Inspection·October 24, 2025

F 0646 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the appropriate authorities when residents with MD or ID services has a significant change in condition. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure completion and accuracy of a Level I Preadmission Screening and Resident Review (PASARR) after a readmission for a resident diagnosed with a Serious Mental Illness (SMI), following a significant change in the resident's mental condition for 1 of 1 residents reviewed for PASARR from a total sample of 12 residents, (#2).Findings: Review of resident #2's medical record revealed she was originally admitted to the facility on [DATE] and readmitted from an acute care hospital on 8/20/25. Her diagnoses included multiple sclerosis, major depressive disorder, anxiety and seizures. Additional diagnoses of bipolar disorder, brief psychotic disorder, and psychosis were added after resident #2's readmission on [DATE]. Review of resident #2's significant change in status Minimum Data Set (MDS) assessment with an Assessment Reference Date of 9/11/25 revealed a Brief Interview for Mental Status score of 15 out of 15 which, indicating intact cognition. The assessment documented a Mood Interview was conducted and no symptoms were identified. It also noted no rejection of care necessary to achieve health and well-being goals and no behavioral symptoms. The MDS assessment listed active diagnoses of anxiety, depression, bipolar, and psychotic disorder. Review of resident #2's Comprehensive Care Plan revealed a focus area initiated on 8/21/25 for a history of exhibiting behaviors. These included recent hallucinations/delusions, impulsivity, physical and verbal aggression, resisting care, crawling on the floor and in hallways, throwing objects when anxious or upset, chronic noncompliance with safety and medical interventions, refusal to wear clothing or briefs, socially inappropriate behaviors such as spitting and yelling. Another focus area showed mood instability, anxiety, bipolar disorder, depression, psychosis, and prior [NAME] Act (52-hour involuntary hold) with suicidal ideations. Review of the progress notes in the medical record revealed the following entries:*8/24/25 - Nurse documented resident #2 called 911 reporting seizures. Upon evaluation, no seizure activity was observed. Emergency Medical Services (EMS) responded, and despite the absence of seizure activity, the resident insisted on being transferred to the hospital and was transferred to the Emergency Room. *9/01/25 - Nurse documented the resident refused medications, food and drink. The Psychiatric Advanced Practice Registered Nurse (APRN) was notified and ordered Lorazepam and Haldol, along with one-on-one observation for safety. The resident continued exhibiting behaviors throughout the night, including removing clothes, and urinating and defecating in the room. The Psychiatric APRN was notified the medications were ineffective and issued an order for a [NAME] Act resident. The nurse notified the Director of Nursing (DON), the resident's husband, and called 911. The [NAME] Act is a Florida law that enables families and loved ones to provide emergency mental health services and temporary detention for people who are impaired because of their mental illness, and who are unable to determine their needs for treatment. (Retrieved from www.ufhealth.org on 11/01/25). Review of resident #2's Certificate of Professional Initiating Involuntary Examination dated 9/01/25 and signed by Psychiatric APRN K listed diagnoses of psychosis, refusal of care, and suicidal ideation. It stated due to her mental illness, the resident was unable to determine whether an examination was necessary, and there was a substantial likelihood she would cause serious bodily harm to herself without treatment. The supportive evidence read, Pt (patient) with history of psychosis and refusing care. Pt has been experiencing the exacerbation. No specific triggers. The patient has been naked, throwing herself on the floor with death wishes. The patient is refusing all kind of care. The patient is not redirectable and refusing to eat or drink. Giving IM medicine has been ineffective. [NAME] Act is the least restrictive alternative to ensure the safety of the other frail residents and staff. If not [NAME] Acted and received appropriate treatment in a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 2 of 8 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2025 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 0646 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few psychiatric hospital, the patient will likely continue to escalate and hurt others. As the behaviors occur periodically and not consistently, [NAME] Act should not be rescinded based on a lack of behavior for a few consecutive hours. Review of the hospital's Attending admission Note dated 9/01/25 revealed an Assessment and Plan including complicated Urinary Tract Infection (UTI), aggression, violent behavior requiring restraints, suicidal ideation, history of