Inspection·August 22, 2024

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 observation, interview, and record review, the facility failed to ensure medications were administered as per physician orders and according to professional standards of practice for 2 out of 5 residents reviewed for medication administration, (#2, #3) Findings: Review of resident #2's medical record revealed she was admitted to the facility on [DATE] with diagnoses including type 1 diabetes with hyperglycemia, chronic respiratory failure, aphonia, cardiac arrest, asthma, acute transverse myelitis, insomnia, depression and anxiety disorder. The Quarterly Minimum Data Set (MDS) assessment dated [DATE] documented she had a Brief Interview for Mental Status (BIMs) score of 15 out of 15 that indicated she was cognitively intact. Review of resident #2's Medication Administration Record (MAR) for July and August 2024 revealed physician orders for the following medications: Doxepin Hydrochloride (HCL) 10 milligrams (m)g at bedtime for insomnia with an order date of 7/27/24 Melatonin 10 mg at bedtime for insomnia with an order date of 8/6/24 Remeron 7.5 mg at bedtime for depression with an order date of 7/29/24 Trazadone 100 mg at bedtime for insomnia with an order date of 7/27/24 Buspirone 30 mg twice daily for anxiety with an order date of 8/11/24 Cefdinir 300 mg twice daily for 7 days for urinary tract infection with an order date of 8/13/24 Celecoxib 100 mg every 12 hours for inflammation with an order date of 7/27/24 Insulin Glargine 22 units every morning and bedtime with an order date of 8/12/24 Insulin Lispro 6 units with meals with an order date of 8/11/24 Insulin Lispro sliding scale before meals and at bedtime with an order date of 7/30/24 (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 105728 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 08/22/2024 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)