Health inspection·April 28, 2022

F 0677 In an interview conducted on 04/28/22 at 4:30 PM, with the facility's Administrator she was told of he findings. 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: 105089 If continuation sheet Page 2 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview and record review, the facility failed to perform appropriate nutrition monitoring on a resident with oral intake; failed to re-assess by monitoring weights per facility policy; and failed to address or prevent the resident's avoidable significant severe, weight loss of 36 percent for 1 of 6 sampled residents reviewed for nutritional risk (Residents #78). Residents Affected - Few The findings included: Review of the facility's policy titled Weights Record maintenance and Interventions Revised March 2021 showed the following: The nursing staff will measure residents' weight within 72 hours of admission and one week after the 1st weight. If no weight concerns are noted at this point, weight will be measured monthly thereafter. Any weight change of 5 pounds or more, since last weight assessment will be taken for confirmation. The threshold for significant unplanned and undesired weight loss will be based on the following criteria (where percentage of body weight loss = (usual weight-actual weight)/(usual weight) times 100. 1 month 5% weight loss is significant; greater than 5% is severe, 3 months 7.5% weight loss is significant; greater than 7.5% is severe and 6 months 10% weight loss is significant; greater than 10% is severe. The care planning for weight loss or impaired nutrition will be a multidisciplinary effort and may include nursing staff, the dietitian and the pharmacist. Review of the facility's policy titled Nutritional Assessment revised in October 2017, showed the following: the dietitian in conjunction with the nursing staff will conduct a nutritional assessment for each resident upon admission and as indicated by a change in conditions that places the resident at risk for nutritional impairment. As part of the comprehensive assessment, the nutritional assessment will be a process that included gathering and interpreting data and using the data to define meaningful interventions for the resident at risk. The Dietitian will assess whether the resident's current intake is adequate to meet his or her nutritional needs and any changes in chewing and swallowing abnormalities. Review of Resident #78's clinical record documented an original admission to the facility on [DATE] transferred to a local hospital on [DATE] and readmitted to the facility on [DATE]. Diagnoses included Parkinson's disease, Unspecific calorie and protein malnutrition, Anemia and Metabolic encephalopathy. The care plan with an onset date of 03/07/22 showed that Resident #78 will be provided with the diet as ordered and continue to observe intake of meals and weights. It further showed the Resident #78 will gradually lose weight monthly of 1-3 pounds a week, and to recommend supplements as needed. Resident #78's Minimum Data Set (MDS) admission assessment dated [DATE], documented a Brief Interview of the Mental Status (BIMS) score of 0 indicating that the resident had severe cognition impairment. The assessment documented under Functional Status revealed that Resident #78 needed extensive assistance with her activities of daily living and was total care for bathing activity. The assessment documented that Resident #78's weight was 173 pounds (lbs.) and Section K of the assessment documented no signs or symptoms of possible swallowing disorders. Review of Resident #78's paper chart contained hospital record that documented that on 02/20/22 the resident weight was 77.11 kgs. (169 lbs.). Review of the weight change history for Resident #78 showed an admission weight on 02/24/22 at 173 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 3 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Level of Harm - Actual harm Residents Affected - Few pounds, weight of 110 pounds on 04/06/22, weight of 106 pounds on 04/19/22 and a weight of 104 pounds on 04/26/22. This revealed that Resident #78 lost 36 precent (63 pounds) of her body weight from 02/24/22 to 04/06/22. The Physician's' Order List showed the following orders for Resident #78: No added salt, low concentrated sweets, Pureed diet dated 02/22/22, Liquid protein 30 millimeters by mouth daily dated 02/22/22, Marinol (appetite stimulant) 2.5 milligrams twice a day dated 04/20/22, and Glucerna (nutritional supplement) 1.5 calories can 3 times a day which was dated 04/20/22. The Nutritional History assessment dated [DATE], which was done after Resident #78's readmission, showed the following: Resident #78 is diagnosed with depression, dementia, and low Hemoglobin; and Stage 2 pressure ulcer in the sacrum area per nursing assessment. It further revealed that Resident #78 was readmitted from the hospital with estimated caloric needs of 1975 calories and 111 grams of protein a day. Protein supplements were recommended, and no other nutritional supplements were noted. This assessment was completed by Staff O, Registered Dietitian (RD). The Meal Intake documentation in the electronic system showed that from 02/25/22 to 03/29/22, only ten meals were documented for percent consumption. No percent intake of meals was documented from 03/02/2 to 03/14/22. From the recorded ten meals, Resident #78 consumed 30 percent to 50 percent of her meals. Continued review of the meal intake from 03/29/22 to 04/19/22 showed that following: 7 meals were consumed at 51 to 75 percent intake, 1 meal was consumed at 76 to 100 percent, 6 meals were consumed at 5 to 25 percent and 4 meals were consumed at 26 to 50 percent. A progress note dated 03/04/22, 12 days after Resident #78's readmission, showed no tongue movement to swallow food, and Resident #78 is at high risk for nutritional decline. A note dated 03/05/22 revealed that Resident #78 is not initiating tongue movement for swallowing and to contact the doctor for being at risk for aspiration, dehydration, and malnutrition. Another