Inspection·February 9, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 2/8/23 at 10:37 a.m., Certified Nursing Assistant (CNA) Staff U said Resident #53 was easy to get along with and did not usually refuse care unless she was very sick. On 2/8/23 at 11:12 a.m., in a telephone interview Resident #53's daughter- in-law said Resident #53 told her about the problem not getting showers. The daughter-in-law said this was a continuing problem at the facility. She said a few months ago she requested they change Resident #53's showers to daytime. On 2/9/23 at 11:48 a.m., the Regional Consultant Registered Nurse (RN) Staff V confirmed Resident #53 was not given a shower according to the resident's preference but should have been. On 2/9/23 at 12:10 p.m., RN Unit Manager Staff T said if a resident refuses a shower, the CNA should tell the nurse assigned to the resident. Staff T confirmed there was no nurse's note indicating Resident #53 refused showers. Staff T verified Resident #53 was still listed for evening showers on the shower schedule. Staff T confirmed showers should be performed according to resident preference and would change the shower to daytime (7:00 a.m. - 3:00 p.m.) for Resident #53. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 2 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to maintain a clean, and safe environment in 1 (Memory Care Unit) of 6 units of the facility. The findings included: On 2/6/23 at 10:36 a.m., during initial observations on the secured memory care unit the following was observed in shared bathrooms. Two unlabeled tubes of skin protection cream, a bottle of liquid soap, a bottle of skin cleanser and a comb were stored on the bathroom sink of room [ROOM NUMBER]. Photographic evidence obtained. The shared bathroom in room [ROOM NUMBER] had unlabeled hairbrushes, liquid soap, skin cleansing spray, and lotions. There were personal items on the sink that were not labeled with a resident name. There was a metal storage cart under the bathroom sink next to the trash that contained additional unlabeled liquid soaps and personal hygiene items. Photographic evidence obtained. room [ROOM NUMBER] had tube feeding and supplies unattended on the bed side table. The shared bathroom had two unlabeled wash basins stored on the bathroom floor on each side of the toilet. On the sink were unlabeled personal hygiene and liquid soaps. Photographic evidence obtained. room [ROOM NUMBER] in the bathroom had an unlabeled wash basin stored on the floor. On the sink were multiple personal items without resident names, including toothbrushes. Photographic evidence obtained. room [ROOM NUMBER] a basket containing skin protection creams, toothpaste and other personal hygiene items was on a bedside table with no name to identify who the supplies belonged to. Photographic evidence obtained. room [ROOM NUMBER] on the bathroom sink were two toothbrushes in a cup and two denture cups without a resident name. There was a bottle of liquid soap on the sink. Photographic evidence obtained. On 2/8/23 at 8:12 a.m., Certified Nursing Assistant (CNA) Staff B confirmed the findings of unsafe and improper storage of personal hygiene items and skin protection creams and soap in the shared bathrooms. CNA Staff B said he would remove the items form the shared bathrooms. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 3 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 2/8/23 at 8:33 a.m., Licensed Practical Nurse Staff C confirmed the findings of unlabeled personal hygiene items and washbasins improperly stored in shared bathrooms. Staff C verified wandering residents could have access to items that could be ingested. Staff C said the personal hygiene items should be labeled and placed in the residents bedside nightstand. On 2/7/23 at 853 a.m., during an observation in room [ROOM NUMBER] there was a large, rolled up plastic barrier in the corner of the room next to the resident's nightstand. There were glue markings on the wall behind the bed where the plastic protector barrier was attached to the wall. photographic evidence obtained. On 2/7/23 at 10:15 a.m., the Maintenance Director verified the plastic wall protector had been removed and said he was not aware but would fix it. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 4 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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, record review and staff interviews the facility failed to develop and implement a comprehensive, resident centered activity plan of care for 1(Resident #84) of 29 resident care plans reviewed. The findings included: The facility Activity and Recreation Service Manual specified, The activity and recreation staff participates in the development of interdisciplinary and comprehensive care plans to address patient's physical, psychosocial, recreational, cognitive needs and or strengths as indicated by the comprehensive assessment. The admission Minimum Data Set (MDS) Assessment with an assessment reference date of 8/2/22 noted it was very important to the resident to listen to music she likes, very important to do things with groups of people, very important to do her favorite activities and very important to get fresh air when the weather is good. Resident #84's cognition was severely impaired. Diagnoses included major depressive disorder, anxiety and psychosis. A review of the [NAME] unit activity calendar for 2/6/23 documented, 9:00 daily chronicle/coffee, 10:30 a.m., morning stretches, 1:30 afternoon sunshine, 2:30 Balloon bop and 3:00 art and snacks. On 2/6/23 at 11:03 a.m., and at 3:00 p.m., Resident #84 was observed seated at a table in the common area in the center of the [NAME] memory care unit. There was no structured or individualized activity in progress. The television was on, but the resident was seated with her back to the television. The [NAME] unit activity calendar for 2/7/23 documented 9:00 daily Chronicle/coffee, 10:00 manicures, 12:00 lunch, 2:00 afternoon stretch. On 2/7/23 between 9:20 a.m., and 9:25 a.m., the Activity Director was observed placing coloring papers and markers, activity blankets, fidget toys and magazines on the tables in front of the eight residents seated at the tables on the [NAME] unit. Resident #84 was seated at a table, in a wheelchair, sleeping. The Activity Director left the unit at 9:30 a.m. At 2:30 p.m., Resident #84 was observed sleeping and seated at the same table with no activity in progress. On 2/8/23 at 10:21 a.m., Resident #84 was observed at the table in center of the unit, sleeping in her chair. There was no activity in progress. On 2/8/23 at 11:45 a.m., the Activity Director confirmed Resident #84 did not have a care plan to address her activity preferences. On 2/9/23 at 2:30 p.m., the Care Plan Coordinator said the process for care plans included all staff involved in the resident's care attend the quarterly or annual MDS meeting and update the care plan. The Care Plan Coordinator confirmed an individualized activity plan was never developed or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 5 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 implemented to meet Resident #84's activity needs. 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: 105723 If continuation sheet Page 6 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the clinical record, and resident and staff interviews, the facility failed to provide the necessary care and services to maintain personal hygiene for 7(Resident #3, #6, #58, #75, #401, #404 and #405) of 29 residents reviewed for activities of daily living (ADLs). Residents Affected - Some The findings included: The facility policy Tub baths and showers (revised 5/20/22) documented, Tub baths and showers provide personal hygiene, stimulate circulation, and reduce tension for a patient. They also allow observation of the condition of a patient's skin and assessment of joint mobility and muscle strength. 