Inspection·July 15, 2021

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few independence by frequently not using call light for transfer assistance. The focus area was initiated 01/30/21 and revised 06/18/21. The following interventions were initiated 01/30/21: anticipate and meet the resident's needs, assist with ADLs (activities of daily living) as needed, call light within reach, physical therapy evaluate and treat as ordered, orient resident to room. The following interventions were initiated in February 2021: educate resident on the use of the call light to call for assistance (02/08), provide appropriate footwear, non-skid socks, when transferring, ambulating, or mobilizing in wheelchair (02/15), therapy eval for transfers and appropriate positioning of the wheelchair (02/16). Only one intervention was added during the time span of 04/12/21-07/12/21 during which the resident had five unwitnessed falls: frequent reminders to use call light for assistance (06/15/21). Review of progress notes in Resident #14's medical record revealed the following entries: 05/01/21: Resident was found on bathroom floor by CNA .1 cm (centimeter) skin tear noted to inner aspect of left middle finger. Resident could not recall how incident occurred but stated, I do this all the time by myself .Instructed resident to use call light for assistance and placed back into bed with 2 assist. 05/11/21: Resident has been noted with increased anxiety and outburst, yelling 'Nurse/Miss/Mr' with anyone who passes by her room, self-transfers immediately after she ask to be laid into bed, even though needs are tended to, as soon as you walk out of her room, the outburst commence again, she is being treated for a UTI (urinary tract infection), symptoms of the UTI have decreased. 05/11/21: Quarterly review held today for resident who is alert with pds (periods) of confusion . 05/14/21: resident having increased confusion, states people are in the closet and is seeing water falling from ceiling fixtures .recently completed abt (antibiotic) therapy for uti . 06/15/21 Interdisciplinary Team (IDT) Note: On 06/15/21 @ (at) 1025 (10:25 a.m.) Patient fell while in her bathroom during a self-transfer on/off toilet .Potential contributing factors to occurrence are: impaired mobility, poor safety awareness, poor impulse control .Skin assessment revealed laceration above left eyebrow, skin tear to left elbow .Intervention: .Re-educated on use of call light Patient alert to person, states she had taken herself to the bathroom when she fell. Patient states she did not use call light, patient unable to state why she did not use call light for assistance. Patient able to verbalize when to use the call light, able to demonstrate use of call light. Patient states she will use call light going forward for assistance 06/18/21: 520am (5:20 a.m.) writer was called to resident room by CNA, resident observed sitting on the floor on her buttocks with her back to her dresser that is in front of her bed, gripper socks in place with legs straight out in front. Resident stated she was trying to get up to use the toilet and fell, also states that she knows she is not supposed to get up by herself due to recent falls but stated 'I still got up anyway' .small, reddened area noted to top/back of head . 06/18/21 IDT Note related to fall on 06/18/21: .Resident recalls recent falls, states she knows she should call for assistance but always thinks she can do it on her own. Patient attempts to maintain independence. Re-educated patient on importance of using call light for transfer assistance . 07/03/21: 2am (2:00 a.m.) writer was called to residents room by CNA, resident observed sitting on her buttocks on the floor in bathroom in front of toilet, brief pulled down slightly, legs straight (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 2 of 11 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 106049 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of New Port Richey 7400 Trouble Creek Road New Port Richey, FL 34653 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few out in front of her with gripper socks in place. Resident stated she was taking herself to the bathroom and lost her balance. When asked why resident did not ring call bell for assistance resident stated, 'I don't know I just didn't.' 07/05/21 IDT Note related to fall on 07/03/21: .Patient able to recall incident .A&OX 3 (alert and oriented times 3) with periods of confusion, states she had taken herself to the bathroom when she fell. Patient states she did not use call light, however, is unable to state why she did not use call light for assistance .Patient states she will use call light going forward for assistance . 