Health inspection·December 16, 2025

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many been stable and uneventful. Medication compliance is good and no side effects have been reported or evidenced.Recommendation: It appears that the patient can tolerate the GDR and will likely remain stable. The risks versus benefits of a gradual dose reduction (GDR) have been considered, and it has been determined that this approach is appropriate. The patient is believed to be able to tolerate a GDR with the possibility of discontinuing the medication completely. Will decrease Clonazepam 1 mg to 0.5 mg PO [by mouth] bid x 7 days, decrease to QD [every day] x 7 days, then d/c [discontinue]; d/c Mirtazapine 15 mg PO qhs[at bedtime]; reduce Seroquel XR 150 mg to IR 100 mg PO qhs x 7 days, decrease to 50 mg qhs x 5 days, reduce to 25 mg qhs x 3 days, then d/c. The other psychiatric medications will be continued at their current dosages. The gradual dose reduction will be conducted over the next several days to weeks to safely discontinue the medication, with close monitoring for any adverse effects or worsening of mental health symptoms. Close monitoring of the patient's response to the medication changes will be necessary, and a follow-up visit to the facility will be scheduled as needed to assess the patient's progress and make any necessary adjustments. This approach aims to provide the patient with the most appropriate and effective treatment while considering their complex clinical presentation and unique needs. Regular monitoring and communication with the patient and the interdisciplinary team will be crucial to ensure the best possible outcome. Review of Resident #1's medical record did not show any documentation medication changes were discussed with the resident or that the resident was involved in the change to the plan of care. Review of primary care provider note showed: 11/19/25 Interval History: Patient seen at bedside. Patient reports she is under stress regarding banking issues (currently on the phone with [bank] investments). Patient upset with GDR of clonazepam. She denies SI/HI [suicidal ideation /homicidal ideation] however does report ongoing anxiety. Psychiatry is following. Review of Resident #1's progress notes showed:11/24/2025 6:23 p.m. Nursing Progress Note: Patient was experiencing shaking from not having her clonazepam 11/28/2025 6:14 p.m. Nursing Progress Note: Patient is having trouble without the clonazepam. She has episodes of shaking and anxiety. her antibiotics are working without any problems 12/11/2025 4:02 p.m. Orders Progress Note: IDT [Interdisciplinary team] team met for GDR discussion. [Resident #1] has been stable at this time and no changes will be made. Review of Resident #1's Psychiatry note dated 12/11/25 showed: Interval History: The information obtained was from nursing staff, observation, and chart review. Physical ROS: All systems negative except symptoms mentioned in Patient's most current H&P.Assessment and Plan for today's visit:The patient is being seen today for an assessment for a gradual dose reduction (GDR), as recommended by CMS guidelines. The patient's current psychotropic medications were reviewed and assessed for the need for any changes or adjustments. According to staff, the patient has been stable and cooperative with care, displaying no signs of agitation. The patient has good medication compliance and no reported side effects. 2. An interview was conducted on 12/16/25 at 9:12 a.m. with Resident #3. The resident said she had been in the facility for a year but had recently had a concern with some medication changes. Resident #3 said she had not been told someone cut her dose of clonazepam in half. She said she cried for days and didn't know why. Resident #3 said she had a history of severe depression and anxiety, and certain sounds/noises are triggering. The resident said no one spoke to her before changing the medication she only spoke to the psychiatry nurse practitioner (NP) after she found out about the change. The resident was tearful throughout the conversation.Review of admission Records showed Resident #3 was admitted on [DATE] with diagnoses including major depressive disorder and anxiety.Review of Resident #3's Quarterly MDS, dated [DATE], Section C, Cognitive Patterns, showed her BIMS score was 13, indicating she was cognitively intact.Review of Resident #3's physician orders showed:-Clonazepam 1 mg. Give 1 tablet by mouth two times a day (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105895 If continuation sheet Page 2 of 9 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 105895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Seminole 9393 Park Blvd Seminole, FL 33777 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 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many related to anxiety disorder. Start date 9/6/25. Discontinued 11/14/25.