Inspection·June 30, 2022

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #216's room and stated the resident was new to her. Staff F acknowledged the resident's juice spill. Continue observation revealed Staff F asked the resident if she could feed herself and the resident mumble, ahau. Staff F changed the resident gown and set her up to eat and left the room. On 06/27/22 at 9:42 AM, observation revealed Resident #216 in bed with her breakfast tray on the table. The resident was holding a small piece of meat. The scrambled eggs and waffles were untouched in the plastic container. Further observation revealed no nursing staff entered the resident's room to encourage or assist her with her meal. On 06/28/2022 at 11:55 AM, observation revealed Resident #216 in her room sitting up in a wheelchair with the table across the wheelchair. The resident was approximately 12 inches away from her lunch tray. Continued observation revealed Staff G, CNA, cutting up resident's meat. The resident picked up a piece of zucchini with her hand and put it on her mouth. An interview was conducted with Staff G and they stated that Resident #216 can feed herself. At 11:57 AM, Staff G left the resident's room. At 11:59 AM, observation revealed the resident drinking from a bottle of regular soda. During an interview, Resident #216 was asked if she was thirsty and stated uhm. Further observation revealed the resident was pulling her right foot sock up and down. The resident's food was untouched. On 06/28/22 at 12:00 noon, Staff G entered Resident #216's room and encouraged her to drink the juice and left her room. On 06/28/22 at 12:21 PM, observation revealed Staff G providing assistance to Resident #216 with feeding. During an interview, Staff G stated that the resident was eating the raw kale and touching her sock. Staff G stated she was not familiar with the resident and that the resident accepted help with the lunch meal. On 06/28/22 at 4:35 PM, in an observation conducted during dinner time, Resident #216 was noted in her room with staff setting up her tray and leaving the room. At 4:50 PM, Resident #216 was noted with the tray which was 100% untouched and no assistance from staff. Continued observation showed nursing staff going into the room and asking Resident #216 if she is eating her dinner meal. (Photographic evidence obtained). On 06/29/22 at 8:10 AM, in an observation conducted during breakfast, staff was noted in Resident #216's room setting up the breakfast tray for the Resident and cutting the pancakes into smaller pieces. Continued observation showed that at 8:17 AM, tray was 100% untouched with no assistance from staff. At 8:34 AM, the tray was still 100% untouched with no assistance from staff. At 8:40 AM, Resident only ate the 6 ounces of grits and the rest was untouched. (Photographic evidence obtained). On 06/29/22 12:26 PM, observation revealed Resident #216 sitting up in bed with her lunch tray on the table and Staff I, CNA, looking at the resident. Continued observation revealed the resident with a full mouth, pocketing the food. Subsequently, an interview was conducted with Staff I and she stated she was not familiar with the resident and was supervising the resident during meal. She added she noticed the resident was not eating. Resident #216 continued pocketing the food. Further observation revealed Staff I did not encourage or cue the resident to swallow the food. The surveyor then asked the resident to swallow her food and the resident did not swallow. At 12:34 PM, observation revealed the resident throwing up the food. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 06/29/22 1:56 PM, a joint interview was conducted with Staff J, Registered Dietitian (RD) and Staff K, RD. Staff J stated Resident #216 was admitted to the facility on [DATE] and she reported having good appetite. The resident's intake had been mostly 51 to 100% with few 26 to 50%. Staff J stated the resident was on a House Diabetic Diet with regular texture and thin liquids and was receiving a snack. During the interview, Staff J and Staff K were apprised of the surveyor observations. Staff J was informed that the nursing staff did not provide feeding assistance to Resident #216 and her intake was poor during the observations. Staff J stated the resident was on weekly weights and is usually done on Mondays. Staff J was asked to submit the resident's weight reading for 06/27/22. On 06/29/22 at 2:30 PM, an interview was conducted with Staff H, a Licensed Practical Nurse (LPN) and she stated Resident #216 could feed herself. Staff H stated the resident had to be reminded to use the spoon or fork because the resident wanted to use her hands. Staff H added that the resident's family brings her food and she tends to eat with her fingers. On 06/30/22 at 9:48 AM, an interview was conducted with the facility's Speech Therapy (ST). She stated that she screened Resident #216 today (06/30/22). The ST stated the resident prefers to use her hands to eat, but was able to chew/masticate solid food, took her a period of time and seemed tired. The ST stated she asked the resident if she prefers soft or pureed diet and stated she prefers pureed diet. On 06/30/22 at 10:10 AM, during an interview, Staff J was asked to reweigh Resident #216. The resident's reweight was 82.6 pounds. Review of the Health Status Note dated 06/29/22 at 5:00 PM documented Resident assisted with dinner ,consumed 100% of her dinner tray. Based on interviews, observations, and record review, the facility failed to provide bathing/grooming for (Resident #419 and #418), and was unable to provide assistance during dining for (Resident #216) 3 of 28 sampled residents for activities of daily livings (ADLs). The findings included: Review of the facility's policy titled Activities of Daily Living dated 01/2021 showed assistance would be based on the resident's comprehensive assessment and consistent with the resident's needs and choices to ensure that the resident's abilities in ADLs do not deteriorate. Care and services will be provided in the following area: bathing, dressing, grooming, and eating, including meals and snacks. 