Health inspection·March 16, 2023

F 0644 diagnoses. She validated the facility did not refer resident #27 for a Level II PASARR screening as required, based on her diagnoses. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 2 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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** Based on observation, interview, and record review, the facility failed to implement the plan of care and follow physician orders for 1 of 2 residents reviewed for tube feeding management out of a total sample of 45 residents, (#2). Findings: Review of the medical record revealed resident #2 was initially admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses of quadriplegia or paralysis of all extremities, gastrostomy tube, gastroesophageal reflux disease, and brain disorder. 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 4/03/23 from www.my.clevelandclinic.org). Review of the Minimum Data Set Annual assessment dated [DATE] revealed the resident had short and long-term memory loss, was totally dependent on two staff for activities of daily living, and required a feeding tube for nutrition. Review of the Enteral Feeding care plan revealed a focus of nutritional risk, nothing by mouth, and a G-tube as the only means of nutrition, hydration, with dependence on staff for intake. The interventions directed nurses to administer enteral feedings and water flushes as medically prescribed. Review of physician orders revealed an order dated 3/11/23 for Jevity 1.5 tube feeding continuously at 50 milliliters per hour for 24 hours. An order dated 12/06/22 indicated the tube feeding spike set was to be changed every 24 hours and as needed. The tube feeding spike set is used to access a sterile, pre-filled tube feeding formula by piercing the seal on the container (retrieved on 4/03/23 from www.med.virginia.edu). On 3/12/23 at 4:17 PM, resident #2's Jevity 1.5 tube feeding infused as ordered. The tube feeding container was dated 3/11/23 and the tube feeding spike set was dated 3/09/23. On 3/12/23 at 4:22 PM, in a joint observation with Licensed Practical Nurse Supervisor O, she confirmed resident #2's tube feeding spike set was dated 3/09/23. She validated the date on the tubing indicated it was changed three days ago and said, It is supposed to be changed every 24 hours. She stated nurses were responsible for following the physician's order to change the tube feeding spike set, and explained it was to be changed at least daily during the 3:00 PM to 11:00 PM shift. On 3/13/23 at 5:05 PM, the Director of Nursing (DON) stated her expectation was nurses would follow the physician's order regarding changing the tube feeding spike set. She explained nurses should verify the order and ensure they had all necessary equipment to complete the task. The DON confirmed all nurses received education regarding tube feeding care and services, and she acknowledged she was ultimately responsible for the Nursing department. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 3 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 The facility's Medication Administration Enteral Tubes Policy dated January 2023 read, The nursing care center assures the safe and effective administration of enteral formulas and medications. Election of enteral formulas, routes and methods of administration, and the decision to administer medications via enteral tubes are based on nursing assessment of the residents' condition, in consultation with the physician, dietitian and pharmacist. 3. Enteral formulas, equipment, route of administration, and rate of flow are selected based on an assessment of the resident's condition and need. The manufacturer's instructions for the tube feeding spike set read, . 13. Discard after 2 hours of initial usage. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 4 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide care and services to identify, monitor and treat pressure injuries for 2 of 3 residents reviewed for pressure ulcers, of a total sample of 45 residents, (#214 and #17). The facility's failure to evaluate alterations in skin integrity and implement appropriate treatments timely resulted in actual harm. Residents Affected - Few Resident #214 was identified to have 2 new facility acquired pressure ulcers/injury identified 15 days after being admitted to the facility. The resident had one stage II pressure wound on her left buttock and an unstageable pressure wound on her sacrum. The facility failed to identify the wounds at an early stage and failed to implement timely treatment and preventable measures. Findings: Pressure ulcers happen when you lie or sit in one position too long and the weight of your body against the surface of the bed or chair cuts off blood supply. If found early there is a good chance they will heal in a few days with little fuss or pain. Without treatment they can get worse. The most important thing to do with any pressure sore is to stop the pressure. If you spend a lot of time in bed, try to move at least every two hours. Stage 2: Skin is broken , leaves an open wound. The sore may ooze clear fluid or pus and it is painful. Stage 3:The