Inspection·December 14, 2023

F 0607 Level of Harm - Minimal harm or potential for actual harm On 12/10/23 at 9:28 AM, Certified Nursing Assistant (CNA) Q was seated at resident #1's bedside. She stated she was assigned to provide one-to-one supervision for the resident because he recently eloped from the facility. Resident #1 confirmed he recently walked through the facility's front doors without signing out, when the receptionist at the front desk was not looking. The resident stated he went to the hospital cafeteria across the street by himself. Residents Affected - Few On 12/10/23 at 12:25 PM, the DON stated she was present in the lobby when resident #1 left the faciity on [DATE]. In conflict with the resident's statement, the DON explained she reminded the resident to sign out and go to the hospital cafeteria on an authorized LOA. When asked to review the resident's medical record, the DON confirmed there was no order for LOA on 11/10/23. She validated resident #1 left the facility unsupervised although there was no indication in the medical record that he should be permitted to do so. The DON explained she did not record the incident on the facility's incident log, and the circumstances were never identified as a failure to provide care and services, and never investigated to rule out neglect. On 12/10/23 at 2:30 PM, in a telephone interview, Licensed Practical Nurse (LPN) R stated she was assigned to resident #1 on 11/10/23, but was unaware he was missing until someone informed her he was retrieved from across the street and brought back to the facility. LPN R recalled she was about to start the required incident documentation when the DON told her it was unnecessary to complete an elopement risk re-evaluation, a progress note, or a risk management/incident report because the event was not considered an elopement. LPN R said, She told me she took care of it. On 12/12/23 at 11:21 AM, the Administrator stated she expected all staff to accurately and immediately report incidents, and as the Risk Manager, she was responsible for making decisions regarding investigating and/or reporting occurrences that were potential or alleged abuse or neglect. The Administrator confirmed it was essential to obtain accurate information by conducting a timely and thorough investigation in order to rule out abuse and neglect. On 12/12/23 at 12:47 PM, the DON stated she escalated incidents to the Administrator and they discussed the issues to determine if the findings met the criteria for reporting. She said, We did not feel it met criteria. There was no investigation done to my knowledge. On 12/14/23 at 11:44 AM, the Administrator acknowledged she did not conduct a thorough investigation of the circumstances that allowed resident #1 to leave the facility unsupervised, even after the facility became aware that he left without an LOA order. The Administrator stated she was unaware of findings uncovered during the complaint investigation survey regarding the incident. She confirmed an investigation would be required to identify if there was potential neglect in order to protect all residents. 2. Review of the medical record revealed resident #10 was admitted to the facility on [DATE] with diagnoses including dementia, prostate cancer, and insomnia. Review of the admission Nursing Evaluation dated 12/01/23 revealed resident #10's skin evaluation indicated he had no wounds. On 12/12/23 at 10:21 AM, Personal Care Attendant (PCA) A stood at resident #10's bedside. The resident had a deep, partial flap skin tear on his right index finger. The wound bed was exposed and there were fresh, semi-solid blood clots at the edges of the wound. PCA A denied the injury occurred during care and she stated the resident already had the injury to his finger when she arrived for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 2 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 7:00 AM shift. PCA A stated she reported the injury to the assigned nurse, LPN H, at about 9:30 AM but the nurse had not yet come to the room. PCA A did not respond when asked why she waited until 9:30 AM to report the significant injury. On 12/12/23 at 10:35 AM, LPN H stood at her medication cart at the nurses' station. She stated she was never informed resident #10 had a skin tear. PCA A approached the nurses' station and LPN H confronted her. LPN H said, You did not tell me the resident had a skin tear. PCA A stated she thought she informed the nurse. On 12/12/23 at 10:37 AM, the Casabella Unit Manager (UM) and LPN H assessed resident #10's finger. LPN H validated the resident had a new skin injury. LPN H stated she was in the resident's room during this morning's change of shift report and then afterward during medication administration. She said, I was right here beside the bed. That injury was not there! On 12/12/23 at 1:12 PM, the DON stated all staff were expected to report new skin injuries immediately. She explained the timeframe was important as the Risk Manager needed to determine if injuries needed to be investigated and reported as possible abuse, neglect and/or injuries of unknown origin within two hours as required. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 3 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop and/or implement person-centered care plan interventions that accurately reflected the plans of care and promoted the highest practicable well-being for 3 of 12 sampled residents, (#1, #9, and #12). Findings: 1. Review of the medical record revealed resident #1 was admitted to the facility on [DATE] with diagnoses including alcohol dependence with alcohol-induced persisting dementia and psychotic disorder with delusions, metabolic encephalopathy (brain dysfunction), Wernicke's encephalopathy (a neurological disorder associated with alcohol abuse), mini-stroke, alcoholic liver disease, and convulsions. The Minimum Data Set (MDS) Quarterly assessment with assessment reference date of 11/10/23 revealed resident #1 had a Brief Interview for Mental Status score of 14 which indicated he was cognitively intact. The document showed the resident did not reject evaluation or care that was necessary to achieve his goals for health and well-being, and did not exhibit wandering behavior. The MDS assessment revealed resident #1 ambulated independently without mobility devices. Review of the medical record revealed a care plan dated 11/10/23 regarding resident #1's preference to have Leave of Absence (LOA) and his noncompliance with signing out in the LOA book. The goal was the resident would notify staff prior to LOA and again on return, and would return to the facility safely. The interventions included remind and educate resident to notify staff when leaving facility [and].sign LOA book when leaving facility. Resident may go LOA accompanied by staff or others. The Certified Nursing Assistant (CNA) care plan or [NAME] included the directives of one-to-one supervision, offer extra coffee or an alternate meal, may go LOA accompanied by staff, and monitor for changes in mental status. The [NAME] did not include instructions to monitor the resident for exit-seeking behaviors or verbalization of intent to leave the facility. On 12/10/23 at 12:25 PM, the Director of Nursing reviewed resident #1's medical record and confirmed the resident did not have an active physician order for LOA on 11/10/23. She acknowledged there was an order for LOA with family or representative dated 5/23/23 that was discontinued on 10/26/23. Further review of medical record showed an active physician order dated 11/30/23 that read, May go LOA with family/representative and meds. On 12/11/23 at 2:26 PM, MDS Coordinator S confirmed there was no LOA physician order in place on the day he created the LOA care plan for resident #1. He stated he never verified that there was an associated physician order although he usually checked the medical record for supporting documentation before making a care plan. He acknowledged the care plan did not accurately reflect the resident's goals and needs until the physician order was written twenty days later, on 11/30/23. 2. Review of the medical record revealed resident #9 was admitted to the facility on [DATE] with diagnoses including Parkinson's Disease, viral pneumonia, adult failure to thrive, generalized muscle weakness, and unsteadiness on his feet. The MDS admission assessment with assessment reference date of 10/10/23 revealed resident #9 did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 4 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few not reject evaluation or care that was necessary to achieve his goals for health and well-being. The resident used a walker or wheelchair and required moderate assistance for mobility. The document showed he needed substantial assistance from staff for toileting hygiene and moderate assistance with showers and personal hygiene. Resident #9 was frequently incontinent of bowel and bladder. Resident #9 had a care plan for assistance with activities of daily living (ADL) care related to multiple factors including weakness and decreased mobility, initiated on 10/04/23. The interventions included encourage and assist the resident with all ADL tasks such as bathing, transfers, toileting, and personal or oral hygiene. There was no documentation of transfer assistance or equipment requirements. On 12/12/23 at 3:06 PM, Personal Care Attendant (PCA) E reviewed resident #9's [NAME] and showed the section of the care directives titled Transferring. He verified there was no instruction on the number of staff required for transfers. On 12/14/23 at 10:08 AM, MDS Coordinator S reviewed resident #9's nursing care plans and [NAME] and validated the documents did not include adequate information to communicate the resident's transfer needs. He acknowledged the purpose of the care plan was to guide resident care and services and it was important for CNAs and nurses to have detailed, accurate instructions to ensure safe care. 3. Review of the medical record revealed resident #12 was admitted to the facility on [DATE] with diagnoses including cerebral atherosclerosis, vascular dementia, and heart disease. She was hospitalized after a fall and readmitted on [DATE] with a new diagnosis of a wedge compression fracture of the first lumbar vertebra. Review of the medical record revealed a care plan for assistance with ADL care was initiated on 12/07/23. The interventions included assistive devices as ordered, spinal precautions as indicated, and a Thoracic Lumbar Sacral Orthosis (TLSO) device, a brace that works like a body cast to limit movement of the spine. A care plan for risk for complications of a lumbar fracture, initiated on 12/07/23, instructed staff to encourage and assist the resident with use of adaptive equipment. A physician order dated 12/07/23 read. Wear TLSO brace while in upright position, may remove for hygiene purposes, every shift. On 12/13/23 at 10:15 AM, resident #12 was in the gym doing upper body exercises. Physical Therapy Assistant O approached and stated the resident should be wearing her brace. On 12/13/23 at 10:25 AM, CNA D confirmed she was regularly assigned to care for resident #12, and although she provided ADL care including assistance with transfers, toileting, and personal hygiene, she had never applied the resident's TLSO brace. She was not sure who was responsible for applying the device, but she thought therapy staff did that task. CNA D reviewed the [NAME] and noted there were no clear instructions on who should apply the TLSO brace or when it should be worn. In addition, she confirmed the [NAME] read, Transfers - transferring but did not include a clear directive on the the number of persons and type of device, if any, were required for a safe transfer. On 12/14/23 at 10:13 AM, MDS Coordinator S stated the resident's care plans and [NAME] as written did not provide staff with specific instructions regarding the TLSO brace. He confirmed the physician order indicated the device should be worn whenever the resident was in an upright position. He said, I would say that means when out of bed. MDS Coordinator S verified it was essential for all staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 5 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete to have accurate information regarding residents' care needs. He stated there was a corporate staff who audited MDS assessments, but he was not sure if anyone audited care plans. Review of the facility's policy and procedure for Comprehensive Person-Centered Care Plans, revised in December 2016, revealed the interdisciplinary team, in conjunction with the resident and/or family, would develop and implement a comprehensive, person-centered care plan for each resident. The document indicated the care plan would describe the services that are to be furnished to attain and maintain the resident's highest practicable physical, mental, and psychosocial well-being. The policy revealed care plans would identify the professionals responsible for each aspect of care and aid in preventing declines in functional status. Event ID: Facility ID: 106123 If continuation sheet Page 6 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0660 Plan the resident's discharge to meet the resident's goals and needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to effectively implement the discharge planning process to arrange necessary post-discharge care and services for 1 of 3 residents reviewed for discharge planning, out of a total sample of 12 residents, (#4). Residents Affected - Few Findings: Review of the medical record revealed resident #4 was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, generalized muscle weakness, unsteadiness on his feet, osteoarthritis, and cognitive communication deficit. Resident #4 was discharged from the facility on [DATE]. The Minimum Data Set (MDS) Discharge - Return Not Anticipated assessment with assessment reference date of [DATE] revealed resident #4 had a Brief Interview for Mental Status score of 6 which indicated severe cognitive impairment. The resident required set-up to supervision assistance for activities of daily living and transfers, and he used a wheelchair for mobility. Resident #4 received Occupational, Physical, and Speech Therapy services from [DATE] to [DATE]. The MDS assessment revealed there was an active discharge plan in place for the resident to return to the community. Review of the medical record revealed resident #4 had no care plan for discharge planning. Review of the Order Summary Report revealed a physician order dated [DATE] to discharge the resident home with medications, a walker, and home health care services for Physical Therapy, Occupational Therapy, and a Home Health Aide. Resident #4's medical record revealed Physical Therapy and Occupational Therapy Discharge Summaries dated [DATE] with recommendations for a home exercise program and home health care services. Review of progress notes revealed a Discharge summary dated [DATE] at 8:51 AM. The document read, Referrals for home health-[name and telephone number of a provider]. Discharge needs - therapy. A Discharge Note dated [DATE] at 2:20 PM read, Resident discharge home with his daughter. He will be living in [name of city] with her the next few weeks. [Name of provider] assigned. On [DATE] at 12:20 PM, in a telephone interview with resident #4's daughter, she explained her father was transferred from the hospital to the facility for short-term rehabilitation. She stated the facility was aware that he was going to be discharged to her home in another county about two hours away. She said, That was the plan all along, from the very start. The resident's daughter stated when she got her father to her home, she realized home health care services had not been arranged. She was informed the medical record indicated home health aide and therapy services were ordered and arranged. The resident's daughter reiterated, They did not arrange therapy. She explained she called the facility and spoke with someone who informed her she would need to find a physician in her own county to order therapy services as her father was no longer resident in the county in which the facility was located. The daughter explained she contacted the Administrator by text message to request the facility arrange therapy services for her father, and he replied that he would. She stated next, she received a phone call from a company that unsuccessfully attempted to deliver a wheelchair and walker to her father's previous address. Resident #4's daughter explained home health care and therapy services were never arranged and her father was soon rehospitalized and subsequently died. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 7 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0660 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of screenshots of text messages between resident #4's daughter and [name of Administrator] dated Wednesday, [DATE] at 2:45 PM, revealed he was informed the resident was discharged home without orders for therapy services or medical equipment. The Administrator's response read, Ok we will send over asap. On [DATE] at 11:40 AM, the Director of Social Service (DSS) explained discharge planning started on admission and continued throughout a resident's stay to prepare for a safe and organized discharge. She stated the facility held a welcome meeting for each resident during the first three days of admission to determine if there was a preferred home health care agency and identify needs based on the individual's living situation including equipment and caregiver support. The DSS stated members of the interdisciplinary team (IDT) met at least weekly to discuss residents' progress and also held scheduled care plan meetings with residents and/or their representatives to review tentative discharge date s and post-discharge services. She explained the facility previously had a Discharge Planner who sent orders or referrals to the home health care companies but that staff member was no longer on staff at the facility. The DSS explained the process was to contact the home health care company to verify they were able to provide all ordered care and services. The DSS reviewed resident #4's medical record and stated she was not really familiar with the company named in the discharge note but to her knowledge it was not a home health care agency. On [DATE] at 11:55 AM, in a telephone call with the owner of the company listed on the discharge note, she clarified that her company provided non-medical care and services such as companion sitters or aides, and assistance with personal care, light cleaning, and laundry. The owner explained her franchise serviced the county associated with the facility's geographic location and there was another franchise with different contact information that serviced the county of resident #4's discharge location. On [DATE] at 12:06 PM, the Director of Rehab stated resident #4's therapy notes showed he was to be discharged home with family. He explained the process was for the therapy department to communicate recommendations regarding residents' post-discharge needs with the DSS and IDT in the days preceding discharge. The Director of Rehab stated resident #4 was supposed to have a home exercise program and in home therapy services arranged for him. The DSS reviewed the medical record and verified there was a physician order for therapy services, medical equipment, and home health aide services, and walker. She confirmed resident #4's discharge was not handled appropriately. On [DATE] at 12:43 PM, the Director of Nursing validated discharge planning should start on admission and all arrangements should be made and verified before the resident left the facility for home Review of the facility's policy and procedure for Discharge Summary and Plan, revised in [DATE], read, When a resident's discharge is anticipated, a discharge summary and post-discharge plan will be developed to assist the resident to adjust to his/her new living environment. The policy indicated the post-discharge plan would be developed by the care planning/interdisciplinary team (IDT) in conjunction with the resident and/or family. The plan was to include where the resident planned to live, arrangements for follow-up care and services, and the degree of caregiver availability and capability to perform care for the resident. The document revealed a member of the care planning/IDT would review the final post-discharge plan with the resident and/or family at least 24 hours before discharge FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 8 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide activities of daily living (ADL) care for 2 of 6 residents reviewed for ADL care out of a total sample of 12 residents, (#9 & #10). Residents Affected - Few Findings: 1. Review of the medical record revealed resident #9 was admitted to the facility on [DATE] with diagnoses including Parkinson's Disease, viral pneumonia, adult failure to thrive, generalized muscle weakness, and unsteadiness on his feet. The Minimum Data Set (MDS) admission assessment with assessment reference date of 10/10/23 revealed resident #9 had clear speech, was able to communicate his needs and wants, and had no issues with comprehension. The MDS assessment showed the resident did not reject evaluation or care that is necessary to achieve the resident's goals for health and well-being. The resident used a walker or wheelchair and required moderate assistance for mobility. The document showed he needed substantial assistance from staff for toileting hygiene and moderate assistance for showers and personal hygiene. Resident #9 was frequently incontinent of bowel and bladder. Review of the medical record revealed a care plan for assistance with ADLs was initiated on 10/04/23. The interventions included encourage and assist resident #9 with ADLs. A care plan for risk for oral/dental health problems, initiated on 10/04/23, instructed staff to assist the resident with oral care. On 12/10/23 at 4:27 PM, a woman stood in the 600 hallway and hung an object on the handle of resident #9's room door. Closer observation revealed the item was a handwritten sign that read Please give my husband a [shower] He smells. She explained during her husband's stay in the facility, lack of showers was an ongoing issue. She stated staff were to provide him with showers at least twice weekly, on Tuesdays and Thursdays, but he definitely was not showered or shaved for more than a week. The resident's wife stated he smelled so bad when she walked in today that she had to spray the room with perfume. She stated her husband's beard was so heavy last weekend that she shaved him herself and had to do it again today as he had not been shaved since then. Resident #9's skin was dry and flaking in areas on his neck, chest, and arms. He had a strong, pungent body odor and his hair was greasy with flakes noted along the hairline. The resident's wife stated she was also frustrated that her husband did not receive adequate assistance with brushing his teeth. She explained she expected staff to provide oral care at last twice daily, but that did not happen as he did not have a toothbrush for days. Resident #9 confirmed his teeth had not been brushed for a while. Review of the Documentation Survey Report for December 2023 indicated resident #9's showers were scheduled for Tuesdays, Thursdays, and Saturdays. The document indicated he received showers on Saturday 12/02/23, Sunday 12/03/23, and Tuesday 12/05/23 which conflicted with his appearance and odor, and the wife's description of his ADL status over the previous week. There was no documentation of showers on Thursday 12/07/23 or Saturday 12/09/23. On 12/10/23 at 5:21 PM, the Director of Nursing (DON) confirmed staff were expected to give showers on all scheduled shower days unless the resident refused. She stated Certified Nursing Assistants (CNAs) should inform the assigned nurse if resident #9 refused ADL care and then it should be documented in the medical record. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 9 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 12/12/23 at 1:08 PM, the DON stated after she was made aware of the concerns related to resident #9's ADL care, she spoke with him and he confirmed staff did not give him showers three times weekly as scheduled. In discussion about the sign posted by the resident's wife, the DON said, I was embarrassed. 