Inspection·December 18, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure residents received wound care as ordered by physician for 1 of 3 residents reviewed for skin conditions, Resident #141.Findings include: During an observation on 12/15/2025 at 9:54 AM, Resident #141 was lying in bed. Resident #141 had a wound dressing on his left shoulder, which was dated 12/11. During an observation on 12/16/2025 at 9:12 AM, Resident #141 was lying in bed, with his left shoulder wound dressing dated 12/11.Review of Resident #141's physician order dated 12/11/2025 read, Left Upper Arm: Cleanse with NS [normal saline], pat dry, apply calcium alginate to wound bed and cover ABD [abdominal] pad and rolled gauze every evening shift.Review of Resident #141's physician order dated 12/11/2025 read, Left Upper Arm: Cleanse with NS, pat dry, apply calcium alginate to wound bed and cover ABD pad and rolled gauze as needed.During an interview on 12/17/2025 at 12:25 PM, the Assistant Director of Nursing #2 (ADON #2) stated, I will round with the wound care provider and then all recommendations I will communicate with the physician, and the physician will have the final say regarding the wound care orders. The wound care orders in the system will supersede any recommendations done by the wound care provider. During an observation on 12/17/2025 at 12:30 PM, the ADON #2 confirmed Resident #141's wound dressing on his left shoulder was dated 12/11/2025.During an observation on 12/17/2025 at 1:00 PM with the ADON #2 and Staff I, Licensed Practical Nurse (LPN), Resident #141's wound dressings on his right lower back, right upper back, left lower extremity and right buttock were dated 12/11/2025.Review of Resident #141's physician order dated 12/11/2025 read, Right Buttock: Cleanse with Dakins 0.125%, allow to air dry, apply medical grade honey, collagen particles and calcium palatinate to wound bed and cover with bordered foam every evening shift.Review of Resident #141's physician order dated 12/11/2025 read, Right Buttock: Cleanse with Dakins 0.125%, allow to air dry, apply medical grade honey, collagen particles and calcium palatinate to wound bed and cover with bordered foam as needed.Review of Resident #141's physician order dated 12/11/2025 read, LLE [Left Lower Extremity]: Cleanse with NS, Pat dry, calcium alginate to wound bed and cover with ABD pad and kelix [Sic.] every evening shift.Review of Resident #141's physician order dated 12/11/2025 read, LLE: Cleanse with NS, Pat dry, calcium alginate to wound bed and cover with ABD pad and kelix [Sic.] as needed.Review of Resident #141's physician order dated 12/11/2025 read, Right Upper Back: Cleanse with NS, pat dry, apply calcium alginate to wound bed and cover with bordered dressing every evening shift for wound care.Review of Resident #141's physician order dated 12/11/2025 read, Right Upper Back: Cleanse with NS, pat dry, apply calcium alginate to wound bed and cover with bordered dressing as needed.Review of Resident #141's physician order dated 12/11/2025 read, Right Lower Back: Cleanse with NS, pat dry, apply calcium alginate to wound bed and cover with bordered dressing every evening shift. as needed.Review of Resident #141's physician order dated 12/11/2025 read, Right Lower Back: Cleanse with NS, pat dry, apply calcium alginate to wound bed and cover with bordered dressing as needed.During an interview on 12/17/2025 at 1:15 PM, the ADON #2 stated wound dressings should be changed daily.During an interview on 12/18/2025 at 10:30 AM, the Director of Nursing (DON) stated, Nurses should check physician orders and provide care based on the orders. Physician orders should be followed. Review of the facility policy and procedures titled Wound Care with the last review date of 6/11/2025 read, Policy: It will be the policy of this facility to provide assessment and identification of residents at risk of developing pressure injuries, other wounds and the treatment of skin impairment. Procedure. 6. Wound care procedures and treatments should be performed according to physician orders. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 2 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure ongoing communication with the dialysis center regarding resident assessment before and after dialysis treatment for 1 resident reviewed for dialysis, Resident #12.Findings include:Review of Resident #12's admission record documented the resident was admitted on [DATE] with diagnosis that included acute respiratory failure with hypoxia, atrial fibrillation (irregular heart rhythms), end stage renal disease (kidneys function less than 15% of normal ability) and dependence on renal dialysis.Review of Residents #12's physician orders showed an order dated 10/25/2025 for dialysis on Tuesdays, Thursdays, and Saturdays.Review of Resident #12's dialysis communication book showed no communication of assessment of Resident #12, no vital signs, and no weights. There was no communication from before or after dialysis treatment and no communication from dialysis.During an interview on 12/18/2025 at 10:26 AM, the Administrator of Dialysis Center stated, We receive hardly any communication from the facility. They [the facility] are one of the harder facilities to get a hold of or communicate with. I have to keep calling them to come and pick him up after dialysis. We are trying to rearrange the schedule to get him in later. He was here Tuesday, and today [12/18/2025] and scheduled for Saturday, then next week will be here on Monday, Wednesday and Friday. I faxed the schedule. He is always in pain as you know if they take meds before they come. We just pull the medication right out with dialysis. No documentation at all from the facility. We do not send any information to the facility unless they have a binder with communication or if they call and request anything.During an interview on 12/18/2025 at 10:44 AM, Staff Q, Certified Nursing Assistant (CNA), stated, We make sure that the residents are clean, have something to eat to go with them and their blanket. We do not do weights or vital signs. We do have restorative nursing that goes around with a clip board, and they will do weights on resident and log the weights and vital signs, but all the residents are different some just once a month, some daily, but we do not weigh or take vital signs before they go to dialysis.During an interview on 12/28/2025 at 10:50 AM, Staff R, CNA, stated, I will make sure the resident is clean and has lunch and blanket. No vital signs or weighs on the resident are obtained. If they have a book, we will send the book with them.During an interview on 12/28/2025 at 11:15 AM, Staff N, Licensed Practical Nurse (LPN), Unit Manager, stated, The resident is supposed to be weighed, and vital signs taken prior to leaving for dialysis and we normally send a face sheet. We do not receive anything back from dialysis.During an interview on 12/28/2025 at 1:00 PM, the Director of Nursing stated, We should have communication notes from our facility with the resident assessment, vital signs and weight, in the resident's binder. We normally get treatment records from the dialysis center.Review of the facility policy and procedure titled Hemodialysis dated 6/11/2025 read, Policy: It will be the policy of this facility to provide the necessary care and services to those residents receiving hemodialysis while a resident at the facility. Procedure. 6. The physician and dialysis center will be alerted to resident non-compliance issues of food and fluid . 9. The facility and the Dialysis Center should maintain regular communication and should a change in condition occur before or during the dialysis treatment, the sending facility should communicate the changes in needs to the receiving facility. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 3 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Immediate jeopardy to resident health or safety Based on interview and record review, the facility failed to ensure residents were free of significant medication errors when the facility failed to ensure residents were administered physician ordered anti-anxiety medications for 1 of 3 residents reviewed for medication administration, Resident #7. The facility failed to ensure residents with prescribed controlled medications were administered the medications per the physician order when failing to remove the medications from the automated medication dispensing machine, failing to notify the pharmacy prior to running out of medications, and failing to notify the physician when the prescribed medications were not administered for Resident #7, with a history of prescribed Ativan use. Resident #7 was prescribed oral Ativan to be administered three times a day. There was a delay in administering Ativan from 12/12/2025 at 10:00 PM through 12/14/2025 at 6:00 AM, for a total of five missed doses. Resident #7 suffered seizure activity. Ativan was administered by intramuscular route on 12/14/2025 at 8:45 AM to treat the seizure activity. Abruptly stopping Ativan throws the system off balance causing withdrawal systems which can be potentially dangerous and even fatal due to the potential to develop seizures during the withdrawal process.The Administrator was notified of the Immediate Jeopardy on December 17, 2025 at 3:38 PM. Findings include:Review of Resident #7's medical record documented the resident was admitted into the facility on 1/29/2025 with diagnosis to include senile degeneration of brain, dementia, anxiety, brief psychotic disorder, and depression. Review of Resident #7's physician orders dated 1/29/2025 read, Ativan oral tablet 1 mg [milligram] (Lorazepam). Give 1 tablet by mouth every 8 hours for anxiety.Review of Resident #7's physician orders dated 1/31/2025 read, Ativan injection solution 2mg/ml [milliliter] (Lorazepam) Inject 2 mg/ml intramuscularly every 5 minutes as needed for seizuresReview of Resident #7's Medication Administration record (MAR) for December 2025 documented Ativan 1 mg oral tablet on 12/12/2025 at 10:00 PM with a