Health inspection·March 11, 2022

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 3/10/22 at 4:32 PM, CNA F stated she worked on the 2 PM-10 PM shift, and resident #34 was on her assignment. CNA F stated the resident was scheduled for showers in the afternoon, and she was not sure if she worked with the resident on her scheduled shower days. CNA F stated when she provided a shower, she would document on the shower sheet at the nurses' station. She verbalized the resident never refused care, and if she had refused, the refusal would be documented, and the resident's nurse made aware. CNA F could not say why the resident did not receive showers on her scheduled shower days. An intervention on the resident care plan At risk for decreased ability to perform ADLs in bathing, grooming, personal hygiene related to encephalopathy, initiated on 1/12/22, with revision on 3/08/22 read, Arrange resident/patient environment as much as possible to facilitate ADL performance. Based on interview, and record review, the facility failed to provide showers as per resident's preferences and as per shower schedule for 2 of 8 residents reviewed for choices, out of a total sample of 51 residents, (#84 #34). Findings: 1. Review of resident #84's medical record revealed she was admitted to the facility on [DATE] with diagnoses including Cerebral Vascular Accident (CVA), Epilepsy, Diabetes Mellitus, Metabolic Encephalopathy, Acute Respiratory Failure and Morbid Obesity. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed she was cognitively intact, required extensive assistance with Activities of Daily Living (ADL) and total assistance with bathing. Review of the plan of care documented resident #84 was at risk for decreased ability to perform ADL's with bathing, grooming, personal hygiene and transfers related to CVA and interventions to transfer resident using mechanical lift with 2 staff members. On 03/07/22 at 1:46 PM, resident #84 stated, I would like to have a shower but they told me I can't take a shower because I can't stand up. On 03/09/22 at 11:25 AM, an interview was conducted with resident #84 and the Director of Nursing. Resident #84 stated that she had never had a shower because the staff told her she could not walk so she could not have a shower. I have only been having bed baths. I would like to get out of bed and have a shower. Review of the 200 Unit Shower Schedule revealed the resident was given showers on Thursday and Friday on the evening shift. On 03/09/22 at 11:13 AM, the 200 Unit Manager (UM) explained when a resident received a shower, the Certified Nursing Assistant (CNA) completed a shower sheet for the nurse to review and sign. She noted the shower sheets were kept in a book. The 200 UM checked the book and stated there were no shower sheets for resident #84. On 03/09/22 at 11:28 AM, the Regional Nurse Consultant stated the resident's bathing preferences were included in the CNA's Kardex. Review of resident #84's CNA Kardex revealed Bathing section ADL (Prefers: SPECIFY) was not completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 2 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Review of the computerized CNA documentation for bathing from 02/12/22 to 03/09/22 revealed showers were not provided and the resident had not refused any showers. Review of the Facility's Resident Bathing Policy, not dated, read, Policy: Guidelines: 1. Residents will be provided showers as per request or as per facility schedule protocols and based upon resident safety. 2. Partial baths may be given between regular shower schedules as per facility policy. Event ID: Facility ID: 105464 If continuation sheet Page 3 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure prompt investigation and timely resolution of concerns for 1 of 1 resident reviewed for grievances, out of a total sample of 51 residents, (#1). Findings: Resident #1 was admitted to the facility on [DATE] and re-admitted on [DATE]. Her diagnoses included stroke, type 2 diabetes, speech and language deficit, muscle weakness and adult failure to thrive. On 3/10/22 at 11:15 AM, resident #1 stated during her stay in the facility, a suitcase which contained her birth certificate, passport and resident alien identification card had been lost when she was moved to another room. She explained the facility replaced the suitcase in December 2021, over a year after it was lost. She stated none of the contents of the suitcase were replaced. Resident #1 stated facility staff made several excuses. She said, They say they are waiting for corporate and waiting for the State. I don't know who corporate is. The resident stated she completed a grievance form in 2020 with assistance from the previous Social Services Director (SSD). She recalled the missing items listed included a resident alien identification card, a passport, her birth certificate, and a gift card. Resident #1 explained the total cost for replacing these items was approximately $700. She said, I grieved for weeks. I don't know how they threw away everything. I couldn't sleep. The resident confirmed she spoke to the facility's Administrator, SSD and the Key [NAME] Unit Manager (UM) regarding the missing items. On 3/09/21 at 1:35 PM, the SSD stated her responsibilities included providing support for residents and addressing their grievances or concerns. She described the facility's grievance process as very quick since resolution was usually achieved within 72 hours. She confirmed resident #1 had a room change in 2020 and reported her suitcase and its contents as missing soon after. The SSD stated the facility replaced the suitcase on 12/31/21. The SSD said, During COVID (Coronavirus Disease) outbreak, the facility threw out personal belongings, birth certificates, passport and the previous Social Service Director was reaching out to [the resident's country of birth]. She confirmed the original grievance form was submitted in 2020 and it included the missing passport and birth certificate. The SSD explained a passport could not be replaced without two forms of identification, and the resident could not get the required types of identification without a birth certificate. The SSD said, It's a circle. She acknowledged the facility's grievance log did not list the concern as closed or resolved. In addition, she explained the facility no longer had a copy of the original grievance documentation from 2020. The SSD stated a recent care plan meeting held in February 2022 was attended by resident #1 and her son. She validated the concerns related to the lost passport and birth certificate were discussed and the resident again requested assistance with replacing the valuable documents. The SSD stated she told resident #1 and her son she would assist them, but acknowledged she had no documentation of re-opening a grievance nor any follow up actions she accomplished in the four weeks that had passed since the care plan meeting. She said, I should have done a grievance then. The SSD confirmed she was aware of the long outstanding issue from 2020 through previous conversations with the Administrator. The SSD was asked to provide copies of social service notes and communications with outside entities regarding replacement of the resident's birth certificate and passport but was unable to do so. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 4 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0585 Level of Harm - Minimal harm or potential for actual harm On 3/09/22 at 3:30 PM, the Director of Nursing (DON) stated the facility's Administrator was ultimately responsible for oversight of the grievance process. She explained the concerns were usually handled by the appropriate department and closed when resolved. She confirmed if a grievance was not resolved within the required period, the facility was required to explore additional options and utilize other resources to ensure satisfactory resolution. Residents Affected - Few On 3/09/22 at 6:18 PM, the Administrator stated she did not have any record of resident #1's grievance that was submitted in 2020. She stated the resident spoke to her about a missing suitcase which was replaced. The Administrator recalled the previous SSD worked on other missing items for this resident but repeated that she did not have any written records to show details. On 3/10/22 at 11:07 AM, the Key [NAME] UM confirmed resident #1's suitcase with her passport and birth certificate were misplaced about one year ago. She said, I am sure Social Services was working on it. I am not aware of any resolution. On 3/10/22 at 11:42 AM, the Administrator stated the facility attempted to achieve resolution of all grievances within three to five days if possible. She explained the facility's SSD was the Grievance Officer, and she was responsible for making sure all grievances had appropriate follow-up and were designated as completed when resolved. The Administrator confirmed the previous SSD was aware of the resident's missing birth certificate and passport, but the facility could not find any documentation related to how the original grievance was addressed. A review of the Resident and Family Grievances policy dated 2021 noted, d. The Grievance Official will take steps to resolve the grievance, and record information about the grievance and those actions, on the grievance form. e. The Grievance Official, or designee, will keep the resident appropriately apprised of progress towards resolution of the grievances. 11. Evidence demonstrating the results of all grievances will be maintained for a period of no less than 3 years from the issuance of the grievance decision. 12. The facility will make prompt efforts to resolve grievances. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 5 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Resident #78 was admitted on [DATE] and readmitted on [DATE]. Clinical record review, revealed the MDS assessments, Discharge Return Anticipated with Assessment Reference Date (ARD) of 2/15/22 and the Entry MDS with ARD of 2/23/22 was listed as in progress. On 3/11/22 at 1:33 PM, MDS Coordinator D stated they had 14 days from the ARD to complete assessments. A review of resident #78' s MDS assessments were conducted with the MDS Coordinator. She acknowledged the Discharge Return Anticipated with ARD 2/15/22, and the Entry MDS with ARD 2/23/22 were all in progress. MDS Coordinator D explained the MDS with ARD 2/15/22 should have been completed by 3/01/22, and the one with ARD of 2/23/22 should have been completed by 3/02/22. MDS Coordinator D reported she took over managed care and must send updates to the managed care companies. She verbalized she was in meetings half of the days, and MDS Coordinator E was only at the facility two days per week. MDS Coordinator D indicated there were days she did not get to touch MDS assessments due to other duties. The facility's policy Assessment Frequency/Timeliness read, An entry tracking record will be completed within 7 days of the reentry event. Based on interview and record review, the facility failed to complete Minimum Data Set (MDS) Assessments within the required timeframe for 2 of 8 residents reviewed for MDS Assessments, of a total sample of 51 residents (#52 and #78). Findings: 1. Resident #52 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses to include quadriplegia, pressure ulcer on right and left buttocks. On 2/17/22 the resident was transferred from the facility to the hospital and returned to the facility on 2/21/22. Review of the MDS Discharge Return Anticipated assessment dated [DATE] and Entry assessment dated [DATE], revealed both assessments were marked still in progress. On 3/11/22 at 1:33 PM, MDS Coordinator D stated the MDS assessments should be completed within 14 days. She confirmed the Discharge Return Anticipated dated 2/17/22 should have been completed by 3/03/22 and the Entry assessment dated [DATE] should have been completed by 3/07/22. She said she had other job duties and did not always have time to complete the assessments. On 3/11/22 at 1:58 PM, the Director of Nursing (DON) explained the facility was aware assessments were late and they were trying to allocate more hours to the part time MDS position. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 6 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a Minimum Data Set (MDS) assessments accurately reflected health conditions for 2 of 6 residents of a total sample of 51 residents, (#69, #55). Residents Affected - Few Findings: Resident #69 was admitted to the facility on [DATE] with diagnoses that included cerebral atherosclerosis and dementia. The physician orders revealed an order to admit to Hospice dated 10/15/21. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] section O-Special Treatments, Procedures, and Programs reflected the Hospice section response was NO. Resident #55 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of heart disease, and hypertension. Review of the physician orders revealed an order for diuretic medication, Chlorthalidone daily to treat blood pressure and fluid retention. Review of the Medication Administration Record (MAR) revealed the resident received Chlorthalidone daily since 4/07/21. Review of the 5-day MDS assessment dated [DATE] section N-Medications indicated the resident did not receive a diuretic medication in the past 7 days. On 3/11/22 at 11:15 AM, MDS Coordinator E stated when completing a resident's MDS assessment, she interviewed the resident, interviewed the nursing staff and reviewed the residents' medical records. She reviewed residents #55 and #69's assessments and acknowledged resident #69 should have been coded for hospice services and resident #55's assessments should have noted the resident received a diuretic medication. She did not explain how the information was missed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 7 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to obtain a physician order for a positioning device recommended by Occupational Therapy, and failed to provide care and services for appropriate placement of the device, to prevent further decrease in range of motion for 1 of 1 resident reviewed for positioning and mobility out of a total sample of 51 residents, (#53). Findings: Resident #53 was admitted from the hospital on 8/15/19 with diagnoses including dementia, stroke with right side paralysis and weakness, muscle weakness, abnormal posture, and pain and stiffness in her right shoulder, elbow, and hand. Review of the Minimum Data Set Medicare End of Part A Stay assessment, with assessment reference date of 1/15/22 revealed resident #53 was totally dependent on two persons for assistance with activities of daily living. Section O of the MDS assessment showed the resident received neither Restorative Nursing Program (RNP) nor active and passive range of motion care and services. The documentation indicated she did not require splints or braces. Review of the resident's medical record revealed a physician's order dated 2/10/22 for application of a right hand splint every morning, to be worn for up to 8 hours a day, as tolerated. The order indicated staff could remove the right hand splint for routine skin checks, hygiene, and exercise. Review of Occupational Therapy (OT) Discharge Summary dated 11/11/21 showed a restorative program was established for resident #53, and staff were trained on a Restorative Splint and Brace Program. The document read, Patient to wear palm guard as tolerated/apply rolled washcloth when patient removes the palm guard usually 2-3 hours. Functional Maintenance Program not indicated at this time. A care plan initiated on 4/24/20 and revised on 12/29/21, indicated a focus area related to use of a right hand splint. On 3/07/22 at 11:27 AM, resident #53 was in bed. She was unable to open her tightly contracted right hand and did not have a splinting device or rolled washcloth in place. Additional observations on 3/07/22 at 2:27 PM, 3/08/22 at 11:02 AM and 5:12 PM , and on 3/09/22 at 10:17 AM, revealed the resident still lacked a splinting device or rolled washcloth in her contracted right hand. On 3/09/22 at 10:59 AM, Certified Nursing Assistant (CNA) B stated resident #53 never moved her right hand independently, and it always remained closed. CNA B stated she had been about to place a rolled towel in the resident's palm, but a therapist instructed her not to do it as Restorative CNA A would be applying a splint that had been ordered. During review of the electronic CNA care plan or [NAME], CNA B confirmed there was an instruction regarding placement of a splint to resident #53's right hand. She validated there was no splint in the resident's room and stated she would have applied it if it were available. On 3/09/22 at 11:54 AM, the Key [NAME] Unit Manager (UM) stated the RNP staff usually apply and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 8 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 0688 remove residents' splints according to recommendation made by the Therapy department. Level of Harm - Minimal harm or potential for actual harm On 3/09/22 at 12:53 PM, the Rehab Director stated resident #53 was on OT caseload from 10/13/21 to 11/11/21. He reviewed the treating OT staff's documentation and explained on discharge from this service, the OT recommended a palm guard with rolled wash cloth for resident #53's right hand to prevent contracture. The Rehab Director confirmed a palm guard device was not the same as a splint, as noted in the resident's physician order and CNA [NAME]. He stated the Therapy department kept palm guards in stock, and could easily have replaced this device if informed by nursing staff that it was missing. The Rehab Director stated the Therapy department developed the RNP interventions and the Director of Nursing (DON) and UMs were responsible for implementation of the RNP. Residents Affected - Few On 3/09/22 at 1:12 PM, the Key [NAME] UM reviewed the list of residents on the unit who were included in the RNP. She validated resident #53 was not included on the list. She stated she obtained RNP recommendations in a written format and sometimes also verbally from the treating therapists, and nurses were responsible for entering orders into the electronic medical record as indicated. On 3/09/22 at 1:31 PM, the OT stated resident #53 was discharged from OT services with a palm guard. She explained the typical discharge process involved providing written RNP instructions to the Rehab Director who would review and sign them off and then follow up with the appropriate UM. On 3/09/22 at 2:14 PM, Restorative CNA A stated Therapy department staff regularly trained Restorative and direct care CNAs on required interventions including splint application. She confirmed resident #53 was to wear a palm guard but she was not listed on the restorative program census for this service. Restorative CNA A said, I think that is where there was the miscommunication. She explained direct care nursing staff would therefore be responsible for application of the palm guard during care, which is a Functional Maintenance Program (FMP). Restorative CNA A explained the resident was seen by RNP staff only for obtaining weekly weight. She explained when a resident was discharged from therapy services, RNP CNAs sign the paperwork with recommendation and then either the DON or UM enter the order into the computer