2. Review of the medical record revealed resident #10 was admitted to the facility on [DATE] with diagnoses including dementia, prostate cancer, and insomnia. Review of the admission Nursing Evaluation dated 12/01/23 revealed resident #10 required assistance with ADLs including bed mobility, transfers, grooming, hygiene, and toileting. Resident #10 had a care plan for ADL self-care deficit related to chronic medical conditions, initiated on 12/04/23. The interventions included encourage and assist the resident with all ADL tasks as indicated. On 12/10/23 at 3:47 PM, resident #10's wife informed the Director of Social Services (DSS) she had several concerns regarding unsatisfactory personal hygiene care for her husband. She told the DSS that staff did not brush her husband's teeth or change his briefs regularly, and when she visited she noted his eyes were stuck shut with heavily crusted, dried drainage which she had to remove herself. She explained her husband had dementia and she was concerned about his care as he could not advocate for himself. The resident's wife stated she checked his brief when she arrived about an hour ago and it was saturated with urine, but no staff had come in to check on him yet. Observation of resident #10 revealed crusted drainage in the inner corners of both eyes, a clear film on his teeth, and a strong odor of urine. On 12/10/23 at 3:59 PM, resident #10's assigned CNA for the 3:00 PM to 11:00 PM shift was located on the unit. CNA B confirmed she had not checked the resident since the start of the shift. A few minutes later at 4:04 PM, CNA B pulled back the resident's sheet to show a visibly saturated brief. On 12/12/23 at 1:12 PM, the DON stated Unit Managers (UMs) were responsible for ensuring residents were cared for properly. She explained the UMs had multiple opportunities to observe ADL care and status throughout the day. On 12/12/23 at 2:39 PM, Personal Care Attendant (PCA) A stated she provided incontinence care for resident #10 prior to getting him out of bed between 10:30 AM and 11:00 AM that morning. She confirmed she had not checked or changed the resident since then. On 12/12/23 at 3:25 PM, PCA E confirmed he was assigned to care for resident #10 during the 3:00 PM to 11:00 PM shift. He explained he received change of shift report from PCA A who told him the resident was alright so he had not yet checked or changed the resident. When informed resident #10 last received incontinence care approximately five hours ago, PCA E acknowledged he should make the resident's care a priority. On 12/12/23 at 3:43 PM, Licensed Practical Nurse (LPN) H confirmed resident #10's skin was fragile and he should receive a brief change, incontinence care, and application of protective barrier cream every two to three hours and as needed. LPN H stated her expectation was PCA A would ensure ADL care was done prior to the end of her shift. The facility's policy and procedure for Supporting Activities of Daily Living (undated) read, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 10 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. The document indicated appropriate care and services would be provided in accordance with the resident's plan of care. Review of the job description for Personal Care Attendant (5/01/23) revealed the PCA would be expected to assist residents with ADLs including one-person transfers, repositioning, oral care, bedbaths, incontinence care, and dressing. Review of the job description for Certified Nursing Assistant (5/10/23) revealed the CNA would provide assistance with ADLs to include grooming, bathing, oral hygiene, incontinence care, and transferring according to the plan of care and within the scope of practice. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 11 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide care and services to promote skin integrity and prevent the development of an avoidable pressure ulcer for 1 of 3 residents reviewed for pressure ulcers, out of a total sample of 12 residents, (#10). Residents Affected - Few Findings: Review of the medical record revealed resident #10 was admitted to the facility on [DATE] with diagnoses including prostate cancer, dementia, and insomnia. Review of the admission Nursing Evaluation dated 12/01/23 revealed resident #10 required assistance with activities of daily living (ADLs) including bed mobility, transfers, grooming, hygiene, and toileting. The skin evaluation indicated the admission nurse noted the resident's skin was intact, with no rashes discolorations, scars, decubitus ulcers or questionable markings. The National Pressure Injury Advisory Panel defines a pressure injury or decubitus ulcer as localized damage to the skin and underlying soft tissue usually over a bony prominence.The injury can present as intact skin or an open ulcer and may be painful (retrieved on 1/03/24 from www.npiap.com). Some of the risk factors for developing pressure ulcers are spending most of the day in bed with minimal movement, incontinence, and spending a lot of time in one position. Preventative interventions include prompt cleaning and drying after incontinence episodes, use of a pillow between bony prominence, placement of a pillow under the calves to lift heels off the bed, and change your position every 1 to 2 hours to keep the pressure off any one spot (retrieved on 1/03/24 from www.medlineplus.gov/ency/patientinstructions/000147.htm). Review of resident #10's medical record revealed a care plan for risk for skin impairment related to weakness and decreased mobility, initiated on 12/04/23. The goal was the resident would be free of any new skin impairment. The interventions included encourage and assist to minimize pressure on bony prominences, turn and reposition as tolerated, monitor skin during routine care, and provide incontinence care promptly. On 12/10/23 at 3:47 PM, resident #10 was seated in bed and a strong odor of urine was noted. The resident's wife stated when she arrived about an hour ago, she checked his brief and it was saturated. The resident's wife expressed concerns regarding the development of sores or rashes on his bottom if he was not cleaned and repositioned appropriately. She lifted the sheet to show her husband wore socks and soft, protective boots, but his heels were not floated off the mattress. Resident #10's wife explained he could not reposition himself appropriately without staff assistance and whenever she visited she found him in the same position, seated on his bottom. On 12/10/23 at 4:04 PM, Certified Nursing Assistant (CNA) B pulled back the resident's sheet to show a visibly saturated brief. On 12/10/23 at 4:20 PM, Licensed Practical Nurse (LPN) H was prompted to conduct a complete skin evaluation to verify resident #10 had no areas of skin breakdown related to his wife's concerns. She noted the skin on his buttocks was slightly red but intact. LPN H removed the resident's socks and noted red areas on the inner aspects of both feet. The area on the right foot was dark red and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 12 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few measured approximately one centimeter (cm) in diameter and the area on the left foot was smaller and a lighter in color. Resident #10's wife confirmed the red areas were not present when her husband was admitted to the facility. She said, They are fresh. LPN H validated the newly identified discolorations were located on bony prominences and were pressure points. Further evaluation of resident #10's feet revealed a red, linear, curved area along the base of the toes of his left foot. LPN H acknowledged the area might be the result of his foot being pressed against the foot board. She stated neither the offgoing night nurse nor the day shift CNA informed her of the new areas of skin breakdown. Review of a progress note dated 12/11/23 revealed resident #10 was assessed by the Wound Physician and found to have a Deep Tissue Pressure Injury on the right medial foot. He noted the maroon-colored area measured 0.8 cm by 0.3 cm. The physician ordered application of wound cleanser and a skin protectant every shift and wrote, He should likely be able to heal if there is proper offloading. Offloading interventions listed were facility pressure injury prevention protocol, wheelchair pressure redistribution cushion, offload heels, and avoid direct pressure to the wound site. The National Pressure Injury Advisory Panel describes a Deep Tissue Pressure Injury as intact or non-intact skin with a localized area of persistent non-blanchable deep red, maroon, purple discoloration. This type of injury results from intense and/or prolonged pressure and the area may evolve rapidly to reveal a full-thickness wound (stage 3, stage 4, or unstageable) below the surface (retrieved on 1/05/24 from www.npiap.com/general/custom.asp?page=PressureInjuryStages). On 12/11/23 at 12:41 PM, CNA K verified the resident was sitting on his bottom and there was no pillow under his lower legs to ensure his heels were floated. On 12/11/23 at 3:07 PM, the Casabella Unit Manager (UM) stated nurses did skin evaluations on admission and then at least once weekly as scheduled. She explained CNAs were expected to check residents' skin daily during personal care and showers. The UM acknowledged it was important to turn and reposition bedbound residents regularly and ensure skin was clean and dry to prevent the development of pressure ulcers. She was informed resident #10 was observed in bed without a pillow to float his heels, and his position was unchanged since lunch time. On 12/11/23 at 3:14 PM, the Casabella UM removed resident #10's brief and confirmed he had been incontinent of urine and stool. She removed the resident's socks and the pressure injury on his right foot appeared darker than when it was discovered 24 hours ago. The UM validated there were no pillows or a wedge cushion in the bed to position the resident off his bottom, to the side, or to offload his heels. On 12/12/23 at 10:21 AM, CNA K removed resident #10's socks to inspect his feet and stated the pressure injury on his right foot had increased in size since she last saw it. On 12/12/23 at 1:12 PM, the Director of Nursing (DON) stated UMs were responsible for ensuring residents received proper care and they had multiple opportunities to observe residents' care and status throughout the day, including any positioning issues. The DON verified resident #10 acquired a pressure injury within 10 days of admission to the facility. She was informed of concerns expressed by the resident's wife regarding finding him in the same position whenever she visited and of repeated observations of the resident in upright seated position over the the past three days, without any positioning devices or pillows in the bed. The DON acknowledged failure to reposition resident #10 regularly could contribute to further skin breakdown. She explained she instructed CNA M to get resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 13 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0686 #10 out of bed yesterday morning, but said, I found out it didn't happen and she just left him in bed. Level of Harm - Minimal harm or potential for actual harm On 12/12/23 at 2:16 PM, CNA M stated she was assigned to care for resident #10 yesterday, 12/11/23. She recalled she provided ADL care and dressed the resident at about 8:45 AM but she did not get him out of bed. She explained the DON was supposed to locate an appropriate reclining chair but never arranged one. CNA M was informed the resident was observed seated upright after lunch. She stated prior to lunch, she repositioned resident #10 to a side-lying position but I did not use a pillow or wedge. CNA M was unable to explain how the resident would have remained on his side without a positioning device and confirmed position changes were important to prevent skin issues. Residents Affected - Few On 12/12/23 at 2:39 PM, Personal Care Attendant (PCA) A confirmed the resident had been sitting up in a chair since approximately 10:45 AM and he was still in the same position almost four hours later. On 12/12/23 at 3:43 PM, LPN H assisted with transferring resident #10 to his bed after five hours in the chair. She validated the resident's skin