Inspection·April 2, 2025

F 0557 or assisting with coffee/hydration pass. Level of Harm - Minimal harm or potential for actual harm On 3/31/2025 at 12:19 p.m., the first tray was brought in from a tray cart, which was located down a hallway, approximately twenty feet away. At 12:25 p.m. it was observed three of the eight residents seated at the long table, were served and set up with their meals. They all were able to eat without assistance. At 12:29 p.m. all eight residents seated at the same table had been served and set up with their meal. Resident #36 was seated in a wheelchair just three to four feet away from the table with the other residents and she was noted without a meal tray. At 12:33 p.m., Staff G brought in the meal tray for Resident #36 and began to set up the meal. Staff G sat next to the resident to cue her with eating. Resident #36 sat with no meal and meal assistance while all other in the room ate from 12:19 p.m. through to 12:33 p.m. Residents Affected - Few Review of Resident #107's medical record revealed he was admitted to the facility on [DATE]. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed; (Cognition/Brief Interview Mental Status or BIMS - no score. The cognition section revealed the resident had Short Term and Long Term memory problem and Severely Impaired Decision Making Skills); (ADL - EATING = Substantial/Maximal Assistance). Review of Resident #36's medical record revealed she was admitted to the facility on [DATE]. Review of the quarterly MDS assessment dated [DATE], revealed; (Cognition/BIMS score - 12 of 15); (ADL - EATING = Set Up or Cleaning assistance). During both observations of the resident while in the dining/activity room, revealed she was not able to answer questions related to her meal service. On 4/1/2025 at 2:00 p.m., an interview with Staff S, Registered Nurse Manager revealed she was not aware there were no supervisory staff in the third floor dining room for lunch on 3/30/2025 and 3/31/2025. She revealed all residents in the room should be served and set up with their meals around the same time and it was unacceptable that Residents #107 and #36 were served with their meals almost an hour after others were served. She revealed she, along with other managers, usually oversaw the dining service, but she was assisting with tray pass on the fourth floor. On 4/2/2025 at 11:00 a.m., the Nursing Home Administrator revealed the facility did not have a specific dining dignity policy and procedure for review. He revealed as part of dignity rights, all residents who sat in the same room and at the same table, should be served and set up generally at the same time, and being served almost an hour after others was unacceptable. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 2 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure residents on two of three floors (2nd and 3rd floors) had an environment free from heavy foul and offensive odors during four of four days observed (3/30/25, 3/31/25, 4/1/25, and 4/2/25). It was found heavy odors emitted from two of thirty-four sampled residents (#163 and #80) and their rooms. Findings included: On 3/30/2025 at 9:58 a.m., the elevator doors opened on the second floor and there was immediately a heavy foul urine and offensive odor. After walking past the unit station and to Resident #163's room, it was observed the room door was closed. After knocking on the door and opening it, a very heavy foul urine and offensive odor emitted from this room. The odor was overpowering and leached throughout out areas to include the activity/dining room, hall near the shower room, the nurse station and down both halls approximately thirty feet away from Resident #163's room. Upon entering Resident #163's room, she was observed lying in bed on her side and over the bed linen. The bed and floor were observed dry and free from incontinence episodes. Resident #163 was also observed receiving nourishment via a tube feeding system. Resident #163 was observed with her eyes open but with cognitive deficits preventing her from being interviewed. The room and bathroom revealed no incontinent episodes, but the room emitted a heavy foul odor. Once the room door was opened to leave, there were various staff who passed by the room and indicated by putting their hands on their mouths and saying what is that smell. The staff members just walked by and did not stop to check on Resident #163. The same areas observed on the second floor were found with the same very heavy urine and offensive odors during the entire 7:00 a.m. - 3:00 p.m. shifts on 3/30/2025, 3/31/2025, 4/1/2025, and 4/2/2025. The heavy odors were also observed on the second floor upon shift change from 11:00 p.m.- 7:00 a.m. through to the 7:00 a.m.