so RNP staff can implement the interventions and complete required documentation. On 3/09/22 at 3:30 PM, the DON stated after residents were discharged from skilled therapy services, the UMs received RNP or FMP recommendations to be implemented by either restorative or assigned nursing staff on the units. She explained the clinical management team reviewed these recommendations and associated orders in daily morning meetings and residents who required RNP or FMP services would be identified at that time. The DON confirmed the Rehab Director was responsible for providing appropriate documentation to the UMs who were expected to follow up and enter orders into the computer system. She stated gentle placement of a rolled towel in the palm of a resident's contracted hand was a basic skill taught to CNAs in school, and should be included on the [NAME] if recommended by therapy staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 9 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 ensure a Peripherally Inserted Central Catheter (PICC) line dressing was changed as per professional standards of practice for 1 of 1 resident reviewed for infection of a total sample of 51 residents, (#149). Residents Affected - Few Findings: Resident #149 was admitted to the facility on [DATE] with diagnoses of osteomyelitis of vertebra, lumbar region, sepsis, hemoptysis, chronic pain syndrome, acute and subacute endocarditis, Methicillin Resistant Staphylococcus Aureus (MRSA), and chronic hepatitis. Physician's order dated 2/25/22 read, change PICC line dressing q (every) week and PRN (as needed). A PICC line is a thin, flexible tube that is inserted into a vein in the upper arm and guided (threaded) into a large vein above the right side of the heart .It is used to give intravenous fluids, blood transfusion .and other drugs. (retrieved from www.cancer.gov Definition of PICC 3/21/22) On 3/07/22 at 4:36 PM, and on 3/08/22 at 4:20 PM, observations showed resident #149 with a PICC line to his right upper arm, with dressing dated 2/27. The resident stated the PICC line was inserted in the hospital, and he received intravenous (IV) antibiotic Vancomycin at 9AM, and 9 PM. On 3/08/22 at 4:26 PM, the A Wing Unit Manager (UM) stated PICC line dressing was monitored every shift and changed weekly and PRN. The resident's PICC line dressing was observed with the UM and she confirmed the date on the dressing was 2/27/22. Review of the resident's Medication Administration Record (MAR) and the Treatment Administration Record (TAR) revealed a signature to indicate the PICC line dressing was changed on 2/25/22, and on 3/04/22. However, the date observed on the PICC line dressing was 2/27/21 which was acknowledged by the UM. On 03/08/22 at 4:35 PM, the Director of Nursing (DON) was made aware of discrepancies with the date on the PICC line dressing, and the dates documented on the MAR/TAR regarding dressing changes. On 03/08/22 at 4:40 PM, Registered Nurse (RN) G stated she did not remember if she changed the PICC line dressing on 3/04/22 as indicated by her signature. RN G said she probably clicked on the dressing change order indicating it was done and did not change the dressing, because something happened and she had to leave. The RN stated and demonstrated a yes/no selection on the TAR for the resident's PICC line dressing change. She verbalized she would select yes, before providing the treatment, and when the treatment was provided, she would then save the response. RN G said she could have been pulled away, or the resident refused his dressing change. When asked the protocol if the resident refused the treatment, the RN stated the refusal would be documented. Review of the resident's progress notes with the RN regarding refusal of dressing /treatment could not be identified. RN D reported she usually dated dressings when completed. On 3/08/22 at 5:00 PM, the DON stated the MAR/TAR should not be signed off until the task was completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 10 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 The facility's policy PICC/Midline/CVAD Dressing Change copyright 2021 read, It is the policy of this facility to change peripherally inserted central catheter (PICC), midline or central venous access device (CVAD) dressing, weekly or if soiled, in a manner to decrease potential; for infection and/or cross-contamination. Physician's orders will specify type of dressing and frequency of changes. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 11 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure Oxygen (O2) therapy was administered as per physician's order for 1 of 5 residents reviewed for O2 therapy of a total sample of 51 residents, (#143). Residents Affected - Few Findings: Resident #143 was admitted on [DATE] with diagnoses of encephalopathy, sepsis, atherosclerotic heart disease, dementia without behavioral disturbance, acidosis, and anemia. Physician's order on 3/02/22 read, Oxygen at 3 liters/minute (L/M) via nasal cannula (NC) as needed for shortness of breath/for saturations below 92%. On 3/07/22 at 12:07 PM, and 2:39 PM, and on 3/08/22 at 11:37 AM, showed resident #143 lying in bed with his eyes closed. The oxygen concentrator was infusing at 2 L/M. On 3/08/22 at 11:41 AM, Licensed Practical Nurse (LPN) K stated the resident was on oxygen at 2 L/M. The resident's physician's order was reviewed with LPN K and she verbalized the order was for oxygen at 3 L/M. The resident's O2 settings were observed with LPN K and she acknowledged the O2 setting was at 2 L/M. LPN K explained oxygen was considered a medication that was administered by physician's order. She recalled she did not check the resident's O2 setting at the beginning of her shift. She reported the expectation was oxygen settings should be checked daily to ensure the residents received oxygen at the ordered rate. On 3/08/22 at 11:48 AM, the A Wing Unit Manager (UM) said O2 was considered a medication, and staff must have physician's orders for administration. She stated O2 settings were to be checked every shift, to ensure the O2 was on the correct L/M. On 3/09/22 at 10:26 AM, the Director of Nursing (DON) stated O2 was a medication, administered by physician's order, and part of the duty of nurses was to ensure O2 was at the correct flow, and administered as ordered. The facility's policy, Oxygen Administration copyright 2021 read, Oxygen is administered under orders of a physician. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 12 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 - Few 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** Based on observation, interview and record review, the facility failed to ensure medications were administered within professional guidelines/parameters for 1 of 5 residents reviewed for unnecessary medication (#145) and failed to ensure intravenous antibiotics were administered as per physician order for 2 residents, (#149, #193) of a total sample of 51 residents. Findings: 1. Review of resident #193's medical record documented he was admitted to the facility on [DATE] with diagnoses including Pneumonia, Arteriosclerotic Heart Disease (ASHD), Esophageal Perforation, with Intraabdominal infection, Elevated [NAME] Blood Cell Count and Abscess of the Stomach. Review of the Medical Certification For Medicaid Long-Term Care Services and Patient Transfer Form (3008) dated 03/03/22 documented the resident ambulated independently, was able to transfer self and was partial weight-bearing. Review of resident #193's plan of care dated 03/07/22 for resident has an active PNA (Pneumonia) infection with intervention to administer medications as ordered. On 03/09/22 at approximately 6 PM, a medication administration observation was conducted with resident #193. Registered Nurse (RN) T stated resident #193 was due for his Ertapenem Sodium Solution 1 Gram (GM) intravenous (IV) every evening over 30 minutes. She was unable to find the medication in the medication cart so she went to the medication room. She returned with 6 bags of 100 milliliters (ml) of Meropenem 1 GM. The 6 bags were labeled with resident #193's name and Meropenem 1 GM over 30 minutes until 03/11/22, dated 03/09/22 to be refilled 03/10/22. RN T said, The Pharmacy sent the wrong medication. She then asked the facility's Nurse Practitioner (NP) if the Meropenem and Ertapenem were the same medication. The NP responded, No they are different medications. At 6:19 PM, an empty IV bag labeled Meropenem 1 GM/100 ml normal saline was observed hanging on an IV pole in resident #193's room. RN T notified the 200 Unit Manager (UM) and at 6:24 PM the 200 UM stated, The pharmacy sent the wrong medication. At 6:49 PM, the 200 UM verbalized there were 2 more IV bags of Meropenem in the medication room and Ertapenem is in the medication dispensing machine located in the medication room. On 03/09/22 at 6:55 PM, the Director of Nursing (DON) provided 4 more IV bags of Meropenem 1 GM. On 03/09/22 at 6:59 PM, the Regional Nurse Consultant (RNC) stated the pharmacy had not delivered any Ertapenem to the facility and Ertapenem may have been removed from the medication dispensing machine. At 7:10 PM the RNC stated, Ertapenem had not been removed from the medication dispensing machine. Review of the Pharmacy Delivery Tracking Form for resident #193 dated 03/03/22-03/09/22 revealed Meropenem 1 GM/100ml normal saline had been delivered on 03/05/22 at 8 AM (9 bags), 03/07/22 at 7:43 PM (6 bags) and on 03/09/22 at 6:13 PM (6 bags). No Ertapenem had been been delivered to the facility. On 03/09/22 at 7:11 PM, 6 bags of IV Meropenem 1 GM were observed in the 200 Unit medication room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 13 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 - Few On 03/09/22 at 7:30 PM, during a telephone interview, the Pharmacist in Charge explained that Ertapenem was originally ordered from the hospital and the order for Ertapenem was transcribed to the pharmacy. He said the pharmacy did a Therapeutic Exchange from Ertapenem to Meropenem. The Pharmacist verbalized the therapeutic exchange information was included on the first Meropenem IV medication labels but was not included on the second Meropenem IV medication labels. He did not explain why the second order of Meropenem IV labels did not contain the information for the therapeutic exchange from Ertapenem to Meropenem. The Pharmacist explained the two medications were in the same classification of antibiotic medications and resident #193 should have received the Meropenem 1 GM IV every 8 hours. On 03/10/22 at 9:34 AM, the DON and RNC stated, Resident #193 had missed 6 doses of his IV Meropenem. Review of resident #193's physician's orders revealed the following orders: Ertapenem Sodium Solution Reconstituted 1 gram (GM) intravenously (IV) every 24 hours for intraabdominal infection with start date of 03/05/22 until 03/11/22. Meropenem 1 GM/100 milliliters (ml) Normal Saline 1 GM IV three times a day for intraabdominal infection/Gastrointestinal abscess/esophageal prolification with start date of 03/5/22 until 03/05/22. A second order dated 03/09/22 for Ertapenem Sodium Solution Reconstituted 1 GM IV in the evening DO NOT SUBSTITUTE relate to Pneumonia until 03/12/22 with start date of 03/07/22 A second order dated 03/05/22 for Meropenem 1 GM/100ml normal saline IV three times a day for intraabdominal infection/gastrointestinal abscess/esophageal prolification until 03/05/22. A third order dated 03/09/22 for Meropenem Solution Reconstituted 1 GM IV every 8 hours for intraabdominal infection related to elevated [NAME] Blood Cell count (WBC) until 03/12/22 Review of the resident's Medication Administration Record (MAR) documented Ertapenem 1 GM IV every 24 ours with start date of 03/05/22 and discontinue date of 03/04/22. No medication was administered. Meropenem 1 GM/100ml normal saline IV three time a day until 03/05/22 with start date of 03/05/22 was administered on 03/05/22 at 6 AM, 2 PM and 10 PM. On 03/06/22 no IV medication had been administered (3 doses omitted). Ertapenam 1 GM IV in the evening for DO NOT Substitute until 03/12/22 at 11:59 PM. The medication was administered on 03/07/22 at 7 PM, 03/08/22 at 7 PM and on 03/09/22 at 7 PM. The nurses signed they had administered Ertapenam when Ertapenem had never been delivered to the facility and no Ertapenem had been removed from the medication dispensing machine. A total of 6 doses of Meropenem were omitted. A total of 9 doses of Meropenem were omitted 03/06/22-03/09/22. On 03/11/22 at 1:10 PM, the NP stated she did complete an order to not exchange the Ertapenem on 03/07/22. She said she had discussed this with resident #193's physician and he wanted the Ertapenem administered once a day. The NP then recalled she had reviewed resident #193 Medication Administration Record (MAR) on 03/07/22 and she was aware that resident #193 had not received any of his ordered IV antibiotic on 03/06/22. She said she reordered the antibiotic again on 03/07/22. The NP did not indicate if she had notified the facility of the omission of resident #193's IV antibiotic medication. On 03/11/22 at 1:45 PM, a review of resident #193's MAR was conducted with the Administrator, RNC (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 14 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 - Few and DON. The Administrator, RNC and DON identified that resident #193 had missed a total of 9 doses of ordered IV Meropenem. The Administrator, RNC and DON verbalized the NP had not made them aware of the omission error for resident #193 Meropenem on 03/06/22. 