Health inspection·August 31, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm undressed, in a nightgown pulled halfway up his body, with his lower body and bilateral status post-surgical above the knee amputee stumps exposed for a period of over an hour, from hallway with room door open and with several staff members observed walking by, with no attempts made to close the privacy curtain. There were no attempts made by facility staff to fully close the bedroom door after providing care to this resident. Photographic Evidence Obtained. Residents Affected - Few During a brief interview with Resident #130 regarding his preference, he stated to this surveyor that he prefers to have either his privacy curtain pulled or his door closed so that his uncovered lower body is not exposed. He said that it does bother him when he has to ask staff more than once to close the curtain or door. During an interview conducted with Staff I, CNA, on 08/30/23 at 11:20 AM, regarding the resident's privacy curtains and bedroom door both being left open, Staff I acknowledged the bedroom door and privacy curtains should not have been left open, exposing the resident's person. During an interview conducted with Staff J, LPN, on 08/30/23 at 11:25 AM, regarding the resident's privacy curtains and bedroom door, both being left open, Staff J acknowledged the bedroom door and privacy curtains should not be left open, exposing the resident's person. 2. Resident #268 was admitted to the facility on [DATE] with diagnoses that included Cerebral Infarction due to Embolism Left Middle Cerebral Artery, Diabetes Mellitus Type II, Morbid Obesity, Aphasia, Dysphagia, Heart Failure, Hypertension and Chronic Obstructive Pulmonary Disease. She had a BIMS score that indicated the resident was severely impaired cognitively. During an observation of Resident #268 conducted on 08/28/23 at 1:51 PM, the resident was sitting up in her Gerichair in her room with the TV (television) on. Upon further entry into the room, the resident was observed with her left leg bent up and open and her night gown left partially opened at the bottom for over an hour, with the privacy curtain only partially closed exposing the lower portion of her abdomen to other residents, staff members and visitors. There were no attempts by staff members entering the room to cover the resident or to close her privacy curtain. Photographic Evidence Obtained. During a second observation of Resident #268 conducted on 08/30/23 10:59 AM, the resident was resting in her bed in her room with the TV on. Upon further entry into the room, the resident was again observed with her left leg bent up and open and her night gown left partially opened at the bottom for over an hour, with the privacy curtain only partially closed exposing the lower portion of her abdomen to other residents, staff members and visitors. 3. Resident #267 was admitted to the facility on [DATE] with diagnoses that included Parkinson's Disease, Chronic Kidney Disease and Gastroesophageal Reflux Disease. The resident had BIMS score of 15, indicting cognition was intact. During an observation of Resident #267 conducted on 08/28/23 at 11:00 AM,the resident was sitting up in bed with the head of the bed elevated and the top half of his nightgown, still on, hanging off his body with his bare chest hairs exposed and uncovered, as well as the lower portion of his legs which were uncovered and exposed to other residents, staff members and visitors for over an hour with multiple staff members observed walking by room, with no attempts made by staff to either cover resident, close his privacy curtain or to close his door. Photographic Evidence Obtained. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 2 of 40 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 08/31/2023 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview conducted with Staff K, CNA, on 08/30/23 at 11:45 AM, regarding the resident's privacy curtains and bedroom door, both being left open, Staff K acknowledged the privacy curtains and bedroom door should not have been left open, exposing the resident's person. During an interview conducted with Staff L, Registered Nurse (RN), on 08/30/23 11:50 AM, regarding the resident's privacy curtains and bedroom door being left open, Staff L acknowledged the privacy curtains and bedroom door should not have been left open, exposing the resident's person. There were no documented behaviors relative to this observation, for any of these residents noted, in either of their care plans, or anywhere in the progress notes. During an interview conducted with the DON, on 08/30/23 at 2:41 PM, regarding the resident's privacy curtains and bedroom doors, both being left open, she acknowledged the bedroom doors and privacy curtains should not have been left open, exposing the resident's person. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 3 of 40 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 08/31/2023 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to transmit Resident Assessments in a timely manner for 20 of 24 sampled residents reviewed for Minimum Data Set (MDS) discrepancies, Residents #142, 143, 26, 120, 13, 20, 65, 136, 118, 140, 135, 95, 63, 117, 77, 67, 92, 48, 51 and 146. Residents Affected - Few The findings included: Following the Survey Day 2 Transition Meeting, the surveyors noted the Resident Assessment Facility Task was triggered for review. Twenty-four (24) residents were identified in this task to be reviewed for Minimum Data Set (MDS) Record over 120 days old. On 08/30/23 at 10:23 AM, the 24 triggered residents' records were reviewed with Staff Q, MDS Coordinator and Staff R, MDS Coordinator. During this record review, it was noted that 20 of the 24 triggered residents had MDS's which were not transmitted properly per the Federal Regulations. During this record review, Staff R stated the facility was aware that there was an issue with transmitting MDS's due to the changing of Electronic Health Records (EHR) systems during June and July 2023. Staff R further stated that the facility had recognized this issue and had a Performance Improvement Plan (PIP) in place 'for a while'. She clarified that the PIP had been in place for months but that the transmission of MDS's was a continued issue. The following are the 20 identified residents with MDS's that were not transmitted in a timely manner: 1. Resident #142 was admitted to the facility on [DATE]. A Quarterly MDS was Open / Completed on 06/14/23 (in the old EHR system) but was never submitted. This Quarterly MDS was the identified issue. 2. Resident #143 was admitted to the facility on [DATE]. A Quarterly MDS was Open / Completed on 06/14/23 (in the old EHR system) but was never submitted. This Quarterly MDS was the identified issue. 3. Resident #26 was admitted to the facility on [DATE]. An Annual MDS was Open / Completed on 06/13/23 (in the old EHR system) but was never submitted. This Annual MDS was the identified issue. 4. Resident #120 was admitted to the facility on [DATE]. An Annual MDS was Open / Completed on 06/30/23 (in the old EHR system) but was never submitted. This Annual MDS was the identified issue. 5. Resident #13 was admitted to the facility on [DATE]. A Quarterly MDS was 'In Progress' since 08/04/23 but was not submitted by the Exit of the survey. This Quarterly MDS was the identified issue. 6. Resident #20 was admitted to the facility on [DATE]. A Quarterly MDS was Open / Completed on 06/23/23 (in the old EHR system) but was never submitted. This Quarterly MDS was the identified issue. 7. Resident #65 was admitted to the facility on [DATE]. A Quarterly MDS was Closed / Completed on 06/16/23 (in the old EHR system) but was never submitted. This Quarterly MDS was the identified issue. 8. Resident #136 was admitted to the facility on [DATE]. A Discharge Return Not Anticipated MDS was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 4 of 40 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 08/31/2023 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 0640 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Closed / Completed on 04/18/23 (in the old EHR system) but was never submitted. This Discharge MDS was the identified issue. 9. Resident #118 was admitted to the facility on [DATE]. A Discharge Return Not Anticipated MDS was Open / Completed on 05/10/23 (in the old EHR system) but was never submitted. This Discharge MDS was the identified issue. 10. Resident #140 was admitted to the facility on [DATE]. A Quarterly MDS was Open / Completed on 06/17/23 (in the old EHR system) but was never submitted. This Quarterly MDS was the identified issue. 11. Resident #135 was admitted to the facility on [DATE]. A Discharge Return Not Anticipated MDS was Open / Completed on 05/02/23 (in the old EHR system) but was never submitted. This Discharge MDS was the identified issue. 12. Resident #95 was admitted to the facility on [DATE]. A Discharge Return Not Anticipated MDS was Open / Completed on 04/20/23 (in the old EHR system) but was never submitted. This Discharge MDS was the identified issue. 13. Resident #63 was admitted to the facility on [DATE]. A Quarterly MDS was Open / Completed on 06/30/23 (in the old EHR system) but was never submitted. This Quarterly MDS was the identified issue. 14. Resident #117 was admitted to the facility on [DATE]. A Quarterly MDS was 'In Progress' since 07/21/23 but was not submitted by the Exit date of the survey. This Quarterly MDS was the identified issue. 15. Resident #77 was admitted to the facility on [DATE]. A Quarterly MDS was 'In Progress' since 07/21/23 but was not submitted by the Exit date of the survey. This Quarterly MDS was the identified issue. 16. Resident #67 was admitted to the facility on [DATE]. A Quarterly MDS was Open / Completed on 06/17/23 (in the old EHR system) but was never submitted. This Quarterly MDS was the identified issue. 17. Resident #92 was admitted to the facility on [DATE]. An Annual MDS was Open / Completed on 06/07/23 (in the old EHR system) but was never submitted. This Annual MDS was the identified issue. 18. Resident #48 was admitted to the facility on [DATE]. A Discharge Return Anticipated MDS was Open / Completed on 03/23/23 (in the old EHR system) but was never submitted. This Discharge MDS was the identified issue. 19. Resident #51 was admitted to the facility on [DATE]. An Annual MDS was Open / Completed on 10/20/22 (in the old EHR system) but was never submitted. A Quarterly MDS was Open / Completed on 01/15/23 (in the old EHR system) but was never submitted. Also, a Quarterly MDS was Open / Completed on 06/15/23 (in the old EHR system) but was never submitted. All 3 of these MDS's were identified issues. 20. Resident #146 was admitted to the facility on [DATE]. An Quarterly MDS was Open / Completed on 06/28/23 (in the old EHR system) but was never submitted. This Quarterly MDS was the identified issue. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 5 of 40 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 08/31/2023 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 0640 Level of Harm - Minimal harm or potential for actual harm During the Quality Assurance Performance Improvement meeting conducted on 08/31/23, it was verbalized by the facility's administration that the PIP for MDS transmissions had been in place for approximately 6 months. They admitted that MDS transmission continues to be a problem at the facility. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 6 of 40 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 08/31/2023 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, record and policy review, the facility failed to identify and treat a wound in a timely manner for 1 of 1 sampled resident, reviewed for diabetic wounds, Resident #148. Residents Affected - Few The findings included: Resident #148 was admitted to the facility on [DATE] and readmitted to the facility on [DATE] post hospitalization. The resident's diagnoses (dx) included End Stage Renal Disease, Type 2 Diabetes Mellitus and Acute Osteomyelitis of left ankle and foot. Review of the Quarterly Minimum Data Set (MDS), with an assessment reference date of 08/07/23, documented a Brief Interview for Mental Status (BIMS) score of 15, indicating the resident was cognitively intact. Review of the Physician's orders for the month of May 2023 revealed a treatment order for A&D ointment and to apply topically to bilateral lower extremities and feet every shift for dryness / skin protection daily, and weekly skin assessments every Friday on the 11-7 shift (11 PM - 7 AM). Review of the Treatment Administration Record (TAR) for May 2023 revealed the weekly skin assessments were completed, and A & D Ointment was applied to lower extremities as ordered. These orders were also carried forward for the month of June 2023 and treatments were documented as being done as ordered. Review of the weekly skin evaluations from 07/01/23 to 07/23/23 revealed skin was intact / skin at baseline for 07/01/23 and no new open areas for 07/08/23 to 07/23/23. Record review revealed the weekly skin evaluations done on 07/08/23 and 07/16/23 were done by Staff BB, Registered Nurse (RN). On 08/31/23 at 2:10 PM, a telephone interview was done with Staff BB. Staff BB stated that she had not done a skin check for Resident #148 on those days. Review of the weekly skin evaluation done on 07/23/23 was documented as done by Staff CC, RN, per record review. A telephone interview was conducted with Staff CC on 08/31/23 at 2:15 PM. Staff CC stated he had not done any skin checks on Resident #148. This surveyor informed Staff CC that his name was on the skin check assessment, and he stated someone must have gotten his password and documented it. Review of nursing progress notes dated 05/03/23 through 05/09/23 revealed no documentation regarding skin changes: On 05/10/23, a wound assessment note documented as written by Staff E, Licensed Practical Nurse (LPN), Wound nurse, revealed bilateral lower extremities dry skin, left 4 and 5 toe amputation, healed I-site. On 07/21/23, Resident # 148 requested a room change which was done that day. On 07/22/23, the nursing progress note documented While family visiting, she stated 'I smelled something and I removed his stocking'. Writer called to the room, checked on his bilateral feet and noted opening areas to both plantars and heels, measurement and photos were taken and recorded. Cleanse bilateral wounds with normal saline and betadine applied, covered with dressing, supervisor called, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 7 of 40 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 08/31/2023 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 0684 MD [Medical Doctor] called made aware, close moniroring. Level of Harm - Actual harm On 07/23/23, the resident was seen by wound care nurse. Residents Affected - Few On 07/26/23, an arterial doppler was ordered by the physician per nursing progress note review. On 07/26/23, the resident started on Nitrofurantoin 100 mg (milligrams) by mouth twice a day for 7 days for a urinary tract infection. On 07/29/23, the nursing progress note revealed a podiatry consult could not be done due to podiatrist not accepting the resident's insurance. On 08/03/23, the Physician order included Santyl External Ointment 250 unit/gram apply to left distal plantar foot topically every shift for wound healing. Clean with normal saline-apply Santyl ointment - then 1/4 strength Dakins soaked [guaze soaked in Dakins solution] and cover with dressing. On 08/09/23, a nursing progress note revealed Resident received wound evaluation by Wound Care MD, and MD explain to the resident, recommendation transfer to the hospital for evaluation left foot venous wound, Wound care MD notified the primary MD and Dr . agree, follow up with transfer to Hospital order, notified to the ADON [Assistant Director of Nurses] and resident's nurse. On 08/09/23, per the nursing progress note, the Resident to be admitted . DX [diagnosis] Diabetic foot infection. On 08/18/23, per nursing progress note, the Resident readmitted to facility . dx: Infected left foot wound; osteomyelitis . Osteomyelitis is a bone infection. On 08/18/23, a skin and wound evaluation of the left plantar forefoot was conducted upon readmission to the facility. The wound was in-house acquired, measurements were documented as an area 8.2 centimeters (cm2), length was 3.5 cm, width was 3.1 cm. On 08/18/23, a Physician order was documented for Ceftazidime 2 gram intravenously every evening every Tuesday, Thursday and Saturday for Sepsis until 09/20/23. Review of the Wound Care physisician notes for the Diabetic Wound of the distal left plantar foot, full thickness, wound documented the measeurements as follows: On 07/26/23, 4.5 x 3.7 x 0.5 cm [centemeters]. On 08/02/23, 4.6 x 3.4 x 0.5 cm. On 08/09/23, 5.9 x 4.1 x 0.5 cm. On 08/23/23, 6.1 x 6.4 x 0.7 cm. On 8/30/23, 3.5 x 3.1 x 0.7 cm. On 08/31/23 at 10:38 AM, an interview was conducted with Resident #148. Resident #148 was asked by this surveyor how the wound on the bottom of the left foot was found. The resident revealed that he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 8 of 40 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 08/31/2023 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 0684 Level of Harm - Actual harm Residents Affected - Few bathes himself, he has neuropathy and he did not see or feel anything on his feet. When asked about the skin checks completed by the nurses that were done, he stated that no one checked his feet. He had kept his socks on because his feet were always cold. The resident continued to state that he recently saw the physician regarding his left foot. The resident said, the physician asked him if he wanted the good news or bad news first. The physician said the good news is we don't have to amputate your whole foot. The bad news is we have to take the top of your foot off. Review of the nursing progress note documentation, dated 08/09/23 documented the physician recommendation to transfer to hospital for evaluation of the left foot venous wound. Review of the hopital physician's note, dated 08/17/23, documented, in part, status post debridement ., no amputation for now, ok to discharge with wound care . Observation of wound care with Staff E, Licensed Practical Nurse (LPN), on 08/31/23 at 11:06 AM revealed the resident stated he did not need pain medication prior to wound care because he could not feel his foot. The wound care was observed to be completed by the nurse as ordered. The wound did not look infected but the resident had remained on intravenous (IV) antibiotics. On 08/31/23 at 12:28 PM, an interview was conducted with Staff X, Certified Nursing Assistant (CNA) on the Unit 300. The surveyor asked who did the skin assessments, and the CNA stated that since they do the ADL's (Activities of Daily Living) daily, they also check the skin and if there are concerns, they bring it to the nurse's attention. On 08/31/23 at 12:30 PM, an interview was conducted with Staff M, LPN, who stated that she is not his nurse currently, but she was his nurse when he was on another unit. She mentioned that the resident liked to care for himself, and shower himself. When asked if he had a shower in his room or used the north unit shower room, Staff M stated the resident would be brought to the shower room by the CNA, and he would ask for privacy to wash himself. Staff M denied any foul odor when she was his nurse on the other unit. In an interview conducted on 08/31/23 at 12:00 PM, with PCT (Patient Care Technician), Staff O, the staff stated that she has been treating Resident #148 in dialysis since his admission into this facility. She noticed the smell in the dialysis room for some time and thought that it was coming from the bathroom. The smell became stronger and at that point Resident #148 told her that he had wounds on his feet. She then told the dialysis RN who spoke to a nurse on the unit to let her know that there was an odorous foul smell coming from the resident. She was told by the nurse that the resident was receiving wound care treatment after dialysis and that it is managed by the wound care doctor (WC Doctor). An interview was conducted with Staff P, RN, on 08/31/23 at 12:20 PM, who stated she had worked with Resident #148 from the first day he had dialysis in the facility. They may check the ankles for edema but not the feet and they don't take the socks off. The first time she was told of the issue was when the PCT brought it to her attention. When the resident first came to them, he was legally blind and was able to see shadows. In a subsequent interview with Resident #148 on 08/31/23 at 12:31 PM during dialysis, he stated that he does not feel his feet and even when they do wound care and scrape his feet, he doesn't feel anything. His vision was very poor, and he has been getting treatment for bleeding behind the eyes. The right eye is better than the left eye which he cannot see out of at all. He has never been able to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 9 of 40 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 08/31/2023 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 0684 Level of Harm - Actual harm Residents Affected - Few have the flexibility to bring the bottom of his foot up for viewing. He further stated that even if he was able to do that, he would not be able to see clearly. There was about 5 feet distance from the dialysis bed to where the PCT and the RN were standing. When asked, of the resident, to identify what he was seeing, he said he could tell they are women but with double and blurry vision, he was not able to see details or facial features. He said that since May (2023), he was never able to take showers and had used a small tub with soapy water to clean himself with a towel which was mostly at the bedside. He was also never able to reach his feet and clean them with a towel. The first day that he moved to the new room (07/21/23), he thought that he had forgotten one of the foods in the bags because of the foul smell. They could not find the source and when his family member helped him with his socks, she saw the wound. At that point, he asked the staff to send him to the hospital and the facility said that they wanted the wound team in the facility to look at his feet. Soon after this, the wound care team saw the wound on his feet and started a wound dressing on his feet. The actual doctor did not see the wound until a week later because he (Doctor) only comes into the facility on Wednesdays and Thursdays. The resident further said that when he found out he had wounds on his feet, he asked to go to the hospital because of another foot infection in 2016 that resulted in amputation of some of the toes. Interview was conducted with the Director of Nurses (DON) on 08/31/23 at 2:20 PM, who when asked by the surveyor if it was possible that another staff member could get access to a nurse's password and sign an assessment, said that would not be possible. An interview on 08/31/23 at 4:04 PM was conducted with the DON who stated the wound was identified on 07/22/23, and wound care was started. It was reviewed with the DON that no staff member had identified the wound, but a family member had first identified the wound. Dialysis staff verbalized an odor on Resident #148 during dialysis. The DON stated the resident refused to have staff check him, but this was not care planned. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 10 of 40 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 08/31/2023 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of policy and procedure, observation, interview and record review, the facility failed to ensure proper usage and documentation of hand splints for 1 of 2 sampled residents reviewed for hand splints, Resident #265. The findings included: Review of the facility policy and procedure on 08/31/23 at 11:35 AM, titled, Medication and Treatment Orders, provided by the Director of Nursing (DON) published 05/19/23, documented in part, the following: Under Policy Statement: Orders for medications and treatments will be consistent principles of safe and effective order writing. Policy Interpretation and Implementation: 2. Only authorized, licensed practitioners, or individuals authorized to take verbal orders from practitioners, shall be allowed to write orders in the medical record 5. The signing of orders shall be by signature or a personal computer key . Review of the facility policy and procedure on 08/31/23 at 11:45 AM, titled, Activities of Daily Living (ADLs), provided by the DON published 12/28/22 documented, in part, the following: under the Policy Statement: Residents will be provided with care, treatment and services as appropriate to maintain or improve their ability to carry out activities of daily (ADLs). Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Policy Interpretation and Implementation: 1. Residents will be provided with care, treatment and services to ensure that their activities of daily living (ADLs) unavoidable . 2. Appropriate care and services will be provided for residents who are unable to carry our ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: a. Hygiene . b. Mobility . c. Elimination . d. Dining . and e. Communication. 3. Care and services to prevent and/or minimize functional decline will include appropriate pain-management, as well as treatment for depression and symptoms of depression .7. The resident's response to interventions will be monitored, evaluated and revised as appropriate . Review of Certified Nursing Assistant (CNA) job description on 08/31/23 at 12:05 PM, dated January 2023, provided by the DON documented, in part, Purpose of your Job Position: .Main duties .H. Report any changes in resident's condition-e.g. eating habits, behavior, temperature, etc. to the charge nurse of the unit .M. Be responsible for well-being and nursing care of all residents assigned to his/her unit while on duty P. Detect and report situations that have a high probability of causing accidents or injuries to residents and/or staff . Review of facility Licensed Practical Nurse (LPN) job description on 08/31/23 at 12:17 PM, dated January 2023, provided by the DON documented, in part, the following: Purpose of your Job Position: Major Responsibilities Administrative . 3. Receives and records physician's orders . 12. Assures nursing assistants comply with policies and procedures . Clinical . 3. Assesses residents .6. Identifies and reports changes in resident's status to physicians, responsible family members, and supervisory nursing staff . 11. Administers treatments and other direct care . 13. Implements restorative and rehabilitative nursing programs . Review of facility Registered Nurse (RN) job description on 08/31/23 at 12:45 PM, dated January (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 11 of 40 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 08/31/2023 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2023, provided by the DON documented, in part, the following: Purpose of your Job Position: . Document resident care services by charting in resident medical record and department records . Consult with resident's physician regarding resident's plan of care as well as notifying them of any changes . Review of facility Occupational Therapy Assistant (OTA) job description on 08/31/23 at 4:10 PM, dated January 2023, provided by the DON, documented, in part, the following: Purpose of your Job Position: 1 .Provides comprehensive appropriate patient treatment in accordance with patient's individual treatment plan as stipulated by supervising Occupational Therapist Communicating with supervisor and interdisciplinary team members regarding patient progress, problems and treatment plans . Review of facility's Occupational Therapist (OT) job description on 08/31/23 at 4:19 PM, dated January, provided by the DON, documented, in part, the following: Purpose of your Job Position: .Communicating with supervisor and interdisciplinary team members regarding patient progress, problems, and treatment plans . Resident #265 was originally admitted to the facility on [DATE] with diagnoses that included Parkinson's Disease, Senile Degeneration of Brain, Metabolic Disorder and Cerebrovascular Disease. The resident had a documented Brief Interview Mental Status (BIMS) score of 0 (severely impaired). review of the physician orders, dated 08/17/23 documented: Palm pillow to Bilateral hands as tolerated with regular skin checks completed with hand hygiene during ADL [Activities of Daily Living] care. During an initial observation of Resident #265 conducted on 08/28/23 at 10:53 AM, it was observed that she was sitting up in her Geri-chair in her room with TV (television) on. The resident was observed with her right palm pillow or roll located next to her person atop her blanket and not observed in place, as ordered. While there was no left palm pillow or roll observed on or near resident for a time frame of well over two (2) hours for a total of five (5) different observations, over the course of three (3) different days. Photographic Evidence Obtained. During a second observation of Resident #265 conducted on 08/28/23 at 2:01 PM, she was still observed with her (right) palm pillow or roll located next to her person atop her blanket, and not observed in place, as ordered. There was still no left palm pillow or roll observed on or near resident, at all. During a third observation of Resident #265 conducted on 08/29/23 at 10:42 AM, the resident was now observed resting in bed on her left side without her bilateral palm pillows or rolls in place as ordered: one palm pillow was observed on top of her dresser drawer and the other one was located visibly inside the top drawer of the resident's bedside dresser. During a fourth observation of Resident #265 on 08/29/23 at 2:13 PM, the resident was still observed resting in bed on her left side without her bilateral palm pillows or rolls in place as ordered: one palm pillow was still observed on top of her dresser drawer and the other one was still visibly located inside the top drawer of the resident's bedside dresser. During a fifth observation of Resident #265 on 08/30/23 10:23 AM, the resident was still observed resting in bed on her left side without her bilateral palm pillows or rolls in place as ordered: one palm pillow was still observed on top of her dresser drawer and the other one was still visibly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 12 of 40 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 08/31/2023 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 0688 located inside the top drawer of the resident's bedside dresser. Level of Harm - Minimal harm or potential for actual harm On 08/30/23 at 11:50 AM, an interview was conducted with Staff K, Certified Nursing Assistant (CNA), who was asked if the resident was supposed to be wearing her bilateral palm pillows or rolls. Staff K answered, yes, she is supposed to be wearing them on both hands. She was then asked why the resident has not been using them and she responded, because she did not see them. She was asked if she notified the nurse or bring this to her attention, and Staff K replied, no Residents Affected - Few On 08/30/23 at 11:55 AM, an interview was conducted with Staff L, Registered Nurse (RN), who was asked if the resident had an order dated 08/17/23 for Palm pillow to bilateral hands as tolerated with regular skin checks completed with hand hygiene during ADL care. Staff L responded, yes, she does. The nurse was asked if this order was being followed and replied, No, not at this time. The nurse stated she was not aware of this order. During a side-by-side computerized record review with the nurse, she was asked if the resident refused them or if the palm pillows were poorly tolerated by the resident and documented in the nursing notes, captured in the care plan or if the doctor had been contacted and made aware. The nurse responded, no, she did not see any of the above, but she said that she would have to check on it. On 08/30/23 at 12:20 PM, an interview was conducted with Staff M, Licensed Practical Nurse (LPN), covering as the Supervisor, who when asked if the resident had an order dated 08/17/23 for Palm pillow to bilateral hands as tolerated with regular skin checks completed with hand hygiene during ADL care, responded, yes, she does. When asked if the order was being followed, she replied, No, not at this time. When asked why the order was not followed, she responded, she was not aware of this order. During a side-by-side computerized record review, when asked if the resident refused the palm pillows or if they were poorly tolerated, was this documented in the nursing notes, captured in the care plan and was the doctor contacted and made aware along with the resident's current palm skin condition, she responded, no, she did not see any of the above. She stated she would have to check on it. On 08/30/23 at 12:45 PM, an interview was conducted with the Assistant Director of Nursing (ADON) who was asked if the resident had an order dated 08/17/23 for Palm pillow to bilateral hands as tolerated with regular skin checks completed with hand hygiene during ADL care, she responded, yes, she does. The ADON was asked if this order was being followed and she replied, No, not at this time. She was asked why the order was not followed and responded she had recorded the order as a Rehabilitation order. She acknowledged that it was not captured on the Medication Administration Record (MAR) or the Treatment Administration