Health inspection·September 14, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some minutes later at 9:28 a.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms were residents were dining for breakfast. e. The call light for resident room [ROOM NUMBER] was observed on at 10:48 a.m. and answered four minutes later at 10:52 a.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms. f. The call light for resident room [ROOM NUMBER] was observed on at 10:57 a.m. and was answered three minutes later at 11:00 a.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms. g. The call light for resident room [ROOM NUMBER] was observed on at 11:02 a.m. and was answered two minutes later at 11:04 a.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms. h. The call light for resident room [ROOM NUMBER] was observed on at 11:12 a.m. and was answered seven minutes later at 11:19 a.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms. i. The call light for resident room [ROOM NUMBER] was observed on at 11:14 a.m. and answered three minutes later at 11:17 a.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms. j. The call light for resident room [ROOM NUMBER] was observed on at 11:42 a.m. and was answered four minutes later at 11:46 a.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms. k. The call light for resident room [ROOM NUMBER] was observed on at 12:08 p.m. and was answered four minutes later at 12:12 p.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms were residents were dining for lunch. l. The call light for resident room [ROOM NUMBER] was observed on at 12:12 p.m. and was answered fourteen minutes later at 12:26 p.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms were residents were dining for lunch. m. The call light for resident room [ROOM NUMBER] was observed on at 12:30 p.m. and was answered seven minutes later at 12:37 p.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms were residents were dining for lunch. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 2 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 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 0550 Observations were made on 9/13/2023 revealed: Level of Harm - Minimal harm or potential for actual harm n. The call light for resident room [ROOM NUMBER] was observed on at 7:10 a.m. and was answered eight minutes later at 7:18 a.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms were residents were dining for breakfast. Residents Affected - Some o. The call light for resident room [ROOM NUMBER] was observed on at 8:02 a.m. and was answered four minutes later at 8:06 a.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms were residents were dining for breakfast. p. The call light for resident room [ROOM NUMBER] was observed on at 8:06 a.m. and was answered nine minutes later at 8:15 a.m. It was noted that the loud high pitch constant noise from the enunciator could be overheard throughout all three halls, most of the resident rooms on the unit, as well as both of the dining/activity rooms were residents were dining for breakfast. The above dates and times of the call light observations were just documented times observed. However, it was noted that throughout the day and night the call lights were activated frequently by the residents. Over thirty of the same observations were made during the 11:00 p.m. - 7:00 a.m. and 7:00 a.m. - 3:00 p.m. shifts for dates 9/11/2023 and 9/14/2023 as well. During various tours of the facility from 9/11/2023 - 9/14/2023, random residents who were interviewable, included residents in rooms [ROOM NUMBER] confirmed they could hear the loud buzzing noise all the time throughout the day and night. None had ever spoken to staff related to the noise, but they did find the noise was very uncomfortable to listen to. Over three other random residents, who wished to remain anonymous, revealed the call light noise was very loud and always on. They too found the noise was very uncomfortable and would like for it to go away. An interview was conducted on 9/13/2023 at 11:00 a.m. with the Maintenance Director and his assistant Staff H. The Maintenance Director and Staff H confirmed that there were three different call light systems on each of the units. - A unit - Call light system only lights up the over the room door lights, there is no enunciator in the hall or in the nurse station. - B unit - Call light system does light up the over the room door lights, as well as an enunciator near the unit station nurse desk. The enunciator beeps one time, then quiet for several seconds, beeps again with several seconds of quiet time in between beeps. The nurses station did have a call light panel on the wall and also lit up which room had the call light on. - D unit - Call light system lit up the over the room door lights, as well as an enunciator on the ceiling directly above the main hallways near the nurses station. When the call light from a room was pressed, the light over the door lit up, the light on the call light panel on the wall at the nurse station lit up the room number, and a very loud ear piercing constant alarm sounds in the hallways. The Maintenance Director and the assistant said they did not think of the loud noise before and did not know if the volume could be lowered. They were trying to get bids