Health inspection·March 3, 2023

F 0550 being seated. Level of Harm - Minimal harm or potential for actual harm 3. Review of resident #115's Quarterly Minimum Data Set (MDS) assessment with assessment reference date (ARD) of 12/10/22 revealed he had a diagnosis of quadriplegia and was totally dependent on staff for eating. Residents Affected - Some On 3/01/23 at 1:29 PM, CNA D stood at resident #115's bedside as she assisted him with his lunch meal. When prompted regarding standing to feed the resident, CNA D said, I'm not going to lie. They told me we should be sitting. CNA D looked around the room and explained she chose to stand as there were no chairs in the room. On 3/02/23 at 3:29 PM, the [NAME] Wing Unit Manager (UM) stated her expectation was CNAs would find and use chairs of appropriate height to allow them to sit at residents' eye level while they assisted with meals. She stated on hire, nursing staff received education in orientation regarding properly assisting with residents' meals. The UM validated CNAs were to be seated while they assisted with meals to ensure residents were treated with dignity. 4. Review of resident #61's medical record revealed a Quarterly MDS assessment with ARD of 1/23/23 with a Brief Interview for Mental Status score was 15, which indicated she was cognitively intact. The MDS assessment showed resident #61 required extensive assistance from staff for toilet use and personal hygiene. On 2/27/23 at 10:30 AM, resident #61 complained that CNAs spoke on their cell phones while they cared for her. The resident pointed to her ears and explained CNAs used cell phones with earphones when they changed her brief and completed personal hygiene tasks. She stated CNAs also stood in her bathroom and continued to speak on their phones. On 3/01/23 at 5:22 PM, the Interim Director of Nursing (DON) stated after the facility was made aware of resident #61's concerns, she interviewed the resident and determined CNA S was the staff member who recently cared for the resident while on the phone. The Interim DON stated CNA S acknowledged she used her cell phone in resident #61's bathroom. 5. On 3/01/23 at 4:11 PM, CNA N was seated in the doorway of the [NAME] Wing Day Room as she spoke on a cell phone speakerphone. Both sides of the conversation were audible from the hallway, and when asked if she was on her personal cell phone, CNA N paused her conversation and said, Yes. She then said goodbye to the other party on the cell phone, hung up, and placed the device in her pocket. CNA N validated she was aware she should not use a personal cell phone while she worked. On 3/01/23 at 4:14 PM, the Interim [NAME] Wing UM confirmed CNA N's actions were not respectful of the residents in the Day Room, and did not reflect dignified treatment. She emphasized it was against the facility's policy for staff to use personal cell phones in patient care areas. On 3/02/23 at 3:29 PM, the [NAME] Wing UM explained the Day Room was used to monitor residents at risk for falls. She stated her expectation was the assigned CNA would not just sit by the door and talk on the phone while she watched the residents. The [NAME] Wing UM stated CNA N's duties included interacting with the residents in the Day Room by offering snacks, water, and juice, and helping them to participate in activities and games. She validated it was not acceptable for any staff member to use a personal cell phone anywhere on the unit during working hours, especially while performing personal care tasks, as it was not professional behavior and created a dignity issue for residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 2 of 47 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 03/03/2023 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Review of the facility's Information Handbook dated December 2021, revealed residents had .the right to be treated with consideration, respect, and full recognition of [their] dignity and individuality. Review of the facility's employee handbook dated December 2022 revealed requirements regarding Use of Personal Cellular Telephones and Electronic Devices. The policy indicated use of personal cellular devices during working hours, while on duty, was prohibited. The document read, Employees are permitted use of personal electronic devices while on their break or meal period as long as the equipment is used in designated outside areas of the care center. Event ID: Facility ID: 105564 If continuation sheet Page 3 of 47 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 03/03/2023 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 0554 Allow residents to self-administer drugs if determined clinically appropriate. 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 determine if self-administration of medication was clinically appropriate and safe for 1 of 8 residents reviewed for choices and resident rights, of a total sample of 66 residents, (#132). Residents Affected - Few Findings: Review of resident #132's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included Chronic Obstructive Pulmonary Disease (COPD), Anemia, Anxiety, and Mood Disorder. Review of the physician orders revealed resident #132 received two inhalation medications: Breo Ellipta Inhalation Aerosol Powder Breath Activated 200-225 micrograms per inhalation (mcg/INH), one puff every day, and Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) mcg per actuation, two puffs every four hours as needed. On 2/27/23 at 9:36 AM, resident #132 was in bed with cough drops, one Breo Ellipta inhaler, and one Albuterol Sulfate inhaler to the left of her pillow. When asked about the inhalers, the resident explained she had COPD and administered the inhaled medications herself. The assigned nurse, nurse GG, was asked to come to the resident's room and when she arrived at 10:10 AM, she observed the resident's inhalers on the bed and stated resident #132 did not self-administer medications. Approximately one to two minutes later, the Assistant Director of Nursing (DON) entered the room and nurse GG explained the situation. Both staff attempted to convince resident #132 to relinquish the inhalers, but the resident adamantly refused to hand them over. Resident #132 slid the inhalers underneath her pillow as she said, Don't take my inhalers. I need them. The ADON stated she would inform the DON, and nurse GG said she would check the physician orders. Medical record review revealed the resident had a Brief Interview for Mental Status score of 13/15 which indicated her cognition was intact. However, the medical record did not contain any evidence that resident #132 had been assessed by facility staff to verify she could self-administer medication safely. On 3/03/23 at 10:07 AM, the ADON stated although resident #132 initially refused to hand over the inhalers, the DON was able to retrieve the medications from her later that afternoon. The ADON added she reviewed resident #132's medical record and did not see a physician's order for the resident to self-administer medications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 4 of 47 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 03/03/2023 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to honor the right to refuse treatment related to a Do Not Resuscitate Order (DNRO), for 1 of 1 resident reviewed for advance directives, of a total sample of 66 residents, (#44). Findings: Review of the medical record revealed resident #44 was admitted to the facility on [DATE], and re-admitted on [DATE] after a hospital stay. His diagnoses included cerebrovascular disease, seizures, hypertension, Alzheimer's disease, and protein-calorie malnutrition. The Florida Agency for Health Care Administration 5000-3008 Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form dated [DATE] revealed resident #44's primary diagnosis in the hospital was septic shock. Septic shock is the final and most severe stage of sepsis, which is the body's extreme reaction to an infection. The inflammation throughout the body can cause dangerously low blood pressure and is life-threatening (retrieved on [DATE] from www.my.clevelandclinic.org). The transfer form indicated resident #44 was not alert and required a surrogate to make healthcare decisions. The Advance Care Planning section of the document read, DO NOT Resuscitate (DNR). The Minimum Data Set (MDS) Significant Change in Status assessment with assessment reference date of [DATE] revealed resident #44 had short-term and long-term memory problems, and severely impaired cognitive skills for daily decision making. The resident required extensive assistance for bed mobility and personal hygiene, and was totally dependent on staff for dressing, eating, and toilet use. The MDS assessment showed resident #44 had functional limitations in range of motion in one arm and both legs and required a wheelchair for mobility. He experienced shortness of breath with exertion and when lying flat. The document indicated resident #44 relied on a feeding tube inserted directly into his stomach for nutrition, and he had four unhealed pressure injuries of different stages. Review of the Order Summary Report dated [DATE] revealed a physician's order dated [DATE] that read, Prognosis: Poor. An active physician's order for Full Code status was entered on [DATE], the day after resident #44 was readmitted from the hospital. Full Code means all resuscitation procedures would be provided to keep someone alive if the person's heart stopped beating and/or he/she stopped breathing, Full resuscitation measures include Cardiopulmonary Resuscitation (CPR) with chest compressions, intubation or insertion of a breathing tube into the airway, and defibrillation, an electric shock to the heart (retrieved on [DATE] from www.webmd.com). Resident #44 had a care plan for advance directives initiated on [DATE] and revised on [DATE]. The document indicated the resident had a Certificate of Incapacity, a Health Care Proxy, and Full Code status. The goal read, Resident will have advanced directives followed. An intervention dated [DATE] directed staff to discuss advance directives with the resident and/or his representative. On [DATE] at 4:55 PM, in a telephone interview with resident #44's daughter, one of his emergency contacts, she clarified that her father should have a DNR code status. She explained during his last hospitalization in [DATE], the physicians spoke with her and her sisters about the severity of their (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 5 of 47 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 03/03/2023 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few father's condition. She stated based on the conversation, the family selected DNR status. The daughter explained if their father died naturally and peacefully at his advanced age, they wanted to prevent aggressive attempts to bring him back. She stated the DNR paperwork was supposed to be included in the hospital transfer documents when he returned to the facility in September. The daughter recalled a telephone call from the facility's Long Term Social Services Director (SSD) regarding her father's code status. She stated she informed him it was supposed to be DNR, and the Long Term SSD suggested she go to the hospital to retrieve the document. The daughter explained she had not yet been able to do so due to her work schedule. Review of the facility's policy and procedure for Advanced Directives revised on [DATE] revealed upon admission, the SSD or Business Development Coordinator would determine if the resident had an advance directive, and if one existed, either person would .obtain a copy and place it in the resident's medical record. The policy indicated advance directives would be reviewed quarterly and as needed, with a purpose of identifying and clarifying current instructions and determining if changes were desired. On [DATE] at 5:00 PM and 5:39 PM, the Long Term SSD stated he discussed resident #44's code status with the daughter but could not recall when. He reviewed the electronic medical record and confirmed there was no documentation regarding the discussion. The Long Term SSD denied knowledge of an existing DNRO and stated he did not tell the daughter to get the document from the hospital. He explained nurses were responsible for reviewing physician orders including advance directives on admission and readmission, and in addition, charts were reviewed in the daily interdisciplinary team clinical meeting. The Long Term SSD acknowledged if the hospital transfer form indicated resident #44 had DNR status but there was no attached DNRO form, the facility should have sought clarification from the family, attempted to obtain the form from the hospital, or initiated a new DNRO form in the facility. He explained the Social Services Department conducted quarterly reviews to update residents' code statuses; however, he stated he was recently hired and had only checked that all residents assigned to him had a code status selected, but he had not verified the information was accurate. On [DATE] at 5:14 PM, the Medical Records staff checked resident #44's paper chart and discovered a hospital Palliative Care Division Progress Note dated [DATE] that read, Goals of Care: Stabilization, no further aggressive invasive treatments. CODE STATUS: Full DNR. The Medical Records staff acknowledged the resident's code status was circled by an unknown person for emphasis, but there was no DNRO form in the chart. Review of the facility's admission Audit checklist revised on [DATE] revealed a chart audit should be conducted within 24 hours for each newly admitted or readmitted resident. This audit included review of the hospital transfer form, hospital discharge summary and history and physical, and advance directives status. On [DATE] at 5:41 PM, the Director of Nursing (DON) stated the charts of all new admissions were reviewed by staff from all departments to ensure pertinent data was complete. The DON said, It is the responsibility of Nursing and Social Services to ensure advance directive information is there and correct. The facility should have called the daughter for verification. She confirmed without the DNRO form, resident #44's code status defaulted to Full Code. On [DATE] at 2:34 PM, the Long Term SSD provided a Care Conference Record that showed meetings held on [DATE] and [DATE] to discuss resident #44's plan of care were attended only by facility staff. The form indicated the daughter who was designated Health Care Proxy did not respond to invitations (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 6 of 47 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 03/03/2023 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 0578 Level of Harm - Minimal harm or potential for actual harm but there was no documentation of attempts to involve the other daughters who were listed as emergency contacts. The Long Term SSD presented a DNRO form dated [DATE], signed by a physician, that showed verbal consent was obtained from the resident's daughter who was his Health Care Proxy. When asked how the facility obtained the DNRO form, the Long Term SSD explained the facility's Admissions staff contacted the hospital. He said, We got it this morning within about an hour. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 7 of 47 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 03/03/2023 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. 