Health inspection·February 17, 2024

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. 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 of 1 resident was assessed to be clinically appropriate to self-administer medication of a total sample of 45 residents, (#18). Residents Affected - Some Findings: Resident #18, a [AGE] year-old female was admitted to the facility on [DATE], with diagnoses that included mechanical complication of internal fixation device of left femur, asthma, atrial fibrillation, and major depressive disorder. The resident's admission Minimum Data Set (MDS) assessment with Assessment Reference Date of 1/10/24, revealed the resident's cognition was intact, with a Brief Interview of Mental Status (BIMS) score of 13 out of 15. On 2/12/24 at 11:48 AM, resident #18 was lying in bed, awake, alert, and oriented. Observation showed a handheld inhaler of Albuterol on the resident's tray table. She stated she administered it herself approximately every eight hours. On 2/12/24 at 4:45 PM, resident #18 was sitting up in her bed, working on a cross word puzzle. The Albuterol inhaler was in her bag, which she took out and showed to the surveyor. The resident stated the Albuterol was prescribed by her Primary Care Physician (PCP) and said the facility was aware she had the Albuterol, because she told them about it when she was admitted to the facility. On 2/12/24 at 4:47 PM, observation of the Albuterol inhaler at the resident's bedside was conducted with Licensed Practical Nurse (LPN) A. The resident shared with the LPN, that she used the inhaler approximately every eight hours. Resident #18 said when she had a cold, she had a terrible time and used the Albuterol inhaler more often. Review of the resident's physician orders with the LPN revealed no physician order for the Albuterol inhaler, and no order for self-administration of medication for resident #18. A self-administration evaluation was also not identified. On 2/12/24 at 4:51 PM, the Director of Nursing (DON) said if a resident was to self-administer medications, an assessment for self-administration of medication had to be completed, a physician order for self-administration obtained, and a lock box provided for the resident to store the medication safely at bedside. However, observation, interview, and record review revealed that this was not done for resident #18. The facility's policy Resident Self-Administration of Medication implemented on 11/2020, read, A resident may only self-administer medications after the facility's interdisciplinary team has determined which medications may be self-administered safely The results of the interdisciplinary team assessment are recorded on the Self-Administration of Medication Evaluation, which is located in the resident's medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 2 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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. Based on observation, and interview, the facility failed to provide a homelike environment for all residents who ate their meals in the main dining room, by serving the resident's meals on serving trays at the table in an institutional manner. Findings: On 2/13/24 at 12:30 PM, during meal observation in the main dining room,13 residents were observed seated at the tables in the dining room. Each resident was noted to have a serving tray on the table in front of them which contained the lunch meal. The plates, cups, bowls and eating ware remained on the tray and were not removed from the trays at the table. On 2/13/24 at 4:46 PM, during meal observation, 12 residents were observed seated in the main dining room. Each resident had a serving tray in front of them with their meal, dinnerware and eating utensils on the tray. On 2/13/24 at 4:50 PM, Certified Nursing Assistant (CNA) P was in the dining room. She acknowledged she was the only staff person in the dining room and had served meals to all 12 residents. CNA P stated the meals were always served on trays in the dining room. On 2/13/24 at 4:56 PM, the Administrator, Director of Nursing (DON) and Regional Nurse Consultant observed the meal trays in front of residents in the dining room. The Administrator and DON acknowledged the dining room should be a home-like environment and resident meals should be removed from meal trays. On 2/16/24 at 10:23 AM, the Administrator explained it was his expectation that staff provide a home-like environment for residents eating in the main dining room. The Administrator explained he was not aware staff were leaving meals on serving trays. The facility's policy and procedure for Safe and Homelike Environment revised 4/11/23 listed under General Considerations, Eliminate the use of meal trays during dining service, unless otherwise requested by the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 3 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and interview, the facility neglected to provide appropriate care and services to prevent a fall with major injury for a vulnerable and physically impaired resident, during a transfer with a mechanical lift and failed to complete a thorough investigation after a fall with major injury for 1 of 6 residents sampled for falls, (#197). On 2/08/24 at approximately 6:00 PM, the facility failed to prevent a fall with major injury during a transfer with a mechanical lift. The facility failed to utilize the appropriate type of mechanical lift and failed to follow policy requiring two staff for mechanical lift transfers. While Certified Nursing Assistant (CNA) G transferred resident #197 by herself from chair to bed using the wrong mechanical lift, the resident became unstable and was manually lowered to the floor. The resident complained of pain and x-rays done at the facility identified a fractured left clavicle, (A clavicle fracture-collarbone, is diagnosed through physical examination and x-rays. Symptoms of a broken collarbone include severe pain and swelling at the site of the fracture with visible deformity in some cases. Because of the critical location of the clavicle, any severe force on the shoulder such as falling directly on the shoulder or falling on an outstretched arm transfers force to the clavicle . retrieved from www. hopkinsmedicine.org on 2/20/24). She was transferred to the hospital on 2/09/24 for further scans and returned the same day with confirmed fractured left clavicle. The facility's failure to provide safe and appropriate care when using mechanical lifts placed all 41 residents who required a mechanical lift for transfers at risk for serious injury/impairment/death and resulted in Immediate Jeopardy starting on 2/08/24. The facility's Administrator, Director of Nursing (DON), and Corporate Clinical Nurse were notified of the Immediate Jeopardy on 2/15/24 at 3:17 PM and provided the IJ templates. The Immediate Jeopardy was determined to be removed on 2/16/24 after verification of the immediate actions implemented by the facility. The scope and severity of the deficiencies was decreased to a D, no actual harm, with potential for more than minimal harm, that is not Immediate Jeopardy Findings: Cross reference to F689 Resident #197, a [AGE] year-old female, was admitted to the facility on [DATE]. Her diagnoses included congestive heart failure, asthma, atrial fibrillation, chronic obstructive pulmonary disease, diabetes, obstructive sleep apnea, obesity, and muscle weakness. On 2/09/24, unspecified left clavicle fracture was added to her diagnosis. The resident's admission Minimum Data Set (MDS) assessment with Assessment Reference Date 2/05/24 revealed the resident's cognition was intact, with a Brief Interview for Mental Status score of 15 out of 15. The assessment noted resident #197 had adequate hearing, clear speech, understood, was understood, and had adequate vision. The assessment indicated the resident was independent for eating, oral hygiene, and personal hygiene, but required partial/moderate assistance for showers and upper body dressing, substantial/maximal assistance with rolling left to right, sit to lying, lying to sitting on the side of the bed, sit to stand, chair to bed/bed to chair, and dependent for toileting (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 4 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few hygiene, and lower body dressing. The assessment also revealed the resident had no impairment to upper or lower extremity range of motion and used a wheelchair for mobility. The assessment indicated resident #197 had no behaviors toward herself or others. On 2/12/24 at 5:17 PM, resident #197 spoke about the incident that occurred on 2/8/24 at 6:00 PM. She stated Certified Nursing Assistant (CNA) G was putting her back to bed from her wheelchair using the sit to stand mechanical lift. The resident said CNA G was attempting the transfer alone and she told the CNA she needed two staff to transfer with the lift. The resident recalled CNA G told her, Don't tell me how to do my job. The resident explained she knew it had to be two staff to use the lift because the physical therapist had instructed another CNA on day shift with the sit to stand mechanical lift and told her it always had to be two staff. That is why I told the CNA it should be 2 people. Resident #197 continued, When I was in the lift, I told the CNA something did not feel right but she walked around to the side of the lift and the next thing I remember, I was on the floor looking up at my nurse. She stated she had pain in her left shoulder now and explained she had to stay in the facility longer as she was not able to do therapy because of the fracture. On 2/13/23 at 10:47 AM, in a telephone interview, Registered Nurse (RN) E stated CNA G was with resident #197 when she called out to him for help. He said when he went in the room, the resident was in the sit to stand mechanical lift sliding down and falling towards the floor. He recalled he tried to help CNA G but resident #197 was too heavy for two staff to lift. He said he called CNA F to come to the room to assist. RN E said the three of them managed to put her on the floor . He stated after the resident was on the floor, CNA F and G went to get the full body mechanical lift and the two CNA's transferred the resident back to her bed. RN E reiterated CNA G was in the room transferring the resident by herself when she called out to him for help. Review of nursing progress note dated 2/09/24 at 12:02 AM, by RN E read, At the time of the incident CNA would call me for help since she was using the stand lift, and the resident was in an unstable position and was kneeling towards the floor. I never crash to the ground. We had to put her on the floor for her safety. We lift her in the 'full body mechanical' lift and transfer her to the bed. On 2/13/24 at 11:13 AM, in a telephone interview, CNA G stated when she went in resident #197's room she was seated in her wheelchair. In conflict with resident #197's and RN E's statements, CNA G stated she and CNA F used the sit to stand mechanical lift to put resident #197 back to bed. CNA G then described resident #197 moved her hands from the hand bar so she called the nurse for assistance. CNA G stated the three staff (herself, RN E and CNA F) took resident #197 off the sit to stand mechanical lift and put her on the floor. CNA G added that she went to get the full body mechanical lift after the nurse, RN E came to the room and she and CNA F transferred the resident back into bed. On 2/14/24 at 9:30 AM, in contradiction to resident #197 and RN E's statements, CNA F stated she was in the room with CNA G to help transfer resident #197 back to bed. She explained, we went in to transfer her from the chair to the bed. CNA F stated she put the sling behind resident #197's back and was hooked the sling to the sit to stand mechanical lift when the resident moved her arm. CNA F stated the resident started to slide down and she and CNA G put her on the floor. CNA F said, The resident was already down on the floor when we called RN E. She stated the RN E came to the room and was told the resident was placed on the floor from the lift. She noted RN E checked the resident for injuries and then she and CNA G transferred the resident to bed using the full mechanical lift. Review of the x-ray done at the facility on 2/08/24 at 7:00 PM, showed the results were reported to the facility at 8:14 PM, with findings of a new non-displaced clavicle fracture. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 5 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Review of the medical record indicated resident #197 was sent to the hospital on 2/09/24 due to continued pain in her shoulder. The results of the x-ray taken at the hospital on 2/09/24 at 12:46 PM indicated resident#197 had an angulated, nondisplaced fracture of the distal left clavicle. On 2/14/24 at 1:53 PM, Physical Therapy Assistant (PTA) I stated resident #197 was motivated on the first week of therapy because she wanted to go home. He explained that due to the fracture, the resident had pain and could not use her left arm so her therapy had to be extended. PTA I said resident #197 previously required moderate assistance for bed mobility but now required maximum to total assistance due to pain. He stated resident #197 told him there was only one person using the lift with her and she knew it was supposed to be two people. PTA I said, I also heard that it was one person using the mechanical lift with resident #197. Review of the care plan and [NAME] revealed resident #197 was assessed to require two-person assist for transfers. There was no indication on either the care plan or the [NAME] as to the type of device needed to transfer the resident until 02/08/24, when the care plan was revised to indicate the resident required use of a full body mechanical lift for transfers. On 2/15/24 at 12:15 PM, the Corporate Nurse explained a two-person transfer, required two staff to be involved in the process of the transfer. She stated this indicated the number of staff required to safely transfer a resident but did not describe what type of lift was to be used. The Corporate Nurse explained the care plan did not detail the type of lift needed to transfer resident #197 until 2/08/24. On 2/13/24 at 8:40 AM, resident #197 stated police officers came to see her last night. The resident stated she was not sure why they were there. She stated they said they were here to see how she was doing but didn't really say much more than that. On 2/13/24 at 10:00 AM, the Administrator stated he called the police and Department of Children and Family (DCF) because resident #197 alleged neglect concerning her fall on 2/8/24. He stated he had not reported the incident to the State Agency as he was still investigating. On 02/15/24 at 5:33 PM, resident #197 stated someone came to her room today and told me she had spoken to me before. The resident explained this person did not introduce themselves when they came to her room. She said this person recounted incorrect information about the incident on 2/08/24. The resident said, this person told me that I had said I had pulled myself up in bed, heard a pop, and that caused the fracture in my shoulder. The resident was visibly upset and noted, I told her I have never said that to you. I don't know where you got that from. On 2/16/24 at 1:50 PM, CNA M spoke about resident #197's transfer needs. I personally would not feel comfortable using a sit to stand with her because she is very dependent on help with any movement. When I took care of her before and after the incident, she was not able to pull herself up in bed. I went into the room at least two to three times during my shift to pull her up in bed and it always took two people. On 2/15/24 at 12:15 PM, an interview was conducted with the Regional Nurse Consultant, the Director of Nursing (DON) and the Administrator. The Nurse Consultant explained that two person assist with transfers meant that two staff should be present to do the transfer. She described it could be for a standing lift or full mechanical lift transfers. She stated two person assist only indicated the number of staff, not the type of mechanical lift to be used. She acknowledged the type of mechanical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 6 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few lift was not reflected on resident #197's care plan until 2/08/24. The Administrator added, in the morning meeting, the Minimum Data Set Nurse inputs any changes to the care plans and [NAME]. He explained after the meeting, any changes would be communicated to the CNAs verbally. He said the type of lift to be used for resident #197 should have been in the electronic system as a task but explained it did not get written in the [NAME] until 2/8/24. He did not clarify if the specific lift was added prior to the incident or after the incident. The Administrator reported the wrong mechanical lift was used for the resident as she did not like the full body mechanical lift and the CNA said she had used the sit to stand mechanical lift previously with the resident. When asked if CNAs determined the type of lift to use to transfer residents, the Administrator did not provide an answer. They were asked to clarify the inconsistencies in statements from the both the resident and RN E who stated only one CNA transferred the resident and CNAs G and F's statements that it was 2 CNAs. The Administrator replied he was told two CNAs transferred the resident. The Abuse, Neglect and Exploitation policy most recently revised 11/16/23 read, Neglect means failure of the facility, it's 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. The facility policy, Safe Resident Handling/Transfers implemented 11/03/2020 and revised 11/29/22 read, It is the policy of this facility to ensure that residents are handled and transferred safely to prevent or minimize risks for injury and provide and promote a safe, secure, and comfortable experience for the resident. Two staff members must be utilized when transferring residents with a mechanical lift. Review of the CNA job description included duties to ambulate and transfer residents utilizing appropriate assistive devices and body mechanics. The resident sample was expanded to include five additional residents who were identified as requiring a mechanical lift for transfers. Review of immediate actions to remove the Immediate Jeopardy implemented by the facility revealed the following, which were verified by the survey team: * On 2-09-24, staff members involved were given 1:1 education by the Staff Development Coordinator on the proper use of mechanical lifts. * On 2-09-24 through 2-15-24 current nursing staff and therapy staff were educated on the transfer of residents and the use of the mechanical lifts by the Director of Nursing, Staff Development Coordinator and Nurse managers. Twenty five nursing staff members were educated on 2-09-24, 8 nursing staff members were educated on 2-12-24, 5 nursing staff were educated on 2-13-24, 1 nursing staff was educated on 2-14-24, 50 staff members were educated on 2-15-24. Newly hired staff members and agency staff will be educated during the orientation process. Staff members that are on vacation will receive education prior to the start of their next shift. * On 2-12-24 through 2-15-24 current staff were educated on ANME (Abuse, Neglect, Misappropriation, Exploitation) by Staff Development Coordinator, Nurse Managers and Department Heads. On 2-12-24, 18 facility staff members were educated, on 2-13-24, 17 facility staff members were educated, and on 2-15-24, 89 staff were educated. Newly hired staff members and agency staff will be educated during the orientation process. Staff members that are on vacation or FMLA will receive education prior to the start of their next shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 7 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 2/16/24, out of 88 Total nursing and therapy employees-77 nursing and therapy employees received education on the use of the mechanical lifts. Level of Harm - Immediate jeopardy to resident health or safety * On 2/16/24, out of 124 Total facility employees, 103 Facility staff received education on ANME. Residents Affected - Few * Ad Hoc Quality Assurance and Performance Improvement (QAPI) meeting was held on 2-16-24 with Medical Director, Administrator, DON, Staff Development Coordinator, Therapy Director, and Unit Manager to discuss transfer status, mechanical lift use and root cause analysis. Interviews conducted from 2/17/24 with 13 facility staff including licensed nurses and CNAs revealed they were knowledgeable about the facility's transfer policy, and the need to review the care plan and [NAME] to identify number of persons and mode of transfer or which mechanical lift for resident transfers. They verified a return demonstration was completed after the education. They confirmed they received Abuse/Neglect education followed by a post test. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 8 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to thoroughly investigate an incident involving neglect and failed to report the results of the investigation to the State Survey Agency related to an avoidable fall with major injury for 1 of 6 residents sampled for falls, of a total sample of 45 residents, (#197). Findings: Resident #197, a [AGE] year-old female, was admitted to the facility on [DATE]. Her diagnoses included congestive heart failure, asthma, atrial fibrillation, chronic obstructive pulmonary disease, diabetes, obstructive sleep apnea, obesity, muscle weakness. On 2/09/24, a diagnosis fracture of unspecified part of left clavicle was added. The resident's admission Minimum Data Set (MDS) assessment with Assessment Reference Date (ARD) of 2/05/24 revealed the resident's cognition was intact, with a Brief Interview for Mental Status (BIMS) score of 15/15. The assessment noted resident #197 had adequate hearing, had clear speech, was understood, and understands, and had adequate vision. The assessment indicated the resident was independent for eating, oral hygiene, and personal hygiene, required partial/moderate assistance for showering and upper body dressing, substantial/maximal assistance with rolling left to right, sit to lying, lying to sitting on the side of the bed, sit to stand, chair to bed/bed to chair, and dependent for toileting hygiene, lower body dressing and putting on/taking off footwear. The assessment also revealed the resident had no impairment to upper extremity( shoulder, elbow, wrist, hand), lower extremity (hip, knee, ankle, foot), and used a wheelchair for mobile device. The assessment indicated the resident had no behaviors. On 2/12/24 at 5:17 PM, resident #197 recalled she was being transferred from her wheelchair to the bed by one Certified Nursing Assistant (CNA) using a sit to stand mechanical lift. She explained CNA G picked her up with the sit to stand mechanical lift and she told CNA G there needed to be two people to use the mechanical lift. The resident said CNA G commented, Don't tell me how to do my job. Resident #197 noted CNA G put her feet in the lift and she told CNA G that something did not feel right. She stated CNA G proceeded to lift her up using the machine and then walked to the back of the machine. She said the next thing she knew, she was on the floor and Registered Nurse (RN) E was sitting next to her. On 2/13/24 at 8:40 AM, the resident stated the police came here last night to see me. On 2/13/24 at 9:44 AM, the Administrator explained on 2/8/23, CNA F and another CNA said while resident #197 was in the sit to stand lift, she moved her hands from the lift and they lowered her to the floor. CNA G said they called RN E to assist them. The Administrator stated he did not report the incident, because there was nothing to report. When asked why the police came to see resident #197 last night, he replied the resident alleged neglect with the mechanical lift incident. The Director of Nursing (DON) stated Department of Children and Families was