Inspection·April 19, 2023

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On [DATE] at 2:40 p.m., Staff I, LPN, stated Resident #257 was a full code. Staff H, LPN, Unit Care Coordinator, reported the concern to Staff I, LPN, who was assigned as his direct care nurse. Staff I, LPN, stated, Yes, that's confusing. On [DATE] at 2:43 p.m., in Resident #257's room, Staff H, LPN, Unit Care Coordinator, showed the resident the My Advance Directive form and asked if he remembered completing the form. The resident stated he remembered signing the form and that he did not want CPR because of his age amongst other health issues. The nurse explained that she would bring the paperwork for him to complete for the DNR and speak with the doctor regarding his wishes. Resident #257 then stated he would think about it and let her know what he wanted to do tomorrow. Staff H, LPN, Unit Care Coordinator, stated she would keep him full code for now until he decided what he wanted to do and make the change to full code status only because it was confusing. On [DATE] at 2:27 p.m., the Director of Nursing (DON) confirmed the resident had a current order for both DNR and full code. She stated the expectation was there was only one code status in the medical record to prevent confusion. The policy provided by the facility Advance Directives and Advance Care Planning reviewed [DATE] revealed the following: 3. c. If the resident has an advance directive, the social worker will request a copy of the directive so that it may become part of the medical record. Documentation of such directives are placed in the Social Services progress note. The resident's attending physician is made aware of such, and the appropriate orders are incorporated into the resident's care plan. 8. Each time the resident is admitted to the facility, quarterly, and when a change in condition is noted in the resident condition, the facility should review the advance directive and advance care planning information. a. This review should focus on if the existing advance directive and ACP match the current goals of care for the resident. The social services director or designee should document this conversion in the medical record and assist as needed with updating the documents that need revision in accordance with state and federal requirements. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 2 of 16 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 04/19/2023 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 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. 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 provide the Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) form to two (Residents #94 and #49) that were terminated from Medicare Part A Services that included physical therapy, occupational therapy, speech therapy, and nursing services, but would remain living in the facility. Residents Affected - Few Findings included: A review of the admission Record for Resident #94 revealed she was admitted into the facility on [DATE] with a principal diagnosis of atherosclerosis of native arteries of left leg with ulceration of heel and midfoot. A review of the SNF Beneficiary Protection Notification Review form completed by the Administrator showed Resident #94's last covered day of Part A Service was 02/06/23 and the facility/provider initiated the discharge from Medicare Part A Services when benefit days were not exhausted. The form indicated the resident was only issued the Notice of Medicare Non-Coverage (NOMNC) form. A review of the admission Record for Resident #49 revealed she was admitted into the facility on [DATE] with a principal diagnosis of Alzheimer's Disease with late onset. A review of the SNF Beneficiary Protection Notification Review form completed by the Administrator showed Resident #49's last covered day of Part A Service was 03/22/23 and the facility/provider initiated the discharge from Medicare Part A Services when benefit days were not exhausted. The form indicated the resident was only issued the NOMNC form. On 04/19/23 at 4:44 p.m., the Administrator confirmed both residents remained in the facility after being terminated from Medicare Part A. The policy Denial or End of Benefits revised 03/30/21 only showed the procedure to issue the Notice of Medicare Non-Coverage form. The Administrator stated they would revisit the policy. He confirmed the SNF ABN form was not issued to the residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 3 of 16 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 04/19/2023 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure resident assessments accurately reflected the resident's status for one (Resident #39) of 32 sampled residents related to assessments. Residents Affected - Few Findings included: Observations