Inspection·April 28, 2022

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the hospital progress note dated 3/08/22 revealed the resident sustained an acute right hip fracture in which several bones were broken and moved out of their normal positions along with soft tissue swelling. Review of the Medical Certification for Medicaid Long Term Care Services and Patient Transfer Form from the hospital dated 3/8/22, revealed resident #106 had right hip surgery and required fall precautions. The form indicated the resident was not ambulatory and had fair rehabilitation potential. In an interview on 4/27/22 at 11:49 AM, the Regional Director of Clinical Operations and the Regional Director of Operations stated resident #106 had four falls since her admission on [DATE]. They explained she had two falls on 1/14/22, one on 3/06/22 which resulted in her transfer to the hospital with right hip fracture and again on 3/26/22 after she returned from the hospital. The Regional Director of Operations stated she was Administrator and Risk Manager (RM) of the facility in February and March of 2022. She explained she was notified on 3/07/22 of the resident's fall and subsequent transfer to the hospital but stated the previous Director of Nursing (DON) was responsible for completing the investigation. At 2:55 PM, the Regional Director of Operations reported she was unable to provide the investigation of resident #106's fall on 3/06/22. She noted investigations were kept on paper, but they could not find it. She explained they could not provide statements from the staff involved nor from the witness. She recalled the former DON spoke to the CNA who found the resident on the morning of 3/07/22, but she never saw an actual statement by the CNA, nor could she recall who it was. She reported all involved parties should have been interviewed in detail to form meaningful interventions for future fall prevention. On 4/28/22 at 10:00 AM, in a telephone interview, CNA B recalled she had worked on the 300 unit the morning resident #106's hip injury was discovered. She explained she had received report from the previous CNA about resident #106's fall the prior evening. CNA B stated when she did her morning rounds, she heard resident #106 complaining of pain, so she uncovered her and saw part of her hip was red and swollen. She remembered she informed LPN A who came to the room and assessed the resident. CNA B explained the previous DON did not interview her or get her statement about the morning she found resident #106's injuries nor was she asked by anyone at the facility for a statement until yesterday when the Regional Director of Operations called her. On 4/28/22 at 12:01 PM, in a telephone interview, LPN A stated she worked as an agency nurse on 3/07/22. She recalled CNA B informed her resident #106's hip was swollen, and she was in pain. She had asked the night nurse why the resident was crying and was told she had fallen the evening before. She explained when she examined the resident, her right hip looked swollen, so she called the doctor and a stat X-ray was ordered. She said when she received the X-ray results, she called the doctor and was told to send the resident to the hospital emergency room. LPN A indicated no one from the facility asked her for a statement or interviewed her about what happened. She stated the only documentation of the incident she provided was the change in condition and progress notes she wrote that day. LPN A stated she had worked at the facility since the incident, but no one had spoken to her about the resident's fracture until she received a call from the facility yesterday. On 4/28/22 at 5:38 PM, the Regional Director of Operations and the DON stated if a fall with major injury occurred, the DON would investigate. They explained the nurse would notify the DON immediately and the DON would investigate what happened by interviewing the staff. They stated the nurse, the CNAs, witnesses and anyone else involved in the resident's care should be interviewed within 24-48 hours. They explained the interviews and witness statements were an important part of the investigation and should be collected as soon as possible so that memories would be more accurate. They (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106144 If continuation sheet Page 2 of 11 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 106144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Apopka Health and Rehabilitation Center 2001 Alston Bay Blvd Apopka, FL 32703 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 indicated the statements and interviews were used in the investigation to help determine the root cause of the incident and put meaningful interventions in place for future prevention. Review of the undated document, Job Description for the Director of Nursing revealed the essential job function to, Comply with, support and enforce