Health inspection·November 2, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few assessments should have been monitored by the nursing staff due to the mechanism of injury from the fall. She said she was not aware Resident #67 had been transported to the hospital by car. She assumed the resident was transported to the Emergency Department via Emergency Medical Services (EMS) which was her preference. On 11/2/2023 at 12:30 p.m. in an interview Resident #67's daughter said the facility called her the day her father fell and told her he had a minor injury. She said the next day they called and said he should go to the Emergency Department because they thought he had broken ribs. She said she and her mother came and drove her father to the hospital. She said the facility should have sent him to the hospital by ambulance as soon as he was injured. She said this was the second time he has fallen and injured himself under their care. She said she was very upset with the care he was receiving at this facility. On 11/2/2023 at 2:15 p.m., in an interview LPN Staff M said when she spoke with Resident #67's wife, she said she wanted to drive the resident to the hospital because of the cost associated with an ambulance. LPN Staff M said the resident had not exhibited any symptoms other than a little rib pain so she did not see a problem with the resident riding to the hospital with family. She called the hospital and gave report. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 2 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview the facility failed to complete a thorough investigation of the alleged violation of abuse and failed to maintain documentation that the alleged violation was thoroughly investigated for one (Resident #77) of three residents reviewed after report of a potential for abuse to the resident. This placed resident #77 and other residents at potential risk of retribution and continued abuse. Residents Affected - Few The findings included: The Policy/Procedure Abuse, Neglect, Exploitation, and Misappropriation of Property Prevention, Protection and Response Policy and Procedures, dated 2/12/18 specified Definition of verbal abuse: the use of oral, written or gestured language that willfully includes disparaging and derogatory terms to patients or their families, or within their hearing distance regardless of their age, ability to comprehend, or disability. Identification Issues: e) Any complaint of the use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to patients or families or within their hearing distance. h) Any behavior control strategy involving corporal punishment. I) Any complaint of humiliation, harassment, threats of punishment or deprivation. V. Investigative issues: Policy: all events reported as possible abuse, neglect, exploitation, and Misappropriation (ANEM) will be investigated to determine where ANEM occurred. VII. Reporting and response issues: Policy: ALL allegations of possible ANEM will be immediately reported to the Abuse Hotline by the Administrator or Designee. During an interview on 10/30/23 at 12:18 p.m., Resident #77 stated there is a staff member that is very rude and unkind to him. The Resident stated the staff member often will not speak to him and has called him lazy and most of the time will not even talk to him. The Resident pointed to Certified Nursing Assistant (CNA) Staff A as she walked past his room in the hallway and said Staff A works day shift and is not nice at all to him, she calls him lazy, and it makes him feel bad. He states that he does not feel that he is lazy. The Resident said he was so upset that he reported the CNA to the administrator. After he reported her to the Administrator the CNA got very mad at him and would not even speak to him or acknowledge when he asked her something. Resident stated that he did not know what the administrator did about it, he was never told. During an interview on 11/01/23 at 9:30 a.m., the Administrator stated the resident had reported the incident with CNA Staff A to someone else and they had told him. The administrator stated that he then went to the resident and asked him about the incident. The resident told him he did not want to talk about it anymore. The administrator said they investigated the situation; they had a talk with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 3 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the staff member about it and took her off the assignment that the resident was on. The administrator said he did not know if Staff A was still off that assignment. During an interview on 11/01/23 at 11:09 a.m., The Risk Manager (RM) stated she got a report about the alleged incident from one of the unit managers. The RM stated the resident was saying CNA Staff A was being bossy. The RM said she then went to see the resident and spoke with him