1). In an interview conducted with Resident #418 on 06/27/22 at 10:03 AM, she stated that she has been asking for staff to give her and Resident #419 (her husband) a shower, but it was not given. She further stated that the facility did not give her a choice of when to get her showers. She was told that her showers would be from 11 PM to 7 AM on Mondays and Thursdays. Resident #419's showers will be from 7 AM to 3 PM on Mondays and Thursdays. Resident #418 stated that the staff had been telling her that they would come to shower her, but none had been provided for her or Resident #419 since admission. Resident #418 then pointed at her hair and said, l feel so dirty with my hair not washed. Resident #418 reported that she loves receiving actual showers in the shower room and is dependent on staff to do so. A record review showed that Resident #418 was admitted on [DATE] with diagnoses of type 2 diabetes, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few acute kidney failure, and hypertension. The Minimum Data Set (MDS) dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 15, which is cognitively intact. The care plan dated 06/30/22 revealed Resident #418 has the potential for ADL self-care performance deficit related to weakness. It further showed to provide a sponge bath when a full bath or shower cannot be tolerated. A review of the Activity Interview for Daily and Activity Preferences dated 06/24/22 showed that it was very important for Resident #418 to choose between a tub bath, shower, bed bath, or sponge bath. The shower documentation by the Certified Nursing Assistants showed that Resident #418 was given showers on 06/18/22 (Saturday) and 06/25/22 (Saturday). Review of the shower schedule book located on the unit showed that Resident #418's scheduled shower days are on Mondays and Thursdays from 11 PM to 7 AM. Further review showed that Resident #419's scheduled shower days are on Monday and Thursdays from 7 AM to 3 PM. Review of the record showed Resident #419 was admitted on [DATE] with diagnoses of heart disease and type 2 diabetes. The care plan dated 06/30/22 revealed Resident #419 has the potential for ADL self-care performance deficit related to weakness. It further showed to provide sponge bath when full bath or showers cannot be tolerated. Review of the Activity Interview for Daily and Activity Preferences dated 06/24/22 showed that it was very important for Resident #419 to choose between a tub bath, shower, bed bath, or sponge bath. The shower documentation by the Certified Nursing Assistants showed that Resident #419 was given showers on 06/18/22 (Saturday) and 06/20/22 (Monday). In an interview conducted on 06/29/22 at 9:50 AM, Staff E, Certified Nursing Assistants, stated that showers are given according to a shower schedule in the nurse's station. She further noted that if a shower is given, it is documented in the shower section under tasks. She then proceeded to show Surveyor the shower schedule pointed out in the shower book in the unit. Upon observation, it was shown that Resident #418 shower days were scheduled for Mondays and Thursdays from the 11 to 7 shift. She further reported that she had not had a chance to give Resident #418 a shower in the past since she had her on different days. When asked if Resident #418 has specific days and times that she likes her showers to be taken, she did not know. In an interview conducted on 06/30/22 at 12:30 PM, with the facility's Director of Nursing, she was informed of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure residents will remain free from falls for 2 of 2 residents reviewed for falls (Residents #58 and #59). The findings included: Review of the facility's policy, titled Fall Prevention Program, date revised 01/2022, revealed the following: Definition of a fall is an event in which an individual unintentionally comes to rest on the ground, floor, or other level, but not as a result of an overwhelming external force. The event may be witnessed, reported, or presumed when a resident is found on the floor or ground, and can occur anywhere. When any resident experiences a fall, the facility will: Assess the resident, complete a post fall assessment, complete an incident report, notify the physician and family, review the resident's care plan and update as indicated, document all assessments and actions, obtain witness statements in the case of injury. 1) During the initial tour of the facility, the surveyor knocked on Resident #58's door on 06/27/22 at 9:36 AM. There was initially no answer, so the surveyor knocked again. The surveyor thought she heard someone asking for help. The surveyor opened Resident #58's door and found the resident with her legs and bottom on the floor and her head and arms on the bed. There was a wheelchair on Resident #58's right-hand side, and she was holding a cane in her right hand (which was on the bed). Resident #58 appeared to be in distress and asked the surveyor for help getting back into her bed. The surveyor saw an aide in the hallway and told the aide that Resident #58 needed help. The aide and a second staff member helped Resident #58 back into bed. The surveyor returned to Resident #58's room on 06/27/22 at 9:47 AM to interview her; at that time, she was in bed and covered with a blanket. Resident #58 stated to the surveyor, I feel sick all over, but