Inspection·November 2, 2022

F 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of CNA (Certified Nursing Assistant) Task for ADL for Bathing for Resident #64 dated 10/3/2022 revealed a checkmark for total dependence on 10/4/2022 at 5:09 AM, on 10/10/2022 at 5:04 PM, on 10/18/2022 at 6:24 AM, on 10/26/2022 at 11:48 AM, and on 10/29/2022 at 1:11 PM. Review of Resident #64's Minimum Data Set (MDS) with assessment reference date (ARD) of 9/30/2022 revealed the resident required extensive assistance for personal hygiene for self-performance and required one-person physical assist for support. Section C- Cognitive Patters revealed a Brief Interview for Mental Status (BIMS) score of 10 (moderately impaired). Review of Resident #64's care plan reads, I need assistance with my ADLs related to weakness, altered mobility, right femur fracture with replacement . Interventions: I require assist of 1 for my AM and PM care . I require assist of 1 with bathing. During an interview on 11/1/2022 at 11:02 AM, Staff I, Registered Nurse (RN), Unit Manager stated, The resident's hair is wet, and we will give her a shower today. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 2 of 14 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 106145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Health & Rehabilitation 7371 Cortez Oaks Blvd Brooksville, FL 34613 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 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, record review, and interview, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice for 2 of 3 residents reviewed, Residents #32 and #182, in a total sample of 39 residents. Residents Affected - Few Findings include: 1. Review of Resident #32's medical records revealed the resident was admitted to facility on 2/17/2022 with the diagnoses including hemiplegia and hemiparesis following cerebral infarct, multiple sclerosis, and gastritis. During an observation on 11/2/2022 at 11:03 AM, Resident #32 was sitting in her wheelchair with a peripheral intravenous (IV) catheter in right forearm. A 1000 milliliter bag of 0.9% Sodium Chloride was labeled as 11/1-2150 @ [Resident #32's room number] [Staff M's initials] Rate=75 ml/hr [milliliter/hour] continuous (Photographic evidence obtained). During an interview on 11/2/2022 at 11:03 AM, Resident #32 stated, The nurse started this for my bowels, constipation/diarrhea if had. I told them I drank lots of water already. Review of the physician orders for Resident #32 revealed no order for IV fluids or to insert an IV catheter. During an interview on 11/2/2022 at 11:10 AM, the Assistant Director of Nursing (ADON) confirmed there was no orders in the electronic chart for Resident #32 to receive IV fluids or IV placement. The ADON walked to Resident #32's room and confirmed IV fluids were running. 2. During an observation on 10/30/2022 at 12:36 PM, Resident #182 had a bandage on her right elbow that had no date. During an interview on 10/30/2022 at 12:36 PM, Resident #182 stated, It is a skin tear I got from a fall. No one has touched this since I came in. During an observation on 10/31/2022 at 12:16 PM, Resident #182 was sitting up in a wheelchair and had no bandage on her right elbow. The bandage was on the lunch meal tray with no date (photographic evidence obtained). During an interview on 10/31/2022 at 12:16 PM, Resident #182 stated, Since no one has touched this since I came in, I took the bandage off. Review of Resident #182's medical records revealed the resident was admitted to the facility on [DATE]. No wound care order for right elbow was documented in Resident #182 medical records. Review of skin and wound evaluation with an effective date of 10/26/22 reads, Section A: skin tear Location: antecubital space present on admission, Wound Measurements: area 1.1 centimeter (cm) x 1.7 cm x 0.8 cm. Treatment: Dressing appearance: intact, dry. Cleansing Solution: normal saline, skin tear present on admission. The Admission/readmission Evaluation dated 10/24/22 12:30 Skin Observation: 1c. marked yes for other skin conditions (vascular, diabetic, rash, skin tear, bruises, surgical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 3 of 14 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 106145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Health & Rehabilitation 7371 Cortez Oaks Blvd Brooksville, FL 34613 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 0684 Level of Harm - Minimal harm or potential for actual harm