was fragile and he should be repositioned when in the bed or chair, and also changed every two to three hours to prevent skin breakdown. On 12/13/23 at 10:35 AM, the facility's Wound Nurse confirmed she assessed resident #10's right foot pressure injury and her most recent finding was the area was darkening. She said, It will probably evolve into something. Review of the facility's policy and procedure for Prevention of Skin Wounds (undated) revealed staff would inspect residents' skin during ADL care to identify any signs of developing wounds, particularly on pressure points. The document indicated it was important to reposition residents and keep the skin clean and free of urine and feces by washing the resident after incontinence episodes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 14 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain a secure environment and provide adequate supervision to prevent unauthorized, unsupervised egress from the facility and the safety of its property, for 1 of 3 residents reviewed for elopement risk, (#1); and failed to ensure a post-fall approach was implemented to prevent further injuries for 1 of 5 residents reviewed for falls, (#10), out of a total sample of 12 residents. Findings: 1. Review of the medical record revealed resident #1 was admitted to the facility on [DATE] with diagnoses including alcohol dependence with alcohol-induced persisting dementia and psychotic disorder with delusions, metabolic encephalopathy (brain dysfunction), Wernicke's encephalopathy (a neurological disorder associated with alcohol abuse), mini-stroke, alcoholic liver disease, and convulsions. The Minimum Data Set (MDS) Quarterly assessment with assessment reference date of 11/10/23 revealed resident #1 had a Brief Interview for Mental Status score of 14 which indicated he was cognitively intact. He had no functional limitation in range of motion, did not use a mobility device, and ambulated independently. Review of the Order Summary Report revealed resident #1 had a physician order dated 5/23/23 for Leave of Absence (LOA) privileges with medications when accompanied by family or representative. The order was discontinued on 10/26/23, the date an elopement care plan was initiated for the resident. Review of the medical record revealed resident #1 had a care plan for elopement and exit-seeking related to difficulty adjusting to his surroundings. The care plan was initiated on 10/26/23 and resolved on 11/08/23. The goals were the resident would remain safe within the facility and make no attempts to exit unaccompanied. The interventions included one-to-one supervision from 10/26/23 to 10/28/23. An Elopement Risk Evaluation dated 11/10/23 at 2:32 PM, deemed resident #1 at risk for elopement as he was independently mobile and exhibited exit-seeking behavior. The evaluation was struck out for incorrect documentation, and another evaluation completed 16 minutes later on 11/10/23 at 2:48 PM, that indicated resident #1 was not at risk for elopement. Review of the medical record revealed a care plan dated 11/10/23 regarding resident #1's preference to have Leave of Absence (LOA) and his noncompliance with signing out in the LOA book. The goal was the resident would notify staff prior to LOA and again on return, and would return to the facility safely. The interventions included remind and educate resident to notify staff when leaving facility [and].sign LOA book when leaving facility. Resident may go LOA accompanied by staff or others. A care plan for behaviors, initiated on 6/08/23 and revised on 11/11/23, revealed the resident exhibited physical and verbal aggression and got upset when he did not like his breakfast. The goals were resident #1 would have fewer episodes of the behaviors and will not leave the facility unattended and without notifying staff. The interventions included one-to-one increased supervision which was implemented on 11/10/23. On 12/10/23 at 9:28 AM, Certified Nursing Assistant (CNA) Q was seated at resident #1's bedside. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 15 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm She stated she was assigned to provide one-to-one supervision for the resident because he recently eloped from the facility. Resident #1 said, They're watching me because I tend to escape. He confirmed he recently walked through the facility's front doors without signing out, when the receptionist at the front desk was not looking. He explained the receptionist opened the door to allow people to exit and he simply walked outside with them. The resident stated he went across the street to the hospital cafeteria by himself. Residents Affected - Few On 12/10/23 at 9:31 AM, CNA G recalled she was told by other staff members that resident #1 got out of the building in November when Receptionist C at the front desk was not paying attention. She verified when the resident was out of he building, staff were not aware of his whereabouts. On 12/10/23 at 10:13 AM, the Maintenance Assistant stated he was aware resident #1 left the building and confirmed the front lobby doors did not malfunction on that day. He explained all doors and alarms were checked daily for functionality and the front lobby doors remained locked unless opened by the receptionist. On 12/10/23 at 12:25 PM, the Director of Nursing (DON) stated on 11/10/23, she was in the lobby when the resident approached and informed her he wanted to go across the street to the hospital for breakfast. She stated she assisted him to sign out in the LOA book at the receptionist's desk. The DON reviewed resident #1's medical record and verified there was no active LOA order on that date. She acknowledged she assisted resident #1, who was not authorized to leave the facility without supervision, to leave the property unaccompanied. On 12/10/23 at 1:11 PM, in a telephone interview, Receptionist C recalled resident #1 tried to leave the facility. She said, I could have sworn the DON signed him out and he said was going to the hospital for breakfast. She stated she could not recall the details of the events when the resident left or when he returned. On 12/10/23 at 1:36 PM, the Infection Prevention nurse stated on 11/10/23, she responded to an overhead page of Code Orange, used to alert staff of a missing resident. She recalled when she arrived at the front of the building, she saw the DON and other staff outside returning with resident #1. The IP nurse stated she overheard the resident tell the DON that he went for breakfast and the DON said something to the resident about signing the LOA book. The IP nurse stated there was no reason that a resident who had independent LOA privileges would need to be escorted back by anyone. The IP nurse explained resident #1 might be alert and oriented, but his safety outside the facility was questionable as he was impulsive and his actions and behaviors were unpredictable. On 12/10/23 at 2:30 PM, in a telephone interview, Licensed Practical Nurse (LPN) R stated she was assigned to resident #1 on the day he got out of the facility. She recalled he was very upset about the quality of his breakfast that morning and he left the unit and was reported to be yelling and screaming in the lobby. She stated she and the offgoing night nurse stopped their change of shift tasks and went to the lobby to retrieve the resident and brought him back to his room. LPN R explained she carried on with medication administration and other tasks on the unit. She recalled at some point someone came to her and said staff just brought him back to the building. She said, I didn't know he was gone.They were looking for him, but nobody notified me although I am the assigned nurse. I talked to him after he came back and he said he went across the street to eat breakfast. LPN R stated she did not document the incident in the medical record as the DON informed her it was not an elopement and she had already taken care of it. LPN R did not know if resident #1 had a physician order for LOA on that date. She stated the front lobby doors were always locked and acknowledged the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 16 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 receptionist was the gatekeeper. Level of Harm - Minimal harm or potential for actual harm On 12/11/23 at 12:33 PM and 12:45 PM, CNA K stated resident #1 was on her regular assignment. She recalled on the day he got out of the facility last month he walked by her with a sneaky smile and said he was on the way to activities and would be back. CNA K stated after five minutes she suddenly realized there were no activities at that time. She stated she walked quickly towards the front of the building and before she got to the lobby she heard the overhead page for Code Orange. She stated when she got to the front doors she saw staff returning with the resident. CNA K stated once back in his room, resident #1 told her he waited for the receptionist to open the doors and snuck out behind people who were going outside. Residents Affected - Few On 12/11/23 at 1:21 PM, the Environmental Services Manager recalled on 11/10/23, he was driving on the way to work and noticed someone familiar walking on the sidewalk. He was not sure who the person was, but since he felt the person might have been a resident, he continued driving to the facility, dropped his passenger at the door, and told her to go inside and alert staff. The Environmental Services Manager stated nobody was in the parking lot and no staff were outside the facility looking for the resident. He stated he drove back out to the street and picked up resident #1, and drove him back to the facility. He confirmed by that time, many staff members, including most of the management team, were outside. On 12/11/23 at 1:27 PM, the Environmental Services Manager showed the location on the opposite side of the street, near the public driveway for the hospital emergency department. He stated the resident was approximately 200 feet away from the facility's driveway when he picked him up. He stated he emailed a statement to the DON after the incident. Review of email communication from the Environmental Services Manager to the DON, sent on 11/10/23 at 10:55 AM, revealed he observed a person who looked like resident #1 on the sidewalk as he drove to work at about 9:00 AM on 11/10/23. The document indicated he continued to the facility and his passenger went inside and asked the front desk staff if there was a reason the resident would be on the street. His passenger then called him and stated nobody knew the resident was outside the building. The Environmental Services Manager returned to pick up the resident and a nearby hospital employee informed him resident #1 asked for help to get back to where he was staying because he was lost and that he had gone to the hospital cafeteria to have breakfast and was ready to come back to his room. The email revealed the resident verbalized he got out the main door. On 12/12/23 at 10:25 AM, resident #1 was re-interviewed due to conflicting staff interview findings. He reiterated, I walked out and nobody saw me. I did not sign out. That day I was about a third of the way back and some guy picked me up in his car and brought me back here. On 12/12/23 at 12:59 PM, Regional Nurse Consultant (RNC) X stated her expectation was staff would have recognized the resident did not have a LOA order and not allow him to leave the facility on his own. On 12/14/23 at 11:44 AM, the DON confirmed the facility discovered resident #1 did not have an LOA order after he left the building. She repeated the incident was not an elopement, rather he went LOA. The DON declined to review and explain the facility's policy and procedure for elopement and insisted resident #1 did not leave the facility without adequate supervision. On 12/14/23 at approximately 11:46 AM, the Administrator maintained the incident did not meet the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 17 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few criteria for an elopement although the resident left the building without knowledge of staff, no physician order, and was discovered unsupervised off property. The Administrator stated the facility reassessed elopement evaluations for several residents on the date resident #1 left the facility unaccompanied. When asked why it was necessary to repeat elopement evaluations on that day, the Administrator explained it could be coincidental as the directive might have been triggered or issued on that day by the corporate office, across all facilities. Review of the facility's policy and procedure for Elopement and Wandering, revised on 7/17/23, revealed the definition of elopement was a situation in which a resident leaves the premises or a safe area without the facility's knowledge and supervision, if necessary. The document indicated staff would initiate the missing resident procedure which included announcing a Code Orange and searching for the resident. When the resident was found and/or returned to the facility, the policy revealed an incident report, an elopement assessment, and a care plan update were required, and State and/or Federal reports would be filed as indicated. The policy read, Document relevant information in the resident's medical record. 