Inspection·December 10, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to accurately document administered medications on the Medication Administration Record (MAR) for 1 of 3 residents reviewed for medications, of total sample of 5 residents, (#1).Findings: Review of resident #1's medical record revealed he was admitted to the facility on [DATE] and readmitted on [DATE] from an acute care hospital. His diagnoses included pneumonia, resistance to multiple antimicrobial drugs, Escheria coli infection, quadriplegia, and dementia. Review of resident #1's physician orders revealed an order dated 11/30/25 for Cefiderocol 2 grams intravenously every 8 hours for the treatment of pneumonia, through 12/08/25. Review of resident #1's MAR for December 2025 revealed blank entries for Cefiderocol doses scheduled on 12/03/25 at 2:00 PM and 12/08/25 at 6:00 AM. The MAR also reflected an X for the scheduled dose on 12/01/25 at 2:00 PM; however, there was no documentation in the medical record indicating the reason the medication was not administered or evidence the physician was notified. On 12/10/25 at 5:49 PM, Regional Nurse Consultant (RNC) B stated the antibiotic was present in the facility on 12/01/25. RNC B indicated there were no progress notes or documentation in the medical record explaining why the medication was not administered on the above-mentioned dates and times. She stated the facility was attempting to contact the nurses assigned to resident #1 on those dates. On 12/11/25 at 1:12 PM, the Administrator (NHA) along with the Unit Manager (UM), RNC C, and Licensed Practical (LPN) D participated in a follow up call regarding the missing documentation for Cefiderocol. RNC C stated the medication was not administered only once, on 12/01/25 at 2:00 PM, because it was delivered to the facility at 3:20 PM. RNC C stated LPN D was assigned to resident #1 on 12/01/25 and reportedly contacted the physician to report the missed dose; however, LPN D stated he was very busy that day and forgot to document the notification. LPN D acknowledged this information during the call. RNC C further stated a similar issue occurred on 12/03/25 when Registered Nurse E forgot to document the administration on the MAR after it was given. RNC C stated the nurse who administered the medication on 12/08/25 also failed to document the administration on the MAR. When asked whether resident #1's medical record accurately reflected the administration of medications in December, neither the NHA nor RNC C provided a response. RNC C stated she collected written statements from the nurses who reported they forgot to document their actions in resident #1's medical record. Review of the facility's policy and procedure titled Medication Administration dated 9/18 read, The individual who administers the medication dose, records the administration on the resident's MAR immediately following the medication being given. In no case should the individual who administered the medications report off-duty without first recording the administration of any medications. Event ID: Facility ID: 105539 If continuation sheet Page 2 of 4 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 105539 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Healthcare and Rehab of Sanford 950 Mellonville Ave Sanford, FL 32771 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility failed to develop and implement a comprehensive system to monitor antibiotic use, failed to effectively document and maintain infection surveillance during a Coronavirus disease 2019 (COVID-19) outbreak, and failed to ensure appropriate infection control practices were implemented to prevent the spread of infection in 2 of 2 units. Findings: Review of an Infection Control Assessment and Response Report (ICAR) conducted on 10/20/25 by the Florida Department of Health (DOH) revealed the visit was initiated due to a COVID-19 outbreak affecting residents and staff. The ICAR included recommendations related to transmission-based precautions (TBP) and environmental services (EVS), including limited access to hand sanitizer pumps and the requirement to use Environmental Protection Agency (EPA)-approved disinfectants for Candida auris in appropriate rooms. The ICAR further identified frontline staff had not received adequate training on which isolation precautions required the use of Viresept disinfectant versus Virex disinfectant, resulting in incorrect disinfectant being used in rooms under TBP. Review of the facility's Infection Prevention and Control Program policy and procedure effective October 2021 revealed the program was intended to address the detection, prevention, and control of infections and communicable diseases among residents, visitors, and staff. The documented goals included monitoring the occurrence of infections and identifying and correcting problems related to infection control and prevention practices. The major activities of the program included surveillance of infections and communicable diseases, antibiotic stewardship, and the implementation of infection control and prevention measures. During an interview on 12/10/25 at 10:14 AM, housekeeper F demonstrated uncertainty regarding cleaning chemicals and infection control practices. She showed a bottle labeled Oxivir Five 16 Concentrate and stated the contents were actually Virex, explaining she had filled the bottle with Virex. She then showed a bottle labeled TrueKleen U-power Heavy Duty and stated it was probably window cleaner but was not sure. During the interview, the Housekeeping