for a new call system so all (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 3 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some three units could be on the same system. The Maintenance Director could not explain why unit A did not have enunciator noise when call lights were on, as opposed to unit D with a very loud constant ear piercing noise. On 9/14/2024 at 11:30 a.m. an interview was conducted with the Nursing Home Administrator (NHA), and the Director of Nursing (DON). Both the NHA and DON were aware of the three units (A, B, and D) all having different call light systems. The [NAME] and DON confirmed all three units did have the appropriate light system with lights above the room door, which indicated when a resident activated the room call light. They both also confirmed only the B and D units have enunciators as an additional option for staff to recognize when a call light was on. The NHA explained the facility had recognized this issue and they were in plans of getting a new system and had been talking about this issue since approximately 5/2023 and 7/2023. The NHA revealed she was not sure she had to have the enunciator along with the actual light for the system, and had been thinking she might be able to just cut the noise from the enunciator on B and D units. However, she was not sure if she could do that. She did confirm the A unit had been operating for quite some time with just the light system and with no enunciator. The NHA and DON confirmed the very loud high pitch noise emitting from the enunciators on the D wing would be something they needed to look into now, rather than awaiting for the newly anticipated call light system. 2. On 9/11/2023 at 9:01 a.m. an observation from the hallway outside Resident #33's room, revealed the room door was wide open and both residents were in the room, lying in bed. As seen from the hallway, Resident #33 was observed lying in her bed, over the bed linen and was observed disrobed, and only wearing an adult brief. The room divider curtain was open. She continued to lay in this position until 9:15 a.m. at which time, an interview was conducted with Staff D Restorative Aide. Prior to the interview with Staff D, there had been several residents and other staff who walked by the room, and where Resident #33 could be seen disrobed. Staff D revealed she was not assigned to any of the residents on this hallway and was assisting with answering call lights and picking up breakfast meal trays from resident rooms. She said she knew the resident was not interviewable and needed extensive assistance from staff with her Activities of Daily Living (ADL), to include dressing. She confirmed Resident #33 was lying in bed disrobed and only wearing an adult brief. She said any staff member who walked by and saw residents unclothed were to assist with privacy and dignity by either closing the door, pulling the privacy curtain closed, and/or assisting the resident with dressing. While interviewing Staff D, it was observed that Resident #33 resides in the window bed and the window blinds/shade was all the way open. Looking out the large window, there was a courtyard where employees sit and frequent. There was two employees seated on chairs about ten feet just outside Resident #33's window. The employees could see in the room if they looked towards the room. A review of Resident #33's medical record revealed she was admitted to the facility on [DATE]. Review of the diagnoses sheet revealed diagnoses to include but not limited to: Dementia, Depression, Weakness, and Cognitive communication deficit. A review of the current quarterly Minimum Data Set (MDS) assessment, dated 7/30/2023 revealed: Cognition/Brief Interview Mental Score or BIMS score - Not scored but checked as Short Term/Long Term memory problems and with Moderately Impaired decision making skills; ADL - DRESSING = Extensive assistance with one person assistance. A review of the nurse progress notes dated from 7/1/2023 through to current date 9/13/2023 did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 4 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some indicate any documentation to support the resident disrobes on her own. Further, there were no care plan problem areas that support the resident had behaviors of disrobing on her own. On 9/14/2023 at 8:00 a.m., during an interview with Staff A, Unit Manager for Unit D, Registered Nurse, she said as the unit manager she ensured, by way of touring and walking the floor, care needs were met. Staff A confirmed staff should not have residents lay in bed disrobed and who could be seen from the hallway. She said if a resident is disrobed, it was expected that staff maintain dignity and privacy by either shutting the door, pulling the privacy curtain, and/or assisting the resident to dress. On 9/14/2023 at 11:40 a.m., an interview with the Nursing Home Administrator (NHA) and the Director of Nursing (DON) both confirmed staff should assist immediately with residents who were disrobed and could be seen from the hallway. They said dignity/privacy should be maintained and all staff were routinely trained and inserviced in this area. The NHA confirmed it did not matter if the staff walking by the room had the resident on their assignment or not, they were to assist to ensure privacy/dignity. 