Record (TAR). The ADON was asked during a side-by-side computerized record review, if the resident refused the palm pillows or if these were poorly tolerated, was this documented in the nursing notes, captured in the care plan and was the doctor contacted and made aware along with the resident's palm skin condition, and she responded, no, she did not see any of the above, but she too would have to check on it, as well. On 08/30/23 at 2:14 PM, an interview was conducted with Staff N, Occupational Therapist (OT), covering for the Director of Therapy, who was asked if the resident had an order dated 08/17/23 for Palm pillow to bilateral hands as tolerated with regular skin checks completed with hand hygiene during ADL care, and responded, yes, she does. The OT stated Resident #265 did make some progress in Occupational Therapy for upper extremity tone, range of motion and positioning. She stated the purpose of the palm pillows is to help prevent decubitus ulcers in the palms, decrease pressure areas and to maintain functional range of motion (ROM) in order to decrease the burden of care. She stated the resident tolerated the palm pillows or rolls, during her therapy. When asked if this order was being followed based upon her review, she replied, No, not at this time. When asked who was responsible to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 13 of 40 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 08/31/2023 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few ensure the palm pillows or rolls are applied daily as ordered, she replied, it is the nursing staff's responsibility to do this once the resident is discharged from therapy. On 07/05/23, review of the care plan documented the palm pillow be placed to bilateral hands as tolerated with regular skin checks to be completed and with hand hygiene during Activities of Daily Living (ADL) care; and for skin inspection to monitor for redness, open areas, scratches, cuts, bruises and immediately report changes to the nurse. The resident's care plan did not document or capture any type of behaviors or refusals by this resident related to wearing or not wearing her palm pillows or rolls. Record review revealed that neither the MAR nor the TAR captured the palm pillows or rolls physician orders. Further record review indicated that there was no assessment documentation recorded in the facility's licensed nursing notes to describe the current actual condition of the resident's skin bilaterally, of her hand palms. There was no documentation recorded in the facility's nurses' notes, or any other facility records, to reflect that the resident had a poor tolerance to wearing her palm pillows or rolls. There was no documentation that this was communicated to the resident's physician. The facility nursing assistant staff had not been checking off on the computerized task list for dates from 08/28/23 through 08/30/23, as to whether or not the palm pillows or rolls had actually been in use and applied to the resident, as ordered. An interview was conducted with the Director Of Nursing on 08/30/23 at 2:41 PM, regarding Resident #265's not wearing her bilateral palm pillows as ordered by the physician, no documented resident refusals or poor toleration documented in the nursing notes, captured in the care plan and no doctor contacted to make aware of the resident's palm skin condition, revealed the palm pillows or rolls should be in place as ordered and the resident's skin condition should be documented and assessed by the licensed nursing staff. There was no evidence this was done. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 14 of 40 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 08/31/2023 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 - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Resident #340 was admitted to the facility on [DATE] from an acute care hospital with diagnoses that included weakness, Rhabdomyolysis and Hepatocellular Carcinoma (liver cancer). Review of the admission assessment dated [DATE] revealed the resident had a small open area noted to left heel and a weight of 146 pounds (#). Residents Affected - Few On 03/31/23, a nutrition assessment was done by Staff G, clinical dietician, which revealed she recommended house shakes three times a day (TID) for increased kcals (calories) to augment intake. On 08/30/23 at 3:49 PM an interview was conducted with Staff G. She stated she would put an order into the Meal Tracker. She stated the system is new and corporate was not able to put the amount given for the mighty shakes in the system. The Meal tracker started after March 2023 which enabled an amount taken to be put into the system. There was no evidence that mighty shakes were being given to the resident. On 04/07/23, a second weight was taken on Resident #340. The resident's weight was 137 pounds. This indicated a 9-pound weight loss in 9 days. On 04/07/23, the order was entered for Ensure Plus 237 ml (milliliters) give one carton by mouth two times daily. This was given to the resident on 04/07/23 and 04/08/23. On 04/08/23, the resident was discharged to the hospital per family request. Based on observations, interviews, and record review, the facility failed to provide nutritional interventions in a timely manner for 2 of 6 sampled residents, reviewed for nutrition, Resident #365 and Resident #340. The findings included: Review of the facility's policy, titled, Nutrition Assessment, dated 05/19/23, documented, in part, the following: the dietitian, in conjunction with the nursing staff, will conduct a nutritional assessment for each resident upon admission (within 14 days). The nutritional assessment will include the current nutritional status and risk factors for impaired nutrition. Review of the facility's policy, titled, Weight Assessment and Intervention, dated 05/19/23, documented, in part, the following: residents' weights are monitored for unintended weight loss. Any weight change of 5 percent or more since the last weight assessment is retaken the next day for confirmation. If the weight is verified, nursing will immediately notify the dietitian in writing. 1. Record review documented Resident #365 was admitted to the facility on [DATE] with diagnoses to include Protein-Calorie Malnutrition and Anxiety Disorder. An interview was conducted on 08/28/23 at 10:20 AM with Resident #365, who stated that all he wants to eat is two peanut butter sandwiches a day and that the facility refused to give them to him. He also said that he preferred something other than the food consistency that is given to him (pureed consistency) daily. In an observation conducted on 08/30/23 at 8:40 AM, Resident #365 was noted in his room with the breakfast tray. Closer observation showed that he ate about 50% of his meals. In this observation, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 15 of 40 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 08/31/2023 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 - Minimal harm or potential for actual harm Residents Affected - Few Resident #365 said that he ate about 50% of his dinner last night but that he did not like the food that was served to him. Record review documented a physician order for a regular, pureed-texture diet dated 06/14/23. Review of the weight log showed the following: the first initial weight taken on 06/28/23 showed that Resident #365 weighed 143 pounds (#). The next weight taken was on 07/06/23, which showed that Resident #365 weighed 122.5 pounds. This showed a significant / severe weight loss of 14% from 06/28/23 to 07/06/23. Record review did not show that an Initial Nutrition Risk Assessment was completed for Resident #365 on admission. The care plan for nutrition showed that Resident #365 was at nutritional risk, which was only initiated on 07/14/23. Review of the nutrition progress note dated 07/14/23 showed that Resident #365 had a 14.3% weight loss in 30 days. It further revealed that he was triggered by malnutrition and that he eats about 60% of his meals. In this note, the facility's clinical dietitian recommended Ensure Plus three times a day (TID), which was ordered on 07/14/23 (eight days after the severe weight loss was identified). A Nutritional History Assessment that was provided by the Director of Nursing (taken from the previous electronic system) showed that an initial assessment was completed for Resident #365 but that it did not have a date, time, or signature of the staff member who completed this assessment. An interview was conducted on 08/31/23 at 2:00 PM, with Staff G, Clinical Dietitian, who was asked why she had not completed the nutritional initial assessment on time when Resident #365 was admitted to the facility. She reported that she completed the assessment and that it was on the old electronic system. She was asked by the surveyor why it took her eight days after the severe weight loss to reassess Resident #365 and she did not know. A Speech Language Reassessment was conducted on 08/30/23 related to surveyor intervention for Resident #365. The new recommendations showed a diet upgrade from pureed to ground texture diet consistency. An interview was conducted on 08/31/23 at 8:45 AM with Resident #365, who stated that he was so happy that his diet was upgraded and was happy with his meal this morning. Continued observation showed that the resident ate over 75% of his breakfast meal. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 16 of 40 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 08/31/2023 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 0693 Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to prevent a significant weight loss of 8.33% and failed to provide nutritional intervention in a timely manner for 1 of 1 sampled resident reviewed for tube feeding, Resident #522. The findings included: Review of the facility policy, titled, Nutritional Assessment, dated 05/19/23, documented, in part, the following: As part of the comprehensive assessment, the nutritional assessment will be a systematic, multidisciplinary process that includes gathering and interpreting data and using that data to help define meaningful interventions for the resident at risk for or with impaired nutrition. For residents who are receiving enteral nutrition support, the nutritional assessment shall include gathering information and documenting why the enteral nutrition is medically necessary. Review of the facility policy, titled, Weight Assessment and Intervention, dated 05/19/23 documented, in part, the following: Under Weight Assessment - Residents are weighed upon admission and at intervals established by the interdisciplinary team [IDT] . Any weight change of 5% or more since the last weight assessment is retaken the next day for confirmation. If the weight is verified, nursing will immediately notify the dietitian in writing. Under Evaluation - Undesirable weight change is evaluated by the treatment team whether or not the criteria for significant weight change has been met. The evaluation includes: the resident's target weight range (including rationale if different from ideal body weight); the resident's calorie, protein, and other nutrient needs compared with the resident's