Health inspection·March 9, 2023

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to take precautionary measures to protect the health and safety of a resident, and failure to report observed or suspected Neglect. The procedure indicated the facility would implement the policy to identify potential Neglect. The document revealed all reported events, including falls, would be investigated by the Director of Nursing (DON), and the investigative process involved completion of an incident report and collection of statements from the resident and all possible witnesses who were in the vicinity. The policy showed the incident should be reported to the appropriate staff and outside agencies within two hours if the resident suffered serious bodily harm, and no more than 24 hours after the event if there was no serious injury. The document read, Report the results of all investigations to the Executive Director or his her designated representative and to other officials in accordance with State law, including the State Survey Agency, within 5 working days of the incident . The policy and procedure Topic: Risk Management revised in October 2022 read, . 11. For all accidents, an Occurrence Report must be completed. Statements are collected from the staff member assigned, the resident, if capable of giving a statement, and any possible witnesses to determine circumstances of the accident. The policy indicated falls would be investigated and reported as required. On 3/09/23 at 3:02 PM, 6:12 PM, and 6:28 PM resident #11's fall with major injury was discussed with both MDS Coordinators, the Director of Nursing (DON), the Regional Nurse, and the Administrator. They explained the only witness to the fall was Licensed Practical Nurse (LPN) B, therefore she was the only person involved. The DON confirmed the facility did not conduct an investigation of resident #11's fall on 11/20/22. He acknowledged the importance of a thorough fall investigation in determining necessary care and services and to prevent Neglect. The MDS Coordinators and the Administrator denied knowledge of a fall incident investigation to determine the circumstances of the fall and rule out Neglect. They confirmed the facility had not filed Federal or State reports related to the incident. On 3/09/23 at 4:10 PM, the LPN MDS Coordinator stated resident #11's fall with major injury was not reported as it was a witnessed fall, and the fact that the resident was injured did not necessarily make it a reportable incident. She stated nurses completed the incident reports for falls which were part of the facility Risk Management program, and the previous Administrator was the Risk Manager at that time. On 3/09/23 at 5:39 PM, LPN B stated she observed resident #11 as he fell from his wheelchair to the floor near the entrance door in the dining room. The LPN recalled she looked around the room for staff and observed two CNAs (Certified Nursing Assistants) behind the double doors, where they were not able to visualize or supervise residents. LPN B stated she evaluated resident #11, noted a large, raised area on his forehead, and immediately initiated emergency medical services to transport him to the hospital. She recalled the residents in the dining room were at risk for falls and required staff supervision. LPN B stated she believed the fall could have been prevented if residents in the dining room had been supervised. She stated the two CNAs told her they were not supervising residents in the dining room as they were on their break. LPN B explained she completed a progress note in the electronic medical health record, but was never asked to provide a statement for or participate in an incident investigation. On 3/09/23 at 5:58 PM, the Activities Director stated on 11/20/22, resident #11 was in the dining room but he was not included in the group of residents at known risk for falls. She explained she was on the other side of the room and heard a loud bang, but did not actually witness the resident's fall. The Activities Director insisted she provided the Weekend Nursing Supervisor with a handwritten statement regarding the incident and could not explain the lack of an incident investigation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105843 If continuation sheet Page 2 of 10 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 105843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harborview Health Center West Altamonte 1099 West Town Parkway Altamonte Springs, FL 32714 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 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement appropriate interventions to include provision of adequate supervision to prevent a fall with major injury for 1 of 1 resident reviewed for accidents, of a total sample of 31 residents, (#11). The facility's failure to increase supervision for a resident with a history of repeated falls resulted in actual harm for resident #11. Findings: Review of the medical record revealed resident #11 was admitted to the facility on [DATE] with diagnoses including seizures, dementia, anxiety, and hypertension. He was hospitalized on [DATE] after a fall with major injury and readmitted from the hospital on [DATE] with additional diagnoses of traumatic subdural hemorrhage, repeated falls, weakness