Health inspection·February 2, 2023

F 0553 Level of Harm - Minimal harm or potential for actual harm Review of resident #9's care plan for psychosocial well-being initiated on 11/27/18 included, Provide opportunities for the resident and resident representative to participate in care. On 1/31/23 at 12:07 PM, resident #9 stated he had never been invited nor participated in a care plan meeting. Residents Affected - Few On 2/02/23 at 4:01 PM, the MDS Coordinator stated resident #9's medical records showed the last care plan meeting was held 7/21/22. She indicated he should have had one in October 2022. She could not provide evidence of a care plan meeting for October 2022. 3. Review of resident #26's medical record revealed she was admitted to the facility on [DATE] with diagnoses of type 2 diabetes, end stage renal disease, dependence on renal dialysis, chronic obstructive pulmonary disease, and coronary artery disease. Review of resident #26's quarterly MDS assessment with ARD of 1/02/23 revealed a BIMS score of 14 out of 15 which indicated she was cognitively intact. The assessment noted no rejection of care necessary to obtain goals for her health and well-being. The admission MDS assessment with ARD of 10/2/22 revealed it was very important to have her family or a close friend involved in discussions about her care. The assessment noted resident #26 and her family or significant other participated in the assessment. On 1/30/23 at 5:40 PM, resident #26 stated the facility had not invited her to participate in care plan meetings. She stated she had concerns about her care and wanted to discuss them at the meeting. On 2/02/23 at 3:31 PM, the MDS Coordinator explained she was responsible for setting up and leading the care plan meetings. She stated she documented the care conference details in the resident's medical record. She explained there were no sign in sheets, but she entered the names and positions of staff who attended the meetings. She noted the initial care conference was usually done by day 21 or soon after the resident's admission to the facility. She explained subsequent meetings would be held quarterly after the MDS assessment was completed. She noted written invitations were previously sent but lately she had been calling the families and visited the residents in person to invite them to their care plan meetings. She indicated she did not enter a progress note and had no documentation of which residents' she had visited. She said she knew, If is not documented it was not done. She indicated the importance of the care conference meetings included ensuring they were meeting the needs of each resident and learn about issues important to them and their families. She confirmed resident #36 should have had at least 2 care conference meetings since her admission. She stated there were no care conference notes in resident #26's medical record. On 2/02/23 at 3:54 PM, the Case Manager explained care plan meetings included a written invitation sent by the MDS Coordinator to the resident or representative. She stated there was a paper trail before it was changed to an electronic process. She explained during the pandemic, all meetings were performed virtually and after that, things did not return to their normal process but it should have. On 2/02/23 at 5:24 PM, the Director of Nursing (DON) explained the facility held care conference meetings twice per week on Tuesdays and Thursdays. She indicated the interdisciplinary team (IDT) included nurses, certified nursing assistants, the resident and their family or representative. She indicated the process included a letter or phone call to invite the resident or representative. She explained the initial care conference was done within 3 days of admission and a second one between days (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 2 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 21 to 28 days after the completion of the comprehensive assessment and at least quarterly thereafter. She indicated the care plan meetings were important for everyone to understand the care and address any care issues. She indicated she signed off on all residents' care plans. She explained they previously used to get all attendees signature, but it was changed to an electronic form to be completed in the resident's medical record. The DON stated the MDS Coordinator was responsible for sending care conference invitation letters. Review of the Care Conference policy and procedure, revised on 10/01/19, read, The Center will hold regularly scheduled interdisciplinary care conferences for the purpose of planning and developing the resident's individualized plan of care, and providing communication between the IDT, resident, and/or resident representative. The procedure included the resident and/or resident representative was invited to attend each of the Interdisciplinary Care Planning Conferences and the IDT met to review the plan of care within 21 days of admission, approximately quarterly and as needed. It also read, Attendees to the Care Plan Conference, including resident and/or representative shall sign the Care Conference Record to verify attendance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 3 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain comfortable temperature in 1 of 2 shower rooms, ([NAME] I) and failed to provide a safe and homelike environment in 1 of 13 rooms in the 300-hall, (room [ROOM NUMBER]). Findings: 1. On 1/31/23 at 11:00 AM, resident #3 stated the shower room was cold and he had informed the Certified Nursing Assistants (CNAs) but nothing was done about it. On 2/01/23 at 11:57 AM, resident #3 said he took a shower today and the shower room was too cold. On 1/31/23 at 12:04 PM, resident #9 explained the shower room could be warmer. He stated he had mentioned the cold temperature in the shower room to the CNAs, but they did nothing to address it. On 1/31/23 at 12:29 PM, resident #26 stated she preferred to get showers but the shower room was too cold. On 02/01/23 at 8:50 AM, Licensed Practical Nurse (LPN) D asked resident #70 if she was taking a shower today. Resident #70 responded as long as it is warm in there, she would take the shower. LPN D said, They always complain that shower room is cold. She explained she had overheard CNAs talk amongst themselves about residents' complaints of the cold shower room. She did not recall if anyone had reported this issue to maintenance. On 2/01/23 at approximately 2:00 PM, the shower