Health inspection·March 14, 2024

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** 2. Review of Resident #18's admission record showed the resident was most recently admitted on [DATE] with the diagnoses that included chronic obstructive pulmonary disease, hypertensive heart disease, and chronic diastolic (congestive) heart failure. Residents Affected - Few During an observation on 3/11/2024 at 1:11 PM, Resident #18 was receiving oxygen at 4 liters per minute via nasal cannula (NC). During an observation on 3/12/2024 at 9:42 AM, Resident #18 was receiving oxygen at 4 liters per minute via NC. During an interview on 3/13/2024 at 8:44 AM, Staff B, LPN, stated, There is no order for the oxygen. The oxygen should be set at 4 liters via Nasal Canula. During an interview on 3/13/2024 at 11:15 AM, the Director of Nursing stated, There are no orders for oxygen administration and the orders should have been written. Review of Resident #18's physician orders revealed no order written for oxygen administration. Review of Resident #18's care plan dated 2/29/2024 read, Focus: I have an alteration in my cardiac respiratory status related to heart failure, exacerbation of Chronic Obstructive Pulmonary Disease (COPD) . Goal: My respiratory status will be managed with care plan interventions. Interventions: I will have my oxygen saturation levels obtained as ordered and as needed. I will have the head of my bed elevated to facilitate my breathing due to shortness of breath . I will receive my respiratory medications as ordered and as needed . I will wear my oxygen via nasal cannula as ordered and indicated. Review of the facility policy and procedures titled Administrative Physician's orders last reviewed on 3/11/2024 read, 8. Verbal and Telephone orders will be documented as such in the Electronic Medical Record . All licensed nurses and QMA's [Qualified Medical Assistants] will follow physician orders. Based on record review and interview, the facility failed to ensure residents received health care services in accordance with professional standards for 1 of 6 residents reviewed for unnecessary medications, Resident #20, and 1 of 4 residents sampled for oxygen therapy, Resident #18. Findings include: 1. Review of Resident #20's admission record showed the resident was initially admitted on [DATE] with the diagnoses that included type 2 diabetes mellitus without complications. Review of Resident #20's physician order dated 2/12/2024 reads, Insulin Glargine Solution 100 unit/ML [milliliters], Inject 15 unit subcutaneously one time a day for diabetes. Review of Resident #20's Medication Administration Record (MAR) for the period from 2/1/2024 through 2/29/2024 for administration of Insulin Glargine revealed the MAR was coded as 5 (Hold/See Nurses Notes) on 2/13/2024, 2/17/2024, 2/18/2024, and 2/19/2024, coded as 9 (Other/See Nurse Notes) on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 2 of 12 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 03/14/2024 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 2/16/2024, and as 2 (Drug Refused) on 2/25/2024, 2/26/2024, and 2/27/2024. Level of Harm - Minimal harm or potential for actual harm Review of Resident #20's Medication Administration Record (MAR) for the period from 3/1/2024 through 3/12/2024 for administration of Insulin Glargine revealed the MAR was coded as 9 (Other/See Nurse Notes) on 3/2/2024, coded as 2 (Drug Refused) on 3/3/2024, 3/4/2024, 3/5/2024, 3/6/2024, 3/10/2024, 3/11/2024, and 3/12/2024, and coded as 5 (Hold/See Nurses Notes) on 3/9/2024. Residents Affected - Few Review of Resident #20's nurses' progress notes for February 2024 and March 2024 revealed no documentation on Resident #20's physician notification or non-administration of Insulin Glargine. During an interview on 3/12/2024 at 12:53 PM, the Director of Nursing stated that the physician should be notified when medications were refused or not administered as ordered by the physician. During an interview on 3/13/2024 at 9:14 AM, when asked about notification of the status for administration of Resident #20's Insulin Glargine, Resident #20's physician stated, Nobody called me. During an interview on 3/13/2024 at 9:28 AM, the Director of Nursing stated she was unable to find documentation indicating Resident #20's physician had been notified when the medication was not given. She added that she would expect the medical doctor to be notified when a medication is not given if the physician had not specified parameters to hold the medication. Review of the facility policy and procedures titled Physician/Clinician/Family/Responsible Party