Inspection visit

InspectionFebruary 12, 2025

REHAB & HEALTHCARE CENTER OF CAPE CORALCMS #10534218 citations on this visit

18 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 18 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0558 Reasonably accommodate the needs and preferences of each resident. 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 accommodate smoking needs and preferences for 1 (Resident #470) of 2 reviewed for smoking, who required a specialized chair for transport to the smoking area, which was not available, that prevented the resident from smoking. This failure caused unnecessary anxiety to the resident, who was a long-term smoker, who required assistance from the facility staff and specialized equipment to get to the designated smoking area. Residents Affected - Few The findings included: Review of the facility policy for Resident Rights Effective November 2024 noted the facility strives to assure that each resident has a dignified existence and self-determination (Self-determination is a set of concepts and values that people with disabilities should have the freedom and support to decide how they live and participate in the community) Review of the facility policy for Smoking/Tobacco Use Effective October 2021, the facility permits smoking and use of tobacco products in accordance with state-specific regulations .The objective of this policy and procedure is not to discourage or restrict one's smoking privileges, but to promote safety for residents, visitors, and employees. Page 2 - The Nursing Home Administrator (NHA) and facility Interdisciplinary Team (IDT) will determine the needs of the residents and establish smoking times . Page 3 - Provide the smoker with assistance and safety devices indicated. Page 4 - Stop Smoking Assistance: Obtain an order from the physician for the use of specific stop smoking assistance techniques and self-help programs (i.e., gum, dermal patches, and oral medications). Review of the Resident Handbook, page 20: Smoking is not permitted inside the facility. Smoking is permitted in the facility's designated smoking areas but only at posted times and under staff supervision. The admission Data Collection and Baseline Care Plan revealed Resident #470 was transferred from another skilled nursing facility and arrived at the facility on 2/5/25 at 5:25 p.m. Diagnoses included right cerebrovascular accident (CVA) with left side affected hypertension, atrial fibrillation, and depression. Resident 470 was oriented to person, place, time and current year and was at the facility for long term care. The Data Collection and Baseline Care Plan revealed Resident #470 smoked and used cigarettes. Resident #470 was not interested in a smoking cessation program. Resident #470's care plan initiated 2/5/25 revealed the resident was a current smoker. Interventions included informing the resident of the smoking policy, informing of designated smoking areas and time, and smoking materials kept by facility staff. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 32 Event ID: 105342 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 02/12/2025 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 0558 Resident #470's smoking evaluation not completed until 2/11/25, six days after admission. Level of Harm - Minimal harm or potential for actual harm On 2/9/25 11:03 a.m., observation of Resident #470 in the bed in the resident's room revealed left sided tightness of the left elbow and hand. The left elbow was bent, and the left hand was drawn to the resident's chest and tightly closed. The resident's left leg was bent and drawn up to the hip area. The resident said she was admitted on [DATE] and her power scooter did not arrive with her. The resident said because of her contractures (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints.) she requires a specialized chair to be transported to the smoking area. She said she told the nurse and several other staff. They told her the chair was coming. She said the chair has not arrived and she has not been able to leave the bedroom. The resident said someone came in to complete the smoking evaluation, but they left and did not come back. Resident #470 said she was going through withdrawal, was miserable. The resident began to cry. Residents Affected - Few On 2/9/25 at 11:15 a.m., in an interview Certified Nursing Assistant (CNA) Staff O said the resident requires a high back chair or something. She said she thinks they are aware of the smoking situation. On 2/9/25 at 11:20 a.m., in an interview the Social Services Director (SSD) said she met with Resident #470 and was not aware of any special issues with the resident. She checked on the resident when she arrived at the facility. She asked the resident if she needed anything, and the resident told her no. On 2/9/25 at 12:41 p.m., in an interview the SSD said she spoke to the resident and went over her goals and the reason she was here at the facility. She said she did not hear of any problems the resident was having. On 2/10/25 at 4:10 p.m., in an interview Licensed Practical Nurse (LPN) Staff W said Resident #470 needed a power chair but it was left at the other facility. Staff W said the resident was unable to smoke and was just lying in bed because the facility did not have a chair for her. She said Resident #470 needed a special high-back chair or Broda chair but the facility only had one and it was currently being used by another resident. On 2/10/25 at 5:06 p.m., in an interview the Rehabilitation Director said they were performing therapy sessions in Resident #470's bedroom because the facility did not have the necessary equipment to transport her out of the bedroom. The Therapy Director said the resident's contractures have been there for years and she needed a special chair to accommodate her transport out of the bedroom. She said Unit Manager LPN Staff M was aware of it. On 2/10/25 at 5:35 p.m., in an interview Unit Manager Staff M said they were trying to find an appropriate wheelchair for Resident #470 so she could get out of bed. She said she met with the resident on 2/6/25. The resident told her she wanted to smoke. Staff M said they did not complete a smoking evaluation since the resident could not leave her room to go smoke. She said the admissions coordinator called the previous facility to arrange for pickup or delivery of the resident's specialized scooter. She said the provider offered the nicotine patch, but the resident declined. Staff M said she did not know the provider's name. On 2/10/25 at 5:57 p.m., in an interview the NHA said he was not aware Resident #470 needed a specialized chair to get out of bed. He said he would obtain a chair from another facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 2 of 32 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 02/12/2025 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete On 2/11/25 at 9:11 a.m., in an interview the Admissions Director said she reviews the medical record before admission and meets the resident if possible. She said she was not aware the resident required a specialized chair. She said she accepted the resident for admission because she thought they had everything in place to accommodate her needs, but they did not. On 2/12/25 at 12:01 p.m., in an interview Resident 470 said she was not offered the nicotine patch in the beginning when it was determined there was no chair for her to be transported outside to smoke. She said at that time she was very upset and anxious and probably would have accepted the nicotine patch. She was not aware that it would take as long as it did (6 days) to acquire a special chair for her to use. Event ID: Facility ID: 105342 If continuation sheet Page 3 of 32 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 02/12/2025 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 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 observations, staff interviews and record reviews, the facility failed to provide a safe, sanitary, and homelike environment as evidenced by dry wall damage in resident's rooms. Failure to identify and complete needed repairs could cause safety and sanitary hazards to residents on Unit 1, which had damage in 8 of 31 rooms. The findings included: On 2/9/25 during the initial tour of Unit 1's resident rooms: observation revealed the drywall and chair-rails behind resident's beds in rooms 6, 9, 14, 18, 21, 35, 37 and 39 were damaged and chair-rails were on the floor. Holes were observed in the dry walls next to the bathroom door in rooms 6, 9, 14, 21, and 39. On 2/9/25 at 10:23 a.m., in an interview with Resident #55, he said the chair rail molding behind bed A and B had been damaged and broken for the past several months. He said he told the staff about the drywall damage in the room, but nothing had been done to repair the drywall damage and the missing chair rails behind the beds in months. The review of the Maintenance Director's Job Description stated they were responsible for the overall maintenance of the facility and provided directions for all activities related to plan operations. Job duties and responsibilities include but were not limited to minor repairs and supervision of the day-to-day repair, improvement and preventive maintenance of the facility to ensure that machines continued to run smoothly, building systems operated effectively, or the physical condition of the facility did not deteriorate. Review of the Physical Environment policy and procedure, effective August 2024, stated a safe, clean, comfortable, and home-life environment would be provided for each resident. Review of the facility policy and procedure titled, Work Orders, with an effective date of April 2017, the policy noted work orders outside of the service reports and equipment records are a mandatory means of maintenance communication. Work orders should be used and completed with priority classification noted by ether the department head or the Administrator. On 2/12/25 at 11:44 a.m., in an interview with the Maintenance Director, he said he was hired as the Maintenance Director 6 days ago. He was told the facility did not have a Maintenance Director for the past several months. He said he was told the Regional Maintenance Director had overseen the continuous maintenance of the facility during the time the facility did not have a full time Maintenance Director. On 2/12/25 at 12:00 p.m., during the tour of residents' rooms on Unit 1, the Maintenance Director confirmed the drywall and chair rails behind resident's beds in rooms 6, 9, 14, 18, 21, 35, 37 and 39 were damaged and chair-rails were on the floor. He also confirmed there was dry wall damage and holes in the drywall next to the bathroom door in rooms 6, 9, 14, 21, and 39. The Maintenance Director said after reviewing the Work Orders in their maintenance computer program, the damage he observed in rooms 6, 9, 14, 18. 