3. On 9/11/2023 9:16 a.m., from the hallway, Resident #136's room door was observed all the way open. There were over six staff in this hallway either speaking with each other next to the meal tray cart, or going in and out of other rooms to pick up meal trays. During this observation, Resident #136 was observed seated upright in his bed. He was observed disrobed and only wearing an adult brief. There were no clothes at or near him, nor were there any clothes on the floor surrounding the bed. The resident resided at the door bed, so he was easily seen from the hallway. There were no staff observed to stop and go in the room to assist him with privacy. This observation went on for fifteen minutes until Staff D came to the room. She confirmed she was just picking up trays and was not assigned to the resident or other residents in the unit. She confirmed Resident #136 should not have been in bed disrobed and he should have been assisted with privacy by either pulling the door or privacy curtain closed. A review of Resident #136's medical record revealed he was resident was admitted to the facility on [DATE]. Review of the diagnosis sheet revealed diagnoses include: Pressure induced deep tissue damage of let heel, Pressure induced deep tissue of right heel, Dementia, Depression, DMII, Paraplegia. A review of the current Significant Change MDS assessment, dated 8/2/2023, revealed: Cog/BIMS score 5 of 15; ADL - BED MOBILITY = Ext. Assist with Two person, TRANSFER = Ext. Assist with Two person, DRESSING = Extensive Assistance with Two person assistance, TOILETING = Total dependent on staff. On 9/14/2023 at 1:00 p.m., an interview with Staff A revealed she as a manager, as well as the floor nurses made rounds throughout the shift to ensure residents were safe, cared for, and provided with dignity and privacy. She said all staff were responsible to ensure residents had privacy while in their rooms and if anyone saw residents unclothed, they were to either assist with dressing them or get a staff member that could, close the door if applicable, and/or pull the privacy curtain until the resident was dressed. On 9/14/2023 the Nursing Home Administrator provided the Dignity Policy and Procedure with review date 1/2023, for review. The Policy Statement revealed; Each resident shall be cared for in a manner that promotes and enhances quality of life, dignity, respect and individuality. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 5 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 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 0550 The Policy Interpretation and Implementation section revealed the following but not limited areas; Level of Harm - Minimal harm or potential for actual harm (1.) Residents shall be treated with dignity and respect at all times. Residents Affected - Some (2.) Treatment with dignity means the resident will be assisted in maintaining and enhancing his or her self-esteem and self-worth. (3.) Staff shall promote, maintain and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures. On 9/14/2023 the Nursing Home Administrator provided the Call Light System Policy and Procedure, with not review date, for review. The Policy Statement revealed; The Life Safety Code designates specific requirements to provide a reasonably safe environment for residents, patients and staff during fires and other similar emergencies in both new construction and existing buildings. It is Solaris HealthCare's policy to follow these Life Safety Codes as they are written. The Call Light System Maintenance section of the policy revealed the following but not limited to: (1.) Check all devices transmitting to, and received from nurse call system, to include pull cords, pendants and pagers. On 9/14/2023 the Nursing Home Administrator provided the Answering the Call Light policy and procedure with a last review date of 1/25/2023, for review. The Purpose of the policy revealed; The purpose of this procedure is to respond to the resident's requests and need. The General Guidelines of the policy revealed the following but not limited to areas: (1.) Report all defective call lights to the nurse supervisor immediately. (2.) Answer the resident's call as soon as possible. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 6 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 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 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, and interview, the facility failed to assess one (Resident #95) of forty-three sampled residents for the ability to self-administer medications. Residents Affected - Few Findings included: On 9/11/23 at 10:32 a.m., an observation was made of a medication cup with medications in it and a medication cup containing applesauce sitting on the dresser of Resident #95. The resident was attending to personal hygiene and/or toileting in the restroom. She returned to the room, opened the top drawer of the dresser and a tube of topical pain relief cream was observed in it. She stated on 9/11/23 at 10:45 a.m., the nurse brought them (the medication) while she was in the restroom and the medication needed to be taken. The resident confirmed 5 tablets were in the cup. A review of the progress notes, observations, and physician orders, showed Resident #95 had not