Health inspection·August 21, 2025

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete of the event. She said she did not verify through observation whether the CNAs which were involved in resident #124's skin tear were using proper transfer techniques in the transfer of residents. On 8/20/25 at 6:08 PM, the Wound Care Nurse verified the facility was still providing physician ordered wound care for the wound sustained on 4/15/25, and the skin injury had not resolved.Review of the facility's policy titled Incident and Reportable Event Management with a most recent revision of 5/4/23 indicated that after an incident/injury the licensed nurse should obtain as much detail as possible including interview statements from whoever who discovered the issue, those who were present during the event, and any other persons who could provide vital information. In the investigation section of the policy, it detailed that the licensed nurse should perform a quick initial investigation to determine the most likely cause of the event. Event ID: Facility ID: 105365 If continuation sheet Page 2 of 11 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 08/21/2025 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to provide timely assessment, treatment, and management of pain for 1 of 1 resident reviewed for pain, of a total sample of 63 residents, (#228). The facility's failure to follow the physician's orders and treat pain and discomfort resulted in actual harm.Findings:Review of the medical record revealed resident #228 was admitted to the facility on [DATE] with diagnoses including wedge compression fracture of the third lumbar vertebra, low back pain, and osteoarthritis. Review of the admission Minimum Data Set (MDS) assessment with Assessment Reference Date of 8/11/25 revealed resident#228's Brief Interview for Mental Status score was 15 out of 15 indicating intact cognition. The MDS assessment noted no behaviors or rejection of evaluation or care necessary to obtain goals for health and well-being. The MDS assessment noted she received PRN (as needed) and scheduled pain medications in the last five days. The assessment noted pain was present daily, which affected sleep and therapy participation. The MDS indicated resident #228 was in pain occasionally and the pain occasionally affected her sleep but rarely affected her participation in therapy, during the five day lookback. The pain intensity was rated moderate. The assessment revealed resident #228 received opioid pain medication during the last seven days or since admission.Review of the Florida Agency for Health Care Administration 5000-3008 Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form dated 8/07/25 revealed resident #228 was ambulatory with assistive device and required assistance for transfers. The document indicated the resident was alert, oriented, and followed instructions. The Pain Assessment section showed a pain level of 5 out of 10 and the last pain medication was administered at 7:45 AM.Review of resident #228's hospital records showed the last administration of Oxycodone-Acetaminophen 5-325 milligrams (mg) prior to her transfer to the facility occurred on 8/07/25 at 4:06 PM. Review of the After Visit Summary from the hospital dated 8/07/25 instructed to continue Hydrocodone-Acetaminophen (Norco) and included a printed prescription to obtain the medication from a pharmacy.Review of the hospital Discharge summary dated [DATE] revealed resident #228 had a history of chronic left knee pain with gait instability and cervical spine injury. Resident #228 presented to the emergency room via ambulance after being pushed by a bystander at a pool landing on her back which resulted in an acute L3 endplate and T12 compression fractures. Resident #228 underwent a kyphoplasty of the L3 vertebral body on 8/01/25. Kyphoplasty is a procedure that treats compression fractures in the spine. Bone cement is added to the affected area to help relieve pain, (retrieved from www.webmd.com on 8/26/25). Review of the Admission/readmission Collection Tool form dated 8/07/25 revealed the pain level was 0 at 7:41 PM. The form included moving around made the pain worse and the resident's acceptable pain level was 3/10. The areas of quality of life that were affected by pain was identified as Sleep and rest. The form revealed opioid medication was used to manage her pain. The progress note section showed resident #228 arrived at the facility at approximately 4:30 PM on 8/07/25, from the hospital. Review of resident #228's physician orders revealed an order entered on 8/07/25 at 10:36 PM, for Hydrocodone-acetaminophen 5-325 mg every six hours as needed (PRN) for pain. Review of resident #228's Baseline Care Plan form dated 8/07/25 showed she was asked, What do you perceive are barriers to your healthcare needs and recovery? Her response was pain.Review of resident #228's Care Plan for potential of pain related to impaired mobility, diabetes, vertebral compression fractures of C3, T12, L3, L4, wedge compression fracture of 3rd lumbar vertebra, osteo-arthritis, low back pain, and chronic left knee pain was revised on 8/14/25. The goal was to minimize pain as much as possible when present. The interventions included administering medications that help manage pain as per order and to offer PRN pain medication as per physician's order Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105365 If continuation sheet Page 3 of 11 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 08/21/2025 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 0697 Level of Harm - Actual harm Residents Affected - Few for complaints or observation of pain/discomfort. An intervention instructed nursing staff to anticipate the resident's need for pain relief and respond immediately to any complaint of pain.On 8/18/25 at 12:28 PM, resident #228 stated she had to wait a prolonged period of time for pain medication after her admission on [DATE]. She explained she was admitted on a Thursday at approximately 5:00 PM and did not get pain medication until Friday at approximately 3:30 PM. She recalled she was in severe pain by the time she received the first dose in the facility, but that the pain medication did not provide relief. She requested additional pain medication before 9:00 PM but was told the medication was not due and had to wait until 9:15 PM for her second dose. She said during that time she was crying and in excruciating pain. She mentioned she asked to speak to anyone in charge, but no one came, so she called her dad, and he called the facility but was unable to speak with the nursing staff. She stated her dad drove to the facility at 11:00 PM on Friday 8/08/25 and after encountering difficulties, he was finally able to entered the facility. She shared the head nurse saw her at around the time her father came in, called the physician and she received Meloxicam. She stated she had asked for an ice pad earlier in the day but did not receive it until midnight when the head nurse finally got it for her. She indicated she shared her pain experience with the case worker during Monday 8/11/25's meeting and on Tuesday 8/12/25 with her Guardian Angel (a staff member assigned to check in on residents in the facility) during her round. She recounted the Guardian Angel wrote something and mentioned someone would come and follow up, but no one ever came. She explained the hospital sent a script for the pain medication with the discharge paperwork. She stated she felt her pain not having been addressed was neglectful. She shared she was not happy about how she was treated and wanted to be discharged at the time. She stated the next morning she was saddened when she overheard staff making fun of her outside her room, but she could not tell who it was. She stated she felt disrespected.Review of the Medication Administration Record (MAR) showed Hydrocodone-Acetaminophen 5-325 mg was administered at 3:00 PM and then at 9:45 PM on 8/08/25. Both times the pain level was documented as 5 out of 10.Review of resident #228's physician orders revealed an order for Meloxicam 7.5 mg two times per day for pain was entered the next morning on 8/09/25 at 12:10 AM and scheduled to be given at 8 AM and 8 PM daily. Review of the Abuse and Grievance Logs for August 2025 revealed no reports regarding resident #228.Review of resident #228's medical record revealed a progress note dated 8/09/25 at 12:39 AM. The note included a call was made to the physician regarding patient complaint of pain said pain management is not effective, a new order was received for Gabapentin and Meloxicam, and family was at bedside and updated.On 8/18/25 at 1:14 PM, the Admissions Assistant confirmed she performed the Guardian Angel round with resident #228 who expressed a lot of concerns. The Admissions Assistant stated resident #228 was complaining about a lot of things and she gave the grievance form she completed to the Social Services Director (SSD) the same day she spoke with the resident. She stated she did not recall the exact day resident #228 shared her concerns and could only recall the resident's concerns about response of the call light. She shared she spoke with the nurse and Certified Nursing Assistant (CNA) assigned to resident #228 and shared her concern about the call light response. She stated everything else was to be addressed by the SSD. She indicated she did not know if there was any follow up with resident #228 after the grievance form was completed and the resident did not mention it again. On 8/18/25 at 1:29 PM, the SSD stated she was the Grievance officer and explained all grievances were to be logged, reviewed in morning meetings, and resolved within 72 hours. She indicated after resolution; she updated the resident or family and ensured the grievance was resolved to their satisfaction. She stated she did not recall any concerns brought to her attention about resident #228. She validated she did not have any grievances documented on the log for this (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105365 If continuation sheet Page 4 of 11 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 08/21/2025 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 0697 Level of Harm - Actual harm Residents Affected - Few resident.On 8/18/25 at 1:40 PM, the Administrator (NHA) joined the interview with the SSD. He indicated he was the Abuse Coordinator and explained the reporting criteria and timeframe for allegations of abuse and neglect. He stated neglect was failing to provide services needed and the facility was required to report allegations of neglect within 24 hours. When asked if he was aware of resident #228's pain concerns, the