nature of relationships, the way people live their lives, and the way people organize the world. 'Cultural Competency' is defined as a developmental process in which individuals or institutions achieve increasing levels of awareness, knowledge, and skills along a cultural competence continuum. Cultural competence involves valuing diversity, conducting self-assessments, avoiding stereotypes, managing the dynamics of difference, and acquiring and institutionalizing cultural knowledge, and adapting to diversity and cultural contexts in communication. 'Effective communication' describes a process of dialogue between individuals. The skills include speaking to others in a way they can understand and active listening and

observation of verbal and non-verbal cues. Understanding what the resident is trying to communicate is essential to giving a response. Additionally, effective communication ensures that information provided to

the resident is provided in a form and manner that the resident can access and understand, including a language that the resident can understand. The facility will provide sufficient guidance for staff, including temporary staff, on how to communicate and deliver care for the resident. Direct care staff will be trained on effective communication that reflects the needs of the resident population and needs of the staff and will correspond with the Facility Assessment. A review of the facility's Resident and Family grievances policy dated revised 01/2026, revealed: . 'Prompt efforts to resolve' include the facility acknowledgment of a complaint/grievance and actively working toward resolution of that complaint/grievance. The facility Social Services Director has been designated as the Grievance Official and can be reached at [SSD Contact Number]. The facility will make prompt efforts to resolve grievances.

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If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/30/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Vivo Healthcare Gandy

4610 S Manhattan Ave Tampa, FL 33611

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

on [DATE REDACTED] at 2:30 p.m. and reported to AHCA on [DATE REDACTED] at 7:48 p.m. The NHA said, To my knowledge we have 24 hours if there is no injury. The NHA confirmed abuse allegations should be reported within 2 hours.

She stated they reviewed the abuse policy. Reviewed policy showed abuse also includes the deprivation by

an individual, including a caretaker of goods or services. 4.Review of the admission record for Resident #6 revealed an admission date of [DATE REDACTED] with diagnoses to include muscle wasting and atrophy, cognitive communication deficit disorder, and unspecified dementia. Review of the facility's abuse log revealed an allegation of abuse was filed on [DATE REDACTED]. Review of a psychology progress note dated [DATE REDACTED] revealed, client reported that three people (1 male and 2 females) were in her room. The male was asleep with her in her bed when one of the females began hitting her. She stated the female began to feed others in the room

before they all left. During an interview conducted with the NHA on [DATE REDACTED] at 5:54 p.m., the NHA stated a family member alleged on [DATE REDACTED] at 1:05 p.m. the resident was beat up by staff. The NHA stated she was notified of the incident when it happened. She stated she notified DCF on [DATE REDACTED] at 2:50 p.m. She stated

she notified AHCA on [DATE REDACTED] at 3:59 p.m. The NHA stated, I know it was not within the two hours. I was with the police. I was not able to do it. The NHA stated reporting of abuse incidents should be within two hours. She stated their investigation was on-going. On [DATE REDACTED] at 11:30 a.m. an interview was conducted with the RDCS. She confirmed there were no reports filed or investigated for Resident #3. The RDCS stated

they were reviewing their reportable events. She stated the NHA should have filed reports in the required timeframes. She stated if the NHA could not do it for one reason or another, another staff member could submit the report.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/30/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Vivo Healthcare Gandy

4610 S Manhattan Ave Tampa, FL 33611

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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

an online neglect report to DCF at 4:52 p.m., police department at 4:05 p.m. and to AHCA on [DATE REDACTED] at 5:31 p.m. The NHA said, She was saying she was abused, but I did not think it was abuse. She stated her findings were that it was neglect because the medications were provided. The NHA stated the resident refused to be interviewed by herself on [DATE REDACTED] and [DATE REDACTED]. She stated she believed the DON may have tried but it was not documented. The NHA said, I don't know why she refused that I interview her. I don't know what she meant by being abused. I never found out. The NHA stated she could have investigated why

