Inspection·April 10, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Fracture with Routine Healing, Generalized Anxiety Disorder, Bipolar Disorder, Difficulty in Walking, Muscle Weakness, and History of Falling. The Minimum Data Set assessment dated [DATE] documented in Section C a Brief Interview of Mental Status score of 4 indicating severe cognitive impairment. On 04/08/25 from 8:30 AM to 8:40 AM an observation was made of Resident #2 constantly banging on her overbed table and yelling for help that she needed to go to the bathroom several times. On 04/08/25 at 8:43 AM an observation was made of Staff M, Certified Nursing Assistant (CNA), going into the room to assist Resident #2. The resident's call light was clipped to the top corner of her pillow and the resident was unable to reach the call light. During an interview conducted on 04/08/25 at 8:43 AM with Resident #2 the resident was asked about her call light and she just yelled at this surveyor to leave her alone. During a side by side observation conducted on 04/08/25 at 8:44 AM with Staff M, CNA, she was asked if Resident #2 can use the call light. She looked for the call light and found it at the top of the bed hanging off of the bed. She then handed the call light to the resident and asked her if she could push it for assistance and the resident did push the call light and yelled at Staff M CNA, now are you going to help me. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 2 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure the residents have a right to a safe, clean, comfortable and homelike environment for 6 of 27 resident rooms observed in the facility. The findings included: 1). On 04/07/25 at 9:20 AM an observation made in room [ROOM NUMBER] A revealed the following: *The wall behind the bed, was noted to be unsmooth and peeling paint. *The standing fan across from the resident's bed was covered with dust and debris. 2). On 04/07/25 at 11:30 AM an observation made in room [ROOM NUMBER] revealed an uncovered fluorescent bulb in the entryway, inside of the room. 3). On 04/07/25 at 11:40 AM an observation made in room [ROOM NUMBER] revealed the following: * An uncovered fluorescent bulb in the entryway, inside of the room. * The A/C vents were covered with dust and debris. * The lightbulb in the bathroom was out. * Unpainted plaster on the bathroom wall, next to the soap dispenser *A leaky faucet in the bathroom sink. 4). On 04/07/25 at 11:30 AM an observation made in room [ROOM NUMBER] revealed the following: *An uncovered fluorescent bulb in the entryway, inside the room. *A leaky faucet in the bathroom sink. *A call light pull cord wrapped around the grab bar in the bathroom. 5). On 04/07/25 at 10:50 AM an observation made in room [ROOM NUMBER] revealed a missing light bulb in the entryway, inside the room. 6). On 04/07/25 at 11:15 AM an observation made in room [ROOM NUMBER] A revealed an uncovered fluorescent bulb in the entryway, inside the room. A side-by-side tour of the facility was conducted on 04/10/25 at 10:20 AM with the Director of Maintenance who stated he has been at the facility for 1.5 weeks and the Administrator who started the week of survey. They acknowledged the above findings. The Administrator stated they will be working on the aforementioned items to get them corrected right away. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 3 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews the facility failed to develop and implement a comprehensive person-centered care plan for pressure ulcer for 1 of 1 sampled resident reviewed for pressure ulcer (Resident #37) and failed to develop and implement a comprehensive person-centered care plan for psychotropic medication for 1 of 1 sampled resident reviewed for Mood/Behavior (Resident #59). The findings included: 1. Record review for Resident #37 revealed the resident was admitted to the facility on [DATE] with diagnoses that included in part the following: Type 2 Diabetes Mellitus, Muscle Weakness, and Unspecified Abnormalities of Gait and Mobility. The Minimum Data Set assessment dated [DATE] documented in Section C a Brief Interview of Mental Status score of 10, indicating moderate cognitive impairment. Review of the Physician's Orders for Resident #37 revealed an order dated 04/04/25 for sacrum pressure ulcer stage 1 cleanse with normal saline (N/S), pat dry, apply calcium alginate daily and PRN (as needed) every day shift was discontinued on 04/04/25. Review of the Care Plan for Resident #37 dated 12/27/23 with a focus on the resident has pressure ulcer to buttock related to Immobility. The goal was for the resident's pressure ulcer will show signs of healing and remain free from infection by/through review date. The interventions included in part the following: Administer treatments as ordered and monitor for effectiveness. Assess/record/monitor wound healing. Measure length, width and depth where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD. Follow facility policies/protocols for the prevention/treatment of skin breakdown Monitor/document/report PRN any changes in skin status: appearance, color, wound healing, signs/symptoms of infection, wound size, stage. In summary the review of the care plan for Resident #37 was not updated to indicate the sacral wound identified and did not indicate the pressure ulcer to the buttock had been resolved. In summary the facility acquired sacral pressure ulcer was not updated on the care plan, additionally there were no interventions in place for Resident #37 to prevent the development of a pressure ulcer. Review of the Wound Care Progress Note by the Wound Care Consultant company dated 04/08/25 documented in part the following: wound location: Sacrum, Length 4 centimeters (cm), Width: 3.2 cm, Depth: 0.2 cm. Status: Recurrent. During an interview conducted on 04/09/25 at 12:30 PM with the Minimum Data Set (MDS) Coordinator who stated she is the only MDS coordinator and has worked at the facility for 3 years and in the MDS department for about 3 months. The MDS Coordinator stated that the Dietary department, Therapy department and the Social Worker all put in their own care plans, and she does all the nursing care plans. The MDS Coordinator stated she would update care plans as needed based on specific findings. When asked when a resident has a wound or skin care plan and develop a new pressure ulcer would the care plan be implemented or updated, she said yes. When asked what the time frame is to update the care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 4 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 0656 Level of Harm - Minimal harm or potential for actual harm plan when there is a new wound, she said if there is something new it should be updated within couple of days. When asked if there should be interventions in the care plan for prevention of skin issues or pressure sores especially if the resident has had a wound in the past, she said yes. The MDS Coordinator acknowledged she did not implement a care plan for the sacral pressure ulcer and that the care plan for the buttock wound should have been resolved a long time ago. Residents Affected - Few 2. Record review for Resident #59 revealed the resident was admitted to the facility on [DATE] with diagnoses that included in part the following: Degenerative Disease of Nervous System, Pain, Restless Agitation, and Depression. The Minimum Data Set assessment dated [DATE] documented in Section C a Brief Interview of Mental Status could not be done due to the resident is rarely/never understood. Review of the Physician's Orders for Resident #59 revealed in part the following orders: An order dated 03/13/25 for Lorazepam Oral Tablet 0.5 MG give 1 tablet by mouth every 6 hours as needed for Agitation related to Restlessness and Agitation for 14 Days and was discontinued on 03/27/25. An order dated 03/13/25 for Seroquel Oral Tablet 25 MG give 1 tablet by mouth one time a day for Depression (Psychosis) related to Depression, Unspecified and was discontinued on 03/24/25. An order dated 03/24/25 for Seroquel Oral Tablet 25 MG give 25 mg by mouth every 12 hours for psychosis. Review of the Care Plan for Resident #59 revealed there was no care plan for psychotropic medications including interventions to monitor for behaviors or side effects. During an interview conducted on 04/10/25 at 9:30 AM with the Minimum Data Set (MDS) Coordinator who was asked if a resident who has psychotropic medications ordered would have a care plan, she said they should have a care plan for the psychotropic medication and include monitoring for behaviors and side effects. When asked about Resident #59, she acknowledged the resident had psychotropic medications ordered and no care plan in place. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 5 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 review of policy and procedure, record review and interview, the facility failed to: 1) promptly notify the ordering physician and promptly administer oral Antibiotics to a resident, in a timely manner, for a resident with a Urinary Tract Infection (UTI) for 1 of 1 sampled resident (Resident #16); and, 2) failed to accurately document and assess the status and condition for a resident with a skin condition for 1 of 1 sampled resident (Resident #2). Residents Affected - Few The findings included: 1) Record review of the facility policy and procedure titled General Laboratory Information provided by the Director of Nursing (DON), reviewed 2024, documented in the Policy Statement: Communicating Urgent Results Notification will be provided to the Principal Investigator, Physician, or his/her authorized representative, as permitted or required by state and federal law, and these authorized personnel will have the responsibility of interpreting the result (s) in the context of the patient's clinical condition. The authorized personnel will be responsible for taking immediate action, if needed. If the authorized personnel are not qualified to make these decisions, he/she has the responsibility of communicating the information to a qualified person immediately All critical results are called in to the facility, three attempts are made to communicate with resident's nurse, DON or unit manager. If unable to communicate verbal results, Biogalax will send an Urgent Fax memo. The Urgent Fax form will state the Name, DOB of the patient and 'Attention to Nurse, DON or Unit Manager.' All critical results must be reported to nurse, DON, or unit manager at facility . Record review revealed Resident #16 was re-admitted to the facility on [DATE] with diagnoses which included Dementia, Type 2 Diabetes Mellitus with Complications, Obstructive and Reflux Uropathy, and a History of Recurrent Urinary Tract Infections. He had a Brief Interview Mental Status (BIM) score of 15, indicative of intact cognition. Review of Resident #16's record documented that the Physician's order had not been entered and uploaded into the facility's computer system by Staff I, a Licensed Practical Nurse, (LPN), until Wednesday 04/02/25 at 7:35 PM. Furthermore it was not translated and captured in the system, until later the next day on Thursday 04/03/25 and read as such: Macrobid Oral Capsule 100 mg (Nitrofurantoin Monohydrate Macro) to give one (1) capsule by mouth two (2) times a day for Urinary Tract Infection (UTI) for ten (10) days, as ordered by the resident's current primary care physician PCP. There had also been two (2) different previously entered computerized physician's orders which indicated for: 1) Urinalysis and Urine Culture dated Monday 03/24/25---one time only for Lethargy for one (1) day. And, 2) dated Wednesday 03/26/25---one time only for Lethargy for three (3) days. Next, computerized record review of the nursing progress notes entered by Staff I, a Licensed Practical Nurse, (LPN) documented that, on Wednesday 03/26/25 at 07:03 AM, Per outgoing nurse report resident has labs .Urine and culture and sensitivity Unable to collect urine this shift even after enforcing extra fluid intake. Tried several times, but remained unsuccessful due to patient urinating in adult briefs by the time this writer had gone to him four (4) times. Oncoming nurse will be made aware. Collection cup left at bedside. Urine tubing, specimen envelope and urine requisition, will be given to relieving nurse. Staff I, also documented on Thursday 03/27/25 at 06:15 AM, Urine + Culture and Sensitivity drawn and picked up yesterday results remain pending. Oncoming nurse will be made aware (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 6 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 Residents Affected - Few Further record review of the Laboratory Report for Resident #16 dated 03/25/25 revealed that Resident #16's urine specimen for Escherichia (E-coli) had been previously collected on Tuesday 03/25/25, received, resulted and reported on Thursday 03/27/25 at 5:43 PM. Additional computerized record review was conducted of the two (2)---a) Physician Progress note dated 03/24/25 at 01:00 AM by Resident #16's PCP documented .Nursing has concerns regarding change in mental status, but patient appears to be at baseline mental status CBC, CMP, ammonia, A1C ordered for lethargy and b) Physician Progress note dated 03/26/25 at 01:00 AM by Resident #16's PCP documented . including change in mental status, Change in Mental Status (03/24/25) Workup initiated: CBC, CMP, ammonia, CXR, UA/UCx. Continue frequent mental status monitoring. As well as, progress notes documented by the Resident's Physician Assistant's (P.A.)'s, progress note visit entered on Tuesday 04/01/25, revealed that the abnormal urine culture results had been first identified and discovered by the P.A., who in turn documented the following entry in the facility record, Pt with new UTI + E-coli. Will start Macrobid 100 mg BID x ten (10) days There was no documentation noted in the nurses' progress notes dated from Wednesday 03/26/25 at 07:03 AM through 04/03/25 at 06:59 AM, to indicate if, when or what time the ordering physician had been notified of these abnormal urine culture results, by the facility. However, further review of Resident #16's April 2025 Medication Administration Record (MAR), documented for the Macrobid 100 mg was not started until Thursday 04/03/25 at 09:00 AM, which is approximately one week after the lab results were reported to the facility. On 04/03/25 at 06:59 AM, Staff I, also documented, Antibiotic Diagnosis: UTI with Macrobid to be started this morning as ordered x 10 days (until Wednesday 04/12). Medication received this morning from pharmacy . A brief telephone interview was conducted on 04/09/25 at 2:06 PM with the a supervisor at the Diagnostic laboratory to clarify the date and time the facility received the results was 03/27/25 at 5:43 PM. He state he would speak with someone and get back to this surveyor, however, there was no response received back during the survey. A telephone interview was attempted on 04/09/25 at 2:22 PM with Resident #16's Physician's Assistant/PCP, in order to ascertain whether or not the physician's office had been notified of Resident #16's abnormal urinalysis and urine culture result of Escherichia (E-coli), by the facility. This Surveyor left a voice message. However, there was no response received back during the survey. A telephone interview was conducted on 04/10/25 at 9:33 AM with Staff I, in order to ascertain whether or not Resident #16's abnormal urine culture results had been promptly reported to the ordering physician. Staff I also acknowledged that the abnormal urine culture lab work had previously been collected on 03/25/25, and reported back to the facility on [DATE] at 5:43 PM, per the lab report. When asked, did you document in the resident's record that you promptly notified the resident's ordering physician of the abnormal E.coli urine culture result, she responded, by saying that, another nurse may have. And Staff I was also asked if she knew why there had been a seven (7) day delay between receiving Resident #16's abnormal urine culture lab work and in Resident #16 finally receiving his oral antibiotics. Staff I responded by saying that, she was not working that whole time and she did not know. However, Staff I, acknowledged that the next nurse should have followed up to find out if the lab results had been obtained so that the resident could have received proper treatment, as indicated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 7 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 Residents Affected - Few During an interview conducted on 04/09/25 at 3:22 PM with the DON, she was also asked to describe the process that occurs when an abnormal lab result report comes in, and who would be responsible for notifying the Physician of this and where would it be documented. The DON responded by saying that, the laboratory would call the facility directly, whenever there was an abnormal or critical lab result. And, she said that the lab would ask to speak to a nurse, take his or her name, and would then fax over the abnormal lab result to the main fax machine located on the [NAME] wing across from the nurses' station, at the facility. Then, the DON said that the assigned nurse would be responsible for reaching out and contacting the ordering physician ASAP, with the abnormal lab results. Next, the DON indicated that the responsible nurse would initial the result, note that the Physician was notified, and would place the abnormal lab result in the box, located at the nurses' station, to be uploaded into the system the next morning, by their medical records department. The DON ended by acknowledging that there was no book or tracking log, at this time, in place to record and store the resident's abnormal lab results, in the facility. Staff member J, a Registered Nurse (RN), who had been working on Thursday 03/27/25 at 5:43 PM, when the lab result was reported in from the lab, was no longer working with the facility and unavailable for an interview. There was no care plan on file specifically for Urinary Tract Infection, care, for this resident. In fact, the physician notification and subsequent order for Resident #16's oral antibiotic had not been performed nor obtained prior, by the facility. The physician's order for treatment was not initiated, with an intervention until five (5) days later, after it was first discovered by the Physician's Assistant. In Summary, the oral antibiotic had not been started and administered to Resident #16 until seven (7) days after the abnormal lab results had been reported to the facility by the laboratory. The DON further recognized and acknowledged on 04/09/25 at: 3:30 PM that facility nursing staff, should have followed through with promptly notifying the ordering physician and she also indicated that there should not have been a delay of seven (7) days between the facility having received an abnormal urine culture result and for Resident #16 finally having received his ordered oral antibiotics for treatment. 