Health inspection·November 5, 2025

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few regimen? -No, Question B. - Received PRN pain medications or was offered and declined? Yes, Question C.- Received non-medication interventions for pain? No, Section J0200 Should pain assessment interview be conducted? Yes, Section J0300 Pain Presence: Ask resident: Have you had pain or hurting at any time in the last 5 days?' Yes, Section J0410 Pain Frequency: Ask resident: How much of the time have you experienced pain or hurting over the last 5 days? Almost constantly, Section J0150 Pain Effect on Sleep: Ask resident: Over the past 5 days, how much of the time has pain made it hard for you to sleep at night? Almost constantly, Section J0520 Pain Interference with Therapy Activities: Ask resident: Over the past five days, how often have you limited your day-to-day activities (excluding rehabilitation therapy sessions) because of pain? rarely or not at all, Section J0600 Pain Intensity- admission on LY ONE of the following pain intensity questions (A or B), A. Ask resident: Please rate your worst pain over the last five days on a zero to 10 scale, with 0 being no pain and 10 as the worst pain you can imagine (show resident 00-10 pain scale) enter 2- digit response enter 99 if unable to answer. 9.A record review of Resident #1's Care Plan showed the following: -Focus of opiate medications related to: pain not managed by alternative interventions, initiated on 9/09/2025 with a goal statement: resident risk for adverse effects related to use of opioids will be minimized through next review date, initiated on 9/09/2025. Interventions include but are not limited to: administer medication as prescribed by the physician (see current MA Rand physician orders for current dosage) initiated on 9/09/2025.-Focus area of pain and/or is at risk for pain related to decreased mobility, PVD (peripheral vascular disease), and neuropathy initiated on 9/02/2025 with a goal statement: the resident will have reduced complaints of pain and/or state that pain is at a tolerable level through next review date initiated 9/02/2025 and will not have an interruption in normal activities due to pain through the review date, initiated on 9/02/2025.A record review of Resident #1's current physician orders showed the following: -Monitor the resident for pain every shift ordered on 10/02/2025 -Gabapentin oral capsule 100 milligrams (mg) to give one capsule by mouth every 8 hours for neuropathy ordered on 10/22/2025 -Hydrocodone- Acetaminophen oral tablet 10mg - 325mg, to give one tablet by mouth every six hours as needed for non-acute pain ordered on 10/24/2025 -Hydrocodone-Acetaminophen oral tablet 10mg- 325mg, to give one tablet by mouth one time a day for non-acute pain ordered on 10/27/2025 -Oxycontin oral tablet ER (12 hours abuse deterrent) 15 mg, to give one tablet by mouth two times a day for non-acute pain ordered on 10/27/2025 - -Ondansetron HCL tablet 4 mg, give one tablet by mouth every 6 hours as needed for nausea and vomiting ordered on 10/02/2025 -Oxycontin oral tablet ER 12-hour abuse-deterrent 15 mg, give one tablet by mouth every 12 hours for non-acute pain, ordered on 10/24/2025 and discontinued on 10/27/2025A review of Resident #1's Medication Administration Record (MAR) for October 2025 revealed one missed dose of Oxycontin ER 15 mg bid on 10/31/2025. A review of Resident #1's MAR for November 2025 revealed five missed doses of Oxycontin ER 15 mg bid on 11/02/2025, 11/03/2025 and 11/04/2025. On 11/04/2025 at 10:28 a.m., an interview was conducted with Staff C, Advanced Nurse Practitioner (ARNP) for Physical Medicine and Rehabilitation/Pain. Staff C, ARNP stated Resident #1 was identified upon admission as a pain management resident who had received prior pain management care at home. Staff C, ARNP, stated the resident was complaining of left hip pain, normally experienced in the past at home, but exacerbated after he fell at home. Staff C, ARNP stated Resident #1 wanted to continue with the pain regimen he had received prior to his admission but, she was trying to make him more functional and to require less pain medication gradually as he participated more in therapy. Staff C stated they went from scheduled pain medication to as needed to work with therapy. Staff C, ARNP stated, therapy stated he was better which then tells me he is tolerating at his dose regimen. Staff C, ARNP stated the primary ARNP for Resident #1 ordered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105620 If continuation sheet Page 2 of 12 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 105620 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Lake Center 4240 Lakeland Highlands Rd Lakeland, FL 33813 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Oxycontin 15 mg ER bid and this morning she (Staff C) stated she went and approved and prescribed this morning to be administered twice a day. Staff C, ARNP stated she spoke with the resident and the resident was updated on the order to continue the Oxycontin 15 mg ER bid. On 11/04/2025 at 11:39 a.m., an interview was conducted with Staff D, ARNP. Staff D, ARNP, stated as of this morning, she had ordered a one-time order for Zofran 4 mg to be administered intramuscularly for his nausea because of his episode of vomiting earlier this morning. Staff D, ARNP, stated some time a few weeks ago, Resident #1 stated to me his pain was not controlled and had not received pain medication scheduled