Code 5 [hold see nurse's note] Dated 12/13/2025 Ativan 1 mg at 06:00 AM, 2:00 PM, and 10:00 PM the record was documented as a Code 9 [Other see nurse's note] 12/14/2025 at 06:00 AM Ativan 1 mg did not contain documentation, it was left blank on the MAR. 12/14/2025 at 08:45 AM documented 2 mg Ativan was administered intramuscularly for seizure activity.Review of the [Name of Hospice] visit note dated 12/12/2025 at 1:00 PM read, [Name of hospice nurse] Medication reconciliation - Yes, medications reconciled during this visit. Schedule 2, 3, and 4 controlled substance medication counted: Ativan and Hydrocodone/Apap (acetaminophen) - Ativan Quantity - (0) hydrocodone (23). No medication change. Narrative note: Meds were counted facility had 0 Ativan in the med cart [Medication Cart].Review of the nurse's note dated 12/12/2025 at 9:27 PM read, Ativan Oral Tablet 1 MG. Give 1 tablet by mouth every 8 hours for anxiety. Medication not available, waiting on pharmacy.Review of the nurse's note dated 12/13/2025 at 6:26 AM read, Ativan Oral Tablet 1 MG Give 1 tablet by mouth every 8 hours for anxiety. Resident does not have any in the facility.Review of the nurse's note dated 12/13/2025 at 1:25 PM read, Ativan Oral Tablet 1 MG. Give 1 tablet by mouth every 8 hours for anxiety. Med not available, waiting for pharmacy. Review of the nurse's note dated 12/13/2025 at 10:24 PM read, Ativan Oral Tablet 1 MG. Give 1 tablet by mouth every 8 hours for anxiety. Med not available, waiting on pharmacy.Review of the nurse's note dated 12/14/2025 at 12:51 AM read, Call made to [Name of hospice] regarding script for resident. Spoke to Nurse [name of nurse] I was informed that 4 scripts was sent to [Name of pharmacy] in November for the resident. Call made inform [Name of pharmacy] that resident is out of the Ativan. I was informed that resident will have her Ativan with the next delivery.Review of [Name of hospice] Nurse Progress note dated 12/14/2025 at 08:09 AM read, Facility staff [Staff C, Registered Nurse's (RN) name] calling from Lady Lake Specialty Care to report patient [Resident #7] had a witness seizure in the dining room. No fall, no injury observed. Patient is currently Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 4 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few seated in common area and is lethargic, not at baseline. Review of medication occurs and instructed to administer Lorazepam [Ativan] per MD [Medical Doctor] order. Lorazepam 2 mg per ML injection solution PRN [as needed] for seizures every 5 minutes times three. Understanding verbalized. [Staff C, RN's name] to administer 1 dose now. Education provided regarding seizure precautions, high fall risk and aspiration precautions. Instructed to keep patient NPO [nothing by mouth] until nurse arrives to assess. Understanding verbalized. Assured [Staff C, RN's name], on call nurse will be notified and visit assigned. Encouraged to call with any further needs or change in patient condition. Understanding verbalized electronically signed by [name of hospice nurse, name of hospice].Review of the Alert Note Einteract Report dated 12/14/2025 at 08:45 AM read, Patient [Resident #7] observed experiencing seizure activity lasting approximately two minutes. No fall, head strike, or injury noted during the event. Lorazepam IM administered per order with good effect. Hospice nurse and hospice team notified. Patient currently stable, resting comfortably, and under observation. [Name of pharmacy] contacted regarding ETA [estimated time of arrival] for Lorazepam PO [by mouth]. [Name of pharmacy] stated it would be on the next run. Nurse made aware that Lorazepam PO is readily available in [name of automated medication dispensing system] for the patient's next scheduled dose. Read Patient observed experiencing seizure activity lasting approximately two minutes.Review of the [Name of hospice] Visit Note Report dated 12/14/2025 at 11:04 AM read, Pt. [patient] reported to have a seizure this AM at the breakfast tablet {sic}. FAC [facility] nurse administered IM Lorazepam [Ativan]. Pt. sleeping, padded with pillows and blanket. Pt. presents in postictal [a temporary period of confusion, drowsiness, and other symptoms following an epileptic seizure] stat. Eyes PERRLA [pupils equal, round, reactive to light, and accommodation]. Lungs sounds clear, no shifting, or tremors of any sort. No food present in mouth. Advise staff that she may sleep all day, to offer water if she wants it. If she is still inactive tomorrow AM to please contact us.Review of the [Name of hospice] note dated 12/14/2025 at 12:40 PM read, [Name of hospice RN] [Name of Staff B, RN] facility refill request calling from Lady Lake Specialty Care facility states that patient is completely out of Ativan 1 milligram which is scheduled Q 8 hours. In [hospice computer program name] assessed, refill was sent to [name of pharmacy] on 11/10 with four refills. She will call [name of pharmacy] now to request refill and will notify triage again if they are unable to refill medication. Confirmed she has a correct number for [name of pharmacy]. She will reach back out to triage if she has any issues requesting refill from pharmacy. Electronically signed by [name of hospice RN].During an interview on 12/15/2025 at 2:53 PM Physician #1, [Name of hospice], Hospice Care Physician stated, I was aware of [Resident #7's name] actually having had a similar episode when she was a resident in one of our other facilities back in January of 2025. She had run out of her Ativan and had seizure activity. I was not informed by the facility this time that they had run out of the medication. I was not told that she had seizure activity or that she was out of the benzodiazepine Ativan. If I would have been called and informed, I could have ordered an alternative benzodiazepine such as Valium. During an interview on 12/15/2025 at 2:55 PM the Director of Operations for [Name of Hospice] stated, The resident [Resident #7] has been with our facility since 2024. Our facility did not receive any notification that the resident was out of Ativan until after she had seizure activity on 12/14/25. They had run out of the Ativan, and she had not had the Ativan for several dosages because they had run out of the medications and was waiting for the pharmacy to fill the medications.During an interview on 12/16/2025 at 09:34 AM the Director of Nursing (DON) stated, I'm in the middle of investigating the situation. I do know and was informed that she [Resident #7] had a seizure on 12/14/2025 and [Staff C, RN' name] went to the [name of medication dispensing system] got out the Ativan 2 mg and administered IM; the seizure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 5 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few lasted about 2 minutes. [Staff A, RN's name] she has to call the pharmacy and check on the orders and notify the physician that the dose was not administered. The Ativan is in the [name of automated medication dispensing system] so she should have got the medication out of the [name of medication dispensing system]. If not, she should call the doctor and tell him that the medication is not available. We did not have a floor supervisor Saturday night, but we rotated call between the ADON [Assistant Director of Nursing] and DON and we did not receive a call from anyone.During an interview on 12/16/2025 at 09:45 AM Staff C, RN stated, I was working on the day that the resident [Resident #7] began seizing in the dining room. Ativan is available in the [name of medication dispensing system] so I pulled the Ativan out of the [name of medication dispensing system] and injected 2 mg of Ativan as ordered IM [intramuscularly] for seizures. After the resident was stabilized we called [Name of pharmacy] to see when the Ativan was going to be delivered, and they told us that it would be delivered on the next run. It was delivered on the evening run between 5 - 6 PM. [Staff A, RN's name] wasn't aware that she could get the medication from the [name of medication dispensing system]. She only thought of calling the pharmacy to see when the medications would be delivered.During an interview on 12/16/2025 at 09:55 AM the DON stated, I began the investigation as soon as I was aware [on 12/14/2025] that the resident [Resident #7] had a seizure. I identified that if the nurse does not use the [name of medication dispensing system] for 30 days then they are locked out and cannot scroll to see if the medications are available. The Ativan is in the [name of automated medication dispensing system] so she should have got the medication out of the [name of medication dispensing system]. If not, she should call the doctor and tell him that the medication is not available.During an interview on 12/16/2025 at 10:20 AM the Facility Medical Director stated, I am aware of [Resident #7's name] and she is under hospice care. I did not receive a call from the facility related to her being out of Ativan but normally I would not. They would call the hospice physician. I would consult if needed. Maybe the on-call physician received a call. [A request was made on 12/16/2025 at approximately 1:00 PM with the Administrator for documentation the on-call physician was notified. By the time of the survey exit on 12/18/2025, no documentation had been provided.] The staff would not call me if they do not have access to the [name of medication dispensing system], but they have before and I tell them to call the pharmacy for authorization. Normally, after five missed doses of Ativan 1 mg it would not cause seizure activity, it is not common, but it could be an exception for her. The facility did respond when she started having the seizures and gave the PRN 2 mg IM for seizure activity. My understanding is she had a seizure for about two minutes; she was never sent to the hospital.During an interview on 12/16/2025 at 10:22 AM Staff A, LPN (Licensed Practical Nurse) stated, There was no Ativan in the medication cart for [Resident #7's name], so I tried to pull it from the [name of medication dispensing system], but it had been locked out. I told [name of a Supervisor, who was not acting as the Supervisor; was working as a licensed practical nurse, on a medication cart] the supervisor that I had no access and I needed help getting access to the [name of medication dispensing system] so that I could get the Ativan. She said she was busy but would come and assist shortly. She came later that night and I reminded her, but she never helped me get access. I called a doctor and left a message, but I don't know who I called and no one ever called me back. I did call pharmacy Friday night and Saturday to request the medications. Saturday, I tried the [name of medication dispensing system] again, even the fingerprint and it would not work so [Staff C, RN's name] tried to help me but couldn't get access.During an interview on 12/16/2025 at 11:39 AM Staff E, RN stated, I normally work 11P-7A [11:00 PM to 7:00 AM]. When I came on 12/14/2025 and the Ativan was still not delivered I called hospice and told the hospice nurse that she [Resident #7] was out of the Ativan. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 6 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few hospice nurse said that the prescription was written back in November, that I needed to call the pharmacy [Name of pharmacy] for them to refill. I called and they [Pharmacy] said that they would fill the prescription, and it would be delivered on the first run. So, I expected to have the medication before 6 AM, which was the time that her next dose was due. I did not call the doctor because I thought we would have the medication. When change of shift came, we did not get the delivery. So, I reported it to the oncoming nurse that we did not have her Ativan and the ADON. There was no supervisor on for this shift, so I did not report to anyone else. I did not try to get it from the [name of medication dispensing system] because I was never given [name of medication dispensing system] access.During an interview on 12/16/2025 at 1:18 PM Staff G, LPN/Weekend Supervisor stated, I was on a cart 12/13/25 and was not informed that [Staff A, RN's name] needed any help. She did not tell me that she needed access to the [name of medication dispensing system]. She did not tell me that [Resident #7's name] was out of Ativan. I could have helped her. I would have retrieved the Ativan for her and called the pharmacist for her. We just need two nurses, one to sign in and one to witness to get medication out of the [name of medication dispensing system]. It is our responsibility to get the medication refilled before we run out or call if we need a prescription written by the doctor before the medication is gone. I try to get the medication replaced before they are out normally when I have 3-5 pills left.During an interview on 12/16/2025 at 1:03 PM interview the Pharmacist [Name of pharmacy] stated, We record the calls and I did not receive a call from the facility on 12/12/2025 or 12/13/2025 but did receive a call on 12/14/2025 at 12:48 AM requesting a refill for the Ativan 1 mg and the nurse was told that the medication would be delivered that day. So, the Ativan was refilled 12/14/2025 and delivered 5:22 PM. Withdrawals from missing Ativan can be general such as dizziness, slurred speech, weakness, and possible seizures. The complications of having seizures is the risk of falls, cognitive impairment, and respiratory obstruction.During an interview on 12/16/2025 at 3:26 PM the ADON #1, LPN stated, I came in around 6:30 AM [12/14/2025]. I was on-call Saturday night [12/13/2025] as I was back up and I received no calls. I came in on Sunday morning just to get caught up and [Staff B, RN's name] said that she had called the pharmacy and that the medication will be delivered. If we run out of medication in the medication carts, we check the [name of medication dispensing system] and if it is available then we pull it. If it's a narcotic, some require pharmacy authorization. We call pharmacy for authorization and if they need a new Rx [prescription], the nurse will call the doctor. New orders or substitute medication whatever is needed, the doctor will give the order. The doctor has to be notified if the medication is not available. I'm not sure if the doctor was notified or not, but it is the responsibility of the nurse to get the medications refilled or a new prescription if needed and the nurse has to call the doctor if medication is not given. If the [name of medication dispensing system] does not have that Rx such as 1 mg of Ativan, the order is written, a call must be placed to the doctor for an order of what we have available. We have .5 mg in the [name of medication dispensing system] so the doctor would have to order two tablets of 0.5 mg Ativan, and we could obtain it from the [name of medication dispensing system]. On orientation we receive education on medication administration, that the doctor has to be notified if medication is not available.During an interview on 12/16/2025 at 3:43 PM Staff I, Hospice Nurse, RN stated, I was at the facility on Friday [12/12/2025] and completed the narcotic count for the resident [Resident #7]. There was zero Ativan. I asked the nurse and she told me that she had used the last Ativan that she had. The nurse did not have her glasses and could not read the refill off the card. So, I told her to give it to me, and it showed that there were 135 [tablets] that were remaining to be refilled. She said to me that she is a weekend nurse and the nurses that normally work during the week do the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 7 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few refills. There was no need for a new Rx. She just needed to call the pharmacy to have the pharmacy send the Rx. The script was already there, and they could fill the Ativan up to 135 [tablets]. Review of the [name of the automated medication dispensing system] inventory documented Lorazepam 0.5 mg tablet is listed as a medication that is available for administration. Review of an undated correspondence provided to the facility by Physician #2 Medical Director read, This statement is provided in my capacity as medical director to address concerns related to an alleged immediate jeopardy (IJ) regarding a resident who experienced a brief seizure episode following an interruption in scheduled lorazepam (Ativan) therapy while residing at Lady Lake Specialty Care. Lorazepam is a short acting benzodiazepine with elimination half-life [an estimation of the time it takes for the medication's initial concentration in the body to decrease by half] of approximately 12 to 15 hours and no active metabolites. Interruption of regular scheduled dosing may result in rapid decline in central nervous system inhibitory activity. Missing four to five consecutive doses of lorazepam administered every 8 hours results in a clinically significant lapse in pharmacological coverage, exceeding multiple medications half-lives and is associated in the medical literature with an increased risk of neurological excitability, including seizure activity. Seizure activity related to abrupt changes in benzodiazepine exposures has been described even when medications are prescribed and used at therapeutic doses, without misuse, abuse, or prior seizure disorders. Medically complex and elderly post-acute patients may be more vulnerable due to physiological dependence and a reduced neurological reserve. In this case, the resident experienced a brief seizure episode lasting approximately 2 minutes, which resolved promptly from administration of 2 milligrams intramuscular lorazepam. The rapid resolution of symptoms following re administration of the scheduled medication is clinically consistent with the medication-interruption related neurological event and aligns with the accepted standard of care for acute seizure management.Review of the American Addiction Centers at americanaddictioncenters.org/Ativan-treatment/withdrawal-timeline titled, Ativan Withdrawal Symptoms, Timeline & Detox Treatment read, Ativan Withdrawal - Physical dependence occurs as a result of an individual taking certain types of drugs over rather lengthy periods of time. When an individual chronically uses or abuses certain classes of drugs, the individual's system becomes acclimated to having the drug present and learns to function at a steady level only when the drug is present in the individual's tissues. The system automatically adjusts its own release of chemical substances, such as neurotransmitters, hormones, and so forth, to account for the presence of the drug. Once the individual abruptly stops taking the particular drug, the system is thrown off balance, and this produces a number of physical symptoms known as withdrawal symptoms. Withdrawal from a benzodiazepine like Ativan can be potentially dangerous and even fatal due to the potential to develop seizures during the withdrawal process. Ativan withdrawal usually occurs in two stages: an acute stage and a prolonged stage. Ativan has a half-life of 10-12 hours on average, so withdrawal symptoms can start relatively quickly (within 24 hours) following the last dose. The average onset of withdrawal symptoms is 3-4 days. Acute withdrawal may begin with a rebound effects that consist of a rush of anxiety, increased blood pressure, increased heart rate, and difficulty sleeping. Acute withdrawal phase symptoms may include: Headache, sweating, tremors (especially in the hands), difficulty concentrating, and/or confusion, Increased blood pressure, heart palpitations, and a rapid heart rate, Nausea, abdominal cramps, vomiting, and/or weight loss, irritability, feelings of anxiety, mood swings, and/or even panic attacks, Seizures can occur in rare cases. Factors Affecting Ativan Withdrawal: The duration and intensity of withdrawal symptoms individuals experience depend on a couple of different factors. Most often, these include: The dose and frequency of Ativan: Chronic users or abusers of Ativan develop tolerance relatively quickly. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 8 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete The higher the dose one takes and the more often one takes Ativan, the more intense and lengthy the withdrawal syndrome will be.Review of the policy and procedure titled, Medication Administration dated 6/11/2025 read, It will be the policy of this facility to administer medications in a timely manner and as prescribed by the physician, unless otherwise clinically indicated or necessitated by other circumstances such as lack of availability of medication or refusals of medication by the resident. 2. The Director of Nursing Services is responsible for the supervision and direction of all personnel with medication administration duties and functions. 3. Medications should be administered in a timely manner and in accordance with physician orders. Newly admitted residents may receive medications prior to delivery from the pharmacy by accessing the Emergency Drug Kit or other medication storage unit used for the purpose of storing medications when certain medications are not available. 13. Should medication be unavailable at the time of medication administration, the nurse should check the [name of medication dispensing system] for availability. If medication is not available the nurse should notify the physician for new orders and contact the pharmacy, as needed.Review of the [Name of pharmacy] Policy and Procedure titled Receiving Controlled Substances dated 08/2020 read, 8. Controlled substances are requested when a five-day supply remains, or in accordance to facility policy, to allow for transmission of the required written prescription to the pharmacy. Event ID: Facility ID: 106003 If continuation sheet Page 9 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Immediate jeopardy to resident health or safety Based on interview and record review the facility administration failed to assume the full responsibility for the day-to-day operations of the facility and use of resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident by failing to implement policy and procedures for physician ordered medication administration. The facility failed to ensure Resident #7 was administered physician ordered Ativan 1 mg every 8 hours on 12/12/2025 at 10:00 PM, 12/13/2025 at 6:00 AM, 2:00 PM, and 10:00 PM, and on 12/14/2025 at 6:00 AM resulting in five missed doses, failed to ensure access to retrieve the physician ordered Ativan from the on-site automatic medication dispensing machine, and failed to notify the physician the ordered Ativan was not administered.The Administration failure to develop and implement a system for verification of access to the medications stored in the on-site automated medication dispensing machine for all licensed nursing staff resulted in Resident #7 suffering a seizure on 12/14/2025 at 8:35 AM and the administration of Ativan 2 mg intramuscularly. Abruptly stopping Ativan throws the system off balance causing withdrawal systems which can be potentially dangerous and even fatal due to the potential to develop seizures during the withdrawal process. The Administrator was notified of the Immediate Jeopardy on December 17, 2025 at 3:38 PM. Findings include:Review of the job description titled Administrator read, The primary Purpose of your position is to direct the day-to-day functions of the facility in accordance with current federal, state and local standard guidelines, and regulations that govern nursing facilities to ensure that the highest degree of quality of care can be provided to our residents at all times. Delegation of authority as administrator you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. Duties and Responsibilities: Administrative Functions: Plan, develop, organize, implement, evaluate, and direct the Facility's programs and activities in accordance with guidelines issued by the VP [Vice President]. Assist department directors in the development, use, and implementation of departmental policies and procedures and professional standards of practice. Ensure that all employees, residents, visitors, and the general public follow the Facility's established policies and procedures. Personnel Functions: Ensure that an adequate number of appropriately trained licensed professional and non-licensed personnel are on duty at all times to meet the needs of the residents. Staff Development: Assist department directors in the topic selection, planning, conducting, and scheduling of in-service training classes and on-the- job training and orientation programs to assure that current material and programs are continuously provided. Equipment and Supply Functions: Ensure that the Facility is maintained in a clean and safe manner for resident comfort and convenience by assuring that necessary equipment and supplies are maintained to perform such duties and services. Working Conditions: Works in office areas as well as throughout the Facility and its premises. Is involved with residents, family members, personnel, visitors, government agencies/personnel, etc., under all conditions and circumstances. Specific Requirement: Must demonstrate the knowledge and skills necessary to provide care appropriate to the age-related needs of the residents served. Must be knowledgeable of reimbursement regulations and nursing practices and procedures, as well as laws, regulations, and guidelines pertaining to nursing facility administration. Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc., that are necessary for providing quality care and maintaining a sound operation. Review of the job description titled Director of Nursing Services read, The primary purpose of your position is to plan, organize, develop, direct the overall operations of our nursing service department in accordance with current federal, state, and local standards, guidelines, and regulations Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 10 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few that cover our facility and as may be directed by the administrator to ensure that the highest degree of quality of care is maintained at all times. As director of nursing services, you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. You are charged with carrying out the residence care policies established by the facility. Duties and Responsibilities: Administrative Functions: Plan, develop, organize, implement, evaluate, and direct the nursing service department, as well as its programs and activities, in accordance with current rules, regulations, and guidelines that govern the nursing care facilities. Develop and implement a nursing service organization structure. Develop, implement, and maintain an ongoing quality assurance program for the nursing service department. Assist in calculating the number of direct nursing care personnel on duty each shift. Report such information to the Administrator or his/her designee to ensure that accurate staffing information is posted. Provide leadership, education, counseling, and discipline, when appropriate, to assigned CNAs and other nursing personnel. Make daily rounds of your unit/shift to ensure that assigned CNAs and other nursing personnel are performing their work assignments in accordance with acceptable nursing standards. Make changes to assignments based upon resident needs and availability of skilled staff. Evaluate daily performance of assigned CNAs and other nursing personnel. Document any disciplinary issues and report problem areas or disciplinary actions to the Nurse Supervisor and/or Unit Manager. Meet with your assigned CNAs and other nursing personnel, on a regularly scheduled basis, to assist in identifying and correcting problem areas, and/or to improve services. Assign personnel accordingly to ensure quality resident care while allowing personnel to improve in areas where they may be deficient, with appropriate supervision. Receive or provide the nursing report upon reporting in and ending shift duty hours. Committee functions: Assist the Pharmaceutical Services Committee in developing, maintaining, implementing, and periodically updating written policies and procedures for the administration, storage, and control of medications and supplies. Personnel Functions: Determine the staffing needs of the nursing service department necessary to meet the total nursing needs of the residents. Nursing Care Functions: Review nurses' notes to ensure that they are informative and descriptive of the nursing care being provided, that they reflect the resident's response to the care, and that such care is provided in accordance with the resident's wishes. Staff Development: Develop and participate in the planning, conducting, and scheduling of timely in-service training classes that provide instructions on how to do the job and ensure a well-educated nursing service department. Develop, implement, and maintain an effective orientation program that orients the new employee to the department, its policies and procedures, and to his and her job position and duties. Safety and Sanitation: Assist in developing safety standards for the nursing service department. Monitor nursing service personnel to ensure that they are following established safety regulations in the use of equipment and all supplies. Ensure that all nursing service personnel follow established departmental policies and procedures. Equipment and Supply Functions: Ensure that a stock level of medications, medical supplies, equipment, etc., is maintained on premises at all times to adequately meet the needs of the resident. Working Conditions: Is involved with physicians, residents, personnel, visitors, governmental agencies or personnel, etc., under all conditions and circumstances. Review of the job description titled Assistant Director of Nursing read, The primary purpose of your position is to assist the director of nursing services and planning, organizing, developing, and erecting the day-to-day function of the nursing service department in accordance with current federal, state, and local