Health inspection·January 23, 2025

F 0576 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In a telephone conversation on 1/23/25 at 5:05 PM, resident #3's son stated he had tried to call his Dad on his room phone many times since about December 20th and had not been able to reach him. He added he had called the facility's main number three times in the past two weeks, but no one answered the calls and they were diverted to the the Administrator's voice mail. He stated he had left three voice messages, but no one had returned his calls. Resident #3's son explained he lived in Maryland and was upset he couldn't reach his dad on Christmas Day or speak with him for approximately a month. He added, the situation was frustrating because he was he was his dad's lifeline and was not able to ascertain if his Dad needed anything. Review of resident #3's Annual MDS assessment dated [DATE], indicated he had no cognitive impairment and documented that being able to use a phone in private was very important for him. On 1/23/25 at 12:44 PM, in an email conversation the local Ombudsman stated her last visit to the facility was on 1/09/25 regarding concerns that the phones in the resident's rooms were not working. She stated she was informed at that time by facility Administration that the facility's new management company was working on the issue, but was not aware the phones had not been resolved. On 1/23/25 at 3:03 PM, Certified Nursing Assistant (CNA) A stated resident #1 and #2 wanted to make phone calls recently. She explained she assisted them to make the calls at the nursing station. CNA A acknowledged she was aware residents desired to make the calls in their own room for privacy and comfort, but they could not. She confirmed the residents were able to come to the nurses' station in their wheelchairs, but had to have their conversations there using the corded phone with no privacy from anyone else in the area. On 1/23/25 at 3:13 PM, Registered Nurse (RN) B stated residents #2 and #3 along with three family members, had previously approached her about resident's phones in their rooms not working. She added the facility's management had never formally communicated with residents or staff that the phones were out of order, what was being done about it, or when they would be repaired. RN B stated, if a resident was unable to get out of bed and come to the nursing station to use the phone, she had to let them use her personal cell phone or they would not be able to utilize the phone at all. She added the facility used to have a couple of cordless phones but explained they had not worked for the past 10 months. On 1/23/25 at 3:00 PM, CNA C stated no one had asked her about making a phone call but said they could use the phone at the nurses' station. She added, it was okay if residents wanted privacy during their calls because she did not think staff around the nursing station would listen to the resident's phone conversations. Review of the facility's grievance log for January 2025 contained a grievance dated 1/13/25 from all the residents in the facility regarding the telephones not working in resident rooms. In interviews on 1/23/25 at 12:45 PM, 1:32 PM, and 4:15 PM, the Administrator confirmed the phone system for the resident rooms had not been working since early January when the phone and internet company disconnected the service due to an unpaid balance when the facility changed management companies in October. He explained this issue was added to the grievance log after the Ombudsman made a visit to the facility following resident and family complaints. The Administrator added there was no resolution date to this issue because the phone lines were still down at the facility. He stated residents could use the phone at the nurses' station or in the activity room if needed by request. The Administrator confirmed residents and their families were not formally notified of the inoperable (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105886 If continuation sheet Page 2 of 3 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 105886 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ansley Cove Healthcare and Rehabilitation 1301 W Maitland Blvd Maitland, FL 32751 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 0576 Level of Harm - Minimal harm or potential for actual harm phones or internet but explained they should be aware they could use the phone at the nurses' station by, word of mouth if they were to ask. He verified the cordless phones the facility had were not in working order and said residents could use his personal cell phone if they wanted privacy. The Administrator did not explain what residents who were bedbound or wanted privacy would do when they wished to use the phone and he was not at the facility. Residents Affected - Some The facility's policy entitled Resident Use of Telephones dated May 2017 indicated designated phones were available to residents to make and receive private telephone calls. It added telephones would be in areas that offered privacy and accommodated the hearing-impaired and wheelchair bound residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105886 If continuation sheet Page 3 of 3