NHA said he would have expected staff to report it if there was an issue. The SSD confirmed in front of the NHA she did not have a grievance form for this resident. He further stated he did not recall discussing any concerns for this resident during morning meetings last week. Later at 1:56 PM, the NHA provided copies of a grievance form completed by the Admissions Assistant on 8/13/25 which mentioned the call light concern shared by resident #228. He could not explain why the grievance was not logged and follow up sections of the form not completed to show the concern was addressed.On 8/20/25 at 4:00 PM, Licensed Practical Nurse (LPN) I shared resident #228 was sleeping when she started her shift on Friday 8/08/25 at 7:00 AM. She indicated when she gave resident #228 the 9:00 AM medications, the resident expressed no concerns or issues. LPN I recalled at approximately 11:00 AM resident #228 complained of pain and she administered Tylenol. She explained she contacted the pharmacy to get an authorization to pull the narcotic from the automated medication dispenser and faxed a request to the pharmacy as instructed, but the request was denied because the medication had been filled in full and in route to the facility. She stated she then contacted the physician and obtained an order for Tylenol and gave resident #228 two pills. When asked to show the documentation supporting the call to the physician and administration of Tylenol, LPN I reviewed the medical record and confirmed there was no evidence of this. LPN I stated she forgot to enter the order for Tylenol. She recalled she asked resident #228 for her pain level and the number was below 5; and validated none of this information was documented in the medical record. She stated she made the physician, the Director of Nursing (DON) and the Unit Manager (UM) aware of this because she had found medications at the bedside, but again she did not document in the medical record which medications were found. She explained the hydrocodone order was entered after the 9:00 PM cut off time to receive it the next morning, therefore it did not come in the morning run from pharmacy. She explained the next pharmacy delivery would be at 2:30 PM. She did not recall resident #228 asking for ice or any other intervention for pain and she recalled checking on resident every 30 minutes who she felt was okay. LPN I showed a written statement she was in the process of completing for the facility's neglect investigation regarding resident #228 and stated there were no questions or discussions about this issue until yesterday from the Assistant DON.On 8/21/25 at 12:47 PM, the Case Manager stated he met with resident #228 on Monday 8/11/25. He stated in attendance were resident #228, along with her father, and other facility staff. He showed a progress note he entered on 8/11/25 at 11:42 AM, which noted resident #228 was now receiving her pain medication in a timely mannner. He stated resident #228 did not go into details of what she meant. He stated he asked if there were any concerns about her care and her response was she was getting her pain medication promptly now. He shared her concern was addressed so no follow up was required.On 8/21/25 at 9:29 AM, during a telephone interview, LPN E confirmed she worked with resident #228 from 7:00 PM on Thursday 8/07/25 through 7:00 AM on Friday, 8/09/25. She did not recall resident #228 asking for pain medication during her shift. She stated never heard any complaints from the resident. On 8/21/25 at 10:40 AM, Physical Therapist (PT) K stated she saw resident #228 for her initial evaluation on Friday 8/08/25 at 8:30 AM, the day after she arrived to the facility. She indicated she found the resident in bed and the resident told her she was in a lot of pain, and she noted grimacing. She said resident #228 reported a pain level of 8 on a scale of 0 to 10 on her lower back. She shared the first 30 minutes of her visit was spent using (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105365 If continuation sheet Page 5 of 11 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 08/21/2025 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 0697 Level of Harm - Actual harm Residents Affected - Few a short-wave diathermy (SWD) to address resident #228's pain. PT K stated after the SWD, resident's pain decreased to 6 and reported feeling better. She mentioned resident #228 suffered from chronic bilateral knee pain. PT K stated resident #228 had a kyphoplasty done on L3-4 and T12 prior to the admission to the facility. PT K stated after she left the resident's room she spoke with the nurse. She recalled the nurse explained the pain medication was not available and this is why she addressed the pain first with the SWD. She indicated the nurse did not mention, and she did not ask if she was trying to obtain another medication to address the pain for the resident. She stated her assessment showed resident #228 was a high risk for fall because of the pain, and addressing the pain was important to make progress with therapy. SWD is a therapeutic treatment that uses electromagnetic waves to generate heat in deeper tissues. It is commonly used for musculoskeletal pain, including conditions like frozen shoulder, knee osteoarthritis, and chronic back pain. SWD can produce thermal effects even in deeper