rooms were observed with CNA L. CNA L stated she felt the difference in temperature from the [NAME] II shower room to the [NAME] I and mentioned it would feel cold for a resident after she stopped the running water. The temperature in [NAME] 1 shower room registered 74.6 degrees (°) Fahrenheit (F). On 2/02/23 at 10:50 AM, the Maintenance Director stated they had complaints with shower room temperatures. The Maintenance Director explained the temperature was set at 70° F and the thermostat was controlled at the nurse's station. He indicated the thermostat for [NAME] II was moved to the Unit Manager's (UM) office. He reported he did not know residents had refused showers because of the cold shower room. On 2/02/23 at 11:03 AM, during tour of the shower room in [NAME] I, the Maintenance Director checked the temperature and stated it was 68° F. He said, It is too cold; 68 is too cold. He noted the thermostat was set at 69°F. The Maintenance Director raised the thermostat to 72°F and said it would take a few hours for the shower room to warm up. He checked the temperature in the [NAME] II's shower room which showed 70°F. He stated this was the correct temperature but the [NAME] 1 shower temperature was too cold. 2. On 1/31/23 at 9:19 AM, the right corner of the bedside table in room [ROOM NUMBER]-B was in disrepair. The top panel was broken on the right side, missing approximately 4 inches long by 2 inches wide. Splints were visible on the bedside table while resident #89 sat in front of the table with her personal papers lying on it. Resident #89 mentioned she had told someone about the condition of her table but did not get a replacement. On 2/02/23 at 10:29 AM, the broken bedside table was still in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 4 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 0584 use in room [ROOM NUMBER]. Photographic evidence was obtained of the broken table on 2/01/23. Level of Harm - Minimal harm or potential for actual harm On 2/02/23 at 10:35 AM, CNA K stated she always had the same assignment in the 300-hall. She stated if she found anything broken in a resident's room she completed a Repair Requisition form located by the nurses' station. She indicated someone from maintenance came every day and checked the completed requisition forms. She stated when she provided care to her residents, she ensured everything was working in their rooms. She indicated if a bedside table was broken, she looked for another one, wiped it down and replaced it. Later at 11:18 AM, CNA K shared she had worked the day before and today in room [ROOM NUMBER]. She explained she brought the meals during her shift which included breakfast and lunch and placed the tray on the bedside table. She indicated she often looked at the condition of bedside table when delivering the trays and she remembered pushing the bedside table to the wall this morning. She indicated she had not noticed the broken table in room [ROOM NUMBER]. CNA K added the resident could have scratched or hurt herself with the broken table. Residents Affected - Some On 2/02/23 at 10:40 AM, the Maintenance Assistant stated they learned about needed repairs or replacement of equipment when staff completed a Repair Requisition form or entered a request in their maintenance electronic system. She indicated they collected the requisition forms every day. Review of submitted requisition forms in January 2023 revealed no requests or issues for room [ROOM NUMBER]. On 2/02/23 at 10:50 AM, the Maintenance Director stated when he inspected resident's rooms, he looked for the integrity of the entire room, paying attention to things that may have been overlooked by staff. He explained he expected the direct care staff to notice a non-working bedside table because they touch the table at least three times a day. On 2/02/23 at 11:10 AM, the Maintenance Director validated the broken bedside table in room [ROOM NUMBER]-B. The Maintenance Director stated this was a new table which probably got stuck and bent by the bed frame and no one reported it. He indicated anyone who delivered a meal tray every day should have noticed, reported and removed it from service right away. Review of the facility policy and procedure titled, Maintenance dated 11/30/14, read, The facility's physical plant and equipment will be maintained through a program of preventive maintenance and prompt action to identify areas/items in need of repair. The procedure revealed daily rounds of the building by the Director to ensure the plant was free of hazards and in proper physical condition. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 5 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 and implement individualized comprehensive care plan for splints for 1 of 28 residents reviewed for care planning of a total sample of 53 residents, (#54) Findings: Review of the medical record revealed resident #54 was admitted to the facility on [DATE], with diagnoses including cerebrovascular disease, contracture of the left shoulder, left elbow, left hand, and schizoaffective disorder. The resident's quarterly Minimum Data Set (MDS) assessment with Assessment Reference Date of 1/12/23 revealed the resident's cognition was moderately impaired with a Brief Interview of Mental Status score of 11/15. The resident required extensive assistance with physical assist of one person for dressing, and personal hygiene, and had functional limitation in range of motion to one side of her upper extremity. Section O of the assessment indicated the restorative program performed splint or brace assistance on 2 days of the seven days look back period. Review of the resident's physician's orders revealed an order dated 10/20/22 for hand splint to be worn for 3-4 hours daily and a carrot to be placed in the resident's hand when the splint was removed. Review of resident #54's care plans showed a care plan for Activities of Daily Living (ADL) self-care performance deficit related to history of cardiovascular accident with left sided weakness, and upper extremity contracture, initiated on 10/30/19 and revised on 7/29/22. The care plan did not include any interventions for the resident's left hand splint or carrot. Review of the resident's Visual/Bedside [NAME] Report, the plan of care for Certified Nursing Assistants (CNA) revealed documentation for adaptive devices, that only noted left hand contracture with thumb opposition between 3rd and 4th digit, but the left-hand splint and the carrot was not listed. On 2/02/23 at 3:34 PM, the resident's clinical records were reviewed with the Regional Director of Clinical Services (RDCS). She confirmed that a care plan for splints could not be identified to address the resident's left hand contracture. On 2/02/23 at 4:13 PM, the Licensed Practical Nurse (LPN) MDS Coordinator stated care plans were updated by the staff person doing the MDS assessment. The resident's quarterly MDS assessment with ARD of 1/12/23 and the resident's care plans were reviewed with the MDS Coordinator. She confirmed the quarterly MDS assessment identified splint/brace assistance, which should have triggered the development of a care plan. She stated it was missed, and a care plan should have been developed for splints for the resident. 