07/07/21: 1150pm (11:50 p.m.) [on 07/06/21] CNA called writer to resident room, resident observed sitting on her buttocks on the floor in bathroom between sink and toilet, legs straight out in front of her, gripper socks in place with wheelchair in front of her, resident stated she took herself to the bathroom and lost her balance, denies hitting head. When resident asked why she didn't ring for assistance resident stated, 'I don't know I just didn't' .small skin tear noted to right elbow .Resident continues to self-transfer without ringing for assistance, resident able to demonstrate use of call bell, 1 hour checks started to maintain safety . 07/07/21 IDT Note related to fall on 07/06/21: .Patient able to recall incident .states she had taken herself to the bathroom when she fell. Patient states she did not use call light, however, is unable to state why she did not use call light for assistance. Patient able to verbalize when to use the call light, able to demonstrate use of the call light . 07/13/21: at approx. (approximately) 2200 (10:00 p.m.) aide informed nurse that resident was sitting on the floor next to her bed. Resident stated she was 'going to the kitchen for breakfast.' resident assessed for injuries. re-opened skin tears from last fall noted. resident assisted back into bed and [wound closure surgical tape strips] applied to left elbow re-opened skin tear. left eyebrow [wound closure surgical tape strips] reinforced as that skin tear reopened as well . An interview was conducted with Staff A, Licensed Practical Nurse (LPN) on 07/15/21 at 9:27 a.m. She confirmed she was Resident #14's nurse that shift. She reported the following behaviors that put the resident at risk for falls: she got up unassisted, she called out constantly nurse, nurse to anyone who walked by her room, she was forgetful. Staff A said the resident doesn't use her call light, [I] don't think she's able to remember. Staff A said, I tell the girls, anticipate her needs. She said, we do have different checks for different people, she isn't on any kind of safety check .if it were up to me, she would be on 15-minute checks but that would be frowned upon because nobody has time. An interview was conducted with Staff G, Certified Nursing Assistant (CNA) on 07/15/21 at 11:05 a.m. She confirmed she was the resident's CNA that shift and confirmed Resident #14 had frequent falls and was at risk for falls. Regarding behaviors that led to falls she said, it's an agitation .she thinks she's gotta do something .thinks she has to get in her car or get her grandkids. Staff G said that the resident did not use her call light, needed at least supervision or limited assistance with any mobility or transfer, was not on any formal safety check schedule, and said, we just try to keep an eye on her because we know her and know she falls. An interview was conducted with Staff H, LPN, Unit Manager (UM) on 07/15/21 at 11:11 a.m. She confirmed Resident #14 had frequent falls, with most recent fall on 07/13/21. She said, we're probably in that room at least every 15 minutes or 30 minutes because every time we pass by the room, she's calling for us .most recent few weeks it's gotten worse. Regarding post-fall interventions she said, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 3 of 11 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 106049 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of New Port Richey 7400 Trouble Creek Road New Port Richey, FL 34653 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few We've reviewed medications, educated on call light, I know that's not enough .unfortunately for us [Resident #14] is still able to get up and walk. Staff H said the facility had not tried any protocol of structured safety checks for Resident #14. She said the resident did not like to be out of her room and did not like to engage in activities. An interview was conducted with the facility Director of Nursing (DON) and the Assistant Director of Nursing (ADON) on 07/15/21 at 12:19 p.m. They confirmed that they worked together in the role of risk management for the facility. They confirmed Resident #14 had frequent falls and the pattern was that they were unwitnessed. The ADON said, I've made sure that her care plan is updated with the poor impulse control, poor safety awareness, frequent reminders to use the call light, we recently did the UA (urinary analysis)/CS (culture sensitivity) .still waiting on the culture and sensitivity. In response to the repeated and primary post-fall intervention being reinforcement of call light use, the ADON said, When I look at her and have a conversation, she's pretty lucid when we speak .she can tell me when she would use call light. They confirmed they had not been able to identify a pattern with the time of day of the falls. The DON confirmed Resident #14 was not on any schedule of safety checks but said, I do think that they [staff] are monitoring her and checking on her frequently. She said that facility decisions for implementing