about the incident. The resident told the RM that he was not allowed to get back in bed and that the CNA was being bossy and would not let him into bed. The risk manager said the Administrator was with her for the first time, but the resident said he did not want to bother the big guy and would not talk about it with him. The Risk manager said she then spoke to CNA Staff A and the nurse that was giving medication in the hallway outside the resident's room. The RM stated the nurse and CNA told her the same story. CNA Staff A was trying to make the bed and the resident was trying to get into bed. The RM stated the bed was wet, and the resident was trying to get back in and she would not let him, so he got mad and said she was bossy. The RM said that she did not have the resident or Nurse write a statement. She had the CNA write one, but it was not clear because she had English as a second language. The RM stated that she did not write anything down and question the resident further. The RM stated that she felt the accusation was not substantiated as verbal abuse, so she did not report it. The RM provided a written statement she said was written by the CNA after she had talked with her. The statement was poorly written, and it was not clear what was being said. RM said she did not document any statements that the CNA had made and did not read it back to her or use an interpreter. A review of Risk Management documentation on the incident described by Resident #77 was as follows: 10/11/2023 - Spoke to Resident #77 about allegation against CNA Staff A, He said she is bossy and is always telling him what to do. When RM inquired about this, he said he was trying to get into bed, and she told him that he couldn't. RM interviewed CNA staff A and the assigned nurse who both said that the resident was attempting to get into bed with wet linens while Staff A was changing the bed, so she told him that he had to wait until she was done. Resident #77 did not have any other specific examples to provide. This did not lead to the finding of abuse or an abuse allegation. Spoke to Unit Manager and Director of Nursing who were to speak to CNA staff A, since the resident perceives her to be bossy. Unit Manager to remove Resident #77 from CNA Staff A's assignment. During an interview on 11/02/23 at 9:46 a.m., Unit Manager, Registered Nurse (RN) Staff H stated she was on duty the day of the incident between Resident #77 and CNA Staff A happened, but she did not see or hear it and was only told about it. RN Staff H said the risk manager had asked her what she thought about the allegation and what Staff A said to the resident. The Unit manager stated that she was not sure what the whole incident was about but was told the situation was about the resident messing that bed and was trying to get back into bed and the CNA Staff A telling him that she needs to remake his bed before he could get back into the bed and he got mad at her. RN Staff H stated she was never asked to write a statement or talk to the resident or participate in interviewing other residents in the area or on the same assignment as the resident to see if anyone else had a problems with staff A. RN Staff H said she was not asked to speak with the resident but was asked to talk with CNA Staff A. During an interview on 11/02/23 at 9:53 a.m., CNA, Staff A stated she remembered the incident that happened with Resident #77 several weeks ago. She stated she had the resident on her assignment. She saw the resident sitting in his room in his wheelchair, and he was wet. CNA Staff A reported the resident was trying to go to get some soda because he did not have any and he drinks a lot of soda (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 4 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few every day and he was a heavy wetter. Staff A said she also thinks he was on a water pill. The CNA said that she came into the room and asked him if she could change him because he was wet, he said that he did not want to be changed and she should come back later. Resident #77 said he had to go somewhere. The CNA said that she saw some wetness under his wheelchair, and she tried again to ask him to let her change him. CNA A said the resident then he got upset and went out in the hall and told people that she was being mean to him. CNA stated that the only person that talked with her after the incident was Unit Manager Staff H. CNA Staff A said that she was told that the Administrator and Risk Manager had tried to talk to the resident, and he had said that he did not want to talk to them about it. The CNA stated that no one had asked her to write a statement about the incident and she did not write any statement. She said the only one who talked to her about it was the unit manager. She said they took her off the assignment with the resident and she has not taken