progress note dated 03/05/22 showed that Resident #78 is at high risk for nutritional decline. A progress note dated 03/10/22 noted that Resident #78 was with a good appetite and fluids intake. On 03/20/22, it was noted that Resident #78 could not swallow properly. An Interdisciplinary team note dated 03/03/22 that was found in Resident #78's paper chart showed that Resident #78 is at risk for nutritional decline. This was based on clinical observations and at aspiration risk, which was done by Staff D, Speech Language Pathologist (SLP). Another Interdisciplinary team note dated 03/04/22 which was placed by Staff D and showed that Resident #78 is at nutritional decline with no tongue movement (photographic evidence obtained). The Speech Therapist Evaluation dated 03/03/22 showed that Resident #78 had a swallow delay of 4 seconds and was exhibiting severe oral pharyngeal dysphagia. It further showed that Resident #78 was with impairment and at high risk for aspiration and significant weight loss. A progress note by the Clinical Dietitian dated 03/29/22 did not address any of the above concerns for high nutritional risks and the Clinical Dietitian recommended to continue with the same plan of care that was recommended on 02/22/22. In this note, a reweight was requested on Resident #78. Continued review of the Clinical Dietitian's notes showed that on 04/08/22, Staff N, Registered Dietitian, (RD) reported that Resident #78 was with fair intake of meals and that the review of the meal intake documentation in the electronic system showed varied intake of meals. In this note, Staff N, requested a reweight and recommended the Glucerna 1.5 (nutritional supplements) twice a day. She further noted that she will follow up on Resident #78's weight but did not address the weight of 110 pounds that was already recorded in the electronic system. On 04/19/22, Staff N recommended an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 4 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Level of Harm - Actual harm Residents Affected - Few appetite stimulant and noted that a verbal weight of 106 pounds was given to her by Certified nursing assistant. In this note, Staff N stated that the Resident #78 did not appear to have had a significant weight loss. In an observation conducted on 04/25/22 at 11:14 AM, showed Resident #78 in bed with the mouth opened. Further observation revealed a beige color quarter size matter in her mouth and a clothing protector was in place. There was no food tray in the resident's room. On 04/26/22 at 2:25 PM, an interview was conducted with Staff R, CNA, who stated that Resident #78 was a total care and needed feeding assistance. Staff R reported that Resident #78 ate 25 precent of her breakfast, 50 percent of her lunch and drank 50 to 100 percent of her liquids. When asked if Resident #78 lost weight she said, I cannot tell if she lost weight or not. On 04/27/22 at 9:02 AM, an interview was conducted with Staff W, a Registered Nurse (RN) who stated that Resident #78 was on Glucerna (dietary supplement) three times a day and that they had to spoon feed it. Staff W was asked if she was aware of Resident #78's meal intake and she said no. She further stated that the Certified Nursing Assistants document in the computer and let the Clinical Dietitian know of any weight loss. On 04/27/22 at 12:35 PM, observation revealed Resident #78 in bed and Staff R, CNA providing feeding assistance. Further observation revealed the Resident #78 ate 50% of her Pureed diet and 90% of Glucerna supplement. On 04/27/22 at 3:40 PM, an interview was conducted with Staff N, RD and Staff O, RD. They were asked about Resident #78's significant weight loss from 173 pounds on 02/24/22 to 110 pounds on 04/06/22 and the lack of weight recorded for the month of March 2022.Staff N stated that they used to have a staff member that oversaw taking all weights, but she left the facility in March. Staff N stated that Staff U, Certified Nursing Assistant (CNA) was doing some of the weights for the most part. Staff N reported that she requested a weight on Resident #78 which was not done, and she requested a weight again on 04/05/22 which was done on 04/06/22 at 106 pounds. Staff N stated that on 04/08/22 she requested Resident #78 to be weighted and was not done. She further said that she added Glucerna supplement twice a day and requested reweight again on 04/11/22 which was also not done. This continued 04/15/22 and was finally given a new reweight on 04/19/22 which was at 106 pounds. According to Staff N, she attempted to call Resident #78's representative on 04/20/22 and was not able to leave a voice message. In this interview, Staff O was asked as to why he did not address the concerns regarding Resident #78's nutritional status in his note on 03/29/22, he did not know. When asked if he saw the two Interdisciplinary team notes dated 03/03/22 and 03/04/22 that were placed in the paper chart, he said no. He further stated that he does not look in the paper chart when doing reassessments. A review of the care plan for Resident #78 showed that the Resident started on Marinol, (appetite stimulant), with nutritional supplements 3 times a day which was only updated on 04/21/22. Further review showed that the goals were never updated to reflect the significant weight loss, and remained at gradual weight loss 1-3 pounds a week. On 04/27/22 at 4:06 PM, observation of Resident #78's weight was taken by Staff S and Staff T, Certified Nursing Assistants (CNA) with a mechanical lift scale. Observation revealed that Resident #78's weight was 105.5 lbs. On 04/28/22 at 12:56 PM, an interview was conducted with Staff D, SLP, who stated that Resident #78 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 5 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Level of Harm - Actual harm Residents Affected - Few was under her care from 03/03/22 to 04/03/22 and was discharged due to her meeting her goals. She was then asked how she communicates with other team members, and she said it is through an