Inspection·May 19, 2022

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the medical record for resident #314 revealed a SBAR [Situation, Background, Assessment, Recommendation] Communication Form dated 4/13/22 which listed a change of condition for falls. A Nursing Home to Hospital Transfer Form dated 4/13/22 included the reason for transfer was a fall. Resident #314's MDS Discharge assessment with assessment reference date (ARD) of 4/13/22 revealed in Section J - Health Conditions, question J1800 related to falls, the resident did not have any falls since his most recent Admission/Entry or Prior Assessment. On 5/19/22 at 4:34 PM, the Director of Nursing (DON) confirmed resident #314 sustained a fall and question J1800 was assessed incorrectly. The DON indicated the facility did not have a policy for MDS assessment accuracy. She explained the MDS Coordinator used the Resident Assessment Instrument as a guide. The DON explained it was management's expectations for the MDS Department to perform self-audits to ensure assessment accuracy. Review of the Centers for Medicare & Medicaid Services (CMS) Resident Assessment Instrument Version 3.0 Manual instructions for J1800 read, Code 1, yes: if the resident has fallen since the last assessment. 2. Resident #94's medical record revealed he was readmitted to the facility on [DATE]. His diagnoses included Alzheimer's disease, dementia with behavioral disturbance, malnutrition, depressive disorder, mood affective disorder, and anxiety. On 5/18/22 at 11:26 AM, resident #94 was observed with an electronic monitoring device on his right ankle. On 5/18/22 at 12:44 PM, Licensed Practical Nurse I confirmed resident #94 wore a monitoring device on his right ankle. She explained she checked and documented the presence of the device daily. A electronic monitoring device is used to alert caregivers whenever a person with dementia who wore the device breached a perimeter or strayed too far (retrieved from www.themedichannel.com on 5/22/22). Review of the medical record for resident #94 revealed a physician's order dated 10/29/21 that read, Check placement of [brand of electronic monitoring device] every shift. A second order dated 10/29/21 instructed nurses to check the function of the device every night shift. Review of the Treatment Administration Records for April and May 2022 showed nurses' documentation regarding daily verification of the resident's monitoring device. The MDS Quarterly assessments with ARDs of 1/21/22 and 4/23/22, and the MDS admission assessment with an ARD of 11/1/21 revealed in Section P0200 related to alarms, that the resident did not use a wander/elopement alarm. On 5/19/22 at 4:31 PM, the DON confirmed resident #94 wore an electronic monitoring device. She acknowledged the three above-mentioned assessments were inaccurate. The DON indicated the MDS Coordinator was expected to conduct observations during assessments of residents to accurately document the presence of electronic monitoring devices. Review of the CMS Resident Assessment Instrument Version 3.0 Manual instructions for P0200: Alarms (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 2 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 0641 Level of Harm - Minimal harm or potential for actual harm read, Identify all alarms that were used at any time (day or night) during the 7-day look-back period. After determining whether or not an item listed in P0200 was used during the 7-day look-back period, code the frequency of use .Code 2, used daily: if the device was used on a daily basis during the look-back period. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 3 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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, interview and record review, the facility failed to develop a resident-centered care plan for use of a right hand palm guard by a dependent resident and personal hygiene and bathing needs for the right hand for 1 of 7 residents reviewed for activities of daily living (ADL) care out of a total sample of 50 residents, (#106). Findings: Resident #106's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses and conditions included a cerebral vascular accident (CVA) or stroke, functional range of motion limitations in both upper extremities, osteoarthritis, dementia, and legal blindness. On 5/16/22 at 4:40 PM, resident #106 had both arms and hands positioned close to her upper chest. She wore a soft right hand palm guard with a sheepskin closure. The outer fabric of the palm guard was discolored with gray residue. The portion of the palm splint located snuggly between her thumb and index finger was tangled. The fingers on both hands were curled inward toward her palms. On 5/17/22 at 10:59 AM, on 5/18/22 at 10:45 AM, and on 5/19/22 at 8:35 AM, resident #106 was observed wearing the right hand soft palm guard which was soiled with light gray to dark gray residue and crusty substance. On 5/19/22 at 9:35 AM, Certified Nursing Assistant (CNA) E confirmed she neither removed the resident's palm guard nor washed her hand on the previous day, 5/18/22, which was the resident's scheduled shower day. CNA E stated she thought therapy staff took care of the palm guard and cleaned the resident's hand. On 5/19/22 at 9:40 AM, Occupational Therapy Aide (OTA) H clarified floor nurses and CNAs were responsible for removing resident #106's palm guard and cleaning her hand. The Minimum Data Set (MDS) Quarterly assessment with an assessment reference date of 4/27/22 indicated resident #106 had functional range of motion limitations in both upper extremities. She was totally dependent on one staff person for personal hygiene and bathing care. Her Brief Interview for Mental Status (BIMS) score was 00, which indicated she had severely impaired cognition. Review of the physician's