Health inspection·February 24, 2022

F 0561 Unit. Level of Harm - Minimal harm or potential for actual harm In additional interviews with the DON on 2/23/22 at 1:12 PM and 3:01 PM, she stated the facility had a reclining shower chair that would enable staff to provide the resident with showers. The DON was not sure where provision of showers would be documented in the electronic medical record. The resident's Task form was reviewed with the DON, and she validated there was documentation to show some type of bed bath was given. She confirmed there was no documentation to indicate resident #20 received showers according to his expressed preference on scheduled shower days. Residents Affected - Few The resident's care plan for ADL self-care performance deficits, initiated on 3/02/20 with revision on 12/26/21 read, Bathing/showering: the resident requires assistance by (1) staff with bathing/showering and as necessary. 2. Resident #65 was admitted to the facility on [DATE] with her most recent readmission on [DATE]. Her diagnoses included metabolic encephalopathy, convulsions, stroke with one-sided weaknesses and paralysis, diabetes type II with diabetic neuropathy, and anxiety disorder. Review of the Annual MDS assessment with ARD of 8/05/21 revealed resident #65 felt it was very important to choose between a tub bath, shower, bed bath or sponge bath. The resident's Quarterly MDS assessment with ARD of 1/20/22 revealed the residents' cognition was intact with a BIMS score of 14/15. Resident #65 required extensive assistance from two people for most of her ADLs and she was totally dependent on staff for bathing. She had functional limitation in range of motion was impairments on both sides of her upper and lower extremities. Review of the resident's Task form showed she was scheduled for daily bathing/showers on Monday and Thursday on the 7 AM to 3 PM shift. For the period 1/26/22 to 2/23/22 there was no documentation to indicate resident #65 received showers as scheduled. On 2/21/22 at 3:20 PM, resident #65 stated she had neither received a shower nor been taken out of bed for one year. The resident stated staff told her it took too long to give her a shower since they had to transfer her from the bed to a wheelchair, then from the wheelchair to the shower chair. She verbalized she was told it was too much. Resident #65 stated she got partial or half bed baths, and verbalized she told staff she was not being cleaned properly. On 2/22/22 at 3:33 PM, CNA P confirmed resident #65 required a mechanical lift for transfers into the wheelchair and then to the shower chair. The CNA stated the resident was paralyzed from her waist down and could not lift her feet up during transfers. CNA P explained the facility did not have a shower bed or stretcher, and a shower bed would not fit in the shower room. She confirmed she had been giving the resident bed baths instead of showers. On 2/23/22 at 10:50 AM, Registered Nurse (RN) R stated resident #65 used to receive showers in the past but had not been showered for approximately one year. RN R explained the DON at that time did not want the resident to be placed in the shower chair due to the resident's risk for falls. She stated the resident received bed baths as the facility did not have a shower bed / stretcher. On 2/23/22 at 1:12 PM, the DON stated the facility had a reclining shower chair, but this device was not rated for transport. She explained staff would have to transfer the resident to a wheelchair, transport her to the shower room and then transfer her again into the reclining shower chair. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 2 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few DON stated she was aware of discussions related to the facility acquiring a shower bed, but she was not certain of the outcome. On 2/23/22 at 3:01 PM, the resident's Task: ADL-Daily Bathing Showers form for the period 1/26/22 to 2/23/22 was reviewed with the DON. She stated there was documentation to show the type of bed bath provided and verbalized there was no additional documentation to indicate the resident received showers. An intervention on the resident's care plan for ADL self-care performance deficits, initiated on 4/10/14 with revision on 1/26/22 read, The resident is totally dependent on staff to provide bath. 3. Resident #75 was admitted to the facility on [DATE] with diagnoses including paraplegia, fusion of the lumbar and thoracic regions of the spine. Review of the admission MDS assessment with ARD of 8/15/21 revealed resident #75 felt it was very important to choose between a tub bath, shower, bed bath or sponge bath. The Quarterly MDS assessment dated [DATE] revealed the resident had a BIMS score of 13 which indicated he was cognitively intact. Resident #75 required extensive assistance from one person for personal hygiene. He was totally dependent on two staff for transfers and totally dependent on one staff for bathing. On 2/21/22 at 3:05 PM, the resident stated he had not received a shower since he was admitted to the facility. He stated staff gave him a bed bath, If that is what you want to call it. Resident #75 explained although he preferred showers, staff gave him bed baths as he required use of a mechanical lift and assistance from two people to get out of bed. Review of the medical record revealed resident #75 had a care plan for bathing/showering initiated on 8/10/21 and revised on 11/10/21. The document indicated the resident required assistance of two staff with bathing/showering and a sponge bath should be given when a full bath or shower could not be tolerated. The care plan indicated the resident required a mechanical lift for transfers. On 2/23/22 at 1:59 PM, CNA O stated resident #75 received bed baths because in order to have a shower he would have to be transferred via a mechanical lift to a wheelchair, taken to the shower room and again transferred with the mechanical lift to the shower chair. She explained after his shower, the resident would have to be put back to bed to have some areas of his body washed. CNA O stated this was necessary because the shower chair did not recline enough to allow access to all areas of the resident's body. She stated a shower bed would be ideal for residents who were unable to stand, and she was not sure why the facility did not have this equipment. On 2/23/22 at 3:12 PM, the DON stated she was not aware of the problem of residents being showered according to their preferences. She confirmed residents should be able to receive showers if that was their preference. The DON could not explain why the facility did not have a shower