pain medication in a timely manner. Currently, the resident has a scheduled Hydrocodone-Acetaminophen 10 mg/325 mg daily prior to physical therapy. Plus, he can get the same medication as needed every six to eight hours. In addition, the resident has scheduled Gabapentin as well as Tylenol as needed. Staff D, ARNP, stated the resident in addition to the pain regimen described, the resident has an additional order for Oxycontin 15 mg ER twice a day scheduled. Staff D, ARNP stated the resident has always stated he has uncontrolled pain, since he's been here. Staff D, ARNP stated she checked on the [web-based electronic narcotics national registry] for Resident #1 and saw the resident was prescribed Oxycontin 15 mg ER and Hydrocodone-Acetaminophen 10mg-325mg in the past. Staff D, ARNP stated Resident #1 has chronic pain and never states his pain level never gets below a 4. Staff D, ARNP, stated as a nurse practitioner, she can only order a 7-day supply prescription but I am always available by phone if needed. Staff D, ARNP stated she was on call last weekend and denied she received a call/text for a renewal/order of the resident's prescription for Oxycontin 15 mg ER. A review of the progress notes provided by the facility did not show any entries from 10/30/2025 to 11/03/2025 of the nursing staff contacting the physician for a missed scheduled dose of Oxycontin 15 mg ER or a request to refill the prescription. On 11/04/2025 at 10:00 a.m., a brief interview was conducted with the Director of Nursing (DON). The DON stated Resident #1 received his Hydrocodone-Acetaminophen 10 mg/325 mg for pain but will have to research his Oxycontin order and why Resident #1 had missed scheduled doses. On 11/05/2025 at 8:30 a.m., an interview was conducted with Staff E, Pharmacist. Staff E, Pharmacist, was able to provide an inquiry search for Resident #1's Oxycontin 15 mg ER order. On 10/24/2025, an order was placed for Oxycontin 15 mg ER to be administered twice daily to dispense 14 tablets. On 10/25/2025 at 4:54 a.m., the pharmacy delivered 12 tablets. Staff E stated, the pharmacy will typically not dispense the full prescribed order in case the medication runs out and the nursing staff could technically pull from their [electronic medication dispensary] for emergency situations. Staff E stated the reason the pharmacy does not dispense all medications would be to offset contacting the physician in a timely manner or requesting more to be dispensed by the nursing staff if the prescription were to still be active. Staff E stated on 10/31/2025 at 5:27 a.m., a request was made by the facility to dispense the final two tablets of Resident #1's Oxycontin 15 mg ER. On 10/31/2025 at 5:50 p.m., the pharmacy delivered the last of the two tablets to complete the prescription to the facility. Staff E, pharmacist, stated on 11/04/2025 at 10:44 a.m., a new prescription was placed for Oxycontin 15 mg ER on e tablet twice daily for Resident #1, to dispense 14 tablets. Staff E, pharmacist, stated on 11/04/2025 at 2:13 p.m. a delivery of Resident #1's Oxycontin was delivered to the facility. A review of the facility's policy titled: Standards and Guidelines: Medication Administration issued 10/2020 and revised on 01/2024 showed:Procedure:.3. Medications are administered in accordance with prescriber orders, including any required time limit.4. Medication administration times are determined by resident need, preference, and benefit, not staff convenience. Factors that are considered include:a. Enhancing optimal therapeutic effect of the medication;b. Preventing potential medication or food interactions: andc. Honoring resident choices and preferences, consistent with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105620 If continuation sheet Page 3 of 12 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 105620 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Lake Center 4240 Lakeland Highlands Rd Lakeland, FL 33813 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 0697 Level of Harm - Minimal harm or potential for actual harm his or her care plan.5. Medication errors are documented, reported, and reviewed by the QAPI (Quality Assurance and Performance Improvement) committee to inform process changes and or the need for additional staff training.(Photographic evidence obtained) Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105620 If continuation sheet Page 4 of 12 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 105620 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Lake Center 4240 Lakeland Highlands Rd Lakeland, FL 33813 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 observations, interviews, and record review, the facility failed to ensure the narcotics policy was followed by nursing to ensure narcotic audits were accurate for three residents (#1, #8 and #9) out of three residents sampled for pain management.Findings included:On 11/04/2025 at 8:33 a.m., an interview was conducted with Staff G, Licensed Practical Nurse (LPN). Staff G, LPN stated when narcotics are delivered, Staff G, LPN would sign a yellow sheet of paper and a hand-held device where an electronic signature would be required by the pharmacy. A copy would be provided to the nurse. Staff G, LPN stated he would take the prescription along with the actual narcotic card and place the prescription in the narcotic book located on the medication cart and place the narcotic card inside the locked area of the medication cart for narcotics. The