orders for resident #106 revealed there was no order for the right hand palm guard. The Treatment Administration Record for May 2022 did not include an order to direct nurses to apply the right hand palm guard or care for the resident's right hand. Review of resident #106's comprehensive care plans revealed there was no care plan that included the use of the right palm guard. Review of the CNA care plans or [NAME] did not mention the resident's palm guard or direct CNAs on how to care for her right hand. On 5/19/22 at 2:44 PM, the Director of Nursing (DON) acknowledged none of resident #106's comprehensive care plans documented the use of her right hand palm guard, information on the persons (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 4 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 responsible for the care of the palm guard, and/or instructions on cleaning the right hand. Level of Harm - Minimal harm or potential for actual harm The policy and procedure for ADL Care and Assistance, issued 4/01/22, included: ADL assistance needs should be reflected on the person-centered plan of care. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 5 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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, interview and record review, the facility failed to provide personal hygiene care for 1 of 7 dependent residents reviewed for activities of daily living (ADL) care of a total of 50 sampled residents, (#106) . Residents Affected - Few Findings: Review of resident #106 medical record revealed she was a long-term care resident who was admitted to the facility on [DATE]. Her diagnoses and conditions included cerebral vascular accident (CVA) or stroke, non-Alzheimer's dementia, legal blindness, osteoarthritis, and functional range of motion limitations in both upper extremities. On 5/16/22 at 4:40 PM, resident #106's elbows were bent at her waist with both arms and hands positioned against her chest. The fingers on both hands were curled into her palms. A soft, palm guard with sheepskin closure to her right hand was discolored and soiled. On 5/17/22 at 10:59 AM, resident #106 was in bed and did not respond when greeted or when asked a question. The resident's right hand palm guard had crusty yellowish residue between her thumb and index finger. Review of the Nursing Unit's Shower Schedule revealed resident #106 was scheduled to receive a shower every Wednesday and Saturday on the 7 AM to 3 PM shift. On Thursday, 5/19/22 at 9:35 AM, resident #106 was observed with Certified Nursing Assistant (CNA) E. The palm guard remained discolored with crusty residue. CNA E reported she had given the resident a full bed bath yesterday, her scheduled shower day. She explained it was more comfortable for the resident to receive a bed bath rather than a shower. CNA E verbalized she did not remove the resident's palm guard during bed baths. She stated it was too difficult to remove the device because of the resident's hand and finger contractures. She reported the resident would pull away during care, so she cleaned the area underneath the palm guard the best she could. CNA E acknowledged the palm guard was soiled with gray residue and crusty substance. CNA E stated she thought therapy staff was responsible to remove the resident's palm guard, and clean it along with her hand. On 5/19/22 at 9:40 AM, during an observation of resident #106's right hand and palm guard the Occupational Therapy Aide (OTA) H stated the resident was not currently on occupational therapy services for the palm guard. OTA H recalled the resident had not been on Occupational Therapy (OT) caseload since last year. She stated after OT services were completed, the resident was referred to restorative nursing care, and then passed on to the nurses and CNAs on the unit for palm guard and hand care. OTA H removed the resident's right palm guard and confirmed the palm guard and the resident's hand were soiled. On 5/19/22 at 9:50 AM, during an observation of resident #106 with the Unit Manager (UM), she confirmed the soiled condition of the resident's palm guard and hand. The UM verbalized nurses and CNAs were responsible to remove the device and wash resident #106's hand during baths and shower. Resident #106's Minimum Data Set (MDS) Quarterly Assessment with an assessment reference date (ARD) of 4/27/22 indicated she had a functional range of motion limitations in both upper extremities, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 6 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 - Few had not received occupational therapy services and/or restorative nursing services during the ARD timeframe, and indicated splint or brace assistance was not received. The MDS assessment revealed the resident was totally dependent on one staff person for personal hygiene and bathing care. Her Brief Interview for Mental Status (BIMS) score was 00, which indicated severely impaired cognition. Resident #106's ADL care plan related to self-care deficit with dressing, grooming, and bathing was initiated on 7/30/2020 with a target date of 8/05/22. The care plan indicated she was totally dependent on staff for assistance with dressing, grooming and bathing due to her cognitive deficit, dementia, impaired mobility, CVA, and limited range of motion in her upper extremities. The document read, The resident does not participate in ADLs and did not include interventions for the use and care of the right hand palm guard The policy and procedure for ADL Care and Assistance, issued 4/1/22, included: It will be the policy of this facility to provide the resident with ADL care and assistance while attempting to maintain the highest practicable level of function for the resident. The policy indicated personal hygiene and bathing included the following: . washing/drying face and hands . and full-body bath/shower, sponge bath . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 7 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 observation, interview, and record review, the facility failed to address the wheelchair positioning needs of a resident with limited range of motion for 1 of 2 residents reviewed for positioning of a total of sample of 50 residents, (#22). Residents Affected - Few Findings: Resident #22's medical record revealed he was admitted to the facility on [DATE]. His diagnoses and conditions included a cerebral vascular accident (CVA) or stroke, right intractability hemorrhage (ICH) with right cranioplasty and external ventricular drain (EVD) surgical interventions, left sided flaccid paralysis, functional range of motion of right upper and lower extremities,difficulty walking, and muscle weakness. Resident #22's Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form revealed he was hospitalized from [DATE] to 5/25/21 prior to the facility admission. He was initially admitted to the facility for services that included nursing, physical therapy, and occupation therapy. On 5/16/22 at 11:30 AM, resident #22 sat in his wheelchair in the hallway by the nurses' station. He held a phone in his right hand and his left upper and lower extremity leaned to the left side of the wheelchair. There were no positioning devices observed in the wheelchair. His left arm pressed up against the arm rest and his left leg pressed up against the metal bar that connected the arm rest to the seat of the chair. His left foot rested on the left side foot rest. No staff members in the vicinity attempted to reposition resident #22. On 5/16/22 at 1:35 PM, resident #22 was observed outside in the smoking area. His left side continued to lean against the left side of his wheelchair. The Certified Nursing Assistants (CNAs) who assisted residents in the smoking area did not offer to reposition the resident in his wheelchair On 5/17/22 at 10:40 AM, resident #22 was assisted with walking in the hallway by CNAs G and F. He became fatigued and when he sat in the wheelchair he promptly leaned to the left side and was once again pressed up against the left side of his wheelchair. There were still no positioning devices utilized to help resident #22 to maintain an upright body position. On 5/18/22 at 12:55 PM, resident #22 was again observed in front of the nurses' station leaning to the left side of his wheelchair. There was a red mark or impression from the metal bar of the wheelchair observed on the resident's thigh just above his knee. The resident stated it would be nice for his left leg not to be pushed up against the metal bar and his left arm not to be pressed against the armrest. On 5/18/22 at 1:50 PM, the Therapy Director discussed resident #22's wheelchair positioning concerns. She stated the Therapy department had not received any screening referrals for the resident's positioning needs. She explained nurses could enter a therapy screening request in the electronic medical record. She confirmed CNAs did not have access to the electronic screening referral forms. She reported the last time the resident was as on Occupational Therapy (OT) caseload was in 2021. On 5/18/22 at 2:05 PM, OTA H confirmed resident #22's last OT evaluation was done on 5/27/21 for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 8 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 - Few balance and strengthening. She stated the resident was discharged from OT caseload on 7/15/21. OTA H conveyed there were no referrals to screen for his positioning needs since that time. She explained OT was responsible for upper body positioning which included wheelchair positioning. She stated it was possible the resident gained weight and therefore required a larger wheelchair. Review of the resident's weights with OTA H revealed since his discharge from OT caseload on 7/15/21, he gained 40 pounds to date. She verified he weighed 190 pounds on 8/03/21 and 10 months later on 5/09/22, he weighed 230 pounds. OTA H acknowledged resident #22 had remained in the same wheelchair since discharge from OT caseload. On 5/18/22 at 2:20 PM, resident #22's positioning was observed with the Therapy Director and OTA H as he sat in his wheelchair in the dining room. Both staff acknowledged the resident leaned to the left and his left leg was pressed up against the metal bar that connected the armrest and the seat. The Therapy Director and OTA H validated the red mark on the resident's left upper outer leg was shaped like the metal bar and measured about 1 inch wide and 4 inches long. They stated screening and probable evaluation from OT services would be appropriate for this finding. The Therapy Director confirmed while regular quarterly screenings had been conducted for the resident, most recently on 2/01/22 and 5/02/22, his wheelchair positioning was not identified as a concern and/or addressed. Review of resident #22's Minimum Data Set (MDS) Quarterly Assessment with an assessment reference date of 2/20/22 indicated he had a Brief Interview for Mental Status (BIMS) score of 15 which indicated he was cognitively intact. He had functional limitation in range of motion (ROM) on one upper and lower side. The MDS assessment indicated the resident was not steady in his balance during transitions and walking, moving from a seated position to standing positions, turning and facing the opposite direction, and during surface to surface transfers, and he required staff assistance for stabilization. Resident #22's comprehensive care plan dated 6/21/21 with target date of 6/02/22 indicated he had self-care and impaired mobility deficits related to generalized muscle weakness and impaired sitting and standing balance due to the effects of CVA with left sided weakness. The facility's policy and procedure Positioning Refer to P/P Resident Mobility and ROM read: . Residents with limited mobility will receive appropriate services, equipment and assistance to maintain or improve mobility . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 9 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 provide intravenous (IV) care and services according to standards of practice and plan of care for 2 of 2 residents reviewed for IV care out of 50 total sampled residents, (#103 and #109). Residents Affected - Some Findings: 1. Review of resident #103's medical record revealed he was admitted to the facility on [DATE] with diagnoses including osteomyelitis and infective myositis to the left hip. Review of the Minimum Data Set (MDS) admission assessment dated [DATE] showed a Brief Interview for Mental Status (BIMS) score of 15 which indicated resident #103 was cognitively intact. Review of the admission Nursing Comprehensive Evaluation form dated 4/19/22 showed resident #103 was admitted to the facility with a Peripherally Inserted Central Catheter (PICC) line to the right upper arm for administration of antibiotics intravenously. Review of the medical record for resident #103 revealed a physician's order dated 4/19/22 that read, Change PICC line dressing to right upper arm every Friday on 7-3 shift. A PICC line is a long, thin tube that's inserted through a vein in your arm and passed through to the larger veins near your heart . A PICC line gives your doctor access to the large central veins near the heart. It's generally used to give medications . A PICC line requires careful care and monitoring for complications, including infection and blood clots (retrieved on 5/22/22 from www.mayoclinic.org). Resident #103's IV therapy care plan, initiated on 4/21/22, included intervention to, Perform IV site care as ordered. On 5/17/22 at approximately 10:15 AM, Licensed Practical Nurse (LPN) I confirmed resident #103 received IV antibiotic three times a day, and specifically twice during her shift. LPN I stated she did not recall the date on resident #103's PICC line dressing. Review of resident #103's Treatment Administration Record (TAR) showed the PICC line dressing was checked off as completed on 5/06/22 and 5/13/22 On 5/17/22 at 10:27 AM, the Director of Nursing (DON) assessed resident #103's IV site and stated the PICC line dressing was dated 5/7. The DON said, the dressing is coming off, so partially intact. The DON indicated she wanted to review resident #103's progress notes as she thought he had refused the change of dressing. The DON reviewed resident #103's medical record and noted there was no evidence he had refused his PICC line dressing change. She confirmed the TAR showed the PICC line dressing was changed on 5/6 and 5/13, which did not match the date on the dressing. The DON noted the staff should have changed the dressing on 5/7/22 and 5/13/22 and did not explain why it was not changed. 2. Review of resident #109's medical record revealed she was admitted to the facility on [DATE] with diagnoses that included osteomyelitis of left foot, cellulitis, dementia, and type 2 diabetes. Review of the MDS admission assessment dated [DATE] showed a BIMS score of 5 which indicated resident #109's cognition was severely impaired. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 10 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 - Some Review of the admission Nursing Comprehensive Evaluation form dated 4/20/22 showed resident #109 was admitted to the facility with a PICC line to the right upper arm for administration of IV antibiotics. On 5/17/22 at 9:05 AM, resident #109's IV antibiotic, Ertapenem infused at 100 milliliter per hour through the PICC line located in her right upper arm. The PICC line dressing was dated 4/20/22 and the upper and lower edges on the right side of the dressing were lifted. Resident #109 was unable to explain when the dressing was last changed. Review of the medical record for resident #109 revealed a physician's order dated 4/20/22 that read, Change PICC line dressing to right upper arm every Wednesday on 7-3 shift. Review of the resident's TAR showed the PICC line dressing was checked off as completed on 4/27/22 and 5/4/22 which did not match the date of 4/20/22 on the dressing. There was no checkmark or exception code noted on 5/11/22, when the PICC line dressing change should have been done. The medical record contained no evidence of resident #109's refusal of the dressing change on 5/11/22. Resident #109's IV therapy care plan, initiated on 4/21/22, included an intervention that read, Perform IV site care as ordered. On 5/17/22 at 9:59 AM, LPN I stated she had 3 residents on her assignment who received IV therapy. She stated she checked the residents' IV sites to ensure there was no infiltration or redness, and the dressing was intact. LPN I explained when PICC line dressings were due to be changed, an alert showed up in the electronic TAR. LPN I explained the PICC line dressing change process included writing the date, time and initials on the new dressing. LPN I stated it was important to change IV site dressings as scheduled to prevent further infections that could compromise the resident's health. During an observation of resident #109's PICC dressing with LPN I, she acknowledged the date on the dressing was 4/20, and had initials. She said, the right upper and right lower sides are not intact, no drainage noted, not red, looks good. LPN I did not explain why a dressing still remained since 4/20/22. LPN I checked the resident's TAR and confirmed the document indicated the dressing change was not done on 5/11/22. She explained she did not pay attention to the date on the dressing, instead she just checked if the dressing was intact. Review of resident #109's TAR for April and May 2022 