-3:00 p.m. shift during the same days listed. On 4/1/2025 at 7:56 a.m., Staff C, Housekeeper was observed to go in Resident #163's room to clean. She confirmed she cleaned the room every day and confirmed the room had a very bad odor. She revealed she cleaned the floors, walls, furniture, bathroom, equipment and the room still smelled. She confirmed the smell occurred in this room for more than a week to her knowledge. Staff C said she reported to staff and believed the nurse was aware. Staff C was observed to clean the room to include emptying the trash cans in room and bathroom, sweeping the room and bathroom, dry mopping the floors in the room and bathroom, wiping down the dresser, over the bed table and other high touch surfaces, as well as wet mopping the room. The cleaning products could be smelled, but the foul odor overpowered the cleaning products. After about twenty minutes the foul odor overpowered the cleaning products completely. Review of Resident #163's medical record revealed she was admitted to the facility on [DATE] and readmitted from the hospital on 3/4/2025. Review of the diagnosis sheet revealed diagnoses to include but not limited to: Dementia, Urogenital implants, History of Urinary Tract Infections, and Neuromuscular Dysfunction of Bladder. Review of the Minimum Data Set (MDS) assessment, dated 3/6/2025 revealed; Cognition/Brief Interview Mental Status or BIMS score: not scored. The section revealed the resident had both a long term and short term memory problem and with severely impaired decision making skills; Activities of Daily (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 3 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Living (ADL) - Toileting hygiene = Dependent on staff, Shower/Bathing = Dependent on staff; Bowel and Bladder - Checked as use of Indwelling Catheter, Urinary Continence - not rated, Bowel - Always incontinent. On 4/1/2025 at 2:05 p.m., Staff B, second floor unit manager was interviewed related to Resident #163 and the odors emitting from her and her room. Staff B revealed she had just come back from leave on Monday 3/31/2025 and she noticed a heavy odor coming from the resident's room. She revealed the resident had an infection that was being treated , she utilized a catheter, and received all nourishment via tube feeding system. Staff B revealed Resident #163's family had not been involved much with care planning. Staff B indicated she monitored staff to check and change residents frequently and at least every two hours. She revealed the resident received bed baths and she was on Palliative care. Staff B confirmed Resident #163 was checked and changed every two hours or as needed and the room was cleaned, but she felt the odor was from the infection she had been treated for. On Sunday 3/30/2025 at 11:12 a.m., on the third floor, the hallway leading to the Resident #80's room was found with heavy offensive body odor. The odor could be smelled over thirty feet before getting to his room. Once Resident #80's room, the last room on the hall was approached, the door was observed opened. The odor was very strong and was emitting from his room. The resident was observed seated upright in his bed and dressed for the day. Resident #80 appeared unshaven, hair unkempt, and the body odor was very strong emitting from him. An attempt to interview Resident #80 revealed he did not want to be bothered and just stated, I'm fine. He was asked about the heavy odor in the room but he did not answer. The heavy body odor emitted from the resident and his room through the third floor hall, approximately thirty feet down from his room during at least the entire 7-3 shift on days 3/30/2025, 3/31/2025, 4/1/2025, and 4/2/2025. Also, the odor could be found during shift change from the 11:00 p.m.-7:00 a.m. shift through to the 7:00 a.m.-3:00 p.m. shift. During many observations during the timeframes listed, there were staff and residents who were observed asking each other where the body odor was coming from. Review of Resident #80's medical record revealed he was admitted to the facility on [DATE] and readmitted from the hospital on 6/15/2022. Review of the diagnosis sheet revealed diagnoses to include but not limited to: Dementia, Mood disorder, and Major Depression. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed; Cognition/Brief Interview Mental Stats or BIMS score - 9 of 15, which indicated moderate cognitive impairment; Behaviors none documented as exhibited during assessment timeframe; Mood - Feeling down 12 - 14 days of assessment period; no other mood indicators; (ADL - TOILETING = Independent, SHOWER/BATHING = Set up assistance, PERSONAL HYGIENE = Set up assistance. Review of the nurse progress notes dated from 1/29/2025 through to current 4/1/2025 revealed: - 3/31/2025 16:15 (4:15 p.m.) Progress note - Patient refused shower today x 3 attempts. Stated Please leave me alone; I just want to sleep. Will follow up with patient tomorrow. Review of the current care plans with a next review date 4/25/2025 revealed the following but not limited to: a. Preference/Choice: Resident has indicated the following preferences and/or has made the following choice regarding their health care: RESIDENT PREFERS TO DECLINE SHOWERS AT TIMES. Also refuses staff to take laundry at times, with interventions in place to include: Inform resident of positive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 4 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some benefits of following plan of care/or recommendations, explain the potential negative outcomes of preferences/choices. b. ADL - Resident has a history of ADL self care performance Deficit, with interventions in place to include PERSONAL HYGIENE = Set up, BATHING = Check nail length and trim and clean on bath day and as necessary, BATHING = Offer/provide with a sponge bath when not a scheduled bath day or unable to tolerate or accepts schedule bath, BATHING = The resident requires supervision. On 3/30/2025 at 3:38 p.m., an interview with Staff T, Licensed Practical Nurse (LPN) revealed she was aware of the body odor emitting from Resident #80's room and confirmed the odor pretty much smells up the entire hallway. She revealed Resident #80 refused showers most times and he did not want to change. She revealed he was difficult most times