Interdisciplinary communication note. Staff D reported that she placed the Interdisciplinary communication notes on 03/03/22 and 03/04/22 in the paper chart for nursing. She also said that she told the nurse verbally of her concerns regarding Resident #78. Staff D said that she also left a note in the Dietary box outside the kitchen for the Clinal Dietitian. According to Staff D, Resident #78 did much better with improved swallowing skills after her initial assessment on 03/03/22. On 04/28/2022 at 1:42 PM, an interview was conducted with the facility's Administrator and the Director of Nursing (DON). The DON stated they did not have a dedicated or an assigned person to do the resident's weight for about a year. The DON stated that Staff U, CNA had been scheduled to do the weights once a week. The Administrator added that the therapists were helping with the weights for those residents that are ambulating. When asked if they had a weekly schedule for the staff who are doing the weights, they said no. During an interview on 04/28/22 at 2:11 PM with Staff U, CNA stated that she does the weights once a week and that if she is on the floor, she will ask other aides to help her take the weights. Staff U said that she is given a list from Dietary with monthly weights and any additional weights needed for reweights. The Rehab Department sometimes helps with taking weights, and she oversees putting the weights into the electronic system. Staff U further reported any weight changes or weight loss; she will report it to the nurse that is assigned to that resident. They are not recording the type of scales that are used each time they weigh a resident, and it is not done at the same time of the day. Staff U further said that at the end of March 2022, she was assigned to do residents' weights plus her other additional duties. When asked by a surveyor, Staff U did not recall taking the weight on Resident #78 in April 2022. When entering the weights in the computer system, she does not inform the Clinical Dietitian of any weights that she did not get to do. In a follow-up interview conducted on 04/28/22 at 2:36 PM, with Staff N, RD, and Staff O, RD, they stated that they pull the weights at the beginning of the month and determine who needs to be weighted. They give the list to Staff U, CNA, who takes the weights on all residents. They do not have an electronic system in place to let them know of any residents who are missing monthly weights. They need to manually investigate each resident to see which ones are missing the monthly weights. When asked why they did not get a reweight on Resident #78, Staff N said she repeatedly requested Staff U to provide the weight and it was not done. Staff N further reported that she was never given the SLP's Interdisciplinary note written on 03/03/22. She was unsure why Staff D addressed it to nursing and not Dietary, which she often does. Staff O stated that he did not provide Resident #78 with nutritional supplements on 03/29/22 because he was not aware of the weight loss of 36 percent. In an interview conducted on 04/28/22 at 2:55 PM with Staff L, Unit Manager who stated that she did not recall anyone telling her about Resident #78's weight reading this month (April 2022). Review of the weight list given to Staff U, which was provided by Staff O, RD, showed that a reweight was requested on Resident #78 on the following days: 04/01/22, 04/05/22, 04/11/22 and 04/15/22. In an interview conducted on 04/28/22 with the DON, and the facility's Administrator, they stated that a Quality Performance Improvement was identified on weights and residents with weight loss which was in July 2021. The Administrator reported that they are monitoring Significant weight loss with specific interventions in place. The DON stated that they are assigning staff to do the weights for the day, depending on the staffing for that day. Surveyor expressed concern that the weight loss for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 6 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 Resident #78 was not identified earlier. They further acknowledged all findings. Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 7 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 0697 Provide safe, appropriate pain management for a resident who requires such services. 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 order, receive and administer pain medications for 1 of 2 sampled residents reviewed for pain management (Resident #49). Residents Affected - Few The findings included: The facility's policy for 'Pain Assessment and Management', dated 2001 and most recently revised March 2015, documented: General Guidelines 2. Pain management is defined as the process of alleviating the resident's pain to a level that is acceptable to the resident and is based on his or her clinical condition and established treatment goals. Recognizing pain 1. Observe the resident (during rest and movement) for physiologic and behavioral (non-verbal) signs of pain. 2. Possible Behavior signs of pain: a. Verbal expressions such as groaning, crying, screaming; b. Facial expressions such as grimacing frowning, clenching of the jaw, etc.; c. Changes in gait, skin color and vital signs. The facility's policy for 'Medication and Treatment Orders' dated 2001 and most recently revised July 2016, documented: 11. Drugs and biologicals that are required to be refilled must be reordered from the issuing pharmacy not less than three (3) days prior to the last dosage being administered to ensure that refills are readily available. Resident #49 was admitted to the facility on [DATE] and most recently readmitted on [DATE]. According to Resident #49's most recent complete assessment, an admission Minimum Data Set (MDS), dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 8 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 0697 Level of Harm - Minimal harm or potential for actual harm [DATE], Resident #49 had a Brief Interview for Mental Status (BIMS) score of 15, indicating 'cognitively intact'. The