02/02/23 4:18 PM, the Case Manager stated that when the quarterly MDS assessments were completed, a review of the residents' care plans would be conducted to ensure their needs were the same, or if there was the need to develop or update a care plan. She stated a care plan for splints should have been developed for resident #54, and said she must have missed it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 6 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 The facility's policy, Plans of Care with effective date of 11/30/2014 directs the facility to Develop a comprehensive plan of care for each resident that includes measurable objectives . to meet the resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 7 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure fingernail care was provided as needed for 1 of 6 dependent residents reviewed for activities of daily living (ADL) of a total sample of 53 residents, (#54) Residents Affected - Few Findings: Review of the medical record revealed resident #54 was admitted to the facility on [DATE], with diagnoses including cerebrovascular disease, contracture of the left shoulder, left elbow, left hand, and schizoaffective disorder. The resident's quarterly Minimum Data Set (MDS) assessment with Assessment Reference Date of 1/12/23 revealed the resident's cognition was moderately impaired with a Brief Interview of Mental Status score of 11/15. The resident required extensive assistance with physical assist of one person for dressing, and personal hygiene, and had functional limitation in range of motion to one side of her upper extremity. On 1/30/23 at 11:36 AM, resident #54's left hand was noted to be contracted, with her thumb extending between her third and fourth fingers. The fingernails to both hands were long, and untrimmed, with a dark substance beneath the nails. The resident stated they needed to be trimmed. On 1/31/23 at 12:36 PM, resident #54 self-ambulated in the hallway between the units. The fingernails to both hands remained the same, long and untrimmed. On 1/31/23 at 5:45 PM, the resident sat on the side of her bed eating dinner. Her fingernails were still long, and untrimmed, with a dark substance under the nails. The resident's fingernails were observed with the Assistant Director of Nursing (ADON). She confirmed the resident's fingernails were long, and untrimmed, with a dark substance under the nails. On 2/01/23 at 9:59 AM, observations of the resident's fingernails were discussed with the Licensed Practical Nurse (LPN) [NAME] 1 Unit Manager (UM). The UM stated nail care could be provided by any staff member, and staff should identify the need for nail care. She stated the facility did not have any specific day to do nail care, it was a part of the daily tasks to be done with care. She said staff should have identified the resident's need for nail care. On 2/01/23 at 11:28 AM, Certified Nursing Assistant (CNA) F stated resident #54 required extensive assistance with her care needs. She stated the resident did not resist care, and loved to be clean. CNA F stated she trimmed residents' nails after showers and verbalized that resident #54 was included in her assignment on 1/30/23 and on 1/31/23. She observed the resident's fingernails and stated she did not get to trim the resident's fingernails, but said she could not recall the reason for not trimming her fingernails. The resident's care plan for ADL (Activities of Daily Living) self-care performance deficit related to history of cardiovascular accident with left sided weakness, and upper extremity contracture initiated on 10/30/19, and revised on 7/29/22, indicated the resident had fluctuations in her abilities on a day to day basis. An Interventions directed staff to check the resident's nail length, and trim and clean the nails on bath day and as necessary. The same information was noted on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 8 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Visual/Bedside [NAME] Report which directed the resident's care for the CNAs. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 9 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 apply splint and carrot cushion to prevent further/worsening contracture for 1 of 4 residents reviewed for Range of Motion (ROM) of a total sample of 53 residents, (#54). Findings: Record review revealed resident #54 was admitted to the facility on [DATE], with diagnoses including cerebrovascular disease, contracture of the left shoulder, left elbow, left hand, and schizoaffective disorder. The resident's quarterly Minimum Data Set (MDS) assessment with Assessment Reference Date of 1/12/23 revealed the resident's cognition was moderately impaired with a Brief Interview for Mental Status score of 11/15. The resident required extensive assistance with physical assist of one person for dressing, and personal hygiene, and had functional limitation in ROM to one side of her upper extremity. Assessment for special treatments, procedures and programs in Section O of the assessment indicated the restorative program performed splint or brace assistance on 2 days. Review of the resident's physician's orders revealed an order dated 10/20/22 for hand splint to be worn for 3-4 hours and a carrot cushion to be placed in the resident's hand when the splint was removed. The Occupational Therapy (OT) Discharge Summary revealed dates of service from 8/25/22 to 10/18/22, and skilled interventions included educating and training the patient/caregiver on donning and doffing of splint. The discharge diagnosis was left hand contracture and the discharge recommendations included splint/brace. The Functional Maintenance Program with effective date of 10/11/22 