Health inspection·July 11, 2024

F 0554 Level of Harm - Minimal harm or potential for actual harm were supposed to have a physician's order for self-administration. She explained the resident had to demonstrate the ability to perform the task, then the medication would be placed in a locked drawer in the resident's room. She said, the resident would then administer the medication in the presence of the nurse. LPN B acknowledged resident #45 did not have a physician's order for self-administration of the Hydrocortisone cream. Residents Affected - Few On 7/09/24 at 11:17 AM, the DON stated a medication self-administration evaluation was completed for resident #46 in May 2024, however, a physician's order was not obtained for self-administration of the Hydrocortisone cream. A review of the resident's Medication Administration Summary for the period 5/14/24 through 7/09/24 revealed no documentation by nurses to indicate the Hydrocortisone cream was ever administered, either by staff or the resident. This was in conflict with resident #46's verbalizations she had applied the cream twice a day. This finding was acknowledged by the Unit Manager, and LPN B. 2. Resident #81, an [AGE] year-old female was admitted to the facility on [DATE], with her most recent readmission on [DATE]. Her diagnoses included Parkinson's disease, respiratory failure, chronic pulmonary edema, dementia, fibromyalgia, stage 4 pressure ulcer, and osteoarthritis. Review of the resident's discharge- return anticipated MDS assessment with ARD of 5/26/24, revealed the resident's cognitive skills for daily decision making was moderately impaired, and she required substantial/maximal assistance from staff for some ADLs, and mobility needs. Review of the medical record revealed a physician's order dated 5/31/24 was for acetaminophen (Tylenol) 325 milligrams (mg) three times daily, as needed for mild pain. On 7/08/24 at 12:08 PM, resident # 81 was sitting up in bed. The resident's family member stated he had fast acting Tylenol locked in a drawer, and he had permission to give the Tylenol to the resident as needed. On 7/09/24 at 10:19 AM, LPN A stated for a resident to self-administer medications, the resident would be assessed for competency to give the medication, a physician's order had to be obtained, and a care plan would be developed for self-administration of medication. LPN A stated if a family member was allowed to administer medication to the resident, the family member would have to inform the nurse when the medication was given. The LPN reviewed the resident's physician orders and acknowledged there was an order for Tylenol three times daily, as needed and verbalized there was no documentation to indicate the family/resident could self-administer the medication. She stated she was not aware the family had administered Tylenol to the resident. On 7/09/24 at 10:30 AM, an observation was conducted in the resident's room with the DON, and LPN A. The resident's family member was in the room, and stated the DON gave him permission to give the resident the Tylenol as needed and shared the Tylenol was in the bedside table drawer. After the observation and interview with resident #81's family member, the DON stated when the resident was first admitted , orders were in place for the family to self-administer the resident's medications. The resident's physician's orders were reviewed by the DON, and she stated the Tylenol order currently in place, was for staff to administer the medication. She acknowledged a physician's order for family administration of the medication was not present. The facility's admission handbook revealed documentation pertaining to the facility's policies (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105960 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 105960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solaris Healthcare Windermere 4875 Cason Cove Drive Orlando, FL 32811 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 0554 Level of Harm - Minimal harm or potential for actual harm regarding self-administration of medication and medication storage at bedside. The document directed that, A physician's order is required for all medications being administered or self-administered .includes over-the-counter medications and patches, lotions/creams, inhalers, eye drops, etc. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105960 If continuation sheet Page 3 of 3