policies involving Risk Management. Residents Affected - Few Review of the Standards and Guidelines: SG Abuse, Neglect, Exploitation and Investigations with revision date of 3/27/21 revealed a guideline for staff to conduct internal investigations of adverse incidents which include but not limited to staff interviews, resident and family interviews, medical record reviews, 24-hour report reviews, and full body skin exams. The document directed staff to notify the resident's representative and the physician of an on-going investigation regarding the alleged incident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106144 If continuation sheet Page 3 of 11 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 106144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Apopka Health and Rehabilitation Center 2001 Alston Bay Blvd Apopka, FL 32703 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 0641 Ensure each resident receives an accurate assessment. 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 ensure Minimum Data Set (MDS) assessments accurately reflected health conditions regarding weight loss for 1 of 3 sampled residents reviewed for nutrition (#88) and failed to accurately assess antipsychotic drug use on a routine basis for 1 of 5 residents reviewed for unnecessary medications, (#51) of a total sample of 47 residents. Residents Affected - Few Findings: 1. Resident #88 was admitted to the facility on [DATE] with diagnoses that included dementia with Lewy Bodies, Parkinson's disease, congestive heart failure and anemia. On 12/9/2021, the resident weighed 145 pounds (lbs.). On 03/3/2022, the resident weighed 130 lbs. which was a 10.34% weight loss. Review of the Quarterly MDS assessment dated [DATE], revealed Section K: Swallowing/Nutritional Status question K 0300 titled Weight Loss was coded with the number 0. This code inaccurately indicated resident #88 had no or unknown weight loss of 5% or more in the last month or loss of 10% or more in last 6 months. The number 2 should have been selected since the resident did have weight loss and was not on physician prescribed weight-loss program. On 4/28/22 at 2:08 PM, Licensed Practical (LPN) MDS Coordinator verified that weight loss was assessed inaccurately for resident # 88 on her assessment dated [DATE]. The LPN MDS Coordinator said she and the Registered Nurse (RN) MDS Coordinators needed to check the dietary section of the MDS for weight accuracy and educate dietary staff as well. The RN MDS Coordinator explained the kitchen manager had assessed resident #88 for no weight loss which was inaccurate as the resident lost 15 lbs. between December 2021 to March 2022. The RN said he only verified the completion of the MDS assessment and not the accuracy. Review of the RAI version 3.0 Manual revealed instructions for completing Section K 0300: Weight Loss. Code 2, yes, not on physician-prescribed weight-loss regiment: if the resident has experienced a weight loss of 5% or more in the past 30 days or 10% or more in the last 180 days, and the weight loss was not planned and prescribed by a physician. 2. Resident #51 was admitted to the facility on [DATE] with diagnoses including depression, anxiety and schizoaffective disorders. A review of the physician order dated 2/3/22 noted Seroquel 25 milligrams by mouth at bedtime for dementia. A review of the Medication Administration Record revealed the resident had received Seroquel since 2/3/222 to present. Seroquel may be used alone or with other medications. Seroquel belongs to a class of drugs called Antipsychotics. (Retrieved from https://www.rxlist.com 4/29/22). Resident #51's Quarterly MDS assessment dated [DATE] section 0410 Medications Received read, Indicate the number of DAYS the resident received the following medications by pharmacological classification .during the last 7 days .Enter 0 if medication was not received by the resident during the last 7 days. Antipsychotic was coded 7, indicated the resident received antipsychotic medication during the review period. Section 0450 Antipsychotic Medication Review read, Did the resident receive antipsychotic medications since admission/entry or reentry or the prior OBRA (Omnibus Budget Reconciliation Act) assessment, whichever is more recent This was coded 0 and read, No-Antipsychotics were not received. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106144 If continuation sheet Page 4 of 11 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 106144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Apopka Health and Rehabilitation Center 2001 Alston Bay Blvd Apopka, FL 32703 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 0641 Level of Harm - Minimal harm or potential for actual harm On 4/28/22 at 2:12 PM, the RN MDS coordinator acknowledged he did the assessment dated [DATE] Section 0450. The MDS RN Coordinator said this was an oversight as he went over it too quickly and should have been marked 1 Yes, since antipsychotics were received on a routine basis, and the resident received them 7/7 days in the look back period. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106144 If continuation sheet Page 5 of 11 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 106144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Apopka Health and Rehabilitation Center 2001 Alston Bay Blvd Apopka, FL 32703 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 0679 Provide activities to meet all resident's needs. 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 an on-going activity program for 1 of 2 residents reviewed for activities, of a total sample of 47 residents, (#516). Residents Affected - Few Findings: Resident #516 was admitted to the facility on [DATE] with diagnoses including Parkinson's Disease, Alzheimer's Disease and cognitive communication deficit. The Minimum Data Set admission assessment with assessment reference date 4/15/22 revealed resident #516 had a Brief Interview for Mental Status score of 4 which indicated he had severe cognitive impairment. He required extensive assistance with transfers and locomotion. The assessment indicated the resident's preferred language was Spanish and he had interest in listening to music and participating in favorite activities. A care plan for activities initiated 4/26/22 indicated resident #516 had expressed interest in both self-directed independent and formal group activities. The goal was for him to have all needed items and materials to fully engage in preferred independent activities and for him to attend formal group activities of choice. The document indicated resident #516 enjoyed playing cards and games, watching television and movies and listening to music. Interventions included activity staff to provide playing cards, crossword and word find puzzles, a channel line-up, radio and a schedule of planned live performances. Review of resident #516's medical record revealed an Activities/Recreation Progress Note dated 4/11/22 which read, Patient requires assistance with activities of daily living, transfers and ambulation to attend daily scheduled activities of choice. On 4/25/22 at 12:12 PM, resident #516 was observed in his wheelchair at a table in the 300-unit dining room with his eyes closed and head lowered. At 1:58 PM, he was observed in his wheelchair at the same table with his head lowered and eyes closed. Resident #516 did not have any activity supplies in front of him during either of these observations. On 4/26/22 at 9:42 AM, resident #516 was observed in his wheelchair at a table in the 300-unit dining room with his back to the hallway and facing an exterior wall. The resident was not able to see the television which was to his left. At 10:58 AM and 12:02 PM, he was observed in same position in the 300-unit dining room. At 1:09 PM, resident #516 was observed at the same table with his back to the television. At 2:17 PM, he was observed at the same table facing the hallway with the television to his right and not visible to him. The resident did not have any activity supplies in front of him during any of these observations. On 4/27/22 at 10:18 AM, resident #516 was observed at a table in the 300-unit dining room facing the hallway. He could not see the television as it was to his right side and he did not have any activity supplies on the table. On 4/27/22 at 1:05 PM, Certified Nursing Assistant (CNA) D stated resident #516 was in the 300-unit dining room most of the day for supervision because he was at risk for falls. She said she was not aware if he attended any activities. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106144 If continuation sheet Page 6 of 11 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 106144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Apopka Health and Rehabilitation Center 2001 Alston Bay Blvd Apopka, FL 32703 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 4/27/22 at 1:19 PM, the 300/400 Registered Nurse Unit Manager stated resident #516 was always in the 300-unit dining room. She explained he needed to be supervised as he was at risk for falls. She indicated he did not speak much English and would probably not understand some of the activities. On 4/27/22 at 1:43 PM, the Activities Director stated he interviewed resident #516's family and identified his interest in dominoes and music. He said he did not know why resident #516 was in the 300-unit dining room all day and explained if a resident needed assistance to attend activities, it was the CNA's responsibility to get the resident to the activity. He reported the resident had attended one group activity since admission. He verbalized the activities staff had not provided the resident with any independent activity supplies. The Activity Director acknowledged there was not a program specifically