instructions included resident to wear the left-hand splint daily as tolerated, and listed the problem as left hand contracture, and skin breakdown. The program's goal was to, Promote joint integrity and prevent further reduced ROM to L (left) hand. Approaches and interventions were for Passive range of motion and gentle stretching of thumb and digits prior to donning L (left) hand splint to patient's tolerance. Recommend 3-4 hours 7 days a week if patient is able to tolerate the wear schedule. Insert hand carrot for when splint is not on to prevent converting back. On 1/30/23 at 11:36 AM, 1/31/23 at 12:36 PM, and 1/31/23 at 5:45 PM, resident #54's left hand was noted to be contracted, and the resident was not wearing a splint, and the carrot cushion was not in the resident's left hand. On 1/31/23 at 5:48 PM, Registered Nurse (RN) E stated resident #54 had contracture of her hand, and awhile back the resident had splint. RN E stated she had not seen the resident with a splint recently. On 2/01/23 at 9:59 AM, the Licensed Practical Nurse (LPN) Unit Manager (UM), stated she reviewed the clinical records of the residents on her unit, and rounded on the residents daily to ensure the residents were provided with the care and services they required. She explained that if a resident had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 10 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 to wear a splint, and was currently on therapy caseload, the splint would be applied by therapy staff. She stated If the resident was not on therapy caseload, splint application would be a part of the Certified Nursing Assistant (CNA) daily task. On 2/01/23 at 10:16 AM, resident # 54 was lying in her bed positioned to her left side facing the door. The resident's left hand was contracted and a splint or hand carrot was not in place. The resident stated her splint was in the drawer of her dresser. On 2/01/23 at 11:28 AM, CNA F, stated resident #54, required extensive assistance with her activities of daily living (ADL). CNA F said the resident wore a splint on her left hand, that was sometimes placed by therapy, and sometimes placed by the resident's CNA. She verbalized the splint was supposed to be applied every day. CNA F could not say when therapy would apply the splint, or when the CNA should apply the resident's splint. Observation of resident #54 was conducted with CNA F, who confirmed the resident was not wearing a splint, and a carrot cushion was not in the resident's left hand. CNA F located the resident's splint along with the carrot cushion in the second drawer of the resident's chest of drawers. On 2/01/23 at 11:47 AM, the Director of Rehab stated resident #54 was discharged from OT with left hand splint, with recommendation for daily application. She stated the CNAs were to apply the splint, and it was placed as a task on the CNA's [NAME]. She stated directions for the splint application was on the Functional Maintenance Program form, and staff should document how long the splint was applied for. She explained she did the Functional Maintenance Program, trained staff how to don/doff the splint, and the Functional Maintenance Program form was hanging in the resident's closet with instructions. She stated the [NAME] 1 Unit Manager (UM) also signed off on the training for splint application. The Director verbalized the resident had not complained of pain when wearing the splint in therapy and would wear the splint if it was applied. She said the resident could take the splint off, but was not able to put it back on. She said not wearing the splint could cause worsening of the resident's contractures, and CNAs should document her tolerance to the wear schedule On 2/01/23 at 11:39 AM, the [NAME] 1 UM stated resident #54 was not on therapy caseload, so her splint should be placed by the floor staff. She explained the Director of Rehab trained the CNAs, and had her own system for the resident's splinting schedule. The UM stated she was not sure if the splinting application was on the CNA's [NAME]. A thirty day look back for the period 1/04/23 to 1/31/23 of the tasks response history for Amount of minutes spent providing splint or brace assistance showed the splint/brace was provided for five minutes on 1/04/23 to 1/06/23, provided for three minutes on 1/10/23, for two minutes on 1/02/23, and 1/25/23, for fifteen minutes on 1/29/23, for thirty minutes on 1/10/23, 1/1/23, on 1/21/23 thirty minutes, and twenty minutes were documented, and provided for sixty minutes on 1/13/23. Documentation indicated the splint was not provided on 1/07/23, 1/08/23, 1/12/23, 1/14/23, 1/15/23 to 1/19/23, 1/22/23, 1/24/23, 1/26/23, 1/30/23, and 1/31/23. The resident's splint was not applied as recommended. The Functional Maintenance Program recommendation was for three to four hours seven days a week if the patient was able to tolerate the wear schedule, and to insert hand carrot for when the splint was not on to prevent the contracture from converting back. Review of the resident's clinical records revealed no documentation regarding the resident's tolerance to the splinting application/ schedule, or to indicate the resident refused the splint application. This was confirmed by the Regional Director of Clinical Services. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 11 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 The facility did not provide a policy related to splint application. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 12 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide intravenous (IV) medications and care according to standards of practice and plan of care for 2 of 2 residents reviewed for IV care of a total sample of 53 residents, (#17 and #310). Residents Affected - Some Findings: 1. Review of resident #310's medical record revealed she was admitted to the facility on [DATE] with diagnoses of osteomyelitis of vertebra, sacral and sacrococcygeal region, Methicillin Resistant Staphylococcus Aureus (MRSA) infection, fracture of coccyx, pressure ulcer of sacral region stage 4 and anxiety. Review of resident #310's care plan with a focus of infection of the bone, osteomyelitis to sacrum with MRSA was initiated on 1/17/23. Interventions included, Administer antibiotic as per MD (physician) orders. Review of resident #310's medical record revealed the following physician's orders: On 1/16/23 - Piperacillin Sodium-Tazobactam Sodium (Zosyn) 3.375 grams (gm) IV every 8 hours (Q8H) for wound