Health inspection·February 16, 2023

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 2/14/23 at 11:49 AM the Director of Nursing stated, If patients need more or less oxygen a doctor should be called, and orders changed. My expectation of my staff is to follow the doctors' orders. Review of the policy titled Oxygen Administration last review 1/19/23, read Standard. Oxygen should be administered under orders of the attending physician, except in the case of an emergency. In an emergency, oxygen may be administered without physician's orders, however, the order should be obtained immediately after the crisis is under control. Process. 1. Obtain physician's orders for the rate of flow and route of administration of oxygen (i.e. by tank, concentrator, nasal cannula, mask, etc.) 5. Attach the oxygen delivery device ordered by the physician to the oxygen unit (mask, cannula). 8 Check oxygen flowmeter for correct liter flow. 2. ) During an observation on 2/12/23 at 10:25 AM Resident #9, was lying in bed resting calmly with eyes closed, oxygen being administer at 2.5 liters per minute via nasal cannula with humidifier. During an observation on 2/13/23 at 8:28 AM Resident #9, was eating breakfast in her room, oxygen being administer at 2.5 liters per minute via nasal cannula with humidifier. During an observation on 2/13/23 at 11:20 AM Resident #9, was lying in bed resting calmly with eyes closed, oxygen being administer at 2.5 liters per minute via nasal cannula with humidifier. Review of the face sheet for Resident #9 documented the resident was admitted on [DATE] with diagnosis that included shortness of breath, obstructive pulmonary disease, and dependence on supplemental oxygen. Review of the physician order dated 12/14/22 reads, O2 (Oxygen) On 2LT /Min [2 liters per minute] Via NC [nasal cannula] with Humidifier DX [diagnosis]: SOB [shortness of breath] During an interview on 2/13/23 at 11:47 AM Staff C, RN/Unit Manager, confirmed Resident #9's oxygen was running at 2.5 Liters and Resident #9 has orders for oxygen at 2 Liters with humidifier. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105321 If continuation sheet Page 2 of 7 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 105321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ocala Health and Rehabilitation Center 1201 SE 24th Rd Ocala, FL 34471 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 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, interview, and record review the facility failed to post daily nurse staffing information on 1 of 5 days of the survey. Residents Affected - Many Findings include: An observation was made of the posted daily nurse staffing information on Sunday, 2/12/23, at 9:00 AM at the time of the entrance into the facility. The posted daily nurse staffing information was dated Friday, 2/10/23 and only the day shift was completed on the form. During an interview on 2/14/23 at 1:30 PM, the Executive Director stated that the nurse staffing information is a continuous working schedule and the Staff Development Coordinator is responsible for updating the posted nurse staffing. During an interview on 2/15/23 at 11:00 AM, the Staff Development Coordinator stated it is her responsibility to maintain the daily nurse staffing posting and in her absence, there is an Registered Nurse in the facility that is responsible for the staff posting. Review of policy number NM.I-5, last reviewed 1/19/23 read Each facility shall post daily at the beginning of the shift the number of direct-care staff on duty for each shift. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105321 If continuation sheet Page 3 of 7 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 105321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ocala Health and Rehabilitation Center 1201 SE 24th Rd Ocala, FL 34471 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that drugs and biologicals used in the facility were stored and labeled in accordance with currently accepted professional principles in 4 of 6 medication carts (south hall, north back hall, north hall, east hall) and failed to ensure medications were secured (photographic evidence obtained). Findings include: 1.) During an observation of south hall medication cart on [DATE] at 9:15 AM with Staff A, Licensed Practical Nurse (LPN), there was an opened bottle of Latanoprost ophthalmic solution with no open or expiration date and one expired bottle of Dorzolamide HCI ophthalmic solution with open dates [DATE] and [DATE] noted on the same bottle. During an interview on [DATE] at 9:25M Staff A, Licensed Practical Nurse (LPN) stated that the medication should be dated when opened and forgo the expiration date in box. During an observation of the north back hallway medication cart on [DATE] at 9:27 AM with Staff B, LPN, there were five medication cups containing unlabeled medications, one opened Toujeo Solostar insulin pen with no open or expiration date, one opened Novolin insulin pen with no open or expire date, and one open bottle of Pro-stat with no open date. During an interview on [DATE] at 9:36 AM, Staff