for cognitive impaired residents nor a formalized one-to-one activity program for residents. On 4/28/22 at 11:44 AM, the Director of Nursing (DON) stated every employee was responsible for assisting residents to activities including the Activities Director, Activities Assistants and CNAs. She verbalized the importance of a resident attending activities was for socialization. On 4/28/22 at 12:07 PM, the Administrator stated the expectation was for the activities department to provide a variety of activities to residents and to honor resident choices. She explained if a resident chose to stay in their room, the expectation was for the activity department to provide books or crafts for the resident to do in their leisure time. She stated the activities department was expected to serve every resident population. Review of the job description for Activities Director revealed the Activity Director's role was to ensure the development, organization and coordination of facility and community resources to provide comprehensive therapeutic recreation services and programs that meet the needs and interest of each resident. The essential job functions included interview and assess all residents, develop an individual recreation plan and develop monthly calendars that reflect and meet the needs of the resident population. Additional job duties included transporting residents to and from activity room as required and working with other departments to promote the best possible care for the residents. The facility's Standards and Guidelines: SG Social and Recreational Programming policy dated 8/29/20 read, It is the standard of this facility to encourage residents to participate in social, recreation, educational and other activities within the facility and the community. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106144 If continuation sheet Page 7 of 11 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 106144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Apopka Health and Rehabilitation Center 2001 Alston Bay Blvd Apopka, FL 32703 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to follow physician orders for medication administration and failed to provide an explanation for medications not administered for 7 of 11 residents reviewed for medication administration of a total sample of 47 residents, (#57, #54, #46, #521, #60, #109, #520). Findings: 1. Resident #57 was admitted to the facility on [DATE] with diagnoses including Parkinson's Disease, type 2 Diabetes, hypertension, anxiety and major depressive disorder. Review of the Minimum Data Set admission assessment with assessment reference date of 3/09/22 revealed resident #57 had a Brief Interview for Mental Status score of 13 which indicated she was cognitively intact. Review of the physician orders revealed resident #57 had orders for Amantadine Hydrochloride (HCL) Extended Release (ER) 129 milligrams (mg) at bedtime for Parkinson's Disease; Clonazepam 1 mg at bedtime for anxiety; Fluoxetine HCL 40 mg at bedtime for major depressive disorder; Insulin Glargine Solution 18 units subcutaneously at bedtime for diabetes; Eliquis 2.5 mg two times a day for blood thinner; Mirapex 1 mg two times a day for Parkinson's Disease; Senna Plus 50 mg two times a day for constipation; Carbidopa-Levodopa 100 mg four times a day for Parkinson's Disease; and Humalog Insulin Solution per sliding scale. On 4/25/22 at 12:15 PM, resident #57 stated she did not receive any medications on the night of 4/23/22. She explained she usually received her medications by 10:30 PM but she fell asleep and woke up at 12:30 AM. She recalled she put on her call light which was answered by a Certified Nursing Assistant (CNA) who informed her none of the residents on that hallway received their medications. Review of the Medication Administration Record (MAR) for April 2022 revealed no documentation on 4/23/22 for resident #57's evening and bedtime medications. The document was blank for the nurse's electronic signature for her 6:00 PM dose of Carbidopa-Levodopa and 9:00 PM doses of Amantadine HCL ER, Clonazepam, Fluoxetine HCL, Insulin Glargine Solution, Eliquis, Mirapex, Senna Plus and Humalog. Additionally, the resident's blood glucose levels were not documented on the MAR. Review of the MARs for residents on the 300/400 hallway revealed six additional residents did not receive their prescribed medications on 4/23/22. There were blank spaces on the MAR with no indication residents #54, #46, #521, #60, #109 and #520 received their evening and bedtime medications. 