Health inspection·July 16, 2025

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some staff response to call lights. The SSD said resident #2's family had a concern on 2/06/25 regarding poor call bell response time. The SSD verified she did not interview the resident to see what shift or exactly how long it took for her call light to be answered. Her investigative findings indicated no concern with other residents on the unit, however only two of the three residents interviewed used the call lights. The facility action was to remind staff to answer call lights as soon as possible which only included two staff who signed a preprinted form on 2/06/25 that read, When I am working on my assignment, I answer my call lights as soon as possible. If a call light is on and I answer it, If I cannot assist at the moment, I inform my resident I will be there as soon as I can. The form did not have any specific details regarding reasonable time frames to answer call lights or to ask another staff person to assist if they were too busy. The SSD could not provide any sign-in sheets regarding education provided or on what topic. On 2/07/25 the facility documented the concerned party was satisfied but did not record any specifics to the situation or their response/what did they say. The concerns dated 3/19/25 were then reviewed with the SSD who verified another issue with the call light on the floor, the resident needed to get changed, staff not wearing name tags, and air freshener taken away. ADON C was assigned and provided education to staff regarding wearing name tags, answering timely call lights, and placing call bell in reach. Resident #2 was informed about the facility policy on air fresheners. The SSD documented concerned party satisfied on 3/21/25 and did not document exactly what the response was at the time or were there any other concerns. Review of a concern dated 4/07/25 from family revealed the problem was the call light again was not in reach and response time was too long. No one asked the resident or family what shift, or which staff was involved. Nor did they query as to what she needed at the time or what care was not provided. The SSD documented a call light audit was completed and now verified the call light audit consisted of interviewing three alert and oriented residents but not physically timing the staff on various shifts. It was noted on the form dated 4/07/25 that the party concerned was satisfied without any further explanation as to what they said or if they had any other concerns. On 5/22/25 the SSD said, the family had concerns regarding the call light not being answered for four hours. The SSD explained that she, as well as the Director of Therapy and ADON C went down to the unit to ascertain what transpired and determined through interview with the staff that it was 1 1/2 hours that the resident did not get care because the family arrived at 12:00 PM and the Certified Nursing Assistant (CNA) had last provided care at 10:30 AM. The concerned party was not pleased with the facility action, and an in-service was provided to staff which included answering call lights timely and keeping them in reach. On 7/15/25 at 4:51 PM, ADON C said the call light complaints were ongoing with resident #2 and her family. ADON C said, a reasonable time she would expect staff to answer call lights was approximately 10 minutes. She explained the staff should at least try to find out what the resident needed and then let them know they would be back. ADON C said she received a three-page email on 6/03/25 regarding resident #2's concerns from the family but the facility did not initiate a grievance for this because they met with the family the next day at a care plan meeting. She recalled the email was about their concerns regarding bathroom transfer protocol, and communication. ADON C acknowledged the follow up was vague and incomplete, and said when the family raised concerns they were told education was being provided but the issues may happen again with their concerns for hospice and pain management, seeking clear guidance from team and hospice. ADON C added, the family wanted clear communication, concrete actions and not just reassurance and education. On 7/15/25 at approximately 5:36 PM, the SSD said she was the Grievance Coordinator for the facility. She explained that she had been in her role for 1 1/2 years and that she was the assistant to the prior SSD. She said the ED signed off on all the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105365 If continuation sheet Page 2 of 5 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 105365 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Altamonte Springs 989 Orienta Ave Altamonte Springs, FL 32701 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete facility grievances as well. On 7/15/25 at 5:55 PM, the ED said he was aware of unresolved grievances with resident #2 and wound be providing the SSD with some additional education. He acknowledged that the facility has not done any physical call light time audits and that they should have initiated a grievance after they received email with numerous concerns from the family on 6/03/35. The facility policy and procedure for grievance Program (Concern and Comment) last reviewed 9/26/24 indicated, Resident and their families have the right to file a complaint without fear of reprisal. Upon request, the facility must give a copy of the grievance policy to the resident .The resident has the right to, and the facility must make prompt efforts by the facility to resolve grievances the resident may have .The facility will post in prominent locations throughout the facility of the right to file grievances .The contact information of the grievance official with whom a grievance can be filed A reasonable expected time frame for completing the review of the grievance .right to obtain a written decision regarding his or her grievance .Resolve the concern, if possible. If resolution is not possible at that time, explain to the individual that another staff member will be assigned to investigate the concern and