been assessed and did not have an order to self-administer medications. During an interview on 9/14/23 at 9:45 a.m., the Director of Nursing (DON) stated residents must have a physician order allowing the self-administration of medications. Staff M, Assistant Director of Nursing/Registered Nurse (ADON/RN) stated a resident was assessed for self-administration of medications every 3 months and/or as needed. The staff member reviewed Resident #95's clinical record (progress notes and facility observations) and confirmed the resident had not been assessed for self-administration of medications. A review of Resident #95's Face Sheet showed admission dates of 6/26/22 and 2/24/23 with diagnoses included but not limited to hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, Type 2 diabetes mellitus with foot ulcer, and unspecified chronic obstructive pulmonary disease. The facility provided a policy for Self-Administration of Medications, revised on January 2018. The policy revealed that In order to maintain the residents' high level of independence, residents who desire to self-administer medications are permitted to do so if the facility's interdisciplinary team has determined that the practice would be safe for the resident and other residents of the facility and there is a Prescriber's order to self-administer. If the resident desires to a self-administer medications, and assessment is conducted by the inter disciplinary team of the residents cognitive can including orientation to time physical and visual ability to carry out this responsibility during the care planning process. For those residents who self-administer this interdisciplinary team verifies the resident's ability to self-administer medications by means of a skill assessment conducted on a quarterly basis or when there is a significant change in condition. The results of the interdisciplinary team assessment of resident skills and of the determination regarding bedside storage are recorded in the residence medical record on the care plan for each medication authorized for self-administration, the label contains a notation that it may be self-administered. When the interdisciplinary team determines that at bedside or in room storage of medications would be a safety risk to other residents wrong well, the medications of residents permitted to self-administer are stored in the central medication cart or medication room. The resident requests each dose from the medication nurse, who provides the medication to the resident in the unopened package for the resident to self-administer. (Photographic Evidence Obtained) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 7 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 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 0756 Level of Harm - Minimal harm or potential for actual harm Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on observation, record review, and interview, the facility failed to accurately follow up on a pharmacy recommendation for one (Resident #85) of five residents sampled for unnecessary medications. Residents Affected - Few Findings included: On 9/12/23 at 8:44 a.m., Resident #85 was observed lying in bed and did not verbally or visually respond to verbal stimuli. A review of the 8/1/23 a Consultant Pharmacist's recommendation for Resident #85 showed the resident had been routinely ordered Pepcid-FAMOTIDINE TAB 20 milligram (MG) every bedtime (QHS) since 5/2021 for Gastroesophageal Reflux Disease (GERD). The section for the Prescriber's response and comment showed a checkmark for other and the comment was order not found, wrong patient. The recommendation was neither signed and dated by the prescriber or the nurse receiving the response. A review of Resident #85's physician order report, dated 8/1 - 9/14/23, showed an open-ended order that started on 5/12/21 for Pepcid (Famotidine) tablet 20 mg oral for the diagnosis of Gastro-esophageal Reflux Disease without esophagitis, scheduled at 9:00 p.m. at bedtime. The August Medication Administration Record (MAR) and September MAR showed the resident had been administered Pepcid (Famotidine) daily at 9:00 p.m. on 8/1 through 9/13/23. An interview was conducted with the Director of Nursing (DON) and the Registered Nurse/Unit Manager (RN/UM). The DON explained the pharmacy recommendation process was that she received the recommendations from the Consultant Pharmacist and then the recommendations were given to the Unit Managers. The RN/UM said the recommendations were given to the doctors unless it was a nursing issue then nursing would follow up on the recommendation. The RN/UM reviewed Resident #85's physician orders and confirmed the resident did receive Pepcid and it had been ordered 5/12/21. The RN/UM and DON confirmed the resident continued to receive Pepcid. The DON and the RN/UM reviewed the recommendation and the DON stated the follow up on the recommendation was unfortunate, regarding that the resident was receiving Pepcid at the time of the recommendation and that it was not signed or dated by the person who reviewed it. The DON stated that the recommendations go back to the Unit Managers who should be following up to make sure the recommendations were correct. On 9/14/23 at 10:26 a.m., an interview was conducted with the Consultant Pharmacist. The