tissues, making it effective for treating deep-seated pain. The treatment involves applying pads or discs with electrodes to the affected areas of the body. (Retrieved from www.clevelandclinic.org on 8/26/25).Review of resident #228's PT Evaluation & Plan of Treatment dated 8/08/25 revealed a Short-term goal, Patient will exhibit a decrease in pain in low back to 5/10 in order to be able to return to prior level of living, in order to facilitate follow-through with techniques and strategies, in order to facilitate safe transition to next level of care and in order to return to prior level of skill performance. The pain level baseline was 8 out of 10. The Pain Assessment section described pain intensity of 8, frequency was constant, location was lumbar spine, description/type was generalized pain, throbbing, sharp, longer-lasting, excruciating, and chronic knee pain. The pain interfered/limited functional activity and sleep. The prescribed medication listed was Hydrocodone 5-325 mg every 6 hours. Causes that exacerbated the pain was sitting, standing, movement, and resting. The results of a balance test showed, unsteady gait due to pain in low back.Review of the PT Treatment Encounter Note(s) dated 8/08/25 read, Barriers Impacting Treatment: medication schedule and pain consistently >8, inconsistent ability to concentrate and attend to therapeutic intervention. The Treatment Modifications to Overcome Barriers read, review medication scheduled revisions with nursing, pre-medicate.On 8/21/25 at 12:21 PM, during a telephone interview, CNA G stated she worked with resident #228 on Thursday 8/07/25 when she was admitted to the facility. She recalled she got the resident a walker and the resident got up to use the bathroom. CNA G stated resident #228 asked about pain medication during her shift but did not recall the time or details. She shared she always informed the nurses when residents asked for pain medication, so she reported it to the nurse. She stated newly admitted residents were usually in pain unless the hospital medicated them before admission.On 8/21/25 at 1:07 PM, Occupational Therapist (OT) L stated she evaluated resident #228 at approximately 2:00 PM. She recalled she found resident #228 in bed and there was a staff member rearranging furniture because they had moved the resident onto an air mattress. She noted resident #228 was crying, fidgeting, and could not seem to get comfortable. OT L indicated resident #228 was grimacing, and her eyebrow and facial expressions indicated she was in pain. She shared she could see how much pain resident #228 was in. OT L indicated she told resident #228 she would speak to her nurse, and the resident told her she had already requested the pain medication but was told it was not available. OT L stated she mentioned to resident #228 she was still going to talk to her nurse. OT L explained the nurse returned to the room with her and said there was nothing else she could do because the medication was not available. OT L stated she told the nurse she was not comfortable with the level of pain resident #228 exhibited, so she asked the nurse if she had anything else she could give or do for the resident. She indicated she asked the nurse if she could call the physician and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105365 If continuation sheet Page 6 of 11 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 08/21/2025 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 0697 Level of Harm - Actual harm Residents Affected - Few clarify if ice could be applied and the nurse responded she could try again. She explained after the nurse stepped out of the room, she assisted the resident in getting more comfortable, assisted to change her gown and provided a pillow to place between her legs. OT L mentioned resident #228 told her she had not received pain medication since the day before at the hospital. She shared she noted in her evaluation one of the barriers impacting treatment was pain level over 8. She recalled asking the nurse if the pain medication that was ordered was not uncommon, what the problem with obtaining it was? OT L shared she felt the nurse did not seem too concerned and responded to her that it was a pharmacy issue. OT L noted the UM did not go into the room during the approximately 45 minutes she spent with resident #228. OT L stated when she finished her visit, she spoke with the nurse again, with the UM present, and was told they were still waiting for pharmacy to deliver the medication. Review of resident #228's OT Evaluation & Plan of Treatment dated 8/08/25 revealed patient was concerned with back pain, and the pain interfered/limited her functional activity and sleep.Review of the OT Treatment Encounter Note(s) dated 8/08/25 noted precautions of fall risk and high pain and that nursing was to address the pain. The form showed the barrier impacting treatment was pain constantly >8, inconsistent ability to concentrate and attend therapeutic intervention. The Treatment Modifications to Overcome Barriers read, discussion with interdisciplinary team.On 8/21/25 at 2:13 PM, the D-Wing UM stated she learned on the afternoon of 8/08/25 resident #228 was asking for pain medication. She explained LPN I told her the pain medication had not arrived. She share the nurse had faxed a request to access the medication