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 implement its policies and procedures to prohibit Abuse and Neglect for 1 of 1 resident reviewed for Abuse, of a total sample of 66 residents, (#61). Residents Affected - Few Findings: Resident #61's medical record revealed she was admitted to the facility on [DATE] with diagnoses including cerebrovascular disease, heart disease, depression, anxiety, and insomnia. The Quarterly Minimum Data Set (MDS) assessment with assessment reference date of 1/23/23 revealed resident #61 had a Brief Interview for Mental Status score of 15 which indicated she was cognitively intact. The document noted she had no mood or behavioral issues and did not reject care that was necessary to achieve the resident's goals for health and well-being. Resident #61 required limited assistance for bed mobility, and extensive assistance for transfers, dressing, and personal hygiene. The MDS assessment showed the resident had no impairments in functional range of motion of her extremities. On 2/27/23 at 10:30 AM, a large purple-brown discoloration was noted on resident #61's right arm. The area extended from above the elbow, to around the joint, and faded towards her forearm. Certified Nursing Assistant (CNA) AA stated she last worked with resident #61 three days ago, on Friday 2/24/23, and there might have been a small bruise on her right arm, but definitely not as large as it was today. CNA AA lifted the resident's sheet to expose the left elbow which had an extensive dark purple bruise around the elbow, which extended from her upper arm to her forearm. There was a dressing dated 2/26/23 on the resident's forearm. CNA AA said, The left arm bruise was not there on Friday. It must have happened over the weekend. I already told the nurse this morning. The resident grimaced and complained of pain as CNA AA repositioned her left arm to support it on a rolled towel. Resident #61 said, The CNAs are very rough when they do things with me. She explained the injury and bruising occurred when a CNA took her clothes off. Review of the facility's incident log for February 2023 revealed no documentation of an incident involving resident #61. Review of the resident's medical record revealed no progress note or change in condition form regarding her bruise or injury. The facility's policy and procedure for Resident Incident / Accident Reports revised on 8/24/17 revealed all incidents and/or accidents should be recorded and reviewed through the facility's Quality Assurance and Performance Improvement process. The procedure indicated an incident report was to be created to document on any happening not consistent with routine operations of the facility or care of a resident. The document directed nurses to conduct an assessment, notify the physician . of any noted or suspected injury. and notify the resident's representative. The policy revealed incidents should be included on the facility's 24-hour report and then reviewed by the Director of Nursing (DON), the interdisciplinary team, and the Administrator. The procedure specified, Certain accidents or incidents may require further investigation. On 2/27/23 at 3:21 PM, during a meeting with the Interim Director of Nursing (DON) and the Administrator, they were informed neither resident #61's report of rough treatment by a CNA nor the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 8 of 47 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 03/03/2023 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few significant bruising on both her arms was documented in the medical record or noted on the incident log. The DON stated her expectation was staff would report skin injuries immediately. The Administrator confirmed he was the facility's Risk Manager and was ultimately responsible for incident investigations and determining if Abuse or Neglect were substantiated. He confirmed he was not made aware of any concerns regarding resident #61. He validated staff should have completed an incident report, initiated an investigation, and notified him. The Administrator stated even if an incident occurred on the weekend, staff should start an investigation and collect statements that would be used in determining if it was necessary to file reports with the State agencies and law enforcement or take other appropriate actions. On 2/27/23 at 3:52 PM, the Interim DON stated she assessed resident #61's left arm and noted a skin tear and a puffy area below her elbow where a large amount of blood seemed to have pooled. On 2/28/23 at 9:44 AM, Registered Nurse (RN) R stated she was resident #61's regularly assigned day shift nurse on Tuesdays, Wednesdays, and Thursdays. She stated she was sure the resident did not have any bruises or discolorations on her arms on the past Thursday. RN R confirmed resident #61's skin had always been very fragile but she never had a geri-sleeve, a protective stocking sleeve, for her arms. She confirmed once made aware of bruises and skin tears, the nurse assigned to resident #61 should have completed change in condition and incident report forms, informed the physician, and done a thorough skin assessment. On 3/01/23 at 10:14 AM, the Short Term Social Services Director (SSD) stated she believed resident #61 reported injuries that resulted from a CNA handling her roughly during care. The Short Term SSD was informed although a weekend nurse applied a dressing to the skin tear, and the day shift CNA and nurse on Monday were aware of the resident's skin condition and report of rough treatment, no staff made a report to the Administrator, DON, or Social Services. She validated any nurse or CNA assigned to the resident should have reported the incident as it needed to be investigated to rule out possible Abuse or Neglect. The Short Term SSD acknowledged the nurse was not to decide if the situation rose to the level of Abuse or Neglect as his/her responsibility was to report the incident. She explained in this situation, after assessing resident #61, the nurse should have ensured the resident's safety by removing the staff member involved. The Short Term SSD said, Since this was not reported properly, the CNA was not removed from the assignment. On 3/01/23 at 5:22 PM, the Administrator and the Regional Director of Clinical Services (RDCS) confirmed the essential components of Abuse and Neglect prohibition were not implemented for resident #61. They stated the weekend nursing staff did not take the proper actions to identify an incident, start an investigation, report appropriately, and protect the resident. The RDCS acknowledged any allegation of rough treatment, whether it resulted in an injury or not, was serious and warranted a focused investigation. The Administrator confirmed the facility had not met the required federal reporting requirements as nursing staff failed to follow and implement the facility's policies and procedures. On 3/02/23 at 10:41 AM, the Medical Director stated resident #61's skin was very thin and fragile. He explained her skin could be bruised or torn during regular activities of daily living (ADL) care. The Medial Director acknowledged preventative skin protection measures such as geri-sleeves and staff taking precautions during care were important. He said, This is an opportunity for CNA education. The facility's policy and procedure for Abuse, Neglect, Exploitation & Misappropriation revised on 11/16/22 defined Abuse as any deliberate action, whether injury or harm was intended, that resulted (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 9 of 47 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 03/03/2023 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete in physical harm, pain, or mental anguish. Neglect was defined as the failure to provide goods and services necessary to avoid physical harm, pain, mental anguish or emotional distress. The policy included examples of Neglect such as failure to take precautionary measures to protect the health and safety of the resident. and failure to notify a resident's representative of an incident or injury. The policy directed staff to report observed or suspected abuse, neglect or misappropriation of resident property to the proper authorities. The procedure indicated the facility would ensure staff were trained on the timelines for reporting allegations of Abuse or Neglect, including injuries of unknown origin, to the Administrator and/or the DON and SSD. The document revealed all reported events including bruises and skin tears would be investigated by the DON and the information forwarded to facility's Administrator or Abuse Coordinator who would investigate allegations of Abuse and/or Neglect and compile a detailed report. The policy indicated employees would be suspended pending investigation and the resident would be evaluated for physical or psychosocial harm. Lastly, the Administrator was responsible for timely and appropriate reporting according to Federal and State regulations. Event ID: Facility ID: 105564 If continuation sheet Page 10 of 47 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 03/03/2023 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the accuracy of the Minimum Data Set (MDS) assessment for 1 of 1 resident reviewed for discharge from the facility, out of a total sample of 66 residents, (#160). Residents Affected - Few Findings: Review of resident #160's medical record revealed he was admitted to the facility on [DATE] with diagnoses of Cerebral Vascular Accident (CVA), Acute Subdural Hemorrhage, Seizures, Hypertension, and Major Depressive Disorder. Resident #160 had a physician's order to discharge home on 2/08/23 with Home Health Services, Home Health Aide, standard wheelchair, and Physical and Occupational Therapy. Review of a nursing progress note dated 2/09/22 at 10:20 AM indicated resident #160 was discharged home with his wife. The Short-Term Social Service Director's (SSD) progress note dated 2/14/23 at 8:30 AM documented resident #160's spouse had expressed that the resident was doing well at home. Review of the Discharge Return Not Anticipated MDS assessment dated [DATE] documented resident #as discharged to the hospital. On 3/01/23 at 5:45 PM, MDS Coordinator T explained the Discharge Return Not Anticipated MDS assessment dated [DATE] had been coded incorrectly. She validated resident #160 had been discharged home and not to the hospital. MDS Coordinator T said, The 2/09/23 MDS will need to be corrected. The facility's Minimum Data Set Policy, dated 09/25/2017 read . Procedure: . Each person completing a section or portion of a section of the MDS signs the Attestation Statement indicating its accuracy. A Registered Nurse signs and certifies that the assessment is complete. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 11 of 47 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 03/03/2023 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the Preadmission Screening and Record Review (PASARR) Level I was correct upon admission and corrected after admission for 2 of 3 residents reviewed for PASARR, out of a total sample of 66 residents, (#15 & #146). Findings: 1. Review of resident #15's medical record revealed she was admitted to the facility on [DATE] with diagnoses of Schizophrenia, Psychosis, and Major Depressive Disorder. The resident's physician orders included Trazodone 50 milligrams (mg) by mouth (PO), give 0.5 tablet daily for depression, and Ziprasidone 20 mg PO two times a day for psychosis. Review of resident #15's PASARR Level I form dated 7/23/22 documented no diagnosis of Serious Mental Illness (SMI) or Intellectual Disability (ID). 2. Review of resident #146's medical record revealed she was admitted to the facility on [DATE] with diagnoses of Schizoaffective Disorder, Major Depressive Disorder and Anxiety Disorder. The resident's physician orders included Trazodone 100 mg PO at bedtime for depressive disorder, Zoloft 50 mg PO daily for depression, and Buspirone 10 mg PO in the morning and at bedtime for anxiety. Review of resident #146's PASARR Level I form dated 12/12/22 documented no diagnosis of SMI or ID. PASARR is a Federal requirement to ensure individuals are evaluated for SMI and/or ID, placed in appropriate setting and provided services they need. Level I is a preliminary screen for SMI and/or ID and if positive, an in-depth evaluation, PASARR Level II, is completed (retrieved from www.medicaid.gov). On 3/01/23 at 4:45 PM, the Director of Clinical Services K explained the admission Coordinator was responsible for ensuring the PASARR Level I was completed and correct before admission to the facility. She explained if there was a diagnoses for SMI or ID then the Social Worker was responsible for a new, corrected PASARR Level I. The Director of Clinical Services K validated the PASARR Level I forms for residents #15's and #146 were incorrect. On 3/02/23 at 9:37 AM, an interview was conducted with the Admissions Coordinator/Marketing Administrator and admission Liaison. They explained PASARR Level I's were reviewed prior to admission to the facility. They explained the reviewed residents' diagnoses and the PASARR Level I forms, and acknowledged the forms needed to be correct, especially for psychiatric diagnoses such as schizophrenia. The Admissions staff said, If the PASARR Level I is incorrect we reach out to the hospital case manager to correct the PASARR Level I. The PASARR Level I has to be correct upon admission to the facility because if the resident has any diagnoses for SMI or ID, a PASARR Level II is initiated. On 3/02/23 at 10:15 AM, the Admissions Coordinator/Marketing Administrator and admission Liaison reviewed the diagnoses and PASARR Level I forms for residents #15 and #146. They both confirmed the residents' PASARR Level I forms were not correct and they should have had a PASARR Level II initiated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 12 of 47 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 03/03/2023 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 3/02/23 at 9:56 AM, the Long-term Social Service Director (SSD) and Short-term SSD stated it was the responsibility of the Admissions staff to review and determine if the PASSAR Level I was correct. If not, they were to contact the Case Manager at the hospital to ensure the PASARR Level I was corrected. They acknowledged the form could also be done by the facility. The SSDs explained they were not qualified to complete the PASARR Level I forms as neither one had the required degree, a Masters of Social Work (MSW). On 3/02/23 at 10:33 AM, the Regional Nurse Consultant confirmed the PASARR Level I forms for residents #15 and #146 were incorrect and needed to be corrected. Review of the facility's Preadmission Screening and Resident Review (PASARR) Policy, dated 11/08/2021 read, Policy: The center will assure that all Seriously Mentally Ill (SMI) and Intellectually Disabled (ID) residents receive appropriate pre-admission screenings according to Federal/State Guidelines. The purpose is to ensure that the residents with SMI or are ID receive the care and services they need in the most appropriate setting. Procedure: 1. It is the responsibility of the center to assess and assure that the appropriate preadmission screenings, either Level I or Level II, are conducted and results obtained prior to admission and placed in the appropriate section of the resident's medical record . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 13 of 47 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 03/03/2023 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to refer a resident with identified mental illness for a Level II Preadmission Screening and Resident Review (PASARR) evaluation and determination for 1 of 3 residents reviewed for PASARR, out of a total sample of 66 residents, (#38). Residents Affected - Few Findings: Review of the medical record revealed resident #38 was admitted to the facility on [DATE] with diagnoses including type 2 diabetes, major depressive disorder, anxiety disorder and hypertension. Review of the Minimum Data Set quarterly assessment with assessment reference date of 1/11/23 revealed resident #38 had a Brief Interview for Mental Status score of 7 which indicated he was severely cognitively impaired. The document indicated his active diagnoses included anxiety disorder, depression (other than bipolar) and psychotic disorder (other than schizophrenia). Review of resident #38's care plans revealed a behavior care plan initiated on 1/17/19 which indicated he was resistive to care related to schizophrenia, psychosis, dementia, depression and anxiety. Interventions included education of the resident of possible outcome of not complying with treatment or care, maintain consistency in timing of care as much as possible and praise the resident when behavior if appropriate. Interventions included providing clear explanation of care activities to occur, leave if resident resists and return five to ten minutes later to try again, and praise resident when behavior is appropriate. Review of resident #38's electronic medical record (EMR) revealed diagnoses of major depressive disorder with an onset date of 9/11/12, anxiety disorder with an onset date of 9/11/12, psychotic disorder with hallucinations with an onset date of 9/23/15, unspecified psychosis with an onset date of 1/15/16, and mood disorder due to known physiological condition with an onset date 6/06/22. The EMR contained a Level I PASARR screening form dated 5/20/21 and signed by the facility's Social Services Coordinator. The form indicated resident #38 had depressive disorder, dementia with behavior disturbance and dysthymia. Dysthymia is a depressive disorder which is a continuous, long-term form of depression. Symptoms may include feeling sad and empty, loss of interest in daily activities and having trouble getting things done. A person may also experience low self-esteem, feeling like a failure and feeling hopeless. These feelings last for years and may interfere with relationships, school, work and daily activities (retrieved 3/05/23 from www.mayoclinic.org). Review of the Level I PASSAR screening form revealed resident #38 was identified as having an indication of a serious mental illness which resulted in functional limitations of major life activities and interfered with interpersonal functioning and may lead to a chronic disability. The form indicated the resident was to be admitted for less than 30 days but would require a Level II Evaluation be conducted within 40 days of admission if the individual was later found to require more than 30 days of nursing facility care. The record did not contain a Level II PASARR Evaluation and Determination form. On 3/02/23 at 12:55 PM, the Director of Clinical Service (DCS) K acknowledged a Level II PASARR (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 14 of 47 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 03/03/2023 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 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete should have been completed for resident #38. She reviewed