2. Resident #149 was admitted to the facility on [DATE] with diagnoses of osteomyelitis of vertebra, lumbar region, sepsis, hemoptysis, chronic pain syndrome, acute and subacute endocarditis, Methicillin Resistant Staphylococcus Aureus (MRSA), and chronic hepatitis. Review of the resident's physician orders revealed the following: 3/02/22 Vancomycin 1.0 gram (gm) every (Q) 8 hours related to osteomyelitis of vertebra, end date 3/03/21. 3/03/21 Vancomycin 1.25 gm two times a day, end date 3/07/21. On 3/07/22 at 4:36 PM, resident #149 stated he received intravenous (IV) antibiotic Vancomycin at 9AM, and 9 PM daily, and had not received his 9 AM dose yet. The resident said he was told there was some mix-up with the pharmacy. On 03/08/22 at 4:20 PM, resident #149 verbalized he was previously on Vancomycin 1 gm, but was now getting Vancomycin 1 gm, and was told the facility was having some problem with the pharmacy regarding the dose. Progress note dated 3/07/22 at 5:15 PM read, Call placed to pharmacy at 0745 regarding dosage of Vancomycin available. Per pharmacy medication to be delivered on later run. Per APRN (Advance Practice Registered Nurse) 0900 1.25 gm dose discontinued. New order received for 1700 (5 PM) dose of Vancomycin 1 gm IV . Review of the Delivery Tracking obtained from the pharmacy for the resident's Vancomycin for the period 2/24/22 to 3/09/22 revealed the following: Twelve doses of Vancomycin 1 GM was delivered to the facility on 2/25/22 at 7:11 AM. Nine doses of Vancomycin 1 GM was delivered on 3/02/22 at 11:32 AM, and on 3/02/22 at 5:27 PM three doses of Vancomycin 1 GM was delivered to the facility. On 3/03/21 at 6:22 AM four doses of Vancomycin 1.25 GM was delivered to the facility. Four additional doses of Vancomycin 1.25 GM was delivered to the facility on 3/07/22 at 7:43 PM. Vancomycin 1.25 GM was not available for the resident's 9 AM dose on 3/07/22. The Medication Administration Record (MAR) was compared with the Delivery Tracking and revealed the four doses of Vancomycin 1.25 gm should have been administered on 3/03/22 at 9 PM, 3/04/22 9 AM and 9 PM, and the final dose should have been administered on 3/05/22 at 9 AM. Documentation on the MAR indicated Vancomycin 1.25 gm was administered on 3/03/22 at 9 PM, 3/04/22 at 9 AM and 9 PM, 3/05/22 at 9 AM, and 9 PM, 3/06/22 at 9 AM and 9 PM. However, only four doses of the Vancomycin 1.25 was delivered by the pharmacy. Another delivery of Vancomycin 1.25 mg was not delivered until 3/07/22 at 7:43 PM. This was confirmed by the Director of Nursing (DON). 03/09/22 at 10:17 AM, the DON stated she spoke with some of the nurses who administered the Vancomycin on 3/05/22 at 9 PM, and on 3/06/22 at 9 AM and 9 PM, and the nurses verbalized to her they administered the correct dose. The DON confirmed the pharmacy delivered four doses of Vancomycin 1.25 G on 3/03/22 and could not say where the doses that were administered on 3/05/22 at 9 PM, and 3/06/22 at 9 AM and 9 PM came from. The DON stated protocol if medication was not available, the nurse should call the pharmacy, check the emergency kit, and if not available, notify the physician for adjustment of the order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 15 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 On 03/09/22 10:38 AM, Registered Nurse (RN) H stated she worked on the 7 AM-3 PM shift on 3/05/22, and 3/06/22, and resident #145 was on 1.25 gm of Vancomycin IV. RN H stated two bags of Vancomycin 1.25 gm were in the refrigerator on Saturday 3/05/22. She said she checked the dosage prior to administration both days and administered Vancomycin 1.25 gm at 9 AM on both days She stated, I cannot speak for the 9 PM dose. Residents Affected - Few On 03/09/22 at 3:49 PM, the DON stated she reviewed the Delivery tracking of the medication from the pharmacy and four doses of Vancomycin 1.25 gm were delivered on 3/03/22 at 6:22 AM. She reviewed the physician's order sheet (POS), which showed Vancomycin 1.25 gm was ordered for 3/03/22 starting at 9 PM. The MAR showed Vancomycin 1.25 gm was administered on 3/03/22 at 9 PM, 3/04/22 at 9 AM, and 9 PM, and the fourth dose was administered on 3/05/22 at 9 AM. She verbalized she spoke to the nurses, and they told her they gave Vancomycin 1.25 gm. She said there was a lot of Vancomycin 1 gm available in the medication room, and most likely 1 gm was administered instead of 1.25 gm, since the next delivery of Vancomycin 1.25 gm was on 3/07/22 at 7:45 PM. The DON stated she could not confirm what dose of Vancomycin was administer on 3/05/22 at 9 PM, and on 3/6/22 at 9 AM, and 9 PM. On 3/09/22 at 4:09 PM, the Regional Nurse Consultant (RNC) reported the DON obtained a statement from RN H who worked on 3/05/22, and 3/06/22 and documented administration of the 9 AM doses on those days. The RNC stated the DON was working on getting statements from the other nurses who signed off on the MAR. She said, it appears dosages of Vancomycin 1 gm was available, but none of the 1.25 gm, and the DON would be reporting a medication discrepancy. In a telephone interview on 3/10/22 at 10:20 AM, Licensed Practical Nurse (LPN) J verbalized she worked 7 PM-7 AM on 3/05/22, and 3/06/22. LPN J stated she distinctly remembered getting Vancomycin 1.25 gm from the refrigerator, two bags were available, and she administered 1.25 gm to the resident on both days. She verbalized she checked her order against the medication, and had it sit out for a while because it was cold. She stated she called the pharmacy and placed an order for the 1.25 gm dosage and reported to LPN K that the resident's dose was not available. She stated LPN K said some was in the medication room, and she told LPN K that it was the wrong dose. When informed that only four doses of Vancomycin 1.25 gm was delivered from the pharmacy, LPN J stated she could not speak for other nurses regarding the dosage that was administered. The facility's policy Medication Administration copyright 2021 read, Review MAR to identify medication to be administered. Compare medication source .with MAR to verify resident name, medication name, form, dose, route, and time . 