Health inspection·January 11, 2024

F 0565 Level of Harm - Minimal harm or potential for actual harm variety of activities. They said they spoke to the Activities Director who made them aware there was no budget for supplies. Some residents stated they did their own activities such as card games and bingo. Review of Resident Council minutes from May 2023 to December 2023 revealed several repeat grievances concerning staffing, dietary, call lights, and activities. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 2 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0583 Keep residents' personal and medical records private and confidential. 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 residents' right to privacy during intimate encounters for 2 of 2 residents reviewed for privacy, out of a total sample of 57 residents, (#48 and #35). Residents Affected - Few Findings: 1. Resident #48 was admitted to the facility on [DATE] with diagnoses including multiple sclerosis, paraplegia, , major depressive disorder and generalized anxiety. Review of the Minimum Data Set (MDS) quarterly assessment with assessment reference date of 11/15/23 revealed resident #48 had a Brief Interview for Mental Status score of 15 out of 15 which indicated he was cognitively intact. The document indicated he was able to make himself understood and understood others and did not exhibit any aggressive behaviors. On 1/08/24 at 12:35 PM, resident #48 stated he had a girlfriend who was another resident at the facility. He explained they had been dating for about a year but began getting physical about a month ago and had intimate encounters in his room. Resident #48 stated his roommate did not like it, but they do not have a private place to meet. Resident #48 stated the Social Services Director (SSD) was aware of their relationship but had not offered them a private place to be together. He noted he would like a private place as he did not want to upset his roommate. Review of resident #48's medical record revealed no progress notes related to his relationship and wish for privacy and no care plan to address his wish for privacy. 2. Resident #35 was admitted to the facility on [DATE] with diagnoses including encephalopathy, acute respiratory failure, hypertension, chronic congestive heart failure and mood disorder. Review of the Minimum Data Set (MDS) quarterly assessment with assessment reference date of 10/06/23 revealed resident #35 had a BIMS score of 12 which indicated she had moderate cognitive impairment. The document indicated she was able to make herself understood and understood others and did not exhibit any behaviors. Review of resident #35's medical record revealed a competency determination completed by two physicians. The document indicated the resident had capacity to make her own decisions. On 1/10/24 at 11:42 AM, resident #35 verified she was in a relationship with resident #48. She confirmed they had been dating for about a year but only became physical recently. Resident #35 explained she did not feel like they had privacy and wanted to have a private place to meet. Review of resident #35's medical record revealed no progress notes related to her relationship and wish for privacy and no care plan to address her wish for privacy. On 1/09/24 at 11:59 AM, the SSD verified resident #48 and resident #35 were in a relationship and were physically intimate with each other in resident #48's room. She acknowledged resident #48's roommate was not happy with their actions in the room and had complained about it last month. The SSD stated she reported the situation to the Administrator and Director of Nursing to determine if resident #48 and resident #35 had capacity to consent to a physical relationship. She recalled she offered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 3 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete resident #48's roommate a room change but he declined. The SSD reviewed the medical record for resident #48 and his roommate. She acknowledged there was no documentation regarding resident #48's relationship or the offer of a room change. The SSD stated she spoke to resident #48 but had not interviewed resident #35 regarding the relationship. She acknowledged the facility had not offered a private place for resident #48 and resident #35 to be alone during their intimate encounters. The SSD was unable to provide a solution to the lack of privacy for resident #48 and resident #35. Event ID: Facility ID: 105471 If continuation sheet Page 4 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 observation, interview, and record review, the facility failed to provide documented evidence that grievances were resolved promptly, and residents/family members were apprised of progress toward a resolution of grievances for 2 of 2 residents reviewed for grievances out of a total sample of 57 residents, (#54, 34). Findings: 1. Resident #54 was admitted to the facility on [DATE] with diagnoses including Friedreich Ataxia, cardiomyopathy, dependence in wheelchair, lack of coordination and muscle weakness. Friedreich ataxia (FA) is a rare inherited disease that causes progressive damage to your nervous system and movement problems (retrieved on 1/12/24 from https://www.ninds.nih.gov/health). Review of the Minimum Data Set (MDS) Quarterly assessment dated [DATE] revealed resident #54's Brief Interview for Mental Status (BIMS) score was 15 of 15 which indicated he was cognitively intact. The MDS assessment showed the resident was moderately dependent on staff for his activities of daily living (ADL) such as bathing and was wheelchair dependent. He had a comprehensive care plan in effect for ADL Self Care Performance Deficit related to [NAME] Ataxia, weakness, and bilateral foot drop. On 1/8/24 at 12:45 PM, resident #54 was observed sitting in an electric wheelchair. He was alert and oriented to person, place, and situation. The resident stated that approximately 2 months ago, Certified Nursing Assistant (CNA) A refused to give him a shower on his shower day and told him, I don't give a f---. Resident #54 noted he did not think it was abuse at the time and said he filed a grievance. He indicated he had not seen CNA A since the incident. Review of the facility grievance and abuse logs did not show any entries for resident #54 in the past 3 months. On 1/10/24 at 9:48 AM, the East Wing Unit Manager said she was not aware of any incidents or grievances involving resident #54 and CNA A using curse words with him. On 1/10/24 at 10:02 AM, the Social Services Director (SSD) verified she was the Grievance Officer and was not aware of any grievances for resident #54 or concerns with CNA A not giving him a shower and cursing. The SSD added, if she had been informed about this, she would have initiated an investigation and spoken to the resident and CNA and then obtained statements if indicated. On 1/10/24 at 2:40 PM, during a follow up interview, the SSD explained resident #54 wanted a shower but CNA A was busy with another resident. He tried asking about his shower later and the CNA was on break. He waited in the hallway for her to come back from break and told her was going to file a grievance against her and the CNA told him she did not give a f---. He said he reported the incident to the Weekend Supervisor who assisted him to complete a grievance form. The SSD indicated that along with completing a grievance form, the Weekend Supervisor should have reported the incident to her and the Director of Nursing. She stated the resident thought the issue was taken care of as he did not see CNA A again. She said the CNA was from an agency and the facility did not notify the agency until it was brought to their attention by the surveyor. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 5 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 On 1/10/24 at 3:01 PM, the Weekend Supervisor said it was 3 weeks ago when he filled out the grievance form for resident #54 and had the resident sign it. He noted the incident occurred on Sunday on the 3 PM-11 PM shift. He explained resident #54 complained to him that he did not get a shower or assisted back to bed. He stated he documented in the form that when the resident told the CNA he was filing a grievance, she stated, does it look like I give a f---. He recalled he left the grievance in the Director of Nursing's (DON) office and did not hear anything else about it. He assumed the SSD would have followed up and processed the grievance. On 1/10/24 at 3:17 PM, the DON said she had not received any grievance from the Weekend Supervisor regarding resident #54 and had been on vacation 3 weeks ago. The DON said the Assistant Director of Nursing (ADON) had not mentioned any grievances involving resident #54 and CNA A. The DON explained the process when a grievance was filed, was to obtain statements from the resident and inform the Grievance Officer/SSD. The DON noted in this case, the CNA's agency would be notified and they would not have the CNA return to work in the facility. On 1/10/24 at 4:42 PM, the ADON verified she covered for the DON while she was on leave but did not go into her office. The ADON explained the Weekend Supervisor should have informed her immediately about resident #54's grievance to ensure timely follow up with his concerns. She would have proceeded to obtain statements from CNA A, resident #54 and any other staff or residents. The ADON added that she would have communicated with the SSD/Grievance officer to determine if this was perhaps an abuse allegation. 2. Resident #34 was admitted to the facility on [DATE] with diagnoses including paraplegia, dependence on renal dialysis, end stage renal disease, type 2 diabetes, seizures and major depressive disorder. Review of the MDS quarterly assessment with assessment reference date of 11/22/23 revealed resident #34 had a Brief Interview for Mental Status score of 15 which indicated he was cognitively intact. He had clear speech and was able to make himself understood and understood others. The document indicated resident #34 did not exhibit any behaviors. On 1/07/24 at 1:19 PM, resident #34 stated he was unhappy with his roommate situation. He explained a female resident and his roommate engaged in sexual conduct while he was in the room. Resident #34 stated he felt very uncomfortable with this situation and had reported it to the Social Services Director, but nothing had been done. Review of the facility's Grievance Log revealed no grievance regarding resident #34's concern with his roommate. On 1/09/24 at 11:48 AM, the SSD verified she was responsible for grievances. She stated anyone could fill out a grievance form, turn it in to Social Services and she provided them to the appropriate department for resolution. She explained that a staff member could complete a grievance form and she often completed them for residents who came to her with a concern. The SSD stated the grievances were recorded on a log and attempts were made to resolve the grievance within 48-72 hours. The SSD confirmed resident #34 had spoken with her in December 2023 regarding his roommate's activities. She could not remember the exact date but stated she reported it to the Administrator and DON right away. The SSD explained resident #34 was offered a room change and declined. She reviewed the medical record for resident #34 and acknowledged there was no documentation regarding his concern or the offer of a room change. The SSD verified she did not complete a grievance form regarding resident #34's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 6 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 FORM CMS-2567 (02/99) Previous Versions Obsolete concern. She explained she was not sure why she did not complete a form. The SSD stated she did not think about documenting it on a grievance form. She acknowledged that a grievance form should have been completed. The SSD was unable to state what the solution to the grievance was and stated she would have to discuss it with their corporate office. Review of the facility's policy and procedure for Grievances Program dated 4/01/22, revealed that a grievance was defined as any concern that could not be resolved to the satisfaction of the person making the objection at the bedside or within four or less hours. The document indicated when there was a grievance, it would be documented on paper form, routed to the Grievance Officer, discussed with appropriate individuals, investigated accordingly and the person filing the concern or grievance would be informed of the findings of the investigation and the actions that would be taken to correct the problem and documented on the appropriate concern form. Event ID: Facility ID: 105471 