21, 35, 37 and 39 were not documented on a Work Order in their computer system as required. He said he was not told of the resident room damage (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 4 of 32 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 02/12/2025 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 0584 identified during the tour. Level of Harm - Minimal harm or potential for actual harm On 2/12/25 at 12:30 p.m., during an interview with the Administrator, he confirmed the facility did not have a full-time Maintenance Director for several months. He confirmed the facility had hired a new Maintenance Director several days ago. He confirmed part of the Maintenance Director responsibilities was to ensure minor repairs and the supervision of the day-to-day maintenance so the building could continue to run smoothly, building systems would operate efficiently, and the physical condition of the facility did not deteriorate as noted by the drywall damage in rooms 6, 9, 14, 18. 21, 35, 37 and 39. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 5 of 32 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 02/12/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the clinical record, and resident and staff interviews, the facility failed to develop a care plan that described the resident's medical, physical, mental and psychosocial needs and preferences and how the facility will assist in meeting these needs and preferences for 1 (Resident #83) of 28 care plans reviewed. The failure to complete an accurate and individualized care plan has the potential to impact the resident's quality of life and quality of care. The findings included: Review of the clinical record revealed Resident #83 was a [AGE] year-old male with a readmission date of 11/8/24. Diagnoses for the resident included hemiplegia (paralysis of one side of the body) and hemiparesis (weakness of one side of the body) following cerebral vascular infarction, anxiety, major depressive disorder, and muscle wasting. The record indicated Resident #83 was on hospice services beginning 1/9/25. A significant change Minimum Data Set (MDS) assessment dated [DATE] documented the resident had a limitation in range of motion (ROM) on both sides of the lower extremities and one side of the upper extremity. The MDS noted Resident #83's cognitive skills for daily decision making were intact. The care plan initiated on 1/9/23 identified Resident #83 was dependent on staff for activities of daily living (ADLs). On 2/9/25 at 11:55 a.m., Resident #83 was observed in bed in a fetal position on his left side. He was noted to hold his left hand in a tight fist and his knees were bent with his heels toward his buttocks. There were no splinting devices or pillows in place to assist the resident with positioning. The resident said he was not able to move his left hand or straighten his legs. During observations on 2/10/25 at 10:01 a.m., and 2/11/25 at 2:14 p.m., Resident #83 was in bed with his left hand in a fist position and his legs and knees drawn up toward his chest and his heels toward his buttocks. He had no splints or positioning devices in place including pillows. Resident #83 said he could move his right leg but when encouraged he was not able to move his leg. On 2/10/25 at 4:35 p.m., in an interview the Director of Rehab said Resident #83 was now on hospice services but had been on case load on and off through the years. The Director of Rehab said therapy had tried all different types of splints and positioning devices for his legs. The resident said would say he was going to wear it and then would refuse. On 2/11/25 at 4:45 p.m., in an interview Registered Nurse (RN) Staff B said she looked in the residents record and found no information regarding the use of splints, pillows etc., for Resident #83's legs contractures. RN Staff B said, I have not been able to find anything that he refused care or splints. He does refuse care all the time. But I did not find any documentation. I know, if it wasn't documented it wasn't done. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 6 of 32 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 02/12/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 2/12/25 at 9:08 a.m., in an interview the Director of Nursing (DON) said she was unaware of the resident's contractures, and the lack of documentation or services for the management of resident #83's contractures. On 2/12/25 at 9:25 a.m., in an interview Care Plan Coordinator Staff I confirmed there was no care plan to address the lower leg contractures for Resident #83. The Care Plan Coordinator said the loss of ROM in the left hand was addressed but confirmed there were no interventions for the left hand including ROM, splints, pillows. Staff I said the Resident #83 was on hospice services and did not receive therapy. Staff I said, We have Interdisciplinary team meetings weekly and there was no mention regarding the presence or care of the lower leg contractures. On 2/12/25 at 10:08 a.m., in an interview Care Plan Coordinator Staff I said Resident #83 received therapy on 11/8/24 after a return from the hospital and he was refusing it. She confirmed the therapy was dated for one day only and was actually an evaluation the resident refused. She confirmed there was no additional documentation of therapy for Resident #83. On 2/12/25 at 10:15 a.m., in an interview RN Care Plan Coordinator Staff H said she completed the Significant change MDS dated [DATE]. She said Resident #83 was not contracted like that when she saw him for the significant change MDS. She said a limitation in ROM does not mean a contracture. She observed the resident and he is contracted now. She confirmed the limited ROM or contracture was not identified in the care plan. On 2/12/25 at 10:43 a.m., in an interview the DON said the facility did not have a restorative program and there was no documentation the direct care staff was educated to provide ROM, or splints to address the resident's contractures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 7 of 32 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 02/12/2025 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 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, review of job description, clinical record review, staff and resident interviews, the facility failed to provide the necessary care and services to maintain personal hygiene for 5 (Resident #24, #69, #72, #83 and #271) of 6 residents reviewed for activities of daily living (ADL's). Residents Affected - Some The findings included: The facility Job Description, Position: CNA's documented The CNA is responsible for assisting with direct residents/patients care. Ensures that each resident's personal care needs are being met in accordance with the resident's/patient' wishes.Bathes residents (recognizing that some residents may physically resist bathing). Gives oral hygiene. Shaves patients. Provides nail and hair care. 1. Review of the clinical record revealed Resident #24 had a readmission date of 10/30/24 with diagnoses including dementia, psychosis, and anxiety. The Quarterly Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date of 1/17/25 documented Resident #24 required substantial to maximum assistance with showers, partial to moderate assistance with toileting and supervision with personal hygiene. The MDS noted Resident #24's cognitive skills for daily decision making were intact. The care plan initiated 3/2/21 identified Resident #24 had an ADL Self Care Performance Deficit and was incontinent of bowel and bladder. The goal specified Will have ADL needs anticipated and met by staff. The interventions included Shower per schedule & as needed; see shower schedule for details. On 2/9/25 at 9:28 a.m., Resident #24 was observed in her bed. Her hair was greasy and matted, her fingernails extended approximately 1/4 inch in length with a brown and black substance under the nails. The resident had a pungent body odor. On 2/10/25 at 9:51 a.m., Resident #24 was observed in bed, her hair was greasy, her fingernails remained long with a brown and black substance under the nails. Resident #24 was lying on her right side in a fetal position. The resident was wearing a shirt and an adult brief. The resident kept repeating, I need a diaper change. On 2/10/25 at 9:59 a.m., Registered Nurse (RN) Staff J said Ok thank you. when informed of the resident's request for an incontinent brief change. On 2/10/25 at 10:17 a.m., 2/10/25 at 10:41 a.m., Resident #24 was was observed in bed in the same position. The call light was on the floor. Resident #24 kept asking for an incontinent brief change. 2. Review of the clinical record revealed Resident #69 had a readmission date of 11/12/23 with diagnoses including quadriplegia, anxiety, need for assistance with personal care, and muscle weakness. The Quarterly MDS dated [DATE] documented Resident #69 had limitations in range of motion on both sides of the upper and lower extremities. The MDS documented the resident was dependent on staff for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 8 of 32 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 02/12/2025 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 0677 showers and required supervision for personal hygiene. Level of Harm - Minimal harm or potential for actual harm The MDS noted Resident #24's cognitive skills for daily decision making were intact. Residents Affected - Some The care plan revised 11/12/23 indicated the Resident has an ADL Self Care Performance Deficit related to quadriplegia. The goal for Resident #69 specified Will minimize risk of decline in ADL self performance. On 2/9/25 at 12:11 p.m., Resident #69 was observed in bed. the left hand fingernails extended approximately ½ in length with brown substances under the nails. In an interview during the observation, the resident said he couldn't cut his own nails, and no one had done it for him. On 2/10/25 at 11:06 a.m., and 2/11/25 at 10:44 a.m., Resident #69 was observed in bed. His fingernails remained approximately 1/2 in in length with a brown substance under the nails. On 2/11/25 at 10:45 a.m., in an interview Resident #69 said, Yes the nails are long but they are not cutting into the skin yet. I will have someone cut them because I can't do it myself. On 2/12/25 at 12:20 p.m., in an interview the Assisted