Inspection·October 2, 2025

F 0732 Post nurse staffing information every day. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to ensure accurate nurse staffing data was posted on a daily basis.Findings include:During an observation on 9/29/2025 at approximately 9:50 AM, the nurse staffing report posted on the Skilled Nursing Unit documented the resident census as 39 (Photographic evidence obtained).During an interview on 9/29/2025 at 9:51 AM, Staff C, Licensed Practical Nurse (LPN), stated that the posted staffing was not correct and the census should have been documented as 29 and it should be corrected.During an interview on 9/30/2025 at 1:43 PM, the Director of Nursing (DON) stated that the expectation was the daily staffing sheet was to be completed by the 11-7 shift [11:00 PM - 7:00 AM] and that the resident census was based on the midnight census. It was not possible that the midnight census on 9/29/2025 was 39, as was documented on the staffing report. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106068 If continuation sheet Page 2 of 8 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 106068 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Terrace Rehab and Health Care Center 110 Lodge Terrace Dr Altoona, FL 32702 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure food was properly stored in 2 of 2 service kitchens (Rehabilitation Unit kitchen and Skilled Nursing Unit kitchen) and failed to ensure food was prepared in a sanitary manner. Findings include:During an observation on 9/29/2025 at 9:55 AM, there were four frozen individually wrapped packages of pancakes in a clear plastic packaging with no label inside of a plastic bin with no label or date inside of a freezer located in the skilled nursing facility kitchen.During an interview on 9/29/2025 at 9:55 AM, Staff F, Certified Dietary Manager (CDM), stated, We did not serve pancakes for breakfast today. We served waffles.During an observation on 9/29/2025 at 10:20 AM, there were one opened container of chocolate syrup, one opened container of mayonnaise, one opened container of hot sauce, and one opened sweet relish the Rehabilitation Unit refrigerator, which were not labeled with opened or discard by dates (Photographic evidence obtained).During an interview on 9/29/2025 at 10:20 AM, Staff F, CDM, stated, Food items and condiments should always be labeled with the date after opening. Review of the facility policy and procedure titled Food Storage with the last review date of 1/17/2025 read, Policy: Sufficient storage facilities will be provided to keep foods safe, wholesome, and appetizing. Food will be stored in an area that is clean, dry and free from contaminants . Procedure: 8. Plastic containers with tight fitting covers or sealable plastic bags must be used for storing grain products, sugar, dried vegetables and broken lots of bulk foods or opened packages. All containers or storage bags must be legible and accurately labeled and dated . 13. Refrigerated food storage . f. All foods should be covered, labeled and dated and routinely monitored to assure that foods (including leftovers) will be consumed by their use dates, or frozen (where applicable) or discarded. During an observation on 9/30/2025 at 12:40 PM, Staff D, Dietary Lead Cook, placed beef into a food processor, pushed a button on the blender, then removed the canister from the food processor, and continued plating food for lunch service for the residents. Staff D then walked to a cabinet, retrieved a stack of dishes from the cabinet, and resumed plating the food. Staff D then passed a plate of food to a staff member with her right gloved thumb touching the inner food contact surface of the plate. Staff D then wiped her gloved thumb on a white towel, which was sitting on the tray line. Staff D then used the same white towel to wipe the top edge of a plate of food. Staff D picked up a baked potato with her gloved right hand and sliced the potato. Staff D did not perform hand hygiene or don new gloves before beginning each new task.During an interview on 9/30/2025 at 12:50 PM, Staff F, CDM, confirmed that the Dietary Lead [NAME] should have removed her gloves, washed her hands, and changed into new gloves before beginning new tasks.Review of the facility policy and procedure titled Hand Hygiene/Hand Washing with the last review date of 1/17/2025 read, Purpose: To prevent transmissible infections and prevent contamination by bloodborne pathogens. Hand washing is the single most effective deterrent to the