If continuation sheet Page 7 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to report an allegation of staff-to-resident abuse to State agencies within the required 2-hour timeframe, and failed to report the incident to law enforcement for 1 of 4 residents reviewed for abuse, out of a total sample of 57 residents, (#13). Findings: Review of the medical record revealed resident #13 was admitted to the facility on [DATE] with diagnoses including pain in her lower back and bilateral lower legs, blood clots in bilateral legs, opioid dependence, morbid obesity, muscle spasms, depression, and insomnia. The Minimum Data Set (MDS) Quarterly assessment with assessment reference date of 12/05/23 revealed resident #13 had clear speech, was able to express ideas and wants, and had no comprehension issues. The resident's Brief Interview for Mental Status score was 15 which indicated she was cognitively intact. The MDS assessment showed resident #13 had no behavioral symptoms and did not reject evaluation or care necessary to achieve her goals for health and well-being. Resident #13 required substantial or maximal assistance for toileting hygiene and lower body dressing, and partial to moderate assistance for bathing. On 1/07/24 at 11:08 AM, resident #13 described an incident which occurred on Friday 1/05/24, when her assigned Certified Nursing Assistant (CNA) was very rough and unkind to her during personal hygiene care. The resident explained she had sensitive skin and she asked the CNA to be gentler as she washed her. Resident #13 stated the CNA became belligerent at being corrected. She said, The more I talked, the louder she got, and it kept escalating. The resident stated the CNA refused to complete washing her, and told her to do it herself. Resident #13 stated the CNA pressed her thumbs into her inner knees and she had to throw my legs up to get the CNA's hands away. Resident #13 stated two floor nurses came to her room to speak to her about the incident, but nobody from the facility's administration such as the Director of Nursing (DON), the Social Services Director (SSD), the Administrator, nor the police had interviewed her about the incident yet. The resident stated she notified her daughter immediately after the incident and it was not until after her daughter arrived at the facility to express her dissatisfaction with the facility's lack of action that the CNA was sent home. Review of resident #13's medical record revealed a nursing note dated 1/05/24 at 5:04 PM that read, [Patient] stated that she was mishandled by the staff that was taking care of her, she was very rude and rough. The note indicated the nurse switched the CNA to another resident care assignment and notified the supervisor. On 1/07/24 at 12:35 PM, the SSD confirmed she was the facility's designated Abuse Coordinator and her responsibilities included assisting the Risk Manager, the Administrator, with investigations of alleged abuse and neglect. She stated if an incident occurred after-hours or on the weekend, the nurse would ensure the safety of residents and then notify DON and Administrator who would involve her by way of a conference call. The SSD explained it was important for staff to report alleged abuse immediately because the facility needed to initiate an investigation to determine if necessary reports had to be filed within two hours. The SSD stated staff notified the DON first and then they called her. The SSD said, I directed them to remove the CNA from the assignment and suspend her. I told them to gather witness statements to get the details and they sent them to me. She stated she reported (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 8 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few her initial findings from her telephone conversations with staff to the Administrator, and he filed the required report to the State Survey Agency. The SSD acknowledged she had not yet interviewed the resident as she wrote a detailed statement. On 1/07/24 at 12:54 PM, the SSD provided a copy of the facility's Immediate Report, filed with the State Agency's federal reporting system, regarding resident #13's allegation of staff-to-resident abuse. The document indicated the incident occurred on 1/05/23 at 7:30 PM, which conflicted with nursing documentation of the event at approximately 5:00 PM. The Immediate Report showed the DON reported the incident to the Administrator and SSD on 1/05/24 at 8:30 PM and the facility's response was to suspend the CNA pending investigation and notify the county sheriff's office. When asked to provide a case number as proof of notification of law enforcement, the SSD stated she did not have confirmation. The SSD explained she asked the nurse to call the police, and the resident and/or her daughter also stated they would call. The SSD acknowledged she did not follow up and was not sure if law enforcement was ever notified. She verified the facility, not the alleged victim, was responsible for notifying law enforcement of abuse allegations in the facility. Review of the alleged perpetrators time card indicated the CNA clocked out on 1/05/24 at 8:24 PM, over three hours after the incident was documented in resident #13's medical record. On 1/07/24 at 2:01 PM, a Deputy Sheriff stood at resident #13's bedside. She explained she was dispatched to the facility in response to an allegation of abuse and would provide the information she obtained from the resident to detectives. Review of the facility's policy and procedure for Abuse, revised on 10/24/22, revealed if the events that caused an allegation involved abuse, the violation would be reported immediately, and not later than two hours after the allegation was made. The document indicated the facility was required to comply with external reporting requirements including the State Agency and law enforcement. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 9 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. Resident #46 was admitted to the facility on [DATE] and readmitted on [DATE] from an acute care hospital. His diagnoses included fractured femur, orthopedic aftercare, and anemia. Review of resident #46's medical record revealed a nursing progress note dated 12/13/23 that noted he was hospitalized for a change of condition, Pain [uncontrolled] and the primary provider instructed to send to the hospital. The facility Transfer to Hospital form dated 12/13/23 indicated unplanned transfer due to recent fall on 12/8/23. Review of the hospital record dated 12/13/23 revealed his principal problem was fractured femur due to fall 5 days ago at SNF (Skilled Nurse Facility). The medical record did not contain Nursing Home Transfer and Discharge Notice form for this hospitalization. On 1/11/24 at 1:40 PM, the facility Nursing Home Administrator stated he was not aware who was responsible for completing the Nursing Home Transfer and Discharge Notice form and notification to the Ombudsman when a resident was transferred to the hospital. Based on interview, and record review, the facility failed to provide written Notification of Transfer or Discharge forms to the residents or their representative, and the Ombudsman for 6 of 6 residents reviewed for hospitalizations of a total sample of 57 residents, (#6, #83, #567, #33, #98 and #46). Findings: 1. Resident #6 was admitted to the facility on [DATE] with diagnoses that included seizures, impulse disorders, anxiety disorder, mood disorder. A nurse's progress note dated 5/18/23 indicated resident #6 was aggressive with other residents by the smoking door. The nurse described resident #6 as having to be restrained and law enforcement was called for assistance. Further review of the medical record revealed the Psychiatric Advanced Practice Registered Nurse (APRN) signed a form for involuntary inpatient placement after she assessed resident #6 to be a risk to others in the facility and required transfer to a higher level of care. Review of resident #6's medical record revealed no written Notification of Transfer or Discharge form for the hospitalization, nor documentation of notification to the state Ombudsman. 2. Resident #83 was admitted to the facility on [DATE] with diagnoses that included disturbed brain function, anxiety disorder, mood disorder due to unknown psychological condition, stroke and Lyme disease. Review of resident #83's medical record revealed a nurse's note dated 5/10/23 that noted due to psychosis and agitation, the physician recommended the resident be transferred to a behavioral health hospital due to dangers posed to himself and others. A form for involuntary inpatient placement was signed by the Psychiatric APRN to transfer resident #83 to a higher level of care due to his aggressive behaviors that were unable to be stabilized at the facility. Review of resident #83's medical record revealed no written Notification of Transfer or Discharge (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 10 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0623 form for the hospitalization, nor documentation of notification to the state Ombudsman. Level of Harm - Minimal harm or potential for actual harm 3. Resident #567 was admitted to the facility on [DATE] with diagnoses that included dementia with behavioral disturbance, traumatic brain injury, seizures, and psychotic disorder with delusions. Residents Affected - Some On 5/13/23 a social service department note detailed resident #567 physically attacked a staff member, punching them multiple times in the face and head. Review of the medical record revealed a form for involuntary inpatient placement was signed by the Psychiatric APRN to transfer resident #567 to a higher level of care due to uncontrolled impulses, mania, delusions and psychosis that made him a threat to the safety of himself and others. The medical record did not contain a written Notification of Transfer or Discharge form for the hospitalization, nor documentation of notification to the state ombudsman. 5. Resident #33 was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease, chronic respiratory failure, type 2 diabetes, emphysema, chronic pulmonary edema and atrial fibrillation. Review of resident #33's medical record revealed he was hospitalized on [DATE] due to rectal bleeding and again on 9/17/23 due to pain in left side. The medical record did not contain Notification of Transfer or Discharge forms for the hospitalizations on 6/06/23 and 9/17/23. 6. Resident #98 was admitted to the facility on [DATE] with diagnoses including sepsis, cholecystitis, occlusion and stenosis of right carotid artery, chronic respiratory failure, type 2 diabetes and brain compression status post craniotomy Review of resident #98's medical record revealed she was hospitalized on [DATE] after being found unresponsive. The medical record did not contain Notification of Transfer or Discharge forms for the hospitalization. On 1/10/24 at 9:55 AM, the Social Services Director (SSD) stated she completed the Notice of Transfer or Discharge forms for residents who discharged to the community, but not for residents who transferred to the hospital. She explained she was not aware the forms needed to be completed for residents who went to a higher level of care. She stated she had not completed any since she was hired in May 2023 nor had she notified the Ombudsman of those transfers. The SSD was unable to identify who completed the Notice of Transfer or Discharge forms for residents who were transferred to the hospital. On 1/11/24 at 1:40 PM, the Nursing Home Administrator explained he did not realize facility initiated transfers required the form to be completed and provided to the resident or resident representative. On 1/11/24 at 2:22 PM, the Social Services Director verified she had not completed Nursing Home Transfer and Discharge Notice forms which included notification to the Ombudsman since she started working at the facility on May 29, 2023. She stated she was unable to locate the Notice of Transfer and Discharge Forms for any resident transferred to the hospital since May 2023. The facility's policy and procedure for Resident Transfer and Discharge dated April 1, 2022 read, Before the Facility transfers or discharges a resident, the Facility shall, in a written notice: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 11 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0623 Level of Harm - Minimal harm or potential for actual harm Notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The Facility must send a [NAME] of the notice to a representative of the Office of the State Long-Term Care Ombudsman. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 12 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 - Some 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 provide appropriate care and services for splinting to prevent worsening of contractures for 1 of 1 residents reviewed for limited range of motion, out of a total sample of 57 residents, (#44). Findings: Review of the medical record revealed resident #44 was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses including encephalopathy (brain dysfunction), paraplegia, stroke, and contractures of all extremities. A contracture is limited movement of a join caused by shortening or contracting of muscles in the arms or legs due to inactivity or inability to move. Contractures are prevented and treated by regular movement and range of motion or stretching exercises, and use of splints to maintain a contracture in a stretched position (retrieved on 1/17/24 from www.drugs.com/cg/contracture-ambulatory-care.html). The Minimum Data Set (MDS) Quarterly assessment with assessment reference date of 11/28/23 revealed resident #44 had severely impaired cognitive skills for daily decision making. The document showed the resident exhibited no behavioral symptoms and did not reject evaluation or care that was necessary to achieve her goals for health and well-being. The MDS assessment revealed the resident had contractures and was totally dependent on staff for self-care and mobility. Review of Section O, Special treatments, Procedures, and Programs, showed resident #44 did not receive any Restorative Nursing Program (RNP) services including range of motion exercises or assistance with splints in the 7-day lookback period. Review of the medical record revealed resident #44 had a care plan initiated on 7/29/20 for activities of daily living self-care performance deficit related to limited mobility and limited range of motion. The goal was the resident would maintain her current level of function. An intervention dated 4/20/23 revealed RNP staff were to perform passive range of motion (PROM) exercises for the resident's shoulders, wrists, and fingers as tolerated, and apply left and right hand and elbow splints for four to six hours as tolerated. Review of an Occupational Therapy Discharge summary dated 10/1023 revealed resident #44 was on Occupational Therapy caseload from 9/01/23 to 10/08/23. She was discharged and referred to the RNP when she achieved her maximum potential. The document indicated therapy staff instructed RNP staff on conducting skin checks and the schedule for application of the resident's splints .in order to preserve current level of function. The discharge summary indicated resident #44's prognosis was excellent with participation in the RNP for bilateral hand and elbow splints. Review of Restorative Nursing Program Instructions dated 10/09/23 revealed resident #44's RNP goal was PROM to her bilateral upper extremities with splint applications, three times weekly. The program activities included instructions to perform PROM on all joints to the resident's end range, three sets of ten, with a 3-second hold for each, in preparation for splinting. The documents indicated bilateral resting hand splints and bilateral elbow splints were to be worn for four to six hours as tolerated, and skin checks performed pre and post splinting. The RNP instruction form was signed on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 13 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 10/10/23 by Restorative Aide F to verify she received training on the RNP requirements for resident #44. Level of Harm - Minimal harm or potential for actual harm On 1/07/24 at 2:52 PM, resident #44's elbows, wrists, and fingers were tightly contracted and held close to her chest. She did not have splints applied, and her long fingernails with sharp edges were pressed into both palms. The Wound Nurse and Restorative Aide F confirmed the resident's fingernails were too long. They explained the resident's daughter usually cut her fingernails but both staff acknowledged facility staff were responsible for contacting the family if the task was not done or to request permission to provide the necessary care. The Wound Nurse and Restorative Aide F validated resident #44's fingernails needed to be cut to prevent injury to her palms and fingers due to her contractures. Restorative Aide F verified skin and fingernail checks should be performed before and after splint application. Residents Affected - Some On 1/07/24 at 3:07 PM, Restorative Aide F showed two hand splints and two elbow splints on the top shelf of resident #44's closet. When asked why the resident did not have the splints applied to her arms, Restorative Aide F explained she had not been able to perform RNP duties for any residents today as she was reassigned at the start of the shift to monitor residents in the the facility's smoking area. She stated resident #44's name had not been on her list of residents who needed splints for a while and only got back on the RNP assignment last week. Restorative Aide F said, I did not do her yesterday as I did not know she was on caseload. I just saw it today. Truthfully, when I had her, I did her as often as I could. My goal was three times a week. She stated the purpose of RNP services was for residents to maintain their abilities. She explained regular splint application was important for residents with contractures as it prevented increased stiffness. On 1/08/24 at 11:12 AM, resident #44 had her splints in place. However, due to contractures of her fingers, the right middle fingernail pressed into the top of her right index finger. The Wound Nurse confirmed the resident's fingernails still had not been cut or filed. On 1/09/24 at 11:21 AM and 1/10/24 at 5:41 PM, the Director of Rehab confirmed resident #44 had significant upper extremity contractures and was seen by Occupational Therapy for management of her contractures related to range of motion and splinting of her elbows and hands. The Director of Rehab said, It is absolutely important for her to wear her splints.We give [RNP] instructions as we want to maintain what we accomplished. She explained the use of splints prevented further contractures, increased range of motion, prevented skin breakdown, and was essential for any resident who had contractures. On 1/10/24 at 5:24 PM, during review of the Documentation Survey Reports, the Assistant Director of Nursing stated resident #44 had her splints applied on six days in October 2023, five days in November 2023, one day in December 2023, and one day in January 2024. The Director of Nursing (DON) confirmed she was the facility's Restorative Nurse and was responsible for the RNP. She stated she met with therapy staff and Restorative Aides once monthly, but she was not aware resident #44's splints had not been applied three times weekly according to therapy recommendations. When asked if she reviewed the flow sheets completed by Restorative Aides, the DON said, Honestly I don't check it. On 1/11/24 at 12:39 PM, Occupational Therapist G stated resident #44 had therapy recommendations for PROM and splinting three times weekly. She explained on Monday 1/08/24, she was informed that RNP staff had not applied the splints as required for three months and she was asked to evaluate the resident's current status. Occupational Therapist G stated her assessment showed resident #44 was no longer able to tolerate her splints for the 4-hour period she achieved on discharge from Occupational (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 14 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Therapy caseload in October 2023. She explained therapists would work with resident #44 until she attained her maximum potential and then she would be referred to the RNP again. The facility's policy and procedures for Specialized Rehabilitative and Restorative Services, dated 4/01/22, revealed the facility would provide restorative services to include range of motion and application of splints and braces as indicated by assessment of the interdisciplinary team. Event ID: Facility ID: 105471 If continuation sheet Page 15 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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** 2. Review of the medical record revealed resident #57 was admitted to the facility on [DATE] and re-admitted from the hospital on [DATE]. His diagnoses included traumatic brain injury, pneumonia, acute and chronic respiratory failure with low oxygen levels, bronchial disease, collapse of the lung(s) and heart failure. Residents Affected - Few The resident's Minimum Data Set (MDS) admission assessment with assessment reference date of 11/23/23 revealed resident #57 did not speak, was rarely or never able to make himself understood or understand others. The resident had severely impaired cognitive skills for daily decision making, showed no behavioral symptoms, and did not reject evaluation or care that was necessary to achieve the his goals for health and well-being. He was totally dependent on staff for self-care and mobility. The MDS assessment indicated resident #57 received oxygen therapy. A nursing note dated 11/17/23 revealed resident #57 was re-admitted to the facility from the hospital on oxygen at 2 liters per minute (L/min) via nasal cannula. Review of the medical record revealed resident #57 had a physician order dated 11/17/23 for continuous supplemental oxygen at 2 L/min via nasal cannula. Physician orders dated 11/18/23 indicated nurses were to change the resident's oxygen tubing and nasal cannula weekly every Friday during the night shift, and as needed for hygiene. Resident #57 had a care plan initiated on 11/20/23 for risk for respiratory distress related to acute on chronic respiratory failure due to mucus plugging, collapsed lung, pneumonia, and need for oxygen therapy. The goal was the resident would maintain optimal breathing pattern and remain free of signs and symptoms of respiratory distress. The care plan indicated resident #57 required oxygen therapy and the interventions instructed licensed nurses to administer oxygen as ordered, observe oxygen precautions, and monitor oxygen levels and lung sounds as ordered. Observations of resident #57 on 1/07/24 at 11:48 AM, 1/07/24 at 2:24 PM, and 1/08/24 at 11:19 AM revealed he did not have oxygen infusing via nasal cannula. There was no oxygen concentrator machine in the resident's room. On 1/08/24 at 12:27 PM, Licensed Practical Nursing (LPN) H confirmed she was assigned to care for resident #57. She explained she was a newly-hired nurse and was and not sure if the resident had a physician order for oxygen therapy, or why he would need oxygen as his oxygen saturation level was 97% this morning. LPN H was prompted to check the electronic medical record and noted there was a designated section to document oxygen use for the resident. Due to a language barrier, the nurse was unable to comprehend and respond to questions regarding her process for verification of resident's care needs from the medical record, change of shift report, or during rounds to ensure oxygen was administered as ordered. On 1/08/24 at 12:32 PM, LPN H checked resident #57's oxygen saturation level and stated it was 93%. She stated it was low and explained the resident needed oxygen. LPN H looked around the resident's room and validated there was no oxygen concentrator machine. For most people, a normal oxygen saturation level is between 95% and 100% (retrieved on 1/16/24 from www.my.clevelandclinic.org/health/diagnostics/22447-blood-oxygen-level). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 16 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 1/08/24 at 12:34 PM, the [NAME] Wing Unit Manager (UM) reviewed resident #57's medical record and confirmed there was a physician order for oxygen and associated diagnoses related to oxygen use. The UM was not aware the resident did not have an oxygen concentrator in his room. On 1/08/24 at 12:38 PM, the Assistant Director of Nursing (ADON) was informed resident #57 had a physician order for continuous oxygen therapy but there was no concentrator in his room. She explained there was an issue with family dynamics and the resident's mother probably did not want him to use oxygen. The ADON confirmed nurses were expected to follow physician orders or notify the physician of any situation that might require an order to be revised. She explained she thought resident #57 probably needed oxygen mainly at night, .and the nurses could possibly be grabbing a concentrator from outside the room. to administer oxygen at night. Review of the facility's policy and procedure for Oxygen Administration, dated 4/01/22, revealed nurses were to verify that a physician order was in place for oxygen administration and administer oxygen at the ordered flow rate via an appropriate device. Based on observation, interview and record review, the facility failed to provide oxygen therapy per physician orders for 2 of 2 residents reviewed for oxygen therapy of a total sample of 57 residents, (#28, and #57). Findings: 1. Resident #28 was admitted to the facility on [DATE] with diagnoses of Parkinson's Disease, hypertension, Type 2 Diabetes Mellitus, and shortness of breath. Resident #28's Quarterly Minimum Data Set assessment dated [DATE] revealed she was cognitively intact, required substantial assistance to roll in bed and did not get out of bed to walk nor use a wheelchair or scooter for mobility. The assessment also indicated resident #28 used oxygen. Resident #28 had a care plan for risk of respiratory distress related to shortness of breath and use of continuous oxygen dated 6/12/23. The goal was for resident #28 to maintain an optimal breathing pattern and to remain free of respiratory distress. The care plan interventions included administration of oxygen as ordered by the physician. Review of the Order Summary Report revealed resident #28 had a physician order for continuous oxygen delivered at 3 liters per minute (LPM) by a nasal cannula (NC) every shift for monitoring dated 6/09/23. On 1/07/24 at 12:15 PM resident #28 was awake and alert in her bed watching TV. She had on a NC attached to an oxygen concentrator that was set to 1.5 LPM. Resident #28 stated she was unsure how much oxygen she was supposed to receive. At approximately 1:50 PM, resident #28 was again observed in bed in her room with the NC attached to the oxygen concentrator set at 1.5 LPM. On 1/08/24 at 11:15 AM, resident #28 was observed in bed watching TV. She was wearing the NC attached to the oxygen concentrator which was set at 1.5 LPM. On 1/09/24 at 9:24 AM, resident #28 was in her room with a breakfast tray in front of her. She did not have the NC on, instead it was on the floor under her bed still attached to the oxygen concentrator that was set at 1.5 LPM. A few minutes later resident #28's assigned Registered Nurse (RN) D (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 17 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated she thought resident #28 had orders for oxygen at 2 LPM. RN D confirmed that resident #28's oxygen concentrator was set at 1.5 LPM and that the NC was on the floor instead of in place as ordered. The nurse then bent down to pick up the NC off the floor under resident #28's bed and started to place the dirty NC back on resident #28's face. RN D was asked if she was going to put the NC that had been on the floor back on the resident without changing it. RN D stopped and said, Oh yeah, I should get her a new one, I am sorry. RN D then went to her medication cart and started to check the orders for resident #28. She was asked to check resident #28's pulse oximeter reading before she put a new NC on her since RN D did not know how long the resident had not been wearing her oxygen. RN D searched her cart for a pulse oximeter to measure resident #28's oxygen level but found the equipment she had did not work. She then went to the other nurse on the unit to borrow one from her. RN D returned a few minutes later to the nurse's station without the pulse oximeter and spoke with the Assistant Director of Nursing (ADON). RN D was reminded that she still had not replaced resident #28's NC and she went to retrieve a new one from the supply room. When she returned she said she did not have a working pulse oximeter on the unit, so the ADON went to the other unit to find one and she returned to resident #28's room to replace the NC. At 11:06 AM on 1/09/24, resident #28 was again sitting in bed, alert and oriented, wearing the NC attached to the oxygen concentrator. The concentrator was now set at 2 LPM instead of 3 LPM as ordered by the physician. RN D was in the hallway and returned to resident #28's room. She was asked about the flow of the oxygen per the physician's order. RN D confirmed she had set the oxygen at 2 LPM, but stated she didn't realize she had only adjusted the oxygen to 2 LPM instead of the ordered 3 LPM. RN D explained that she was supposed to follow the physician's order and not decide herself what to set a patient's oxygen flow rate. On 1/10/24 at 4:59 PM, the Director of Nursing stated her expectation was the assigned nurse check the resident's oxygen saturation and the physician orders depending on if it is as needed or continuous flow when the nurse did their rounds. The Regional Nurse explained it was best practice for the nurse to look at both the resident using the oxygen and the oxygen concentrator when they did rounds at the beginning of their shift in order to ensure physician orders were followed and that residents' oxygen needs were being met. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 18 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide sufficient licensed nurses on the 7:00 AM to 7:00 PM shift to meet the needs and achieve the goals according to the plans of care for residents on 2 of 2 units, (West and East Wings). Findings: 1. On 1/07/24 at 11:43 AM, Licensed Practical Nurse (LPN) E stood at his medication cart in the hallway outside room [ROOM NUMBER]. The computer screen displayed medication administration tasks in red and LPN E explained the red color indicated the residents' medications were late. He confirmed most of the medications were scheduled for 9:00 AM and should have been given by 10:00 AM at the latest. He stated he was scheduled to work from 7:00 AM to 7:00 PM but came in late for his shift this morning. LPN E explained he was scheduled to work from 7:00 AM to 7:00 PM yesterday, but ended up working until almost 1:00 AM as no nurse showed up to take his assignment. He stated the facility was eventually able to find a nurse from a staffing agency to relieve him, but he was tired after yesterday's unplanned 18-hour shift, so he came in late. On 1/07/24 at 12:00 PM, Registered Nurse (RN) C exited a resident's room and walked towards her medication cart in the hallway. She confirmed she was still administering scheduled 9:00 AM medications. RN C explained she got a late start due to a staffing issue this morning. She stated she was originally assigned to the other medication cart on the unit but her assignment was changed to allow LPN E to return to the assignment he had yesterday. On 1/08/24 at 11:24 AM, RN H stated she just completed administration of her assigned residents' scheduled 9:00 AM medications. She explained she had been on staff for three days so her medication administration process was very slow. RN H acknowledged she had not asked the Unit Manager (UM) or a supervisor for assistance, and she did not notify the physician(s) that medications were administered outside the required timeframe. On 1/09/24 at 10:41 AM, LPN I stood at her medication cart near room [ROOM NUMBER]. She stated she worked for a nurse staffing agency and was unfamiliar with her assigned residents because she had not worked at this facility for about a year. She confirmed she was still administering residents' scheduled 9:00 AM medications. LPN I checked her computer and counted 14 residents' names displayed in red on the screen. She acknowledged their medications still had to be administered. LPN I said, I'm late as there are a lot of residents. On 1/09/24 at 10:47 AM, the [NAME] Wing UM stated she was not aware a significant number of residents' medications were administered outside the acceptable range of one hour before or one hour after the scheduled time. She acknowledged sometimes nurses might be delayed when they had to locate residents who were not in their rooms, for example, those who required close supervision in the unit's common area. She said, That takes more time. When asked if she ever assisted with medication administration in the mornings, the [NAME] Wing UM stated she did not. She explained she assisted nurses with paperwork or notification of the physician if there was an incident such as a fall. She stated the unit's census was 65 residents and there were two licensed nurses assigned to the care for them. The [NAME] Wing UM confirmed each nurse was therefore tasked to medicate 32 to 33 residents within a 2-hour window. She acknowledged it was not possible due to the number of residents and the quantity of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 19 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some medications, and another nurse would be helpful. The [NAME] Wing UM denied knowledge of any current plans in place to solve the problem. On 1/10/24 at 11:50 AM, LPN E stood at his medication cart and confirmed he was still administering scheduled 9:00 AM medications. He said, Only two left, so will finish by 12:00 PM. This assignment is heavy, especially for morning med pass. Lots of pills. Definitely needs three nurses to complete med pass on time. On 1/09/24 at 1:30 PM, during review of the facility's Grievance Log with the Social Service Director (SSD), she discussed a grievance related to late administration of medications. She stated a resident's family member reported on 1/07/24 that scheduled 9:00 PM medications were not given until 12:00 AM. The SSD verified the issue occurred on the [NAME] Wing and said, We are aware that side is a little heavy. 2. On 01/07/2024 at 2:35 PM, RN C stated she was responsible for 34 residents on the [NAME] Wing. She had been assigned to a maximum of 35 residents. She acknowledged that her workload was heavy and it was difficult to manage the resident's 9:00 AM medication pass. She noted majority of the 34 residents had their medications scheduled at 9:00 AM, and some residents did not receive their medications on time. On 01/09/2024 at 10:40 AM, RN D stated her workload was difficult, managing 34 residents on the [NAME] Wing. The highest number of residents assigned to her was 38. RN D confirmed the morning medication passes were very challenging due to the number of residents scheduled to receive 9:00 AM medications. She acknowledged she did not complete her 9:00 AM medication pass timely and some residents received their medications late. On 01/10/2024 at 9:34 AM, the Director of Nursing (DON) stated the nurses on the [NAME] Wing Long Term Care (LTC) Unit had a maximum of 35 residents on their assignment. The nurses on the East Wing were assigned a maximum of 25 residents. She explained the level of staffing required for each unit was based on census, acuity, and resident's needs. She noted workload concerns brought to her attention were discussed with the Assistant Director of Nursing (ADON) and the Administrator. The DON acknowledged she received a grievance from a resident's family member via email on 12/15/23 that indicated resident # 25 received her medications late. On 12/18/23, the DON witnessed the administration of medications to residents and reviewed the Medication Administration Records (MAR). She stated they identified the residents on the [NAME] Wing received their medications a couple of hours late. She stated she was aware of the excessive number of residents scheduled to receive their medications simultaneously. The DON expressed concern for the nurses' workload and recognized there was a need for additional staff. The DON said she discussed her findings with the Administrator, and the Administrator agreed with the need for additional staff. The DON explained while in the process of recruiting new nurses to ensure residents' needs were met, they had only two nurses managing the unit's workload. The DON confirmed the facility had a new medication cart since December 2023, however, there was a lack of facility staff to utilize the new medication cart to support the nursing team. The DON acknowledged that she and the Administrator jointly decided against hiring agency staff in the interim of hiring new nurses because of the cost. On 01/10/24 at 1:28 PM, LPN E stated he had 31 residents on his assignment on the [NAME] Wing. He articulated it was very difficult to manage the morning medication pass as almost all his 31 residents had their morning medications scheduled at 9:00 AM. He confirmed that some of the residents did not receive their 9:00 AM medications until 12:00 pm which coincided with their afternoon medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 20 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some He noted that despite voiced concerns about the unmanageable workload and its impact on the timely administration of resident medications, management had not provided any feedback, and no action had been taken to address the issue. Review of the Facility Assessment Tool updated on 10/18/23, revealed a factor that the facility must take