1. Review of the clinical record revealed Resident #6 had diagnoses including dementia, anxiety, and muscle weakness. The Quarterly Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date of 11/5/22 documented Resident #6 required extensive assistance for personal hygiene and was dependent on staff for bathing. The MDS noted Resident #6's cognitive skills for daily decision making were severely impaired. The Certified Nursing Assistant (CNA) Kardex, (provides instruction on specific resident care needs) noted staff were to provide a shower every Monday and Thursday in the evening. The care plan initiated 8/12/20 documented the resident will be clean, dressed, and well-groomed daily to promote dignity and psychosocial wellbeing. On 2/6/23 at 10:07 a.m., Resident #6 was observed in a wheelchair on the [NAME] memory care unit, seated in the center common area of the unit. Her hair was greasy, uncombed and her appearance was disheveled. Review of the CNA documentation for January 2023 documented Resident #6 received a bed bath on 1/12/23, and refused bathing on 1/26/23, and 1/31/23. The CNA documentation for 2/1/23 through 2/6/23 documented Resident #6 received a bed bath on 2/3/23. 2. On 2/6/23 at 11:34 a.m., Resident #58's spouse was at her bedside and said he did not feel the facility was keeping his wife clean. Resident #58 was observed in her room in bed. She was dressed in a hospital gown; her hair was greasy and matted. The resident's fingernails were long, extending over 1/2 inch in length, with a brown substance under the nail beds. Her appearance was disheveled. Review of the clinical record revealed Resident #58 had diagnoses including dementia, Alzheimer's, rheumatoid arthritis, and muscle weakness. The Quarterly MDS with an assessment reference date of 12/16/22 documented Resident #58 required extensive assistance for personal hygiene and was dependent on staff for bathing. The MDS noted Resident #58's cognitive skills for daily decision making were severely impaired. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 7 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 The CNA Kardex noted staff were to provide a shower every Tuesday and Friday in the evening. Level of Harm - Minimal harm or potential for actual harm Review of the CNA documentation for January 2023 documented Resident #58 received her scheduled shower on 1/13/23, 1/20/23 and 1/27/23. Resident #58 received a bed bath on 1/3/23, 1/6/23, 1/10/23, 1/17/23, 1/24/23, 1/31/22. Residents Affected - Some The clinical record contained no documentation Resident #58 had refused her showers. On 2/7/23 at 1:15 p.m., in an interview CNA Staff F said, there was a shower schedule in the Kardex in the electronic record and staff follow that for showers. CNA Staff F said Resident #58 did not get out of bed and she did not know why. CNA Staff F said Resident #58 required total care. 3. On 2/6/23 at 10:30 a.m., Resident #75 was observed sitting in a wheelchair at the table in the center of the [NAME] memory care unit. The resident had short, greasy hair and her fingernails were long with a brown substance under the nail beds. Review of the clinical record revealed Resident #75 had diagnoses including dementia, anxiety, depression, and glaucoma. The admission MDS with an assessment reference date of 10/24/22 documented Resident #75 was dependent on staff for bathing. The MDS noted Resident #75's cognitive skills for daily decision making were severely impaired. The CNA Kardex noted staff were to provide a shower every Tuesday and Friday in the evening. Review of the CNA documentation for January 2023 documented Resident #75 received bed baths on 1/3/23, 1/6/23, 1/10/23, 1/17/23, 1/24/23, 1/31/23. Review of the clinical record showed no documentation Resident #75 refused her scheduled showers. On 2/9/23 at 8:40 a.m., Registered Nurse (RN) Supervisor Staff H said if a resident was scheduled for a shower the expectation was for the resident to receive a shower. If a resident refused or wanted a bed bath, then it would be given. On 2/9/23 at 9:11 a.m., the Regional Nurse Consultant (RNC) said residents' showers are scheduled and are placed on the CNA Kardex. The CNA is expected to provide a shower and if the resident wants a bed bath, they give a bed bath. For the dementia residents who can't specify, the expectation is the CNA follows the shower schedule, if they give a bed bath it should be documented in the progress note the resident requested or refused a shower. The RNC confirmed dementia residents with cognitive impairments were not always capable of requesting a bed bath and staff should document in a progress note why the resident did not get the scheduled shower. The RNC said all residents are scheduled for showers and it is on the CNA Kardex. 7. A review of Resident #3's clinical record showed an Annual Minimum Data Set (MDS) Assessment with an Assessment Reference Date (ARD) of 12/2/22 which documented Resident #3 needed assistance with feeding. The MDS specified the resident required extensive physical assistance of one person for eating. The Certified nursing assistant (CNA) Kardex (specified care needs the resident required for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 8 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some food/fluids), documented to assist the resident with meals as needed, upright and out of the bed for all meals, and supervision for all meals. The Care Plan initiated on 7/2/19 specified for the resident to be upright and out of bed for all meals. On 2/6/23 at 12:40 p.m., Resident #3 was not out of bed for lunch. She was lying bed in the upright position. A Certified Nursing Assistant was feeding Resident #3 her lunch. On 2/7/23 at 10:10 a.m., Resident #3 was lying in bed, smiling, and making eye contact when talked to. Resident #3 did not get out of bed for breakfast. On 2/8/23 at 12:37 p.m., a CNA was observed feeding Resident #3. The resident was lying in bed in the upright position. On 2/8/23 at 2:51 p.m., the Director of Therapy (DOT) said when Resident #3 was discharged from therapy, she had a therapy communication to nursing with instructions to be out of bed for all meals. She said the Certified nursing assistants (CNA) were educated, and signed they received the education and instructions. On 2/9/23 at 1:15 p.m., Certified Nursing Assistant (CNA) Staff Q verified she did not get Resident #3 up for breakfast, and she should have. 4. Review of Resident #401's care plan with an effective date of 1/27/23 noted the resident had limited functional mobility and Activity of daily living self-care deficits related to muscle weakness and physical limitations after hospitalization. The Kardex noted the resident required assistance of one to two with all activities of daily living. On 2/6/23 at 10:00 a.m., resident #401 was observed sitting in his room, in a hospital gown with the over the bed tray table in front of him. His nails were long, jagged, and had visible brown substance underneath. On 2/6/23 at 1:47 p.m., Resident #401 was observed finishing lunch. He was dressed in an orange T-shirt and shorts. Resident #401's nails remain with an accumulation of a brown substance under his nails. He had substantial growth of facial hair. On 2/7/23 at 10:37 a.m., Resident #401 was dressed in the same T-shirt and shorts from 2/6/23, and gripper socks. His nails remain long, jagged with brown substance both under the nails and on top of some of the nails, He has significant beard growth. On 2/8/23 at 8:40 a.m., Resident #401 was observed and did not have a basin, toothbrush, razor or toiletries in his room or bathroom. On 2/8/23 at 9:55 a.m., resident #401 was observed wearing the same orange T-shirt with food stains on the front, black shorts and yellow gripper socks. Resident stated he was not good, they washed my face with a wipe and demonstrated with a wiping motion washing is face and head with his hands. Resident #401 was care planned to have a shower/bath as needed. A complete record review failed to show documentation of any shaving or nail care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 9 