-Clonazepam 1 mg. Give 1 tablet by mouth two times a day related to anxiety disorder. Start date 11/14/25. Discontinued 12/11/25.-Clonazepam 1 mg. Give 0.5 tablet by mouth two times a day for anxiety for 10 days. Start date 12/11/25. Review of Resident #3's Psychiatry note dated 12/11/25 showed: Interval History: The information obtained was from nursing staff, observation, and chart review. Physical ROS: All systems negative except symptoms mentioned in Patient's most current H&P.Assessment and Plan for today's visit: The patient was seen and evaluated today, and medications were reviewed to consider dose reduction (GDR), as recommended by CMS guidelines. After a careful review of the chart and evaluation of the patient's current conditions, discontinuation of all psychotropic medication would not achieve the desired therapeutic effects. Based on documented history and current behaviors the following medication changes will be made today as noted in the assessment/plan-reduce Clonazepam 1 mg PO bid to 0.5 mg PO bid x 10 days, reduce to QD x 10 days then d/c on 12/31. Review of Resident #3's medical record did not show any documentation medication changes were discussed with the resident or that the resident was involved in the change to the plan of care. Review of Resident #3's Psychiatry note dated 12/15/25 showed: Patient is seen today for follow up appointment following recent medication changes. She is alert and oriented, seen in her wheelchair. Patient reports difficulty adjusting to the reduction in clonazepam and expresses that she needs this medication to control her anxiety. She understands the clinical reasoning behind the medication adjustment but would like to like to discuss reinstatement of her previous clonazepam dosage with her primary medical provider. Patient counseled on smoking and marijuana use history.Staff Reports: Staff reports that patient is having a hard time adjusting to the clonazepam reduction but presents without behavioral issues, agitation, or restlessness. 3. An interview was conducted on 12/15/25 at 2:20 p.m. with Resident #6. The resident said he has been on gabapentin for over a decade, and it had been changed to Lyrica (Pregabalin) for a while. He said he was then taken of Lyrica and put back on gabapentin and didn't know why. He said no one ever spoke to him about it or asked him what he needed. He said Lyrica worked better than the gabapentin had previously. Resident #6 said the same happened with his baclofen; at the beginning of the year, he was transitioned to Methocarbamol and this past week he was taken off of that and put back on Baclofen. The resident said he didn't know who was doing this but there was no discussion with him about the changes. Resident #6 said he had wanted more Tylenol and his Percocet was stopped and then it got added back after several days. Review of admission Records showed Resident #6 was admitted on [DATE] with diagnoses including muscle wasting and atrophy, chronic pain syndrome, generalized anxiety disorder, major depressive disorder, and adjustment disorder with mixed anxiety and depressed mood. Review of Resident #6's 10/31/25 MDS, Section C, Cognitive Patterns showed a BIMS score of 15, indicating he was cognitively intact. Review of Resident #6's physician orders showed:Pregabalin Oral Capsule 300 mg. Give 1 capsule by mouth every 12 hours for neuropathy. Start date 2/6/25. Discontinued 12/11/25. -Methocarbamol Oral Tablet 750 mg. Give 1 tablet by mouth every 12 hours as needed for muscle spasm. Start date 1/14/25. Discontinued 12/11/25. -Baclofen Oral Tablet 10 mg. Give 1 tablet by mouth every 12 hours for chronic muscle spasms, pain. Start date12/11/25. -Percocet Oral Tablet 10-325 mg (Oxycodone w/ Acetaminophen) Give 1 tablet by mouth every 6 hours for Nonacute pain. Hold for sedation. Total Acetaminophen dose not to exceed 3gm/day. Start date 10/4/25. Discontinued 12/2/25. - Percocet Oral Tablet 10-325 mg (Oxycodone w/ Acetaminophen) Give 1 tablet by mouth every 6 hours for nonacute chronic pain. Hold for sedation, lethargy, confusion, hypotension, decreased respirations. Start dated 12/8/25. Review of Resident #6's Progress notes showed: 12/11/2025 3:48 p.m. Orders Progress Note: IDT team met for GDR discussion. [Resident #6] has been stable at this time and no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105895 If continuation sheet Page 3 of 9 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 105895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Seminole 9393 Park Blvd Seminole, FL 33777 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 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many changes will be made. Review of Resident #6's psychiatry provider note from 12/11/25 showed: Plan: Given the patient's stability and minimal effective dosages of psychotropic medications, a GDR was deemed contraindicated as it could potentially