care of him again. CNA said a nurse had been outside the room when she was trying to ask the resident if she could change him, but she did not talk to her. During the interview CNA spoke in a clear and concise manner and did not have any problems understanding the questions that were asked of her in the interview. During an interview on 11/02/23 at 11:32 a.m., the Risk Manager (RM) stated that she felt that she did a thorough investigation and she never knew that she had to get witness statements or write out statements from staff and/or residents. She said she feels she talked to the people involved and wrote it into the paragraph that she had in her risk file. She stated that was her investigation and documentation. When told what the CNA had told the surveyor about her account of the incident and the situation she said, that is so strange she must have gotten her days mixed up. CNA also stated that no one had talked to her about the incident except the unit manager and she had never written a statement. RM said nothing when this was revealed to her. RM acknowledged that she did not have any documented statement from the resident or from the nurse. The RM acknowledged that she had no documentation that interviews were done of other residents in the CNAs assignment that were interview about treatment and if they felt that they had ever been verbally abused by any staff member. The RM stated she had the Unit Manager talk to the CNA about how she talks to residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 5 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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** 5. Review of the clinical record revealed Resident #105 had an admission date of 3/5/19. Diagnoses included Alzheimer's disease, depression, and dementia. Residents Affected - Some The Annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #105's cognition was significantly impaired, and a Brief Interview for Mental Status (BIMS) score could not be assessed. Resident #105 was frequently incontinent of bowel and bladder. Review of Resident #105's Care plan revealed the resident had impaired toileting and occasional frequent bladder and bowel incontinence related to diagnosis of Alzheimer's disease with severe cognitive deficit and inability to retrain. The resident was to be toileted every two hours while awake and as needed. The resident was to be kept in a clean and comfortable condition. On 10/31/23 at 10:13 a.m. Resident #105 was observed in the dayroom on D wing with six other residents. No staff was observed in the dayroom with the residents. Resident #105 was dozing off in a chair. Resident #105 stood up. The front and back of her pants were wet and the resident had a strong urine smell. Resident #105 walked out of the day room, pulled the back of her pants, made a face, and said, wet. Resident #105 went back in the day room and sat in a chair. No staff came in the dayroom to check on the resident for 40 minutes of continuous observation. On 10/31/23 at 11:30 a.m., the observation was shared with the Director of Nursing who verified Resident #105's pants were wet, and the resident had a strong urine odor. She asked a nurse and a Certified Nursing Assistant to change the resident. Based on observation, review of the clinical record, review of facility's policy and procedure, staff and resident interviews, the facility failed to provide the necessary care and services to maintain personal hygiene for 6 (Residents #6, #113, #156, #26, #105, #162) of 7 residents reviewed for activities of daily living. The findings included: The facility policy Activities of Daily Living, Supporting, documented Residents will be provided with care, treatment and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADL's). Residents who are unable to carry out activities of daily living independently will receive the services to maintain good nutrition, grooming, and personal and oral hygiene. Appropriate care and services will be provided for residents who are unable to carry out ADL's independently with the consent of the resident and in accordance with the plan of care including appropriate support and assistance with hygiene bathing dressing grooming and oral care. 1. Review of the clinical record revealed Resident #6 had an admission date of 8/18/21 with diagnoses including cerebral vascular accident resulting in right sided hemiparesis, right hand contracture, right leg numbness, weakness, dementia, decreased balance, mobility, strength and endurance. The Quarterly Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date of 8/22/23 documented Resident #6 required (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 6 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 extensive to total assistance with personal hygiene and bathing. Level of Harm - Minimal harm or potential for