2. Review of the medical record revealed resident #10 was admitted to the facility on [DATE] with diagnoses including dementia, prostate cancer, and insomnia. Review of an admission Nursing Evaluation dated 12/01/23 revealed a fall risk evaluation was completed by the admission nurse. The document showed he was alert and oriented to self, had periodic confusion, and lacked understanding of his cognitive limitations. Fall prevention interventions in place included placement of his bed in the lowest position. A care plan for risk for falls related to non-ambulatory status was initiated on 12/04/23. The goal was to minimize the potential for fall-related injuries by implementing fall precautions and interventions. The care plan instructed staff to put resident #10's bed in the lowest position. Additional interventions to encourage the resident to use the call bell and re-educate the resident on safety precautions were not appropriate according to the resident's cognitive status as assessed on admission. On 12/10/23 at 3:47 PM, resident #10's wife informed the Director of Social Services (DSS) that she arrived to visit her husband and discovered he sustained injuries from a fall that occurred either yesterday or earlier today. The wife explained in the previous facility, her husband had floor mats on both sides of his bed to prevent injuries from falls. On 12/10/23 at 4:09 PM, LPN H entered resident #10's room with two floor mats wrapped in plastic. She explained the resident fell yesterday afternoon and a few minutes ago, she was instructed to put floor mats down beside his bed. LPN H confirmed her shift started at 7:00 AM and she was not told that floor mats were necessary either in change of shift report or at any time during last nine hours. On 12/10/23 at 4:37 PM, and 4:51 PM, Registered Nurse (RN) J confirmed she was resident #10's assigned nurse when he fell on [DATE]. She stated she initiated a risk management form for the incident and obtained treatment orders from the physician for the resident's injuries. When asked if an intervention was put in place to prevent further falls and/or injuries, RN J stated she made sure his bed was lowered to floor. LPN H added that nurses could and should implement an intervention at the time of the fall to promote the resident's safety. On 12/10/23 at 5:19 PM, the DON was informed resident #10 fell on [DATE] but did not have a new (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 18 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few fall prevention approach implemented until approximately 24 hours later, when the resident's wife brought it to the attention of the DSS. On 12/11/23 at 4:34 PM, RNC Y verified RN J initiated a risk report for resident #10 who fell on [DATE] at about 4:15 PM. The RNC confirmed RN J did not document any new approaches after the fall. The RNC stated she added the intervention of bilateral floor mats and also entered a physician order on 12/10/23 at 4:04 PM. She explained her expectation was either the assigned nurse or a nurse manager would develop and implement an immediate intervention to prevent another fall or injury. She stated fall incidents should be reviewed and revised if necessary when the clinical team had its next daily meeting. Review of the facility's policy and procedure for Managing Falls and Fall Risk (undated), revealed staff would identify interventions related to a resident's specific fall risk factors to prevent the resident from falling and minimize fall-related complications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 19 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide appropriate care and services to prevent complications related to tube feedings for 1 of 1 resident reviewed for tube feeding, out of a total sample of 12 residents (#11). Findings: Review of the medical record revealed resident #11 was admitted to the facility on [DATE] and re-admitted on [DATE]. Her diagnoses included stroke with left side weakness and paralysis, dysphagia or difficulty swallowing, protein-calorie malnutrition, and gastrostomy. A gastrostomy is a surgical procedure in which a tube is inserted directly into the stomach through an incision in the abdomen wall. The tube is used to provide feeding or medications (retrieved on 12/28/23 from www. medical-dictionary.thefreedictionary.com/gastrostomy) A Minimum Data Set (MDS) Significant Change in Status assessment with assessment reference date of 11/08/23 revealed resident #11 had severely impaired cognitive skills for daily decision making and altered level of consciousness that was continuously present. The MDS assessment indicated the resident had no behavioral symptoms, did not reject care, and was dependent on staff for self-care and mobility. The document showed resident #11 had signs and symptoms of a swallowing disorder and received 51% or more of her total calories and 501 milliliters (ml) or more per day of fluid via a feeding tube. Review of the medical record revealed resident #11 had a care plan initiated on 11/07/23 for tube feeding related to dysphagia, stroke, and inability to eat or drink orally. The goal was the resident would remain free of complications from the tube feeding. The interventions included keeping the head of the bed elevated, following physician orders, nothing by mouth, monitor for any signs and symptoms of aspiration. A care plan for risk for aspiration related to dysphagia and swallowing problems was initiated on 11/07/23. The interventions included diet as prescribed. Review of the Order Summary Report revealed a physician order dated 11/06/23 to administer Jevity 1.5 tube feeding formula continuously at 40 ml per hour via gastrostomy tube (G-tube). An order dated 11/06/23 instructed nursing staff to elevate the head of resident #11's bed to at least 30 degrees or greater as tolerated while tube feeding was administered. The document revealed a physician order dated 12/06/23 for hydration at 25 ml per hour via the resident's G-tube. On 12/11/23 at 1:13 PM, the Mar Vista Unit Manager (UM) stated resident #11 was a long-term resident of the unit and recently had a major stroke. The UM explained the resident was hospitalized for evaluation and treatment, and readmitted with a G-tube. On 12/12/23 at 10:05 AM, resident #11 was in bed with the head of her bed only slightly elevated, between 20 and 25 degrees, and her head was on the lower edge of her pillow. The Jevity 1.5 tube feeding formula infused at 40 ml per hour as ordered. The Mar Vista UM entered resident #11's room and immediately stopped the tube feeding pump. She validated the head of the bed was elevated to less than 30 degrees. She validated the resident's position was unsafe as it placed her at risk for aspiration. The UM stated the resident was neatly groomed and appeared to have recently received personal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 20 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few care. She explained Certified Nursing Assistants were expected to ask the nurse to stop the tube feeding pump prior to starting care and then ask them to resume the feeding afterward. The UM confirmed only nurses were permitted to pause and resume tube feedings. On 12/12/23 at 10:13 AM, Licensed Practical Nurse (LPN) P stated she was resident #11's nurse and during rounds at the start of the 7:00 AM shift, she checked the resident and the tube feeding pump. LPN P recalled the resident was seated upright at that time, and she used her arm to demonstrate that the head of the bed was elevated to approximately 45 degree. She stated neither the assigned CNA nor any other staff member asked her to pause the tube feeding or turn off the pump since the start of the shift. On 12/12/23 at 10:18 AM, the Director of Nursing confirmed accepted standards of practice for tube feeding included elevation of the head of the bed to about 45 degrees as tolerated, but definitely not less than 30 degrees. Review of the facility's policy and procedure for Tube Feeding, revised in November 2018, revealed the head of the resident's bed should be between 30 and 45 degrees for feeding. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 21 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 - Minimal harm or potential for actual harm Residents Affected - Some 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 observation, interview, and record review, the facility failed to ensure nursing staff had the appropriate competencies and skill sets required to meet residents' needs as determined by assessments and indicated in the plans of care. Findings: Review of the Facility assessment dated [DATE] revealed the facility would admit and care for residents with common diseases including psychiatric, neurological, musculoskeletal, metabolic, and skin disorders. The document indicated staff would provide activities of daily living care, mobility and fall or fall with injury prevention services, incontinence care, toileting assistance, pressure injury prevention and care, nutrition services, and management of medical conditions. The Facility Assessment revealed the facility provided person-centered care such as providing family support, identifying risks and hazards, preventing abuse and neglect, and ensuring staff honored residents' preferences and routines. The facility's Staffing Plan showed the Assistant Director of Nursing (ADON) would oversee the staff education program. The document listed required competencies for all staff and additional topics for clinical personnel. Review of the job description for Personal Care Attendant (PCA) dated 5/01/23 revealed PCAs worked under direct supervision of a Registered Nurse (RN) or Licensed Practical Nurse (LPN). The PCA was expected to assist residents with activities of daily living and keep rooms clean and organized. Job responsibilities included making beds, passing meal trays, performing one person transfers, giving oral care and bed baths, and changing incontinence briefs. The PCA's qualifications were 16 hours of classroom training and eight hours of supervised simulation to demonstrate competencies, followed by two weeks of training on the nursing unit. Review of the job description for Certified Nursing Assistant (CNA) dated 5/10/23 revealed responsibilities included Knowledgeable of the individualized care plan for residents and provide support to the resident according to the care plan. The CNA was expected assist with ADLs, promptly report incidents or evidence of abuse and provide care that maintains each resident's skin integrity to prevent pressure ulcers, skin tears, and and other damage by changing incontinent residents, turning, repositioning immobile residents. The job description indicated the CNA had no supervisory responsibility. 