of Resident #39 on 4/16/23 at 12:50 p.m. revealed the resident seated in the 100 hall common room in her motorized wheelchair. Closer observations at this time revealed the resident had a clip seatbelt attached around her lower trunk which was also noted to be attached to her wheelchair. A family interview on 4/17/23 at 9:25 a.m. revealed she was the resident's daughter and joint Power of Attorney (POA) with her sister. She reported she was not aware of the seat belt being in use, but thought the chair came with the seat belt already attached. She reported the facility was probably using the seatbelt for safety as her mother had falls in the past. Review of Resident #39's record revealed she was originally admitted to the facility on [DATE] and re-admitted on [DATE]. The resident had diagnosis that included Hemiplegia and Hemiparesis following unspecified cerebrovascular disease affecting right non-dominant side. The resident had a Brief Review For Mental Status score of 11 (Moderate cognitive impairment) dated 2/1/23. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed that trunk restraints were not used in chair or out of bed. Review of the annual MDS dated [DATE] revealed that trunk restraints were not used in chair or out of bed. Review of the Required Indoor Powered Mobility Skills Test form dated 11/21/19 revealed that the resident was able to demonstrate the component of Fasten and release seat belt. The form indicated for the section titled Operate Door that Pulls to open in hand written font the resident was Unable due to R hemiplegia. For the section titled Operate Door that Pushes to open in hand written font the resident was Unable due to R hemiplegia. For the statement that says Uses one hand to release door in hand written font the form indicated R hemiplegia. . An interview on 4/19/23 at 9:50 a.m. with Staff A, Certified Nursing Assistant (CNA) revealed when getting Resident #39 up into the wheelchair she made sure the seatbelt was on tight enough so that the resident did not fall forward. She reported the resident was unable to open or close the seatbelt due to paralysis on one side. An interview on 4/19/23 at 9:54 a.m. with Staff B, Licensed Practical Nurse (LPN), revealed she was familiar with Resident #39 and had seen her in her motorized wheelchair. She reported she and other staff were ensuring the seatbelt was secure. An interview on 4/19/23 at 10:00 a.m. with Staff C, MDS Coordinator Lead, revealed the facility had no restraints. Staff C reviewed section P of the resident's most recent annual and most recent (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 4 of 16 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 04/19/2023 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few quarterly MDS and reported that on both documents the section reflects no restraints in use. Staff C reported that If a restraint was in use, it would typically be reflected in the MDS. She was not sure why it was not reflected. She reported if the resident was assessed to need a restraint, it should be reflected in the care plan. An interview on 4/19/23 at 10:16 a.m. with the Director of Nursing (DON) revealed this was a no restraint facility. She reported if there was a restraint in place, the resident should be assessed for it, should be able to release it, and should be care planned for it. In an interview on 4/19/23 at 10:23 a.m., Staff D, LPN Unit manager revealed she was not aware Resident #39 had a seatbelt on her chair, but if she were aware she would make sure there was an order in place, the resident could release it, and the resident's skin was checked. Review of the facility policy titled Physical Restraint Use with an issued date of 11/1/2017 and a most recent reviewed date of 9/12/2022 revealed the following: Assessment 1. When alternatives to restraint use are not effective, the interdisciplinary team evaluates the least restrictive restraint to promote safety and attain/maintain the highest practical physical, mental and psychosocial function of the resident. 2. The type of restraining device, frequency/duration, and medical reason(s) for restraining device are documented on the Physics Restraint Informed Consent (LCCA-508). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 5 of 16 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 04/19/2023 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. A review of Resident #4's admission Record identified the resident was initially admitted on [DATE] and re-admitted on [DATE]. On 4/17/23 at 9:17 a.m., Resident #4 was observed lying in bed with bright red blood in catheter tubing. The resident was anxious and reported not wanting to die, pointing at the catheter. The 100-hall Unit Manager reported the residents' tearfulness was normal and was being followed by psychiatric services (psych). On 4/18/23 at 8:50 a.m., Resident #4 was sitting in a motorized wheelchair in front of 100-hall nursing station. The resident said to this writer honey I need water and indicated going to the office to make a complaint. The Assistant Director of Nursing (ADON) came into the hallway and Resident #4 stated to the ADON I want to kill myself. The ADON directed the resident into the ADON's office. The admission Record included the following diagnoses: - unspecified Impulse Disorder, onset of 5/2/19 during stay, - unspecified recurrent Major Depressive Disorder, onset 5/2/19 active at admission, - Vascular dementia unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. The onset date was 5/2/19 and was active at admission. - Generalized anxiety disorder, onset date of 7/15/20 and active at admission. - Schizoaffective disorder - bipolar type, onset date of 11/25/20 and active at admission. - Psychotic disorder with hallucinations due to known physiological condition, onset on 3/31/21 that was identified during stay. - Impulsiveness identified during stay with an onset date of 4/7/21. - Panic disorder (episodic paroxysmal anxiety), identified on 4/7/21 during the residents' stay. - Adjustment disorder with mixed disturbance of emotions and conduct, identified during stay with an onset date of 11/1/21. A review of one of Resident #4's Preadmission Screening and Resident Review (PASRR) identified that the form was completed by the facility's Assistant Director of Nursing (ADON) on 3/22/23. Section 1: PASRR Screen Decision-Making indicated that findings were based on documented history and not behavioral observations or medications. The section did not indicate the resident had any mental illness (MI) or suspect mental illness (SMI), such as: anxiety disorder, bipolar disorder, depressive disorder, disassociate disorder, panic disorder, personality disorder, psychotic disorder, schizoaffective disorder, schizophrenia, somatic symptom disorder, substance abuse, or any other diagnosis. The decision making section did not indicate the resident was currently receiving services for MI, had previously received services for MI or had been referred for MI services. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 6 of 16 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 04/19/2023 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A Psychiatry Subsequent note, dated 2/22/23, included the following psychotropic medications for Resident #4: Ativan 0.5 milligram (mg) every 8 hours as needed x 14 days for anxiety, Duloxetine Delayed Release 20 mg daily for depression, Quetiapine Fumarate 200 mg tablet three times a day for schizoaffective disorder, and Depakote 12.5 mg twice daily. The note identified Resident #4's chief complaint was depression, anxiety, and schizoaffective disorder. It was reported on 12/21/22 the resident was aggressive, yelling, and impulsive requiring frequent redirection, and Depakote twice daily was started. The summary of the note identified on 9/6/22 the resident had a schizoaffective disorder and Seroquel (Quetiapine) was increased to 200 mg three times a day. On 10/5/22 the resident's Seroquel was decreased to twice a day, and on 10/12/22 the Seroquel was increased to three times a day. The summary indicated on 12/21/22 Resident #4's Seroquel was decreased to 300 mg. The plan of action indicated Ativan was to continue for anxiety, Duloxetine was to continue for depression, Quetiapine continued for schizoaffective disorder, and Depakote continued for mood disorder. The Psychiatry Subsequent note, dated 3/28/23, indicated the plan for Resident #4 was to continue the medication Ativan for anxiety, Duloxetine for depression, Quetiapine for schizoaffective disorder, and Depakote for mood disorder. The provider started the resident on Paxil 10 mg every bedtime for depression and anxiety, discontinued Cymbalta and increased Depakote to 250 mg BID for mood disorder. The note identified the resident had been unstable since last seen and nursing reported the resident was more aggressive and touching staff inappropriately. During the provider visit the resident reported feeling anxious, and difficulty controlling anxiety and dealing with feelings of loss of control. The provider documented the residents' Symptoms are unstable causing a moderate level of distress. A review of Resident #4's care plan indicated the facility documented the following: .behavior problem related to (r/t) yelling at and making sexual comments to staff, making derogatory comments to others, calling out i.e. help repetitively despite assistance from staff and being educated on using call bell, and making disruptive sounds. Has continuous behaviors of screaming with request, noted to throw things in room, out doorway of room, and/or