and paralysis of the left side and visiospatial deficit and spatial neglect following a stroke. A subdural hemorrhage is bleeding between the covering and surface of the brain that is often the result of a severe head injury. Compression of the brain can cause brain injury or death (retrieved on 3/22/23 from www.medlineplus.gov). Visiospatial deficit and spatial neglect are common consequences of a one-sided brain injury. Persons who suffer from these conditions do not process visual stimuli and images on one side of the body (retrieved on 3/22/23 from www.medscape.com). The Minimum Data Set (MDS) quarterly assessment with assessment reference date of 9/08/22 showed the resident had a Brief Interview for Mental Status score of 4 out of 15, which indicated the resident was severely cognitively impaired. The MDS assessment noted there were no behavioral symptoms or rejection of care and treatment, and the resident required extensive staff assistance for bed mobility, and limited assistance for eating during the look back period. Fall risk evaluations completed on 8/14/22 and 10/26/22 identified the resident as high risk for falls. A Change in Condition form dated 8/14/22 indicated resident #11 was observed sitting on the floor beside his bed. A Change in Condition dated 10/26/22 indicated resident #11 was observed on the floor. Review of a Nursing Progress Note dated 11/15/22 at 9:47 AM, revealed resident #11 was found on the floor in the television room. He informed nursing staff he was asleep and slid out of his chair. Review of a Change in Condition form dated 11/20/22 read, Resident fell out of wheelchair and hit his head. The document indicated resident #11 grimaced and complained of pain, level 8 on a 0 to 10 scale, to the right side of his forehead. The resident required emergency medical transport to the hospital for evaluation and treatment. Review of resident #11's medical record revealed a care plan, initiated on 1/28/20, that indicated he was at risk for falls. The goals, revised on 8/16/22, included minimizing the risk of sustaining serious injury and an intervention directed nursing staff to anticipate and meet the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105843 If continuation sheet Page 3 of 10 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 105843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harborview Health Center West Altamonte 1099 West Town Parkway Altamonte Springs, FL 32714 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 0689 needs. Level of Harm - Actual harm A care plan for an actual fall was initiated on 1/22/20 and had a goal of minimizing the risk of further incidents. An intervention dated 1/24/20 indicated staff were to place items on the right side of the resident's body. An approach dated 2/17/22 directed staff to encourage and assist him to be in the day room or dining room when in the wheelchair. The care plans did not specify the level of supervision or frequency of monitoring required to prevent falls and/or injury, and ensure the resident's safety. The resident's care plan was revised on 11/30/22, five days after readmission from the hospital where he was treated for a subdural bleed, to include increase supervision. However, the care plan still did not provide specific instructions for staff regarding the frequency of rounds and whether or not the resident needed be monitored in a fall prevention program. Residents Affected - Few On 3/09/23 at 5:39 PM, Licensed Practical Nurse (LPN) B stated she observed resident #11 as he fell from his wheelchair to the floor near the entrance door in the dining room on 11/20/22. The LPN recalled she looked around the room for staff and observed two Certified Nursing Assistants (CNAs) behind the double doors, where they were not able to visualize or supervise residents. LPN B stated she evaluated resident #11, noted a large, raised area on his forehead, and immediately initiated emergency medical services to transport him to the hospital. She recalled the residents in the dining room required supervision because they were at risk for falls. LPN B stated she believed the fall could have been prevented if residents in the dining room had been supervised. She stated the two CNAs told her they were not supervising residents in the dining room as they were on their break. On 3/09/23 at 5:58 PM, the Activities Director stated she knew which residents were at risk for falls as they were supervised by a CNA in the common area on the unit. She stated those residents required staff assistance to get to the dining room for activity functions. She explained a CNA remained in the area by those residents for safety. She stated resident #11 was not included in the group of residents with known risk for falls on 11/20/22. The Activities Director recalled on that day, she heard a loud bang in the dining room, looked around, and saw resident #11 on the floor. She stated she did not see the resident fall as she was on the other side of the dining room. On 3/09/2023 at 6:28 PM, the Director of Nursing (DON) acknowledged resident #11 had not been provided with increased supervision although he had a history of multiple falls prior to the fall with major injury on 11/20/022. The DON explained residents identified as at risk for falls