Inspection·July 17, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm condition and providing treatment(s) according to the resident's wishes and physician's orders. Procedure: 1. Observe resident during routine care and during monthly/quarterly/annual assessment periods to identify significant changes in physical or mental conditions, orientation, change in vital signs, weights, etc. 7. Contact the primary physician to update him/her to the change in condition. In the event the primary physician cannot be notified, attempt to contact the facility's medical director. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106099 If continuation sheet Page 2 of 4 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 106099 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villages Healthcare and Rehabilitation Center, The 900 Highway 466 Lady Lake, FL 32159 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and policy review, the facility failed to prevent the possible spread of infection by failing to ensure staff performed hand hygiene during medication administration for 2 of 2 residents, Residents #11 and #12, reviewed for medication administration. Findings include:During an observation on 07/16/2025 at 09:00 AM Staff E, Licensed Practical Nurse (LPN) entered Resident #11's room, did not complete hand hygiene, and used an automatic blood pressure cuff on Resident #11's right wrist and obtained the blood pressure reading. Staff E, LPN exited the resident's room, did not perform hand hygiene, walked back to the medication cart, and placed five tablets and one capsule (oral medications) into a medication cup. Staff E, LPN entered Resident #11's room, did not perform hand hygiene and handed Resident #11 the medication cup. Resident #11 proceeded to take the medications orally with water. Staff E, LPN exited Resident #11's room, did not perform hand hygiene, walked back to the medication cart in the hallway, and placed a new medication cup on top of the medication cart. Staff E, LPN stated that he was going to check the blood pressure of another resident and picked up the blood pressure cuff and preceded to a different resident's room.During an interview on 07/16/2025 at 09:10 AM, Staff E, LPN confirmed that he did not perform hand hygiene before or after administering medications to Resident #11. Staff E, LPN stated, I should have cleaned my hands.During an observation on 07/16/2025 at 08:51 AM, Staff D, LPN placed four tablets and one capsule (oral medications) into a medication cup. Staff D, LPN proceeded to enter Resident #12's room, did not perform hand hygiene, handed the medication cup to Resident #12. Resident #12 preceded to take the pills and dropped one pill on her shirt. Staff D, LPN picked up the pill with her bare hand and placed it back into the medication cup. Resident #12 took the remaining pills.During an interview on 07/16/2025 at 08:57 AM, Staff D, LPN confirmed that she did not perform hand hygiene upon entering the resident's room, picked up the pill from Resident #12's shirt without wearing gloves, and placed it back into the medication cup. Staff D, LPN stated, I should have worn gloves to pick up the pill.During an interview on 07/16/2025 at 10:10 AM, the Director of Nursing (DON) stated that her expectation is that nurses are to complete hand hygiene before and after administering medications, and when hands are visibly soiled. The DON stated that when a pill is dropped, the nurse is to pick up the pill using a gloved hand, dispose of the pill, and obtain a new pill for the resident.During an interview on 07/16/2025 at 11:00 AM Staff F, LPN the Unit Manager stated he expects the nurses to perform hand hygiene before and after administering medications to residents. Should a resident drop a pill on themselves or on the floor, if the resident picks up the pill themselves, and takes it, that is the resident's right, however, if the resident does not pick up the pill, the nurse should wear gloves to pick up the pill, dispose of it, and get the resident a new pill.Review of the policy and procedure titled, Medication Administration Issued 4/1/2022, read, Policy: It will be the policy of this facility to administer medications in a timely manner and as prescribed by the physician, unless clinically indicated or necessitated by other circumstances, such as lack of availability of medication or refusals of medication by the resident. Procedure: 11. Established facility infection control procedures (e.g., handwashing, antiseptic technique, gloves, isolation precautions, etc.) must be followed during the administration of medications.Review of the policy and procedure titled, Infection Prevention and Control Program Revised 11/28/2022, read, Policy: The primary mission is to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Procedure: It is the standard that this facility's Infection Prevention and Control program (IPCP), is based upon information from the Facility Assessment and follows national standards to prevent, Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106099 If continuation sheet Page 3 of 4 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 106099 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villages Healthcare and Rehabilitation Center, The 900 Highway 466 Lady Lake, FL 32159 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm recognize, and control the onset and spread of infection whenever possible. The Infection Prevention and Control Program includes: h. The hand hygiene guidelines to be followed by staff involved in direct resident contact. Surveillance/Monitoring: h. Safeguards against exposure to a potential source of infection. i. Uses appropriate hand hygiene prior to and after all guidelines. n. Ensures that reusable equipment is appropriately cleaned, disinfected, or reprocessed. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106099 If continuation sheet Page 4 of 4