was unable to answer any specific questions or give any further information to the surveyor. Resident #58 was admitted to the facility on [DATE]. Resident #58 had a medical history of dementia, cerebral atherosclerosis, psychosis, falls, anxiety, depression, restlessness/agitation, end stage degenerative disease of the nervous system (for which she is on Hospice). An admission Minimum Data Set (MDS) was completed on 05/02/22 which documented that Resident #58 had a Brief Interview of Mental Status (BIMS) score of 8, which indicates moderately impaired cognition. For functional status, this MDS showed Resident #58 required extensive assistance from one staff member for bed mobility, transfers, locomotion, dressing and total dependence of one staff member for toileting and personal hygiene. Resident #58 had a Care Plan in place regarding falls with interventions that included for staff to anticipate and meet needs, ensure call light is within reach, and offer and assist with toileting promptly. Resident #58 did not have any specific orders regarding fall risk status besides an order written (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 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 0689 on 04/22/22 for her bed to be in the low position while the resident is in bed. Level of Harm - Minimal harm or potential for actual harm An initial Morse Fall Scale was completed on 04/22/22 which documented that Resident #58 was at high risk for falling. Residents Affected - Few During the subsequent days of the survey, the surveyor noted that no documentation was done regarding the fall suffered by Resident #58 on 06/27/22. No orders were written for neurological checks. No incident notes were written and no neurological evaluations or fall risk assessments were completed. All subsequent observations made by the surveyor (06/28/22 at 8:30 AM, 06/28/22 at 10:30 AM, 06/29/22 at 8:30 AM, 06/29/22 at 11:46 AM, 06/29/22 at 1:50 PM, 06/30/22 at 9:22 AM) were of Resident #58 in her bed. An interview was conducted on 06/30/22 at 9:30 AM with Staff B, Registered Nurse. The surveyor asked if Staff B knows the facility's policy regarding neurological checks and incident notes following a fall. She replied that both neurological checks and incident notes should be completed for 72 hours. The surveyor asked for clarification, if these should be completed one time per day or on each shift for 72 hours. She replied these should be documented on each shift for 72 hours. The surveyor asked Staff B if she was working on 06/27/22 and Staff B confirmed that she was working day shift that day. When asked specifically about Resident #58 and her fall on 06/27/22, Staff B stated she did not remember being told by any staff members that Resident #58 had a fall on that day. An interview was conducted on 06/30/22 at 9:34 AM with Staff C, Certified Nursing Assistant. Staff C confirmed that she was the staff member in the hallway whom the surveyor asked to assist Resident #58 back into bed on 06/27/22. When the surveyor asked if she told Staff B about Resident #58's fall that morning, Staff C said she did not tell Staff B, but she did tell the floor supervisor and that the supervisor said she was going to tell Staff B about the fall. An interview was conducted on 06/30/22 at 9:37 AM with Staff D, Nursing Supervisor. Staff D confirmed that she was working day shift on 06/27/22. The surveyor asked if she remembered Staff C telling her about Resident #58 falling the morning of 06/27/22; she said yes, she did remember Staff C telling her about the fall. The surveyor asked if she remembered telling Staff B about Resident #58's fall; she said she does remember telling Staff B about the fall. Due to a breakdown in communication between the staff members, Resident #58 suffered a fall on 06/27/22 which was not properly relayed to her nurse. Because of this, the doctor was never notified of the fall, Resident #58 was never properly assessed post fall, and the fall was not properly documented in Resident #58's medical chart. 2) During the initial tour of the facility and initial interview of Resident #59 on 06/27/22 at 10:05 AM, Resident #59 told the surveyor that she had suffered a fall the night before, on 06/26/22. The surveyor observed that Resident #59 had lots of bruising on her arms. Resident #59 told the surveyor that she was taking a blood thinner. Resident #59 was admitted to the facility on [DATE]. Resident #59 had a medical history of diabetes, kidney disease, pressure ulcers, hypertension, mini strokes, blood clots, psychosis, and cancer. A Quarterly Minimum Data Set (MDS) completed on 05/03/22 documented that Resident #59 had a Brief Interview of Mental Status (BIMS) score of 15, indicating she was cognitively intact. For functional status, this MDS showed Resident #59 required limited assistance from one staff member for bed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few mobility, transfers, toileting, personal hygiene; independent for locomotion and eating; and extensive assistance from one staff member for dressing. Resident #59 had a Care Plan in place regarding her fall risk status. This was updated on 06/26/22 after she suffered her fall. The written interventions included for staff to offer and assist with frequent toileting, observe Resident #59 for low blood pressure, anticipate and meet needs, ensure call light is within reach, remind Resident #59 to call staff for assistance with transfers and toileting, neurological checks for 72 hours, monitor/document/report to doctor for 72 hours (pain, bruising, mental status changes, new onset confusion or sleepiness). Orders were written on 06/26/22 for x-rays of the lower extremities, knees, tibias & fibulas, ankles, wrists, and left