bed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 3 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop an individualized care plan for 1 of 5 residents reviewed for oxygen therapy of a total sample of 54 residents, (#51). Findings: Resident #51 was admitted to the facility on [DATE] with diagnoses including Cardiopulmonary Obstructive Pulmonary Disease (COPD), anxiety disorder, and dementia. Review of the medical record revealed a physician order for oxygen at two liters via nasal canula as needed for shortness of breath and COPD. Review of resident #51's care plans revealed there was no specific care plan for oxygen therapy, and this intervention was not listed in any other care plan. On 2/24/22 at 2:30 PM, the Minimum Data Set (MDS) Coordinator stated if there was an active physician order for oxygen use or a diagnosis of COPD, residents should have an associated care plan for oxygen therapy. The MDS Coordinator reviewed all of resident #51's care plans and confirmed there was no active care plan to address the resident's oxygen use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 4 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide non-surgical site treatment according to a physician's order for 1 of 2 residents reviewed for non-pressure skin condition out of a sampled of 54 residents, (#83). Residents Affected - Few Findings: Review of resident #83's medical record revealed she was admitted to the facility on [DATE] with diagnoses including cardiac arrest, aortic stenosis, coronary artery bypass graft, prosthetic heart valve and coronary pacemaker. The Quarterly Minimum Data Set assessment dated [DATE] documented she had moderate cognitive impairment, required extensive assistance with activities of daily living and had a surgical wound and wound care / non-surgical dressings. Review of #83's medical record revealed physician orders dated 2/11/22 to observe the right subclavian area status post removal of central line for signs/symptoms of infection and to notify the physician if signs were present. The order directed nurses to change dry sterile gauze and secure with tape daily and as needed if soiled or dislodged, until healed. Observations conducted on 2/21/22 at 11:35 AM, and 2/22/22 at 9:19 AM, 4:06 PM, and 5:13 PM revealed the dressing to resident #83's right upper chest area was dated 2/19/22. Review of the Treatment Administration Record (TAR) revealed the physician's order was transcribed correctly to reflect observation for signs and symptoms of infection and to complete a daily dressing change until the wound as healed. The TAR was initialed by nurses to verify the treatment was completed on 2/20/22 and 2/21/22. On 2/22/22 at 5:13 PM, the Director of Nursing (DON) confirmed the dressing on #83's right upper chest was dated 2/19/22. The DON stated the physician's order was written to observe for signs and symptoms of infection and to change the dressing daily and as needed. The DON explained the nurses' initials on the TAR indicated they completed the dressing change daily on 2/20/22 and 2/21/22. The DON said, Since the dressing was dated 2/19/22, the daily dressing change had not been completed as ordered by her physician. Review of the facility's policy Dressings, Dry/Clean Procedure, revised September 2013, read, Purpose: The purpose of this procedure is to provide guidelines for the application of dry, clean dressings. Preparation: 1. Verify that there is a physician's order . check the treatment record . Steps in the Procedure: . 17. Apply the ordered dressing and secure with tape or border dressing per order. Label with date and initials to the top of the dressing . Documentation: 1. The date and time the dressing was changed . 9. The signature and initials of the person recording the data . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 5 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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** Residents Affected - Some 4. Resident #32 was admitted to the facility on [DATE] with diagnoses to include COPD, Parkinson's Disease, and chronic kidney disease. The medical record included physician orders for oxygen at 2 LPM via nasal cannula at night and PRN for shortness of breath and admit to hospice for diagnosis of end stage COPD and Parkinson's Disease. The Annual Minimum Data Set (MDS) dated [DATE] indicated the resident's health conditions included shortness of breath. The assessment showed she used oxygen and received hospice services. Resident #32 had a care plan for oxygen related to end stage respiratory failure, and COPD. On 2/21/22 at 10:12 AM, an oxygen concentrator was noted next to resident #32's bed. The nasal canula tubing was dated 2/07/22 and it was in a plastic bag, also dated 2/07/22. The tubing was connected to the oxygen concentrator that had an external filter covered in a thick gray dust-like substance. Additional observations on 2/21/22 at 1:54 PM and 3:14 PM, and on 2/22/22 at 8:48 AM revealed no change in the condition of the filter. On 2/22/22 at 1:39 PM, the Unit Manger (UM) stated resident #32 used oxygen at night and as needed during the day. She validated the oxygen tubing and nasal cannula should be changed every Sunday night and confirmed the resident's tubing was dated 2/07/22, two weeks ago. The UM confirmed the external filter was covered with thick, gray dust-like material and stated she was unsure who was responsible for cleaning the filter. 5. Resident #13 was admitted to the facility on [DATE] with diagnoses to include acute respiratory failure with hypoxia, COPD, dependence on supplemental oxygen, and chronic heart failure. The Annual MDS assessment dated [DATE] indicated the resident used oxygen. A physician order directed nurses to apply oxygen at 2 LPM via nasal canula as needed for shortness of breath. Resident #13 had a care plan for use of oxygen due to respiratory illness, COPD and acute respiratory failure. On 2/21/22 at 10:41 AM, resident #13's oxygen concentrator was noted to have no external filter on the back of the machine. On 2/22/22 at 9:00 AM, the oxygen concentrator still did not have a filter. On 2/22/22 at 1:41 PM, the UM validated the oxygen concentrator had no external filter. She confirmed oxygen concentrators should always have a filter. On 2/23/22 at 3:00 PM, the DON stated she was not sure who was responsible for cleaning the external filters on the oxygen concentrators. She stated this is a new issue that was brought to her attention by the survey team. Based on observation, interview and record review, the facility failed to maintain oxygen flow rate as ordered by the physician for 1 resident (#60); and failed to ensure oxygen