copy of the yellow sheet will go to the unit manager's box. Staff G, LPN stated if a narcotic and/or a resident has been discontinued, the process would be to remove the narcotic card and take the Unit Manager, and both will sign off. The Unit Manager will bring the discontinued narcotic cards to the Director of Nursing (DON). Staff G, LPN stated he has two discontinued narcotic cards in the assigned cart. On 11/04/2025 at 8:40 a.m., an interview was conducted with Staff A. Staff A, LPN stated when pharmacy delivers a narcotic medication, a yellow copy is signed, and a copy would be provided to the nurse. Staff A, LPN stated a signature would be required as well on the pharmacist's phone. Staff A, LPN stated she would get another nurse to witness the narcotic card going into the cart to ensure the count is correct. Staff A, LPN stated pharmacy delivers at different times. Staff A, LPN stated the card count (Controlled Substance Audit Record) requires two nurses' signature at the change of shift but again she may or may not get a second witness during the day if she places a new narcotic card in the locked narcotic box in the medication cart. Staff A, LPN stated discontinued narcotics are brought to the unit manager or DON along with the white prescription sheet, the count would be verified, and the card count sheet would be updated.On 11/04/2025 at 8:58 a.m., an interview was conducted with Staff H, Registered Nurse (RN). Staff H, RN stated pharmacy delivers around 5-6:00 p.m., and 4-5:30 a.m. Staff H, RN stated the nurse will sign the yellow copy, pharmacy will give a copy to the nurse, and the nurse would sign in their phone. Staff H, RN stated she would get a second nurse to witness the narcotic card placed inside the medication cart. Staff H, RN stated if the narcotic is discontinued, she would take the medication out , adjust the log and bring the narcotic to the Unit Manager or the DON.On 11/04/2025 at 2:30 p.m., an interview was conducted with the DON. The DON stated on 10/21/2025 (Tuesday) she was walking the hallways prior to their 9:00 a.m. morning clinical meeting. The DON stated there were no staff present at the nurses' station, including the Unit Manager assigned to the unit and stated she was probably making her morning rounds. The DON stated she saw in the nurses' station a medication monitoring sheet on top of the nurses' work area. The DON stated the medication monitoring sheet was for Resident #1 and the prescription was for his Hydrocodone 10 mg (milligrams)/325 mg with the date of 10/18/2025 signed by Staff I, LPN. The DON stated the medication monitoring sheet showed the documented total number of tablets received at the top but no further tallies were noted on the sheet. The DON stated she went to cart HP1 to see if the actual medication was in the narcotic drawer. The DON stated there was no narcotic card within the locked narcotic box within the medication cart. The DON stated she looked through the entire medication cart just in case it was misplaced. The DON stated she contacted her Assistant Director of Nursing for assistance. The DON stated they looked in other care areas, checked the med rooms, and shred boxes. The DON stated she checked the shred box in front of the Unit Manager's office and found a blister pack with Resident #1's name still (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105620 If continuation sheet Page 5 of 12 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 105620 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Lake Center 4240 Lakeland Highlands Rd Lakeland, FL 33813 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 the pack. The DON stated she immediately notified the Nursing Home Administrator (NHA). The DON stated we notified our regionals and started an immediate investigation. The DON stated upon review of Resident #1 Medication Administration Record (MAR) the resident received his as needed pain medication upon request. The DON stated this particular medication is also available in their [electronic medication dispensary] to ensure the resident had the requested medication for pain available. The DON stated the primary physician was notified and the Advanced Registered Nurse Practitioner (ARNP) prescribed another prescription at no cost to the resident. The DON stated all residents in the unit with a Brief Interview for Mental Status (BIMS) of 12 (mildly impaired) or higher were interviewed. The DON stated all the residents denied any issues with receiving their medications. The DON stated she did not ask specifically about narcotics. The DON stated Staff I, LPN, works per diem and sometimes assigned to other areas in the facility. The DON stated she interviewed the two nurses who had worked with Staff I, LPN and both stated they did not see any medications lying around, nor notice odd behavior from Staff I, LPN. The DON stated she interviewed three certified nursing assistants, but all stated they did not see loose medication or odd behavior from Staff I, LPN. The DON stated she called Staff I, LPN on 10/22/2025 for an interview. The DON stated Staff I, LPN admitted to signing in the narcotic on 10/18/2025 but could not account for the blister pack. She was informed she was suspended pending the investigation. The DON stated we reviewed the sign-in and sign-out log sheet for the narcotic cards (Controlled Substance Audit Record) and we did not see any discrepancies. The DON stated a 30-day audit for narcotics was initiated