Notification for Change in Condition, last reviewed on 3/11/2024, showed the policy read, Purpose: To ensure that medical/psychological care problems are communicated to the attending physician/clinician and family/resident representative in a timely, efficient, and effective manner . Policy: 1. The facility must immediately inform the resident; consult with the resident's physician/clinician; and notify, consistent with his or her authority, the resident representative(s) when there is . A need to alter treatment significantly (that is, a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 3 of 12 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 03/14/2024 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 0692 Provide enough food/fluids to maintain a resident's health. 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 were assessed by registered dietician and measures were put into place to maintain acceptable parameters of nutritional status to prevent weight loss for 1 of 4 residents reviewed for nutritional status, Resident #25. Residents Affected - Few Findings include: Review of Resident #25's admission record showed that the resident was admitted on [DATE] with the diagnoses including fracture of T (thoracic) 9 through T10 vertebrae, fall on same level, repeated falls, urinary tract infection, paroxysmal atrial fibrillation (an irregular heartbeat), unspecified dementia, cognitive communication deficit, mixed receptive expressive language disorder, and essential primary hypertension. Review of Resident #25's weights and vitals summary showed the resident's weight as 230.8 pounds on 1/8/2024, 228.2 pounds on 1/22/2024, 224.6 pounds on 1/29/2024, 221.8 pounds on 2/7/2024, 217.6 pounds on 2/14/2024, 213 pounds on 3/7/2024, and 210.3 pounds on 3/13/2024. This is an 8.93% weight loss in 2 months. Review of Resident #25's mini nutritional assessment dated [DATE] showed a score of 10 (at risk of malnutrition). Review of Resident #25's progress notes dated 2/1/2024 read, Resident with stage 3 sacral wound, noted to be improving. Current nutrition interventions include: Prostat 30 ml [milliliters] 2x/day, Vit C [Vitamin C] and Zinc 1x/day, Has varied oral intake but overall average is > 50% with occasional refusals. Has 8.8 lb [pound] weight loss from 1/8/2024-1/29/2024. BMI [Body Mass Index] is in obese range. No new recommendations at this time. Review of Resident #25's medical record revealed no additional Registered Dietitian assessments. Review of Resident #25's task sheet for meals (food and fluid consumption) from 2/19/2024 through 3/13/2024 showed refusal for breakfast and lunch and 0-25% consumption for dinner on 2/19/2024; 0-25% consumption for breakfast, lunch, and dinner on 2/20/2024; 51-75% consumption for breakfast, 25-50% consumption for lunch, and 0-25% for dinner on 2/21/2024; refusal for breakfast and lunch, and 0-25% for dinner on 2/22/2024; 76-100% consumption for breakfast, 25-50% consumption for lunch, and 51-75% consumption for dinner on 2/23/2024; 51-75% consumption for breakfast, 75-100% consumption for lunch, and refusal for dinner on 2/24/2024; 51-75% consumption for breakfast, 76-100% consumption for dinner, and 0-25% consumption for dinner on 2/25/2024; 0-25% consumption for breakfast, lunch, and dinner on 2/26/2024; 25-50% consumption for breakfast and refusal for lunch and dinner on 2/27/2024; 25-50% consumption for breakfast and lunch and refusal for dinner on 2/28/2024; 25-50% consumption for breakfast, lunch, and dinner on 2/29/2024; refusal for breakfast and lunch and 0-25% consumption for dinner on 3/1/2024; 25-50% consumption for breakfast, lunch, and dinner on 3/2/2024; 0-25% consumption for breakfast, lunch, and dinner on 3/3/2024; 25-50% consumption for breakfast, lunch, and dinner on 3/4/2024; 25-50% consumption for breakfast, refusal for lunch, and 51-75% consumption for dinner on 3/5/2024; refusal for breakfast and lunch, and 51-75% consumption for dinner on 3/6/2024; 25-50% consumption for breakfast and lunch, and 0-25% consumption for dinner on 3/7/2024; refusal for breakfast and lunch, and 0-25% consumption for dinner on 3/8/2024; no documentation for breakfast and lunch, and 0-25% consumption for dinner on 3/9/2024; no documentation for breakfast and lunch, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 4 of 12 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 03/14/2024 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 0-25% consumption for dinner on 3/10/2024; 75-100% consumption for breakfast and lunch, and refusal for dinner on 3/11/2024; refusal for breakfast and lunch, and 0-25% consumption