yells to get staff attention. Can be demanding with needs. Makes false accusations. Attention seeking through negative action or reaction. The interventions associated with this focus indicated Psych was to evaluate and treat as needed for signs/symptoms (s/s) (of) mood instability which was initiated on 5/16/19. On 12/30/21, an intervention was created that staff were to if reasonable, discuss the resident's behavior. Explain/reinforce why behavior is inappropriate and/or unacceptable to the resident. A review of a PASRR completed by the ADON on 4/18/23 for Resident #4, identified the PASRR was completed using not the residents' given name but a name that they preferred to be called. The PASRR did not identify any of the residents' mental health diagnoses, that the resident was currently, previously, or had been referred to MI services, and that the findings were based on documented history and did not include the resident's medications or behavioral observations. 4. A review of Resident #24's admission Record identified that the resident was admitted on [DATE] and included diagnoses that were active at admission (onset date 8/19/21) and not limited to adjustment disorder with mixed anxiety and depressed mood, other mixed anxiety disorders, mild recurrent major depressive disorder, unspecified schizoaffective disorder, and unspecified dementia unspecified severity without behavioral disturbance psychotic disturbance, mood disturbance, and anxiety. The admission Record also identified a diagnoses that occurred during the resident's stay with an onset date on 11/1/21 of recurrent severe major depressive disorder without psychotic features. A request was made to the facility for multiple residents' PASRR's and also any Level II (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 7 of 16 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 04/19/2023 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few determinations that were applicable. The request for current PASRR's and Level II determinations included Resident #24. The review of Resident #24's clinical record identified a PASRR - Resident Review-Evaluation Request for a Significant Change for Serious Mental Illness (SMI) and/or Intellectual Disability or Related Conditions (ID) for Medicaid Certified Nursing Facility (NF) Only, dated 8/12/21 and completed at the facility. The evaluation request identified that a Level I PASRR was completed on 6/5/20 and the most current Level II PASRR was on 8/12/21. The evaluations section II: Significant Change indicated that the resident had an increase of behavioral, psychiatric, or mood-related symptoms, Behavioral, psychiatric, or mood-related symptoms that have not responded adequately to ongoing treatment, Change in behavior, psychiatric, or mood suggestive of a suspicion of SMI (where dementia is not the primary diagnosis), and will not resolve itself without intervention by staff or the implementation of standard disease related clinical interventions and/or modification of care plan. The facility did not provide a PASRR from Resident #24's admission or a Level II determination for the resident. The facility did provide a PASRR for Resident #24, dated 4/18/23, that was completed by the facility's Assistant Director of Nursing (ADON). The decision-making section did not indicate that the resident had any Mental Illness (MI) or suspected Mental Illness (SMI), or was currently, had previously, or had been referred for MI services. A review of Resident #24 of the active Order Summary Report identified that the resident was currently receiving the following medications: - Klonopin 1 milligram (mg) at bedtime for anxiety - Hold for sedation, dated 3/27/23. - Seroquel 100 mg at bedtime for brief psychosis, dated 4/7/23. The Order report indicated that staff were to monitor for side effects related to Seroquel use and to monitor behaviors related to the use of Seroquel and Clonazepam, these orders were dated 2/10/22. The review of Resident #24's Psychiatry Subsequent Notes indicated the following: - 11/30/22: Diagnoses of anxiety and schizoaffective disorder. The note indicated that on 10/6/22 Seroquel was decreased with later increased as the resident had become more aggressive. The assessment indicated that the resident was unstable requiring medication changes. - 12/7/22: The note indicated diagnoses of anxiety and schizoaffective disorder and that it had been reported that the resident was unstable. The plan of action was to continue Baclofen for muscle spasms, Clonazepam for anxiety, Melatonin for insomnia and to decrease Seroquel to 200 mg every bedtime. - 12/21/22: The note indicated that the resident continued with diagnoses of anxiety and schizoaffective disorder. The note indicated that during the providers interview the resident changed