the EMR and paper medical records and explained she was unable to locate a Level II PASSAR Evaluation and Determination. She stated she did not know whether or not a screening was completed. The facility's policy and procedure for Preadmission Screening and Resident Review (PASARR) revised 11/08/21 read, If it is learned after admission that a PASSAR Level II screening is indicated, it will be the responsibility of the Social Services to coordinate and/or inform the appropriate agency to conduct the screening and obtain the results. The form indicated the results of the screening evaluation would be placed in the appropriate section of the individual's medical record. Event ID: Facility ID: 105564 If continuation sheet Page 15 of 47 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 03/03/2023 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 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** 3. Resident #89 was admitted to the facility on [DATE] with diagnoses including unspecified sequelae of nontraumatic intracerebral hemorrhage, type 2 diabetes, essential hypertension, end stage renal disease, chronic embolism and thrombosis of other specified veins, seizures, major depressive disorder and insomnia. Review of the MDS admission assessment with assessment reference date of 1/17/23 revealed resident #89 had a Brief Interview for Mental Status score of 15 which indicated he was cognitively intact. His active diagnoses included non-traumatic brain dysfunction, coronary artery disease, deep venous thrombosis and/or pulmonary embolus, hypertension, renal failure, diabetes mellitus, seizure disorder and depression. The MDS indicated resident #89 received oxygen therapy, intravenous medications and dialysis. The Care Area Assessment (CAA) associated with the admission MDS assessment dated [DATE] indicated resident had conditions which required further evaluation. The identified areas were visual function, communication, activities of daily living (ADL) function, urinary incontinence, falls, nutritional status, pressure ulcer, and psychotropic drug use. The care planning decision was to address these conditions through the care planning process. Review of resident #89's electronic medical record (EMR) revealed a comprehensive person-centered care plan was not developed to address the areas identified in the CAA related to discharge and advance directive status. On 3/01/23 at 11:49 AM, MDS Coordinator T reviewed resident #89's EMR and acknowledged a comprehensive person-centered care plan had not been developed and implemented. She clarified a CAA would identify areas of concern once a comprehensive assessment was completed. She stated the interdisciplinary team (IDT) would then have 7 days to develop a comprehensive care plan. She explained resident #89 was previously a resident and had been discharged home and returned. She stated the comprehensive care plan should have been reviewed, updated, and implemented upon his return to the facility following the comprehensive assessment. MDS Coordinator T said, It got missed. It did not get done. Review of the job description for MDS Coordinator LPN I revealed his/her duties and responsibilities included completing accurately and timely MDS assessments and plans of care in accordance with the Resident Assessment Instrument Manual guidelines for all residents in the facility. The facility's policy and procedure for Plans of Care revised 9/25/17 revealed the procedure was to develop a comprehensive plan of care for each resident that includes measurable objectives and timetables to meet the resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. 2. Review of resident #562's medical record revealed she was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, osteoporosis, and insomnia. The Quarterly MDS assessment with assessment reference date of 1/31/22 revealed resident #562 rarely or never understood others, was not able to express her needs, and had memory problems. The document indicated during the lookback period the resident required extensive assistance with activities of daily living such as bed mobility, transfers, dressing, and personal hygiene, and did not walk. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 16 of 47 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 03/03/2023 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of a Nursing Progress Note dated 7/12/22 at 3:30 PM revealed earlier that day at 11:30 AM, resident #44 was found on the floor beside her bed, with her head leaning on the bathroom door. The facility's Report of Resident Fall investigation dated 7/12/22 revealed resident #562 had an unwitnessed fall to the floor in her room. Her activity at the time of the fall was documented as rolled out of bed. Possible causative factors noted were agitation and confusion. The document read, A new Plan of Care / Intervention has been completed to prevent further events. Resident #562 had a care plan for an actual fall related to poor problems, comprehension, and communication initiated on 07/13/22. The goal was to minimize the risk of further incidents. Interventions implemented 7/13/22 included floor mats on both sides of the bed, and a scoop mattress with raised sides, Review of the Treatment Administration Record (TAR) for February and March 2023 revealed nurses' initials every shift to verify floor mats were at resident #562's bedside for safety as ordered by the physician. There was no physician's order for a scoop mattress transcribed to the TAR. On 2/27/23 at 2:12 PM, resident #562 was in bed, close to the edge of a regular mattress. There was a floor mat noted to the right side of the bed only. Across the room, the resident's roommate had a floor mat to the right side of her bed. Licensed Practical Nurse (LPN) E was informed the resident was close to the edge of the mattress. She explained that position was normal for the resident and she was not concerned as she did not move around in bed. On 2/28/23 at 10:04 AM and 3/01/23 at 9:46 AM, resident #562 remained in bed on a regular mattress with a floor mat to the right side of her bed. There was still no floor mat to the left of her bed and the other floor mat in the room remained against the roommate's bed. On 3/01/23 at 4:19 PM, Certified Nursing Assistant (CNA) Y stated he was familiar with his assigned residents' care needs and explained he received information from other CNAs in change of shift report. When asked about resident #562's floor mat, he said, She didn't used to have it, but it showed up once. During review of resident #562's [NAME] or CNA care plan with CNA Y, he discovered the safety intervention of bilateral floor mats. He went to the resident's room and confirmed there was only one bedside floor mat on the right side of the bed, and the floor on the left side of the bed had none. CNA Y acknowledged if the resident rolled off the left side of her bed, she would hit the floor. On 3/02/23 at 3:16 PM, LPN Z was asked to review resident #562's fall prevention care plan. She checked the resident's electronic medical record and validated the care plan indicated she required bilateral floor mats and a scoop mattress for safety. LPN Z was asked to check the resident's room, and she confirmed the mattress on the bed was not a scoop mattress. The facility's policy and procedure for Fall Management revised on 7/29/19 indicated after a fall, the resident's fall risk would be re-evaluated and the care plan and [NAME] would be updated with new, appropriate interventions. Based on observation, record review and interview, the facility failed to develop and/or implement person-centered comprehensive care plans related to medication side effects (#157), falls (#562), and care concerns triggered by the Care Area Assessment (#89), for 3 residents out of a total sample of 66 residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 17 of 47 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 03/03/2023 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 0656 Findings: Level of Harm - Minimal harm or potential for actual harm 1. Review of resident #157's medical record revealed he was admitted to the facility on [DATE] with diagnoses of Parkinson's Disease, Seizures, Heart Failure, Chronic Atrial Fibrillation, Dementia, Psychotic Disturbance, Mood Disturbance, and Anxiety. Residents Affected - Few Review of the Hospital Medication Orders revealed Aspirin (ASA) 81 milligrams (mg) chewable tablet, chew 1 tablet each day. The resident's physician orders documented ASA 81 mg by mouth (PO) daily for heart failure. Review of resident #157's February 2023 Medication Administration Record (MAR) documented he received ASA 81 mg PO daily at 9 AM. Review of resident #157's plan of care revealed no care plan for the use of his ASA, to include monitoring for signs of bleeding. Review of resident #157's History and Physical (H&P) dated 2/09/23 included the instruction to monitor him for signs and symptoms of bleeding. On 3/02/23 at 10:50 AM, Minimum Data Set (MDS) Coordinator T and MDS Coordinator U both explained they used the hospital H&P, physician orders, and assessments to develop the resident's care plan. MDS Coordinator T confirmed resident #157 had been receiving ASA and there should have been a care plan for the use of the ASA with interventions to monitor for signs of bleeding. On 3/02/23 at 11:30 AM, the Director of Nursing (DON) and Regional Nurse Consultant (RNC) reviewed resident #157's electronic medical record. The RNC explained that the admitting nurses should have completed the MAR and nurses should have been monitoring for bleeding for a resident receiving ASA. The RNC said, The care plan should have included the use of ASA with interventions to observe for signs of bleeding. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 18 of 47 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 03/03/2023 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility's nursing staff failed to adhere to standards of professional practice to promote skin integrity, obtain and implement appropriate wound care orders, and apply treatments and dressings as ordered for 2 of 2 residents reviewed for non-pressure skin conditions, of a total sample of 66 residents, (#61 & #30). Residents Affected - Few The facility's failure to implement adequate preventative interventions and follow policies and procedures for skin and wound care resulted in actual harm for resident #61, preventable injuries during activities of daily living (ADLs) care and development of a skin infection. Findings: 1. Review of resident #61's medical record revealed she was admitted to the facility on [DATE] with diagnoses including cerebrovascular disease, heart disease, hypertension, depression, anxiety, and insomnia. The Quarterly Minimum Data Set (MDS) assessment with assessment reference date (ARD) of 1/23/23 revealed resident #61 had a Brief Interview for Mental Status (BIMS) score of 15 which indicated she was cognitively intact. The document noted she had no mood or behavioral issues and did not reject care that was necessary to achieve the resident's goals for health and well-being. Resident #61 required limited assistance for bed mobility, and extensive assistance for transfers, dressing, and personal hygiene. The MDS assessment showed the resident had no impairments in functional range of motion of her extremities. On 2/27/23 at 10:30 AM, a large purple-brown discoloration was noted on resident #61's right arm. The area extended from above the elbow, around the joint, and faded towards her forearm. Certified Nursing Assistant (CNA) AA stated she last worked with resident #61 three days ago, on Friday 2/24/23, and there might have been a small bruise on her right arm, but definitely not as large as it was today. CNA AA lifted the resident's sheet to expose the left elbow which had a large dark purple bruise around the elbow, which extended from her upper arm to her forearm. Beneath the left elbow there was a large, dark red, pendulous area which had the appearance of a blood blister. A dressing dated 2/26/23 on the resident's forearm indicated the probable presence of a wound. CNA AA said, The left arm bruise was not there on Friday. It must have happened over the weekend. I already told the nurse this morning. The resident grimaced and guarded her left arm as CNA AA repositioned and supported the extremity on a rolled towel. The resident stated she had requested pain medication since the incident. Resident #61 said, The CNAs are very rough when they do things with me. She explained the injury and bruising occurred when a CNA took her clothes off. Review of the medical record revealed resident #61 had a care plan for ADL self-care performance deficit initiated on 7/02/19. The interventions directed nursing staff to conduct weekly skin inspections and observe for redness, cuts, and bruises. A care plan for actual skin impairment related to fragile skin, initiated on 7/02/19, had interventions that included avoid scratching, keep skin clean and dry, and use caution during transfers and bed mobility to prevent striking the resident's extremities. Resident #61 had a physician order dated 1/16/23 to check for bleeding and bruising every shift related to use of blood thinner medication, Clopidogrel 75 milligrams once daily. An order dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 19 of 47 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 03/03/2023 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 0684 Level of Harm - Actual harm Residents Affected - Few 2/15/23 directed staff to apply and moisturizing ointment to the resident's extremities for dry skin. A physician order dated 2/17/23 indicated weekly skin evaluations were scheduled on Tuesdays for the 3:00 PM to 11:00 PM shift. Review of resident #61's medical record revealed no Change in Condition forms regarding a recent wound or other skin injury. A Change in Condition form dated 2/15/23 indicated the physician was notified of the resident's decreased appetite and signs of depression. The document revealed the nurse completed a skin evaluation and noted no issues on that date. A Weekly Skin Integrity Review dated 2/21/23 showed resident #61's skin was intact, with no bruises, discolorations, or skin tears noted. The Treatment Administration Record (TAR) for February 2023 revealed nurses' initials to verify they monitored resident #61 for signs and symptoms of bleeding and bruising every shift from Friday 2/24/23 to Monday 2/27/23. However, review of nursing progress notes revealed no documentation to indicate if, when or how the resident suffered the bruises and skin tear. The TAR did not reflect any treatment order for the dressing dated 2/26/23 that was observed on resident #61's left arm. On 2/27/23 at 3:21 PM, during a meeting with the Interim Director of Nursing (DON) and the Administrator, they were informed resident #61 reported rough treatment by a CNA and showed evidence of significant bruising on both arms, neither of which was documented anywhere in the medical record. The DON stated her expectation was staff would report skin injuries immediately, and the Administrator stated nurses should have completed an incident report. On 2/27/23 at 3:52 PM, the Interim DON stated she assessed resident #61's left arm and confirmed the resident had a skin tear and a puffy area below her elbow where a large amount of blood seemed to have pooled. She acknowledged there was also a discolored area to the resident's right arm around the elbow. The Interim DON validated a nurse applied a dressing to the skin tear without making physician notification or obtaining an order. Review of the medical record revealed the Regional Director of Clinical Services (RDCS) completed a Change in Condition form effective 2/27/23 at 5:12 PM. The document indicated resident #61 had a skin tear left elbow and discoloration to bilateral elbows.Resident states CNA from 3-11 shift was rough while removing her shirt causing a skin tear. The physician was notified on 2/27/23 at 4:55 PM and gave an order to apply triple antibiotic ointment, wrap with gauze and apply geri-sleeves. The resident's son was notified a few minutes later at 5:10 PM. On 2/28/23 at 9:44 AM, Registered Nurse (RN) R stated she was resident #61's regularly assigned day shift nurse on Tuesdays, Wednesdays, and Thursdays. She stated she was sure the resident did not have any bruises or discolorations on her arms on the past Thursday, 2/23/23. RN R stated when she checked the electronic medical record this morning she discovered resident #61 had suffered a skin tear at some point over the weekend and had a new treatment order. RN R confirmed resident #61's skin had always been very fragile but she never had an order for a geri-sleeve, a protective stocking sleeve, for her arms. She confirmed once made aware of bruises and skin tears, any nurse assigned to resident #61 should have completed change in condition and incident report forms, informed the physician and family, and done a thorough skin assessment. RN R explained the resident received a daily blood thinner and was at high risk for bleeding and bruising. She confirmed resident #61's left arm showed signs of significant bleeding under the skin. RN R measured the discolored area on the resident's right arm as approximately 15 centimeters (cm) x 17 cm. She stated the bruised area on the left arm was even larger. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 20 of 47 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 03/03/2023 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 0684 Level of Harm - Actual harm Residents Affected - Few On 3/01/23 at 5:22 PM, a meeting was held with the Administrator, the RDCS, and the DON. The DON stated she interviewed resident #61 and determined she was alert and oriented and displayed good recall ability. She stated the resident reported an evening shift CNA on the past weekend injured her arm when she removed her shirt which was tight. The DON and RDCS acknowledged it was the CNA's responsibility to recognize the resident's shirt was tight, and remove it with the appropriate level of care and caution to avoid skin injuries. The RDCS verified the assigned nurse should have notified the physician to obtain an immediate treatment order, informed the family, and then contacted the DON regarding the incident. She stated nursing staff assigned to the resident over the weekend and on Monday morning should all have reported the issue to ensure the resident received appropriate care. The RDCS stated resident #61's day shift nurse on Monday received information on the skin tear in change of shift report and applied a treatment although there was no treatment order on the TAR. The RDCS explained the day shift nurse simply followed the treatment applied by a previous nurse without clarifying the absence of a physician order. The RDCS said, We are not calling this a bruise. The resident said the issue with her elbows comes and goes. As far as I see, it does not seem those are bruises. Her skin is thin and there's like a pocket. We are calling them discolorations. She already has something going on and she had orders for an ointment for her skin. We are waiting for [name of the Medical Director] or the Nurse Practitioner to see resident and she needs a dermatologist to diagnose her condition. The RDCS validated there was no nursing documentation in the medical record of bruises on the resident's elbow during the past four weeks. She confirmed she had not yet done additional research to see if resident #61 had a known dermatological condition that was never diagnosed or treated during her time in the facility. Review of a Progress Note dated 2/08/23 revealed resident #61 was assessed by an Advanced Practice Nurse practitioner (APRN) during a long-term care follow up visit. The note indicated nursing staff did not report any acute changes, and the resident was alert and oriented to person, place, and time, and had no complaints. The APRN's Physical Examination read, The elbows/forearms are normal in appearance, mobility, and are nontender. An integumentary or skin examination revealed the resident's skin was pale, but the texture was normal and there were no rashes, eruptions, or skin ulcers observed. On 3/02/23 at 10:41 AM, resident #61's attending physician, the facility's Medical Director, assessed her left arm. He removed the geri sleeve which had been applied only after the facility was informed of the resident's skin injuries. The geri-sleeve was soiled with a moderate amount of drainage from the wound. The Interim DON validated the dressing on resident #61's left arm was dated 2/28 which indicated daily wound care was not performed and a clean treatment not applied on 3/01/23 as ordered by the physician. The Medical Director used normal saline solution to loosen the dressing which was stuck to the wound to reveal the treatment in place was a petrolatum dressing and not the triple antibiotic ointment with gauze that was ordered. After removal of the dressing, resident #61's skin tear actively bled and the Medical Director had to hold pressure on the area with a gauze pad until the bleeding was controlled. The Interim DON confirmed it was not acceptable for a nurse to substitute a dressing without a physician's order. The Medical Director stated the skin tear measured 4 cm x 2 cm and nurses should have called him and/or the Wound Care specialist physician in a timely manner to report the injury and obtain treatment orders. He explained the resident's skin was fragile and thin, and could be bruised or torn during regular ADL care. The Medical Director acknowledged preventative skin protection measures such as geri-sleeves and staff taking precautions during care were important. He said, This is an opportunity for CNA education. When informed the RDCS suggested a dermatological consult was necessary for a possible untreated skin condition, the Medical Director disagreed. He stated he was very familiar with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 21 of 47 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 03/03/2023 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 0684 Level of Harm - Actual harm Residents Affected - Few resident #61 and explained she sometimes developed clear, fluid-filled blisters on her bilateral arms as a result of low albumin levels, despite supplementation. The Medical Director informed the Interim DON he recommended a collagen or hydrogel type dressing to promote healing, and consultation with the Wound Care specialist physician for evaluation and treatment. He assessed the skin surrounding the wound and resident #61's left elbow and said, She has developed a cellulitis. The Medical Director explained he would also order an oral antibiotic to treat the resident's skin infection. Cellulitis is a bacterial skin infection that causes redness, swelling, and pain in the infected area. If untreated, cellulitis can spread and cause serious health problems. Good wound care and hygiene are important for preventing cellulitis (retrieved on 3/14/23 from www.cdc.gov). 2. Review of the medical record revealed resident #30 was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses including type 2 diabetes, hypertension, obesity, and insomnia. Review of the Annual MDS assessment with ARD of 1/28/23 revealed resident #30 had a BIMS score of 15 which indicated he was cognitively intact. He required extensive assistance for ADLs including bed mobility. transfers, dressing, and personal hygiene. The MDS assessment showed the resident had no skin issues. Resident #30 had a care plan for ADL self-care performance deficit initiated on 8/15/22. The interventions included weekly skin inspections to observe for issues such as redness and open areas, and report changes as indicated. A care plan for potential for skin impairment related to fragile skin, incontinence, and decreased mobility was initiated on 8/15/22. The interventions directed nursing staff to keep the resident's skin clean and dry, apply lotion on dry skin, and use caution during transfers and bed mobility. On 2/27/23 at 2:43 PM, resident #30 stated he had an unknown type of wound on his bottom, possibly even an infection. CNA AA stated the resident still had a dressing on his sacrum, but the area was now completely healed and the dressing was in place for protection of the skin. Resident #30's Weekly Skin Integrity Review forms revealed on 2/15/23 his skin was intact. A skin evaluation dated 2/20/23 indicated the resident had a pressure ulcer to his left buttock with an intact, clean, dry dressing. The document read, no other open areas, bruising, or redness noted. On 2/28/23 at 9:34 AM, CNA AA prepared to provide ADL care for resident #30. She stated she usually informed nurses when she was ready to start morning care as it was a convenient time for her to assist nurses to turn and reposition the resident for wound care and application of the dressing to his sacrum. CNA AA recalled yesterday, Monday 2/27/23, when she asked the day shift nurse if she was ready to do the dressing change, the nurse informed her there was no order for a dressing in the electronic medical record. With resident #30's permission, CNA AA repositioned him to his right side to expose a bordered dressing on his sacrum which was soiled with feces and slightly lifted around the right side edges. The dressing was dated Sunday 2/26/23 on the 7:00 AM to 3:00 PM shift. Resident #30's sacrum was slightly pink and no open areas were noted. Review of the TAR for February and March 2023 revealed resident #30 had an active physician treatment order initiated on 2/08/23. The order read, Clean Left buttock area with normal saline, apply skin prep to peri wound. Apply Calcium Alginate to wound bed. Cover with Foam dressing. Secure with tape, every day shift for open blister. Review of the TARs revealed nurses' initials to verify the daily treatment was done as ordered except on 3/01/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 22 of 47 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 03/03/2023 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 0684 Level of Harm - Actual harm On 3/02/23 at 12:33 PM, the Interim DON was informed resident #30 had a two-day-old dressing in place on his sacrum that did not reflect the physician order, and there was no blister as noted on the TAR. She validated nurses were expected to follow physician orders, and if there was a discrepancy, they should seek clarification from the provider. Residents Affected - Few On 3/03/23 at 12:22 PM, the Interim DON stated she assessed resident #30 with the [NAME] Wing Unit Manager and they found his skin was intact and he no longer had a dressing to his sacrum. She explained the facility had a Wound Care specialist and a nurse who rounded with him, and nurses should have alerted either provider or any member of nursing management that the area was healed. The Interim DON could not explain why nurses continued to apply a dressing without appropriate orders or documentation. Review of the facility's policy and procedure for Dressing Change revised on 12/06/17 revealed clean dressings would be applied to wounds to promote healing. The procedure directed nurses to apply treatments as ordered and then document in the medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 23 of 47 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 03/03/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to provide adequate supervision to prevent elopements for 1 of 3 residents reviewed for elopement, in a total sample of 66 residents, (#134). Findings: Review of the medical record revealed resident #134 was admitted to the facility's secure Memory Care Unit on 3/01/22. Her diagnoses included Schizophrenia, Delusional Disorder, Hypertension, and Bipolar Disorder. The Quarterly Minimum Data Set (MDS) assessment dated [DATE] noted the resident had a Brief Interview for Mental Status score of 15 out of 15, which indicated she was cognitively intact. The MDS assessment revealed resident #134 was able to walk independently in her room, but she required supervision of one staff member to person for locomotion both on and off the Memory Care Unit. An Elopement Risk Evaluation dated 7/14/22 indicated resident #134 was at risk for elopement. Review of resident #134's medical record was being seen by a psychiatric provider and there were several notes regarding her delusional thinking. A progress note dated 6/09/22 read, Patient is currently taking Risperidone for schizophrenia disorder.Per staff patient has been delusional, she thinks the family killed her baby. She has been very paranoid. A progress note dated 11/14/22 read, .patient has been exhibiting delusional thinking and refusing medications. On 2/28/23 at 11:37 AM, resident #134 was in her room and there was Certified Nursing Assistant (CNA) seated in the hallway just outside the resident's room door to provide one-to-one supervision. Resident #134 explained she was admitted to the facility from the hospital about a month ago and said, I became very aggressive because I've been kidnapped and held against my will. When I checked in here they told me I could never leave. However, resident #134 stated she had been able to get out of the facility on two occasions. She recalled she went out through an exit door at the end of the hall. Resident #134 stated at about 4:00 PM one afternoon she pushed the exit door an alarm sounded. The resident said, You have to really shove it, the door, real hard, and it breaks the lock. It's an insecure lock. They have it set up this way so people can do this. She recalled two staff members apprehended her and brought her back into the facility. Resident #134 stated the second time she eloped from the facility successfully was one morning at approximately 5:00 AM, when all the staff on the Memory Care Unit were busy in residents' rooms. The resident stated she figured out the best time to leave was either nighttime or early in the morning. She explained, Because they were not going out in the dark to come after you. It's not the CNAs' job duties to come after you in the dark. It's a legal thing. She stated the second time she left the facility, she hid in the woods for two and a half hours. She recalled the facility sent three ladies and four Deputy Sheriffs to search for her. Resident #134 stated when she was found, she told the Deputy Sheriffs she had been kidnapped but they took her back to the facility anyway. She said, The Deputies don't care because they are going to get a big payoff. On 2/28/23 at 12:00PM, resident #134 left her room, walked to the Memory Care Unit nurses' station, and pointed to the the exit door at the end of the hallway. The confirmed she got out twice through that exit door. Upon returning to her room, resident #134 pointed to CNA G and stated that she was one of the staff members who apprehended her. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 24 of 47 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 03/03/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 2/8/23 at 12:11 PM, CNA G recalled the events of resident #134's first elopement attempt on 12/14/22. She stated it was prior to the Big Elopement that occurred in the early morning hours of 12/19/22. CNA G stated she was working during the 3:00 PM to 11:00 PM shift and at around dinner time as staff passed out the meal trays, she saw resident #134 at the exit door. She confirmed it was the same exit door that resident #134 had pointed out. CNA G stated the resident had a bag in her hand and she pushed the door once and the alarm went off. CNA G stated she called out, Stop! However, instead of stopping, the resident made a big push and the exit door opened. CNA G explained she ran after the resident and caught up with her halfway towards the front of the facility. She stated resident #134 was swung the bag at her and the former Assistant Executive Director and other staff helped to bring the resident back to the facility. On 3/1/23 at 10:42 AM, CNA D recalled the events of resident #134's second elopement, on 12/19/22. She said she arrived at the facility at approximately 6:45 AM that morning, and as she entered the facility, the Medical Records Staff was handing out pictures of the missing resident. She stated she joined a nurse and a CNA from a staffing agency in the search for the resident. CNA D recalled they checked the empty field behind the facility and walked along the wooded area on the east side of the facility. She stated as they walked towards the front of the facility towards the main highway, they spotted resident #134 in a construction site on the adjacent property. She stated as they approached the resident, she raised her arm and swung a large piece of wood, probably debris from the construction site, at the three staff members. CNA D said the nurse got close enough to hug the resident while the other two staff disarmed her. CNA D stated she waved over to the Deputy Sheriff's car as they were also searching for the resident. She explained the resident told the Deputy she had been kidnapped and that her family paid eight million dollars to keep her at the facility. CNA D recalled resident #134 said, Take me to jail. I attacked y'all. Take me to jail. Didn't I? Didn't I attack y'all. It was assault and battery and this is eight to ten years in jail. CNA D stated the Deputy Sheriffs were able to convince the resident to return to the facility by telling her she would have to sign papers and retrieve her personal items before she went to jail. On 3/01/23 at 4:30 PM, the resident most likely elopement route was retraced and measured. The resident left her room and exited the facility through South-East Door #4. The resident walked 701.7 feet until she reached the entrance to the construction site where she was only 261.5 feet from a busy 4-lane divided highway. The resident walked another 80.8 feet over rough,uneven ground towards the center of the construction site. On 3/01/23 at 4:58 PM, the Project Superintendent of the construction site recalled the morning an elderly women got out of the nursing home and staff were seen chasing her. He stated she was swinging a piece of lumber at staff that was either 2 inches x 2 inches or 2 inches x 1 inch. The Project Superintendent stated his work crews were there and they usually arrived at about 6:30 AM. He recalled the sun was already up, but it was a cold morning. On 3/01/23 at 5:21 PM, the Regional Nurse Consultant (RNC), Director of Nursing (DON), and the Administrator discussed resident #134's elopement on 12/19/22. They explained the facility obtained statements from staff that showed on the morning of 12/19/22 at approximately 5:45 AM, a nurse on the unit adjacent to the Memory Care Unit heard an exit door alarm while she was passing medication. They stated the investigation indicated that nurse entered the Memory Care Unit, went out the exit door and looked around for a resident. The nurse did not find a resident so she returned to the building and informed the night shift nursing supervisor. The elopement code was paged overhead and staff conducted a head count on all nursing units and discovered resident #134 was missing. They stated staff continued to search for the missing resident and law enforcement was notified. The facility staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 25 of 47 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 03/03/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some found resident #134 in the construction site on the adjacent property and the Deputy Sheriffs brought her back to the facility. Resident #134 was then placed on one-to-one supervision. The RNC stated that incident was the first time resident #134 had eloped from the facility and the facility's Root Cause Analysis of the elopement was that the resident did not want to be in the facility. On 3/02/23 at 10:27 AM, the Maintenance Director verified resident #134 exited the facility through the South-East Door #4 on the Memory Care Unit. He explained the exit door had a 15-second delayed egress function, and if someone depressed the crash bar, an alarm would sound, and after 15 seconds the magnetic lock would release to unlock the door. However, he stated if someone pushed on the crash bar and/or door with significant force, it was possible to bypass the 15-second delay and open the door. The Maintenance Director stated the exit door was set up that way as a safety feature, so if there was an emergency, staff and residents would not have to wait 15 seconds to get out of the facility. On 3/02/23 at 1:30 PM, the receptionist stated she sometimes worked on the nursing units as a CNA, and she was very familiar with resident #134. She stated she believed she worked on 12/14/22 during the 3:00 PM to 11:00 PM and recalled resident #134 got out of the facility in the afternoon or early evening. The receptionist stated staff were about to pass out dinner trays and resident #134 gave the South-East Door #4 a big push, and the exit door opened. The receptionist stated the person who was the receptionist that day, the Assistant Administrator and a nurse from a staffing agency retrieved the resident and brought her back inside. The receptionist validated resident #134 also got out on 12/19/22. She stated the resident was very smart and she always peeked out from her doorway see if regular staff worked or if there were new staff. On 3/02/23 at 2:53 PM, the Administrator stated that he had just interviewed facility staff and he found out that resident #134 had indeed eloped twice from the facility, on 12/14/22 and 12/19/22. He stated that neither he nor the RNC had been made aware of the first elopement on 12/14/22, until they were informed today. On 3/03/23 at 3:33 PM, resident #134's two elopements were discussed with the Administrator and the RNC. They acknowledged the resident had been at risk for elopement since July 2022, but she refused to wear a electronic monitoring device on her person. The resident elopement care plan was reviewed and the approach, Frequent Monitoring was added on 7/22/22 since the resident refused to wear a electronic monitoring device. The Administrator and the RNC were not able to define the term Frequent Monitoring. They were informed staff were not able to describe the frequency or intervals of safety checks and observations that were necessary to prevent resident #134 from leaving the facility again. They acknowledged the facility needed to determine the Root Cause Analysis of each elopement, to include the ease with which the the exit door was breeched, so the appropriate amount of supervision could had been determined. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 26 of 47 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 03/03/2023 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 0692 Provide enough food/fluids to maintain a resident's health. 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 follow a dietitian's recommendations to maintain sufficient fluid intake and adequate hydration for 1 of 1 resident reviewed for hydration, of a total sample of 66 residents, (#44). Residents Affected - Few Findings: Review of the medical record revealed resident #44 was admitted to the facility on [DATE], and re-admitted on [DATE] after a hospital stay. His diagnoses included cerebrovascular disease, difficulty swallowing, Alzheimer's disease, protein-calorie malnutrition, and gastrostomy. A gastrostomy tube or G-tube is a feeding tube that is inserted directly into the stomach through a surgical incision in the abdominal wall. A feeding tube is necessary if someone has difficulty swallowing as it allows the person to receive adequate nutrition, hydration, and medication (retrieved on 3/10/23 from www.my.clevelandclinic.org). The Minimum Data Set (MDS) Significant Change in Status assessment with assessment reference date of 11/29/22 revealed resident #44 had severely impaired cognitive skills for daily decision making. He had difficulty swallowing and was totally dependent on staff for eating and drinking. The MDS assessment indicated resident #44 had a feeding tube that provided 51% or more of his total caloric intake and 501 milliliters (ml) or more of his fluid intake per day. Review of resident #44's medical record revealed a care plan for the potential for imbalanced nutrition related to his disease process, initiated on 7/20/22. The interventions directed nurses to provide tube feeding and water flushes as ordered. A care plan for tube feeding related to swallowing problems was initiated on 7/20/22. The interventions indicated the Registered Dietitian (RD) would evaluate the resident and make recommendations as needed. Review of the Order Summary Report dated 3/01/23 revealed resident #44 had an physician order dated 9/07/22 for 50 ml water flushes before and after each bolus feeding. A conflicting physician order dated 2/18/23 indicated the resident was to receive continuous tube feeding at 75 ml per hour for 22 hours daily, to be turned off between 12:00 PM and 2:00 PM. There was no associated physician order for water flushes related to the continuous tube feeding. Tube feedings can be administered as boluses several times a day or by continuous infusion. Bolus feedings involve giving the total required volume as separate feedings at regular intervals throughout the day. These bolus feedings are usually administered via a syringe attached to the feeding tube and infuse by gravity. After bolus feedings, the G-tube is flushed with water to prevent clogging (retrieved on 3/10/23 from www.merckmanuals.com). On 2/27/23 at 2:23 PM, Licensed Practical Nurse (LPN) BB stood at resident #44's bedside and started the pump which was set to infuse his tube feeding at 75 ml per hour. There was no container of water hanging on the pole with the tube feeding, and no container with a syringe at bedside to indicate a water flush was administered. On 2/28/23 at 11:51 AM and on 3/01/23 at 1:38 PM, resident #44's tube feeding pump was off as ordered, and only the bottle of tube feeding solution hung on the pole. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 27 of 47 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 03/03/2023 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 3/01/23 at 7:25 PM, in a telephone interview, resident #44's daughter stated during her father's stay in the facility, he was hospitalized several times. She recalled on one occasion, she was informed by hospital staff that her father was dehydrated. The daughter said, I don't understand because he has the tube to his stomach and they can give him water. Review of the Facility Assessment dated 2/24/23 revealed the facility offered services and care to meet the needs of residents with G-tubes. The document indicated nursing staff were competent in providing specialized care to include tube feedings. On 3/02/23 at 11:30 AM, the facility's RD recalled resident #44 previously had physician orders for six cans of tube feeding formula daily, divided into two cans per shift, with water flushes before and after each bolus. The RD explained due to recent weight loss, she calculated the resident required increased calories, so on 2/16/22 she made a recommendation for continuous tube feedings at 75 ml per hour for 22 hours daily. The RD stated she also recommended resident #44 receive 250 ml of water every six hours for a total of 1000 ml daily. The RD was informed her recommendation for water flushes was never implemented but nurses continued to sign for water flushes after bolus feedings although that type of feeding was discontinued almost two weeks ago. The RD stated she provided her recommendations to the dietary manager who should have passed them on to the Director of Nursing (DON). She said, That is a significant difference. The order was not completed. I need to have the DON change it. He is at risk for dehydration [and] abnormal lab values. On 3/02/23 at 12:01 PM, the [NAME] Wing Unit Manager checked resident #44's medical record and verified the recommendation for free water flushes was never ordered or implemented. She recalled the resident used to get water flushes after his bolus feedings but could not explain what nurses were doing now that the resident had continuous tube feeding. On 3/02/23 at 12:23 PM, the Interim DON explained she never received a copy of the RD's recommendation regarding water flushes for resident #44. She stated all assigned nurses over the past two weeks should have noted the discrepancy, notified the physician, and/or collaborated with the RD. The Interim DON stated inadequate fluid intake could result in dehydration and electrolyte imbalance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 28 of 47 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 03/03/2023 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 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 provide pharmaceutical services related to safe administration of controlled release medications, and accurate and/or timely acquisition of medication to meet the needs of 12 residents who received controlled release medications, of a total sample of 66 residents, (#8, #40, #49, #50, #69, #110, #112, #125, #126, #131, #141 & #146). Findings: 1. Review of resident #112's medical record revealed he was admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses included atherosclerotic heart disease, hypertension, and mini-strokes. Review of resident #112's active Order Summary Report revealed a physician order dated 2/05/23 for Isosorbide Mononitrate ER 24 hour 30 milligrams (mg) once daily for hypertension. Controlled release drugs which include those with the suffixes ER (Extended Release) and DR (Delayed Release) are designed to release medicine over an extended period of time to promote smooth release and a longer duration of action. Crushing may mean a fatal dose is released (retrieved on 3/10/23 from www.drugs.com). On 2/27/23 at 7:49 AM, Licensed Practical Nurse (LPN) M crushed the resident's Isosorbide Mononitrate ER 30 mg tablet. On 2/27/23 at 7:57 AM, LPN M was prompted not to administer the crushed medication. He was asked to retrieve and read the blister pack for resident #112's Isosorbide Mononitrate ER. He discovered printed instructions that read, Do NOT CHEW or CRUSH before swallowing. May cause DIZZINESS. Medication affects blood pressure. He stated he was familiar with his assigned residents and knew resident #112 would spit out his pills if they were not crushed. When asked why ER medication should not be crushed, LPN M explained the medication would be released at a faster rate than intended. Review of the Memory Lane Report Sheets revealed the instruction for nurses to crush resident #112's medication. On 2/27/23 at 8:09 AM, the Interim Director of Nursing (DON) was informed that LPN M crushed an ER tablet contrary to instructions on the blister pack. She stated her expectation was prior to medication administration, all nurses would follow professional standards related to medication administration. The Interim DON explained nurses should check medication lists and containers to ensure medications could be crushed safely. She stated the decision to crush medications should be based on recommendations by the manufacturer and/or pharmacy. The Interim DON stated there should be a physician's order transcribed to the Medication Administration Record (MAR) regarding crushing medication if not contraindicated. She acknowledged LPN M should have notified the physician resident #112 was no longer able to swallow his medication whole. On 2/28/23 at 4:25 PM, LPN DD was asked to check the medication cart to ensure resident #112's Isosorbide Mononitrate ER 30 mg tablets had been replaced with an alternative form of the medication. She retrieved the same blister pack utilized by LPN M during medication administration the previous (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 29 of 47 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 03/03/2023 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some day and confirmed the instruction was not to crush the tablet. LPN DD checked her nursing report sheet and confirmed it indicated his medication had to be crushed. She checked the MAR for 2/28/23 and validated resident #112 received the ER tablet again despite the medication error identified on the previous day. On 2/28/23 at 4:42 PM, the Interim [NAME] Wing Unit Manager (UM) was informed neither the assigned nurses nor nursing management removed resident #112's Isosorbide Mononitrate ER tablets after the facility was made aware of the concern related to crushing the tablet. She acknowledged the physician should have been notified immediately and a new order obtained to ensure the resident's medications were administered in an appropriate form. Order Summary Report forms for all residents in the facility who had physicians' orders for medication with the suffix ER were reconciled with nursing report sheets from all medication carts. 2. Resident #8 had physician orders dated 3/22/22 for Namzaric capsule ER 24 hour 21-10 mg once daily for Alzheimer's disease, and Pantoprazole Sodium DR 40 mg once daily for gastroesophageal reflux disease. The blister pack for Namzaric ER 21-10 mg capsules read, Swallow whole - Don't chew/crush. Review of the Memory Lane Report Sheets revealed the instruction for nurses to crush resident #8's medication. 3. Resident #40 had a physician order dated 3/17/22 for four capsules Zonisamide 100 mg once daily for seizures and an order dated 1/11/19 for Potassium Chloride ER 20 milliequivalents (meq) once daily for hypokalemia. Zonisamide is a drug used to treat seizures. The manufacturer's instructions directed, Swallow the capsule whole and do not crush, chew, break, or open it (retrieved on 3/13/22 from www.drugscom).The Potassium Chloride ER blister pack read, Do NOT CHEW or CRUSH before swallowing. Review of the East Wing Cart 3 nursing report sheet revealed the instruction for nurses to crush resident #40's medication. 4. Resident #49 had a physician order dated 3/29/17 for Tylenol 8 hour Arthritis ER 650 mg every eight hours as needed for pain. Review of the West Wing Cart 2 nursing report sheet revealed the instruction for nurses to crush resident #49's medication. On 2/28/23 at 4:52 PM, LPN EE stated she worked for a staffing agency and was not familiar with residents on her assignment. She explained she utilized the nursing report sheets to determine which residents' pills had to be crushed. She checked the medication cart and confirmed there was no container of the ordered drug Tylenol Arthritis ER 650 mg for resident #49. LPN EE explained if the resident complained of pain she would instead administer two tablets of the available stock medication, Tylenol 325 mg. When prompted regarding following physician orders and best nursing practice, LPN EE acknowledged the physician should be notified that the ordered medication was not available. 5. Resident #50 had a physician order dated 2/21/23 for Metoprolol Succinate ER 24 hour 100 mg at bedtime for hypertension. The medication blister pack read, Not to be chewed or crushed. Review of the East Wing Cart 3 nursing report sheet revealed the instruction for nurses to crush resident #50's medication. 