should participate in the fall program, and be supervised around the clock. He verified resident #11 should have been placed on close supervision prior to his fall with major injury on 11/20/22 because he had falls before this happened. The facility's policy and procedure for Topic: Fall Prevention Program (undated) indicated the facility would .implement specialized safety precautions to ensure safety. of residents identified to be at risk for falls. The procedure indicated specific interventions for residents deemed to be at high risk for falls included alarms, floor mats, bed bolsters, appropriate recreational activities, and increased supervision, i.e. ½ hour observations/monitoring rounds. The facility's policy and procedure for Topic: Risk Management (undated) revealed avoidable accidents occurred when the facility failed to Implement interventions, including adequate supervision, consistent with a resident's needs, goals, plan of care, and current standards of practice in order to reduce the risk of an accident; and/or monitor the effectiveness of the interventions and modify the interventions as necessary, in accordance with current standards of care. The document indicated supervision was an intervention utilized to mitigate fall risk. Adequate supervision was noted to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105843 If continuation sheet Page 4 of 10 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 105843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harborview Health Center West Altamonte 1099 West Town Parkway Altamonte Springs, FL 32714 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 0689 the type and frequency of supervision required to meet a resident's person-centered care needs. Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105843 If continuation sheet Page 5 of 10 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 105843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harborview Health Center West Altamonte 1099 West Town Parkway Altamonte Springs, FL 32714 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** Based on observation, interview, and record review, the facility failed to follow pharmaceutical procedures to ensure proper administration and accurate documentation of medications for 1 of 5 residents reviewed for medication administration, of a total sample of 31 residents, (#81). Findings: Review of the medical record revealed resident #81, an [AGE] year-old man, was admitted to the facility on [DATE] with diagnoses that included malnutrition, cancer of the immune system, muscle weakness, and adult failure to thrive. The Minimum Data Set admission (MDS) assessment dated [DATE] indicated resident #81 had moderate cognitive impairment, delusions, and disorganized thinking which fluctuated in severity. The MDS assessment also showed resident #81 did not reject care in the look back period. Review of resident #81's medical record revealed no care plan for self-administration of medications. His baseline care plan dated 2/06/23 read, No in the section designated for self-administration of medication. On 3/06/23 at approximately 10:46 AM, resident #81 was in bed with his eyes closed. There were two medicine cups on the tray table next to his breakfast tray. One cup contained several pills and the other cup contained two pills. Resident #81 responded to his name being called and was alert and oriented to person and place. He motioned to the medicine cup with several pills and explained those were pain medications that the nurse left there this morning as he did not need them. He stated the other cup with two pills was from last night. On 3/06/23 at 10:54 AM, the Sub-Acute Specialty Unit Manager (UM) stated she was the nurse assigned to resident #81 that morning. She confirmed there were two cups with medications on the resident's tray table and acknowledged she left one of the medication cups that morning. She said, They were only vitamins. She stated she was not sure who left the other cup of medications on resident #81's bedside and explained she did not see them earlier when she did her rounds. The Sub-Acute Specialty UM confirmed it was against the facility's policy and procedure to leave medications at a resident's bedside for self-administration unless the resident was assessed to self-administer medications. A few minutes later at the nurses' station, the Sub-Acute Specialty UM confirmed there were five and a half pills in the cup she left on the tray table. She looked at resident #81's medical record and explained the cup contained one Cholecalciferol (Vitamin D) tablet, one Dexamethasone (steroid) tablet, one Vitamin B complex tablet, one Vitamin E capsule, one Zinc Gluconate tablet and one half of a Benadryl tablet. She checked the electronic medical record (EMR) and discovered the medications left in the second cup were one Marinol Capsule and one Levothyroxine tablet that should have been administered on the previous shift. The Sub-Acute Specialty UM confirmed her documentation reflected administration of the medications although she left them on the tray table. She explained Licensed Practical Nurse (LPN) A, the Weekend Supervisor and resident #81's assigned nurse on the previous shift, also documented that the medications left on the tray