revealed LPN I flushed the IV line with normal saline and administered the ordered dosages of Ertapenem 1 gram IV 10 times during the 27 days since the IV site dressing was last changed. Her initials were noted on the TAR on 4/30/22, 5/05/22, 5/0622, 5/08/22, 5/09/22, 5/10/22, 5/11/22, 5/15/22, 5/16/22, and 5/17/22. On 5/17/22 at 10:22 AM, the DON explained when nurses administered IV antibiotics, they were expected to look at PICC line dressing and IV site for signs of infection and infiltration. The DON stated resident #109's dressing was to be changed weekly. The DON explained if a resident refused the dressing change, the nurse was to notify the physician and educate the resident on the importance of dressing changes to decrease the risk of infection. Review of the facility's policy and procedure titled Central Venous Catheter dated February 2009 revealed the purpose was To provide a general procedure regarding central venous catheters. The steps to site care included label the dressing and include the date and nurse's initials. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 11 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of the medical record revealed resident #96 was admitted to the facility on [DATE] with diagnoses including left foot pain, schizophrenia, and depression. The Order Summary Report included a physician order dated 4/22/22 for Diclofenac Sodium 1%, with directions to apply the medication to the resident's left foot and ankle topically for pain, every day and evening shift. The order did not include a dosage amount. Diclofenac Sodium is a medication used to treat pain. Manufacturer's instructions indicated no more than 16 grams of Diclofenac should be applied to any single joint of the lower body per day. The document revealed measuring cards were included with the medication to ensure an accurate dose was administered (retrieved on 5/20/22 from www.WebMD.com). On 5/19/22 at 10:47 AM, Registered Nurse (RN) C prepared Diclofenac for resident #96. She opened the tube and squeezed the medication into a cup. She then took the medication into the room and applied the Diclofenac to resident #96's left foot and ankle. When asked how she measured the medication she did not respond. During review of the physician order with RN C, she acknowledged the order did not include a specific dosage amount for the medication. She stated she was not aware Diclofenac required a dosage. Review of the Treatment Administration Record for April 2022 and May 2022 revealed resident #96 received Diclofenac 50 times during this period without the pharmacist or nurses obtaining clarification from the physician regarding the dose to be administered. 3. Review of the medical record revealed resident #38 was admitted to the facility on [DATE] with diagnoses to include heart failure, end stage renal disease, right knee pain, and depression. Review of the MAR for April and May 2022 revealed the resident had a physician order for Diclofenac Sodium Gel 1% that directed nurses to apply it to the right knee topically for pain, twice daily. The MAR indicated resident #38 received Diclofenac 97 times during this period without the pharmacist or nurses obtaining clarification from the physician regarding the dose to be administered. On 5/19/22 at 10:49 AM, the B Wing Unit Manager (UM) stated physician orders were reviewed in the daily clinical meetings. She explained the night shift nurse was responsible for double checking all new orders added to residents' charts after admission. The UM acknowledged resident #38's Diclofenac order did not have the required dosage. She stated the pharmacist reviewed each resident's chart every month and the facility had never been instructed to obtain clarification regarding the dosage for this medication. On 5/19/22 at 12:50 PM, the facility's Consultant Pharmacist stated he reviewed all residents' medications monthly. He said, I look at medication dose, strength, interaction, and frequency. Every medication should have a dose. He reviewed the order for Diclofenac for resident #38 and acknowledged the order did not have a dose to indicate the amount of the medication to be used. He explained the dose should have been noted as either 2 or 4 grams as selected by the physician. The Administering Medications policy revised January 2022 read, The individual administering the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 12 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some medication must check the label THREE (3) times to verify the right resident, right medication, right dosage, right time and right method (route) of administration before giving the medication. Based on observation, interview, and record review, the facility failed to ensure medications were not crushed prior to administration according to manufacturers' and pharmacy instructions for 1 of 9 residents reviewed for medication administration, (#76); and failed to obtain appropriate dosage orders for medications for 2 of 5 residents reviewed for unnecessary medications, (#96 & #38) of a total sample of 50 residents. Findings: 1. Review of the medical record revealed resident #76 was admitted to the facility on [DATE] with diagnoses that included vascular dementia, stroke, anxiety and seizures. The Minimum Data Set (MDS) Quarterly assessment dated [DATE], showed resident #76 had memory problems and severely impaired cognition. The MDS assessment revealed she required extensive assistance from one staff person for eating and had a mechanically altered diet. Resident #76 had a care plan for nutritional risk related to difficulty with swallowing. Interventions included staff to give medications as ordered, observe for signs or symptoms of aspiration and a pureed diet. The Order Summary Report dated 5/19/22 revealed a physician order dated 5/31/18 that