when it came to personal hygiene and showers. Staff T confirmed there had been other residents on the hallway who have complained about the odor, but she felt there was nothing they could do, because he had the right to decline showers and personal hygiene. Staff U, Registered Nurse (RN) was interviewed related to the heavy body odor coming from Resident #80's room. He revealed the resident continually refused showers and personal hygiene. He revealed management had spoken to him about not bathing, and so had the Medical Doctor. Staff U also confirmed Resident #80 was being seen by psychological services, but was unaware if he had been working with psych regarding behaviors of not wanting to bath and or change clothes. On 4/2/2025 at 11:59 a.m., an interview with Staff V, Housekeeping Director revealed she and her staff were aware of several rooms that had constant odors and she was able to explain housekeeping cleaning schedules and what type of cleaning was completed. She said she or her staff identified odors that did not go away and found the odor was emitting from the resident, she and her staff notified management staff and nurses on the floor of the issue. She confirmed currently and from at least Sunday on 3/30/2025, Residents #80 and #163's rooms had a very heavy foul odor. She provided verbal processes of what type of cleaners were used in resident rooms and revealed the rooms were cleaned, but understood the odor emitted from the rooms, out into the halls, and into other resident rooms. On 4/2/2025 at 1:00 p.m., during an interview with a resident group, which consisted of five interviewable residents who wished to be confidential interviews, all confirmed there were bad smells that don't go away on a couple of the floors. The residents had passed their concerns along to staff to include aides, nurses, managers; but felt nothing had been corrected. The residents felt the ongoing foul odors had been a problem for about a week. Two of the residents who were in the group meeting resided near Resident #80 and #163's room. On 4/2/2025 at 9:30 a.m. during an interview with Staff A, Assistant Director of Nursing (ADON), she confirmed she and her direct care staff to include Certified Nursing Aides (CNAs) and Nurses, had noticed the very heavy odors at and near Resident #163 and Resident #80 rooms. She revealed Resident #163 had been treated for an infection which had caused a heavy odor and staff routinely checked and changed her, and observed the catheter for proper placement and leaks. She revealed the odor was very overpowering and she believed after the resident had completed her regimen of antibiotics, the odor would dissipate. She had ensured housekeeping services went in the room for cleaning more frequently than other rooms. Staff A said Resident #80's room and hallway near his room had a very heavy body odor and she and her staff had tried to educate him on the risks of not bathing and also to ensure a homelike environment for all the other residents on the hallway. She said he refused baths and changing of his clothes and he had the right to refuse. She was working with the Director of Nursing and the Nursing Home Administrator to see what other interventions they could put in place to fix the odor situation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 5 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 0584 Review of the Physical Environment policy and procedure with an effective date August 2024 showed; Level of Harm - Minimal harm or potential for actual harm A safe, clean, comfortable, and home-like environment is provided for each resident, allowing the use of personal belongings to the greatest extent possible. Sufficient space and equipment in dining, health services, recreation, and program areas are provided to enable staff to provide residents with needed services. All essential mechanical, electrical, and resident care equipment is maintained in a safe operating condition through the facility's Preventative Maintenance Program. Residents Affected - Some The procedure section of this policy included but not limited to: 2 . Maintain sufficient space and equipment in dining, health services, recreation, and program areas. 4 . Assure resident care equipment is clean, properly stored, and identified. Review of the Housekeeping policy and procedure with an effective date April 2017 showed; The facility will monitor each facility's housekeeping program for operational efficiency, quality, effectiveness and budget control. Provide a clean, safe, pleasant and a functional environment for residents, staff and visitors. Each facility will assign one person for each department who is responsible for the planning and coordination of consistent, effective housekeeping program. The procedure section of the policy revealed: Housekeeping to include: 1. Cleaning schedule and procedures, 2. Product usage, 3. Daily job assignments, 4. Room condition check list, 5. Frequency schedules FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 6 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure care plan interventions were implemented related to call light placement when residents were in bed for three (#163, #80, and #113) of thirty-four sampled residents. Finding included: 1. During observations on 3/30/2025 at 9:58 a.m., 3/31/2025 at 11:20 a.m., 12:25 p.m., 1:11 p.m., and on 4/1/2025 at 7:40 a.m., Resident #163 was seen in her room lying flat in bed and on top of the covers. She was noted looking up and at the wall with no