3. Resident #145 was admitted to the facility on [DATE] with diagnoses including, acute osteomyelitis right ankle, rheumatoid arthritis, atrial fibrillation, hypertension, diabetes type II, and bacteremia. On 3/07/22 at 11:26 AM, resident #145 stated he had not received his regular morning medications yet and added his medications were late a number of times. The resident verbalized his medications were nearly two and a half hours late. He explained he had rheumatoid arthritis, and if he did not get his medication, Lyrica on time, it caused pain and spasms. On 3/07/22 at 12:24 PM, Licensed Practical Nurse (LPN) K was observed standing at the resident's room pulling medications from her medication cart. On 3/07/22 at 2:13 PM, LPN K stated resident #145 received his 9 AM medications at noon. She said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 16 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 - Few the protocol for medications administered late was to inform management, and to make the physician aware. LPN K stated she called the physician but did not document the communication. Review of the Medication Admin Audit Report for the day shift on 3/07/22 revealed the following: Resident #145 received his scheduled 9 AM medications between 12:21 PM and 12:33 PM including Lyrica 150 milligram (mg) ordered two times daily for chronic pain, Amlodipine 10 mg, and Carvedilol 12.5 mg ordered daily for high blood pressure, Prednisone 10 mg ordered daily for inflammation, Eliquis 5 mg ordered two times daily for clot prevention, Bumex 1 mg ordered two times daily for edema, and Buspirone 30 mg ordered two times daily for anxiety. His scheduled 2 PM antibiotic Cefazolin 2 gram ordered every 8 hours for osteomyelitis was administered at 4:16 PM. On 3/10/22 at 11:14 AM, the A Wing Unit Manager (UM) explained staff had one hour before and one hour after the scheduled time to administer medications. The resident's Medication Admin Audit Report was reviewed with the UM. She acknowledged the resident's 9 AM medications were administered outside of the parameters on 3/07/22. The resident's clinical records were also reviewed with the UM. She noted there was no documentation to indicate the physician was made aware of the resident's medications being administered late. On 3/10/22 at 11:27 AM, LPN K stated she was behind on medications on 3/07/22, just as I am today and resident #145 received his medications late. The Medication Admin Audit Report for the resident was reviewed with LPN K. She confirmed she gave the resident's medications outside of parameter of one hour before and one hour after the scheduled time. On 3/10/22 at 11:35 AM, the Director of Nursing (DON) stated nurses had a window of one hour before and one hour after scheduled time to administer medications. She said she expected staff would administer medications timely. The DON said if the nurse was late, she should make management and the physician aware. The Medication Admin Audit Report was reviewed with the DON. She indicated medications were administered outside of parameter on the day shift on 3/07/22. The facility's policy Medication Administration copyright 2021 read Medications are administered by licensed nurses .as ordered by the physician and in accordance with professional standards of practice. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 17 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 obtain dental services for 1 of 2 residents reviewed for dental services out of a total sample of 51 residents, (#84). Residents Affected - Few Findings: Review of resident #84's medical record documented she was admitted to the facility on [DATE] with diagnoses including Metabolic Encephalopathy, Epilepsy, Seizures, Cerebral Vascular Accident (CVA) and Acute Respiratory Failure. Review of the Annual Minimum Data Set (MDS) assessment dated [DATE] documented she had no cognitive issues, was on a mechanically altered/therapeutic diet and had obvious or likely cavity or broken teeth. Review of resident #84's plan of care noted resident had a dental or oral problem related to broken teeth dated 02/28/22. The goal included the resident to be free of infection, pain or bleeding in the oral cavity through review date of 06/03/22. The intervention included dental referral as needed. On 03/07/22 at 1:32 PM, resident #84 stated she had been missing her front bottom teeth and she told them that she had a tooth that was cracked and it needed to be fixed. They never offered me dental services. Review of the admission Assessment Oral Evaluation dated 12/09/21 documented resident was edentulous (no natural teeth) and no dentures. On 01/20/22 and on 02/08/22 the Oral Evaluations documented no missing teeth and no dentures. On 03/11/22 at 3:43 PM, the Director of Nursing (DON) stated she had reviewed the three Oral Evaluations and she could not explain the documentation. The DON explained, If you are edentulous it means you have no teeth. The DON then noted she was not sure which documentation for resident #84's oral status was correct. On 03/09/22 at 11:55 AM, the Social Service Director (SSD) said she was responsible for the facility's dental program for residents with dental issues. She noted the process was to refer residents with dental issues to the contracted dental office. She said the dental office had a Medicaid funded program for residents with dental issues. The SSD explained she sends the resident's enrollment form and face sheet to the dental office and the resident is placed on a list to be seen by the dentist. The SSD confirmed resident #84 was on Medicaid, had a care plan for dental issues related to broken teeth, and was on a mechanically altered diet. The SSD checked the list and said the resident was not on the list to be seen by the dentist. Review of the dental list for March 2022 revealed resident #84 had not been placed on the list to be seen by the dentist. On 03/09/22 at 3:56 PM, the SSD explained resident #84 needed to be seen by and I am not sure why she was not put on the list when she was assessed with dental concerns. On 03/09/22 at 4:13 