sore has gone through the second layer of skin into the fat tissue. It looks like a crater and may have a bad odor. Stage 4: The sore is deep and big. You may be able to see tendons, muscles and bone. Unstageable: is when you can't see the bottom of the sore, so you don't know how deep it is. It can only be staged once it is clean out. (Web MD at www.webmd.com, retrieved 3/24/23) Resident #214 was admitted to the facility on [DATE] from an acute care hospital with diagnoses that included cerebral infarction, altered mental status, type 2 diabetes, and dementia. The resident's quarterly Minimum Data Set (MDS) assessment dated , 2/26/23 indicated the resident had severe cognitive impairment and was rarely or never understood. The resident required total dependence of two staff persons for bed mobility, transfers, toilet use, and total dependence of one person for dressing, eating and personal hygiene. She was bed or chair bound and always incontinent of bowel and bladder. The assessment indicated the resident had no pressure ulcers but was at risk for developing pressure ulcers. Review of the resident's medical record revealed a care plan initiated on 2/22/2023 for wound risk with interventions to assist to turn/reposition as needed. A care plan for Activities of Daily Living (ADL) initiated on 2/22/2023 included an intervention that resident was totally dependent on staff for ADL's. Review of the Order Summary Sheet dated 2/22/2023 showed an order for Skin Checks Every Shift for 3 days to end on 2/25/2023. There was no evidence in the medical record to show the resident's skin (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 5 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0686 checks were completed every shift for three days. There was only one Weekly Skin Check form completed on 2/22/23 that noted no skin impairment. There were no other skin assessments found. Level of Harm - Actual harm Residents Affected - Few Review of a Skin and Wound Evaluation form completed on 3/09/23 showed the resident now had two wounds, a Stage 2 to her left buttock and an unstageable wound to her sacrum. The Stage 2 left buttock pressure wound measured 2.6 centimeters (cm) by 1.0 cm with light serosanguinous exudate. The unstageable sacrum pressure wound measured 5.8 cm by 4.9 cm and 2.0 cm deep. with 100% slough and moderate serosanguinous exudate. A care plan for actual wound initiated the same day, on 3/9/23, noted the resident had an actual wound on her sacral area and left gluteus. Interventions included for the Certified Nursing Assistant (CNA) to encourage/remind/assist to turn/reposition as needed, pressure reducing mattress, and nursing to monitor wound weekly. An incontinence care plan implemented on 3/13/2023 noted nursing should observe condition of skin with each incontinent episode. On 3/14/23, the unstageable sacrum measured 6.2 cm, by 4.9 cm, and 1.8 cm in depth. The wound was 20% granulation and 80% slough with moderate serosanguinous exudate and noted the wound dressing was saturated. On 3/14/23 at 1:26 PM, CNA N stated she tried to reposition her residents but, we cannot always do it every two hours but I try. When there are only four of us, it is hard to do everything that we need to do for the residents. On 3/15/23 at 4:04 PM, the Assistant Director of Nursing (ADON) verified resident #214 was admitted three weeks ago with intact skin and now had 2 acquired pressure ulcers. On 3/16/23 at 1:45 PM, the Director of Nursing (DON) stated she did wound rounds with the ADON and Unit Manager on Tuesdays. She said she tried to spot check the residents at least weekly to make sure they were getting turned and repositioned. She stated her expectation was that the residents get turned every 2 hours. She acknowledged the skin checks for resident #214 were not done which would have identified areas of concern before they developed into actual pressure wounds. On 3/15/23 at 11:44 AM, in a telephone interview, the resident's daughter-in-law stated the family was very distressed the resident had two pressure ulcers. She said she had never had a pressure ulcer before and it had not even been a few weeks before she got the wounds. She recalled the facility just put the resident on the air mattress a few days ago. She stated the family was praying the wounds get better quickly because the resident did not need another infection. 2. Resident #17 was admitted to the facility on [DATE] and readmitted from an acute care hospital on 1/27/23 with diagnoses of acute embolism and thrombosis of right iliac vein, pyelonephritis, low back pain, malignant neoplasm of bladder. The resident's quarterly MDS assessment dated [DATE] revealed he had moderate cognitive impairment with a Brief Interview for Mental Status score of 10/15. The assessment noted he required extensive assistance of two staff for bed mobility and transfers and extensive assistance of one person for dressing, toileting, personal hygiene and eating. He had an indwelling urinary catheter and was always incontinent of bowel. He had occasional moderate pain and was admitted with an unstageable pressure ulcer. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 6 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0686 Level of Harm - Actual harm Residents Affected - Few The Skin and Wound Evaluation dated 1/31/23 indicated the resident was readmitted from the hospital with an unstageable pressure ulcer to his sacrum that measured 3.8 cm in length by 2.8 cm in width and 1.8 cm deep with 80% slough and light serosanguinous exudate. On 3/15/23 the wound measured 4.3 cm by 3.7 cm, and 1.7 cm deep with 80% slough and moderate serosanguinous exudate with surrounding tissue erythema. Review of the weekly skin checks noted the resident's skin assessments were done on 2/06/23, 2/13/23 and 3/06/23. No other weekly skin checks could be located. There were no weekly skin assessments done on 2/20/23 or 2/27/23. On 3/16/23 at 1:45 PM, the DON stated her expectation was that skin assessments be done weekly and acknowledged the skin checks were missed for resident #17. The Wound Prevention and Treatment Overview Policy and Procedure, dated October 2021 read: Review skin integrity on a weekly basis as a proactive approach enabling the facility staff to identify possible changes in skin integrity/condition. The Registered Nurse job description read: Ensures that resident are handled properly, specifically lifting, turning , moving, positioning. Observes and reports the presence of pressure areas and skin breakdowns to prevent ulcer. The CNA job description read: Turns and repositions residents. Observes and reports the presence of pressure areas and skin breakdowns to prevent ulcer. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 7 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to provide podiatry services for 1 of 3 residents reviewed for Activities of Daily Living (ADLs), out of a total sample of 45 residents, (#44). Residents Affected - Few Findings: Review of the medical record revealed resident #44 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of encephalopathy or brain disorder, lack of coordination, chronic respiratory failure, and osteoarthritis of his left shoulder. Review of the Minimum Data Set (MDS) admission assessment dated [DATE] revealed a Brief Interview for Mental Status score of 2 out of 15 which indicated severe cognitive impairment. The MDS assessment showed the resident required extensive assistance to total dependence on staff for ADLs including hygiene and bathing. Review of the resident's care plan for ADLs revealed interventions to provide assistance as indicated. The medical record included a physician order dated 2/07/23 that read, Podiatry services as needed. On 3/12/23 at 10:45 AM, resident #44 was in bed with his feet uncovered. The toenails on both the right and left feet were long, and some toenails grew downwards and curved underneath his toes, while others were approximately half inch long, discolored, thick, brittle, and/or splitting. On 3/13/23 at 5:05 PM, the Director of Nursing (DON) stated the facility's practice was to have the podiatrist visit weekly to evaluate and treat the residents whose names were placed in a designated podiatry book at the nurses' station. The DON explained the Social Services Director (SSD) would follow up. On 3/14/23 at 10:54 AM, the SSD explained her responsibilities included advocacy for residents to assist them with obtaining ancillary services such as podiatry care. She stated nurses would enter the name of any resident who needed to be seen by the podiatrist into the book on the unit. She stated the podiatrist visited the facility either once weekly or once every two weeks. The SSD stated she was never made aware of any concerns regarding resident #44 requiring arrangements for podiatry services. On 3/14/23 at 11:47 AM, Licensed Practical Nurse (LPN) Supervisor O stated toenail care was included in normal ADL care, but there were exceptions. She explained residents' names would be added to the podiatry list if they were diabetic, if Certified Nursing Assistants (CNAs) reported toenails were too thick for them to cut, or if a podiatry visit was requested by the resident or a family member. LPN Supervisor O confirmed weekly skin checks conducted by nurses included monitoring of residents' feet. On 3/14/23 at 12:25 PM, resident #44 validated his toenails were too long and he wanted them to be cut, but he had not yet been seen by a podiatrist. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 8 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0687 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the 100-Unit Podiatry book revealed the names of residents to be seen by the podiatrist with dates visits were requested between 4/11/22 and 2/28/23, with the last date a resident was seen noted as 3/06/23. Resident #44's name was not listed in the Podiatry book to indicate he required a visit from the podiatrist. On 3/14/23 at 12:52 PM, CNA Q stated residents' feet were to be washed and socks changed every day. She explained if she noticed a resident with long toenails, she would notify the nurse. On 3/16/23 at 9:58 AM, the DON removed the sock from resident #44's right foot and confirmed the second toenail was one centimeter (cm) long. She said,It's a little long. He can use a visit with