noted medications may be given as solid, liquid or crushed as resident #76's condition required, unless contraindicated. Resident #76 also had physician orders for a pureed texture diet, and the medications Levetiracetam (Keppra) 500 milligrams (mg) by mouth for seizures and Divalproex (Depakote) Delayed Release 250 mg by mouth for mood. On 5/18/22 at 4:58 PM, Licensed Practical Nurse (LPN) A prepared to administer resident #76's medications. He stated the resident required a pureed diet, and her medications needed to be crushed and mixed with pudding. On 5/19/22 at 12:17 PM, LPN B stated she cared for resident #76 regularly and had crushed all her medications for at least a couple of weeks. She explained resident #76 required her medications crushed because she had trouble swallowing and could not swallow the pills whole. LPN B confirmed the resident's physician ordered Depakote Delayed Release tablets should not be crushed, but she acknowledged she crushed the medication anyway. LPN B validated the blister packs for resident #76's Depakote Delayed Release and the Levetiracetam tablets warned Do Not Crush on the packaging. LPN B could not give a reason why she knowingly crushed the medications and confirmed she was aware she should have called the physician for clarification of the orders. Review of the Medication Administration Record (MAR) from February 2022 to May 2022 revealed resident #76 received Levetiracetam tablet twice a day and Depakote Delayed Release tablet three times a day from 2/01/22 until 5/18/22 as documented by all assigned nurses. On 5/19/22 at 12:50 PM, in a telephone interview, the facility's licensed Consultant Pharmacist, stated a list of medications that should never be crushed was located on medication carts in the facility. He explained blister pack medication labels also had warnings from the pharmacist if medications should not be crushed. The Consultant Pharmacist confirmed the manufacturers of Levetiracetam and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 13 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 0755 Level of Harm - Minimal harm or potential for actual harm Depakote Delayed Release tablets recommended that patients take the pills whole, and not crush or chew them. He explained Depakote Delayed Release tablets were designed to release the medication at a slow rate, and if crushed or chewed, the resident would get the entire dose at once. He stated his expectation was for nurses to follow the pharmacy's recommendations. He verified alternate forms of delivery were available for these medications. Residents Affected - Some Review of the manufacturer's Prescribing Information for Levetiracetam tablets dated October 2020 revealed the direction, Swallow the tablets whole. In bold lettering the guide advised, Do Not chew or crush tablets. Further, the guide directed users to ask their healthcare provider for the oral solution if they could not swallow whole tablets (retrieved on 5/25/22 from www.ucb.com). Review of the manufacturer's Medication Guide for Depakote Delayed Release tablets revised October 2021, noted medication to be swallowed whole. The guide advised patients not to crush or chew tablets, and inform the healthcare provider if they could not swallow the tablets whole as a different medicine might be necessary (retrieved on 5/25/22 from www.depakote.com). On 5/19/22 at 4:25 PM, the Director of Nursing (DON) stated her expectation was for nurses to call the doctor if there was an order for medications that should not be crushed but the resident required crushed medications. She stated nurses should read the directions noted on the medication blister packs provided by the pharmacy. She confirmed crushing extended-release medications would deliver the whole dose of a medication at once, instead of over time. Review of the facility's Policy and Procedure Administering Medications revised January 2022, revealed if a medication was identified as having potential adverse consequences or was associated with potential adverse consequences for the resident, the person who prepared or administered the medication should contact the attending physician or Medical Director to discuss the concerns. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 14 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 0791 Provide or obtain dental services for 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 refer a resident with lost upper and lower dentures for dental services in a timely manner, and failed to conduct a reassessment for appropriate diet texture for 1 of 2 residents reviewed for dental services of a total sample of 50 residents, (#7). Residents Affected - Few Findings: The medical record for resident #7 revealed she was admitted to the facility on [DATE]. Her diagnoses included type 2 diabetes, pulmonary hypertension, chronic kidney disease, and dementia. Business office records indicated the resident's payor source was Medicaid as of 11/02/2020. On 5/16/22 at 12:56 PM, resident #7 smiled when greeted. Her open-mouthed smile revealed she had no upper or lower teeth. On 5/17/22 at 12:39 PM, resident #7 prepared to eat lunch. She smiled and was noted to be edentulous. There were no dentures or denture cup on her nightstand or overbed table. A thick slice of ham on her plate measured about 5 inches by 6 inches, and the other foods on the plate were of regular texture. None of the food had been cut into smaller, manageable pieces. The resident's meal ticket on the tray revealed she received a No Added Salt (NAS) and Carbohydrate Controlled (CCHO), regular textured diet. The resident indicated through gestures and pointing motions that she had dentures but did not know where they were. She said, lost and shrugged her shoulders then raised both hands in the air. The physician's diet order for