for dinner on 3/12/2024; and refusal of breakfast and lunch on 3/13/2024. During an interview on 3/13/2024 at 2:35 PM, Staff C, Licensed Practical Nurse (LPN), stated, I had not been told that he [Resident #25] had been refusing meals. I should be told if they have a poor appetite or refuse meals. I don't work with him a lot. During an interview on 3/13/2024 at 2:31 PM, the Registered Dietician stated, I was not aware of his [Resident #25] weight decline. He has not been a subject in our weekly weight meetings, and I have no notes on him. I was not told about his meal refusals, and we have a nutritional risk meeting and look at weights. I did not look at the weights. I should have been notified about his poor intake and his meal refusals. We should have implemented something before today. During an interview on 3/13/2024 at 3:09 PM, the Director of Nursing (DON) stated, The CNAs [Certified Nursing Assistants] should be notifying the nurses if a resident is refusing meals, and they should notify the dietician and doctor. We have weekly meetings related to residents and weight loss. He [Resident #25] did have C diff. [Clostridioides difficile] and had a history of COVID, which could have affected his appetite and weights. But we did not implement any measures to address his weight loss. During an interview on 3/14/2024 at 8:30 AM, Staff C, LPN, stated, I was not aware that [Resident #25's name] was refusing meals. We should be told by the CNAs if they are eating less than 50% of the meals. We should notify the doctor, the dietician, and the residents representative. I don't see any documentation of that. During an interview on 3/14/2024 at 11:00 AM, the Medical Doctor (MD) stated, This is a significant weight loss, truly attributed to his use of antibiotics. But, I was not notified of his weight loss until today and if I had been, I would have put measures such as dietary supplements in place. I was not notified about his poor intake and meal refusals and should have been. Review of the facility policy and procedures titled Weight Monitoring with an implementation date of 11/29/2023 read, Policy: Based on the resident's comprehensive assessment, the facility will ensure that all residents maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this is not possible or resident preferences indicate otherwise. Compliance Guidelines: Weight can be a useful indicator of nutritional status. Significant unintended changes in weight (loss or gain) or insidious weight loss (gradual unintended loss over a period of time) may indicate a nutritional problem. 1. The facility will utilize a systemic approach to optimize a resident's nutritional status. This process includes: a. Identifying and assessing each resident's nutritional status and risk factors . c. Developing and consistently implementing pertinent approaches. d. Monitoring the effectiveness of interventions and revising them as necessary . 4. Interventions will be identified, implemented, monitored and modified (as appropriate), consistent with the resident's assessed needs, choices, preferences, goals and current professional standards to maintain acceptable parameters of nutritional status. 5. A weight monitoring schedule will be developed upon admission for all residents . c. Residents with weight loss-monitor weight weekly . 6. Weight Analysis: The newly recorded weight should be compared to the previous weight. A significant change in weight is defined as: a. 5% weight change in 1 month (30 days), b. 7.5% weight change in 3 months (90 days) . 7. Documentation: a. The physician should be informed of a significant change in weight and may order (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 5 of 12 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 03/14/2024 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 0692 nutritional interventions . e. The Registered Dietician or Dietary Manager should be consulted to assist with interventions; actions are recorded in the nutrition progress notes. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 6 of 12 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 03/14/2024 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 consistent with professional standards of practice for 1 of 4 residents reviewed for respiratory care, Resident #19. Residents Affected - Few Findings include: Review of Resident #19's admission record showed the resident was most recently admitted on [DATE] with the diagnoses including chronic obstructive pulmonary disease, type 2 diabetes mellitus, seizures, essential primary hypertension, unspecified dementia, unspecified mood disorder, and anxiety disorder. Review of Resident #19's physician order dated 1/23/2024 read, Oxygen at 3 lpm [liters per minute] via nasal cannula continuous, every shift for COPD [Chronic Obstructive Pulmonary Disease]. During an observation on 3/11/2024 at 12:35 PM, Resident #19 was in bed, receiving oxygen from the concentrator via nasal cannula at 4 liters per minute. During an observation on 3/13/2024 at 7:46 AM, Resident #19 was in bed, receiving oxygen via nasal cannula at 4 liters per minute. During an observation on 3/13/2024 at 8:33 AM, Staff E, Certified Nursing Assistant (CNA), confirmed that the oxygen was running at 4 liters per minute and stated, I do not adjust or start oxygen. During an interview on 3/13/2024 at 8:35 AM, Staff F, Registered Nurse (RN), stated, Nurses should be checking what oxygen is running at when they administer medications. We should follow physician orders. During an interview on 3/13/2024 at 8:37 AM, Staff G, RN, stated, I gave medications already. I did not verify oxygen amounts. We should check them and follow physicians' orders for it. Review of the facility policy and procedure titled Oxygen Therapy with the last approval date of 3/11/2024 read, Policy: It is the policy of this facility to provide adequate oxygenation to residents with health conditions that require continuous or as needed oxygen therapy . Procedure: 1. Oxygen may be administered when it has been ordered by a physician or in emergency situations, by a licensed nurse/RT [Respiratory Therapist] . 3. The physician order will be written to include the liter flow and delivery device (i.e., nasal cannula, mask) as well as any other specific orders such as saturation levels that may be included . Oxygen Administration- Concentrator: 1. Verify physician order (except in emergency). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 7 of 12 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 03/14/2024 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure residents were from unnecessary medications for 1 of 3 residents reviewed for urinary tract infections, Resident #209. Residents Affected - Few Findings include: Review of Resident #209's admission record showed the resident was most recently admitted on [DATE] with diagnoses including displaced intertrochanteric fracture of left femur, fall, essential primary hypertension, chronic obstructive pulmonary disease, acute kidney failure, diverticulosis, and cognitive communication deficit. Review of Resident #209's interact SBAR (Situation, Background, Assessment, Recommendation) dated 3/8/2024 at 4:45 PM read, Nursing observations, evaluation and recommendations are: Resident expressed feelings of hopelessness and sadness. Resident states she is having PTSD [post-traumatic stress disorder] from experiencing 09/11. MD [Medical Doctor] contact and psych [psychiatric] consult ordered, every 15 minute checks initiated, and UA to be collected. Resident daughter [Resident #209's daughter's Name] called and explained resident is prone to UTIs [urinary tract infections] and believes behavior could be related to UTI. Review of Resident #209's physician order dated 3/8/2024 read, U/A [urinalysis], Urine C&S [culture and sensitivity].Review of Resident #209's physician order dated 3/9/2024 read, Ciprofloxacin HCL [hydrochloride] 500 mg tab [tablet] (100 EA), Give 1 tablet every 12 hours for UTI for 5 days. Review of Resident #209's urinalysis lab results report with the final report date of 3/10/2024 showed no growth at 24 hours. Review of Resident #209's Medication Administration Record (MAR) showed Resident #209 was receiving Ciprofloxacin 500 mg every 12 hours from 3/9/2024 through 3/13/2024. During an interview on 3/13/2024 at 9:53 AM, Staff C, Licensed Pracctical Nurse (LPN), stated, I was not aware that her culture came back negative. I will need to call and make sure that it [Ciprofloxacin] is needed as she had no symptoms of a UTI. We should have called when we first got the negative urine culture. During an interview on 3/13/2024 at 10:00 AM, the Medical Doctor (MD) stated, I was not told that the culture results were negative. I would have discontinued the antibiotic as soon as I was told. It would be considered not needed because she does not have a UTI. This was started prophylactically when her daughter told staff she can get tearful and sad when she has a urinary tract infection, but once determined that she did not have a UTI, we should have discontinued this medication. During an interview on 3/13/2024 at 11:22 AM, Staff F, Registered Nurse (RN), stated, Typically, it is the nurses' responsibility