Health inspection·June 23, 2022

F 0584 the Director from the laundry was supposed to bring them today. Level of Harm - Minimal harm or potential for actual harm On 06/22/2022 at 12:06 PM the resident stated they only found one shirt. The resident was noted to be wearing what appeared like a white undershirt and red plaid pajama bottoms. Residents Affected - Few On 06/23/2022 at 8:22 AM, Resident #17 said he had to wear the same shirt three days this week and three days last week. Record review of Resident #17 reveals he was admitted on [DATE] with diagnoses that include blindness, diabetes, heart failure and right foot amputation. A BIMS done on 03/30/2022 states the resident is cognitively intact. 4. On 06/20/2022 at 9:43 AM Resident #12 stated that someone stole his clothes twice. He said that it happened six months ago, and he reported it and nothing was done about it. He said it happened again just recently and he reported it again. The Social Services Director on 06/22/2022 at 2:06 PM stated that a grievance report was filed on 04/18/2022 regarding the laundry by Resident #12 with the documentation that it was resolved. On 06/23/2022 at 11:25 AM Resident #12 stated again that his clothes were never returned, replaced and it was not fixed. Record review for Resident #12 revealed he was admitted on [DATE] with a diagnosis of stroke with paralysis. A BIMS done on 06/19/2021 states the resident is cognitively moderately impaired. 5. On 06/20/2022 at 10:14 AM Resident #100 stated that they had bleached his clothes by mistake and ruined them a few months ago. He said he bagged them up and turned them in. He reported it to the Director of Nurses and the Assistant Director of nurses. He stated the Social Services Director filed a grievance for him and nothing was ever done. He stated, they said they were going to replace the clothes, but they never did. Record review for Resident #100 reveals he was admitted on [DATE] with the diagnosis of quadriplegia (paralyzed from the waist down). A BIMS done on 06/03/2022 states the resident is cognitively intact. On 06/22/2022 at 12:04 PM the Director of Laundry Services stated they found some of the residents clothing. She stated that they are not short staffed, they just have so much to do and keep track of. On 06/22/2022 at 2:06 PM, an interview with the Director of Social Services and Assistant Director of Social Services revealed they have morning meetings with administration and a new process for laundry was discussed. They were unable to locate grievances for Residents #65, #17, or #100. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 2 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide activities to meet the needs of a cognitively impaired resident for 1 of 4 residents reviewed for activities, Resident #61. Residents Affected - Few The findings included: Resident #61 was admitted to the facility on [DATE] and most recently readmitted to the facility on [DATE]. According to the resident's most recent complete assessment, a Medicare 5-Day Minimum Data Set (MDS), Resident #61 was not assessed for cognition due to 'resident is rarely/never understood'. The MDS documented that Resident #61 was totally dependent upon staff for all activities of daily living. Resident #61's diagnoses at the time of the assessment included: Coronary Artery Disease; Neurogenic bladder; Diabetes Mellitus; Hyperlipidemia; Cerebral Infarction; Dysphagia Following unspecified Cerebrovascular Disease; Pressure Ulcer of left heel, unstageable; Pressure Ulcer of Sacral Region, Unstageable; Respiratory failure with Hypoxia or Hypercapnia; Pressure Ulcer of Sacral Region Stage 4. Resident #61's orders included: Enteral Feed - two times a day Glucerna 1.5 at 80 ml/hr for 20 hours via g-tube. On at 3PM off at 11AM. Resident #61's care plan, created on 03/31/22 and most recently revised on 04/01/22, documented Resident #61 has little or no activity involvement r/t Physical Limitations. The goal of the care plan was documented as, Resident will express satisfaction with type of activities and level of activity involvement when asked through the review date. 03/31/22 with a target date of 06/30/22. Interventions to the care plan included: * Establish and record prior level of activity involvement and interests by talking with resident, caregivers, and family on admission and as necessary. * Explain the importance of social interaction, leisure activity time and encourage participation. * Invite/encourage family members to attend activities with resident in order to support participation. * Modify daily schedule, treatment plan PRN to accommodate activity participation. * Remind the resident they may leave activities at any time, and are not required to stay for entire activity. * Resident needs assistance/escort to activity functions. Resident's