actual harm The MDS noted Resident #6's cognitive skills for daily decision making were severely impaired. Residents Affected - Some The care plan identified Resident #6 had an alteration in ability to perform daily care tasks. The goal for the resident was to participate in her care as able and will be kept in a clean and comfortable. The care plan interventions instructed staff to, brush hair daily and as needed. Honor bathing preference of shower, sponge or bed bath three times a week, shampoo hair. On 10/30/23 at 2:15 p.m., in an interview Resident #6 said she was not receiving showers and was only washed in bed. Resident #6 said she wanted a shower and had told the staff, but she had not received her scheduled showers. The resident's hair was greasy and uncombed, she was in bed dressed in a nightgown. On 10/31/23 at 1:39 p.m., in an interview Certified Nursing Assistant (CNA) Staff C said most of the residents are showered every other day. The CNA said, in the morning you get your assignment, there is a sheet at the desk with your assignment. Staff C said the assignment sheet lets you know when the residents' showers are due. Staff C said she completes the little man body sheets (identifies any changes in the resident's skin) on shower days and we do our charting in the computer. On 10/31/23 at 2:01 p.m., in an interview CNA Staff D said she had a three times rule with showers. She asks the resident in the morning and if they refuse she will come back two more times and ask again. Staff D said she will offer a bed bath if the resident refused three times and would notify the nurse if the resident declined the shower. On 11/1/23 at 9:06 a.m., Resident #6 said she still had not received a shower and had asked for one. On 11/2/23 at 1:30 p.m., Resident #6 was observed in bed in a hospital gown. Resident #6 said she still had not received a shower and said, I want a shower, not a wash in bed. I don't know when the last time my hair was washed. I want a real shower. On 11/1/23 at 11:42 a.m., in an interview Unit Manager Licensed Practical Nurse (LPN) Staff B said Resident #6 was scheduled for showers on Tuesdays, Thursdays, and Saturdays on the 3:00 p.m., to 11:00 p.m. shift. Staff B confirmed she was not able to locate any documentation Resident #6 received her scheduled showers. 2. Review of the clinical record for Resident #113 revealed a readmission date of 5/22/23 with diagnoses including depression and anxiety. The Quarterly MDS dated [DATE] documented Resident #113 required extensive assistance with personal hygiene and bathing. The MDS noted Resident #113's cognitive skills for daily decision making were intact. The care plan identified Resident #113 required extensive to total assistance with most of her care. The care plan goal specified Resident #113 will reach independent level of Activities of Daily (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 7 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 Living performance by next review. Level of Harm - Minimal harm or potential for actual harm The interventions included, Turn and reposition from side to side and offload sacrum every 2 hours and as needed. Honor bathing preference of shower, sponge or bed bath 3x/week (three times a week), shampoo hair unless done in beauty shop. Residents Affected - Some On 10/30/23 at 1:50 p.m., in an interview Resident #113 said she was not receiving showers. She had an indwelling catheter (a tube inserted into the bladder to collect urine) and it was leaking and had wet the bed. Resident #113 said she put the call light on, and no one came to change her. Resident #113 said no one answers her call light. On 10/31/23 at 9:23 a.m., Resident #113 was observed in bed dressed in a hospital gown, her hair was uncombed, matted, and greasy. She said she had not received a shower in weeks and did not know why. The resident said she had asked the staff to shower her. Resident #113 was positioned on her back in the bed. On 10/31/23 at 1:22 p.m., Resident #113 was observed in bed with a hospital gown on and lying on her back, she said no one had offered to turn her and she was not able to turn herself. She said she had not received her scheduled showers since her readmission. On 11/1/23 at 11:42 a.m., in an interview Unit Manager LPN Staff B said Resident #113 was scheduled for showers on Mondays, Wednesdays and Fridays on the 3:00 p.m., to 11:00 p.m. shift. Staff B confirmed she was not able to locate any documentation to show the resident received scheduled showers. 