on 10/23/2025 where the Unit Manager would review the Controlled Substance Audit Record) and then sent to Medical Records. The DON stated we did not notice any abnormalities for the counts (Controlled Substance Audit Record). The DON stated after a review of the audits, no changes to their policy was needed. The DON stated Staff I, LPN resigned over the phone.On 11/05/2025 at 8:28 a.m., a telephone interview was conducted with Staff F, account manager for the contracted pharmacy services. Staff F stated the delivery driver will bring the sealed package directly to the nurse(s). The delivery driver will stand there until the nurse accepts the delivery. A yellow copy would be signed by the nurse, as well as an electronic signature. The delivery driver would give a copy of the yellow copy to the nurse as well as the sealed tote bag. Staff F stated the tote bag will contain medications to be delivered but the narcotic medication would be separated from the other medication. The narcotic card and prescription are in the sealed tote bag. Staff F stated it is the responsibility of the nursing staff to verify all information is accurate before receiving the medications. Staff F denied any knowledge or contact from the facility of a potential diversion scenario recently at the facility. Staff F provided information under an inquiry from the pharmacy's electronic tracking device for deliveries. A review showed the following: 10/18/2025 at 4:41 p.m., the pharmacy approved a one-time dose of Resident #1's Hydrocodone-Acetaminophen 10 milligrams/325 milligrams (mg) to be pulled from the facility's [electronic medication dispensary] -10/18/2025 at 5:32 p.m., Staff I, LPN pulled one tablet of Hydrocodone-Acetaminophen 10mg/325 mg for Resident #1. -10/18/2025 at 5:34 p.m., a delivery for Resident #1's prescribed Hydrocodone-Acetaminophen 10 milligrams/325 milligrams (mg) was delivered, 12 tablets, signed by Staff I, LPN -10/18/2025 at 22:24 p.m. Staff I, LPN pulled another tablet approved by pharmacy for Resident #1. Staff F stated no further episodes of medication pulled from the [electronic medication dispensary]. Staff F stated the most likely reason Staff I; LPN was able to pull another tablet of Hydrocodone-Acetaminophen 10 mg/325 mg despite a delivery of 12 tablets at 5:34 p.m. was that the delivery driver may have still been delivering to other facilities and had not arrived back to home base for the pharmacist to document delivery.On 11/05/2025 at 10:09 a.m., a telephone interview was conducted with Staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105620 If continuation sheet Page 6 of 12 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 105620 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Lake Center 4240 Lakeland Highlands Rd Lakeland, FL 33813 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 I, LPN. Staff I, LPN stated she had worked Saturday (10/18/2025) 7 a.m. to 7 p.m. Staff I, LPN, stated she had received a delivery from the pharmacy between 4-5 in the afternoon. Staff I, LPN stated at the end of the shift she and the oncoming nurse counted the narcotic cards in the narcotic box when I noticed the medication itself was missing. Staff I, LPN stated she immediately called the administrator on call, Staff J, ADON, and she told me to search everywhere for the medication. Staff I, LPN, stated she searched everywhere, the residents' rooms, soiled utility room, dumpster, garbage pails, and when we got the keys, we searched the shred box. Staff K, LPN/Unit Manager and Staff L, RN/weekend supervisor opened up the shred box and together we searched for any signs of the missing medication. Staff I, LPN stated she had already contacted the ARNP to get a new script for Resident #1. When the ARNP called me back, I was told not to say anything to the ARNP. Staff I, LPN stated she allowed the administration to look through her personal bag. Staff I stated she did not leave the facility until 11:00 p.m. but before she left the facility had me sign a piece of paper related to education for safekeeping of medication. Staff I, LPN stated during the delivery of the medication, Resident #1 was the only resident to receive a narcotic medication delivery. Staff I, LPN, stated she dispensed the medications to the other carts. Staff I, LPN stated, I can only think I may have thrown it away accidently. Staff I, LPN stated the DON and the NHA were present as well and were actively trying to find the missing medication. Staff I, LPN stated the DON and the NHA also searched in the shred box as well. Staff I, LPN, stated she recalls earlier in the morning she gave Resident #1 his last Hydrocodone-Acetaminophen 10 mg/325 mg and placed a request to pharmacy to dispense more for the resident. Staff I, LPN stated she later in the day was able to pull the medication for Resident #1 while waiting for a delivery. Staff I, LPN, stated she had made a joke with the pharmacy delivery driver because she had just administered the medication to Resident #1 minutes before the driver arrived with the medication. Staff I, LPN, stated she pulled another Hydrocodone-Acetaminophen 10 mg/325 mg from the [electronic medication dispensary] later in the night because the oncoming nurse asked for my assistance, but I did not document in the MAR, she did. Staff I, LPN, stated she was working with Staff M, LPN and another nurse but could not recall her name (Staff later identified as Staff N, RN). Staff I, LPN, stated Staff M, LPN