Director stopped by at 10:23 AM and informed Housekeeper F the TrueKleen bottle was a degreaser. Housekeeper F stated she did not participate in staff meetings or in-services and had not received education regarding TBP or signage posted on resident room doors. She indicated that while personal protective equipment (PPE) was sometimes available, there were occasions when PPE was not present, and she was told to just put a mask on. She stated no one explained the expectations to her and staff assumed she already knew. When asked about the frequency of deep cleaning in resident rooms, she presented a deep cleaning schedule dated December 2023 from a binder on her cart and stated she was not aware of any recent deep cleaning being conducted. On 12/10/25 at 11:15 AM, the Wing One Unit Manager (UM) stated she did not attend Quality Assurance and Performance Improvement (QAPI) meetings. The UM shared the Infection Preventionist (IP) was previously the Assistant Director of Nursing; however, that induvial left the facility and the Director of Nursing (DON) assumed the IP role. The UM stated she currently assisted the DON with IP functions including ensuring residents on TBP had appropriate signage and PPE. She indicated she began assisting with antibiotic stewardship for Wing One in December 2025. The UM reported the facility experienced a COVID-19 outbreak in September 2025 affecting fewer than 10 residents and some staff, and facility wide testing was conducted. She stated she did not attend the DOH meeting in October and was unaware of any recommendations made. On 12/10/25 at 11:56 AM, the Administrator (NHA) confirmed DOH conducted a visit during the COVID-19 outbreak on 10/20/25 but stated he could not locate any documentation related to the visit. He stated he was unaware of any deficiencies or corrective actions identified by DOH. The NHA indicated the DON and nursing staff met with DOH, but he did not attend the meeting. He stated the DON was out of the facility this week and attempts to contact her were unsuccessful. He indicated the UM Residents Affected - Many (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105539 If continuation sheet Page 3 of 4 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 105539 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Healthcare and Rehab of Sanford 950 Mellonville Ave Sanford, FL 32771 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete searched the Infection Control (IC) binder but did not locate documentation related to the DOH visit. During a joint interview with the UM and the NHA on 12/10/25 at 1:29 PM, the UM presented the IC binder containing data collected by the IP through 2025. The NHA stated a review conducted on 11/21/25 revealed the IC binder lacked infection surveillance reports and antibiotic stewardship documentation for the months of August, September, and October 2025. The UM reviewed the binder and was unable to locate COVID-19 testing results from the recent outbreak with the exception of documentation dated 10/06/25. The UM stated once deficiencies were identified, the DON completed the November 2025 report retrospectively, however, no data was available for August, September or October. The NHA then presented a QAPI containing forms dated 11/21/25. Review of the documentation revealed a Problem Statement indicating the facility failed to follow proper Infection Control and Prevention processes including monthly monitoring, tracking, and trending of infections resulting in an increase in facility acquired infections. The plan identified a goal for the IP to ensure staff followed proper infection control practices. The Root Cause Analysis identified a knowledge deficit and lack of understanding of the IC program, with contributing factors including leadership changes and lack of staff accountability. The documentation lacked an estimated completion date or an actual completion date. When asked if the Performance Improvement Plan (PIP) had been presented to or approved by the QAPI committee, the NHA stated it had not yet been reviewed but was planned for discussion at the next QAPI meeting scheduled for 12/17/25. The NHA further stated no QAPI meeting was held in November 2025 and an ad hoc QAPI meeting was not convened to address the infection control deficiencies identified. There was no evidence of the ICAR, DOH recommendations, or follow up actions maintained in the IC binder. On 12/10/25 at 3:31 PM, the Housekeeping Director stated he began working in the facility during the last week of September 2025. He indicated he was responsible for overseeing the housekeeping and laundry staff and ensuring compliance with the facility policies and procedures. He reported housekeeping and laundry staff had not received formal infection control education from the facility, aside from the videos provided through their employer, and he was unsure of the frequency of that education. He stated when DOH visited in October 2025, they inquired about cleaning chemicals used in resident rooms. He confirmed the facility was using Virex 2-256 at that time and acknowledged there was confusion regarding the appropriate use of Virasept, which should only be used for Candida auris cases when identified. He stated he later learned Virasept should not be used for cleaning rooms of residents with COVID-19 and confirmed that practice was corrected. He validated housekeeper F should not have been using an Oxivir-labeled bottle containing a different chemical. Event ID: Facility ID: 105539 If continuation sheet Page 4 of 4