Health inspection·February 5, 2026

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 implement a person-centered comprehensive care plan to address a hearing impairment, including interventions to promote the resident's highest practicable well-being for 1 of 1 residents reviewed for communication/sensory needs, of a total sample of 57 residents, (#189). Findings: Cross Reference F697 Review of resident #189's medical record revealed she was admitted to the facility on [DATE] with diagnoses including fracture of the neck of the left femur, fracture of the lower end of the left radius, and history of falling. Review of the original State Agency 5000-3008 Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form, dated 1/28/26, revealed resident #189 was non-ambulatory, alert, oriented, and able to follow instructions. The form indicated the resident had impaired hearing and used a left hearing aid. Review of the hospital History and Physical form, dated 1/09/26, revealed a medical history of hearing loss, and on physical examination, the resident was documented as hard of hearing. Review of resident #189's Baseline Care Plan, dated 1/28/26, revealed hearing adequate was checked, while hearing impaired and appliance used were not checked. Review of the Activity Comprehensive Evaluation, dated 1/30/26, indicated activities should be modified to accommodate the resident's hearing deficit. On 2/02/26 at 12:39 PM, during an interview attempt, resident #189 was observed to be very hard of hearing. Friends visiting the resident stated she used a left hearing aid, which had broken the previous week. Resident #189 requested the surveyor write questions in a notebook so she could understand. The resident reported the hearing aid battery was replaced but the device was still not functioning. Her friends stated that when the hearing aid worked, communication was effective, but without it communication was very difficult. Observation noted the words hearing aids written on a whiteboard in the resident's room. One hearing aid was observed on top of some tissues on the bedside table; the friend placed it in the resident's left ear and instructed her to keep it in place to prevent loss. Review of a Social Service progress note, dated 2/03/26, revealed resident #189 was alert and oriented to self, time, and place, and was documented as very hard of hearing. The note revealed the resident was short-term and social services would assist with discharge planning and social services needs as required. On 2/03/26 at 9:30 AM, resident #189 stated she frequently asked staff to write what information on a notepad because she could not hear. She explained her left hearing aid was not working, and friends were attempting to obtain a replacement. On 2/03/26 at 5:24 PM, Certified Nursing Assistant (CNA) G stated resident #189 could hear her and she was unaware whether the resident used hearing aids. On 2/03/26 at 6:10 PM, Registered Nurse (RN) I stated she spoke louder when communicating with resident #189 due to hearing difficulty. She stated she did not use a notebook to communicate and reported the resident used a hearing aid. On 2/04/26 at 11:06 AM, CNA F stated she was unaware whether resident #189 used a hearing aid and had not seen one in the room. She indicated when unsure of resident needs, she referred to the resident's Page 1 of 8 106127 106127 02/05/2026 Solaris Healthcare Celebration 1290 Celebration Blvd Kissimmee, FL 34747

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few care plan. Upon review of the care plan with the surveyor, CNA F validated no information regarding hearing impairment or hearing aid use was present. On 2/04/26 at 12:02 PM, RN E stated resident #189 had a left hearing aid that was not functioning well, and a family member was expected to bring a special battery. RN E stated the resident could hear when spoken to loudly and at close range. Review of the comprehensive care plan for resident #189 revealed no interventions addressing hearing impairment or communication needs. On 2/04/26 at 12:49 PM, the first floor Unit Manager stated she was unaware of hearing aids or communication issues for resident #189. She indicated the Minimum Data Set (MDS) staff created and updated the care plan based on hospital documentation. On 2/04/26 at 1:30 PM, the MDS Lead stated she was responsible for developing care plans, including identifying individualized areas of concern and interventions for residents. She stated care plans were created after admission and updated at least quarterly, and all staff used the care plans. Upon review of resident #189's care plan, she validated there was no communication focus addressing the resident's hearing impairment. She stated it was important for staff to be aware of such needs. She indicated she did not have an explanation for why this information was not included. On 2/04/26 at 3:53 PM, the Director of Nursing stated use of hearing aid should be included in the care plan and staff relied on it for pertinent resident information. Review of the facility's policy titled Care Planning - Interdisiplinary Team (IDT) dated 12/08/25 revealed the IDT was responsible for the development of an individualized comprehensive care plan for each resident. 106127 Page 2 of 8 106127 02/05/2026 Solaris Healthcare Celebration 1290 Celebration Blvd Kissimmee, FL 34747