psychosis, acute metabolic encephalopathy and one-on-one sitter under continued [NAME] Act status. Review of hospital's psychiatrist note dated 9/01/25 indicated the patient was admitted under a [NAME] Act after being violent and confused. The patient's husband described the situation as going out of whack, correlating with her refusal to eat and discontinuation of prescribed medications. Her symptoms included confusion and behavioral disturbances. The psychiatrist noted a possible exacerbation of bipolar disorder and anxiety, worsened by the UTI. Review of additional progress notes in resident #2's medical record following hospital discharge revealed the following entries:*9/06/25 - The DON documented upon resident #2's return from the hospital, staff were instructed to increase monitoring and report any changes in condition promptly to their immediate supervisor or directly to the DON.*9/11/25 - Resident appeared confused; husband expressed concern regarding mental status. Nurse attributed confusion to UTI. *9/14/25 - Resident was agitated, spat out medications, punched staff, refused care, yelled profanities, and threw food trays. *9/16/25 - Resident called 911 multiple times, tore items in her room, and hid her phone. *9/19/25 - Resident was transferred to the hospital for altered mental status (AMS). Review of APRN I's progress note dated 9/12/25 read, Prior to last visit, [NAME] Act was initiated. Patient had increased anxiety and agitation. Patient was throwing self on the floor with no clothes and her symptoms were out of control. Started Haldol 5 mg (milligrams) PO (by mouth) or IM (intramuscularly) bid (twice a day) for 14 days and Ativan 1 mg IM q 8hrs (every 8 hours) as needed for 14 days. During last visit, patient had increased somatic delusions and had psychosis . Increased Seroquel to 75 mg TID (three times a day) for psychosis. Review of APRN I's progress note dated 9/15/25 documented medication adjustments including Haldol, Ativan, Seroquel, and Depakote to address psychosis, agitation, and mood instability. The Mental Status Examination described the resident as poorly groomed, disheveled, with impair insight and judgement. Diagnoses were updated to schizoaffective disorder (bipolar type) and unspecified dementia with behavioral disturbance. Review of APRN J's progress notes dated 9/15/25 through 9/19/25 described resident #2 as continuing to exhibit psychotic episodes, agitation, elevated ammonia levels, and combative behavior. Review of a Change in Condition progress note dated 9/19/25 revealed resident #2 was transferred to the hospital due to AMS. Review of resident #2's medical record revealed a State of Florida Agency for Health Care Administration Preadmission Screening and Resident Review (PASRR) Level I Screen form dated 9/04/25. Section I. A, MI (mental illness) or suspected MI, (check all that apply) was left blank. Section IV indicated No diagnosis or suspicion of SMI or ID (intellectual disability) indicated. Level II PASRR evaluation not required. There was no evidence in the medical record a new Level I PASARR was completed after readmission or following the onset of new psychiatric diagnoses and behavioral changes. On 10/23/25 at 1:44 PM, Licensed Practical Nurse (LPN) H stated resident #2 had a lot of psych behaviors, including throwing herself on the floor, yelling, refusing medications and care, throwing food and medications, and spitting. LPN H reported resident #2's behaviors worsened before the [NAME] Act, and the hospital later identified a UTI. She stated psychiatric services saw resident #2 at least twice weekly and the behaviors continued daily after her return on 9/06/25. On 10/23/25 at 4:01 PM, Social Services Assistant L stated he did not know whether Social Services was involved in reviewing or resubmitting the PASARR. He indicated he was unaware of any mention of it by the former Social Services Director (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 3 of 8 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2025 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 0646 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete (SSD). On 10/23/25 at 8:53 PM, during a telephone interview, Registered Nurse (RN) C reported caring for resident #2 the night she was [NAME] Acted. She described the resident as out of control, screaming, crying, throwing objects, removing clothes, defecating, urinating on the floor, and refusing food and fluids. She confirmed APRN K ordered the hospital transfer under a [NAME] Act. On 10/23/25 at 4:20 PM, the DON explained new admissions were reviewed by the interdisciplinary team the next business day, including PASARR documentation received from the hospital. She stated the SSD or DON was responsible for reviewing the PASARR and one should be completed when a new SMI diagnosis or behavioral changes occurred. The DON acknowledged a new PASARR was not completed despite significant behavioral changes during resident #2's stay. On 10/24/25 at 1:30 PM, the Administrator (NHA) stated resident #2 had an extensive