will contact them in a timely manner . Event ID: Facility ID: 105365 If continuation sheet Page 3 of 5 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 105365 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Altamonte Springs 989 Orienta Ave Altamonte Springs, FL 32701 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to administer Oxygen (O2) therapy as ordered by the physician for 2 of 2 residents reviewed for respiratory care, of a total sample of 4 residents, (#2 and #4).1. Resident #2 was admitted to the facility on [DATE] with diagnoses of chronic obstructive pulmonary disease (COPD), muscle weakness, hypertension, dependence on supplemental oxygen and need for assistance with personal care. Review of the Minimum Data Set (MDS) significant change assessment with assessment reference date (ARD) of 6/03/25 revealed the resident had a Brief Interview for Mental Status (BIMS) score of 14/15 which indicated she was cognitively intact. The MDS assessment noted the resident required substantial to maximum staff assistance with dressing/personal hygiene care and received oxygen therapy. The assessment also noted the resident did not exhibit behavior symptoms or rejection of care necessary to achieve the resident's goals for health and wellbeing. Review of resident #2's medical record revealed a care plan revised on 1/30/24 which indicated the resident received oxygen to be administered per respiratory medication orders. Supplemental oxygen therapy helps people with COPD, COVID-19, emphysema, sleep apnea and other breathing problems get enough oxygen to function and stay well. Low blood oxygen levels (hypoxemia) can damage organs and be life-threatening, (retrieved on 7/18/25 from www.myclevelandclinic.org).Resident #2's Order Summary Report showed an active physician's order dated 5/30/25 for oxygen at 2 liters per minute (LPM) via NC to maintain SPO2 (peripheral oxygen saturation) at 92% and for the nurses to check the oxygen delivery every shift for SOB (shortness of breath). On 7/15/25 at 9:30 AM, resident #2 was observed sitting up in bed with O2 delivered through a nasal cannula (NC). The O2 tubing was connected to a concentrator set to deliver 4 LPM. Resident #2 was alert and oriented to person, place, and time. The resident denied adjusting her O2 concentrator settings. Later that day on 7/15/25 at 11:34 AM, resident #2 was sitting up in a wheelchair with oxygen administered through a nasal cannula. The oxygen tubing was connected to an O2 concentrator set at 4 LPM. 2. Resident #4 was admitted to the facility on [DATE] with diagnoses of congestive heart failure, chronic kidney disease, dependence on supplemental oxygen, atrial fibrillation, diabetes type 2, and COPD. Review of the MDS Annual assessment with ARD of 5/23/25 revealed the resident had a BIMS score of 13/15, which indicated she was cognitively intact. The MDS assessment noted the resident required substantial to maximum staff assistance with dressing/personal hygiene care and received oxygen therapy. The assessment also noted the resident did not exhibit behavior symptoms or rejection of care necessary to achieve the resident's goals for health and wellbeing. Review of resident #4's medical record revealed a care plan revised on 1/26/24 which indicated a resident focus for Respiratory Risk which included an intervention to apply oxygen therapy as per order via nasal cannula with the goal that she would not experience acute respiratory distress. Resident #4's current active physician order dated 9/06/24 was for oxygen at 2 LPM continuously via nasal cannula. On 7/15/25 at 11:25 AM, resident #4 was lying in bed with O2 administered through a NC. The O2 tubing was connected to a concentrator set at 3.5 LPM. On 7/15/25 at 11:38 AM, Licensed Practical Nurse (LPN) A explained she was assigned to residents #2 and #4 and checked both of their oxygen liter flow rates earlier today but could not remember specifically their flow rate orders. LPN A relied on LPN E who was seated at the nurses' station to check her orders in the electronic medical record. LPN E said, both residents were supposed to be on 2 LPM of oxygen. On 7/15/25 at 11:40 AM, LPN A observed and acknowledged both residents #2 and #4 were not getting their oxygen as ordered. She was observed changing resident #2's oxygen flow rate from 4 LPM to 2 LPM and resident #4's from 3.5 LPM to 2 LPM. Post observation the nurse verified she did not check the residents' flow rates when passing her 9:00 Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105365 If continuation sheet Page 4 of 5 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 105365 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Altamonte Springs 989 Orienta Ave Altamonte Springs, FL 32701 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete AM medications to ensure they were getting it as prescribed by the physician. On 7/15/25 at 12:51 PM, The Director of Nursing (DON) and Assistant DON B said the nurses were supposed to check oxygen liter flow rate at eye level at least every shift. The DON verbalized the expectation that nurses should check the physician's order and give what was ordered. She acknowledged that although the order for resident #2 indicated for staff to keep her SPO2 level at a certain rate there were no parameters given other than 2 LPM. The DON confirmed the nurse should have clarified the order with the physician. ADON B explained that giving too much oxygen could cause toxicity in some residents and good nursing practice was to check every time they went in the room to ensure residents were getting what was ordered by the physician. Review of the facility's Oxygen Administration policy revised 4/08/25 indicated, The facility must ensure that resident who needs respiratory care .is provided such care consistent with professional standards of practice . Oxygen order should be written for specific liter flow required by the resident . Verify the practitioner's orders for oxygen therapy because oxygen is considered a medication . Event ID: Facility ID: 105365 If continuation sheet Page 5 of 5