Inspection·May 5, 2022

F 0623 Level of Harm - Minimal harm or potential for actual harm Review of the physician's orders revealed that the resident received the antidepressant medication Sertraline. Review of progress notes indicated on 4/18/22, staff reported the resident had suicidal ideations and the Social Worker notified the Psychiatric APRN. A Certificate of Professional Initiating Involuntary Examination form dated 4/18/22 revealed the APRN assessed resident #229 and ordered a transfer to the hospital under the State [NAME] Act. Residents Affected - Some Resident #229's medical record revealed the facility did not notify the Office of the State Long-Term Care Ombudsman of the resident's [NAME] Act with transfer to the hospital. The resident returned to the facility after hospital treament on 4/21/22. 5. Resident #291's record revealed the resident was admitted to the facility on [DATE] and most recently re-admitted from acute care hospital on 4/18/22 with diagnosis including recurrent complicated urinary tract infection, Multiple Sclerosis, respiratory failure, and pneumonia. Review of the resident's medical record revealed Minimum Data Set (MDS) Discharge - Return Anticipated assessments for discharge to acute care hospital on the following dates: 3/14/22, 2/23/22, 1/31/22, and 12/16/22. The medical record did not contain evidence of Notification of Transfer to the Local Long Term Care Ombudsman Council forms for the resident's four transfers to the hospital. On 5/05/22 at 2:20 PM, the Social Services Director (SSD) stated he believed nursing staff were responsible for submitting residents' discharge and transfer notification to the Office of the State Long-Term Care Ombudsman. On 5/05/22 at 2:40 PM, the Executive Director of Nursing (DON) and the Assistant Administrator stated the facility was not currently transmitting the required notifications regarding transfers and discharges to the Ombudsman. The Executive DON stated nursing staff were responsible for completion of transfer, bed hold and notice of discharge forms when residents were transferred to the hospital or discharged to the community. The Executive DON explained the Social Services Department was responsible for transmitting the required notifications to the Office of the State Long-Term Care Ombudsman. The Executive DON and the Assistant Administrator were unable to confirm when the facility's discharge and transfer notifications were last transmitted to the Ombudsman and could not explain why the practice was discontinued. On 5/05/22 at 3:50 PM, the SSD said, We stopped sending the list of the transfers and discharges to the Ombudsman in November 2021. This was due to challenges in the facility which included Covid-19 and staffing challenges. The facility's policy and procedure titled Bed Hold and In-House Transfer-Florida effective February 2021 indicated when a resident was temporarily transferred, copies of notices for emergency transfers should be sent to the Ombudsman. The policy revealed the facility could submit a list of residents who were discharged and/or transferred from the facility monthly. 3. Resident #173's record revealed the resident was admitted to the facility on [DATE] with diagnoses including pulmonary disease, type 2 diabetes, bilateral below the knee amputation, and depression. Review of the medical record revealed the resident was transferred to the hospital on 1/16/22 and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105728 If continuation sheet Page 2 of 14 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 105728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orlando Health and Rehabilitation Center 830 West 29th Street Orlando, FL 32805 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some returned to the facility on 1/19/22. The Nursing Home Transfer form dated 1/06/22 was completed, and the Bed Hold Notice and Discharge Notice dated 1/06/22 was provided to the resident or representative. The medical record did not include documentation of the required notification to the Ombudsman. 4. Resident #230's record revealed the resident was admitted to the facility on [DATE] with diagnoses including dementia, skin cancer, paraplegia, heart disease, and type 2 diabetes. Review of the medical record revealed the resident was transferred to the hospital on 3/30/22 and returned to the facility on 4/06/22. The Nursing Home Transfer form date 3/30/33 was completed and the Bed Hold Notice and Discharge Notice dated 3/30/22 was provided to the resident or representative. The medical record did not include documentation of the required notification to the Ombudsman. