Health inspection·April 21, 2021

F 0641 Level of Harm - Minimal harm or potential for actual harm Information indicated discharge assessment-return anticipated. This indicated resident #157 would be returning to the facility. Review of the Monthly Census Recap for March 2021 revealed resident #157 was discharged from the facility to another Skilled Nursing Facility (SNF). Residents Affected - Few On 4/21/21 at 5:24 PM, MDS Coordinator B said, The information in question F which had been coded 11-return anticipated was assessed incorrectly and should have been coded 10 return not anticipated. She was unable to explain why it was coded incorrectly as the staff who completed the assessment had retired. Review of the medical record revealed a physician's order dated 3/17/21 for resident #157 to be discharged to another SNF on 3/18/21. A Social Services progress note dated 3/17/21 at 3:01 PM read, Per family and resident request, resident is being discharged on 3/18/21 to a SNF. The note indicated the facility arranged transportation to the new SNF for resident #157. A nursing' progress note dated 3/18/21 at 1:10 PM revealed resident #157 was discharged earlier that morning at 10:50 AM via stretcher to another SNF. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 2 of 6 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 105564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lotus Nursing and Rehabilitation Center 7950 Lake Underhill Road Orlando, FL 32822 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 provide nail care for 1 of 5 dependent residents reviewed for activities of daily living (ADL) of a total sample of 64 residents (#131). Residents Affected - Few Findings: Resident #131 was initially admitted to the facility on [DATE] then readmitted on [DATE]. His diagnoses included Dementia, Diabetes Mellitus Type 2, Schizophrenia, and Epilepsy. The quarterly Minimum Data Set (MDS) assessment with assessment reference date of 03/31/21 revealed resident #131 had severely impaired cognition, and was totally dependent on 1 staff person for personal hygiene and bathing. On 04/18/21 at 3:40 PM, resident #131 was in bed, alert and watching television. His fingers nails to both hands were approximately 3/4 centimeters (cm) long with hardened, yellowish debris underneath. His main language was Spanish but he was able to answer minimal English questions. His right hand was able to move freely without limitation. His left hand was contracted. On 04/19/21 at 10:19 AM, resident #131 was observed in bed, alert and watching television. The resident's fingernails remained the same, long with yellowish debris under the nails. The resident was noted to scratch the right side of his face with his nails. On 04/20/21 at 10:00 AM, the resident's fingernails remained the same. At this time the resident lifted his left arm with his right hand to move position. His right hand fingernails pressed into his left lateral forearm deep enough to leave marks. On 04/21/21 at 9:20 AM, resident #131 opened his left hand using his right hand. There was redness measuring 2 cm x 3 cm on his palm near the thumb area from the long fingernails. On 04/21/21 at 11:20 AM, Certified Nursing Assistant (CNA) D said the resident was totally dependent on 2 staff for most of his ADLs. She said he had a gastrostomy tube (GT) for feeding but was provided pleasure foods during meals which he was able to eat with his right hand. She said she provided bed baths for the resident and during bathing, she inspected his skin from head to toe, and cleaned his nails. She noted that Activity Staff usually did nail care for the residents. She indicated the resident sometimes refused care but complied when attempted at a later time. On 04/21/21 at 11:53 AM, Licensed Practical Nurse (LPN) C acknowledged the resident's finger nails were long and dirty. She said they needed to be cut and cleaned. She stated she had not noticed his nails when she administered medications and added that CNAs had not reported that his nails needed to be trimmed. She indicated that CNAs were responsible to clean and cut the nails but with this particular resident, she had to cut them herself. Care plan initially created on 01/28/2019 revealed that resident #131 had an ADL self-care performance deficit related to Dementia, Diabetes Mellitus, Schizophrenia, and Anxiety. Interventions for bathing/showering: check nail length and trim and smooth rough edges, and clean on bath day and as necessary. Report any changes to the nurse. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 3 of 6 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 105564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lotus Nursing and Rehabilitation Center 7950 Lake Underhill Road Orlando, FL 32822 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 Policy and procedures for Care of Nails dated 11/30/2014, revised 09/01/2017 stated that Procedure .trim fingernails .clean nails. 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: 105564 If continuation sheet Page 4 of 6 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 105564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lotus Nursing and Rehabilitation Center 7950 Lake Underhill Road Orlando, FL 32822 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 obtain physician orders for 1 of 3 residents reviewed for oxygen therapy out of a total sample of 64 residents, (#77). Residents Affected - Some Findings: Resident #77 was initially admitted to the facility on [DATE], then readmitted on [DATE]. His diagnoses included chronic obstructive pulmonary disease, cerebral infarction, hypertensive heart failure, and vascular dementia. Review of the resident's quarterly Minimum Date Set (MDS) assessment with assessment reference date of 3/2/2021 revealed resident #77 was cognitively impaired, required extensive assistance of 2 staff for activities of daily living (ADL), and used oxygen for respiratory treatment. On 4/19/21 at 10:33 AM, resident #77 was lying in bed. The resident was not interviewable. He had oxygen tubing with a nasal cannula attached to an oxygen concentrator. The regulator was set at 4.5 liters of oxygen per minute (LPM). On 4/19/21 at 10:44 AM, Licensed Practical Nurse (LPN )E acknowledged the regulator was set at 4.5 LPM. LPN E decreased the oxygen regulator down to 2 liters per minute. LPN E stated, someone has been messing with this, it should be on 2. She stated the resident did not touch the oxygen equipment as he could not get out of bed on his own. She stated that she checked it earlier and the flow was set at 2 LPM. She indicated that nurses had to make sure the concentrator was set to deliver the oxygen as per physician orders. On 4/19/21 at 10:50 AM, LPN E checked the physician orders for resident #77. She stated she could not find a physician order for resident #77's oxygen. On 4/19/21 at 10:55 AM, the East Unit Manager (UM) checked the physician orders. She acknowledged there were no current orders for oxygen for the resident. The UM stated the nurse should have obtained a physician order whenever a resident required oxygen therapy. She noted that a physician order is required to administer oxygen as it was a medication. On 4/21/21 at 7:30 PM, the Director of Nursing (DON) stated the nurses were expected to obtain orders for all medications administered, including oxygen. The DON had no explanation as to how, when or why the resident was placed on oxygen without a physician order. The DON added that nurses were expected to observe residents on oxygen and confirm orders. Review of the nursing and physician progress notes and from 8/1/2020 through 4/19/2021 showed a nurse's progress note dated 1/14/2021 at 11:44 PM which read that resident #77 had vomited and was congested. The note showed the resident was given a nebulizer treatment and was placed on oxygen on 2 liter per minute via nasal cannula. A review of the resident's medical record with the Unit Manager showed there was an order for oxygen at 2 LPM as needed for saturation less than 90 per cent (%) dated 5/16/2019. This order was discontinued on 7/27/2020 when resident #77 was discharged to the hospital. The UM stated that upon readmission to the facility on 7/31/2020, resident #77's oxygen orders did not get reordered. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 5 of 6 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 105564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lotus Nursing and Rehabilitation Center 7950 Lake Underhill Road Orlando, FL 32822 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm A review of physician orders summary report from 1/1/2021 through 4/18/2021 did not indicate any orders for oxygen therapy. Review of the Medication Administration Record from 1/1/2021 to 4/18/2021 revealed no orders for oxygen therapy. Review of the facility policy and procedure for Administration Medication revealed, Residents Affected - Some .2. Medications are administered in accordance with prescribed orders, Including any time frame. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 6 of 6