2) Record review of the facility policy and procedure titled Dressing, Non-Sterile provided by the Director of Nursing (DON), reviewed April 2019, documented in the Policy Statement: This procedure may involve potential/direct exposure to blood, body fluids, infectious diseases, air contaminants, and hazardous chemicals. Purpose: The purposes of this procedure is to provide guidelines for non-sterile dressing changes to protect wounds from injury and to prevent the introduction of bacteria. Steps in the Procedure: .15. Observe the wound and surrounding skin .Reporting and Documentation: The following information be documented in the resident's electronic record medical record: 1. The date and initials of the person that performed the procedure. 2. Type of dressing used and wound care give Record review revealed Resident #2 was re-admitted to the facility on [DATE] with diagnoses which included Fracture of Shaft of Left Tibia, Subsequent Encounter for Closed Fracture with Routine Healing, Bipolar Disorder, Unspecified and Generalized Edema. She had a Brief Interview Mental Status (BIM) score of 5, indicating severe cognitive impairment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 8 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 Residents Affected - Few During an observational tour conducted on 04/07/25 at 11:03 AM, Resident #2 was observed, her left pant leg partially pulled up, with a partially attached dressing, located on her left upper front shin area with two (2) exposed and uncovered sutures noted underneath. And, upon closer observation of Resident #2's left leg, just above her left knee, she was observed to have four (4) additional exposed and uncovered sutures noted. Photographic Evidence Obtained. Resident #2 was asked, in general if she had any pain, at this time and she replied, yes, sometimes she has an intermittent pressure type pain from the top of her left knee to her upper left shin, pain level 8/10, for which she gets medication for. It was noted that the edges of both incisions with sutures, were well approximated, with no redness or drainage noted, at this time. Record review of the current physician's orders dated 04/07/25 documented, Left lower extremity: Clean surgical site with normal saline (N/S), pat dry, apply Xeroform, cover with protective dressing daily. Record review of Resident #2's re-admission note dated 03/24/25 documented, Left leg Tibia Fibula fracture, bruises behind left calf from the fracture Skin is warm and dry to touch. However, further record review of all subsequent nursing progress dated from 03/24/25 until 04/08/25, makes no mention of the existence, presence, current status nor current condition of Resident #2's exposed and open to air sutures or surrounding skin, on her left lower shin, nor on the upper portion above her left knee. An additional record review of a progress note dated 04/04/25 by Staff K, an RN, in which it was documented, Resident left Tibia Fibula Fracture dressing changed: cleanse with N/S, pat dry, apply Xeroform, cover with protective dressing. Wound dry and clean no sign of infection noted, no swelling, redness, drainage noted, no complaints of pain. Treatment in place will continue to monitor. Again, there was no mention of the existence, presence, current status nor current condition of Resident #2's sutures or surrounding skin on her left lower shin, nor on the upper portion above her left knee. During a subsequent observation conducted on 04/09/25 at 11:04 AM, Resident #2 was now observed with three (3) dressings, all initialed and dated 04/09/25, with one (1) located on the area above her left knee, a second one located to the resident's left upper and a third one located on the resident's lower outer front shin area covering the previously seen sutures, of the two (2) upper skin dressing areas. Photographic Evidence Obtained. During a brief interview conducted on 04/09/25 at 11:04 AM with Resident #2's assigned nurse Staff L, RN, she stated that all three (3) dressings had been changed earlier that morning by Staff E, an RN, and by the Assistant Director of Nursing (ADON). An interview was conducted on 04/09/25 at 2:45 PM with the ADON, in which she acknowledged that she did assist Staff E, during the dressing change to Resident #2's left lower leg earlier that morning at 7 AM, and she acknowledged that Resident #2 did have sutures in place in her left lower leg at various locations. The ADON also acknowledged, as recorded in the resident's Treatment Administration Record (TAR) dated April 7th and April 8th, that Staff K had also initialed that she had done the dressing changes to the left lower extremity for Resident #2. However, she also stated and noted that neither Staff K, nor Staff E, had documented anything regarding the existence, presence, current status nor current condition of Resident #2's sutures or surrounding skin on her left lower shin, nor on the upper portion above her left knee, in Resident #2's record for the date of April 9th 2025. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 9 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 There was no care plan specifically addressing Resident #2's surgical dressing and sutures. Level of Harm - Minimal harm or potential for actual harm Moreover, there was no record of the nursing progress note for the dressing change performed on 04/09/25 at 7 AM, for this resident's left lower leg. Residents Affected - Few Record review was also conducted of the TAR for the dates of Monday April 7th, Tuesday April 8th by Staff K, and for the date of Wednesday April 9th by Staff E, RN, Staff nurse, who performed the left lower dressing change, all indicated with initials that the dressing had been done and the physician's order was: Left lower extremity: Clean surgical site with N/S, pat dry, apply Xeroform, cover with protective dressing daily one time a day - Start Date Monday 04/07/25 at 0800 AM. Nonetheless, there had still been no mention of the existence, presence, current status, nor current condition detailing Resident #2's sutures or surrounding skin on her left lower shin and on the upper portion above her left knee, anywhere in the resident's record for either of these three (3) above dates. The DON recognized and acknowledged on 04/09/25 at: 3:14 PM, that the resident's complete skin status, including her sutures, should be assessed and should have been documented in detail in the resident's record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 10 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review the facility failed to ensure that a resident receives care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers for 1 of 1 sampled resident reviewed for pressure ulcers (Resident #37). Residents Affected - Few The findings included: Record review for Resident #37 revealed the resident was admitted to the facility on [DATE] with diagnoses that included in part the following: Type 2 Diabetes Mellitus, Muscle Weakness, and Unspecified Abnormalities of Gait and Mobility. The Minimum Data Set assessment dated [DATE] documented in Section C a Brief Interview of Mental Status score of 10, indicating moderate cognitive impairment. Review of the Physician's Orders for Resident #37 revealed in part the following orders: *An order dated 02/06/24 Weekly skin assessment every Tuesday 7:00 AM to 7:00 PM Shift. *An order dated 04/04/25 for sacrum pressure ulcer stage 1 cleanse with normal saline (N/S), pat dry, apply calcium alginate daily and PRN (as needed) every day shift was discontinued on 04/04/25. *An order dated 04/05/25 sacrum: Cleanse with N/S, pat dry, apply calcium alginate daily and PRN (as needed) every day shift for wound. *An order dated 04/04/25 for air mattress. *An order dated 04/06/25 to encourage resident to turn and reposition frequently. Review of the TAR (Treatment Administration Record) for the month of April 2025 had no documentation of wound care to the sacrum was provided on 04/04/25. Review of the Progress Notes for Resident #37 from 03/01/25 to 04/04/25 revealed no documentation of turning or repositioning the resident nor was there documentation of the resident refusing to be turned and repositioned. Review of the Care Plan for Resident #37 revealed no care