safety checks was usually made by the IDT team and said, The frequent checks are really used almost as a last intervention because of the enormity of time it takes. She confirmed that one on one for safety was something the facility could choose to provide. Regarding the fall on 07/13/21, the ADON said, I'm still working it up today .was actually going to follow back up with her today to see what she could recall from the fall today. The DON said, I'm going to go ahead and put her on 1 hour safety checks now. Review of the facility policy titled, Falls Management dated 06/04/20 revealed, The facility will assess the resident upon admission/readmission, quarterly, with change in condition, and with any fall event for any fall risks and will identify appropriate interventions to minimize the risk of injury related to falls. The following federal regulatory excerpt was included in the policy: Each resident receives adequate supervision and assistance devices to prevent accidents. The definition of Avoidable Accident within the policy included, .an accident occurred because the facility failed to: .Implement interventions, including adequate supervision and assistive devices, consistent with a resident's needs, goals, care plan and professional standards of practice in order to eliminate the risk, if possible, and, if not, reduce the risk of an accident .Monitor the effectiveness of the interventions and modify the care plan as necessary, in accordance with current professional standards of practice. The definition of Supervision/Adequate Supervision within the policy included, .Facilities are obligated to provide adequate supervision to prevent accidents .This determination is based on the individual resident's assessed needs .Adequate supervision may vary from resident to resident and from time to time for the same resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 4 of 11 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 106049 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of New Port Richey 7400 Trouble Creek Road New Port Richey, FL 34653 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to prescribe when necessary (PRN) psychotropic medication within the acceptable duration of use for one (Resident # 17) of five sampled residents who were reviewed for unnecessary medications. Findings included: Resident # 11 is a [AGE] year-old female originally admitted to the facility on [DATE] and a readmission date of 9/22/2020. Diagnoses included, multiple sclerosis, functional quadriplegia, chronic pain syndrome, post-traumatic stress disorder, major depressive disorder and generalized anxiety. A review of Resident #11's quarterly minimum data set (MDS) section C dated 7/12/2021 revealed that she was cognitively intact. Section D had no reported concerns related to mood; and section D did not indicate that resident was exhibiting any behavioral symptoms directed to herself or others. A review of Resident #11's physician order date 7/1/2021 revealed an order for Alprazolam 1 milligram(mg) every 6 hours by mouth PRN for anxiety. Order date 5/12/2021. A review of her Medication Administration Record (MAR) dated 5/1/2021, 6/1/2021 and 7/1/2021 revealed Alprazolam 1 mg was documented administered on an average of 3 to 4 times daily. A review the most recent physician progress notes dated 6/11/2021 and 7/2/2021 did not reveal documentation or rational for PRN Alprazolam extending more than the acceptable duration. During an interview with the Director of nursing (DON) on 7/15/2021 at 1:32 p.m. she confirmed that PRN orders for antipsychotic drugs should be limited to 14 day. She stated that Resident #11 primary care physician may have documented the continued used of Alprazolam 1 mg PRN every 6 hours. On 7/15/21 at 9:21 a.m., an interview with Resident#11 primary care physician was conducted. She stated that Resident #11 need to be on Alprazolam 1 mg PRN, she did not want to order the medication routinely, despite the medication being administered on an average of 3 to 4 times daily. The MD stated that she understood that PRN psychotropic medication should have a time frame and her documentation should have reflected the rational for continuous use of the medication PRN. A review of the facility's policy and procedure titled, Psychotropic Medication Use, effective date 12/01/07 and updated 11/28/16 page 2 #6. reads: PRN orders for psychotropic drugs should be limited to 14 days and should be renewed unless the attending physician or prescribing practitioner evaluates the resident for the appropriateness of that medication. 