care plan, created on 03/19/22 and most recently revised on 05/03/22, documented, Resident #61 has impaired cognitive function/impaired thought process r/t Resident is rarely (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 3 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 understood/understands speech unclear but mostly nonverbal. Level of Harm - Minimal harm or potential for actual harm The goal of the care plan was documented as, Resident will be able to communicate basic needs on a daily basis through the review date. 03/19/22 with a target dated of 06/30/22. Residents Affected - Few Interventions to the care plan included: * Communicate with family/caregivers regarding residents capabilities and needs. * Cue, reorient and supervise as needed. * Discuss concerns about confusion and/or disease process with family/caregivers. * Engage resident in simple, structured activities that avoid overly demanding tasks. * Keep routine consistent and try to provide consistent care as much as possible. * Medications as ordered. * Monitor any changes in cognitive function, specifically changes in: decision making, memory recall, general awareness, level of consciousness, mental status and/or difficulty expressing self/understanding others. During the initial pool process, on 06/20/22, at approximately 10:00 AM, Resident #61 was observed in bed sleeping with the television on. It was noted that there was no volume from the television. On 06/21/22 at 10:44 AM, Resident #61 was observed in bed with TF initiated and was sleeping. It was noted that the resident's television on with no volume. On 06/22/22 at 12:02 PM Resident #61 was observed in bed sleeping and did not respond to being greeted by name. It was noted that the resident's television was on with no volume. Resident #61's roommate stated that Resident was able to speak. During an interview, on 06/22/22 at 1:26 PM, with the Activities Director and the Activities Assistant, when asked about activities for Resident #61, the Activities assistant replied, I do three things with him, he is on TF and does not get out of his room. I take him to live entertainment, that last time was the 11th. Sunday for Father's Day, we had him out here in activities - he didn't partake (eat anything) but he observed. On 06/18/22, live entertainment. Most of the time, I just sit and talk, and I read to him for 15 minutes tops. When asked for documentation of the interactions, the Activities Assistant stated that she did not document when she talked or read to Resident #61, The Activities Director stated, He refused books on tape (by shaking his head). I don't' think that I offered anything else because of his mental acuity. When asked if there had been any opportunities for other activities after refusing the books on tape, the Activities Director stated that there had not been any. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 4 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete When it was brought to the attention of the Activities Director and the Activities Assistant that Resident #61 had been observed in bed with the television on and no volume, they replied that they were not aware of the television not having any volume. On 06/23/22 at 8:15 AM the Activities Assistant stated, He had 2 visitors last night - I talked to them and told them that there was live entertainment on Saturday, and I will arrange for him to be out and that they can come. I apologized to them for not inviting them for Father's Day. Event ID: Facility ID: 105067 If continuation sheet Page 5 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and facility policy the facility failed to properly assist a resident with Preoperative care for 1 of 1 resident reviewed for surgery (Resident #17). Residents Affected - Few The findings included: On 06/20/2022 at 2:38 PM Resident #17 stated that he was having eye surgery on Thursday (06/23/2022) at [NAME] Eye Institute. Record review of Resident #17 revealed he was admitted on [DATE] with diagnoses that include blindness, diabetes, heart failure and right foot amputation. A Minimum Data Set (MDS) assessment done 03/30/2022 documents Resident #17 as cognitively intact with a functional status of requiring extensive assistance to total care for all activities except eating, which requires set up and supervision. On 06/22/2022 at 11:20 AM, the Surveyor noted the anticoagulant (blood thinner) for Resident #17 was being held but no other preoperative instructions were documented on the chart. Staff F, RN was questioned about the preop instructions. She stated she was unable to locate the orders. The Director of Nurses (DON)was called for assistance. The DON arrived and was unable to locate the preop orders and instructions from [NAME] Eye Institute. On 06/22/2022 at 11:28 AM, Staff D LPN unit manager