Health inspection·October 1, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few times a day. (a medication to decrease the amount of acid produced in the stomach)-Carbamazepine 200 mg. 1 tablet three times a day. (a medication to treat seizures, nerve pain, or manage episodes of mania associated with bipolar disorder)-Clopidogrel 75 mg. 1 tablet one a day. Resume on 8/26/25. (medication used to prevent blood clots)-Duloxetine 20 mg delayed release. 1 capsule once a day. (a medication used to treat mental health conditions such as depression and anxiety as well as some chronic pain conditions)-Folic acid 1 mg. 1 tablet once a day. (medication used as a dietary supplement)-Lactulose 10 grams (g) oral. Once a day. (a medication used to treat constipation and to manage a brain condition caused by liver disease)-Losartan 100 mg. 1 tablet once a day. (a medication used to treat high blood pressure)-Melatonin 3mg. 1 tablet daily at bedtime as needed for sleep.-polyethylene glycol 3350 oral powder. 17 g as needed. (a medication to treat occasional constipation)-Propranolol 60 mg. 1 tablet two times a day. (a medication used to treat heart related issues such as high blood pressure and irregular heartbeats, migraines, tremors, and some types of anxiety)-Senna 8.6 mg. 2 tablets two times a day as needed for constipation. (a medication used for short term relief of constipation) Review of Resident #1's facility order listing report showed the above medications were not entered into the resident's medical record as a physicians' order at the facility. Resident #1's hospital Discharge Instructions: Medications showed: -Lidocaine topical 5%. 1 patch every 24 hours. (a medication used for local pain relief)-Atorvastatin 40 mg. 1 tablet daily at bedtime. (a medication used to lower cholesterol)-Clopidogrel 75 mg. 1 tablet once a day. Resume on 8/26/25. (a medication used to prevent blood clots) Review of Resident #1's facility order listing report showed upon admission the order entered for Lidocaine was for a 5% patch and the ordered entered for Atorvastatin was for 80 mg daily at bedtime. The order entered for Clopidogrel started on 8/23/25. Review of Resident #1's facility physician orders showed the following medications ordered at the facility upon admission that were not on the resident's hospital discharge medication list:-Albuterol-Budesonide Inhalation Aerosol 90-80 micrograms per actuation (mcg/act). 2 puffs inhale orally every 4 hours as needed for shortness of breath.- Ascorbic acid tablet 500 mg. 1 tablet two times a day for vitamin deficiency.-Azithromycin 500 mg. 1 tablet one time a day for antibiotic related to a urinary tract infection (UTI) for 5 days.-Carvedilol 3.125 mg. 1 tablet by mouth 2 times a day. Hold if systolic blood pressure (SBP) is <100 and pulse <50 related to essential hypertension.-Fluticasone propionate suspension 50 micrograms per actuation (mcg/act). 2 sprays in each nostril every 24 hours as needed for allergy symptoms.-Furosemide 20 mg. 1 tablet by mouth one time a day for edema.-Ipratropium-Albuterol 0.5-2.5 mg/2ml. 1 dose inhale orally every 4 hours as needed for shortness of breath.-Medrol oral therapy pack 4 mg. 1 tablet every morning and at bedtime related to chronic obstructive pulmonary disease (COPD) exacerbation.-Trelegy Ellipta Inhalation Aerosol powder breath activated 100-62.5-25 mcg/act. 1 puff inhale orally one time a day related to COPD exacerbation. Review of Resident #1's Medication Administration Record (MAR) for August 2025 showed:-Trelegy Ellipta inhalation aerosol 100-62.5-25 mcg/act for COPD (acute) was administered on August 24th, 25th, 26th, 27th, 28th, 29th, and 30th.-Ascorbic acid oral tablet 500 mg for Ascorbic Acid Deficiency, was administered on August 23rd, 24th, 25th, 26th, 27th, 28th, 29th, and 30th (morning dose)-Carvedilol oral tablet 3.125 mg was administered on August 23rd, 24th, 25th, 26th, 27th, 28th, 29th, and 30th-Medrol oral tablet therapy pack 4 mg for COPD (acute) was administered on August 23rd, 24th, 25th, 26th, 27th, 28th, 29th, and 30th.-Atorvastatin calcium oral tablet 80 mg was administered August 23rd through 29th.-Azithromycin oral tablet 500 mg for a Urinary tract infection was administered August 23rd through 27th.-Furosemide oral tablet 20 mg for edema was administered August 23rd through 30th.-Lidocaine external patch 4% for pain was administered August 23rd through 30th.-Pantoprazole sodium oral tablet 40 mg (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 2 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few (incorrect dose was administered August 23rd through 30th. Review of Resident #1's Nursing Admission, readmission Screening and History, dated 8/22/25, completed by Staff A, Licensed Practical Nurse (LPN) showed:Medication ReconciliationAre these orders to be clarified? No - Reviewed and no clarification neededMedications recommended by Hospital that need clarification: (no documentation)Note Clarification needed: (no documentation)Results after physician notification (continue, stop, change): (no documentation). Are there medications taken before hospitalization NOT currently on the hospital recommended list? No - Reviewed and no clarification neededMedications taken before hospitalization not currently on hospital recommended list?Comments such as reason for med (medication) and reason it was stopped in hospital (if known): (no documentation)Results after Physician notification (continue, stop, change): (no documentation) Review of Resident #1's medical record did not show any documentation the medication orders from the hospital were reconciled with a medical provider prior to being entered into the computer. Review of Resident #1's vital signs showed the resident had an elevated blood pressure of 202/116 on 8/25/25 at 7:53 a.m. and 170/108 at 4:46 p.m. (Normal blood pressure 120/80). Review of a provider note dated 8/25/25 by Resident #1's primary care Nurse Practitioner (NP) showed . labs on 8/26/25. Patient blood pressure has been elevated and a new order for carvedilol was started today. Will monitor for medication efficacy. Review of Resident #1's lab results, reviewed by the NP on 8/26/25 at 2:03 p.m. showed: SODIUM 135 milliequivalents (mEq)/liter (L) reference range 136-145 LowCHLORIDE 89 mEq/L reference range 98-110 LowGLUCOSE 364 mg/deciliter (dL) reference range 74-109 HighBUN 43 mg/dL reference range 7-25 High CREATININE 1.62 mg/dL reference range 0.6-1.3 HighB/C RATIO 26.54 reference range 8.0-25.0 HighAST (SGOT) 12 Units (U)/L reference range 13-39 Low ALKALINE PHOSPHATASE157 U/L reference range 34-104 HighGlomerular Filtration Rate (GFR) 32 reference range >60 ml/min Low GFR Reference Range: Stage IIIB Moderate to Severe loss of kidney function 30-44 milliliters/minute (ml/min) Review of progress notes showed an 8/26/25 nurse's note revealing Advanced Registered Nurse Practitioner (ARNP) ordered Intravenous fluids (IVF) normal saline (NS) at 50 ml/hour (hr) for 1000 ml total related to (r/t) lab results today. Review of Resident #1 physician orders showed:Peripheral line catheter continuous infusion: 0.9% sodium chloride, 50ml/hr, 1000ml total. Every shift monitor infusion related to dehydration for 2 days. Dated 8/26/25. Review of Resident #1's medical record did not show any documentation the NP or the facility addressed the residents blood glucose level of 364 mg/dL and the resident did not receive insulin. Review of Resident #1's vital signs showed the resident had an elevated blood pressure of 189/112 on 8/28/25 at 7:26 a.m. and 164/102 on 8/28/25 at 4:09 p.m. Review of Resident #1's medical record showed no documentation the provider was notified of the elevated blood pressure on 8/28/25 at 7:26 a.m. There was a nursing note on 8/28/25 at 4:39 p.m. explaining the provider was notified of the blood pressure reading of 164/102 and new order was received for a one time does of medication. Review of Resident #1's orders showed a one-time order for Amlodipine 5 mg for blood pressure of 164/102 on 8/28/25. A follow up blood pressure revealed on 8/28/25 at 9:06 p.m. was 140/80. Review of Resident #1's Lab results showed repeat labs were reviewed by Staff B, LPN on 8/28/25 at 5:10 p.m. The lab results showed: SODIUM 132 mEq/L 136-145 LowCHLORIDE 89 mEq/L 98-110 LowGLUCOSE 487 mg/dL 74-109 HighBUN 45 mg/dL 7-25 HighCREATININE 1.58 mg/dL 0.6-1.3 HighB/C RATIO 28.48 8.0-25.0 HighAST (SGOT) 12 U/L 13-39 LowALKALINE PHOSPHATASE 155 U/L 34-104 HighGFR 33 >60 ml/min Low Review of Resident #1's medical record showed no documentation a provider was notified of the abnormal lab results after the nurse reviewed them on 8/28/25 at 5:10 p.m. There was no documentation showing the resident's elevated blood glucose level of 487 mg/dL was addressed. Review of Resident #1's vital signs showed the resident had an elevated blood pressure of 180/114 on 8/29/25 at 7:38 a.m. Review of Resident #1's medical record (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 3 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few revealed there was no documentation a provider was notified of the resident's elevated blood pressure on 8/29/25 at 7:38 a.m. Review of Resident #1's progress notes showed:8/30/25 at 1:34 p.m. Resident BS [blood sugar] noted HI on meter, HI reading indicated a BS over 600. ARNP updated with new orders to give 15 units now after rechecking sugar then start lantus and insulin lispro low dose sliding scale8/30/25 3:29 p.m. Resident BS remains high on meter, ARNP updated with new orders to send to ER [emergency room] for eval [evaluation]. Review of Resident #1's MAR showed Insulin Lispro pen injector 200 u/ml. 15 units was administered at 1:40 p.m. on 8/30/25. Review of Resident #1's Summary for Providers, dated 8/30/25 showed:Change in ConditionNursing observations, evaluation, and recommendations are: Resident noted more lethargic than normal, able to arouse. BS reading HI on machine indicated over 600. 