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 2/8/23 at 9:49 a.m., CNA Staff I stated started her shift by checking the assignment, checking the residents, then get them up for breakfast because some people have to sit upright when they eat. Get them coffee, pass breakfast trays. While they are eating, I get the others cleaned up whoever isn't up to get them ready for the day and make their bed. When I clean them up, I change them and wipe them down, make sure they smell clean, wash their hands and face. Staff I stated resident #401 doesn't have any clothes because I guess no one has brought anything for him. 5. Resident #404's care plan with an effective date of 1/30/23 noted resident #404 has limited functional mobility and Activity of daily living self-care deficits related to Muscular Dystrophy. He required extensive assistance to transfer positions. On 2/6/23 at 9:37 a.m., resident #404 was observed in bed. His hair looked matted and greasy. On 2/6/23 at 3:24 p.m., resident #404 was observed in bed watching television. His eyes had crusted drainage in the corners and a copious amount of grey drainage covered the right lower eyelid. On 2/7/23 at 10:32 a.m., Resident #404 was observed in common area, at dining table. He stated he doesn't know why he has not shaved but needs it really bad. Resident stated his fingernails were long needed to be trimmed. On 2/8/23 at 8:54 a.m., Resident #404 was observed in bed. Resident did not have any toiletries, towel or washcloth in room, no comb, brush, razor or basin in bathroom or closet. Resident #404 was care planned to have a shower/bath as needed. A complete record review failed to show documentation of any shaving or nail care. He had one bed bath and one shower since arrival to the facility on 1/27/23. On 2/8/23 at 9:02 a.m., Certified Nursing Assistant (CNA) Staff J, said she has worked at the facility for 29 years. She said, At the start of my shift, I get report, check on my people and get some up for breakfast. I let them wash their hands and face. Then I pass the trays for breakfast. I collect the trays after breakfast is finished. I get them ready for therapy, made their beds and provide morning care. Morning care is where I take them to the bathroom or change them if they are incontinent, let them brush their teeth and wash their face. Some are independent so I just need to hand them towel and washcloth and get them dressed. 6. Resident #405's care plan with an effective date of 1/30/23 noted resident #405 has limited functional mobility and Activity of daily living self-care deficits related to impaired balance and right knee pain after sustaining a right knee fracture. On 2/6/23 at 1:58 p.m., Resident #405 stated she has not had a shower or bed bath since coming here. Resident was admitted on [DATE]. She stated, my hair has never, ever felt like this. I would give anything for a shower or bath. They told me I can't get a bath because I can't go out of my room because of Covid. I could wear a mask and gown just like they do in here. On 2/7/23 at 3:54 p.m., Resident #405 stated she was feeling down today. She said, I was hoping I would get a shower today. I asked the nurse last night, and she said I would get one in the morning. Today, they told me no because I'm still on isolation. They have not offered me a sponge bath. I asked [Certified Nursing Assistant (CNA) Staff J], to please wash my back because it was itching so bad and she did, that's all she did. They just don't have enough help to get everything done. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 10 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 2/9/23 at 9:05 a.m., Resident #405 stated she still had not received a shower or bed bath, and really needed one. She said, I have a doctor apt today and am already dressed but if I could please have one before I go home. Resident #405 was care planned to have a shower/bath on Monday and Thursdays. The CNA documented not applicable on each scheduled day. No other showers/baths were completed. On 2/8/23 at 11:54 a.m., shower and certified nursing assistant care sheets were reviewed with the Director of Nursing (DON) and Divisional Registered Nurse. They confirmed the residents may not have had the necessary care provided. The DON reviewed the ADL charting and agreed the documented responses of N/A (Not applicable) for planned care would not be acceptable for any resident requesting care. On 2/9/23 at 9:14 a.m., during a joint visit of the 600 unit, the DON verified Resident #404 and #401 had not been shaved and wished to, and both have long, jagged fingernails that needed to be cleaned and trimmed. On 2/9/23 at 1:35 p.m., The DON reported she made an apt with the beautician for resident #404 to be shaved and the cost would be covered by facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 11 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 5. The quarterly Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date (ARD) of 11/6/22 documented Resident #84's cognitive skills for daily decision making were severely impaired. Residents Affected - Some Resident #84 diagnoses included major depressive disorder, anxiety, and psychosis. The care plan created on 8/1/22 did not have an individualized activity plan of care. On 2/6/23 at 11:03 a.m., and at 3:00 p.m., Resident #84 was observed seated at a table in the common area in the center of the [NAME] memory care unit. There was no structured or individualized activity in progress. The television (TV) was on, but the resident was seated with her back to the television. On 2/7/23 between 9:20 a.m., and 9:25 a.m., the Activity Director was observed placing coloring papers and markers, activity blankets, fidget toys and magazines on the tables in front of the 8 residents seated at the tables on the [NAME] unit. Resident #84 was seated at a table, in a wheelchair, sleeping. The Activity Director left the unit at 9:30 a.m. On 2/7/23 at 2:30 p.m., Resident #84 was observed sleeping and seated at the same table with no activity in progress. On 2/8/23 at 10:21 a.m., Resident #84 was observed at the table in center of the unit, sleeping in her chair. There was no activity in progress. 6. Review of the clinical record for Resident #6 revealed diagnosis including dementia, anxiety, major depression, and psychotic disorder. A Quarterly MDS with ARD of 11/5/22 documented Resident #6 cognitive skills for daily decision making were severely impaired. The current activity care plan documented Resident #6 enjoyed activities such as reading, the newspaper, watching television, news, and movies, listening to soft music, outdoors, pet therapy, and socials. The interventions included Resident #6 will actively participate in activities that promote socialization with peers consistent with likes and interests two to three times weekly such as socials, beauty salon, current events, music programs, and pet therapy visits. Encourage participation in group activities of interest. On 2/6/23 at 9:11 a.m., Resident #6 was observed in a wheelchair on the memory care unit. Resident #6 was wandering about the unit and going into other resident rooms. Housekeeper Staff G was observed redirecting Resident #6. No activity program was in progress. On 2/7/23 at 9:44 a.m., Resident #6 was observed on the unit at a beverage cart with the hot water and coffee metal carafe on top. Resident #6 was observed pouring the hot coffee into different cups on the cart. The only staff member in the area was Housekeeper Staff G who redirected the resident away from the beverage cart. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 12 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During random observations on 2/7/23 and 2/8/23, Resident #6 was observed wandering on the unit into other resident rooms with no supervision and taking items form the rooms. There were no structured activity programs observed on the unit. 7. Review of the clinical record for Resident #58 revealed a Quarterly MDS with an ARD of 12/16/22 section documented Resident #58's cognitive skills for daily decision making were severely impaired. The record documented Resident #58's diagnosis included Alzheimer's disease and major depressive disorder. The care plan initiated 3/19/18 specified Resident #58 enjoys activities such watching TV news, sport movies, word games, country music, being around animals, taking walks, group activities, socials, music programs, religious services, and going outdoors for fresh air. Patient has a diagnosis of dementia which creates barriers, desires and motivation to learn. On 2/6/23 at 11:34 a.m., during observation and interview, Resident #58 was in her bed, no TV or radio was on. The resident's spouse at bedside said, they don't get my wife out of bed, she is in here all the time. No one comes to the room; she just lays here. On 2/6/23 at 3:45 p.m., Resident #58's spouse was at her bedside and said no one came to do any activity with her. She just laid here all day. There was no TV or radio on in the room. The spouse had no newspaper or other items with him. During random observations on 2/7/23 at 10:42 a.m., and 2:00 p.m., Resident #58 was in her bed with her spouse at the bedside. No activity was in progress and no TV or radio was on in the room. On 2/8/23 at 9:30 a.m., the Activity Director said Resident #58 did not leave her bed. Her spouse visits daily and reads her the newspaper every day for socialization. The Activity Director confirmed she had not provided any individualized, specialized activity to meet the needs for Resident #58. 8. Review of the clinical record for Resident #75 revealed a Quarterly MDS with an ARD of 1/24/23 documented Resident #75's cognitive skills for daily decision making were severely impaired. Resident #75's diagnosis included anxiety disorder, depression, altered mental status, and dementia with behavioral disturbance. The care plan initiated 10/20/22 documented Resident #75 enjoyed activities such as sewing, baking for her family and animals. The interventions included, offer activity program directed toward specific interests/needs. On 2/6/23 at 10:25 a.m., Resident #75 was observed sitting at a table in the memory care unit. Resident #75 was calling out for help for 20 minutes, with no response from staff. Housekeeper Staff G approached the resident and provided her with magazines to read. Staff G said there were two certified nursing assistants (CNA) assigned to the unit on the unit, both were busy, and the nurse assigned to the memory care unit was also assigned to cover another unit and was in and out of the area. On 2/6/23 at 11:30 a.m., Resident #75 was observed sitting at the table calling out for assistance and there was no staff in the area and no activity in progress. Resident had a magazine in front of her on the table. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 13 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 2/6/23 at 3:42 p.m., Resident #75 was observed in the same location in her wheelchair at the table. The television was on, but Resident #75 was not watching it. No structured activity was in progress. The [NAME] memory care unit, activity calendar 2/6/23 documented A review of the [NAME] unit activity calendar for 2/6/23 documented, 9:00 daily chronicle/coffee, 10:30 a.m., morning stretches, 1:30 afternoon sunshine, 2:30 Balloon bop and 3:00 art and snacks. The [NAME] memory care unit, activity calendar for 2/7/23 documented 9:00 daily Chronicle/coffee, 10:00 manicures, 12:00 lunch, 2:00 afternoon stretch, 3:30 AFV and snacks. The [NAME] memory care unit, activity calendar for 2/8/23 documented 8:00 daily chronicle/coffee, 10:00 morning stretch, 12:00 lunch, 1:00 afternoon sunshine, 1:30 music, 3:00 cards and snacks. On 2/8/23 at 8:01 a.m., CNA Staff E said there were only two CNA's on the unit now, there used to be three. When there is no activity staff present, the CNAs are supposed to do the activities on the calendar but can't always do it. She said, We are rushed, we have to take care of the residents and we can't do the activity. We try and give them the books, busy blankets, and bubble poppers. On 2/8/23 at 8:25 a.m., CNA Staff B said the CNAs were responsible to provide the activity when no activity staff were present on the unit. Staff B said the CNAs are busy with resident care and it was hard to keep up. She said, We put the TV on and give them things to do at the table, but we are not always able to supervise and do the activity. On 2/8/23 at 8:37 a.m., Licensed Practical Nurse (LPN) Staff C said the CNAs on the unit were responsible to provide the activity when the activity director was not on the unit. He said, I try to help out, but I am assigned on two units, and I can't be here all the time. I try to spend as much time as I can here in the morning when I am giving medications. On 2/8/23 at 9:30 a.m., the Activity Director she said she was the only one here most days for entire building and on Tuesdays she attended care conference meetings. The Activity Director said the CNAs on the memory care unit were responsible to provide the scheduled activity when there was no one from the activity department on the unit. The Activity Director said she was unsure who was responsible to ensure the CNAs were providing the activity per the calendar and said, I assume the nurse would be responsible. She said there was an activity cart with activity aprons, magazines, and other items for the staff to provide to the residents. The Activity Director said, I do the daily coffee and news chronicle in the mornings on all the units. Based on observations, interviews, records review the facility failed to provide activities to meet the interests of 8 (Resident #3, #6, #17, #42, #58, #68, #75, and #84) of 9 residents reviewed for activities. The lack of an ongoing activity program and lack of contact and interaction with the community could lead to a decline in residents' mental and psychosocial well-being. The findings included: The facility Activity and Recreation Service Manual 7/19 specified The multi-faceted activity and recreational program creates a therapeutic environment that promotes cognitive, physical, social and sensory stimulation. The program of activities is designed to recognize and accommodate patient limitations while maximizing strengths, interests, and abilities. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 14 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 1. Review of the clinical record for Resident #3 revealed an admission date of 1/14/19. The Annual Minimum Data Set (MDS) assessment with a target date of 12/2/22 revealed Resident #3 scored a 3 on the Brief Interview for Mental Status, indicative of severe cognitive impairment. The MDS noted it was somewhat important for Resident #3 to keep up with news, listen to music, very important to be around animals such pets, somewhat important to do things with group of people, do favorite activities, get fresh air when weather is good, and to participate in religious services or practices. Resident #3 was totally dependent on physical assistance of staff for transfer and locomotion on and off unit. Diagnoses listed on the order summary report included cerebral vascular disease, vascular dementia unspecified severity, dysphasia (difficulty swallowing) following cerebral infarction, and cognitive communication deficit. The activity care plan initiated on 1/5/19 with a target date of 3/26/23 noted the resident enjoyed activities such as animals, watching local news, watching TV movies, gospel music, religious church services, and being around family. The goal was for Resident #3 to accept one to one friendly visits from activities two to three times a week and participate in independent leisure activities of choice such as watching local news, gospel music, and visits with son. The interventions included to assist to transport to and from activities of choice; Encourage participation in group activities of interest; and offer activities consistent with patient's known interest, physical and intellectual