lead to an exacerbation of the patient's psychiatric symptoms and instability. Therefore, all current psych medications were continued without any changes. Review of Resident #6's medical record did not show any documentation medication changes were discussed with the resident or that the resident was involved in the change to the plan of care. An interview was conducted on 12/16/25 at 3:02 p.m. with Staff H, Registered Nurse (RN)/Unit Manager (UM). Staff H reviewed Resident #6's medical record including psychiatry notes and progress notes. Staff H said she did not see any documentation as to why the medications were changed on 12/11/25. She confirmed the resident's psychiatry notes showed the medications were not going to be changed on that date. Upon further review Staff H said a nurse practitioner (NP) with a third party company that saw the resident made the changes to the medications, but the facility did not have any notes or documentation for the visit or information about why the medications were changed.An interview was conducted on 12/16/25 at 4:00 p.m. with Staff I, NP. Staff I said she was new to seeing Resident #6 and had only had him on her assignment for three weeks. Staff I said she made the medication changes on 12/11/25 for a gradual dose reduction. Resident #6's progress notes and psychiatry notes from 12/11/25 were reviewed with Staff I, NP indicating no GDR was needed for the resident. Staff I said she did not know the facility had reviewed Resident #6 for a GDR that day. Staff I said she often saw the facility's psychiatry provider in other buildings and they communicate but did not communicate about this resident's GDR and plan of care. Staff I said she saw Resident #6 on 12/11/25 and told him she was changing his medication but the resident didn't want to wake up .but I told him. 4. An interview was conducted on 12/15/25 at 9:55 a.m. with Resident #10. The resident said the facility cut off her sleep and anxiety medication about a month ago. Resident said it was not discussed with her, and she doesn't know why they stopped them. She said she had a diagnosis for the medications she was on. Resident #10 said she started having symptoms of anxiety and not sleeping well so she asked and was told her medication had been stopped. The resident said when she asked why the facility told her the pharmacist's license was on the line and the state said she could not have the medication for sleep. Resident #10 was tearful and emotional while discussing her concerns. Review of admission Records showed Resident #10 was admitted on [DATE] with diagnoses including complete paraplegia, post-traumatic stress disorder, chronic pain, major depressive disorder, and generalized anxiety disorder. Review of Resident #10's Quarterly MDS, dated [DATE], Section C, Cognitive Patterns, showed her BIMS score was 15, indicating she was cognitively intact. Review of Resident #10's physician orders showed:-Buspirone HCl Oral Tablet 10 mg. Give 1 tablet by mouth three times a day for anxiety. Start date 5/15/25. Discontinued 11/4/25.-Buspirone HCl Oral Tablet 10 mg. Give 1 tablet by mouth two times a day for anxiety for 5 Days AND Give 0.5 tablet by mouth two times a day for anxiety for 5 Days AND Give 0.5 tablet by mouth one time a day for anxiety for 4 Days. Start date 11/4/25. Discontinued 11/18/25.- Eszopiclone Oral Tablet 1 mg. Give 1 tablet by mouth at bedtime for insomnia hold for sedation. Start date 5/7/25. Discontinued 11/17/25. An interview was conducted with Staff H, RN/UM. Staff H said she had not been at the facility very long but the GDR meeting she attended included the facility's psychiatry NP, the UMs, Director of Nursing (DON), Assistant DON (ADON), and social services. Staff H said the psychiatry NP comes with a list of residents that need to be reviewed for GDR and the UMs or DON add any residents they had concerns with. She said the group discussed which residents were stable or not. She said after the decisions were made to do a GDR the psychiatry NP spoke to the residents that were cognitively intact, and the staff called the representatives for residents that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105895 If continuation sheet Page 4 of 9 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 105895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Seminole 9393 Park Blvd Seminole, FL 33777 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 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete were not cognitively intact. Staff H said she had a couple of residents tell her they had medications changed without being notified or included in the discussion. Staff H said she had the psychiatry NP go speak to those residents. An interview was conducted on 12/16/25 at 12:38 p.m. with the facility's psychiatry NP. The NP said they had monthly GDR meetings at the facility with herself, the UMs, DON and