plan for the sacral pressure ulcer or prevention of pressure ulcers. Review of the Wound Care Progress Note by the Wound Care Consultant company dated 04/08/25 documented in part the following: wound location: Sacrum, Length 4 centimeters (cm), Width: 3.2 cm, Depth: 0.2 cm. Status: Recurrent. An interview was conducted on 04/09/25 at 11:05 AM with the Assistant Director of Nursing (ADON) who stated she has worked at the facility or 1 year. When asked how do you identify if a resident is high risk for development of pressure ulcer, the ADON stated by doing a Pressure ulcer screening and Braden scale assessment and history of resident. They are done on admission, depending on the score of the screening or assessments it will populate to reassess the resident. If the resident is high risk when it would populate for a reassessment again but does not know the exact time frame for the reassessment to be completed next. When asked about Resident #37, the ADON stated the resident had a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 11 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few pressure ulcer screening done on 10/12/24 that documented a score of 7 indicating less than 8 not high risk for developing a pressure ulcer. On 12/31/24 the resident had a Braden Scale Predicting Pressure Sore Risk documenting a score of 17 indicating at risk for developing a pressure ulcer. The ADON verified the resident had an order dated 02/06/24 for skin checks every Tuesday 7:00 AM to 7:00 PM shift. The licensed nurse weekly skin observation were completed on 12/11/24, 01/08/25, 01/22/25, 02/19/25, 03/26/25, 04/05/25, and 04/08/25. The ADON acknowledged the weekly skin checks were not performed weekly as ordered. The ADON then stated on 04/04/25 documented in an Exception report was sacral ulcer stage I, however she believes this was documented as stage I in error and should have been a stage II. The documentation on 04/05/25 of sacral ulcer as stage 2. When asked if the wound care to the sacrum was documented as performed on 04/04/25 as ordered, the ADON acknowledged there was no documentation of the wound care being performed. An interview was conducted on 04/09/25 at 10:30 AM with Staff A, Certified Nursing Assistant (CNA), who stated she has worked at the facility for 7 years. When asked does she turn and reposition residents and if so how often, she said they turn and reposition residents every 2 hours. When asked where she documents the turning and repositioning, she said they do not have a place for her to document this in the electronic medical record. An interview was conducted on 04/09/25 at 10:45 AM with Staff B, Registered Nurse (RN), who stated she has worked at the facility since 2020. When asked what interventions the facility uses to prevent pressure ulcers or skin breakdown, she said they do weekly skin check and turn and reposition the resident's every 2 hours. When asked where this is documented, she said the weekly skin assessments are documented in the Weekly Skin Check Assessment. When asked about the documentation for turning and repositioning, she said only if there is an order they are documented on the TAR (Treatment Administration Record) or they can document on a progress note. During an interview conducted on 04/09/25 at 1:30 PM with the Director of Nursing (DON) who was asked about Resident #37 and sacral wound, she stated some nurses had documented a sacral wound but not any measurements or staging, she said this may have been documented incorrectly, because all of the orders for treatment were for buttock wounds at the time when this documentation was in effect in late December 2024 to early January 2025. The 3008 form from the transferring hospital dated 12/19/23 documented skin condition of sacrum and buttocks as having road rash. The DON acknowledged there was no evidence in the resident's medical record that she had a pressure ulcer on her sacral wound while at the facility. The DON provided a statement on letterhead signed by her and dated 04/09/25 Resident #37 does not have any history of pressure ulcer on her sacrum. During a telephone interview conducted on 04/10/25 at 1:45 PM with the Advanced Registered Nurse Practitioner (ARNP) from the wound care company who was asked about the documentation of the sacral wound care for Resident #37 dated 04/08/25, she said she put recurrent because that is what the DON had told her that the resident had a sacral wound in the past. She stated this was the first time she had seen the resident, and she did not review the chart, she just documented based on what the DON had told her. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 12 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 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. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Resident #167 was admitted to the facility on [DATE] with diagnoses of Anemia, Respiratory Failure, and Hyperlipidemia. A review of the Physician's order noted two overlapping orders for tube feeding: If vital AF 1.2 (tube feeding formulary type) is not available, may substitute with Peptamen 1.5 (tube feeding formulary type) at 240 milliliters (ml) every 4 hours dated 4/4/25. Another order was noted for 20 hours at 10:00 AM and off at 2:00 PM. Enteral Feeding: Vital Advanced Formula, 1000ml, 55ml an hour, which was dated 4/5/25. A review of the Medication Administration Record showed that both above tube feeding orders were checked as administered in April 2025. In an observation conducted on 4/7/25 at 10:35 AM, Resident #167 was noted in bed with the tube feeding Peptamen 1.5 at 50ml an hour, which was dated 4/7/25, but no start time. The tube feeding was noted at the 750ml mark out of the 1000ml capacity bag. In an observation conducted on 4/7/25 at 3:30 PM, Resident #167 was noted in bed with the tube feeding Peptamen 1.5 at 50ml an hour, which was dated 4/7/25, but no start time. The tube feeding was noted at the 700ml mark out of the 1000ml capacity bag. This showed that only 50ml was administered in the last 1 hour and a half. In an observation conducted on 4/7/25 at 5:20 PM, Resident #167 was noted in bed with the tube feeding continuous Peptamen 1.5 at 50ml an hour, dated 4/7/25, and no start time. The tube feeding was noted at the 600ml mark out of the 1000ml capacity bag, which showed that 100ml was infused in the last 2 hours. In an observation conducted on 4/8/25 at 5:48 AM, Resident #167 was noted in bed with the tube feeding on hold. The tube feeding bag started at 5:00 AM on 4/8/25 and was at the 900ml mark out of a 1000ml capacity bottle. In an interview conducted on 4/8/25 at 1:00 PM with Staff F, the Registered Nurse stated she only realized this morning when she started her shift that Resident #167 had two overlapping tube feeding orders. She asked the Nurse supervisor to check the tube feeding orders and update them accordingly. Staff F acknowledged that both orders were checked as given in the MAR under each specific order. A review of the weights log revealed Resident #167's admission weight of 89.4 pounds, dated 4/5/25. A new weight was obtained on 04/08/25, as per this Surveyor's request, which showed Resident #167 was at 87.2 pounds, indicating a 2-pound weight loss. In an interview conducted on 4/8/25 at 1:30 PM with Resident #167' son stated his father used to be around 120 pounds about a year ago and has been in and out of the hospitals for some time. The nutrition assessment dated [DATE] showed the following: Resident #167's Ideal Body Weight was 136 pounds. He does not eat anything by mouth, and his only route of nutrition and hydration is enteral feeding. This assessment addressed the tube feeding order of Vital AF 1.2 every 4 hours but not the continuous order of tube feeding with Vital Advanced Formula, 1000ml, 55ml an hour. Resident #167 was noted at malnutrition and that the current tube feeding order was meeting needs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 13 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 A new tube feeding order for 20 hours of Enteral feeding-Peptamen (tube feeding formulary)1000ml,60ml, and hour, dated 4/8/25, was noted. Level of Harm - Actual harm Residents Affected - Few A review of the Care Plan showed Resident #167 has nutritional and hydration problems related to nothing by mouth status and medical history. It further revealed that enteral feedings and flushes should be provided as ordered. 3. Resident #169 was readmitted to the facility on [DATE] with diagnoses of Cerebral infarction, Gastrostomy, and Muscle Weakness. The Minimum Data Set (MDS) dated [DATE] showed Resident #169 had a Brief Interview of Mental Status (BIMS) score that is severely impaired. A review of the Physician ' s orders revealed an order for every shift of Peptamen 1.5 at 70ml an hour times 20 hours. The feed starts at 2:00 PM daily until a total volume of 1400ml has been infused. It may be substituted with Glucerna 1.5 (tube feeding formulary) if Peptamen 1.5 is unavailable, as dated 4/6/25. A review of the weight log showed the following weights: 4/2/2025 169.8 pounds. 