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105728 If continuation sheet Page 3 of 14 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 105728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orlando Health and Rehabilitation Center 830 West 29th Street Orlando, FL 32805 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop a baseline care plan in a timely manner related to intravenous (IV) services and treatments for1 of 1 newly readmitted residents reviewed for IV therapy services, of a total sample of 95 residents (#716). Findings: Resident #716's record revealed the resdient was initially admitted to the facility on [DATE] with diagnoses that included diabetes, a partial traumatic amputation of the right midfoot, osteomyelitis of the right foot and ankle, and an acute myocardial infarction. On the day of admission, the facility transferred the resident back to the hospital due to acute respiratory failure and hypoxia. Resident #716 was readmitted to the facility on [DATE]. Review of hospital discharge paperwork revealed physician orders to administer the antibiotic medications Vancomycin 1.25 grams (gm) daily and Cefepime 1 gm every 8 hours for 15 days. Both antibiotics were ordered to be given intravenously through a peripherally inserted central catheter (PICC) located in the resident's right upper arm. On 5/02/22 at 10:55 AM, resident #716 had an intact right upper arm IV PICC line. He verbalized that the IV PICC line was inserted in the hospital so he could receive antibiotics for his foot infection. Resident #716's readmission nursing data assessment and nursing progress note dated 5/01/22 at 2:35 PM did not reveal any evidence the admitting nurse had identified his right upper arm IV PICC line and that he required IV antibiotic therapy. On 5/05/22 at 11:30 AM, during review of resident #716's medical record with the 1st Floor Director of Nursing (DON), she acknowledged a baseline care plan was not developed for the resident's IV PICC line and antibiotic therapy and services. She explained the admitting nurse was expected to enter the IV PICC line information into the electronic readmission assessment which would then automatically trigger and initiate a baseline care plan for the PICC line. On 5/05/22 at 6:50 PM, the Minimum Data Set (MDS) Director verbalized the baseline care plan must be developed within 48 hours of a resident's admission or readmission. She conveyed the process was for the nurses to initiate the baseline care plan through their electronic medical record system, then the MDS team would take over and develop comprehensive care plans. She acknowledged the baseline care plan for #716 had not been developed. The facility's Admission/readmission Data Collection Policy and Procedure, dated 10/2021, included that The baseline plan of care must be created in the system [electronic medical record] after completion of the assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105728 If continuation sheet Page 4 of 14 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 105728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orlando Health and Rehabilitation Center 830 West 29th Street Orlando, FL 32805 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop a comprehensive care plan for continuous oxygen (O2) therapy via a nasal cannula and oxygen concentrator for 1 of 5 residents reviewed for respiratory care services, of a total sample of 95 residents (#120). Findings: Resident #120's record revealed the resdient was initially admitted to the facility on [DATE]. He was hospitalized on [DATE] and readmitted to the facility on [DATE]. His primary diagnoses were congestive heart exacerbation and shortness of breath. Other diagnoses included chronic obstructive pulmonary disease and orthostatic hypotension. The hospital to facility transfer form dated 12/01/21 revealed the resident received O2 at 3 liters per minute (l/m) via a nasal cannula during his hospitalization and required continuous oxygen therapy. On 5/02/22 at 10:25 AM, resident #120 was observed in bed. He received O2 at 2.5 l/m via a nasal cannula and O2 concentrator. The resident verbalized he needed the oxygen to breathe better. He explained he required continuous O2, even when he went to the restroom as he would become short of breath if he walked without it. On 5/03/22 at 11:40 AM, the resident remained on O2 via a nasal cannula connected to an O2 concentrator set at 2.5 l/m. Resident #120's Nursing readmission Data Collection Evaluation/Baseline Care Plan dated 12/01/21 at 9:20 PM, revealed the resident had shortness of breath upon exertion. Resident #120's Minimum Data Set (MDS) admission assessment with an assessment reference date (ARD) of 11/20/21, and his MDS Quarterly assessment with an ARD of 2/19/22 indicated he received oxygen therapy services. Review of resident #120's comprehensive care plans revealed there was no care plan and no interventions related to oxygen therapy services. On 5/05/22 at 12:25 PM, resident #120 was observed with the Executive Director of Nursing (DON) and the 1st floor DON. They acknowledged the resident received oxygen at 2.5 l/m per oxygen concentrator via a nasal cannula. On 5/05/22 at 12:40 PM, the Executive DON acknowledged there was no documentation or evidence that the facility had developed a written comprehensive care plan for the resident's oxygen therapy needs. On 5/05/22 at 6:50 PM, the facility's MDS Director stated that the MDS department was responsible for the development of the comprehensive care plans. She acknowledged resident #120's written comprehensive care plans did not include one for oxygen therapy. She confirmed the resident's MDS assessments indicated he received oxygen therapy since his initial admission and the current MDS assessment dated [DATE] noted the resident used oxygen. She validated the MDS department did not have the oxygen care plan in place for resident #120. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105728 If continuation sheet Page 5 of 14 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 105728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orlando Health and Rehabilitation Center 830 West 29th Street Orlando, FL 32805 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to obtain physician orders for continuous oxygen (O2) therapy for 1 of 5 residents reviewed for respiratory care services of a total sample of 95 residents (#120). Residents Affected - Few Findings: Resident #120's recored revealed the resident was initially admitted to the facility on [DATE]. He was hospitalized on [DATE] and readmitted to the facility on [DATE]. His primary diagnoses were congestive heart exacerbation and shortness of breath. Other diagnoses included Chronic Obstructive Pulmonary Disease (COPD) and orthostatic hypotension. The hospital to facility transfer form dated 12/01/21 revealed the resident received O2 at 3 liters per minute (l/m) via a nasal cannula during his hospitalization and required continuous O2 therapy. Resident #120's Nursing readmission Data Collection evaluation dated 12/01/21 at 9:20 PM revealed the resident had shortness of breath upon exertion. A Pulmonolgist's consultation note dated 12/02/22 indicated resident #120 was on oxygen therapy at home prior to admission. A Respiratory Therapist's (RT) assessment dated [DATE] revealed resident #120's diagnoses included COPD, respiratory failure, asthma, acute on chronic hypoxia and hypercapnia. The RT documented that the resident's breath sounds were diminished with a faint respiratory wheeze and his O2 saturation was at 96% on 3 liters per minute (l/m) via a nasal cannula. Resident #120's Minimum Data Set (MDS) admission assessment with an assessment reference date (ARD) of 11/20/21 and his Quarterly MDS with an ARD of 2/19/22 indicated he received oxygen therapy services at the facility. On 5/02/22 at 10:25 AM, resident #120 was observed in bed. He received O2 at 2.5 l/m with an O2 concentrator via nasal cannula. The resident verbalized he needed the oxygen to breathe better. He explained required continuous O2, even when he went to the restroom as he would become short of breath if he walked without it. On 5/03/22 at 11:40 AM, the resident remained on O2 via a nasal cannula connected to an O2 concentrator set at 2.5 l/m. Review of resident #120's physician orders and the Medication and Treatment Administration Records for May 2022 did not reveal any physician orders for oxygen therapy and care. On 5/05/22 at 12:25 PM, resident #120 was observed with the Executive Director of Nursing (DON) and the 1st floor DON. They acknowledged the resident received oxygen at 2.5 l/m with an oxygen concentrator via a nasal cannula. On 5/05/22 at 12:40 PM, the Executive DON acknowledged that physician orders for oxygen therapy and care had not been obtained from the resident's physician when he was readmitted on [DATE]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105728 If continuation sheet Page 6 of 14 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 105728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orlando Health and Rehabilitation Center 830 West 29th Street Orlando, FL 32805 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 Level of Harm - Minimal harm or potential for actual harm On 5/05/22 at 1:11 PM, resident #120's assigned nurse, Registered Nurse (RN) B, conveyed she was not aware there were no orders for his oxygen therapy and care. RN B stated when the resident transferred to the D Wing from the C Wing on 3/20/22, his oxygen was already in place. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105728 If continuation sheet Page 7 of 14 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 105728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orlando Health and Rehabilitation Center 830 West 29th Street Orlando, FL 32805 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 - Few 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** Resident #716's record revealed the resident was initially admitted to the facility on [DATE] with diagnoses that included diabetes, osteomyelitis of the right foot and ankle, partial amputation of the right midfoot, and an acute myocardial infarction. On the day of admission, the facility transferred the resident back to the hospital due to acute respiratory failure and hypoxia. Resident #716 was readmitted to the facility on [DATE] at 2:36 PM. Review of hospital discharge paperwork revealed a physician's order for the intravenous (IV) antibiotic Cefepime 1 gram (gm) to be administered every 8 hours for an acute right foot osteomyelitis. The Cefepime was ordered to be given intravenously via a peripherally inserted central catheter (PICC) located in the resident's right upper arm. Review of the facility's readmission nursing data collection assessment revealed the admitting nurse did not identify the resident's right upper arm PICC IV line and/or that he required IV antibiotic