1. On 12/12/23 at 3:06 PM, PCA E stated he had been on staff for three weeks. He explained he relied on verbal report from nurses or CNAs at the start of the shift to get information on residents' care needs. PCA E was not aware of any written instructions regarding resident care requirements and he was not familiar with the term [NAME], the CNA care plan. He was prompted on the steps to access residents' Kardexes in the electronic medical record and asked to review the care directives for two residents he had cared for recently. PCA E discovered one resident's [NAME] did not indicate the number of staff required for transfers. When asked how he transferred the resident from the bed to the wheelchair and into the shower, he stated he decided to do the transfer without assistance as he felt the resident was able to assist. PCA E confirmed he also transferred the second resident without assistance and demonstrated how he stood, held the resident under the armpits, picked him up, and pivoted to place him in bed. When PCA E reviewed the [NAME] for the second resident, he discovered the instruction for two staff to utilize a mechanical lift for transfers. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 22 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 - Minimal harm or potential for actual harm Residents Affected - Some 2. On 12/12/23 at 3:28 PM, after being informed PCA A left one of his assigned residents seated in a chair for approximately four hours during the previous shift, PCA E explained he arrived at 3:00 PM and rounds were done every two hours so he had until 5:00 PM to check the resident. He was prompted to reposition and/or provide incontinence care for the resident since more time had passed and the resident's care should be a priority. He donned clean gloves and attempted to explain to the resident that he wanted to check his brief. The resident was hard of hearing, mumbled incoherently, and neither heard nor understood the conversation. PCA E uncovered the resident's lower body, pulled the elastic waistband of his pants away from his body, pushed his gloved hand inside resident's pants, and squeezed the resident's brief to check if it was wet. The resident became belligerent, said, What the hell are you doing in there? PCA E walked away and explained the resident had a right to refuse care. On 12/12/23 at 3:43 PM, LPN H validated PCA E's approach to the resident was not appropriate and she instructed him to get another staff member to assist with transferring the resident back to bed. The resident's wife revealed her husband had dementia and could not be given a choice regarding care as he did not understand. She explained he needed simple instructions and encouragement. 3. On 12/10/23 at 4:11 PM, CNA B was observed as she provided incontinence care. She placed one basin of clean water on the tray table and dropped two washcloths into the water. She retrieved one washcloth from water and squirted body wash directly onto washcloth and washed the resident's penis, scrotum, and groin, then dropped the washcloth back into the corner of the basin. She patted the resident dry with a towel without rinsing the area with clean water. CNA B turned the resident to wash his buttocks. She removed the other washcloth from the basin of water and again squirted soap directly onto it. She used the washcloth to wash the resident's buttocks, and then used it to remove a small amount of feces and clean around his rectum. She placed the soiled washcloth in a plastic bag and retrieved and re-used the soiled washcloth in the basin to rinse and finish cleaning the resident's bottom. CNA B did not remove and replace her gloves before application of barrier cream to the resident's skin. LPN H, who assisted CNA B, confirmed staff usually only used one basin of water to do peri-care. CNA B explained she did not need two basins of water as she put the soap directly on the washcloths instead of into the water. She confirmed the label on the bottle of body wash did not indicate no rinsing was required. On 12/10/23 at 5:00 PM, CNA B was informed of concerns during incontinence care related to use of a single basin of water, inadequate number of washcloths, and re-use of a soiled washcloth on a clean area. CNA B recalled she demonstrated competency in this skill in her orientation and said, I was told one basin of water was okay. On 12/10/23 at 5:19 PM, the Director of Nursing (DON) was informed of the issues identified during incontinence care performed by CNA B. The DON said, That is not the way we do it, and we have disposable wipes. She explained if staff chose to do peri-care with soap and water, the expectation was to use two basins of water and/or sufficient washcloths to avoid re-using them. Review of a competency checklist for Male Incontinence/Perineal Care (3/23/19) revealed if staff used one basin of water, a minimum of four washcloths was necessary to wash and rinse the genital and rectal areas. The document indicated a clean washcloth should be used to rinse soap from the skin. 4. On 12/12/23 at 2:16 PM, CNA M confirmed she did not get one of her assigned residents out of bed yesterday as she felt he needed a reclining chair rather than his regular wheelchair. When asked how she knew what type of chair the resident required, CNA M said, Not sure. He just didn't look like (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 23 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 - Minimal harm or potential for actual harm Residents Affected - Some he would be safe in a wheelchair. She was not aware of a [NAME] in the electronic medical record and was prompted on the steps to retrieve care directives for the resident. CNA M stated she had been on staff at the facility for over two years and had never been shown how to access that information. She said, This would have saved me a lot of trouble. I'm glad you're telling me now. 5. On 12/12/23 at 2:51 PM, CNA D stated she had been on staff in the facility for three months. She was asked to access the [NAME] for one of her assigned residents to verify safety interventions related to falls, wandering, and elopement. She logged into the electronic medical record selected the area designated for documentation of tasks completed during the shift. When asked how she knew the type of care the resident needed for example number of staff needed for transfers or whether a resident was at risk for falls, CNA D said, There are no instructions there. She explained she relied on verbal report from CNAs or nurses to obtain necessary information on her assigned residents. CNA D acknowledged it was possible for someone to forget important details or make errors in verbal report. On 12/13/23 at 10:15 AM, a resident was seated in the gym doing upper body exercises without a thoracic lumbar sacral orthosis (TLSO) brace that was ordered after a recent fall. On 12/13/23 at 10:25 AM, CNA D confirmed she was regularly assigned to the resident and transferred her from the bed to the wheelchair and assisted her with toileting and personal care. CNA D said, I have never put that brace on her.I've put her in bed before and she did not have it on. When asked to review the resident's [NAME], she discovered instructions for Spinal Precautions and TLSO brace as indicated. She acknowledged she had not checked the [NAME] and was not aware she was responsible for application of the brace and did not know what spinal precautions meant. On 12/12/23 at 10:58 AM, the Infection Prevention nurse stated her responsibilities in the area of staff education included small group or individual education in identified areas for improvement, if asked to do so. She said, I do not do skill fairs, plan education program or classes. I do not have oversight of PCA and CNA education. That is the responsibility of the ADON who is in another building at this time. On 12/12/23 at 4:39 PM, the DON discussed concerns identified regarding competency and skills of PCAs and CNAs. She stated she did not particularly like to utilize PCAs, but the facility tried to hire people who at least had a background in healthcare. The DON explained the Assistant Director of Nursing (ADON) was responsible for training the PCAs. She stated PCAs received mandatory 24-hour training, a paid feeding attendant course and then spent one week working with CNAs on the units where they learned and demonstrated skills. The DON's statement contradicted the above PCA job description requirement for two weeks of training on the floor. The DON explained the process was for CNAs and the ADON to validate PCAs' skills and competencies. She acknowledged two PCAs should not give report to each other at the change of shift and verified PCAs A and E did not communicate important information regarding resident care needs on 12/12/23. When informed of concerns related to PCAs and CNAs who were either not aware of the existence of a [NAME] or did not use it, the DON verified failure to use the [NAME] as a resource for essential care directives was a safety concern. The DON stated CNAs and Unit Mangers were to observe PCAs and report any care concerns, but ultimately, she was responsible for ensuring staff were competent to give appropriate care. On 12/12/23 at 5:09 PM, the Staffing Coordinator explained she scheduled PCAs for five days' training on the floor. Review of the PCA In-Service & Attendance Record showed PCA A completed simulation competencies on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 24 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 - Minimal harm or potential for actual harm Residents Affected - Some 11/15/23 and PCA E completed his on 11/20/23. The facility was not able to provide documentation of two weeks' training on the floor for PCAs A and E. On 12/14/23 at 12:05 PM, a meeting was conducted with the Administrator and DON. The Administrator confirmed the facility's clinical educator, the ADON, had been helping out in another facility since 12/04/23. The DON explained the ADON would normally be responsible for monitoring the PCAs, but the Infection Prevention nurse had been handling staff education. The DON was informed that Infection Prevention nurse denied any supervisory responsibilities for PCAs or any knowledge of her role as educator. She stated mentors were expected to show PCAs how to use the [NAME] and to her knowledge, all CNAs had been educated on this topic when hired. The DON stated monthly competencies and check off forms were done after staff completed required education as listed on the facility's annual education calendar. However, the DON was unable to produce documentation of any competencies or in-service attendance sheets for PCAs and CNAs for the facility's scheduled monthly trainings. On 12/14/23 at 12:16 PM, after a review of all findings and concerns regarding nursing staff, the DON acknowledged she was ultimately responsible for ensuring all residents received the care and services they deserved from skilled and competent staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 25 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, interview, and record review, the facility failed to post required nurse staffing information daily, to ensure accurate and comprehensive data was accessible to residents and/or visitors. Residents Affected - Many Findings: On 12/10/23 at 9:50 AM, during tour of the facility, nurse staffing information was posted on a column to the right of the reception desk in the lobby. The document was dated 12/08/23. Receptionist F stated she was not familiar with the nurse staffing hours form posted on the wall. She stated she only knew there was a form with staff names and unit assignments that was kept in an acrylic holder on the counter behind the reception desk. On 12/10/23 at 10:26 AM, the Administrator was informed the form posted with required nurse staffing hours was dated Friday, 12/08/23. She stated the receptionist was responsible for posting the current form with nurse staffing hours on Saturdays and Sundays. On 12/10/23 at 10:30 AM, Receptionist F reiterated, I have never been told anything about that staffing paper. On 12/12/23 at 9:30 AM, the facility's Staffing Coordinator explained her responsibilities included calculating, recording, and posting daily projected totals of hours by all nursing staff. She stated she worked from Monday to Friday and posted the documents on those days. The Staffing Coordinator stated the Weekend Nursing Supervisor was responsible for posting the forms on Saturdays and Sundays; however, that position had been open for a few months and there was currently no nursing supervisor on the weekends. She stated in the past, she used to place the nurse staffing postings in a folder of documents for the Weekend Nursing Supervisor, before she left the faciity on Friday afternoon. The Staffing Coordinator explained she recently started leaving the documents at the front desk. She acknowledged she was aware the forms were not posted on the weekends and said, I have come in on a Monday and seen Friday's paper there. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 26 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility's administration failed to effectively utilize its resources to provide adequate education, support and oversight for the Nursing department to ensure residents received appropriate care and services according to the plans of care. Residents Affected - Some Findings: 1. On 12/13/23 at 10:32 AM, the facility's Wound Nurse stated she was scheduled to work from Monday through Friday, and rounded with the wound care physician for the entire day on Mondays. She explained if a resident was admitted on a Friday, she would not do a skin assessment until the following Tuesday. The Wound Nurse stated her daily process was to identify any newly admitted resident and complete their skin assessments. She validated she had not been looking at residents who were re-admitted so the floor nurses did those skin evaluations. The Wound Nurse confirmed there was a resident who now had pressure injuries that she felt were present on admission, but probably missed by the floor nurse. She said, The problem is if I am out, then nobody does my job as far as assessments [but] the nurses do dressings and treatments. However, she stated on the days she worked, nurses expected her to do all wound treatments, assess new skin conditions, and also round with the wound physician. She stated there was no specific nurse assigned to cover her duties if she was not there, and therefore no continuity of care. 2. On 12/12/23 at 9:30 AM, the Staffing Coordinator stated the majority of residents on the Via [NAME] unit were totally dependent on staff for care. She stated she used to assign three CNAs to that unit, but for quite a while it had been only two CNAs. She stated nurses and CNAs complained they need more help to properly care for the residents. The Staffing Coordinator confirmed she spoke to the Administrator and the Director of Nursing (DON) multiple times and was told, Hold on and we will work on it. 3. On 12/12/23 at 3:30 PM and 3:55 PM, Licensed Practical Nurse (LPN) U discussed concerns regarding inadequate supervision of Certified Nursing Assistants (CNAs) and Personal Care Attendants (PCAs). She explained staff assigned to hallways close to her nurses' station actually reported to LPN H at another nurses' station. LPN H validated it was difficult to supervise her assigned residents and their CNAs and PCAs due to way the assignment was divided across two different areas. LPN H stated she rarely had a chance to sit as she spent a lot of time walking from one area to another. On 12/10/23 at 4:47 PM, LPN V was not able to verbalize the PCA scope of practice although in a supervisory role over a PCA for the shift. On 12/10/23 at 4:48 PM, CNA W stated the other staff member on the unit was a PCA. She explained the PCA was assigned to 14 resident and she had 15 residents. CNA W stated the assignments were heavy and it was impossible for her to monitor the PCA and manage her own team. She stated she had no responsibility for oversight of the PCA to ensure care was being given appropriately, but she would answer questions if asked. On 12/14/23 at 12:16 PM, the DON reviewed all survey findings including deficient practices and concerns related to assistance with activities of daily living, prevention of falls and injuries, appropriately individualized care plans, nursing staff competencies, staff assignments, pressure ulcer (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 27 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0835 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete prevention, tube feeding services to prevent aspiration, and accuracy of the medical record. She verified she was ultimately responsible for ensuring residents received all required care and services. The DON stated she was not aware of any of these concerns and she relied on UMs to monitor care on each unit and reach out to her when necessary. Review of the job description for Director of Nursing (undated) revealed the DON provides leadership and direction for the nursing staff while being responsible for the overall management of the Nursing Department. The DON's responsibilities included execution of administrative, nursing, and resident care policies and she was expected to coordinate and implement systems necessary to deliver high quality care. Event ID: Facility ID: 106123 If continuation sheet Page 28 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to maintain a medical record that accurately documented behaviors for 1 of 3 residents reviewed for elopement risk, out of a total sample of 12 residents, (#1). Findings: Review of the medical record revealed resident #1 was admitted to the facility on [DATE] with diagnoses including alcohol dependence with alcohol-induced persisting dementia and psychotic disorder with delusions, metabolic encephalopathy (brain dysfunction), Wernicke's encephalopathy (a neurological disorder associated with alcohol abuse), mini-stroke, alcoholic liver disease, and convulsions. The Minimum Data Set (MDS) Quarterly assessment with assessment reference date of 11/10/23 revealed resident #1 had a Brief Interview for Mental Status score of 14 which indicated he was cognitively intact. He had no functional limitation in range of motion, did not use a mobility device, and ambulated independently. Review of the medical record revealed resident #1 had a care plan for elopement and exit-seeking related to difficulty adjusting to his surroundings. The care plan was initiated on 10/26/23 and resolved on 11/08/23. The goals were the resident would remain safe within the facility and make no attempts to exit unaccompanied. The interventions included one-to-one supervision (10/26/23 to 10/28/23), distract resident from exit seeking by offering pleasant diversions (10/26/23 to 11/08/23), identify pattern of wandering (10/26/23 to 11/08/23), and provide structured activities (10/26/23 to 11/08/23). Review of the medical record revealed no progress notes on 10/26/23 to support the development of a care plan for exit-seeking or elopement. On 12/11/23 at 2:26 PM, MDS Coordinator S stated he could not recall resident #1 had a care plan for elopement created on 10/26/23. He explained the resident might have exited the building but he did not know if there was an elopement that day. He reviewed the medical record and noted a User Defined Assessment completed by the Casabella Unit Manager (UM) on 10/26/23. He stated he was not sure why that assessment was done as it was not necessary for the MDS assessment. On 12/11/23 at 2:50 PM, the Casabella UM did not recall why she completed the re-assessment/re-evaluation on 10/26/23. She stated it probably popped up on her computer as being due. She was informed it was not a scheduled assessment and therefore would not have been triggered. The UM stated she was not aware of any elopement attempts or incidents for this resident, and she had never witnessed any exit-seeking behaviors. On 12/11/23 at 2:46 PM, the Director of Nursing (DON) stated she was not aware of any incidents on 10/26/23 that could have triggered an elopement care plan and a re-evaluation. She was unable to explain why the decisions were made and stated it must have been a mistake. The DON recalled on 10/20/23, during the week prior to 10/26/23, resident #1 was upset and stormed through the front lobby doors. She stated the evening shift nursing supervisor followed the resident outside, re-directed him, and brought him back inside. The DON reviewed the resident's medical record and acknowledged there were no progress notes regarding any exit-seeking or attempted elopement incident on 10/26/23. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 29 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm confirmed there was no documentation by the evening shift nursing supervisor, the assigned nurse, or herself, regarding the incident she described on 10/20/23. The DON verified every resident's chart should accurately describe status, change in condition, and any occurrence out of the ordinary. She said, I would have expected at least a progress note. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 30 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0895 Have a Compliance and Ethics Program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to effectively communicate and implement the standards of its compliance and ethics program to promote ethical conduct, and failed to adequately enforce those requirements to deter violations and ensure the provision of quality care and promote the highest practicable well-being for resident #1 and all residents in the facility. Residents Affected - Many Findings: Review of the facility's Compliance and Ethics Program Overview (2022) revealed the key corporate values of the operating organization were Performance, Integrity, and Transparency. The document indicated the program included a Code of Conduct, policies and procedures, education, monitoring, reporting noncompliance, disciplinary actions, and program oversight. Participation in the compliance and ethics program was mandatory for all staff and its goal was to improve the overall quality of care received by residents. The document read, The Facility strives to cultivate an environment of transparency.requires all of its personnel, including those working at or with the Facility in any capacity, to be forthcoming when a mistake is realized or anticipated, or a reportable event occurs. The program overview indicated the facility would discipline anyone who knowingly violated principles of the compliance and ethics program in order to deter others from noncompliance. 1. On 12/10/23 at 9:28 AM, resident #1 explained he had one-to-one staff supervision as he tended to escape from the facility. The resident stated he recently went across the street to the hospital cafeteria. Resident #1 stated he would also like to find a bar to get a drink. He said, I don't lie. If you tell lies, you have to remember them. That's why I tell the truth. The resident explained he did not sign the leave of absence (LOA) book before he left the facility. He described walking through the front door when the receptionist was not looking. On 12/10/23 at 9:31 AM, and 1:04 PM, Certified Nursing Assistant (CNA) G stated she found out from other staff members that resident #1 got out of the facility last month when the receptionist at the front desk was not paying attention. CNA G confirmed staff were not aware he left and explained, That's why they were searching. All the staff know it.The facility is trying to cover it up. CNA G stated the word compliance sounded familiar to her, possibly from some training, but she could not offer any information on the topic. She stated she would not know how to report concerns in the facility anonymously. On 12/10/23 at 10:48 AM, the Infection Prevention nurse recalled on 11/10/23, there was a Code Orange overhead page for a missing resident. She stated when she responded to the front of the facility, resident #1 was on the sidewalk and there were a lot of people with him. She was not sure who found the resident but recalled the Director of Nursing (DON) was definitely out there. On 12/11/23 at 11:50 AM, Receptionist C was asked to describe the events that occurred on 11/10/23 when resident #1 left the facility's property. She stated the only things she remembered was that it was very busy that day and she saw the DON sign resident #1 out in the LOA book. Receptionist C stated she did not recall anything about the circumstances of the resident's return to the facility. When asked for additional questions regarding the resident's actions that morning, Receptionist C continuously repeated, I don't remember anything else. On 12/10/23 at 12:25 PM, the facility's DON offered a description of the events that occurred