wounds, etc.) Section D documents resident is alert oriented to Person, Place and Time. talkative, Comprehension is quick and answers question readily. Review of the physician order dated 10/30/2022 at 10:45 PM reads, Cleanse right arm with normal saline, pat dry, apply collagen and xeroform, cover with dry clean dressing as needed for saturation/soiled. Residents Affected - Few Review of Resident #182's Treatment Administration Record (TAR) for October 2022 reads, Cleanse right arm with normal saline, pat dry, apply collagen and xeroform, cover with dry clean dressing as needed for Saturation/Soiled. Start Date: 10/30/2022, 22:45 [10:45 AM] . Cleanse right arm with normal saline, pat dry, apply collagen and xeroform, cover with dry clean dressing every day shift every other day for skin tear. Start Date: 10/31/2022 07:00 [7:00 AM]. No entries were documented as completed on 10/30/22 or 10/31/22 on the TAR. During an interview on 10/31/2022 at 2:30 PM, the Director of Nursing (DON) confirmed it was nursing standards of practice to date, time and initial each dressing change. Upon viewing the undated bandage Resident #182 had removed, the DON stated, I see that is a problem. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 4 of 14 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 106145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Health & Rehabilitation 7371 Cortez Oaks Blvd Brooksville, FL 34613 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure 2 of 2 residents who were fed by enteral means, Residents #181 and #183, received properly labeled enteral feeding bag with date, time, and initials of nurse. Findings include: 1. During an observation on 11/1/2022 at 8:15 AM, Resident #183 was frail, eyes closed with a pale complexion and tube fed with Jevity 1.5. The formula was hung in a clear Enteral Feeding Bag and pump was running at 60 milliliters (ml) per hour (ml/hr). The bag contained approximately 800 ml of formula. The formula appeared thick and lumpy, with cottage cheese like appearance and consistency. The label on the feeding bag was torn and the date, time or nurses' initials of when the formula was hung were not legible (Photographic evidence obtained). During an interview on 11/1/2022 at 8:19 AM, Staff K, Licensed Practical Nurse (LPN), stated, I rounded on my resident this AM and I did not find any concerns. The residents that are tube fed reported no discomfort. Staff K was not able to identify the formula being thick and lumpy, with cottage cheese like appearance and consistency. Staff K stated the label was torn and the bag appeared dirty. During an interview on 11/1/2022 at 8:25 AM, the Director of Nursing (DON) stated the formula bag should have a label and appeared thick. Review of Resident #183's medical records revealed the resident was admitted to the facility on [DATE] with the diagnoses including fracture of mandible, dysphasia, muscle wasting, liver cancer, anemia, immunodeficiency, severe protein-calorie malnutrition, gastric ulcer, and cachexia. Review of Resident #183's physician orders reads, Nothing by mouth (NPO) diet NPO Texture. Order Date: 10/19/2022 . Jevity 1.5 at 60 ml/hr continuous every shift. Order Date: 10/27/2022. 2. During an observation on 11/1/2022 at 8:35 AM, Resident #181 was in bed, holding his stomach and frowning. The resident was tube being fed with Jevity 1.5. The formula was hung in a clear Enteral Feeding Bag and pump was running at 80 ml/hr. The bag contained approximately 600 ml. The formula appeared thick and lumpy, with cottage cheese like appearance and consistency. The label on the feeding bag was torn and the date, time or nurses' initials of when the formula was hung were not legible (Photographic evidence obtained). During an interview on 11/1/2022 at 8:35 AM, Resident #181 stated he had a stomachache and was nauseated not feeling well at all. During an observation on 11/1/2022 at approximately 8:40 AM, the Assistant Director of Nursing (ADON) arrived in Resident #181's room and looked at the formula and turned off the feeding pump. During an interview on 11/1/2022 at 8:40 AM, the ADON stated this looked the same as the other formula for Resident #183. Review of Resident #181's medical records revealed the resident was admitted to the facility on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 5 of 14 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 106145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Health & Rehabilitation 7371 