concentrators were in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 6 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 - Some clean and safe condition for 6 residents (#60, #83, #49, #32, #13, and #83), out of 7 residents reviewed for respiratory care, of 16 residents receiving oxygen therapy. Findings: 1. Resident #60 was re-admitted to the facility on [DATE] with diagnoses of Chronic Obstructive Pulmonary Disease (COPD), cardiomegaly, anemia, dementia, and recent Corona Virus Disease 2019 (COVID-19) infection. On 2/21/22 at 12:05 PM, resident #60 was observed in bed. She did not have oxygen applied as the nasal cannula (NC) was draped over the left bed rail. The tubing was attached to a dirty oxygen concentrator. The rear vents of the concentrator were covered in a thick layer of gray dust particles. The oxygen flow rate was set at 3 liters per minute (LPM). A review of physician orders dated 10/15/20 noted oxygen at 2 LPM via NC as needed (PRN) for shortness of breath. An order directed nurses to change the oxygen tubing weekly and PRN, label, and date on each change every night shift on Sundays, to start on 10/18/20. Resident #60 had care plan, revised on 1/18/22, for oxygen therapy related to respiratory illness, history of COVID-19 including interventions for, Oxygen Settings: O2 via nasal prongs at 2L. On 2/21/22 at 3:00 PM, resident #60 wore the NC and received oxygen via the concentrator which was set to deliver a low rate of 3.5 LPM. The rear vents of concentrator were still covered with thick gray dust particles. On 2/21/22 at 3:08 PM, Licensed Practical Nurse (LPN) D stated she was assigned to resident #60 on the 7 AM to 3 PM shift. LPN D checked the electronic medical record (EMR) and confirmed the resident was to have her oxygen concentrator set at 2 LPM. LPN D checked the setting on resident #60's oxygen concentrator and verified it was set at 3.5 LPM. She said she had not checked the oxygen setting until prompted and acknowledged the resident was not receiving oxygen as ordered by the physician. LPN D added she thought that since the tubing was changed earlier that morning on the 11 PM to 7 AM shift, the nurse would have checked the setting then. LPN D did not notice that the thick layer of gray dust on the rear vents of the oxygen concentrator. On 2/22/22 at 10:02 AM and 2:05 PM, resident #60 wore the NC which was attached to the concentrator at bedside. The rear vents of the machine were unchanged. On 2/22/22 at 2:25 PM, LPN A and housekeeper B acknowledged resident #60's oxygen concentrator was dusty and dirty. Neither LPN A nor housekeeper B knew whether nursing or housekeeping staff were responsible for cleaning the oxygen concentrators. They did not know any details of the facility's policy related to cleaning and maintenance of oxygen concentrators. On 2/22/22 at 2:42 PM, the Environmental Services Supervisor said, Housekeeping staff do not clean or touch any of the oxygen concentrators when the residents are using them. They will clean them when the resident is finished using or when instructed by the nurse. On 2/23/22 at 3:00 PM, the Director of Nursing (DON) stated nurses were expected to check concentrator settings at least every shift to ensure oxygen infused at the prescribed flow rate. She explained residents with COPD could get carbon dioxide overloaded and make their condition worse if they got (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 7 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 too much oxygen. The DON stated cleaning of concentrators was a new issue for the facility, and confirmed staff required further education regarding the concern. Review of the policies and procedures revised October 2010 titled, Oxygen Administration read, Preparation: Verify that there is a physician's order for this procedure. Review the physician's orders. Residents Affected - Some 2. Review of resident #83's medical record revealed she was admitted to the facility on [DATE] with diagnoses including heart failure, COPD, Coronary Artery Bypass Graft (CABG), Aortic Stenosis, and cardiac arrest. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] documented she had moderate cognitive impairment and had been on oxygen therapy. Review of the plan of care dated 9/17/21 revealed the resident required oxygen therapy related to COPD and shortness of breath. Goals included monitor for respiratory distress, oxygen via nasal cannula at 2 to 4 liters LPM continuously. Review of the physician's orders documented oxygen at 2 to 4 LPM minute with humidifier via nasal cannula continuously for shortness of breath / COPD. The orders indicated nurses could remove oxygen for short periods as tolerated, oxygen tubing was to be changed weekly and as needed, and stored in a labeled and dated bag. On 2/21/22 at 11:39 AM; 2/22/22 at 9:19 AM, 2:38 PM and 4:06 PM; and 2/23/22 at 9:26 AM resident #83's oxygen concentrator was noted to have no external filter. There was gray dust built up on the inlet area where the room air entered the oxygen concentrator. On 2/22/22 at 2:38 PM, LPN E observed resident #83's oxygen concentrator and said, There is no external filter in the concentrator. There should be a filter to filter the air from the room. LPN E confirmed gray dust had built up in the space where the external filter should have been located. LPN E explained resident #83 was on oxygen all the time and was therefore inhaling unfiltered air. On 2/22/22 at 5:14 PM, the DON confirmed resident #83's oxygen concentrator did not have an external filter. The DON said, There should have been a filter on the concentrator to filter the room air. 3. Review of resident #49's medical record revealed she was admitted to the facility on [DATE] with diagnoses including COPD, congestive heart failure (CHF), and asphyxia. Review of the Quarterly MDS assessment dated [DATE] revealed the resident was cognitively intact and had been on oxygen therapy. Review of resident #49's plan of care dated 4/04/2016 and revised on 1/18/22, documented the resident sometimes had difficulty breathing related to her COPD, may need to use oxygen, and would use oxygen at bedtime. Interventions included physician ordered oxygen via nasal cannula at 2 LPM at bedtime. The goal was for resident #49 to have no complications related to shortness of breath. Review of the medical record revealed a physician's orders for oxygen at 2 LPM via nasal cannula due to low oxygen saturation levels during the night. On 2/21/22 at 10:54 AM and 2:40 PM, and on 2/22/22 at 9:27 AM and 1:45 PM, the filter on resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 8 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 #49's oxygen concentrator was noted to be completely covered with a gray dust-like substance. Level of Harm - Minimal harm or potential for actual harm On 2/22/22 at 2:38 PM, LPN E stated resident #49 wore her oxygen at night because her oxygen levels went down. LPN E observed the concentrator's external filter and confirmed it was completely covered with gray dust. LPN E then peeled the layer of dust from the external filter. She explained the external filter was used to clean the air from the room and in order for the oxygen concentrator to function properly the filter should be clean. She said, If the filter is not cleaned it becomes clogged and the resident may not receive the correct percentage of oxygen ordered by the physician. LPN E stated she was not aware who was responsible for checking and cleaning the external filters. Residents Affected - Some On 02/23/22 at 9:41 AM, the Director of Nursing (DON) stated there should be an clean external filter on the oxygen concentrators. The purpose of the filter was to filter/clean the room air before concentrating and providing the percentage of oxygen per physician order to the resident. The DON explained the nurses were not aware they were responsible for checking and cleaning the filters. The licensed nursing orientation did not include oxygen concentrator filter training. Review of the Invacare Perfecto2 V Oxygen Concentrator User Manual, dated 2016, read, . 1.2 The intended use of the oxygen concentrator is to provide supplemental oxygen to patients with respiratory disorders, by separating nitrogen from room air, by way a a molecular sieve . 7.3 Cleaning the Cabinet Filter . Do Not operate the concentrator without the filter installed or with a dirty filter. There is one cabinet filter located on the back of the cabinet. 1. Remove the filter and clean as needed . 2. Clean the cabinet filter with a vacuum cleaner or wash with a mild liquid dish detergent (such a Dawn) and water. Rinse thoroughly. 3. Thoroughly dry the filter and inspect for fraying, crumbling, tears and holes. Replace filter if any damage is found . 7.6 Preventive Maintenance Checklist On Each Inspection . Clean Cabinet Filter . During Preventive Maintenance Schedule, Or Between Patients every 3 years of continuous use (Equivalent to 26,280 hours) . Clean/Replace Cabinet filters . Review of the Facility Assessment revealed the facility was capable of caring for residents with diagnoses of COPD, Pneumonia, Asthma, Chronic Lung Disease, Respiratory Failure, Bronchitis and Influenza. Respiratory treatments would include oxygen therapy, suctioning, tracheostomy care and ventilator or respirator. The document indicated the facility would determine the skills, education, and equipment necessary to meet the needs of the residents. Staff competencies would be based on the resident's needs and staff were expected to demonstrate competency during orientation, class room instruction, videos, computer-based instruction and skill's fairs. 6. Resident # 20 was admitted to the facility on [DATE] with diagnoses of chronic diastolic (congestive) heart failure, acute respiratory failure with hypoxia, atrial fibrillation, dementia without behavioral disturbance, chronic obstructive pulmonary disease, and cardiac pacemaker. Review of the medical record revealed a physician order dated 10/26/20 for oxygen at 2 LPM via nasal cannula as needed for shortness of breath while awake. Review of the resident's Quarterly Minimum Data Set (MDS) assessment with assessment reference date of 12/15/21 revealed the resident's cognition was moderately impaired with a Brief Interview For Mental Status (BIMS) score of 12/15. The assessment indicated the resident had shortness of breath or trouble breathing with exertion. On 2/21/22 at 3:03 PM, resident #20 was in bed. An oxygen concentrator to the left of his bed did not have an external filter. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 9 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 - Some On 2/22/22 at 2:48 PM, LPN A stated the resident had physician's order for oxygen at 2 LPM as needed. During observation of the resident's oxygen concentrator with LPN A, he confirmed the machine did not have an external filter. He explained the maintenance department was responsible for replacing the filter. On 2/22/22 at 2:55 PM, the DON confirmed the oxygen concentrator did not have an external filter. She stated the maintenance department was responsible for replacing these filters. On 2/23/22 at 10:01 AM, Registered Nurse (RN) D stated the resident had orders for oxygen as needed. RN D checked the resident's oxygen concentrator and confirmed there was no external filter in place. RN D stated even if oxygen was ordered only as needed, and the resident was not currently connected to the machine, the filter should be in place. On 2/23/22 at 10:03 AM, Maintenance Assistant V stated maintenance staff check and replace the external filters on the oxygen concentrators monthly, and after resident use of the machine was completed. Maintenance Assistant V stated he did not know when the external filter for resident #20's oxygen concentrator was last changed. He verbalized the external filter was missing and stated he recently replaced it. The resident's care plan for oxygen therapy related to ineffective gas exchange and COPD, initiated on 10/26/20 and revised on 12/26/21 read, O2 via nasal prongs @ 2L PRN while awake and connected to C-pap at night. The facility's policy Oxygen Administration revised October 2010 read, Check the mask, tank, humidifying jar etc., to be sure they are in good working order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 10 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 - Many 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 interview and record review, the facility failed to maintain sufficient nurse staffing on the night shift to promote the highest practicable level of well-being for residents on 2 of 2 units; and failed to provide necessary care and services and ensure safety according to the plans of care for 7 of 16 residents reviewed for staffing concerns, (#2, #3, #10, #12, #45, #62, and #79). Findings: On 2/21/22 at 10:18 AM and 2/22/22 at 1:31 PM, resident #45, the Resident Council President, voiced a concern about the skeleton crew on the night shift. She explained there were nights when only 2 nurses and 2 Certified Nursing Assistants (CNAs) were assigned to take care of over 80 residents in the building. She explained that number of staff was not able to adequately care for everyone. She recalled residents' complaints regarding being left on the toilet