standards, guidelines, and regulations that govern our facility, and as may be directed by the administrator, the medical director, and or the director of nursing services to ensure the highest degree of quality of care is maintained at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 11 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few all times. Delegation of Authority: As assistant director of nursing you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. In absence of the director of nursing services you are charged with carrying out the residence care policies established by the facility. Ensure that all nursing service personnel are following their respective job descriptions. Participate in the development, maintenance, implementation, and updating of the written policies and procedures for the administration, storage, and control of medication and supplies. Delegate to the RN's, LPN's, and nurse supervisors the administrative authority, responsibility, and accountability necessary to perform their assigned duties. Make daily rounds of the nurse service department to ensure that all nursing service personnel are performing their work assignments in accordance with acceptable nursing standards. Report findings to the director. Monitor medication passes and treatment schedules to ensure the medications are being administered as ordered and that treatments are provided as schedule. Report medication errors to the director. Report problem areas to the director. Assist in developing and implementing corrective actions. Participate in developing, planning, conducting, and scheduling in service training classes that provide instructions on how to do the job and ensure a well-educated nursing service department. Develop, implement, and maintain an effective orientation program that orients the new employee to the department, its policies, and procedures, and to his or her job position and duties. Provide leadership training that includes the administrative and supervisory principles essential for nurse supervisors, RN's and LPN's. Ensure that an adequate stock level of medications, medical supplies, equipment, is maintained on premises at all time to actually meet the needs of the resident.Review of the job description titled Unit Manager read, The primary purpose of your position is to assist the director of nursing services and planning, organizing, developing, and erecting the day-to-day functions of the nursing service department in accordance with current federal, state, and local standards. Guidelines to regulate relations that govern the facility, and as may be directed by the administrator, the medical director, and or director of nursing services, to ensure the highest degree of quality of care is maintained at all times. As unit manager you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. Ensure that the nursing service procedure manuals reflects the day-to-day nursing care procedures used by the facility, and making sure that all nursing service personnel are following their respective job descriptions. Participate in the development, maintenance, implementation, and updating of the written policies procedures for the administration, storage, and control of medication and supplies. Make daily rounds of the nursing service department to ensure that all nursing service personnel are performing their work assignments in accordance with acceptable nursing standards. Report findings to the director of nursing services. Schedule daily rounds to observe residents and determine if nursing needs are being met. Report medication errors to the director of nursing.Review of Resident #7's medical record documented the resident was admitted into the facility on 1/29/2025 with diagnosis to include senile degeneration of brain, dementia, anxiety, brief psychotic disorder, and depression. Review of Resident #7's physician orders dated 1/29/2025 read, Ativan oral tablet 1 mg [milligram] (Lorazepam). Give 1 tablet by mouth every 8 hours for anxiety.Review of Resident #7's physician orders dated 1/31/2025 read, Ativan injection solution 2mg/ml [milliliter] (Lorazepam) Inject 2 mg/ml intramuscularly every 5 minutes as needed for seizuresReview of Resident #7's Medication Administration record (MAR) documented Ativan 1 mg oral tablet on 12/12/2025 at 10:00 PM with a Code 5 [hold see nurse's note] Dated 12/13/2025 Ativan 1 mg at 06:00 AM, 2:00 PM, and 10:00 PM the record was documented as a Code 9 [Other see nurse's note] 12/14/2025 at 06:00 AM Ativan 1 mg did not contain documentation, it was left blank (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 12 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few on the MAR. 12/14/2025 at 08:45 AM documented 2 mg Ativan was administered intramuscularly for seizure activity.Review of the [Name of Hospice] visit note dated 12/12/2025 at 1:00 PM read, [Name of hospice nurse] Medication reconciliation - Yes, medications reconciled during this visit. Schedule 2, 3, and 4 controlled substance medication counted: Ativan and Hydrocodone/Apap (acetaminophen) - Ativan Quantity - (0) hydrocodone (23). No medication change. Narrative note: Meds were counted facility had 0 Ativan in the med cart, but medication card has 135 tablets remaining [per interview with the name of the hospice nurse, the author of this note, clarification was provided. There are 135 Ativan 1 mg tablets remaining on the prescription for refills.] That can be refilled. Facility was instructed to call [Name of hospice] with any emergencies or concerns.Review of the nurse's note dated 12/12/2025 at 9:27 PM read, Ativan Oral Tablet 1 MG. Give 1 tablet by mouth every 8 hours for anxiety. Medication not available, waiting on pharmacy.Review of the nurse's note dated 12/13/2025 at 6:26 AM read, Ativan Oral Tablet 1 MG Give 1 tablet by mouth every 8 hours for anxiety. Resident does not have any in the facility.Review of the nurse's note dated 12/13/2025 at 1:25 PM read, Ativan Oral Tablet 1 MG. Give 1 tablet by mouth every 8 hours for anxiety. Med not available, waiting for pharmacy. Review of the nurse's note dated 12/13/2025 at 10:24 PM read, Ativan Oral Tablet 1 MG. Give 1 tablet by mouth every 8 hours for anxiety. Med not available, waiting on pharmacy.Review of [Name of hospice] Nurse Progress note dated 12/14/2025 at 08:09 AM read, Facility staff [Staff C, Registered Nurse's (RN) name] calling from Lady Lake Specialty Care to report patient [Resident #7] had a witness seizure in the dining room. No fall, no injury observed. Patient is currently seated in common area and is lethargic, not at baseline. Review of medication occurs and instructed to administer Lorazepam [Ativan] per MD [Medical Doctor] order. Lorazepam 2 mg per ML injection solution PRN [as needed] for seizures every 5 minutes times three. Understanding verbalized. [Staff C, RN's name] to administer 1 dose now. Education provided regarding seizure precautions, high fall risk and aspiration precautions. Instructed to keep patient NPO [nothing by mouth] until nurse arrives to assess. Understanding verbalized. Assured [Staff C, RN's name], on call nurse will be notified and visit assigned. Encouraged to call with any further needs or change in patient condition. Understanding verbalized electronically signed by [name of hospice nurse, name of hospice].Review of the Alert Note Einteract Report dated 12/14/2025 at 08:45 AM read, Patient [Resident #7] observed experiencing seizure activity lasting approximately two minutes. No fall, head strike, or injury noted during the event. Lorazepam IM administered per order with good effect. Hospice nurse and hospice team notified. Patient currently stable, resting comfortably, and under observation. [Name of pharmacy] contacted regarding ETA [estimated time of arrival] for Lorazepam PO [by mouth]. [Name of pharmacy] stated it would be on the next run. Nurse made aware that Lorazepam PO is readily available in [name of automated medication dispensing system] for the patient's next scheduled dose. Read Patient observed experiencing seizure activity lasting approximately two minutes.Review of the [name of the automated medication dispensing system] inventory documented Lorazepam 0.5 mg tablet is listed as a medication that is available for administration.During an interview on 12/15/2025 at 2:53 PM Physician #1, [Name of hospice], Hospice Care Physician stated, I was aware of [Resident #7's name] actually having had a similar episode when she was a resident in one of our other facilities back in January of 2025. She had run out of her Ativan and had seizure activity. I was not informed by the facility this time that they had run out of the medication. I was not told that she had seizure activity or that she was out of the benzodiazepine Ativan. If I would have been called and informed, I could have ordered an alternative benzodiazepine such as Valium.During an interview on 12/16/2025 at 09:34 AM the Director of Nursing (DON) stated, I'm in the middle of investigating the situation. I do know and was informed that she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 13 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few [Resident #7] had a seizure on 12/14/2025 and [Staff C, RN' name] went to the [name of medication dispensing system] got out the Ativan 2 mg and administered IM; the seizure lasted about 2 minutes. [Staff A, RN's name] she has to call the pharmacy and check on the orders and notify the physician that the dose was not administered. The Ativan is in the [name of automated medication dispensing system] so she should have got the medication out of the [name of medication dispensing system]. If not, she should call the doctor and tell him that the medication is not available. We did not have a floor supervisor Saturday night, but we rotated call between the ADON [Assistant Director of Nursing] and DON and we did not receive a call from anyone.During an interview on 12/16/2025 at 09:55 AM the DON stated, I began the investigation as soon as I was aware [on 12/14/2025] that the [Resident #7 name] had a seizure, I identified that if the nurse do not use the [name of medication dispensing system] for 30 days then they are locked out and cannot scroll to see if the medications are available.During an interview on 12/16/2025 at 10:20 AM the Medical Director stated, I am aware of [Resident #7's name] and she is under hospice care. I did not receive a call from the facility related to her being out of Ativan but normally I would not. They would call the hospice physician. I would consult if needed. Maybe the on-call physician received a call. [A request was made on 12/16/2025 at approximately 1:00 PM with the Administrator for documentation of the on-call physician was notified. By the time of the survey exit on 12/18/2025, no documentation had been provided.] The staff would not call me if they do not have access to the [name of medication dispensing system], but they have before and I tell them to call the pharmacy for authorization. Normally, after five missed doses of Ativan 1 mg it would not cause seizure activity, it is not common, but it could be an exception for her. The facility did respond when she started having the seizures and gave the PRN [as needed] 2 mg IM for seizure activity. My understanding is she had a seizure for about 2 minutes; she was never sent to the hospital.During an interview on 12/16/2025 at 10:22 AM Staff A, LPN (Licensed Practical Nurse) stated, There was no Ativan in the medication cart for [Resident #7's name], so I tried to pull it from the [name of medication dispensing system], but it had been locked out. I told [name of a Supervisor, who was not acting as the Supervisor; was working as a licensed practical nurse, on a medication cart] the supervisor that I had no access and I needed help getting access to the [name of medication dispensing system] so that I could get the Ativan. She said she was busy but would come and assist shortly. She came later that night and I reminded her, but she never helped me get access. I called a doctor and left a message, but I don't know who I called and no one ever called me back. I did call pharmacy Friday night and Saturday to request the medications. Saturday, I tried the [name of medication dispensing system] again, even the fingerprint and it would not work so [Staff C, RN's name] tried to help me but couldn't get access.During an interview on 12/16/2025 at 11:39 AM Staff E, RN stated, I normally work 11P-7A [11:00 PM to 7:00 AM]. When I came on 12/14/2025 and the Ativan was still not delivered I called hospice and told the hospice nurse that she [Resident #7] was out of the Ativan. The hospice nurse said that the prescription was written back in November, that I needed to call the pharmacy [Name of pharmacy] for them to refill. I called and they [Pharmacy] said that they would fill the prescription, and it would be delivered on the first run. So, I expected to have the medication before 6 AM, which was the time that her next dose was due. I did not call the doctor because I thought we would have the medication. When change of shift came, we did not get the delivery. So, I reported it to the oncoming nurse that we did not have her Ativan and the ADON. There was no supervisor on for this shift, so I did not report to anyone else. I did not try to get it from the [name of medication dispensing system] because I was never given [name of medication dispensing system] access.During an interview on 12/16/2025 at 1:18 PM Staff G, LPN/Weekend Supervisor (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 14 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few stated, I was on a cart 12/13/25 and was not informed that [Staff A, RN's name] needed any help. She did not tell me that she needed access to the [name of medication dispensing system]. She did not tell me that [Resident #7's name] was out of Ativan. I could have helped her. I would have retrieved the Ativan for her and called the pharmacist for her. We just need two nurses, one to sign in and one to witness to get medication out of the [name of medication dispensing system]. It is our responsibility to get the medication refilled before we run out or call if we need a prescription written by the doctor before the medication is gone. I try to get the medication replaced before they are out normally when I have 3-5 pills left.During an interview on 12/16/2025 at 1:03 PM interview the Pharmacist [Name of pharmacy] stated, We record the calls and I did not receive a call from the facility on 12/12/2025 or 12/13/2025 but did receive a call on 12/14/2025 at 12:48 AM requesting a refill for the Ativan 1 mg and the nurse was told that the medication would be delivered that day. So, the Ativan was refilled 12/14/2025 and delivered 5:22 PM. Withdrawals from missing Ativan can be general such as dizziness, slurred speech, weakness, and possible seizures. The complications of having seizures is the risk of falls, cognitive impairment, and respiratory obstruction.During an interview on 12/16/2025 at 3:26 PM the ADON stated, I came in around 6:30 AM [12/14/2025]. I was on-call Saturday night [12/13/2025] as I was back up and I received no calls. I came in on Sunday morning just to get caught up and [Staff B, RN's name] said that she had called the pharmacy and that the medication will be delivered. If we run out of medication in the medication carts, we check the [name of medication dispensing system] and if it is available then we pull it. If it's a narcotic, some require pharmacy authorization. We call pharmacy for authorization, if they need a new Rx [prescription], the nurse will call the doctor. New orders or substitute medication whatever is needed, the doctor will give the order. The doctor has to be notified if the medication is not available. I'm not sure if the doctor was notified or not, but it is the responsibility of the nurse to get the medications refilled or a new prescription if needed and the nurse has to call the doctor if medication is not given. If the [name of medication dispensing system] does not have that Rx such as 1 mg of Ativan, the order is written, a call must be placed to the doctor for an order of what we have available. We have .5 mg in the [name of medication dispensing system] so the doctor would have to order two tablets of 0.5 mg Ativan, and we could obtain it from the [name of medication dispensing system]. On orientation we education on medication administration, that the doctor has to be notified if medication is not available.During an interview on 12/16/2025 at 3:43 PM Staff I, Hospice Nurse, RN stated, I was at the facility on Friday [12/12/2025] and completed the narcotic count for the resident [Resident #7]. There was zero Ativan. I asked the nurse and she told me that she had used the last Ativan that she had. The nurse did not have her glasses and could not read the refill off the card. So, I told her to give it to me, and it showed that there were 135 [tablets] that were remaining to be refilled. She said to me that she is a weekend nurse and the nurses that normally work during the week do the refills. There was no need for a new Rx. She just needed to call the pharmacy to have the pharmacy send the Rx. The script was already there, and they could fill the Ativan up to 135 [tablets]. During an interview on 12/18/2025 at 12:37 PM the DON stated, I make sure that the nursing team has what they need to do their job, which includes medication availability, storage and administration. I have general oversight of the nursing department, safety and resident rights. I assure that the operations of the department is effective. We have an orientation itinerary, and I do portions related to expectation and education, abuse, and neglect. Everything is my responsibility and I oversee the managers and the ADONs. I expect that clinical rounds are completed to check on the residents every two hours to make sure they have what they need. If there are any issues or problems that are discovered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 15 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few during rounds, we [the administrative team] will address it. We have a clinical meeting twice a day and during the day they [nursing staff] report to me as needed. I was never informed that [Resident #7's name] did not get her medications until after the seizure on 12/14/2025. Then I was informed that she [Resident #7] did not receive her medications. [ADON #2's name] made sure that she [Staff A] had access. [Staff A's name] didn't remember her PIN [personal access code for medication storage] and her fingerprint did not work. Staff B, RN did not have access.During an interview on 12/18/2025 at 1:28 PM Staff N, LPN Unit Manager, stated I have been in the role as a Unit Manager since August 2025. I followed a manager that was leaving and completed computer work and some in-services. I don't remember exactly, but I did receive education on leadership. One of the topics was delegation. I had three days of training and then I went on the floor and worked. I do not remember if I received access to the [name of automated medication dispensing system] on orientation or not but I've always had access; I've never lost access.During an interview on 12/18/2025 at 1:55 PM ADON #1 stated, I put nurses access into the [name of automated medication dispensing system] so that they can obtain medications that they need. No form is filled out, no log is maintained, and no handouts are provided. The [name of automated medication dispensing system] access is part of the medication administration during our orientation and if we do not have too many nurses I will give them access then. If it is too busy, I will wait and give them access when they are working the medication cart. I will provide [name of automated medication dispensing system] access for them. I just need the nurse to be with me, they pick their own PIN number for access, and they will use the fingerprint. I don't have a log showing everybody who gets access or when they get access. I've been