from the automated dispensing machine to pharmacy, but the request was denied because the medication was already out for delivery. She indicated she instructed the nurse to talk to the resident to see if she could get her something else to address her pain. The UM stated the nurse told her she gave her Tylenol. The UM stated she assisted the housekeeper to move resident #228's bed. She indicated she did not ask resident #228 her pain level but told her the pharmacy had sent her pain medication.On 8/21/25 at 2:19 PM, the Regional Director of Clinical Services stated she spoke with LPN I and was told an order for Tylenol was obtained. She validated there was no order for Tylenol, or a progress note in resident #228's medical record with this information. She stated the medications found at bedside did not include anything for pain. She mentioned resident #228 was ambulating according to the CNA documentation. The Regional Director of Clinical clarified what she meant by the resident was ambulating per the CNA documentation, she stated pain was what the resident reported. She indicated a pain level of 6 for some people may be excruciating.On 8/21/25 at 5:45 PM, the DON stated Hydrocodone-Acetaminophen 5-325 mg was available in the automated dispensing machine. She validated nurses' documentation did not show resident #228 reported pain until 8/08/25 at 3:00 PM when the Hydrocodone was administered, despite documentation from PT and OT showing the resident complained of pain and the nurse allegedly contacted the physician at approximately 11:00 AM to report pain and obtain an order for Tylenol. The DON shared the last time resident #228 received medication for pain, Oxycodone-Acetaminophen, was in the hospital on 8/07/25 at 4:00 PM. The DON offered to share a witness statement obtained from the CNA assigned to resident #228 on 8/08/25 from 7:00 AM to 3:00 PM which indicated she assisted the resident multiple times during the day and stated the resident did not report any pain to her. The DON acknowledged LPN I reported calling the physician and the pharmacy and attempted to obtain the medication from the automated dispensing machine showed the resident reported pain, despite no evidence found in the medical record showing resident #228 received any pain medication until 3:00 PM on 8/08/25. Review of the facility's policy and procedure titled Pain Assessment and Management reviewed on 9/05/24 revealed an intent to provide treatment to residents based on the comprehensive assessment, professional standards of practice, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105365 If continuation sheet Page 7 of 11 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 08/21/2025 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 0697 Level of Harm - Actual harm the resident's choices related to pain. The procedure list included, Identifying target signs and symptoms (including verbal report and non-verbal indicators from the resident) and using standardized assessment tools can help the interdisciplinary team evaluate the resident's pain and responses to interventions and determine whether the care plan should be revised. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105365 If continuation sheet Page 8 of 11 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 08/21/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure the medical record reflected the correct site for blood pressure (BP) measurement for 1 of 2 residents reviewed for dialysis, of a total sample of 63 residents, (#10).Findings: Review of the medical record revealed resident #10 was admitted to the facility on [DATE] with diagnoses including end stage renal disease requiring dialysis, type 2 diabetes, and bacteremia. Review of the Order Summary Report revealed a physician order dated 1/07/25 which included resident #10 received dialysis on Monday, Wednesday, and Friday and specified no BP on the right arm with fistula/shunt. Review of the Blood Pressure Summary report from 7/19/25 to 8/19/25 revealed documentation of BP obtained on the right arm 13 times: 7/19/25 at 3:10 PM, 7/22/25 at 9:00 PM, 7/25/25 at 6:07 PM, 7/26/25 at 9:21 AM, 7/26/25 at 5:47 PM, 7/27/25 at 9:41 AM, 8/02/25 at 9:38 AM, 8/02/25 at 4:56 PM, 8/03/25 at 5:31 PM, 8/08/25 at 9:01 PM, 8/10/25 at 4:00 PM, 8/18/25 at 9:04 PM, and 8/19/25 at 7:16 PM. On 8/21/25 at 9:44 AM, during a telephone interview, Licensed Practical Nurse E indicated vital signs were obtained by the Certified Nursing Assistants and she entered them in the medical record. When asked about documentation of the BP on the right arm on 8/10 at 4:00 PM, she stated she probably just picked an arm when documenting it. On 8/21/25 at 12:30 PM, Registered Nurse (RN) F stated he did not recall which arm he used to take resident #10's BP but may have documented it incorrectly because of rushing. He confirmed he documented BP on the right arm incorrectly on 7/19/25 at 3:10 PM and 7/27/25 at 9:41 AM. He explained he would have checked the physician orders prior to obtaining the BP for a dialysis resident, and some residents even alerted him if he had not noticed. On 8/21/25 at 1:54 PM, the D-Wing Unit Manager validated resident #10's medical record was inaccurate when BP was documented on the right arm but taken on the left. She stated she did not audit vital sign records. Review