too long. She expressed fear of fire or other emergency situations that would require staff to assist residents to evacuate their rooms or the building. The Resident Council President was particularly concerned about residents who were bed bound or required extensive assistance for mobility. She confirmed she had spoken to the facility's Administrator about staffing concerns on the night shift and was told the facility had a back-up plan and could call in staff when needed. On 2/21/22 at 12:34 PM, resident #10 stated the facility was short staffed and CNAs were overburdened. She explained she has a urinary catheter preferred to use a small drainage bag strapped to her leg. She stated staff replaced the small bag with a large drainage bag to cut down on the number of times needed to empty the leg bag. Review of resident #10's medical record revealed her diagnoses included generalized muscle weakness, heart failure, legal blindness, neuromuscular dysfunction of bladder and stroke with right side weakness and paralysis. Resident #10's Minimum Data Set (MDS) Significant Change in Status assessment dated [DATE] revealed she was cognitively intact and did not resist care. She required extensive assistance with bed mobility, transfers, dressing, toilet use and personal hygiene. Resident #10 had an indwelling urinary catheter. On 2/23/22 at 10:00 AM during a Resident Council group meeting, the Resident Council President reiterated the facility had a staffing issue on the night shift. She stated she had used this forum in the past to encourage resident to express their concerns about staffing and how it affected them. She explained during the last scheduled meeting of the Resident Council on 2/16/22, the group requested a meeting with the facility Administrator, Director of Nursing (DON) and the company's Chief Executive Officer (CEO) in order to address their concerns regarding staffing. The following residents expressed specific concerns related to staffing: On 2/23/22 at approximately 10:20 AM, resident #2 stated the facility is often short-staffed, especially on the night shift. Review of the resident's medical record revealed her diagnoses included generalized muscle weakness, stroke and type II diabetes. Resident #2's Minimum Data Set (MDS) Quarterly assessment dated [DATE] revealed she required extensive assistance for bed mobility, transfers, locomotion, dressing, toilet use and personal hygiene. The resident did not walk and had impairments of both upper extremities. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 11 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 - Many On 2/23/22 at approximately 10:25 AM, resident #79 recalled nights when she did not receive care for the entire night shift. She said, I got changed on the 3-11 shift and went through the night shift without being changed. Resident #79 explained she wore an incontinence brief, and not being changed regularly increased her risk for bedsores especially since she had them in the past. Review of resident #79's medical record revealed her diagnoses included stroke, generalized muscle weakness, type II diabetes, and morbid obesity. Resident #79's MDS Significant Change in Status assessment dated [DATE] revealed she was cognitively intact, did not reject care and required extensive assistance of two staff for bed mobility and extensive assistance of one staff for transfers and personal hygiene. The resident was totally dependent on two staff for toilet use. She had impaired range of motion in one upper extremity, used a wheelchair for mobility and was always incontinent of bowel and bladder. Resident #79 had a care plan for activities of daily living (ADL) self-care performance deficit dated 2/22/21. The interventions included check for incontinence with routine care and provide incontinence care as indicated. A care plan for risk for pressure injury and other skin impairment dated 2/22/21 had a goal initiated on 2/09/22 related to moisture associated skin damage on resident #79's sacrum. The interventions included assist resident to turn and reposition frequently, keep skin clean and dry and provide perineal care after each incontinent episode. On 2/23/22 at approximately 10:30 AM, resident #12 stated night shift staff did not have time to provide a thorough bath or incontinence care. She said, They hurry through and do not take their time. Review of resident #12's medical record, revealed her diagnoses included left side weakness and paralysis following a stroke, generalized muscle weakness, morbid obesity, type II diabetes and acute respiratory distress syndrome. Review of the MDS Quarterly assessment dated [DATE] revealed the resident was cognitively intact and did not reject care. She required extensive assistance of two staff for bed mobility, transfer and toilet use and extensive assistance of one staff for personal hygiene and dressing. She had impaired range of motion in one upper and one lower extremity and used a wheelchair for mobility. She was always incontinent of bladder and frequently incontinent of bowel. Resident #12 had a care plan for ADL self-care performance deficit revised on 9/21/21. Interventions included provide sponge bath when a full bath cannot be tolerated, and resident requires extensive assistance of two staff to turn and reposition in bed. Document revealed resident #12 had 42-inch bed and needed assistance with proper positioning in the center of the bed. A care plan for risk for pressure injury and other skin impairment revised on 9/24/21 directed staff to assist resident to turn and reposition frequently and keep skin clean and dry. A care plan for oxygen therapy related to decreased oxygen level when sleeping at night directed nursing staff to monitor for signs and symptoms of respiratory distress. The care plan directed CNAs to prevent abdominal compression and respiratory compromise by routinely checking the resident's position to ensure she did not slide down in bed. On 2/23/22 at approximately 10:35 AM, resident #62 said, Sometimes you ring the bell needing to go to the bathroom or get changed and they do not respond. I laid there all night one night. Review of resident's medical record revealed she had diagnoses including stroke with right side paralysis and weakness, a history of falling, difficulty walking, generalized muscle weakness and type II diabetes. The MDS Significant Change in Status assessment dated [DATE] revealed the resident was cognitively intact and did not reject care. She required extensive assistance of one staff for bed mobility, transfers, dressing, toilet use and personal hygiene. She used a wheelchair for mobility and was frequently