Health inspection·January 11, 2024

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was moving from side to side in the bed. LPN B said this behavior was a change from the last time she worked with the resident. She recalled the resident had an order for an intravenous line, and they were about to start antibiotic therapy, because her labs were abnormal. LPN B stated the resident's family visited and requested the resident be transferred to the hospital, as they did not want to wait for the treatment to start. LPN B acknowledged the resident was having pain but said she did not recall if any pain medication was given to the resident prior to her transfer to the hospital. On 1/10/24 at 2:14 PM, LPN A recalled the resident's condition started possibly on 12/24/23. She verbalized the resident was not drinking or eating and was lethargic and she notified the physician. She explained stat labs were done, and IV fluids were ordered. LPN A stated she spoke with the resident's daughter and received consent to start the IV line. LPN A said IV services had not come to the facility to insert the IV line, and IV fluids ordered by the physician was not started before her shift was completed at 3 PM. She indicated she gave report to the oncoming nurse and she did not work the next day, on 12/25/23. She reported she was unsure when the IV services responded. LPN A explained the process for IV services, included physician orders, obtaining consent for the insertion, calling the IV Services to place the order, and placing original order in the IV services binder kept at the nurse's station. On 1/10/24 at 2:44 PM, the Director of Nursing (DON) confirmed the process for IV services explained by LPN A. The DON stated that before the IV Services came out, nurses were told to at least attempt to insert a peripheral line. The DON noted that if the first two attempts to insert the IV line were unsuccessful, then they should call IV services. The DON stated that a Registered Nurse (RN) attempted once and was unsuccessful. She verbalized she was unsure of the time IV services was called, but as per the nurse, it was immediately after she could not get the IV line inserted. The DON stated resident #1 started to refuse fluids and food on 12/23/24. On 12/24/23, the physician was notified again as the resident continued to refuse fluids and food. She explained physician orders were obtained for labs, and to start IV fluids. She stated the resident was admitted to the facility on [DATE], and was already in acute renal failure, and her labs were worsening. She explained that when the lab results were reviewed, the physician changed the IV fluids, and also ordered an antibiotic for possible sepsis. The DON recalled that on 12/25/23 she was informed the resident's daughter was upset and she spoke with the daughter. She indicated the daughter wanted the resident transferred to the hospital, as the resident was in pain. The DON stated the resident was hitting her head against the side rail, smacking her forehead with her hands, and looked uncomfortable. She said the resident was sent to the hospital via 911. The DON recalled she was told IV services came and could not get the IV line started and they had to send another nurse. She said If she had been made aware of this, she would have directed staff to send the resident to the hospital. She said she did not expect to get a call regarding a new order for IV fluids but expected to be informed of the unsuccessful attempt to insert the IV line and the delay of IV services. She stated she was not aware of the situation, until she was told the resident's daughter wanted to talk with her. The DON verbalized that record review revealed the IV line was inserted on 12/25/23 at 12:18 PM, approximately 24 hours after the order was obtained. She stated her expectation was that nurses would have treated the order with urgency and expected a quick response time from the IV services. She verbalized that a resident could decompensate quickly, and nurses needed to notify the physician of any change in condition. The DON confirmed that there was no documentation in the resident's clinical record to indicate the physician was made aware of the delay by IV services, and delay in implementing orders for IV fluids. On 1/11/24 at 12:01 PM, the Medical Director stated resident #1 was admitted to the Memory Care Unit with history of dementia. He recalled during the Christmas weekend, the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 2 of 4 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 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 - Minimal harm or potential for actual harm Residents Affected - Few facility placed a call to the on-call service, and reported the resident was not eating or drinking but was taking her medications. He stated that based on the on-call report, labs, and reports showed worsening chronic kidney disease. He recalled an IV midline placement was ordered on 12/24/23 but when he rounded in the facility on 12/25/23, the resident did not have an IV midline, and had not received IV fluids. He said he was informed there was an issue with the IV team coming to the facility on [DATE]. He verbalized the resident's behavior was out of her baseline, but her heart rate was stable. He recalled he was very concerned because of her altered mental status, and abnormal labs. The Medical Director explained his expectation was that orders would be carried out, and for nurses to notify the physician of the IV services delay, so the provider could triage appropriately. He said resident #1's vital signs were stable, her labs were severe, and his decision would have been to send the resident to the hospital. He stated it is a disservice if interventions were not implemented. He said the goal was to take care of what can be taken care of in a safe manner in their setting and educating nursing staff that as a clinician he can feel comfortable in adhering to that goal. He explained his expectation was that within 4 hours, the IV team would respond to the order/request. If an order for IV fluids was given, he would want that order carried out within 4 to 12 hours, not 24 hours. Review of the hospital records dated 12/25/23 revealed the Emergency Department (ED) diagnosis for resident #1 was urinary tract infection, dehydration, acute kidney injury, and hypernatremia. Review of the Patient Care Timeline revealed the resident arrived in the ED on 12/25/23 at 4:40 PM, via Emergency Medical Services with a complaint of altered mental status. Assessment revealed the resident was confused, crying, oriented to person, and restless. Pain assessment using the Wong-Baker FACES pain rating revealed the resident Hurts whole lot, and the pain was described as acute, and location was the head. The Emergency Department Physician Note with date of service of 12/25/23 at 5:16 PM revealed the resident's chief complaint was altered mental status. Physical exam showed hematoma to her forehead, and the resident was disoriented, confused, and uncooperative. Documentation revealed the resident appeared thin with dry mucous membranes and altered mental status .noted to have a hematoma to her forehead .CT head obtained showing no acute process. Labs obtained showing hypernatremia, hyperglycemia, elevated creatinine, leukocytosis and elevated troponin. The patient was given fluid .Urinalysis obtained showing pyuria .she was started on Cefepime and Vancomycin and given additional fluid . Patient will be admitted to PCU (Progressive Care Unit) .Diagnosis urinary tract infection, dehydration, acute kidney injury, hypernatremia, atrial fibrillation. Hypernatremia is the medical term to describe too much sodium in your blood (Retrieved on 1/17/24 from webmd.com) Hyperglycemia is when there's too much glucose (sugar) in your bloodstream. (Retrieved on 1/17/24 from webmd.com) Leukocytosis refers to an increase in the total number of white blood cells .can be caused by infection, inflammation .or other miscellaneous causes. (Retrieved on 1/17/24 from emedicine.medscape.com) Pyuria is the presence of an excess of white blood cells in your urine. (Retrieved on 1/17/24 from webmd.com) Cefepime and Vancomycin are antibiotics (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 3 of 4 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 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 - Minimal harm or potential for actual harm Residents Affected - Few The Hospital History and Physical documentation read, In the ER, patient was noted to be severely dehydrated .also noted to have UTI (Urinary Tract Infection) admitted for further management Patient blood sugar continued to trend up .Patient noted to be in DKA .consulted ICU for upgrade. Diabetic Ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. (Retrieved on 1/17/24 from www.cdc.gov) Additional hospital record review revealed the resident was admitted to ICU on 12/26/23 at 3:55 AM. The facility's policy Notification of Change in Condition with effective date of 11/30/2014, and revision date of 12/16/2020 directs staff to promptly notify the attending physician when there is a change in the resident's status or condition. The document read, The nurse to notify the attending physician .when there is a(n) . significant change in the patient/resident's physical, mental or psychosocial status. Need to alter treatment significantly .Discontinuation of a current treatment due to but not limited to: . acute condition. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105564 If continuation sheet Page 4 of 4