shoulder. Orders were also written on 06/26/22 for neurological checks and post fall incident notes to be written every shift for 72 hours. On 06/28/22, orders were written for wound care to be done for Resident #59's right forearm, right knee, and left shin. An Incident Note was written on 06/26/22 at 11:20 PM which stated the following: Resident observed sitting on the floor. When asked resident what happened, she said she was trying to go to her w/c [sic: wheelchair]. Resident assisted back to bed, sustained 2 skin tears one to RT elbow and one below the Rt knee, TX [sic: treatment] applied. Resident able to move all extremities, VS [sic: vital signs] stable. Resident c/o [sic: complained of] pain, pain medication administered. MD [sic: physician] notified received order for X-ray, call place to family message left. A Neurological Check List was documented on 06/26/22 at 5:00 PM. A Morse Fall Scale was documented on 06/26/22 at 5:00 PM which showed the resident is at high risk for falling. A Post Fall Checklist was started on 06/26/22, but under Status, it said errors, so the surveyor was unable to review this document. A Skin Observation Tool was completed on 06/26/22 at 11:40 PM, which documented the new skin tear to right elbow and right knee (these were not noted on the previous Skin Observation Tool which was done on 06/21/22). It also documented that Resident #59's physician and family were notified of the fall. Further Incident Notes were written on 06/27/22 at 3:23 PM, 06/27/22 at 10:06 PM, and 06/29/22 at 3:03 PM. However, this does not satisfy the physician's order for Incident Notes to be documented every shift for 72 hours post fall. A second Neurological Check List was documented on 06/28/22 at 11:24 PM. However, this does not satisfy the physician's order for Neurological Check Lists to be documented every shift for 72 hours post fall. A Skin/Wound Note was written on 06/28/22 at 2:27 PM which stated the following: Follow up skin and wounds: Wound specialist in facility (6/27/22) to follow up on resident. Skin tears to the right forearm, right dorsal knee and left shin. Will apply Xeroform gauze daily and prn [sic: as needed]. An interview was conducted with Resident #59 on 06/29/22 at 11:55 AM. She stated she was still sore from her fall. The surveyor noted that Resident #59's right elbow and knee were wrapped in gauze per the wound care order. An interview was conducted on 06/30/22 at 9:30 AM with Staff B, Registered Nurse. The surveyor asked if Staff B knows the facility's policy regarding neurological checks and incident notes following a fall. She replied that both neurological checks and incident notes should be completed for 72 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete hours. The surveyor asked for clarification, if these should be completed one time per day or each shift for 72 hours. She replied it is each shift for 72 hours. The staff were aware of Resident #59's fall and there were proper orders in place for post fall assessments and documentation. However, the staff failed to properly and fully complete the assessment and documentation each shift for the ordered 72 hours. Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide nutritional interventions in a timely manner for 1 of 3 residents reviewed for nutrition (Resident #416). Residents Affected - Few The findings included: A review of the facility's policy titled Nutritional Management reviewed on 01/2022 showed the following: the facility provides care and services to each resident to ensure the resident maintains acceptable parameters of nutritional status. Monitoring of the resident's condition and care plan intervention will occur on an ongoing basis. A review of the facility's policy titled Weight Assessment/Evaluation and intervention revised on 04/20/22 showed the following: the multidisciplinary team will strive to prevent, monitor, and intervene for undesirable weight loss of residents. It further showed that 5 percent of weight loss in 1 month is significant, and greater than 5 percent is severe. A record review showed that Resident #416 was admitted to the facility on [DATE] with diagnoses dehydration, hemiplegia, and edema. The Minimum Data Set (MDS) dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 13 which is cognitively intact. In an interview conducted on 06/27/22 at 9:26 AM with Resident #416's family member, she stated that the resident has not been getting her fluids as needed and is dehydrated. She further noted that Resident #416 was in the hospital for dehydration on 06/17/22 and is concerned that the facility is not providing the resident with enough fluids. In this interview, Resident #416 wrote on paper that she had diarrhea recently and felt thirsty. She further noted that her lips are dry, and her tongue feels dry as well. In an observation conducted on 06/27/22 at 9:30 AM, Resident #416 was noted in her wheelchair. Closer observation showed that Resident #416's lips appeared dry and looked cracked on the edges. In a phone interview conducted on 06/27/22 at 9:35 AM with a different family member, she stated that she called the facility last week to tell them that the resident was dehydrated and that they needed to call 911, and she was taken to the hospital 3 hours later. She further reported that the hospital doctor told her that her mom was dehydrated. In an observation conducted on 06/28/22 at 10:30 AM, Resident #416 was noted in her room. The fluid bag at the bedside was pointed out with a water level of 700 milliliters (ml) out of a 1000 ml bottle. Closer observation showed a start date of 06/27/22 with no start time. The water tube was not connected to the tube feeding at the observation time. In this observation, Resident #416's family member said, you see, she is not getting her fluids as needed. In an interview conducted on 06/28/22 at 11:00 AM, Resident #416's family member stated that she visits daily. She further reported that Resident #416 is not eating any of her meals and is dependent on tube feeding to provide most of her nutrition. A review of the weights for Resident #416 showed the following weights: admission weight on 06/11/22 was 123.2 pounds, 116 pounds on 06/16/22, and 111 pounds on 06/24/22. The weight drop from 123.2 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 pounds to 116 pounds showed a 5.8 percent significant weight loss in 5 days. Level of Harm - Minimal harm or potential for actual harm The Enteral Nutrition assessment dated [DATE] showed that Resident #416 was started on tube feeding Glucerna (formulary) 1.2 at 45 milliliters an hour times 12 hours. It also showed that the Resident would be provided with 3 meals a day, and the tube feeding rate would be increased if her intake of meals is poor. In this assessment, Resident #416 remained at risk for altered nutrition and hydration status. Residents Affected - Few A review of the Physician's orders showed an order for auto flashes enteral tube water with 30 ml times 16 hours dated 06/23/22. Enteral feeding order with Glucerna 1.2 at 65 ml an hour times 12 hours dated 06/23/22. A Nutrition Progress note dated 06/22/22, 6 days after the severe weight loss was identified, showed the following: significant weight loss of 6 percent in 1 week and current tube feeding formula Glucerna 1.2 at 45 ml times 12 hours. In this note, Staff J, Clinical Dietitian, recommended increasing the tube feeding rate to 65 ml an hour times 16 hours due to poor intake of meals. A Nutrition Progress note dated 06/24/22 showed a significant weight loss of 10 percent in 2 weeks for Resident #416. Resident #416's intake of meals, and tube feeding tolerance will be monitored. A progress note dated 06/28/22 showed that the Resident communicated via writing with the Clinical Dietitian. She reported that she could not swallow and prefers being on a continuous tube feeding protocol. A review of the Physician's orders showed an order for tube feeding Glucerna 1.2 at 65 ml an hour times 12 hours that was ordered on 06/23/22. This was 7 days after the severe weight loss was identified. The care plan initiated on 06/13/22 showed that Resident #416 has the potential for dehydration and fluid deficit. She is in increased need of assistance with malnutrition and failure to thrive. It further showed that Resident #416 would maintain adequate nutrition and hydration. An interview was conducted on 06/30/22 at 10:00 AM with Staff J and Staff K, Clinical Dietitians. They reported that high-risk nutrition residents are the ones who are on tube feeding, have a poor appetite, and have weight loss. The weights are taken by restorative staff and given to them to enter the electronic system. This way, they can catch any weight loss as soon as possible. Staff J stated that any resident on a tube feeding with weight loss should be addressed within 48 hours. Any recommendations for tube feeding changes are placed in the electronic system pending physicians' approval. He further said that since Resident #416 went to the hospital for 1 day, he missed her coming back and assessing the weight loss. Staff K reported that Resident #416 is not eating her meals, which is why they changed the tube feeding rate and timing. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 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 observations, interviews, and record reviews, the facility failed to ensure oxygen tubing was changed in a timely manner for 2 of 2 sampled residents (Residents # 4 and #48). Residents Affected - Few The findings included: Review of the facility's policy titled Oxygen Administration, date revised 1/2022, revealed the following: Change oxygen tubing and mask/cannula weekly and as needed if it becomes soiled or contaminated. 1) During the initial tour of the facility and initial interview with Resident #4 conducted on 06/27/22 at 8:40 AM, an observation was made that Resident #4 was on oxygen at 2 liters per minute via nasal cannula (tubing designed to deliver oxygen directly into a resident's nose). Resident #4's nasal cannula tubing was dated 06/16/22. Resident #4 was originally admitted to the facility on [DATE]. Resident #4 was hospitalized multiple times for urinary tract infections and respiratory issues. Her last readmission to the facility was on 07/01/21. Resident #4 has a medical history of respiratory failure, altered mental status, muscle weakness, depression, pneumonia, anxiety, chronic obstructive pulmonary disease, heart failure, morbid obesity, pleural effusions, diabetes, pulmonary HTN, and atrial fibrillation. A Quarterly Minimum Data Set (MDS) completed on 06/17/22 showed Resident #4 had a Brief Interview of Mental Status (BIMS) score of 15, which indicates she was cognitively intact. This MDS also documented that Resident #4 was on oxygen therapy. Resident #4 had a Care Plan in place regarding her use of oxygen. Written interventions included ensuring Resident #4 maintains proper body alignment for optimal breathing and monitoring for breathing abnormalities and reporting any to the physician. Resident #4 had an active order which was placed on 03/30/21 for oxygen to be administered at 2 liters per minute via nasal cannula. Subsequent observations were made by the surveyor on 06/29/22 at 11:50 AM and 06/30/22 at 9:20 AM of Resident #4's oxygen tubing. Both of these observations revealed the nasal canula tubing was still dated 06/16/22. (Photographic evidence obtained). An interview was conducted on 06/30/22 at 9:30 AM with Staff B, Registered Nurse. The surveyor asked Staff B if she knows what the facility policy is for how often to change oxygen tubing. She replied, it should be changed weekly. The staff of the facility properly followed physician's orders for Resident #4's oxygen use but did not follow facility policy regarding the changing of oxygen tubing weekly. 