psychiatric history and was followed closely by psychiatric providers. The NHA confirmed documentation showed resident #2 exhibited delusions, including claims of giving birth in the facility. The NHA validated the PASARR was not resubmitted, calling it an oversight. On 10/24/25 at 2:18 PM, the Regional Nurse Consultant (RNC) stated residents receiving psychotropic medications were followed by psychiatric providers. The RNC acknowledged the PASARR should have been reviewed but opined that a Level II may not have been issued even if resubmitted. On 10/24/25 at approximately 2:45 PM, the NHA stated the facility did not have a policy defining which staff member was responsible for updating PASARRs. A copy of the facility's policy regarding Behavioral Health or Behavior Management was requested but not provided. Event ID: Facility ID: 106123 If continuation sheet Page 4 of 8 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain sufficient nursing staff to provide the necessary care and services and ensure resident needs and preferences were addressed timely for 4 of 9 residents reviewed for call light response, of a total sample of 12 residents, (#7, #10, #11 and #12).Findings: On 10/22/25 at 1:17 PM, observation of the Montecito South's nurses station computer screen showed three rooms with active call lights and the following wait times: room [ROOM NUMBER] - 25 minutes, room [ROOM NUMBER] - 20 minutes, and room [ROOM NUMBER] -8 minutes. On 10/22/25 at 1:22 PM, call lights were illuminated outside rooms #301, #302 and #303. Resident #12, in room [ROOM NUMBER], was heard calling out, Hello, I need assistance, please. 1.On 10/22/25 at 1:24 PM, resident #12 was lying in bed, holding his left thigh approximately 45 degrees upward. Staples were present on his left stump, with redness noted around the incision site. Resident #12 stated he had returned from the hospital the previous evening for wound care and therapy. He reported pressing his call light to request pain medication, as his last dose was received at 9:00 AM and he was now due for more. He rated his pain as 9 out of 10 on his left stump. The surveyor exited the room at 1:28 PM; no staff were seen in the hallway, and the call lights for rooms #301 and #303 remained on. Review of resident #12's medical record revealed he was originally admitted to the facility on [DATE] and readmitted from an acute care hospital on [DATE] with diagnoses including orthopedic aftercare following a surgical amputation, infection of the amputation stump, type 2 diabetes, and repeated falls. Review of the 5-day Minimum Data Set (MDS) assessment with an Assessment Reference Date (ARD) of 10/08/25 showed resident #12 Brief Interview for Mental Status (BIMS) score of 15 out of 15, indicating intact cognition. Review of resident #12's Medication Administration Record (MAR) revealed resident #12 last received Oxycodone 10 milligrams (mg) on 10/22/25 at 11:46 AM, with the effect noted as effective. The physician's order specified Oxycodone 10 mg every 8 hours as needed (PRN) for moderate pain. Prior to his readmission, the resident had received 2 tablets of Oxycodone 10 mg every 4 hours PRN for non-acute pain from 10/03/24 to 10/10/25. Review of resident #12's comprehensive care plan dated 10/22/25 revealed a focus on pain related to neuropathy, postoperative discomfort, wound, and disease process. Interventions directed nurses to evaluate the effectiveness of pain interventions and to notify the physician if interventions were unsuccessful. 2. On 10/22/25 at 1:29 PM, resident #10 was sitting in a wheelchair in her room, #301. She stated she wanted to be transferred back to bed because she had been sitting for over two hours. She explained she required assistance from a Certified Nursing Assistant (CNA) to stand and could not do so without help. She reported her call light had been on for approximately 30 minutes, adding, We are having a big staffing issue around here. She mentioned another resident down the hall had been yelling for help and said, I normally wait 30 minutes for the call light to be answered. On 10/22/25 at 1:32 PM, CNA B entered resident #10's room, stating she was not the resident's assigned CNA but was responding to the call light. On 10/22/25 at 1:33 PM, while exiting room [ROOM NUMBER], the surveyor heard resident #12 moaning and cursing, with his call light still illuminated. Review of resident #10's medical record revealed she was admitted to the facility on [DATE] with diagnoses including heart failure, migraine, difficulty in walking, and osteoarthritis. Review of the MDS quarterly assessment with an ARD of 7/22/25 showed resident #10's BIMS score was 15 out of 15, indicating intact cognition. Review of resident #10's comprehensive care plan with a focus on Activities of Daily Living (ADL) selfcare deficit related to chronic medical conditions, fatigue, and impaired balance was revised on 4/22/25. Interventions indicated resident #10 may require dependent assistance from one or two staff for ADL care, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 5 of 8 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some with needs fluctuating based on weakness, fatigue, and weight bearing status. On 10/23/25 at 12:40 PM, resident #10 stated she had waited over an hour for assistance the previous day due to staffing shortages. She expressed frustration, saying, Why do I have to wait until they are done with everybody else? She added she felt sidelined. She described CNAs as overworked, managing dressing, toileting, meal services, and transfers, and concluded, The wait times tell me they are understaffed and overworked. 