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 obtain wound care orders and document wound care treatment per the resident's comprehensive, person-centered care plan, (#188); and failed to implement physician orders for treatment of psoriasis consistent with professional standards of practice, (#33), for 2 of 2 residents reviewed for non-pressure skin conditions, of a total sample of 57 residents.Findings: Residents Affected - Few 1.Review of resident #188's medical record revealed he was admitted to the facility on [DATE] with diagnoses including syncope and collapse, thrombocytopenia, anemia, and atrial fibrillation. Thrombocytopenia refers to a low platelet count, which increases the risk of bleeding due to impaired clot formation, (retrieved from www.mayoclinic.org on 2/07/26). Review of resident #188's physician orders revealed the following wound care orders initiated on 2/02/26: *Skin tear to left inner forearm: cleanse with normal saline, apply skin prep to periwound, apply Xeroform, cover with rolled gauze and tape every evening shift on Monday, Wednesday, and Friday (M-W-F). *Skin tear to right shin: same treatment and schedule. *Skin tear to right lower arm: same treatment and schedule. * Monitor every shift for signs of abnormal bleeding including black tarry stools, hematuria, bruising, nose bleeds, bleeding gums, sudden severe headache, coffee ground emesis, muscle joint pain, changes in mental status or vital signs and lethargy. Document N if none of the above are noted; if Y, document in a progress note and notify the physician. * Clopidogrel 75 milligrams (mg) daily, initiated 1/31/26, for clot prevention. Review of resident #188's comprehensive care plan, revised on 2/02/26, identified actual and potential impairment to skin integrity related to fragile skin, dryness of extremities, and incontinence. The care plan identified skin tears to the right shin, left inner forearm, and right lower arm, and instructed nurses to perform wound care as ordered. An addition focus area identified the resident was receiving anticoagulant and platelet aggregation inhibitor therapy, placing him at increased risk for bleeding, bruising, and hemorrhage. On 2/03/26 at 9:13 AM, resident #188 was observed in bed eating breakfast with a rolled gauze dressing dated 2/02/26, shift 3-11, on his right arm that was saturated with blood. Blood smears were observed on the right bed enabler rail. The resident stated he was on blood thinners and bled a lot. On 2/03/26 at 5:11 PM, Certified Nursing Assistant (CNA) G stated she reported blood on resident #188's wound dressing to the assigned nurse the previous day. She indicated the dressing was clean when she began her shift at 3:00 PM. On 2/04/26 at 10:48 AM, CNA F stated resident #188's wound dressing had required two dressing 106127 Page 3 of 8 106127 02/05/2026 Solaris Healthcare Celebration 1290 Celebration Blvd Kissimmee, FL 34747

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few changes the previous day due to bleeding. She shared blood was visible again that morning and she notified the nurse. On 2/04/26 at 11:54 AM, Registered Nurse (RN) E stated he previously served as the Wound Care Nurse (WCN) for one year before returning to floor nursing. He shared he changed resident #188's wound the dressing twice the previous day and the resident was scheduled to be seen by the wound care physician the following day. RN E stated the previous day he first applied calcium alginate, and an abdominal pad, secured with rolled gauze, but the second time he changed the wound dressing he applied Xeroform as ordered. He indicated he did not obtain a physician order for the calcium alginate and abdominal pad because he wanted to see if it worked first. He acknowledged the treatment did not work initially. He stated he later applied Xeroform, which controlled the bleeding for the remainder of the shift. Review of resident #188's progress notes and physician orders from 2/03/26 through 2/04/26 revealed documentation by RN E regarding wound care provided to a to the left inner forearm. On 2/04/26 at 3:05 PM, RN E stated there was no bleeding noted for resident #188 on Monday. He indicated the dressing was changed twice on 2/03/26 and he reported this to the WCN that day. He acknowledged he was expected to document the dressing changes in a progress note or the Treatment Administration Record (TAR) but stated he forgot. He explained there was no option to document the dressing change in the TAR because the order was not written as PRN (as needed). He stated he was unsure whether he could request a PRN order. He validated he did not notify the physician or the WCN at the time of increased bleeding and changed the dressing twice without obtaining an order. On 2/04/26 at 12:49 PM, the first floor Unit Manager (UM) confirmed there was no progress note and no physician order addressing the wound care provided on 2/03/26. She acknowledged the wound care orders did not include PRN dressing changes and stated nurses were expected to notify the WCN so she could evaluate the resident and obtain additional orders if needed. On 2/04/26 at 3:17 PM, during an interview with the WCN and the Director of Nursing (DON), the WCN stated she was responsible for performing a second head-to-to-toe skin assessment on newly admitted residents. She indicated if she identified skin impairments requiring treatment, she contacted the wound care physician to obtain orders. She explained she entered the physician's wound care orders into the system and the assigned nurse carried out the treatment. The WCN stated she assessed resident #188 on 2/02/26 and identified three skin tears, a deep issue injury to the sacrum, and discoloration to the left knee. She stated she entered the wound care orders as given by the physician and the orders did not include PRN dressing changes. The WCN mentioned RN E informed her on 2/04/26 that resident #189's dressing had been a little bit dirty the previous day. The WCN said RN E did not inform her the dressing was saturated with blood or that it had been changed twice due to bleeding. She stated if she had informed of increased bleeding, she would have assessed the resident and contacted the physician as indicated. The DON stated the assigned nurse would be expected to obtain a one-time PRN order if a dressing needed to be changed outside of the schedule order. The DON confirmed there was no progress note documenting increased bleeding, no documentation of two dressing changes on 2/03/26, and no physician order obtained for a change in treatment. On 2/05/26 at 9:17 AM, the Medical Director stated if there was a significant change in a wound, including increased bleeding, it should be communicated to the physician. He indicated nurses could contact his group or the on-call physician to obtain additional orders. 106127 Page 4 of 8 106127 02/05/2026 Solaris Healthcare Celebration 1290 Celebration Blvd Kissimmee, FL 34747

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility's policy titled Skin and Wound Management, dated 12/08/25, revealed nursing staff were to assess, describe, document and report wound conditions, and the physician would authorize appropriate wound treatment orders. The policy indicated treatments were to be implemented in accordance with physician authorization and documented accordingly. 2. Resident # 33 was admitted to the facility on [DATE] with diagnoses that included encounter for orthopedic aftercare following surgical amputation/osteomyelitis, type 2 diabetes mellitus and morbid obesity. A review of the medical record revealed physician orders for resident #33 to receive Triamcinolone Acetonide External Cream 0.5% with directions for nurses to apply topically to rash on extremities and abdomen twice a day for psoriasis. On 2/02/26 at 12:02 PM, resident #33 appeared was sitting up in his wheelchair. He had dry, reddened areas on his arms and legs. Resident #33 said he had psoriasis but was not getting the cream ordered by the physician as prescribed. He explained that staff always told him they were out or they were waiting on pharmacy for the cream. He continued to explain that he could not understand how administration of the medication could be so inconsistent, or why the pharmacy could not send a larger amount, so it did not run out so quickly. On 2/04/26 at 2:30 PM, the TAR revealed resident #33 did not receive the 9:00 AM treatment on 2/02/26, nor on 2/03/26; and the entry was left blank on 2/04/26 by RN B. The TAR revealed resident #33 had documentation to indicate he received the 5:00 PM treatment the same day on 2/02/26 by RN D and on 2/03/26 by RN C. On 2/04/26 at 2:52 PM, the assigned RN B explained he did not apply the cream for the last three days because the cream was not here. RN B explained that on 2/02/26 he might have heard during shift report that the cream was on its way from the pharmacy but said he did not write awaiting pharmacy in his progress note because he was unsure. He continued that on 2/03/26 he had forgotten to call the pharmacy nor to write a progress note about what happened. RN B said he did not sign the TAR today because he was waiting to see if the medication came in on the 2:00 PM pharmacy delivery, and since it was almost the end of his shift, he would call the pharmacy to find out if when it would arrive. On 2/04/26 at 3:10 PM, RN C explained that on 2/03/26 at 5:00 PM, the cream was applied as ordered because it was in the treatment cart. On 2/04/26 at 3:20 PM, RN D said that on 2/02/26, the cream was applied because it was in the treatment cart. Together with the Assistant Director of Nursing (ADON), RN C proceeded to open the locked treatment cart to reveal two tubes of the prescribed cream for resident #33. The almost empty tube had a received date of 1/28/26 and the other almost full tube had a received date of 2/01/26. On 2/05/26 at 10:45 AM, the DON acknowledged that all assigned nurses except RN B had provided the treatment and said her expectation was that if the medication was not there or not given, nurses were supposed to call the pharmacy, call the doctor, notify the family and also document in the medical record. The DON acknowledged RN B did not do that. The undated facility policy on specific medication administration procedures, addressed the notification of the physician for persistent refusals, held medications and suspected adverse drug reactions. 106127 Page 5 of 8 106127 02/05/2026 Solaris Healthcare Celebration 1290 Celebration Blvd Kissimmee, FL 34747