2. Resident #54 was admitted to the facility on [DATE] with diagnoses including Atherosclerotic Heart Disease, Chronic Kidney Disease, Atrial Fibrillation and nonrheumatic mitral valve insufficiency. Review of the physician orders revealed resident #54 had orders for Niacin 500 mg at bedtime for cholesterol; Senna Plus 50 mg at bedtime for constipation; Colace 100 mg two times a day for constipation; Eliquis 5 mg two times a day for clot prevention; Glucosamine-Chondroitin 400 mg two times a day for nutritional support; Levocarnitine 500 mg two times a day related to stage 3 chronic kidney disease; Multaq 400 mg two times a day for Atrial Fibrillation; and Hydralazine HCL 10 mg three times a day for hypertension. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106144 If continuation sheet Page 8 of 11 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 106144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Apopka Health and Rehabilitation Center 2001 Alston Bay Blvd Apopka, FL 32703 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 0755 Level of Harm - Minimal harm or potential for actual harm Review of the MAR for April 2022 revealed on 4/23/22, resident #54 did not receive her 9:00 PM doses of Niacin, Senna Plus, Colace, Eliquis, Glucosamine-Chondroitin, Levocarnitine, Multaq and Hydralazine HCL. 3. Resident #46 was admitted to the facility on [DATE] with diagnoses including stage 2 pressure ulcer of sacral region, hypertension and nonrheumatic aortic valve stenosis. Residents Affected - Some Review of the physician orders revealed resident #46 had orders for Docusate Sodium 100 mg two times a day for constipation; Hydralazine HCL 50 mg two times a day for hypertension; Polysaccharide Iron Complex 150 mg two times a day for deficiency; Symbicort Aerosol 2 puffs by oral inhalation two times a day for shortness of breath; and Gabapentin 600 mg three times a day for pain. Review of the MAR for April 2022 revealed on 4/23/22, resident #46 did not receive her 1:00 PM dose of Gabapentin nor her 5:00 PM doses of Docusate Sodium, Hydralazine HCL, Polysaccharide Iron Complex and Symbicort Aerosol. 4. Resident #521 was admitted to the facility on [DATE] with diagnoses including depression, hyperlipidemia, anxiety, hypertension, Atrial Fibrillation and Chronic Obstructive Pulmonary Disease. Review of the physician orders revealed resident #521 had orders for Atorvastatin Calcium 10 mg at bedtime for hyperlipidemia; Montelukast Sodium 10 mg in the evening for allergies; Eliquis 5 mg two times a day for stroke prophylaxis; Guaifenesin ER 600 mg every 12 hours for cough for 10 days; Hydralazine HCL 50 mg two times a day for hypertension; and Diltiazem HCL 60 mg three times a day for hypertension. Review of the MAR for April 2022 revealed on 4/23/22, resident #521 did not receive her 9:00 PM doses of Atorvastatin Calcium, Montelukast Sodium, Eliquis, Guaifenesin ER, Hydralazine HCL and Diltiazem HCL. 5. Resident #60 was admitted to the facility on [DATE] with diagnoses including Chronic Obstructive Pulmonary Disease, anxiety and bipolar disorder. Review of the physician orders revealed resident #60 had orders for Midodrine HCL 5 mg every 8 hours for hypotension and to obtain vital signs every shift. Review of the MAR for April 2022 revealed on 4/23/22, resident #60 did not receive her 2:00 PM dose of Midodrine HCL and her blood pressure was not documented. 6. Resident #109 was admitted to the facility on [DATE] with diagnoses including hemiplegia and hemiparesis following cerebral infarction, hypertension and an automatic cardiac defibrillator. Review of the physician orders revealed resident #109 had orders for Carvedilol 25 mg two times a day for cardiomyopathy and to obtain vital signs every shift. Review of the MAR for April 2022 revealed on 4/23/22, resident #109 did not receive her 5:00 PM dose of Carvedilol and her vital signs were not documented. 7. Resident #520 was admitted to the facility on [DATE] with diagnoses including Type 2 diabetes, hypothyroidism, hypertension and Atherosclerotic Heart Disease. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106144 If continuation sheet Page 9 of 11 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 106144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Apopka Health and Rehabilitation Center 2001 Alston Bay Blvd Apopka, FL 32703 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 0755 Level of Harm - Minimal harm or potential for actual harm Review of the physician orders revealed resident #520 had an order for Ozempic Solution to be injected subcutaneously one time a day every Saturday for diabetes. Review of the MAR for April 2022 revealed on 4/23/22, resident #520 did not receive her 6:00 PM dose of Ozempic. Residents Affected - Some On 4/26/22 at 5:00 PM, the Director of Nursing (DON) stated the facility had initiated an investigation based on resident #57's report of not receiving her evening and bedtime medications on 4/23/22. She explained the investigation was still in process and at this time she had identified two additional resident that had not received their medications on that shift. On 4/28/22 at 5:55 PM, the Regional Director of Clinical Operations (RDCO) stated the facility ran a