helped her look as well during the initial search for the missing medication. Staff I, LPN, stated she attempted numerous times on Sunday to work on her up and coming schedule with the staffing coordinator, but her voicemails were never returned. Finally, on Tuesday I received a call from the DON to inform me I was suspended. Staff I, LPN, stated at some point she was requested to go downtown to the DCF (Department of Children and Families) for a statement. The DCF agent informed me the facility found an empty narcotic card in the shred box on Tuesday (October 21st). Staff I, LPN, stated she provided an email to the facility with her statement. Staff I, LPN, stated she could not figure out how the card eventually was found in the shred box when on Saturday, the shred box was opened and search not only by Staff L and Staff K but also the DON, ADON and the NHA on separate searches. Staff I, LPN, stated her normal routine does not have her throw away empty medicine cards in the shred box. Staff I, LPN, stated, she felt two people are supposed to check narcotics in, but it has been only one person and added we are so busy.On 11/05/2025 at 11:08 a.m., an interview was conducted with Staff M, LPN. Staff M stated on 10/18/2025 she saw Staff I, LPN receive the narcotic/medications but did not continue to watch Staff I, LPN, once the medications were delivered. Staff M, LPN stated at the end of her shift, Staff I, LPN, came to her asking if she had seen a loose narcotic medication card. Staff M, LPN, stated Staff I was very nervous. Staff M, LPN, stated she helped Staff I, LPN, search the unit. Staff M, LPN, stated they searched the soiled utility rooms, all three carts, and residents' rooms. Staff M, LPN stated she witnessed Staff I, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105620 If continuation sheet Page 7 of 12 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 105620 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Lake Center 4240 Lakeland Highlands Rd Lakeland, FL 33813 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 LPN, Staff L, RN/weekend supervisor and Staff K, LPN/Unit Manager, search the shred box in [NAME] Point. Staff M, LPN, stated she was never asked for a statementOn 11/05/2025 at 11:22 a.m., an interview was conducted with Staff N, RN. Staff N, RN stated she was not aware of missing narcotic card until she returned to work the following morning (Sunday). Staff N, RN stated she did not notice anything, nor did anyone approach her on Saturday evening. Staff N, RN, stated none of her residents had a delivery of narcotics. Staff N, RN, stated she was not asked to give a formal statement.A record review of the Controlled Substance Audit Record for Cart #1 (Rm 301-305) (right side) with starting ledger date 10/29/2025 was reviewed as part of the auditing process the DON stated was initiated after the missing narcotic card. This Controlled Substance Audit Record was obtained by Staff B, LPN/UM, who had obtained the documentation from medical records. The DON stated the ledger had some missing items, blank spaces where a narcotic name should have been written and numbers were not added up. The DON stated the ledger was reviewed without any concern because it was in medical record. (photographic evidence obtained) 1. A review of Resident #1's admission Record showed an admission date of 8/30/2025 with the following diagnoses: Metabolic Encephalopathy Sepsis Type 2 diabetes mellitus w/ hyperglycemia Chronic diastolic (congestive) heart failure Cellulitis of unspecified part of limb Acute kidney failure with tubular necrosis Cardiomyopathy Difficulty in walking not elsewhere classified Chronic venous hypertension with ulcer of bilateral lower extremities Depression (unspecified_ Varicose veins of bilateral extremities with other complications Lymphedema not elsewhere classified A record review of Resident #1's admission Minimal Data Set (MDS), dated [DATE], revealed a Brief Interview for Mental Status (BIMS) score of 13 out of total of 15, indicating the resident was cognitively intact.A record review of Resident #1's Care Plan showed the following: -Focus of opiate medications related to: pain not managed by alternative interventions, initiated on 9/09/2025 with a goal statement: resident risk for adverse effects related to use of opioids will be minimized through next review date, initiated on 9/09/2025. Interventions include but are not limited to: administer medication as prescribed by the physician (see current MA Rand physician orders for current dosage) initiated on 9/09/2025.-Focus area of pain and/or is at risk for pain related to decreased mobility, PVD (peripheral vascular disease), and neuropathy initiated on 9/02/2025 with a goal statement: the resident will have reduced complaints of pain and/or state that pain is at a tolerable level through next review date initiated 9/02/2025 and will not have an interruption in normal activities due to pain through the review date, initiated on 9/02/2025.A record review of Resident #1's current physician orders showed the following: -Monitor the resident for pain every shift ordered on 10/02/2025 -Gabapentin oral capsule 100 milligrams (mg) to give one capsule by mouth every 8 hours for neuropathy ordered on 10/22/2025 -Hydrocodone- Acetaminophen oral tablet 10mg - 325mg, to give one tablet by mouth every six hours as needed for non-acute pain ordered on 10/24/2025 -Hydrocodone-Acetaminophen oral tablet 10mg- 325mg, to give