was unable to locate the preop instructions for Resident #17 scheduled for surgery on 06/23/2022. On 06/22/2022 at 11:30 AM, a physician's order was entered, Appointment at UHEALTH [NAME] EYE INSTITUTE AT PALM BEACH GARDEN on 6/23/2022 at 12 noon. TRANSPORTATION pick up at 10:15 AM. [sic] On 06/22/2022 at 11:31 AM, Staff E, Health Services Information Clerk, stated she is unable to locate any preoperative documentation from [NAME]. On 06/22/2022 at 11:33 AM, Staff A, RN, Unit Manager, called [NAME] for preoperative orders. She said that [NAME] stated they spoke with someone from the facility last week on 06/15/2022 to review preoperative requirements, instructions, and orders. She stated that Resident #17 needed a COVID Polymerase Chain Reaction (PCR) test , a comprehensive history and physical, and other tests. She said that they told her they had not received the items requested and needed all the preoperative work today by 2:00 PM or the surgical case is cancelled. On 06/22/2022 at 12:01 PM, the preoperative instructions and orders were found by Staff F, RN in Resident #17's room. On 06/22/22 12:54 PM, a Nurse Progress note by Staff D, LPN states, Spoke to Medical Tech at Eye Institute office. Requested COVID PCR stated COVID antigen test is okay. COVID test was completed yesterday. COVID test negative. ARNP is here to see pt. [sic] On 06/22/2022 at 12:45 PM, order placed for NPO (nil per os, means nothing by mouth) after Midnight. On 06/22/2022 at 2:15PM, COVID PCR test done, completed at 3:04 PM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 6 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 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 On 06/22/2022 at 4:54 PM Resident #17's preoperative COVID PCR test was faxed to [NAME]. Level of Harm - Minimal harm or potential for actual harm On 06/22/2022 at 5:19 PM Resident #17's clearance and electrocardiogram was faxed to [NAME]. Residents Affected - Few On 6/23/2022 at 8:00 AM, Resident #17 was being served breakfast. Staff B, LPN was at the bedside. Staff G, CNA was preparing the breakfast tray cutting up the sausage, opening the milk carton, removing the juice and oatmeal lids. When asked by the surveyor why he is eating before surgery, Resident #17 stated his surgery was cancelled because [NAME] did not receive the requested preoperative documents in time. (Photographic evidence of breakfast tray taken). On 06/23/2022 at 8:05 AM, no documentation in the Physician's Orders was found for Resident #17's surgery being cancelled. An order dated 6/22/2022 stated NPO after midnight preop. On 06/23/2022 at 8:10 AM, the Surveyor questioned Staff B LPN regarding Resident #17's surgery being cancelled. She stated did not know why. On 06/23/2022 at 8:15 AM, the Surveyor questioned Staff D LPN regarding Resident #17's surgery being cancelled. She stated she did not know it was cancelled and would call [NAME] Eye Institute to find out why. She notified the DON who came to the unit. The DON stated she also did not know that Resident #17's surgery had been cancelled. The surveyor informed the DON the resident was served breakfast and was getting ready to eat. The DON went into Resident #17's room, inquired if he ate or drank anything yet and removed his breakfast tray. On 06/23/2022 at 9:49 PM, Resident #17 stated, I still do not know if I am having surgery or not. No one has said anything to me. I have not washed up. I am not dressed. I was supposed to be picked up at 10:00 AM. They took my tray and never came back. This is ridiculous. On 06/23/2022 at 9:52 PM, Staff D, LPN, entered Resident #17's room and informed him she spoke with [NAME] Eye Institute, they have everything, and his surgery is back on the schedule for today. She went on to say that transportation will be here soon, and they will help him get ready. Facility Policy titled Physician Orders dated 10/24/2017 state, Physician orders are obtained to provide a clear direction in the care of the resident. Orders given by a physician or state permitted health care professional must be accepted by a licensed nurse and documented on the physician order sheet and must be cosigned and dated by the ordering physician or state permitted health care professional. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 7 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on on observation, interview, and record review, the facility failed to perform tracheostomy (trach) care as ordered for 1 of 1 residents reviewed for trach care (Resident #107). Residents Affected - Few The findings included: A review of the facility's policy titled Tracheostomy Care, dated 04/24/2018, revealed the purpose: 1. To maintain patency of the airway 2. To keep tracheostomy tube and the surrounding area clean 3. To prevent infection of the airways and the area around the tracheostomy tube and 4. To prevent excoriation of the area around the tracheostomy tube A Licensed Nurse or a Respiratory Care Practitioner performs this procedure. Resident #107 was admitted to the facility on [DATE] with diagnoses which included Acute Respiratory Failure and Tracheostomy (hole in the resident's neck to facilitate breathing). A recent comprehensive assessment dated [DATE] documented the resident had severe cognitive impairment, and required total two-person assist with activities of daily living. The comprehensive assessment further documented Resident #107 had a tracheostomy, and required oxygen and suctioning. Resident #107 was care planned for impaired gas exchange/ineffective airway clearance related to Respiratory Failure with presence of tracheostomy and history of ventilator dependence. Interventions included medications/treatments as ordered and respiratory treatment as ordered. A review of Resident #107's orders revealed an order dated 08/31/21 for trach care every shift and as needed. Resident #107 was observed on 06/21/22 at 12:00 PM in bed with eyes closed. Resident #107's trach was observed with dried, crusty secretions. Resident #107 was observed on 06/22/22 at 1:00 PM in bed with eyes closed. The resident was observed again with dried crusty secretions on the trach and trach collar. An interview was conducted with Staff L, Assistant Director of Nursing, on 06/22/22 at 1:30 PM. Staff L stated she was also the staff educator. Staff L stated trach care should be performed every shift, and as needed. Staff L confirmed there was a physician order for Resident #107 to have trach care done every shift, and as needed. Staff L further stated trach care should be documented on the Treatment Administration Record (TAR). Staff L acknowledged there was no designated place to document trach care on Resident #107's TAR. An interview was conducted with Staff M, a Licensed Practical Nurse, on 06/22/22 at 2:00 PM. Staff M stated she did not perform trach care on Resident #107. Staff M stated trach care should be done as needed, and charted in the resident's progress notes. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 8 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 An interview was conducted with the Director of Nursing (DON) on 06/23/22 at 4:00 PM. The DON acknowledged there was no documentation of trach care done on Resident #107. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 9 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to document the providers' response and/or rationale to decline the pharmacist's recommendations from the Medication Regimen Review (MMR), for 5 of 5 residents reviewed (Residents #31, #56, #58, #78 and #103). The facility also failed to develop and implement policies and procedures for the required monthly Medication Regimen Review conducted by their pharmacy. The findings included: 1) On 06/23/2022 during review of the pharmacy recommendations from the monthly MRR (Medication Regimen Review) for Resident #103, the recommendation dated 02/15/2022 was to discontinue three medications for constipation to reduce long-term side effect and a request for an assessment of risk versus benefit, to validate continuing the medications. The document was signed by a provider and the DON (Director of Nursing) on the same day. Review of the medical record found all three medications with new orders continuing daily administration a few days later (02/18/2022). No documentation from the provider could be found identifying the rationale for declining the recommendation to discontinue the medications, or the risk versus benefit for continuing the medications. 2) For Resident #78, a recommendation on 12/12/21 identified an abnormally low platelet count and a daily order for aspirin. The provider and the DON signed the recommendation on the same day. There was no notation from the provider on the form indicating acceptance or declination and neither was found in the record. Current orders showed the resident still taking aspirin. A recommendation dated 01/27/2022 for Resident #78 revealed a recommendation was provided by the pharmacist consultant marked CLINICALLY URGENT RECOMMENDATION; PROMPT RESPONSE REQUESTED regarding multiple orders for levothyroxine that were unclear. There were two orders to give the medication in the morning and neither of the orders said whether they should be given together or not. There was also no current TSH (Thyroid Stimulating Hormone) level in the chart, which is necessary to order an accurate dose. The recommendation was signed the same day by the DON. The lab was drawn on 01/31/2022 however, there was no progress or provider note or change in orders until 02/14/2022. Additionally, for Resident #78 on 05/27/2022, the pharmacy recommendation was for a pain re-evaluation because the