3. On 10/22/25 at 1:33 PM, resident #11 was sitting in her wheelchair in her room and stated she activated her call light over 15 minutes ago. She reported suffering from breathing problem and needed her inhaler before physical therapy, scheduled for 1:15 PM. She added, her main concern was waiting at times for call lights to be answered. Resident #11, who had been in the facility less than a week, noted long call light wait times regardless of shift or day. She said, The fellow across in room [ROOM NUMBER] kept hollering hello, hello multiple times earlier and also had to wait a long time for whatever he needed. Resident #11 mentioned she became anxious when waiting, displaying pursed-lip breathing and a productive cough. The surveyor exited her room at approximately 1:43 PM and no staff were visible. Review of resident #11's medical record revealed she was admitted to the facility on [DATE] with diagnoses including wedge compression fractures (T7-T8 and T5-T6), chronic obstructive pulmonary disease (COPD), generalized anxiety disorder, and acute and chronic respiratory failure with hypercapnia (high blood levels of carbon dioxide) and hypoxia (low levels of oxygen in the body tissues). Review of resident #11's comprehensive care plan identified risk for altered respiratory status related to COPD and episodes of shortness of breath. Review of a Summary of Skilled Services note dated 10/20/25 which indicated resident #11 was alert, required extensive assistance with mobility and transfers, and had experienced several anxiety episodes displaying pursed lip breathing and treated effectively with pain medication. 4. On 10/24/25 at 9:35 AM, resident #7 shared she had served as Resident Council President for over two years. She reported a great shortage of staff, especially on weekends, which made it very hard on staff and residents. Resident #7 described an incident where in the dining room a resident waited more than 20 minutes for service, prompting her to ask the receptionist to page the staff. She indicated the kitchen staff subsequently collected meal trays and instructed residents to return to their rooms, stating meals would be delivered to their rooms due to staffing shortages. Resident #7 noted short staffing had been discussed in previous Resident Council meetings and offered to provide meeting notes emphasizing, If they don't know what we talked about, how is anything going to be corrected? Review of resident #7's medical record revealed she was admitted to the facility on [DATE] with diagnoses including peripheral vascular disease, difficulty in walking, osteoarthritis, and myalgia (muscle pain). Review of the MDS quarterly assessment with ARD of 9/25/25 revealed resident #7's BIMS score of 15 out of 15, indicating intact cognition. Review of Resident Council meeting minutes dated 10/06/25, 9/29/25, and 9/08/25 reflected repeated concerns noted as shortages - staff & supplies and very short staffed. On 10/22/25 at 2:03 PM, CNA B stated she noticed call lights were active in rooms #302 and #303 when she exited room [ROOM NUMBER] but was redirected to assist another resident in room [ROOM NUMBER] who required immediate care. She shared some of her assigned residents had complained about long waits and stated she apologized when this occurred, adding all staff were expected to answer call lights. On 10/22/25 at 3:23 PM, CNA A stated she was assigned to residents #10, #11, and #12 and was assisting another resident when the call lights were activated. She described the workload as heavy, saying That hall is kind of difficult. She reported some residents expected assistance on fixed schedules, which was not always possible. CNA A acknowledged, An hour wait would not be acceptable, and admitted she had planned to transfer resident #10 at 1:00 PM but was delayed assisting in room [ROOM NUMBER]. She confirmed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 6 of 8 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete resident #12 frequently requested pain medication and that nurses occasionally became frustrated with repeated requests. She concluded, Not answering call lights in a timely manner could be considered neglect. On 10/24/25 at 5:19 PM, during a telephone interview, CNA F reported at times only one CNA was assigned to a unit during the 11:00 PM - 7:00 AM shift. She noted delays occurred due to having to locate supplies and the need for two staff to assist residents with transfers. When