one tablet by mouth one time a day for non-acute pain ordered on 10/27/2025 -Oxycontin oral tablet ER (12 hours abuse deterrent) 15 mg, to give one tablet by mouth two times a day for non-acute pain ordered on 10/27/2025 - -Ondansetron HCL tablet 4 mg, give one tablet by mouth every 6 hours as needed for nausea and vomiting ordered on 10/02/2025 -Oxycontin oral tablet ER 12-hour abuse-deterrent 15 mg, give one tablet by mouth every 12 hours for non-acute pain, ordered on 10/24/2025 and discontinued on 10/27/2025A comparison record review between Resident #1's MAR and his Medication Monitoring Control Record for the month of October 2025 was compared for the prescribed order of Hydrocodone-Acetaminophen 10mg-325 mg and showed the following: -October 4th- two tablets documented as given and three tablets documented as pulled from the narcotic cart-October 7th- one tablet documented as given and three tablets documented as pulled from the narcotic (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105620 If continuation sheet Page 8 of 12 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 105620 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Lake Center 4240 Lakeland Highlands Rd Lakeland, FL 33813 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 cart-October 8th- two tablets documented as given and four tablets documented as pulled from the narcotic cart -October 9th- one tablet documented as given and three tablets documented as pulled from the narcotic cart-October 10th -zero documented as given and four c -October 11th- one tablet documented as given and three documented as pulled from the narcotic cart-October 12th- one tablet documented as given and three documented as pulled from the narcotic cart-October 13th- zero documented as given and four one tablet documented as given and three documented as pulled from the narcotic cart-October 15thone tablet documented as given and three documented as pulled from the narcotic cart-October 16th- two tablets documented as given and four documented as pulled from the narcotic cart October 17th- one tablet documented as given and four documented as pulled from the narcotic cart October 18th - one tablet documented as given and two documented as pulled from the narcotic cart October 19th- two tablets documented as given and one documented as pulled from the narcotic cart October 20th- four tablets documented as given and five documented as pulled from the narcotic cart October 21st- zero documented as given and three documented as pulled from the narcotic cart October 23rd- zero documented as given and four documented as pulled from the narcotic cart October 24th - zero documented as given and three documented as pulled from the narcotic cart October 25th- one tablet documented as given and three documented as pulled from the narcotic cart October 26th - two tablets documented as given and three documented as pulled from the narcotic cart October 29th- two tablets documented as given and three documented as pulled from the narcotic [NAME] comparison record review between Resident #1's MAR and his Medication Monitoring Control Record for the month of November 2025 was compared for the prescribed order of Hydrocodone-Acetaminophen 10mg-325 mg revealed the following: November 2nd- two tablets documented as given and four documented as pulled from the narcotic cart2.On 11/5/2024 at 1:15 p.m. an interview was conducted with Resident #9. She revealed she is currently on a pain management program and she receives routine and as needed pain medications for her lower back pain. Resident #4 revealed she has at times refused her medications but felt mostly when she calls out for pain medication, the nurses will provide her with the medication. Resident #8 could not remember a time when she believed she did not receive her pain medications. Resident #8 felt after the medication was provided, she felt relief.Review of Resident #9's medical record to include 9/2025, 10/2025, and 11/2025 Medication Administration Record (MAR), as well as the Medication Monitoring/Control records for 9/2025, 10/2025 and 11/2025 revealed medications subtracted and signed off in the Medication Monitoring/Control records were not documented in the MAR for the medication Oxycodone/APAP Tab 5 mg-325 mg 1 PO (by mouth) TID (three times a day) PRN (as needed) for non-acute pain as follows: 9/28/25 2130 - (medication was not documented as offered/provided in the Medication Administration Record (MAR).9/29/25 0600 (medication was not documented as offered/provided in the Medication Administration Record (MAR).9/30/25 0600- (medication was not documented as offered/provided in the Medication Administration Record (MAR).10/2/25 0900- (medication was not documented as offered/provided in the Medication Administration Record (MAR).10/2/25 1200- (medication was not documented as offered/provided in the Medication Administration Record (MAR).10/3/25 0845- (medication was not documented as offered/provided in the Medication Administration Record (MAR).10/3/25 2057- (medication was not documented as offered/provided in the Medication Administration Record (MAR).10/5/25 2024(medication was not documented as offered/provided in the Medication Administration Record (MAR).10/6/25 1500- (medication was not documented as offered/provided in the Medication Administration Record (MAR).10/6/25 2004- (medication was not documented as offered/provided in the Medication Administration Record (MAR).10/8/25 