assessment documented that Resident #49 required assistance with Activities of Daily Living (ADLs), with the exception of eating. Resident #49's diagnoses at the time of the assessment included: Atrial fibrillation; Hypertension; GERD; Drug-induced polyneuropathy; Nicotine dependence; History of falling; Pressure ulcer of sacral region; Escherichia coli as the cause of diseases classified elsewhere. Residents Affected - Few Resident #49's orders included: Gabapentin 300 mg capsule - give one capsule by mouth, one time a day - 04/25/22. Gabapentin 600 mg capsule - Administer one tablet by mouth at 2PM and 10PM daily - 04/25/22. Acetaminophen 325 mg tablet - give two tablets (650 mg) by mouth daily prior to wound care - 02/10/22. Acetaminophen 325 mg tablet - give two tablets (650 mg) by mouth every four hours as needed for pain 02/10/22 Oxycodone HCL (IR) 10 mg tab - one tab by PO every 4 hours PRN, on ucute pain - 02/10/22. Resident #49's care plan, dated 01/21/22, documented, risk for pain related to multiple wounds upon admit, diagnosis of neuropathy The goal of the care plan was documented as, Will verbalize pain relief/show non-verbal signs or symptoms of pain/discomfort ½ to 1 hour after medication intervention with a target date of 06/21/22 Interventions to the care plan included: * Observe for non-verbal signs and symptoms of pain (eg. Changes in breathing, grunting, mons, constant motion, grimacing and other resident specific changes) nd provide interventions as indicated. * Medicate ½ to 1 hour prior to treatment (therapy or wound care as indicated. * Monitor for any patterns of pain and documented on positive findings. * Administer pain medication as requested/ordered. Document effectiveness, location, severity. A Nursing note, dated 02/19/22 at 3:23, documented, Resident complained of Methadone making him very lethargic. Resident stated that he would rather the PRN as needed Oxycodone instead of the routine Methadone. 2PM Methadone was refused. Report given to Oncoming Nurse. A Nursing note, dated 03/19/22 at 3:35 PM, documented, Writer called for script for oxycodone. Writer spoke to Medical Doctor and MD (name) to fax script pharmacy. Endorsed to on coming shift to follow up. A Nursing Note, dated 03/19/22 at 11:27 PM, documented, (Pharmacy) had not received prescription from Doctor (name) by 8pm. Left message at (name) phone. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 9 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A Nursing Note, dated 04/11/22 at 1:24 PM, documented, Script for Oxycodone sent to Pharmacy by Pain Management. (Pharmacy) called, script received, will be delivered next delivery. A Nursing Note, dated 04/19/22 at 4:27 AM, documented, Resident yelling and in pain. Oxycodone hci (ir) 10 mg tablet given at 4:17 AM from PIXX machine on North wing Res calming. Rx (prescription) was called and stated resident med would be on the next delivery. Awaiting delivery. A Nursing Note, dated 04/19/22 at 4:38 PM, alert and oriented documented, Resident received in bed AAO X3 able to voice needs. Resident in bed Screaming at Staff I need my [sic] pain pills from pharmacy now. Resident is reminded by writer to not respond verbal aggression towards staff. Resident is also reminded that Pharmacy has beed called, and delivery is pending. Pharmacy called, authorized 2 from Pixis (Auth 22321) both given during shift. Per Pharmacy will be delivered on afternoon delivery. A Nursing Note, dated 04/25/22 at 11:31 AM, documented, Resident was given last PRN pain med @ 6:34 AM, per report from previous shift Nurse, Pharmacy called , stated will deliver on next shift. 9AM Writer also called Pharmacy x 2 ordered med Stat. Per Pharmacy tech will send stat with a time frame delivery of 4 hours. Tylenol 650MG were administered with routine medication, with little effect. Pixis check, none available. Pharmacy also made aware of Pixis with 0 tabs. Writer explained to Resident the occurrence. Resident verbalized understanding and stated to Writer, Ill wait til the delivery, I can wait it out. 11:30AM NP (Nurse Practioner) in to see and assess Resident. A Nursing Note, dated 04/25/22 at 12:24 PM, documented, 1219 Stat pain med arrived from Pharmacy and administered. During an interview with Resident #49, on 04/25/22 10:52 AM, when asked about any problems with pain, Resident #49 replied, I am supposed to have my pain pills every 4 hours and they don't have any to give me right now. They say that they don't have any. When asked the location of the pain, Resident #49 replied, Both my shoulders, my right hip and my lower back. During the interview, Resident #49 was showing facial expressions indicative of significant pain. During an interview, o 04/25/22 at 10:56 AM, with Staff G, LPN, when asked about pain medication for Resident #49, Staff G replied, we called the pharmacy and they said that they are on the way. He was on the last pill this morning. He gets it every 6 hours. It was taken at 7 this morning. We offered Tylenol, he took it and he said that it worked. The other nurse talked to the doctor to send a prescription. He already had some in the Pixis and we gave it to him. During an interview, o 04/25/22 at 10:59 AM, when Staff H was asked about Resident #49's pain medication, Staff H replied, they refill it and he takes it every four hours. He got the last one at 6:34 AM. We are just waiting for the delivery. This morning, he had Tylenol, he had Baclofen. He is out of the Oxycodone and he gets it Q 4 (every four) hours, PRN. We are going to ask to send it stat. We usually have it in the pixis. We gave it out of the Pixis this morning. He just got thirty last week, but he takes them every 4 hours. He had quite a few on Friday when I worked. Usually when we order it stat, it takes about an hour - give or take. Usually we pull it and order within a couple of days remaining. I told the DON (Director of Nursing) that we needed it now. I gave him some Tylenol and Baclofen at 9:00. I talked to him and he knows that we are working with the pharmacy. They called