3/31/2025 171.0 pounds. 3/31/2025 172.0 pounds. 3/25/2025 174.8 pounds. 3/17/2025 176.4 pounds. 2/24/2025 187.3 pounds. 2/21/2025 188.0 pounds. In an observation conducted on 4/7/25 at 12:12 PM, Resident #169 was noted in bed with the tube feeding Peptamen 1.5 running at 60ml an hour. The tube feeding was noted at the 800ml mark out of a 1000ml capacity bag, which was dated 4/7/25 but had no start time. In an observation conducted on 4/7/25 at 3:33 PM, Resident #169 was noted in bed with the tube feeding Peptamen 1.5 running at 60ml an hour, which was dated 4/7/25 but had no start time. The tube feeding was noted at the 700 mark out of the 1000ml capacity bag. This showed that 100ml was administered in the last 3 hours, from 800ml to 700ml. In an observation conducted on 4/7/25 at 5:20 PM, Resident #169 was noted in bed with the tube feeding Peptamen 1.5 at 60ml an hour, which was dated 4/7/25, but no start time. The tube feeding bag was noted at the 600ml mark out of a 1000ml capacity bottle. Only 200ml of formulary was administered in the last 5 hours, and not the necessary 350ml of formulary. In an observation conducted on 4/08/25 at 6:20 AM, Resident #169 was noted in bed with the tube feeding Peptamen 1.5 running at 60ml an hour. The bag had a start date of 4/8/25 with a start time of 5:00 AM. It was also noted at the 900ml mark out of a 1000ml capacity bag. In this observation, Staff G, a Registered Nurse, stated Resident #169 tolerated his tube feeding well. She further said that she started the feeding tube a little less and increased it to where it needed to be when Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 14 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 #169 was more elevated with his head on the bed. Level of Harm - Actual harm The Nutrition assessment dated [DATE] revealed the following: Resident #169 is at risk for malnutrition with a weight loss of 6.1% over the past 30 days, likely due to tube feeding dislodgement and replacement. The current tube feeding order of Peptamen 1.5 at 60ml an hour for 20 hours is meeting estimated needs. Residents Affected - Few A follow-up nutritional note dated 4/6/25 showed Resident #169 had a Body Mass Index (BMI) of overweight status. The enteral regimen is adequate in nutrients to meet his current needs. The Clinical Dietitian recalculated the energy and protein needs and recommended increasing the tube feeding regimen to 70ml an hour from 60ml an hour. This was not followed in the above observations. Based on observations, interviews, and record reviews, the facility failed to provide nutritional assessments and interventions in a timely manner which resulted in significant weight loss for 1 of 1 sampled resident (Resident #51); The facility also failed to follow tube feeding Physician's orders for 2 of 5 sampled residents (Resident #167 and Resident #169). The findings included: A review of the facility's policy titled Weighing and Weight at-risk Protocol and revised in March 2020 showed the following: Weights: Nursing to complete all weights with reweights on the following parameters: 0-175 pounds - variances of 4 pounds - loss or gain. Identification: When all weights (weekly and monthly) are completed, the Dietary Department will review weights for significant weight loss and at risk weight loss and determine variances with reweights as noted above. The Dietary Department will notify nursing staff of significant and at risk residents the next day during the morning meeting. Investigation: The Dietary Department and nursing staff begin investigating weight loss: Is the Resident assisted with eating? Is Staff assisting with eating appropriately? Giving enough time? Does the Resident like food? Have food preferences? Family involved in bringing food? Intervention: Notify Dietitian of newly identified significant weight loss. Review intakes at a minimum weekly. Documentation: Dietary will document within 72 hours of investigation. Dietary to document monthly until resolved. Review weekly with nursing and dietary until weight loss resolved. Keep minutes of the meetings. Resident reviewed, and interventions initiated on all residents with significant weight loss and at risk. A review of the American Society for Parental and Enteral Nutrition titled Standards for Specialized Nutrition Support for Adult Residents of Long-Term Care Facilities dated February 2006 showed the following: Monitoring and Re-evaluating the Nutrition Care Plan, Parameters and Frequency: The frequency of monitoring should depend on the severity of illness, degree of malnutrition, and level of metabolic stress. Daily or more frequent monitoring should be required in residents who are critically ill, have unstable debilitating diseases or infections, are at risk for refeeding syndrome complications, are transitioning between Enteral feeding and oral diet, or have experienced complications. https://aspenjournals.onlinelibrary.[NAME].com/doi/10.1177/011542650602100196. A record review showed that Resident #51 was admitted to the facility on [DATE] and readmitted back to the facility on 8/30/24 with diagnoses of seizures and type 2 diabetes mellitus without complications. The Minimum Data Set (MDS) quarterly dated 2/26/25 revealed that the Brief Interview of Mental Status (BIMS) score is 3, which indicates severe cognitive impairment. A thorough review of the weight log for Resident #51 showed the following respectively: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 15 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 4/8/2025: 123.4 pounds. Level of Harm - Actual harm 03/05/2025: 131.2 pounds. Residents Affected - Few 02/05/2025: 129.2 pounds. 01/07/2025: 136.2 pounds. 12/11/2024: 139.8 pounds. 12/05/2024: 143.6 pounds. 11/05/2024: 146.6 pounds. 10/4/2024: 149.2 pounds. 09/30/2024: 152 pounds. 09/23/2024: 153.6 pounds. 09/16/2024: 157.4 pounds. 09/09/2024: 156.4 pounds. 09/04/2024: 155.6 pounds. 08/29/2024: 160.0 pounds. 08/15/2024: 165.0 pounds. Further review showed a 7.8-pound weight loss from 03/05/2025 to 4/8/2025, which indicates a 5.9% weight loss in a month. From 08/29 to 10/04 (36 days), severe weight loss of 6.7%. From 08/29 to 11/05 (67 days), showed a severe weight loss of 8.37% From 09/16 to 12/11 (3 months), showed a severe weight loss of 11.18% Resident #51 had an overall significant trending weight loss of 25.2% from 08/15/2024 to 04/08/2025 (past 8 months). The monthly weight taken on 4/8/25 was due to this Surveyor's intervention in attempting to obtain a monthly weight before Resident #51 left for the hospital. A chronological review of the orders indicated the following: In August 2024: Enteral Feed Order Glucerna 1.5 tube feeding at 60 ml per hour for 20 hours at 2:00 PM and off at 10:00 AM. This started on 08/30/2024 and was discontinued on 09/16/2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 16 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 - Actual harm Residents Affected - Few In September 2024: an order was placed for enteral feed two times a day Glucerna 1.5 tube feeding at 60 ml per hour for 12 hours on at 7:00 PM and off at 7:00 AM. This started on 09/16/2024 and discontinued on 09/18/2024. An order was placed for enteral feed every night shift Glucerna1.5 tube feeding at 60 ml/hr. for 12 hours on at 6:00 PM and off at 6:00 AM. This started on 09/18/2024 and discontinued on 12/09/2024. From 9/16/24 to 10/18/24, Resident #51 was only on tube feeding, which was not meeting her needs and was decreased from 20 hours to 12 hours a day on 09/16/2024. In October 2024, an order was placed for an enteral feed every night shift, Glucerna 1.5 tube feeding 60 ml per hour for 12 hours at 6:00 PM and off at 6:00 AM. This started on 09/18/2024 and was discontinued on 12/09/2024. An order was placed for a no-add-salt, low-concentrated sweet diet, mechanical soft texture, regular/thin consistency, and fortified foods for all meals, which started on 10/18/2024 and was discontinued on 12/9/2024. In December 2024, an order was placed for a regular, no-added-salt diet with a puree texture and nectar-thick consistency and no fortified food from 12/10/2024 to 01/13/2025. In January 2025, several orders were placed: from 01/13/25 to 01/15/25, a regular no-added-salt diet with a mechanical soft texture; from 01/15/25 to 01/15/25, a no-added-salt diet and low-concentrated sweet diet with a mechanical soft texture; from 01/16/25 to 02/06/25, a regular no-added-salt diet with a mechanical soft texture; and from 01/15/2025 to 03/19/2025, an order for Boost twice a day. In February 2025: an order was placed for enteral feed two times a day Jevity 1.5 at 50 ml/hr. for 12 hours, to be run until 600 ml infused, on at 6:00 PM and off at 6:00 AM which started on 02/06/2025. An order was placed for a regular diet mechanical soft texture on 02/06/2025. An order was placed to add fortified foods with all meals on 02/06/2025. A review of the orders indicated that Resident #51 spent 54 days (from 12/10/2024 to 02/05/2025) only being fed by mouth with no order of enteral feeding. Further review showed a second