consultant reviewed Resident #85's recommendation and stated the expectation was for the recommendation to be addressed within 30 days, signed and dated by the prescriber, and uploaded into the electronic clinical record. He said the recommendation would have been addressed at the end of the month when destroying narcotics with the Director of Nursing. The policy - Documentation and Communication of Consultant Pharmacist Recommendations, revised January 2018 revealed The consultant pharmacist works with the facility to establish a system whereby the consultant pharmacist observations and recommendations regarding residents' medication therapies are communicated to those with authority and/or responsibility to implement the recommendations, and are responded to in an appropriate timely fashion. Comments and recommendations concerning medication therapy are communicated in a timely fashion. The timing of these recommendations should enable a response prior to the next medication regimen review. Recommendations are acted upon and documented (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 8 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 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 0756 Level of Harm - Minimal harm or potential for actual harm by the facility staff and or the Prescriber if the Prescriber does not respond to recommendations directed to him her within 30 days the director of nursing and or the consultant pharmacist may contact the medical director. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 9 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the medication error rate was less than 5.00%. Twenty-six medication administration opportunities were observed, and four errors were identified for four (Residents #356, #456, #97, and #95) of seven residents observed. These errors constituted a 15.38% medication error rate. Residents Affected - Few Findings included: 1. On 9/13/23 at 8:49 a.m., an observation of medication administration with Staff N, Licensed Practical Nurse (LPN), was conducted with Resident #356. Staff N was observed dispensing the following medications: - Topiramate 50 milligram (mg) tablet - Vitamin D 25 microgram (mcg) (1000 international unit) over-the-counter tablet - Duloxetine 30 mg capsule - Furosemide 40 mg tablet - Lidocaine topical patch 4% - Potassium Chloride 20 milliequivalent's (meq) Extended Release (ER) capsule - Carbidopa/Levodopa 25/100 mg tablet - Artificial Tears eye drops - Acetaminophen 325 mg 2 tablets Staff N confirmed the number of tablets, the patch, and the eye drops. Staff N applied gloves and administered one drop of Artificial Tears to the right eye then the left eye. Staff N applied the topical Lidocaine patch to the lower back and after multiple redirections was able to administer oral medications to the resident. A review of Resident #356's Medication Administration Record (MAR) on 9/14/23 showed the resident was to be administered 150 mg's of Topiramate every 12 hours. The blister package of the residents' Topiramate showed it contained 50 mg tablets of Topiramate which would require the resident to be administered 3 tablets to equal the ordered 150 mgs. The policy - Medication Administration General Guidelines, revised January 2018, revealed Medications are administered as prescribed in accordance with good nursing principles and practices and only by persons legally authorized to do so personnel authorized to administer medications do so only after they have been properly orientated to the facilities medication distribution system (procurement, storage, handling, and administration). The procedure instructed staff in the Five (5) Rights (of medication administration): Right resident right drug right dose right route and right time are applied for each medication being administered a triple check of these 5 rights is recommended at three (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 10 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few steps in the process of preparation of a medication for administration: (1) when the medication is selected, (2) when the dose is removed from the container and finally (3) just after the dose is prepared and the medication put away. Prior to administration of any medication, the medication and dosage schedule on the resident's medication administration record (MAR) are compared with the medication label. The administration instructions identified that Medications are administered in accordance with written orders of the Prescriber. 2. On 9/13/23 at 12:01 p.m., an observation of medication administration with Staff O, Licensed Practical Nurse (LPN), was conducted with Resident #456. Staff O obtained a blood glucose level of 123 from the resident. The staff member applied a needle to a Humalog [insulin pen], dialed the dosage selector to one (1) unit, re-entered the resident's room, and injected one unit from the [insulin pen] into the right upper extremity of the resident. Staff O did not prime the insulin pen. 3. On 9/13/23 at 12:36 p.m., an observation of medication administration with Staff P, Licensed Practical Nurse (LPN), was conducted with Resident #97. Staff P stated a blood glucose level of 301 had previously been obtained for the resident. The staff member reviewed the memory of both available glucometers and one read 201 and the other read 336, which the staff member revealed was the level of another resident not #97. The staff member removed a Novolin R insulin pen from the cart, applied a needle, turned the dosage selector to 2 units and with the needle pointing to the floor the staff member pressed the selector to it reached zero (0). Staff P dialed the pen to 4 units and injected the insulin into the residents left upper extremity. 