story regarding sleep habits. The plan was to continue Baclofen, Clonazepam, melatonin, and Seroquel. The annual Minimum Data Set (MDS), dated [DATE], indicated Resident #24 had not exhibited any (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 8 of 16 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 04/19/2023 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few behaviors, had active diagnoses of non-Alzheimer's disease, anxiety disorder, depression (other than bipolar), schizophrenia, and adjustment disorder with mixed anxiety and depressed mood. The MDS assessment identified the resident had received 7 days of antipsychotic and antianxiety medications during the assessment period. The care plan for Resident #24 identified the resident refused care frequently and staff were to notify psych for increased behaviors, the resident had potential to be verbally aggressive and inappropriate, belligerent, demeaning, sexually inappropriate toward staff, falsely accusing staff, threw things at staff, noted to have paranoia towards staff and required care of 2-person due to inappropriate behaviors. The care plan indicated that the resident was at risk for change in mood or behavior due to schizoaffective disorder, depression, anxiety, panic attacks, adjustment disorder, and insomnia. The review of the residents' care plan identified the resident used anti-anxiety medication related to anxiety, panic attacks, and insomnia. The resident used psychotropic medication related to schizoaffective disorder, had an adjustment disorder with mixed anxiety, depressed mood and insomnia. 5. A review of Resident #82's admission Record indicated the resident was initially admitted on [DATE] and re-admitted on [DATE]. The record included diagnoses not limited to generalized anxiety disorder (onset date 10/19/21), recurrent severe major depressive disorder without psychotic features (onset date 10/19/21), bipolar type schizoaffective disorder (onset date 10/19/21), and alcohol abuse in remission (onset date 11/23/21). The admission Record identified the above diagnosis were active at admission. The PASRR for Resident #82, completed at an acute facility on 10/12/21, did not identify the resident had any Mental Illness (MI) or suspected MI (SMI). The service section of the decision making identified the resident had a history of anxiety, was not currently, had previously, or had been referred to MI services. The Order Summary Report for Resident #82 identified the resident was actively receiving Desvenlasfaxine Succinate Extended Release 50 mg tablet daily for depression, Olanzapine 15 mg daily for schizoaffective disorder, and Trazodone 100 mg daily for insomnia with depression. The Psychiatry Subsequent Note, dated 3/29/23 identified Resident #82's chief complaint was for depression, anxiety, and schizoaffective disorder and the reason for the visit was the patient was unstable requiring psychiatric assessment. The note indicated the resident was having anxiety but refused to take any SSRI's due to those don't work. The Psychiatry Subsequent Note, dated 4/5/23, identified that Resident #82 was being seen for depression, anxiety, and schizoaffective disorder. The plan indicated that the resident was unstable but did not require any medication changes. The plan of action was to continue Olanzapine for schizoaffective disorder, Trazodone for depression, and Desvenlafaxine for anxiety. The quarterly Minimum Data Set (MDS), dated [DATE], identified Resident #82 had active diagnoses that included seizure disorder or epilepsy, anxiety disorder, depression other than bipolar, and schizophrenia. The assessment indicated the resident received 7 days of antipsychotics and antidepressant medications during the period. A review of Resident #82's care plan identified the resident had behavior problem - yelled, screamed, and refused care/treatment. The care plan indicated the resident was at risk for change in mood or behavior due to schizophrenia, schizoaffective disorder, bipolar disorder, depression with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 9 of 16 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 04/19/2023 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few insomnia, hallucinations - having conversations with others that are not present at times, initiated on 10/20/21. Resident #82's care plan identified that the resident received antidepressant medication Trazodone related to depression with insomnia (initiated on 10/20/21) and used the psychotropic medications Effexor/Olanzapine related to schizophrenia/bipolar disorder (initiated 10/20/21). On 4/18/23 at 2:27 p.m., the Nursing Home Administrator stated that PASRR's are done in the hospital and that Social Services at the facility assists with them. On 4/19/23 at 3:43 p.m., the Social