1900- (medication was not documented as offered/provided in the Medication Administration Record (MAR).10/11/25 1542-(medication was not documented as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105620 If continuation sheet Page 9 of 12 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 105620 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Lake Center 4240 Lakeland Highlands Rd Lakeland, FL 33813 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 offered/provided in the Medication Administration Record (MAR).10/12/25 0800-(medication was not documented as offered/provided in the Medication Administration Record (MAR).10/12/25 2000-(medication was not documented as offered/provided in the Medication Administration Record (MAR).10/13/25 2139- (medication was not documented as offered/provided in the Medication Administration Record (MAR).10/15/25 2000- (medication was not documented as offered/provided in the Medication Administration Record (MAR).Review of Resident #9's medical record revealed she was admitted to the facility on [DATE] with diagnoses including: Intervertebral Disc displacement, Morbid Obesity, Neuropathy, Noncompliance with medication regimen. Review of the current Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview of Mental Status (BIMS) score of 15 of 15, indicating intact cognition. Review of the Physician's Order Sheet (POS) for months 10/2025 and 11/2025 revealed Resident #9 was on a pain management program for mild pain and lower back pain.Review of the 10/2025 and 11/2025 Physician's Order Sheet revealed Resident #9 was ordered and received the following but not limited to medications: -Oxycodone/APAP (Percocet) tab 5-325 mg 1 tab by mouth three times a day as need (PRN) for non-acute pain. This order originated on 6/4/2024.3. Review of Resident #8's medical record to include 10/2025, and 11/2025 Medication Administration Record (MAR), as well as the Medication Monitoring/Control records for 10/2025 and 11/2025 revealed medications subtracted and signed off in the Medication Monitoring/Control records were not documented in the MAR for the medication Oxycodone/APAP Tab 5-325 1 tablet by mouth every six hours as needed for pain for five days as follows: -10/02/25 1730 - (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/08/2025 1952 - (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/10/2025 2100- (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/11/25 2032- (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/12/25 1600(medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/13/25 2015- (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/14/25 2030- (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/18/25 0715- (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/18/25 1230- (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/22/25 0800(medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/22/25 2100- (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/25/25 1700-(medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/26/25 1800-(medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/27/25 0700-(medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/27/25 1300(medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/27/25 1800- (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/28/25 0900- (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/28/25 1500- (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/31/25 0925- (medication was not documented as offered/provided in the Medication Administration Record (MAR).-10/31/25 2100(medication was not documented as offered/provided in the Medication Administration Record (MAR).-11/01/25 0900- (medication was not documented as offered/provided in the Medication Administration Record (MAR). Review of Resident #8's medical record revealed she was admitted to the facility on [DATE] with diagnoses including: Pyogenic arthritis, chronic obstructive pulmonary disease, type 2 diabetes malignancies with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105620 If continuation sheet Page 10 of 12 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 105620 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Lake Center 4240 Lakeland Highlands Rd Lakeland, FL 33813 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 hyperglycemia, bilateral primary osteoarthritis of knee, and muscle weakness.Review of Resident #8's admission Minimum Data Set (MDS) assessment, dated 9/30/2025 revealed, Section C. Cognition/Brief Interview Mental Status score or BIMS 15 of 15 showing intact cognition. Review of Section J. Heal Conditions revealed Resident #8 received pain medication.Review of the 10/2025 and 11/2025 Physician's Order Sheet revealed Resident #8 was ordered and received the following but not limited to medications:-Oxycodone-Acetaminophen Oral Tablet 5-325 mg give one tablet by mouth every six hours as needed for non-acute pain. This order originated on 09/30/2025.On 11/05/2025 at 11:34 a.m., an interview was conducted with the DON and the Regional Nurse Consultant regarding the discrepancies upon record review for Resident #1. The DON stated she reviewed the Controlled Substance Audit Record sheets ledgers but did not go into detail. The Regional Nurse Consultant stated she thinks the nurses do not understand which could be looked at as misappropriation of the medications. The nursing staff need to have a better understanding of the severity of documenting in the medical