4. On 9/13/23 at 12:48 p.m., Staff P, Licensed Practical Nurse (LPN), said a blood glucose level of 336 was previously obtained from Resident #95. The staff member removed the residents' Insulin Lispro insulin pen from the medication cart, applied a needle, dialed the dosage selector to 2 units, and while the needle was pointed toward the floor, the staff member depressed the selector till it reached 0 (zero). Staff P dialed the dosage selector to 4 units, entered the residents' room, and injected the insulin into the right lower quadrant of the abdomen. An interview was conducted with Staff P on 9/13/23 at 12:51 p.m. Staff P reported remembering from nursing school about priming the insulin pens to get rid of air. Staff P reported she honestly didn't know where the bubble (air) would be if the needle was pointed toward the floor. During an interview on 9/14/23 at 10:03 a.m., with the Director of Nursing (DON) and Staff M, Assistant Director of Nursing (ADON), the observed medication errors were discussed. The DON stated that all insulin pens should be primed but did not identify if the needle should be in the up or down position. The DON confirmed if the needle (of the pen) was held downwards the air bubble would be at the top of the cartridge. The facility provided the instructions for the use of Humalog (insulin lispro) [insulin pen]. The instructions revealed that the staff were to Prime before each injection and identified the reasons for priming was a means removing the air from the Needle and Cartridge that may collect during normal use and ensures that the Pen is working correctly and warned If you do not prime before each injection, you may get too much or too little insulin. A continued review of these instructions identified the following: - Step 6: To prime your pen, turn the dose knob to select 2 units. - Step 7: Hold your pen with the needle pointing up. Tap the cartridge holder gently to collect air (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 11 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 bubbles at the top. Level of Harm - Minimal harm or potential for actual harm - Step 8: Continue holding your pen with needle pointing up. Push the dose selector in until it stops, and 0 is seen in the dose window. Hold the dose knob in and count to 5 seconds slowly. You should see insulin at the tip of the needle. If you do not see an insulin, repeat priming step 6 to 8 no more than 4 times. If you still do not see insulin, change the needle, and repeat priming step 6 to 8. Small air bubbles are normal and will not affect your dose. Residents Affected - Few The manufacturer instructions for the Novolin R FlexPen, reviewed at https://www.novo-pi.com/novolinr.pdf, instructed the following: Giving the air shot before each injection. Before each injection small amounts of air may collect in the cartridge during normal use. To avoid injecting air and to make sure you take the right dose of insulin: - E. Turn the dose selector to select 2 units. - F. Hold your Novolin R FlexPen with the needle pointing up. Tap the cartridge gently with your finger a few times to make any air bubbles collect at the top of the cartridge. - G. Keep the needle pointing upwards, press the push-button all the way in. The dose selector returns to 0 (zero). A drop of insulin should appear at the needle tip. If not, change the needle and repeat the procedure no more than 6 times. If you do not see a drop of insulin after 6 times, do not use the Novolin® R FlexPen® and contact Novo Nordisk at [PHONE NUMBER]. A small air bubble may remain at the needle tip, but it will not be injected. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 12 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to 1. have personal protective equipment (PPE) immediately available for staff use to protect residents who were on enhanced barrier precautions for one (Residents #407) of two residents reviewed and 2. failed to ensure staff cleaned their multi-use mask after each use for one (Resident #127) of two residents reviewed. Residents Affected - Few Findings included: 1. A review of Resident #407's face sheet revealed he was admitted to the facility on [DATE] from an acute care hospital. Review of his medical diagnoses included but were not limited to sepsis, non-pressure chronic ulcer of the right foot, right toe, left foot, and left second toe. A review of Resident #407's physician orders revealed an order to start on 9/7/2023 without an end date for enhanced barrier precautions related to left groin surgical incision site and bilateral lower extremity ulcers for every shift, days, evenings, and nights. An observation was made on 9/11/23 at 8:29 a.m. of Staff Q, CNA in Resident #407's room removing a blood pressure cuff from the resident's arm. The resident was observed to be in bed talking with Staff Q, Certified