6. Resident #69 had a physician order dated 12/17/22 for Namenda XR Extended Release 24 hour 14 mg via G-tube once daily for dementia. A gastrostomy tube or G-tube is a feeding tube that is inserted directly into the stomach through a surgical incision in the abdominal wall (retrieved on 3/10/23 from www.my.clevelandclinic.org). Review of the MAR for February 2023 revealed the resident received (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 30 of 47 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 03/03/2023 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the medication daily as ordered, which indicated it was crushed and dissolved in order to be administered via the tube. 7. Resident #110 had physician orders dated 1/09/23 for Aspirin Enteric Coated DR 81 mg once daily for clot prevention and Diltiazem HCl ER 12 hour 60 mg twice daily for hypertension. Review of the West Wing Cart 1 nursing report sheet revealed the instruction for nurses to crush resident #110's medication. 8. Resident #125 had a physician order dated 7/12/22 for Desvenlaxafine Succinate ER 24 hour 50 mg once daily for major depressive disorder, and an order dated 1/07/22 for Alendronate Sodium 70 mg every Monday morning for osteoporosis. The manufacturer's instructions for administration of Alendronate read, Do not crush, chew, or suck on an Alendronate regular tablet. Swallow it whole (retrieved on 3/13/23 from www.drugs.com). Review of the West Wing Cart 1 nursing report sheet revealed the instruction for nurses to crush resident #125's medication. 9. Resident #126 had a physician order dated 7/30/21 for Potassium Chloride ER 10 meq once daily for edema. Review of the West Wing Cart 2 nursing report sheet revealed the instruction for nurses to crush resident #126's medication. On 3/02/23 at 12:06 PM, LPN FF walked by the [NAME] Wing nurses' station. He held a plastic cup with pills and informed the [NAME] Wing UM resident #126 refused to take her medication. The [NAME] Wing UM checked the nursing report sheet and informed LPN FF that the resident required her medication crushed. LPN FF returned to the medication cart to crush the tablets and when asked to pull the blister packs to verify if the pills should be crushed, he verified the Potassium Chloride ER pack read, Not to be chewed or crushed. Take with plenty of water. 10. Resident #131 had a physician order dated 1/14/22 for Procardia XL ER 24 hour 30 mg once daily for hypertension. The medication blister pack read, Do NOT CHEW or CRUSH before swallowing. Review of the Memory Lane Report Sheets revealed the instruction for nurses to crush resident #131's medication. 11. Resident #141 had a physician order dated 7/10/22 for Vitamin B12 oral tablet ER 1000 micrograms (mcg) for Vitamin B12 deficiency. Review of the Memory Lane Report Sheets revealed the instruction to crush resident #8's medication. On 2/28/23 at 4:25 PM, LPN DD reviewed resident #141's MAR and noted the resident had an ER medication although she needed her medications crushed. LPN DD checked the medication cart for the Vitamin B12 ER tablet and stated no such medication was in the cart. She explained there was a bottle of Vitamin B12 500 mcg tablets and nurses probably gave two of those tablets instead. The Interim [NAME] Wing UM stated she was not familiar with the ER form of Vitamin B12, and it was not a formulary stock medication. She confirmed resident #141 could not have received the medication as ordered since the facility did not stock it and it was not sent from the pharmacy. The Interim [NAME] Wing UM stated all assigned nurses over the previous six months should have clarified the physician's order to ensure the resident received the correct medication in the appropriate form. 12. Resident #146 had a physician order dated 1/14/23 for two tablets Metoprolol Succinate ER 25 mg once daily for hypertension. The medication blister pack read, Not to be chewed or crushed. Review (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 31 of 47 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 03/03/2023 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 0755 of the Memory Lane Report Sheets revealed the instruction for nurses to crush resident #146's medication. Level of Harm - Minimal harm or potential for actual harm On 2/27/23 at 1:48 PM, LPN BB stated she worked for a staffing agency and this shift was her second shift in the facility. LPN BB explained she was not familiar with the residents as yesterday she was assigned to another unit. She stated she relied on the nursing report sheet and verbal report from the offgoing nurse. LPN BB showed the report sheet with her handwritten notes and pointed to the indicators beside each resident's name, C for crushed pills or W for whole pills. Residents Affected - Some On 2/28/23 at 4:17 PM, Registered Nurse (RN) CC stated he was on staff and had a regular assignment so he knew which residents took their pills whole and which ones needed their pills to be crushed. During review of the nursing report sheet for RN CC's assignment, he indicated there were inaccuracies on the form related to whether or not to crush pills. He acknowledged it was a concern as nurses from a staffing agency would simply follow the printed instructions. On 2/28/23 at 4:25 PM, LPN DD stated she worked for a staffing agency and this was her first shift on the Memory Care unit. She explained she received a verbal report from the day shift nurse and also had a report sheet with her assigned residents' names, room numbers and other important information such as whether medication were to be crushed. She showed her pre-printed report sheet which had some residents' names with the letter W struck out and replaced with the letter C. LPN DD confirmed the offgoing nurse told her those residents now needed their medications crushed. She reviewed the list of residents who received controlled release drugs and confirmed some of her assigned residents who required crushed medications were on that list. LPN DD validated it was concerning that nurses followed information on a report sheet rather than physician orders, pharmacy instructions, and drug manufacturers' warnings. She acknowledged nurses were responsible for identifying contraindications and informing the ordering physician. On 2/28/23 at 5:03 PM, LPN FF stated he worked for a staffing agency and relied on nursing the report sheet to determine whether or not to crush his assigned residents' medications. He was asked to review the list of residents on controlled release medications and pull the blister packs to check instructions. He searched for resident #69's Namenda XR Extended Release 24 hour 14 mg tablets and confirmed it was not in the medication cart and the MAR indicated it was not administered as ordered during the day shift. He then searched for resident #110's Diltiazem HCl ER 12 hour 60 mg and stated that medication was not in the cart either. He checked the MAR and discovered the drug was not administered during the day shift and was not available for this evening's dose. He explained the nursing report sheet indicated resident #110 required crushed medications, but based on change of shift report, I scratched out crush. He acknowledged he had not verified whether or not the resident had difficulty swallowing. LPN FF randomly selected blister packs with controlled release medications from the cart and was not able to identify instructions regarding not crushing or chewing. He was shown the instructions and prompted to read the card carefully. He stated he would not have noticed the instructions due to the fine print and said, It would be much safer if the pharmacy put warnings in another color like red. On 3/02/23 at 10:59 AM, the facility's Medical Director was informed of significant concerns related to nurses crushing controlled release medications although contraindicated. He stated his expectation was nurses would follow physicians' orders as written, and immediately notify the provider if any change in status including difficulty swallowing suggested an alternate medication was necessary. The Medical Director confirmed nurses should not select substitutions for medications that were not available. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 32 of 47 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 03/03/2023 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 3/03/23 at 10:24 AM, in a telephone interview, the facility's Consultant Pharmacist confirmed she conducted Monthly Medication Reviews for all residents of the facility to identify any irregularities in medication regimens. She was informed of concerns identified related to residents who required medications to be crushed due to swallowing issues receiving controlled release medications despite contraindication. The Consultant Pharmacist said, I am sure there is a policy and procedure to call the physician. If the instructions say do not crush they should call the physician to substitute. The Consultant Pharmacist stated she was able to answer only general questions regarding medication action, not resident-specific concerns. When given the example of nurses crushing Metoprolol Succinate ER, she repeated that facility would have to follow its policy. The Consultant Pharmacist was asked how the medication action was affected by being crushed. She said. Obviously it would not be Extended Release then. The facility's policy and procedure for Administering Medications revised in April 2019 read, Medications are administered in a safe and timely manner, and as prescribed. The policy read, The individual administering the medication checks the label THREE (3) times to verify the right resident, right medication, right dosage, right time and right method (route) prior to giving the medication. The document indicated if nurses believed a medication dosage was inappropriate or if a potential adverse consequence was identities, the nurse would contact a physician to address the concern. Review of the Facility Assessment dated 2/24/23 revealed the facility could care for residents with common diagnoses and conditions, and offered services to meet residents' needs including medication administration via G-tube and oral routes. The document indicated all nursing staff would demonstrate competency in medication administration on hire, annually, and as needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 33 of 47 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 03/03/2023 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. 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 behavior monitoring and documentation were implemented and conducted for the use of antipsychotic medications for 1 of 2 residents reviewed for behavioral/emotional monitoring, out of a total sample of 66 residents, (#157). Residents Affected - Few Findings: Review of resident #157's medical record revealed he was admitted to the facility on [DATE] with diagnoses of Parkinson's Disease, Seizures, Heart Failure, Chronic Atrial Fibrillation, Dementia, Psychotic Disturbance, Mood Disturbance, and Anxiety. The admission Minimum Data Set (MDS) assessment dated [DATE] documented short-term and long-term memory problems, independence with cognitive skills for daily decision making, and no behavioral symptoms. The MDS assessment revealed resident #157 required extensive assistance of one to two staff for activities of daily living (ADL), used a wheel chair for mobility, and was frequently incontinent of bowel and bladder. He received antipsychotic medication on six days and antianxiety medication on three days in the lookback period. Resident #157's physician orders for March 2023 included Clonazepam, an anti-anxiety drug, 0.5 milligrams (mg) by mouth daily for unspecific dementia, unspecific severity without behavioral disturbances, psychotic disturbance, mood disturbance, and anxiety. There were orders dated 2/09/23 for Olanzapine, an antipsychotic drug, 2.5 mg by mouth daily for mood disorder and Lorazepam, an anti-anxiety drug. 0.5 mg by mouth every 8 hours as needed for anxiety. Review of the plan of care dated 2/09/23 revealed a care plan for antipsychotic medication therapy with a goal to remain free form antipsychotic drug related complications. Interventions included administer medications as ordered by the physician and monitor behavioral symptoms and side effects of medication. A care plan for antianxiety medication had a goal to be free from discomfort or adverse reactions related to antianxiety therapy. Interventions included administer medication as ordered by the physician and monitor for side effects and effectiveness of medication every shift. A care plan for mood problem related to admission had a goal of improved mood state. Interventions included administer medications as ordered by the physician, and monitor and document for side effects and effectiveness. Observations of resident #157 on 2/28/23 at 9:30 AM and 12:12 PM, and on 3/01/22 at 9:35 AM and 12:00 PM revealed the resident was in bed. He was well dressed and groomed, calm and relaxed with no behavioral symptoms noted. There was a one-to-one (1:1) sitter at his bedside. Physician visit notes dated 2/09/23 and 2/17/23 documented that the resident was seen at the hospital for altered mental status. Upon admission to the facility, the resident threw himself out of bed onto the floor and yelled, It's a trap. His past medical history included Parkinson's disease, Unspecific dementia, and seizures. The documentation showed the resident reported difficulty concentrating, irritability/mood changes, anxiety, forgetfulness and previous use of psychotropic medication. The Assessment and Plan dated 2/09/23 included monitor side effects of current medications, and monitor for worsening of symptoms of behavioral issues. The Psychiatric Evaluation dated 2/16/23 showed the resident had diagnoses of severe dementia with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 34 of 47 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 03/03/2023 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 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few other behavioral disturbances, psychotic disorder with delusions, and general anxiety disorder. The document indicated resident #157 received Lorazepam 0.5 mg by mouth every eight hours for anxiety, Olanzapine 10 mg by mouth twice a day for dementia, and Clonazepam 0.5 mg by mouth daily for dementia. Staff were to document and monitor the resident's behaviors. Review of the Medication Administration Record (MAR) revealed no behavior monitoring related to #157's antipsychotic, mood, and anti-anxiety medication use. Review of the progress notes dated 2/08/23 to 3/02/23 revealed the only documentation of resident #157's behaviors during the 3-week period occurred on: 2/09/23 at 2:52 PM (agitation and anxious behavior), 2/10/23 at 11:21 AM (no behaviors), 2/19/23 at 2:41 PM (agitation), 0/20/23 at 6:51 AM (resting quietly), 2/21/23 at 5:50 AM (anxiety with ADL care), 2/22/23 at 11:45 AM (anxious), and on 2/23/23 at 1:57 PM (combative behavior). On 3/02/23 at 10:50 AM, MDS Coordinator T explained with all antipsychotic medications listed on the MAR, associated documentation of the behaviors was to be completed every shift. She stated the documentation should include the specific behavior, the number of times the behavior occurred, and the intervention for the behavior. MDS Coordinator T reviewed resident #157's MAR and said, There are no behaviors being monitored or documented. On 3/02/23 at 11:18 AM, Licensed Practical Nurse (LPN) I stated resident #157 required a 1:1 sitter for behaviors of running, unsteady gait, going in and out of residents' rooms, striking out at staff with redirection, and he had kicked and hit at staff. LPN I explained the resident received antipsychotic and anti-anxiety medications and there was behavior monitoring in place or charting of behaviors. LPN I said, We should be documenting his behaviors every shift. The behaviors should be specific and individualized to the resident. LPN I then reviewed resident #157's MAR and acknowledged, No behaviors are listed on the MAR and no documentation is being completed. On 3/01/23 at 12:00 PM, Home Heath Aide (HHA) L stated he worked with a staffing agency and was assigned to provide 1:1 supervision for resident #157's behaviors and also to assist with ADLs including eating and ambulation to the bathroom. HHA L said, He has not had any behaviors during his time and most of the time he was in bed sleeping. On 3/02/23 at 11:30 AM, an interview with the Director of Nursing (DON) and Regional Nurse Consultant revealed the admitting nurse would complete the MAR and the nurse should have included behavior monitoring for his antipsychotic medication use. The RNC stated, The behaviors need to be specific and individualized to the resident and monitored and documented every shift. The DON and RNC confirmed behavior monitoring was not completed every shift for resident #157. Review of the facility's Behavior Management Policy and Procedure dated 03/21/2019 read, Policy: Residents with dementia or related disorders are not responsible for their reactions due to the irreversible changes in the brain. Reactionary conduct can only be prevented and controlled by well-trained therapeutic caregivers . Secondary Interventions: The Memory Care Manager/designee and the Charge Nurse shall document and track undesirable reactions or conduct as it occurs in order to maximize the potential for future episodes. Modifications and restructuring of individual resident routines may be needed in order to control the possibility of future episodes . Review of the facility's Psychotropic Medication Management Policy and Procedure, dated 10/24/2022, read, Policy . Psychotropic medication is any medication that effects brain activity's associated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 35 of 47 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 03/03/2023 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 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete with mental process and behavior. These drugs include, but are not limited to , drugs in the fallowing categories: antipsychotic, antidepressant, antianxiety and hypnotic . Procedure: . 