Director of Nursing (ADON) said the expectation if a resident refused care, the CNA was to notify the nurse. The nurse will speak with the resident and document the reason of the refusal of care. 3. Review of the clinical record revealed Resident #72 had a readmission date of 5/8/24 with diagnoses including depression, anxiety and vascular dementia, cerebral infarction, and mood disorder. The Quarterly MDS dated [DATE] documented Resident #72 required substantial to maximum assistance with showers/bathing and partial/moderate assistance with personal hygiene. The MDS noted Resident #72's cognitive skills for daily decision making were severely impaired. The care plan initiated on 3/3/23 documented The Resident has an ADL Self Care Performance Deficit. Resident re-admitted under hospice services for end of life. The goal for Resident #72 specified Will have ADL Needs anticipated and met by staff through next review Date Initiated: 09/01/2022 Revision on: 06/13/2024. The interventions included the resident was totally dependent on staff for ADL's. On 2/9/25 at 9:41 a.m., Resident #72 was observed in bed. The resident looked unkempt with approximately seven days of facial hair growth. His fingernails extended approximately 1/4 of an inch with a brown substance under the nails. On 2/9/25 at 2:09 p.m., in an interview CNA Staff F said Resident #72 required total care and assistance of two for transfers. CNA Staff F said the resident was incontinent and not able to do anything for himself. On 2/10/25 at 10:04 a.m., Resident #72 was observed in bed. He had approximately eight days of facial hair growth. His fingernails remained with a brown substance under the nails. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 9 of 32 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 02/12/2025 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 0677 Level of Harm - Minimal harm or potential for actual harm Review of the CNA documentation for January 2025 revealed Resident #72 was scheduled for showers on Tuesdays and Fridays on the 7:00 a.m. to 3:00 p.m. shift. There was no documentation the scheduled showers were provided on 1/3/25, 1/6/25, 1/7/25, 1/10/25, 1/17/25, 1/21/25, 1/28/25. On 1/14/25 Resident #72 refused his shower. On 1/24/25 and 21/31/25 there was no documentation the resident refused a shower, he received a bed bath. Residents Affected - Some Review of the February 2025 CNA documentation showed on 2/4/25, 2/7/25 and 2/11/25 the resident refused bathing. 4. Review of the clinical record revealed Resident #83 was a [AGE] year-old male with a readmission date of 11/8/24. Diagnoses included hemiplegia and hemiparesis following cerebral vascular infarction, anxiety, major depressive disorder, muscle wasting, mood disorder and psychotic mood disorder. Resident #83 received hospice services. Review of the significant change MDS dated [DATE] revealed Resident #83 had a limitation in range of motion (ROM) on both sides of the lower extremities and one side of the upper extremities. The MDS noted Resident #83's cognitive skills for daily decision making were intact. The care plan initiated on 1/9/23 identified Resident #83 was dependent on staff for ADL's. On 2/9/25 at 11:55 a.m., Resident #83 was observed in bed wearing an adult incontinent brief and a hospital gown. His hair was matted, greasy and extended to his neck. The resident's fingernails extended approximately ½ inch in length with a brown substance under the nails. On 2/9/25 at 1:02 p.m., in an interview CNA staff F said the resident will feed himself but that is all he can do. She said the resident was dependent for his care and he receives a shave when needed. On 2/10/25 at 9:52 a.m., Resident #83's call light was on. In an interview, the resident said he needed water because he had a pill stuck in his throat. He said he was wet and needed to be changed. RN Staff J was informed Resident #83 said he needed water because he had a pill stuck in his throat and also needed to be changed. RN Staff J replied, Ok, thank you. On 2/10/25 at 10:08 a.m., Resident #83's call light was on. Resident #83 asked for water and said he wet and needed to be changed. He was unkempt with long greasy, matted hair, approximately one inch of facial hair growth. His fingernails had a brown substance under the nails. On 2/10/25 at 3:05 p.m., in an interview CNA Staff G said Resident #83 refuses showers. He will resist you and says to leave him alone. When he refuses she tells the nurse. On 2/10/25 at 3:00 p.m., in an interview the Administrator said the expectation is for the staff to check oral care, shaving and nail care daily and provide it if needed. For incontinent care they check the residents every two hours and as needed. The Administrator said staff shower residents according to the shower list and if they refuse, the staff are to notify the nurse. On 2/10/25 at 3:16 p.m., in an interview Unit Manager RN Staff E said Resident #83 was a hospice (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 10 of 32 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 02/12/2025 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some patient and refuses care. RN Staff E said the expectation is for the residents to be cleaned daily. She said she made an appointment with the beautician for Resident #83 for a hair cut and a shave this week. RN Staff E said if a resident is refusing care it should be documented in the progress note, that is, if the CNA lets you know. On 2/12/25 at 8:55 a.m., in an interview CNA Staff C said The shower schedule was at the desk, and we follow it. We shave and cut or clean nails when the resident needs it. If a resident refuses we notify the nurse. On 2/12/25 at 9:21 a.m., in an interview CNA Staff A said, shaving for males is done weekly at the beauty shop and nail care is done by the nurse, we are not allowed to cut fingernails. For showers, there is a list and we follow the shower schedule. CNA Staff A said if a resident refuses care then we let the nurse know. Review of the CNA documentation for January 2025 documented showers were scheduled every Tuesday and Friday on the 3-11 shift. The documentation showed on 1/3/25, 1/7/25, 1/10/25, 1/14/25, 1/21/25 and 1/24/25 Resident #83 received bed baths only. There was no documentation the resident refused care and showers. 5. On 2/9/25 at 10:16 a.m., in an interview Resident #271 said he was not a complainer, but he had not had a shower since he was admitted and would love to feel warm water on his skin. He said he would appreciate a beard trim and have his neck shaved. He said no one has offered a shower or a shave. He said he has a hard time standing but can sit up in the wheelchair. On 2/10/25 at 3:50 p.m., in an interview Resident #271 said he still has not been showered or shaved. The beard was long and covered most of his neck. On 2/10/25 at 4:12 p.m., in an interview LPN Staff W said the rule was showers twice a week by the CNA. She said if the resident refuses, the CNA should report to the nurse, and she will check with the patient and document in the progress notes the refusal. She said she is taking care of Resident #271 and was not aware of any recent refusals. On 2/10/25 at 4:17 p.m., in an interview Unit Manager LPN Staff M said Resident #271's showers were scheduled on Wednesdays and Saturdays on the evening shift. The residents get their beards shaved or trimmed on shower days and by special request. On 2/10/25 at 4:37 p.m., in an interview the Minimum Data Set (MDS) Coordinator said Resident #271 was alert and oriented. She could not recall the resident refusing showers. She said he got a partial bed bath on 1/27/25, partial bed bath on 1/29/25, and a bed bath on 2/1/25. She said there were no behaviors listed for Resident 271. On 2/10/25 at 4:48 p.m., CNA Staff Q said she takes care of the resident on the evening shift, but showers don't fall on her shift. She said Resident #271 never refuses care but she's never shaved him. On 2/10/25 at 5:32 p.m., Staff Q said she shaved the resident but did not ask him if he wanted a shower. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 11 of 32 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 02/12/2025 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 2/12/25 at 10:58 a.m., in an interview CNA Staff O said she took care of Resident #271 during day shift and gave him a good bed bath. She said he has all those tubes and things in the abdomen, and she did not think it was a good idea to give a shower. She said no one ever told her the resident could not get a shower; she just figured it was not a good idea. She said she did not shave or shower him. Review of the care plans for ADLs included instructions for Shower Device: Shower Bed; shower per schedule and as needed; see shower schedule for details, initiated on 1/27/25. Resident 271's care plan did not include refusals of care, including showers. Review of the progress notes failed to show documentation Resident 271 refused showers or care. Review of the CNAs ADL documentation record for 1/2025 and 2/2025 revealed Resident #271's showers were scheduled on Wednesdays and Saturdays on the 3:00 p.m., to 11:00 p.m. shift. On 1/27/25 the resident received a partial bath at 10:55 p.m. On 1/29/25 the resident was given a bed bath at 10:57 p.m. There were no additional entries on the February ADL sheet from 2/2/25 through 2/11/25. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 12 of 32 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 02/12/2025 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and staff interviews, the facility failed to have documentation nursing staff addressed a reported change of condition for 2 (Residents #46 and #66) of 3 residents reviewed for changes that may indicate a change in health status and need to revise the plan of care. Residents Affected - Some The findings included: Review of the facility's policy and procedure titled, Notification of Resident/Patient Change in Condition effective October 2021 revealed, Notify the Physician . if there is a significant change in condition, regardless of the time of day . Review of the facility's Stop and Watch Early Warning Tool noted, If you have identified a change while caring for or observing a resident, please circle the change and notify a nurse. Either give the nurse a copy of this tool or review it with her/him as soon as you can. The symptoms to report included but were not limited to: Overall needs more help, ate less, tired, weak, confused, or drowsy, help with walking, transferring, toileting more than usual. Review of the clinical record revealed Resident #46 was admitted to the facility on [DATE]. Diagnoses included but were not limited to obstructive and reflux uropathy, compression fracture of lumbar vertebra, and history of pulmonary embolism. Review of the admission Minimum Data Set (MDS) Assessment with a target date of 1/15/25 revealed Resident #46 scored 15 on the Brief Interview for Mental Status (BIMS), indicating intact cognition. Diagnoses included but were not limited to Respiratory failure, Cerebrovascular Accident, and Obstructive uropathy (urine flow blockage). The care plan initiated on 1/24/25 noted Resident #46 used an indwelling urinary catheter (catheter inserted in the bladder to drain urine) with risk for infection and/or complications: Uropathy. The interventions included to observe, document, report to the physician signs and symptoms of urinary tract infection which included but were not limited to altered mental status, change in behavior, change in eating patterns. Review of the progress notes revealed: 1. On 2/2/25 at 12:23 p.m., Physical Therapy Assistant (PTA) Staff S documented, PTA facilitated functional transfer from bed to w/c (wheelchair) with max (maximum) assist. Patient reported not feeling well and hot. Checked room air and conditioner not working today. Nurse reports putting info in TELS (Electronic building management platform) . PTA instructed patient with BLE (Bilateral Lower Extremities) exercises with patient unable to follow commands. Returned to nursing and patient placed in bed. Nursing notified . On 2/10/25 at 3:20 p.m., in an interview PTA Staff S said on 2/2/25 when she saw Resident #46, Something with his transfers was more difficult. We got him sitting on the side of the bed, asked him to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 13 of 32 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 02/12/2025 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 0684 Level of Harm - Minimal harm or potential for actual harm reach for the arm rest. He went from a moderate to maximum assistance with transfers. She said, The therapists don't know if there is anything going on medically with the resident, that's why they report their observation to nursing. The clinical record lacked documentation of a nursing evaluation. Residents Affected - Some Review of the TELS log for 2/1/25, 2/2/25 and 2/3/25 showed no documentation of request for repair (work order) for the air-conditioning unit in Resident #46's room. The log noted, There are no completed work orders matching your filters. On 2/11/25 at 11:43 a.m., in an interview the Director of Nursing (DON) said she reviewed Resident #46's clinical record and could not find documentation nursing addressed the concern PTA Staff S reported. She said, If someone brings a resident back and the resident says they're not feeling well, they should document an assessment. 2. On 2/2/25 at 2:14 p.m., Certified Occupational Therapist Assistant (COTA) Staff Y documented in a progress note she reported to the nurse Resident #46 stated he wasn't feeling well. The nurse took the resident's temperature which was 97.1. The clinical record lacked documentation of a nursing evaluation. On 2/2/25 at 4:51 p.m., Licensed Practical Nurse (LPN) Staff W documented a pulse of 66, and a blood pressure of 127/65. On 2/11/25 at 11:43 a.m., in an interview the Director of Nursing (DON) said when COTA Staff Y reported Resident #46 was not feeling well, the nurse took the resident's temperature but there was no documentation the nurse evaluated the resident. The DON said the nurse should have assessed the resident and should have documented her assessment. 3. On 2/3/25 at 4:10 p.m., Occupational Therapist (OT) Staff AA documented a missed session in a progress note. The OT documented the session was withheld due to the resident's status. Resident #46 appeared to be, not at normal baseline with shortness of breath at rest. Unable to get clear reading on vitals (pulse, respiration, blood pressure). Further therapy withheld. Nursing conferred on patient status and notified. On 2/10/25 at 3:00 p.m., in an interview Certified Nursing Assistant Staff N said she remembered Resident #46. She said she reported to the nurse on 2/3/25 that he was not acting right, he was not talking as much and did not eat as much. On 2/11/25 at 11:43 a.m., in an interview the DON said she could not find documentation nursing obtained vital signs or assessed Resident #46 on 2/3/25 when OT Staff AA reported to nursing that therapy was withheld due to patient status, shortness of breath at rest and unable to get clear readings on vitals. She said 911 should have probably been called then. The DON said, When you have therapists hounding you and telling you someone is not feeling well, you should assess the resident and call the doctor. On 2/11/25 at 4:45 p.m., in an interview Occupational Therapist Staff AA said on 2/3/25 when she went to see Resident #46 with the Physical Therapist, he looked pretty sick. Staff AA said, I hope he's alright. She said she tried to get vital signs on different machines but could not get a reading, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 14 of 32 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 02/12/2025 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 0684 including the resident's oxygen saturation. They reported it to RN Staff R. Level of Harm - Minimal harm or potential for actual harm 4. On 2/3/25 at 5:17 p.m., PTA Staff Z documented in a progress note, . Patient is observed to be SOB (short of breath) and isn't as mobile. Therapy after multiple failed attempts to get BP (blood pressure), HR (heart rate), O2 (oxygen) reported patient current condition to nursing and left patient in nursing care . Residents Affected - Some On 2/12/25 at approximately 2:00 p.m., in an interview the Administrator said he reviewed the facility's surveillance video for 2/3/25 and it showed PTA Staff Z saw resident #46 at approximately 1:48 p.m. The clinical record lacked documentation of nursing evaluation addressing the concerns by PTA Staff Z . 5. On 2/3/25 at 5:35 p.m., the Advanced Practice Registered Nurse (APRN) documented in a progress note Resident #46 was seen and evaluated today for ataxic gait and general management of his medical comorbidities. The assessment and plan was to continue with physical/occupational therapy for the ataxic gait; coronary artery disease, aspirin and continue supportive care; atrial fibrillation, continue to monitor heart rate, Gastroesophageal reflux, proton pump inhibitor and continue supportive care. On 2/10/25 at 12:10 p.m., in an interview the APRN said on 2/3/25 she saw Resident #46 before lunch. It was between 10:00 a.m., and 11:00 a.m., but wrote the progress note on 2/3/25 at 5:30 p.m. She said the Certified Nursing Assistant was in the room providing care. Resident #46 was ok and talking with her. She did not notice any signs of distress. She did not look at the resident's urine in the catheter as it was covered and the aide was providing care. She said the resident was alert and oriented and able to say if he wasn't feeling well. She said when she saw him that morning, he did not voice any concerns. He was his normal self. On 2/12/25 at approximately 2:00 p.m., in an interview the Administrator said he reviewed the facility's surveillance video for 2/3/25 and it showed the APRN saw resident #46 at approximately 11:45 a.m. 6. On 2/3/25 at 6:45 p.m., Registered Nurse (RN) Staff B, Evening Supervisor documented in a progress note the resident noted to have increased confusion and shortness of breath. Oxygen saturation was 88 and put onto oxygen at 3 liters. Blood pressure low and call to physician with new orders noted for updraft treatment (nebulizer therapy to deliver medication to the lungs) and give one dose of Solumedrol (steroid) intramuscularly (IM). Updraft treatment and IM Solumedrol given per order. The note did not specify a blood pressure reading. On 2/11/25 at 10:10 a.m., in an interview Evening Supervisor RN Staff B said on 2/3/25 RN Staff R called her to come and evaluate Resident #46. It was around 6:30 p.m. His oxygen saturation was 70%. She put him on oxygen and called the Practitioner on call. The APRN gave an order for the Solumedrol and Oxygen. She said to monitor him and if not better in an hour to send him to the hospital. She said she retrieved the Solumedrol from the emergency drug kit and they administered it to the resident right away. A while later the nurse called again and said Resident #46 got better but then got worse. She went and assessed the resident. His nailbeds were blue. They called 911. RN Staff B said she could not find her handwritten notes with a timeline of the event. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 15 of 32 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 02/12/2025 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of the transaction print out of the emergency drug kit revealed the Solumedrol was removed from the machine on 2/3/25 at 6:27 p.m. 7. On 2/3/25 at 8:05 p.m., Evening Supervisor RN Staff B documented in a progress note the resident was noted with some improvement earlier after updraft treatment and solumedrol injection. She went to see the resident again and he had declined again with lower oxygen level. Vital signs were unstable and oxygen level decreased and the resident was on a non-rebreather (oxygen face mask) at this time. The resident was sent to the emergency room via 911. On 2/11/25 at 5:00 p.m., in an interview RN Staff R said on 2/3/25 she was assigned to Resident #46 when he was sent to the hospital. She said she spent a lot of time with the resident that day, checked his oxygen saturation but did not document her assessments. She said, I am sorry. I am still new here. RN Staff R said she thought RN Staff B the Evening Supervisor would document everything. Review of the hospital record for 2/3/25 revealed Resident #46 presented to the emergency department via ambulance due to concerns of respiratory distress. Emergency Medical Services report the patient was hypotensive (low blood pressure) on scene. They felt as though he was periarrest. They gave him fluids and transported him to the hospital. The patient is unresponsive and in respiratory distress. Patient with agonal respirations on arrival (gasping, labored breathing). Resident #46 was intubated and transferred to the Intensive Care Unit for further management. The admitting diagnosis was sepsis (life threatening complication of an infection). Review of the clilnical record for Resident #66 revealed an admission date of 12/9/24. Diagnoses included rapid atrial fibrillation, muscle wasting, pneumonia, chronic obstructive pulmonary disease and respiratory failure. Review of the admission and discharge log revealed: On 12/27/24, Resident #66 was transferred to the hospital. Diagnoses listed on the hospital 3008 form included intractable nausea and vomiting. On 1/10/25, Resident #66 was transfered to the hospital. Diagnoses upon return included Salmonella enteritis (bacterial infection of the intestines) and rapid Atrial Fibrillation. Review of the heart rate log revealed: On 1/9/25 at 2:55 p.m., the resident's heart rate was76 beats per minute. On 1/10/25 at 11:51 a.m., the resident's heart rate was 135 beats per minute, new onset and irregular. Review of the nursing progress note revealed on 1/10/25 at 6:50 a.m., Registered Nurse (RN) Staff X documented, Resident called nurse for pain medication, and nurse gave her the pain relief medication. The resident asked for ice water, which the nurse gave to her as well. However, the resident kept pouring the water in her basin and said that she needed more water. I gave her ice chips instead because she kept pouring the water in her basin. For that reason, she said that she wanted to go to the hospital because they would treat her better there, and she asked the nurse to have the supervisor to come into the room. The nurse went and told the supervisor about the resident's request. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 16 of 32 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 02/12/2025 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the nursing progress notes and assessments from 1/9/25 at 11:00 p.m. through 1/10/25 at 6:50 a.m., failed to reveal documentation RN Staff X assessed Resident #66 when she requested to go to the hospital. On 1/10/25 at 11:48 a.m., a nursing progress note revealed the practitioner was at the facility, saw Resident #66 and issued an order for the resident to be transfered to the hospital. Review of the practitioner's late entry progress note dated 1/10/25 revealed Attempt at obtaining an IV (intravenous) line were unsuccessful due to hypovolemia and hypotension due to multiple vomiting episodes. Resident is not medically stable and requires hospitalization. On 2/10/25 at 11:44 a.m., in an interview Resident #66 said the incident on 1/9/25 really bothered her. She said on 1/9/25 she had been sick all day with nausea and vomiting. On 1/10/25 at 2:30 a.m., after vomiting all day and vomiting several cups of water, she told Registered Nurse (RN) Staff X she wanted to go to the hospital. Resident #66 said RN Staff X said he could not call the doctor at 2:30 in the morning. She asked to see the supervisor but the supervisor never came. Later on the morning of 1/10/25, she told Unit Manager LPN Staff M she wanted to go to the hospital. Staff M told her the practitioner would be at the facility in 30 minutes to see her. She said LPN Staff M took her pulse and it was 135 beats per minute. On 2/11/25 at 1:43 p.m., in an interview the Risk Manager said she was not aware of the incident involving Resident #66 on 1/9/25 and 1/10/25 until today. She interviewed the resident and RN Staff X. Staff X told her Resident #66 requested to go to the hospital, but he did not contact the provider and did not transfer the resident to the hospital. The risk manager said RN Staff X was suspended pending the outcome of the investigation. The risk manager said RN Staff X that could have initiated the hospital transfer without a doctor's order. It is similar to a resident calling 911 for themselves if they were at home. Review of the facility's investigation initiated on 2/10/25 revealed Resident #66 signed a statement noting, On the day I went to the hospital, around 2:30 a.m., I told (Staff X) I had chest pain and wanted to go to the hospital. He gave me a pain pill and it didn't stay down. I was told the doctor said stay and will see me in the morning. Around 10:30 - 11:00 a.m., a provider came to see me. She said if they couldn't start an intravenous line (IV) they would send me to the hospital. They couldn't get the IV in, so I went to the hospital. In the ambulance they couldn't start an IV. I went to (Hospital name). I didn't tell anyone except my husband, and he was going to call the state. Review of RN Staff X's hand-written witness statement dated 2/11/25 revealed, Resident was asking for water. I gave the resident a cup of water. After a couple minutes, a CNA was passing by the resident's room, and I heard the resident ask the CNA for water. I went into the resident's room and told her that I just gave her water. However, the resident said she threw it up and wanted another cup. I went and got her another cup of water, but that time I did not leave the room fully. I was hiding myself behind the curtain to see what the resident was doing and I saw the resident poured the cup of water in her basin. I told her, Okay, I see what's going on with the water. I will give you ice (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 17 of 32 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 02/12/2025 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some chips instead. I went and gave her a cup of ice chips. The resident kept saying that she wanted to go to the hospital. When I asked her to give me a reason or something to say to the provider, she said that they will treat her better at the hospital because they will give her water there. On 2/11/25 at 4:24 p.m., in an interview Unit Manager Staff M said on 1/10/25 in the morning, Resident #66 refused therapy. She went to see the resident in her room. Resident #66 was pale, sweating, and had an abnormally fast heartbeat at 135 beats per minute (normal heart rate is between 60 and 100 beats per minute). She said she recognized it as an emergency and called the doctor. The doctor ordered Zofran (used for nausea and vomiting). Resident #66 refused the Zofran. She wanted to go to the hospital. The provider came to the facility and gave the order to send Resident #66 to the hospital. On 2/11/25 at 4:56 p.m., Resident #66 said RN Staff X the night shift nurse told her she would be kicked off the physician's service for going to the hospital too many times. She said it was scary at the facility, and she wanted to go home. On 2/12/25 at 1:24 p.m., in an interview Licensed Practical Nurse (LPN) Staff M said she inaccurately documented the vital signs and transfer date on the 1/10/25 hospital transfer form. She obtained the vital signs from 1/9/25, and those vital signs did not portray an accurate description of the resident at the transfer time. Staff M said there was no nursing assessment for the night shift when the resident initially requested hospital transfer. She said if the nurse was not going to call the doctor, he should have assessed the resident and/or sent the resident to the hospital. On 2/12/25 at 3:49 p.m., the Director of Nursing (DON) said she would expect RN Staff X to document a nursing assessment during the night shift when the resident requested transfer to the hospital, but there was nothing in the progress notes, vital signs log or evaluations. The DON said if Staff X was unwilling to contact the physician and the nurse did not transfer the resident, the nurse should have documented that everything was okay. The DON said Staff X was suspended pending the investigation outcome. Review of the Hospital Progress note dated 1/13/25 at 6:40 a.m., noted Resident #66 presented to the hospital with nausea, vomiting and diarrhea going on for two days. The resident was admitted for further evaluation. A stool panel was positive for Salmonella (bacterial infection). Her IV went out and was unable to find an IV per Emergency Medical Personnel . Central line was placed on 1/12. Was continued on IV Amiodarone for rate control, continued hydration. Patient still with reasonable nausea and vomiting . Central line was placed yesterday due to lack of access. Review of the progress note Revealed Resident #66 returned to the facility on 1/20/25, 10 days after she was transfered to the hospital. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 18 of 32 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 02/12/2025 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record review, staff and resident interviews, and review of facility policy and procedure, the facility failed to identify and provide the appropriate services and interventions for the management of contractures and limitations in range of motion (ROM) for 1(resident #83) of 3 residents reviewed for limitations in ROM. The failure to provide the necessary services and interventions has the potential to cause pain and worsening of the contracture and loss of ROM. The findings included: The facility policy Restorative Nursing Programs and Guidelines (revised 10/17) documented The facility provides Restorative Nursing Programs that involve interventions to improve or maintain the optimal physical functioning. Contracture management and prevention.includes the provision of active and or passive ROM exercises/movements to maintain or improve joint flexibility as well as strength. Review of the clinical record revealed Resident #83 was a [AGE] year-old male with a readmission date of 11/8/24. Diagnoses for the resident included hemiplegia and hemiparesis following cerebral vascular infarction, anxiety, major depressive disorder, and muscle wasting. The record indicated Resident #83 was on hospice services beginning 1/9/25. The facility identified Resident #83 had a change in his condition and a significant change MDS standardized assessment tool that measures health status in nursing home residents) dated 1/16/25 documented the resident had a limitation in range of motion (ROM) on both sides of the lower extremities and one side of the upper extremity. The MDS noted Resident #83's cognitive skills for daily decision making were intact. The care plan initiated on 1/9/23 identified Resident #83 was dependent on staff for activities of daily living (ADL's). Review of the Occupational Therapy (OT) Discharge summary dated [DATE] documented LLE (left lower extremity) splint for increased extension/ROM of LLE.PROM/AAROM (passive/active range of motion) of LUE (left upper extremity).Patient denies splint wear tolerance, behavioral outbursts when attempted on LLE increasing caregiver burden and increased risk of contractures and joint stiffness. The OT discharge summary for services from 2/5/24 to 4/30/24 documented, Therapist provided patient with gentle/prolonged stretch of LLE fingers and wrist in preparation for LUE splint tolerance and increased ROM, decreased stiffness needed. Therapist engaged