decrease in the tube from 60 ml/hr. to 50 ml/hr. from 02/06/2025. A review of the Dietary progress note dated 08/30/2024 (the day after Resident #51 got readmitted to the facility from the hospital) revealed the following: The Registered Dietitian stated that Resident #51 estimated needs were 1825-2190 kilocalories, 73-88 grams of protein and 1825-2190 milliliters(ml) of fluids. Resident #51 was put on pleasure feeding of pureed/thin and tolerated the tube feeding well with no issues. The Dietary progress note further revealed an order clarification to Glucerna 1.5 (tube feeding formulary) at 60 ml x 20 hours (hrs.), flush with 50 ml for 20 hours, providing 1800 kilocalories (kcal), 99 grams (G) of Proteins and 1911 milliliters of total fluids, which will be meeting the lower end of the resident caloric needs and meeting over 100% of proteins. A review of the Dietary progress note dated 01/15/2025 (135 days after the previous Dietary progress note) revealed the following: The Registered Dietitian stated that Resident #51 weighs 136.2 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 17 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 - Actual harm pounds and has a normal Body Mass Index (BMI) of 23.4 for height. The progress note further indicated that Resident #51 weight loss was likely due to the transition from tube feeding to per oral with variable intake. A recommendation of: Boost 1 can (240 ml) by mouth 2 times a day and fortified cereal at Breakfast with a diet of no added salt (NAS), mechanical soft, thin liquids were put in place. Residents Affected - Few A review of the Dietary progress note dated 02/06/2025 (the day after the 5.1% weight loss was identified) revealed the following: The Registered Dietitian stated that Resident #51 had significant weight loss calculated respectively for 1 month: 5.1%, 3 months: 11.8% and 6 months: 21.6% with a normal BMI for the height of 22.2 and a weight of 129.2 pounds. Further review showed a recommendation to discontinue: No added salt restriction, clarify diet to a regular, mechanical soft texture, thin liquids, and fortified food with meals. A re-estimation of the needs based on current weight indicated Kcal: 1770-2065, Protein: 59-77g, Fluids: 1770-2065 ml. A recommendation to re-start nocturnal feeds was placed with Jevity 1.5 (tube feeding formulary) at 50 ml per hour for 12 hours, run until 600 ml infused via percutaneous endoscopic gastrostomy tube (PEG) (on 6 PM, off 6 AM), water flush at 40 ml/hr and for 12 hours, run until 480 ml infused via PEG (on 6:00 PM, off 6:00 AM). It will provide 900 kcal, 38g protein, 936 ml free water, and 1080 ml total fluids. The new recommendation of tube feeding will be missing 870 kcal, 21g of protein, and 690 ml of fluids to meet the lower end of Resident #51's nutritional need, which would be provided from the diet intake by mouth (PO). A review of the Dietary progress note dated 03/28/2025 revealed the following: The Registered Dietitian (RD) stated that Resident #51 weighed 131.2 pounds and had a BMI of 22.5 on 03/05/2025, which indicated weight loss resolved due to a 1-pound gain since 02/05/2025. A recommendation was made to continue a no added salt diet with a mechanical soft texture and thin liquid PO. The RD further stated that Resident #51's intake varies from 25% to 75%. A recommendation is to continue supplemental enteral feeds of Jevity 1.5 at 50 ml per hour for 12 hours starting at 6:00 PM daily until 600 ml has been infused (900 kcal and 42.5 grams of protein and 450 ml of free water). A review of the progress note further revealed a calculation of Resident #51 nutrient and hydration needs with PO diet and enteral regimen: Energy need:1500-1800 kcal, Protein needs:60-72 grams, and Fluid needs:1500-1800 ml. This indicates that the enteral feeding of 900 kcal, 42.5g of protein, and 450 ml of free water is not meeting the Resident's nutritional and hydration needs. The RD also stated that the enteral regimen is well tolerated, with no signs and symptoms of diarrhea, constipation, abdominal distention/cramping, fluid overload, or aspiration. A review of the doctors' progress note dated 12/11/2024 indicated under the treatment section and sub-section of attention to gastrotomy tube a recommendation of Glucerna 1.5 tube feeding at 60 ml per hour for 20 hours at 2 PM and off at 10 AM. A review of the orders showed that this recommendation was never placed in the orders. A review of the care plan initially dated 08/30/2024 and revised on 03/28/2025 stated that Resident #51 is at risk for nutritional and hydration problems. Risk related to nocturnal tube feeding as a supplement route of nutrition and hydration associated with Cerebro Vascular Accident. Medical diagnoses included Respiratory failure, Seizure, Essential Hypertension, Hypernatremia, Gastroesophageal Reflux Disease (GERD), and Diabetes Mellitus (DM). Mechanical soft diet provided PO at all meals. A review of the past 30 days (from 03/09/2025 to 04/07/2025) of the amount eaten showed various percentages of food intake for Resident #51: 16 meals between 0 and 25%, 13 meals between 26 and 50%, 51 meals between 51 and 75% and 8 meals between 76 and 100%. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 18 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 - Actual harm In an observation conducted on 04/07/2025 at 5:46 PM, Human Resources staff, Staff R, was seen setting up the tray and leaving the room right after. At 6:10 PM, the tray was still untouched; Resident #51 only ate the dinner roll and the cake. At 6:13 PM, Certified Nurse Assistant, Staff S, wrote 30% of the intake on Resident #51's meal ticket and took the tray out of the room. Residents Affected - Few In an observation conducted on 04/07/2025 at 6:25 PM, Registered Nurse (RN) Staff T was seen writing Resident #51's information, including the tube feeding start time (6:25 PM) on the tube feeding bottle. After setting up the feeding, the Staff realized the Peg tube was missing a part and called Registered Nurse Staff U for help. Staff T stated that she always sets up the tube feeding for Resident #51 at night because during the day the Resident eats by mouth. In another observation conducted on 04/07/2025 at 6:40 PM, this Surveyor observed that the feeding started at 6:42 PM, but the monitor stopped and displayed an error message due to clogs. After multiple attempts, tube feeding finally started at 6:50 PM. In an observation conducted on 04/08/2025 at 5:40 AM, Resident #51 was awake in bed with no tube feeding bottle running or noted in the room. Staff V, RN, stated Resident #51 vomited all over the bed and she stopped the tube feeding at 5:30 AM. The bottle was about half full when she stopped it. Staff V stated that Resident #51 usually tolerates her tube feeding well with no issues. An order was placed on 04/08/2025 to send Resident #51 to the emergency room for coffee ground emesis identified on 04/08/2025. In an interview conducted on 04/08/25 at 8:00 AM, the Director of Nursing (DON) stated that specific staff members take the weights on all residents, and the list is then given to Staff D, Medical Records, to put in the electronic system. Staff D calls the Registered Dietitian to discuss any weight losses before recording them in the electronic system. The DON said Resident #51's weight was taken on 4/1/25 but was not able to provide one and then said, Maybe it was written on a piece of paper. In an interview conducted on 04/08/25 at 8:12 AM with Staff D, she stated she has two staff members who take the weights on all residents, and the list is then given to her to record in the electronic system. The monthly weights are taken on all residents from the 1st to the 5th of the month. If a resident has lost weight, the Registered Dietitian will ask for a reweigh to ensure the accuracy of the weights. For any weekly weights, the Registered Dietitian will provide her with a list of residents. When asked about the facility's policy for weights, Staff D stated residents' weights are taken on admission, once a week for 4 weeks, and monthly thereafter. For the monthly weights, the Registered Dietitian (RD) reviews all residents in the electronic system on a regular basis and will ask for a reweigh of any discrepancies. The RD comes to the facility once a week and has remote access as well to be able to assess the residents when not in the facility. When asked if the monthly weight was taken on Resident #51, Staff D said, It might have slipped us a little bit when we did all the monthly weights from the 1st to the 5th of this month. According to Staff D, the RD can see any significant/severe weight losses when she reviews the weights of all residents. If she sees any weight loss, she will notify the RD as soon as possible. In an interview conducted on 04/08/2025 at 11:00 AM, Resident #51's daughter (her caregiver) stated that she realized that her mother had lost a lot of weight and that she had been wanting to talk to someone. She said: I've been sad lately because that's not my mom'. Resident #51's daughter said her mother used to weigh