Health inspection·March 13, 2025

F 0554 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 50-grams was found. Resident #83 stated her daughter brought it for her to use on her knees as she did at home. On 3/10/25 at 4:48 PM, the resident's nightstand was observed with RN D, the 3:00-11:00 PM supervisor, and the primary nurse who observed the tube of Voltaren at the bedside. A few minutes later resident #83's physician orders were reviewed with RN D who acknowledged there were no orders for the Voltaren. RN D stated he would contact the physician for an order to administer the Voltaren. He acknowledged the medication should not be kept at bedside for self-administration and placed the Voltaren in a plastic bag for safekeeping on the treatment cart. On 3/12/25 at 12:09 PM, the DON stated residents were assessed for self-administration upon admission. The DON stated the resident's assessment revealed she was not to self-administer her own medications. The DON said that facility policy was residents must be evaluated, deemed appropriate and have physician orders to self-administer medication. A review of the facility's policy and procedure for Resident Self-Administration of Medication dated 6/2023 revealed, A resident may only self-administer medications after the facility's interdisciplinary team has determined which medications may be self-administered safely. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105757 If continuation sheet Page 2 of 12 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westminster Towers 70 West Lucerne Circle Orlando, FL 32801 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 interview, and record review, the facility failed to ensure a written summary of the baseline care plan was provided to 1 of 2 residents reviewed for care plans, (#390); and failed to provide a written summary of the baseline care plan within the required time frame for 1 of 2 residents reviewed for care plans, (#546), of a total sample of 34 residents. Findings: 1. Resident #390, a [AGE] year-old male was admitted to the facility on [DATE]. His diagnoses included right ankle osteomyelitis, asthma, generalized anxiety disorder, and open wound, right foot. Review of the admission Minimum Data Set (MDS) assessment dated [DATE], revealed the resident's cognition was intact, with a Brief Interview For Mental Status (BIMS) score of 15 of 15. On 3/10/25 at 2:46 PM, resident #390 stated he did not recall receiving a written summary of his initial care plan. Review of the resident's Baseline Care Plan Assessment with effective date of 2/23/25, and lock date of 2/24/25, revealed signatures for staff who completed the plan, however a signature for the resident or his representative was not identified. On 3/12/25 at 11:13 AM, the Social Service Director (SSD) stated baseline care plans were initiated on admission. He explained that the Interdisciplinary Team (IDT) would review the baseline care plan with the resident/ family, the baseline care plan would then be signed by the members of the IDT, the resident/ family, and nursing would provide a copy of the baseline care plan to the resident/family. On 3/12/25 at 12:41 PM, the 2nd Floor Unit Assistant Director of Nursing (ADON) stated he completed the baseline care plans, reviewed them with the residents/ families, signed the baseline care plan, and provided a copy to the residents/families. Resident #390's Baseline Care Plan Assessment was reviewed with the ADON. He confirmed he completed the baseline care plan and acknowledged that a signature for the resident/ representative was not documented on the baseline care plan. The ADON verbalized the baseline care plan should be signed by the resident, printed and a copy provided to the resident, then the signed, printed copy would be uploaded to the resident's medical record. He could not say if a copy was provided to resident #390 as required. A review of the resident's clinical records, revealed documentation to indicate a copy of the baseline care plan was provided to the resident/representative could not be identified. This was acknowledged by the ADON. On 3/12/25 at 2:32 PM, the Director of Nursing (DON) explained that when there was a new admission, the baseline care plan was triggered, should be completed by the IDT, printed, and a copy provided to the resident/representative. She said the ADONs were responsible to obtain a signature from the resident/representative. On 3/12/25 at 3:12 PM, the DON, and Administrator stated they could not locate a copy of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105757 If continuation sheet Page 3 of 12 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westminster Towers 70 West Lucerne Circle Orlando, FL 32801 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 resident's baseline care plan. The Administrator stated they spoke with the resident, showed him the document and the resident said he did not recall seeing the document. The facility could not identify any documentation or locate a copy of the signed baseline care plan to indicate a copy was provided to the resident/representative. Residents Affected - Few 2. Resident #546 was admitted to the facility on [DATE] with diagnoses including aftercare following surgery on the digestive system, weakness, low back pain, and fistula of the intestines. Review of the MDS admission assessment with an assessment reference date of 3/06/25 revealed resident #546 had a BIMS score of 14/15, which indicated she was cognitively intact. On 3/10/25 at 2:20 PM, resident #546 stated she was admitted to the facility for care following surgery on Friday, 2/28/25, and had received an