15 units units [sic] given per ARNP orders, recheck in 1 hour, re-checked and still showing HI. ARNP updated with new orders to send to the ER for evaluation. Review of Resident #1's vital signs did not show any documented blood glucose checks completed by the nurse from 8/22/25 until 8/30/25 when the resident was transferred to the hospital. An interview was conducted on 9/29/25 at 5:10 p.m. with Staff A, LPN. She said she had Resident #1 when she was admitted on [DATE]. She said another nurse, Staff C, LPN helped her by starting to put medications in the computer queue for the resident prior to her getting to the facility. Staff A said when the resident came, Staff C, continued to help with the paperwork then Staff C said these [orders] don't match you need to finish them because she had to assist her residents. Staff A said there was a lot going on that night and she didn't get to look at Resident #1's orders again until early the next morning when she finished putting them in the computer. She said she did not remember seeing insulin orders on the paperwork for the resident. Staff A said when the resident arrived Staff C sent the admission paper, the 3008, and the hospital medication list to the provider over the facility's text messaging system. Staff A said she did not remember the provider sending back or making any changes to Resident #1's orders. Staff A confirmed Resident #1 was confused and would not have known her medications. An interview was conducted on 9/29/25 at 2:58 p.m. with Staff C, LPN. Staff C said Staff A, LPN was assigned to Resident #1 on admission. She said all she did was start putting Resident #1's hospital orders in the queue. Staff C said she entered some of the medication orders in the computer then informed Staff A she needed to finish entering the orders and review everything. Staff C said she was just helping. An interview was conducted on 10/1/25 at 4:30 p.m. with Staff E, Certified Nursing Assistant (CNA). Staff E cared for Resident #1 on 8/25-8/28/25 on the 7: 00 a.m.-3:00 p.m. shift. Staff E said on 8/25/25 when she first met Resident #1, I thought maybe she was recovering from something, because she would kind of flop and throw herself back in bed. She said she had to get the nurse to assist her with transferring the resident. Staff E said a day, or two later Resident #1 must have gotten a new medication or maybe it was the IV fluids she got, but the resident was able to hold a good conversation. Staff E said she was able to get Resident #1 to shower and she made more sense. Staff E said she was off for a couple of days and when she returned, she was told the resident had gone back to the hospital. A follow-up interview was conducted on 10/1/25 at 3:18 p.m. with Staff C, LPN. She said she only assisted with entering medication orders for Resident #1 after the resident arrived at the facility. She said she entered orders from the paperwork the resident brought from the hospital. An interview was conducted on 9/29/25 at 1:43 p.m. with Resident #1's primary care NP. The NP said she did not get notified of Resident #1's abnormal lab results on 8/28/25. She confirmed it was a Thursday, and she would have been the person contacted. The NP said staff notified her about the abnormal labs on 8/26/25 and she ordered some IV fluids. She said Resident #1 did not say anything about her blood sugar levels. The NP did confirm Resident #1 was confused. During a follow-up interview on 10/1/25 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 4 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few at 5:51 p.m. the NP said she knew the resident had some high blood pressure readings and was put on a blood pressure medication. She said she had been notified of previous high blood pressures for Resident #1 but was not notified the resident's blood pressure was high on 8/29/25. She said for the abnormal labs she saw Resident #1's glucose level was high but thought maybe she was dehydrated and that is why she ordered IV fluids. She said she did not know about the second abnormal labs on 8/28/25. The NP did not want to comment on Resident #1 being on furosemide because she did not order it but said in general furosemide removes fluid from the body. The NP agreed it could cause dehydration. An interview was conducted on 9/29/25 at 1:52 p.m. with Staff B, LPN. Staff B confirmed she had cared for Resident #1, but she did not remember dates that far back and did not remember the resident very well. She said when a lab was reviewed by the nurse it is marked on the lab itself with the date and time it was reviewed. Staff B said if the results were abnormal they should have been sent to the provider and a nursing note put in the computer saying a provider was notified. An interview was conducted on 9/30/25 at 10:32 a.m. with Staff D, Registered Nurse (RN). Staff D said she remembered Resident #1 and was the supervisor in the facility when the resident was sent to the hospital. Staff D said she made rounds frequently on the units and touched base with nurses. She said on 8/30/25 a CNA came to her and said Resident #1 was different than she had been the weekend before. She said the CNA told her the previous weekend, August 23rd/24th, the resident had been up walking around and was busy. Staff D said on 8/30/25 Resident #1 was lying in bed, lethargic, and would talk, but barely. Staff D said she had seen Resident #1 the weekend she had been admitted to the facility. She said the resident had been confused, but the family said it was her baseline. She said the resident got up and walked around her room sometimes without waiting for assistance. Staff D said when she saw how the resident was on 8/30/25 she did a full assessment on Resident #1 and part of that was checking her blood glucose level since she was diabetic. Staff D said the resident's blood glucose was high and she worked with Resident #1's assigned nurse to update the provider and get orders. Staff D said she looked at the resident's medical record because she liked to gather what information she can provide to paramedics and the emergency department. She said during her review she noticed Resident #1 had two sets of labs since her admission that showed high blood glucose levels, one in the 300s and one in the 400s. Staff D said during her chart review she noticed the resident was not being administered any insulin or medication for diabetes by mouth. Staff D said she had not been informed the resident had any blood pressures issues but noticed Resident #1 had high blood pressure readings that week and was started on medication. Staff D said she pulled up Resident #1's admission paperwork from the hospital to compare to the orders the resident had in the computer, and she noticed Resident #1 had orders for some medications that had been on her hospital discharge list and some of her medications were not on the list. She said she did not recall the exact medications, but there were some wonky ones. She said she noticed the resident had been discharged on a few blood pressure medications but had not received them upon admission. Staff D said she notified nursing management and left all the paperwork she had gathered so it could be investigated. Staff D said she notified the on-call provider about the medication discrepancies. An interview was conducted on 9/30/25 at 9:40 a.m. with the Assistant Director of Nursing (ADON) and the Director of Nursing (DON). They both reviewed Resident #1's hospital discharge medication list and the resident's physician orders in the facility. They confirmed the medication lists did not match. The DON said she did not know what happened and wanted to look into it further. A follow-up interview was conducted on 9/30/25 at 4:55 p.m. with the ADON and DON. They said the new admission process expectation would be the resident arrives at the facility with hospital discharge paperwork, and the admitting nurse is notified. The nurse takes the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 5 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few hospital medication orders and sends them to the provider for review. Once the medications are reconciled with the provider, the medication orders are entered into the computer. Then nurses on the 11:00 p.m. -7:00 a.m. shift are responsible for doing a chart check for all new admissions that day. The ADON and DON said the new admission paperwork was at the nurses' station, so the night shift nurse had it available to review orders to ensure they were transcribed correctly. The ADON and DON said if a nurse worked a double shift (from 3:00 p.m.-11:00 p.m. and then 11:00 p.m. -7:00 a.m.) that nurse could do their own chart check. They said there was no process in place to document chart checks were being completed on the 11:00 p.m.-7:00 a.m. shift; they were trusting it was being completed. The ADON and DON said the second chart check was completed after the morning clinical meeting, each morning Monday through Friday. They said the Unit Manager (UM) was responsible for bringing new admission charts to the meeting and reviewing the orders for accuracy. Review of the facility's admission packet checklist included the following items: -Notify MD [medical doctor] of admission-admission note completed in progress notes-Orders per 3008, medication list, and [vendor texting system with providers]-Hospital DC [discharge] summary-Add Order Sets-Parameters for blood pressure meds-BS [blood sugar] checks for diabetes (need to have labeled machine)-Hypoglycemic orders for all residentsHypoglycemia Policy1. Anti-diabetic medication-observed for signs and symptoms of hypoglycemia including but not limited to blurred vision, sweating, tachycardia, unable to swallow, or ability to follow instructions, slurred speech, AMS [altered mental status]. Notify PCP [primary care provider] with accu-check results. (Q [every] shift monitoring)2. (For all Residents, Diabetic or non-diabetic) Accu-check as needed for signs/symptoms of hypoglycemic/hyperglycemic. If BG [blood glucose] is below 70, is alert and able to swallow, give 15 grams glucose gel or carbohydrates to include but not limited to: one cup of fruit juice, one cup of non-diet soda, or sugar packets by mouth; followed by a protein snack, notify PCP.3. [blank]4. For severe hypoglycemic symptoms-Glucagon Emergency Injection Kit 1 mg- inject 1 mg IM [intramuscular] as needed for BG below 70 with lethargy and unable to swallow, may repeat x 1, notify PCP.This checklist does not have places to check off each item or a place to sign showing it was completed An interview was conducted on 9/30/25 at 5:00 p.m. with Staff G, LPN/UM. Staff G confirmed he was the UM for Resident #1. A copy of her admission packet checklist was requested. Staff G's office was observed to have large stacks of paper on a bookcase. Staff G stated those were admission packet checklists for residents, but he did not have an admission packet checklist completed by the nurse for Resident #1. Staff G explained that the admitted nurse filled out the admission check sheets then night shift nurses did a chart check and then management did a chart check the next morning. An interview was conducted on 9/30/25 at 11:31 a.m. with the RR for Resident #1. The RR said the resident had been on blood pressure medication prior to being admitted to the facility. She said the hospital never mentioned Resident #1 having urinary tract infection (UTI), but the nurse at the facility said she had a UTI coming from the hospital, which was