resident had an order for Tramadol PRN (as needed). On the same day, the DON and the provider signed the document and marked the space to decline the recommendation but there was no documentation of the rationale for declining it. 3) For Resident #58, a recommendation from 12/14/2021 regarding Vitamin D/Calcitrol requested monitoring blood phosphate levels every 1 to 3 months and monitor PTH (Parathyroid Hormone level) every 3 to 6 months. There is also a request to specify frequency of testing. The provider and DON signed the document on the same day. There is no physician notation on the form. No progress or practitioner note was located either approving or declining it. No PTH or phosphate levels were found in the record since the recommendation. On 01/27/2022 a recommendation for Resident #58 to monitor a serum magnesium concentration on the next convenient lab day and every six months thereafter. No magnesium level or progress/provider note (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 10 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 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 0756 was found in the record. Level of Harm - Minimal harm or potential for actual harm On 02/15/2022 a recommendation for Resident #58's supplements requested the facility add the diagnosis and/or documentation supporting continued use of them. The active physician orders for the renal capsule and Vitamin D3 say supplement rather than a diagnosis or rationale to support administration. Also, on 02/15/2022, the pharmacist reported a long-term blood glucose level (A1c) of 9.2% from 11/29/2021 and that point of care glucose checks were elevated. The recommendation was to reassess existing management of the resident's diabetes to help prevent long term consequences of prolonged hyperglycemia. A practitioner and the DON signed the form the same day however no progress or practitioner note could be found accepting or declining it and the sliding scale insulin was not adjusted for three months on 05/17/2022. Residents Affected - Few On 03/28/2022 a CLINICALLY URGENT RECOMMENDATION; PROMPT RESPONSE REQUESTED notice for Resident #58 regarding active orders for Vitamin D analogs, calcitriol, ergocalciferol and Vitamin D3 for SUPPLEMENT was identified as a potential duplication of therapy. The request was the same action as stated in the 12/14/2021 recommendation because dosing requires frequent adjustments based on blood levels. The practitioner signed the recommendation the same day and declined but did not document a rationale. On the same day another recommendation requesting a reassessment of the current insulin regime because the resident was receiving frequent sliding-scale insulin. The provider and DON signed the document the same day and the provider declined the recommendation without documenting a rationale. No progress or practitioner note was found and no adjustment to oral antidiabetic agents or insulin injections were made around this time. Also for Resident #58 was a recommendation dated 04/21/2022 regarding a current order for levothyroxine without a recent TSH level in the record. The pharmacist requested the lab be drawn on the next convenient lab day. The most recent lab level for a TSH was from 11/2021 and no other levels or orders for the lab work could be found. No progress or practitioner note could be found. On the same day, another recommendation/request to reassess the current regime for diabetes medications was issued by the pharmacist due to frequent sliding-scale insulin being given. The DON and the practitioner signed the form the same day however no change to the regimen or a progress/practitioner note could be found in the record. Continuing for Resident #58 is a recommendation dated 05/16/2022 requesting the provider reevaluate the continued use of blood thinners and low-dose aspirin together because of the serious risk of severe bleeding. No provider or progress notes were found in the record and the resident continues to have active orders for both medications. 4) For Resident #56, a recommendation was made on 12/16/2021 regarding frequent requests for PRN Percocet. The recommendation requested a re-assessment of the pain management regime to minimize breakthrough pain and address pain control needs. The document was signed the same day. No progress or provider note or change in orders around this time was identified in the record. On 02/16/2022, a recommendation for Resident #56 regarding an order for melatonin 10mg at bedtime requested a trial discontinuation of it. The document was signed the same day. No progress or provider note was located, and the resident continues to take melatonin. For Resident #56, a second recommendation was issued on 04/21/2022 regarding frequent doses of PRN Percocet and requested a reevaluation of