Nursing Assistant (CNA). On 9/11/23 at 8:29 a.m., Staff Q, CNA washed her hands with soap and water and stepped out of the room with the vital sign machine. Outside of Resident #407's room was a sign which showed STOP Enhanced Barrier Precautions everyone must: clean their hands, including before entering and when leaving the room. Providers and staff must also: wear gloves and a gown for the following High-Contact Resident Care Activities. dressing, bathing/showering transferring, changing linens, providing hygiene, changing briefs or assisting with toileting, device care or use: central line, urinary catheter, feeding tube, tracheostomy wound care: any skin opening requiring a dressing. It was also observed there was no PPE immediately outside of the resident's room. On 9/11/23 at 8:33 a.m., Staff Q, CNA reviewed the enhanced barrier sign and said I believe I was supposed to put on PPE when I took his vitals, but I will have to check. She looked in a plastic container located in an alcove next to the resident's room and said, I think the PPE are supposed to be in here, but I'll have to check with my DON (Director of Nursing). On 9/11/23 at 8:37 a.m., Staff Q, CNA filled the container in the alcove with reusable yellow gowns. Removed one gown and stated, where are the gloves? Staff Q, CNA walked down the hall, found a box of gloves hanging on the wall, and removed 2 gloves from the box. She donned the reusable gown and gloves and entered another resident's room. (Picture Evidence Obtained) An interview was conducted on 9/14/23 at 11:17 a.m. with the Infection Preventionist. She said with enhanced barrier precaution she expected the staff to gown up during high contact with a resident who had a Foley, g-tube, intravenous line, or a wound. She said taking vitals on the resident was not high contact for the residents. she also stated I tell my staff when you are going to be rubbing up against the resident, you are in all these other resident rooms, and you don't want your clothes touching and rubbing against the resident, enhanced barrier precautions are to protect the resident. The Infection Preventionist said the facility was not in short supply of PPE. The only PPE the staff were reusing were face shields and the facility was not in store supply of face shields. She also said because the staff were going into the resident's room about 20 times a day the staff were reusing their face shields and that was something they started when COVID-19 first hit because they were going through so many. She stated her expectation was for staff to come out of the room, spray their face shields with the alcohol spray, and place them in their name labeled brown bag. She also stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 13 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few PPE for enhanced barrier precautions were located in the linen cart and also in the clean utility room. The staff could use the blue disposable gowns or the yellow reusable gowns. 2. On 9/12/2023 at 7:35 a.m., Staff K, Certified Nursing Assistant (CNA) and Staff L Licensed Practical Nurse (CNA) were observed at Resident #127's door standing in front of a Personal Protective Equipment (PPE) table. Resident #127's door had hanging PPE with signage that indicated the room was on Isolation Precautions. An earlier interview with Staff L revealed that Resident #127 was COVID positive and the room was on full isolation precautions. Staff K and L were both observed to don PPE prior to going in the room. Staff K was observed to sanitize hands, then placed a N95 mask respirator over her surgical mask, which was already on prior to walking up to the room. Staff K then took out gloves and gloved her hands. Staff K took a face shield out from the door PPE hanger and then placed it on the over the bed table, next to the room door. She then pulled out a pre packaged blue plastic gown and donned it. She donned the face shield and then knocked on the door and went into the resident's room. Staff L did not go in the room. On 9/12/2023 at 7:42 a.m., Staff K walked out of the room after she performed Activities of Daily Living (ADL) care/assistance with the resident #127. Staff K then doffed her PPE and placed her face shield in a brown paper bag. She did not use the alcohol spray, which was placed on the over table next to the room door. Staff K sanitized her hands and walked over to the nurse and conversed with her. She then went down the hallway, removed her surgical mask, and grabbed another surgical mask from a hanging box of surgical masks near the unit station. Staff K then discarded her used mask in the trash bin at the nurse station. On 9/12/2023 at 7:46 a.m., while Staff K was observed passing breakfast trays on another hall, she was asked about room Resident #127 and what the expectations were prior to entering her room. Staff K indicated that the room has signage on the door that indicated isolation precautions, Staff L had already explained to her prior to coming on shift that the resident in the room had COVID, and what the PPE expectations were. Staff K was asked when she left the room what were the expectations of PPE removal. She revealed that she removed the N95, gown and gloves prior to leaving the room. She then said she took the plastic face shield off and then