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 ensure the flow rate for Oxygen (O2) therapy was administered as per physician's order for 1 of 2 residents reviewed for O2 therapy, of a total sample of 57 residents, (#88).Findings:Resident #88 was admitted to the facility on [DATE] with diagnoses of Alzheimer's disease, failure to thrive, anemia, anxiety, depression, and subsequent encounter for palliative care. On 2/02/26 at 11:55 AM, resident #88 was observed in bed, she wore a nasal cannula attached to an oxygen concentrator. The O2 was set at 2.5 liters per minute (LPM), with the concentrator located inside her bathroom. A review of resident #88's medical record revealed O2 was ordered by the physician for 2 LPM by nasal cannula. The Quarterly Minimum Data Set, dated [DATE] showed a Brief Interview for Mental Status of 12/15, which indicated the resident's cognition was moderately impaired. The assessment indicated the resident required moderate to maximum assistance for activities of daily living. The next day on 2/03/26 at 9:00 AM, resident #88 was observed with O2 via nasal cannula. The oxygen concentrator was set at 2.5 LPM. On 2/03/26 at 9:25 AM, Licensed Practical Nurse (LPN A) confirmed resident #88's oxygen concentrator was set to 2.5 LPM of oxygen. She verified the physician's order was for 2 LPM. She explained that possible a CNA had bumped it. She confirmed she was supposed to check the oxygen every shift in the morning and said she did it before she got report or counted medications. On 2/04/26 at 3:52 PM, the Director of Nursing (DON) commented no staff were supposed to change the flow rate of oxygen without a physician's order, and they should check the flow rate every shift to ensure accuracy. A review of the Oxygen Administration policy, revised 12/08/25, recommended to review the physician's orders and administer the proper flow of O2 at the rate it was ordered. Residents Affected - Few 106127 Page 6 of 8 106127 02/05/2026 Solaris Healthcare Celebration 1290 Celebration Blvd Kissimmee, FL 34747

F 0697 Provide safe, appropriate pain management for a resident who requires such services. 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 implement physician orders for pain management accurately and timely; and failed to effectively manage pain in accordance with the resident's care plan and goals, for 1 of 2 residents reviewed for pain, of a total sample of 57 residents, (#189). Findings: Cross Reference F656 Review of resident #189's medical record revealed she was admitted to the facility on [DATE] with diagnoses including fracture of the neck of the left femur, fracture of the lower end of the left radius, and history of falling. Review of resident #189's Brief Interview for Mental Status assessment dated [DATE] revealed a score of 15 out of 15 indicating intact cognition. Review of the comprehensive care plan, initiated on 1/30/26, revealed resident #189 had pain and discomfort related to fractures of the left femur and left radius. The goal was for pain to be at or below the resident's stated acceptable level. Interventions included administering pain medication per physician orders; encouraging the resident to verbalize pain; evaluating pain levels; observing for nonverbal signs and symptoms of pain; reporting to the charge nurse; and providing comfort measures per resident preference. Review of physician orders initiated on 1/29/26 included:*Non-weight bearing (NWB) to he left upper (LUE) and left lower extremities (LLE)*Methocarbamol (muscle relaxer) 500 milligram (mg) with meals for muscle spasm for seven days *Ibuprofen 600 mg with meals for pain for seven days *Acetaminophen 325 mg, two tablets, four times a day for pain for seven days *Lidocaine 4% topical patch applied to lower back daily for pain*Pain Management Log every shift and as needed (PRN) On 2/02/26 at 12:39 PM, resident #189 stated she asked for pain medication prior to therapy but did not receive it. She explained was unable to work with therapy due to her pain. On 2/03/26 at 9:24 AM, resident #189 stated she experienced significant pain during the previous therapy session and was uncertain if she could participate again. She reported pain at 8 out of 10, with episodes of 10 out of 10 pain when positioned poorly. She stated she had not previously required pain medication but now needed it and believed pain medication prior to therapy would allow participation. On 2/03/26 at 5:24 PM, Certified Nursing