confusing. The RR said Resident #1 did not have COPD or breathing issues and had not been on medications related to that. The RR said when Resident #1 admitted to the facility she had been talking, up walking around, and had been able to stand up from the bed on the lowest position by the floor. The RR said Resident #1 downgraded to not talking, not walking, and not getting up to go to the bathroom while in the facility. The RR said since leaving the facility, the resident had recovered some of her abilities but was not back to where she was prior to being admitted there. An interview was conducted on 10/1/25 at 1:22 p.m. with the facility's Medical Director of the facility. The Medical Director said he was informed of the admission errors with medication orders for Resident #1 but was not fully aware of the specifics. He said his expectation on admission was a picture of the resident's hospital orders (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 6 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete were sent to the physician; the physician reviewed and verified the orders and sent clarification and/or new orders. The Medical Director said the provider is expected to review orders between visits to ensure accuracy. He said he expected the nurses to have completed audits to ensure accuracy. He confirmed he would have expected the nurse to have documented that medications were reconciled with the provider. The Medical Director said no doubt a provider should have been notified if a resident's vital signs and lab results were out of normal parameters. He said as the Medical Director of the facility, if the facility had difficulty with a provider not responding to a condition or if education to another provider was necessary, he should have been notified because it was his job to have discussions regarding protocols and standards of practice. Review of Resident #1's hospital records dated 8/30/25 showed:Presenting Problem: hyperglycemia, given 15 units of insulin at facility.History of Present Illness: [AGE] year-old female with a past medical history of diabetes, hyperlipidemia,hypertension, and prior breast cancer (status post left mastectomy and lymph node removal, in remission), [NAME] [inferior mesenteric artery] occlusion and SMA [superior mesenteric artery] stenosis presents with a 3-day history of abdominal pain and hyperglycemia. Glucose greater than 600 at facility given insulin prior to transport. Patient notes her pain is diffuse 8 out of 10 intensity nonradiating with no alleviating factors. Lab results in the emergency department showed:8/30/2025 5:58 p.m.WBC (white blood cell count) 16.42 x10^3/ microliter (uL) HIGHPlatelet 600 x10^3/uL HIGHNeutrophil Auto 72.5 % HIGHLymphocyte Auto 13.3 % LOWMonocyte Auto 12.4 % HIGHEosinophil Auto 0.3 % LOWAbsolute Neutrophil 11.91 x10^3/uL HIGHAbsolute Monocyte 2.03 x10^3/uL HIGHBUN 44 mg/dL HIGHCreatinine 1.47 mg/dL HIGHEstimated glomerular filtration rate (eGFR) Chronic kidney disease-equation for prediction and interpretation (CKD-EPI) 36 mL/min/1.73m^2 LOWCalcium Level 11.3 mg/dL HIGHAlkaline Phosphatase 182 U/L HIGHLipase Level 127 U/L HIGHPro b-type natriuretic peptide (PBNP) 1,010 pg/mL HIGHHS Troponin-T 60 ng/L CRITICALLY HIGHCarbamaz Level <2.0 ug/mL LOWT4 Free 1.86 ng/dL HIGHUrinalysis (UA) Appear ClearUA Color Pale yellowUA Glucose 4+UA Ketones 1+UA Protein 3+UA Bacteria Auto FewUA Epithelial Cells Auto None SeenUA Hyaline Cast Auto Few8/30/25 6:22 p.m.POC [point of care] Potassium 3.4 mmol/L LOWPOC Sodium 129 mmol/L LOWPOC [NAME] [lactate] 3.30 mmol/L HIGH Vital signs8/30/25 6:00 p.m.Blood pressure 158/93Heart rate 101Respiratory rate 18 breathes/minute Discussion of Management with Hospitalist revealed: [AGE] year-old female presents to the emergency department with diffuse abdominal pain in the setting of known severe atherosclerosis of the aorta [NAME] SMA. CT [comp[TRUNCATE Event ID: Facility ID: 106120 If continuation sheet Page 7 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews, hospital record review, facility documentation and policy review, the facility failed to ensure the nursing staff was competent to reconcile hospital discharge medication orders, blood glucose levels were monitored for a diabetic resident, or recognize and respond to elevated blood pressures and abnormal lab results for one resident (#1) out of three residents reviewed. This failure created a situation that resulted in a worsened condition to Resident #1 and resulted in the determination of Immediate Jeopardy beginning on 8/22/25. The findings of Immediate Jeopardy were determined to be removed on 10/1/2025 and the severity and scope was reduced to a D after verification of removal of immediacy of harm.Findings included: An interview was conducted on 9/30/25 at 11:45 a.m. with the Resident Representative (RR) for Resident #1. The RR said Resident #1 was not given her required insulin from the time she arrived at the facility on 8/22/25 until the day she had to go to the hospital on 8/30/25. The RR said the facility called and informed them Resident #1 had not gotten her insulin because they did not know she needed it. The RR said when Resident #1 was admitted to the facility she spoke with staff at the facility and specifically told them the resident was on sliding scale insulin. The RR said Resident #1's hospital records clearly showed the resident took insulin daily. The RR said on 8/30/25 she was told a nurse noticed Resident #1 was not getting insulin and checked her blood glucose level and it was 380; they gave the resident insulin and sent her to the hospital. The RR said Resident #1 had dementia and was confused so she would have been unable to tell them she needed insulin during her stay. The RR said Resident #1's health went downhill after being admitted to the facility. The RR said the hospital thought Resident #1 might have had a stroke when she was readmitted and the resident had been more confused and not herself since this happened. A review of admission Records showed Resident #1 was admitted on [DATE] with diagnoses including nontraumatic intracerebral hemorrhage intraventricular, type 2 diabetes mellitus, and hypertension. Review of Resident #1's Nursing admission Screening and History, dated 8/22/25, showed the resident did not have intact cognition and was confused. Review of Resident #1's hospital Discharge Instructions: Medications included but were not limited to: -Enoxaparin 30 milligram (mg)/0.3 milliliters (ml). 0.3 ml subcutaneous daily. (a medication to treat or prevent blood clots)-Insulin Lispro 100 units (u)/ml injectable solution. Low corrective scale subcutaneous three times a day with meals. (a fast-acting medication to lower blood glucose levels)-Tamsulosin 0.4 mg capsule. 1 capsule after breakfast. (a medication for urinary retention)-Amlodipine 10 mg. 1 tablet once a day. (a medication used to treat high blood pressure)-Dicyclomine 10 mg. 1 capsule two times a day. (a medication to relax muscles in the gastrointestinal tract.)-Gabapentin 100 mg. 1 capsule three times a day. (a medication to treat seizures or nerve pain)-Insulin glargine 100 u/ml. 30u subcutaneous daily at bedtime. (a long-acting medication to lower blood glucose levels)-Linagliptin 5mg. 1 tablet once a day. (a medication to help manage high blood glucose levels)-Pantoprazole 20 mg enteric coated. 2 tablets two times a day. (a medication to decrease the amount of acid produced in the stomach)-Carbamazepine 200 mg. 1 tablet three times a day. (a medication to treat seizures, nerve pain, or manage episodes of mania associated with bipolar disorder)-Clopidogrel 75 mg. 1 tablet one a day. Resume on 8/26/25. (medication used to prevent blood clots)-Duloxetine 20 mg delayed release. 1 capsule once a day. (a medication used to treat mental health conditions such as depression and anxiety as well as some chronic pain conditions)-Folic acid 1 mg. 1 tablet once a day. (medication used as a dietary supplement)-Lactulose 10 grams (g) oral. Once a day. (a medication used to treat constipation and to manage a brain condition caused by liver disease)-Losartan 100 mg. 1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 8 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few tablet once a day. (a medication used to treat high blood pressure)-Melatonin 3mg. 1 tablet daily at bedtime as needed for sleep.-polyethylene glycol 3350 oral powder. 17 g as needed. (a medication to treat occasional constipation)-Propranolol 60 mg. 1 tablet two times a day. (a medication used to treat heart related issues such as high blood pressure and irregular heartbeats, migraines, tremors, and some types of anxiety)-Senna 8.6 mg. 2 tablets two times a day as needed for constipation. (a medication used for short term relief of constipation) Review of Resident #1's facility order listing report showed the above medications were not entered into the resident's medical record as a physicians' order at the facility. Resident #1's hospital Discharge Instructions: Medications showed: -Lidocaine topical 5%. 1 patch every 24 hours. (a medication used for local pain relief)-Atorvastatin 40 mg. 1 tablet daily at bedtime. (a medication used to lower cholesterol)-Clopidogrel 75 mg. 1 tablet once a day. Resume on 8/26/25. (a medication used to prevent blood clots) Review of Resident #1's facility order listing report showed upon admission the order entered for Lidocaine was for a 5% patch and the ordered entered for Atorvastatin was for 80 mg daily at bedtime. The order entered for Clopidogrel started on 8/23/25. Review of Resident #1's facility physician orders showed the following medications ordered at the facility upon admission that were not on the resident's hospital discharge medication list:-Albuterol-Budesonide Inhalation Aerosol 90-80 micrograms per actuation (mcg/act). 2 puffs inhale orally every 4 hours as needed for shortness of breath.- Ascorbic acid tablet 500 mg. 1 tablet two times a day for vitamin deficiency.-Azithromycin 500 mg. 1 tablet one time a day for antibiotic related to a urinary tract infection (UTI) for 5 days.-Carvedilol 3.125 mg. 1 tablet by mouth 2 times a day. Hold if systolic blood pressure (SBP) is <100 and pulse <50 related to essential hypertension.-Fluticasone propionate suspension 50 micrograms per actuation (mcg/act). 2 sprays in each nostril every 24 hours as needed for allergy symptoms.-Furosemide 20 mg. 1 tablet by mouth one time a day for edema.-Ipratropium-Albuterol 0.5-2.5 mg/2ml. 1 dose inhale orally every 4 hours as needed for shortness of breath.-Medrol oral therapy pack 4 mg. 1 tablet every morning and at bedtime related to chronic obstructive pulmonary disease (COPD) exacerbation.