current intake; the relationship between current medical condition or clinical situation and recent fluctuations in weight; and whether and to what extent weight stabilization or improvement can be anticipated. In an interview conducted with Resident #522 on 08/28/23 at 1:12 PM, Resident #522 stated he was receiving tube feeding via bolus and had just finished his feeding for the afternoon. He stated he had concerns regarding weight loss since he had entered the facility and that he had a new wound on his foot. During this interview, the surveyor observed there was no tube feeding infusing. Record review documented Resident #522 was admitted to the facility from an acute care facility on 08/11/23. The resident had a medical history with diagnoses that included Aspiration Pneumonia, Respiratory Failure, Asthma, Dysphagia, and Parkinson's Disease. Review of the admission Minimum Data Set (MDS) initiated on 08/15/23 revealed Resident #522 had a Brief Interview of Mental Status (BIMS) score of 12 of 15, indicating he had moderate cognitive impairment. Section K (for Swallowing Disorders) was completed on 08/21/23 that documented Resident #522 had a loss of liquids / solids while eating / drinking, the presence of holding food in mouth/cheeks or residual food in mouth after meals, the presence of coughing / choking during meals or when swallowing medications, and complaints of difficulty or pain when swallowing. This section also (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 17 of 40 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 08/31/2023 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 0693 Level of Harm - Actual harm Residents Affected - Few documented that Resident #522 was on tube feedings and not on an oral diet (NPO). This section also documented unknown or no for weight loss status. This MDS did not document the presence of pressure ulcers. Review of the hospital records dated 08/11/23 showed Resident #522 was complaining of generalized weakness, nausea, vomiting, and diarrhea. During his hospital stay, Resident #522 had the following complication: Code rescue called due to respiratory failure caused by aspiration. He was later transferred out of the ICU [Intensive Care Unit] for further management of aspiration and dysphagia. Over the course of the hospitalization, a Barium Swallow study (this test is an imaging study that checks for problems in a person's upper gastrointestinal tract. It is the gold standard for a patient or resident to receive an oral diet after being intubated or being identified as having a swallowing disorder) was attempted but the patient had another aspiration episode and the evaluation had to be stopped. After discussion with the patient and the high risk for aspiration, he agreed for a percutaneous endoscopic gastrostomy (PEG) tube. A PEG tube is a special feeding tube which is surgically placed into a person's stomach through their abdominal wall. This tube is used to deliver tube feeding formula directly into the person's stomach due to the person having difficulty swallowing. Further review of hospital records revealed a note from the internal medicine doctor on 08/09/23 that documented a weight of 189.42 pounds. Review of Resident #522's paper chart in the facility revealed an admission diet order to the facility (admission on [DATE]) of the following: Full Liquid Diet with Honey Thickened Liquids and Tube Feeding Jevity 1.5 (tube feeding formulary) infuse at 60mL/hr. Continued review of Resident #522's paper chart showed the resident was admitted from the hospital with an identified pressure wound on the buttocks area. The admission form from the hospital (08/11/23) documented a current weight of 192 pounds. Review of the facility's physicians orders revealed the following orders: a. an order for Full Liquid Diet, which was started on 08/11/23 and was discontinued on 08/14/23. b. an order for Jevity 1.5 (tube feeding formulary) at 60 milliliters per hour (mL/hr), which was started on 08/11/23 and was discontinued on 08/16/23 (please note this was an incomplete tube feeding order due to there was no time/hour limit parameter on the 60mL/hr). c. an order for NPO was written on 08/14/23. d. on 08/17/23, a new physician order was written for Nutren 2.0 (tube feeding formulary) at 75mL/hr start at 5:00 PM infuse for 13 hours for a total of 2000 calories a day and 84 grams of protein a day. e. on 08/17/23, an order was written for bolus tube feeding of Nutren 2.0 of 237 mL daily providing an additional 474 calories and 21 grams protein. Review of Resident #522's weights documented by the facility revealed the initial weight taken on 08/15/23 (4 days after admission) was 156 pounds. The following weight was taken on 08/24/23 which (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 18 of 40 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 08/31/2023 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 0693 showed significant weight loss of 8.33% from 156 pounds to 143 pounds. Level of Harm - Actual harm Further review of the resident's weights revealed the following: Residents Affected - Few 08/09/23, Hospital weight: 189 pounds (#). 08/11/23, admission form weight: 192#. 08/15/23, Initial assessment weight: 156# (4 days after admission). 08/24/23, weight: 143# (wheelchair) (significant at 8.3% loss). 08/29/23, weight: 143# / 148# (wheelchair). 08/30/23, with Hoyer lift: 141.5#. Review of the initial Nutrition Risk Assessment was conducted and it was noted that this assessment was started on 08/15/23 and locked (in the electronic system) on 08/28/23. This assessment documented Resident #522 had a diet order of NPO [nothing by mouth] and was receiving a Tube Feeding Bolus of 237mL Nutren via peg tube bolus 1 time a day to provide an additional 474 calories and a Continuous Feeding of Nutren 2.0/1000mL via peg tube at 75mL/hr. Auto water flush 1000mL at 75mL/hr. Start at 5:00 PM infuse until complete ~13 hrs. 2000calories, 84 grams protein, TFV 2000mL. This was inaccurate because the Physicians Orders as above showed on 08/15/23, Resident #522 was still on the Jevity 1.5 formulary. In this assessment, Resident #522's estimated Nutritional Needs were documented as 2377 to 2732 calories per day and 71 to 89 grams of protein per day. It further showed underweight status and skin condition was marked with injury of pressure injury 3 sacrum. Further review of the described tube feeding order revealed that the resident was receiving the low end of the Estimated Nutritional Needs, which was started 6 days after admission [DATE]). Review of a Nursing Progress Note written on 08/11/23 at 8:42 PM, referred to the pressure ulcer on Resident #522's sacrum. Further review of notes revealed a Nursing Progress Note written on 08/26/23 at 2:33 PM which stated, skin was observed, has no skin concerns, skin is warm, dry and intact. Further record review revealed a Skin and Wound Evaluation documented on 08/30/23 which showed a deep tissue injury pressure injury to the resident's left heel which was noted on 08/28/23. Review of the Speech Language Pathologist's initial assessment dated [DATE] showed severe oral pharyngeal dysphagia and resident at risk for aspiration pneumonia and weight loss. It was further recommended that Resident #522 be placed on an NPO diet. Review of the Care Plans revealed Resident #522 was on a tube feeding for nutritional support related to dysphagia and pneumonitis. This care plan was initiated on 08/21/23 (10 days after admission). It further showed that Resident #522 was at increased risk of dehydration related to enteral feeding, dysphagia, and significant weight loss since admission, which was only initiated on 08/21/23 and revised on 08/30/23 (after the significant weight loss was identified by the surveyors). Continued review of the care plans also showed that Resident #522 was at risk for pressure injury development and encouraged the staff to notify the nurse immediately of any new areas of skin breakdown, which was initiated on 08/14/23 and revised on 08/30/23. A Dietary Consultation was also ordered in this care plan regarding supplements including Zinc and Vitamin C via g-tube, which was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 19 of 40 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 08/31/2023 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 0693 initiated on 08/28/23 (17 days after admission). Level of Harm - Actual harm Continued review of Resident #522's record showed an additional Nutren 2.0 tube feeding bolus (now written for two times per day) was written on 08/24/23 to provide a total of 2900 calories per day and 126 grams of protein per day meeting the higher end of his estimated nutritional needs. (This was done 13 days after Resident #522's admission to the facility). Residents Affected - Few In an observation conducted on 08/29/23 at 3:40 PM, Resident #522's weight was taken by staff using a wheelchair. The weight was recorded by the surveyor at 143 pounds. This weight was later placed in the electronic charting system by the facility staff at 148 pounds. A secondary weight was requested by the surveyor. This weight was taken by staff on 08/30/23 at 9:37 AM using the Hoyer lift. The weight showed 141.5 pounds. This indicated Resident #522 suffered additional weight loss during the week of survey (08/28-31/23). An interview was conducted with the facility's Speech Therapist (ST) on 08/29/23 at 3:28 PM. She stated she works full time at the facility. She stated residents who come into the facility are screened by her to ensure they are on a correct diet form. She stated if a resident comes into the facility with a PEG tube (percutaneous endoscopic gastrostomy, a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach), therapy screenings will be ordered, and she would see the resident within the first couple of days. She stated when a person receives a PEG tube, a Barium Swallow study had already been performed by the hospital prior to the PEG placement. She further stated, If I think they are better or I could get different results from another study, then I do another one. She stated, If they come in on [an oral] diet and I don't think it's safe, I will change it. She further stated that if the nurses have a concern, they can call her, and she will assess the resident. She stated she reviews the medical records from the hospital prior to writing her assessment and recommendations. The ST stated she recalled that Resident #522 came to the facility from the hospital with the PEG tube in place, so she performed a screening on him due to his high-risk status. She said she saw him the Monday after he was admitted and assessed his ability to handle the oral diet with the PEG tube. She stated she reviewed his chart in depth and saw he had failed an initial swallow study and that a secondary swallow study was not performed. She stated she felt he was not safe to continue an oral diet. She stated she had a sit down with Resident #522 and explained that she was not comfortable with keeping him on an oral diet. She said Resident #522 told her that she had heightened his awareness that food or liquid could be there and he may not feel it. He agreed to wait and be