asked if she had mentioned her concerns to management, she responded she had not because management must be aware of staffing shortages. CNA F stated assisting with dining room service was difficult as it would leave only one CNA on the unit for up to two hours. On 10/24/25 at 2:18 PM, during an interview with the Administrator (NHA) and the Director of Nursing (DON), the NHA stated resident #12 frequently activated his call light immediately after staff left his room. The DON described the resident as drug seeking and clarified that while scheduled pain medications could be given one hour early or late, PRN medication could not be administered sooner than prescribed. Both the NHA and DON acknowledged expectations for timely call light response. The NHA confirmed residents had voiced staffing concerns during Resident Council meetings but stated she and the DON had made rounds on evening and weekends without noting issues. Review of the facility's Call lights policy and procedure, revised January 2024, read, Resident will have a call light to summon facility personnel to ensure the resident's needs will be met. The Procedure required staff to Answer call light promptly. All facility personnel are expected to respond to call light. Listen to resident's request. DO NOT make residents feel that you are too busy. Respond to resident's request, if unable to assist, notify the nurse. Return to the resident promptly with a reply. Review of the Facility Assessment, approved by the Quality Assurance and Performance Improvement committee on 10/14/25, revealed its purpose was to determine the resources necessary to provide competent resident care using a competency-based approach. The assessment identified staffing levels based on resident population, acuity, and care needs, and read, Staffing is adjusted to meet the needs of current population and resident needs. Data showed the following number of residents required staff assistance with ADLs:Dressing 1-2 staff: 93 residents dependent: 26 residentsBathing 1-2 staff: 93 residents dependent: 29 residentsTransfer 1-2 staff: 74 residents dependent: 36 residentsEating 1-2 staff: 97 residents dependent: 4 residentsToileting 1-2 staff: 75 residents dependent: 41 residents The assessment emphasized timely response to ADL and toileting needs to maintain continence, dignity, and person-centered care. Event ID: Facility ID: 106123 If continuation sheet Page 7 of 8 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2025 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 0880 Provide and implement an infection prevention and control program. 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 follow appropriate hand hygiene and personal protective equipment (PPE) practices in accordance with infection control standards when assisting a resident with an intravenous (IV) infusion for 1 of 1 residents observed during the facility tour, from a total sample of 12 residents, (#5).Findings: Review of resident #5's medical record revealed she was admitted to the facility on [DATE] with diagnoses including metabolic encephalopathy (brain dysfunction), type 2 diabetes, stroke, anemia, and weakness. Review of resident #5's comprehensive care plan identified a focus area related to a midline catheter in the right upper extremity for treatment of anemia. The goal of the care plan was for the resident to experience no complications associated with the IV access or its use through the next review date. On 10/23/25 at 12:09 PM, Licensed Practical Nurse (LPN) G exited resident #5's room wearing gloves on both hands. While outside the resident's room, LPN G used scissors from the medication cart to open an IV-line package, then reentered the room. Inside the room, LPN G connected the IV line to a medication pouch on the IV pole, pulled a garbage can closer to her and the IV pole and continued setting up the IV tubing to begin an iron infusion. After several minutes working with the IV machine, LPN G informed resident #5 she needed to step out to obtain assistance. On 10/23/25 at 12:15 PM, LPN G confirmed she had exited resident #5's room without removing her gloves or performing hand hygiene and then returned to the room wearing the same gloves. She validated she moved the trash can wearing the same gloves and resumed working with the IV line. LPN G stated she was in a rush because the resident was waiting on her to finish setting up the infusion to eat her lunch. She acknowledged her actions violated infection control protocol and placed resident #5 at risk for infection. On 10/24/25 at approximately 2:20 PM, the Director of Nursing (DON) stated staff were expected to remove gloves before exiting a resident's room and perform hand hygiene immediately afterward. The DON added, Obviously, the nurse knew it was incorrect. Review of the Facility Assessment, updated on 10/06/25, revealed all staff received infection control and hand hygiene education upon hire and annually thereafter. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106123 If continuation sheet Page 8 of 8