Assistant (CNA) G stated resident #189 had complained of back pain previously, but not that day. CNA G indicated she did not recall seeing a Lidocaine patch on the resident's back. On 2/04/26 at 11:06 AM, CNA F stated resident #189 often complained of back pain and required assistance with repositioning. CNA F indicated she worked with resident #189 on 2/03/26 and 2/04/26 and did not observe a Lidocaine patch in place. On 2/04/26 at 11:52 AM, resident #189 stated she did not have a Lidocaine patch applied and had not received one previously. On 2/04/26 at 12:02 PM, Registered Nurse (RN) E stated resident #189's care primarily focused on pain management and reported her pain ranged from 2 to 4, stating pain management was effective. RN E acknowledged the resident was ordered a Lidocaine patch but stated he had not yet applied it. When asked why the Medication Administration Record (MAR) reflected administration of the patch, RN E stated it was his fault for documenting administration when it had not occurred. RN E stated he believed the patch may have fallen off previously and acknowledged he did not follow the physician's order. Review of the Medication Admin Audit Report revealed RN E documented on 2/04/26 at 10:37 AM, that the Lidocaine Patch was administered at 9:36 AM. On 2/04/26 at 12:49 PM, the first floor Unit Manager (UM) stated medications and treatments were to be documented after administration, not before. On 2/04/26 at 3:53 PM, the Director of Nursing (DON) confirmed documentation of medication administration prior to actual administration constituted inaccurate medical record and a failure to follow physician orders. On 2/05/26 at 10:20 AM, resident #189 expressed continued concerns regarding pain during therapy. At approximately 10:30 AM, a therapist and Licensed Practical Nurse (LPN) H entered the room. The therapist asked whether Residents Affected - Few 106127 Page 7 of 8 106127 02/05/2026 Solaris Healthcare Celebration 1290 Celebration Blvd Kissimmee, FL 34747

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few pain medication had been given. LPN H stated the resident had been medicated and left the room. The resident stated she needed additional pain relief. The therapist indicated he would contact nursing. On 2/05/26 at 10:36 AM, resident #189's physician informed the resident of her current pain regimen. The resident requested additional pain control prior to therapy. At 10:45 AM, the physician stated he believed Tramadol had been administered prior to therapy the previous day. He later stated pain medication should be administered as prescribed, and nursing should report ineffective pain management. On 2/05/26 at 10:51 AM, LPN H showed the Tramadol tablets in the medication cart for resident #189 and stated none had been administered. He stated the medication was scheduled for 1:00 PM. Review of physician progress notes dated 2/04/26 and 2/05/26 revealed Tramadol was ordered due to ongoing pain limiting participation in therapy and later increased in frequency due to inadequate pain control. On 2/05/26 at 11:10 AM, the Director of Rehabilitation (DOR) stated pain had limited the resident's participation in therapy and confirmed therapy communicated pain concerns to nursing. Review of a Physical Therapy (PT) and Occupational Therapy (OT) evaluations and treatment notes from 1/29/26 through 2/04/26 consistently documented pain as a barrier to therapy, with nursing notified, and noted the resident was unable to tolerate treatment due to pain. Review of physician orders revealed Tramadol was ordered on 2/04/26, discontinued, re-entered, and scheduled for 2/05/26 at 1:00 PM. Review of the MAR confirmed Tramadol was not administered on 2/04/26. Review of controlled substance records revealed no Tramadol was removed from the automated medication dispenser on 2/04/26 - 2/05/26. On 02/05/26 at 11:37 AM, the DON stated resident #189 did not arrive from the hospital with an opioid prescription to treat pain. She further stated that if therapy did not communicate pain with nursing, we cannot read minds. The DON acknowledged fractures were painful and stated effective pain management was important. She further stated she was not a physician and could not prescribe medications. Later at 1:18 PM, the DON stated Tramadol was available in the automated medication dispenser machine and the nurse could have obtained it. She stated she was unaware of unrelieved pain for resident #189's or that therapy had informed nursing of ongoing pain concerns. On 2/05/26 at 1:39 PM, the first floor Unit Manager confirmed therapy informed her of resident #189's pain and that she was aware of the Tramadol order. She acknowledged she did not follow up to reassess the resident's pain level or response after therapy reported pain. Review of the facility policies titled Pain Assessment and Management and Administration Procedures for All Medications, dated 12/08/25, revealed expectations for timely pain management, reporting ineffective treatment, and accurate documentation following medication administration. 106127 Page 8 of 8