to notify the physician of the culture results and they [the physician] will make the determination of whether a resident would stay on the antibiotic. I have her on the log [the infection control log] for March as a community acquired UTI. This was within 24 hours of admission. I cannot answer if I was told about the culture result or not. I just don't remember. It (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 8 of 12 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 03/14/2024 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 0757 [the culture results] should have been followed up on, either by myself or the nurse. Level of Harm - Minimal harm or potential for actual harm Review of the facility policy and procedure titled, Antibiotic Stewardship Program with an implementation date of 11/1/2023 read, Policy: It is the policy of this facility to implement an Antibiotic Stewardship Program as part of the facility's overall infection prevention and control program. The purpose of the program is to optimize the treatment of infections while reducing the adverse events associated with antibiotic use. Policy Explanation and Compliance Guidelines . 4. The program includes antibiotic use protocols and a system to monitor antibiotic use . b. Monitoring antibiotic use: i. Monitor response to antibiotics, laboratory results when available, to determine if the antibiotic is still indicated or adjustments should be made (e.g., antibiotic time-out) . 5. Nursing will monitor the initiation of antibiotics on residents and conduct an antibiotic timeout within 48-72 hours of antibiotic therapy to monitor response to the antibiotic and review laboratory results and will consult with the practitioner to determine if the antibiotic is to continue or if adjustments need to be made based on the findings. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 9 of 12 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 03/14/2024 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 medications were securely stored in 1 of 6 residential halls, Hall 500. Findings include: During an observation on 3/11/2024 at 9:52 AM, Resident #101 was in her room. There were one container of eye drops and single doses of eye lubricant stored on Resident #101's bedside table. During an interview on 3/11/2024 at 9:52 AM, Resident #101 stated that the items stored on her bedside table were her over-the-counter eye medications. Review of Resident #101's physician orders revealed an order with the start date of 2/13/2024 for administration of one drop of Xalatan Ophthalmic Solution 0.005% in both eyes at bedtime for dry eyes. Review of Resident #101's care plan initiated on 2/14/2024 revealed no focus on self-administration of medications. During an interview on 3/13/2024 at 9:04 AM, Staff A, Licensed Practical Nurse (LPN), stated, The facility completes a self-administration of medication assessment of a resident and obtains an order from the physician before a resident is able to self-administer medications. Staff A confirmed the facility had not completed a self-administration of medication assessment with Resident #101. During an observation on 3/11/2024 at 9:42 AM, Resident #20 was in his room lying in bed. There was a nasal spray pump stored in a tissue box on Resident #20's bedside table. There was no nurse or other facility staff present in Resident #20's room. During an interview on 3/11/2024 at 9:42 AM, Resident #20 stated the nasal spray pump contained his over-the-counter nasal spray. Review of Resident #20's physician orders revealed an order with the start date of 2/9/2024 for administration of 2 sprays of allergy relief nasal suspension 50 micrograms in both nostrils one time a day for allergies. Review of Resident #20's care plan initiated on 12/12/2023 revealed no focus on self-administration of medications. During an interview on 3/13/2024 at 9:06 AM, Staff A, LPN, stated, that Resident #20 did not have an assessment for self-administration of medication. During an interview on 3/13/2024 at 9:28 AM, the Director of Nursing stated, Usually, the facility contacts the physician to see if the doctor is okay with that [self-administration of medications]. The facility will have the medical doctor write an order for self-administration if the facility obtained physician's approval for a resident to self-administer medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 10 of 12 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 03/14/2024 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 Review of the facility policy and procedure titled Self-Administration of Medication, last reviewed on 3/11/2024, showed the policy read, General Guidelines: 1. A resident may not be permitted to administer or retain any medication in his/her room unless so ordered, in writing, by the attending physician/clinician. 