Cortez Oaks Blvd Brooksville, FL 34613 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm [DATE] with the diagnoses including muscle wasting and atrophy, immunodeficiency, dysphagia pharyngeal phase, dysphagia oropharyngeal phase, and gastro-esophageal reflux disease without esophagitis. Review of Resident #181's physician order reads, Jevity 1.5 cal/Fiber at 80 ml/hr continuous every shift for Enteral Feeding. Residents Affected - Some Review of the facility policy and procedures titled Gastric Tube Feeding Via Continuous Pump last revised in 1/2019, reads, Purpose: To provide nourishment to the resident who is unable to obtain nourishment orally . Procedure: - Label the enteral feeding bag/bottle with date, time, rate and initials of the nurse. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 6 of 14 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 106145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Health & Rehabilitation 7371 Cortez Oaks Blvd Brooksville, FL 34613 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 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 residents received respiratory care services consistent with professional standards of practice for 2 of 3 residents reviewed for respiratory care, Residents #54 and #1, in a total sample of 39 residents. Residents Affected - Few Findings include: 1. During an observation on 10/30/2022 at 10:00 AM, Resident #54 was resting in bed, wearing a nasal cannula and the oxygen concentrator was set at 4 liters per minute (Photographic evidence obtained). Review of Resident #54's medical records revealed the resident was admitted to the facility on [DATE] with the diagnoses including pleural effusion, respiratory failure, personal history of COVID-19, pneumonia and pulmonary hypertension. Review of the physician order dated 10/11/2022 for Resident #54 reads, Oxygen at 2 lpm [liters per minute] via nasal cannula every shift. During an observation on 10/30/2022 at 11:00 AM, Resident #54 was sitting in wheelchair, wearing a nasal cannula and the oxygen concentrator was set at 4 liters per minute. During an observation on 10/30/2022 at 11:50 AM, Resident #54 was sitting in wheelchair, wearing a nasal cannula and the oxygen concentrator was set at 4 liters per minute. During an interview on 10/30/2022 at 11:50 AM, Staff F, Licensed Practical Nurse (LPN), stated Resident #54's oxygen should be at 2 liters per minute. 2. During an observation on 10/30/2022 at 10:10 AM, Resident #1 was resting in bed, wearing a nasal cannula and the oxygen concentrator was set at 2.5 liters per minute (Photographic evidence obtained). Review of Resident #1's medical records revealed the resident was admitted to the facility on [DATE] with the diagnoses including emphysema and chronic respiratory failure. Review of the physician order dated 10/11/2022 for Resident #1 reads, Oxygen at 2 lpm via nasal cannula every shift for SOB [shortness of breath]. During an observation on 10/30/2022 at 12:10 PM, Resident #1 was sitting in wheelchair, wearing a nasal cannula. Resident #1's portable oxygen tank was on the back of the wheelchair and connected to Resident #1's nasal cannula and the setting was at 1 liter per minute. During an interview on 10/30/2022 at 12:10 PM, Staff A, Licensed Practical Nurse (LPN), stated, Oxygen is supposed to be on 2 liters. Oh, I was not aware it was on 3 liters. During an interview on 10/30/2022 at 12:20 PM, the Assistant Director of Nursing confirmed the order for oxygen for Resident #1 was 2 liters per minute. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 7 of 14 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 106145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Health & Rehabilitation 7371 Cortez Oaks Blvd Brooksville, FL 34613 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 0695 Level of Harm - Minimal harm or potential for actual harm Review of the facility policy and procedure titled Oxygen Concentrator revised in 2/2020 reads, Purpose: To provide instruction for safe, appropriate set-up and utilization of room oxygen concentrators . General Guidelines . 2. Verify physician's order. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 8 of 14 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 106145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Health & Rehabilitation 7371 Cortez Oaks Blvd Brooksville, FL 34613 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of Resident #5's medical records revealed the resident was admitted on [DATE] with the diagnoses including anxiety disorder, major depressive disorder, and dementia. Review of Resident #5's physician orders dated 8/13/2022 reads, Depakote Oral Tablet Delayed Release 125 MG (Divalproex Sodium) Give 1 tablet by mouth two times a day for anxiety . Quetiapine Fumarate Oral Tablet 50 MG Give 1 tablet by mouth at bedtime for behaviors . Sertraline HCl Oral Tablet 50 MG (Sertraline HCl) Give 1 tablet by mouth one time a day for anxiety. Review of Resident #5's physician orders dated 8/17/2022 reads, Memantine HCl Oral Tablet 10 MG (Memantine HCl) Give 1 mg by mouth every 12 hours for Agitation . Rivastigmine Tartrate Oral Capsule 1.5 MG (Rivastigmine Tartrate) Give 1 capsule by mouth every 12 hours for Agitation. Review of Resident #5's order summary report on 11/1/2022 at 11:00 AM revealed no physician orders for monitoring behaviors for resident. Review of Resident #5's Treatment Administration Record for October 2022 revealed no documentation of behavioral monitoring. Review of Resident #5's care plan dated 9/16/2022 reads, Focus: I have a risk for side effects related to the use of psychotropic meds [medications]. Further review of the care plan did not reveal an intervention to monitor the resident's behavior while receiving psychotropic medications. During an interview on 11/2/2022 at 7:45 AM, Staff C, Registered Nurse (RN), Unit Manager, stated, When residents are on psychotropic medication, we monitor for all side effects and signs of behaviors. Normally we will have an order by the doctor, and we will be able to input the information on the TAR [Treatment Administration Record]. We are able to mark No or Yes. If it is Yes, we can then write notes regarding observations. During an interview on 11/2/2022 at 9:45 AM, the Director of Nursing (DON) stated, We were monitoring behaviors, but she went out to the hospital, and I guess the order fell out. Review of the facility policy and procedures titled Psychoactive Medications/ Gradual Dose Reduction (GDR)/ Unnecessary Medications Policy last revised in 10/2022, reads, Procedure . 3. Residents receiving psychoactive medications will have a care plan initiated that contains resident diagnosis and interventions regarding the target behaviors and possible adverse side effects of the medication(s). 4. Nursing will observe for adverse side effects of psychoactive medications every shift and document on the electronic MAR. 2. During an observation on 10/30/2022 at 9:15 AM, Resident #56 was in bed with flat affect and did not want to engage in conversation. During an observation on 10/31/2022 at 8:16 AM, Resident #56 was in bed and did not want to engage in conversation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 9 of 14 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 106145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Health & Rehabilitation 7371 Cortez Oaks Blvd Brooksville, FL 34613 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 0758 Level of Harm - Minimal harm or potential for actual harm During an interview on 10/31/2022 at 8:16 AM, Resident #56 stated she did not want to engage in activity and preferred to stay in room. Review of Resident #56's medical records revealed the resident was admitted on [DATE] with diagnoses including adjustment disorder with depressed mood and depression. Residents Affected - Some Review of Resident #56's physician orders dated 9/21/2022 reads, Lexapro Oral Tablet (Escitalopram Oxalate) Give 10 mg by mouth one time a day for depression. Review of Resident #56's Minimum Data Set (MDS) dated [DATE] revealed Brief Interview for Mental Status (BIMS) score of 15 (intact cognitive response). Review of Section D- Mood revealed total severity score of 12 (moderate depression). Review of Resident #56's physician orders dated 10/20/2022 reads, Abilify Oral Tablet 2 MG (Aripiprazole) Give 1 tablet one time a day for depression. Review of Resident #56's MAR for September and October 2022 revealed the resident received Lexapro 5 mg oral tablet at 9 AM on 9/22/22 through 9/24/22 and Lexapro 10 mg oral tablet at 9 AM from 9/26/2022 through 10/31/2022. Further review of the MAR and TAR for the months of September 2022 and October 2022 revealed no monitoring for mood and behavior documented. Review of Resident #56's care plan reads, Focus: I have a risk for side effects related to the use of antidepressants. The interventions of the care plan did not include behavior monitoring. During