social services. She said the process for the GDR meeting was that the pharmacy sent recommendations for GDR and the facility followed state guidelines for GDR. The NP said when she saw a patient for a while and they were stable she tried to GDR their medication to find the lowest effective dose or reduce the number of medications needed. The NP said during the meeting they also looked at how many residents were on antipsychotic medications and what affected the facility's quality assurance measures and what the team could do to bring those measures up. The NP said after it was decided which residents they were doing a GDR with, and she spoke to those residents. She said a lot of the residents are not happy because she took them off of controlled substances. The NP said several residents go out on leave of absences and consume alcohol or marijuana and her policy was if the resident did that, she took them off of controlled substances. She said she had residents not happy about it, but she said it was risking her license, and it was what was supposed to be done. The NP said she usually put it in her notes when she talked to the residents. An interview was conducted on 12/16/25 at 2:10 p.m. with the Regional [NAME] President (RVP). The RVP said they reviewed medical records for Residents #1, #3, #6, and #10 and did not see documentation the residents were included in a discussion about medication changes. The RVP said they spoke to the psychiatry NP and the head of psychiatry and determined the form they used to document psychiatry notes did not have a place to indicate communication with the resident regarding changes to medication or the plan of care and they were going to add it. An interview was conducted on 12/16/25 at 3:45 p.m. with the Nursing Home Administrator (NHA). The NHA said for Resident #6 they were not aware the third-party NP started a GDR on the resident. She was not sure why there was no communication with the facility and the psychiatry team. The NHA said they would reach out to that company. The NHA said she expected there to be communication with residents when medications were changed. Review of a facility policy titled Notification of Change in Condition, revised 12/16/20, showed: Policy: The center to promptly notify the Patient/Resident, the attending physician, and the Resident Representative when there is a change in the status or condition.Procedure:The nurse to notify the attending physician and Resident Representative when there is a(n):Need to alter treatment significantly -new treatment -discontinuation of a current treatment due to but not limited to:S Adverse consequencesS Acute conditionS Exacerbation of a chronic condition Review of a facility policy titled Resident Rights, dated 11/30/14, showed: Policy:It is the policy of the company to:1. Make residents and their legal representatives aware of residents' rights.2. Ensure that residents' rights are known to staff. Event ID: Facility ID: 105895 If continuation sheet Page 5 of 9 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 105895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Seminole 9393 Park Blvd Seminole, FL 33777 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined the facility failed to provide Quality Assurance and Performance Improvement (QAPI) practice that demonstrated identification, monitoring and implementation of an effective Action Plan to improve findings of deficient practice on the recertification survey conducted on 12/15/2025-12/16/2025 regarding maintaining a clean, sanitary and safe physical environment.Findings included: The facility plan of correction completion date was 11/07/2025. The plan of correction for F584 showed, Closet, wall and floors in identified rooms were cleaned on 10/7/2025. Facility wide audit completed with no other rooms identified. 100% education for housekeeping staff on 5 and 7 step cleaning and 100% Department Heads/IDT (Interdisciplinary team) on identification and appropriate notification of dark spots, discoloration and bio-growth. Audits will be done 4 x weekly for 1 month then then weekly Biweekly for 4 weeks and 1xmonthly ongoing. Audits will be brought to QAPI Committee until the QAPI Committee reports substantial compliance has been met. until substantial compliance An observation was conducted on 12/15/2025 at 3:45 p.m. with Staff E, Certified Nursing Assistant (CNA) of the shower room. Staff E noticed the black growth on the floor in the past and informed the nurse so it could be entered into the facility's maintenance system. However, she was unaware if the nurse submitted the cleaning request as the growth was still there. Staff E stated she had seen housekeeping clean the shower room, so she knew the room had been cleaned. An observation and interview were conducted on 12/15/2025 at 3:46 p.m. with the Housekeeping Director about cleaning procedures for the shower