PM, the DON stated the admission care plan dated 2/28/22 documented the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 18 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete resident had dental issues related to broken teeth. She added, The dental process stopped and the facility did not obtain dental services for resident #84's needs. Review of the Facility's Dental Services Policy, not dated, read, Policy: It is the policy of this facility to assist residents in obtaining routine (to the extent covered under the State plan) and emergency dental care. Definitions: Routine dental services means an annual inspection of the oral cavity for signs of disease . dental cleaning, fillings . Emergency dental services includes services needed to treat . broken or otherwise damaged teeth . that required immediate attention by a dentist . Policy Explanation and Compliance Guidelines: 1. The dental needs of each resident are identified through the physical assessment and MDS assessment process, and are addressed in each resident's plan of care . 2. Residents and/or resident representatives, during the admission process, are notified of dental services available under the State plan . a. The facility will assist residents who are eligible and wish to participate to apply for reimbursement for dental services . 3. The Social Services Director maintains contact information for providers of dental services that are available to facility residents at nominal cost. Event ID: Facility ID: 105464 If continuation sheet Page 19 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 0908 Keep all essential equipment working safely. 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 the facility's oxygen concentrator external filters were clean and in safe operating condition for 3 of 6 residents reviewed for respiratory care out of a total sample of 51 residents, (#37, #84, #197). Residents Affected - Some Findings: Review of resident #37's medical record documented he was admitted to the facility on [DATE] with diagnoses including Chronic Obstructive Pulmonary Disease (COPD) and Acute and Chronic Respiratory Failure Review of the physician's orders revealed oxygen at 4 liters (L) per minute via nasal cannula. Review of the 5 day Minimum Data Set (MDS) assessment dated [DATE] documented resident received oxygen therapy. Review of resident #37's plan of care for at risk for cardiovascular complications dated 07/20/20 with intervention to administer oxygen as ordered. Observations conducted on 03/07/22 at 2:43 PM, 03/08/22 at 10:37 AM and on 03/09/22 at 10:21 AM revealed the oxygen concentrator's external filter was covered with gray dust. Review of resident #84's medical record noted she was admitted to the facility on [DATE] with diagnoses including Pneumonia and Acute Respiratory Failure with Hypoxia. Review of the physician's orders revealed oxygen at 2 L per minute via nasal cannula. Review of the admission MDS assessment dated [DATE] documented resident received oxygen therapy. Review of the resident's plan of care for at risk for cardiovascular complications dated 01/24/22 with intervention to administer oxygen per physician order. Observations conducted on 03/07/22 at 1:44 PM, 03/08/22 at 10:32 AM, and 03/09/22 at 10:31 AM revealed the oxygen concentrator's external filter was covered with gray dust. Review of resident #197's medical record revealed he was admitted to the facility on [DATE] with diagnoses including Pneumonia, Chronic Obstructive Pulmonary Disease and Malignant Neoplasm of Bronchus or Lung. Review of the physician's orders documented oxygen at 3 L per minute via nasal cannula. Review of the admission MDS assessment dated [DATE] documented he received oxygen therapy. Review of resident #197's plan of care for at risk for cardiovascular complications dated 03/01/22 noted intervention to administer oxygen as ordered. Observations conducted on 03/07/22 at 11 AM, 03/08/22 at 11:09 AM, 03/09/22 at 9:45 and 11:02 AM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 20 of 21 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 105464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anchor Care & Rehabilitation Center 1515 Port Malabar Blvd NE Palm Bay, FL 32905 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 0908 revealed the oxygen concentrator's external filter covered with gray dust. Level of Harm - Minimal harm or potential for actual harm On 03/09/22 at 11:02 AM, the Director of Nursing (DON) stated residents #37's, #84's and #197's oxygen concentrator external filters were soiled with gray dust and needed to be cleaned. She explained she was unsure who was responsible to clean the external filters. It may be maintenance staff or the central supply person. The DON explained the purpose of the external filters was to remove dust and particles from the room air entering the concentrator. The concentrator then delivers clean oxygen to the resident at the liter flow ordered by the physician. She then indicated if the external filter was soiled it would not function properly. Residents Affected - Some 03/09/22 at 11:48 AM, the Central Supply employee stated he was not responsible for cleaning the oxygen concentrator filters. 03/09/22 at 12:40 PM, the Maintenance Director stated he had never been responsible for cleaning the external filters on the oxygen concentrators. Review of the Facility's Oxygen Administration Policy, not dated, read, Policy: Oxygen is administered to residents who need it, consistent with professional standards of practice, the comprehensive person-centered care plans, and the resident's goals and preferences . 5 . Other infection control measures include: a. Follow manufacturer recommendations for the frequency of cleaning equipment filters . Review of the .Oxygen Concentrator Instruction Guide, not dated, read, . (page 8) Air Filter, The air filter should be inspected periodically and cleaned as needed by the user or care giver. Replace if torn or damaged. To clean, these steps should be followed: The frequency of inspection and cleaning of filter may be dependent upon environmental conditions like dust and lint. 1. Remove the air filter located on the back of the unit. 2. Wash in a solution of warm water and dishwashing detergent. 3. Rinse thoroughly with warm tap water and towel dry. The filter should be completely dry before reinstalling . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105464 If continuation sheet Page 21 of 21