Inspection·February 22, 2024

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure residents maintained acceptable parameters of nutritional status to prevent weight loss for 1 of 6 reviewed residents, Resident #660. Residents Affected - Few Findings include: During an interview on 2/19/2024 at 10:11 AM, Resident #660 stated, I have lost weight and do not always receive foods I request on my tray. During an observation on 2/20/2024 at 12:20 PM, Resident #660 was eating lunch with only bites taken from his plate. During an interview on 2/20/2024 at 12:21 PM, Resident #660 stated lunch was not a favorite meal, and he did not get the bowl of soup he requested. Review of Resident #660's records showed the resident weighed 148 lbs (pounds) on 11/22/2023, 147.5 lbs on 11/24/2023, 146.5 lbs on 11/27/2023, 141 lbs on 12/20/2023, 138.0 lbs on 1/1/24 and, 135 lbs on 2/1/2024, which is a -8.78 % loss. Review of Resident #660's dietary note authored by the Registered Dietician (RD) dated 11/28/2023 read, At risk for weight loss and malnutrition. RD to monitor. Review of Resident #660's care plan dated 11/22/2023 showed nutritional focus to provide diet as ordered and honor food preferences. During an interview on 2/20/2024 at 2:20 PM, the RD confirmed that she had not charted or had interventions in place for Resident #660 to prevent further weight loss and there should have been interventions of fortified foods, updating food preferences, or supplements added for more caloric intake. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105858 If continuation sheet Page 2 of 11 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 105858 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Health and Rehabilitation Center 701 Medical Court East Inverness, FL 34452 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 administer oxygen per physician orders and according to professional standards of practice for 2 of 3 residents reviewed for respiratory care, Residents #55 and #64. Residents Affected - Few Findings include: Review of Resident #64's admission record showed the resident was most recently admitted on [DATE] with the diagnoses including chronic obstructive pulmonary disease (COPD), and multiple subsegmental pulmonary emboli without acute cor pulmonale. Review of Resident #64's physician order dated 6/26/2022 reads, May apply O2 [oxygen] @ [at] 2 LPM [liters per minute] via nasal cannula prn [as needed] for respiratory distress. During an observation on 2/19/2024 at 10:50 AM, Resident #64 was sitting in a wheelchair, receiving oxygen via nasal cannula. The oxygen concentrator was set at 3 liters per minute and was across the room and out of the resident's reach. During an interview on 2/19/2024 at 10:50 AM, Resident #64 stated, I pretty much use my oxygen all the time, but I can take it off to go outside. I do not change the amount. I just take off my cannula and leave it on the bed until I come back in. During an observation on 2/20/2024 at 8:52 AM, Resident #64 was sitting in a wheelchair, receiving oxygen via nasal cannula with the oxygen concentrator set at 3 liters per minute. During an observation on 2/22/2024 at 6:40 AM, Resident #64 was in bed, receiving oxygen via nasal cannula with the oxygen concentrator set at 3 liters per minute. During an interview on 2/22/2024 at 6:40 AM, Staff E, Licensed Practical Nurse (LPN), stated, All oxygen should be checked when we do meds. I think she will adjust the oxygen sometimes; she will take herself on and off. 2. Review of Resident #55's admission record showed the resident was admitted on [DATE] with the diagnoses including chronic obstructive pulmonary disease, acute diastolic congestive heart failure, paroxysmal atrial fibrillation (an irregular heartbeat), and atherosclerotic heart disease of native coronary artery with unspecified angina pectoris. Review of Resident #55's physician order dated 3/14/2023 reads, Continuous O2 at 2 L/MIN [liters/minute] via N/C [nasal cannula] q [every] shift, every day for COPD. During an observation on 2/20/2024 at 10:45 AM, Resident#55 was in bed, receiving oxygen at 3 liters per minute via nasal cannula through concentrator. During an interview on 2/20/2024 at 10:45 AM, Resident #55 stated, I don't change the oxygen. The nurses do that. During an observation on 2/22/2024 at 6:05 AM, Resident #55 was in bed, receiving oxygen at 3 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105858 If continuation sheet Page 3 of 11 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 105858 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Health and Rehabilitation Center 701 Medical Court East Inverness, FL 34452 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 liters per minute via nasal cannula through concentrator. Level of Harm - Minimal harm or potential for actual harm During an observation on 2/22/2024 at 10:26 AM, Resident #55 was in bed, receiving oxygen at 3 liters per minute via nasal cannula. Residents Affected - Few During an interview on 2/22/2024 at 10:27 AM, Staff F, LPN, confirmed that oxygen was running at 3 liters per minute for Resident #55. Staff F stated, The oxygen should be checked when we give medications. I didn't today. I should have. It is not at the ordered amount. During an interview on 2/22/2024 11:01 AM, the Director of Nursing (DON) stated, We need to verify oxygen is correct daily. We should be following the orders. Review of the facility policy and procedures titled, Oxygen Administration with the last approval date of 1/24/2024 reads, Policy: It is the policy of this facility to provide guidelines for safe oxygen administration. Procedure . 