room. He stated the last time the shower room equipment was pressure washed was November 28th, 2025. He stated there was no documentation or logs ensuring the pressure washing had been done. An observation and interview were conducted on 12/16/2025 at 9:29 a.m. with the Maintenance Director about room [ROOM NUMBER]A (loose sink and bed lamination), room [ROOM NUMBER] (loose toilet), room [ROOM NUMBER] (shower chair and shower floor) and room [ROOM NUMBER] (loose toilet and sink). He did not remember the shower repair visit for room [ROOM NUMBER]A. The Maintenance Director was informed that the resident stated she told him of the loose sink during that shower repair visit. However, review of work orders did not show an order for the sink in room [ROOM NUMBER]. The Maintenance Director asked if the loose sink and bed lamentation work order was on the list. He said, then no I do not know about it. He stated if there were any issues, an order needs to be put in facility's maintenance system. He said that whoever the resident told was supposed to do it. He then stated he should have put in the order himself. He stated a lot of times residents tell him stuff as he is passing by so he cannot put in the work orders right away. An observation and interview were conducted on 12/16/2025 at 10:47 a.m. with the NHA and Regional [NAME] President about the expectations of the facility's QA process. The NHA stated it was the unit manager's responsibility to ensure cleanliness of shower rooms. The NHA stated the Housekeeping Director conducts random checks to ensure cleanliness of the facility. He then reports findings to the NHA. She stated that housekeeping staff do not have a system or log that tracks things/rooms needing to be cleaned as the staff directly reports it to the Housekeeping Director. The NHA said the expectation was to adhere to the cleaning schedule for rooms, shower room, and shower room equipment. The NHA stated the daily room rounds conducted by staff and herself included caulking, cracks in the rooms, floors and equipment such as shower chairs. After the checks, she would inform maintenance about any issues. The NHA said that staff were to report anything wrong into the facility's maintenance system, and the staff have been trained on how to access and utilize this maintenance system. The NHA stated the administration performed education refreshers on this, as well as annual education (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105895 If continuation sheet Page 6 of 9 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 105895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Seminole 9393 Park Blvd Seminole, FL 33777 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete about the maintenance system. The NHA stated if the residents told Maintenance Director, he was really good about addressing the concerns as he would put it into the maintenance system himself. However, if it were something quick, he would not put it in the system. The NHA and Regional [NAME] President were informed of the situation in room [ROOM NUMBER]A about the loose sink that the resident told the Maintenance Director about, and it was still not fixed. The Regional [NAME] President stated more features could be added to the checklist which would prompt staff to inspect more. The NHA and Regional [NAME] President were also informed that on 12/15/2025, concerns about room [ROOM NUMBER] discoloration around the toilet, shower room floors, shower room equipment having bio growth, and room [ROOM NUMBER] shower chair and floor had bio growth had been relayed to the Maintenance and Housekeeping Directors. room [ROOM NUMBER] had a loose sink and toilet that were not resolved as of 12/16/2025. The NHA said moving forward she would have a meeting with department heads, and she would talk about exactly what needs to be looked at during daily rounds. The Regional [NAME] President stated she would add additional checklist items to the daily rounds and increase the volume of daily audits and follow-ups. Review of a facility policy titled, Policies and Procedures Quality Assurance Performance Improvement Program (QAPI), Revised 10/24/2022, showed: The center and organization has a comprehensive, data-driven Quality Assurance Performance Improvement Program that focuses on indicators of the outcomes of care and quality of life.Program Design and Scope: 1. The center's QAPI program is on-going comprehensive review of care and services provided to residents. Including but not limited to:i. Environmental Services3. Review of activities may include but not be limited to:f. Environment of care/safety4. The program is a coordinated effort among departments and services within the organization that involves leadership working with input from Center staff, residents and families. Data Collection Systems and Monitoring: The center will collect and monitor data from