2) During the initial tour of the facility on 06/27/22 at 10:05 AM, the surveyor observed that Resident #48 was receiving oxygen at 2 liters per minute via nasal cannula. The surveyor noted that Resident #48's nasal cannula tubing and the oxygen tubing connected to the respiratory medication nebulizer machine were both dated 06/16/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #48 was admitted to the facility on [DATE]. Resident #48 had a medical history of chronic obstructive pulmonary disease, dyspnea, respiratory failure, cardiomyopathy, anxiety, cerebral infarction, atrial fibrillation, depression, psychosis, and reduced mobility. A Quarterly Minimum Data Set (MDS) completed on 04/30/22 showed Resident #48 had a Brief Interview of Mental Status (BIMS) score of 13, which indicates she was cognitively intact. This MDS also documented that Resident #48 was on oxygen therapy. Resident #48 had a Care Plan in place regarding her use of oxygen. Written interventions included for staff to keep the head of the bed elevated, administer medications as ordered, remind Resident #48 not to push beyond endurance, monitor for anxiety, and monitor difficulty breathing on exertion. An order was placed on 02/17/22 for Resident #48 to receive oxygen continuously via nasal cannula at 2 liters per minute. An order was placed on 07/21/21 for Resident #48 to receive Albuterol Sulfate Nebulization Solution to be inhaled orally via nebulizer every 6 hours as needed for Shortness of Breath. An order was placed on 07/30/21 for Resident #48 to receive Ipratropium-Albuterol Solution to be inhaled orally every 4 hours as needed for Shortness of Breath or Wheezing via nebulizer. Subsequent observations were made by the surveyor on 06/29/22 at 2:00 PM and 06/30/22 at 9:24 AM of Resident #48's nasal cannula and nebulizer tubing. Both of these observations revealed the tubing remained dated 06/16/22. (Photographic evidence obtained). An interview was conducted on 06/30/22 at 9:30 AM with Staff B, Registered Nurse. The surveyor asked Staff B if she knows what the facility policy is for how often to change oxygen tubing. She replied, it should be changed weekly. The staff of the facility properly followed physician's orders for Resident #48's oxygen use but did not follow facility policy regarding the changing of oxygen tubing weekly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2) On 06/27/22 at 8:25 AM, during an initial observational room tour, it was noted that there was a roll-on container of over-the-counter (OTC) un-dated Icy Hot Medication with Lidocaine 4% located on the over-the-sink shelf next to Resident #109's bedside; it was unsecured, accessible and available to other residents, staff members and visitors. Resident #109 was originally admitted to the facility on [DATE] with diagnoses which included Cerebral Infarction, Chronic Kidney Disease, Peripheral Vascular Disease, Diabetes. She had a Brief Interview Mental Status (BIM) score of 15 (cognitively intact). Photographic evidence obtained of the (OTC) Icy Hot Medication with Lidocaine 4% medication. On 06/27/22 at 8:30 AM, subsequently, it was also noted that there was a half-filled round plastic jar container of prescription Triamcinolone Acetonide cream 0.1% with a refill date of 04/29/22 for Resident #109 along with a half-filled container of un-dated (OTC) Ammonium Lactate 12% moisturizing lotion, both located on the joint dresser top, in plain view, between both Resident #109 and Resident #8, residing in the room; both containers were unsecured, accessible and available to other residents, staff members and visitors. Resident #8 was admitted to the facility on [DATE] with diagnoses which included Transient Cerebral Ischemic Attack, Epilepsy, Mood Disorder, Aphasia, Diabetes, Failure, Atrial Fibrillation and Gastrostomy. She had a Brief Interview Mental Status (BIM) score of 03 (severely impaired). (Photographic evidence obtained of the (OTC) Ammonium Lactate 12% moisturizing lotion and of the prescription container of Triamcinolone Acetonide cream 0.1% medication). During a brief interview with Resident #109 on 06/27/22 at 8:37 AM, this surveyor inquired of Resident #109, regarding the (OTC) Ammonium Lactate 12% moisturizing lotion and of the prescription container of Triamcinolone Acetonide cream 0.1% medication and the Icy hot Medication with Lidocaine 4% on her sink and joint dresser, the resident replied that as far as she knew the medication creams have been there in her room, used for her back pain, but she was not sure for how long. On 06/27/22 at 2:25 PM, during a second observational room tour, it was still noted that there was a roll-on container of (OTC) un-dated Icy hot Medication with Lidocaine 4% located on the over-the-sink shelf next to Resident #109's bedside. On 06/27/22 at 2:30 PM, subsequently, it was still noted that there was a half-filled round plastic jar container of prescription Triamcinolone Acetonide cream 0.1% with a refill date of 04/29/22 for Resident #109 along with a half-filled container of un-dated (OTC) Ammonium Lactate 12% moisturizing lotion, both located on the dresser top, in plain view, between both Resident #109 and Resident #8, residing in the room. On 06/28/22 at 9:30 AM and 3 PM, during a third and fourth observational room tour, it was still noted that there was a roll-on container of (OTC) un-dated Icy hot Medication with