affect. Resident #163 had cognitive impairment and was not able to answer questions related to her day, medical care and services. During each observed time, Resident #163 was found with the call light cord and button not on her bed, and not within reach. The call light was located on the floor back behind the head of the bed, and out of her reach. Photographic evidence obtained. On 4/1/2025 at 1:25 p.m., Staff G, Certified Nursing Assistant (CNA) confirmed the call light was on the floor and out of the resident's reach while she was in bed. Staff G revealed that all staff when coming in the room were responsible for ensuring the call light was placed on the bed and within the resident's reach. She said she did not believe Resident #163 had any behaviors of throwing or placing the call light button on the floor. Staff G was not aware the call light was on the floor and had been there for several days in the same position. Review of Resident #163's medical record revealed she was admitted to the facility on [DATE] and readmitted from the hospital on 3/4/2025. Review of the diagnosis sheet revealed diagnoses to include but not limited to: Dementia, Adult Failure to Thrive, Anxiety, and Mood disorder. Review of the current Minimum Data Set (MDS) assessment, dated 3/6/2025 revealed; Cognition/Brief Interview Mental Status or BIMS score: not scored. The section revealed the resident had both a long term and short term memory problem and with severely impaired decision making skills; Activities of Daily Living (ADL) - Dependent on staff for all Activities of Daily Living. Review of the current care plans with a next review date of 4/17/2025 showed a. Fall - The resident is at risk for falls or fall related injury because of: Gait/balance problems, Psychoactive drug use, with interventions in place to include but not limited to: Provide environmental adaptations: CALL LIGHT WITHIN REACH. 2. During tours on 3/30/2025 at 11:12 a.m., 1:00 p.m., 3/31/2025 at 8:20 a.m., and on 4/1/2025 at 9:50 a.m., Resident #80 was observed in his room and seated upright in bed, under the bed linen, and without a call light placed within his reach. When he was asked if he used the call light and if he knew where it was, he replied, I do use it to call for staff, and I don't' know where it is at. He said at times, the staff did not place it on his bed. His call light was observed on the floor, back and behind the head of the bed, and well out of his reach. Resident #80 said he could not reach it and there were times when he believed staff put it on the floor. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 7 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #80's medical record revealed he was admitted at the facility on 2/4/2020 and readmitted from the hospital on 6/15/2022. Review of the diagnosis sheet revealed diagnoses to include but not limited to: Dementia, Mood disorder, and Major Depression. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] showed; Cognition/Brief Interview Mental Stats or BIMS score - 9 of 15, which indicated moderate cognitive impairment. Review of the care plans with a next review date of 4/25/2025 showed a. Falls - The resident is at Risk for falls or fall related injury because of: Deconditioning, Gait/Balance problems, Psychoactive drug use, with interventions in place to include but not limited to: Provide environmental adaptations: CALL LIGHT WITHIN REACH. On 4/1/2025 at 3:30 p.m. interviews with Staff T, Licensed Practical Nurse (LPN) , and Staff U, Registered Nurse (RN) both revealed all residents had the right to have their call light buttons placed within their reach when they were in bed and when they were in chairs near their bed. Staff T and U confirmed that all direct care staff should be monitoring frequently throughout the shift to ensure the call lights were within reach of the resident and if they found them out from reach, they were to reposition them. Staff U, as a floor supervisor, revealed he would make rounds throughout the shift as well to ensure the residents were properly positioned and with the call light placed within their reach. Staff T and Staff U confirmed they, as well as all staff in the building, had received and continued to receive inservicing/education related to the use and placement of call light cords/buttons. On 4/2/2025 at 9:30 a.m., an interview with the Assistant Director of Nursing revealed all staff were trained and inserviced on placing call lights within the resident's reach when the residents were in their room and in bed or in a chair. She confirmed it did not matter if the resident regularly used the call light or not, all residents had the right and were to have the call light button placed within their reach at all times. She was not aware the call light button was not placed within reach for Residents #163 and #80. 3. On 03/30/25 at 9:45 a.m. Resident #113 was observed laying in bed with his call light out of reach. Resident #113 stated he had a hard time getting his call light and it was always out of reach. Review of Resident #113 admission Record revealed Resident #113 was admitted to the facility on [DATE] with diagnoses to include hemiplegia and need for assistance with personal care. Review of Resident #113 quarterly Minimum Data Set (MDS) dated [DATE] revealed in Section C, a Brief Interview for Mental Status (BIMS) score of 14 which indicated intact cognition. Review of Resident #113's active care plan revised on 01/03/2025, showed a focus area of ADL [Activities of daily living]:The resident has an ADL self care performance deficit weakness, impaired balance, recent hospitalizations and decline in function. Further review showed an Intervention of Call bell within reach while in room . A policy on Care Plans was requested; however, the facility was unable to provide. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 8 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews and interviews, the facility failed to provide treatment and care in accordance with professional standards of practice related to physician orders for pain parameters and administration of pain medications for one (Resident #147), and nebulizer treatments for one (Resident #132) of 34 residents reviewed for physician orders. Residents Affected - Few Findings included: 1. On 3/30/25 at 9:52 a.m. during an interview and observation, Resident #132 said at the end of his of a breathing treatment he removed the nebulizer mask because staff took a long time to return. In the top drawer of Resident #132's bedside table were three plastic unopen ampules. Resident #132 said the ampules contained medication for his breathing treatment. Resident #132 twisted the cap off of one ampule and poured the clear liquid contents in the top opening of the connection between the mask and the medicine cup part of the nebulizer mask. Review of Resident #132's Minimum Data Set (MDS), dated [DATE], section c, showed the resident was independent with making decisions regarding tasks of daily living. Review of Resident #132's care plan showed a care plan focus for: the resident had oxygen therapy related to shortness of breath. Review of Resident #132's Medication Administration Record, dated March 2025 showed an order dated 3/18/25 for Ipratropium-Albuterol Solution, inhale 3 ml orally by nebulizer every six hours for cough for 7 days. Pre Evaluation: Describe Lung Sounds (CL-clear, D-diminished, R-rales, RH-rhonchi, W-wheezing). On 3/30/25 the documentation showed the administration of the medication did not occur. Resident #132's lung sounds are not documented. 3/25/25 was the last date administration of Ipratropium-Albuterol Solution was documented. During an interview on 4/1/25 at 9:50 a.m. Staff B, Registered Nurse (RN), Unit Manager (UM) said she needed to check the Resident #132's medical record to verify medication orders. She said Resident #132 needed Ipratropium-Albuterol Solution and she had changed the resident's oxygen supplies on 3/31/25. During an interview and record review on 4/1/25 at 5:15 p.m. with the Director of Nursing (DON), she was unable to find a current order for Resident #132 to receive Ipratropium-Albuterol Solution. The DON said her expectation was for residents to have a current order for each medication they received. Review of the facility's Medication Administration general guidelines, section 7.1 dated 09/18 showed the following: Policy- Medications are administered as prescribed in accordance with manufacturers' specifications, good nursing principles and practices .Procedures: Medication Administration 1. Medications are administered in accordance with [the] written orders of the prescriber. 2. During an observation on 03/3/2025 at 10:17 a.m., Resident #147 was observed lying in bed dressed in a hospital gown sleeping. Review of Resident #147's admission record revealed an admission date of 07/09/2024. Resident #147 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 9 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was admitted to the facility with diagnosis to include Muscle Wasting and Atrophy, Not Elsewhere Classified, Multiple Sites, Dysphagia, Oropharyngeal Phase, Other Neuromuscular Dysfunction Of Bladder, Acute Embolism And Thrombosis Of Unspecified Deep Veins Of Lower Extremity, Bilateral. Review of Resident #147's quarterly Minimum Data Set (MDS) dated [DATE] revealed, Section C. Cognitive Patterns, Brief Interview Mental Status (BIMS) 11 out of 15 which indicated Moderate cognitive impairment. Section N. Medications Antidepressant, Anticoagulant, Diuretic, and Opioid. Review of Resident #147's Orders revealed: 03/20/2025 Tramadol HCl Oral Tablet 50 MG (Tramadol HCl) *Controlled Drug* Give 50 mg by mouth every 6 hours as needed for Moderate to Severe Pain level 5 to 10 Review of Resident #147's Treatment Administration Record (TAR) for January, February and March 2025 revealed: Tramadol HCl Oral Tablet 50 MG (Tramadol HCl) .Severe Pain level 5 to 10 Pain level was recorded at 2 and medication was dispensed on 01/04/2025, 01/06/2025, 01/16/2025, 01/31/2025, 02/27/2025, 03/07/2025, 03/09/2025, and 03/12/2025. During an interview on 04/02/2025 at 12:44 p.m., Staff I, Licensed Practical Nurse (LPN) stated Resident #147 was prescribed Tramadol as needed for his neck and back pain. If his pain level was at a 1 or 2 she would give him Tylenol first. If that did not help, she would then give him Tramadol. During an interview on 04/02/2025 at 1:53 p.m., the Director of Nursing stated her expectation was for Nurses to follow physician orders. She stated she would not expect Pain medication to be given outside of the parameters on the order. There was no policy related to the concerns in this citation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 10 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to provide suctioning for one (Resident #70) with a Tracheostomy out of 34 residents sampled. Residents Affected - Few Findings Included: During an observation on 03/30/2025 at 10:12 a.m., Resident #70 was observed sitting in bed dressed