the order in on Saturday 04/23/22 On 04/25/22 at 11:16 AM, Staff H reached out to pharmacy for order, Staff H reported that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 10 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 0697 Level of Harm - Minimal harm or potential for actual harm pharmacy representative said that from the pharmacy it usually takes up to four hours. Staff H stated, We have a NP and I am going to talk with her and see what else we can do for him. On 04/25/22 at 11:26 AM, Staff H reported that Resident #49 would rather wait until pharmacy delivery than have other interventions. Residents Affected - Few On 04/25/22 at 12:23 PM, Staff H reported that the medicine had arrived and given to Resident #49. During a follow up interview, on 04/26/22 at 10:39 AM, with Resident #49, when asked about pain medication, Resident #49 replied, They run out of the medications about every 3 weeks. That's the only thing that seems to work (referring to the Oxycodone). They inform the pharmacy that they need them, but they just don't get here unless they pay to have them delivered guaranteed within 4 hours, otherwise, they have to go to the pixus that is on another wing and the Pixus ran out twice already. During an interview with the Consultant Pharmacist, on 04/26/22 at 1:30 PM, when asked about the Oxycodone for Resident #49, the Consultant Pharmacist replied, He had some Oxycodone stat yesterday. I got a call from the DON to have the pharmacy send it so I called the pharmacy and they ordered it and then they brought it over. I did not know of any requests for pain medication. This is the first time hearing about it. He has Oxycodone around the clock, Percocet every 6 hours and methadone 15 mg every 6 hours for non-acute pain, Gabapentin for nerve pain. We sent 30 yesterday, but that was upon your prompting. I saw him when I was walking through the unit this morning. I haven't seen where they ordered or didn't order. During an interview, on 04/26/22 at 3:36 PM, with Staff I, when asked about Resident #49's Oxycodone order, Staff I replied, I had a doctor assess him and he was saying that his pain wasn't addressed, he said that he wanted to manage his pain better. He had Methadone and that didn't work, and he went back to the Oxycodone. Our nurses have been very good at giving it to him every four hours. Sometimes pharmacy falls through, sometimes the doctor doesn't write the order. This is not the first time that this has happened. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 11 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interviews, record review and policy review; the facility failed to remove narcotics from 2 of 8 medication carts for 3 of 3 sampled residents who did not have current orders for the narcotics, Resident #84, #135 and #438. The findings included: The facility's policy titled Storage of Medication revised April 2007 reveals The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals. All such drugs shall be returned to the dispensing pharmacy or destroyed. On 04/28/22 at 9:30 AM, the Medication Cart for Team 1 in the 100 unit was reviewed with Staff J, a Registered Nurse (RN). Resident #84's medication card for Ativan 0.5 milligrams (mg) was in the narcotic lock box with no current order. The order stopped on 04/22/22. On 04/28/22 at 9:45 AM, the Medication Cart for Team 2 in the 300 unit was reviewed with Staff K, a Licensed Practical Nurse (LPN). Resident #135's medication card for Tramadol 50 mg was in the narcotic lock box. The order stopped on 04/15/22. Additionally, in the Medication Cart for Team 2 in the 300 unit, was a medication card for Resident #438. Resident #438's medication card for Tramadol 50 mg was in the narcotic lock box. The order stopped on 04/27/22. On 04/28/22 at 11:45 AM, an interview was conducted with the Director of Nursing who stated that medication should not be in the cart without a physician's order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 12 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 interviews and record review, the facility failed to ensure that a psychotropic (drugs that affect a person's mental state) medication ordered by the practitioner were necessary and the resident's representative was aware and involved in the decision for 1 of 5 sampled residents reviewed for unnecessary medications (Resident #110). The findings included: Review of the facility policy titled Administering Medications revised in April 2019 showed that following: if medication and dosage is believed to be excessive for the resident, or has been identified as having potential adverse consequences, the person preparing the medication will contact the prescriber and the resident's attending physician to discuss the concerns. In an interview conducted on 04/25/22 at 12:30 PM, with Resident #110's son, he stated that his mom was placed on psychotropic medication without their knowledge. He further said that the only reason he knew that his mom was placed of the new psychotropic medication was after the facility called him regarding his mom's behaviors. According to him, this was the first time that his mom was placed on antipsychotic medication and that he was never told as to why or signed the consent for the new medication. Resident #110's son further stated that he spoke to the facility's Director of Nursing on 04/08/22 and asked her to stop the medication until the prescribing physician called him back. In this interview, Resident #110's son, also called Resident #110's niece who verified the information that was reported by the son. Resident #110 was admitted to the facility on [DATE] and readmitted to the facility on [DATE] with diagnoses of Dementia without behavioral disturbances, Alzheimer's and Anxiety. Review of the Minimum Data Set (MDS) dated [DATE] showed that under Section E for behavior, Resident #110 did not use physical behavior symptoms directed at others. Further review of the Behavior Monitoring from 04/01/22 to 04/26/22 showed that for most days Resident #110 had no problem