the pain management. The document was signed the same day without any provider notation. No progress or provider note or change in orders around this time was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 11 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 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 0756 identified in the record. Level of Harm - Minimal harm or potential for actual harm On 05/27/2022 a recommendation was issued for Resident #56 due to an active order for blood thinners. The recommendation specified a yearly CBC (complete blood count) a serum creatinine level and a bleeding assessment at least every six months. It was signed by the DON and a provider the same day. The provider declined the recommendation however did not provide a rationale. On the same day a second request to attempt a trial discontinuance of melatonin was issued. The DON, psychiatric provider and the attending provider signed it the same day. The recommendation was declined but no rationale was documented. Residents Affected - Few 5) Resident #31 was admitted to the facility on [DATE] and diagnoses included Atrial Fibrillation, Heart Failure, and Pacemaker. Review of the Resident #31's medication regimen review revealed on 02/15/22, the Pharmacist recommended to monitor a Fasting Lipid panel on the next convenient Lab day, for the medication Atorvastatin Calcium. The Pharmacist stated that the Resident did not have a current Fasting Lipid panel documented in the medical record. On 06/23/22 at 9:00 AM, during a review of the Resident's Electronic Medical Record, there was no documentation that the test was completed. On 06/23/22 at 10:30 AM, during an interview with the Director of Nursing she could not find any documentation or information that the fasting Lipid panel was completed. 6) On 06/23/22 at 3:25 PM, during an interview with the DON about the signatures on the reports, when asked what she was signing to with her signature, she said, that the doctor has signed it. On 06/23/22 at 3:37 PM, during an interview with the Consultant Pharmacist by phone, she said a provider's signature confirms agreement with the recommendation unless he notes an objection. On 06/23/22 at 4:15 PM, during an interview with the DON and the NHA, the NHA said she called the pharmacy who said the doctor's signature on the form is that he reviewed it. During this interview, all three parts needed for compliance were clarified with the DON and the NHA at which time both acknowledged the absence of providers' responses and rationale for declining (where necessary). On 06/23/22 at 6:09 PM, the NHA was asked for the facility policy for Medication Regimen Review, and she informed the team that there wasn't one. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 12 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 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** Based on interview and record review, the facility failed to monitor behaviors for psychotropic medications for 1 of 5 residents reviewed for unnecessary medications (Resident #56). The findings included: A review of the facility's policy Psychotropic Medication Assessment and Monitoring, dated 10/30/2018, documented; Monitoring of residents receiving antipsychotic medication will be completed by a licensed nurse as per acceptable standards of practice using the behavior monitoring record. The policy further documented each resident's drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used without adequate monitoring. Resident #56 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident was cognitively intact, had some verbal behaviors toward others, and was on antidepressants. Resident #56 was care planned on 11/18/21 for having the potential to demonstrate physical and/or verbally abusive behaviors related to anger, at times confabulates and yells throughout the facility. Interventions included to anticipate resident's needs, evaluate for side effects of medications, and psychiatry evaluation as needed. The resident was care planned for antidepressant use dated 05/10/22, with intervention to monitor for ongoing signs and symptoms of depression. A review of Resident #56's progress notes revealed a progress note dated 02/28/2022 at 10:14 AM that documented a resident to resident incident involving Resident #56. A review of Resident #56's orders revealed an order dated 02/28/22 for a psych consult for behavioral management. A review of an Initial Psychiatric Evaluation, dated 03/01/22, documented to start Lexapro (antidepressant) 10 milligrams (mg) every day. The evaluation further documented to monitor the resident's response and tolerance to the medication. Note any improvement in patience and decrease irritability and reactive angry aggressive behaviors. A review of Resident #56's orders revealed an