incontinent of bowel and bladder. Resident #62 had a care plan for ADL self-care performance deficit dated 5/19/21. An intervention directed CNAs to assist with toileting as the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 12 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 - Many resident was frequently incontinent. A care plan for risk for pressure injury and other skin impairment dated 1/17/22 had interventions including keep skin clean and dry and observe for changes in skin status with routine care. On 2/23/22 at 11:44 AM following the Resident Council meeting, the Director of Recreation stated he was responsible for arranging resident council meetings and recording minutes. He confirmed the Resident Council members voiced concerns regarding night shift staffing during the last meeting. He stated he informed the Administrator and DON of the Resident Council's request for a meeting with them and the CEO to discuss their concerns. On 2/21/22, the Staffing Coordinator (SC) stated she facility often did not meet the State minimum staffing requirements. She confirmed that State required staffing ratios were not met for night shift nurses and/or CNAs on 13 of 14 days from 2/06/22 to 2/19/22. She stated the actual number of staff on the night shift on those days was disturbing. On 2/22/22 at 11:38 AM, the facility Director of Nursing (DON) was informed of staffing concerns on the night shift related to two to four scheduled CNAs instead of the minimum of five recommended according to the census. She acknowledged she had received complaints from staff regarding their workload on the night shift. When asked if two CNAs could adequately care for 81 residents, the DON did not have an answer. The DON from a sister facility, DON C, explained the facility was currently on a self-imposed moratorium and had not admitted new residents for over a month as it was unable to maintain and adequate number of staff. DON C acknowledged staffing on the night shift was a problem and stated she could not guarantee the residents were receiving adequate care with current staffing levels on the night shift. She confirmed the facility had not initiated the Personal Care Attendant (PCA) program to improve staff ratios on the night shift. The PCA program permits a nursing home to employ PCAs who are participating in a training program to perform designated duties in a limited scope of practice under direct supervision of licensed nursing staff and in collaboration with CNAs. Each PCA may work within a facility for up to 4 months before becoming a CNA. The purpose of this program was to provide additional staff to meet resident care needs during the Corona Virus-19 State of Emergency (retrieved on 3/03/22 from www.fhca.org). On 2/22/22 at 11:46 AM, the Administrator validated residents may not have received good care due to low staffing on the night shift. He confirmed the facility had not implemented a PCA program to supplement staffing. On 2/22/22 at 3:54 PM, CNA G stated she worked on both the evening and night shift. She said, The night shift can be vicious. She explained that on Monday night, 2/21/22, there were four CNAs assigned to care for all residents in the building, but one CNA worked only half a shift. She stated on the nights when there were only 2 CNAs, each CNA was assigned to twenty-two residents. CNA G explained in addition to a heavy assignment there was one resident, resident #3, who required assistance from three staff to turn and reposition her. CNA G felt she did not provide good patient care under those circumstances because she could not get all her assigned tasks done. She said, It takes a miracle to finish a shift. Review of resident #3's medical record revealed her diagnoses included heart disease, type II diabetes and morbid obesity. Resident #3's MDS Annual assessment dated [DATE] revealed the resident required extensive assistance of two or more staff for bed mobility and personal hygiene and was totally dependent on two or more staff for toilet use. She had impaired range of motion in both upper and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 13 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 - Many lower extremities and was always incontinent of bowel and bladder. Resident #3 had a care plan for ADL self-care performance deficit initiated 5/03/17. The interventions included three to four staff to assist with bathing, bed mobility, dressing, toilet use and transfers. A care plan for risk for falls initiated on 3/25/19 included interventions for bariatric bed for bed mobility, encourage and remind resident to call for assistance and use a slide sheet for bed mobility. A care plan for risk for pressure injury and other skin injury dated 5/03/17 included interventions to provide perineal care after each incontinent episode, reposition in bed as needed and support with pillows due to frequent leaning to one side and pull up in bed with sliding lift sheet. Resident #3's [NAME] or CNA care plan reflected interventions including assistance of three to four staff for bed mobility, dressing, transfers, and toilet use. On 2/22/22 at 4:26 PM, CNA H stated she normally worked on the 500 unit on the evening shift but occasionally picked up extra shifts on the night shift. She confirmed sometimes there were only two CNAs for the entire facility on the night shift. She described the situation as rough. She explained most residents needed assistance and with that many residents she could not check on each on every two hours as required. She said, I cannot provide all the care needed. On 2/22/22 at 11:38 PM, in a telephone interview, CNA J stated she normally worked on the night shift and was frequently one of two CNAs on the 500 unit. She explained with two CNAs, they would have to divide the 45 residents between them and was only able to make rounds twice for the shift rather than every two hours. She acknowledged CNAs should check and reposition residents at least every two hours. CNA J said, It is absolutely not possible. We cannot give the proper care like that. I would go in there more often if we had enough CNAs. On 2/22/22 at 11:51 PM, in a telephone interview, Licensed Practical Nurse (LPN) K stated the facility has been short-staffed for the last 6 months. She recalled two nights recently when she worked the 400 unit with only one CNA. She acknowledged it was not appropriate for one CNA to care for almost 40 residents. She explained on those nights the CNA was not able to check and change the residents every two hours. On 2/23/22 at 12:04 AM, in a telephone interview, Registered Nurse (RN) L stated he was usually assigned to the 500 