record.On 11/05/2025 at 11:50 a.m., an interview was conducted with the DON and Regional Nurse Consultant present. The DON stated on 10/18/2025 she received a call in the evening from the ADON, who was the Administrator on call. The ADON informed the DON, Staff I, LPN, telephoned her (ADON) of a missing narcotic card. The DON stated she (ADON) informed the NHA and both arrived at the facility. The DON stated she arrived at the facility along with the NHA and the ADON. At the time the DON arrived she stated, Staff K, LPN/UM and Staff L, RN/ weekend supervisor were searching for the missing narcotic card. The DON stated we looked in all the carts, trach cans, the residents' rooms on [NAME] Point, shred boxes. Staff K, LPN/UM looked in the unlocked locker rooms. The DON stated Staff I, LPN, does not have a locker but allowed us to look into her personal bag and pockets. The DON stated Staff I, LPN appeared calm, she did not look like she was hiding anything and stated, Staff I, LPN was baffled. The DON stated Staff I, LPN, wanted to go dumpster diving in the trash compacter but we stopped her. The DON stated we kept looking throughout the weekend but could not find the missing narcotic card. The DON stated Resident #1 did get a new prescription for his medication. The DON stated she went again to look on Tuesday the 21st to look for the yellow copy packing slips stating, I wanted to make sure I did not miss it. The DON stated she looked in the shred box and found the missing narcotic card with all the 12 tablets punched out and missing. The DON stated the shred box was searched twice on Saturday by two different parties of staff, herself and the NHA, included unsuccessfully. The DON stated the investigation started at this point because the narcotic medication card was located. The DON stated Sunday and Monday, she did her morning rounds as usual with nothing out of the ordinary. The DON stated Staff I, LPN, was suspended pending investigation but she verbally resigned while talking with her on the phone.On 11/05/2025 at 12:29 p.m., an interview was conducted with the NHA. The NHA stated he could not recall who notified him nor the time, but he stated he arrived to the facility after dinner time. The NHA stated he participated in searching for the missing medication. The NHA stated he searched in the residents' rooms, outside by the three storage sheds and trash cans outside but stated he does not recall looking in the shred box. The NHA stated Staff I, LPN, provided an e-mail statement 10/21/2025 at 11:06 a.m. In the email, Staff I, LPN, wrote on 10/18, Saturday, multiple medications were delivered. She stated she accepted the Hydrocodone 12 tablets, she placed the paper in the narc book after punching holes in the sheet. Staff I, LPN stated during shift narcotic count was when she discovered the missing narcotic medication card. Staff I, LPN, wrote there was a mass search for the missing card, but she assumed the card was thrown away accidentally. The NHA denied an Ad-Hoc meeting was held to discuss the missing narcotic medication card. At the conclusion of the interview, the DON stated no change in their policy of handling, receiving or storing of narcotics . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105620 If continuation sheet Page 11 of 12 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 105620 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Lake Center 4240 Lakeland Highlands Rd Lakeland, FL 33813 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 FORM CMS-2567 (02/99) Previous Versions Obsolete The DON stated education was started on 10/21/2025 with the topic titled: Misappropriation for the entire facility.Review of the facility policy titled Narcotic Count Sheet, dated 6/2024, revealed the following: Policy: The facility will reconcile schedule II narcotics each shift. Procedure: .3. schedule II controlled medications are received upon arrival, counted and entered on a count sheet. 4. When it's scheduled to medication is administered, the licensed nurse will complete the count sheet indicating the date and time of administration, amount administered, amount remaining and signature.6. Not just experience at the end of each shift, the oncoming nurse and the off going nurse will count the medication and reconcile them with the count sheets.7. If the account is incorrect, an investigation will be started immediately. 8. The [NAME] will be notified of the discrepancy and will make every attempt to reconcile the discrepancy. Reconcilable discrepancies are documented by the [NAME] and a report. If there is a major discrepancy, or a pattern of discrepancies, the Don, administrator and the consultant pharmacist will make a determination to notify police or other enforcement agencies and any other actions to be taken.9. Disposition of schedule 2 medications will be conducted by the Don/designee.Review of the facility policy titled medication administration, with a date of 1/2024, revealed the following: Standard: Medications are ordered and administered safely as prescribed. Guideline: medications will be administered safely and as prescribed by only licensed personnel. Procedure:. 17. As required are indicated for a medication, the individual administering the medication records and the residence medical record: a. The date and time the medication was administered; b. The dosage; c. The route of administration;. Event ID: Facility ID: 105620 If continuation sheet Page 12 of 12