capabilities. On 2/6/23 at 10:27 a.m., Resident #3 was observed in bed sleeping on her back, her privacy curtain was pulled. The resident was not participating in any activity. The television wasn't turned, or any radio observed on in the resident's room. On 2/7/23 at 9:30 a.m., 10:15 a.m., and 10:51 a.m., Resident #3 was observed sitting up in bed. The resident was not engaged in any activity. The television or radio was not turned on. Resident #3 was able to make eye contact and smile. On 2/7/23 at 3:11 p.m., Resident #3 was observed in bed sleeping. The television or radio was not turned on. On 2/8/23 at 9:40 a.m., Resident #3 was observed in bed sleeping. The television or radio was not turned on. On 2/9/23 at 10:25 a.m., and 11:43 a.m., Resident #3 was observed lying in bed. The resident was not engaged in any activity. The television or radio was not on. 2. Review of the clinical record for Resident #17 revealed an admission date of 11/13/18. The Annual Minimum Data Set (MDS) assessment with a target date of 11/2/22 revealed Resident #17 scored a 2 on the Brief Interview for Mental Status, indicative of severe cognitive impairment. The MDS noted it was somewhat important for Resident #17 to listen to music, to be around animals such pets, to do things with group of people, do favorite activities, and to participate in religious services or practices. Resident #17 was totally dependent on physical assistance of staff for transfer and locomotion on and off unit. Diagnoses listed on the order summary report included major depressive disorder, dysphasia (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 15 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 0679 following cerebral infarction, unspecified vascular dementia, and cognitive communication deficit. Level of Harm - Minimal harm or potential for actual harm The activity care plan initiated on 11/18/18 with a target date of 2/24/23 noted the resident enjoys activities such as reading books and magazines, cooking and baking, exercise walking, Spanish music, being around dogs, church socials, and religious services. The goal was for Resident #17 to actively participate in activities that promote socialization with peers consistent with likes and interests once to twice weekly. Residents Affected - Some The interventions included to assist in planning and/or encourage to plan own, leisure times activities; assist to transport to and from activities of choice; Encourage participation in group activities of interest; Encourage patient to use glasses during activities that require them to read or see; Provide supplies/materials for leisure activities as needed/requested. On 2/6/23 at 11:20 a.m., Resident #17 was observed in room sitting up in her wheelchair. The resident was not participating in any activity. On 2/7/23 at 9:31 a.m., Resident #17 was observed in bed. The resident was not participating in any activity. The television or radio was not on. 2/7/23 at 10:15 a.m., 10:19 a.m., and 11:05 a.m., Resident #17 was observed lying in bed. The resident was not participating in any activity. The television or radio was not on. 2/7/23 at 3:11 p.m., Resident #17 was observed lying in bed. The resident was not participating in any activity. The television or radio was not on. On 2/8/23 at 2:46 p.m., Resident #17 was observed up in her wheelchair in her room. The resident was not participating in any activity. The television or radio was not on. On 2/9/23 at 10:15 a.m., Resident #17 was observed lying in bed in her gown. The resident was not participating in any activity. The television or radio was not on. 3. Review of the clinical record for Resident #42 revealed an admission date of 11/30/22. The admission Minimum Data Set (MDS) assessment with a target date of 12/7/22 revealed Resident #42 scored a 7 on the Brief Interview for Mental Status, indicative of severe cognitive impairment. The MDS noted it was very important to have books, newspapers, and magazines to read, somewhat important for Resident #42 to listen to music, to be around animals such pets, to keep up with the news, to do things with group of people, do favorite activities, and to get fresh air when the weather is good. Resident #42 was totally dependent on physical assistance of staff for transfer and locomotion on and off unit. Diagnoses listed on the order summary report included major depressive disorder, disorder of muscles, dementia unspecified severity, and urine retention. The activity care plan initiated on 12/5/22 with a target date of 3/23/23 noted the Resident #42 enjoyed activities such as watching the news, listening to music, and going outdoors. The goal was for Resident #42 to actively participate in leisure activities of choice. The interventions included to assist in planning and/or encourage to plan own leisure times activities; assist to transport to and from activities of choice. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 16 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 0679 Level of Harm - Minimal harm or potential for actual harm On 2/6/23 at 10:27 a.m., Resident #42 was observed lying in bed. Resident #42 was not participating in any activity. No television or music was on. On 2/7/23 at 10:42 a.m., Resident #42 was observed sleeping in bed. Resident was not participating in any activity. No television or music was on. Residents Affected - Some On 2/8/23 at 2:40 p.m., Resident #42's family member at bedside said every time they visit, she is in bed. They ask staff to get her up. 4. Review of the clinical record for Resident #68 revealed an admission date of 11/15/21. The Quarterly Minimum Data Set (MDS) assessment with a target date of 1/3/22 revealed Resident #68 scored a 10 on the Brief Interview for Mental Status, indicative of moderate cognitive impairment. The MDS noted it was very important for Resident #68 to listen to music, to be around animals such pets, to keep up with the news, to do things with group of people, do favorite activities, and to get fresh air when the weather is good, somewhat important to do favorite activities. Resident #68 was totally dependent on physical assistance of staff for transfer and locomotion on and off unit. Diagnoses listed on the order summary report included dysphasia following unspecified Cerebrovascular infarction, disorder muscle, and major depressive. The activity care plan initiated on 11/16/21 noted the resident enjoyed activities such as being around dogs, arts and crafts, computer use, cooking, reading the newspaper, watching [NAME] news/children's movies, listening to 50's music, outdoors, and socializing. The goal was for Resident #68 to actively participate in independent leisure activities of choice and actively participate in activities that promote socialization with peers consistent with likes and interests once to twice weekly such as nail care and music programs. The interventions included to assist in planning and/or encourage to plan own leisure time activities; assist to transport to and from activities of choice; and encourage participation in group activities of interest. On 2/6/23 at 11:20 a.m., Resident #68 was observed in her room lying in bed. The resident was not participating in an activity. The television or radio was not on. On 2/7/23 at 10:15 a.m., Resident #68 was observed in room lying in bed sleeping. The resident was not engaged in activity. The television or radio was not on. On 2/7/23 at 3:12 p.m., Resident #68 was observed in room lying in bed sleeping. The television or radio was not on. On 2/8/23 at 1:50 p.m., Resident #68 was observed in room lying in bed. The resident was not engaged in any activity. The television or radio was not on. On 2/9/23 at 10:15 a.m., Resident #68 said someone in the activity department used to come and do visits, but they don't come anymore. On 2/8/23 at 12:48 p.m., the Activity Director (AD), stated We chart in the electronic record, that's done daily, and the one-on-one are done Wednesdays and Fridays scheduled. I do some one-on-one visits on