at the facility for one year. I tell them if they have a problem let me know. They have two alternatives they can use the PIN number, that is their personal number that they have chosen for access or their fingerprint. I tell them if they have a problem come to me, [ADON #2's name or the DON's name]. When I came in on Sunday morning [on 12/14] I was catching up on some stuff and during the time that is when [Resident #7's name] began seizing. I was told by [Staff B's name] that she was out of her Ativan and it was being delivered by pharmacy. She never told me that she did not have access to the [name of automated medication dispensing system] and I was never informed by any nurses that they did not have access to the medication [name of automated medication dispensing system]. They all know my position, and I give access to the [name of automated medication dispensing system] so everyone should have told me if they did not have access or their access did not work, I could have fixed it. I do medication observations competencies with the new hires after they come off of orientation. Then with staff that have been here for a while we do competencies yearly with our yearly skills fairs. We will cover the rights of medication administration. No one reported to me that [Resident #7's name] did not receive her Ativan for those five doses because they did not have to report to me. They should have called the pharmacy, the doctor and the representative and documented. They did not have to notify me they just needed to follow the process. They should have told me that they did not have access to the [name of automated medication dispensing system] and I could have given them access. The doctor was never called and told that [Resident #7's name] never got her medications and I was never informed that she did not have access to the [name of automated medication dispensing system]. [Staff A and Staff B's name] should have told me that she did not have access. She should have called the pharmacist for a refill of the medication. Staff B, RN should have told me also that she was never given access to the [name of automated medication dispensing system], and both of them [Staff A, and Staff B], should have followed the process when they could not access the [name of automated medication dispensing system].During an interview on 12/18/2925 at 3:38 PM the DON stated, I was not aware that anyone (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 16 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete needed to be logged into the [name of automated medication dispensing system]. I do receive emails from pharmacy related to discrepancies, but I do not have access to run any other reports from the [name of automated medication dispensing system]. If the staff don't tell me or the ADON, then we do not know that they need access. The only report that I get is the discrepancy report. I called pharmacy and they provided the report of medication pulled for [Resident #7's name]. I do not know if they have a report for staff that have access and are active or for those that are inactive and have lost access. The nurse's complete orientation and a 3-day orientation on the floor. Access to the [name of automated medication dispensing system] is given during orientation or when the nurse gets to the floor by [ADON #2's name]. No printed information is provided [regarding how to use the automated medication dispensing system]. We normally have a quick guide in the med room, or they can come and ask me for the Quick guide. I was not aware that there was a 30-day lockout for the [name of automated medication dispensing system] until I started to investigate the staff that did not have access. I do not know if the 30-day lock is the manufacture process, the pharmacy or this facility but staff that went 30 days without accessing the [name of automated medication dispensing system] were locked out. I've never kept a list of everyone that had been given access. Even during orientation, we never listed who received access and who needed it during floor orientation. We do not provide any written information on what to do if the staff finds that they have no access. I do have a quick guide that is available if they need directions. Staff are to follow the chain of command for any concerns including not having access to the pyxis. I was never informed that the staff did not have access until [Resident #7's name] had the seizure and I was informed of the seizure and I started the investigati[TRUNCATED] Event ID: Facility ID: 106003 If continuation sheet Page 17 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on observation, record review, and interview, the facility failed to accurately document wound care treatments for 1 of 3 residents reviewed for skin conditions, Resident #141, failed to document blood pressure and pulse when administering blood pressure medications for 1 of 6 residents reviewed for medication management, Resident #99, and failed to ensure residents had accurate medication orders for 1 of 6 residents reviewed for unnecessary medications, Resident #25.Findings include:1) During an observation on 12/15/2025 at 9:54 AM, Resident #141 was lying in bed. Resident #141 had a wound dressing on his left shoulder, which was dated 12/11. During an observation on 12/16/2025 at 9:12 AM, Resident #141 was lying in bed, with his left shoulder wound dressing dated 12/11.Review of Resident #141's physician order dated 12/11/2025 read, Left Upper Arm: Cleanse with NS [normal saline], pat dry, apply calcium alginate to wound bed and cover ABD [abdominal] pad and rolled gauze every evening shift.During an observation on 12/17/2025 at 12:30 PM, the Assistant Director of Nursing #2 (the ADON #2) confirmed Resident #141's wound dressing on his left shoulder was dated 12/11/2025.Review of Resident #141's Treatment Administration Record (TAR) for December 2025 for left upper arm wound care showed the resident received treatment on 12/12/2025, 12/13/2025, 12/14/2025, 12/15/2025, and 12/16/2025.During an observation on 12/17/2025 at 1:00 PM with the ADON #2 and Staff I, Licensed Practical Nurse (LPN), Resident #141's wound dressings on his right lower back, right upper back, left lower extremity and right buttock were dated 12/11/2025.Review of Resident #141's physician order dated 12/11/2025 read, Right Buttock: Cleanse with Dakins 0.125%, allow to air dry, apply medical grade honey, collagen particles and calcium palatinate to wound bed and cover with bordered foam every evening shift.Review of Resident #141's TAR for December 2025 for right buttock wound care showed the resident received treatment on 12/12/2025, 12/13/2025, 12/14/2025, 12/15/2025, and 12/16/2025.Review of Resident #141's physician order dated 12/11/2025 read, LLE [Left Lower Extremity]: Cleanse with NS, Pat dry, calcium alginate to wound bed and cover with ABD pad and kelix [Sic.] every evening shift.Review of Resident #141's TAR for December 2025 for left lower extremity wound care showed the resident received treatment on 12/12/2025, 12/13/2025, 12/14/2025, 12/15/2025, and 12/16/2025.Review of Resident #141's physician order dated 12/11/2025 read, Right Upper Back: Cleanse with NS, pat dry, apply calcium alginate to wound bed and cover with bordered dressing every evening shift for wound care.Review of Resident #141's TAR for December 2025 for right upper back wound care showed the resident received treatment on 12/12/2025, 12/13/2025, 12/14/2025, 12/15/2025, and 12/16/2025.Review of Resident #141's physician order dated 12/11/2025 read, Right Lower Back: Cleanse with NS, pat dry, apply calcium alginate to wound bed and cover with bordered dressing every evening shift. as needed.Review of Resident #141's TAR for December 2025 for right lower back wound care showed the resident received treatment on 12/12/2025, 12/13/2025, 12/14/2025, 12/15/2025, and 12/16/2025.During an interview on 12/18/2025 at 10:30 AM, the Director of Nursing (DON) stated Nurses should not check off a task as completed until it is fully completed. Documentation should be accurate.During an interview on 12/18/2025 at 12:04 PM, Staff B, Registered Nurse (RN), stated, I made a mistake. I was giving report, and I was going to go after to do the dressing change. I had a new admission come in and I was so tired. I forgot to do the dressing changes.Review of the facility policy and procedures titled Wound Care with the last review date of 6/11/2025 read, Policy: It will be the policy of this facility to provide assessment and identification of residents at risk of developing pressure injuries, other wounds and the treatment of skin impairment. Procedure. 6. Wound care procedures and treatments should be performed according to physician orders. 