Medication Administration Audit Report and identified a total of eight residents whose medications were not documented as having been administered. She confirmed during the facility's investigation, residents #57 and #60 reported they did not receive all their medications on 4/23/22. The RDCO reconciled resident #57's narcotics and verified her scheduled 9:00 PM dose of Clonazepam had not been removed from the medication cart. On 4/28/22 at 6:31 PM, the Housekeeping Supervisor explained she was the Manager on Duty on 4/24/22 and recalled resident #60 requested to see her. She stated resident #60 informed her she had not received her medication the previous night. She stated she informed the Administrator on 4/24/22. On 4/28/22 at 7:04 PM, CNA H acknowledged resident #60 informed her on the day shift on 4/24/22 that she did not receive her medications the previous night shift. She said she did not inform anyone of the resident's concern. The facility's Standards and Guidelines: SG Medication Administration policy revised 3/27/21 read, It will be the standard of this facility to administer medications in a timely manner and as prescribed by the physician. The document contained guidelines including, 7. Medications should be administered within one (1) hour before or after their prescribed time and 14. When medications are administered, the individual administering the medication must record in the resident's medical record/MAR. The document indicated if a medication was withheld, refused or not administer as scheduled, the nurse must indicate this deviation from the physician's order on the MAR or noted in the medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106144 If continuation sheet Page 10 of 11 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 106144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Apopka Health and Rehabilitation Center 2001 Alston Bay Blvd Apopka, FL 32703 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 0759 Ensure medication error rates are not 5 percent or greater. 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 prevent medication errors greater than 5 per cent for 1 of 4 residents sampled for medication administration, (#26). There were 3 errors in 26 opportunities on 1 of 2 units by 1 of 4 nurses observed, for a medication error rate of 11.54%. Residents Affected - Few Findings: Resident #26 was admitted on [DATE] with diagnoses that included hemiplegia and hemiparesis, major depressive disorder, rheumatoid arthritis and conversion disorder with seizures or convulsions. The quarterly Minimum Data Set (MDS) assessment dated [DATE] indicated resident #26 had moderately impaired cognition. She was able to eat independently with minimal help and was on mechanically altered diet. The resident's physician orders read, 07/27/21, Carbamazepine tablet Chewable 100 milligrams (mg), give 2 tablets by mouth three times a day for seizures; 10/14/21, Hydroxychloroquine Sulfate 200 mg. tablet, give 400 mg by mouth one time a day for rheumatoid arthritis; and 07/28/21, Prednisone 2.5 mg tablet, give 7.5 mg by mouth one time a day for rheumatoid arthritis. On 04/27/22 at 10:34 AM, Registered Nurse (RN) E prepared 9:00 AM medications for resident #26. She pulled 1 Aspirin 81 mg tablet, 1 Carbamazepine 100 mg Chewable tablet, 1 Fluoxetine 10 mg capsule, 1 Hydroxychloroquine 200 mg tablet, 1 Potassium Chloride 20 milliequivalents (mEq) tablet, 1 Prednisone Tablet 2.5 mg, 1 PreserVision AREDS capsule and 1 Multivitamins with minerals tablet. RN E confirmed she had prepared a total of 8 pills for resident #26 which were verified by comparing the actual pills against the medication cards. On 04/27/22 at 10:53 AM, medications were administered to resident #26. RN E was then asked to review the medication cards for Carbamazepine, Hydroxychloroquine and Prednisone. Medication cards were verified with orders in the electronic system. RN E acknowledged she administered 1 Carbamazepine 100 tablet instead of 2, 1 Hydroxychloroquine 100 mg tablet instead of 2 and 1 Prednisone 2.5 mg tablet instead of 3. On 04/28/22 at 6:00 PM, the Director of Nursing (DON) stated if a nurse failed to administer the correct dose of medication, she was expected to notify the physician about the situation and follow his orders to either give the additional dose as soon as possible or continue with the next dose at the scheduled time. She added whatever the case may be, the physician needed to be notified. Standards and Guidelines on Medication Administration revised on 03/27/21 read, Guideline #8. After successfully identifying the resident to receive medication administration, the individual administering the medication should ensure that the right medication, right dosage, right time and right method of administration are verified FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106144 If continuation sheet Page 11 of 11