until 1/25/23. The order was discontinued on 1/17/23 at 11:27 AM and reentered the same day due at 10:00 PM and Q8H until 1/26/23. Review of the Medication Administration Record (MAR) for January 2023 revealed resident #310 did not receive the following doses of Piperacillin Sodium-Tazobactam Sodium 3.375 gm: 1/16 at 10 PM, 1/17 6 AM, 1/17 10 PM, 1/25 and 1/26 at 6 AM for a total of 5 doses. Review of a nursing progress note dated 1/17/23 read, new admission, awaiting from pharmacy, nurse will contact pharmacy to follow up. On 2/01/23 at 6:18 AM, during observation of medication administration, Licensed Practical Nurse (LPN) G showed the IV antibiotic bag and the label read, Zosyn 3.375 gm/50 milliliters (ml) Q8H until 1/26/23. LPN G looked for the order in the electronic record but stated she could not find it. She explained she had resident #310 assigned to her last week and she had administered the antibiotic in the morning. She stated it looked like the antibiotic was discontinued. LPN G looked in the MAR and stated resident did not receive it on 1/24 and 1/25 at 6 am. LPN G showed 4 bags of Zosyn with resident #310's name on each label in the fridge located in the medication room. She could not explain why the additional bags were in the fridge. On 2/01/23 at 6:42 AM, the Assistant Director of Nursing (ADON) stated the MAR showed Zosyn was not administered when resident #310 was admitted and it started on 1/17/23 at 10 PM. She indicated after that, 2 additional doses were not given, each at 6 AM on 1/25 and 1/26. She indicated she did not know why the doses were not administered as she could not find documentation with the details or notification to the physician about the missed doses. On 2/01/23 at 10:58 AM, the Director of Nursing (DON) explained a new resident must be admitted to the facility before pharmacy sent their medications. The DON stated the facility had an automated medication dispensing machine which contained the most used IV medications such as Vancomycin, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 13 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0694 Level of Harm - Minimal harm or potential for actual harm Rocephin and Zosyn. She indicated nurses had access to the automated medication dispensing machine. The DON said this looks like omission of medication. I looked in the progress notes and could not find any notes explaining why the antibiotic was not given on 1/25 and 1/26. She explained she expected the nurses to contact the pharmacy when they encountered issues with medications, and to notify the physician and document it in the resident's medical record. Residents Affected - Some 2. Resident #17 was admitted to the facility 1/05/2023 with diagnoses of pneumonia, urinary tract infection (UTI), cellulitis, and acute kidney failure. Review of resident #17's medical record revealed the Minimum Data Set (MDS) admission assessment with Assessment Reference Date (ARD) 1/11/2023 showed the resident was cognitively intact with a Brief Interview for Mental Status (BIMS) score of 15 out of 15. The assessment showed the resident did not reject care and had no behaviors. On 2/02/2023 at 11:20 AM, the Advanced Practice Registered Nurse (APRN) B stated she wrote an order on 1/25/2023 for insertion of a peripherally inserted central catheter (PICC) line and for Intravenous (IV) administration of Amikacin Sulfate injection 1 gram (GM) IV solution daily to be started for resident #17 for UTI. She explained she expected the IV antibiotic to be started within 24 hours after writing the order. Review of the medical record showed the PICC line was inserted on 1/27/2023 at 12:30 PM, 2 days after the order was written. Review of the Medication Administration audit report showed the IV antibiotic, Amikacin was first administered on 1/27/2023 at 12:53 PM, 2 days after the order was received. On 2/02/2023 at 12:44 PM, the Assistant Director of Nursing (ADON) explained APRN B was at the facility on 1/25/2023, reviewed the lab results for resident #17, ordered PICC line insertion, and the resident received the first IV antibiotic dose on 1/28/2023. She acknowledged treatment was delayed and said there were no progress notes or physician notifications about the delay. On 1/31/2023 at 11:17 AM, Licensed Practical Nurse (LPN) C checked the medication refrigerator and found a bag of IV Amikacin labeled for resident #17 with a dispensed date of 1/25/2023 that was not administered. On 02/01/2023 at 10:49 AM, the Director of Nursing (DON) acknowledged the PICC line was inserted late. She said the expectation for nurses was to notify the physician when medication orders were not administered. She confirmed the resident's treatment was delayed and he missed a dose of his IV antibiotic. On 2/01/2023 at 8:17 AM, resident #17 stated he was supposed to receive 6 doses of IV antibiotics, and he only received 5 because an evening dose was missed. The resident recalled the nurse that inserted the PICC line explained to him 6 doses were ordered to be administered 2 times a day. He was visibly upset and said the morning of 1/31/2023 he told the ADON that a dose was missed but she wasn't concerned and removed the PICC line access. On 2/01/2023 at 9:11 AM, the ADON said she removed resident #17's PICC line on 1/31/2023 after she confirmed with LPN C the last dose had been administered. She explained the facility's standing process was for PICC line removal after the last IV dose. The ADON stated when she removed resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 14 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0694 #17's PICC line the resident did not mention any concerns about a missed dose. Level of Harm - Minimal harm or potential for actual harm Resident #17's Order Audit Report showed the ADON created an order from APRN B on 2/01/2023 at 9:28 AM with a back dated order of 1/31/2023 at 9:27 AM that read, DC (discontinue) IV after last dose of ABT (antibiotic) today. Residents Affected - Some On 2/02/2023 at 12:44 PM, the ADON remembered resident #17 was concerned and told her he missed a dose when she removed the PICC but she was not able to view previous administrations to confirm the missed dose. She said physician orders were required to discontinue a PICC line and she entered the order on 2/01/2023 because on 1/31/2023 the APRN had not entered it before leaving for an emergency. The ADON stated she could not recall the name of the APRN who gave her the verbal order. On 2/02/2023 