spread of infection . Procedure: 1. All staff shall perform hand hygiene to prevent the spread of infection. Before handling clean equipment or supplies; Before and after serving food. Event ID: Facility ID: 106068 If continuation sheet Page 3 of 8 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 106068 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Terrace Rehab and Health Care Center 110 Lodge Terrace Dr Altoona, FL 32702 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 record review and interview, the facility failed to ensure medical records were complete and accurate regarding medication administration and blood sugar monitoring for 1 of 5 residents reviewed for unnecessary medications (Resident #2).Findings include:Review of Resident #2's physician order dated 9/3/2025 read, Accu-check blood sugar monitoring, two times a day.Review of Resident #2's Medication Administration Record (MAR) for blood sugar monitoring two times a day (discontinued on 9/19/2025 at 2:07 PM) for September 2025 revealed the resident refused the blood sugar check on 9/6/2025 at 9:00 AM and 9:00 PM, 9/7/2025 at 9:00 AM, 9/8/2025 at 9:00 AM, 9/9/2025 at 9:00 AM and 9:00 PM, 9/10/2025 at 9:00 PM, 9/11/2025 at 9:00 PM, 9/12/2025 at 9:00 AM and 9:00 PM, 9/13/2025 at 9:00 AM and 9:00 PM, 9/14/2025 at 9:00 PM, 9/15/2025 at 9:00 AM and 9:00 PM, 9/16/2025 at 9:00 AM and 9:00 AM, 9/17/2025 at 9:00 AM and 9:00 PM, 9/18/2025 at 9:00 AM and 9:00 PM, and 9/19/2025 at 9:00 AM.Review of Resident #2's physician order dated 9/19/2025 read, Accu-check blood sugar monitoring, twice a day 0630 [6:30 AM] and 2100 [9:00 PM] two times a day.Review of Resident #2's MAR for blood sugar monitoring twice a day at 6:30 AM and 9:00 PM for September 2025 revealed the resident refused the blood sugar check on 9/19/2025 at 9:00 PM, 9/20/2025 at 6:30 AM and 9:00 PM, 9/21/2025 at 9:00 PM, 9/22/2025 at 6:30 AM and 9:00 PM, 9/23/2025 at 6:30 AM, 9/24/2025 at 6:30 AM and 9:00 PM, 9/25/2025 at 9:00 PM, 9/26/2025 at 9:00 PM, 9/27/2025 at 6:30 AM and 9:00 PM, 9/28/2025 at 6:30 AM and 9:00 PM, 9/29/2025 at 6:30 AM; 9/29/2025 at 9:00 PM, 9/30/2025 at 9:00 PM.Review of Resident #2's physician order dated 9/19/2025 read, Accu-check blood sugar monitoring, twice a day 0630 [6:30 AM] and 2100 [9:00 PM] two times a day.Review of Resident #2's physician order dated 8/28/2025 read, Lantus SoloStar 100 unit/ml [milliliter] Solution pen-injector, Inject 10 unit subcutaneously at bedtime related to type 2 diabetes mellitus with other specified complication.Review of Resident #2's physician order dated 8/28/2025 read, Insulin Glargine Subcutaneous Solution 100 unit/ml (Insulin Glargine), Inject 10 unit subcutaneously at bedtime related to type 2 diabetes mellitus with other specified complication.Review of Resident #2's MAR for administration of Insulin Glargine for August 2025 revealed the resident refused the medication on 8/28/2025.Review of Resident #2's MAR for administration of Insulin Glargine for September 2025 revealed the resident refused the medication on the following dates: 9/9/2025, 9/10/2025, 9/11/2025, 9/12/2025, 9/14/2025, 9/15/2025, 9/18/2025, 9/19/2025, 9/20/2025, 9/21/2025, 9/22/2025, 09/24/2025, 9/25/2025, 9/26/2025, 9/27/2025, 9/28/2025, 9/29/2025, and 9/30/2025.Review of Resident #2's progress notes for September 2025 revealed no documentation of notification to or communication with Resident #2's primary care provider/physician regarding refusal of blood sugar monitoring and insulin administration.During an interview on 9/30/2025 at approximately 2:00 PM, Staff A, Licensed Practical Nurse (LPN), stated that the doctor was aware that Resident #2 was refusing his accu-checks and his insulin, but that according to his family, he had not had the same behavior at home. The doctor wanted the insulin given even if the resident refused to have his blood sugar checked. His blood sugars, when they were able to check them, were usually pretty stable.During an interview on 9/30/2025 at 2:30 PM, the Director of Nursing (DON) stated that residents had the right to refuse treatments or medications. If a resident refused three days in a row, they were supposed to notify the physician.During an interview on 10/1/2025 at 10:00 AM, Staff B, LPN, stated that if a resident refused a medication, she would attempt multiple times to administer it, because sometimes they would change their mind, and she knew it was better for the resident and her, if they took the medicine. If they continued to refuse the