in a hospital gown and was observed to have a Tracheostomy with no suction. During an observation on 03/30/2025 at 12:15 p.m., the Risk Manager was observed bring a Suctioning machine onto the 3rd floor and putting into resident #70's room. During an observation on 03/30/2025 at 12:26 p.m., a suctioning machine was observed on the dresser in Resident #70's room. Review of Resident #70's admission record revealed a re-admission date of 03/29/2025 and initial admission date of 11/25/2024. Resident #70 was admitted to the facility with diagnosis including Pneumonitis Due to Inhalation Of Food And Vomit, Chronic Respiratory Failure, Unspecified Whether With Hypoxia Or Hypercapnia, Encounter For Attention To Tracheostomy, Chronic Obstructive Pulmonary Disease, And Other Nonspecific Abnormal Finding Of Lung Field. Review of Resident #70's quarterly Minimum Data Set (MDS) dated [DATE] revealed, Section C. Cognitive Patterns, Brief Interview Mental Status (BIMS) of 14 out of 15 which indicated intact cognition. Review of section O. Special Treatments, Procedures and Programs, revealed Oxygen therapy, Suctioning, and Tracheostomy care. Review of Resident #70's Orders revealed: 03/29/2025 Trach: Suction Trach Post Record Amount of Secretions Characteristics of secretions: (Color, Odor, Viscosity) Lung Sounds, HR, Respirations and Tolerance as needed for Suction 03/29/2025 Maintain suction set up at bedside every shift and as needed. Review of Resident #70's Treatment Administration Record (TAR) for March 29th, 30th and April 2025 revealed: Trach: Suction Trach Post Record Amount of Secretions Characteristics of secretions: (Color, Odor, Viscosity) Lung Sounds, HR, Respirations and Tolerance as needed for Suction was blank. During an interview on 04/01/2025 at 5:49 p.m., Staff M, Registered Nurse (RN), stated Resident #70 secretions were white and sticky. She stated he had to be suctioned twice during her day shift on 04/01/2025. During an interview on 04/02/2025 at 10:58 a.m., the Risk Manager stated she brought up a suctioning machine to the 3rd flood on Sunday or Monday but could not remember if it was for Resident #70. She stated she did not normally work on the weekends and did not normally get equipment needed for newly admitted residents. The admitting nurse was responsible for getting all the supplies for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 11 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few residents when they were admitted to the building. She stated they would only have the supplies ready for a resident who they knew were coming back to the facility and they did not know Resident #70 was coming back to the facility on [DATE]. During an interview on 04/02/2025 at 11:15 a.m., the Director of Nursing (DON) stated the machine had to be ordered because the one they had for Resident #70 had a broken knob. She stated they were not aware that Resident #70 was coming back on 03/29/2025 so they could not have ordered the supplies ahead of time. When the resident arrived, the nurse called the weekend supervisor and notified her the resident needed the suctioning machine. She reviewed the TAR for Resident #70 and stated the nurses should be documenting his secretions on the TAR. Review of the facilities undated policy titled Tracheal Bronchial Suctioning revealed: Purpose: Tracheal Bronchial suctioning is an effective way to maintain a clear airway and to aid in the removal of secretions for patients who are unable to clear their secretions when coughing. Procedure . 4. Gather the necessary equipment A. suction machine: I. Suction canister ii. Suction tubing Documentation:7. Color, consistency and amount of secretions. 8. Signature and credentials of personnel performing procedure. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 12 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility did not ensure 1) availability of personal protective equipment (PPE) for four out of five bins on hallway 4 Long, 2) proper storage of respiratory equipment for one (Resident #132) of two residents, and 3) proper Contact Precautions were followed for one (Resident #155) of two residents on transmission-based precautions. Residents Affected - Few Findings included: 1. On 3/30/2025 at 9:01 a.m., an observation was made of the 4 Long hallways of four out of five PPE bins missing gowns and/or gloves. Bin Five was located at the end of 4 Long hallways close to 4 Short hallway and had two gowns observed in the bottom drawer. On 3/30/2024 at 9:24 a.m., an observation was made in front of room [ROOM NUMBER] with a Contact Isolation Precaution sign on the front door with no PPE in the bin on the outside of the immediate room entrance. An unidentified Certified Nurse Assistant went down to the 4 Long hallways where bin 5 was and pulled the remainder of the two gowns there, offered one to the surveyor and placed the other gown in the bin in front of room [ROOM NUMBER]. On 3/30/2025 at 11: 45 a.m., an observation and interview was made of Staff S, Registered Nurse (RN) resupplying the PPE bins on the 4 Long hallways. Staff S stated she was the weekday Unit Manager for the fourth floor and stated she was called into work today due to the survey. Staff S stated PPE supplies were located on the first-floor central supply. Staff S stated anyone could obtain supplies at anytime during day or night. Staff S stated there was no excuse for the lack of supplies observed on the 4 Long hallways' PPE bins. 2. On 3/30/25 at 9:52 a.m., during an interview and observation