different departments reflecting its performance.8. The center will identify data sources and timeframe for collection. Data sources may include but are not limited to:d. Incident/Accident logs Systematic Analysis and Action: The center will ensure systems and actions are in place to improve performance12. The center will develop corrective actions based on the information gathered and review effectiveness of the actions Identifying Quality Deficiencies and Corrective Action: The center will monitor department performance systems to identify issues or adverse events.14. Center will review department system data15. If a quality deficiency is identified, the committee will oversee the development of corrective action(s)16. The center may choose the method of corrective action i.e. Plan, Do, Study, Act or Performance Improvement Project Photographic Evidence Obtained. Event ID: Facility ID: 105895 If continuation sheet Page 7 of 9 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 105895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Seminole 9393 Park Blvd Seminole, FL 33777 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews the facility did not ensure proper infection control practices on five halls (100, 200, 400, 500, 600) out of six halls in the facility related to contact precautions, personal protective equipment (PPE) use, clean linen storage, and improper storage of oxygen equipment.Findings included: Review of a list of residents on Trasmission Based Precautions provided by the facility showed residents in room [ROOM NUMBER], 108, and 511 were on contact precautions. During a tour of the facility on 12/15/25 from 9:45-10:15 a.m. the following observations were made:-room [ROOM NUMBER] had a nebulizer mask uncovered on the bedside table. No bag for mask storage was observed.-An open, unlabeled water bottle sitting on the railing in the 200 hall with a used washcloth underneath.-room [ROOM NUMBER] had an oxygen mask on the bedside table uncovered. No bag for mask storage was observed.-room [ROOM NUMBER] was observed to have a partially obscured contact precaution sign on the door and a staff member was in the room providing care to the resident with no PPE on.-A beside commode was sitting outside room [ROOM NUMBER]. Staff D, Licensed Practical Nurse (LPN) was observed at the door preparing the resident's medication. She said she did not know why the commode was in the hallway. The nurse then entered the room with no PPE on. There was a contact precaution sign on the door of the room. -room [ROOM NUMBER] and 108 did not have contact precautions signs on the door.-The linen cart on the 400 hall had a bottle of cleaner, box of pens, and air freshener stored on the shelf with the clean linen. -The linen cart on the 100 hall and perineal/body wash and an open can of soda on the shelf with the clean linen. An interview was conducted on 12/15/25 at 1:14 p.m. with Staff D, LPN. Staff D confirmed the resident in room [ROOM NUMBER] was on contact precautions for c-diff. PPE should have been worn in the room. An observation conducted on 12/15/25 at 12:29 p.m. revealed room [ROOM NUMBER] had a contact precaution sign on the door and Staff B, Certified Nursing Assistant (CNA) was observed walking into the resident room to deliver and set up a food tray without wearing PPE. An interview was conducted on 12/15/25 at 12:38 p.m. with Staff B, CNA. Staff B said she did not wear PPE into room [ROOM NUMBER] because she only needed to wear it when providing close care. Staff B confirmed wearing PPE only on close contact applied to a resident on contact precautions, such as the resident in room [ROOM NUMBER]. An interview was conducted on 12/15/25 at 12:32 p.m. with Staff C, LPN. Staff C confirmed she was assigned to room [ROOM NUMBER] and 108. Staff C said room [ROOM NUMBER] was the only room on the unit on contact precautions. Staff C said there were a couple of others, but their precautions ended. An interview was conducted on 12/16/25 at 2:29 p.m. with Staff F, Registered Nurse (RN). She said respiratory masks should be bagged at the bedside not sitting out uncovered. Staff F said they do use plastic storage bags on the unit, but she would have to ask central supply for them. Staff F said nothing should be stored in the linen cart with clean linen. An interview was conducted on 12/16/25 at 1:05 p.m. with Staff H, RN/Unit Manger (UM). Staff H said if a resident was on contact precautions, staff should have worn gown and gloves anytime they are in the room and a mask if there is a chance of splattering. Staff H said with enhanced barrier precautions (EBP) PPE was worn when providing close care to a resident. Staff H confirmed room [ROOM NUMBER], 108, and 511 were on contact precautions, although rooms [ROOM NUMBERS] came off precautions in the afternoon of 12/15/25. Staff H said room [ROOM NUMBER] was still on contact precautions and