the podiatrist. She proceeded to remove the sock from the resident's left foot and validated the second and third toenails were curved underneath the toes. The DON stated the resident's toenails measured one cm and had jagged edges. She said, If he is not on the list for the podiatrist, I will see about him being put on the list to be seen by the podiatrist. The facility's Process / Guidance for ADL assistance (undated) revealed staff would provide assistance with ADLs per plan of care or CNA care plan, to include assistance with routine hygiene, grooming, and nail care. Review of the Facility Assessment dated 8/18/17 showed the facility would provide general care and services including ADL care. The document read, Part 3: Facility Resources Needed to Provide Competent Support and Care for our Resident Population Every Day and During Emergencies Staff type 3.1.Medical/Physician Services (e.g., Medical Director, Attending Physician, Physician Assistant, Nurse Practitioner, Dentist, Podiatrist, ophthalmologist). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 9 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents received appropriate services to prevent further decrease in range of motion related to application of hand splints for 2 of 2 residents reviewed for limited range of motion, out of a total sample of 45 residents, (#53 and #83). Findings: 1. Review of the medical record revealed resident #53 was admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses including Alzheimer's disease, paralysis affecting right dominant side, contractures of the right hand, left hand, right lower leg, and right elbow, muscle contractures at multiple sites, lack of coordination, and muscle wasting atrophy. A contracture is a fixed tightening of muscle, tendons, ligaments or skin. It prevents normal movement of the associated body part. (retrieved on 4/03/23 from www.medlineplus.gov). The Minimum Data Set (MDS) Quarterly assessment with assessment reference date (ARD) of 12/07/22 indicated the resident had short and long-term memory deficit. Resident #53 was totally dependent on staff for all activities of daily living (ADLs) including bed mobility, transfers, dressing, toilet use, and personal hygiene. On 3/12/23 at 11:49 AM, resident #53 was noted to have contracted right and left hands, but no splints in place. Review of the medical record showed a physician order dated 9/03/21 for restorative nursing as needed. Review of the resident's care plan for range of motion included interventions for bilateral palm guard splints as tolerated, right elbow extension splint as tolerated, and observe and report any decline in range of motion. On 3/13/23 at 5:54 PM, and 3/14/23 at 12:16 PM, resident #53 was observed without splints, braces, rolled washcloths, or carrot-shaped soft splints in her hands. On 3/14/23 at 12:33 PM, Registered Nurse (RN) L confirmed resident #53's hands were contracted and she did not have any type of splinting device applied. He said, She should have something in her hands. RN L was unsure if resident #53 received range of motion services from restorative nursing staff or therapy staff. On 3/14/23 at 12:52 PM, Certified Nurses Assistant (CNA) Q explained she usually applied residents' splints and range of motion exercises were done by restorative nursing staff. During review of resident #53's electronic CNA care plan or Kardex she noted there were no directions or instructions regarding range of motion or hand splints for the resident. CNA Q referenced the Kardex and said, Not here. On 3/15/23 at 11:52 AM, Licensed Practical Nurse (LPN) Supervisor O stated either the assigned CNA or therapy staff applied residents' palm guards and visually checked to make sure palm guards were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 10 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0688 provided. Level of Harm - Minimal harm or potential for actual harm On 3/14/23 at 11:54 AM, the Director of Nursing (DON) stated initially therapy staff screened residents for contractures, then they would make recommendations or design a program for the resident. She stated interventions and orders depended on the results of therapy screenings and recommendations. Residents Affected - Few On 3/14/23 at 12:46 PM, Occupational Therapist F explained resident #53 was to have two palm guard finger separators, one for each hand, and one elbow splint for the right arm, applied daily for four hours. She stated the resident was on the Restorative Nursing Program (RNP), but she was unsure if nursing staff were documenting on provision of restorative care and services. Occupational Therapist F provided a copy of the recommendation for therapy request for orders dated 10/6/22, restorative maintenance recommendations dated 11/22/22, and Occupational Therapy treatment note dated 12/07/22 that indicated all caregivers were trained and gave 100% return demonstration on proper technique and steps for application of splints. She provided a copy of the splinting program form dated 12/08/22 with in-service training signature page showing eleven signatures, orthotic needs, treatment notes and splinting program forms dated 