order dated 03/10/22 for Lexapro 5 mg daily for depression (not 10 mg as per psych's plan). No documentation of behavior monitoring was found for Resident #56 from 03/01/22- 03/13/22. A review of a Subsequent Psychiatric Evaluation dated 03/13/22, documented patient remained anxious, irritable, and short tempered. Recommendation for Lexapro 10 mg a day, and Depakote 250 mg every 12 hours (medication to treat manic symptoms in patients with bipolar disorder). Monitor patient response and tolerance. Note any improvement in mood, anger, and outbursts. (No response to the recommendation.) No documentation of behavior monitoring was found for Resident #56 from 03/13/22- 03/22/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 13 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 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 A review of a Subsequent Psychiatric Evaluation dated 03/22/22, documented patient continues to have loud aggressive behaviors with no effect with medications. Recommendations included to discontinue Lexapro, start Cymbalta 30 mg a day (antidepressant) and Seroquel 25 mg (antipsychotic) at bedtime as an adjunct to major depression. Monitor for mood with decrease irritability and no impulsive physical reactivity. Residents Affected - Few A review of resident #56's orders revealed an order dated 03/22/22 for Cymbalta 30 mg daily for depression, and Seroquel 25 mg at bedtime as an adjunct to major depression (Lexapro was discontinued). A progress note dated 03/22/2022 at 4:16 PM documented: Resident seen by Psych. New order received for Seroquel 25 mg at bed time, Cymbalta 30 mg daily and to D/C Lexapro. No documentation of behavior monitoring was found for Resident #56 from 03/22/22- 04/08/22. A physician Progress Note by psych dated 04/08/22 documented Resident #56's mood and behavior did improve with verbal report from nursing. Medication reduction done per their request by medical (Seroquel discontinued). No documentation of behavior monitoring was found for Resident #56 from 04/08/22- 04/25/22. A psych consult was ordered on 04/26/22 for screaming/yelling for 4 days (Resident not seen by psych until 05/27/22). A progress note dated 04/26/22 at 12:57 PM documented: Resident alert and oriented x 3, screaming, yelling, self propel wheelchair pacing around, throwing things around his room, medicated for pain, and redirect with no success. No documentation of behavior monitoring was found for Resident #56 from 04/27/22- 05/26/22, except for 05/04/22. A progress note dated 05/04/2022 at 9:17 AM documented: Resident alert already medicated for pain, screaming, yelling, cursing, using profanity, redirect with no success. A Subsequent Psychiatric Evaluation dated 05/27/22 documented decreased episodes of angry abrupt inappropriate behavior. No new psychiatric recommendations. Continue monitoring for response/potential adverse reactions. Continue Cymbalta 30 mg every day. Monitor for increased angry, combative and aggressive behaviors. No documentation of behavior monitoring was found for Resident #56 from 05/27/22-06/13/22. A Subsequent Psychiatric Evaluation dated 06/13/22 documented occasional episodes of anger outbursts. Increase Cymbalta to 60 mg a day for depression and anxiety. Monitor patient response and tolerance. Note improving mood as evidence by no yelling, no anger outbursts and improving compliance. (Cymbalta was not increased) A psych consult was ordered on 06/14/22 for increased behaviors. No documentation of behavior monitoring was found for Resident #56 from 06/13/22-present. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 14 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 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 FORM CMS-2567 (02/99) Previous Versions Obsolete An interview was conducted with Psych Nurse Practitioner (NP) on 06/22/22 at 3:46 PM. The NP stated Resident #56 needs his behaviors monitored and recorded in order for her to properly treat the resident. Surveyor asked the NP why her orders/recommendations weren't carried out. The NP shrugged her shoulders. An interview was conducted with the Director of Nursing (DON) on 06/22/22 at 4:00 PM. The DON acknowledged the lack of monitoring Resident #56's behaviors. The DON further acknowledged orders/recommendations from psych not carried out. Event ID: Facility ID: 105067 If continuation sheet Page 15 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 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 0803 Level of Harm - Minimal harm or potential for actual harm Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, interview and record review, the facility failed to provide meals according to residents' preferences for 1 of 4 residents reviewed for preferences, Resident #213. Residents Affected - Few The findings included: Resident #213 