on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 31 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0895 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 11/10/23 which conflicted with statements and interviews from resident #1 and facility staff. She stated she was in the lobby and assisted resident #1 to sign the LOA book before he left the facility to go across the street for breakfast. The DON recalled she then attended the daily clinical meeting and to her knowledge, the resident returned by himself. She stated she did not recall a Code Orange overhead page. The DON emphasized she never left the meeting to go outside and the next time she saw the resident was later that morning on his unit. The DON stated she was not aware the resident did not have a physician order for LOA on that date. Review of the LOA binder at the receptionist's desk revealed resident #1's signatures, but the date and location of LOA were noted to be different handwriting and ink. On 12/10/23 at 11:19 AM, the DON explained she completed the form herself as she knew the resident's planned destination. On 12/10/23 at 1:36 PM, the Infection Prevention nurse stated after resident #1 was returned to the facility on [DATE], the DON instructed her to complete a new elopement evaluation. She recalled the document showed the resident was at risk for elopement so the DON asked her to re-do the evaluation and change the document to reflect the resident was not at risk for elopement. On 12/10/23 at 2:30 PM, in a telephone interview, Licensed Practical Nurse (LPN) R stated the DON instructed her not to complete any documentation regarding the incident on 11/10/23 as she already took care of it. On 12/11/23 at 1:21 PM, the Environmental Services Manager stated resident #1 was walking on the sidewalk approximately 200 feet away from the facility when he drove past him on the morning of 11/10/23. He stated he dropped his passenger at the facility, told her to alert staff, and he drove back to pick up the resident. He recalled by the time he returned to the facility, several staff members, including most of the management team were outside. On 12/11/23 at 2:26 PM, Minimum Data Set (MDS) Coordinator S stated he was in his office on 11/10/23 when he heard the overhead page for Code Orange. He stated he quickly went to the front door of the facility and saw resident #1 coming through the doors. MDS Coordinator S said, Everybody was outside, including the DON and Administrator. He estimated there were approximately ten staff members outside the facility. MDS Coordinator S recalled after the resident returned, the DON instructed him to create a care plan for LOA privileges for the resident. On 12/14/23 at 9:56 AM, MDS Coordinator S confirmed he knew how to report compliance and ethics issues, but did not consider reporting for this incident. On 12/12/23 at 12:47 PM, the DON added to her previous description of the events of 11/10/23. She stated she assisted resident #1 to sign out and leave the facility, but failed to communicate with floor staff so they began searching for him. She said, I am not sure how he came back in. The DON was informed of the results of interviews with staff including the Environmental Services Manager who stated he provided her with a written statement. The DON denied knowledge of the statement and suggested the Administrator might have collected it. The DON stated she could not explain the discrepancies between her version of the event and the recollections of other staff. She denied directing staff to change an elopement evaluation of create a care plan for LOA. Review of email communication from the Environmental Services Manager to the DON, sent on 11/10/23 at 10:55 AM, revealed he observed a person who looked like resident #1 on the sidewalk as he drove to work at about 9:00 AM on 11/10/23. The document indicated he continued to the facility and his passenger went inside and asked the front desk staff if there was a reason the resident would be on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 32 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0895 Level of Harm - Minimal harm or potential for actual harm street. His passenger then called him and stated nobody knew the resident was outside the building. The Environmental Services Manager returned to pick up the resident and a nearby hospital employee informed him resident #1 asked for help to get back to where he was staying because he was lost and that he had gone to the hospital cafeteria to have breakfast and was ready to come back to his room. The email revealed the resident verbalized he got out the main door. Residents Affected - Many On 12/14/23 at 11:44 AM, a meeting was conducted with the Administrator, DON, and Regional [NAME] President of Operations (VPO). The Administrator explained to her knowledge, resident #1 left the faciity on LOA and did not elope, therefore it was not an incident that required investigation or reporting. The DON was asked to clarify the discrepancies identified during the complaint investigation but she was not able to offer additional information. When asked if she was instructed not to report or investigate the incident as an elopement or allegation of neglect, the DON looked at the Administrator and Regional VPO and said, No response. The Administrator was informed there were significant concerns regarding another elopement or unauthorized LOA without supervision. failure to investigate an incident to rule out neglect, and possible falsification of the medical record. The Administrator did not respond when asked if she received guidance or instructions regarding not reporting or documenting all facts related to the incident. Review of the job description for the Director of Nursing (undated) revealed she was expected to serve as a role model to nursing staff, actively participate in committees such as the Ethics Committee, and participate in and adhere to corporate compliance programs. 2. Additional interviews with staff regarding their knowledge of the facility's Compliance and Ethics Program revealed the following: On 12/10/23 at 3:45 PM, CNA D stated she did not know about the corporate compliance program or where to locate contact information. CNA D was unsure of how to report any concerns in the facility, other than to communicate with supervisors. On 12/10/23 at 4:40 PM, Patient Care Attendant (PCA) E did not recall any training regarding compliance and ethics, and did not know how to anonymously report issues within the facility. On 12/11/23 at 1:12 PM, CNA I stated she was not aware of any method of contacting the corporate office regarding problems within the facility. CNA I stated she thought she heard of compliance in a training or in-service. On 12/12/23 at 10:27 AM, CNA T was not able to define ethics and compliance or explain if it was possible to report ethical concerns confidentially. On 12/12/23 at 10:41 AM, Licensed Practical Nurse (LPN) U was asked about the facility's Compliance and Ethics program. She stated she recognized the terms but she was not sure how she would contact someone at the corporate level about issues in the facility. LPN U explained she would definitely report grievances to the facility's Director of Social Services or the DON. However, she did not respond when asked what she would do if the issue involved either of those individuals or another member of management. On 12/12/23 at 3:55 PM, LPNs H and U described concerns that affected their daily nursing practice in the facility. LPN U said, It is almost to the point where it is unethical working like this. Sometimes I go home wondering if I have done my best for the residents and completed all the things I (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 33 of 34 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera, FL 32940 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 0895 should be doing. LPN H agreed and stated it was challenging to complete her duties as assigned. Level of Harm - Minimal harm or potential for actual harm On 12/12/23 at 10:43 AM, PCA L explained she recently completed orientation and PCA training but did not recall learning anything about compliance and/or ethics. She said, It was a lot of information in three days training. Residents Affected - Many On 12/14/23 at 10:54 AM, in a telephone interview, the operating organization's Chief Compliance Officer (CCO) stated in her role, she was responsible for oversight of all facilities to ensure compliance with regulations and policies and adherence to legal and ethical standards. She explained the organization had a comprehensive Program Overview document that included extensive information on the program. The CCO explained a simplified version of the document was reviewed with all employees in new-hire orientation and Town Hall meetings. She stated the program documents were also reviewed by the facility's Quality Assurance and Performance Improvement committee. She stated there was also a section in the employee manual that provided the definition of ethics and guidance regarding ethical conduct. The CCO stated there were two methods for staff to report compliance and/or ethical concerns, either by contacting her directly or by reporting anonymously to a third party company that operated a 24-hour line. The CCO was informed staff interviews revealed lack of knowledge of the corporate compliance program as the majority of staff did not know how to report concerns anonymously, and some verbalized fear of retaliation. She acknowledged the program would not be as effective as intended if staff were not able to or chose not to provide the organization with important information. The CCO confirmed she was aware of a complaint investigation survey done by the State Survey Agency in July 2023 that resulted in egregious findings related to a resident's elopement that was not investigated or reported as required. She was informed investigative findings related to that incident showed staff, including members of the facility's administrative and nursing management teams including the current DON and Assistant DON, were aware the resident was found off property, walking away from the facility after another resident alerted staff. The CCO was informed the State Survey Agency's investigation showed the facility created and provided a conflicting narrative and statements that showed the resident walked through the front doors, did not enter the parking lot, and remained in line of sight of staff at all times. She was updated on the investigative findings for the current complaint investigation survey, which again showed significantly conflicting statements and failure to thoroughly investigate another incident involving a resident who left the facility unaccompanied and without medical authorization. The CCO said, Of course it gives me concern if the situation occurred again. She stated she was not aware of the details of the current investigative findings and she felt it was concerning if multiple staff were aware of compliance and ethics violations but had not reported them. The CCO verified accurate incident reporting was an important component of transparency and integrity, two of the organization's key corporate values. When asked what measures were implemented after the survey in July 2023 to prevent reoccurrence of the compliance and ethical concerns, the CCO stated the operating organization contracted with a company that specialized in clinical consultation and regulatory risk management. She explained representatives conducted monthly education with staff including Administration and monitored facility security. She did not mention any disciplinary actions or education provided to staff regarding reporting compliance and ethics concerns and consequences of not doing meeting expectations. The CCO stated the corporation expected administrative and clinical leaders to adhere to their professional codes of ethics in addition to corporate standards. She verified licensed nurses and nursing home administrators in particular were ethically bound to promote resident rights and safety. The CCO said, We have to ensure that the building represents the values of our corporation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 34 of 34