patient. She stated she feels he was improving in his health and swallowing status at this point. An interview was conducted with Staff G, Clinical Dietitian on 08/29/23 at 2:57 PM. Staff G stated she worked full time, Monday through Friday at the facility. When asked about the criteria for new resident assessments, Staff G stated she had 5 days to complete the initial Nutrition Risk Assessment. When asked which residents would be considered high risk, she stated any residents with wounds, dialysis, or enteral feedings were considered high risk residents. When asked what the time frame was for completing the Nutrition Risk Assessment on all residents (high risk or not), Staff G stated, I think its 5 to 7 days. She then stated, it can be completed earlier, but no more than 7 days. When asked how she determined what to order for tube feedings for residents, Staff G stated she must complete the assessment within 7 days and wait for the initial weight from the Certified Nursing Assistant (CNA), and then she determined her recommendations for tube feedings. She further stated when she does an assessment, she would review the resident's weight, whether (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 20 of 40 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 08/31/2023 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 0693 Level of Harm - Actual harm Residents Affected - Few they had wounds, and what type of diet they were on previously before she wrote her recommendations. She also stated if a resident came in on tube feedings, she would look in their record to see if there were speech therapy notes, what tube feeding the resident was on previously, and their diagnoses to determine her recommendations. The surveyor then asked how Staff G determined what kind of tube feeding to recommend if the resident had not been at this facility previously. Staff G stated she would review the hospital records and write orders for what the resident had been receiving at the hospital. When asked what the guideline was for resident weights, she stated residents are to be weighed on admission, then weekly for 4 weeks, then monthly. She confirmed this was the facility's policy. The surveyor then asked whose responsibility it was for obtaining the resident's weights. Staff G stated there was a designated CNA at the facility who took all admission weights and then from there after weights were the responsibility of the CNA who was assigned to the resident. When asked how the CNAs knew which residents were due for weights, Staff G stated she kept a list. When asked who was responsible for documenting the weights in the electronic chart, Staff G stated the CNAs used to chart the weights, but then she noticed she was not able to review the weights first to know if residents had suffered weight loss, so she had recently been documenting all the weights herself. Staff G further stated when she got the monthly weights from the CNAs, she was able to identify significant weight loss and put interventions in place quickly. When asked how many days after monthly weights are obtained did it take for her to receive them, Staff G did not answer. When asked to explain what significant weight loss was, Staff G stated 2% in 1 week, 5% in 1 month, 7.5% in 3 months, or 10% in 6 months. When asked what a reasonable amount of time was to wait to implement interventions after significant weight loss was identified, she stated 2 to 3 days. When asked specifically about Resident #522's nutritional status, Staff G stated he was admitted from the hospital on [DATE]. When the surveyor asked why her initial Nutrition Risk Assessment was started on 08/15/23 and locked on 08/28/23, she stated I locked it before and then went in and made changes. I reopened it yesterday. When asked when it was locked initially, Staff G stated she did not know but would have to ask the administrator if it was possible to view the initial time stamp. When asked why there were no nutritional needs documented on the Mini Nutritional Assessment, Staff G did not respond. The surveyors asked for an explanation for why she chose to change her initial documentation on the Nutrition Risk Assessment, Staff G did not respond. The surveyor explained that it was very confusing that Staff G changed Resident #522's initial clinical presentation to include later orders and diet changes and that the Nutrition Risk Assessment did not tell a true story of how Resident #522 presented to the facility. Staff G stated When he came in, it was in on a weekend, then when I came back in I tried to find out exactly what was going on. He was initially receiving an oral diet and no tube feeding was ordered, so I had to put in a tube feeding order. The surveyor explained that it was concerning that an incomplete tube feeding order, with timeframes. was not written until Resident #522 had been at the facility for 6 days and that order was meeting the lower end of his estimated needs. The surveyor further explained that it was concerning that the additional bolus order was not written for 7 more days, contributing to Resident #522 losing a significant amount of weight. Staff G agreed that Resident #522's nutritional needs were not being (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 21 of 40 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 08/31/2023 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 0693 Level of Harm - Actual harm met. She further stated that Resident #522 was working with the facility's speech therapist to get back to the level where he is eating. She stated Resident #522 was eating when he came into the facility but that after the speech therapist conducted her evaluation, the speech therapist decided to make him NPO. When asked if she conducted any further evaluations besides her initial, Staff G stated she had not. Residents Affected - Few In a secondary interview conducted with Staff G on 08/30/23 at 3:45 PM, the surveyor expressed further concern regarding the timing of nutritional interventions for high risk residents and the inaccuracy of her initial nutritional assessment documentation. An additional interview was conducted with Staff G on 08/31/23 at 4:05 PM. The surveyor asked her how she obtains her information regarding new residents. Staff G explained that she reviews the resident's History and Physical, labs, history, and the admission form from the hospital, which includes height and weight. When asked if she reviewed these documents for Resident #522, Staff G stated she did not review hospital admission form before documenting her initial assessment. She further stated she did see the hospital weight of 192#, after she had documented her assessment. She stated she did question the significant weight change but he is a tall man. Staff G then stated Resident #522 mentioned initially to the speech therapist that he was not feeling too well with the tube feeding so she decided to monitor him for a few days before increasing the tube feeding rate. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 22 of 40 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 08/31/2023 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on records review, observations and interviews, the facility failed to ensure that residents medications refills were reorder in a timely manner for 3 of 7 sampled residents reviewed for medications and timeliness of administration, Resident #44, # 89, and #434. The findings included: Review of the facility's policy, titled, Medication Ordering and Receiving from Pharmacy, revised dated January 2018, documented, in part, .the facility maintains accurate records of medication order and receipt . Review of the facility's policy, titled, Medication and treatment Orders, published dated 05/19/23, documented, in part, .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 . 1. Review of Resident #44's clinical record documented an admission on [DATE] with no readmission. The resident's diagnoses included Dry Eye Syndrome, Dementia and Cerebral Infarction. Review of Resident #44's Minimum Data Set (MDS) annual assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 10, indicating the resident had moderate cognition impairment. Review of Resident #44's clinical record documented a physician order dated 07/19/23 for Muro 128 Ophthalmic Solution one drop in both eyes four (4) times a day for Dry Eye Syndrome, scheduled on military time at 0800 (8:00 AM), 1200 (noon), 1600 (4:00 PM) and 2000 (8:00 PM). Review of Resident #44's August 2023 Medication Administration Record (MAR) for Muro 128 Ophthalmic Solution eye drops was conducted. The review revealed documentation of code #9, meaning-other/see nurses notes, for the eye drops from 08/22/23 at 1600 hours through 08/25/23 at 2000 hours. Further review revealed that Resident #44 was administered Muro 128 eye drops on 08/26/23, 08/27/23, and on 08/28/23 at 0800 and 1200 hours, then code #9 was documented on 08/26/23 and 08/27/23 at 1600 and 2000 hours. Review of Resident #44's electronic medication administration note (code #9 note) dated 08/22/23 1725 hours (5:15 PM) documented Muro 128 Ophthalmic Solution- not found in the cart, request refill. Review of Resident #44's electronic medication administration note (code #9 note) dated 08/22/23 2036 hours (8:36 PM) documented Muro 128 Ophthalmic Solution- pending delivery. Review of Resident #44's electronic medication administration note (code #9 note) dated 08/23/23 1737 hours (5:37 PM) documented Muro 128 Ophthalmic Solution-pending delivery. Review of Resident #44's electronic medication administration note (code #9 note) dated 08/23/23 2044 hours (8:44 PM) documented Muro 128 Ophthalmic Solution-pending delivery. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 23 of 40 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 08/31/2023 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 Review of Resident #44's electronic medication administration note (code #9 note) dated 08/24/23 at 1809 hours (6:09 PM) documented Muro 128 Ophthalmic Solution-pending delivery. Review of Resident #44's electronic medication administration note (code #9 note) dated 08/25/23 at 1425 hours (2:25 PM) documented Muro 128 Ophthalmic Solution-med unavailable. Residents Affected - Few Review of Resident #44's electronic medication administration note (code #9 note) dated 08/25/23 at 2040 hours (8:40 PM) documented Muro 128 Ophthalmic Solution-pending delivery. Review of Resident #44's electronic medication administration note (code #9 note) dated 08/28/23 at 1703 hours (5:03 PM) documented Muro 128 Ophthalmic Solution-medication not available/call pharmacy. Review of Resident #44's electronic medication administration note dated 08/28/23 at 1823 hours (6:23 PM) documented not available in stock, pharmacy contacted at 6:24 PM, will be delivered by the end of the shift. On 08/28/23 at 4:24 PM, medication administration observation for Resident #44 performed by Staff S, Licensed Practical Nurse (LPN) started. Staff S proceeded to review the resident's medications scheduled for 4:00 and 5:00 PM and stated Resident #44 was due for Muro 128 Ophthalmic Solution (eye drops) at 4:00 PM (1600 hours). Observation revealed Staff S looking through the medication cart's drawers and stated she did not see Resident #44's Muro 128 ophthalmic solution bottle in the medication cart. During the interview, Staff S stated that Resident #44's Muro 128 eye drops were scheduled to be given four (4) times a day at 8:00 AM, 12:00 PM, 4:00 PM and 8:00 PM. Staff S stated she would call the pharmacy to reorder it and for a delivery. On 08/28/23 at 6:35 PM, during an interview, the Assistant Director of Nursing (ADON) was apprised of Resident #44's Muro 128 eye drops not being available for administration at 4:00 PM. The ADON replied she was not informed about it. On 08/28/23 at 6:45 PM, during an interview, Staff S stated that Resident #44's Muro 128 eye drops had not been delivered from the pharmacy as of yet. On 08/29/23 at 1:40 PM, an interview was conducted with Staff Y, Registered Nurse (RN). Staff Y stated that she remembered Resident #44 not having her eye drops, but that she had not been scheduled back to work on this unit. Staff Y stated she looked that it was reordered and was waiting to be delivered. Staff Y stated she did not call the doctor regarding the resident missing the eye drops and did not call the pharmacy to follow up on the reordering of the resident's eye drops. Staff Y was apprised that Resident #44 missed two doses on her shift on 08/25/23. A side-by-side review of the facility's pharmacy electronic reordering system was conducted with Staff Y. The screen displayed that Resident #44's last eye drops reorder was on 08/22/23 and dispensed on 08/28/23. On 08/29/23 at 3:27 PM, an interview was conducted with Staff U, RN. A side by side of Resident #44's August 2023 MAR was conducted with Staff U. The review revealed that he coded the resident's Muro 128 ophthalmic eye drops with a code number nine (#9). Staff U stated that code #9 is used when a medication is not given, and they have to document the reason. Staff U stated that when a medication is not available at the pharmacy, they will call the doctor, and added if the pharmacy does not tell (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 24 of 40 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 08/31/2023 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 them that they don't have the medication when it is reordered, they wait until it is delivered. Staff U stated that they don't call the doctor because the pharmacy takes time to send the refills. Staff U added that he had made many calls in the past to get medications. Staff U was apprised that Resident #44 did not get her eye drops as order for many days in a row. Staff U was asked why he did not communicate with the Director of Nursing (DON) regarding the delay on refills from the pharmacy. Staff U replied the DON should have been notified and added will do better next time. On 08/30/23 at 8:19 AM, during an interview, the Consultant Pharmacist (CP) was apprised regarding Resident #44 Muro 128 Ophthalmic (eye drops) not being available for administration during medication administration observation on 08/28/23 at 4:00 PM. The CP was asked to provide evidence of the eye drops receipt of reordering from pharmacy. The CP stated that Muro 128 was an eye lubricant, and that Refresh Tears was a house stock compatible that the staff could use. The CP stated that the staff did not need to call the pharmacy for a refill because it was a house stock item. A side-by-side review of the Resident #44's Muro eye drop entry in the electronic system revealed that it was not entered as a house stock medication. On 08/30/23 at 8:35 AM, an interview was conducted with Staff T, LPN who stated the process about reordering medications refills was calling the pharmacy, especially if running very low, or reorder via the electronic medical record when the medications had three days left. Staff T stated having no issues reordering medications during the month of August 2023. Staff T was asked if she administered Resident #44 Muro 128 eye drops on 08/26/23, 08/27/23, and on 08/28/23 at 0800 and 1200 hours and stated she did not. Staff T was asked why she documented it as administered if she did not and replied, My error, I probably got interrupted and initialed as given. Staff T was asked if she called the pharmacy to reorder the eye drops and stated she did not. Staff T was asked if she called the doctor to inform about the medication not given as ordered, and replied she did not. On 08/30/23 at 10:15 AM, the CP provided an e-mail from the pharmacist that documented the Muro 128 Ophthalmic Solution was ordered on 07/21/23 and there were no other requests via phone call regarding the eye drops. The CP stated the drops were good for 30 days and should have been reordered by 08/21/23. On 08/30/23 at 2:45 PM, during an interview, the DON was apprised of the findings. The DON stated that Muro 128 ophthalmic drops were not a house stock medication and should have been ordered from the pharmacy. On 08/31/23 at 3:10 PM, during an interview, the DON stated she was not able to find any written nursing documentation of notification to the doctor regarding Resident #44's Muro 128 eye drops not been administered as ordered by the physician. 2. Review of Resident #89's clinical record documented an admission on [DATE] with no readmissions. The resident's diagnoses included Hypothyroidism, Protein-Calorie Malnutrition, Vitamin D deficiency and Alcohol Abuse. Review of Resident #89's MDS annual assessment dated [DATE] documented a BIMS score of 15 indicating no cognition impairment. Review of Resident #89's physician order dated 04/28/23 documented, Slow Release tab (tablets) 45 mg (milligrams) give one tablet orally in the afternoon with meals related to Anemia scheduled at 1700 hours (5:00 PM). The physician's order did not state the medication name. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 25 of 40 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 08/31/2023 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 Review of Resident #89's August 2023 MAR documented refusal of the medication 23 of 27 days during the month of August 2023. Review of Resident #89's nurse progress notes lacked written evidence regarding physician notification of Resident #89 refusal of Slow Release tablets 23 of the 27 days in August 2023. Residents Affected - Few On 08/28/23 at 4:42 PM, medication administration observation for Resident #89 performed by Staff S, LPN started. Staff S proceeded to review the resident's medications scheduled for the observation time. Staff S stated the resident was scheduled for Slow Release 45 mg and added Slow release what? Staff S stated that she could not find Slow Release tablets in the medication cart for Resident #89 and added that if she found it, she did not want to give it because it did not state the medication name. Observation revealed Staff S reordered Slow Release 45 mg medication via the EMR. Staff S stated the medication was for anemia. On 08/28/23 at 6:25 PM, an interview was conducted with the ADON who stated the facility did not have Slow Release Iron in house stock. The ADON added that the medication was reordered as 'expedite delivery today'. On 08/30/23 at 8:45 AM, an interview was conducted with Staff T, LPN who stated that Resident #89 refuses to take her Slow Release medication a lot of times. Staff T was asked if she notified the doctor about refusal of the medication and replied she believes she did but did not know how to find the note. On 08/30/23 at 8:50 AM, observation revealed Staff T receiving medications from the pharmacy Technician (tech). An interview was conducted with the pharmacy tech who stated that they do delivery medications to the facility two times a day. On 08/30/23 at 9:30 AM, an interview was conducted with the DON regarding Resident #89's Slow Release 45 mg tablets not being available for administration on 08/28/23 5:00 PM dose. The DON stated Slow Release medication was not available and was not an over the counter medication (OTC). On 08/30/23 at 2:15 PM, a side-by-side review of Resident #89's Slow Release 45 mg tablets delivery card documented date of delivery as of 08/28/23. On 08/31/23 at 3:10 PM, during an interview, the DON stated she was not able to find any written nursing documentation of notification to the doctor regarding Resident #89's refusal of taking Slow Release - Iron tablets as ordered by the physician. 3. Review of Resident #434's clinical record documented an admission on [DATE] with no readmissions. The resident's diagnoses included Type 2 Diabetes Mellitus, Heart Failure and Dementia. Review of Resident #434's Minimum Data Set (MDS) admission assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 9, indicating that the resident had moderate cognition impairment. Review of Resident #434's care plan, titled, The resident has Diabetes Mellitus, initiated on 08/08/23, documented interventions to include: diabetes medication as ordered by the doctor. Review of Resident #434's physician order dated 08/08/23 documented Insulin Lispro Solution (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 26 of 40 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 08/31/2023 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 Pen-injector inject 20 units subcutaneously before meals related to Type 2 Diabetes Mellitus. Level of Harm - Minimal harm or potential for actual harm Review of Resident #434's August 2023 MAR documented Insulin Lispro Solution Pen-injector inject 20 units subcutaneously before meals related to Type 2 Diabetes Mellitus scheduled for 0730 (7:30 AM), 1130 (11:30 AM) and 1630 (4:30 PM). Residents Affected - Few Review of Resident #434's August 2023 MAR documented on 08/28/23 a number 12 (#12) above the nurse initials (Staff V, LPN). On 08/28/23 at 5:16 PM, medication administration observation for Resident #434 performed by Staff W, LPN started. Staff W stated the resident was scheduled for a blood sugar check and insulin administration at 4:30 PM. Staff W, performed the resident's blood sugar and stated the result was 226 [mg/dl]. Observation revealed Staff W walked to the medication cart and started to look for the resident's insulin pen and stated he could not find it. Staff W walked to the medication room, looked into the emergency kit in the refrigerator and stated he did not find any Insulin-Lispro for Resident #434. The ADON came to the medication room, looked in the refrigerator and stated they had to call the doctor to get an order for another insulin since they did not have Insulin - Lispro in the facility for Resident #434. On 08/28/23 at 5:20 PM, an interview was conducted with the facility evening supervisor who stated the pharmacy had not done any medications delivery yet. Subsequently, a joint interview with the supervisor and the ADON was conducted. They were apprised that Resident #434 was scheduled for Insulin-Lispro 20 units at 4:30 PM and the insulin was not available as per Staff W, LPN. On 08/28/23 at 5:43 PM, during an interview, the evening supervisor and the ADON stated that Resident #434's Insulin-Lispro insulin pen was reordered on 08/08/23 as per the pharmacy staff. The supervisor stated that the insulin pen has only 5 doses and should have been reordered on 08/13/23. The pharmacy