-Trelegy Ellipta Inhalation Aerosol powder breath activated 100-62.5-25 mcg/act. 1 puff inhale orally one time a day related to COPD exacerbation. Review of Resident #1's Medication Administration Record (MAR) for August 2025 showed:-Trelegy Ellipta inhalation aerosol 100-62.5-25 mcg/act for COPD (acute) was administered on August 24th, 25th, 26th, 27th, 28th, 29th, and 30th.-Ascorbic acid oral tablet 500 mg for Ascorbic Acid Deficiency, was administered on August 23rd, 24th, 25th, 26th, 27th, 28th, 29th, and 30th (morning dose)-Carvedilol oral tablet 3.125 mg was administered on August 23rd, 24th, 25th, 26th, 27th, 28th, 29th, and 30th-Medrol oral tablet therapy pack 4 mg for COPD (acute) was administered on August 23rd, 24th, 25th, 26th, 27th, 28th, 29th, and 30th.-Atorvastatin calcium oral tablet 80 mg was administered August 23rd through 29th.-Azithromycin oral tablet 500 mg for a Urinary tract infection was administered August 23rd through 27th.-Furosemide oral tablet 20 mg for edema was administered August 23rd through 30th.-Lidocaine external patch 4% for pain was administered August 23rd through 30th.-Pantoprazole sodium oral tablet 40 mg (incorrect dose was administered August 23rd through 30th. Review of Resident #1's Nursing Admission, readmission Screening and History, dated 8/22/25, completed by Staff A, Licensed Practical Nurse (LPN) showed:Medication ReconciliationAre these orders to be clarified? No - Reviewed and no clarification neededMedications recommended by Hospital that need clarification: (no documentation)Note Clarification needed: (no documentation)Results after physician notification (continue, stop, change): (no documentation). Are there medications taken before hospitalization NOT currently on the hospital recommended list? No - Reviewed and no clarification neededMedications taken before hospitalization not currently on hospital recommended list?Comments such (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 9 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few as reason for med (medication) and reason it was stopped in hospital (if known): (no documentation)Results after Physician notification (continue, stop, change): (no documentation) Review of Resident #1's medical record did not show any documentation the medication orders from the hospital were reconciled with a medical provider prior to being entered into the computer. Review of Resident #1's vital signs showed the resident had an elevated blood pressure of 202/116 on 8/25/25 at 7:53 a.m. and 170/108 at 4:46 p.m. (Normal blood pressure 120/80). Review of a provider note dated 8/25/25 by Resident #1's primary care Nurse Practitioner (NP) showed . labs on 8/26/25. Patient blood pressure has been elevated and a new order for carvedilol was started today. Will monitor for medication efficacy. Review of Resident #1's lab results, reviewed by the NP on 8/26/25 at 2:03 p.m. showed: SODIUM 135 milliequivalents (mEq)/liter (L) reference range 136-145 LowCHLORIDE 89 mEq/L reference range 98-110 LowGLUCOSE 364 mg/deciliter (dL) reference range 74-109 HighBUN 43 mg/dL reference range 7-25 High CREATININE 1.62 mg/dL reference range 0.6-1.3 HighB/C RATIO 26.54 reference range 8.0-25.0 HighAST (SGOT) 12 Units (U)/L reference range 13-39 Low ALKALINE PHOSPHATASE157 U/L reference range 34-104 HighGlomerular Filtration Rate (GFR) 32 reference range >60 ml/min Low GFR Reference Range: Stage IIIB Moderate to Severe loss of kidney function 30-44 milliliters/minute (ml/min) Review of progress notes showed an 8/26/25 nurse's note revealing Advanced Registered Nurse Practitioner (ARNP) ordered Intravenous fluids (IVF) normal saline (NS) at 50 ml/hour (hr) for 1000 ml total related to (r/t) lab results today. Review of Resident #1 physician orders showed:Peripheral line catheter continuous infusion: 0.9% sodium chloride, 50ml/hr, 1000ml total. Every shift monitor infusion related to dehydration for 2 days. Dated 8/26/25. Review of Resident #1's medical record did not show any documentation the NP or the facility addressed the residents blood glucose level of 364 mg/dL and the resident did not receive insulin. Review of Resident #1's vital signs showed the resident had an elevated blood pressure of 189/112 on 8/28/25 at 7:26 a.m. and 164/102 on 8/28/25 at 4:09 p.m. Review of Resident #1's medical record showed no documentation the provider was notified of the elevated blood pressure on 8/28/25 at 7:26 a.m. There was a nursing note on 8/28/25 at 4:39 p.m. explaining the provider was notified of the blood pressure reading of 164/102 and new order was received for a one time does of medication. Review of Resident #1's orders showed a one-time order for Amlodipine 5 mg for blood pressure of 164/102 on 8/28/25. A follow up blood pressure revealed on 8/28/25 at 9:06 p.m. was 140/80. Review of Resident #1's Lab results showed repeat labs were reviewed by Staff B, LPN on 8/28/25 at 5:10 p.m. The lab results showed: SODIUM 132 mEq/L 136-145 LowCHLORIDE 89 mEq/L 98-110 LowGLUCOSE 487 mg/dL 74-109 HighBUN 45 mg/dL 7-25 HighCREATININE 1.58 mg/dL 0.6-1.3 HighB/C RATIO 28.48 8.0-25.0 HighAST (SGOT) 12 U/L 13-39 LowALKALINE PHOSPHATASE 155 U/L 34-104 HighGFR 33 >60 ml/min Low Review of Resident #1's medical record showed no documentation a provider was notified of the abnormal lab results after the nurse reviewed them on 8/28/25 at 5:10 p.m. There was no documentation showing the resident's elevated blood glucose level of 487 mg/dL was addressed. Review of Resident #1's vital signs showed the resident had an elevated blood pressure of 180/114 on 8/29/25 at 7:38 a.m. Review of Resident #1's medical record revealed there was no documentation a provider was notified of the resident's elevated blood pressure on 8/29/25 at 7:38 a.m. Review of Resident #1's progress notes showed:8/30/25 at 1:34 p.m. Resident BS [blood sugar] noted HI on meter, HI reading indicated a BS over 600. ARNP updated with new orders to give 15 units now after rechecking sugar then start lantus and insulin lispro low dose sliding scale8/30/25 3:29 p.m. Resident BS remains high on meter, ARNP updated with new orders to send to ER [emergency room] for eval [evaluation]. Review of Resident #1's MAR showed Insulin Lispro pen injector 200 u/ml. 15 units was administered at 1:40 p.m. on 8/30/25. Review of Resident #1's Summary for Providers, dated 8/30/25 showed:Change in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 10 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few ConditionNursing observations, evaluation, and recommendations are: Resident noted more lethargic than normal, able to arouse. BS reading HI on machine indicated over 600. 15 units units [sic] given per ARNP orders, recheck in 1 hour, re-checked and still showing HI. ARNP updated with new orders to send to the ER for evaluation. Review of Resident #1's vital signs did not show any documented blood glucose checks completed by the nurse from 8/22/25 until 8/30/25 when the resident was transferred to the hospital. An interview was conducted on 9/29/25 at 5:10 p.m. with Staff A, LPN. She said she had Resident #1 when she was admitted on [DATE]. She said another nurse, Staff C, LPN helped her by starting to put medications in the computer queue for the resident prior to her getting to the facility. Staff A said when the resident came, Staff C, continued to help with the paperwork then Staff C said these [orders] don't match you need to finish them because she had to assist her residents. Staff A said there was a lot going on that night and she did not get to look at Resident #1's orders again until early the next morning when she finished putting them in the computer. She said she did not remember seeing insulin orders on the paperwork for the resident. Staff A said when the resident arrived Staff C sent the admission paper, the 3008, and the hospital medication list to the provider over the facility's text messaging system. Staff A said she did not remember the provider sending back or making any changes to Resident #1's orders. Staff A confirmed Resident #1 was confused and would not have known her medications. An interview was conducted on 9/29/25 at 2:58 p.m. with Staff C, LPN. Staff C said Staff A, LPN was assigned to Resident #1 on admission. She said all she did was start putting Resident #1's hospital orders in the queue. Staff C said she entered some of the medication orders in the computer then informed Staff A she needed to finish entering the orders and review everything. Staff C said she was just helping. An interview was conducted on 10/1/25 at 4:30 p.m. with Staff E, Certified Nursing Assistant (CNA). Staff E cared for Resident #1 on 8/25-8/28/25 on the 7: 00 a.m.-3:00 p.m. shift. Staff E said on 8/25/25 when she first met Resident #1, I thought maybe she was recovering from something, because she would kind of flop and throw herself back in bed. She said she had to get the nurse to assist her with transferring the resident. Staff E said a day, or two later Resident #1 must have gotten a new medication or maybe it was the IV fluids she got, but the resident was able to hold a good conversation. Staff E said she was able to get Resident #1 to shower and she made more sense. Staff E said she was off for a couple of days and when she returned, she was told the resident had gone back to the hospital. A follow-up interview was conducted on 10/1/25 at 3:18 p.m. with Staff C, LPN. She said she only assisted with entering medication orders for Resident #1 after the resident arrived at the facility. She said she entered orders from the paperwork the resident brought from the hospital. An interview was conducted on 9/29/25 at 1:43 p.m. with Resident #1's primary care NP. The NP said she did not get notified of Resident #1's abnormal lab results on 8/28/25. She confirmed it was a Thursday, and she would have been the person contacted. The NP said staff notified her about the abnormal labs on 8/26/25 and she ordered some IV fluids. She said Resident #1 did not say anything about her blood sugar levels. The NP did confirm Resident #1 was confused. During a follow-up interview on 10/1/25 at 5:51 p.m. the NP said she knew the resident had some high blood pressure readings and was put on a blood pressure medication. She said she had been notified of previous high blood pressures for Resident #1 but was not notified the resident's blood pressure was high on 8/29/25. She said for the abnormal labs she saw Resident #1's glucose level was high but thought maybe she was dehydrated and that is why she ordered IV fluids. She said she did not know about the second abnormal labs on 8/28/25. The NP did not want to comment on Resident #1 being on furosemide because she did not order it but said in general furosemide removes fluid from the