patient in donning LUE hand splint. Patient requires assistance with donning and doffing of bilateral hand splints. On 11/9/24 Resident #83 was referred to OT after an inpatient hospital stay but the resident refused the evaluation. Review of Physical Therapist (PT) progress and discharge summary from 4/11/23 to 4/30/23 documented, the patient presents with right knee flexion contracture.the goal indicated The patient will demonstrate decreased right knee contracture. The goal was not met due to patient not very cooperative (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 19 of 32 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 02/12/2025 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 0688 with PT and inconsistent participation. Level of Harm - Minimal harm or potential for actual harm On 11/4/24 Resident #83 had a PT evaluation and refused services. Residents Affected - Few On 2/9/25 at 11:55 a.m., Resident #83 was observed in bed in a fetal position on his left side. He was noted to hold his left hand in a tight fist and his knees were bent with his heels toward his buttocks. There were no splinting devices or pillows in place to assist the resident with positioning. The resident said he was not able to move his left hand or straighten his legs. During random observation on 2/10/25 at 10:01 a.m., and 2/11/25 at 2:14 p.m., Resident #83 was in bed with his left hand in a fist position and his legs and knees drawn up toward his chest and his heels toward his buttocks. He has no splints or positioning devices in place including pillows. Resident #83 said he could move his right leg but when encouraged he was not able to move his leg. On 2/10/25 at 3:16 p.m., in an interview with Registered Nurse Unit Manager Staff E said Resident #83 refuses and does not tolerate anything for positioning not even pillows. On 2/10/25 at 4:35 p.m., in an interview with the Director of Rehab said Resident #83 is now on hospice services but was on case load on and off through the years. The Director of Rehab said therapy had tried all different types of splints and positioning devices for his legs and he would say he was going to wear it and then would refuse. On 2/11/25 at 11:20 a.m., in an interview the hospice certified nursing assistant (CNA) said she visits twice a week to provide showers/bed bath for the resident. She said, Resident #83 has never been physically aggressive to her but he was very verbally combative, he will curse and yell and say don't touch me, get out. Resident #83 was observed in bed and he was using the bed controls to put the head of the bed up and down repeatedly. He was noted in the same position as previous observations with no positioning devices. The CNA said I wash him, and I put a pillow between his legs because of the pressure. I don't know if he keeps it on or not because I leave after I am done. I was not informed by the facility staff of any splints or anything for him. On 2/11/25 at 11:43 a.m., in an interview the Director of Rehab said Resident #83 was on hospice services and is not followed by therapy unless there was a problem that needed to be addressed. On 2/11/25 at 4:45 p.m., in an interview RN Staff B said she looked in the residents record and found no information regarding the use of splints, pillows etc., for Resident #83's leg contractures. RN Staff B said I have not been able to find anything that he refused care or splints. He does refuse care all the time. But I did not find any documentation, I know, if it wasn't documented it wasn't done. On 2/12/25 at 8:56 a.m., in an interview CNA Staff C said if a resident had a problem with ROM we tell the nurse and the nurse lets therapy know. If they have a splint the directions would be on the inside of the closet door. On 2/12/25 at 9:08 a.m., in an interview the Director of Nursing (DON) said she was unaware of the resident's contractures, and the lack of documentation or services for the management of Resident #83's contractures. On 2/12/25 at 9:25 a.m., Care Plan Coordinator Staff I confirmed there was no care plan to address (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 20 of 32 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 02/12/2025 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 0688 Level of Harm - Minimal harm or potential for actual harm the lower leg contractures for Resident #83. The Care Plan Coordinator said the loss of ROM in the left hand was addressed but confirmed there were no interventions for the left hand including ROM, splints, pillows. Staff I said the Resident #83 was on hospice services and did not receive therapy. Staff I said we have interdisciplinary team meetings weekly and there was no mention regarding the presence or care of the lower leg contractures. Residents Affected - Few On 2/12/25 at 9:41 a.m., in an interview CNA Staff A said she has worked at the facility for three years and Resident #83 has had the left hand and both knee contractures since she started working at the facility. He has not had any splints that I'm aware of. There were two positioning wedges located on top of the closet and the CNA said we do use them when we position him. On 2/12/25 at 10:08 a.m., in an interview Care Plan Coordinator Staff I said Resident #83 received therapy on 11/8/24 after a return from the hospital and he was refusing it. She confirmed the therapy was dated for 1 day only and was actually an evaluation the resident refused. She confirmed there was no additional documentation of therapy for Resident #83. On 2/12/25 at 10:15 a.m., in an interview RN Care Plan Coordinator Staff H said she completed the significant change MDS dated [DATE]. She said she observed the resident and Resident #83 was not contracted like that when I saw him for the significant change MDS. She said a limitation in ROM does not mean a contracture, but he is contracted now. She confirmed the limited ROM or contracture was not identified in the care plan. On 2/12/25 at 10:43 a.m., the DON confirmed the facility did not have a restorative program and there was no documentation of education provided for the staff on ROM, contractures or splints. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 21 of 32 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 02/12/2025 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 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, and staff interviews, the facility failed to provide appropriate care and services to prevent urinary tract infection for 1 (Resident #107) of 2 residents reviewed with indwelling urinary catheter. The findings included: Clinical record review revealed Resident #107 was admitted to the facility on [DATE] and had a re-admission date of 1/23/25. The admission Minimum Data Set (MDS) assessment with a target date of 1/23/25 noted the resident was rarely/never understood. Diagnoses included cerebral infarction, cerebral edema (swelling), compression of the brain, obstructive uropathy (flow of urine is blocked in the urinary tract). Resident #107 had an indwelling urinary catheter (catheter inserted into the bladder to drain urine). The care plan initiated on 12/2/24 noted Resident #107 used a urinary catheter with risk for infection and/or complications related to retention. The goal was for early identification and treatment of UTI (urinary tract infection). The interventions included but were not limited to: Provide catheter care daily and as needed. Review of the Interdisciplinary Team progress note dated 12/10/24 revealed Resident #107 was recently started on antibiotics related to a complicated urinary tract infection with the addition of prophylactic methenamine (anti-infective) due to history of recurrent urinary tract infections. On 2/12/25 at 4:59 p.m., Certified Nursing Assistant (CNA) Staff BB and CNA Staff CC were observed providing incontinent care and catheter care to Resident #107. The Director of Nursing (DON) was in the room observing. A wash basin with soapy water was observed on the resident's over the bed table. When asked about the soap used for catheter care, the DON said CNA Staff BB used the soap from the hand soap dispenser in the bathroom. CNA Staff BB donned gloves and used a washcloth with the soapy water. She wiped between the resident's right and left thighs and outer labia from front to back. CNA Staff BB used another washcloth with soapy water and wiped the resident's inner thighs. She used another soapy washcloth and wiped the resident from back to front (rectal area to catheter insertion site). CNA Staff CC stopped her and instructed her to wash from front to back. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 22 of 32 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 02/12/2025 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 0690 Level of Harm - Minimal harm or potential for actual harm CNA Staff BB did not reply and turned the resident to her side. She said she was done with the catheter care. On 2/12/25 at 5:10 p.m., in an interview the DON said CNA Staff BB did a great job with the perineal care and catheter care. Residents Affected - Few Review of the facility's competency for Perineal Care/Catheter care revealed: Female residents: 1. Applies a small amount of liquid soap to each wash cloth as it is being used. 2. Cleans in a downward motion from front to back. 3. Properly separates labia for procedure. 4. Changes water and repeats procedure to remove soap, changes gloves, washes hands and re-gloves. 5. Dries entire perineal area, using a blotting motion from front to back. Catheter care Male and Female For those residents with foley catheters: PCAs (Patient Care Assistants) may need additional wash cloths. 1. PCA uses a wash cloth for the cleaning with soap and rinsing with changed water. 2. Catheter is held with thumb and index finger where it exits the urethral meatus. 3. Catheter is cleansed downward from the meatus exit four inches. On 2/12/25 at 5:15 p.m., the facility's perineal care, catheter care step by step list was reviewed with the DON. The DON said the CNAs did not provide perineal care or catheter care correctly which placed the resident at risk for urinary tract infection. She verified CNA Staff BB did not follow the steps in the list for the catheter care and perineal care. Review of CNA Staff BB's competency review revealed on 4/25/24 CNA Staff BB completed a competency related to performing female perineal care, and catheter care. CNA Staff BB also attended an in-service on 1/6/25 on perineal care and catheter care, using the step by step list. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 23 of 32 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 02/12/2025 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 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. Based on observation, review of facility policy and procedure, record review and staff interview the facility failed to follow physician's orders for an abdominal binder over a feeding tube for 1 (Resident #26) of 1 resident reviewed, to prevent pulling and accidental removal of the tube. The findings included: The facility policy Medication Administration General Guidelines documented The individual who administers the medication, records the administration on the resident's MAR immediately following the medication being given. If a scheduled medication is withheld, refused, the space provided on the front of the MAR/TAR (treatment administration record) for that dosage administration is initialed and circled. An explanatory note is entered. Review of the clinical record revealed Resident #26 had a readmission date of 1/28/25 with diagnoses including dysphagia, need for assistance with personal care, delusional disorders, and obesity. The record indicated the resident was Spanish speaking only. A nursing progress note with a date of 1/30/25 documented SOC (standards of care) meeting today. Resident readmitted to facility 2 days ago after hospitalization. Resident previously pulled her feeding tube out and was reinserted during hospitalization. Abdominal binder in place for protection to be removed for skin integrity checks and feeding tube care every shift. Will continue to monitor. A physician order dated 1/30/25 instructed Maintain abdominal binder in place. Remove for PEG tube care and to monitor skin integrity, every shift for monitoring skin integrity. On 2/9/25 at 12:07 p.m., during an observation Resident #26 was in bed wearing a hospital gown she had pulled up, exposing the feeding tube. The feeding tube insertion site was leaking on resident's gown. There was no abdominal binder covering the feeding tube. On 2/9/25 at 1:20 p.m., during an observation of the feeding tube with Registered Nurse (RN) Staff K said the resident was to have an abdominal binder on because she will pull the feeding tube out, but they could not find it. She had the feeding tube covered with a towel and the towel had a large stain form the leaking tube feeding. RN Staff K said the resident had recently pulled the feeding tube out twice. A review of the Treatment Administration Record (TAR) revealed RN Staff K had signed the TAR for the day and evening shifts indicating the abdominal binder was in place. On 2/10/25 at 3:23 p.m., Resident #26 was in bed, the room door was open. The resident had the covers down and her shirt up. She had the feeding tube in her hand pulling on the tube. A review of the TAR revealed the abdominal binder was signed on the TAR as applied by the nurse for the day and evening shift on 2/10/25. On 2/10/25 at 3:44 p.m., an observation with RN Unit Manager Staff E verified the abdominal binder had not been applied for resident #26 as ordered by the physician. She said it was sent to the laundry to be washed. RN Staff E confirmed if the abdominal binder was not available, the nurse should (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 24 of 32 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 02/12/2025 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 0693 not have documented it was applied. Level of Harm - Minimal harm or potential for actual harm On 2/11/25 at 10:00 a.m., RN Staff K said she did not sign the TAR to indicate the abdominal binder was in place on 2/9/25. RN Staff K said it was in the laundry and so we used a sheet and wrapped it around her abdomen because she has pulled the feeding tube out twice now. RN Staff K confirmed she had signed the TAR indicating she had applied and checked the placement of the abdominal binder Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 25 of 32 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 02/12/2025 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to ensure short peripheral catheter (a thin, flexible tube is inserted into a vein, usually in the back of the hand, the lower part of the arm) cover dressing was changed every 7 days to prevent local and systemic infection related to the intravenous (IV) catheter for 2 residents (271 and 23) of 3 reviewed for IV catheters. Residents Affected - Few The findings included: Review of the policy for Vascular Access Devices and Infusion Therapy Procedures Dressing Change for Vascular Access Devices dated 10/2024, the purpose is to prevent local and systemic infection related to the IV catheter. A sterile dressing is maintained on all peripheral and central vascular access devices to protect the site, provide microbial barrier, and to provide vascular access device securement. Short peripheral catheter dressings are changed every 7 days or when the integrity of the dressing is compromised. On 2/9/25 at 10:16 a.m., Resident #271 was observed in bed with intravenous (IV) antibiotic infusing through an IV line inserted in the resident's right upper arm. The insertion site dressing dressing was dated 1/22. Photographic evidence obtained. On 2/9/25 at 10:40 a.m., Licensed Practical Nurse (LPN) Supervisor Staff V entered the bedroom and observed the IV dressing. In an interview LPN Staff V stated, The IV cover dressing is outdated and should be changed every 7 days. Review of Resident 271's Medication Administration Record (MAR) for February 2024 revealed a physician's order written on 1/27/25 at 1:50 p.m. to change the IV cover dressing every 7 days and as needed for soiling or dislodgement. The MAR contained documentation that the nurse signed off the dressing was changed on 2/3/25. Review of Resident #271's care plans revealed a care plan initiated on 1/28/25 for IV medications with instructions to check the IV catheter site daily and change the IV dressing per physician's orders and facility policy. Review of the progress notes from 1/27/25 through 2/11/25 revealed no documentation Resident #271 refused to have the IV cover dressing changed. On 2/9/25 at 10:54 a.m., Resident #23 was observed with an IV insertion site to the left upper arm. The dressing was dated 1/31/25. The dressing was eight days old. Photographic evidence obtained. Review of Resident #23's MAR for February 2024 revealed a physician's order dated 1/31/25 at 4:56 p.m. to change the IV cover dressing every 7 days and as needed for soiling or dislodgement. The MAR contained documentation that the nurse signed off the dressing was changed on 2/1/25 and 2/8/25. Review of Resident #23's care plans revealed a history of refusing care including medications and activities of daily living care dated 7/17/23. The care plan did not include information Resident #23 refused IV catheter dressing change. Review of the nursing progress notes from 1/30/25 through 2/12/25 revealed no documentation that Resident #23 refused to have the IV cover dressing changed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 26 of 32 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 02/12/2025 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 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete On 2/12/25 at 9:06 a.m., in an interview the Director of Nursing (DON) said the IV dressings are changed every seven days to prevent infection. The DON said the nurses did not follow physician's orders to change the dressings for Resident #271 and #23. The DON said the expectation is the nurse signs off when a task is completed and not prior to completing the task, in case the nurse does not get to the task because of being side-tracked or forgetting to do it. She said the MARS for February 2024 for both Residents #271 and #23 were incorrect. She said the nurses documented completion of dressing changes that were not done. Event ID: Facility ID: 105342 If continuation sheet Page 27 of 32 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 02/12/2025 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, clinical record review and staff interviews the facility failed to ensure a medication error rate less than 5 percent. 29 opportunities, 5 residents and four different nurses were observed. Four medication errors were identified resulting in a medication error rate of 13.79%. Residents Affected - Some The findings included: On 2/9/25 at 9:15 a.m., Registered Nurse (RN) Staff R was observed administering 11 different medications to Resident #470, including: Lidocaine Patch 5% (topical anesthetic), one patch to the resident's left shoulder and one patch to the resident's left knee. Loratadine (antihistamine) 10 milligrams (mg), one tablet by mouth. Venlafaxine 75 mg (antidepressant), one tablet by mouth. Reconciliation of the medication administration observation with the physician's orders revealed the current physician's orders included: Lidocaine external patch 4%, apply to left shoulder/left leg topically one time a day for chronic pain. Venlafaxine HCL (Hydrochloride) 75 mg, give one tablet by mouth one time a day related to Major Depressive Disorder, administer with 37.5 mg total to be administered is 112.5 mg. The physician's orders included to administer Cetirizine 10 mg, one tablet one time a day for allergies. The medication was scheduled to be administered daily at 9:00 a.m. RN Staff R was not observed administering the Cetirizine as ordered. Complete review of the clinical record failed to reveal a physician's order for Loratadine 10 mg administered to the resident. On 2/9/25 at 3:22 p.m., in an interview RN Staff R verified she did not administer Venlafaxine 37.5 mg with the Venlafaxine 75 mg per the physician's order. She verified there was no physician's order for the Loratadine 10 mg she administered to Resident #470. RN Staff R said she administered Loratadine 10 mg instead of Cetirizine 10 mg to the resident. She said, That's an allergy pill, that's what we give. RN Staff R asked if the Loratadine and Cetirizine were not the same thing. She said she did not realize the strength of the Lidocaine patches she applied to the resident's left shoulder and left knee were 5%. She did not realize the physician's order was for Lidocaine patch 4%. On 2/9/25 10:11 a.m., RN Staff K was observed administering four medications to Resident #60, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 28 of 32 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 02/12/2025 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 0759 including one tablet of Torsemide 10 mg. Level of Harm - Minimal harm or potential for actual harm Review of the physician's orders for Resident #60 revealed