therapy. On 5/02/22 at 10:55 AM, resident #716 was observed with an intact and clean right upper arm IV PICC line. The resident verbalized he had the PICC line inserted in the hospital so he could receive IV antibiotics for his foot infection. He stated he had not received any doses of the IV antibiotic since he was readmitted . The resident explained the IV antibiotic was supposed to be given every 8 hours and he had already missed the first two doses. A review of resident #716's IV Cefepime order on the Medication Administration Record (MAR) for May 2022 read, Cefepime Hydrochloride (HCl) reconstituted 1 gram. Use 1 gram IV every 8 hours for Osteomyelitis until 5/17/22 at 11:50 PM [for 15 days]. The order was not transcribed onto the medical record until 5/02/22 at 9:56 AM, approximately 19 hours after he was re-admitted . The MAR indicated IV Cefepime was scheduled to be given at 6 AM, 2 PM, and 10 PM. However, review of the document revealed on 5/01/22 at 10 PM, on 5/02/22 at 6 AM, and on 5/02/22 at 10 PM, the antibiotic had not been administered. There was no documentation in the medical record regarding why the medication was not administered as ordered. On 5/05/22 at 11:15 AM, resident #716's Unit Manger (UM) and the 1st floor DON acknowledged the resident had not received IV Cefepime at the three above-listed scheduled dates and times. They were not sure why nurses did not retrieve the antibiotic from the facility's IV Emergency Drug Kit (EDK) and administer the medication in a timely manner. Observation of the unit's IV EDK with the UM and 1st floor DON revealed it contained four bottles of the IV Cefepime 1 gm. Pharmacy documentation in the EDK showed the drug was delivered to the facility on 2/16/22. The UM and 1st floor DON acknowledged the medication was available to the nurses at the scheduled times, but had not been administered. On 5/05/22 at 5:39 PM, in a telephone interview, the Infectious Disease (ID) Advanced Practitce Registered Nurse (APRN) explained missing three doses of IV Cefepime for osteomyelitis in a total six week therapy regimen was not ideal, and she would probably have to extend the antibiotic treatment from 15 days to 17 or 18 days due to the missed doses. On 5/05/22 at 6:20 PM, RN A confirmed she conducted resident #716's readmission assessment on 5/01/22, but did not notice the physician's order for IV Cefepime in the hospital discharge paperwork. He acknowledged that upon readmission, he did not reconcile the resident's medication orders with the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105728 If continuation sheet Page 8 of 14 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 105728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orlando Health and Rehabilitation Center 830 West 29th Street Orlando, FL 32805 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 - Few admitting physician, and did not transcribe it onto the MAR. RN A indicated that even if he had seen the hospital order, he was not familiar enough with the IV EDK to have pulled Cefepime from it to administer the antibiotic to the resident. Based on observation, interview and record review, the facility failed to provide pharmaceutical services to ensure medications were administered according to physician orders for 1 of 5 residents reviewed for medication administration, of a total sample of 95 residents (#716). Findings: FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105728 If continuation sheet Page 9 of 14 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 105728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orlando Health and Rehabilitation Center 830 West 29th Street Orlando, FL 32805 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility's Consultant Pharmacist failed to identify and report irregularities related to use of a medication contrary to a physician's order for 1 of 5 residents reviewed for unnecessary medications, of a total sample of 95 residents (#142). Findings: Resident #142's record revealed the resident was admitted to the facility on [DATE] with diagnoses including Multiple Sclerosis, vascular headache, hypertension, anxiety, and depression. The Order Summary Report included a physician order dated 8/29/21 for Ativan 1 milligram (mg) by mouth every 12 hours as needed for seizures. Ativan is a prescription medicine used to treat anxiety disorders. Misuse of this drug can cause addiction, overdose, or death (retrieved on 5/13/22 from www.drugs.com). Review of the Medication Administration Record forms for September 2021 to May 2022 revealed over the 9-month period, resident #142 received 35 doses of Ativan 1 mg in September 2021, 34 doses in October 2021, 33 doses in November 2021, 29 doses in December 2021, 27 doses in January 2022, 32 doses in February 2022, 33 doses in March 2022, 29 doses in April 2022, and 4 doses from May 1st to 3rd, 2022. On 5/05/22 at 12:45 PM, the Consultant Pharmacist stated he reviewed residents' medications once monthly and made recommendations as necessary. When asked about the use of Ativan for seizures, the Consultant Pharmacist stated it was appropriate if the resident had muscle spasms. He was informed the medication was