body. The NP agreed it could cause dehydration. An interview was conducted on 9/29/25 at 1:52 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 11 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few p.m. with Staff B, LPN. Staff B confirmed she had cared for Resident #1, but she did not remember dates that far back and did not remember the resident very well. She said when a lab was reviewed by the nurse it is marked on the lab itself with the date and time it was reviewed. Staff B said if the results were abnormal, they should have been sent to the provider and a nursing note put in the computer saying a provider was notified. An interview was conducted on 9/30/25 at 10:32 a.m. with Staff D, Registered Nurse (RN). Staff D said she remembered Resident #1 and was the supervisor in the facility when the resident was sent to the hospital. Staff D said she made rounds frequently on the units and touched base with nurses. She said on 8/30/25 a CNA came to her and said Resident #1 was different than she had been the weekend before. She said the CNA told her the previous weekend, August 23rd/24th, the resident had been up walking around and was busy. Staff D said on 8/30/25 Resident #1 was lying in bed, lethargic, and would talk, but barely. Staff D said she had seen Resident #1 the weekend she had been admitted to the facility. She said the resident had been confused, but the family said it was her baseline. She said the resident got up and walked around her room sometimes without waiting for assistance. Staff D said when she saw how the resident was on 8/30/25 she did a full assessment on Resident #1 and part of that was checking her blood glucose level since she was diabetic. Staff D said the resident's blood glucose was high and she worked with Resident #1's assigned nurse to update the provider and get orders. Staff D said she looked at the resident's medical record because she liked to gather what information she can provide to paramedics and the emergency department. She said during her review she noticed Resident #1 had two sets of labs since her admission that showed high blood glucose levels, one in the 300s and one in the 400s. Staff D said during her chart review she noticed the resident was not being administered any insulin or medication for diabetes by mouth. Staff D said she had not been informed the resident had any blood pressures issues but noticed Resident #1 had high blood pressure readings that week and was started on medication. Staff D said she pulled up Resident #1's admission paperwork from the hospital to compare to the orders the resident had in the computer, and she noticed Resident #1 had orders for some medications that had been on her hospital discharge list and some of her medications were not on the list. She said she did not recall the exact medications, but there were some wonky ones. She said she noticed the resident had been discharged on a few blood pressure medications but had not received them upon admission. Staff D said she notified nursing management and left all the paperwork she had gathered so it could be investigated. Staff D said she notified the on-call provider about the medication discrepancies. An interview was conducted on 9/30/25 at 9:40 a.m. with the Assistant Director of Nursing (ADON) and the Director of Nursing (DON). They both reviewed Resident #1's hospital discharge medication list and the resident's physician orders in the facility. They confirmed the medication lists did not match. The DON said she did not know what happened and wanted to look into it further. A follow-up interview was conducted on 9/30/25 at 4:55 p.m. with the ADON and DON. They said the new admission process expectation would be the resident arrives at the facility with hospital discharge paperwork, and the admitting nurse is notified. The nurse takes the hospital medication orders and sends them to the provider for review. Once the medications are reconciled with the provider, the medication orders are entered into the computer. Then nurses on the 11:00 p.m. -7:00 a.m. shift are responsible for doing a chart check for all new admissions that day. The ADON and DON said the new admission paperwork was at the nurses' station, so the night shift nurse had it available to review orders to ensure they were transcribed correctly. The ADON and DON said if a nurse worked a double shift (from 3:00 p.m.-11:00 p.m. and then 11:00 p.m. -7:00 a.m.) that nurse could do their own chart check. They said there was no process in place to document chart checks were being completed on the 11:00 p.m.-7:00 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 12 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few a.m. shift; they were trusting it was being completed. The ADON and DON said the second chart check was completed after the morning clinical meeting, each morning Monday through Friday. They said the Unit Manager (UM) was responsible for bringing new admission charts to the meeting and reviewing the orders for accuracy. An interview was conducted on 9/30/25 at 11:31 a.m. with the RR for Resident #1. The RR said the resident had been on blood pressure medication prior to being admitted to the facility. She said the hospital never mentioned Resident #1 having urinary tract infection (UTI), but the nurse at the facility said she had a UTI coming from the hospital, which was confusing. The RR said Resident #1 did not have COPD or breathing issues and had not been on medications related to that. The RR said when Resident #1 admitted to the facility she had been talking, up walking around, and had been able to stand up from the bed on the lowest position by the floor. The RR said Resident #1 downgraded to not talking, not walking, and not getting up to go to the bathroom while in the facility. The RR said since leaving the facility, the resident had recovered some of her abilities but was not back to where she was prior to being admitted there. An interview was conducted on 9/30/25 at 11:16 a.m. with Staff G, LPN/Unit Manager (UM). He said he saw Resident #1 while she was admitted due to her being on his unit. He said the first time he saw her was on 8/25/25. He said Resident #1 stayed in bed mostly but would go to therapy. He said he did not recall any issues with her blood pressure that week, but he would notify a provider for a blood pressure of 180/114. Staff G said after Resident #1 was admitted he did check her medication list; specifically, the hospital discharge paperwork that came with the resident. Staff G said he did an audit after the resident went to hospital, and he saw that she had not been receiving insulin. Staff G was shown the resident's hospital discharge medication list and her facility orders to compare. He said the provided hospital discharge list was not what he had when he was reviewing her admission. Staff G was confused and said he did not understand. Staff G said he did not think he had another resident's discharge medication list because he always compared date of birth and social security number to ensure he was looking at the correct resident's information. He said he did not know what list he had used when he completed his review. Staff G said he did not understand how this happened. Review of education for Staff A, LPN showed she completed a Clinical Skill Review on 5/15/25. These skills included managing diagnostic results: What is the process for contacting physicians with normal and abnormal diagnostic results and admission evaluation and orders. The admission evaluation and order skills reviewed the nurse's role in the admission or new resident or readmission, review of necessary documentation and required evaluation, data collection, interim plan or care and initial nurse's note, process for transcribing orders, medication reconciliation, and system for obtaining medications for new admissions/readmissions. Review of education for Staff G, LPN showed she completed a Clinical Skill Review on 5/6/25. These skills included managing diagnostic results: What is the process for contacting physicians with normal and abnormal diagnostic results and admission evaluation and orders. The admission evaluation and order skills reviewed the nurse's role in the admission or new resident or readmission, review of necessary documentation and required evaluation, data collection, interim plan or care and initial nurse's note, process for transcribing orders, medication reconciliation, and system for obtaining medications for new admissions/readmissions. An interview was conducted on 10/1/25 at 11:55 a.m. with Staff G, LPN/UM. He said education to nurses occurred during orientation with another nurse. He said the new nurse received a checklist from the staffing coordinator and it was completed during shadowing with a tenured nurse that signed off on the items. Staff G said if the new nurse had any questions or if the tenured nurse felt the nurse needed additional education, management would complete additional one on one training with the new nurse. Staff G said competency checks are completed yearly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 13 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few and as needed in between. An interview was conducted on 10/1/25 at 11:24 a.m. with Staff F, LPN/UM. Staff F said upon hire the staff coordinator gives new nurses checklists to be completed while they are shadowing another nurse. She said if the new nurse had questions a member of nurse management would provide extra training for that nurse. Staff F said the education is always one to one and can sometimes be a topic specific to a nurse or the DON may determine education on topic is necessary for the entire clinical team. Staff F said education on the admission process is completed during orientation while shadowing another nurse or when they first receive an admission they would have assistance from another nurse. Staff F said the admission packet had a checklist that nurses needed to complete. She said the nurse took the orders from the admission packet for the resident and sent them to the physician for verification, when the physician replied and confirmed or changed orders the nurse entered them into the facility orders. Staff F said the 11:00 p.m.