an interview on 10/31/2022 at 2:35 PM, the Director of Nursing (DON) stated, It is the admitting nurse's responsibility for putting the orders for monitoring behavior and mood once the resident has diagnosis and medication for depression. I expect the nurses to monitor and document mood and behavior. Based on observation, interview, and record review, the facility failed to ensure residents who use psychotropic drugs received behavioral interventions for 3 of 3 reviewed residents, Residents #5, #56, and #70, in a total sample of 39 residents. Findings include: 1. Review of Resident #70's medical records revealed the resident was admitted on [DATE] with the diagnoses including encephalopathy, dementia with other behavioral disturbance, paranoid personality disorder, and personal history of traumatic brain injury. Review of Resident #70's Medication Administration Record (MAR) revealed the resident was receiving Alprazolam 0.25 mg [milligrams] for anxiety, Mirtazapine for depression, and Risperdal 1 mg at bedtime, and 0.5 mg daily for agitation. Review of Resident #70's care plan reads, Focus: I have a risk for side effects related to the use of psychotropic meds. Further review of the care plan did not reveal an intervention to monitor the resident's behavior while receiving psychotropic medications. During an interview on 10/31/2022 at 2:15 PM, Staff J, Certified Nursing Assistant (CNA), stated, Approximately 4-5 PM, she has a severe sun downing, where she gets out of her room, wanders in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 10 of 14 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 106145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Health & Rehabilitation 7371 Cortez Oaks Blvd Brooksville, FL 34613 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some hallway looking for her daughter. She does not remember that her daughter visited her today. I do not see her cry. She can get feisty but not aggressive. During an interview on 11/1/2022 at 10:33 AM, the Regional Nurse Consultant stated, There must be a way for the nurses to document behavior and is just showing a check mark, and record shows Y for yes and N for no. I will check further with IT [Information Technology]. During an interview on 11/1/2022 at 2:30 PM with Staff H, Licensed Practical Nurse (LPN), when asked how she monitored the behavior of a resident who was receiving an antipsychotic, anxiolytic and hypnotic drugs, she stated, In the MAR, we are supposed to write Yes or No, but the computer is not showing that. There is a separate option that we need to add to monitor for behaviors. [Resident #70's name] MAR did not show to monitor for behaviors, and I know as reported to me that she has behavior issues in the evening. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 11 of 14 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 106145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Health & Rehabilitation 7371 Cortez Oaks Blvd Brooksville, FL 34613 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure the drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and included the expiration date when applicable. Findings include: During an observation of the 200 Hall Medication Cart on 10/30/2022 at 11:10 AM with Staff A, Licensed Practical Nurse (LPN), there were two insulin pens with no opened date on pens: one Insulin Aspart with order date on label 10/22/22, and one Insulin Glargine with order date of 10/21/22 (Photographic evidence obtained). During an interview on 10/30/2022 at 11:10 AM, Staff A, LPN, stated, They are both used. The insulin pens should be labeled. I don't know who opened the insulin pens and did not date them. During an observation of the 500 Hall Medication Cart on 10/30/2022 at 11:25 AM with Staff B, LPN, there were one vial of Insulin Glargine with no opened date. (Photographic evidence obtained). During an interview on 10/30/2022 at 11:25 AM, Staff B, LPN, stated, The insulin vial should be dated when vial is first opened. Review of the facility policy and procedure titled Guidelines for Medication Storage and Labeling revised in 7/2020 reads, Purpose: Medications and biologicals are stored safely, securely and properly, following manufacture's recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. General Guidelines . 