called but did not accept the report. The Administrator stated he was still investigating and was still within the time frame for reporting the incident. On 2/14/24 at 1:33 PM, the Administrator explained the morning after the incident he interviewed CNA F, CNA G and RN E by telephone as it was priority. He stated he had them describe what happened (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 9 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 - Few when they transferred the resident with the sit to stand lift. The Administrator said he was aware of x-ray results when he did interviews. The Administrator was informed that interviews obtained yesterday with the three staff involved were different. Each CNA had a different story and the nurse reported there was only one CNA in the room when he was called to help. CNA G stated resident #197 was in the lift when she called the nurse and the three of them put the resident on the floor. CNA F stated resident #197 was already on the floor when the nurse was called to the room. The Administrator replied, they all told him there were two people doing the transfer. He did not provide any documentation of his telephone conversations with the staff. Review of the resident's record revealed an x-ray was completed at the facility post incident on 2/08/24 at 7:00 PM. The report showed the resident had nondisplaced distal clavicle fracture, new. (Clavicle fracture-collarbone, is diagnosed through physical examination and x-rays. Symptoms of a broken collarbone include severe pain and swelling at the site of the fracture and with visible deformity in some cases. Because of the critical location of the clavicle, any severe force on the shoulder such as falling directly on the shoulder or falling on an outstretched arm transfers force to the clavicle . retrieved from https: www. hopkinsmedicine.org on 2/20/24). The record revealed on 2/09/24, resident #197 was transported to the hospital for follow up x-rays which confirmed the left clavicle fracture. Review of the care plan and [NAME] revealed the resident required two person assist for transfers, using a full body mechanical lift. Resident #197 was transferred by one person using a sit to stand mechanical lift and sustained a fracture during the intended transfer. Review of the facilities Compliance with Reporting Allegations of Abuse/Neglect/Exploitation implemented 11/2020 and revised 8/15/22 read: It is the policy of this facility to report all allegations of abuse/neglect/exploitation or mistreatment.are reported immediately to the Administrator of the facility and to other appropriate agencies in accordance with current state and federal regulations within prescribed timeframes. Neglect: failure of the facility, 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. The facility will report all alleged violations and all substantiated incidents to the state agency and to all other agencies as required and take all necessary corrective actions depending on the results of the investigation . The Administrator or designee will: Notify the appropriate agencies immediately: as soon as possible, but no later than 24 hours after discovery of the incident. In the case of a serious bodily injury, no later than 2 hours after discovery or forming the suspicion. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 10 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure a thorough investigation was conducted for a fall with fracture for 1 of 6 residents reviewed for falls of a total sample of 45 residents, (#197). Residents Affected - Few Findings: Resident #197, a [AGE] year-old female, was admitted to the facility on [DATE]. Her diagnoses included congestive heart failure, asthma, atrial fibrillation, chronic obstructive pulmonary disease, diabetes, obstructive sleep apnea, obesity, and muscle weakness. On 2/09/24, the diagnosis, fracture of unspecified part of left clavicle was added. The resident's admission Minimum Data Set (MDS) assessment with Assessment Reference Date (ARD) of 2/05/24 revealed the resident's cognition was intact, with a Brief Interview for Mental Status (BIMS) score of 15/15. The assessment noted resident #197 had adequate hearing, clear speech, was understood, and understands, and had adequate vision. The assessment indicated the resident was independent for eating, oral hygiene, and personal hygiene, required partial/moderate assistance for showering and upper body dressing, substantial/maximal assistance with rolling left to right, sit to lying, lying to sitting on the side of the bed, sit to stand, chair to bed/bed to chair, and dependent for toileting hygiene, lower body dressing and putting on/taking off footwear. The assessment also revealed the resident had no impairment to upper extremity( shoulder, elbow, wrist, hand), lower extremity(hip, knee, ankle, foot), and used a wheelchair for mobile device. The assessment indicated the resident had no behaviors. On 2/12/24 at 5:17 PM, resident #197 explained Certified Nursing Assistant (CNA) G put her back to bed from her wheelchair using the sit to stand mechanical lift by herself on 2/8/24. She said she told the CNA there should be two staff when transferring her with the lift and the CNA responded, Don't tell me how to do my job. The resident said she told the CNA that something did not feel right but the CNA continued to move me in the lift. The resident said the next thing she remembered was being on the floor looking up at a nurse. 02/13/24 08:40 AM, the resident stated, the police came here last night to see me. She said she was not sure why they came but they said they were here to see how she was doing. They didn't really say much more and they left. On 2/13/24 at 10:00 AM, the Administrator stated he called the police as the resident alleged neglect with the mechanical lift incident. He explained he was still investigating the 2/8/24 incident. On 2/13/23 at 10:47 AM, during a telephone interview, Registered Nurse (RN) E recalled CNA G was with resident #197 and called out to him for help. The RN stated when he went in the room the resident was in the sit to stand mechanical lift in what looked like an unsafe position. When I entered the room, CNA G was with resident #197 by herself. I called CNA F to come and help us. On 2/13/24 at 11:13 AM, during a telephone interview, CNA G stated she was with CNA F when they transferred resident #197 back to bed. CNA G explained the resident took her hands off the lift, became unstable and she called for the nurse, RN E. She said the three of them lowered the resident to the floor. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 11 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 - Few On 2/14/24 9:30 AM, during a telephone interview, CNA F stated she was in the room with CNA G to help with the transfer from the wheelchair to the bed. She said resident #197 took her hands off the sit to stand lift and started to slide down and the two CNAs lowered the resident to the floor. In a conflicting statement, CNA F stated resident #197 was on the floor when the nurse came into the room. Review of the care plan and [NAME] revealed the resident was assessed to require assistance from two staff persons for transfers with a full body mechanical lift, not the sit to stand mechanical lift which was being used at the time of the incident. On 2/14/24 at 1:33 PM, the Administrator recalled he interviewed the 2 CNAs and the nurse by telephone. He said the Unit Manager interviewed the resident. He stated he was aware the resident had a fractured clavicle and he was told the CNA's had her on the ground before they called the nurse. The Administrator explained the root cause of the accident was the resident got weak and felt a little dizzy and that is when they lowered her to the ground. In response to the discrepancies in the interviews with the CNAs and the RN, he explained he was told there were two people doing the transfer and the resident was on the floor when the nurse went in the room. He did not provide any written documentation of his interviews. Review of the Unit Manager's written statement noted she spoke to the resident about her shoulder pain after the incident with the lift. She wrote the resident told her she had torn rotator cuffs in both shoulders and her left shoulder started hurting after she pulled herself up in bed. The statement also noted resident #197 stated the mechanical lift was used incorrectly when she was transferred. The statement documented the Unit Manager asked the resident about the placement of the mechanical lift sling and informed the resident it was applied appropriately. On 02/16/24 at 12:26 PM, resident #197 stated she was not physically capable of pulling herself up in bed and never told anyone that she hurt her shoulder by pulling herself up in bed. She explained she was told about 25-30 years ago that she had a torn rotator cuff but she did not have pain. On 2/17/24 at 8:30 AM, the Administrator said he did not report the incident to the State agency as he there was nothing to report. He said the staff involved told him the transfer was completed with two staff in attendance. He did not explain the inconsistent statements from RN E and the resident who noted only one CNA transferred the resident. He did not provide an explanation as to why a sit to stand lift was used when the resident was assessed to require a full mechanical lift. He said he only interviewed the staff by telephone and did not request a demonstration of how the resident was transferred and how she sustained a fractured clavicle. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 12 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure Minimum Data Set (MDS) assessment accurately reflected health conditions regarding bladder and bowel for 1 of 1 resident reviewed for urinary catheter, of a total sample of 45 residents, (#20). Residents Affected - Few Findings: Record review revealed resident #20 was a 52- year-old-male admitted to the facility on [DATE], with his most recent readmission on [DATE]. His diagnoses included hydronephrosis with ureteral stricture, spinal muscular atrophies, paranoid schizophrenia, malignant neoplasm of prostate, paraplegia, and anoxic brain damage. Review of the resident's Medical Certification For Medicaid Long-term Care Services And Patient Transfer Form (3008) dated 3/01/22 revealed the resident had a colostomy, and a right Urostomy/nephrostomy. A colostomy is surgery to create an opening called a stoma. The opening creates a passage from the large intestines to the outside of your body . so that solid stool and gas can leave the body through the stoma instead of passing through the rectum. (retrieved on 2/21/24 from cancer. net) A Urostomy is a surgically created opening in the abdominal wall through which urine passes. A urostomy may be performed when the bladder is either not functioning or has to be removed. (retrieved on 2/21/24 from ostomy.org) A nephrostomy is a procedure to drain urine from your kidney using a catheter (tube) (retrieved on 2/21/24 from healthdirect.gov.au). The resident's physician orders dated 9/02/22 read, colostomy and urostomy care every shift. Review of a Provider progress note dated 10/05/23, showed documentation that read, History of prostate cancer/obstructive uropathy-s/p (status/post) urostomy-s/p colostomy Review of the quarterly MDS assessment dated [DATE], revealed Section H: Bladder and Bowel question H0100 titled Appliances, indwelling catheter (including suprapubic catheter and nephrostomy tube) was checked, Ostomy (including urostomy, ileostomy, and colostomy) was not checked. Question H0300, urinary continence was coded with the number 3, indicating the resident was always incontinent. Question H0400 bowel continence was also coded with the number 3, indicating the resident was always incontinent of bowel. On 2/13/24 at 4:59 PM, and on 2/15/24 at 11:11 AM, the resident's primary nurses, Registered Nurse (RN) E, and Licensed Practical Nurse (LPN) B stated resident #20 had a colostomy, and a urostomy, that were monitored as per physician's orders. On 2/16/24 at 9:30 AM, the MDS Coordinator stated MDS assessments were completed doing a seven day look back, and included review of the resident's clinical records, a bedside assessment of the resident, interview of the resident if the resident's cognition was intact, and if not, an interview would be conducted with the family/responsible party, interview of the resident's primary nurse, rehab, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 13 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and the resident's Certified Nursing Assistants (CNA) as needed. The MDS Coordinator stated a care plan would be initiated and implemented based on the resident's comorbidities, and diagnoses. Resident # 20's quarterly MDS assessment dated [DATE] was reviewed with the MDS Coordinator. He confirmed the resident had a colostomy, and urostomy, and explained he completed the assessment, and section H was not accurate. For H0100 ostomy should have been checked and for H0300, and H0400 the number 9 should have been coded, for not rated, since the resident had a urostomy, and a colostomy. The facility's policy MDS 3.0 Completion implemented on 11/03/20, and reviewed/revised on 9/19/22, read, According to federal regulations, the facility conducts initially and periodically a comprehensive, accurate and standardized assessment of each resident's functional capacity. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 14 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a Baseline Care Plan timely for 2 of 2 residents of a total sample of 45 residents, (#25, #82). Findings: 1. Review of the medical record revealed resident #25, a [AGE] year old female was admitted to the facility on [DATE] from an acute care hospital with diagnoses that included Alzheimer's Disease, malnutrition, diabetes, failure to thrive, and need for assistance with personal care. The Baseline Care Plan scanned to the Electronic Health Record (EHR) noted the nurse signed the plan of care was developed on 10/15/23. The document did not indicate any notations or signatures that indicated the resident or resident's representative was included. On 2/16/24 at 9:30 AM, the MDS Coordinator explained development of the Baseline Care Plan was included in the initial admissions process that staff nurses on the units completed. He said immediate treatment plans were important and the resident or resident representative needed to be involved as, it enhances their recovery and treatment. 2. Review of the medical record revealed resident #82, an [AGE] year old female was admitted to the facility on [DATE] from an acute care hospital with diagnoses that included Addisonian crisis (low cortisol levels), dementia, and gastrostomy (feeding tube) status. The Baseline Care Plan scanned to the Electronic Health Record (EHR) noted the nurse signed the plan of care was developed on 12/21/23. The document showed the resident signed the form and dated the review on 12/28/39. There was an illegible handwritten line added and crossed over the number 28. On 2/16/24 at 1:47 PM, the Director of Nursing (DON) stated her expectation was for Baseline Care Plans to be completed by the nurse who admitted the resident within 24 to 72 hours. She said she was not aware of any problems that nurses had not completed them timely. Review of the facility's standards and guidelines titled Baseline Care Plan dated 9/18/23 read, . The facility will develop and implement a baseline care plan of reach resident that includes the instructions needed to provide effective and person-centered care of the resident that meets professional standards of care. The baseline care plan will: a. be developed within 48 hours of a resident's admission. A supervising nurse shall verify within 48 hours that a baseline care plan has been developed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 15 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 interview, and record review, the facility failed to accurately assess a resident's vision and failed to initiate a comprehensive care plan for impaired vision for 1 of 2 residents reviewed for vision/hearing of a total sample of 45 residents, (#197). Findings: Resident #197, a [AGE] year-old female, was admitted to the facility on [DATE]. Her diagnoses included congestive heart failure, atrial fibrillation, diabetes, and fracture of left clavicle. The resident's admission Minimum Data Set (MDS) assessment with Assessment Reference Date (ARD) of 2/05/24 revealed the resident's cognition was intact, with a Brief Interview for Mental Status (BIMS) score of 15/15. The assessment noted resident #197 had adequate vision and was independent with eating. On 2/13/24 at 8:40 AM, Certified Nursing Assistant, (CNA) Q explained to resident #197 where the food was situated on her plate. The CNA stated the resident did not see very well so we always make sure she knows where the food and drinks are situated on her plate. The resident stated she was legally blind and could only see shadows. On 2/17/24 at 10:57 AM, the MDS Coordinator said he was not aware resident #197 was visually impaired. He acknowledged the resident did not have a care plan for impaired vision and added that while MDS did most of the care plans, other staff could add a care plan and stated it was an interdisciplinary responsibility. On 2/17/24 at 1:34 PM, the Director of Nursing (DON) stated care plans were reviewed at care plan meetings. She stated her expectation was that anyone who cared for the resident should contribute to their care plan to address the resident's needs. Review of the Comprehensive Care Plans policy implemented 11/2020 and revised 7/27/2022 read: The comprehensive care plan will be developed within 7 days after the completion of the comprehensive MDS assessment. Other factors identified by the interdisciplinary team, or in accordance with the resident's preferences , will also be addressed. The comprehensive care plan will describe, at a minimum, the following: Resident specific interventions that reflect the resident's needs. The comprehensive care plan will be prepared by an interdisciplinary team, that includes, but is not limited to: A registered nurse with responsibility for the resident A nurse aide with responsibility for the resident FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 16 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Resident #80 was an 89- year-old female admitted to the facility on [DATE] with diagnoses which included displaced fracture of anterior wall left acetabulum, history of falls, generalized muscle weakness, and cognitive communication deficit. Review of the resident's quarterly MDS assessment dated [DATE], revealed the resident's cognition was severely impaired with a BIMS score of 03 out of 15. On 2/12/24 at 12:41 PM, resident #80's daughter stated she had not been invited or approached regarding any care plan meeting for the resident. On 2/14/24 at 11:28 AM, in an interview with the Registered Nurse (RN) MDS Coordinator, and the Licensed Practical Nurse (LPN) MDS, they stated that previously, invitation letters for care plan meetings were sent out by the prior receptionist, and two weeks ago MDS took over the task. The LPN MDS explained that a schedule of the monthly care plan meetings due were pulled, and invitation letters, were given and/or mailed to the resident and /or the resident's Power of Attorney (POA)/responsible party. She stated the POA/responsible party would also be called to inform them that the invitation letter was mailed out. A care plan meeting would be scheduled as confirmed by the resident/POA/responsible party, and the meeting could be held via telephone, in person, or in the resident's room. She stated a copy of the invitation letter was placed in a drive in the facility's electronic record. The RN MDS Coordinator stated resident #80's last care plan meeting was held on 1/12/24. He stated he tried to contact the resident's family, since no one was sending invitation letters out, but never received a response. However, there was no documentation to indicate an attempt was made to contact the resident's family. On 2/16/24 at 9:30 AM, the RN MDS Coordinator stated it was important to get the family involved in the resident's care plan meeting, because the family could participate, be updated about the resident's care, which would benefit the resident, and help to guide the residents' care. The resident's Care Plan Conference Summary dated 1/12/24, was reviewed with the RN MDS Coordinator. There was no documentation to indicate any involvement of the family /resident in the care plan meeting. The only signature for attendees documented on the form was the RN MDS Coordinator. This was confirmed by the RN MDS Coordinator. He stated no other Care Plan Conference Summary could be identified for the resident. He explained that if a summary was not in place, it indicated that a care plan meeting had not been conducted. 4. Resident # 83, a [AGE] year-old female was admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnoses included diabetes type II, asthma, gastrostomy, heart failure, hyperlipidemia, hypertension, and major depressive disorder. Review of the resident's quarterly MDS dated [DATE], revealed the resident's cognition was intact with a BIMS of 15 out of 15. On 2/13/24 at 1:24 PM, resident #83 stated she had not attended any care plan meeting, did not know if the facility had care planning meetings, and would have attended the meeting if she was made aware. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 17 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 2/14/24 at 11:28 AM, the RN MDS Coordinator stated resident #83's last care plan meeting was held on 12/01/23, and the resident was not present. He stated an invitation letter was to be provided to the resident, however no documentation could be identified to indicate the resident was informed or invited to her care plan meeting. On 2/14/24 at 11:32 AM, the Regional MDS Coordinator said when a care plan meeting was held, a signature sheet/summary sheet would have documentation of all persons in attendance. Review of the resident's Care Plan Conference Summary dated 9/14/23, and 11/16/23 revealed no documentation to indicate the resident was invited or participated in her care plan meeting. On 2/16/24 at 9:30 AM, the RN MDS Coordinator stated at first he was not aware of all he had to do in his role. He said he could not identify any additional Care Plan Conference Summary for the resident, apart from the ones mentioned, and acknowledged the resident with intact cognition was not involved in her care plan meetings. The facility's policy Care Planning-Resident Participation implemented on 11/03/20, and reviewed/revised on 1/2024 read, This facility supports the resident's right to be informed of, and participate in, his or her care planning and treatment . The facility will make an effort to schedule the conference at the best time of the day for the resident/resident's representative. The facility will obtain a signature from the resident and/or resident representative after discussion or viewing of the care plan. Based on interview and record review, the facility failed to ensure 2 residents/representatives were provided the opportunity to participate in their care plan reviews, (#33, #58); and failed to ensure 2 residents/representatives were invited and participated in the development of care plans, (#80, #83), of a total sample of 45 residents. Findings: 1. Review of the medical record revealed resident #33, a [AGE] year old female was admitted to the facility on [DATE] and readmitted from an acute care hospital on 2/07/23. Her diagnoses included thoracic vertebra (mid-spine) fractures, heart failure, pulmonary (lung) hypertension, atrial fibrillation (heart rhythm dysfunction), Chronic Obstructive Pulmonary Disease (COPD) with acute exacerbation, malnutrition and, type 2 diabetes mellitus with kidney disease. The most recent Minimum Data Set (MDS) Quarterly Assessment with Assessment Reference Date (ARD) of 2/01/24 noted the resident scored 13 out of 15 on the Brief Interview for Mental Status (BIMS) that indicated the resident was cognitively intact. Functional Abilities and Goals noted the resident had functional range of motion limitations in both legs, required moderate to substantial assistance from staff for mobility in bed, to transfer, and to complete Activities of Daily Living (ADLs), was incontinent of bladder and bowel functions, was at risk for pressure ulcers, received pain medications as needed, and received routine high risk insulin, anti-anxiety, anti-coagulant (blood thinner), and diuretic (fluid removing) medications during the look back period. Participation in Assessment and Goal Setting indicated the resident was an active participant in setting her goals with a discharge plan to return to the community. The Comprehensive Care Plan initiated 9/07/22 and revised 3/07/23 included interventions and goals for diabetes, risk for falls/injury, adverse medication effects, impaired mobility, incontinence, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 18 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few pain, psychosocial well-being, preferred activities, behaviors, malnutrition, risk for skin impairment, ADL self-care performance deficits, and discharge plans to remain in the facility for long-term care services. The Order Summary Report revealed resident #33's active physician's ordered medications included Tylenol 650 milligrams (MG) as needed for pain, Alendronate Sodium 35 MG for osteoporosis, Apixaban (blood thinner) 5 MG for atrial fibrillation, Atorvastatin 40 MG for high cholesterol, Guaifenesin as needed for cough, Furosemide (water pill) 20 MG for heart failure, Jardiance 25 MG for heart failure and diabetes, Lactulose as needed for constipation, Lantus insulin injection for diabetes, Meclizine as needed for dizziness, Metoprolol Tartrate 50 MG for elevated heart rate, Novolog insulin injection for diabetes, Nystatin cream for rash, Ondansetron HCI 4 MG as needed for nausea/vomiting, Protonix 40 MG for Gastroesophageal Reflux Disease (GERD), Senna 17.2 MG for constipation, Sertraline 100 MG for depression, Trulicity 0.75 MG injection for diabetes and neuropathy (nerve pain), and Triamcinolone Acetonide Cream 0.5% for rash. On 2/13/24 at 10:20 AM, resident #33 said staff had not offered her the opportunity to participate in Interdisciplinary Team (IDT) discussions or meetings about her plan of care. Review of resident #33's Electronic Health Record (EHR) revealed the last Care Plan Meeting Invitation to the resident was dated almost one year ago on, 2/27/23 for a 3/09/23 scheduled meeting. The EHR did not include additional invitations or Care Plan Conference Summary documents to show the resident or resident representative participated in subsequent plan of care reviews. In an interview on 2/16/24 at 9:30 AM, the MDS Coordinator stated the former Business Office Manager was responsible for the completion of residents/representative care plan meeting invitations. He explained, he had taken over the duties for approximately two weeks and they had been, behind schedule. He said it was important for residents and their families to be involved in their care planning because, they do better. 2. Review of the medical record revealed resident #58, an [AGE] year old female was admitted to the facility on [DATE] and readmitted from an acute care hospital on 8/31/23 with diagnoses of Parkinson's Disease, stroke, neuro-cognitive disorder, diabetes, malnutrition, dementia, hypertension, depression, spondylosis (small crack between two spinal bones), lumbar (lower back) stenosis (narrowing of spinal canal), and history of falls. The most recent MDS Quarterly Assessment with an ARD of 11/24/23 noted the resident scored 2 out of 15 on the BIMS that indicated the resident was severely cognitively impaired. Functional Abilities and Goals noted the resident had functional range of motion limitations in both legs, required substantial/maximum assistance to dependence from staff for mobility in bed, to transfer, and to complete ADLs, was incontinent of bladder and bowel functions, had 1 fall, received pain medications as needed, and routine high risk insulin, anti-depressant, and anti-biotic medications during the look back period. Participation in Assessment and Goal Setting indicated the resident was an active participant in setting her goals and there were no discharge plans to return to the community. The Comprehensive Care Plan included interventions and goals for history of falls and risk for falls/injury, adverse medication effects, diabetes, impaired mobility, incontinence, risk for gastrointestinal complications, anemia, impaired cognition, dementia, depression, insomnia, pain, psychosocial well-being, preferred activities, refusals of care, nutrition and weight loss, risk for skin impairment, ADL self-care performance deficits, advanced directives, and discharge plans to remain in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 19 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0657 facility for long-term care services. Level of Harm - Minimal harm or potential for actual harm The Order Summary Report revealed resident #58's active physician's ordered medications included Tylenol 650 MG as needed for pain, Amlodipine 5 MG for high blood pressure, Bisacodyl EC 5 MG as needed for constipation, Escitalopram 10 MG for depression, Melatonin 3 MG for insomnia, Memantine HCI 5 MG for Alzheimer's, Novolin 70/30 insulin injection for diabetes, Rytary ER 36.5-145 MG for Parkinson's disease, and Trazodone HCL 50 MG for insomnia, Residents Affected - Few On 2/16/24 at 9:30 AM, the MDS Coordinator explained residents' Comprehensive Care Plans were reviewed routinely by the IDT according to the MDS schedule, after admission, quarterly, annually, and for significant changes. Review of the EHR Care Plan Review History revealed quarterly reviews were completed 11/11/23 and 2/09/24. The Care Plan Conference Summary scanned in the record noted the last IDT review with the resident's representative was held 8/17/23. On 2/17/24 at 10:33 AM, the Social Services Director explained that she was part of the IDT and attended care plan meetings where she discussed advanced directives and ensured they were up to date to reflect the correct choice. She said a record of meetings was kept on Care Plan Conference Summary forms that were signed by participants. She said it was important for residents and their representatives to be informed of their care reviews and advanced directives on record. She stated the meetings and discussions were important, and the process affected overall health and treatment outcomes. She explained, the goal in social services was, to reduce anxiety and depression so they can make decisions in their care. Review of the facility's standards and guidelines titled Comprehensive Care Plans dated 7/27/22 read, . Person-centered care means to focus on the resident as the locus of control and support the resident in making their own choices and having control over their daily lives., and . 4. The comprehensive care plan will be prepared by an interdisciplinary team, that includes, but is not limited to: . e. The resident and the resident's representative . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 20 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 provide mouth care for 1 of 5 residents observed for Activities of Daily Living (ADL) care of a total sample of 45 residents, (#72). Residents Affected - Few Findings: Resident #72 was admitted to the facility on [DATE] with diagnoses to include stroke, difficulty swallowing, aphasia, and need for assistance with personal care. The resident's 5-day Minimum Data Set (MDS) assessment with Assessment Reference Date (ARD) of 1/13/24 revealed the resident's cognition was severely impaired. The assessment noted his speech was unclear and he required maximum assistance for oral hygiene. The assessment noted the resident did not have any behaviors. On 2/13/24 at 3:14 PM, the resident was observed lying in bed with his eyes closed. He had his mouth open and his tongue and teeth were coated with a thick white substance. On 2/14/24 at 10:43 AM, the resident was observed lying in bed awake looking at the television. His tongue and teeth were coated with a thick white substance. On 2/14/24 at 3:10 PM, the resident was observed lying in bed and his tongue and teeth were covered with a thick white substance. At 3:15 PM, Licensed Practical Nurse (LPN) C observed the residents mouth and acknowledged the resident needed mouth care. The LPN explained mouth care should be done at least every shift and as needed. LPN C directed Certified Nursing Assistant (CNA) O to provide mouth care to the resident. The CNA stated she tried to clean resident #72's mouth earlier and he would not let her. She stated he kept closing his mouth. She proceeded to use the mouth care swabs and the resident remained still, with his mouth open to allow her to clean it. Review of resident #72's Order Summary Report revealed an active order that read, complete oral care every shift. Resident #72's Care Plan for enteral feeding had an intervention that read, mouth care every shift and prn (as needed), initiated 11/17/23. The Activities of Daily Living (ADL'S) policy implemented on 11/03/2020 and revised on 11/29/22 read: Care and services will be provided for the following activities of daily living: Bathing, dressing, grooming, and oral care. A resident who is unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 21 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0679 Provide activities to meet all resident's needs. 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 provide an on-going individualized program of activities for 2 of 2 residents reviewed for activities of a total sample of 45 residents, (#2, #79). Residents Affected - Some Findings: Record review revealed resident #2, a [AGE] year-old female was admitted to the facility on [DATE]. Her diagnoses included diabetes type II, Chronic Obstructive Pulmonary Disease (COPD), heart disease, psychosis, dementia, blindness of her right and left eye, anxiety disorder, and cognitive communication deficit The annual Minimum Data Set (MDS) assessment, with assessment reference date of 2/24/23 revealed resident #2 had a Brief Interview of Mental Status score of 7 which indicated the resident had severe cognitive impairment. Section F- Preferences for customary routine and activities revealed code 1 was documented, indicating it was very important to the resident for the following activities: listen to music she liked, be around animals such as pets, do things with groups of people, do favorite activities, go outside to get fresh air when the weather is good, and participate in religious services or practices. The assessment indicated the resident was the primary respondent for the daily and activity preferences. The assessment noted resident #2 was totally dependent on staff for transfers and required extensive assistance with bed mobility. The resident's quarterly MDS assessment dated [DATE], revealed the resident's BIMS score was 3, indicating worsening cognitive impairment from the assessment done on 2/24/23. A care plan for activities initiated 6/23/23 and revised on 2/15/24, indicated resident #2's previous recreational interests/patterns included group activities, leisure time outside, and listening to music. The goal was for her to participate in activities of choice and participate in one-on-one visits at least 2 times per week. Interventions included activity staff to provide one-on-one visits, provide a program of activities that was of interest, and to provide room activities that included healthy hands, conversing, snack delivery, prayer, and visits with family and friends. A 30 day look back of the resident's POC (Point Of Care) Response History for the period 1/14/24 to 2/15/24 revealed no data for one-to-one activities, activity participation, self-directed/independent activities, or group activities. An Activity Participation Note dated 5/23/21 read, She spends most of her time in her room with little participation in limited group programs Friendly activities are offered 2-3 x week for social stimulation and support. Room activities include healthy hands, putting lotion on resident's hands, music (tablet), singing, prayer, daily word, conversing, snack facetime with volunteers and assisting with TV/headset operation. Leisure time is spent listening to music. On 2/12/24 at 10:02 AM, on 2/13/24 at 1:45 PM, resident #2 was observed lying in bed on her back, the television was not on, and the radio on her bedside table was not on. On 2/15/24 at 11:11 AM, Licensed Practical Nurse (LPN) B stated the resident was confused, and they tried to get the resident out of bed one to two times weekly, and one-on-one activities was done by the activities department. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 22 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 2/15/24 at 3:43 PM, resident #2 was observed lying in bed on her back. Her eyes were closed, but the resident responded when her name was called. The radio on her bedside table was off, and the television was not on. When asked if she liked music, the resident said yes ma'am I do. On 2/15/24 at 3:51 PM, the Activities Director stated residents were assessed for activities depending on their level of independence. She explained they had three levels of assessment, and level II was for residents with impaired cognition, and the assessment would be completed by conducting interviews with the resident's family, responsible party, or staff, and review of the admission nursing assessment. She stated bedside activities were provided, along with friendly visits. If the resident was bed ridden, room visits would be provided three times weekly, and documented in the facility's electronic medical record under the POC screen. Review of the resident's medical records with the Activities Director revealed no documentation regarding room visits, one-on-one visits, or any other activities provided for the resident. The Activities Director shared that she had not documented activities for the day and did not know how to review the history for documentation. She stated she would review the resident's activity progress notes that were documented when a care plan was initiated. Review of the resident's care plan for activities revealed it was initiated on 6/23/23, and the last documented Activity Note identified was dated 5/23/21. This was confirmed by the Activities Director. On 2/15/24 at 4:00 PM, observation with the Activities Director, showed resident #2 lying in bed on her back with no television or radio on. The Activities Director acknowledged neither the radio was playing nor the television was on. On 2/15/24 at 4:52 PM, and on 2/16/24 at 11:44 AM, the Activities Director, stated she called the Activity Assistant who documented room visits. The Activities Director identified there was not any documentation history for the resident from 2023. She verbalized the Activity Assistant did not visit with resident # 2, and the resident was not seen on 12/14/24 for activities. She confirmed that no documentation electronic or otherwise could be identified to indicate the resident was provided with activities as indicated in her care plan. 2. Resident #79 was admitted to the facility on [DATE] with diagnoses to include stroke, gastrostomy status(feeding tube), encephalopathy, and difficulty swallowing. The resident's quarterly MDS assessment with Assessment Reference Date (ARD) of 12/02/23 revealed the resident's cognition was severely impaired with a Brief Interview for Mental Status (BIMS) of rarely/never understood. Review of resident #79's activity care plan revealed an intervention to provide 1:1 visits three times weekly. Review of the Activities- Initial - Review dated 6/08/23 at 2:09 PM read: resident #79 enjoys spending time in room and in hallway for social interaction. She enjoys music socials and morning visits. Friendly and 1:1 visits offered daily. On 2/12/23 at 4:30 PM, resident #79 was observed lying in bed with her eyes open. On 2/13/24 at 9:15 AM, resident #79 was observed lying in bed with her eyes closed. The resident's daughter was at the bedside and stated her mother did not go out of the room and she had never seen anyone from activities in the room with her mother. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 23 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 2/13/24 at 5:14 PM, resident #79 was observed lying in bed on her left side, eyes closed and head of bed elevated. On 2/14/24 at 10:49 AM, resident #79 was observed lying in bed facing the window, with her eyes open. On 2/16/24 at 3:01 PM, the Activity Director stated resident #79 used to come out of her room every day for activities but she chose not to come out anymore. She stated someone from the activity team went to her room several times per week to visit and read to her. The Activity Director explained all visits with residents were documented in the medical record. She reviewed the resident's medical record and was unable to locate any documentation for room visits. She stated, I am not sure why the documentation is not showing up. We do visit resident #79 in her room. She noted she did not know how to pull up the notes and would try to ask someone how to retrieve the notes. The Activity Director did not provide any documentation for one to one room visits for resident #79. Review of the Activities- Initial - Review dated 6/08/23 at 2:09 PM read: resident #79 enjoys spending time in room and in hallway for social interaction. She enjoys music socials and morning visits. Friendly and 1:1 visits offered daily. The facility's policy Activities implemented on 11/2020, and reviewed/revised on 1/2024 read, It is the policy of this facility to provide an ongoing program to support residents in their choice of activities based on their comprehensive assessments, care plan, and preferences . activities will be designed to meet the interests of each resident, as well as support their physical, mental, and psychosocial well-being . Special considerations will be made for developing meaningful activities for residents with dementia and /or special needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 24 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to prevent a fall with major injury for a vulnerable, physically, impaired resident, and failed to ensure the correct procedure was followed when using a mechanical lift to transfer residents for 1 of 6 residents sampled for falls, out of a total sample of 45 residents, (#197). On 2/08/24 at approximately 6:00 PM, the facility failed to prevent a fall with major injury during a transfer with a mechanical lift. The facility failed to utilize the appropriate type of mechanical lift and failed to follow policy requiring two staff for mechanical lift transfers. While Certified Nursing Assistant (CNA) G transferred resident #197 by herself from chair to bed using the wrong mechanical lift, the resident became unstable and was manually lowered to the floor. The resident complained of pain and x-rays done at the facility identified a fractured left clavicle, (A clavicle fracture-collarbone, is diagnosed through physical examination and x-rays. Symptoms of a broken collarbone include severe pain and swelling at the site of the fracture with visible deformity in some cases. Because of the critical location of the clavicle, any severe force on the shoulder such as falling directly on the shoulder or falling on an outstretched arm transfers force to the clavicle . retrieved from www. hopkinsmedicine.org on 2/20/24). She was transferred to the hospital on 2/09/24 for further scans and returned the same day with confirmed fractured left clavicle. The facility's failure to provide safe and appropriate care when using mechanical lifts placed all 41 residents who required mechanical lift for transfers at risk for serious injury/impairment/death and resulted in Immediate Jeopardy starting on 2/08/24. The facility's Administrator and Director of Nursing, and Corporate Clinical Nurse were notified of the Immediate Jeopardy on 2/15/24 at 3:17 PM, and provided the IJ templates. The Immediate Jeopardy was determined to be removed on 2/16/24 after verification of the immediate actions implemented by the facility. The scope and severity of the deficiencies was decreased to D, no actual harm, with potential for more than minimal harm, that is not Immediate Jeopardy. The census at the start of the survey was 93. Findings: Cross reference to F600 Resident #197, a [AGE] year-old female, was admitted to the facility on [DATE]. Her diagnoses included congestive heart failure, asthma, atrial fibrillation, chronic obstructive pulmonary disease, diabetes, obstructive sleep apnea, obesity, and muscle weakness. On 2/09/24, the diagnosis of fractured left clavicle was added. The resident's admission Minimum Data Set (MDS) assessment with Assessment Reference Date (ARD) 2/05/24 revealed the resident's cognition was intact, with a Brief Interview for Mental Status (BIMS) score of 15 out of 15. The assessment noted resident #197 had adequate hearing, clear speech, understands, was understood, and had adequate vision. The assessment indicated resident #197 was independent for eating, oral hygiene, and personal hygiene. She required partial/moderate assistance for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 25 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few showers and upper body dressing, substantial/maximal assistance with rolling left to right, sit to lying, lying to sitting on the side of the bed, sit to stand, chair to bed/bed to chair, and was dependent for toileting hygiene and lower body dressing. The assessment also revealed resident #197 had no impairment to her upper or lower extremities and used a wheelchair for mobility. The assessment indicated the resident had no behaviors towards herself or others. On 2/12/24 at 5:17 PM, resident #197 stated CNA G had put her back to bed from her wheelchair using the sit to stand mechanical lift on 2/08/24. The resident explained CNA G was in the room getting ready to transfer her by herself and she told the CNA she needed another person to help. Resident #197 said CNA G's response was Don't tell me how to do my job. The resident recalled, When I was in the mechanical lift, I told CNA G something did not feel right but she walked around to the side of the lift and the next thing I remember was being on the floor looking up at my nurse. A sling was observed on the resident's overbed table. She stated she had pain in her left shoulder now and explained she had to stay in the facility longer as she was not able to do therapy because of the fracture. She stated the fractured shoulder had set her back in her progress with therapy and delayed her discharge to home. Review of the x-ray done at the facility on 2/08/24 at 7:00 PM, showed the results were reported to the facility at 8:14 PM, with findings of a new non-displaced clavicle fracture. Review of the medical record indicated resident #197 was sent to the hospital on 2/09/24 due to continued pain in her shoulder. The results of the x-ray taken at the hospital on 2/09/24 at 12:46 PM indicated resident#197 had an angulated, nondisplaced fracture of the distal left clavicle. On 2/13/23 at 10:47 AM, during a telephone interview, Registered Nurse (RN) E stated CNA G was providing care to resident #197 and called out to him for help. The RN stated when he went in the room, CNA G was in the room alone. He recalled the resident was in the sit to stand mechanical lift in what looked like an unsafe position. He described the resident's knees were going toward the floor like she was going to fall. He said he called CNA F to the room to assist and they held the resident and lowered her to the floor. He reiterated only one CNA, CNA G was in the room when he was called to the resident's room. On 2/13/24 at 11:13 AM, in a telephone interview, CNA G stated when she went in resident #197's room, she was seated in her wheelchair. In conflict with resident #197's and RN E's statements, CNA G stated she and CNA F used the sit to stand mechanical lift to put resident #197 back to bed. CNA G then described that resident #197 moved her hands from the hand bar, became unstable, so she called RN E for assistance. CNA G stated the three of them, herself, RN E and CNA F took resident #197 off the sit to stand mechanical lift and held her to put her on the floor. CNA G added, she went to get the full body mechanical lift after RN E came to the room and she and CNA F transferred the resident back into bed. On 2/14/24 at 9:30 AM, during an interview, CNA F stated she was in the room with CNA G to help transfer resident #197 back to bed. She explained she put the sit to stand lift sling behind resident #197's back and hooked the sling to the lift machine when the resident moved her arm. She reported the resident became unstable and started to slide down and the two of us put her on the floor. CNA F stated she was sure the resident was already down on the floor when we called RN E. CNA F stated it was herself and CNA G that put the resident on the floor after she started to slide from the lift. She repeated the nurse, RN E was called to the room after they had lowered her to the floor. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 26 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few On 2/15/24 at 12:15 PM, the Corporate Nurse explained a two-person transfer, required two staff to be involved in the process of the transfer. She stated this indicated the number of staff required to safely transfer a resident but did not describe what type of lift was to be used. The Corporate Nurse explained the care plan did not detail the type of lift needed to transfer resident #197 until 2/08/24. Review of the resident's care plan and [NAME] revealed resident #197 was assessed to require two-person assist for transfers. There was no indication on either the care plan or the [NAME] as to the type of device needed to transfer the resident until 02/08/24, when the care plan was revised to indicate the resident required use of a full body mechanical lift for transfers. On 2/14/24 at 1:53 PM, Physical Therapy Assistant (PTA) I stated resident #197 was motivated on the first week of therapy because she wanted to go home. He explained that due to the fracture, the resident had pain and could not use her left arm so her therapy had to be extended. PTA I said resident #197 previously required moderate assistance for bed mobility but now required maximum to total assistance due to pain. He stated resident #197 told him there was only one person using the lift with her and she knew it was supposed to be two people. PTA I said, I also heard that it was one person using the mechanical lift with resident #197. Review of the written statement provided by the Administrator noted only one CNA was in the room when RN E was called to assist. The statement from RN E dated 2/8/24 at 6:00 PM, read, At the time of the incident CNA called me for help since she was using stand hoyer lift and she resident was in a unstable position and was kneeling towards the floor. She never crash to the ground. We had to put her on the floor for her safety. On 2/14/24 at 1:33 PM, the facility Administrator stated he came to the facility on 2/9/24 to interview staff after he was made aware of resident #197's x-ray results. He said resident #197 had been interviewed by the [NAME] Wing Unit Manager (UM) prior. The Administrator stated after his interviews, it was determined the root cause of the incident was resident #197 had become weak and a little dizzy during the transfer. He explained the two CNAs lowered her to the ground, then went to get the nurse. The Administrator stated resident #197 said she blacked out and could not recall the details. When asked if he had interviewed the resident, he said he had not interviewed the resident, but the UM did. When informed of the inconsistent statements from the two CNAs indicating whether RN E was present when the resident was placed on the floor from the lift, the Administrator did not provide an answer. On 2/15/24 at 12:15 PM, an interview was conducted with the Regional Nurse Consultant, the Director of Nursing (DON) and the Administrator. The Nurse Consultant explained that two person assist with transfers meant that two staff should be present to do the transfer. She described it could be for a standing lift or full mechanical lift transfers. She stated two person assist only indicated the number of staff, not the type of mechanical lift to be used. She acknowledged the type of mechanical lift was not reflected on resident #197's care plan until 2/08/24. The DON reported that CNAs would know the type of lift to be used with the resident as, It would be on the care plan and on the task. We manually add directions to the task. The Administrator added, in the morning meeting, the Minimum Data Set Nurse inputs any changes to the care plans and [NAME]. He explained after the meeting, any changes would be communicated to the CNAs verbally. He said the type of lift to be used for resident #197 should have been in the electronic system as a task but explained it did not get written in the [NAME] until 2/8/24. He did not clarify if the specific lift was added prior to the incident or after the incident. The Administrator reported the wrong mechanical lift was used for the resident as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 27 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few she did not like the full body mechanical lift and the CNA said she had used the sit to stand mechanical lift previously with the resident. When asked if CNAs determined the type of lift to use to transfer residents, the Administrator did not provide an answer. They were asked to clarify the inconsistencies in statements from the both the resident and RN E who stated only one CNA transferred the resident and CNAs G and F's statements that it was 2 CNAs. The Administrator replied he was told two CNAs transferred the resident. Review of CNA G's completed training included CNA Transfer/Lifting Competency Test completed one year ago, on 2/09/23. The facility policy, Safe Resident Handling/Transfers implemented 11/03/2020 and revised 11/29/22 read: It is the policy of this facility to ensure that residents are handled and transferred safely to prevent or minimize risks for injury and provide and promote a safe, secure, and comfortable experience for the resident. Two staff members must be utilized when transferring residents with a mechanical lift. Review of the CNA job description included duties to ambulate and transfer residents utilizing appropriate assistive devices and body mechanics. The resident sample was expanded to include five additional residents who were identified as requiring a mechanical lift for transfers. Review of immediate actions to remove the Immediate Jeopardy implemented by the facility revealed the following, which were verified by the survey team: * On 2-09-24, staff members involved were given 1:1 education by the Staff Development Coordinator on the proper use of mechanical lifts. * On 2-09-24 through 2-15-24 current nursing staff and therapy staff were educated on the transfer of residents and the use of the mechanical lifts by the Director of Nursing, Staff Development Coordinator and Nurse managers. Twenty five nursing staff members were educated on 2-09-24, 8 nursing staff members were educated on 2-12-24, 5 nursing staff were educated on 2-13-24, 1 nursing staff was educated on 2-14-24, 50 staff members were educated on 2-15-24. Newly hired staff members and agency staff will be educated during the orientation process. Staff members that are on vacation will receive education prior to the start of their next shift. * On 2-12-24 through 2-15-24 current staff were educated on ANME (Abuse, Neglect, Misappropriation, Exploitation) by Staff Development Coordinator, Nurse Managers and Department Heads. On 2-12-24, 18 facility staff members were educated, on 2-13-24, 17 facility staff members were educated, and on 2-15-24, 89 staff were educated. Newly hired staff members and agency staff will be educated during the orientation process. Staff members that are on vacation or FMLA will receive education prior to the start of their next shift. * On 2/16/24, out of 88 Total nursing and therapy employees-77 nursing and therapy employees received education on the use of the mechanical lifts. * On 2/16/24, out of 124 Total facility employees, 103 Facility staff received education on ANME. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 28 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete * Ad Hoc Quality Assurance and Performance Improvement (QAPI) meeting was held on 2-16-24 with Medical Director, Administrator, DON, Staff Development Coordinator, Therapy Director, and Unit Manager to discuss transfer status, mechanical lift use and root cause analysis. Interviews conducted from 2/17/24 with 13 facility staff including licensed nurses and CNAs revealed they were knowledgeable about the facility's transfer policy, and the need to review the care plan and [NAME] to identify number of persons and mode of transfer or which mechanical lift for resident transfers. They verified a return demonstration was completed after the education. They confirmed they received Abuse/Neglect education followed by a post test. Event ID: Facility ID: 105332 If continuation sheet Page 29 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure enteral feeding was infused as prescribed by the physician for 1 of 2 residents reviewed for tube feeding, of a total sample of 45 residents, (#83). Enteral feeding refers to intake of food via the gastrointestinal (GI) tract. (Retrieved from https//www.healthline.com 2/27/24). Findings: Resident #83, a [AGE] year-old female was admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnoses included diabetes type II, asthma, gastrostomy, heart failure, hyperlipidemia, hypertension, and major depressive disorder. Review of the resident's quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed the resident's cognition was intact with a Brief Interview for Mental status (BIMS) of 15 out of 15. The assessment revealed the resident had a feeding tube, and received a mechanically altered, and therapeutic diet. The resident's physician's order dated 9/16/23 noted Glucerna 1.5 continuous at 65 milliliters (ml) per hour for twenty (20) hours per day, off at 8:00 AM to 12:00 PM. The Nutrition Risk Screen dated 12/06/23 revealed the resident's tube feeding was Glucerna 1.5 at 65 ml/hour for 20 hours. On 2/13/24 at 1:33 PM, resident #83 was observed with enteral feed Glucerna 1.5 connected to a feeding pump and infusing at 75 ml/hour. The bottle was dated 2/13/24, no time was documented, and 750 ml of the formula remained in the bottle. On 2/14/24 at 11:59 AM, resident #83 was observed lying in bed on her back, with the head of the bed elevated at approximately 45 degrees. The resident's eyes were closed, and there was no response when spoken to. Glucerna 1.5 bottle dated 2/13/24 was noted at the feeding pump, and infused at 75 ml per hour. On 2/14/24 at 2:41 PM, observation showed enteral feed Glucerna via feeding pump infused at 75 ml per hour, with 200 milliliters remaining in the bottle. On 2/14/24 at 2:43 PM, Licensed Practical Nurse (LPN) B stated resident #83 was on enteral feed, Glucerna 1.5 at 75 ml per hour, off at 8 AM, and back on at 12 PM. Review of the resident's physician orders conducted with the LPN showed order for Glucerna 1.5 at 65 ml/hour. On 2/14/24 at 2:56 PM, observation of the resident's enteral feed was conducted with LPN B. Glucerna 1.5 bottle dated 2/13 9 PM, labeled with rate 75 ml, was hanging, and infusing via a feeding pump at 75 ml/hour. LPN B stated she usually checked, but when she received report at the beginning of her shift, she was told a bottle was already hanging, and running, and she did not check the rate. She verbalized the enteral feed should be infusing at 65 ml/ hour. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 30 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 2/14/24 at 3:01 PM, the Director of Nursing (DON) stated the expectation was that nurses would check physician orders, to ensure enteral feed was infusing as ordered. The resident's care plan At risk for Malnutrition related to diabetes . gastrostomy status .enteral feeding .was initiated on 8/31/23, with revision on 10/12/23. A goal was to maintain nutritional status, and interventions included, Provide enteral feeding as ordered. The facility's policy Care and Treatment of Feeding Tubes implemented on 11/03/20, and reviewed/revised on 1/2024 read, Feeding tubes will be utilized according to physician orders, which typically include: the kind of feeding and its caloric value, volume, duration, mechanism of administration, and frequency of flush. The document directed staff to provide Periodic evaluation of the amount of feeding being administered for consistency with practitioner's orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 31 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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, interview, and record review, the facility failed to ensure Oxygen (O2) therapy was administered at the correct flow rate as per the physician's order and care plan intervention for 1 of 1 resident, reviewed for O2 therapy, of a total sample of 45 residents, (#2). Residents Affected - Few Findings: Review of the clinical record revealed resident #2, a [AGE] year-old female was admitted to the facility on [DATE]. Her diagnoses included diabetes type II, Chronic Obstructive Pulmonary Disease (COPD), heart disease, psychosis, dementia, blindness of her right and left eye, anxiety disorder, and cognitive communication deficit. The resident's quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed the resident's cognition was severely impaired with a Brief Interview For Mental Status (BIMS) score of 3 out of 15. The assessment revealed the resident was dependent on staff assistance for eating, toileting hygiene, and personal hygiene, and indicated the resident received O2 therapy. The resident's physician order dated 7/26/21 noted O2 at 2 Liters per minute (LPM) continuous via nasal cannula (NC) every shift, related to shortness of breath. On 2/13/24 at 1:45 PM, observation showed resident #2 resting in bed, O2 via NC, was infusing at 3 LPM. On 02/13/24 at 1:50 PM, the East Wing Unit Manager (UM) stated the resident was on O2 at 2 LPM, per physician orders. On 2/13/24 at 1:52 PM, observation of O2 settings for resident #2 was conducted with the UM. She confirmed O2 therapy was being administered at 3 LPM, not 2 LPM as ordered by the physician. The UM stated nurses should review physician orders and ensure O2 was on the correct setting. On 2/13/24 at 2:02 PM, the resident's primary nurse, Licensed Practical Nurse (LPN) B, stated O2 setting would be reported on during shift report, and a review of the physician order would be conducted. She said usually she checked O2 therapy in the morning, and again before her shift ended. She verbalized O2 therapy was a physician order and should be followed as ordered. On 2/13/24 at 4:55 PM, the Director of Nursing (DON) stated the expectation was that nurses should ensure O2 was administered as ordered by the physician. A review of the resident's care plan for COPD and at risk for respiratory complications initiated 3/03/23 directed staff to administer nebulizer treatments and oxygen therapy as ordered. The facility's policy Oxygen Administration implemented on 11/2020, and reviewed/revised on 5/04/22 read, Oxygen is administered under orders of a physician. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 32 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and interview, the facility failed to follow physician orders for 1 of 5 residents reviewed for unnecessary medications of a total sample of 45 residents, (#57). Residents Affected - Few Resident #57 was admitted to the facility on [DATE] with diagnoses to include diabetes, hypertension, dementia, and depression. Review of the physician orders indicated the resident received Glimepiride, Januvia, Metformin, and Novolog insulin by sliding scale for diabetes. Review of the Medication Regimen Review for January 2024 indicated a recommendation to change Glimepiride 4 milligrams (mg) (long-acting agent) to a short acting agent ( Glipizide). The review noted the physician agreed with the recommendation and on 1/05/24 ordered Glipizide 2 mg. daily. Review of the order in resident #57's medical record read, Glimepiride 2 mg and not Glipizide 2 mg which was ordered. On 2/17/24 at 2:58 PM, the Director of Nursing (DON) stated her expectation was to have the pharmacy recommendations completed within 72 hours. She stated her process was to hand the recommendation to the physician and request the physician to complete the form and hand it back to her. The DON said when the recommendation form was returned to her, she transcribed the orders into the electronic health record. The DON said, I completed all the recommendations in one day, on January 5, 2024. She acknowledged she entered the medication order incorrectly and stated it was probably because she completed all the orders in one day. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 33 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on interview, and record review, the facility failed to ensure the Quality Assurance and Performance Improvement (QAPI) committee implemented effective Performance Improvement Plans (PIPs) to correct and monitor identified deficiencies, and ensure sustained improvements. Findings: In a joint interview with the Nursing Home Administrator (NHA) and Director of Nursing (DON) on 2/17/24 at 3:51 PM, the NHA stated the facility's QAPI committee implemented PIPs to address regulatory noncompliance identified during surveys, and as needed. The DON provided a document dated 6/09/23 that she identified as a PIP for falls. She explained the Regional Director of Operations had re-implemented the plan on 2/16/24. She noted they intended to identify opportunities for improvement related to fall occurrences that included investigations and identification of the root causes and stated, so we can put a true intervention in place. The NHA said regulatory compliance was discussed when any entity visited the facility whether it was a State Agency, Department, or the Ombudsman. He stated there was an Ad Hoc meeting held in December after a complaint survey for falls, and there were none in January 2024. He explained, any identified problems were discussed in morning meetings and regular QAPI meetings. He stated PIPs were discussed monthly for monitoring, improvement tracking, and revision. He said if the problems improved, they were tracked quarterly until they were removed. The NHA explained that in August 2024, the facility developed a Resident Engagement Program to provide increased supervision for residents with a high fall risk. He said he wasn't sure if the facility had monitored their PIPs with documentation and /or audits. The DON said she was not aware of any documentation. The NHA stated, I guess we don't have them; I don't know where they could be. The NHA provided copies of signature pages from QAPI meetings from the previous year. He provided an additional document dated 1/05/24 that he identified as a PIP for improvement in the timeliness of processed applications. He explained, the PIP included plans to have all documentation within 72 hours, and the former Business Office Manager was supposed to update him weekly on the status of all open applications. He said the Business Office Manager had not completed the interventions or met the standards and stated, it didn't work out that well, so we are going to be starting over. On 2/17/24 at 8:30 AM, the NHA said he investigated a resident's fall in the facility that occurred on 2/08/24 and resulted in a fracture. He explained he interviewed the staff involved over the telephone. He said he had not interviewed the resident, and his investigation had not included a staff return demonstration of the incident. He explained his investigation concluded a Facility Related Incident report was not required. He said he was not aware the staff involved provided inconsistent recollections to surveyors during their interviews. Review of the facility's regulatory compliance history revealed the nursing home had repeat deficiencies at

F609 and F610 identified during the 2 prior complaint surveys on 11/15/23, and 5/9/23. The facility had a prior Immediate Jeopardy at F689 one year ago, on 2/17/23 and on 4/13/2021. The facility's policies and procedures titled Quality Assurance and Performance Improvement (QAPI) dated 8/08/22 read, .Adverse Event is an untoward, undesirable and usually unanticipated event that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 34 of 35 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 105332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winter Park Care and Rehabilitation 2970 Scarlett Rd Winter Park, FL 32792 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some causes death or serious injury, or the risk thereof, including near misses. High Risk refers to care or service areas associated with significant risk for the health or safety of residents . Performance Improvement (PI) is the continuous study and improvement of processes with the intent to improve services or outcomes, and prevent or decrease the likelihood of problems, by identifying opportunities for improvement, and testing new approaches to fix underlying causes of persistent/systemic problems or barriers to improvement. Quality Assurance (QA) is the specification of (1) standards for quality of care, service and outcomes, and (2) systems throughout the facility for assuring that care is maintained at acceptable levels in relation to those standards. QAPI is the coordinated application of two mutually reinforcing aspects of a quality management system: (QA) and Performance Improvement (PI). 4. The facility will maintain documentation and demonstrate evidence of its ongoing QAPI program. Documentation may include . b. Systems and reports demonstrating systematic identification, reporting, investigation analysis, and prevention of adverse events. c. Documentation demonstrating the development, implementation, and evaluation of corrective actions or performance improvement activities. 5. The plan and supporting documentation will be presented to the State Agency or Federal surveyor at each annual recertification survey and upon request. 3. Program Feedback, Data Systems, and Monitoring -- a. The facility maintains procedures for feedback, data collection systems, and monitoring including adverse event monitoring. The Facility Assessment Executive Summary read, Date of Assessment/Update: 9/19/2023 . Date Assessment Reviewed with the Quality Committee: 9/20/2023 . 3.2b Staffing Plan . quality assurance . 3.4 Policies and Procedures for Provisions of Care . QAPI will evaluate what policies and procedures may be required in the provision of care, and how you ensure those meet current professional standards of practice, include, our process to determine if new or updated policies are needed, and how they are developed or updated. Examples of policies and procedures include . fall prevention . 3.5a Expectations . QAPI committee will meet quarterly to discuss standard, protocols and help develop the best quality of care for residents. This will include working medical professionals, MD [Medical Doctor], physician, ARNP [Advanced Registered Nurse Practitioner], etc. to develop, adjust or implement process and protocols . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105332 If continuation sheet Page 35 of 35