3. Review of the clinical record for Resident #156 revealed a readmission date of 10/20/23 with diagnoses including hemiplegia (Paralysis of one side of the body) and hemiparesis (Weakness of one side of the body) following cerebral infarction affecting left non-dominant right side and altered mental status. The Quarterly MDS dated [DATE] documented Resident #156 was nonverbal and dependent for all ADLs. The care plan identified Resident #156 had impaired selfcare. The care plan goal specified the resident will be kept clean and comfortable. The care plan interventions instructed staff to honor bathing preference of shower, sponge or bed bath 3x/week, shampoo hair. On 10/30/23 at 12:09 p.m., Resident #156's family members were present and reported concerns expressing the resident was not showered in over a week and was not receiving care. The family members said they had been doing everything for the resident because the staff to do not come and said no one makes the bed and no one from the staff will change his soiled brief. On 10/30/23 at 1:11 p.m., in an interview, Resident #156's son said he has come in the mornings and has found his father often wet and smelling of urine. He said he spoke to the Director of Nursing, and the Unit Manager but it happens daily. He said his father had not been showered for almost two weeks. He said no one comes into the room to assist the resident when the family is here. The resident's sister was present and said she did not want to have to change her brother when he was wet because it is her brother, and she should not have to do that. She said no one comes in to check on her brother when the family is present, and she had reported it to the management. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 8 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 - Some On 10/31/23 at 9:14 a.m., Resident #156 was observed in bed. Resident #156 was non verbal, made no eye contact, and did not respond to his name. On 11/1/23 at 11:42 a.m., in an interview Unit Manager LPN Staff B said Resident #156 was scheduled for showers on Tuesdays, Thursdays and Saturdays on the 3:00 p.m., to 11:00 p.m. shift. Staff B confirmed she was not able to locate any documentation to show the resident received his scheduled showers. On 10/31/23 at 3:12 p.m., in an interview the Director of Nursing (DON), said she was not able to determine by the CNA documentation if Resident #6, #113 and #156 received the scheduled showers. The DON said she was not able to state if showers were provided. 4. Review of the facility policy for Fingernail and Toenail Care revealed the purpose of the procedure is to clean the nail bed, keep nails trimmed and prevent infections. General Guidelines included, trimmed and smooth nails prevent the resident from accidentally scratching and injuring his or her skin. Reporting included, notify the supervisor if the resident refuses the care. Review of the clinical record for Resident #26 revealed an admission date of 7/24/14. Diagnoses included Alzheimer's disease. Review of the Minimum Data Set with an assessment reference date of 10/2/23 revealed Resident #26's cognition was severely impaired, and Resident #26 never/rarely made decisions. Review of the physician order report revealed Resident #26 was admitted to hospice services on 1/4/23. Review of Resident #26's care plan for Activities of Daily Living (ADLs) Functional Status/Rehab Potential with a problem start date of 6/20/19, revealed Resident #26 was dependent on staff for all ADLs related to impaired mobility, strength, endurance, old age, bowel and bladder incontinence, communication deficit. The Resident has a history of refusing showers. Staff was to collaborate with hospice staff for comfort and care. The approaches initiated on 6/20/19 included, nail care weekly and as needed. Review of the hospice Certified Nursing Assistant (CNA) progress notes revealed documentation the facility nurse was notified that nail care was not done for Resident #26 on 9/11/23, 9/15/23, and 9/18/23. There was no documentation in the facility's progress notes from 9/5/23 through 11/1/23 Resident #26 refused nail care. On 10/30/23 at 9:49 a.m., Resident #26's right thumb nail and right fourth fingernails were observed extending one inch from the fingertips. The nails were yellow and thick. Resident #26 did not respond to verbal stimuli and did not respond when asked if she wanted her fingernails trimmed. On 10/30/23 at 4:19 p.m., Resident #26's daughter was in the room with Resident #26. The daughter said she was one of the health care surrogates (HCS) for Resident #26, and it bothered her the two fingernails were long and was afraid Resident #26 may scratch herself with the long nails. She said she asked the staff to do something about the nails, but they did not. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 9 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 - Some On 11/1/23 at 11:50 a.m., facility CNA Staff G said she takes care of Resident #26 and was aware her fingernails were long and thick. She said when she tries to trim her nails, the resident pulls her hand away. Staff G confirmed CNAs are responsible to tell the nurse when a resident refuses care. She said she did not tell the nurse about the long, thick nails because the nurse is busy. On 11/1/23 at 12:05 p.m., Licensed Practical Nurse (LPN) Staff I said she has taken care of Resident #26 recently, but was not aware of the long, thick nails. On 11/2/23 at 8:59 a.m., Unit Manager Staff B said the CNAs are responsible for fingernail trimming, and when the resident refuses, the CNAs are supposed to tell the nurse. The nurse should document the refusal in the record and contact the physician if necessary. She confirmed Resident #26's right thumb, and fourth fingernails were long and thick. She said no one informed her the resident's nails needed to be trimmed. On 11/2/23 at 10:19 a.m., in an interview the hospice CNA who was in the facility said Resident #26 refuses nail care, and he tells the facility nurse. On 11/2/23 at 11:15 a.m., the Director of Nursing (DON) said with the family's permission, she expects the staff to trim Resident #26's fingernails. 6. Review of the clinical record revealed Resident #162 was admitted to the facility on [DATE] with diagnoses including right femur fracture, Cellulitis of right and left lower limb. The Annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #162's cognition was intact with a Brief Interview for Mental Status (BIMS) score of 13. Review of Resident #162's Care plan indicated the resident had impaired transfers, balance, range of motion, activity tolerance, toileting, and coordination. Approach identified included to honor bathing preference of shower, sponge, or bed bath three times weekly, shampoo hair unless done in beauty shop. On 10/30/2023 at 12:57 p.m., in an interview Resident #162 said she had been a resident for approximately three months. She was alert and oriented and able to verbalize her plan of care at the facility. She said she loved her showers but didn't always receive them because the facility was short staffed. She said she was scheduled to receive her showers on the 3:00 p.m., to 11:00 p.m., shift on Tuesdays, Thursdays, and Saturdays. She said she did not receive her shower this past Saturday when she asked for it and was told there was not enough staff. On 11/1/2023 at 11:05 a.m., in an interview Resident #162 said she has yet to get a shower. She said a CNA gave her a wipe down bath on Monday but it isn't the same thing. She said she feels so much better when she can shower and wash her hair. She said staff told her there was not enough staff to shower her. She said staffing was worse on the 3:00 p.m., to 11:00 p.m. shift. On 11/1/2023 at 1:15 p.m. in an interview Unit Manager LPN Staff B verified Resident #162 was scheduled for showers on Tuesdays, Thursdays, and Saturdays on the 3:00 p.m. to 11:00 p.m., shift. Staff B confirmed she was not able to locate any documentation to show the resident received her scheduled showers. The shower log located at the nurse's station identified scheduled times for residents' showers. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 10 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 Clinical record review failed to show documentation Resident #162 received her showers as scheduled. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 11 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation review of facility policy and procedures review of the clinical records and resident and staff interviews the facility failed to assure and maintain the highest practical, physical, mental and psychosocial well-being for 6 (Resident #156, #113, #6, #162, #26, #105) of 7 residents reviewed. The findings included: The facility policy Staffing Policies and Procedures effective 1/25/23 documented, The Director of Nursing shall have sufficient nursing staff on a 24-hour basis to provide nursing and related services to residents in order to maintain the highest practicable, physical, mental and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care. 1. Review of the clinical record revealed Resident #6 had an admission date of 8/18/21 with diagnoses including cerebral vascular accident resulting in right sided hemiparesis, right hand contracture, right leg is numb, weakness, and dementia, decreased balance, mobility, strength and endurance. The Quarterly Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date of 8/22/23 documented Resident #6 required extensive to total assistance with personal hygiene and bathing. The MDS noted Resident #6's cognitive skills for daily decision making were severely impaired. The care plan identified Resident #6 had an alteration in ability to perform daily care tasks. The goal for the resident was to participate in her care as able and will be kept in a clean and comfortable. The care plan interventions instructed staff to, brush hair daily and as needed. Honor bathing preference of shower, sponge or bed bath 3x/week, shampoo