6.1 Reads: The facility should not extend PRN psychotropic orders beyond 14 days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 5 of 11 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 106049 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of New Port Richey 7400 Trouble Creek Road New Port Richey, FL 34653 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility did not ensure that the medication error rate was below 5.00%. A total of twenty-five medications were observed administered and three errors were identified for three (Residents #72, #91, and #99) of three residents observed. These errors constituted a medication error rate of 12 percent. Residents Affected - Few Findings included: An observation of the 200 Hall medication administration on 07/13/2021 at 09:11 a.m., resulted in Staff F, Licensed Practical Nurse (LPN), giving Resident #91 Stiolto Respimat (Tiotropium/Olodaterol), 2.5 microgram (mcg) inhaler which had instructions on the label to administer 1 puff inhale orally one time a day. Staff F (LPN) administered to Resident #91 two (2) puffs of the medication instead of one (1) puff. Staff F (LPN) was asked what the directions for the medication were and she turned to the Medication Administration Record (MAR) and showed the surveyor Symbicort Aerosol MCG/ACT (Budesonide-Fomoterol Fumarate), 2 puffs inhale orally two times a day for Shortness of Breath (SOB) and Pneumonia (PNA). The nurse indicted that this was the medication that she gave to the resident. Staff f, (LPN) was asked again to show the surveyor the medication that she gave and she pulled out Stiolto Respimat (Tiotropium/Olodaterol), 2.5 microgram (mcg) inhaler, from the first drawer from the top of the medication cart. An observation on the 100 Hall medication administration on 07/14/2021 at 9:24 a.m., resulted in Staff B (LPN) giving Resident # 72 Metoprolol Tartrate Tablet 100 MG by mouth. The pharmacy label and the MAR read, Hold if SBP SBP <=130 or HR , <=60. After the observation of Staff B (LPN) administering the medication, she was asked if Resident #72's Blood Pressure (BP) was checked prior to administration. Staff B (LPN), stated, The Certified Nursing Assist (CNA) took the BP earlier and it was 129/64 with Pulse of 65. As she looked at the medication on (MAR) screen, she stated, I did not realize that it was under the parameters. She said she would call the doctor to let them know that she gave the medication outside of the parameter. An observation was conducted on 07/14/2021 at 09:47 a.m., of Staff D, (LPN) administering one (1) late medication of which read on the pharmacy label Niacinamide Tablet 500 MG Give 1 Tablet by mouth three times a day. Staff D (LPN) pointed to the MAR and it showed that it was due at 08:00 a.m. Staff B (LPN), was interviewed and asked why the medication was being administered at 9:47 a.m. She stated, This is my first time working this cart, I do not know the residents, and I know it is not an excuse because the medication is late. He takes all his other meds at 9:00 am not sure why this is scheduled for 08:00 am. Staff D (LPN) then put the medication in the clear medication cup with the other medications to administer together. In an interview with the Director of Nursing (DON) on 07/14/2021 at 11:40 a.m., she was informed of observations made during medication administration for Resident's #72, #91 and #99. The DON stated, No medication should be given late, and they must notify the physician of it is late, and as far as medications being given outside the physician ordered parameters, they must call the physician and notify them of what they did. No medication should be given without an order. On her computer, the DON pulled up Resident #91's active physician orders and could not find one for Stiolto Respimat (titropium/olodaterol) 2.5 mcg/2,5/mcg inhaler 1 puff orally one time a day. The DON accompanied the surveyor down to Staff F's (LPN), medication cart on the 200 Hall. She asked Staff F (LPN) for Resident # 91's inhaler and indicated to Staff F(LPN) she was removing the inhaler from the medication cart. As the DON walked away from Staff F, (LPN) and the medication cart, she stated, I will call the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 6 of 11 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 106049 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of New Port Richey 7400 Trouble Creek Road New Port Richey, FL 34653 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Consultant Pharmacist to see if they substituted this med, if they did it should say in the order, and the nurse should not have given 2 puffs. During a subsequent interview conducted with the DON on 07/14/2021 at 12:45 p.m., she indicated that she went through Resident #91's medical record looking to see if there was a physician order for the medication. The DON stated, The resident had the medication discontinued on 6/19/2021 and that medication should not have been given to him. She indicated that the medication is now in her office on her desk. On 07/15/2021 at 12:24 p.m., a telephone interview was conducted with