of the facility's Medical Record Organization policy reviewed on 2/27/25 read, All medical records must be complete, accurately documented, readily accessible, and systematically organized. Event ID: Facility ID: 105365 If continuation sheet Page 9 of 11 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 08/21/2025 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident was able to call for staff assistance through a call bell system for 1 of 1 resident reviewed for call bells, of a total sample of 63 residents, (#229).Findings: Review of resident #229's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included secondary malignant neoplasm of the brain, mobility abnormalities, muscle weakness, need for assistance with personal care, and rheumatoid arthritis. Review of the Minimum Data Set (MDS) admission assessment with Assessment Reference Date of 8/06/25 revealed resident #229's Brief Interview for Mental Status score was 14 out of 15 which indicated she was cognitively intact. The MDS assessment noted no behaviors or rejection of evaluation or care necessary to obtain goals for health and well-being. The assessment showed no vision, hearing or speech impairment. Resident #229 had functional limitation in range of motion (ROM) on an upper extremity and used a wheelchair for mobility. The MDS assessment noted resident #229 needed partial assistance from staff for eating and was dependent on staff for toileting hygiene, personal hygiene, dressing, bathing and donning and doffing footwear. She was also dependent on staff for transfers. She was occasionally incontinent of bladder and continent of bowel. Review of resident #229's care plan initiated on 8/12/25 showed a self-care deficit with Activities of Daily Living (ADL) which required limited to extensive assistance of one to two staff related to impaired mobility, decreased endurance and strength, limited ROM to the left upper extremity (LUE), and episodes of incontinence. Review of resident #229's care plan showed resident #229 was at risk for falls due to impaired mobility, self-care deficits, decreased endurance and strength, episodes of incontinence, use of pain medications, use of psychotropic medications, history of falls, use of diabetic medication, and limited ROM to LUE revised on 8/12/25. Interventions directed staff to assist with transfers and encourage/remind resident #229 to call for assistance before getting up to transfer. On 8/19 at 11:03 AM, staff was observed in resident #229's room attempting to draw blood. A short time later on 8/19/25 at 11:14 AM, resident #229 was sitting in her wheelchair with a bedside table in front of her while eating her lunch in her room. The call light cord was wrapped around the bedside rail and not within reach. Later, at 12:15 PM, resident #229 remained in her wheelchair, still without access to her call light. The resident's room door was closed, and her television was on. The lunch tray had been removed from her room. Resident #229 stated she needed to go back to bed and be changed. She shared she needed to have the gadget (call light) near her to call the nurse for assistance with toileting needs. She shared she had been sitting in the wheelchair while after working with therapy. On 8/19/25 at 12:22 PM, Certified Nursing Assistant (CNA) H reported she checked residents hourly and ensured call lights were in reach. She acknowledged it was important for safety and fall prevention. CNA H stated resident #229 was acting differently today and she reported the change in behavior to her nurse. Later at 12:30 PM, CNA H and the State Surveyor walked into resident #229's room and the resident shared she wanted to get back to bed. CNA H indicated resident #229 went to therapy at 10 AM. CNA H stated she brought in her lunch tray and picked the lunch tray up. CNA H validated the call light was not within resident #229's reach and stated she did not notice it the times she went into the room. On 8/20/25 at 5:21 PM, Licensed Practical Nurse (LPN) J stated laboratory staff came to draw blood for resident #229 on 8/19/25. She shared other nursing staff were assisting with obtaining the blood work, so she stepped out of the room. LPN J stated she obtained a blood sugar sample at 11:31 AM. She indicated she did not notice resident #229's call light was not within her reach. She shared when residents did not have a way to call staff, they could attempt to stand up by themselves, which placed them at Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105365 If continuation sheet Page 10 of 11 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 08/21/2025 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 0919 Level of Harm - Minimal harm or potential for actual harm risk for falls, or might make them anxious if they couldn't call for help. On 8/21/25 at 2:07 PM, the D-Wing Unit Manager stated it was everyone's responsibility to ensure the residents had their call lights within reach. Review of the facility's policy and procedure titled Resident Call System reviewed on 1/15/24 read, The call light should be positioned within reach of the resident. The call system must be accessible to residents while in their bed or other sleeping accommodations within the resident's room. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105365 If continuation sheet Page 11 of 11