at 11:20 AM, APRN B said she expected to be notified whenever there was a delay in treatment. She stated her expectation was for nurses to notify the physician when a dose was missed. She explained a delay in treatment could have led to sepsis. APRN B stated she did not give the ADON an order on 1/31/2023 to remove resident #17's PICC line. ARNP B was concerned the ADON had entered an order from her because she had not worked on 1/31/2023. On 2/02/2023 at 5:45 PM, the Regional Director of Clinical Services stated the facility did not have an IV medication administration policy and procedure aside from general medication administration. The facility's policies and procedures read, Notification of Change in Condition Document Name N-105, revision date 12/16/2020, read, Policy: The Center the Patient/Resident, the attending physician, and the Resident Representative when there is a change in the status or condition. PROCEDURE The nurse to notify the attending physician and Resident Representative when there is a(n): Need to alter treatment significantly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 15 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure physician orders for oxygen therapy included the flow rate for administration for 1 of 1 resident reviewed for oxygen (O2) therapy of a total sample of 53 residents, (#56). Residents Affected - Few Findings: Clinical record review revealed resident #56 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of cirrhosis of the liver, end stage renal disease, chronic respiratory failure with hypoxia, and shortness of breath. Review of the resident's physician order noted an order dated 8/22/22 for O2 continuous every shift for shortness of breath. A flow rate was not included in the order. The resident's quarterly Minimum Data Set (MDS) assessment with Assessment Reference Date of 12/01/22 indicated the resident's cognition was intact with a Brief Interview of Mental Status score of 15/15. The assessment noted the resident used oxygen. On 1/30/23 at 11:16 AM, resident #56 was lying in bed with his eyes closed. Oxygen via nasal cannula (N/C) was infusing at 3 liters per minute (LPM). On 2/01/23 at 9:43 AM, resident #56 was sitting up in bed watching television. Oxygen via N/C was infusing at 2.5 LPM. The resident stated he used O2 continuously, and the flow rate should be 2 LPM. He stated the flow rate was adjusted by the nurse, and he did not adjust the flow rate. On 2/01/23 at 9:59 AM, [NAME] 1 Unit Manager (UM) stated resident #56 was on continuous O2 therapy. She reviewed the resident's physician's order for O2, and stated a flow rate was not indicated. On 2/01/23 at 10:49 AM, the Director of Nursing (DON) stated the UM and nurses should review physician orders daily, and If orders needed clarification, the nurse or UM should call the physician for clarification of orders. The DON stated O2 therapy required a physician's order and should include the flow rate. The resident's physician orders were reviewed with the DON and she confirmed a flow rate for administration of the O2 was not included. The resident's care plan for altered respiratory status/difficulty breathing related to sleep apnea initiated on 9/12/22 with revision on 9/24/22 included, O2 via nasal cannula as ordered. The policy Oxygen Therapy with effective date of 11/30/2014, and revision date of 8/28/2017 procedure noted Physician's order for oxygen therapy shall include Administration modality . liter flow rate. Continuous or PRN (as needed) and directed staff to review the physician's order, and to start the O2 flow rate at the prescribed liter flow. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 16 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 ensure sufficient nursing staff on the 7 AM to 3 PM shift to provide timely medication administration per professional standards for 14 of 56 residents on [NAME] 1 Unit, (#1,#2, #10,#14, #31, #35, #48, #49, #54, #56, #58, #96, #210, #211). Findings: Cross Reference F755 On 1/30/23 at 11:10 AM, Licensed Practical Nurse (LPN) D stated her assignment was usually from room [ROOM NUMBER] to 110, but currently was from 100 to 116 due to staffing shortage. LPN D stated [NAME] 1 Unit usually was staffed with three nurses, but now it was only two nurses. She stated staffing was based on census and verbalized that [NAME] 1 Unit was a subacute unit, and it was busy. LPN D verbalized she was behind with her 9 AM medications, and currently had four residents left to administer medications. She stated six rooms with ten residents in her assignment were on droplet precautions. She explained some of the rooms did not have Personal Protective Equipment (PPE) readily available at their doors, due to the facility running out of the overdoor PPE kits. She verbalized that a room close to the nurses station had additional PPE, and she retrieved PPE from there which took additional time. On 1/30/23, the census on [NAME] 1 unit was 56, and there were two nurses. On 1/30/23 at 11:43 AM, LPN D stated she was now giving her last 9 AM medication. On 2/01/23 at 10:00 AM, LPN D stated she had rooms 100 to 116, and had more residents to give their 9 AM medications. On 2/01/23 at 11:36 AM, LPN D stated she was still giving 9 AM medications and had five residents left to give their 9 AM medications. She stated she asked the Unit Manager (UM), and Assistant Director of Nursing (ADON) for help but did not get any help. She stated, this was not a new situation. On 2/01/23 at 11:39 AM, [NAME] 1 Licensed Practical Nurse (LPN) UM was seated at the nurses' station along with the ADON. The UM stated medications should be administered one hour before and one hour after the scheduled time, and if nurses were running behind, they should ask for help, notify the physician, and should document a note pertaining to the communication with the physician. The UM stated she was not aware that LPN D was still giving 9 AM medications, since she did not ask for help. The UM stated staffing was done based on census, and nurses were allowed to have up to forty residents in their assignment. She verbalized that if she saw the need for additional staff, she would speak with the staffing coordinator. The UM stated she would talk with LPN D, and see if she still needed help with medication administration and call the physician regarding medications being administered outside of scheduled times. On 2/02/23 at 9:27 AM, LPN D stated her assignment was from room [ROOM NUMBER] to 110, and the unit was staffed with three nurses. The LPN stated when there were two nurses on the unit, and her assignment included up to room [ROOM NUMBER] it was overwhelming and she was not able to give the care she would want to give to her residents. She stated her assignment included long-term and short-term care residents, and it was so much better with three nurses. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 17 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 On 2/02/23 at 1:18 PM, the Regional Director of Clinical Services (RDCS) stated staffing was based on census and acuity. She explained that staffing needs were reviewed by the Administrator, the DON and the Staffing Coordinator, and the expectation was that they would review the census and acuity and would decide on the level of staffing required for the unit. The RDCS stated that due to the number of residents on the unit on droplet isolation precaution, that condition would create higher acuity. She verbalized it would be time consuming for the nurse due to donning/doffing of PPE and the additional evaluation required for those residents. The RDCS said the expectation if nurses were late with medication administration, was for them to notify their immediate supervisor, and ask for help. They should notify the physician, and obtain additional orders as required and document the discussion with the provider. She said this was important specifically if the next scheduled dose of a medication was due. Nurses should notify the provider for directive to hold the medication or give the scheduled medication at a later time. The Regional Clinical Nurse stated she reviewed the Medication Admin Audit Report for LPN D and verbalized that 9 AM medications were administered outside of parameters for 14 residents in her assignment. Clinical record review of the affected residents were reviewed with the RDCS who acknowledged no documentation could be identified to indicate the physician was notified of the late administration of medications. On 2/02/23 at 5:00 PM, the Administrator stated staffing was based on census, and they also looked at acuity, which changed frequently. Staffing would have to be changed based on what was going on with residents. The Administrator stated she relied on clinical leadership to know the acuity of residents in the facility and staffing should be based on acuity and census. The Administrator stated LPN D told her on 1/30/23 that she was behind on medications and she informed the [NAME] 1 UM that the LPN was struggling to complete her medications on time, and needed some assistance. The Administrator said she did not follow up with the UM to see if the situation was addressed. She said normally [NAME] 1 would be staffed with three to four nurses, but one Registered Nurse (RN) was out, and probably that could be a part of the issue. The facility assessment reviewed on 12/22/2022 indicated that staff assignments was based on census and acuity, and nursing management evaluates the resident population, acuity, and facility layout to determine the number of staff needed to provide care and services to the residents, and staffing would be adjusted as necessary to meet the needs of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 18 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 ensure scheduled medications were administered as ordered, according to accepted professional standards during the 7 AM to 3 PM shifts, on 1 of 2 units for 14 of 56 residents on [NAME] 1 unit, (#1, #2, #10, #14, #31, #35, #48, #49, #54, #56, #58, #96, #210, #211). Findings: On 1/30/23 at 11:10 AM, Licensed Practical Nurse (LPN) D was observed at her medication cart. She verbalized she was behind with her 9 AM medications, and currently had four residents to give their 9 AM medications. On 1/30/23 at 11:43 AM, LPN D stated she was now giving her last 9 AM medication. On 2/01/23 at 10:00 AM, LPN D stated she had rooms 100 to 116, and had more residents to give their 9 AM medications. On 2/01/23 at 11:36 AM, LPN D stated she was still giving 9 AM medications and had five residents left to give their 9 AM medications. She stated she asked the Unit Manager (UM), and Assistant Director of Nursing (ADON) for help but did not get any help. She stated, this was not a new situation. On 2/01/23 at 11:39 AM, [NAME] 1 Licensed Practical Nurse (LPN) UM was seated at the nurses' station along with the ADON. The UM stated medications should be administered one hour before and one hour after the scheduled time, and if nurses were running behind, they should ask for help, notify the physician, and should document a note pertaining to the communication with the physician in the resident's medical record. The UM stated she was not aware that LPN D was still giving 9 AM medications. Review of the Medication Admin Audit Reports for the day shift on 1/30/23, and 2/01/23 revealed the following: 1. Resident #1 received her scheduled 9 AM medications between 10:47 AM and 10:48 AM on 1/30/23, and at 11:06 AM on 2/01/23 including Metoprolol 50 milligram (mg), Lisinopril 2.5 mg for high blood pressure, Furosemide 40 mg for chronic heart disease, Xarelto 15 mg a blood thinner, and Gabapentin 300 mg for neuropathy. 2. Resident #2 received her scheduled 9 AM medications at 10:56 AM on 1/30/23, and between 12:01 PM and 12:05 PM on 2/01/23 including Amlodipine 5 mg for high blood pressure, Trileptal 600 mg twice daily (BID) for seizures, Clonazepam 0.5 mg BID for generalized epilepsy, Lexapro 5 mg for depression, and Plavix 75 mg for clot prevention. 3. Resident #10 received his scheduled 9 AM medications at 11:07 AM on 1/30/23, and at 12:42 PM on 2/01/23 including Furosemide 20 mg, Aldactone 25 mg for fluid retention, Glipizide 5 mg for diabetes, and Allopurinol 100 mg for elevated uric acid. 4. Resident #14 received her scheduled 9 AM medications between 11:13 AM and 11:16 AM on 1/30/23, and between 10:45 AM and 10:47 AM on 2/01/23 including Furosemide 40 mg for edema, Aripiprazole 5 mg (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 19 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 for schizophrenia, Venlafaxine 75 mg for depression, Carvedilol 6.25 mg BID, Lisinopril 10 mg, Isosorbide Mononitrate 30 mg for high blood pressure, and Buspirone 10 mg for anxiety. 5. Resident #31 received her scheduled 9 AM medications at 10:42 AM on 1/30/23 and between 10:56 AM and 10:58 AM on 2/01/23 including Naproxen 220 mg every 12 hours for acute pain, Jardiance 25 mg for diabetes, Losartan Potassium 50 mg for high blood pressure, Paroxetine 40 mg for depression, and Gabapentin 300 mg BID for neuropathy. 