the Pharmacy Consultant and was informed of the observations made during medication administration for Resident's #72, #91 and #99 by nursing staff. She stated Yes giving a medication without an order, and not holding a medication with BP parameters area, and giving a supplement late are all medication errors. A facility provided policy titled, Administration of Medications, from Chapter 6: Clinical Services Manual, revision date 05/06/2020 Page 01 of 02 reads under Standard, All medications are administered safely and appropriately per physician order to address residents' diagnoses and signs and symptoms. Policy: -A physician order that includes dosage, route, frequency, duration, and other required considerations including the purpose, diagnoses or indication for use is required for administration of medication. -The nurse must clarify any order that is incomplete, illegible, or unclear. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 7 of 11 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 106049 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of New Port Richey 7400 Trouble Creek Road New Port Richey, FL 34653 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations, interviews, and record review, the facility failed to appropriately secure medications in five (100, 200, and 300 Halls) of five medication carts. Findings included: On 07/15/2021 at 10:23 a.m., an observation was conducted of Medication Cart #2 located on the 100 Hall and the findings were as follows. In the second drawer from the top of the medication cart there were two loose ½ white tablets, and one loose ¼ piece of a tablet. The third drawer from the top of the medication cart included four and 1/2 loose tablets. Staff A, Licensed Practical Nurse (LPN) confirmed the presence of the unsecured tablets. On 07/15/2021 at 10:45 a.m., an observation was conducted of the Medication Cart #1 located on 100 Hall, which included in the second draw from the top of the medication cart unsecured tablets. Staff B, (LPN) confirmed the presence of one orange capsule, one white oval tablet, two round yellow tablets, one round tablet and two pieces of ½ a tablet. (Photographic Evidence Obtained.) On 07/15/2021 at 11:00 a.m., an observation was conducted of Medication Cart #2 on the 200 Hall. During the observation, the second drawer from the top included loose medications of one blue and white capsule, one yellow tablet, one pink tablet, and one white tablet. Staff C, (LPN) confirmed the presence of the unsecured medications. On 07/15/2021 at 11:20 a.m., an observation of Medication Cart #1 located on the 200 Hall included one loose clear gel capsule. Staff D, (LPN) confirmed the presence of the unsecured medication. On 07/15/2021 at 11:42 a.m., an observation was conducted on the 300 Hall Medication Cart which included in the second drawer from the top of the medication cart, two ½ pieces of a white tablet. The third drawer from the top of the medication cart was observed to have a loose ½ piece of a white tablet. Staff E (LPN) confirmed the presence of the loose tablets. On 07/15/2021 at 1:00 p.m., an interview with the Director of Nursing (DON) was conducted. The DON was informed of the observations made in all five medications carts located in the facility. The DON stated, When staff find them [tablets] popped out of the medication cards, they dispose of them in the drug buster that are in all the carts for medication disposal. On 07/15/2021 at 12:24 p.m., a telephone interview was conducted with the pharmacy consultant, who was informed of the observations of unsecured medications in five of five medication carts. During the telephone interview she stated, Unsecured tablets and or loose tablets in the medication carts should not be found in any part of the medication carts. A facility provided policy titled, 5.3 Storage and Expiration of Medications, Biologicals, Syringes and Needles, Page 01, 02 of Page 04, with Revision Date 10/31/16, was reviewed and read under Procedure: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 8 of 11 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 106049 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of New Port Richey 7400 Trouble Creek Road New Port Richey, FL 34653 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 0761 Level of Harm - Minimal harm or potential for actual harm 2. The Facility should ensure that medications and biologicals are stored in an orderly manner in cabinets, drawers, carts refrigerators/freezers of sufficient size to prevent overcrowding. 10. Facility should ensure that the medications and biologicals for each resident are store in the containers in which they were originally received. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 9 of 11 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 106049 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of New Port Richey 7400 Trouble Creek Road New Port Richey, FL 34653 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on observation of medication administration and of medication storage carts, both with facility nurses, review of facility documents and interview with facility staff including the Director of Nursing and the Administrator, it was determined the quality assessment and assurance committee failed to implement appropriate plans of action related to the facility's plan of correction for education and competency not being fully implemented and their auditing tools, even with identification of the continued concern of expired medications, were not changed to ensure compliance. Findings included: 1-During a revisit survey, conducted on 09/09/2021 to ensure compliance with regulations cited on a recertification survey (07/12 - 07/15/2021), the facility's plan of correction was reviewed. The plan of correction for administering medications without error included educating licensed nurses to ensure discontinued medications were removed from the medication cart so they couldn't be administered to residents inappropriately, ensure medications were administered to residents in compliance with the physician's prescribed parameters and to ensure medications were administered within the prescribed time frame. Education had occurred with facility nurses, according to the plan of correction (POC), on 07/14/21/, 07/21/21, and 08/04 and 08/05/2021. Audits were planned weekly to ensure the three areas of noncompliance did not recur. Random medication administration observations were planned twice a week to ensure the medication administration error rate fell under 5%. Comparison of the list of nurses who attended the inservice given on 08/04 and 08/05/2021 which reviewed the survey issues for the deficient practice cited for medication administration did not include one nurse who had been re-hired after the POC date of 08/05/2021. This nurse was on the schedule to work the day of the revisit. The list of nurses who attended the inservice given on 08/04 and 08/05/21 included five nurses who had not been included on the audits of nurses observed during medication administration. It was explained by the Administrator on 09/09/2021 in an interview beginning at 6:15 p.m. that they were nurses who never passed medications. Prior to the exit interview, which began at 6:40 p.m. on 09/09/2021, Medication Administration observations were provided for these five nurses which had been completed between 08/18/21 and 09/04/2021, which was past the POC date of 08/05/2021. 2-During observation of the facility medication and treatment carts and through review of facility audits, it was revealed that medications and biologicals were stored inappropriately with some having expired. Audits conducted after the POC date of 08/05/2021 of the carts revealed that storage of medications had not been corrected. Audits of all medication and treatment carts were conducted as well as education with all nurses on 07/14/2021 and 08/05/2021. Random weekly audits were planned to ensure compliance continued. Audits conducted after the POC date of 08/05/2021 found continued noncompliance on the 200 hall on 08/10/21, 08/13/2021, 08/30/2021 and 08/31/2021. Two audits were reviewed for the 200 hall after 09/03/2021 without any concerns noted. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 10 of 11 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 106049 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of New Port Richey 7400 Trouble Creek Road New Port Richey, FL 34653 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Audits conducted after the POC date of 08/05/2021 found continued noncompliance on the 100 hall in two of the four medication and treatment carts on 08/06/2021 but not after that date. Audits conducted after the POC date of 08/05/2021 found continued noncompliance on the 300 hall on 08/10/21 which included expired insulin, on 08/24/21 which included an insulin pen that was not dated, and various concerns on 08/31/21 in both medication carts. There were no audits available for the 300 hall after 08/31/2021. An interview was conducted with the Administrator on 09/09/2021 beginning at 6:15 p.m., to discuss the plan of correction and the facility's quality assurance review of the plan of correction. The Administrator confirmed that the education and the audits had been conducted according to the POC. The Administrator reported that the audits were reviewed in their morning meetings and weekly as a way to take a larger view. He reported that the Quality Assurance Committee did not find concerns with the audits and it wasn't suggested that more education was needed as the audits were finding the noncompliance was continuing. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 11 of 11