medication, she would follow the protocol which was to call the doctor and write a note.During an interview on 10/1/2025 at approximately 11:00 AM, Staff A, LPN, stated that regarding (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106068 If continuation sheet Page 4 of 8 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 106068 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Terrace Rehab and Health Care Center 110 Lodge Terrace Dr Altoona, FL 32702 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 #2 refusing his accu-checks and/or insulin, she communicated with the physician by writing a note in the physician communication binder at the nurses' station.During an interview on 10/1/2025 at 2:15 PM, the DON stated that she had reviewed Resident #2's chart and the Physician Communication Binder. The DON confirmed a number of occurrences where Resident #2 had refused either his accu-check and/or his insulin injection, and that there was no documentation except for the codes used on the MAR to indicate the resident had refused. The DON's previous statement regarding the policy of notifying the physician after a resident refused medication or treatment for three days, was an inaccurate statement and pertained to a policy from a facility where she worked previously.During an interview on 10/1/2025 at 3:59 PM, Staff E, LPN, stated that if a resident refused medication, she would educate them about what the medication was and why they needed it. She would let the doctor know. She would call them (the doctors) and document it. Event ID: Facility ID: 106068 If continuation sheet Page 5 of 8 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 106068 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Terrace Rehab and Health Care Center 110 Lodge Terrace Dr Altoona, FL 32702 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 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility failed to ensure the arbitration agreement included the required elements for 3 of 3 residents reviewed for arbitration (Residents #11, #36, and #35). Findings include:Review of Skilled Nursing Facility admission and Financial Agreement for Resident #11 entered into on 7/8/2025 between the facility and Resident #11 showed it contained a section titled 44. Dispute Resolution, which did not contain the information specifying that signing the dispute resolution was not a requirement of admission or continuing care; the resident or representative could rescind the dispute resolution within 30 days of signing; the resident was not prohibited from communicating with other entities or agencies; the arbitration would be held in a location convenient to both parties; and the resident or representative understood the dispute resolution agreement.Review of Skilled Nursing Facility admission and Financial Agreement for Resident #35 entered into on 12/11/2025 between the facility and Resident #35 showed it contained a section titled 44. Dispute Resolution, which did not contain the information specifying that signing the dispute resolution was not a requirement of admission or continuing care; the resident or representative could rescind the dispute resolution within 30 days of signing; the resident was not prohibited from communicating with other entities or agencies; the arbitration would be held in a location convenient to both parties; and the resident or representative understood the dispute resolution agreement.Review of Skilled Nursing Facility admission and Financial Agreement for Resident #36 entered into on 9/22/2025 between the facility and Resident #35 showed it contained a section titled 44. Dispute Resolution, which did not contain the information specifying that signing the dispute resolution was not a requirement of admission or continuing care; the resident or representative could rescind the dispute resolution within 30 days of signing; the resident was not prohibited from communicating with other entities or agencies; the arbitration would be held in a location convenient to both parties; and the resident or representative understood the dispute resolution agreement. During interview on 10/2/2025 at 8:08 AM, the Clinical Liaison confirmed the admission agreement with dispute resolution entered into by Resident #11, Resident #35 and Resident #36 was the arbitration agreement in effect at the facility. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106068 If continuation sheet Page 6 of 8 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 106068 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Terrace Rehab and Health Care Center 110 Lodge Terrace Dr Altoona, FL 32702 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 0848 Provide a neutral and fair arbitration process and agree to arbitrator and venue. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility failed to ensure the arbitration agreement provided for the selection of a venue convenient to both parties for 3 of 3 residents reviewed for arbitration (Residents #11, #36, and #35).Findings include:Review of Skilled Nursing Facility admission and Financial Agreement for Resident #11 entered into on 7/8/2025 between the facility and Resident #11 showed it contained a section titled 44. Dispute Resolution, which failed to specify that the arbitration would be held in a location convenient to both parties.Review of Skilled Nursing Facility admission and Financial Agreement for Resident #35 entered into on 12/11/2025 between the facility and Resident #35 showed it contained a section titled 44. Dispute Resolution, which failed to specify that the arbitration would be held in a location convenient to both parties.Review of Skilled Nursing Facility admission and Financial Agreement for Resident #36 entered into on 9/22/2025 between the facility and Resident #35 showed it contained a section titled 44. Dispute Resolution, which failed to specify that the arbitration would be held in a location convenient to both parties.During interview on 10/2/2025 at 8:08 AM, the Clinical Liaison confirmed the admission agreement with dispute resolution entered into by Resident #11, Resident #35 and Resident #36 was the arbitration agreement in effect at the facility. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106068 If continuation sheet Page 7 of 8 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 106068 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Terrace Rehab and Health Care Center 110 Lodge Terrace Dr Altoona, FL 32702 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, interview, and record review, the facility failed to ensure staff performed hand hygiene during medication administration when required to prevent the possible spread of infection and communicable diseases.Findings include:During an observation on 10/1/2025 at 10:00 AM, Staff B, Licensed Practical Nurse (LPN), was preparing oral medications for Resident #25. Staff B touched a Ferrous Sulfate tablet with her ungloved hand. During administration, Resident #25 dropped a tablet from the medication cup into her lap. Staff B picked up the tablet with her ungloved hand and handed it to Resident #25 for oral administration.During an interview on 10/1/2025 at 10:08 AM, Staff B, LPN, stated that she usually attempted to just pour the pills out of the bulk bottle into the bottle lid and then into the cup because she knew she was not supposed to touch the medications. Staff B confirmed that she used her ungloved hand to pick up a tablet and hand it to Resident #25.During an interview on 10/2/2025 at approximately 9:00 AM, the Director of Nursing (DON) stated that the expectation was during medication administration, nurses should perform hand hygiene, wear gloves, and if a pill dropped onto an unclean surface, such as in a resident's lap, identify the pill, discard it, and replace the pill. If the nurse was not able to identify the pill, notify the physician, and write an incident report. Nurses should not touch medications with their hands.Review of the facility policy and procedure titled Administering Medications with the last approval date of 1/17/2025 read, Policy Statement: Medications are administered in a safe and timely manner, and as prescribed. Policy Interpretation and Implementation: 25. Staff follows established facility infection control procedures (e.g. handwashing, antiseptic technique, gloves, isolation precautions, etc.) for the administration of medications. Review of the facility policy and procedure titled Hand Hygiene/Hand Washing, with the last approval date of 1/17/2025 read, Purpose: To prevent transmissible infections and prevent contamination by bloodborne pathogens. Hand washing is the single most effective deterrent to the spread of infection. Procedure: 1. All staff shall perform hand hygiene to prevent the spread of infection. Before and after assisting with medications; After contact with contaminated material or surfaces, even if gloves are worn. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106068 If continuation sheet Page 8 of 8