hair. On 10/30/23 at 2:15 p.m., in an interview Resident #6 said she was not receiving showers and was only washed in bed. Resident #6 said she wanted a shower and had told the staff, but she had not received her scheduled showers. The resident's hair was greasy and uncombed, she was in bed dressed in a nightgown. On 10/31/23 at 1:39 p.m., in an interview Certified Nursing Assistant (CNA) Staff C said most of the residents are showered every other day. The CNA said, in the morning you get your assignment, there is a sheet at the desk with your assignment. Staff C said the assignment sheet lets you know when the resident's showers are due. Staff C said she completes the little man body sheets (identifies any changes in the resident's skin) on shower days and we do our charting in the computer. On 10/31/23 at 2:01 p.m., in an interview CNA Staff D said she had a 3 time rule with showers, she asks the resident in the morning and if they refuse she will come back 2 more times and ask again Staff D said she will offer a bed bath if the resident refused 3 times and would notify the nurse if the resident declined the shower. On 11/1/23 at 9:06 a.m., Resident #6 said she still had not received a shower and had asked for one. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 12 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 11/2/23 at 1:30 p.m., Resident #6 was observed in bed in a hospital gown. Resident #6 said she still had not received a shower and said, I want a shower, not a wash in bed. I don't know when the last time my hair was washed. I want a real shower. On 11/1/23 at 11:42 a.m., in an Interview the Unit Manager Licensed Practical Nurse (LPN) Staff B said Resident #6 was scheduled for showers on Tuesday, Thursday, and Saturday on the 3 p.m., to 11 p.m., shift. Staff B confirmed she was not able to locate any documentation Resident #6 received her scheduled showers. 2. Review of the clinical record revealed Resident #113 had a readmission date of 5/22/23 with diagnoses including depression and anxiety. The Quarterly MDS dated [DATE] documented Resident #113 required extensive assistance with personal hygiene and bathing. The MDS noted Resident #113's cognitive skills for daily decision making were intact. The care plan identified Resident #113 required extensive to total assistance with most of her care. The care plan goal specified Resident #113 will reach independent level of ADL performance by next review. The interventions included, Turn and reposition from side to side and offload sacrum every 2 hours and as needed. Honor bathing preference of shower, sponge or bed bath 3x/week, shampoo hair unless done in beauty shop. On 10/30/23 at 1:50 p.m., in an interview Resident #113 said she was not receiving showers. She had an indwelling catheter (a tube inserted into the bladder to collect urine) and it was leaking and had wet the bed. Resident #113 said she put the call light on, and no one came to change her. Resident #113 said no one answers her call light. On 10/31/23 at 9:23 a.m., Resident #113 was observed in bed dressed in a hospital gown, her hair was uncombed, matted, and greasy. She said she had not received a shower in weeks and did not know why. The resident said she had asked the staff to shower her. Resident #113 was positioned on her back in the bed. On 10/31/23 at 1:22 p.m., Resident #113 was observed in bed with a hospital gown on and lying on her back, she said no one had offered to turn her and she was not able to turn herself. She said she had not received her scheduled showers since her readmission. On 11/1/23 at 11:42 a.m., in an interview the Unit Manager LPN Staff B said Resident #113 was scheduled for showers on Monday, Wednesday and Fridays on the 3 p.m., to 11 p.m., shift. Staff B confirmed she was not able to locate any documentation to show the resident received scheduled showers. 3. Review of the clinical record revealed Resident #156 had a readmission date of 10/20/23 with diagnoses including hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant right side and altered mental status. The Quarterly MDS dated [DATE] documented Resident #156 was nonverbal and dependent for all ADL's. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 13 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some The care plan identified Resident #156 had impaired selfcare. The care plan goal specified the resident will be kept clean and comfortable. The care plan interventions instructed staff to honor bathing preference of shower, sponge or bed bath 3x/week, shampoo hair. On 10/30/23 at 12:09 p.m., Resident #156's family members were present and reported concerns expressing the resident was not showered in over a week and was not receiving care. The family members said they had been doing everything for the resident because the staff to do not come and said no one makes the bed and no one from the staff will change his soiled brief. On 10/30/23 at 1:11 p.m., in an interview, Resident #156's son said he has come in the mornings and his father is often wet and smells of urine. He said he spoke to the Director of Nursing, and the Unit Manager but it happens daily. He said his father had not been showered for almost 2 weeks. He said no one comes into the room to assist the resident when the family is here. The residents' sister was present and said she did not want to have to change her brother when he was wet because it is her brother, and she should not have to do that. She said no one comes in to check on her brother when the family is present, and she had reported it to the management. On 10/31/23 at 9:14 a.m., Resident #156 was observed in bed. Resident #156 was non verbal, made no eye contact, and did not respond to his name. On 11/1/23 at 11:42 a.m., in an interview Unit Manager LPN Staff B said Resident #156 was scheduled for showers on Tuesdays, Thursdays and Saturdays on the 3:00 p.m., to 11:00 p.m., shift. Staff B confirmed she was not able to locate any documentation to show the resident received his scheduled showers. On 10/30/23 at 12:01 p.m., in an interview Certified Nursing Assistant (CNA) Staff J said the staffing was a problem, we are short staffed especially on the 3:00 p.m. to 11:00 p.m., shift. The CNA said there was not enough staff to provide the care the residents required. On 10/30/23 at 3:22 p.m., in an interview LPN Staff J said Sometimes on the afternoon 3:00 p.m. to 11:00 p.m., shift is short for CNAs. On 11/2/23 at 10:42 a.m., in an interview the Staffing Coordinator said We staff by ratios on the 7:00 a.m. to 3:00 p.m. shift. The staffing is 10 residents to every one CNA. On the 3:00 p.m., to 11:00 p.m., shift the staffing is 15 residents to one CNA. On the 11:00 p.m., to 7:00 a.m., shift the ratio is 20 residents to one CNA. The Staffing Coordinator said she goes by the resident acuity level and the needs of the residents when staffing the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 14 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observations, interviews, and record review the facility failed to keep a record of controlled substances awaiting disposition to ensure an accurate inventory, and allow periodic reconciliation. Residents Affected - Few The findings included: Review of the facility policy for Controlled Substance Storage Revised January 2018: Medications subject to abuse or diversion are stored in a permanently affixed, (double-locked) compartment. Accountability records for discontinued controlled substances are maintained with the unused supply until it is destroyed or disposed of. On 11/2/23 at 9:30 a.m., during an interview Unit Manager, Registered Nurse (RN) Staff H said the unused narcotics are periodically removed from the medication carts and taken to the Director of Nursing (DON) to be locked in her office. On 11/2/23 at 11:00 a.m., during an interview the DON confirmed the nurses periodically bring unused narcotics to her office. She stores them in a locked file cabinet in her office. She said the maintenance director has a key to her office, but only unlocks the door in an emergency. She said when the consultant pharmacist visits, she scans the narcotics, creates a log, and destroys them with the pharmacist. She said currently she has a few narcotics in the locked cabinet, but she was not sure what narcotics and how many were in there. She said the last time she scanned and destroyed controlled substances with the pharmacist was 10/19/23. The narcotics in the cabinet would be the ones that were brought to her office after that date. On 11/02/23 12:43 p.m., the DON reiterated she was not sure of what or how many controlled substances were in the locked file cabinet in her office, and there was not a way to ensure the controlled substances in the file cabinet were all of the ones that had been brought to her. She said she has handled them this way for a long time and did not realize it was a problem. She opened the file cabinet to reveal the following unused controlled substances: Lorazepam 0.5 milligrams (mg) 11 tablets (tabs) Lorazepam 0.5 mg 26 tabs. Tramadol 50 mg 30 tabs. Tramadol 50 mg 1 tab. Tramadol 50 mg 23 tabs. Tramadol 50 mg 30 tabs. Tramadol 50 mg 19 tabs. Tramadol 50 mg 5 tabs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 15 of 16 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 105859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Charlotte Harbor 4000 Kings Hwy Port Charlotte, FL 33980 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 Tramadol 50 mg 14 tabs. Level of Harm - Minimal harm or potential for actual harm Morphine sulfate 14.5 milliliters (ml). Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105859 If continuation sheet Page 16 of 16