administered to resident #142 with almost daily frequency over the previous nine months, and interviews with nurses revealed the medication was administered for anxiety. The Consultant Pharmacist said, Now that I am looking at it, he is using it frequently. I will make a recommendation. He explained if the Ativan was used that often to treat seizure activity the resident should be on a scheduled seizure medication too. Review of the Medication Monitoring Medication Management policy dated November 2017 read, Each resident's drug regimen is reviewed to ensure it is free from unnecessary drugs. The policy indicated the Consultant Pharmacist would compile, analyze, and provide findings regarding proper monitoring of medication therapy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105728 If continuation sheet Page 10 of 14 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 105728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orlando Health and Rehabilitation Center 830 West 29th Street Orlando, FL 32805 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and medical record review, the facility gave a prescribed medication without adequate indications for use to 1 of 5 sampled residents reviewed for medication administration, of a total sample of 95 residents (#142). Residents Affected - Some Findings: Resident #142's record revealed the resident was admitted to the facility on [DATE] with diagnoses including Multiple Sclerosis, vascular headache, hypertension, anxiety, and depression. The Order Summary Report included an order dated 8/29/21 for Ativan 1 milligram (mg) by mouth every 12 hours as needed for seizures. Ativan is a prescription medicine used to treat anxiety disorders. Misuse of this drug can cause addiction, overdose, or death (retrieved on 5/13/22 from www.drugs.com) Review of the Medication Administration Record forms for September 2021 to May 2022 revealed over the 9-month period, resident #142 received 35 doses of Ativan 1 mg in September 2021, 34 doses in October 2021, 33 doses in November 2021, 29 doses in December 2021, 27 doses in January 2022, 32 doses in February 2022, 33 doses in March 2022, 29 doses in April 2022, and 4 doses from May 1st to 3rd, 2022. On 5/05/22 at 8:34 AM, Registered Nurse (RN) B stated she had never witnessed the resident having a seizure. She said, If he tells me he needs the medicine, I give him the Ativan. RN B stated the resident had anxiety so the medication would help with that symptom. On 5/05/22 at 9:11 AM, RN C said, I have never seen him have a seizure. She stated she administered Ativan if requested by the resident as he had anxiety. On 5/05/22 at 1:33 PM, the Executive Director of Nursing (DON) stated if a medication was ordered for seizures, the nurses should not administer it for anxiety. She stated her expectation was the nurses would call the physician to have the order revised to reflect the appropriate indication if it was not accurate. The Executive DON stated she did random monthly chart checks for accuracy throughout the facility, but did not identify this concern. On 5/05/22 at 5:36 PM, RN D stated she was regularly assigned to resident #142 and had not witnessed him having any seizures. She explained if the resident reported anxiety, she gave him Ativan. Review of nursing progress notes from January to April 2022 reflected no documentation of seizure activity for resident #142. Review of the Medication Administration policy dated September 2018 read, Medications are administered in accordance with written order of the prescriber. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105728 If continuation sheet Page 11 of 14 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 105728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orlando Health and Rehabilitation Center 830 West 29th Street Orlando, FL 32805 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, record review and interview the facility failed to ensure dietary staff utilized hair restraints, stored food correctly, maintained kitchenware and equipment in a clean, sanitary and functional manner. Findings: 1. On 5/02/22 at 9:29 AM, the initial kitchen inspection was conducted. On a wire shelf in the dry pantry, there was an eleven-pound tub of vanilla frosting dated that it was opened on 4/20/22. The label on the container provided the manufacturer's directions for use. Instruction #6 read, Once icing container has been opened, the icing can be stored covered at room temperature for one week. After this time period, store covered in the cooler. When asked if the kitchen staff read the manufacturer's directions, the Certified Dietary Manager (CDM) said, Probably not. 2. On 5/02/22 at 10:00 AM, a cook prepared a salad plate in the food preparation area. He had a full, bushy beard and wore an N95 respirator mask, but no beard guard. The N95 respirator mask did not restrain all of his facial hair. The cook acknowledged he had not applied a beard guard and the CDM confirmed this was required. 