-7:00 a.m. shift was responsible for doing a chart check for accuracy and the unit manager completed a chart check the next morning to ensure accuracy. Staff F provided a manager checklist and stated she did not think other unit managers utilized the checklist. Review of the admission packet checklist, used by the admitting nurse, included the following items: -Notify MD [medical doctor] of admission-admission note completed in progress notes-Orders per 3008, medication list, and [vendor texting system with providers]-Hospital DC [discharge] summary-Add Order Sets-Parameters for blood pressure meds-BS [blood sugar] checks for diabetes (need to have labeled machine)-Hypoglycemic orders for all residentsHypoglycemia Policy1. Anti-diabetic medication-observed for signs and symptoms of hypoglycemia including but not limited to blurred vision, sweating, tachycardia, unable to swallow, or ability to follow instructions, slurred speech, AMS [altered mental status]. Notify PCP [primary care provider] with accu-check results. (Q [every] shift monitoring)2. (For all Residents, Diabetic or non-diabetic) Accu-check as needed for signs/symptoms of hypoglycemic/hyperglycemic. If BG [blood glucose] is below 70, is alert and able to swallow, give 15 grams glucose gel or carbohydrates to include but not limited to: one cup of fruit juice, one cup of non-diet soda, or sugar packets by mouth; followed by a protein snack, notify PCP.3. [blank]4. For severe hypoglycemic symptoms-Glucagon Emergency Injection Kit 1 mg- inject 1 mg IM [intramuscular] as needed for BG below 70 with lethargy and unable to swallow, may repeat x 1, notify PCP.This checklist does not have places to check off each item or a place to sign showing it was completed. Review of the admission chart review checklist, used by the unit managers, included the following items to be checked:-chart review-Hospital DC [discharge] summary if NO, notify medical records to fax request and keep confirmed fax on/in chart.-Hard scripts for narcotics, order summary. Get if needed ASAP [as soon as possible]-Parameters for blood pressure meds-BS [blood sugar] checks for diabetics (need to have a labeled machine)-Hypoglycemia PRN [as needed] protocolNew antibiotics-diagnosis-stop date-IV or PO (by mouth)-Surveillance infection criteria-Isolation yes or no An interview was conducted on 9/30/25 at 5:00 p.m. with Staff G, LPN/UM. Staff G confirmed he was the UM for Resident #1. A copy of her admission packet checklist was requested. Staff G's office was observed to have large stacks of paper on a bookcase. Staff G stated those were admission packet checklists for residents, but he did not have an admission packet checklist completed by the nurse for Resident #1. Staff G explained that the admitted nurse filled out the admission check sheets then night shift nurses did a chart check and then management did a chart check the next morning. An interview was conducted on 10/1/25 at 1:22 p.m. with the facility's Medical Director of the facility. The Medical Director said he was informed of the admission errors with medication orders for Resident #1 but was not fully aware of the specifics. He said his expectation on admission was a picture of the resident's hospital orders were sent to the physician; the physician reviewed and verified the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 14 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 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 0726 Level of Harm - Immediate jeopardy to resident health or safety orders and sent clarification and/or new orders. The Medical Director said the provider is expected to review orders between visits to ensure accuracy. He said he expected the nurses to have completed audits to ensure accura[TRUNCATED] Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 15 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews, hospital record review, facility documentation and policy review, the facility failed to ensure one resident (#1) of three reviewed for new admission orders was free from significant medication errors as evidenced by the resident not receiving the correct medications order upon admission. This failure created a situation that resulted in a worsened condition and the likelihood for serious injury and or death to Resident #1 and resulted in the determination of Immediate Jeopardy beginning on 8/22/25. The findings of Immediate Jeopardy were determined to be removed on 10/1/25 and the severity and scope was reduced to a D after verification of removal of immediacy of harm. Findings included: An interview was conducted on 9/30/25 at 11:45 a.m. with the Resident Representative (RR) for Resident #1. The RR said Resident #1 was not given her required insulin from the time she arrived at the facility on 8/22/25 until the day she had to go to the hospital on 8/30/25. The RR said the facility called and informed them Resident #1 had not gotten her insulin because they did not know she needed it. The RR said when Resident #1 was admitted to the facility she spoke with staff at the facility and specifically told them the resident was on sliding scale insulin. The RR said Resident #1's hospital records clearly showed the resident took insulin daily. The RR said on 8/30/25 she was told a nurse noticed Resident #1 was not getting insulin and checked her blood glucose level and it was 380; they gave the resident insulin and sent her to the hospital. The RR said Resident #1 had dementia and was confused so she would have been unable to tell them she needed insulin during her stay. The RR said Resident #1's health went downhill after being admitted to the facility. The RR said the hospital thought Resident #1 might have had a stroke when she was readmitted and the resident had been more confused and not herself since this happened. A review of admission Records showed Resident #1 was admitted on [DATE] with diagnoses including nontraumatic intracerebral hemorrhage intraventricular, type 2 diabetes mellitus, and hypertension. Review of Resident #1's Nursing admission Screening and History, dated 8/22/25, showed the resident did not have intact cognition and was confused. Review of Resident #1's hospital Discharge Instructions: Medications included but were not limited to:-Enoxaparin 30 milligram (mg)/0.3 milliliters (ml). 0.3 ml subcutaneous daily. (a medication to treat or prevent blood clots)-Insulin Lispro 100 units (u)/ml injectable solution. Low corrective scale subcutaneous three times a day with meals. (a fast-acting medication to lower blood glucose levels)-Tamsulosin 0.4 mg capsule. 1 capsule after breakfast. (a medication for urinary retention)-Amlodipine 10 mg. 1 tablet once a day. (a medication used to treat high blood pressure)-Dicyclomine 10 mg. 1 capsule two times a day. (a medication to relax muscles in the gastrointestinal tract.)-Gabapentin 100 mg. 1 capsule three times a day. (a medication to treat seizures or nerve pain)-Insulin glargine 100 u/ml. 30u subcutaneous daily at bedtime. (a long-acting medication to lower blood glucose levels)-Linagliptin 5mg. 1 tablet once a day. (a medication to help manage high blood glucose levels)-Pantoprazole 20 mg enteric coated. 2 tablets two times a day. (a medication to decrease the amount of acid produced in the stomach)-Carbamazepine 200 mg. 1 tablet three times a day. (a medication to treat seizures, nerve pain, or manage episodes of mania associated with bipolar disorder)-Clopidogrel 75 mg. 1 tablet one a day. Resume on 8/26/25. (medication used to prevent blood clots)-Duloxetine 20 mg delayed release. 1 capsule once a day. (a medication used to treat mental health conditions such as depression and anxiety as well as some chronic pain conditions)-Folic acid 1 mg. 1 tablet once a day. (medication used as a dietary supplement)-Lactulose 10 grams (g) oral. Once a day. (a medication used to treat constipation and to manage a brain condition caused by liver disease)-Losartan 100 mg. 1 tablet once a day. (a medication used to treat high blood pressure)-Melatonin 3mg. 1 tablet daily at bedtime as needed Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 16 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few for sleep.-polyethylene glycol 3350 oral powder. 17 g as needed. (a medication to treat occasional constipation)-Propranolol 60 mg. 1 tablet two times a day. (a medication used to treat heart related issues such as high blood pressure and irregular heartbeats, migraines, tremors, and some types of anxiety)-Senna 8.6 mg. 2 tablets two times a day as needed for constipation. (a medication used for short term relief of constipation) Review of Resident #1's facility order listing report showed the above medications were not entered into the resident's medical record as a physicians' order at the facility. Resident #1's hospital Discharge Instructions: Medications showed: -Lidocaine topical 5%. 1 patch every 24 hours. (a medication used for local pain relief)-Atorvastatin 40 mg. 1 tablet daily at bedtime. (a medication used to lower cholesterol)-Clopidogrel 75 mg. 1 tablet once a day. Resume on 8/26/25. (a medication used to prevent blood clots) Review of Resident #1's facility order listing report showed upon admission the order entered for Lidocaine was for a 5% patch and the ordered entered for Atorvastatin was for 80 mg daily at bedtime. The order entered for Clopidogrel started on 8/23/25. Review of Resident #1's facility physician orders showed the following medications ordered at the facility upon admission that were not on the resident's hospital discharge medication list:-Albuterol-Budesonide Inhalation Aerosol 90-80 micrograms per actuation (mcg/act). 2 puffs inhale orally every 4 hours as needed for shortness of breath.- Ascorbic acid tablet 500 mg. 1 tablet two times a day for vitamin deficiency.-Azithromycin 500 mg. 1 tablet one time a day for antibiotic related to a urinary tract infection (UTI) for 5 days.-Carvedilol 3.125 mg. 1 tablet by mouth 2 times a day. Hold if systolic blood pressure (SBP) is <100 and pulse <50 related to essential hypertension.-Fluticasone propionate suspension 50 micrograms per actuation (mcg/act). 2 sprays in each nostril every 24 hours as needed for allergy symptoms.-Furosemide 20 mg. 1 tablet by mouth one time a day for edema.-Ipratropium-Albuterol 0.5-2.5 mg/2ml. 1 dose inhale orally every 4 hours as needed for shortness of breath.-Medrol oral therapy pack 4 mg. 1 tablet every morning and at bedtime related to chronic obstructive pulmonary disease (COPD) exacerbation.-Trelegy Ellipta Inhalation Aerosol powder breath activated 100-62.5-25 mcg/act. 1 puff inhale orally one time a day related to COPD exacerbation. Review of Resident #1's Medication Administration Record (MAR) for August 2025 showed:-Trelegy Ellipta inhalation aerosol 100-62.5-25 mcg/act for COPD (acute) was administered on August 24th, 25th, 26th, 27th, 28th, 29th, and 30th.-Ascorbic acid oral tablet 500 mg for Ascorbic Acid Deficiency, was administered on August 23rd, 24th, 25th, 26th, 27th, 28th, 29th, and 30th (morning dose)-Carvedilol oral tablet 3.125 mg was administered on August 23rd, 24th, 25th, 26th, 27th, 28th, 29th, and 30th-Medrol oral tablet therapy pack 4 mg for COPD (acute) was administered on August 23rd, 24th, 25th, 26th, 27th, 28th, 29th, and 30th.