4. Monitor behavior and side effects every shift utilizing the Behavior Monitoring Flow Record (BMFR) or electronic equivalent. 5. Resident centered non-pharmacological interventions should be initiated as indicated . The Facility Assessment, documented the facility's ability to provide competent staff with the ability to provide care and services to meet the needs for residents with mental health and behavioral diagnoses. The document read, .manage the medical conditions and medication-related issues causing psychiatric symptoms and behavior, identify and implement interventions to help support individuals with issues such as dealing wish anxiety, care of someone with cognitive impairment, care of individuals with depression, trauma, other psychiatric diagnoses, intellectual or developmental disabilities . Event ID: Facility ID: 105564 If continuation sheet Page 36 of 47 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 03/03/2023 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 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** 2. On 2/27/23 at 7:51 AM, medication administration was observed for resident #5 with LPN H. Observation of the medication label on the blister package showed Trazodone 50 mg tab, give one by mouth at hour of sleep. The medication blister pack had resident #79's name, a resident located in another room. LPN H placed the medication from the blister pack into a medication cup, poured water into a water cup, and proceeded to walk down the hall into resident #5's room with medication and water in hand. LPN H was prompted to stop the medication administration task. She was informed the Trazodone 50 mg medication label had another resident's name and was therefore not dispensed by the pharmacy for resident #5. Residents Affected - Few Upon return to the medication cart, LPN H retrieved the Trazodone medication blister pack. LPN H confirmed there was another resident's name on the label. She confirmed the medication error and said, I am supposed to check for right name, time, dosage, med. LPN H stated she did not check for the resident's name or read the label carefully prior to placing it in the medication cup. She confirmed she was never to use another resident's medications. She stated she was responsible for checking blister pack labels and confirmed she received orientation related to medication administration two weeks ago. On 2/27/23 at 9:09 AM, the Interim DON stated the expectation was nurses would check the physician's order, and verify the right medication, person, dosage, and time. She said,It is a professional standard. The Interim DON stated it was not accepted facility practice to use another resident's medications. She explained if a resident did not have the ordered medication, nurses were to call the doctor, verify the medication, contact the pharmacy, and ask the doctor if the medication could be administered when it arrived from the pharmacy. She stated it was the nurse's responsibility to check and make sure he or she followed physician orders and professional standards for medication administration. On 2/27/23 at 1:41 PM, during medication reconciliation, a physician order dated 2/08/23 for Acetaminophen 500 mg one tablet by mouth three times a day was noted. The order indicated the dose LPN H administered to resident #5 on 2/27/23 at 7:51 AM,during medication administration observation, was a medication error. On 2/27/23 at 1:46 PM, LPN H stated she could ensure administration of the right medication by taking her time. She stated she was now aware that she administered Acetaminophen 325 mg, and not the ordered dosage of Acetaminophen 500 mg. On 3/03/23 at 04:14 PM, a team interview for the Quality Assessment Assurance (QAA) review was conducted with the Administrator and Regional Nurse Consultant (RNC). The RNC stated the facility was not aware nurses administered medications without following physician orders and adhering to professional standards. She explained the Staff Development Coordinator observed nurses during medication administration and was responsible for conducting audits to ensure accuracy. She stated the pharmacy consultant also came into facility and observed nurses during medication administration and did additional audits. The RNC stated audits and pharmacy reports were presented at QAA meetings. Both the RNC and the Administrator acknowledged they were unsure of the last QAA meeting review of pharmacy reports. The Administrator stated medication administration observations concerns did not show up in the last QAA meeting. The RNC added to ensure medication errors did not reoccur, the facility should do internal audits on medication administration. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 37 of 47 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 03/03/2023 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The facility's policy and procedure for Administering Medications revised in April 2019 revealed medications would be administered as prescribed and in a safe manner. The policy read, The individual administering the medication checks the label THREE (3) times to verify the right resident, right medication, right dosage, right time and right method (route) prior to giving the medication. Review of the Facility Assessment revised on 8/18/17 showed on page 8 under the heading Part 2: Services and Care We Offer Based on our Residents' Needs, Resident Support/care needs a section for General Care Medications Specific Care of Practices awareness of any limitations of administering medications Administration of medications that residents need By route: oral, . Etc. Assessment/management of polypharmacy. On page 15 under Education/In-Services a section for Education Nurses for Medication Administration. Timing on Hire/Annual/PRN/On-Demand. Based on observation, interview, and record review, the facility failed to maintain a medication error rate of less than five percent for 2 of 4 residents reviewed for medication administration, of a total sample of 66 residents, (#5 & #112). The facility's medication error rate was 14.81% Findings: 1. Review of resident #112's medical record revealed he was admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses included atherosclerotic heart disease, hypertension, and mini-strokes. On 2/27/23 at 7:49 AM, Licensed Practical Nurse (LPN) M prepared to administer resident #112's eight scheduled morning medications. LPN M stood at the medication cart and crushed all the tablets which included one tablet Isosorbide Mononitrate Extended Release (ER) 30 milligrams (mg) and one tablet Chewable Aspirin 81 mg. He then mixed six crushed tablets, one whole capsule and the contents of one capsule into applesauce in a small plastic cup. On 2/27/23 at 7:57 AM, LPN M approached resident #112 to administer the medication, and was prompted to stop as he raised the spoon to the resident's mouth. On return to the medication cart LPN M was asked to retrieve and read the blister pack for resident #112's Isosorbide Mononitrate ER. He reviewed the blister pack and discovered printed instructions that read, Do NOT CHEW or CRUSH before swallowing. Medication affects blood pressure. He stated he was familiar with his assigned residents and knew resident #112 would spit out his pills if they were not crushed. When asked why Extended Release medication should not be crushed, LPN M explained the medication would be released at a faster rate than intended. Controlled release drugs which include those with the suffixes ER and DR are designed to release medicine over an extended period of time to promote smooth release and a longer duration of action. Crushing may mean a fatal dose is released. Enteric Coated (EC) medications have a special coating to protect the stomach from the drug and/or protect the drug from the action of stomach acid, and promote release of the drug in the intestine (retrieved on 3/10/23 from www.drugs.com). On 2/27/23 at 8:09 AM, the Interim Director of Nursing (DON) was informed that LPN M crushed an ER tablet contrary to instructions on the blister pack. She stated her expectation was prior to medication administration, all nurses would should check all necessary identifiers and follow professional standards related to medication administration to include verification the right medication. The Interim DON explained nurses should check medication lists and containers to ensure medications could be crushed safely. She stated the decision to crush medications should be based on recommendations by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 38 of 47 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 03/03/2023 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the manufacturer and/or pharmacy. The Interim DON stated there would be a physician's order transcribed to the Medication Administration Record regarding crushing medication if not contraindicated. She acknowledged LPN M should have notified the physician resident #112 was no longer able to swallow his medication whole. Review of resident #112's active Order Summary Report during medication reconciliation revealed physician orders for Isosorbide Mononitrate ER 24 hour 30 mg once daily for hypertension and Aspirin EC Delayed Release (DR) 81 mg once daily for clot prevention, not Chewable Aspirin 81 mg as administered by LPN M. The document did not contain a physician order related to crushing medications. Event ID: Facility ID: 105564 If continuation sheet Page 39 of 47 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 03/03/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, record review, and interview, the facility failed to label stored foods in the walk-in refrigerator and defrost frozen foods under running water. Residents Affected - Some Findings: Review of the facility menu revealed broccoli florets would be served at the lunch meal on 2/27/23. During an initial kitchen inspection on 2/27/23 at 6:16 AM, the facility's walk-in refrigerator was observed. There were two half-pans covered with foil paper. One of the pans had lima beans and the other pan contained cooked rice. The pans were not labeled with the date or the contents. The prep sink was filled with water and there were eight bags floating in the water. The water faucet was not running and the sink was not draining. At 6:34 AM, a Dietary Aide drained the prep sink, removed the bags of broccoli and placed them in a steam table pan. The bags of broccoli were warm to the touch and some of the bags of broccoli were full of water. The prep sink did not have a drain stop and the Dietary Aide explained she used one of the bags of broccoli as a drain stop. On 2/27/23 at 6:54 AM, the walk-in refrigerator was observed with the Certified Dietary Manager (CDM). She confirmed the pans of lima beans and rice were not dated or labeled. A large metal bowl on the shelf covered with foil was also not dated or labeled. The CDM removed the foil and said there was pudding in the bowl. A plastic bowl covered with clear wrap was not labeled or dated. The CDM said the plastic container contained tomato sauce. She explained food and leftovers that were stored in the walk-in refrigerator must be labeled and dated. She indicated kitchen staff had been educated on dating and labeling of stored foods. When informed of the bags of broccoli that were soaking in the prep sink, the CDM stated the bags of broccoli should have been defrosted under running water with the drain open. Chapter 3 of the Food and Drug Administration's (FDA) 2022 Food Code noted labeling of foods and the thawing of foods that are completely submerged under running water. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 40 of 47 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 03/03/2023 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility's administration failed to effectively utilize its resources to implement processes to identify and address deficient practices, and failed to provide adequate oversight of staff to ensure the provision of necessary care and services to maintain the highest practicable well-being for all residents. Residents Affected - Many Findings: Review of the Facility Assessment updated on 2/24/23 revealed the facility was a 180-bed skilled nursing facility that could meet the needs of residents with common diseases and special conditions. The document indicated residents would receive care and services as determined by their needs and plans of care to include assistance with activities of daily living (ADL) care, prevention of falls, promotion of skin integrity, medication management and administration, and infection control and prevention. The Facility Assessment revealed the facility's intent to offer person-centered care such as build relationship with resident/get to know him/her; engage resident in conversation.prevent abuse and neglect, identify hazards and risks for residents. The document noted the necessary resources to provide competent care for residents included adequate Administration, Nursing, Food and Nutrition, Pharmacy and Support staff. In order to promote coordination and continuity of care, the facility would strive to arrange consistent and routine assignments, and ensure staff were trained and were competent to meet residents' needs. The document listed training topics and competencies such as Resident Rights, Abuse / Neglect / Exploitation, Infection Control, Medication Administration, Resident Assessment and other Specialized Care. Nursing staff competencies would be reviewed on hire, annually, and as needed. In addition to facility staff, contracted staff for Dietary, Housekeeping, and Laundry services were expected to provide necessary services to meet residents' needs and ensure the facility's operational success. On 3/01/23 at 10:00 AM, the Short Term Social Services Director (SSD) was informed of concerns identified related to addressing residents' concerns, specifically for residents who were bedbound and/or cognitively impaired, and not able to adequately make their needs and desires known to staff or actively pursue resolution themselves. She stated in addition to the facility's official grievance process, issues that affected vulnerable residents could be identified during Angel Rounds. The Short Term SSD explained the program involved members of management rounding on assigned rooms every morning. She showed a checklist titled Mock Survey (Quality Assurance) that instructed management staff on required observations and to ensure resident is without grievances/concerns. When asked about a specific resident, the Short Term SSD checked the Angel Rounds assignment sheet and explained the resident was in one of five rooms assigned to the Assistant Business Office Manager (BOM). The Short Term SSD stated the facility no longer had an Assistant BOM and said, That person left a while ago. We have a back up person, the Business Office Manager. On 3/01/23 at 10:24 AM, the BOM stated she had been on staff for approximately three months and there was no Assistant BOM during that period. She said, I have never been told to Angel Rounds. She was shown the Mock Survey (Quality Assurance) form which indicated she was assigned to to daily rounds of five rooms and serve as back up for the Assistant BOM in another five rooms. The BOM stated she had never seen the checklist. She acknowledged if daily Angel Rounds were completed, the concerns of residents in those rooms would probably have been noticed and addressed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 41 of 47 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 03/03/2023 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 0835 Level of Harm - Minimal harm or potential for actual harm On 3/01/23 at 11:00 AM and 3/02/23 at 9:47 AM, the Administrator confirmed the facility no longer had a functional Angel Rounds program in which management staff were assigned to daily room and resident rounds. He said, I stopped the program. because we have changed so many staff members and have all new management staff. The Administrator acknowledged the program would be an effective method of identifying important issues that affected residents' comfort and well-being. Residents Affected - Many On 3/03/23 at 1:06 PM, Licensed Practical Nurse (LPN) Minimum Data Set (MDS) Coordinator T explained issues identified related to obtaining and implementing physician orders, following interdisciplinary team recommendations, and ensuring continuity of care for residents through the chart review process were in large part attributable to lack of adequate oversight from nursing management. She explained the facility had not been staffed with consistent Unit Managers or a