10. Document in the clinical record when treatments are performed.2) Review of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 18 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident #99's physician order dated 11/29/2024 read, Metoprolol Tartrate Oral Tablet 25 MG [milligram] (Metoprolol Tartrate) Give 1 tablet by mouth one time a day for HBP [high blood pressure] hold if sbp<110 dbp<60 and or pulse <60 [systolic blood pressure less than 110, diastolic blood pressure less than 60 and or pulse less than 60].Review of Resident #99's Medication Administration Record (MAR) for November 2025 for administration of Metoprolol Tartrate Oral Tablet 25 mg showed NA [not applicable] documented for pulse on 11/2/2025, NA documented for blood pressure and pulse on 11/10/2025, NA documented for blood pressure and pulse on 11/16/2025, NA documented for pulse on 11/21/2025, and NA documented for blood pressure and pulse on 11/26/2025.Review of Resident #99's MAR for December 2025 for administration of Metoprolol Tartrate Oral Tablet 25 mg showed NA documented for blood pressure and pulse on 12/2/2025 and on 12/9/2025.During an interview on 12/18/2025 at 10:10 AM, Staff I, Licensed Practical Nurse (LPN), stated, I don't recall that. Usually, I will take the blood pressure before giving the medication and document it. The facility expects me to document the blood pressure in the medication record. Before I give the medication, I always check the blood pressure and make sure it follows physician orders.During an interview on 12/18/2025 at 10:30 AM, the Director of Nursing stated, Vital signs should be recorded in the medication record before the medication is going to be administered. The staff should document blood pressure manually and or in a progress note.3) Review of Resident #25's physician order dated 10/9/2025 read, Lidocaine Pain Relief 4% Patch. Apply to per additional directions topically one time a day for pain at night.Review of Resident #25's physician order dated 9/9/2025 read, Diclofenac Sodium External Gel 3% (Diclofenac Sodium (Actinic Keratoses) apply to bilateral knees topically two times a day for knee pain. Review of Resident #25's physician order dated 11/12/2025 read, Diclofenac Sodium External Gel 1% (Diclofenac Sodium Topical) apply to right knee topically three times a day for right knee pain.During an interview on 12/18/2025 at 10:30 AM, the Director of Nursing stated, Diclofenac does not have a dose amount included and it should. It was part of an old batch orders and needs to be updated.Review of the facility policy and procedure titled Charting and Documentation with the last review date of 6/11/2025 read, Policy: It is the policy of this facility that services provided to the resident, or any changes in the resident's medical or mental condition, shall be documented in the resident's clinical record as is needed. Procedure: 1. Observations, medications administered, services performed, etc., should be documented in the resident's clinical records. Event ID: Facility ID: 106003 If continuation sheet Page 19 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, and interview, that facility failed to ensure staff performed hand hygiene and appropriately used personal protective equipment (PPE) while providing wound care for 1 of 3 residents reviewed for skin conditions, Resident #141, and failed to ensure respiratory equipment were stored appropriately for 3 of 5 residents reviewed for respiratory services, Residents #6, #75, and #100, to prevent the possible spread of infection and communicable diseases.Findings include: Residents Affected - Few 1) During an observation on 12/17/2025 at 12:37 PM, the Assistant Director of Nursing #2 (ADON #2) asked Staff I, Licensed Practical Nurse (LPN), to perform wound care on Resident #141. Without preforming hand hygiene, Staff I approached the treatment cart and started to collect items needed for wound care. Staff I did not have normal saline in the treatment cart. Staff I returned all supplies back to the treatment card and walked to the central supplies. Staff I returned to the treatment cart. Without performing hand hygiene, Staff I retrieved all wound care supplies. Staff I and the ADON #2 walked to Resident #141's room and performed hand hygiene and donned gown and gloves. Staff I did not tie his gown. Staff I's gown was loose and portion of torso and shoulders was not covered by the gown. Staff I removed the dressing from Resident #141's right buttock, removed his gloves and washed his hands. Staff I donned new set of gloves and proceeded to clean the wound with a scrubbing motion, going over area that he had cleaned initially. Staff I began to open the dressing packet and treatments without preforming hand hygiene. Staff I stopped and went to the bathroom and performed hand hygiene. Staff I then applied treatment and dressing. Review of Resident #141's physician order dated 12/11/2025 showed the resident required enhanced barrier precautions related to wounds every shift. During an interview on 12/18/2025 at 10:10 AM, Staff I, LPN, stated, I should have performed hand hygiene and I should have made sure I had tied my gown properly in the beginning of wound care. I should have cleaned the wound in a circular motion from inside of the wound to the outer portion. During an interview on 12/18/2025 at 10:30 AM, the Director of Nursing stated, Staff should wash their hands before gathering all supplies. Gown should have been properly donned. Staff should have washed hands before touching the clean supplies. The wound should have been cleaned in circular motion from inside of the wound to the outside, so it would not contaminate the clean area. Review of the facility policy and procedure titled Wound Care with the last review date of 6/11/2025 read, Procedure: 7. Wound care treatment should maintain proper technique, as is indicated by the type of wound and physician orders. Review of the facility policy and procedure titled Hand Hygiene with the last review date of 6/11/2025 read, Policy: This facility considers hand hygiene the primary means to prevent the spread of infections. Procedure: 5. Use an alcohol-based hand rub containing at least 62% alcohol; or alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: b. Before and after direct contact with residents; g. Before handling clean or soiled dressings, gauze pads, etc.; l. after contact with objects (e.g., medical equipment) in the immediate vicinity of the resident. Review of the facility policy and procedure titled Enhanced Barrier Precautions with the last review date of 6/11/2025 read, Policy: It will be the policy of this facility to implement enhanced barrier precautions for preventing transmission of novel or targeted multidrug resistant organisms. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 20 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 Definitions: Enhanced barrier precautions refer to the use of gown and gloves for certain residents during specific high-contact resident care activities that have been found to increase risk for transmission of multidrug-resistant organisms. Procedure: 4. For residents for whom EBP [Enhanced Barrier Precautions] are indicated, EBP is employed when performing the following High-Contact resident care activities- h. wound care. Residents Affected - Few 2) During an observation on 12/15/2025 at 9:40 AM, Resident #6's nebulizer mask was lying on top of a black handbag on top of the recliner, not stored in a bag (photographic evidence obtained). During an observation on 12/15/2025 at 12:40 PM, Resident #6's nebulizer mask was lying on top of the black handbag on top of the recliner. Review of Resident #6's physician order dated 12/11/2025 read, Ipratropium-Albuterol Solution 0.5-2.5 (3) MG [milligram]/3 ML [milliliter] 3 ml inhale orally four times a day for SOB [shortness of breath] and wheezing. 3) During an observation on 12/15/2025 at 12:46 PM, Resident #100's nasal cannula was not bagged and hanging on the wheelchair (photographic evidence obtained). During an observation on 12/16/2025 at 9:08 AM, Resident #100's nasal cannula was lying on top of the wheelchair, not bagged (photographic evidence obtained). Review of Resident #100's physician order dated 11/24/2025 read, Oxygen at 2 liters/minute via NC [nasal cannula] with humidification when on concentrator. May be without humidification when on a tank, every shift for hypoxia. Review of Resident #6's care plan showed a focus for a potential for complications of respiratory distress with an intervention initiated on 11/26/2025 that read, Store respiratory equipment in infection control bag when not in use; change q [every] week and prn [as needed]. During an interview on 12/17/2025 at approximately 2:10 PM, the Director of Nursing stated, The nebulizer mask and nasal cannula should be bagged when not in use. The nurses should verify that it is done. During an interview on 12/18/2025 at 2:43 PM, Staff N, LPN, stated, Oxygen nasal cannulas and nebulizer mask should always be bagged when not in use. If the resident takes off the nebulizer mask before the treatment is done once the nurses goes back to the room, she should verify that the mask is stored in a bag. 4) During an observation on 12/15/2025 at 10:09 AM, Resident #75's nebulizer was lying on the ground and open to air (Photographic evidence obtained). During an observation on 12/15/2025 at 3:30 PM, Resident #75's nebulizer was lying on the ground and open to air. During an interview on 12/15/2025 at 3:30 PM, Resident #75 stated, I get my breathing treatments every 6 hours if I don't, I can't breathe. I received my treatments last night and already twice today. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 21 of 22 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 106003 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lady Lake Specialty Care Center and Rehab 630 Griffin Avenue Lady Lake, FL 32159 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 Review of Resident #75's physician order dated 11/7/2025 read, Ipratropium-Albuterol Solution 0.5- 2.5 (3) MG/3 ML 3 ml inhale orally four times a day for COPD [Chronic Obstructive Pulmonary Disease]. During an interview on 12/15/2025 at 4:00 PM, Staff D, LPN, stated, Nebulizer must be placed back in the plastic bags after each use. Residents Affected - Few Review of the facility policy and procedure titled Respiratory Care with the last review date of 6/11/2025 read, Policy: It is the policy of this facility to provide respiratory care and safe oxygen administration to meet the needs of the residents. Procedure: 9. After completing the oxygen setup/administration or adjustment, nebulizer treatment, inhaler medication administration or other respiratory treatment, it is appropriate to document in the appropriate locations of the clinical record such as nurses' note, MAR/TAR [Medication Administration Record/ Treatment Administration Record], etc. When not in use, staff will appropriately store the tubing, mouth devices used for nebulizers or CPAP/BIPAP [Continuous Positive Airway Pressure/Bilevel Positive Airway Pressure] masks in a manner that promotes infection control practices such as storing in plastic bag when not in use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106003 If continuation sheet Page 22 of 22