12/08/22, and therapy recommendation for restorative functional maintenance program dated 1/20/23. She stated therapy recommendations were given to the DON and the Unit Managers. On 3/14/23 at 3:44 PM, the Administrator stated there was no documentation of concerns or Performance Improvement Plans (PIPs) related the RNP in the facility's Quality Assessment and Assurance (QAA) book. The Administrator and the DON stated the issue was discussed in an Ad Hoc QAA committee meeting outside of the scheduled monthly meeting. The Administrator explained the DON had not provided any documentation of the discussions so that it could be placed in the QAA book. The DON provided a Quality Assessment & Performance Improvement Plan form with a start date of 1/16/23. However, the document did not include information regarding an Ad Hoc meeting regarding the facility's RNP. The DON then provided the facility's Ad Hoc Meeting Restorative Plan. She stated they used a list of the residents on restorative therapy as their audit tool. No actual audit forms were completed and the DON did not provide any audit tool report. The DON stated there were no audits for Certified Nursing Assistants (CNA) inservice or audits for restorative nurse documentation. Review of the facility's restorative Nursing Programs and Guidelines with revision date October 2017 revealed The facility provides Restorative Nursing Programs that involve interventions to improve or maintain the optimal physical, mental and psychological functioning Combinations to consider that may enhance the Restorative nursing Process: Passive range of Motion (PRPM) + Splint/Brace Assist Review of the facility Process and Procedure no date showed Overview: The Contracture Prevention and Management (Splinting/Bracing) Program is designed to promote optimal improvement, preserve function, and minimize deterioration within the limits of the normal aging process and/or a recognized disease process. 2. Review of the medical record revealed resident #83 was admitted [DATE] and readmitted to the facility on [DATE] with diagnoses including contracture of left hand, contracture of muscle of left hand, contracture of left knee, stroke due to occlusion or stenosis of right middle cerebral artery, and hemiplegia and hemiparesis to the left non-dominant side. The MDS quarterly assessment with ARD 12/04/2022 identified the resident scored 14 out of 15 on the Brief Mental Status Interview (BIMS), that indicated the resident was cognitively intact, did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 11 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few reject care necessary for health and well-being, and was totally dependent on staff for activities of daily living (ADL). The MDS assessment indicated resident #83 did not receive splint or brace assistance during the look back period. The resident's orders included occupational therapy to be provided 5 times per week from 11/11/2022 to 12/21/2022 for contracture of the left hand and splint management. The resident's care plan included an intervention, Wrist-Hand-Finger-Orthosis (splint device) to left upper extremity as tolerated, initiated 6/06/2022, and revised 3/11/2023. The Kardex for Certified Nursing Assistants (CNA) to identify resident care information indicated resident #83's daily care required, Wrist-Hand-Finger-Orthosis (splint device) to left upper extremity as tolerated. The Kardex did not show the splint was being put on or taken off by staff. On 3/12/2023 at 11:03 AM, resident #83 was observed lying in bed awake. The resident's left wrist was bent towards her arm and there was no splint in place. On 3/12/2023 at 4:16 PM, the resident was observed lying in bed awake. Her left wrist was bent towards her arm without a splint on. Resident #83 said staff applied a splint to her left wrist, every once in a while. She explained she preferred having the splint on because it helped with pain. The resident made a grimacing expression while putting her hand on her left wrist. She said she was having a muscle contraction and it was, very painful. On 3/13/2023 at 8:51 AM, the resident was observed lying in bed with her eyes closed. The resident's left wrist did not have a splint in place. On 3/13/2023 at 5:27 PM, a splint was observed sitting on the overbed table next to the resident. The resident stated staff had not applied the splint to her left wrist all day. On 3/14/2023 at 8:46 AM, the resident explained since she had not been wearing the splint, she had experienced increased muscle spasms in her left wrist. She recalled the splint was missing a few weeks prior, and she told staff she was willing to purchase a new one. She said the splint was eventually found in a drawer and had been used once. She explained she sometimes had pain from muscle spasm in the left wrist from 8 to 10 on the 1-10 pain scale. On 3/14/2023 at 9:18 AM, CNA C said she regularly had resident #83 on her assignment. She said CNAs did not put on or take off the splint for the resident because therapy staff did it. 03/14/2023 at 10:24 AM, Certified Occupational Therapy Assistant (COTA) E said he was familiar with resident #83 and acknowledged the resident