the resident alleged abuse and why she refused care from her CNA. On [DATE REDACTED] at 11:30 a.m. an interview was conducted with the RDCS. The RDCS confirmed there were no reports filed or investigated for Resident #3. The RDCS stated they were reviewing their reportable events. She stated the NHA should have filed reports in the required timeframes. She stated if the NHA could not do it for one reason or another, another staff member could submit the report. Review of a job description signed by the Nursing Home Administrator on [DATE REDACTED] revealed - the primary purpose of your position is to direct the day-to-day functions of the Facility in accordance with current federal, state and local standards guidelines, and regulations that govern nursing facilities to assure that the highest degree of quality care can be provided to our residents at all times.Duties and responsibilities included:-Review resident complaints and grievances and make written reports of action taken. Discuss such actions with resident and family as appropriate.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/30/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Vivo Healthcare Gandy

4610 S Manhattan Ave Tampa, FL 33611

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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

for four and half hours of video. She stated the administration was not forthcoming at all. She stated they had an unsupervised smoking patio which they corrected in [DATE REDACTED]. The RDCS said, I wanted to be transparent. I have integrity. I did not know about the 4.5 hours. I would have investigated it further. The RDCS stated they took immediate action last night and have several staff members who will not be returning. The RDCS said, We have now reported the neglect allegation. The CNO stated they became aware the NHA had a culture of hiding everything. She said, She is not returning. She hid stuff from us. The CNO stated they could not have an unethical culture.Review of a facility policy titled, Compliance and Ethics Reporting, revised 01/2026 revealed the facility implements and publicizes a reporting system that allows anyone to report compliance violations anonymously without fear of retribution and that ensures the integrity of the reports.Policy explanation and compliance guidelines:1. This facility supports an open door policy in which anyone may discuss concerns or report compliance violations to any supervisor, manager, HR representative, or compliance professional at any time.2. The facility has a designated contact person to which anyone may report suspected violations. This person is (insert job title) and may be reached at (insert contact information, or location of contact information).3. This facility has a (hotline number, intranet application, drop box, etc.) for reporting suspected violations anonymously, without fear of retribution.4.

Information related to reporting compliance violations is posted (insert locations). Training shall be provided

on a regular basis, not less than upon orientation and annually, to remind individuals of the reporting system, what to report, timeframes for reporting, and how to report.5. All information pertaining to a report will be kept confidential within the law. Anyone who reports a violation or suspected violation in good faith shall not be harassed, reprimanded, or discriminated against in any way.6. Employees with knowledge of a violation or suspected violation of the compliance program's standards, policies, and procedures are required to report it immediately. Staff who knowingly fail to report a violation shall be subject to disciplinary action, up to and including termination.7. Should any person have questions regarding compliance with state or federal laws, they should immediately seek clarification from the compliance officer, a supervisor, or through the facility hotline and/or web reporting.8. Once a report is received, an investigation will be conducted to determine whether a substantial violation or opportunity for improvement exists. Corrective actions will be implemented as necessary.9. The compliance and ethics program contact person shall follow up with those individuals making a report, except in those instances where the report was made anonymously.10. All reports will be tracked for purposes of QAPI and evaluating the effectiveness of the compliance and ethics program. Documentation shall be maintained for a minimum of three years by (insert job title).

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/30/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Vivo Healthcare Gandy

4610 S Manhattan Ave Tampa, FL 33611

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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

precautions necessary when visiting the and precautions necessary when visiting the resident . 13) Resident/Family/Visitor Education and Screening: a) Residents, family members, and visitors are provided information relative to the rationale for the isolation, behaviors required of them in observing these precautions, and conditions for which to notify the nursing staff. Isolation signs are used to alert staff, family members, and visitors of transmission-based precautions . 13) Resident/ Family/Visitor Education and Screening: a)Residents, family members, and visitors are provided information relative to the rationale for

the isolation, behaviors required of them in observing these precautions, and conditions for which to notify

the nursing staff. D) Passive screening, such as signs, are posted in the facility to alert family members use.

Review of the facility's policy titled, Oxygen Administration, revised 1/2026 revealed the following: . 5 e) Keep delivery devices covered when not in use.

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Facility ID:

If continuation sheet