was admitted to the facility for current stay on 06/17/22. An admission Assessment, dated 06/17/22, documented that Resident #213 had no dental/oral concerns. The assessment documented that Resident #213 was cognitively intact with a BIMS score of 15, with vision and hearing documented as 'adequate' without the use of devices. Resident #213's Diet orders were documented as, Regular - NAS diet, Regular texture - 06/17/22. Resident #213's care plan, created on 06/18/22, documented, [RESIDENT PREFERRED NAME] is at risk for decreased nutritional status & dehydration r/t. The goal of the care plan was documented as, Resident will be free from significant weight changes through the review date - 06/18/22. Interventions to the care plan included: * Assist with meals as needed * Diet as ordered * Encourage PO fluids * Labs as ordered * Monitor diet tolerance * Monitor PO intakes * Monitor weight as ordered * Observe for s/s dehydration: i.e. poor skin turgor, dry mucous membranes, labs, concentrated urine, elevated temps and sudden changes in cognition and behaviors * Provide food preferences & substitutions * RD/DTR to evaluate as needed During an interview with Resident #213, on 06/20/22 at 1:44 PM, when asked about the food served by the facility, Resident #213 replied, I haven't eaten since I have been here. I have lost 6 pounds already. they weighed me this morning. I told them it was terrible. Resident #213 further stated that she did not remember who she told. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 16 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 06/22/22 at 8:32 AM, observed Resident was served breakfast by the Admissions Coordinator. Resident stated to the Admissions Coordinator that she did not like cereal. The Admissions Coordinator replied to the resident 'okay' and exited the room and returned to the food trolley to continue passing residents' breakfasts. During an interview with Resident #213, on 06/22/22 at 8:47 AM, Resident #213 stated, I told them several times not to bring me milk. I don't like milk and I don't like cereal. Usually they take it away. I have told them that I don't like pancakes, but they gave them to me anyway. I'll eat them, but I don't like them. It was noted that the meal that was served to the resident on her over bed table included a pre-packaged serving of dry cereal, a one pint container of milk and pancakes. During an interview, on 06/23/22 at 7:58 AM, with the Admissions Coordinator, when asked if she had attempted to provide a substitution for the portion of the breakfast meal that Resident #213 reported to her that she did not like or want, the Admissions Coordinator replied, I told the kitchen, I let them know and I just relay the message to the kitchen and they are supposed to adjust the tickets. I didn't give anything to her after that (for breakfast). On 06/23/22 at 8:50 AM, Resident #213 was observed in bed eating breakfast. It was noted that the meal consisted of hard-boiled egg, sausage patties, waffles, dry cereal (with no milk). It was noted that there was a hand-written note on the paper slip that accompanied that stated, Dislike Cereal. During an interview, on 06/23/22 at 9:55 AM, with the Dietary Technician, when asked about assessing Resident #213 for preferences, the Dietary Technician replied, I met with her yesterday afternoon around 2 PM. And discussed her meal preferences and what she did and did not want. I was unable to see her until yesterday. Initially there were meal preferences on her meal ticket from a previous admission that we had to resolve. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 17 of 18 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 105067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boulevard Rehabilitation Center 2839 S Seacrest Blvd Boynton Beach, FL 33435 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to prepare and serve food in a sanitary manner. Residents Affected - Many Th findings included: On 6/20/22 at 9:30 AM , conducted an initial kitchen tour in the main kitchen, accompanied by the CDM and Assistant CDM. The following was observed: (1) A box of Pancake mix stored in an open container in the dry storage room. (2) A container of dried split pea stored in a open container in the dry storage room. (3) Toaster was dirty with built up bread crumbs. (4) Stove top all burners were greasy with built up burnt on, food spills. (5) Disposable containers and utensils stored in a open box with no cover. (6) The oven was greasy, dirty with built up food spills. (7) One 13 oz box of Cheerios open in the kitchen. (8) The table top can opener holder sticky and dirty. On 06/23/22 at 1:00 PM, conducted an interview with the CDM, and he was informed of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105067 If continuation sheet Page 18 of 18