explanation of her care plan. The resident stated she remembered signing many papers since admission but was not given a copy of the care plan. A review of the resident's clinical records revealed a baseline care plan, which indicated resident #546's admission date was 2/28/25. The summary and signature areas revealed the document was not signed until 3/03/25 by the ADON and by the resident on 3/04/25. On 3/13/25 at 1:03 PM, the 2nd floor ADON said resident #546 was admitted on a Friday. The ADON said he did not work Saturdays, so the Weekend Supervisor should have completed the baseline care plan that day. The ADON stated he finished the baseline care plan on 3/03/25 and gave it to the resident to sign on 3/04/25. He acknowledged that the baseline care plan should have been completed and signed within 48 hours of admission, so the resident could be knowledgeable of the care plan. Review of the facility's policy and procedure for baseline care plan dated 7/2023 revealed, The baseline care plan will be developed within 48 hours of a resident's admission. A supervising nurse shall verify within 48 hours that a baseline care plan has been developed .A written summary of the baseline care plan shall be provided to the resident and representative .the person providing the written summary of the baseline care plan shall: a. Obtain a signature from the resident/representative to verify that the summary was provided. b. Make a copy of the summary for the medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105757 If continuation sheet Page 4 of 12 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westminster Towers 70 West Lucerne Circle Orlando, FL 32801 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, interview and record review, the facility failed to provide showers per resident preference and as scheduled for 1 of 2 resident reviewed for Activities of Daily Living (ADLs), of a total sample of 34 residents, (#75). Residents Affected - Few Findings: Review of resident #75's medical record revealed he was originally admitted to the facility on [DATE] and readmitted from a short-term, acute hospital on [DATE]. His diagnoses included atrial fibrillation, chronic pain syndrome, spinal stenosis (narrowing of the space around the spinal cord or nerves) and fusion of spine. Review of resident #75's quarterly Minimum Data Set (MDS) assessment with Assessment Reference Date of 2/17/25 revealed he had a Brief Interview for Mental Status score of 15 out of 15 which indicated intact cognition. The MDS assessment showed resident #75 was dependent on staff for showers/baths and required extensive assistance for personal hygiene. The MDS assessment noted no rejection of care necessary to obtain goals for his health and well-being. Review of resident #75's comprehensive care plan with ADL focus revised on 2/26/25 revealed he preferred showers three times a week and as needed. The interventions showed he required transfers with a mechanical lift by two staff. Review of resident #75's [NAME] Report (plan of care used by Certified Nursing Assistants (CNAs)) revealed showers were scheduled every Monday, Wednesday, and Friday during the 7 AM to 3 PM shift. On 3/10/25 at 11:22 AM, resident #75 stated he took daily showers prior to his admission to the facility. He shared he had not received showers as scheduled in the facility. He explained he was not asked if he wanted his shower on the scheduled shower days and at times received a bed bath instead, but he preferred showers. Review of resident #75's ADL - Showers Report from February to March 2025 revealed he did not receive a shower or bed bath on the following scheduled days: 2/05, 2/12, 2/19, 2/28, 3/03, 3/05, and 3/10. Review of resident #75's Progress Notes from February to March 2025 revealed no refusals of showers or care documented. On 3/12/25 at 1:30 PM, CNA E stated resident #75 required total care for showers. She explained when resident #75 refused showers, she offered, and he agreed to bed bath. She indicated she informed the nurse when he received a bed bath instead of a shower so the nurse could document why she gave a bed bath. On 3/12/25 at 1:46 PM, CNA F stated resident #75 required transfer assistance with a mechanical lift and was dependent on staff for showers. She shared he sometimes refused showers. She explained she informed the nurse when he refused showers, even when she provided a bed bath. She indicated she documented what he received in his medical record. She stated documentation should reflect a bed bath or shower three times per week. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105757 If continuation sheet Page 5 of 12 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westminster Towers 70 West Lucerne Circle Orlando, FL 32801 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 - Few On 3/12/25 at 2:46 PM, Registered Nurse (RN) G stated the facility honored resident wishes. RN G indicated when a resident refused showers, she entered a progress note in the medical record. She stated she was not aware of any refusals for showers for resident #75. RN G said, No one has reported any refusals to me. On 3/12/25 at 3:52 PM, the Unit Manager (UM) for the 3rd floor unit stated she was not aware of any refusals of showers from resident #75. Later at 5:05 PM, the UM indicated she could not say why showers were not documented when scheduled. She mentioned she checked the nursing staff documentation on her unit, but said she did not feel comfortable discussing her findings with the surveyor. On 3/12/25 at 5:39 PM, the Director of Nursing (DON) explained residents received showers based on the schedule in the [NAME]. She stated she was not aware resident #75 was not getting showers as scheduled or refusing showers. The DON indicated she expected CNAs to ask residents if they wanted to take a shower on their scheduled days and if they refused, the CNAs should offer a bed bath. She shared that refusals should be documented in the medical record. Review of the Resident Showers policy and procedure revised on 8/2023 read, Residents will be provided showers as per request or as per facility schedule protocols . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105757 If continuation sheet Page 6 of 12 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westminster Towers 70 West Lucerne Circle Orlando, FL 32801 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to follow physician orders and ensure the comprehensive care plan was implemented for 1 of 5 residents reviewed for unnecessary medications and medication regimen, of a total sample of 34 residents, (#43). Residents Affected - Some Findings: Review of resident #43's medical record revealed she was originally admitted to the facility on [DATE] and readmitted from a short-term, acute hospital on 1/13/25. Her diagnoses included atrial fibrillation, hypertension (HTN), type 2 diabetes, and stroke. Review of resident #43's comprehensive care plan with a cardiac focus revised on 3/12/25 revealed potential for altered cardiovascular status. The interventions included, Administer cardiac medications as ordered . Monitor vital signs as ordered. Review of resident #43's medical record revealed a physician order dated 1/13/25 for Hydralazine 100 milligrams (mg) three times a day (TID) for HTN. The order directed the nurses to hold the medication if the systolic blood pressure (SBP) was less than 110 and the heart rate (HR) was less than 65. Review of the Pharmacist's Report to Nursing form dated 6/22/24 read, This resident has the following order which includes blood pressure (BP) and/or heart rate parameters to follow prior to administration. The form listed Hydralazine 100 mg TID for HTN, hold if SBP was less than 110 or HR less than 65. The pharmacist's recommendation included, Suggest ensure parameters are understood, followed and documented accurately. Per EMAR (Electronic Medication Administration Record), HR has been less than 65 and medication was administered or checked as administered multiple times. The form had a check mark with the Director of Nursing (DON)'s initials and dated 9/11/24. Review of resident #43's Medication Administration Record (MAR) for February 2025 revealed Hydralazine 100 mg was administered outside of the ordered parameters, 27 times with a HR of less than 65 as follows: 6:00 AM dose: 2/2, 2/3, 2/7, 2/10, 2/13, 2/14, 2/18, 2/23, 2/24, 2/26, and 2/28 2:00 PM dose: 2/2, 2/3, 2/9, 2/11, 2/12, 2/18, 2/19, 2/20, 2/21, and 2/28 10:00 PM dose: 2/4, 2/7, 2/11, 2/15, 2/16, and 2/21 Review of resident #43's MAR for March 2025 revealed Hydralazine 100 mg was administered outside of the ordered parameters, 13 times with a HR of less than 65 as follows: 6:00 AM dose: 3/2, 3/3, 3/4, and 3/9 2:00 PM dose: 3/2, 3/3, 3/4,3/7, and 3/10 10:00 PM dose: 3/1, 3/3, 3/9, and 3/12 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105757 If continuation sheet Page 7 of 12 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westminster Towers 70 West Lucerne Circle Orlando, FL 32801 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 - Some On 3/13/25 at 11:45 AM, Licensed Practical Nurse (LPN) H explained not all the medications for HTN included parameters. She was asked to review resident #43's order for Hydralazine. LPN H stated she would review the BP and HR before administering the medication. LPN H reviewed the MAR for March 2025 and confirmed she documented she administered Hydralazine on 3/03/25, 3/04/25, and 3/10/25 even though the HR was less than 65. When asked why medication was given outside of the parameters, she did not respond. LPN H then said, the parameter used to be different and she may have been going by what the previous parameter was. She stated she did not realize the order had been changed. She agreed she should follow the current physician orders. Review of resident #43's MAR for February 2025 revealed Hydralazine 100 mg was administered by LPN H seven times with a HR of less than 65 on 2/3, 2/9, 2/11, 2/18, 2/19, 2/20, and 2/28. In March 2025, she administered the medication three times with a HR of less than 65 on 3/3, 3/4, and 3/10. On 3/13/25 at 12:33 PM, the DON acknowledged nurses documented Hydralazine was given outside the parameters set by the physician. She explained the nurses were not reading resident #75's order for Hydralazine correctly. The DON indicated she expected nurses to follow the physician orders. Review of the Medication Regimen Review policy and procedure revised on 6/2023 read, Facility staff shall act upon all recommendations according to procedures for addressing medication regimen review irregularities. Review of the Medication Administration policy and procedure revised on 7/2023 revealed an intent to administer medications as ordered by the physician and in accordance with professional standards of practice. The guidelines read, Obtain and record vital signs, when applicable or per physician orders. When applicable, hold medication for those vital signs outside the physician's prescribed parameters. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105757 If continuation sheet Page 8 of 12 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westminster Towers 70 West Lucerne Circle Orlando, FL 32801 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 0840 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to obtain an outside eye specialist appointment for 1 of 1 residents reviewed for care coordination, of a total sample of 34 residents, (#45). Findings: Review of resident #45's medical record revealed an admission date of 6/24/22. His diagnoses included quadriplegia unspecified (paralysis), slurred speech, polyneuropathy, and mild vascular dementia with anxiety. His record included that he had no known allergies. His annual Minimum Data Set, dated [DATE] indicated his Brief Interview of Mental Status score was 13/15, meaning his cognition was intact. Review of resident #45's medical record revealed a current order that resident #45 may have vision consults as needed for medical necessity with a start date of 6/24/22. Review of resident #45's current medications included artificial tears solution 1% drop in both eyes two times a day for eye irritation, with a start date of 3/06/25. Review of resident #45's January 2025 medication administration record revealed an order for Artificial Tears Solution 1%, 2 drops in both eyes every 4 hours as needed for eye irritation. The record indicated the medication was administered four times that month. Review of resident #45's February 2025 medication administration record revealed an order for Artificial Tears Solution 1%, 2 drops in both eyes every 4 hours as needed for eye irritation and on 2/28/25 the drops were indicated on the medication administration record as not being effective. Review of resident #45's administration note dated 2/28/25 regarding the ineffectiveness of the Artificial Tears Solution detailed that the resident was complaining of right eye discomfort. It was noted that the physician was aware and that resident #45 was waiting to be seen by an eye medical doctor. Review of resident #45's medication administration record for February 2025 indicated Moxifloxacin HCl ophthalmic solution 0.5% (an antibiotic eye drop) was administered, 1 drop in right eye three times a day for pink eye. The doses were documented as being administered three times a day from 2/03/25 to 2/10/25. Review of resident #45's progress note dated 3/06/25 revealed that resident #45's physician had been notified of the resident's eye complaints and ordered artificial tears twice a day as well as an eye doctor consult. On 3/10/25 at 10:13 AM, resident #45 was observed with watering eyes and reddened conjunctivas (the white part of the eye surrounding the pupil). A few days later on 3/13/25 at 12:23 PM, resident #25 said the pain in his right eye was an 8/10 this morning, but described the pain as, not too bad now. Both of the resident's eyes were tearing and had red conjunctivas. On 3/12/25 at 9:08 AM, the Assistant Director of Nursing (ADON)/Unit Manager (UM) of the 3rd floor reviewed an email she had sent 1/08/25 to the Social Services Director requesting the resident be seen by an eye specialist provider. She verified there had been no lab sampling of eye fluid to assess (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105757 If continuation sheet Page 9 of 12 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westminster Towers 70 West Lucerne Circle Orlando, FL 32801 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 0840 if resident #45 had a bacterial infection or had received a course of antibiotic eyedrops in 2025. Level of Harm - Minimal harm or potential for actual harm On 3/12/25 at 9:18 AM, the Social Services Director verified that he received the ADON/UM 3rd floor's email sent 1/08/25 requesting eye specialist care for resident #45. He said the plan was for resident #45 to be seen by the eye care specialist that provides services within the facility on 1/13/25. The Social Services Director called the office of the eye care specialist group who is the facility's in-house eye specialist provider by phone. They confirmed they had not seen resident #45 as a patient in 2025. The Social Services Director could not explain why resident #45 did not have the eye specialist consult on 1/13/25. The Social Services Director provided documentation that was dated 2/06/25 that indicated the eye specialist who provided services in the facility was out of network for resident #45's health insurance. The Social Services Director could not recall when nor did he document when he told resident #45 that his insurance would not cover the eye specialist provider who visited the facility. The Social Services Director stated that resident #45 had told him he did not have enough money to pay for the eye specialist service that comes to the facility out of pocket. The Social Services Director verified he did not do any additional coordination of care for resident #45 to see an eye specialist after resident #45 said he could not pay out of pocket for the care. The Social Services Director said that he could request from the facility's Administration to pay for resident #45 to get care from the eye specialist service who provides care within the facility, and he had no explanation why he had not previously arranged for that. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105757 If continuation sheet Page 10 of 12 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westminster Towers 70 West Lucerne Circle Orlando, FL 32801 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure documentation was accurate and complete for 1 of 1 resident reviewed for accidents, of a total sample of 34 residents, (#55). Findings: Resident #55, a 98- year-old male was admitted to the facility on [DATE]. His diagnoses included heart failure, weakness, unsteadiness on feet, difficulty walking, dementia, cardiac pacemaker, and acute embolism and thrombosis of right femoral vein Review of the resident's admission Minimum Data Set (MDS) assessment dated [DATE], revealed the resident's cognition was moderately impaired with a brief interview for mental status score of 8 of 15, moderate cognitive impairment. The assessment indicated the resident required substantial/maximal assistance for toileting hygiene, and partial/moderate assistance for sit to stand, and for chair/bed-to chair transfer. A care plan for at risk for falls and injuries related to need for physical assistance, and weakness was initiated on 1/13/25. Interventions included, assist resident with toileting, incontinence care, and provide physical assistance for transfers. The resident's care plan for impaired mobility and self-care deficit related to cognitive impairment related to dementia, medical conditions, and weakness was initiated on 1/13/25. Interventions revealed the resident required one person assist with transfers. On 3/10/25 at 12:44 PM, the resident's family member stated there was limited help on nights and weekend at the facility. He verbalized that a couple of Mondays ago the resident was wandering by the elevators, trying to get out, but he did not have his walker. Since that incident, the family decided to hire private sitters, 24/7. On 3/12/25 at 9:57 AM, resident #55 was lying in bed on his back, his eyes were closed, his family member and a private sitter were in the room. The family member stated that the resident's wandering happened approximately four Mondays ago. He said the resident wandered into the hallway, was at the elevator, and ended up in the bathroom of another resident in a room next to his room. He stated that another family member was notified and spoke to the supervisor about the incident. The family member stated that when that happened, the family increased the private sitter to 24/7. Review of the resident's clinical records for the period 1/10/25 to 3/12/25 revealed no documentation regarding the incident reported by the resident's family, and there were no entries on the facility's incident log pertaining to the resident for the same period. On 3/12/25 at 2:16 PM, an interview was conducted with the Administrator, the Director of Nursing (DON), and the Administrator in Training. The Administrator stated that about a month ago close to the resident's admission he was confused and went to the wrong bathroom, he went out of his room to the room next to his at approximately 6:30 AM-7:00 AM. The Administrator stated the resident was not exit seeking, and said it was a singular incident, not a pattern. The DON explained the resident did not wander; they recalled the night shift nurse found the resident in the next room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105757 If continuation sheet Page 11 of 12 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westminster Towers 70 West Lucerne Circle Orlando, FL 32801 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 3/13/25 at 9:21 AM, the DON stated she called all of the night nurses, and they were not aware of the incident. She stated she checked documentation in the resident's clinical record and could not identify the incident described by the resident's family. On 3/13/25 at 9:30 AM, the Administrator stated that on 2/26/25, he met with the resident's son, and he voiced concern that the resident was found in the room next to his room. The Administrator said the incident was reported to the 11 PM-7 AM nurse by the resident's primary care giver that came in on 2/25/25 at 6:30 AM. He verbalized the resident had a private care giver since his admission, but this service was increased to 24/7. The Administrator recalled he sent an email to the team that comprised of the Director of Rehabilitation, the Social Service Director, the DON, and Assistant DON on 2/26/25, because the son had additional concerns he wanted to address. Record review of the resident's clinical record revealed no documentation regarding the incident, and no documentation could be identified to indicate a skin assessment was completed, or to indicate if any monitoring of the resident's condition was performed status post the incident on 2/25/25. There was also no documentation by the nurse whom the Administrator stated the incident was reported to. This was acknowledged by the Administrator. On 3/13/25 at 10:45 AM, in a telephone interview, Registered Nurse (RN) A stated she worked as the 11:00 PM to 7:00 AM supervisor. She said she was off at the time she was told the incident occurred, and when she returned to work the following night Certified Nursing Assistant (CNA) B told her that resident #55 was found in another resident's bathroom. The RN stated she passed the information on in report to the oncoming nurse the following morning. RN A said usually a note would be documented when an incident occurred. However, no documentation could be identified. On 3/13/25 at 11:12 AM, a telephone call was made to CNA B. However, the interview could not be completed due to her inability to hear adequately. The policy Documentation in Medical Record reviewed/revised 6/2023 read, Each resident's medical record shall contain an accurate representation of the actual experiences of the resident and include enough information to provide a picture of the resident's progress through complete, accurate, and timely documentation . Documentation shall be completed at the time of service, but no later than the shift in which the assessment, observation, or care service occurred. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105757 If continuation sheet Page 12 of 12