used a splint. He explained splints were used to prevent decline and maintain range of motion (ROM). He explained if a splint was not used to manage a contracture, the contracture could worsen. On 3/14/2023 at 10:34 AM, Occupational Therapist (OT) F explained resident #83 had used a splint for contractures and did very well in therapy while tolerating the splint about 4-5 hours at a time. She said the resident seldom refused the splint and it needed to continue to be put on daily by nursing staff after skilled therapy discontinued for functional maintenance. She said nurses and CNAs were supposed to put on and take off the splint for 4-6 hours a day. She said contractures usually worsen when not used daily because tissues and ligaments can shorten causing increased pain and reduced (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 12 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete joint mobility. She conveyed it was very important for resident #83 to continue splint therapy to maintain range of motion and prevent decline. On 3/14/2023 at 11:20 AM, the Director of Nursing (DON) said after therapy was completed, some residents transition to restorative nursing for ROM and splinting treatment and services. She explained therapy completed the plan of treatment and the directions should be shown on the CNA Kardex to complete daily resident tasks. She said resident #83's program should show up on the CNA software like other tasks for the CNA to sign off and document as completed. She said she was aware of problems with CNAs not completing restorative tasks for ROM and splints since January 2023. She said she was going to look at the problem again to, revamp. Event ID: Facility ID: 105618 If continuation sheet Page 13 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Based on observation, and interview, the facility failed to provide services to prevent complications from a gastronomy tube for 1 of 2 residents observed for enteral feeds, out of a total sample of 45 residents, (#214). Findings: Resident #214 was admitted to the facility 2/22/23 with diagnoses to include dysphagia, gastrostomy status, and type 2 diabetes. The resident's quarterly Minimum Data Set (MDS) assessment dated , 2/26/23 indicated the resident was severely cognitively impaired and was rarely or never understood. The assessment revealed the resident did not have any behaviors and was totally dependent on staff persons for activities of daily living. On 3/13 /23 at 12:30 PM, the resident was observed lying in bed with the tube feeding infusing. The head of the bed was not elevated and the resident lay flat in bed. Registered Nurse (RN) L confirmed the head of the resident's bed was not elevated and the tube feed was infusing. He stated the head of the bed should have been elevated at least 30-45 degrees. On 3/13/23 at 3:55 PM, the resident was again observed lying flat in bed with the tube feed running. The head of the bed was not elevated and the resident was lying flat. The MDS nurse confirmed the head of the bed was flat and the tube feeding was infusing. She stated the head of the bed should have been elevated to prevent the resident from aspirating the feed. She was not aware which staff left the head of bed down. On 3/14/23 at 1:26 PM, Certified Nursing Assistant (CNA) N stated she always raised the head of the bed for a resident with tube feedings when the feed was infusing. The resident's care plan for tube feeding dated 3/13/23 included an intervention to elevate the head of bed during administration of feeding or medication administration. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 14 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure intravenous (IV) dressing was changed as ordered for 1 of 1 resident reviewed for IV therapy, of a total sample of 45 residents, (#269). Residents Affected - Few Findings: Resident #269 was admitted to the facility on [DATE] with diagnoses including infection and inflammatory reaction due to other cardiac and vascular devices, cardiac pacemaker and other bacterial infections of unspecified site. Review of the Minimum Data Set (MDS) admission assessment with assessment reference date of 3/08/23 revealed resident #269 had a Brief Interview for Mental Status score of 13 out of 15 which indicated she was cognitively intact. She did not exhibit any behavioral symptoms and did not reject care that was necessary to achieve her goals for health and well-being. The document revealed resident #269 had a diagnosis of wound infection and received IV antibiotics. A care plan for IV Medications was initiated on 3/03/23 and revised 3/11/23. The care plan indicated resident #269 received IV antibiotics for a pacemaker site infection. Interventions included to Check dressing at site daily, change per facility policy/MD orders. Review of resident #269's electronic medical record (EMR) revealed a physician order dated 3/03/23 which instructed licensed nurses on the evening shift to change IV dressing every 7 days and as needed for soiling and/or dislodgement. Review of the Medication Administration Record (MAR) for March 2023 revealed Registered Nurse (RN) B documented he had changed the