Mondays when I am doing the cart, and my assistant does some on the weekend, time (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 17 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete permitting. One-on-One visits consist of leisure cart. For the ladies, manicure, and hand massage, and just visiting. We try to spend 10-15 minute depending on the conversation and cognitive ability. Our biggest hurdle is the Certified Nursing Assistants (CNAs) not getting people out of bed to attend activities. On 2/9/23 at 1:10 p.m., the Activity Director said she had not done any one-on-one visits with Resident #3, #17, #42, and #68. Record review confirmed Residents #3, #17, #42 and #68 had not had one-on-one visits. Event ID: Facility ID: 105723 If continuation sheet Page 18 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, staff and resident interview, the facility failed to demonstrate effective coordination to ensure 1 resident (Resident #84) of 6 residents reviewed with wounds, received the appropriate preventive care and treatment. This failure can cause delayed wound healing and potential infection. Residents Affected - Few The findings included: The facility Skin Assessment Guidelines purpose documented, To describe the process steps required for identification of patients at risk for the development of skin alterations, identify prevention techniques and interventions to assist with the management of pressure injuries and skin alterations. The individualized comprehensive care plan addresses the skin management program, the goal for prevention and treatment, individualized interventions to address the patient's specific risk factors and the plan for reduction of risk. Review of Resident #84's clinical record revealed an admission date of 7/30/22 with diagnosis including adult failure to thrive, osteoarthritis and anxiety. The Quarterly Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date of 11/6/22 documented Resident #84 required extensive physical assistance of one for bed mobility and personal hygiene. The assessment noted Resident #84 did not have any wounds. The MDS noted Resident #84's cognitive skills for daily decision making were severely impaired. The care plan identified Resident #84 was at risk for alteration in skin integrity related impaired mobility and incontinence. The goal was to decrease/minimize skin breakdown risks. The interventions included, encourage to reposition as needed and observe skin condition with activity of daily living care daily and report abnormalities. On 2/6/23 at 10:47 a.m., Resident #84 was observed in her wheelchair (w/c) at the dining table with an uncovered wound on the left outer ankle. The surrounding skin was visibly red and swollen. The center of the wound appeared dry. On 2/6/23 at 11:01 a.m., Licensed Practical Nurse (LPN) Staff C said Resident #84 had a scabbed wound to the left outer ankle that had been there for a while. LPN Staff C observed Resident # 84 left ankle wound and said, It does look very red, it was not like that, I will call the doctor. On 2/6/23 at 12:22 p.m., Resident #84's family member was visiting and said the wound had been there for a while, but it looked very inflamed and swollen today. The facility never told them the cause of the wound. On 2/6/2023 at 12:55 p.m., a nursing progress note documented Resident #84 had an old callus scabbed area on the outer ankle with some redness and warmth to touch. The Advanced Practice Nurse Practitioner notified, new orders for treatment. On 2/6/2023 at 2:30 p.m., Licensed Practical (LPN) Staff C said he called the physician and received orders for the wound and put a dressing on the wound, and notified the family. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 19 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 2/7/23 at 11:21 a.m., the Divisional Consultant Registered Nurse (DCRN) said the nurses chart by exception and the skin checks are on the medication administration record (MAR). The nurse completes the skin check and then initials the Medication Administration Record (MAR). The DCRN said the nurse does not complete any other documentation of skin check unless an issue was identified. On 2/7/23 at 1:40 p.m., the Director of Nursing (DON) said there was no documentation Resident # 84 had the left ankle wound before 2/6/23. On 2/7/23 at 5:05 p.m., the physician ordered Mupirocin External Ointment (antibiotic) and Santyl External Ointment (ointment to remove dead tissue) to apply to the left ankle wound every shift. Further review of the clinical record revealed a Skin and Wound Evaluation dated 2/7/23 at 4:29 p.m., documented Resident #84 had an in house acquired, arterial wound on the left lateral malleolus (left outer ankle), date when first assessed was unknown. The form documented the wound was 0.9 centimeters (cm) length, 1 cm width with 0.1 cm depth. The wound bed was described as 100% slough (dead tissue) with no evidence of infection or swelling. On 2/8/23 at 3:00 p.m., LPN Staff A said she completed the weekly body audit every Wednesday evening for Resident # 84 for the month of January 2023 and completed her scheduled body audit on 2/1/23. LPN Staff A said Resident #84 had a scabbed area on the left ankle and it had been there for a long time, it was not new. LPN Staff A said, if it was new, I would have documented it and called the physician. I did not document it because it was there and not something new. LPN Staff A said she did not notice it looked infected or red. On 2/8/23 at 3:15 p.m., Wound Care Registered Nurse (WCRN) Staff M said she was unaware Resident # 84 had a left ankle wound. She said she will have the wound care Nurse Practitioner assess the wound on Friday. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 20 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 record review and resident and staff interviews, the facility failed to provide the necessary care and services to prevent a decline in range of motion for 1 (Resident #58) of 3 residents reviewed for decline in range of motion. The findings included: On 2/6/23 at 11:34 a.m., Resident #58 was observed in her room in bed. The resident's hands were contracted with the pads of the fingertips pressing into her palms. There were no pressure reduction or splinting devices in her hands. Resident #58's family member at her bedside said no one puts anything in her hands for the contracture. Review of the clinical record revealed Resident #58 had diagnoses including dementia, Alzheimer's, rheumatoid arthritis, and muscle weakness. The Quarterly Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) Assessment with an assessment reference date of 12/16/22 documented Resident #58 required extensive assistance for personal hygiene. The MDS noted Resident #58's cognitive skills for daily decision making were severely impaired. The Certified Nursing Assistant (CNA) [NAME], (provides instruction to CNA's on specific resident care needs) instructed, Pt to wear bilateral palm protectors at all times. Remove them for skin check daily. The clinical record contained no documentation the palm protectors were applied for Resident #58. On 2/7/23 at 1:15 p.m., Certified Nursing Assistant (CNA) Staff F said the resident required total care and did not have anything placed in her hands for the contractures. On 2/9/23 at 8:45 a.m., CNA Staff E said she did not know what happened to Resident #58's palm protectors, she used to have them. The CNA said the resident did not open her hands and it was hard to get anything in the hands. The CNA said she did not know if splints or palm protectors were on the CNA [NAME] for the Resident #58. On 2/9/23 at 8:35 a.m., the Occupational Therapist (OT) Staff CC said residents were screened by therapy quarterly but Resident #58 was a hospice patient and they do not screen unless hospice gives the therapist permission. The OT said she knew Resident #58 and had worked with her in the past but said she did not know if there any splints for her hands. On 2/9/23 at 8:40 a.m., in an interview