Inspection·January 8, 2026

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for 1 (Resident # 0) of 8 residents reviewed. Findings include:During an interview on 1/5/2025 at 11:08 AM, Resident #50 stated, The port was when I was getting chemotherapy.During an observation on 1/5/2026 at 11:08 AM, Resident #50 had a venous access port (a small, implanted device placed under the skin to provide long term access to a vein for medications, fluids, and blood draws) near her left shoulder with a dressing covering it. The dressing is dated 12/5/2025. Photographic evidence obtained on 1/5/2025 at 11:08 AM. During record review of Resident #50's resident centered plan of care, there is no care plan for Resident #50's venous access port.During interview on 1/7/2026 at 10:10 AM, [NAME] Unit Manager, Licensed Practical Nurse (LPN) stated, I do not see a care plan for the resident for her access port. There should have been a plan of care for her venous access port.Record review of facility policy titled, Comprehensive Assessments and Care Plans, with last review date of 4/1/2022, reads, Standard: It will be the standard of this facility to make a comprehensive assessment of a resident's needs, strengths, goals, life history and preferences, using the resident assessment instrument (RAI) specified by CMS (Center for Medicare & Medicaid Services). The assessment will include at least the following: (xvii) Documentation of summary information regarding the additional assessment performed on the care areas triggered by the completion of the Minimum Date Set (MDS). Event ID: Facility ID: 105375 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 105375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE South Campus Care Center and Rehab 715 E Dixie Ave Leesburg, FL 34748 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 Based on observation, interview, and record review, the facility failed to ensure residents unable to carry out activities of daily living, receive the necessary services to maintain good grooming and clean clothing for 1 of 7 residents (Resident #33) reviewed for activities of daily living.Findings include:On 1/5/26 at 11:04 AM, Resident #33 was observed in a visibly soiled jacket and pants, facial hair unkept in appearance and had a sour body odor. Resident was pleasantly confused, standing at the doorway to his room.On 1/6/26 at 9:58 AM, Resident #33 was observed in the same visibly soiled jacket and pants, partially fallen due to missing belt loops, facial hair unkept in appearance, and a foul/sour body odor. Resident is observed standing in the hallway next to the door of his room.On 1/7/26 at 8:52 AM, Resident #33 was observed in the same visibly soiled jacket and pants, partially fallen due to missing belt loops, facial hair unkept in appearance, and a foul/sour body odor. Resident #33 is observed walking the hallway in the unit.Review of Resident #33's admission record documented an admission date of 11/2/23 with a diagnosis that include metabolic encephalopathy, vascular dementia, and muscle weakness. Review of Resident #33's person centered care plan, revised 12/2/25, documented, [Resident #33's Name] has a self-care deficit with dressing, grooming, bathing r/t [related to]: generalized weakness, visual limitations. Interventions included provide hands on assistance with dressing, grooming, bathing as needed.Review of Resident #33's person centered care plan, revised 12/22/23, documented, [Resident #33's Name] needs assistance with ADL's r/t muscle weakness. Interventions include assist/provide ADL care and support as needed.Review of Resident #33's person centered care plan did not document shower refusals or behavior concerns with ADL care.Review of Resident #33's progress notes found no documentation of refusal of showers.During an interview on 1/6/26 at 9:58 AM , Resident #33 was asked if he had another jacket and pants to change. Resident #33 stated, this is my jacket, I got it on. Resident #33 was unable to understand question regarding changing his clothing, Resident #33 was observed to remove glasses and started talking about his wife.During an interview on 1/7/26 at 12:22 PM, Staff A, Licensed Practical Nurse (LPN), stated, [Resident #33's Name] did not get a shower last night, it is documented as resident was not available. I know that [Resident #33's Name] can refuse showers and be difficult.During an interview on 1/7/26 at 12:26 PM, Staff B, Certified Nursing Assistance (CNA), stated, [Resident #33's Name] dresses himself, always pick out the same outfit each day. We will help [Resident #33's Name] get ready for the day or change and then [Resident #33's Name] goes right back to picking out the same clothes.An observation of Resident #33's closet was observed with CNA and the resident does have other jackets, shirts and pants in closet.During an interview on 1/7/26 at approximately 2:20 PM, Director of Nursing (DON), stated, If a resident refuses an shower, the CNA responsibility is to let the nurse know so the resident can be approached another time. Then document that the resident refused to be able to address possibly on the next shift.During an interview on 1/8/26 at 9:20 AM, Administrator stated, the shower was provided last night, the documentation was in error. [Resident #33's Name] clothing has a peculiar odor from re-wearing the same clothing items. Review of the facility policy titled, Showers/Bathing, issued 4/1/2022. Read, Policy: It will be the policy to assure that showers/bathing are offered at least two times weekly or per resident/resident representative preference , unless specifically ordered otherwise by the physician or care planned otherwise. Procedure 4. Refusals for shower/bathing should be reported to nursing staff via placement on the 24 hour report, verbally comment via denotation of refusal In the electronic health record POC [point of care] system or in any other acceptable means to ensure the nurse is aware of the refusal. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105375 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 105375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE South Campus Care Center and Rehab 715 E Dixie Ave Leesburg, FL 34748 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to adhere to professional standards of practice for the care and maintenance of a venous access catheter port for 1 (Resident #50) of 2 residents reviewed.Findings include:Review of the medical record for Resident #50, documented tunneled venous access catheter was in place for the administration of chemotherapy for cancer. During an interview on 1/5/2026 at 11:05 AM, Resident #50, stated I had the port placed for chemotherapy. They are not using it now. During an observation on 1/5/2026 at 11:05 AM, Resident #50 has a venous access port (implanted device to provide long term access for medications) near her left shoulder with a dressing covering it. The dressing is dated 12/5/2025. (Photographic evidence obtained) During an interview on 1/7/2026 at 10:10 AM, the [NAME] Unit Manager/Licensed Practical Nurse (UMLPN) stated, Our policy is an access port needs to have weekly changes of the Huber needle and dressing. The dressing should have been changed.Review of the facility policy and procedures titled, Implanted Venous Port with a last review date of 2/2019, read, Purpose: To provide the guidance for the care of the venous port, to access the venous septum to administer medication, and proper procedure to de-access the non-coring port needle from the port.14. A folded 2 inch by 2 inch sterile gauze may be placed under the wings of the non-coring needle if it does not obscure the insertion site. This would be done if needle is not at same level as the port to stabilize it, or for protection of the skin. This is not considered to be a gauze dressing and can stay in place for 7 days. 15. Cover needle with transparent sterile dressing, making sure that edges of the dressing are firm against the skin. Use skin protecting agent (e.g., Skin Prep) on skin first, if necessary, and let dry before placing dressing on skin. 16. Label dressing with date, time, and initials of person who is performing procedure. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105375 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 105375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE South Campus Care Center and Rehab 715 E Dixie Ave Leesburg, FL 34748 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. Based on observation, interview, and record review the facility failed to maintain complete and accurate medical records for 1 (Resident #117) of 3 residents reviewed for advance directives and respiratory services.Findings include:Review of the admission record for Resident #117 documented an initial admission date of 12/2/25 and a re-admission date of 1/3/26.On 1/5/25 at 10:50 AM, Resident #117 was observed wearing oxygen (O2) via nasal cannula on 2 liters with the oxygen concentrator.During an interview on 1/5/26 at 10:50 AM, Resident #117's significant other, who was at resident's bedside, stated [Resident #117's Name] was hospitalized for Respiratory Syncytial Virus (RSV) and was brought back to facility on Saturday after the hospital said she was stable to return. The cough has been persistent since diagnosis of RSV and has improved. [Resident #117's Name] being on oxygen is new and never [had] been on oxygen prior to this episode. On 1/6/26 at 3:24 PM, Resident #117 was observed in bed wearing O2 on 2 liters with the oxygen concentrator, resident is being repositioned by significant other and facility staff.On 1/7/26 at 11:20 AM, Resident #117 was observed in bed wearing O2 on 2 liters with the oxygen concentrator.Review of the Medical Certification for Medicaid Long Term Care Services and Patient Transfer Form dated 1/3/26 documented in Section V: Treatment Devices the resident was transferred on 2 liters of continuous oxygen.Review of physician orders for Resident #117 for the period of 1/3/2026 through 1/7/2026 documented no physician orders for Oxygen therapy.Review of the clinical record for Resident #117 showed a yellow document titled Do Not Resuscitate (DNR) signed and dated 9/8/25.Review of Progress notes dated 12/4/25 read, Resident admitted for Long Term Care diagnosis hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant aphasia. Resident spouse is Durable Power of Attorney (DPOA) and is currently a DNR.Review of physician orders for Resident #117 dated 1/3/25 read, Advanced Directive: Full Code.During an interview on 1/5/26 at 1:20 PM, the Administrator stated, The code status should have been checked on admission by nursing.During an interview on 1/7/26 at 11:39 AM, the Director of Nursing stated, The expectation is for the nurse to review the incoming orders and transcribe into [Name of clinical record software]. The weekend nursing supervisor should go through the admission packet to verify all orders are transcribed correctly. Review of the facility policy titled, Admissions Policy, issued 4/1/2022, reads, Policy: It will be the policy of this facility to provide appropriate admission guidelines when admitting residents to the facility in accordance with federal guidelines. The facility will evaluate/ assess and document the resident condition upon admission, confirm orders with the physician and obtain appropriate demographic and contact information. Procedure: 7. At the time each resident is admitted , the facility must have physician's orders for the resident immediate care. In the event the resident arrives to the facility without specific instructions the nursing staff should reach out to the medical director or physician assigned to a newly admitted resident to receive orders for care and services. 9. The newly admitted resident should have diet/type of nourishment, medications and treatments and advanced directives verified by the physician, communicated to the pharmacy for delivery and transcribed to the MAR/ TAR or entered into the electronic health record. Event ID: Facility ID: 105375 If continuation sheet Page 5 of 5