Service Director stated if the PASRR from the hospital was not correct a new one should be submitted. He said he would only submit another one if a new MI diagnosis was the primary diagnosis. A review of Resident #24's evaluation was done and the SSD stated the review was to notify the agency that the facility was thinking they needed to be reviewed again. The SSD reviewed Resident #82's PASRR and said the diagnoses needed to be checked off because it did not say the MI needed to be a primary diagnosis. A review of Resident #4's PASRR was conducted and the SSD stated the form should have been completed in the resident's given name not the name the resident preferred to be called. The PASRR should indicate the MI diagnoses and the resident received psychiatric services. The SSD said the PASRR's completed on 4/18/23 were done by request of the Director of Nursing and Regional [NAME] President for further review. The policy titled - Pre-admission Screening and Resident Review, issued 6/6/19 and revised 10/6/22, indicated that the facility would ensure that potential admissions are be screened for possible serious mental disorders or intellectual disabilities and related conditions. The initial pre-screening is referred to as a PASARR Level I and is completed prior to admission to a nursing facility. A negative Level I screen permits admission to proceed and ends the PASARR process unless a possible serious mental disorder or intellectual disability arises later. A positive Level I screen necessitates an in-depth evaluation of the individual by the state-designated authority, known as PASARR Level II which must be conducted prior to admission to a nursing facility. The procedure portion of the policy indicated that the facility was to ensure Level I PASARR screening had been completed on potential admissions prior to admission. A record of the pre-screening should be retained in the resident's medical record. As part of the PASARR process, the facility is required to notify the appropriate state mental health authority or state intellectual disability authority when a resident with a mental disorder (MD) or intellectual disability (ID) has a significant change in their physical or mental condition. Any resident with newly evident or possible serious mental disorder, ID, or a related condition must be referred by the the facilty to the appropriate state-designated mental health or intellectual disability authority for review. Examples of individuals who may not have previously been identified by PASARR to have MD, ID or a related condition include but is not limited to: a. A resident who exhibits behavioral, psychiatric, or mood related symptoms suggesting the presence of a mental disorder (where dementia is not the primary diagnosis). Based on record review and interview, the facility failed to complete the Preadmission Screening and Resident Review (PASARR) Level II upon a qualifying mental health diagnosis for five (Residents #257, #25, #24, #82, and #4) of thirty-two residents sampled for PASARR Level II. Findings included: 1. A review of the admission Record showed Resident #257 was admitted into the facility on [DATE] with a diagnosis of major depressive disorder with an onset date of 04/01/23. Review of Resident #257's PASARR Level I Screen dated 03/22/23, completed at a local hospital, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 10 of 16 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 04/19/2023 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 0644 revealed no qualifying mental health diagnosis and the Level II PASARR evaluation was not required. Level of Harm - Minimal harm or potential for actual harm 2. A review of the admission Record showed Resident #25 was admitted into the facility on [DATE] with diagnoses of paranoid schizophrenia, brief psychotic disorder, bipolar disorder, current episode depressed, mild or moderate severity, unspecified, and generalized anxiety disorder with on onset date of 03/23/23. Residents Affected - Few Review of Resident #25's PASARR Level I Screen dated 03/20/23, completed at a local hospital, revealed no qualifying mental health diagnosis and the Level II PASARR evaluation was not required. On 04/19/23 at 4:02 p.m. the Social Services Director (SSD) stated because the psych diagnoses for each resident was not the primary diagnosis, he would not check the box for the diagnoses on the Level I PASARR because it would have triggered him to complete a Level II PASARR. A Level II PASARR was only needed if the primary diagnosis was a psych diagnosis. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 11 of 16 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 04/19/2023 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to revise the care plan for one (Resident #24) of thirty-five sampled residents related to code status. Findings included: A review of Resident #24's admission Record indicated the resident had been admitted to the facility on [DATE] with diagnoses that were not limited to Multiple Sclerosis, unspecified heart failure, and unspecified chronic obstructive pulmonary disease. A review of Resident #24's care plan, on [DATE] at 2:28 p.m., included a focus that identified the resident as (resident) has Advance Directives Cardiopulmonary Resuscitation (CPR) - Full code. Certificate of Terminal Illness (CIT) in place. The focus was initiated on [DATE] and revised by Staff G, Minimum Data Set Licensed Practical Nurse (MDS, LPN) on [DATE]. The interventions attached to the residents' advance directives included the following: - Code status will be reviewed on a quarterly basis and as needed (prn), initiated [DATE]. - Resident has decided to remain a full code, initiated [DATE] and revised on [DATE]. The review of Resident #24's admission Record indicated that the resident's chose of advance directives was Do not resuscitate per patient request. The resident's Order Summary Report included an active physician order, dated [DATE], Do not resuscitate per patient request. The observation of Resident #24's clinical record located in the 100-hall nursing station indicated a goldenrod-colored Do Not Resuscitate Order, signed on [DATE] by both the physician and resident. The Care Plan Conference Record, dated [DATE], indicated that there was no change in Code Status. On [DATE] at 3:30 p.m., Staff G, MDS LPN, stated when a resident had a change in status the facility revised the care plan. Staff G reviewed Resident #24's care plan and stated, Yes, the care plan should have been revised and Social Work are the ones who would have revised the care plan. During an interview on [DATE] at 2:27 p.m. with the Director of Nursing (DON), she reviewed Resident #24's care plan and said an issue was identified with the care plans. The facility was working on a Performance Improvement Plan (PIP) to ensure care plans were accurate, current, and patient-centered. The facility provided a policy titled Comprehensive Care Plans and Revisions, issued [DATE] and reviewed [DATE]. The policy indicated that The facility will ensure the timeliness of each residents person-centered, comprehensive care plan and to ensure that the comprehensive care plan is reviewed and revised by an interdisciplinary team composed of individuals who have knowledge of the resident and his/her needs, and that each resident and resident representative, if applicable, is involved in developing the care plan and making decisions about his or her care. The procedure indicated that the resident should be monitored and the person-centered plan of care be updated when the resident condition changes and when the changes occur, the facility should review and update the plan of care to reflect the changes to care delivery, this can include; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 12 of 16 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 04/19/2023 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 0657 a. Additional interventions on existing problems, Level of Harm - Minimal harm or potential for actual harm b. Updating goal or problem statements,. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 13 of 16 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 04/19/2023 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 the medication error rate was below 5.00%. A total of twenty-seven medications were observed, and two errors were identified for two (Residents #8, #78) of four residents observed. These errors constituted a medication error rate of 7.41 percent. Residents Affected - Few Findings included: On 04/19/2023 at 08:00 a.m., an observation of medication administration with Staff F, Registered Nurse (RN), was conducted with Resident #8. Staff F was observed administering medication Trelegy Ellipta Inhalation one (1) puff inhaled. The resident inhaled two (2) puffs and then was observed to be given a clear medication cup of 09:00 a.m. medications with water. Resident #8 swallowed the medications with water and did not rinse her mouth during the observation. Review of the pharmacy label for the above medication read Wait one minute between inhalation and rinse mouth after use. A review of the Medication Administration Record (MAR) for Resident #8 showed the medication was scheduled to be administered at 10:00 a.m., and not at 08:00 a.m. Record review of the active physician's orders for Resident #8 dated 03/27/2023 read Trelegy Ellipta Inhalation Aerosol Powder Breath Activated 200-62.5-25 MCG/ACT (Fluticasone-Umeclidinium-Vilanterol) One puff inhale orally one time a day for diagnosis of COPD. During an interview conducted on 04/19/2023 at 2:32 