9. Multi-dose vials that have been opened or accessed (e.g., needle-punctured) should be dated when the vial is first accessed and discarded within 28 days unless manufacture specifies a different (shorter or longer) date for that opened vial. Review of the facility policy and procedures titled 5.3 Storage and Expiration Dating of Medication, Biologicals revised on 7/21/2022, reads, Procedure . 5. Once any medication or biological package is opened, Facility should follow manufacture/supplier guidelines with respect to expiration dates for opened medications. Facility staff should record the date opened on the primary medication container (vial, bottle, inhaler) when the medication has a shortened expiration date once opened or opened. 5.1 Facility staff may record the calculated expiration date based on the date opened on the primary medication container. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 12 of 14 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 106145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Health & Rehabilitation 7371 Cortez Oaks Blvd Brooksville, FL 34613 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, record review, and interview, the facility failed to ensure food was stored in accordance with professional standards in the walk-in cooler and walk-in freezer. Residents Affected - Some Findings include: During an initial tour of the facility's walk-in freezer conducted with the Kitchen Manager on 10/30/2022 beginning at 9:48 AM, the surveyor observed unlabeled and undated partial bags of breaded chicken tenders, French fries and mixed vegetables, opened and partially unwrapped box of corn on the cob, freezer storage bags with onion rings and sliced potatoes, an unwrapped single chicken breast portion on top of a box of individually wrapped frozen fish portions, an open plastic food storage bag with French fries, and an opened and partially unwrapped box of French toast slices in the walk-in freezer (Photographic evidence obtained). During an initial tour of the facility's walk-in cooler conducted with the Kitchen Manager on 10/30/2022 beginning at 10:12 AM, the surveyor observed an unsealed plastic storage bag containing two bottles of liquid, one of which was open and partially full, a plastic bag containing unidentified contents, a plastic food storage bag with waffles and French toast slices, small plastic bowl with plastic wrap covering it containing diced green peppers and onions, a partially used bag of mozzarella cheese, plastic wrapped cheese slices, square bucket container containing an opened unsealed bag of parboiled eggs without a lid, and two portions of unwrapped rolls. A lidded container of hotdogs with a use by date of 10/28/22 on the label and a lidded container of pureed bread with a use by date of 10/29/22 on the label were observed on shelves in the walk-in cooler during the tour (Photographic evidence obtained). During an interview on 10/30/2022 at 10:25 AM, the Kitchen Manager confirmed the opened unlabeled and undated items were in the freezer and cooler and the leftover hotdogs and pureed bread were past the use by date. She stated, All of the food in the cooler and freezer should be closed, labeled and dated. Review of the facility policy and procedures titled Leftovers reviewed on 1/1/2022 reads, Procedure . 2. All foods stored for later use shall be covered, labeled with the food name, and dated with the current date, as well as a use by date, then stored appropriately (refrigerated or frozen if necessary) immediately after the end of the meal service. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 13 of 14 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 106145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Health & Rehabilitation 7371 Cortez Oaks Blvd Brooksville, FL 34613 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, and interview, the facility failed to ensure the garbage and refuse were disposed of properly. Residents Affected - Few Findings include: During an observation of dumpster area on 10/31/2022 at 2:15 PM with the Food Services Director, the surveyor observed one lid on each of the two dumpsters were open and refuse was around the dumpsters including used wrappers, a blue glove, and a N-95 mask (Photographic evidence obtained). During an interview on 10/31/2022 at 2:17 PM, the Certified Dietary Manager confirmed the dumpster lids were open and there was refuse on the ground around the dumpsters. During an interview on 11/1/2022 at 9:08 AM, the Administrator stated the facility did not have a policy regarding dumpster maintenance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 14 of 14