3. On 5/02/22 at approximately 10:10 AM, the nozzle of the spray gun attached to the juice dispensing machine was removed for inspection. There was a brown sludge-like substance noted inside the nozzle. The Registered Dietician (RD) validated the substance was present and said, We need to put that on the cleaning list. When asked why the juice dispensing machine was not already on the cleaning list, neither the Registered Dietician (RD) nor the CDM responded. The facility's large three-spout coffee maker was located next to the juice dispensing machine. Observation of the underside of the spouts on the coffee machine revealed brown spots and evidence of hard water calcification. 4. On 5/02/22 at approximately 10:20 AM, there were four large stainless steel frying pans hanging from a wire shelf. The pans were significantly warped and when placed on the steel work table, the bottom of the pan would not sit flat against the surface. The food contact surfaces of two frying pans had a black carbon-like build up noted, and all four pans had knife-like cuts on the food contact surfaces. The RD stated that the four frying pans should be replaced immediately. 5. On 5/05/22 at 3:56 PM, in the C Wing pantry, a tray of snacks was seen on the counter which contained three 4-ounce containers of apple sauce, two peach yogurts, two half-pints of chocolate milk, and two previously frozen ice cream-like supplements. The tray also contained three egg sandwiches, one tuna sandwich, two chocolate puddings and an individual serving of apple juice. Licensed Practical Nurse (LPN) Z stated she was not sure who put the snacks in the pantry, but explained it was not the nursing staff. LPN Z added that the snacks were supposed to be passed out to residents after lunch. The CDM and the RD arrived at the C Wing pantry during the inspection and they used a bayonet style digital thermometer to check the temperature of the chocolate milk. They confirmed the temperature was 55 degrees Fahrenheit, although the holding temperature of milk was supposed to be 41 degrees Fahrenheit or below. The CDM stated all snacks on the tray would be thrown out as they should have been placed in the C Wing pantry refrigerator and not left on the counter. On 5/05/22 at 4:21 PM, during inspection of the A Wing pantry, the Risk Manger confirmed there was a tray of snacks left out on the counter. The RD checked the temperature of a container of peach (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105728 If continuation sheet Page 12 of 14 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 105728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orlando Health and Rehabilitation Center 830 West 29th Street Orlando, FL 32805 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete yogurt and found it was 72.5 degrees Fahrenheit. The RD validated the yogurt was out of a safe temperature range and had to be discarded. On 5/09/22 at 5:42 PM, the CDM stated the facility had two kitchen supervisors who were responsible for the day-to-day operations of the kitchen and the monitoring staff. The CDM could not explain why the supervisors had not noticed the cook did not wear a beard guard or the issues discovered regarding food storage and kitchen sanitation. Event ID: Facility ID: 105728 If continuation sheet Page 13 of 14 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 105728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orlando Health and Rehabilitation Center 830 West 29th Street Orlando, FL 32805 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to dispose of garbage properly and maintain the garbage storage area in a sanitary manner. Residents Affected - Many Finding: On 5/02/22 at approximately 10:30 AM, a tour of the garbage storage area was conducted. Observation of the area revealed there was a trash compactor located near the recycled materials dumpster. There were several, clear plastic bags of garbage piled from the ground to a height of approximately four feet along the length of the recycled materials dumpster. The clear plastic bags contained soiled, disposable incontinence pads and briefs and other waste products. The Maintenance Director stated the trash compactor stopped working on the previous day, Sunday. He stated he called the garbage contractor on Sunday evening and left a message, and called again on Monday morning at about 7:00 AM. When asked if he requested another dumpster as a temporary solution, the Maintenance Director did not provide an answer. The Housekeeping Supervisor stated housekeeping staff and the floor technician brought garbage out of the facility to the dumpster area and were therefore responsible for the unsanitary conditions observed. There were several large carts parked in the grassy area behind the trash compactor and the Housekeeping Supervisor explained those carts were inoperable due to broken wheels. The Maintenance Director and the Housekeeping Supervisor were asked why the facility had not devised a temporary solution to the garbage storage problem. Neither the Maintenance Director nor the Housekeeping Supervisor responded. On 5/05/22 at 6:05 PM, the facility's Registered Dietitians stated they were not aware of any contingency plans in place for garbage storage and disposal in the event of an emergency. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105728 If continuation sheet Page 14 of 14