resident #7, dated 4/05/22, revealed instructions for a NAS/CCHO diet, regular texture, thin consistency liquids, no fried foods, and ensure she received a bedtime snack. Resident #7's comprehensive nutritional and hydration care plan initiated on 3/19/19 with target review date of 8/11/22, revealed she was at risk due to food and nutrition knowledge deficit related to confusion. There was no documentation on the care plan of the resident's edentulous status and/or her use of full upper and lower dentures. The document included an intervention for a dental consult as needed. Review of resident #7's personal inventory sheet dated 3/04/19 revealed she was admitted to the facility with full upper and lower dentures. The facility's monthly complaint log dated April 2022 included an entry for resident #7 dated 4/06/22 regarding missing dentures. The log indicated resident #7's grievance was resolved on 4/14/22. On 5/18/22 at 9:25 AM, the facility's complaint investigation and follow-up of resident #7's missing dentures was reviewed with the Social Services Director (SSD). The SSD verbalized the resident reported her missing dentures on 4/06/22. She stated they started a facility-wide search for the dentures, but after a couple of days they were not found. The facility's resolution for the grievance regarding the resident's missing dentures was to arrange a dental appointment. A facility appointment form revealed resident #7 was referred to the dentist on 4/12/22 for the dental appointment, 6 days after her dentures were reported missing. The SSD confirmed the dental appointment was scheduled for 5/25/22, approximately 7 weeks after the resident's dentures were reported missing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 15 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 0791 Level of Harm - Minimal harm or potential for actual harm Review of resident #7's medical record did not reveal any documented evidence that a reassessment for an appropriate diet texture had been conducted with the resident. On 5/18/22 at 9:45 AM, the SSD validated the facility did not arrange or conduct a therapy screen and reassessment to determine a safe and appropriate diet texture for resident #7. Residents Affected - Few On 5/18/22 at 10:00 AM, the Interim Therapy Director confirmed a therapy screen and reassessment had not been done for resident #7. The Therapy Director confirmed a reassessment would be the ideal or expected step to determine an appropriate diet texture for resident who had lost their dentures and was on a regular textured food diet. She explained the reason was to ensure the resident was able to safely chew and swallow her food. She explained a therapy assessment would have determined if resident #7's regular diet needed to be downgraded or changed to a mechanical soft diet until she obtained new dentures. On 5/18/22 at 1:00 PM, resident #7 stated she did not know what happened to her upper and lower dentures. She explained they were lost somewhere in the facility. The resident explained it was difficult for her to chew hard and tough foods, especially meats. When asked if she had any difficulty eating the large piece of ham served at lunch on the previous day, the resident stated she had to cut the ham into tiny pieces to eat it. The resident stated it would be nice and much easier for her to eat the tough meats if the facility served them already cut up. The facility's policy and procedure Dental Services/Oral Services issued 4/01/22, included the following: . Beginning 11/28/17, the facility must promptly, within 3 [business] days, refer residents with lost or damaged denture for dental services. If a referral does not occur within 3 days, the facility must provide documentation of what they did to ensure the resident could still eat and drink adequately while awaking dental services and the extenuating circumstances that led to the delay . Specific dental/oral needs should be identified in the resident's plan of care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 16 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 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 observation, interview, and record review, the facility failed to ensure the medical record was complete for 1 of 1 resident reviewed for edema, of a total sample of 50 residents, (#32). Findings: Review of the medical record revealed resident #32 was admitted to the facility on [DATE] with diagnoses that included muscle weakness, dementia, hypertension and depressive disorder. On 5/16/22 at 11:00 AM, resident #32's lower legs were wrapped in orange, self-adhesive bandages. The left leg bandage was torn and white gauze was visible under the edges. The resident's skin was shiny on his left lower leg in the area that showed through the large hole in the bandage. The resident stated someone applied the bandages to his legs several weeks before, but he was unable to recall exactly when they were applied or who applied them. Resident #32 also had long, thickened, yellowish toenails on both his feet. The nails on both big toes curled over the front of his toes and pointed downward. Resident #32 stated he wished someone would cut his toenails as it had not been done for a while. On 5/18/22 at 1:32 PM, resident #32 stated someone recently cut his toenails and changed the wraps on his legs. He was unable to say who provided these services. Review of resident #32's Order Summary Report dated 5/18/22 revealed a physician's order dated 5/31/18 for a podiatry consult, with an indefinite end date. There were no physician's orders for lymphedema physician specialist consult or application of lymphedema wraps to the resident's legs. Lymphedema is tissue swelling, often in the arms and legs, caused by a build up of fluid that is usually drained by a part of the circulatory system (retrieved on 5/25/22 from www.mayoclinic.org). On 5/18/22 at 1:37 PM, Licensed Practical Nurse (LPN) B confirmed she cared for resident #32 for the last three days, but did not notice his long toenails. She checked the unit's podiatry book and was unable to find resident #32's name on the list of residents scheduled to be seen by the podiatrist. LPN B verified there was no referral to request podiatry services and she did not know of a podiatrist's visit in the last three days. She confirmed resident #32 had lymphedema wraps on his legs and stated she was not aware if the lymphedema physician specialist assessed and treated resident #32 recently. LPN B recalled seeing an outside provider with the resident that morning, but she did not know which specialty the provider represented, what services were rendered, nor if any follow up was necessary. Review of resident #32's medical record revealed no documentation of podiatry visits since 1/16/21 and no progress notes from the lymphedema physician specialist. On 5/18/22 at approximately 1:54 PM, in a telephone interview, the lymphedema physician specialist stated he visited the facility weekly. He explained he made hand-written progress notes after each visit and brought them to medical records at the following week's visit. The lymphedema physician specialist stated resident #32 had never refused lymphedema care and services. He stated he changed resident #32's leg wraps on Wednesday of the past week. He recalled during that visit he noticed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 17 of 18 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 105431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyards of Orlando Care Center and Rehab 1900 Mercy Drive Orlando, FL 32808 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 resident #32 had long, thickened toenails and said, They looked bad. He stated he told someone at the facility resident #32 needed a podiatry consult to address the condition of his toenails. On 5/18/22 at 2:21 PM and 4:46 PM, the Social Service Director (SSD) confirmed resident #32's medical record did not contain any documentation by the consultant lymphedema physician specialist nor of progress notes for any recent visits by the podiatrist. She stated after she had been informed there were no podiatry progress notes in the resident's chart since last year, she contacted the podiatrist's office. The SSD explained she was informed the office had internal documentation that resident #32 refused toenail care every month since December 2021. She confirmed the facility had no evidence of these refusals as the podiatrist did not provide written notes regarding failed attempts. The SSD stated there was currently no system in place to keep track of which residents refused visits, so the facility was not aware of who was not seen by the podiatrist. The SSD acknowledged if the facility was not aware, staff could not develop or implement appropriate interventions to promote acceptance of podiatry care. On 5/18/22 at 4:16 PM, the Medical Records staff stated there was a binder at the nurses' station on both units for consultant notes that needed to be scanned into the medical record. She explained she checked the binder every morning, five days a week. She opened the binder for the 100 unit and confirmed there was no documentation present for resident #32's recent visits from the podiatrist or lymphedema physician specialist. The Medical Records staff stated within the past couple hours the Administrator provided her with the lymphedema physician specialist's progress notes for resident #32's treatments on 3/09/22, 3/16/22, 3/23/22, 3/30/22, 4/06/22, 4/13/22, 4/20/22, 4/27/22, 5/04/22 and 5/11/22. The Medical Records staff confirmed she never received any of these notes before. She stated the medical record was not complete if consulting physicians did not provide progress notes and/or documentation related to residents' care. She explained most of the attending physicians who visited residents in the facility had access to the electronic medical record and the expectation was for them to either enter an electronic note or provide a hand-written note at every visit. On 5/18/22 at 4:26 PM, the Medical Director stated his expectation was for physicians to enter their consult notes in the computer or ensure written consult notes were available to the facility at the time of, or soon after, the visit. He explained the consult notes should be part of the medical record. The Medical Director acknowledged the facility needed to streamline the process for entry of consultant physicians' notes into the medical record. On 5/19/22 at 12:11 PM, LPN B stated she had never seen the podiatrist herself, nor was she notified a resident had refused care. She stated she would typically look in the medical record under the Documentation section for consults and would expect the documents to be there. On 5/19/22 at 4:22 PM, the Director of Nursing stated the expectation was for consultants to give report to the nurse or leave the consultant report within a few days. She explained staff needed to know what was going on to promote continuity of care for the resident, even if the resident refused. She said, Otherwise, the nurse might not know what was going on, or that the consultant even came to see the resident. Review of the facility's policy and procedure for Physician Services revised January 2022 revealed the physician will . provide adequate, timely information about the resident's condition and medical needs . Additionally, the document included, Physician orders and progress notes shall be maintained in accordance with current [Omnibus Budget Reconciliation Act] OBRA regulations and facility policy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105431 If continuation sheet Page 18 of 18