behavior noted. The Behavior Monitoring documented from 02/01/22 to 02/14/22 showed that Resident #110 did not have any problem behavior noted. Review of the Medication Administration record showed the following orders: Ativan 0.5 milligrams (mg) tablet to give by mouth 3 times a day as needed for agitation which started on 03/22/22 and discontinued on 04/08/22, another order of Ativan 3 times a day as needed from 04/08/22 and stopped on 04/22/22, Dekapote 500 milligrams one tablet a day which started on 04/01/22 and stopped on 04/22/22. Review of the psychiatrist consultation Staff M (Psychiatrist doctor) dated on 08/26/21 and 11/02/21, showed that Resident #110 was diagnosed with depression and confusion, but no other additional medications were recommended. Review of the Initial Psychiatric Evaluation which was completed on 03/31/22 by the nurse's practitioner showed the following, Resident #110 is receiving Ativan around the clock with little effect and diagnosed Resident #110 with unspecific dementia and Behavioral disturbances. She further recommended to start Resident #110 on Depakote 500 mg and discussed with nursing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 13 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 Review of the Subsequent Psychiatrist evaluation which was done on 04/08/22 by Staff C (Psychiatrist doctor) showed the following, Resident #110 had periods of wandering and exit seeking behaviors and had to be on Depakote 500 mg regimen to maintain functional status. Review of progress notes showed the following, a note dated 04/15/22 showed that Resident #110 was unable to redirect, and the son was called so he can speak to his mom. In this note the son asked about the new medication Depakote and asked Staff C, to call him, which the Director of Nursing was aware. Another note dated 04/25/22 which was 10 days later showed that Resident #110's son requesting to speak to Staff C. A progress note dated 04/25/22 showed that the son was informed of the discontinuation of the Depakote which was on 04/22/22. A note dated 04/26/22 showed that Staff M, saw Resident #110 and ordered Ativan 0.5 mg twice daily as needed for Agitation and Anxiety. She also ordered an additional Ativan 0.5 mg every eight hours. In a phone interview conducted on 04/27/22 at 11:00 AM, with Staff C, he stated that he did not do the first initial consultation for Resident #110 on 03/31/22. He further stated that he was first told that Resident #110's son wanted to speak with him regarding the Depakote on 04/25/22, when he was in the facility. Staff C said that he reassessed Resident #110 on 04/08/22. In an interview conducted on 04/26/22 at 4:30 PM, With Staff M, she stated that she assessed Resident #110 in the past and stated that she was asked to take over the case and reassessed Resident #110. In an interview conducted on 04/28/22 at 12:00 PM, Staff P, Certified Nursing Assistant, stated Resident #110 had good days and bad days and at times can be resistant to care. In an interview conducted on 04/28/22 at 11:08 AM, with the facility's Consultant Pharmacist, it was stated that when Depakote (new medication) is being prescribed by a psychiatrist, it is used as a mood stabilizer and in this case, it is considered psychotropic medication. She further said that when residents are on Depakote, she will also attempt a gradual dose reduction for the resident. The care plan showed that Resident #110 is taking an Anxiety medication for generalized Anxiety, which was initiated on 04/26/22 after surveyor interventions. In an interview conducted on 04/28/22 at 4:30 PM, with the Administrator, she was informed of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 14 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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** Based on observations, interviews and record review, the facility failed to secure medications for 1 of 1 sampled residents (Resident #190) identified in the north wing. The findings included: Review of the facility's policy titled Storage of Medications revised on 04/2007 documented .drugs shall be stored in an orderly manner in cabinets, drawers, carts, or automatic dispensing systems . Review of the facility's policy titled Preparation and General Guidelines-Self-Administration of Medications revised on 01/2018 documented .if the residents desires to self-administer medications, an assessment is conducted by the interdisciplinary team .the interdisciplinary team verifies the resident's ability to self-administer medications . Review of Resident #190's clinical record documented an admission to the facility on [DATE]. The resident's diagnoses included Left Hip repaired, Hypertension, Diabetes Mellitus, Depression, Macular Degeneration, Glaucoma and Muscle weakness. The residents baseline care plan included a care plan related to Impaired Vision. Review of the resident's physician orders documented,Latanoprost 0.005% eye drops one drop both eyes once daily at bedtime, wish was discontinued on 04/18/22. Physician order dated 04/18/22 documented, Dorzolamide 2% eye drop instill one drop to both eye three times a day for Glaucoma. Further review revealed a lack of a physician's order for Latanoprost eye drops and Systane eye drops. Review of Resident #190's April 2022 Medication Administration Record (MAR) documented Dorzolamide 2% eye drops instill one drop to both eye three times a day at 8:00 AM; 2:00 PM and 8:00 PM. Further review revealed Latanoprost 0.005% eye drops discontinued on 04/18/22. On 04/25/22 at 11:36 AM, observation revealed Resident #190;s room door wide open and the resident was not in the room. On 04/25/22 at 12:10 PM, observation revealed Resident #190 was being wheeled down the hallway and into her room, by a therapist. Subsequently, an interview was conducted with the resident and she stated that she went to therapy. During the interview, further observations revealed three bottles of eye drops on top of her nightstand. One bottle label read Systane lubricant eye drops another bottle label read