6. Resident #35 received his scheduled 9 AM medications at 11:34 AM on 2/01/23 including Metoprolol 25 mg for high blood pressure, Sertraline 25 mg for depression, Lidocaine 5% every 12 hours, Metformin 500 mg TID for diabetes. 7. Resident #48 received his scheduled 9 AM medications at 11:33 AM on 1/30/23, and between 11:21 AM and 11:22 AM on 2/01/23 including Potassium Chloride 20 milliequivalents (MEQ) BID for low potassium, Losartan 25 mg for high blood pressure, Buspirone 5 mg BID for anxiety, and Furosemide 40 mg BID for edema. 8. Resident #49 received her scheduled 9 AM medications at 11:36 AM on 1/30/23, and between 11:07 AM and 11:08 AM on 2/01/23 including Buspirone 15 mg three times a day (TID) for anxiety, and Duloxetine 60 mg for depression. Her scheduled 1 PM Buspirone was administered at 12:07 PM, on 2/01/23 one hour after the first dose was given. 9. Resident #54 received her scheduled 9 AM medications at 10:25 AM on 2/01/23 including Norvasc 10 milligram (mg), Losartan Potassium 100 mg for high blood pressure, Plavix 75 mg for blood clot prevention, and Citalopram 20 mg for depression. 10. Resident #56 received his scheduled 9 AM medications at 11:04 AM on 1/30/23, and at 12:45 PM on 2/01/23 including Brilinta 90 mg BID a blood thinner, Fosrenol 1000 mg TID, for end stage renal disease, Sevelamer Carbonate 800 mg TID for diabetic nephropathy, Midodrine 5 mg for low blood pressure, Coreg 3.125 mg BID for high blood pressure. His scheduled 1 PM Fosrenol 1000 mg TID, Sevelamer Carbonate 800 mg TID, and Midodrine 5 mg was documented as given at 12:23 PM on 1/30/23 approximately 1 hour after the first dose was given. They were administered between 12:45 PM and 12:48 PM on 2/01/23 indicating both doses of the medications were administered at the same time. 11. Resident #58 received his scheduled 9 AM medications at 10:40 AM on 2/01/23 including Tramadol 50 mg BID for pain. 12. Resident #96 received his scheduled 9 AM medications between 11:23 AM and 11:24 on 1/30/23, and between 11:16 AM and 11:19 AM on 2/01/23 including Potassium Chloride 10 milliequivalents (MEQ) for low potassium, Metoprolol 25 mg, and Lisinopril-Hydrochlorothiazide 20-12.5 mg for high blood pressure. 13. Resident #210 received his scheduled 9 AM medications at 11:35 AM on 2/01/23 including Midodrine 10 mg for low blood pressure, Furosemide 20 mg for edema. His 1 PM dose of Midodrine was administered at 12:06 PM, thirty-one minutes after the first dose was administered. 14. Resident #211 received his scheduled 9 AM medications between 12:24 PM and 12:26 PM on 2/01/23 including Duloxetine 60 mg BID for depression, Potassium Chloride 10 MEQ for low potassium, and Baclofen 10 mg BID for muscle pain. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 20 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 On 2/02/23 at 1:18 PM, the Regional Director of Clinical Services (RDCS) stated the expectation if nurses were out of time frame for medication administration was for the nurses to notify their immediate supervisor, and ask for help. She said nurses should notify the physician, and obtain additional orders as required and document the discussion with the provider in the resident's clinical record. The RDCS said this was important specifically if the next scheduled dose of a medication was due. She verbalized that nurses should notify the provider for directive to hold the medication or give the scheduled medication later. The RDCS stated she reviewed the Medication Admin Audit Report for the residents in LPN D's assignment for 1/30/23 and 2/01/23 and verbalized the 9 AM medications were administered outside of medication administration time parameters for 14 residents in the LPN's assignment. Clinical record review of the affected residents were reviewed with the RDCS and she acknowledged no documentation could be identified to indicate the physician was notified of the late administration of medications. The policy Medication Administration Times with effective date of 12/01/07 and revision date of 1/01/22 read, Facility should commence medication administration within sixty (60) minutes before the designated times of administration and should be completed by sixty (60) minutes after the designated times of administration. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 21 of 22 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 105530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Manor Healthcare and Rehabilitation Center 1550 Jess Parrish CT Titusville, FL 32796 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, and interview, the facility failed to ensure medications were inaccessible to non-authorized staff and residents for 1 of 3 medication carts on the [NAME] I unit. Findings: During a tour of the [NAME] I unit on 2/01/23 at 5:05 AM, an unlocked medication cart was observed in the hallway between rooms [ROOM NUMBERS]. The unlocked drawers of the medication cart were easily accessible and contained the medications for the residents in the front hall of [NAME] I. There was an insulin pen, a blood sugar meter, and scissors on top of the medication cart. Two residents were observed walking past the unlocked medication cart and no staff were observed in the hall. On 2/01/23 at 5:08 AM, Registered Nurse (RN) E said, I had an emergency, one (resident) fell trying to go to the bathroom. She stated she should have locked her medication cart when stepping away to avoid unauthorized access to the medications. RN E said, I know I should have done that. On 2/01/23 at 10:58 AM, the Director of Nursing (DON) stated the nurse should have ensured the medication cart was locked and residents walking by had no access to it and were safe. The DON indicated use of the medication cart lock was important to prevent unauthorized access to the medications. She noted anyone passing by could have accessed all medications except the narcotics. She stated even during an emergency, locking the medication cart was required. Review of the facility policy and procedure titled, 5.3 Storage of and Expiration Dating of Medications, Biologicals revised on 7/21/22, read, Facility should ensure that all medications and biologicals, including treatment items, are securely stored in a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105530 If continuation sheet Page 22 of 22