table were given on the previous shift. The Sub-Acute Specialty UM did not respond when asked how she could be sure resident #81 took the medications if she left them on the table. She confirmed she would go back to the EMR and strike out the inaccurate documentation that indicated the medications were administered. The Sub-Acute Specialty UM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105843 If continuation sheet Page 6 of 10 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 105843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harborview Health Center West Altamonte 1099 West Town Parkway Altamonte Springs, FL 32714 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 validated it was not appropriate to leave the medications at resident #81's bedside. Level of Harm - Minimal harm or potential for actual harm In a telephone interview on 3/09/23 at 9:44 AM, LPN A stated he gave resident #81 the Marinol capsule and the Levothyroxine tablet in the early morning on 3/06/23. He recalled he handed the resident the cup with the pills, and assumed the resident took them after he left the room. LPN A stated he knew the facility's policy required him to ensure resident #81 actually swallowed the medications, but he explained he was in a hurry as he still to administer medications to several other residents. LPN A verified leaving the medications at the bedside was a safety issue for a resident who was not assessed and determined to be appropriate for self-administration of medication. Residents Affected - Few On 3/08/23 at 9:26 AM, the Regional Nurse stated her expectation was nurses would never leave medications at the bedside. She stated it was a safety issue because another resident could wander in and take the pills, and the nurse would not know if the resident actually took the medications. She explained nurses were not to document medications as given unless they actually saw the resident take the medications. Review of the facility's policy and procedure Medication Administration dated October 2021, revealed the Standards Of Practice #11, Medications may not be left unattended after pouring and should be administered immediately. Medication is not to be pre-poured, nor left at the bedside for the resident to take at a later time. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105843 If continuation sheet Page 7 of 10 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 105843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harborview Health Center West Altamonte 1099 West Town Parkway Altamonte Springs, FL 32714 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 - Few 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** 2. Review of the medical record revealed resident #78 was most recently re-admitted to the facility on [DATE] from an acute care hospital with diagnoses that included Peripheral Venous Disease, right leg amputation above the knee, Diabetes Mellitus, heart failure, major depressive disorder, chronic abnormal heart rhythm, hypertension, heart disease, and hyperlipidemia. The Minimum Data Set (MDS) Medicare 5-day assessment dated [DATE] revealed resident #78 had moderate cognitive impairment and received both scheduled and as needed (prn) pain medications for his frequent pain. The assessment also indicated resident #78 received insulin injections six times, antidepressants seven times and opioid pain medications seven times during the 5-day look back period. Resident #78 had care plans for anticoagulant therapy related to his abnormal heart rhythm, diuretic therapy related to his heart failure, anti-depressant medications related to his depression, pain and diabetes mellitus. Review of the Order Summary Report forms for February and March 2023 revealed resident #78 had a physician order dated 2/14/23 for Lantus insulin subcutaneous solution, inject five unit at bedtime for diabetes. The document did not include an order for blood glucose monitoring until 3/09/23 after the facility was made aware the task was not being done. Review of the Medication Administration Record (MAR) for February and March 2023 revealed resident #78 received Lantus insulin subcutaneous injection every day since his admission on [DATE], except once when it was refused. The MAR indicated resident #78 received daily blood glucose monitoring up until 2/07/23 when he was discharged to the hospital but the task was not resumed on re-admission from the hospital on 2/14/23. Review of the Medication Regimen Review form dated 2/16/23 revealed the review was for a new admission for resident #78. The recommendation made to the attending physician to review indicated resident #78 was recently admitted with Insulin orders without blood glucose monitoring. Please consider adding twice daily fingersticks for 14 days, notify MD if [blood glucose] <70 or >250, to allow assessment and adjustment of dosing, if necessary. Review of the document revealed no physician signature to indicate review of and response to the pharmacist's recommendation. On 3/09/23 at approximately 11:30 AM the Executive Director was asked to provide the attending physician's corresponding response to the MRRs provided. On 3/09/23 at 4:44 PM, the DON stated he called the attending physician today to get his response for the MRR for resident #78 dated 2/16/23. He confirmed there was still no documentation of the attending physician's response until today and no associated physician order for blood glucose monitoring until he entered it today at 12:24 PM. The DON explained his process was after he received an email from the pharmacist, he would put it in the binder for the attending physician to review. He was unable to say what happened or why it had not been done. On 3/09/23 at 2:20 PM, the Regional Nurse stated the facility, specifically the DON, was responsible for follow up to the pharmacist's medication recommendations. She stated the facility and DON were disorganized and they could not locate the pharmacy forms which indicated the attending physician's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105843 If continuation sheet Page 8 of 10 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 105843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harborview Health Center West Altamonte 1099 West Town Parkway Altamonte Springs, FL 32714 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 had either accepted or declined the pharmacist's recommendations with a rationale if declined. She acknowledged she was unable to find all of the responses and said recommendations were not followed because, the system was not in place for the nurses to know it had to be done. She explained the DON was new and was unorganized in his process, so they were unable to find the signed responses from the attending physicians. Residents Affected - Few Review of the undated Policy/Procedure, Pharmacy Services-Drug Regimen Review revealed the intent of the policy was to maintain the resident's highest practicable level of physical, mental, and psychosocial well-being, and to prevent or minimize adverse consequences related to medication therapy by providing oversight by a licensed pharmacist, attending physician, medical director and director of nursing. The procedure indicated the drug regimen of each resident was to be reviewed at least monthly, any irregularities would be reported by the pharmacist to the attending physician, medical director and the DON, and the reports would be acted upon. Furthermore, the procedure described the attending physician's duty to document that the identified irregularity was reviewed and what if any actions were taken, or if there were no changes, to document the rationale behind the decision. Additional procedures included the responsibility of the facility to develop and maintain policies and procedures for this review which was to include time frames for the different steps in the process and what steps the pharmacist must take if there was an urgent action needed. Based on record review and interview, the facility failed to ensure pharmacy recommendations that resulted from monthly Medication Regimen Reviews (MRRs) were addressed and signed by the physician for 2 of 5 residents reviewed for Unnecessary Medications, of a total sample of 31 residents, (#66 & #78). Findings: 1. Review of the medical record revealed resident #66 was admitted to the facility on [DATE] with diagnoses including schizoaffective disorder, major depressive disorder, impulse disorder, insomnia, and seizures. Review of the resident's medical record revealed active medication orders included Trazodone 100 milligrams (mg) for schizoaffective disorder, ordered on 5/04/21; Zyprexa 5 mg for schizoaffective disorder, ordered on 8/18/22; and Tramadol 25 mg for pain, ordered on 7/11/22. Review of the record showed the monthly pharmacy MRR report dated 1/11/23 included the pharmacist's recommendations to evaluate the need for Tramadol and discontinue if appropriate, as the resident had not used it recently. A MMR form dated 9/19/22 revealed the pharmacist noted the resident had a recent fall and Zyprexa could increase the risk. The recommendation was to evaluate, consider tapering the dose or implementing an alternative treatment. A similar recommendation was made on 9/19/2022 regarding the medication Trazodone and the increased risk of drowsiness and falls. None of the three recommendations by the pharmacist were signed by the physician to indicate the document had been reviewed and/or recommendations addressed. On 3/09/23 at 4:39 PM, the Director of Nursing (DON) stated the process for monthly MRR was to keep the documents received from the pharmacy in a binder in his office. He explained he recently requested the pharmacy consultant reprint reviews when he discovered they were missing. He stated the MRR process was important and should be tracked and completed to avoid adverse effects related to medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105843 If continuation sheet Page 9 of 10 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 105843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harborview Health Center West Altamonte 1099 West Town Parkway Altamonte Springs, FL 32714 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 On 3/09/23 at 3:48 PM, in a telephone interview, the facility's Pharmacy Consultant recalled there had been issues with the facility completing physician reviews of pharmacy MRR recommendations since about January 2023. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105843 If continuation sheet Page 10 of 10