4. Oxygen therapy is administered by way of an oxygen mask, nasal cannula, and/or nasal catheter as is ordered by the physician or required to provide for the needs of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105858 If continuation sheet Page 4 of 11 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 105858 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Health and Rehabilitation Center 701 Medical Court East Inverness, FL 34452 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure the drugs and biologicals used in the facility were stored and labeled in accordance with currently accepted professional standards. Findings include: 1. During an observation on 2/19/2024 at 10:20 AM, there were Orajel tooth ache cream, Afrin Nasal Spray, and Prednisolone Acetate on Resident' #48's bedside table (Photographic evidence obtained). Review of Resident #48's records revealed no physician order or care plan related to self-administration of medications. During an interview on 2/20/2024 at 10:30 AM, Staff B, RN (Registered Nurse), stated, Those medications should not have been left at [Resident #48's name] bedside. 2. During an observation on 2/19/2022 at 10 AM, there was Spiriva Respimat 2.5 mcg/actuation inhaler on Resident #712's bedside table (Photographic evidence obtained). During an interview on 2/19/2024 at 10:05 AM, Resident #712 stated, I use that when I need it. Review of Resident #712's records revealed no physician order or care planned intervention related to self-administration of medications. During an interview on 2/20/2024 at 10:35 AM, Staff B, RN, stated, That is a prescription medication and should not have been left in [Resident #712's name] room. During an interview on 2/21/2024 at 9:50 AM, the Director of Nursing stated, My expectation is that medications should never be left at the bedside. 3. During an observation on 2/19/2024 at 12:16 PM, there was a bottle of nasal spray at Resident #40's bedside on the tray table. During an observation on 2/19/2024 at 12:41 PM, accompanied with the Assistant Social Services Director (ASSD), there was one bottle of nasal spray at Resident #40's bedside. During an interview on 2/19/2024 at 12:45 PM, the ASSD stated meds were not supposed to be at bedside. During an interview on 2/20/2024 at 1:10 PM, the Director of Nursing (DON) stated her expectation was for no medications to be at bedside and if found should be removed immediately. 4. During an observation of Medication Cart #2 on 2/19/2024 at 9:06 AM, with Staff C, Licensed Practical Nurse (LPN), there was one unlabeled white pill in a clear plastic bag in the narcotic drawer. During an interview on 2/19/2024 at 6:10 AM, Staff C, LPN, stated, Oh that is Tylenol #3. I went to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105858 If continuation sheet Page 5 of 11 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 105858 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Health and Rehabilitation Center 701 Medical Court East Inverness, FL 34452 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few administer it to [Resident #94's name] and she had her Oxycodone at her bedside, so I didn't want to give her both at the same time. During an interview on 2/19/2024 at 9:23 AM, the DON stated, Medications should never be left at the bedside. Narcotics should not be returned to the narcotic drawer if a resident refuses them. They should be destroyed with 2 nurses. Review of the facility policy and procedures tilted Medication/Biological Storage with the last review date of 1/24/2024 read, Policy: It will be the policy of this facility to store medications, drugs and biologicals in a safe, secure and orderly manner. Procedures . 8. Drugs shall be stored in an orderly manner in cabinets, drawers, carts or automatic dispensing systems. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105858 If continuation sheet Page 6 of 11 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 105858 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Health and Rehabilitation Center 701 Medical Court East Inverness, FL 34452 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, interview, and record review, the facility failed to ensure food was properly and safely stored, covered and labeled in the areas of the kitchen coolers and freezers and failed to ensure the equipment and storage containers were kept in a clean condition. Findings include: During a walk-through tour of the kitchen on 2/19/2024 at 9:08 AM with the Certified Dietary Manager (CDM), there were 102 unlabeled and undated large and small bowls filled with food items in the walk-in cooler and numerous boxes with flaps open exposing food items including veggie burgers and waffles in walk-in freezer. The can opener had food debris on it. During an interview on 2/19/2024 at 9:12 AM, the CDM confirmed that the 102 bowls contained gelatin and they should have identifying labels and dates. The CDM stated that all boxes in the freezer should be closed to protect the food from freezer burn and as a cover for the food contents.The CDM verified the can opener was dirty with food debris and should have been washed on the previous night shift. During an observation on 2/20/2024 at 6:05 AM, Staff A, Dietary Aide, was getting prepared to place fruit cocktail from the dented cans in dessert bowls. During an interview on 2/20/2024 at 6:10 AM, Staff A, Dietary Aide, stated that she should not be using dented cans of food. During an observation on 2/20/2024 at 6:15 AM, there was a partially-open drawer under the toaster. The drawer contained clean cooking utensils. There were breadcrumbs and bread ties in the drawer. During an interview on 2/20/2024 at 6:15 AM, the CDM stated the drawer should not have been opened to allow debris to fall onto the clean utensils. Review of the facility policy and procedures titled Food Receiving and Storage with the last review date of 1/4/2024 reads, Policy Interpretation and Implementation . 8. All foods stored in the refrigerator or freezer will be covered, labeled and dated (use by date). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105858 If continuation sheet Page 7 of 11 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 105858 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Health and Rehabilitation Center 701 Medical Court East Inverness, FL 34452 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 record review and interview, the facility failed to ensure medical records were accurate and complete for 1 of 3 residents reviewed for insulin administration, Resident #93, and for 1 of 3 residents reviewed for changes in condition, Resident #108. Findings include: 1. Review of Resident #93's admission record revealed the resident was admitted to the facility on [DATE] with the diagnoses including type 2 diabetes mellitus with diabetic neuropathy, acute on chronic systolic (congestive) heart failure and atherosclerotic heart disease of the native coronary artery with angina pectoris (chest pain). Review of Resident #93's physician order dated 11/17/2023 reads, Humalog Kwikpen Subcutaneous Solution Pen-injector 100 unit/ml [milliliter] (Insulin Lispro) inject as per sliding scale if: 0-59= Notify provider, 60-150= 0, 151-200= 2, 201-250= 4, 251-300= 6, 301-350= 8, 351-400= 10, 401-999= 10 Notify MD [Medical Doctor], subcutaneously before meals and at bedtime for DM2 [diabetes mellitus type 2]. Review of Resident #93's Medication Administration Record (MAR) for December 2023 showed no blood sugar level documented on 12/23/2023 at 6:30 AM, and on 12/25/2023 at 6:30 AM. Review of Resident #93's MAR for January 2024 showed no blood sugar level documented on 1/16/2024 at 9:00 PM, with the code 4 (vitals outside parameters for administration). Review of Resident #93's MAR for February 2024 showed a blood sugar level of 411 documented on 2/5/2024 at 6:30 AM, and a blood sugar level of 410 documented on 2/18/2023 at 6:30 AM, with the code 10. Review of the nursing progress notes for Resident #93 from 12/23/2023 through 2/18/2024 revealed no progress notes related to holding insulin and physician notification of elevated blood sugars. During an interview on 2/22/2024 at 8:15 AM, the Director of Nursing (DON) stated, All blood sugars should be documented. I don't know why they aren't. All documentation should be accurate. The nurse did call the doctor and get orders to hold the insulin. I spoke to the nurses with the elevated blood sugars and they notified the ARNP [Advanced Registered Nurse Practitioner]. They just failed to document this. They should have documented it. Review of the facility policy and procedures titled Medication Administration with the last review date of 1/24/2024 reads, Policy: It will be the policy of this facility to administer medications in a timely manner and as prescribed by the physician, unless otherwise clinically indicated or necessitated by other circumstances such as lack of availability of medication or refusals of medication by the resident. Procedure . 9. The individual administering the medication must initial the resident's MAR on the appropriate line and date for that specific day when administering the next resident's medication . 14. When medications are administered, the individual administering the medication must record in the resident's medical record/MAR. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105858 If continuation sheet Page 8 of 11 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 105858 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Health and Rehabilitation Center 701 Medical Court East Inverness, FL 34452 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 2. Review of the admission record for Resident #108 revealed the resident was recently admitted to the facility on [DATE] with the diagnoses including cerebral infarction (stroke), hyperlipidemia (high cholesterol), paroxysmal atrial fibrillation (an irregular heart beat), essential primary hypertension, anemia, major depressive disorder, osteoarthritis, heart failure, unspecified dementia, and anxiety disorder. Review of Resident #108's nursing progress note dated 11/30/2024 at 10:30 PM read, Aides approached this writer to come evaluate patient. Upon entering the patient room, patient observed to have minimal amount of vomit/spit coming out of right side of mouth, shallow breathing and was not responding to verbal or sternal rub stimulation. Call placed to [Advanced Practice Registered Nurse's name] with [Medical Doctor's name] and order to send patient to ER for further evaluation and treatment given. Patient transferred and wife [Resident #108's Representative's name] notified. Review of Resident #108's nursing progress note dated 12/1/2023 at 7:15 AM read, This writer called [hospital name] and spoke with RN [Registered Nurse] in PCU [Progressive Care Unit]. Patient admitted for A Fib [atrial fibrillation] with RVR [rapid ventricular rate] and aspiration. Review of Resident #108's SBAR (Situation, Background, Assessment, Response) Communication Form dated 11/30/2023 at 10:28 PM read, Vital Signs B/P [blood pressure]: 140/72, pulse 82, RR [respiratory rate]: 18.0, Temp [temperature]: 97.3, Pulse Oximetry (if indicated): 96.0%. Review of the nursing Progress Note with an effective date of 11/30/2023 at 10:17 PM showed the vital signs recorded on the SBAR were completed on 11/30/2023 for the BP at 1:11 PM, Pulse at 1:13 PM, RR at 1:14 PM, Temp at 1:12 PM, and the Pulse Oximetry at 1:14 PM. The vital sign values were present 9 hours and 14 minutes prior to the resident being sent to the hospital which did provide for inaccurate assessment for when the resident suffered a change in condition. During an interview on 2/21/2024 at 2:15 PM the Director of Nursing (DON) stated, There are no vital signs documented for this resident when he went to the hospital. We should have vital signs documented for him, a heart rate, temperature, and accucheck if needed. A neurological assessment should be done when they have an altered mental status. It is our policy to document accurately what is happening with the residents. Review of the facility policy and procedures titled Change in Condition with the last review date of 1/24/2024 reads, Procedure . 2. When a change is noted, gather pertinent data such as vital signs, weights and other clinical observations. Review of the facility policy and procedures titled Charting and Documentation with the last review date of 1/24/2024 reads, Policy: It is the policy of this facility that services provided to the resident, or any changes in resident's medical or mental condition, shall be documented in the resident's clinical record as is needed. Procedure: 1. observations, medications administered, services performed, etc., should be documented in the resident's clinical records. 2. Incidents, accidents, or changes in the resident's condition should be recorded in the clinical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105858 If continuation sheet Page 9 of 11 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 105858 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Health and Rehabilitation Center 701 Medical Court East Inverness, FL 34452 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure staff performed hand hygiene during medication administration in 6 of 12 observations for medication administration. Residents Affected - Some Findings include: During an observation on 2/22/2024 at 8:45 AM, Staff G, Registered Nurse (RN), prepared medications for Resident #73. Staff G entered Resident #73's room and administered the medications. Staff G exited the room and returned to the medication cart. At 8:50 AM, Staff G prepared medications for Resident #54. Staff G entered Resident #54's room and administered the medications. Staff G exited the room and returned to the medication cart. At 8:52 AM, Staff G prepared medications for Resident #59. Staff G entered Resident #59's room and administered the medications. Staff G exited the room and returned to the medication cart. At 8:55 AM, Staff G entered Resident #72's room to obtain the resident's blood pressure prior to administering the resident's medications. Staff G exited the room after obtaining the resident's blood pressure and returned to the medication cart. Staff G prepared the resident's medications, entered Resident #72's room and administered the resident's medications. Staff G did not perform hand hygiene during observation of medication administration process. During an interview on 2/22/2024 at 9:15 AM, Staff G, Registered Nurse (RN), stated, I didn't think I had to do it [hand hygiene] when I left the room and walked straight to the med cart, so I didn't. During an interview on 2/22/2024 at 12:15 PM, the Director of Nursing (DON) stated, They should perform hand hygiene if their hands are visibly soiled, after they take gloves off, when they are pulling medications. 