Inspection·February 19, 2026

F 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Tablet Extended Release 24 Hour 250 MG (Divalproex Sodium) Give 1 tablet by mouth two times a day for Mood Disorder Pharmacy 4/13/2025 17:00 Discontinued 4/28/2025Divalproex Sodium ER Oral Tablet Extended Release 24 Hour 500 MG (Divalproex Sodium) Give 500 mg by mouth two times a day for Mood Disorder Pharmacy 4/28/2025 17:00 Discontinued 5/06/2025Review of Resident #1's Medical Administration Record (MAR) revealed Resident #1 received:Haldol Injection solution 5 MG/ML, on 04/26/2025Divalproex Sodium oral capsule delayed release sprinkle 125 MG, three times a day from 04/01/2025 through 04/12/2025 and two times on 04/13/2025Depakote ER oral tablet extended release 24 Hour 250 MG, one time on 04/13/2025 and 04/28/2025 and two times a day from 04/14/2025 through 04/27/2025.Depakote ER oral tablet extended release 24 Hour 500 MG, one time on 04/28/2025 and two times a day on 04/29/2025 and 04/30/2025.Review of Resident #1's Minimum Data Set (MDS), section C, dated 12/04/2025, revealed the resident had a Brief Interview Mental Status (BIMS), of 03, which indicated severe cognitive impairment.Review of Resident #1's progress notes showed a note dated 04/26/2026, which revealed: Resident #1 had approached staff and stated having had a disagreement with a roommate and if the dispute continued, Resident #1 was going to practice self defense. The note revealed Resident #1 was not redirectable and attempted to argue with a roommate while staff was in the room. The note revealed Haldol was given to the resident for severe agitation due to unredirectable nature.A late entry progress note dated 04/28/2025, revealed: behavioral health provider in to asses patient related to behaviors. Education provided to Resident #1's family member. Resident #1's family member gives consent for medication.A progress note dated 05/06/2025, revealed: on 5/6/2025 facility staff spoke with Resident #1's family member on the phone, about concerns of psychotropic medication use. The note showed the family member changed decisions about new medication. The note revealed education was provided and wasn't receptive at the time. The note showed the psych provider was notified and new orders were received to discontinue medication.Review of Resident #1's medical documents revealed a Psychotropic Medication Administration Disclosure form, in which consent was given on 04/28/2025, by phone through verbal consent from Resident #1's HCS.Review of Resident #1's care plan revealed a focus of Resident #1 having potential for adverse effects related to use of psychotropic medication use: -antidepressant to manage depression -anti-anxiety to manage anxiety, initiated on 04/29/2025. The goal was for Resident #1 to have a reduced risk of adverse reactions related to medication use through next review date, initiated on 04/29/2025. The interventions included: administer medications as ordered by the physician. Observe side effects and effectiveness, initiated 04/29/2025. Another intervention was to consult with pharmacy & Medical Doctor (MD), for gradual dose reduction when clinically appropriate, initiated 04/29/2025. Another intervention was to observe for adverse reactions to medication and report to MD as needed, dated 04/29/2025.During an interview on 02/19/2026 at 04:45 PM, the Director of Nursing (DON), stated psych saw residents, performed evaluations, wrote orders, and then called families of residents to provide education about the risk benefit of psychotropic medications. The DON stated family members of residents planned to take psychotropic medication, would have been contacted prior to administering the medication as somebody's got to give consent. The DON stated, unless there was an emergent situation like a psychotic breakdown, there would have been no reason not to notify the family of a psychotropic medication change. The DON stated Resident #1 was on divalproex known as Depakote, for mood disorders, from 03/31/2025 until 04/13/2025. The DON stated Resident #1received Haldol once on 04/26/2025. The DON stated Depakote was received on 04/28/2025. The DON stated consent should have been obtained for Haldol and Depakote prior to administering the medication. The DON stated Resident #1's HCS first contact would have been the nurse practitioner. The DON stated, typically, staff would have documented on Resident #1's medical record that the provider (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105455 If continuation sheet Page 2 of 3 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 105455 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Placid Health and Rehabilitation Center 125 Tomoka Blvd S Lake Placid, FL 33852 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 0552 Level of Harm - Minimal harm or potential for actual harm notified the family. The DON stated not having seen in the resident's medical record that the provider spoke with the family on 03/31/2026. The DON was unable to confirm consent for Haldol and Depakote was obtained prior to administering the medication. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105455 If continuation sheet Page 3 of 3