with Resident #132 his nebulizer treatment mask was lying uncovered on top of his bedside table. Resident #132 said he placed the nebulizer on top of his bedside table after the breathing treatment was completed, because it took a long time for staff to return. During an interview on 4/1/25 at 9:50 a.m., Staff B, Registered Nurse (RN), Unit Manager (UM) said she changed Resident #132's oxygen supplies on 3/31/25 and placed a new plastic storage bag. Staff B, RN, UM, agreed that when the nebulizer mask was not in use Resident #132 could not reach the storage bag. Staff B, RN, UM said the facility expected oxygen supplies to be placed in the storage bags when not in use. Review of the facility policy and procedure titled Oxygen Therapy dated effective November 2023 showed: Policy: Oxygen is provided to residents based on physician's orders to supplement oxygen as needed per disease process. 5. Oxygen Devices; a. Nasal cannula, . vi. Place in a labeled bag when not in use . 3. An observation was conducted on 04/01/25 at 1:00 p.m., Resident #155's room door had a sign posted above the room number to the right of the door entrance. The sign was laminated and bright yellow which showed: STOP CONTACT PRECAUTIONS EVERYONE MUST: Clean their hands, including before entering and when leaving the room. PROVIDERS AND STAFF MUST ALSO: Put on gloves before room entry. Discard gloves before room exit. Put on gown before room entry. Discard gown before room exit. Do not wear the same gown and gloves for the care of the care of more than one person. Use dedicated or disposable (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 13 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 equipment. Clean and disinfect reusable equipment before use on another person. Level of Harm - Minimal harm or potential for actual harm On 04/01/25 at 1:03 p.m., Staff P, Certified Nursing Assistant (CNA), was observed carrying a lunch tray and entered Resident #155's room. Staff P, CNA did not put on any Personal Protective Equipment (PPE). Residents Affected - Few On 04/01/25 at 1:05 p.m., Staff P, CNA, was observed sitting in a chair with no PPE on while in the room of Resident #155, assisting the roommate with lunch. During an interview on 04/01/25 at 1:11 p.m., Staff O, Registered Nurse (RN) stated Resident #155 had a wound infection, currently being treated and requiring contact precautions. Staff O, RN stated for anyone who entered the room of Resident #155 a gown and gloves should be worn. Staff O, RN stated the signage on the door indicated to the staff what PPE and isolation precautions were to be followed. During an interview on 04/01/25 at 1:13 p.m., Staff P, CNA stated the signs on the door tell them what isolation precautions should be followed. Staff P, CNA confirmed the contact isolation sign on the outside of Resident #155's door. Staff P, CNA confirmed not wearing any PPE while in the room, due to not assisting Resident #155. Staff P, CNA stated they only needed to wear PPE when providing care for Resident #155, not entering the room. During an interview on 04/01/25 at 1:23 p.m., Staff Q, CNA stated they only needed to wear PPE when providing direct care to the resident, not upon entering the room. During an interview on 04/01/25 at 1:33 p.m., Staff R, CNA stated they only needed to wear PPE when providing direct care, not upon entering the room. During an interview on 04/02/25 at 11:46 a.m. with the Director of Nursing (DON) and Staff S, RN they stated the staff knew who was on isolation based on the signage outside of the door. The DON stated contact isolation required gown and gloves upon entering the room, regardless if care was being provided or not. Review of Resident #155's admission record revealed an admission date date of 08/21/24 and a readmission date of 10/30/24 with diagnoses of Extended Spectrum Beta Lactamase (ESBL), pressure ulcer, Focal Traumatic Brain injury, and numerous other comorbidities. A review of Resident #155's physician orders reveals an order dated 02/19/25 for Contact Precautions ESBL on wound. A review of Resident #155's care plan revealed a Focus dated 2/18/25 INFECTION: the resident has an infection - ESBL. Reveals: Intervention/Tasks: dated 2/18/25 TYPE OF ISOLATION REQUIRED: Contact Precautions. Review of the facility policy and procedure titled Isolation Precautions - Categories of Transmission - Based Infections dated effective October 2021 showed: Policy: Standard Precautions shall be used when caring for residents regardless of their suspected or confirmed infection status. Transmission-Based Precautions shall be used when caring for residents who are documented or suspected to have communicable diseases or infections that can be transmitted to others. Contact Precautions: In addition to Standard Precautions, implement Contact Precautions for residents known or suspected to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 14 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete infected or colonized with microorganisms that can be transmitted by direct contact with the resident or indirect contact with environmental surfaces or resident-care items in the resident's environment. a. Examples of infections requiring Contact Precautions include, but are not limited to: (1) Gastrointestinal, respiratory, skin, or wound infections or colonization with multi-drug resistant organisms (e.g., MRSA, VISA, VRSA, VRE); . c. Gloves and Handwashing (1) While caring for a resident, change gloves after having contact with infective