Director of Nursing for several months. LPN MDS Coordinator T stated as a result, the daily clinical meeting had not been as effective as required. She stated concerns identified related to grievances and advance directives were the responsibility of the Social Services department which had also been short-staffed for a while. On 3/03/23 at 3:34 PM, a meeting was held with the facility's Administrator and the Regional Director of Clinical Services (RDCS). They confirmed a resident successfully eloped from the facility on 12/19/22. The Administrator and RDCS were informed the resident and facility staff reported a previous elopement attempt approximately five days before the actual elopement. They denied knowledge of any previous elopement attempts by the resident and could not explain why the incident investigation did not reflect the previous attempt and increased risk. The RDCS confirmed the facility did not define increased or enhanced supervision to ensure direct care staff could provide appropriate care and supervision to prevent additional elopements. The Administrator acknowledged although the facility had recently decreased use of Certified Nursing Assistants from staffing agencies, they continued to rely heavily on nurses from staffing agencies. The RDCS validated reliance on agency nurses who were not familiar with residents and the facility's policies and procedures, in conjunction with lack of general oversight of nursing staff were contributing factors to the breakdowns noted in resident care and services. She explained experienced nurses had been filling in for open Director of Nursing (DON), Assistant Director of Nursing (ADON), and Unit Manager (UM) positions, but the facility experienced the outcomes of overall lack of stability in Nursing department leadership. The Administrator recalled since November 2022, the facility had gone through two DONs, two Interim ADONs, and two UMs who lasted no more than one month. He acknowledged daily clinical and department head meetings were still conducted but might not be as productive as they should be. He stated the facility never considered a moratorium on admissions despite the known concerns in the Nursing department. The Administrator and RDCS were informed of a staff CNA who did not know how to locate the [NAME] or CNA care plan in his assigned resident's medical record, an LPN on staff for one year who verbalized he never received education or showed competency in medication administration and wound care, a repeated medication error 24 hours after the the initial error was brought to the attention of nursing management, and multiple residents who received crushed, controlled release medications despite contraindication. The RDCS acknowledged all nursing staff should receive education on hire to ensure they met the facility's standards. She stated the identified medication error was repeated due to lack of communication between nursing management staff. Review of the job description for Director of Clinical Services or DON (undated) revealed the purpose of the position included ensuring .the highest degree of quality care is maintained at all times. The DON's duties and responsibilities included hiring a sufficient number of staff and directing the Nursing and care plan team. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 42 of 47 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 03/03/2023 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 0835 Level of Harm - Minimal harm or potential for actual harm Review of the job description for Executive Director I or Administrator (undated) revealed duties and responsibilities were to recruit, hire and provide adequate orientation and training to ensure the facility had a sufficient number of qualified staff, and to ensure a safe, clean and comfortable environment. The functions of the Administrator's position included .provide leadership to all facility staff in meeting the goal of providing quality resident care. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 43 of 47 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 03/03/2023 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 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 maintain proper infection control practices to prevent contamination during medication administration for 1 of 4 residents reviewed for medication administration (#112), and during wound care for 1 of 1 resident observed for wound care of 5 residents reviewed for skin conditions and pressure injuries (#44), of a total sample of 66 residents. Residents Affected - Few Findings: 1. Review of resident #112's medical record revealed he was admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses included atherosclerotic heart disease, hypertension, and mini-strokes. On 2/27/23 at 7:49 AM, Licensed Practical Nurse (LPN) M prepared to administer resident #112's scheduled morning medications. He did not perform hand hygiene prior to beginning the task although a bottle of alcohol-based hand sanitizer was on the medication cart. LPN M retrieved two capsules Gabapentin 100 milligrams (mg) and added them to the small plastic cup that contained other scheduled medications. LPN M explained he had to crush the resident's tablets as he would not swallow them whole, but the capsules could not be crushed so he had to open them to access the medication. LPN M unsuccessfully attempted to separate the Gabapentin capsules from the tablets by pouring them into another plastic cup. He checked the drawers of the medication cart, did not find gloves, and used his finger to scoop the Gabapentin capsules from the cup with the tablets into an empty cup. Next, LPN M picked up a capsule with his fingers, pulled it apart at the middle, and rolled each half of the capsule between his thumbs and index fingers to empty the medication into the plastic cup. LPN M repeated the process with the second Gabapentin capsule. On 2/27/23 at 7:57 AM, LPN M approached resident #112 to administer the medication, and was prompted to stop as he raised the spoon to the resident's mouth. On return to the medication cart, LPN M was informed of concerns related to the lack of hand hygiene and touching medication with his bare hands. LPN M acknowledged he should have used the hand sanitizer before starting the medication administration task, and applied gloves prior to touching the Gabapentin capsules. On 2/27/23 at 8:09 AM, the interim Director of Nursing (DON) stated her expectation was nurses would perform hand hygiene prior to the medication administration task. She stated LPN M should have paused the task to get gloves and not touch resident #112's tablets and/or capsules with his fingers. The facility's policy and procedure for Administering Medications revised in April 2019 revealed medications would be administered as prescribed and in a safe manner. The policy revealed nurses would follow the facility's infection control procedures related to handwashing and glove use during medication administration. 2. Review of the medical record revealed resident #44 was admitted to the facility on [DATE], and re-admitted on [DATE]. His diagnoses included cerebrovascular disease, Alzheimer's disease, and protein-calorie malnutrition. The Minimum Data Set (MDS) Significant Change in Status assessment with assessment reference date of 11/29/22 revealed resident #44 had four unhealed pressure injuries. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 44 of 47 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 03/03/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm Review of resident #44's medical record revealed a care plan for pressure ulcers, initiated on 7/20/22. The care plan indicated as of 2/14/23, the resident's pressure ulcers were located on his sacrum, right hip, right heel, and right lower leg. The goal read, The resident's Pressure injury will show signs of healing and have minimal risk of infection. Interventions included a wound physician consult and administer treatments as ordered. Residents Affected - Few The Treatment Administration Record revealed Wound Care physician orders dated 3/01/23 that included a twice daily treatment to the resident's right hip wound. The order directed nurses to irrigate the wound with 1/2 strength Dakin's solution, apply skin prep to the peri-wound area, lightly pack the wound bed with Santyl ointment and moist gauze, cover with foam, and secure the dressing with tape. On 3/01/23 at 1:38 PM, LPN M prepared to performed wound care for resident #44's right hip wound. He explained the resident had a wound infection and staff were required to wear personal protective equipment when providing care. LPN M removed a gown and gloves from the caddy on the door and donned them without performing hand hygiene. LPN M pointed to the treatment and dressing supplies on resident #44's overbed table. The items included packets of 4 inch x 4 inch gauze, border dressings, individual tubes of normal saline solution, a bottle of 1/2 strength Dakin's solution, a tube of Santyl ointment, and two pairs of gloves. They were scattered across the overbed table in a disorganized manner, with no barrier between the treatment supplies and the surface of the table. A bottle of the resident's tube feeding solution was on the overbed table with the treatment supplies. LPN M positioned the overbed table to place the supplies within reach and then realized he did not have a trash can nearby. He walked around the bed, picked up a trash can with his gloved hands, and carried it to the far side of the bed. Next, without removing his dirty gloves or performing hand hygiene, LPN M reached across the resident to move the bottle of tube feeding to the edge of the overbed table. He then touched and rearranged the packets of gauze packets and dressing supplies. LPN M repositioned resident #44 to his left side and removed the dressing was saturated with a large amount of serosanguinous drainage, from the right hip wound. He dropped the soiled dressing in the trash and removed the gauze packing from the wound bed. Still wearing the same gloves, LPN M picked up the bottle of Dakin's solution, unscrewed the cap, placed it on the table and poured the Dakin's solution which spilled over the side of the cap onto the table. Next, he opened a package of gauze, dipped a corner of the gauze into the Dakin's solution and used it to clean resident #44's right hip wound. He repeated the process two more times and then screwed the cap back onto the bottle. LPN M then opened another package of gauze, moistened the gauze with normal saline, picked up tube of Santyl ointment, squeezed the medication along the length of the gauze, and touched the tip of the tube to the gauze before he replaced the cap. LPN M packed resident #44's wound with the gauze and covered with a bordered gauze dressing. LPN M used the same gloves throughout the entire wound care procedure. On 3/01/23 at 1:55 PM, LPN M validated he did not perform hand hygiene before or during wound care, did not change gloves between clean and dirty tasks and should have removed his gloves after he touched the trash can. However, he explained use of the Dakin's bottle cap was acceptable as each time he dipped a clean gauze pad into the solution. He was informed the gauze was clean prior to removal from the package, and reminded that he held every item with dirty gloves. He said, I don't know what the facility policy and procedure is for wound care and dressing changes. He picked up a clean pair of gloves and was prompted not to perform the resident's three additional wound treatments until a member of nursing management addressed the identified infection control concerns. On 3/01/23 at 2:01 PM, the Interim [NAME] Wing Unit Manager (UM) was informed of the breaks in infection control during resident #44's right hip wound care. She observed the overbed table with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 45 of 47 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 03/03/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few scattered treatment supplies and spilled Dakin's solution and immediately stated the supplies should be on a Styrofoam tray or other type of barrier. She explained the resident's bottle of tube feeding should not in the vicinity of treatment supplies. The Interim [NAME] Wing UM expressed concerns related to continued wound care with use of the same gloves after touching the trash can and the soiled and saturated dressings as the resident had a wound infection. She acknowledged there was only one pair of gloves on top of the scattered treatment supplies and no hand sanitizer, but LPN M should have been prepared to change gloves and do hand hygiene multiple times during care of resident #44's four wounds. The Interim [NAME] Wing UM stated the Santyl ointment should have been placed in a plastic cup prior to starting the procedure to prevent contamination of the tube, and the cap of the Dakin's solution should not have been used as a container and then returned to the bottle. She explained the bottle of Dakin's solution should be discarded to avoid other residents being affected, and the treatment for resident #44's right hip wound needed to be re-done using proper infection control practices. Review of the facility's policy and procedure for Dressing Change revised on 12/06/17 revealed clean dressings would be applied to wounds to promote healing. The procedure directed nurses to assemble equipment including a bag for disposal of soiled dressings. The document read, Place supplies on a prepped work surface, perform hand hygiene, apply gloves, remove and dispose of soiled dressing, remove gloves, perform hand hygiene, apply gloves, evaluate wound. cleanse wound as ordered, dispose of gauze, remove gloves and perform hand hygiene, apply treatment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 46 of 47 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 03/03/2023 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure residents completed pneumococcal vaccine consent forms and received pneumococcal vaccines upon request, for 2 of 5 residents reviewed for immunizations, out of a total sample of 66 residents, (#120 & #137). Residents Affected - Few Findings: 1. Review of the medical record revealed resident #120 was originally admitted to the facility on [DATE] and readmitted on [DATE]. The medical record indicated pneumococcal vaccine consent was obtained by telephone consent from the resident's guardian on 12/28/21. The box was checked to note the facility received permission to administer the pneumococcal vaccine. Review of the immunization audit report and the Medication Administration Records did not reveal administration of the pneumococcal vaccine to resident #120. 2. Review of the medical record revealed resident #137 was admitted to the facility on [DATE], with a previous admission on [DATE]. Review of the electronic medical record's immunization section, and the immunization audit report dated 3/02/23 showed no pneumococcal vaccine administration documentation by nursing staff. Review of the resident's pneumococcal vaccine consent showed the resident's signature dated 11/23/22 with no documentation under box number one for acceptance to give with permission to administer, box number two for offered pneumococcal vaccine and declined, or box number three for offered pneumococcal vaccine but already received. Resident #137's pneumococcal vaccine consent showed incomplete documentation as none of the boxes were selected. On 3/01/23 at 11:05 AM, the Interim Director of Nursing (DON) stated pneumonia vaccines were offered upon admission. She stated nurses would obtain consents with signature and then administer and document the vaccine when given. On 3/02/23 at 1:45 PM, the Director of Clinical Services from the sister facility stated she was unable to locate documentation identifying if the vaccines were administered. She confirmed nurses did not administer the pneumococcal vaccines. On 3/02/23 at 1:53 PM, the Interim DON stated immunizations were part of the admission process. She explained nurses were to administer the vaccine if the resident consented or hold the vaccine if they declined. She noted the Staff Development Coordinator was responsible for monitoring the documentation and the DON was ultimately responsible. She acknowledged the pneumococcal vaccines were not given. The facility's Pneumococcal Vaccine Policy revised October 2019, showed All residents will be offered pneumococcal vaccines to aid in preventing pneumonia/pneumococcal infections. Under Policy Interpretation and Implementation number 2 revealed Assessments of pneumococcal vaccination status will be conducted within 5 days(5) working days of the resident's admission if not conducted prior to admission. Number 4 revealed Pneumococcal vaccines will be administered to residents (unless medically contraindicated, already given, or refused) per our facility's physician- approved pneumococcal vaccination protocol. Number 6 showed For residents who receive the vaccines, the date of vaccination, lot number, expiration date, person administering, and the site of vaccination will be documented in the resident's medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 47 of 47