Lidocaine 4% located on the over-the-sink shelf next to Resident #109's bedside. On 06/28/22 at 9:35 AM and 3:05 PM, it was still noted that there was a half-filled round plastic (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few jar container of prescription Triamcinolone Acetonide cream 0.1% with a refill date of 04/29/22 for Resident #109 along with a half-filled container of un-dated (OTC) Ammonium Lactate 12% moisturizing lotion, both located on the dresser top, in plain view, between both Resident #109 and Resident #8, residing in the room. On 06/29/22 at 9:40 AM and 1:00 PM, during a fifth and sixth observational room tour, it was still noted that there was a roll-on container of (OTC) un-dated Icy hot Medication with Lidocaine 4% located on the over-the-sink shelf next to Resident #109's bedside. On 06/29/22 at 9:45 AM and 1:05 PM, it was noted that there was a half-filled round plastic jar container of prescription Triamcinolone Acetonide cream 0.1% with a refill date of 04/29/22 for Resident #109 along with a half-filled container of un-dated (OTC) Ammonium Lactate 12% moisturizing lotion, both located on the dresser top, in plain view, between both Resident #109 and Resident #8, residing in the room. Side-by-side record review was conducted with Staff A, a Licensed Practical Nurse (LPN), which indicated that neither Resident #109's nor Resident #8's hard copy chart nor their computerized medical record indicated that the residents had any self-assessment completed in order for them to be able to administer their own medications. An interview was conducted on 06/29/22 at 1:11 PM with Resident #109 and Resident #8's nurse, Staff A, an (LPN), regarding the (OTC) and prescription medications containers observed on Resident #109 and Resident #8's sink and joint dresser table, and she acknowledged that the prescription and (OTC) medication containers should not have been there. There was no order on Resident #109's nor Resident #8's Medication Administration Record (MAR) for the (OTC) and prescription medications to be administered to either of these residents. The (OTC) and prescription medications were not removed from either of these residents' sink/joint dresser table, until after surveyor intervention. On 06/29/22 at 2:02 PM the Director of Nursing (DON) further acknowledged and recognized that the (OTC) and prescription medications should not have been left unsecured at either of the resident's sink or joint dresser tables. Based on observations, interviews, and record reviews, the facility failed to properly secure treatment carts and the facility failed to properly secure medications at the resident's bedside (Resident's # 109 and #8). The findings included: Review of the facility's policy, titled Storage of Medications (undated), revealed the following: The facility shall store all drugs and biologicals in a safe, secure, and orderly manner. The nursing staff shall be responsible for maintaining medication storage AND preparation areas in a clean, safe and sanitary manner. The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals. All such (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 drugs shall be returned to the dispensing pharmacy or destroyed. Level of Harm - Minimal harm or potential for actual harm Compartments (drawers, cabinets, rooms, refrigerators, carts, and boxes) containing drugs or biologicals shall be locked when not in use, and trays or carts used to transport such items shall not be left unattended if open or otherwise potentially available to others. Residents Affected - Few 1) During the initial tour of the facility conducted on 06/27/22 at 08:00 AM, the surveyor noted a treatment cart was left in the hallway unlocked directly outside of room [ROOM NUMBER]. The surveyor walked past the same treatment cart at 8:15 AM and it continued to be unlocked and unattended in the same location of the hallway. The surveyor walked past the cart again at 8:28 AM, during observation of breakfast trays being delivered to the residents, and there were two staff members removing items from the cart. These items being removed appeared to be wound care supplies. After the two staff members were finished removing the items from the treatment cart, the cart was locked by one of the staff members. This hallway did have residents who were mobile and able (and observed) to be in the hallway unattended throughout the survey. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4). Review of Resident #71, clinical record documented an initial admission on [DATE] with no readmission. The resident's diagnoses included Anxiety Disorder, Major Depressive Disorder, Anemia, Transient Ischemic Attack (TIA), Aphasia (loss of ability to understand or express speech) and Ataxia (presence of abnormal, uncoordinated movements) following Cerebral Infarction. Review of Resident #71's Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 6 indicating that the resident had severe cognition impairment. The assessment documented under Functional Status section that the resident needed set-up only with meals. Review of the resident's care plan titled (Resident #71) is at risk for altered nutrition/hydration status and weight changes . initiated on 08/18/21 and revised on 05/18/22. The care plan interventions included: provide, serve diet as ordered .Monitor intake and record every meal . Review of the physician orders dated 04/02/22 documented a diet as NAS (No Added Salt) diet, level 5Minced & Moist (mechanical soft/ground) texture . On 06/28/22 at 11:50 AM, observation revealed Resident #71 in bed sitting up at the edge of the bed with a fork in his hand. Attempted to interview the resident and he did not answer or attempt to answer questions asked. Continue