IV dressing during the evening shift on 3/11/23. On 3/12/23 at 11:39 AM, resident #269 was observed in bed with head of bed elevated watching television. An IV medication bag was hanging from the IV pole but not connected. Resident #269 stated she was receiving an antibiotic due to an infection at her pacemaker site. She lifted her sleeve to show the IV insertion site on her left arm. The area was covered with a transparent dressing dated 3/02/23. Resident #269 stated the dressing had not been changed since her admission to the facility. On 3/12/23 at 11:55 AM, Licensed Practical Nurse (LPN) A observed resident #269's IV dressing and verified it was dated 3/02/23. She reviewed resident #269's EMR and reported the dressing was scheduled to have been changed 3/11/23. LPN A acknowledged 7 days from date on IV dressing would have been 3/09/23. She could not explain why it was scheduled for 3/11/23 or why it had not been changed as ordered. On 3/14/23 at 9:53 AM, the Director of Nursing (DON) stated the purpose of the IV dressing was to hold the IV in place and keep the insertion site clean to prevent infection. She reviewed resident #269's EMR and acknowledged the IV dressing should have been changed every 7 days according to the physician order. The DON reported she spoke with RN B who should have changed the dressing on the evening shift of 3/11/23. Per the DON, he was apologetic and confirmed he had not changed the IV dressing as ordered. She was unable to explain why the IV dressing change was scheduled for 3/11/23 instead of 7 days from date on IV dressing which was 3/09/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 15 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0694 Level of Harm - Minimal harm or potential for actual harm The facility's policy and procedure for Dressing Change for Vascular Access Devices dated February 2016 indicated the purpose was to prevent local and systemic infection related to the IV catheter. The policy read, Central venous access device and midline dressing changes will be done at established intervals . transparent semi-permeable membrane dressings are changed every 7 days and [as needed]. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 16 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Resident #3 was admitted to the facility on [DATE] with diagnoses of cerebral infraction, epilepsy, dementia, depressive disorder, insomnia, psychosis, schizophrenia, and anxiety disorder. Review of pharmacy May 2022, recommendation showed a request to add behavior and side effect monitoring for Cymbalta. There was no signature on the report to indicate the physician had reviewed the recommendation. On 3/15/2023 at 3:23 PM, the DON stated the facility practice was to send the pharmacy recommendations to the physicians, to either accept, or decline the recommendations usually within 21 days. She acknowledged the May 2022 recommendation was not addressed until 2 months later, on 7/8/22. She stated it was her responsibility to ensure the physicians received the pharmacy recommendations and addressed them timely. Review of the facility Medication Regimen Review and Reporting policy dated 01/23 showed Resident specific monthly regimen review (MRR) recommendations and findings are documented and acted upon by the nursing care center and or the physician. The nursing center follows up on the recommendations to verify that appropriate action has been taken. Recommendations shall be acted upon within 30 calendar days. Based on interview, and record review, the facility failed act timely on pharmacy Monthly Regimen Review (MRR) recommendations for 2 of 5 residents reviewed for unnecessary medications from a total sample of 45 residents, (#29, #3) Findings: 1. Review of the medical record revealed resident #29 was admitted to the facility on [DATE] with diagnoses including respiratory failure, encephalopathy, psychosis, major depressive disorder, and anxiety. The resident's medication orders included Meclizine HCI 25 milligrams (mg) for dizziness ordered 7/11/2022, and discontinued 2/6/2023, Melatonin 3 mg for sleep ordered 2/22/2023 and Montelukast 10 mg for respiratory failure, ordered 7/12/2022, and discontinued 12/07/2022. Review of the July 2022 MRR reports received by the facility from the consulting pharmacist showed recommendations to consider discontinuing Meclizine. The July MRR report was not signed by the physician indicating it had been reviewed. The medical record showed the medication was discontinued 7 months later, on 2/6/23. Review of the October 2022 MRR reports received by the facility from the consulting pharmacist showed the physician signed recommendations on 10/01/2022 to discontinue the medication Montelukast. The medical record indicated the medication was ordered to be discontinued 2 months later, on 12/07/2022. Review of the November 2022 MRR report showed the physician signed recommendations on 11/01/2022 to discontinue the medication Melatonin. The medical record indicated the medication was ordered to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 17 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0756 discontinued one month later, on 12/07/2022. Level of Harm - Minimal harm or potential for actual harm On 3/16/2023 at 2:20 PM, the Director of Nursing (DON) was asked to provide any documentation to support or clarify why documentation was missing and was unable to provide any further information. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 18 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 Based on observation, interview, and record review, the facility failed to prevent medication error rate of 5 per cent or greater for 1 of 6 residents sampled for medication administration, (#67). There were 3 errors in 25 opportunities on 1 of 2 units by 1 of 3 nurses observed, for a medication error rate of 12%. Residents Affected - Few Findings: On 3/14/23 at 8:36 AM, during a medication administration observation, Registered Nurse (RN) D removed the following medications and placed them in a cup, Metoprolol 12.5 milligrams (mg), Dicyclomine 10 mg, Acidophilus 200 mg, and Sodium Chloride 1 gram. The nurse stated vitamin D3 was not available in the medication cart and she would ask her supervisor to get it for her. During medication administration, resident #67 refused the Sodium Chloride and said she was not taking it because, they are not monitoring my sodium level. During the reconciliation process it was noted on the Medication Administration Record (MAR) that the Sodium Chloride was marked as given. The following medications were also signed off as given at 9:00 AM, Anoro Elipta Inhaler-one puff, and Apixaban 5 mg. These medications were not given during the medication administration observation but were signed as given. Review of the Medication Administration Audit Report revealed all the above medications were sighed off at 8:39 AM. On 3/14/23 at 9:46 AM, the Director of Nursing (DON) was informed of the medication errors. RN D confirmed she only gave 4 pills during the medication observation and the resident refused to take the Sodium Chloride. She acknowledged she did not give all the medication during the medication observation and stated she had given some of the medications earlier. On 3/14/23 at 9:05 AM, resident #67 stated she did not use the Anoro Elipta inhaler because she had a machine at the bedside and she used that for breathing treatments. She stated she knew her medications and she did not receive Apixoban and acknowledged she refused the Sodium Chloride. She stated the only time she received the medications from RN D was at 8:36 AM with the surveyor present. She said RN D did not give her medications at any other time. On 3/16/23 at 1:45 PM, the DON stated her expectation during medication administration is for the nurse to identify the resident and give the medications according to the order. If there are any discrepancies, the expectation is the nurse would notify the physician and the family. Review of Medication Administration General Guidelines dated 01/23 read: The individual who administers the medication dose, records the administration the resident's MAR immediately following the medication being given. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 19 of 20 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 105618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park of Winter Park 558 N Semoran Blvd Winter Park, FL 32792 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 0907 Provide enough space and equipment to meet each resident's needs Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, and interview, the facility failed to repair a stand lift used for physical therapy in a timely manner for 1 of 1 lift. Residents Affected - Few Findings: On 3/12/23 at 4:00 PM, resident #11 who was admitted to the facility on [DATE] with diagnoses of Multiple Sclerosis stated the standing machine she used in physical therapy was broken for a year. On 3/14/23 at 10:26 AM, Physical Therapist (PT) M stated the standing lift was not working. He stated he was not sure how long it had been broken but he had been working at the facility since November of 2022 and the machine had been broken since then. He explained the lift was used to strengthen the muscles in the legs for residents who were unable to stand. He explained the lift had a pad on the bottom that lifted the resident to stand up to strengthen the leg muscles and increase endurance. On 3/16/23 at 10:29 AM, the Administrator stated she believed the lift had been broken for a few months but she could not access the previous maintenance person's email to get the dates or the companies contacted in the past for a new motor for the lift. She presented an invoice that was sent this morning for a new motor for the machine. On 3/16/23 at 2:24 PM, the Maintenance Assistant stated he was unable to find the work order for the broken lift in the therapy gym. He said he began working on it in last June and was out of work due to illness. He recalled a outside vendor looked at the lift but were unable to repair it. He remembered he tried to fix it in January 2023 but it was still not working. He stated he was not aware the Administrator ordered a motor this morning. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105618 If continuation sheet Page 20 of 20