-Atorvastatin calcium oral tablet 80 mg was administered August 23rd through 29th.-Azithromycin oral tablet 500 mg for a Urinary tract infection was administered August 23rd through 27th.-Furosemide oral tablet 20 mg for edema was administered August 23rd through 30th.-Lidocaine external patch 4% for pain was administered August 23rd through 30th.-Pantoprazole sodium oral tablet 40 mg (incorrect dose was administered August 23rd through 30th. Review of Resident #1's Nursing Admission, readmission Screening and History, dated 8/22/25, completed by Staff A, Licensed Practical Nurse (LPN) showed:Medication ReconciliationAre these orders to be clarified? No - Reviewed and no clarification neededMedications recommended by Hospital that need clarification: (no documentation)Note Clarification needed: (no documentation)Results after physician notification (continue, stop, change): (no documentation). Are there medications taken before hospitalization NOT currently on the hospital recommended list? No - Reviewed and no clarification neededMedications taken before hospitalization not currently on hospital recommended list?Comments such as reason for med (medication) and reason it was stopped in hospital (if known): (no documentation)Results after (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 17 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Physician notification (continue, stop, change): (no documentation) Review of Resident #1's medical record did not show any documentation the medication orders from the hospital were reconciled with a medical provider prior to being entered into the computer. Review of Resident #1's vital signs showed the resident had an elevated blood pressure of 202/116 on 8/25/25 at 7:53 a.m. and 170/108 at 4:46 p.m. (Normal blood pressure 120/80). Review of a provider note dated 8/25/25 by Resident #1's primary care Nurse Practitioner (NP) showed . labs on 8/26/25. Patient blood pressure has been elevated and a new order for carvedilol was started today. Will monitor for medication efficacy. Review of Resident #1's lab results, reviewed by the NP on 8/26/25 at 2:03 p.m. showed: SODIUM 135 milliequivalents (mEq)/liter (L) reference range 136-145 LowCHLORIDE 89 mEq/L reference range 98-110 LowGLUCOSE 364 mg/deciliter (dL) reference range 74-109 HighBUN 43 mg/dL reference range 7-25 High CREATININE 1.62 mg/dL reference range 0.6-1.3 HighB/C RATIO 26.54 reference range 8.0-25.0 HighAST (SGOT) 12 Units (U)/L reference range 13-39 Low ALKALINE PHOSPHATASE157 U/L reference range 34-104 HighGlomerular Filtration Rate (GFR) 32 reference range >60 ml/min Low GFR Reference Range: Stage IIIB Moderate to Severe loss of kidney function 30-44 milliliters/minute (ml/min) Review of progress notes showed an 8/26/25 nurse's note revealing Advanced Registered Nurse Practitioner (ARNP) ordered Intravenous fluids (IVF) normal saline (NS) at 50 ml/hour (hr) for 1000 ml total related to (r/t) lab results today. Review of Resident #1 physician orders showed:Peripheral line catheter continuous infusion: 0.9% sodium chloride, 50ml/hr, 1000ml total. Every shift monitor infusion related to dehydration for 2 days. Dated 8/26/25. Review of Resident #1's medical record did not show any documentation the NP or the facility addressed the residents blood glucose level of 364 mg/dL and the resident did not receive insulin. Review of Resident #1's vital signs showed the resident had an elevated blood pressure of 189/112 on 8/28/25 at 7:26 a.m. and 164/102 on 8/28/25 at 4:09 p.m. Review of Resident #1's medical record showed no documentation the provider was notified of the elevated blood pressure on 8/28/25 at 7:26 a.m. There was a nursing note on 8/28/25 at 4:39 p.m. explaining the provider was notified of the blood pressure reading of 164/102 and new order was received for a one time does of medication. Review of Resident #1's orders showed a one-time order for Amlodipine 5 mg for blood pressure of 164/102 on 8/28/25. A follow up blood pressure was reading on 8/28/25 at 9:06 p.m. was 140/80. Review of Resident #1's Lab results showed repeat labs were reviewed by Staff B, LPN on 8/28/25 at 5:10 p.m. The lab results showed: SODIUM 132 mEq/L 136-145 LowCHLORIDE 89 mEq/L 98-110 LowGLUCOSE 487 mg/dL 74-109 HighBUN 45 mg/dL 7-25 HighCREATININE 1.58 mg/dL 0.6-1.3 HighB/C RATIO 28.48 8.0-25.0 HighAST (SGOT) 12 U/L 13-39 LowALKALINE PHOSPHATASE 155 U/L 34-104 HighGFR 33 >60 ml/min Low Review of Resident #1's medical record showed no documentation a provider was notified of the abnormal lab results after the nurse reviewed them on 8/28/25 at 5:10 p.m. There was no documentation showing the resident's elevated blood glucose level of 487 mg/dL was addressed. Review of Resident #1's vital signs showed the resident had an elevated blood pressure of 180/114 on 8/29/25 at 7:38 a.m. Review of Resident #1's medical record revealed there was no documentation a provider was notified of the resident's elevated blood pressure on 8/29/25 at 7:38 a.m. Review of Resident #1's progress notes showed:8/30/25 at 1:34 p.m. Resident BS [blood sugar] noted HI on meter, HI reading indicated a BS over 600. ARNP updated with new orders to give 15 units now after rechecking sugar then start lantus and insulin lispro low dose sliding scale8/30/25 3:29 p.m. Resident BS remains high on meter, ARNP updated with new orders to send to ER [emergency room] for eval [evaluation]. Review of Resident #1's MAR showed Insulin Lispro pen injector 200 u/ml. 15 units was administered at 1:40 p.m. on 8/30/25. Review of Resident #1's Summary for Providers, dated 8/30/25 showed:Change in ConditionNursing observations, evaluation, and recommendations are: Resident noted more lethargic than normal, able to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 18 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few arouse. BS reading HI on machine indicated over 600. 15 units units [sic] given per ARNP orders, recheck in 1 hour, re-checked and still showing HI. ARNP updated with new orders to send to the ER for evaluation. Review of Resident #1's vital signs did not show any documented blood glucose checks completed by the nurse from 8/22/25 until 8/30/25 when the resident was transferred to the hospital. An interview was conducted on 9/29/25 at 5:10 p.m. with Staff A, LPN. She said she had Resident #1 when she was admitted on [DATE]. She said another nurse, Staff C, LPN helped her by starting to put medications in the computer queue for the resident prior to her getting to the facility. Staff A said when the resident came, Staff C, continued to help with the paperwork then Staff C said these [orders] don't match you need to finish them because she had to assist her residents. Staff A said there was a lot going on that night and she did not get to look at Resident #1's orders again until early the next morning when she finished putting them in the computer. She said she did not remember seeing insulin orders on the paperwork for the resident. Staff A said when the resident arrived Staff C sent the admission paper, the 3008, and the hospital medication list to the provider over the facility's text messaging system. Staff A said she did not remember the provider sending back or making any changes to Resident #1's orders. Staff A confirmed Resident #1 was confused and would not have known her medications. An interview was conducted on 9/29/25 at 2:58 p.m. with Staff C, LPN. Staff C said Staff A, LPN was assigned to Resident #1 on admission. She said all she did was start putting Resident #1's hospital orders in the queue. Staff C said she entered some of the medication orders in the computer then informed Staff A she needed to finish entering the orders and review everything. Staff C said she was just helping. An interview was conducted on 10/1/25 at 4:30 p.m. with Staff E, Certified Nursing Assistant (CNA). Staff E cared for Resident #1 on 8/25-8/28/25 on the 7: 00 a.m.-3:00 p.m. shift. Staff E said on 8/25/25 when she first met Resident #1, I thought maybe she was recovering from something, because she would kind of flop and throw herself back in bed. She said she had to get the nurse to assist her with transferring the resident. Staff E said a day, or two later Resident #1 must have gotten a new medication or maybe it was the IV fluids she got, but the resident was able to hold a good conversation. Staff E said she was able to get Resident #1 to shower and she made more sense. Staff E said she was off for a couple of days and when she returned, she was told the resident had gone back to the hospital. A follow-up interview was conducted on 10/1/25 at 3:18 p.m. with Staff C, LPN. She said she only assisted with entering medication orders for Resident #1 after the resident arrived at the facility. She said she entered orders from the paperwork the resident brought from the hospital. An interview was conducted on 9/29/25 at 1:43 p.m. with Resident #1's primary care NP. The NP said she did not get notified of Resident #1's abnormal lab results on 8/28/25. She confirmed it was a Thursday, and she would have been the person contacted. The NP said staff notified her about the abnormal labs on 8/26/25 and she ordered some IV fluids. She said Resident #1 did not say anything about her blood sugar levels. The NP did confirm Resident #1 was confused. During a follow-up interview on 10/1/25 at 5:51 p.m. the NP said she knew the resident had some high blood pressure readings and was put on a blood pressure medication. She said she had been notified of previous high blood pressures for Resident #1 but was not notified the resident's blood pressure was high on 8/29/25. She said for the abnormal labs she saw Resident #1's glucose level was high but thought maybe she was dehydrated and that is why she ordered IV fluids. She said she did not know about the second abnormal labs on 8/28/25. The NP did not want to comment on Resident #1 being on furosemide because she did not order it but said in general furosemide removes fluid from the body. The NP agreed it could cause dehydration. An interview was conducted on 9/30/25 at 10:32 a.m. with Staff D, Registered Nurse (RN). Staff D said she remembered Resident #1 and was the supervisor in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 19 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few facility when the resident was sent to the hospital. Staff D said she made rounds frequently on the units and touched base with nurses. She said on 8/30/25 a CNA came to her and said Resident #1 was different than she had been the weekend before. She said the CNA told her the previous weekend, August 23rd/24th, the resident had been up walking around and was