between 200 and 230 pounds and that she is very concerned about the weight (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 19 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 - Actual harm Residents Affected - Few loss and how her mom looks now. Especially since she always attends all the care plan meetings and weight loss was never addressed or her preferences. She further explained that her mother doesn't like the food served in the facility, and that may be the reason why she only eats the sweets that are served. Resident #51's daughter stated that sometimes the Staff tells her that her mother eats 60% but doesn't believe it because her mother barely eats 30% when she is present, which is about 3 times a week. In an interview conducted on 04/09/1015 at 12:30 PM, the Registered Dietitian (RD) stated that she started working for this facility on 03/12/2025 and works between 15 to 20 hours a week and comes only on Fridays. RD explained that she sees the residents on Fridays when she comes and logs in every day to see new admissions. If a new resident is admitted with something crucial like tube feeding, she calls the Director of Nursing and tries to do the assessment within 24 hours and after monthly. RD further explained that if a resident is on pleasure feeding, then the tube feeding must meet all the resident's needs. A resident on tube feeding is considered at high risk, and to take a resident off the tube feeding, one of the criteria is that the resident is consistently eating 75% or more. As for the weight, RD explained that she runs an exception report between last month and this month, which tells her what happened so she can make the necessary adjustments. RD did not adjust the tube feeding for Resident #51 because Resident had a 1-pound weight gain and was waiting for the monthly weight to consider changes. When asked by this Surveyor if she visited Resident #51 or spoke to her daughter regarding food likes and preferences, she said no. The current facility Registered Dietitian did not reweigh Resident #51 or adjust the estimated needs of the Resident due to the 1-pound weight gain and did not consider the trending significant weight loss for the last 6 months. In an interview conducted on 04/09/2025 at 2:28 PM, the Director of Nursing (DON) stated that she had four different dietitians in 6 months. There was no dietitian coverage from 12/07/2024 to 12/10/2024. The DON further explained that the expectation for a resident on tube feeding is to be seen weekly by the RD, and if residents are stable, then the visits should be monthly. She also expected the RD to recognize the weight loss on Resident #51 and acknowledged that no RD notes were placed for Resident #51 from August 2024 to January 2025 (4 months). In an interview conducted on 04/09/2025 at 2:45 PM with a Registered Nurse, Staff E stated that she is familiar with Resident #51. She further stated that Resident #51 tolerates tube feeding well and has been eating between 50% and 60% on average. In an interview conducted on 04/09/2025 at 3:00 PM with Medical Records, Staff D stated that she has been working at the facility for 6 years and is very familiar with Resident #51. Staff D explained that Resident #51 would drink a lot but only ate 25% more or less. In an interview conducted on 04/10/2025 at 2:25 PM with a Certified Nurse Assistant (CNA), Staff P stated that she is familiar with Resident #51 and that her food intake depends on the type of food. For example, for Breakfast, she will eat 50% some days, but for lunch and dinner, she wouldn't eat more than 25%. Staff further stated that Resident #51 is not a big eater, and that Breakfast is the best one for her. In an interview conducted on 04/10/2025 at 2:30 PM with the Registered Nurse, Staff Q stated that she is familiar with Resident #51. Staff Q explained that Resident #51 likes to drink (coffee, milk, and orange juice) more than eat. Her food texture changed on multiple occasions from pureed (because (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 20 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 - Actual harm she did not want it) to regular texture. Once it was changed to a regular texture, Resident #51 started choking, so it had to be changed to mechanical chopped. Staff Q further stated that as the RN on the floor, the CNAs come to her and inform her of Resident #51's intakes. Breakfast is her best food, and she eats 50% of it. Residents Affected - Few In an interview conducted on 04/10/2025 at 2:10 PM, Resident #51's daughter (caregiver) stated that she is not happy with the weight loss; her dad cried when he saw his wife at the hospital because she had lost so much weight; That should have never happened in the first place, they should have been feeding my mom properly. The Resident's daughter further reported that the doctor at the hospital explained that her mother would never be able to eat by mouth again. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 21 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 - Few 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. Record review revealed Resident #45 was admitted to the facility on [DATE] and readmitted on [DATE] with a diagnosis of Anxiety Disorder, Dementia, and Muscle Weakness. The Quarterly Minimum Data Set (MDS) assessment dated [DATE] showed that Resident #45 had a Brief Interview of Mental Status (BIMS) score of 11, which indicates moderate cognitive impairment. A review of the Physician's orders showed an order for Apixaban (an anticoagulant medication): give one tablet, 2.5 milligrams, every 12 hours, for Chronic Atrial Fibrillation. No order was noted to monitor side effects or adverse effects of the above medication. A review of the Care Plan dated 8/20/24 showed the following: Resident #45 is on anticoagulant therapy related to Atrial Fibrillation. Resident #45 will be free from discomfort or adverse reactions to anticoagulant use through the review date. It further showed to monitor/document/report adverse reactions of anticoagulant therapy: blood-tinged or red blood in urine, black tarry stools, dark or bright red blood in stools, sudden severe headaches, nausea, vomiting, diarrhea, muscle joint pain, lethargy, bruising, blurred vision, loss of appetite, sudden changes in mental status, significant or sudden changes. Further record review of the Medication Administration Record (MAR) and Treatment Administration Record (TAR) for Resident #45 did not show that the facility was monitoring the side effects and adverse reactions of the anticoagulant medication. In an interview conducted on 4/9/25 at 10:47 AM with the Director of Nursing (DON), she stated that there should be a batch order to monitor the side effects of anticoagulant medication, and nursing should document this in the MAR and the TAR. In an interview conducted on 04/09/25 at 10:51 AM, Staff H, a Registered Nurse, stated Resident #45 was on an anticoagulant and was being monitored for side effects such as bleeding and bruising. She then said it is documented in the MAR and the TAR and proceeded to show this Surveyor in the electronic system. She then responded to the surveyor and said,It is not here. Based on interviews and record reviews, the facility failed to ensure adequate monitoring of side effects and behaviors for residents receiving psychotropic medications for 2 of 5 sampled residents reviewed for Unnecessary Medication (Resident #1); for 1 of 1 resident sampled residents reviewed for Mood/Behavior (Resident # 59); and failed to ensure adequate monitoring of side effects of residents prescribed anticoagulants (blood thinner) for 1 of 1 sampled residents reveiwed for Unnecessary Medications (Resident #45). The findings included: 1. Record review for Resident #59 revealed the resident was admitted to the facility on [DATE] with diagnoses that included in part, the following: Degenerative Disease of Nervous System Unspecified, Pain, Restless Agitation, and Depression. The Minimum Data Set assessment dated [DATE] documented in Section C, a Brief Interview of Mental Status could not be done due to the resident is rarely/never understood. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 22 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 Review of the Physician's Orders for Resident #59 revealed in part, the following orders: Level of Harm - Minimal harm or potential for actual harm *An order dated 03/13/25 for Lorazepam Oral Tablet 0.5 MG give 1 tablet by mouth every 6 hours as needed for Agitation related to Restlessness and Agitation for 14 Days and was discontinued on 03/27/25. Residents Affected - Few *An order dated 03/13/25 for Seroquel Oral Tablet 25 MG give 1 tablet by mouth one time a day for Depression (Psychosis) related to Depression, Unspecified and was discontinued on 03/24/25. *An order dated 03/24/25 for Seroquel Oral Tablet 25 MG give 25 mg by mouth every 12 hours for psychosis. *An order dated 03/24/25 for Side Effect Observation Order #2: 15-Appetite change/weight change ; 16-Insomnia ; 17-Confusion ; 18-Akathisia-restlessness/pacing/inability to sit still/anxiousness/sleep disturbances ; 19-Tardive dyskinesia--lip smacking/chewing/abnormal tongue movement/spasmodic movement of arms/legs-rocking/swaying ; 20-Blood abnormalities ; 21-Sore throat ; 22-Seizures ; 23-Photosensitivity ; 24-Suicidal ideations ; 25-Gastrointestinal disturbances ; 26-Hepatic or renal abnormalities ; and 27-Ataxia every shift for Behaviors. *An order dated 03/24/25 for Side Effect Observation Order #1: 1-Dystonia, torticollis (stiffness of neck) ; 2-Anticholinergic symptoms: dry mouth/blurred vision, constipation/urinary retention ; 3-Hypotension ; 4-Sedation/drowsiness ; 5-Increased falls/dizziness ; 6-Cardiac abnormalities (tachycardia, bradycardia, irregular, H.R., NMS) ; 7-Anxiety/agitation ; 8-Blurred Vision ; 9-Sweating/rashes ; 10-Headache ; 11-Urinary retention/hesitancy ; 12-Weakness ; 13-Hangover effect ; and 14-Pseudo parkinsonism every shift for Behaviors. *An order dated 03/24/25 for Behavior Code 1 : Depressed / withdrawn - Document # of times behavior occurred each shift every shift for Behaviors An order dated 03/24/25 for Behavior Code 1 : Depressed / withdrawn - Document # of times behavior occurred each shift every shift for Behaviors. *An order dated 03/24/25 for Behavior Code 2 : Agitated - Intervention Codes: 1. One on one 2. Activity 3. Adjust room temperature 4. Backrub 5. Change position 6. Give fluids 7. Give food 8. Redirect 9. Refer to progress notes 10. Remove resident from environment 11. Return to room [ROOM NUMBER]. Toilet every shift for Behaviors. *An order dated 03/24/25 for Behavior Code 3 : Agitated - Document Outcome Code: I-Improved ; S-Same ; W - Worsened every shift for Behaviors. In summary Resident #59 was ordered 2 separate antipsychotic medications (Lorazepam and Seroquel) on 03/13/25 and there was no order to monitor side effects or behaviors for these medications until 03/24/25. Review of the Medication Administration Record (MAR) and Treatment Medication Administration (TAR) for Resident #59 documented the resident had received the Seroquel as ordered, and was not administered the Lorazepam. There was no documentation of behavior or side effect monitoring until 03/24/25. Review of the Care Plan for Resident #59 revealed there was no care plan for psychotropic (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 23 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 medications including interventions to monitor for behaviors or side effects. Level of Harm - Minimal harm or potential for actual harm An interview was conducted on 04/10/25 at 9:40 AM with Staff L Registered Nurse (RN) who stated she has worked at the facility since October 2020. When asked about when a resident is receiving psychotropic medications do they monitor for behaviors and side effects, she said yes. When asked where this is documented she said on the MAR and if there is a behavior or side effect observed then you make a progress note. Residents Affected - Few An interview was conducted on 04/10/25 at 9:50 AM with Staff B Registered Nurse (RN) who stated she has worked at the facility since October 2020. When asked about when a resident is receiving psychotropic medications do they monitor for behaviors and side effects, she said yes. When asked where this is documented she said on the MAR and if there is a behavior or side effect observed then you make a progress note. 2. Record review revealed Resident #1 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnosis of Acute Chronic Diastolic (congestive) Heart Failure and Cardiac Arrest due to an underlying heart condition. The quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score was 3, which indicates severe cognitive impairment. A review of the physician orders indicated that Resident #1 had an order for Citalopram Hydrobromide Oral Tablet of 10 milligrams (mg.) once a day for Depression dated: 02/27/2025. A review of a care plan dated 04/07/2023 indicated that Resident #1 is prone to side effects and changes in behavior, mood and cognition related to the use of antidepressant medications. Observation and monitoring for potential changes in behaviors, mood and side effects such as rigid muscles, insomnia, appetite loss, dry eyes, dry mouth, fecal impaction, and gait changes are necessary. A review of the physician orders, Medication Administration Record (MAR) and the Treatment Administration Record (TAR) indicated that the facility failed to implement interventions to monitor changes in behavior, mood and potential side effects related to the use of antidepressant medications for Resident #1. In an interview conducted on 04/10/2025 at 11:00 AM, Director of Nursing (DON) stated that they don't monitor mood and behaviors or side effects for antidepressant medications because it's not part of the protocol that they follow. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 24 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of policy and procedure, observation, interview and record review, the facility failed to wear or don appropriate personal protective equipment (PPE), preventing infection control, during high-contact resident care activity for 1 of 1 sampled resident observed for Indwelling Urinary Catheter, Resident #171. Residents Affected - Few The findings included: Record review of the facility policy and procedure titled Enhanced Barrier Precautions provided by the Director of Nursing (DON) reviewed November 2019 documented in the Policy Statement: Enhanced Barrier Precautions expand the use of PPE beyond situations in which exposure to blood and body fluids is anticipated and refer to the use of gown and gloves during high-contact resident care activities that provide opportunities for transfer of Multidrug-resistant Organisms (MDRO) to staff hands and clothing Record review of the facility policy and procedure titled Catheter Care, Urinary provided the DON reviewed July 2015 documented in the Policy Statement: This procedure may involve potential/direct exposure to blood, body fluids, infectious diseases, air contaminants, and hazardous chemicals. Protective Barriers that may be needed: .Gown .Purpose: The purpose of this procedure is to prevent infection of the resident's urinary tract Record review revealed Resident #171 was admitted to the facility on [DATE] with diagnoses which included Neurogenic Bladder. She had a Brief Interview Mental Status (BIM) score of 00, indicating severe cognitive impairment. A physician's order dated 04/03/25 documented for Enhanced Barrier Precautions: Wound/foley catheter/biliary drain. During an observation conducted on 04/09/25 at 9:52 AM, of Peri-care-Foley catheter care for Resident #171, it was noted that Peri-care-Foley catheter care was being performed by Staff N, a Certified Nursing Assistant (CNA). Staff N was observed setting up, preparing and beginning to perform hands-on Peri-care and Foley catheter care on this resident, while only wearing gloves, with no protective PPE gown on. During the start of this observation, Staff N was observed leaning over, and in-close proximity to the resident, whose peri-area with his Foley catheter, was visibly exposed. Staff N was subsequently interrupted, by Staff Member O, a CNA, who reached inside of Resident #171's room door in order to hand Staff N, a protective gown to wear. Upon inquiry by the surveyor, Staff N, was unable to provide a clear explanation, when asked, as to why she had begun pulling back the resident's covers, touching his person, re-positioning his Foley catheter and proceeding to begin with the resident's peri-Foley care, without first donning a clean protective gown over her clothing, prior to performing this procedure, for Resident #171. On 04/09/25 at 10:17 AM an interview was conducted with Staff O, in which she was asked about why she was observed handing a protective gown through the resident's room door to Staff N, after peri-Foley care had already begun for this resident. Staff O acknowledged that she had done so because she noticed that Staff N, was not wearing one and she said that she should have been, since the resident had a Foley catheter, in place. During an interview on 04/09/25 at 2:17 PM, the DON (Director of Nursing), also functioning as the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 25 of 26 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 105009 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golfcrest Nursing Center 600 North 17th Ave Hollywood, FL 33020 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 Level of Harm - Minimal harm or potential for actual harm Infection Control Nurse) stated that on 04/02/25 and 04/09/25, she had recently educated the nursing staff nurse on the importance of Infection Control procedures, including appropriate PPE as well as handwashing and providing Perineal care to the residents. The DON acknowledged that the CNA should have donned appropriate PPE gown, prior to performing Peri-care-Foley care for Resident #171. Residents Affected - Few Photographic Evidence Obtained FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105009 If continuation sheet Page 26 of 26