Dorzolamide HCL ophthalmic solution 2% and a third bottle label read Latanoprost 0.005% ophthalmic solution. During the interview, Resident #190 stated that she puts the drops in when the nurses do not come. On 04/26/22 at 10:07 AM, observation revealed Resident #190 sitting in a wheelchair in her room. The aforementioned three eye drop bottle observed on 04/25/22 were on top of her nightstand. An interview was conducted with the resident and she stated that staff had not come today to put her eye drops in and she did it herself. She stated she does the Dorzolamide eye drops three times a day, the Systane drops, as needed for dry eyes and Latanoprost at night. Resident #190 further stated the directions on the bottle were wrong and added that she needed the prescription drop on her right eye only. The resident was asked if any nurse from the facility had observed her putting her drops in and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 15 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 stated that no one had watched her putting the eye drops in her eyes. Observation revealed Resident #190 administered Systane eye drops to both eyes during the interview. Resident #190 was asked if the facility knew that she had her eye drop bottles in her room and she stated that her son gave them a list of all her personal items brought into the facility. Review of Resident #190's clinical record contained the following: Resident Inventory Sheets dated 04/18/22 and documented resident stated my son made a list and gave it to the office. Review of a list in the resident clinical record documented the resident name- personal possessions .3 eye drop bottles . On 04/26/22 at 10:17 AM, an interview was conducted with Staff Q, a Licensed Practical Nurse, (LPN) who stated she had not administered Resident #190's eye drops because the surveyor was in her room. On 04/26/22 at 10:24 AM, the surveyor was approached by Staff L, a Registered Nurse (RN) who stated she was calling Resident #190's physician's because her eye drop was due at 8:00 AM and Staff Q, LPN had not administered the drops yet. Subsequently, a side-by-side review of the resident's electronic Medication Administration Record (e-MAR) was conducted with Staff Q and Staff L. The review revealed Resident #190 Dorzolamide eye drop was scheduled at 8:00 AM, 2:00 PM and 8:00 PM. Staff Q stated the Latanoprost eye drop was discontinued on 04/18/22 and there was not an order for Systane eye drops. On 04/26/22, at 10:32 AM, observation revealed Resident #190's daughter visiting. During an interview, the resident's daughter stated the resident had to have the aforementioned eye drops and she knew how to do it. On 04/26/22 at 10:33 AM, a side-by-side review of Resident 190's eye drops bottle on top of her nightstand was conducted with Staff L, RN and Staff Q, LPN. Staff L stated she helped the resident with her hearing aid around 8:30 AM on 04/25/22 and did not see the bottles on her nightstand. Staff L was apprised that the resident's three eye drop bottles were observed on her nightstand on 04/25/22 before and during lunch time and on 04/26/22. On 04/26/22 at 10:41 AM, an interview was conducted with the Director of Nursing (DON) who stated that Staff L, informed her of the findings. She stated they will complete an assessment and will find out where she obtained her eye drops from. The DON was asked if Resident #190 was assessed to do self-administration of medications and stated she did not see one in the residents' paper chart nor the electronic chart. On 04/26/2022 at 11:21 AM, an interview was conducted Staff X, MDS Coordinator and the facility's Staff Development Coordinator (SDC). They both stated that Resident #190 was not assessed for Self-administration of medications. 04/26/22 at 02:34 PM, an interview was conducted with Staff R, a Certified Nursing Assistant (CNA) who stated she assisted the resident to the bathroom. Staff R stated she saw two bottles of eye drops, one with a blue top and another with an orange top that morning on her stand. She stated she was going to bring them to the nurses but did not and she also did not tell the nurse. On 04/27/22 at 1:25 PM, a side-by-side review of Resident #190's Resident Inventory Sheets dated 04/18/22 and a list of the resident personal possessions was conducted with Staff L, RN. She had no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 16 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 comments. 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: 105089 If continuation sheet Page 17 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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** 3). Resident #34 was admitted to the facility on [DATE]. According to the residents most recent complete assessment, a Quarterly Minimum Data Set (MDS), dated [DATE], Resident #34 had a Brief Interview for Mental Status (BIMS) score of 15, indicating 'cognitively intact'. The MDS documented that Resident #34 required 'supervision' for Activities of Daily Living (ADLs), including eating. Resident #34's diagnoses at the time of the assessment included: Hypertension; Diabetes mellitus; hyperlipidemia; Seizure disorder; Depression; Bipolar Disorder; Ulcer of esophagus without bleeding; GERD. The MDS documented that Resident #34 did not have any swallowing disorders and no oral/dental concerns. Resident #34's diet order included: LCS (Limited Concentrated Sweets), Mechanical Soft. Chopped Meat 01/31/22 During an observation of lunch served to Resident #34 in the resident's room, on 04/25/22 at 12:24 PM, Resident #34 was served intact and large pieces of sausage and large pieces of potato. It was noted that the large pieces of potato were also cooked in a manner to have a rigid and hard texture on the outside of the potato. During an interview, on 04/28/22 at 11:42 AM with the Speech Language Pathologist (SLP), when asked about the meal being appropriate for the resident based on the order, the SLP stated that she would not be able to conclude because she would have had to