2. During an observation on 2/22/2024 at 6:00 AM, Staff D, Licensed Practical Nurse (LPN), prepared medications for Resident #88. Staff D entered Resident #88's room and administered the medications. Staff D exited Resident #88's room and returned to the medication. At 6:08 AM, Staff D prepared medications for Resident #30. Staff D entered Resident #30's room and administered the medications. Staff D removed the straw with her ungloved hand and placed her right index finger over the tip of the straw and asked the resident to open her mouth and dropped water from the straw into the resident's mouth. Staff D then placed the straw back in the cup and the resident took several sips of water from the tip of straw that Staff D had her finger on. Staff D exited Resident #30's room and returned to the medication cart. At 6:11 AM, Staff D prepared medications for Resident #71. Staff D assembled all supplies for blood glucose check. While outside of the room, Staff D donned gloves without performing hand hygiene, removed the alcohol pad from the packet and placed the alcohol swab within her gloved hand. Staff D entered Resident #71's room with gloves on and administered the oral medication. Staff D then took the alcohol swab, cleaned Resident #71's finger in one sweep with the alcohol swab. Staff D did not wait for the finger to dry and obtained the blood sample for the accucheck. Staff D doffed her gloves, exited the resident's room, returned to medication cart, and began preparing medications for another resident. Staff D did not perform hand hygiene during observation of medication administration process. During an interview on 2/22/2024 at 6:18 AM, Staff D, LPN, stated, I should have used hand sanitizer before I poured my meds [medications]. We should either wash our hands or use sanitizer before and after we put on gloves. I should have waited to put on my gloves and opened the alcohol swab until I was in the room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105858 If continuation sheet Page 10 of 11 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 105858 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Health and Rehabilitation Center 701 Medical Court East Inverness, FL 34452 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an observation on 2/22/2024 at 6:20 AM, Staff E, LPN, donned gloves and cleaned an accucheck machine and placed the accucheck machine in a plastic cup. With the same gloves on, Staff E prepared Resident #4's oral medications, entered the resident's room, and administered the oral medications. Staff E doffed her gloves and returned to the medication cart. Staff E assembled all accucheck supplies, donned gloves and returned to Resident #4's bedside. Staff E performed the accucheck, doffed her gloves, and exited the resident's room. Staff E returned to the medication cart and prepared insulin. Staff E donned gloves and entered Resident #4's room. Staff E administered the insulin to the resident, doffed her gloves and returned to the medication cart and began preparing medications for another resident. Staff E did not perform hand hygiene during observation of medication administration process. During an interview on 2/22/2024 at 6:35 AM, Staff E, LPN, stated, I should have used hand sanitizer and changed my gloves. During an interview on 2/22/2024 at 11:15 AM, the Director of Nursing (DON) stated, I expect all staff to use hand sanitizer when our policies state they should. Review of the facility policy and procedures titled Hand Hygiene with the last review date of 1/24/2024 read, Policy: This facility considers hand hygiene the primary means to prevent the spread of infection. Procedure . 2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents and visitors . 5. Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap (antimicrobial or non-microbial) and water for the following situations . b. Before and after direct contact with residents; c. Before preparing or handling medications . f. Before donning sterile gloves . l. After contact with objects (e.g. medical equipment) in the immediate vicinity of the resident; m. After removing gloves . 6. Hand hygiene is the final step after removing and disposing of personal protective equipment. 7. The use of gloves does not replace hand washing/hand hygiene. Integration of glove use along with routine hand hygiene is recognized as the best practice for preventing healthcare-associated infections. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105858 If continuation sheet Page 11 of 11