into account is the acuity of the resident case mix that needs, preferences, and routines in order to help each resident attain or maintain the highest practicable physical, mental and psychosocial well-being. The facility assesses the needs for all residents on an individual level and assigns direct care staff accordingly. Review of the Nursing Home Administrator's job description revealed the administrator implements operational and financial objectives of Management and allocates resources in an efficient and economical manner to attain or maintain the highest practicable physical, mental and psycho-social well-being of each resident. Review of the Director of Nursing's (DON) job description revealed the DON develops staffing plans that assure sufficient numbers of qualified, competent nursing staff to meet direct care needs, conducts assessments as required, develops plans of care, evaluates residents' responses to interventions and documents effectively in compliance with state and federal requirements. Recommends numbers and types of nursing personnel necessary to provide care and to maintain compliance with facility mission and with regulations. Hires and retains qualified competent nursing staff to provide nursing and nursing related services to attain or maintain highest practicable physical, mental and psycho-social well-being of each resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 21 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on interview, and record review, the facility failed to retain daily nurse staffing data for 9 out of 27 weekends out of 18 months reviewed for staffing. Residents Affected - Many Findings: On 01/09/2024 at 1:34 PM, the Scheduling Director stated she had worked in her position for one month. It was her responsibility to record staffing information for each shift on the weekdays and retain the daily nurse staffing forms for 18 months. She acknowledged she was unable to locate and provide the daily nurse staffing forms for July 1, 2, 8, 9, 22, 23, 29, 30 and September 30 of 2023. On 01/10/2024 at 9:34 AM, the Director of Nursing (DON) stated she had worked at the facility for 8 months. She explained it was Weekend Supervisor's responsibility to complete the daily nurse staffing forms on the weekends. She explained that once posted, these forms were given to the Scheduling Director, who kept them on file for 18 months. She was unable to explain the missing weekend staffing forms. Review of the facility's Policy and Guidelines, Posting Direct Care Staffing Numbers, dated 4/6/2022 revealed staffing information for each shift will be kept for a minimum of eighteen (18) months or as required by state law (whichever is greater). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 22 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services to ensure timely medication administration in accordance with accepted standards of practice for 1 of 5 residents reviewed for unnecessary medications, (#25); and failed to acquire medications within an appropriate timeframe for 1 of 19 residents with new admission status, (#218), out of a total sample of 57 residents. Findings: 1. Review of the medical record revealed resident #25 was admitted to the facility on [DATE] with diagnoses including epilepsy, major depressive disorder, anxiety disorder, communication/comprehension disorder, tremors, migraine headaches, and insomnia. The Minimum Data Set (MDS) Quarterly assessment with assessment reference date of 11/14/23 revealed resident #25 had a Brief Interview for Mental Status score of 5 which indicated she had severe cognitive impairment. The MDS assessment showed the resident had no behavioral symptoms and did not reject evaluation or care that was necessary to achieve her goals for health and well-being. Resident #25 received scheduled pain medication for frequent pain in the 5-day lookback period. The resident received anti-anxiety, anti-depressant, hypnotic or sleep aids, and opioid or narcotic medication. Review of the resident's medical record revealed comprehensive care plans with focus areas including use of anti-anxiety, anti-depressant, and sleep aid medications, behavioral issues, impaired cognitive function, and generalized pain related to epilepsy and migraines. Review of the Order Summary Report revealed resident #25's physician orders included Amitriptyline 10 milligrams (mg) at bedtime for salivary secretions, scheduled for 9:00 PM; Escitalopram Oxalate 10 mg, two tablets once daily for chronic major depression, scheduled for 9:00 AM; Zolpidem Tartrate 10 mg at bedtime for insomnia, scheduled for 9:00 PM; Pramipexole Dihydrochloride 1 mg, two tablets twice daily for tremors, scheduled for 9:00 AM and 5:00 PM; Methocarbamol 500 mg twice daily for neck spasms, scheduled for 9:00 AM and 9:00 PM; Quetiapine Fumarate 25 mg twice daily chronic major depression, scheduled for 9:00 AM and 5:00 PM; Tramadol 50 mg every eight hours Monday through Saturday for pain, scheduled for 6:00 AM, 2:00 PM, and 10:00 PM; Tramadol 50 mg twice daily on Sunday, scheduled for 6:00 AM and 10:00 PM; Diazepam 2.5 mg four times daily for anxiety, scheduled for 9:00 AM, 1:00 PM, 5:00 PM, and 9:00 PM. On 1/09/24 at 10:03 AM, resident #25's father explained he was his daughter's healthcare surrogate and responsible party. He expressed concerns related to nurses, particularly agency nurses on the weekends, who repeatedly administered her scheduled medications at the wrong times. The resident's father explained he was worried about the possibility of overmedication and dangerous side effects and/or decreased effectiveness when her medications were administered at the wrong intervals. He explained although his daughter did not communicate verbally, she was able to text and inform him when her medications were actually received. The resident's father stated she frequently had to stay up after 11:00 PM at night to wait for her 9:00 PM medications which included a sleeping pill. On 1/09/24 at 1:30 PM, the Social Services Director confirmed resident #25's father often made grievances regarding agency nurses who were assigned to care for his daughter. She confirmed he submitted grievances regarding late medication administration, drugs that were administered twice in error, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 23 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 and 9:00 PM medications not given until almost 12:00 AM. Level of Harm - Minimal harm or potential for actual harm On 1/10/24 at 9:34 AM, the Director of Nursing confirmed she was aware of the concerns expressed by resident #25's father since December 2023. She stated she observed nurses during the medication administration task in December, and validated his concerns as medications were being given two hours after the scheduled time. Residents Affected - Some Review of the Medication Administration Audit Report from 12/01/23 to 1/08/23 revealed the scheduled and actual times for resident #25's medication administration. The report showed: On 12/01/23, she received all scheduled 9:00 PM medications at 11:21 PM. She received her scheduled 10:00 PM dose of Tramadol 50 mg at 11:22 PM. On 12/02/23, she received all scheduled 9:00 PM medications at 11:02 PM. On 12/04/23, she received her scheduled 9:00 AM dose of Diazepam 2.5 mg at 10:54 AM and the scheduled 1:00 PM dose at 3:18 PM. She received the scheduled 2:00 PM dose of Tramadol 50 mg at 3:18 PM, and all scheduled 9:00 PM medications at 10:22 PM. On 12/05/23, she received the scheduled 1:00 PM dose of Diazepam 2.5 mg and the scheduled 2:00 PM dose of Tramadol 50 mg at 3:30 PM. On 12/06/23, she received the scheduled 1:00 PM dose of Diazepam 2.5 mg at 2:26 PM. On 12/07/23, she received the scheduled 1:00 PM dose of Diazepam 2.5 mg at 2:21 PM. All scheduled 9:00 PM medications and the scheduled 10:00 PM Tramadol 50 mg were administered at 11:43 PM. On 12/08/23, she received the scheduled 9:00 PM medications at 11:01 PM. On 12/09/23, she received the scheduled 9:00 AM dose of Diazepam 2.5 mg at 10:50 AM, and the scheduled 1:00 PM dose at 12:45 PM, less than two hours apart. On 12/11/23, she received the scheduled 1:00 PM dose of Diazepam 2.5 mg and the scheduled 2:00 PM dose of Tramadol 50 mg at 4:07 PM. On 12/15/23, she received all scheduled 9:00 PM medications and the scheduled 10:00 PM dose of Tramadol 50 mg at 11:31 PM. On 12/16/23, she received the scheduled 1:00 PM dose of Diazepam 2.5 mg at 4:05 PM and the scheduled 2:00 PM dose of Tramadol 50 mg at 4:07 PM. On 12/17/23, she received the scheduled 1:00 PM dose of Diazepam 2.5 mg at 2:44 PM and the scheduled 2:00 PM dose of Tramadol 50 mg was given at 4:10 PM. The report showed the scheduled 5:00 PM dose of Diazepam 2.5 mg was given at 6:49 PM, and all scheduled 9:00 PM medications were administered at 11:31 PM. She received the scheduled 10:00 PM dose of Tramadol 50 mg at 11:31 PM. On 12/20/23, she received all scheduled 9:00 PM medications at 10:36 PM. On 12/21/23, she received all scheduled 9:00 AM medications including the dose of Diazepam 2.5 mg (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 24 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 at 11:34 AM. She received the scheduled 1:00 PM dose of Diazepam 2.5 mg at 2:40 PM, three hours later. Level of Harm - Minimal harm or potential for actual harm On 12/22/23, she received the scheduled 9:00 AM dose of Diazepam 2.5 mg at 10:31 AM and the scheduled 1:00 PM dose at 3:54 PM. She received all scheduled 9:00 PM medications at 10:33 PM. Residents Affected - Some On 12/23/23, she received all scheduled 9:00 AM medications including the dose of Diazepam 2.5 mg at 1:54 PM. The nursing documentation indicated she received the scheduled 1:00 PM dose of Diazepam 2.5 mg at 1:52 PM, at the same time as the morning dose. She received all scheduled 9:00 PM medications at 11:02 PM. On 12/26/23, she received all scheduled 9:00 AM medications including Diazepam 2.5 mg, the scheduled 1:00 PM dose Diazepam 2.5 mg, and the 2:00 PM dose of Tramadol 50 mg at 9:50 AM. The resident received all scheduled 9:00 PM medications at 10:50 PM. On 12/28/23, she received the scheduled 1:00 PM dose of Diazepam 2.5 mg at 2:50 PM. On 12/29/23, she received the scheduled 9:00 AM dose of Diazepam 2.5 mg at 5:16 PM and the scheduled 1:00 PM dose a few minutes later at 5:19 PM. All scheduled 9:00 PM medications including Diazepam 2.5 mg and Zolpidem Tartrate 10 mg, and the Tramadol 50 mg scheduled for 10:00 PM were given at 11:51 PM. On 12/30/23, she received all scheduled 9:00 AM medications including the dose of Diazepam 2.5 mg at 10:53 AM. The scheduled 1:00 PM dose of Diazepam 2.5 mg was given at 2:31 PM, less than four hours later. All scheduled 9:00 PM medications were given at 10:49 PM. On 1/03/24, she received all scheduled 9:00 AM medications including Diazepam 2.5 mg at 10:51 AM. She received the scheduled 1:00 PM of Diazepam 2.5 mg and scheduled 2:00 PM Tramadol 50 mg at 4:47 PM. On 1/04/24, she received all scheduled 9:00 AM medications including Diazepam 2.5 mg at 10:10 AM. The 1:00 PM dose of Diazepam 2.5 mg was given at 7:49 PM, and all scheduled 9:00 PM medications were given at 11:22 PM. She received the scheduled 10:00 PM Tramadol 50 mg at 11:22 PM. On 1/05/24, she received all scheduled 9:00 PM medications at 11:07 PM. On 1/06/24, she received the scheduled 1:00 PM dose of Diazepam 2.5 mg at 3:17 PM, and all scheduled 9:00 PM medications were administered at 10:45 PM. On 1/07/24, she received the scheduled 5:00 PM dose of Diazepam 2.5 mg at 6:31 PM, and the scheduled 9:00 PM dose at 8:35 PM, two hours apart. On 1/08/24, she received the scheduled 10:00 PM dose of Tramadol at 11:36 PM. Review of the facility's policy and procedures for Medication Administration Times (undated) revealed the following medication guidelines were based on accepted standards of practice. The document read, Medication administration pass may begin sixty (60) minutes before the scheduled times of administration but may not exceed sixty (60) minutes after the scheduled time of administration. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 25 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 2. Review of the medical record revealed resident #218 was admitted to the facility on [DATE] with diagnoses include stroke, left side paralysis and weakness, heart disease, heart failure, type 2 diabetes, sleep apnea, insomnia, and weakness. The resident was discharged to the hospital on 7/01/23. The admission Nursing Data Collection form dated 7/01/23 revealed resident #218 was admitted on [DATE] at 1:00 PM. The document indicated the physician was notified of the resident's admission on [DATE] at 3:30 PM, two and a half hours after the resident's arrival. The assessment showed the resident was alert and oriented to person, place, time, and situation. He was totally dependent on staff for transfers and bed mobility, was unable to ambulate, and used a wheelchair for mobility. Review of the Order Summary Report revealed resident #218's physician orders included Atorvastatin 80 mg at bedtime for high cholesterol, Melatonin 3 mg at bedtime for insomnia, Ropinirole 0.25 mg at bedtime for restless leg syndrome, Acetaminophen 1000 mg every 8 hours for any level pain or temperature greater than 100.4 degrees, Insulin Glargine 46 units once daily for diabetes, Clopidogrel Bisulfate 75 mg once daily for coronary artery disease, Pregabalin 150 mg at bedtime and Pregabalin 125 mg twice daily for neuropathic or nerve pain, Carvedilol 12.5 mg twice daily for high blood pressure, and Insulin Lispro 16 units before breakfast, 17 units before lunch, and 10 units before supper as ordered. Review of the Medication Administration Report (MAR) for June 2023 revealed resident #218 did not receive any of his scheduled evening medications on 6/30/23. The document showed he was not given Acetaminophen for pain as needed. The physician's orders for Insulin Lispro 10 units before supper and Pregabalin 150 mg at bedtime were not transcribed to the MAR on 6/30/23. The MAR for July 2023 showed the resident did not receive Pregabalin 125 mg or Acetaminophen 1000 mg medication on 7/01/23. A Nursing Progress Note dated 7/01/23 at 8:33 AM read, Resident called 911 so he can go to [name of hospital] to get pain meds, was waiting for pain med to be delivered to facility, but resident said that he was having pain to the legs, Resident returned shortly after, in bed at this time asleep, will notify pain management for order for pain med since resident does not have pain med on order. Review of Orders - Administration Notes dated 7/01/23 at 12:18 PM, 12:25 PM and 12:26 PM revealed nursing documentation that read, Waiting for supply from pharmacy. Review of the pharmacy Packing Slip dated 7/01/23 revealed a nurse's signature to verify receipt of some of resident #218's medications. The document did not indicate a time of delivery. The pharmacy documentation did not show delivery of the resident's Pregabalin tablets for his neuropathic pain. Review of the medical record revealed no additional nursing notes to show the date, time, and circumstances related to resident #218's subsequent transfer to the hospital and discharge from the facility. On 1/09/24 at 4:05 PM and 1/11/24 at 3:34 PM, the Clinical Executive stated after resident #218 was discharged from the facility, his family made an allegation of neglect related to his medications not being available for 48 hours after admission, which necessitated his transfer to the hospital. The Clinical Executive stated the facility's investigation showed the resident complained of pain and while nurses waited for the pharmacy to deliver his pain medications, the resident called 911 and went to the hospital. During review of the pharmacy delivery slip, she acknowledged the Pregabalin for neuropathic pain was not delivered. The Clinical Executive stated the process of acquiring medications for residents admitted on the evening shift was for pharmacy to deliver medications during the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 26 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 night shift to ensure morning medications were available. She stated her expectation was for nurses to access ordered drugs from the facility's emergency medication kits in the medication rooms and/or call the physician to obtain an order for an available, appropriate medication until any pharmacy issues could be sorted out. She validated the facility was responsible for acquiring and administering medications to meet resident #218's needs. During review of the medical record, the Clinical Executive verified the resident was actually admitted on the day shift, not the evening shift, and there would have been adequate time to arrange for his medications before evening and bedtime doses were due. She acknowledged the medication list was not entered into the computer system until 5:30 PM, approximately four hours after the resident was admitted . She said, The nurses should put in meds as soon as possible. It is not acceptable that the resident arrived at 1:30 PM and staff took four hours to enter the meds. Review of the facility's policy and procedure for Medication Administration Times (undated) revealed medication would be administered within 60 minutes before or after the dosing schedules and medications ordered before meals were to be given approximately 30 minutes before meal time. The facility's policy and procedure for Providing Pharmacy Services (undated) revealed the pharmacy would ensure the facility's staff had access to medications 24 hours daily. The document indicated the facility could prevent a delay in medication therapy by requesting that the physician order a substitute medication stocked in the emergency kit. If drug substitution was not possible, the nurse should ask if it could be initiated the next morning and document the conversation. The policy revealed if a drug was considered essential and could not be substituted or delayed, the nurse should contact the pharmacy's emergency number. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 27 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0759 Ensure medication error rates are not 5 percent or greater. 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 prevent medication administration error rate of 5% or greater for 1 of 4 residents sampled for medication administration, (#35). There were 2 medication errors in 26 opportunities for a medication error rate of 7.69%. Residents Affected - Few Findings: Resident #35's medical record revealed she was admitted to the facility on [DATE] from an acute care hospital. Her diagnoses included stroke, myocardial infarction, hypertension, congestive heart failure, mood disorder, anxiety, depression, and pseudobulbar affect. Pseudobulbar affect (PBA) is a condition that's characterized by episodes of sudden uncontrollable and inappropriate laughing or crying (retrieved on 1/12/24 from https://www.mayoclinic.org). On 1/8/24 at 9:25 AM, Registered Nurse (RN) B prepared to administer resident #35's 11 scheduled morning medications and placed a total of 10 ½ pills into a small plastic cup which included Aspirin 81 milligram (mg) enteric coated tablet and did not include Dextromethorphan Quinidine 20-10 mg capsule. RN A then approached resident #35 with cup of 10 ½ pills and administered the medication to resident by mouth. A record review post medication administration for resident #35 revealed an order dated 10/20/23 that read, Aspirin tablet chewable 81 mg by mouth one time a day for myocardial infarction. The nurse omitted medication for order dated 2/23/23 that read, Dextromethorphan-Quinidine capsule 20-10 mg give 1 capsule by mouth every 12 hours for PBA related to pseudobulbar affect. On 1/8/24 at 10:52 AM, a follow up interview was conducted with RN B. The Assistant Director of Nursing (ADON) facilitated interview with RN B who had difficulty with English as Spanish was her first language. RN B proceeded to pull out medication card for resident #35 from the medication cart for Nuedexta 20-10 mg give 1 capsule by mouth every 12 hours. RN B said she did not give Nuedexta because she read Dextromethorphan-Quinidine in the computer and did not realize it was the same drug as Nuedexta. RN B admitted that she signed off giving the 9 AM dose although she did not administer the medication. RN B said she gave enteric coated Aspirin because she did not have chewable form in her medication cart. Dextromethorphan/quinidine, sold under the brand name Nuedexta, is a fixed-dose combination medication for the treatment of pseudobulbar affect. (retrieved on 1/12/24 from https://en.wikipedia.org). The ADON stated, prior to giving the medications RN B should have stopped and went to the medication storage room to find the chewable form of aspirin. Review of the facility's policy and procedure for Medication Administration published 12/4/23 read, Meditations shall be administered in safe and timely manner, and as prescribed Medications must be administered in accordance with orders The individual administering the medications must check the label to verify the right medication FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 28 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure the menus/recipes were being followed and failed to demonstrate that a reasonable effort was made to ensure the menu/food met the needs of the residents. The facility also failed to ensure residents received foods based on the menus and meal tray tickets for 1 of 3 sampled residents, #53, in a total sample of 57 residents. Findings: 1. On 1/8/24 at 2:04 PM, a meeting was held with the resident council group. They conveyed their displeasure with the menus and foods they were served. They expressed concerns that some of the meals were not palatable and food portions were small. One resident stated he was to receive double portions according to his meal tray ticket, but at times he did not receive double portions when the meal tray arrived at his room. The residents all agreed the food items they received did not match the meal tray ticket which identified their nutritional needs and food preferences. Several of the residents reported a few times, all they received was starches but no protein foods. The residents discussed the lack of fresh fruits and vegetables and said they received only canned fruits and/or frozen vegetables. Some residents stated they received a salad which consisted of only lettuce. They noted there was an always available menu of sandwiches and hamburgers in case they did not like the main entree but that sandwiches and hamburgers were not always available. The residents reported both the Administrator and Certified Dietary Manager had attended resident council meetings but had not made a reasonable effort to address their food concerns or make changes to the menu. 2. Review of the lunch menu for 1/10/24 revealed the main entree consisted of Classic Meatloaf, Cheesy Mashed Potatoes, Harvard Beats and Cinnamon Baked Apples. On 1/10/24 at 11:49 AM, the lunch tray line was observed. The Cinnamon Baked apples were observed already portioned out, on a rack that had been pulled out of the walk-in refrigerator. On 1/10/24 at 12:40 PM, a test tray of the foods noted above was sampled. The Meatloaf was bland and the Cinnamon Baked Apples were cold. At 1:35 PM, the recipes for the Meatloaf and the Cinnamon Baked Apples were requested from the cook, Registered Dietician (RD) and the Regional dietary Director. The recipe for the Meatloaf noted for a 100 servings 5 raw onions and 5 green peppers would be required along with oil, eggs, black pepper, ground beef and breadcrumbs. If 150 servings were made then 7.5 Onions & [NAME] peppers would be required. The staff did not provide how many servings of Meatloaf were made. The cook stated she brought out onions and 3 green peppers and the CDM prepared the meatloaf. The cook added, I'm just defending myself. The recipe for the Cinnamon Baked Apples consisted of sliced apples, brown sugar, water, salt ground cinnamon and ground nutmeg. The apples were to baked at 350 degrees Fahrenheit for 30 minutes until the apples were tender. The recipe noted to Serve warm. Neither the RD or the Regional Dietary Director explained why the Baked Cinnamon Apples were served cold. On 1/11/24 at 12:10 PM, yesterdays lunch was discussed with the CDM and the Regional Dietary Director. The CDM explained there were onions in the meatloaf but admitted not having enough green peppers as required by the recipe. He stated he was aware the Baked Cinnamon Apples were served cold and not warm as per the recipe. He said in the past the kitchen staff had a difficult time trying to keep them warm without burning. He noted they were not able to put the Cinnamon Baked Apples on the steam table due to lack of space. The CDM and Regional Dietary Director could not explain why no one had spoken up about the infeasibility of this dessert during menu review. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 29 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 3. Resident #53 was admitted to the facility on [DATE] with diagnoses that included Cerebral Palsy, Type II Diabetes Mellitus, morbid obesity and hyperlipidemia. Review of the Annual Minimum Data Set assessment dated [DATE] revealed resident #53 had adequate hearing, clear speech and could understand and be understood. She was cognitively intact, required set up assistance for eating and had a therapeutic diet per the assessment. Resident #3 also had care plans for risk for nutritional complications and unstable blood sugar related to her medical history. Interventions included dietary restrictions, following the nutritional plan, and for the facility to provide and serve the diet as ordered. A Nutrition Risk screen with Mini Nutritional assessment dated [DATE], revealed resident #53 had a regular texture, carbohydrate-controlled diet with no food allergies and a good appetite. The assessment indicated resident #53 desired to have small portion of starch-based foods and a large portion of vegetables for better control of her blood sugar. In an interview on 1/07/24 at 12:30 PM, resident #53 stated she has diabetes and would like to have better control of her blood sugar levels but her meals often had too many carbohydrate type foods like rice, potatoes and bread instead of her preferred vegetables. She stated she was not happy as the facility often served her food she wasn't supposed to eat and said she was worried about her blood sugar levels being too high. Resident #53 explained she was not expecting gourmand foods but would like to have some fresh food sometimes, not just fruits and vegetables from a can. On 1/07/24 at 12:52 PM, resident #53's lunch tray was on her bedside table. Her meal consisted of a hamburger patty, canned or frozen carrots and stuffing. Resident #53's lunch ticket listed a salad and dressing as part of the menu for that day's lunch, but she did not receive the salad and she stated she had not had any fresh fruits or vegetable for some time. On 1/08/24 at 12:45 PM, resident #53 was in her room with her lunch tray on her bedside table. Her lunch ticket described a salad and dressing as part of her meal, but it was not present on her tray. A few minutes later at 1:03 PM, the Registered Dietitian (RD) confirmed resident #53 was supposed to receive salad and dressing as part of her lunch per her meal ticket but did not receive it. The RD said the menu for resident #53 was not correct if the kitchen was not providing the foods as listed on her ticket. She said someone should notify the residents if an item had to be changed because it was not available, and that the calorie count for the resident was based on the items listed on the menu. On 1/10/24 at 10:39 AM, the RD said she followed up with the manager of the kitchen about resident #53's missing salad but was unable to give a reason why resident #53 had not received it as per the menu. She said she explained to the kitchen manager that if a resident was not going to receive an item as described on the menu, he must communicate it to the residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 30 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, and group interview, the facility failed to ensure meals were palatable, attractive, and served at an appetizing temperature. Residents Affected - Some Findings: Cross reference: F803 During the group interview conducted 01/08/24 at 2:04 PM, 16 interviewable residents complained the food was not served hot, was not palatable, and was not nutritious. The residents stated the eggs served to them were uncooked and were not real eggs; eggs were cold, portion size was small; the meals did not match the meal ticket; hot food was served cold; there was no fresh fruits or vegetables, only frozen or canned. Review of the lunch menu for 1/10/24 revealed the main entree consisted of Classic Meatloaf, Cheesy Mashed Potatoes, Harvard Beets and Cinnamon Baked Apples. On 1/10/2024 at 12:00 PM, a lunch test tray was requested. At 12:35 PM, the last food tray was served to a resident. At 12:40 PM, the food tray was sampled. Meat loaf registered 118 degrees Fahrenheit and had no taste and did not appear to contain onions or green peppers. Mashed potatoes registered 138 degrees Fahrenheit and were unappealing, bland with no flavor. Beets registered 120 degrees Fahrenheit and were served cold and were either from frozen or canned. Lemonade was not cold. Cinnamon baked apples were served cold. On 1/10/24 at 1:35 PM, the recipes for both meatloaf and baked apples were reviewed. Based on the recipe for meatloaf, the meatloaf ingredients included green peppers and onions. The meat loaf provided lacked green peppers and onions. Based on the cinnamon baked apple recipe, the apples needed to be baked and served warm. On 01/11/24 at 12:10 PM, the CDM explained there were onions in the meatloaf but he did not have enough green peppers as required by the recipe. He acknowledged the baked apples were served cold but were supposed to be served warm. The CDM stated he attended Resident group meetings and was aware of the food concerns but he did not provide any specific changes to improve food palatability. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 31 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 - Some 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** 4. Resident #40 admitted to the facility on [DATE] and his diagnoses included Cerebral Infarction, Gastric Ulcer, Gout, Major depressive disorder and history of Alcohol Dependency. Review of the Minimum Data Set (MDS) assessment dated [DATE] noted the resident required substantial/maximum assistance with bathing. During interviews on 1/8/24 at 11:55 AM, on 1/9/24 at 10:29 AM, and 1/10/24 at 10:12 AM, resident #40 stated he did not have a shower. On 1/9/24 at 11:02 PM, the shower scheduled was noted in a binder near the nurses station. The shower schedule showed resident #40 was to have showers on Tuesdays, Thursdays and Saturdays on the 7AM to 3 PM shift. On 1/9/24 at 11:08 PM, showers were discussed with the resident's direct care Certified Nursing Assistant, (CNA) K. She stated resident #40 had not asked her to give him a shower. On 1/9/24 at 4:04 PM, the East Wing Unit Manager confirmed resident #40's shower days were on Tuesdays, Thursdays and Saturdays on the 7 AM to 3 PM shift. She stated the resident should had been showered today on the 7 AM to 3 PM shift. She explained when the CNAs gave a shower, they were to document the shower on the shower sheet. She said she could not find a shower sheet for resident #40. She reviewed the Kardex in the computer and said CNA K had documented the resident was given a shower. On 1/10/24 at 10:29 AM, the East Wing Unit Manager said she spoke to CNA K who told her resident #40 had refused a shower yesterday, and decided to have a bed bath. The Unit manager noted CNA K should have documented the resident's shower refusal and should not have documented she gave the resident a shower. Based on observation, interview, and record review, the facility failed to maintain medical records that accurately documented completion of physician-ordered wound treatments for 1 of 7 residents reviewed for pressure ulcers, (#44); oxygen administration for 2 of 2 residents reviewed for respiratory care, (#57 & #28); and provision of activities of daily living (ADL) care for 1 of 7 residents reviewed for ADLs, (#40), for 4 out of a total sample of 57 residents. Findings: 1. Review of the medical record revealed resident #44 was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses including encephalopathy (brain dysfunction), paraplegia, dementia, comprehension/communication disorder, stroke, contractures of all extremities, and pressure ulcers of the left hip and sacrum. Review of the Order Listing Report revealed resident #44 had physician orders dated 12/22/23 for wound treatments to her sacrum and right hip. The orders instructed nurses to cleanse the areas with wound cleanser, pat dry, apply collagen powder to the wound beds, then apply absorbent fiber dressings and cover with gauze island border dressings. On 1/07/24 at 2:46 PM, during observation of wound care, the Wound Nurse completed wound care and applied dressings to resident #44's sacral and right hip wounds as ordered. She initialed and dated both dressings with a distinct, bright green-colored ink. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 32 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 - Some On 1/08/24 at 11:12 AM, the Wound Nurse confirmed resident #44's wounds still had the same dressings she applied the day before. She confirmed she applied the dressings on 1/07/24 at about 3:00 PM although they were scheduled for 7:00 AM. The Wound Nurse verified the night shift nurse had not changed the dressings as ordered. Review of the Treatment Administration Record (TAR) for January 2024 revealed on 1/07/24, the Wound Nurse initialed the document as Jhnn to show she completed resident #44's sacral and right hip wound treatments at 7:00 AM rather than the actual time the tasks were completed, at 3:00 PM. The TAR showed the initials jls on 1/07/24 at 7:00 PM to indicate both wounds had dressing changes done on the night shift in conflict which did not support investigative findings. On 1/10/24 at 5:00 PM, the Regional Clinical Executive stated her expectation was nursing documentation would accurately reflect nursing actions and resident status. The Assistant Director of Nursing verified it was not acceptable for nurses to document any task that was not completed. 2. Review of the medical record revealed resident #57 was admitted to the facility on [DATE] and re-admitted from the hospital on [DATE]. His diagnoses included traumatic brain injury, pneumonia, acute and chronic respiratory failure with low oxygen levels, bronchial disease, collapse of the lung(s) and heart failure. Review of the medical record revealed resident #57 had a physician order dated 11/17/23 for continuous supplemental oxygen at 2 liters per minute (L/min) via nasal cannula. Physician orders dated 11/18/23 indicated nurses were to change the resident's oxygen tubing and nasal cannula weekly every Friday during the night shift, and as needed for hygiene. Observations of resident #57 on 1/07/24 at 11:48 AM, 1/07/24 at 2:24 PM, and 1/08/24 at 11:19 AM, revealed he did not have oxygen infusing via nasal cannula. There was no oxygen concentrator machine in the resident's room. On 1/08/24 at 12:32 PM, resident #57's assigned nurse, Licensed Practical Nursing (LPN) H, confirmed the resident did not have oxygen applied and there was no oxygen concentrator machine in his room. Review of the TARs from November 2023 to January 2024 revealed the the physician order for continuous oxygen at 2 L/min was never transcribed to the document, but an order for oxygen use for shortness of breath, every shift, was noted. The TAR was initialed on 1/07/24 day shift by JeGi and 1/07/24 night shift by Fs10 to verify resident #57's use of oxygen although he did not have oxygen during that time. There were no associated nursing notes related to clarification of the physician order regarding oxygen settings. The TARs showed nurses' initials to confirm the resident's oxygen tubing and nasal cannula were replaced every Friday night. Review of the facility's policy and procedure for Charting and Documentation, dated 4/01/22 read, All services provided to the resident, or any changes in the resident's medical or mental condition, shall be documented in the resident's medical record. The policy revealed documentation of procedures and treatments should include care-specific details such as the date and time the procedure or treatment was completed, the resident's tolerance of the treatment, assessment findings, and any refusals. 3. Resident #28 was admitted to the facility on [DATE] with diagnoses that included Parkinson's Disease, Type 2 Diabetes Mellitus, high blood pressure and shortness of breath. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 33 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 - Some Review of the Order Summary Report revealed a physician's order for oxygen delivered by a nasal cannula (NC) at 3 liters per minute (LPM), continuously every shift dated 6/09/23. On 1/07/24 at 12:15 PM, resident #28 was observed in bed wearing a NC connected to an oxygen concentrator set at 1.5 LPM. Resident #28 was alert and oriented to person, place and situation, but she was not sure what her oxygen flow rate was supposed to be. On 1/07/24 at 2:45 PM, the resident was in bed with a NC connected to the oxygen concentrator set at 1.5 LPM. On 1/08/24 at 11:14 AM, resident #28 was sitting in bed and had NC connected to the oxygen concentrator that was set at 1/5 LPM. On 1/09/24 at 9:28 AM, resident #28 was in bed, and her NC was on the floor under her bed. It was still connected to the oxygen concentrator set at 1.5 LPM. At 9:45 AM, Registered Nurse (RN) D confirmed resident #28 was not wearing her NC and the oxygen concentrator was set at 1.5 LPM. RN D was not sure what rate resident #28's oxygen was ordered by the physician. RN D stated she was supposed to check the oxygen concentrator setting but said she had not done it. RN D checked the electronic physician orders and noted resident #28's oxygen was ordered to be flowing at 3 LPM not 1.5. Review of the Medication Administration Record for January 2024 revealed nurses documented resident #28's oxygen was set at 3 LPM via NC on all 3 shifts on 1/07/24 and 1/08/24 contrary to the observations of the actual setting of 1.5 LPM . On 1/10/24 at 4:59 PM, the Regional Nurse stated her expectation was nurses accurately document what was done, and not document what had not actually been done. She confirmed best practice for nurses was to verify oxygen delivery and settings during rounds and document their findings accurately. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 34 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on interview and record review, the facility failed to ensure the Quality Assurance and Performance Improvement (QAPI) program developed and implemented timely and appropriate plans of action to prevent repeat deficient practices related to respiratory care, pressure ulcer care, nurse staffing postings and kitchen sanitation. Findings: Cross reference F686, F695, F732 and F812 Review of the facility's survey history revealed repeat deficiencies related to the delivery of oxygen per physician orders, provision of preventive care for pressure ulcers, retaining and posting of daily nurse staffing sheets and the cleanliness and sanitation of the kitchen during the current survey ending 1/11/24. Past deficiencies revealed systemic concerns with comparable findings on the previous recertification survey of 5/31/22 for pressure ulcer care and prevention, posting and retaining of daily nurse staffing forms, and following physician orders for oxygen delivery. As well as a repeat deficiency for sanitation of food surfaces in the kitchen from a recent complaint survey on 12/14/23. Review of the Quality Assurance and Performance Improvement (QAPI) Policy and Procedure with most recent revision date of April 2022 revealed the purpose and guidelines for implementation, To provide continuous evaluation of (company name) systems with the objectives of keeping systems functioning satisfactorily; preventing deviation from care processes; discerning issues and concerns; providing points of accountability for ensuring quality of care and quality of life; allowing the Facility to deal with quality deficiencies in a confidential manner; and correcting inappropriate care processes. The document further described QAPI as a multi-level management process that must be ongoing and facility wide. The procedure section detailed the facility's QAPI would take action aimed at performance improvement and would prioritize problem prone areas. The document further described the facility would measure the success of the improvements and track the performance to ensure they were realized and sustained. On 1/11/24 at 4:11 PM, a meeting was held to discuss the facility's QAPI program with the Executive Director of Clinical Services, the Administrator, the Social Service Director and the Director of Nursing. The Executive Director of Clinical Services stated their new company took over the facility in May of 2023 and started a new QAPI agenda in November 2023. She described how their QAPI looked at previous action plans, reports by department heads, mock survey results and review of regulatory compliance in order to determine what areas they would focus on. The Administrator stated QAPI went over a lot of things and gave him a recap of those things to which he gave his input. He stated he was unaware of what concerns or citations the facility had on the last survey. The group was asked how they ensured the work of the QAPI program was effective to prevent repeat deficiencies? The Administrator then stated they were very aware of past survey history and what was received. He explained the committee knew there were previous concerns with pressure wounds but was not able to provide an explanation of what the committee did to ensure previous concerns were not a continued problem. The Administrator and the Executive Director of Clinical Services acknowledged the facility was unaware of the concerns brought to their attention over the course of the current survey which included repeat deficiencies. They were unable to give an explanation as to how the facility QAPI ensured any problems identified and addressed by the committee were realized and sustained. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 35 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0880 Provide and implement an infection prevention and control program. 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 follow accepted standards of practice to prevent cross-contamination during wound care for 1 of 2 residents observed during wound care, (#44) to control and prevent infections for 2 out of a total sample of 57 residents. Residents Affected - Few Findings: Review of the medical record revealed resident #44 was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses including encephalopathy (brain dysfunction), paraplegia, dementia, comprehension/communication disorder, stroke, contractures of all extremities, and pressure ulcers of the left hip and sacrum. The National Pressure Injury Advisory Panel defines a pressure ulcer or pressure injury as localized damage to the skin and underlying soft tissue usually over a bony prominence.The injury can present as intact skin or an open ulcer and may be painful (retrieved on 1/14/24 from www.npiap.com). The Minimum Data Set (MDS) Quarterly assessment with assessment reference date of 11/28/23 revealed resident #44 had severely impaired cognitive skills for daily decision making. The document showed the resident exhibited no behavioral symptoms and did not reject evaluation or care that was necessary to achieve her goals for health and well-being. The MDS assessment indicated resident #44 had two unhealed, facility-acquired, stage 4 pressure injuries. The document described a stage 4 wound as full thickness tissue loss with exposed bone, tendon or muscle. that might also have some necrotic or dead tissue. The resident received skin and ulcer treatments including pressure injury care, ointments, and medications. Review of resident #44's medical record revealed a care plan initiated on 8/03/23 for impaired skin integrity related to a pressure ulcer on her sacrum, an infection wound on her right hip, and a pressure ulcer on her left hip that had a wound vacuum in place. The care plan goal was the resident's wounds would exhibit signs and symptoms of healing with continued treatment. The interventions included obtain and provide treatment as ordered by the physician. The resident had a care plan for an active wound infection of Methicillin-resistant Staphylococcus aureus (MRSA). MRSA is caused by a type of bacteria that is resistant to many of the antibiotics used to treat ordinary infections (retrieved on 1/14/24 from www.mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc-20375336). The care plan indicated the resident received antibiotics to treat the infection and was on contact isolation precautions as the infection represented an increased risk for contact transmission of the organism. Review of the Order Listing Report revealed resident #44 had physician orders dated 12/22/23 for wound treatments to her sacrum and right hip. The orders instructed nurses to cleanse the areas with wound cleanser, pat dry, apply collagen powder to the wound beds, then apply absorbent fiber dressings and cover with gauze island border dressings. On 1/07/24 at 2:36 PM, the facility's Wound Nurse stated resident #44's sacral pressure wound had been declining and the wound specialist physician ordered a wound culture that showed the resident had a MRSA infection. She stated the resident currently received antibiotic injections and all staff who worked with her were required to wear disposable gloves and gowns to prevent the transmission of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 36 of 37 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 105471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center of Orlando 9311 S Orange Blossom Trl Orlando, FL 32837 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few MRSA. She explained resident #44's right hip wound was not a pressure injury as it started as a skin infection. On 1/07/24 at 2:46 PM, prior to observation of resident #44's wound care, the Wound Nurse placed all treatment supplies and gloves on a styrofoam tray and took them to the resident's room. She placed two paper towels on the tray table and set the styrofoam tray on top of them. The Wound Nurse donned clean gloves and then realized she did not have a trash can nearby. She asked the Certified Nursing Assistant (CNA) who stood on the other side of the bed to give her the trash can, then she walked to the foot of the bed to retrieve it. The Wound Nurse held the trash can with both gloved hands and placed it under the tray table. She removed her gloves, dropped them in the trash can and retrieved a clean pair of gloves from the styrofoam tray. She donned the clean gloves without performing hand hygiene and reached towards the treatment supplies on the tray table. The Wound Nurse was prompted to remove her gloves and perform hand hygiene before donning clean gloves to start wound care. After washing her hands and donning clean gloves, the Wound Nurse removed the soiled dressing with a moderate amount of drainage from resident #44's sacrum, dropped it in the trash can, and with the soiled gloves, she touched items on the the styrofoam tray as she selected a gauze pad and a tube of wound cleanser. Next, the Wound Care Nurse wiped the resident's infected sacral wound, dropped the gauze pad in the trash can, and removed her soiled gloves. She applied another pair of clean gloves, without performing hand hygiene, and completed the dressing as ordered. The Wound Nurse removed the gloves, washed her hands and returned to the tray table with treatment supplies. She donned clean gloves, removed the soiled dressing from resident #44's right hip wound, and disposed of the soiled dressing and gloves in the trash can. She then donned clean gloves, again without performing hand hygiene, and cleansed the wound. She disposed of the gauze pad and gloves in the trash can and retrieved another pair of gloves. She failed to wash her hands or use hand sanitizer, and donned the gloves to continue wound care and apply the dressing as ordered. The Wound Nurse stated she was not sure if hand hygiene was required after removing soiled gloves and before donning clean gloves. She was not familiar with the facility's policy and procedures related to changing gloves after removing a soiled dressing to avoid cross-contamination of treatment supplies and other wounds. The Wound Nurse explained she kept hand sanitizer in the treatment cart and usually brought it into rooms to do wound care and treatments. However, she stated resident #44 was on contact isolation for an infection and she did not want to take any items into the room and return them to the treatment cart. On 1/10/24 at 5:16 PM, the Director of Nursing stated the Wound Nurse received specialized training in wound care and the Assistant Director of Nursing (ADON) confirmed she had verified the Wound Nurse's competencies. They acknowledged appropriate performance of hand hygiene during wound care was essential for infection prevention and they expected nurses to follow the facility's policy and professional standards for wound care. The ADON confirmed the Wound Nurse could have obtained a designated container of hand sanitizer and left it in resident #44's room. Review of the facility's policy and procedure for Clean Dressing Change, dated 4/01/23, revealed the table used for treatment supplies should be cleaned with a germicidal wipe prior to establishing a clean field and a trash can should be placed within reach. The document indicated next, the nurse would remove gloves, perform hand hygiene, set up supplies on the barrier, perform hand hygiene again, and apply clean gloves. The procedure instructed nurses to remove the soiled dressing , place it in the trash can, remove gloves, and perform hand hygiene, and don clean gloves. After cleansing the wound and patting the area dry, gloves should be removed, followed by hand hygiene and placement of clean gloves to complete the dressing change. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105471 If continuation sheet Page 37 of 37