material (for example, fecal material and wound drainage). (2) Remove gloves leaving the room and wash hands with an antimicrobial agent or a waterless antiseptic agent. (3) After removing gloves and washing hands, do not touch potentially contaminated environmental surfaces or items in the resident's room. d. Gown (1) In addition to wearing a gown as outlined under Standard Precautions, wear a gown (clean, non-sterile) for interactions that may involve contact with the resident or potentially contaminated items in the resident's environment. Remove the gown and perform hand hygiene before leaving the environment. (2) After removing gown, do not allow clothing to contact potentially contaminated surfaces. g. Signs - A sign will be used to alert staff and visitors of the implementation of transmission based. Precautions while respecting the resident's privacy. The sign will be placed on the Resident's door & should state Report to Nurse Before Entering Room - The Nurse will educate individuals on the precautions implemented. Event ID: Facility ID: 105234 If continuation sheet Page 15 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure 1. Call light cords and buttons were placed within reach while residents were in bed in five of ninety-six resident rooms, on two of three floors, (Rooms 214a, 216p, 234a, 302a 310a, and 310b, ; and 2. Did not ensure bathroom call light cords were free hanging and not tied to hand rails for resident bathrooms 220, 226, 228, 234, and 310, during three of four days observed (3/30/25, 3/31/25, 4/1/25). Residents Affected - Some Findings included: During various tour observations on 3/30/2025 at 10:00 a.m., 1:30 p.m., 3:00 p.m.; 3/31/2025 at 9:30 a.m., 2:00 p.m.; and on 4/1/2025 at 10:30 a.m. the following was observed: 1. Resident room [ROOM NUMBER]a was observed with the resident lying in bed and with the call light button and cord out from reach, lying on the floor back behind the head of the bed. 2. Resident room [ROOM NUMBER]p was observed with the resident lying in bed and with the call light button and cord out from reach, lying on the floor back behind the head of the bed. 3. Resident room [ROOM NUMBER]a was observed with the resident lying in bed and with the call light button and cord out from reach, lying on the floor back behind the head of the bed. 4. Resident room [ROOM NUMBER]a was observed with the resident lying in bed and with the call light button and cord out from reach, lying on the floor back behind the head of the bed. 5. Resident room [ROOM NUMBER]a was observed with the resident lying in bed and with the call light button and cord out from reach, lying on the floor back behind the head of the bed. 6. Resident room [ROOM NUMBER]b was observed with the resident lying in bed and with the call light button and cord out from reach, lying on the floor back behind the head of the bed. The resident room bathroom call lights in resident rooms 220, 226, 228, 234, 310 were observed wrapped several times or were tied to the metal wall hand rail. The call system could not be activated when pulling down on the cord. Photographic evidence obtained. On 4/1/2025 at 1:25 p.m., Certified Nursing Assistant (CNA) Staff G revealed that all staff when coming in the room were responsible for ensuring the call light was placed on the bed and within the resident's reach. On 4/1/2025 at 3:30 p.m., during interviews with Staff T, Licensed Practical Nurse (LPN) , and Staff U, Registered Nurse (RN) both revealed all residents had the right to have their call light buttons placed within their reach when they were in bed and when they were in chairs near their bed. Staff T and Staff U confirmed that all direct care staff should be monitoring frequently throughout the shift to ensure the call lights were within reach of the resident and if they found them out of reach, they were to reposition them. Staff U, as a floor supervisor, revealed he would make rounds throughout the shift as well to ensure the residents were properly positioned and with the call light placed within their reach. Staff T and Staff U confirmed they, as well as all staff in the building, had received and continued to receive inservicing/education related to the use and placement of call (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 16 of 17 Printed: 05/28/2026 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 105234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation and Healthcare Center of Tampa 4411 N Habana Ave Tampa, FL 33614 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 0919 light cords/buttons. Level of Harm - Minimal harm or potential for actual harm On 4/2/2025 at 9:30 a.m., an interview with the Assistant Director of Nursing revealed all staff were trained and inserviced on placing call lights within the resident's reach when the residents were in their room and in bed or in a chair. She confirmed it did not matter if the resident regularly used the call light or not, all residents had the right and were to have the call light button placed within their reach at all times. Residents Affected - Some On 4/2/2025 at 11:00 a.m., an interview with the Nursing Home Administrator revealed the facility did not have a Call Light policy and procedure for review. He confirmed all residents should have call lights placed within their reach. Staff were to ensure the call lights were within the resident's reach each time they go in the room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105234 If continuation sheet Page 17 of 17