observation revealed the resident's lunch tray had a medium size raw piece of kale. Consequently, a review of the resident's meal ticket was conducted and documented 5- Minced & Moist Mechanical soft/ground diet. At 12:05 PM, continue observation revealed the resident's tray was picked up by Staff G, a Certified Nursing Assistant (CNA). During an interview, Staff G stated the resident ate 25-50% of his meal. The raw piece of kale was still in his tray. On 06/29/22 at 1:37 PM, a joint interview was conducted with Staff J, RD and Staff K, RD. Staff J stated he had followed Resident #71 since his admission. Staff J stated the resident's diet was No added salt, minced, moist texture. Staff K stated the facility had implemented the International Dysphagia Diet Standardization Initiative (IDDSI). Resident #71 diet was on a level-5, soft and moist .easy to squash with tongue. Staff K and Staff J were asked if the resident's meal should have a raw kale on his tray and they stated No. On 06/30/22 at 9:34 AM, an interview was conducted with the facility's Speech Therapist (ST) and she stated raw kale/garnish couldn't be moisten, and should not be on Resident #71's tray. Based on observations, interviews, and chart review, the facility failed to provide the correct diet consistencies per the Physician's orders for 4 of 4 sampled residents during dining observations (Residents #80, #10, #8 and #71). The findings included: Review of the facility guidelines titled Minced and Moist taken from the Audit Tool dated June 2020 showed that foods could be easily mashed with little pressure from a dinner fork and easily (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few separated. Minimal chewing should be needed to eat this food texture, and tongue force should be able to break the food. Review of the facility guidelines titled Soft and Bite-Sized taken from the Audit Tool dated June 2020 showed that chewing abilities are needed for this texture, although biting is not required. Pieces should be bite-size at the time of serving and must be equal to or less than 15 millimeters by 15 millimeters. 1.) A record review showed that Resident #80 was admitted on [DATE] with diagnoses of Dementia, and Anemia. Review of the Minimum Data Set (MDS) dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 08, which is cognitively impaired. A review of Physicians' orders showed an order for House Diabetic, No Added Salt diet 6- Soft & Bite-sized (Chopped Meats) texture, 0- Thin consistency dated 04/02/22. In an observation conducted on 06/28/22 at 12:17 PM in the main dining room on the second floor, the following was noted: Resident #80 was noted eating her lunch meal with a meal ticket that had an order for Soft & Bite-sized (Chopped Meats). Closer observation showed a large piece of raw kale that was used as a garnish on the plate. (Photographic evidence obtained). 2.) A record review showed that Resident #10 was readmitted on [DATE] with diagnoses of Dementia, Anxiety and Anemia. A review of Physicians' orders showed an order for Regular diet 5- Minced & Moist (mechanical soft/ground) texture, 0- Thin consistency, no rice, which was dated 04/15/22. Review of the Minimum Data Set (MDS) dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 06, which is cognitively impaired. In an observation conducted on 06/28/22 at 12:17 PM in the main dining room on the second floor the following was noted: Resident #10 was noted eating his lunch meal with a meal ticket that had an order for Regular diet 5- Minced & Moist (mechanical soft/ground) texture. Closer observation showed a large piece of raw piece of kale that was used as a garnished on the plate. (Photographic evidence obtained). 3. A record review showed that Resident #8 was admitted on [DATE] with diagnoses of altered mental stats, dysphagia, and diabetes. A review of Physicians' orders showed an order House Diabetic, No Added Salt diet 5- Minced & Moist (mechanical soft/ground) texture, 0- Thin consistency, dated 04/02/22. Review of the Minimum Data Set (MDS) dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 03, which is severely cognitively impaired. In an observation conducted on 06/28/22 at 12:17 PM in the main dining room on the second floor the following was noted: Resident #8 was noted eating her lunch meal with a meal ticket that had an order for House Diabetic, No Added Salt diet 5- Minced & Moist (mechanical soft/ground) texture, 0- Thin consistency. Closer observation showed a large piece of raw piece of kale that was used as a garnish on the plate. (Photographic evidence obtained). An interview conducted on 06/30/22 at 9:35 AM with the facility's Speech Therapist who stated that the facility follows the International Dysphagia Diet, which is broken down into 7 levels. Level 5 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105083 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 105083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Nursing & Rehabilitation Center 1330 S Andrews Ave Fort Lauderdale, FL 33316 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete foods are moist and minced, and level 6 foods are bite-size and moist. When asked if raw Kale is an appropriate food texture for Level 5 and Level 6 diets, she said no. She further stated that the central kitchen is aware of the different levels of food textures and follows these guidelines. In an interview conducted on 06/30/22 at 10:00 AM with Staff J and Staff K, the facility's Clinical Dietitians they stated that raw Kale should not be on the trays of any residents on Level 5 and Level 6 diet consistencies. Staff K said, They know better than that, but you know mistakes are sometimes made. Event ID: Facility ID: 105083 If continuation sheet Page 18 of 18