placed it in a brown paper bag with her name on it and then placed the bag on the table next to the door, which is out in the hallway. She was asked if she did anything with the face shield prior to bagging it and she denied. She was asked if she knew what the plastic spray bottle was that was on the table next to the brown paper bagged face shields. She said she could not remember and she did not use it for anything. Photographic evidence was taken. On 9/12/2023 at 8:36 a.m., Staff B, Certified Nursing Assistant was observed to walk up to Resident #127's room door and was approached by three other staff who spoke to her about what PPE to wear prior to going in. She then grabbed a new face shield from the door PPE hanger. She placed the face shield on the table next to the door and then grabbed a prepackaged blue gown and donned the gown. She then gloved and then put on a 95 mask over her surgical mask. Staff B then donned the face shield and then knocked on the door and went inside. On 9/12/2023 at 8:50 a.m., Staff B walked out of the resident's room and had already doffed her gown, N95 and gloves. She removed her face shield and placed it in the brown paper bag, which was on the table beside the door. Staff B did not use the alcohol spray bottle to spray the face shield prior to bagging it. Staff B at 8:52 a.m. confirmed she had exited the room and placed her face shield in her named paper bag, but did not spray it with the alcohol spray prior. She was not sure if she had to or not. The table outside Resident #127's room had various brown paper bags with staff names on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 14 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few them, as well as a bottle of alcohol spray and a note that revealed, please take a brown paper bag to store your face shield in after cleaning with alcohol. Thanks, Infection Preventionist. Photographic evidence was taken. On 7/13/2023 at 8:30 a.m., an interview was conducted with the Infection Preventionist. She revealed they had sufficient PPE supplies to include face shields but they had just stuck to the same practice as when COVID first started. She revealed that in the COVID + rooms, there were dedicated staff that worked in them each shift and therefore, the staff would reuse the face shields. After use, they would use the alcohol spray and spray down the plastic face shield (both sides), and store it in a brown paper bag, which was positioned outside the room door, in the hallway. She said the paper bags were labeled with the staff member's name. The Infection Preventionist was informed that during several observations during the 11:00 p.m.-7:00 a.m. shift and the 7:00 p.m.-3:00 p.m. shifts, some staff were observed to take off their face shield, place it in the brown paper bag, and did not spray it with the alcohol spray. She said she said the spray bottle was stored on the table in the hallway, right next to the isolation room, and on the same table as where all the bagged face shields were. Review of the facility's policy titled Implementation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs) with an effective date of 8/16/2022 revealed, Implementation when implementing Contact Precautions or Enhanced Barrier Precautions, it is critical to ensure that staff have awareness of the facility's expectations about hand hygiene and gown/glove use, initial and refresher training, and access to appropriate supplies. To accomplish this: .Make PPE, including gowns and gloves, available immediately outside of the resident room. Review of The National Institute for Occupational Safety and Health (NIOSH) Strategies for Conserving the Supply of Eye Protection revised on May 9,2023 revealed, Conventional Capacity Strategies Use eye protection according to product labeling and local, state, and federal requirements In healthcare settings, eye protection is used by healthcare personnel (HCP) to protect their eyes from exposure to splashes, sprays, splatter, and respiratory secretions. Single use eye protection should be removed and discarded. Reusable eye protection should be cleaned and disinfected after each patient encounter. .Crisis Capacity Strategies .Re-use disposable (single use) eye protection It may be possible to re-use disposable (or single use) eye protection during severe shortages. However, it is possible that the integrity of the single use eye protection may be degraded after multiple uses or following contact with cleaners or disinfectants. If implementing reuse, disposable eye protection should be dedicated to one HCP and appropriate cleaning and disinfection should be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 15 of 16 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 105544 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Bayonet Point 7210 Beacon Woods Dr Hudson, FL 34667 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 performed after each use and if it becomes visibly soiled or difficult to see through during use. Eye protection should be discarded if damaged (e.g., face shield or goggles can no longer fasten securely to the provider, if visibility is obscured and cleaning and disinfecting does not restore visibility) . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105544 If continuation sheet Page 16 of 16