staff should have worn PPE anytime they entered the room. Staff H said nothing should be stored in the linen carts except clean linen and she will have a discussion with staff. Staff H confirmed it is an infection control concern to have other items with the linen. Staff H said opened water bottles and used washcloths should not be left in the halls. She said she throws water bottles away all the time when she sees them in the hall. Staff H Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105895 If continuation sheet Page 8 of 9 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 105895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Seminole 9393 Park Blvd Seminole, FL 33777 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 FORM CMS-2567 (02/99) Previous Versions Obsolete said all staff are educated on infection control but said it could be confusing with EBP and the facility may change to more distinctly colored signs to help clarify. Review of a facility policy titled Infection Control, revised October 2018, showed:Policy StatementThis facility's infection control policies and practices are intended to facilitate maintaining a safe, sanitary and comfortable environment and to help prevent and manage transmission of diseases and infections.Policy Interpretation and Implementationl. This facility's infection control policies and practices apply equally to all personnel, consultants, contractors, residents, visitors, volunteer workers, and the general public alike, regardless of race, color, creed, national origin, religion, age, sex, handicap, marital or veteran status, or payor source.2. The objectives of our infection control policies and practices are to:a. Prevent, detect, investigate, and control infections in the facility;b. Maintain a safe, sanitary, and comfortable environment for personnel, residents, visitors, and the general public;c. Establish guidelines for implementing Isolation Precautions, including Standard and Transmission-Based Precautions;d. Establish guidelines for the availability and accessibility of supplies and equipment necessary for Standard and Transmission-Based Precautions;e. Maintain records of incidents and corrective actions related to infections; andf. Provide guidelines for the safe cleaning and reprocessing of reusable resident-care equipment. Review of a facility policy titled Initiating Transmission-Based Precautions, revised August 2019, showed:Policy StatementTransmission-Based Precautions are initiated when a resident develops signs and symptoms of a transmissible infection; arrives for admission with symptoms of an infection; or has a laboratory confirmed infection; and is at risk of transmitting the infection to other residents.Transmission-Based Precautions may include Contact Precautions, Droplet Precautions, or Airborne Precautions.The facility makes every effort to use least restrictive approach to managing individuals with potentiallycommunicable infections. Transmission-Based Precautions are used only when the spread of infection cannot be reasonably prevented by less restrictive measures.Policy Interpretation and Implementation2. Transmission-based precautions are utilized when a resident meets the criteria for a transmissible infection AND resident has risk factors that increase the likelihood of transmission. These may include (but are not limited to):a. Uncontained excretions/secretions;b. Non-compliance with standard precautions; orc. Cognitive deficits that restrict or interfere with the resident's ability to maintain precautions.3. When Transmission-Based Precautions are implemented, the Infection Preventionist (or designee):a. Clearly identifies the type of precautions, the anticipated duration, and the personal protective equipment (PPE) that must be used;b. Explains to the resident (or representative) the reason(s) for the precautions;c. Provides and/or oversees dle education of the resident, representative and/or visitors regarding the precautions and use of PPE;d. Determines the appropriate notification on the loom entrance door and on die front of resident's chart so that personnel and visitors are aware of the need for and type of precautions:(1) The informs the snffofdle type of CDC precaution(s), instructions for use ofPPE, and/or instructions to see a nurse before entering the room.(2) Signs and notifications comply with the resident's right to confidentiality or privacy.e. Ensures thatprotective equipment (i.e., gloves, gowns, masks, etc.) is maintained outside resident's room so that anyone entering the room can apply the appropriate equipment;f. Ensures that protective equipment and supplies needed to maintain precautions during care are in the resident's room; andg. Ensures an appropriate linen barrel/hamper and waste container, appropriate liner, are placed in or near the resident's room Event ID: Facility ID: 105895 If continuation sheet Page 9 of 9