Inspection·February 22, 2023

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on observation, record review, and staff interview the facility failed maintain an indwelling catheter (tube inserted into the bladder to drain urine) in a safe and sanitary manner for 1(Resident #69) of 1 resident sampled with an indwelling catheter. This had the potential to cause urinary tract infection and complications. The findings included: Review of the clinical record revealed Resident #69 had an admission date of 9/19/22 with diagnoses including dementia, epilepsy and hemiplegia affecting the left side, urinary tract infections and neurogenic bladder (lack of bladder control due to brain, spinal cord, or nerve problem). The Quarterly Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date of 12/21/22 documented Resident #69 required extensive assistance with transfers and bed mobility. The MDS noted Resident #69's cognition was intact. The care plan initiated on 9/19/22 documented the Resident uses a urinary catheter with risk for infection and or complication. The care plan goal specified to minimize the risk of complications associated with catheter usage. The care plan interventions specified, provide catheter care daily and as needed, and keep drainage bag (collects urine from the catheter) below level of bladder. Observations on 2/19/23 at 9:53 a.m., 11:24 a.m., and 3:47 p.m., Resident #69 was in bed. The urinary catheter drainage bag was lying on the floor next to the bed. Photographic evidence obtained. On 2/20/23 at 8:29 a.m., during an observation with Registered Nurse (RN) Staff R, the urinary catheter drainage bag for Resident #69 was lying on the floor next to the bed. RN Staff R confirmed the observation and said the urinary drainage bag should be positioned off the floor. On 2/21/23 at 11:30 a.m., the Regional Nurse Consultant said the facility had no policy regarding catheter drainage bags or care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 2 of 6 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 105342 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehab & Healthcare Center of Cape Coral 2629 Del Prado Blvd Cape Coral, FL 33904 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. Based on observation, record review, review of facility policy, and staff interviews, the facility failed to ensure 1(Resident #69) of 1 resident reviewed for accidents was assessed for alternative interventions prior to the use of bed rails. The facility failed to review the risks and benefits of bed rails with the resident or resident representative and obtain informed consent prior to installation. In addition, the facility failed to have ongoing routine maintenance of the bed rails to ensure they remained safe for resident's use. The findings included: The facility policy Side Rail-Assistive Device (effective 10/21) documented, Side rails will not be used unless or until all other alternative devices have been exhausted. If a side rail is used the facility must ensure correct installation, use and maintenance of rail. Side rails may be a restraint or entrapment risk. Side rails will not be used as a restraint. The facility strives to ensure the safety of residents by following manufacturer's instructions and through preventive maintenance of side rails. Facility will maintain a list of residents utilizing side rails as assistive devices and will routinely audit for appropriate usage, safety and function. Assistive device: Any item used by, or in the care of the resident to promote, supplement, or enhance resident function and or safety. Side rails: include rails of various sizes. Review of the clinical record revealed Resident #69 had an admission date of 9/19/22 with diagnoses including dementia, epilepsy (seizure) and hemiplegia (paralysis) affecting the left side. The Quarterly Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date of 12/21/22 documented Resident #69 required extensive assistance with transfers and bed mobility. The MDS noted Resident #69's cognitive skills for daily decision making was intact. On 2/19/23 at 3:41 p.m., Resident #69 was observed in a low bed, on an air mattress with inflatable sides. The bed had grab bars in the raised position on both sides of the bed. Resident #69 said he did not know what a grab bar was and was not observed using the device. Further review of the clinical record for Resident #69 revealed no documentation of signed consent or alternative interventions attempted prior to the use of the grab bars. On 2/22/23 at 8:25 a.m., the Regional Nurse Consultant (RNC) said she was not able to locate a consent or documentation of alternative interventions before the use of grab bars for Resident #69. The RNC said, it was her understanding grab bars were not considered side rails. The RNC said therapy usually assesses a resident for grab bars, but she found no documentation that therapy assessed the resident prior to the use of the grab bars. The facility failed to provide requested documentation of routine maintenance including assessment of entrapment for use of the grabs used for Resident #69. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 3 of 6 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 105342 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehab & Healthcare Center of Cape Coral 2629 Del Prado Blvd Cape Coral, FL 33904 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation and staff interview, the facility failed to post the required current daily staffing data in a prominent place readily accessible to residents and visitors. Residents Affected - Some The findings included: On 2/19/2023 at 11:21 a.m., the facility daily staffing was posted and reflected a current census of 114 for 2/19/2023. On 2/20/2023 at 7:29 a.m., the facility daily staffing posted and remained dated as 2/19/23 but the census was changed to 111. On 2/20/23 at 3:38 p.m., the facility daily staffing was not updated and remained dated as of 2/19/23. On 2/22/23 at 12:25 p.m., the facility daily staffing was not updated and remained dated 2/19/23 with a census of 111. On 2/22/23 at 12:30 p.m., the administrator stated the staffing coordinator was responsible for posting and updating the staffing numbers. He said The process needed to be posted and updated daily for all visitors or residents to view at the receptionist desk. The administrator stated the staffing should reflect today's date and verified the staff information posted was from 2/19/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 4 of 6 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 105342 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehab & Healthcare Center of Cape Coral 2629 Del Prado Blvd Cape Coral, FL 33904 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on a review of the Consultant Pharmacist's Medication Regimen Review report, and staff interview, the facility failed to have documentation of monthly medication review for 2 (Resident #93, and #27) of 5 residents sampled for unnecessary medication review. The findings included: Review of the facility policy Medication Monitoring Section 8.1 Medication Regimen Review (MRR) and Reporting dated 09/18 Procedures: The consultant pharmacist reviews the medication regimen and medical chart of each resident at least monthly . The findings are communicated to the Director of Nursing (DON) or designee and the medical director. The findings are documented and filed with other consultant pharmacist recommendations in the resident's chart. Resident specific MRR recommendations and findings are documented and acted upon by the nursing care center and/or physician. A record of the consultant pharmacist's recommendations is made available .within 48 hours of completion. The nursing care center follows-up on the recommendations to verify that appropriate action has been taken. Recommendations shall be acted upon within 30 calendar days. 1. Review of Resident #27's clinical record revealed an admission date of 6/14/22. The resident remained at the facility without discharge or transfer to the hospital. Review of the Consultant Pharmacist's Medication Regimen Review from 6/2022 through January 2023 failed to show documentation the Consultant Pharmacist reviewed Resident #27's medication regimen in September 2022 or January 2023. 2. Review of the clinical record for Resident #93 revealed an admission date of 8/17/22. Resident #93 remained at the facility without discharges or transfer to the hospital. Review of the Consultant Pharmacist's Medication Regimen Review from 8/2022 through January 2023 failed to show documentation the Consultant Pharmacist reviewed Resident #93's medication regimen in December 2022. On 2/22/23 at 10:00 a.m., the DON said he could not locate documentation the Consultant Pharmacist reviewed the Medication Regimen for Resident #27 in July 2022 or January 2023. He said he did not have documentation of Medication Regimen Review for Resident #93 for December 2022. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 5 of 6 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 105342 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehab & Healthcare Center of Cape Coral 2629 Del Prado Blvd Cape Coral, FL 33904 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to remove outdated medications from the refrigerator and failed to ensure proper storage of medications to prevent unauthorized access for 1 (Unit 2) of 2 units observed. The findings included: The Facility policy titled: Medication Storage, Section 4.1, dated 9/18, was provided. The policy stated the medication supply shall be accessible only to licensed nursing personnel, pharmacy personnel or staff members lawfully authorized to administer medications. Procedure #3 indicated in order to limit access to prescription medications, only licensed nurses, pharmacy staff, and those lawfully authorized to administer medications are allowed access to medication carts. Medication rooms, cabinets, and medication supplies should remain locked when not in use or attended by persons with authorized access. Procedure #14 indicated outdated, contaminated, discontinued, or deteriorated medications, and those in containers that are cracked, soiled or without secure closures are immediately removed from stock, and disposed of according to procedures for medication disposal. 1. On [DATE] at 12:30 p.m., observation of Unit 2 medication storage room refrigerator with Licensed Practical (LPN) Staff A revealed two pre-drawn tubersol (test to diagnose tuberculosis infection) syringes expired [DATE], and [DATE]. LPN Staff A verified the tubersol syringes were expired and said she would discard them. 2. On [DATE] at 10:32 a.m., an opened box containing seven bottles of medications was observed on the counter of Unit 2's nurse's station. Registered Nurse Staff D closed the box, placed a 3-hole puncher and stapler on the box and walked away from the nurse's station, leaving the box of medications unattended and accessible to residents, visitors and unauthorized staff. 3. On [DATE] at 10:46 a.m., the administrator came to unit 2 nursing station and verified the box of medication was unattended at the nurse's station. He removed the box and stated he would take it to the Director of Nursing (DON). On [DATE] at 3:43 p.m., the DON said he needed to remind and educate staff to lock medication and treatment carts. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 6 of 6