unit with a census of over forty residents. He explained there was usually only one nurse assigned to that unit. He confirmed there were often only two CNAs on the unit for the night and there were occasions when there was only one CNA assigned to the residents. He explained when the staffing was this low, the CNAs had to prioritize because there were too many residents to do everything necessary. He agreed the residents should be checked every two hours but said, It is not possible if one CNA has the unit. On 2/23/22 at 12:10 AM, in a telephone interview, CNA M stated there had been a staff shortage on the night shift for last couple of months. She said, I often work alone on this unit for the whole night shift. I cannot check my residents every two hours if I am alone. When asked how she cared for 44 residents, she said, I know who needs to be changed and who is usually soiled. But you cannot change people every two hours. She stated the facility's management knew there was a problem, but she did not see anything changing. On 2/23/22 at 9:17 AM, CNA F stated although she usually worked the day shift, she was aware of staffing concerns on the night shift. She explained at the start of her shift, she sometimes found residents heavily saturated with urine if there were one or two CNAs working on the night shift. CNA F confirmed resident #3 required three to four staff to care for her and one or two CNAs on the night (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 14 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 shift could not adequately care for her. Level of Harm - Minimal harm or potential for actual harm The facility's Policy and Procedure for Staffing revised in April 2007 included the statement, Our facility maintains adequate staffing on each shift to ensure that our resident's needs and services are met. Licensed registered nursing and licensed nursing staff are available to provide and monitor the delivery of resident services. Residents Affected - Many The Facility Assessment dated 2/18/22 included a staffing plan to ensure a sufficient number of qualified staff were available to meet each resident's needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 15 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 post daily nurse staffing information that included hours worked from 1/01/21 to 2/21/22. Residents Affected - Many Findings: On 2/21/22 at 10:45 AM, the Staffing Coordinator (SC) confirmed she was responsible for posting the daily nurse staffing information. She explained she completed the section of the form for the day shift, and the evening and night nurse supervisors should update the form at the start of those shifts. The SC stated sometimes this was not done and she would update the form on the following day after she took it down. On 2/21/22 at 10:55 AM, the SC provided nurse staffing forms for January 2021. Review of the form dated 1/01/21 revealed it did not include a column to display the number of hours worked by each category of licensed and unlicensed nursing staff. Review of forms for January 2021 and February 2022 revealed several forms were incomplete with blank spaces left for evening and night shift data. The SC confirmed there was no column to record the number of hours worked by any staff. She stated she was not aware of the requirement for these hours to be posted. On 2/21/22 at 10:57 AM, the daily nurse staffing posting Staffing Report - Direct Resident Care form dated 2/21/22 was reviewed with the SC. The document was posted in the hallway outside the facility's main dining room and included the facility's name, census, and number and type of nursing staff on the day shift only. There was no column to display the number of hours worked per shift and rows for the evening and night shift were blank. On 2/21/22 at 11:02 AM, the Administrator was informed the facility's nurse staffing postings were incomplete as the form did not include the numbers of hours worked by nursing staff for each shift. The Administrator stated he was aware the hours for each position should be posted but did not know the current form did not display this data. He confirmed the purpose of the form was for transparency so residents and the public could easily obtain information on the facility's daily nurse staffing. Review of the facility's Policy and Procedure for Posting Direct Care Daily Staffing Numbers (undated) indicated shift staffing information would be recorded each shift, and would include, the actual time worked during that shift for each category and type of nursing staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 16 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain safe and sanitary conditions for food storage in 1 of 2 nutrition rooms, (400-unit). Findings: On 2/24/22 at 9:40 AM, during a tour of the 400-unit nutrition room / pantry with the Unit Manager (UM), undated food items observed inside the refrigerator included: bag labeled room [ROOM NUMBER] with a large bucket of fried chicken with 3 biscuits, bag with 1 box onion rings, box containing fish/shrimp/French fries, box with biscuit and shrimp, bag with 2 containers of [NAME] slaw, 2 slices of cheesecake, and 64 ounces vanilla creamer which was almost empty. Food particles and trash were observed on the cabinet shelves and inside drawers. The cabinets were disorganized and there were miscellaneous condiments, nut mixture and cereal noted in the drawers as well as the cabinets. The upper cabinet adjacent to the coffee supplies had an undated bagel wrapped in tinfoil. The upper right cabinet had a bag containing 4 bottles of various vitamins and supplements and a bruised red apple was left on the countertop. The UM said, Whoever puts items into the refrigerator needs to date them and the night staff are to throw out the outdated food. The UM acknowledged the cabinets, drawers, and refrigerator were dirty, disorganized, and had outdated or undated food items present. She said, I wound not want my house kept like this. On 2/24/22 at 10:30 AM, the Food Service Director was interviewed regarding concerns identified on the 400-unit nutrition room. He said, Food brought from the outside to the panty and nutrition rooms must be thrown out after 3 days. Anyone can clean the pantries. He explained nursing staff were responsible for throwing out the outdated food and the kitchen staff should rotate items such as milk and juice. On 2/24/22 at 12:30 PM, the Food Service Director stated since nursing staff checked the refrigerator temperatures in the pantries, they would be responsible for cleaning up and throwing out outdated food. He explained Environmental Services staff cleaned the panty and nursing staff were assigned on all shifts to clean the refrigerator and throw out outdated items. The Food Service Director stated when family members provide food for the residents, nursing staff should put the residents' room number and current date on the item(s). Review of the facility policy for, Food from Family, Visitor, Community read, Food stored for resident should be labeled and dated appropriately and discarded per safe food storage guidelines. Review of the facility policy and procedure dated 2016 for, Handling Leftover Food read, Leftover food stored in the refrigerator shall bed wrapped dated, labeled with a use by date that is no more than 72 hours from the time of first use. Refrigerated leftovers stored beyond 72 hours shall be discarded. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 17 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to utilize its resources effectively to develop and implement a plan that ensured sufficient staffing on the night shift to meet residents' care needs. Residents Affected - Many Findings: On 2/21/22 at 11:19 AM during a review of State staffing calculation forms with the Staffing Coordinator (SC), she stated she was aware the facility did not meet minimum State staffing requirements on a few days. She was informed minimum staffing requirements were not met on a significant number of days, 13 of the 14 nights shifts on the days reviewed. She stated the supervisor or manager on duty should have handled call-offs or openings in the schedule by attempting to call staff or a staffing agency to fill those slots. The SC stated she notified the Administrator whenever staffing was not sufficient. She was unable to confirm whether the supervisor or manager on duty attempted to utilize other licensed or certified staff from other departments on the dates when staffing was insufficient. On 2/22/22 at 11:38 AM, the Director of Nursing (DON) from a sister facility, DON C, stated the facility was currently on a self-imposed moratorium and had not admitted any new residents for over a month because they had been unable to maintain an adequate number of staff. DON C acknowledged staffing on the night shift was a problem. She confirmed the facility had never initiated the Personal Care Attendant (PCA) program to supplement staffing on the night shift. On 2/22/22 at 11:46 AM, during review of the State staffing calculation with the Administrator, he was informed on some nights there were only 2 CNAs in the building caring for over 80 residents and there were frequently two nurses with no nursing supervisor assigned to care for all residents. He stated he was not aware of the extent of the staffing concern on the night shift. He explained he was not responsible for hiring nursing staff. The Administrator stated he had informed his direct supervisor of the facility's staffing issues and discussed the possibility of implementing the PCA program; but at this point it had not been authorized. The PCA program permits a nursing home to employ PCAs who are participating in a training program to perform designated duties in a limited scope of practice under direct supervision of licensed nursing staff and in collaboration with CNAs. Each PCA may work within a facility for up to 4 months before becoming a CNA. The purpose of this program was to provide additional staff to meet resident care needs during the Corona Virus-19 State of Emergency, (retrieved on 3/03/22 from www.fhca.org). On 2/24/22 at 11:36 AM, the Administrator stated staffing was reviewed daily for compliance with State-mandated ratios and direct patient care hours. He explained the facility used agency to help fill openings on shifts. He stated the facility had discharged some patients to a sister facility; but said, It is hard to find other facilities who will take Medicaid patients. The Administrator clarified he understood what need to be done under regular circumstances, but this was a public health crisis. He could not elaborate on why the corporation had not implemented the PCA program which was designed to mitigate staffing shortages in this crisis. On 2/24/22 at 11:36 AM, the Administrator stated he was aware the facility had significant staffing concerns. He confirmed the facility had an emergency staffing plan but could not give specifics. He (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 18 of 19 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 105479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Central Park 411 North Dillard Street Winter Garden, FL 34787 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 0835 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many acknowledged staffing requirements had to be met under regular circumstances; but stated the facility was impacted by the current public health crisis. The Administrator could not explain why the corporation had not implemented the PCA program in the almost two years the program had been in existence. He verbalized understanding the PCA program was designed to mitigate staffing shortages in this crisis. When asked what census the facility's current staffing could accommodate, the Administrator responded he was not certain and would have to calculate. DON C stated the current availability of night shift CNAs would support a census of 50 to 60 residents. The Facility Assessment dated 2/18/22 included a staffing plan to ensure a sufficient number of qualified staff were available to meet the resident's needs. Review of the job description for the Staffing Coordinator revised on 10/06/17 revealed he/she was responsible for ensuring nursing units were adequately staffed. Essential functions included accommodating unplanned staffing variances and communicating with staff on duty or making calls to off duty personnel to adjust staffing as necessary. Review of the job description for the facility's Nursing Director revised 9/20/17 revealed he/she would plan, organize, develop and direct the operations of the nursing department. The document indicated the DON ensures a sufficient number of nursing staff is assigned daily to meet the total nursing needs of the residents. Review of the job description for the facility's Administrator revised on 3/10/20 revealed he/she was responsible for directing day-to-day functions of the facility in accordance with regulations. Essential functions included managing human resources functions such as hiring and work assignments and ensuring there was an adequate number of staff on duty at all times to meet residents' needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105479 If continuation sheet Page 19 of 19