2. Should the resident's attending physician/clinician permit the resident to administer his/her medication(s), the following condition should apply: a. A self-administration of medications evaluation will be completed that indicates that the resident is capable of self-administering drugs. This is to be completed quarterly and as needed with resident cognition or physical ability changes. b. Storage of medications in the resident's room must be such that it will prevent access by other residents; c. Only the medications permitted for self-administration shall be left at the bedside. Review of the facility policy and procedure titled Guidelines for Medication Storage and Labeling, last reviewed on 3/11/2024, showed the policy read, Purpose: Medications and biologicals are stored safely, securely, and properly, following manufacturer'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. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 11 of 12 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 03/14/2024 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to adhere to professional standards of infection Based on observation, interview, and record review, the facility failed to ensure staff performed hand hygiene during medication administration to help prevent the possible transmission of infections and communicable diseases during 3 of 7 observations of medication administration. Residents Affected - Few Findings include: During an observation of medication administration on 3/13/2024 at 7:59 AM, Staff C, Licensed Practical Nurse (LPN), began preparing Resident #219's medications without performing hand hygiene. Staff C poured three medications into a medication cup. Then, Staff C removed one medication, which was not able to be crushed, with his bare hand and placed it in a different medication cup. Staff C crushed the medications and added the whole medication and mixed with applesauce. Staff C entered Resident #219's room and administered the medications. Staff C exited Resident #219's room and returned to the medication cart. At 8:07 AM, Staff C began preparing Resident #209's medications. Staff C entered Resident #209's room and administered the medications. Resident #209 dropped a medication on her chest and Staff C picked up the medication and placed it in the resident's mouth. After Resident #209 completed taking medications, Staff C exited the room and returned to the medication cart. At 8:15 AM, Staff C prepared Resident #25's medications, entered Resident #25's room, and administered the medications. Staff C did not perform hand hygiene during the medication administration. During an interview on 3/13/2024 at 10:30 AM, Staff C, LPN, stated, I thought I did use hand sanitizer. We should always use hand sanitizer when we do medications. I didn't realize I touched the medications. I should not have touched them. During an interview on 3/13/2024 at 3:24 PM, the Director of Nursing stated, All staff should follow infection control standards at all times. Review of the facility policy and procedures titled Medication Administration with an implementation date of 11/1/2023 read, Policy: Medications are administered by licensed nurses, or other staff who are legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice, in a manner to prevent contamination or infection. Policy Explanation and Compliance Guidelines . 4. Wash hands prior to administering medication per facility protocol and product . 13. Remove medication from source, taking care not to touch medication with bare hand . 15. Observe resident consumption of medication. 16. Wash hands using facility protocol and product. Review of the facility policy and procedures titled, Hand hygiene with an implementation date of 11/1/2023 read, Policy: All staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. This applies to all staff working in all locations within the facility. Policy Explanation and Compliance Guidelines: 1. Staff will perform hand hygiene when indicated, using proper technique consistent with accepted standards of practice. 2. Hand hygiene is indicated and will be performed under the conditions listed in, but not limited to, the attached hand hygiene table . Hand Hygiene Table . Between resident contacts . Before preparing or handling medications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106145 If continuation sheet Page 12 of 12