the Registered Nurse (RN) Supervisor Staff H said she did not know if Resident #58 was to have a splint in her hands and said she would have to find out. On 2/9/23 at 9:29 a.m., the Director of Rehab (DOR) said Resident #58 was on hospice services and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 21 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 they do not screen unless hospice requests a screen. The DOR said they do not screen any residents unless they receive a request from the staff. The DOR said Resident #58 was on hospice services and the hospice discontinued the splints. On 2/9/23 at 1:53 p.m., in an interview the DOR said she assessed Resident #58 and located the palm protectors in the residents room. The DOR said she was able to place them into the resident palms, and they still fit well and were tolerated by the resident. Further review of the clinical record for Resident #58 showed she was discharged from hospice services on 6/8/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 22 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on observation, record review, and staff interviews, the facility failed to store the urinary catheter drainage bag in a sanitary manner for 2 (Residents #39 and #402) of 4 residents reviewed with urinary catheters. The findings included: Review of the facility Infection Control Manual Chapter 2 Guidelines Section 1 dated 7/2021, indicated that Breaking the chain of infection, an essential part of patient care, involves preventing access of pathogens into the portal of entry from the urinary tract and to Recognize a susceptible host and protect high risk-patients, such as those with cancer or the elderly. Review of the facility policy on Catheter Care Procedure #15 stated, Avoid placing the (urinary) drainage bad on the floor to reduce the risk of contamination. 1. Review of Resident #39's medical record revealed an elderly resident with a history of bladder cancer, making Resident #39 a susceptible host and high risk for infection. Resident #39 had an indwelling urinary catheter (tube inserted in the bladder to drain urine) due to obstructive and reflux uropathy (urine cannot drain through the urinary tract). Review of Resident #39's physician orders as of 2/9/23 revealed an order for two intravenous antibiotics started on 2/1/23 for treatment of a current urinary tract infection (UTI). Review Resident #39's admission Minimum Data Set (MDS) Section G dated 1/22/23 revealed Resident #39 required extensive assistance with bed mobility, transfers, toilet use and personal hygiene. On 2/6/23 at 10:16 a.m., observed Resident #39 in bed. The resident's urinary catheter drainage bag was stored on the floor. Resident #39 said he could not get out of bed on his own. Photographic evidence obtained On 2/6/23 at 4:58 p.m., Resident #39's urinary catheter drainage bag was observed stored directly on the floor. On 2/7/23 at 1:19 p.m., Resident #39's urinary catheter drainage bag was inside of a blue privacy bag and hooked to the back of the wheelchair. The blue bag was stored on the floor. Photographic evidence obtained On 2/8/23 at 8:46 a.m., Resident #39's urinary catheter drainage bag was observed inside a blue privacy bag, hooked to the back of the wheelchair. The blue privacy bag was touching the floor. Photographic evidence obtained 2. On 2/8/23 at 1:21 p.m., Resident #402 was observed sitting in a wheelchair in the common area. The resident's urinary catheter drainage bag was observed in a blue privacy bag hooked to the back of the wheelchair. The blue privacy bag was on the floor. Staff were observed walking in the common (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 23 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 0690 area around Resident #402, and did not remove the bag from the floor. Level of Harm - Minimal harm or potential for actual harm Photographic evidence obtained Residents Affected - Few On 2/8/23 at 3:07 p.m., Certified Nursing Assistant (CNA) Staff D said resident #39 could not get out of bed or move the urinary catheter drainage bag himself. Staff D said the catheter drainage bag should not be on the floor because bacteria on those surfaces can travel along the drainage tubing into the bladder. On 2/9/23 at 3:03 p.m., Registered Nurse (RN) Staff R, Infection Preventionist for the facility acknowledged Resident #39 was high risk for urinary tract infections. She confirmed the urinary drainage bags are a source of infection for both Resident #39 and Resident #402 and should never be in contact with the floor. She said bacteria from those surfaces can move up the drainage tubing into the bladder. Staff R said it did not matter if the urinary drainage bags were in the blue privacy bag or not, they should never be in contact with the floor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 24 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review and staff interview the facility failed to follow physician's orders for oxygen therapy for 2 (Resident #3 and #68) of 2 residents reviewed for oxygen administration. Failure to follow prescribed oxygen therapy may result in inadequate oxygen treatment or an increased risk of side effects and complications. Residents Affected - Few The findings included: 1. Review of the clinical record for Resident #3 revealed an admission date of 1/14/19. The Annual Minimum Data Set (MDS) assessment with a target date of 12/2/22 revealed Resident #3 scored a 3 on the Brief Interview for Mental Status, indicative of severe cognitive impairment. Diagnoses listed on the order summary report included cerebral vascular disease, vascular dementia unspecified severity, dysphasia following cerebral infarction, and cognitive communication deficit. Review of Resident #3's physician orders noted order for Oxygen 2 liters/minute via nasal cannula every shift. On 2/6/23 at 10:27 a.m., Resident #3 was observed in bed sleeping, the Oxygen (O2) was set at 3 and a half liter (L) per minute via nasal cannula (n/c). On 2/7/23 at 9:30 a.m., Resident #3 was observed lying in bed sleeping, the O2 was set at 3 ½ liters per minute via n/c. On 2/8/23 8:56 a.m., Resident #3 was observed lying in bed sleeping, the O2 was set at 3 ½ L per minute via n/c. On 2/9/23 at 11:43 a.m., Resident #3 was observed lying in bed watching television, the O2 was set at 3 ½ L per minute via n/c. On 2/9/23 at 12:10 p.m. Licensed Practical Nurse (Staff P) verified the setting for Resident #3's oxygen machine was set at 3 ½ liters per minute and said the setting should be two liters per minute 2. Review of the clinical record for Resident #68 revealed an admission date of 11/15/21. The Quarterly Minimum Data Set (MDS) assessment with a target date of 1/3/22 revealed Resident #68 scored a 10 on the Brief Interview for Mental Status, indicative of moderate cognitive impairment. Diagnoses listed on the order summary report included dysphasia following unspecified cerebrovascular infarction, disorder muscle, and major depressive. Review of Resident #68's physician orders included Oxygen at 2 liters/minute via nasal cannula as needed for Hypoxia (deficiency in the amount of oxygen reaching tissues)/Shortness of Breath (SOB). On 2/6/23 11:20 a.m., Resident #68 was observed lying in bed, Oxygen (O2) was set at 2 and half Liters (L) via nasal cannula (n/c). On 2/7/23 9:31 a.m., Resident #68 was observed lying in bed, the O2 was set at 2 1/2 liters per (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 25 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 minute via n/c. Level of Harm - Minimal harm or potential for actual harm On 2/8/23 at 9:40 a.m., Resident #68 was observed lying in bed, the O2 was set at 2 ½ liters per minute via n/c. Residents Affected - Few On 2/9/23 at 12:10 p.m. in an interview, License Practical Nurse (Staff P) verified the setting for Resident #68's O2 machine was set at 2 ½ liters per minute and said the setting should have been two liters of oxygen per minute. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 26 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 record review, policy review, staff and resident interviews, the facility failed to provide pharmacy services to ensure timely administration of medications in accordance with physician orders for 4 residents (#401, #402, #404, and #407) of 4 newly admitted residents reviewed. The findings included: The facility's policy New Orders for Non-Controlled Substances effective 8/2018 was provided. Section 4 stated, if the medication is needed before the next scheduled delivery, Nursing Center staff should utilize the Emergency medication Supplies. If the medication is not available staff should: Ensure the orders have been faxed or transmitted to the pharmacy; Notify the pharmacy via phone as to when the medication is needed. Facility document titled, Medication and Treatment Administration Guidelines, Long-Term Care stated, new medication orders are to be initiated by the time of the next scheduled routine dose unless otherwise indicated in the medical practitioner's order. Licensed nursing staff may utilize the center EDK if needed to obtain ordered medications. Pharmacy documentation stated medications ordered by 10:00 a.m., would be delivered within 4 hours. Medications ordered by 9:00 p.m., would be delivered within 4 hours. This applied to admissions, new orders, and refills 7 days a week. 1. Review of the clinical record revealed Resident #401 was admitted on [DATE] at 4:21 p.m., and the medications orders verified with the physician on 1/26/23 at 4:24 p.m. The Physician ordered Allopurinol 300 milligrams (mg), 1 tablet once a daily for gout, Celexa 40mg once daily for anxiety, Glipizide XL extended release 2.5 mg once daily for diabetes. The medication administration record for January 2023 indicated the resident did not receive the ordered medications until January 30th, 2023. Lansoprazole 15mg ordered once daily for gastroesophageal reflux disease was not administered until 1/31/23, 4 days following admission. Geodon 20mg was ordered twice daily for manic episodes. The medication administration record for January, 2023 indicated the resident did not receive the medication ordered from 1/27/23 through 2/1/23, for a total of 8 missed doses. 2. Resident #402 was admitted on [DATE] at 7:56 p.m. Physician ordered Baclofen 5 mg twice daily and Cefuroxime 500 mg twice daily for urinary tract infection. The medication administration record indicated the resident did not receive the medication until 2/5/23. 3. Resident #404 was admitted on [DATE] at 9:17 p.m. Physician ordered Amlodipine 5mg daily for blood pressure control, Citalopram 20mg once daily for depression, Plavix 75 mg once daily to reduce the risk of blood clots. The medications were ordered to start on 1/28/23. The medication administration record indicated the resident first received these medications on 1/30/23. Nursing progress notes indicated the medications were not available on 1/28/23. There was no indicated that the physician, pharmacy, or administration were notified. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 27 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 4. Resident #407 was admitted on [DATE] at 7:12 p.m. The physician ordered Fludrocortisone 100 micrograms (mcg) once daily, Calcium-Magnesium-Zinc 300mg twice daily, diphenoxylate-atropine give 2 tablets twice daily 2.5mg-.025mg for irritable bowel syndrome, Midodrine 2.5mg three times daily for low blood pressure. The medication administration record for January and February 2023 indicated the medications were not administrated until 2/1/23. Residents Affected - Some On 2/8/23 at 8:20 a.m., the Director of Nursing stated the pharmacy is supposed to deliver to this facility twice daily. We only got one delivery yesterday in the middle of the night. Newly admitted residents are seen by the admission nurse who works full time Monday through Friday. The admission nurse reviews the hospital orders that come through the system and calls the admitting physician to clarify any medications. The face sheet and medication orders are faxed to the pharmacy within four hours of admission. There has not been a process to check charts for new orders but we will be instituting that today. If a medication is not available, we should have it in the Omnicell in the medication room to pull emergency medication from. The doctor is notified. If we don't have the medication and pharmacy cannot deliver it then the physician can change the order, we can request it be drop shipped or obtain from a local pharmacy. On 2/9/23 at 2:24 p.m., the Infection preventionist, staff R stated pharmacy delivers medications twice daily. She said there was a lot of follow up every day and a variety of reasons for not having the medication. The pharmacy usually just tells the facility it will be delivered on the next run, then it's not on the next run. On 2/9/23 at 2:44 p.m., the Administrator stated he was not aware the facility was experiencing pharmacy issues. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 28 of 29 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 105723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Health and Rehabilitation Center 1600 Matthew Drive Fort Myers, FL 33907 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observations, resident and staff interviews, the facility failed to document food allergy to ensure 1 (Resident #402) of 1 resident reviewed did not receive food items listed on allergy list. The findings included: A facility policy titled food preferences effective 11/2020 was obtained. It stated Food preferences are entered in the Dietary eKardex meal profile for the patient. Dislikes and allergies/sensitivities print on the tray care for reference during the meal service. It is recommended that meal preferences be checked on a routine basis and updated. Resident #402 was admitted to the facility on [DATE]. The physician orders on admission noted the resident was allergic to corn and corn related products. On 2/7/23 at 10:41 a.m., Resident #402, stated he was allergic to corn and corn related products. He stated the night before, they thickened his liquids with corn starch causing itching all over, his back, his butt, his ankles. The resident said, its miserable. On 2/7/23 at 12:00 p.m., in a telephone interview the Resident's significant other said Resident #402 was seen at a hospital and was told to avoid corn and corn products. On 2/7/23 at 1:08 p.m., Resident #402's lunch meal was observed. The Resident was served ground fish with gravy, mashed potatoes with gravy and ground vegetable. The meal ticket did not list any allergies. On 2/7/23 at 4:45 p.m., The Kitchen Manager provided a package of the product used for the gravy served to Resident #402 for lunch. The Ingredients included corn syrup solids, and hydrolyzed vegetable protein (corn, soy and/or wheat). She stated she was not aware Resident #402 had a corn allergy. The Kitchen Manager stated the previous dietitian interviewed residents upon admission regarding food preferences and allergies. On 2/8/23 at 11:11 a.m., the Registered Dietitian (RD), stated she was planning to see resident #402 today. She said the resident was a new admission and had only been here for five days. The kitchen manager stated no one has been able to meet with the resident yet to discuss food preferences. The dietitian stated any resident food allergies are entered into the electronic health record and the eKardex (electronic system) pulls the information to be updated on the meal tickets. She said, In this case that did not happen. I have never seen that happen before. We fixed it today when we heard about the issue. The RD and kitchen manager confirmed Resident #402 received gravy on 2/7/23 with his lunch meal and the thickener contained corn products in it. On 2/8/23 at 11:54 a.m., The Director of Nursing (DON) stated any food allergies should be on the care plan, so it's communicated to staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105723 If continuation sheet Page 29 of 29