p.m., with Staff F, she revealed she did not realize she administered the medication early. Staff F confirmed she gave the medication early and further stated I'm sorry, I did not see the pharmacy directions, and I should have had the resident rinse and spit out after I gave the medication. A review of a facility-provided policy titled Administration of Medications with revision date 02/13/2023, Pages 01, 02 of Pages 04, revealed: Policy: The facility will ensure medications are administered safely and appropriate per physician order to address residents 'diagnoses and signs and symptom. Procedure: 3. Right Dose -Check the Medication Administration Record (MAR) and the doctor's order before medicating 5. Right Time and Frequency- check the order for when it would be given and when was the last time it was given. On 4/19/2023 at 11:06 a.m., an observation of medication administration with Staff B, Licensed Practical Nurse (LPN), was conducted with Resident #78. Staff B was observed administering Humalog Kwik-Pen Insulin (Lispro) U-100/Milliliter (ML). Staff B was observed not priming the insulin pen first with an air shot of two units. Staff B dialed up sixteen units and administered the insulin to Resident #78. An immediate interview was conducted with Staff B who confirmed she did not prime the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 14 of 16 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 04/19/2023 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 insulin pen first before administering the dose to Resident #78. Staff B stated, I always thought when it was a new pen opened, you primed it, I did not know you had to do that every time you give insulin. A record review of active physician orders for the Resident #78 read as follows: Dated 12/30/2022 Humalog Kwik Pen Insulin (insulin lispro) 100 unit/ml, sliding scale units before meals three times a day, and at bedtime for Diagnosis of Type 2 Diabetes, Mellitus with hyperglycemia. According to manufacturer instruction insert for priming Humalog Kwik-Pen Insulin (Lispro) U-100, https://pi.lilly.com/us/humalog-kwikpen-um.pdf Priming your Pen: -Prime before each injection. - Priming your Pen means removing the air from the Needle and Cartridge that may collect during normal use and ensures that the Pen is working correctly. -If you do not prime before each injection, you may get too much or too little insulin. -Step 6: - To prime your Pen, turn the Dose Knob to select 2 units. Step 7: - Hold your Pen with the Needle pointing up. Tap the Cartridge Holder gently to collect air bubbles at the top. Step 8: - Continue holding your Pen with Needle pointing up. Push the Dose Knob in until it stops, and 0 is seen in the Dose Window. Hold the Dose Knob in and count to 5 slowly. You should see insulin at the tip of the Needle. - If you do not see insulin, repeat priming steps 6 to 8, no more than 4 times. - If you still do not see insulin, change the Needle, and repeat priming steps 6 to 8. Small air bubbles are normal and will not affect your dose. An interview was conducted with the Director of Nursing (DON) on 04/19/2023 at 11:58 a.m. During the interview, the DON was informed of the observations conducted of medication administration for Resident's #8 and #78. The DON stated Nurses should be priming the (insulin) pen before administration of each dose; and the medication Trelegy, was given one hour before it was supposed to be given. I will make sure education is given to the nurses to follow pharmacy labeling instructions for dose, rinsing and spitting out after use of the medication. A facility provided policy titled, Insulin Pen Administration, dated 08/10/2022, Page 01 and Page 02, reads under Policy The facility will ensure residents with orders for insulin administration through the use of a pen delivery device is performed in accordance with current standards or practice (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 15 of 16 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 04/19/2023 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 and manufacturer's guidance. Level of Harm - Minimal harm or potential for actual harm Procedure: Residents Affected - Few 4. The insulin pen should be primed prior to each use (in accordance with manufacturers' guidelines) to prevent the collection of air in the insulin reservoir. a. General guidance on priming an insulin pen in the absence of manufacturers guidance. i. Dial 2 units by turning the dose selector clockwise. ii. With the needle pointing up, push on the plunger, and watch to see that at least one drop of insulin appears on the tip of the needle. If not, repeat this procedure until at least one drop of insulin appears. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106049 If continuation sheet Page 16 of 16