see the resident eat, masticate and swallow the meal. Based on observations, interviews, and record review, the facility failed to follow physician's orders for 3 of 3 sampled resident reviewed for nutrition, therapeutic diets (mechanical soft) for Residents #110, #51, and #34. The findings included: A review of the facility's guidelines utilized the the main kitchen titled, Nutritional Education for Mechanical Soft Diet from the Manual of Medical Nutrition Therapy 2019 Edition showed the following: foods allowed in the mechanical soft diet are eggs, ground or chopped moist meats, baked fish, stewed made with tender chopped meat, finely ground chicken and well-cooked vegetables. A review of the facility's Speech Language Pathologist guidance titled Understanding Mechanical Soft Diets, undated, showed the following: Level-2 consist of foods that are moist, soft texture and easily swallowed. Meats are ground or finely cut to equal size no bigger than 1/4 inch. A review of the Nutrition Care Manual under section Dysphagia Level 3: Advanced or Mechanical Soft, showed the following: no hard sticky or crunchy foods, foods should be moist, meat cut up and chopped, food particles are served in bite-sized pieces and less than 1 inch. (https://www.nutritioncaremanual.org/topic.cfm?ncm_toc_id=273657). 1. In an observation conducted on 04/27/22 at 12:15 PM, Resident #110 was observed in her room eating her lunch meal with no assistance from staff. Closer observation showed a lunch meal that consisted of a hamburger bun, round hamburger patty, and diced carrots with various sizes with some sizes larger than 2 inches. After the resident finished her meal, the surveyor completed hand hygiene and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 18 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 placed on gloves. In this observation the surveyor was unable to cut the meat patty and the diced carrots with a knife and had to use moderate force to cut through the foods. The meal ticket for Resident #110 showed a Mechanical soft diet, finger foods and pleasure food (photographic evidence obtained). Review of the Speech assessment dated [DATE], which was completed by Staff D, Speech Language Pathologist (SLP), showed the following: Resident #110 has mild impairment between 25-50 percent with risk of aspiration on liquids. It further showed mild oral residue and may need meats ground or chopped with intermittent supervision. Resident #110 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of unspecific dementia without behavioral disturbances, Alzheimer's and Anxiety. 2. In an observation conducted on 04/27/22 at 12:18 PM, Resident #51 was observed in her room with the lunch tray at the bedside. The meal ticket showed a Mechanical soft diet. The tray consisted of hamburger bun, round hamburger patty, and diced carrots with various sizes with some sizes larger than 2 inches. Closer observation also showed a grilled cheese sandwich with dry crusty bread that was hard to the touch (photographic evidence obtained). Record review showed that Resident #51 was admitted to the facility on [DATE] with diagnoses of anxiety disorder and Dementia. Review of the Speech assessment dated [DATE] which was completed by Staff D, Speech Language Pathologist (SLP) showed the following: Resident #51 has impaired cognition that can impact chewing skills. Patient can safely tolerate cut up meat, with diagnosis of dysphagia. In an interview conducted on 04/27/22 at 12:25 PM with Staff D, SLP, stated that the Mechanical soft diets in the facility are general and are modified as needed. The meats on a Mechanical Soft Diet, can be chopped, grounded, and may even be meat that is not chopped according to resident's preferences. Staff D reported that some residents may want to cut their meat themselves and did not think that the size of the meats provided in the aforementioned observations were a problem. When asked by surveyor as to the specific consistency of the mechanical soft diet she said, Dietary will be better at answering these questions. When asked again, Staff D then said that on the Mechanical soft diet the meats need to be with soft texture, and no raw carrots allowed. According to her, the size of the vegetable is not an issue in the Mechanical soft diet if they are soft. Surveyor stated that the carrots in the above observations were not easy to cut and a moderate force was used to slice through them. To that Staff D said that may be a problem. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 19 of 20 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 105089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at Fort Lauderdale Rehabilitation and Nursin 1701 NE 26th St Fort Lauderdale, FL 33305 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interviews; the facility failed to carry out a physician's order for blood testing for 1 of 5 sampled residents reviewed for unnecessary medications (Resident #11). The findings included: Resident #11 was admitted to the facility on [DATE] with diagnoses that include unspecified dementia without behavioral disturbances, atrial fibrillation, and major depressive disorder. A 5 day Minimum Data Set with an assessment reference date of 11/17/21 revealed in Section C a Brief Interview for Mental Status of 0, which indicates the resident has severe cognitive impairment. A review of the physician's orders dated 04/01/22 reveals an order for Depakote DR (delayed-release) 125 milligrams (mg) sprinkle cap administer two by mouth three times daily. An additional order dated 04/01/22 reads Depakote level in one week, Thyroid profile all in one week along with FBS (fasting blood sugar). Further record review revealed there was no evidence the orders were completed. An interview was conducted with Staff F, the consultant pharmacist, and the Director of Nurses on 04/27/22 at 3:30 PM. They acknowledged the blood tests were never ordered and a new order was written for the blood to be drawn on 04/28/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 20 of 20