busy. Staff D said on 8/30/25 Resident #1 was lying in bed, lethargic, and would talk, but barely. Staff D said she had seen Resident #1 the weekend she had been admitted to the facility. She said the resident had been confused, but the family said it was her baseline. She said the resident got up and walked around her room sometimes without waiting for assistance. Staff D said when she saw how the resident was on 8/30/25 she did a full assessment on Resident #1 and part of that was checking her blood glucose level since she was diabetic. Staff D said the resident's blood glucose was high and she worked with the resident's assigned nurse to update the provider and get orders. Staff D said she looked at the resident's medical record because she liked to gather what information she can provide to paramedics and the emergency department. She said during her review she noticed Resident #1 had two sets of labs since her admission that showed high blood glucose levels, one in the 300s and one in the 400s. Staff D said during her chart review she noticed the resident was not being administered any insulin or medication for diabetes by mouth. Staff D said she had not been informed the resident had any blood pressures issues but noticed Resident #1 had high blood pressure readings that week and was started on medication. Staff D said she pulled up Resident #1's admission paperwork from the hospital to compare to the orders the resident had in the computer, and she noticed Resident #1 had orders for some medications that had been on her hospital discharge list and some of her medications were not on the list. She said she did not recall the exact medications, but there were some wonky ones. She said she noticed the resident had been discharged on a few blood pressure medications but had not received them upon admission. Staff D said she notified nursing management and left all the paperwork she had gathered so it could be investigated. Staff D said she also notified the on-call provider about the medication discrepancies. An interview was conducted on 9/30/25 at 9:40 a.m. with the Assistant Director of Nursing (ADON) and the Director of Nursing (DON). They both reviewed Resident #1's hospital discharge medication list and the resident's physician orders in the facility. They confirmed the medication lists did not match. The DON said she did not know what happened and wanted to look into it further. A follow-up interview was conducted on 9/30/25 at 4:55 p.m. with the ADON and DON. They said the new admission process expectation would be the resident arrives at the facility with hospital discharge paperwork, and the admitting nurse is notified. The nurse takes the hospital medication orders and sends them to the provider for review. Once the medications are reconciled with the provider, the medication orders are entered into the computer. Then nurses on the 11:00 p.m. -7:00 a.m. shift are responsible for doing a chart check for all new admissions that day. The ADON and DON said the new admission paperwork was at the nurses' station, so the night shift nurse had it available to review orders to ensure they were transcribed correctly. The ADON and DON said if a nurse worked a double shift (from 3:00 p.m.-11:00 p.m. and then 11:00 p.m. -7:00 a.m.) that nurse could do their own chart check. They said there was no process in place to document chart checks were being completed on the 11:00 p.m.-7:00 a.m. shift; they were trusting it was being completed. The ADON and DON said the second chart check was completed after the morning clinical meeting, each morning Monday through Friday. They said the Unit Manager (UM) was responsible for bringing new admission charts to the meeting and reviewing the orders for accuracy. An interview was conducted on 9/30/25 at 11:31 a.m. with the RR for Resident #1. The RR said the resident had been on blood pressure medication prior to being admitted to the facility. She said the hospital never mentioned Resident #1 having urinary tract infection (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 20 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few (UTI), but the nurse at the facility said she had a UTI coming from the hospital, which was confusing. The RR said Resident #1 did not have COPD or breathing issues and had not been on medications related to that. The RR said when Resident #1 admitted to the facility she had been talking, up walking around, and had been able to stand up from the bed on the lowest position by the floor. The RR said Resident #1 downgraded to not talking, not walking, and not getting up to go to the bathroom while in the facility. The RR said since leaving the facility, the resident had recovered some of her abilities but was not back to where she was prior to being admitted there. An interview was conducted on 10/1/25 at 1:22 p.m. with the facility's Medical Director of the facility. The Medical Director said he was informed of the admission errors with medication orders for Resident #1 but was not fully aware of the specifics. He said his expectation on admission was a picture of the resident's hospital orders were sent to the physician; the physician reviewed and verified the orders and sent clarification and/or new orders. The Medical Director said the provider was expected to review orders between visits to ensure accuracy. He said he expected the nurses to have completed audits to ensure accuracy. He confirmed he would have expected the nurse to have documented that medications were reconciled with the provider. He said as the Medical Director of the facility, if the facility had difficulty with a provider not responding to a condition or if education to another provider was necessary, he should have been notified because it was his job to have discussions regarding protocols and standards of practice. An interview was conducted on 9/30/25 at 1:34 p.m. with the facility's consultant pharmacist. She said she had been notified about the medication errors for Resident #1, but she had only been told about the resident not receiving insulin; she was not aware of all the medication issues. The pharmacist was read the list of medications from the resident's hospital discharge medication list and the medications ordered in the facility. She said after hearing the list, she would be more concerned with the medication Resident #1 did not receive. She said it would depend on why Resident #1 was on some of the medication such as carbamazepine and lactulose. The pharmacist said carbamazepine could be used for seizures or depression and lactulose could be for constipation or for abnormal ammonia levels. The pharmacist said she had not seen anything like this happen before. She said when a new resident is admitted she completes a medication review, however she is looking at the medications in the facility orders to ensure there are no interactions or issues. She said unless she sees something that looks really off, she does not pull the hospital discharge medication list to review. The pharmacist said her expectation is for the facility to enter the medication orders correctly. Review of Resident #1's hospital records dated 8/30/25 showed:Presenting Problem: hyperglycemia, given 15 units of insulin at facility.History of Present Illness: [AGE] year-old female with a past medical history of diabetes, hyperlipidemia,hypertension, and prior breast cancer (status post left mastectomy and lymph node removal, in remission), [NAME] [inferior mesenteric artery] occlusion and SMA [superior mesenteric artery] stenosis presents with a 3-day history of abdominal pain and hyperglycemia. Glucose greater than 600 at facility given insulin prior to transport. Patient notes her pain is diffuse 8 out of 10 intensity nonradiating with no alleviating factors. Lab results in the emergency department showed:8/30/2025 5:58 p.m.WBC (white blood cell count) 16.42 x10^3/ microliter (uL) HIGHPlatelet 600 x10^3/uL HIGHNeutrophil Auto 72.5 % HIGHLymphocyte Auto 13.3 % LOWMonocyte Auto 12.4 % HIGHEosinophil Auto 0.3 % LOWAbsolute Neutrophil 11.91 x10^3/uL HIGHAbsolute Monocyte 2.03 x10^3/uL HIGHBUN 44 mg/dL HIGHCreatinine 1.47 mg/dL HIGHEstimated glomerular filtration rate (eGFR) Chronic kidney disease-equation for prediction and interpretation (CKD-EPI) 36 mL/min/1.73m^2 LOWCalcium Level 11.3 mg/dL HIGHAlkaline Phosphatase 182 U/L HIGHLipase Level 127 U/L HIGHPro b-type natriuretic peptide (PBNP) 1,010 pg/mL HIGHHS Troponin-T 60 ng/L CRITICALLY HIGHCarbamaz Level <2.0 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106120 If continuation sheet Page 21 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete ug/mL LOWT4 Free 1.86 ng/dL HIGHUrinalysis (UA) Appear ClearUA Color Pale yellowUA Glucose 4+UA Ketones 1+UA Protein 3+UA Bacteria Auto FewUA Epithelial Cells Auto None SeenUA Hyaline Cast Auto Few8/30/25 6:22 p.m.POC [point of care] Potassium 3.4 mmol/L LOWPOC Sodium 129 mmol/L LOWPOC [NAME] [lactate] 3.30 mmol/L HIGH Vital signs8/30/25 6:00 p.m.Blood pressure 158/93Heart rate 101Respiratory rate 18 breathes/minute Discussion of Management with Hospitalist revealed: [AGE] year-old female presents to the emergency department with diffuse abdominal pain in the setting of known severe atherosclerosis of the aorta [NAME] SMA. CT [computed tomography] angiogram above no evidence of ischemic colitis unclear etiology of the patient's pain white count is 17 she was given vancomycin and Zosyn. Glucose greater than 600 now in the 400s after insulin. Given further fluids and insulin in the emergency department. She will be admitted for further management of her hyperglycemia possible underlying sepsis blood cultures were sent. Lactate was 3.3. [normal is <2] Of note patient also with new ischemic appearing EKG [electrocardiogram] with lateral ST depressions elevated troponins of 60 and 54. She is not complaining of chest pain however concern for potential NSTEMI [Non-ST-Segment Elevation Myocardial Infarction] given elevated troponins and ischemic EKG. She will be admitted to the cardiac floor for further management of numerous above conditions.Diagnoses listed were hyperglycemia due to type 2 diabetes mellitus, abnormal EKG, elevated troponin, lactic acidemia, hypertension, and abdominal pain. A Cleveland Clinic article titled Troponin Test, reviewed on 3/17/22, explained: A troponin test looks for the protein troponin (there are two forms related to your heart, troponin I and troponin T) in your blood. Normally, troponin stays inside your heart muscle's cells, but damage to those cells - like the kind of damage from a heart attack - causes troponin to leak into your blood. Higher levels of troponin in[TRUNCATE Event ID: Facility ID: 106120 If continuation sheet Page 22 of 22