B, LPN, stated that the medication should be immediately dated and initial when opened. She confirmed medication should be stored in their original bottle. During an observation of the north hall medication cart on [DATE] at 9:38 AM with Staff C, Registered Nurse (RN), there was one expired bottle of Azopt 1% eye drops with an open date [DATE], one expired bottle of Latanoprost 0.005% ophthalmic solution with an open date of [DATE] with instructions to discard after 42 days, one expired bottle of Travoprost 0.004% eye drops with an open date of [DATE], one expired bottle of artificial tears with an opened date of [DATE] and one expired bottle of artificial tears with an open date [DATE]. During an interview on [DATE] at 9:44 AM, Staff C, RN, stated that the expired medication should be removed from the active section of the cart, and they will either go back to pharmacy or the Director of Nursing will destroy them. During an observation of the east hall medication cart on [DATE] at 9:50 AM with Staff D, LPN, there was one expired bottle of Pro-stat with an open date of [DATE], one bottle of fungi care with no original pharmacy packing and no open date, one opened bottle of Timolol with no open date, and a closed package of cookies. During an interview on [DATE] at 9:55 AM, Staff D, LPN, stated that the medication should be dated when opened and the bottle of fungi care should not be in the cart because the treatment was discontinued. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105321 If continuation sheet Page 4 of 7 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 105321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ocala Health and Rehabilitation Center 1201 SE 24th Rd Ocala, FL 34471 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on [DATE] at 12:39 PM the Director of Nursing stated, Medication should be opened and dated. If the medication is expired, staff should reorder and check stock in house. The staff should discard expired medication. 2.) During an observation on [DATE] at 10:14 AM Resident #81 was lying in bed. A bottle of antacid tablets were on the bedside table next to the resident. During an interview on [DATE] at 10:15 AM Resident # 81 stated I don't really know how to take one. During an observation on [DATE] at 10:45 AM, Resident #52 was lying in her bed watching television. An inhaler was observed on Resident #52's bedside table next to resident. During an interview on [DATE] at 10:46 AM, Resident #52 stated I take the inhaler on my own. During an observation on [DATE] at 8:23 AM, Resident #81 was lying in bed having breakfast. A bottle of antacid tablets was observed on the resident's bedside table next to resident. During an observation on [DATE] at 9:10 AM, Resident #81 was lying in bed. A bottle of antacid tablets was observed on the resident's bedside table next to resident. During an interview on [DATE] at 9:14 AM, the Director of Nursing stated, medications should be kept in medication cart. Review of the policy titled Storage and Expiration Dating of Medications, Biologicals last reviewed on [DATE] read Procedure. 4. Facility should ensure that medications and biologicals that: (1) have an expired date on the label; (2) have been retained longer than recommended by manufacturer or supplier guidelines; or (3) have been contaminated or deteriorated, are stored separate from other medications until destroyed or return to the pharmacy or supplier. 5. Once any medication or biological package is opened, Facility should follow manufacturer/supplier guidelines with respect to expiration dates for open medication. Facility staff should record the date opened on the primary medication container (vial, bottle, inhaler) when the medication has a shortened expiration date once opened or opened. 5.4 When an ophthalmic solution or suspension has a manufacturers shortened beyond use date once opened, facility staff should record the date opened and the date to expire on the container. 9. Facility should ensure that the medications and biologicals for each resident are stored in the containers in which they were originally received. 13. Bedside Medication Storage. 13.2. Facility should store bedside medications or biologicals in a locked compartment within the resident's room. 16. Facility should destroy or return all discontinued, outdated/expired, or deteriorated medications or biologicals in accordance with Pharmacy return/destruction guidelines and other Applicable Law, and in accordance with Policy 8.2 (Disposal/Destruction of Expired or Discontinued Medication.) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105321 If continuation sheet Page 5 of 7 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 105321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ocala Health and Rehabilitation Center 1201 SE 24th Rd Ocala, FL 34471 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure all foods were stored, covered, labeled, and discarded in accordance with professional standards for food service safety in the main kitchen and 2 of 3 nourishment rooms and failed to ensure sanitary standards were maintained in the walk-in cooler, walk-in freezer, and the stock/storage room. Findings include: During an initial tour of the kitchen on 2/12/23 at 09:10 AM with the Certified Dietary Manager (CDM) and the Administrator, the walk-in cooler had a large container labeled Pureed Meat dated 7/23, three unlabeled clear containers of food, one half gallon container of milk with approximately 16 ounces remaining that did not have an opened date on the container. The walk-in freezer had several opened boxes that exposed the food to the elements and the potential for freezer burn, a large buildup of ice under the sprinkler head on the left wall, two breadsticks and a piece of raw fish on the floor, and multiple pieces of trash and debris on the floor under the food racks. The reach-in cooler had one thickened sweetened tea with lemon and one thickened flavored water with no opened date. During an interview on 2/12/23 at 9:30 AM, the CDM confirmed that pureed foods should be discarded after each meal and not saved as a leftover per policy, all boxes in the freezer should be closed to protect the integrity of the food products, the walk-in freezer should not have food product and debris left on the floor and under the food racks and all products should be labeled and dated for storage, or an open date placed on bulk products that had been opened for use in the kitchen and in the nourishment rooms. During a tour of the kitchen on 2/13/23 at 9:20 AM with the Administrator, there were 36 clean fruit dishes and 124 clean dessert plates stored on an open cart that were not inverted or covered, four hood lights that were not working, a flat of 20 raw shell eggs left on the grill top, the clean robot coupe blender with water around the blade and bottom of the bowl, and the test strips for the 3-compartment sink with an expiration date of 2019. No other test strips were available. During an interview on 2/13/23 at approximately 9:45 AM, the CDM confirmed that raw shell eggs should have been stored in an ice bath when pulled from the cooler and returned to the cooler immediately after meal service, the expiration date on the test strips was 2019 and that expired strips may not be reliable for accurate readings for the sanitization of pots and pans. The CDM acknowledged that clean dishes should be either inverted or the top dish covered completely, verified that 4 lights were not working under the stove hood and that the robot coupe blender should be left to completely air dry after being washed, rinsed, and sanitized and not placed back on the base creating a potential wet nesting or allowing potential microorganisms to grow. During a tour of three nourishment rooms with the Administrator on 2/14/23 at 11:30 AM, the east nourishment room had an opened undated container of thickened cranberry cocktail, and the south nourishment room had an opened undated and unlabeled container of Red Bull drink, Pepsi soda, and a bottle of juice stored in the refrigerator. During an interview on 2/14/23 at 11:30 AM, the Administrator confirmed that 2 of 3 nourishment room refrigerators had opened products that did not have an opened date or labeled with a name. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105321 If continuation sheet Page 6 of 7 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 105321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ocala Health and Rehabilitation Center 1201 SE 24th Rd Ocala, FL 34471 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Review of the policy titled Leftover Food Storage and Use last reviewed 1/19/23, read, Purpose. To assure that food borne illnesses are avoided. Process. b. Leftover foods should be covered, labeled and dated. c. Refrigerated leftover food should be used within 72 hours (three days). If not used within 72 hours, refrigerated foods should be discarded. h. Pureed foods should not be re-used. Review of the policy titled Food Receipt and Storage last reviewed 1/19/23, read, k. Open food items should be covered, labeled, and dated; opened dry goods should be kept in tightly sealed containers. p. If food items with expiration dates are removed from the original containers, the expiration date should be transferred to the food item and identified as the expiration date. Review of the policy titled Three Compartment Sink Sanitization last reviewed 1/19/23, read, Process. The final rinse should be monitored for the proper temperature, if hot water sanitization is used, and for proper chemical concentration if chemical sanitization is used. Review of the policy titled Cleaning of Miscellaneous Equipment and Utensils last reviewed 1/19/23, read, 16. Food Processor: (after each use) Air dry on clean surface or use clean paper towels or cloth to dry. 18. Freezer: b. Walk-In Type (weekly). Mop floor, Shelves should be pulled out and washed as needed. 35. Refrigerator: (weekly) a. Reach In Type. 3. Check with the supervisor and sort and throw away food not usable or past the storage period. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105321 If continuation sheet Page 7 of 7