to administer Torsemide 5 mg, one tablet by mouth one time a day for Congestive Heart Failure/edema (swelling caused collection of fluid in the tissues). Residents Affected - Some On 2/9/25 at 3:37 p.m., in an interview RN Staff K verified the physician's order was to administer Torsemide 5 mg one time a day to the resident. She acknowledged the medication error and said she administered Torsemide 10 mg to Resident #60, which was twice the amount of Torsemide ordered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 29 of 32 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 02/12/2025 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Review of the clinical record for Resident #107 revealed an admission date of 11/27/24 and re-admission date of 1/21/25. Diagnoses included cerebral infarction, cerebral edema (swelling), Hemiplegia (paralysis) and hemiparesis (weakness). Resident #107 was bedbound and dependent on staff for all activities of daily living. Residents Affected - Some Review of the progress note dated 1/22/25 revealed Resident #107 was readmitted with a surgical wound to the sacral area with staples and sutures, and a stage 3 pressure injury to the left ear. On 2/11/25 at 2:00 p.m., Registered Nurse (RN) Staff K was observed changing the dressings to the resident's sacral wound and the stage 3 pressure ulcer to the resident's left ear. Evening Supervisor RN Staff B was assisting with the wound care. RN Staff K donned gloves placed a barrier field on the resident's over the bed table. She placed her supplies, including Mupirocin 2% ointment (antibiotic), Gentamycin 0.1% (antibiotic) squeezed into individual medicine cups, collagen wound dressing, silicone dressing, and opened packs of gauze which she placed into plastic cups. RN Staff K removed the gloves. RN Staff K picked up a bottle of wound cleanser from the treatment cart and dropped it on the floor in the resident's room. She donned gloves, picked up the bottle of wound cleanser and placed it on the barrier field with the rest of the clean and sterile wound care supplies. RN Staff B Evening Supervisor turned Resident #107 to the left. RN Staff K removed the soiled dressing to the resident's right buttock. She removed her gloves, performed hand hygiene and donned a clean pair of gloves. RN Staff K took her glasses from the top of her head and placed them on her face. She did not change gloves or perform hand hygiene. She used the bottle of wound cleanser she picked up from the floor and sprayed wound cleanser on 4 by 4 gauze. She wiped the resident's wound multiple times, going from the wound to the surrounding area, wiped between the resident's buttocks and wiped back into the wound. RN Staff K did not remove her gloves or performed hand hygiene. She used her gloved fingers to apply the mupirocin ointment and the gentamicin ointment in and around the wound. She spread the ointments in the resident's wound, the surrounding skin, between the resident's buttocks and back to the wound bed. She applied a silicone dressing to the wound. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 30 of 32 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 02/12/2025 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 0880 RN Staff K performed hand hygiene and donned gloves. Level of Harm - Minimal harm or potential for actual harm She removed the dressing to the resident's left ear. She sprayed wound cleanser onto 4 by 4 gauze. Residents Affected - Some She removed her gloves and donned a new pair of gloves. She wiped the wound to the left ear multiple times in an up and down motion. She applied a collagen dressing to the left ear and secured the dressing with rolled gauze she wrapped around the resident's head. She removed her gloves, did not wash her hands. She went to the treatment cart, retrieved scissors which she placed on the resident's nightstand. RN Staff K did not clean or sanitize the scissors. She used it to cut the rolled gauze and tape to secure the dressing to the left ear. She then unwrapped the resident's left and right heel without performing hand hygiene or changing her gloves. She applied skin prep (skin protective film) to the resident's heels. On 2/11/25 at 5:30 p.m., in an interview, RN Staff K said she realized she failed to follow infection prevention technique during the wound care which placed Resident #107 at risk for wound infection. RN Staff K said, Thank you for telling me. On 2/12/25 at approximately 12:15 p.m., in an interview the Assistant Director of Nursing said it was not acceptable for the nurse to pick up the bottle of wound cleanser from the floor and use it. Review of the facility's aseptic dressing change skills checklist revealed to apply gloves, remove the soiled dressing, remove gloves, wash hands, cleanse the wound with Normal Saline (Clean to dirty) or other physician ordered cleansing agent. Then, remove gloves and wash hands. Apply gloves perform the wound treatment according to the physician's order. Based on observation, staff interview and facility policy review the facility failed to provide appropriate infection control practices during wound care for 2 (Residents #53 and #107) of 3 residents reviewed for Infection control/Enhanced Barrier Precautions. The findings included: Review of the clinical record revealed Resident #53 was admitted to the facility on [DATE]. Her medical history included Senile Degeneration, Dementia, Weight Loss, and pressure wounds. She had Physician orders for daily wound care. She also had Physician orders for Enhanced Barrier Precautions. There was PPE (Personal Protective Equipment) and a sign on her room door along with a sign over her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 31 of 32 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 02/12/2025 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 0880 bed that said EBP (Enhanced Barrier Precautions); Gown and gloves required. Level of Harm - Minimal harm or potential for actual harm The Policy and Procedure provided by the facility for Barrier Precautions Residents Affected - Some with an effective date of April 2024 stated Enhanced Barrier Precautions (EBP) refers to an infection control intervention designed to reduce transmission or multi-drug-resistant organisms that employ targeted gown and glove use during high contact resident activities. EBP are used in conjunction with standard precautions and expand the use of PPE to donning of gown and gloves during high contact resident care activities that provide opportunities for transfer of MDROs (Multi Drug Resistant Organization) to staff hands and clothing. EBP is indicated for residents with any of the following: 1. Infection or colonization with a CDC (Center for Disease Control)-targeted multi-drug-resistant organism when Contact Precautions do not otherwise apply or, 2. Wounds and/or indwelling medical devices even if the resident is not known to be infected or colonized with a multi-drug resistant organism. On 2/12/2025 at 11:00 a.m., Licensed Practical Nurse (LPN) Staff M, and Registered Nurse (RN) Staff L were observed providing wound care for Resident #53. Staff M, LPN and Staff L, RN only utilized gloves during wound care. After wound care was completed for Resident #53, they were asked if Resident #53 was on EBP precautions. They both answered yes. They were then asked if gowns should have been worn during wound care? They both answered yes. On 2/12/2025 at 11:30 a.m., in an interview the Director of Nursing (DON) and the Regional DON were asked if Enhanced Barrier Precautions Policy required staff to wear a gown and gloves during dressing change for wound care. Both answered yes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105342 If continuation sheet Page 32 of 32

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Citations

18 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0030GeneralS&S Dpotential for harm
List the names and contact information of those in the facility.
0033GeneralS&S Dpotential for harm
Establish methods for sharing information.
0039GeneralS&S Fpotential for harm
Conduct testing and exercise requirements.
0345GeneralS&S Fpotential for harm
Have approved installation, maintenance and testing program for fire alarm systems.
0712GeneralS&S Fpotential for harm
F712 - Frequency of physician visits
Have simulated fire drills held at unexpected times.
0761GeneralS&S Fpotential for harm
F761 - Labeling of Drugs and Biologicals
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
0918GeneralS&S Dpotential for harm
F918 - Bathroom Facilities
Have generator or other power source capable of supplying service within 10 seconds.
0558GeneralS&S Dpotential for harm
F558 - The right to reside and receive services in the facility with reasonable
Reasonably accommodate the needs and preferences of each resident.
0584GeneralS&S Epotential for harm
F584 - Safe Environment
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.
0656GeneralS&S Dpotential for harm
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
0677GeneralS&S Epotential for harm
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
0688GeneralS&S Dpotential for harm
F688 - Mobility
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
0690GeneralS&S Dpotential for harm
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
0693GeneralS&S Dpotential for harm
F693 - Assisted nutrition and hydration
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.
0694GeneralS&S Dpotential for harm
F694 - Parenteral Fluids
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
0880GeneralS&S Epotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0684GeneralS&S Epotential for harm
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
0759GeneralS&S Epotential for harm
F759 - Medication Errors
Ensure medication error rates are not 5 percent or greater.

FAQ · About this visit

Common questions about this visit

What happened during the February 12, 2025 survey of REHAB & HEALTHCARE CENTER OF CAPE CORAL?

This was a inspection survey of REHAB & HEALTHCARE CENTER OF CAPE CORAL on February 12, 2025. The surveyor cited 18 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at REHAB & HEALTHCARE CENTER OF CAPE CORAL on February 12, 2025?

Yes, 18 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "List the names and contact information of those in the facility."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

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Data from CMS Care Compare public records. Dataset last refreshed June 15, 2026. If you believe any information is inaccurate, report it here.

Inspection·February 12, 2025