did not have any record of the Resident #434's Insulin-Lispro Pen Injector reordered since 08/08/23. The supervisor stated she would call the doctor and added that if there is a substitute the physician would let her know, she would check the emergency kit and would administer it. On 08/28/23 at 5:55 PM, during an interview, the evening supervisor stated the doctor had not call back yet regarding Resident #434's 4:30 PM scheduled dose of Insulin that was not available. The supervisor stated that the pharmacy would be sending an Insulin-Lispro Pen Lispro 100,000 units per ml, a three (3) ml pen, which would last 5 days. On 08/28/23 at 6:09 PM, the surveyor left Resident #434's unit and no insulin had been delivery yet as per ADON. On 08/28/23 at 6:41 PM, per ADON, no insulin for Resident #434 had been delivered. On 08/29/23 at 2:02 PM, an interview was conducted with Staff Z, LPN, who stated she was not sure of the facility's reordering medications protocol. Staff Z added the night shift staff tend to check on insulins for the residents and reorders them. Staff Z was asked if she notices that an insulin pen was going low what she would do and replied, she was not sure. A side by side review of Resident #434's Insulin Lispro Pen 100,000 units per ml three (3) ml was conducted with Staff Z. The Insulin-Lispro Pen pharmacy label was dated as opened on 08/29/23. Staff Z was not able to tell how many doses of insulin the pen had. Staff Z added that Insulin is (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 27 of 40 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 08/31/2023 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 important, as if not given as ordered, the resident's blood sugar would be high, may need to be sent to the hospital and the doctor would not be happy. On 08/29/23 at 2:44 PM, an interview was conducted with Staff AA, RN, who he worked 3 PM - 11 PM shifts most of the time. Staff AA stated that if a resident was getting insulin three times a day, it will go fast. Residents Affected - Few On 08/29/23 at 3:13 PM, an interview was conducted with Staff W, LPN, who stated that on 08/28/23 Resident #434's doctor called back and ordered 20 units of Novolog Insulin. Staff W stated he checked the resident's blood sugar at 2000 hours (8:00 PM) and the result was 321 mg/dl and at 2026 hours (8:26 PM) administered 20 units of Novolog (short acting insulin), and 10 units of Insulin Glargine (long acting insulin) as scheduled for 2000 hours (8:00 PM). On 08/29/23 at 3:16 PM, a side by side review of Resident #434 medication administration record was conducted with Staff W. The review revealed the resident was administered 20 units of Novolog insulin at 2026 hrs (8:26 PM), a one time dose. The resident was scheduled for Insulin coverage at 1630 hours (4:30 PM). On 08/30/23 at 8:19 AM, during an interview, the Consultant Pharmacist (CP) was apprised of the findings during medication administration observation on 08/28/23. The CP stated they could have gotten the Insulin-Lispro from the Cubex medication supply system. On 08/30/23 at 9:40 AM, an interview was conducted with the ADON who stated the Cubex did not have Insulin Pens because it needed refrigeration before opening. On 08/31/23 at 9:24 AM, an interview was conducted with Staff V, LPN who confirmed she worked on 08/28/23 and was assigned to Resident #434. A side by side review of the resident's August 08/28/23 MAR was conducted with Staff V. Staff V stated she did not have to give any insulin to Resident #434 on 08/28/23 at 7:30 AM because the blood sugar result of 126 mg/dl. Staff V added that insulin was usually given for blood sugar higher than 200 mg/dl. On 08/31/23 at 3:29 PM, an interview was conducted with the DON who was apprised that on 08/28/23 at 7:30 AM, Staff V, LPN, stated that she did not administer Resident #434's scheduled insulin because of the blood sugar. The DON was apprised that Staff V documented a code #12 that indicated Insulin no required. The DON was apprised of concerns related to the resident's Insulin-Lispro insulin administration for 14:30 hour (2:30 PM) not given until 2026 hours (8:26 PM) and no record of reordering of the insulin to pharmacy since 08/08/23. The DON was apprised that the insulin pen only had 5 doses according to the pharmacy and should have been reordered on 08/13/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 28 of 40 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 08/31/2023 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 observations, interviews, and record review, the facility failed to ensure that PRN (as needed) physician orders for psychotropic drugs are limited to 14 days for 1 of 5 sampled residents for unnecessary medication (Resident #144). The findings included: Record review documented that Resident #144 was admitted on [DATE] with diagnoses to include Major Depressive Disorder and Unspecific Psychosis. Review of the Physician's orders showed the following order, dated 04/17/23 with no stop date, for Lorazepam 0.5 milligrams to be given every 6 hours as needed for anxiety. Review of the Pharmacy recommendation book showed the following: no recommendations were provided on 04/25/23 regarding the above medication PRN status; no recommendations were provided on 05/09/23 for the above medication PRN status; and no recommendation was provided on 06/29/23 for the above medication PRN status. Further review showed that it was not until 07/29/23 that a recommendation was given regarding the Lorazepam PRN order that was PRN with no stop date. In this note, the Pharmacist recommended either discontinuing the medication, adding a stop date, or even considering updating to scheduled dosing as appropriate. The Physician addressed the recommendation on 07/30/23 and noted to renew the PRN order for 30 days and that he would reassess later. An interview conducted on 08/30/23 at 3:10 PM with the facility's Pharmacist who stated she comes into the facility at least once a month to conduct medication reviews on all residents. For any orders of PRN with no stop date, she submits the recommendation to discontinue, make a routine, or to reassess the resident. The pharmacist stated this is then given to the Director of Nursing who is the one who prints out the recommendations and executes them. She will check out the progress of the recommendations with the Director of Nursing the next month when she comes in. When asked about Resident #144 order, which started on 04/17/23 and was not addressed until 07/29/23, she said it was incorrect. The Pharmacist said the PRN order was started on 04/17/23 and stopped on 05/01/23. It only started again for a PRN status on 07/19/23. A review of Resident #144's Medication Administrator Record for May 2023 showed that Resident #144 had an order for Ativan 0.5 milligrams every 6 hours PRN with a start date of 05/05/23 and was recorded as given on different days for the entire month of May 2023. In an interview conducted on 08/30/23 at 3:44 PM, the Director of Nursing stated that she reviews the pharmacy recommendations and would contact the specific doctors for the pharmacy recommendations. Each doctor has a folder where she will place the recommendations. She leaves the doctors a note for them to return it to her, and she would move forward from that point. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 29 of 40 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 08/31/2023 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 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide the correct fluid consistency for 1 of 6 sampled residents reviewed for nutrition, Resident #63. The findings included: Record review documented Resident #63 was admitted to the facility on [DATE] with diagnoses that included Lupus, Anemia, and Major Depression. Review of the physician ordered diet included: diet order dated 06/14/23 for no added salt diet with regular texture and nectar-thickened liquids. The annual Minimum Data Set (MDS) dated [DATE] documented Resident #63 had a Brief Interview of Mental Status (BIMS) score of 15, indicating the resident is cognitively intact. The care plan initiated on 07/10/23 documented Resident #63 is at high nutritional risk for dysphagia and is on thickened liquids by the Speech Language Pathologist (ST). It further showed that Resident #63 is blind in one eye. In an observation conducted on 08/28/23 at 10:34 AM, Resident #63 was in her room with the breakfast tray. The meal ticket showed an order for a no-added salt diet with thick nectar liquids. Closer observation showed thickened apple juice, Mighty Shake nutritional supplement, regular milk that was not thickened, and hot tea that was not thickened. Further observation showed there was no thickened powder on the tray. In an observation conducted on 08/28/23 at 12:00 PM, Resident #63 was noted in the room. Closer observation showed a regular water pitcher with 800 ml of water at the bedside, which was not thickened. In this observation, Resident #63 asked the surveyor if she could take the water pitcher out of the room. An interview was conducted on 08/28/23 at 12:05 PM, with Staff A, Licensed Practical Nurse, who stated the regular water pitcher should not have been given to Resident #63, and that it was a mistake. In an observation conducted on 08/29/23 at 9:12 AM, Resident #63 was noted in her room with a breakfast tray on her side table. Closer observation showed the name on the breakfast tray belonged to another Resident (Resident #39). In this observation, Resident #63 said, I do not think this is my breakfast tray. In an interview conducted on 08/29/23 at 9:15 AM, with Staff B, Certified Nursing Assistant, was asked if she had brought Resident #63 the wrong tray. Staff B replied, yes. She further said that she is new to this side of the unit and that it is her first time serving the meal trays to the residents. In an interview conducted on 08/31/23 at 9:22 AM, the Dietary Manager stated the nursing staff told her that Resident #63 was okay to have thickened powder on the meal tray and that she would mix her fluids independently. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 30 of 40 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 08/31/2023 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 0807 In an interview with the Director of Nursing on 08/31/23 at 8:00 AM, she was told of the 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 31 of 40 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 08/31/2023 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that a nourishing snack was available at bedtime if more than 14 hours passed between the evening and breakfast meals. This was observed for 3 of 3 sampled residents during dining observations, Resident #138, Resident #39 and Resident #92. It had the potential to affect 33 residents who resided on the 300 Unit, of the census of 181 residents. The findings included: A review of the facility's Bulk Snack list provided by the Dietary Manager showed the following: a pitcher of orange juice, a pitcher of cranberry juice, graham crackers or soft cookies, ½ peanut butter and jelly sandwich, fresh fruit, apple sauce, yogurt, tea bags, and sugar. Review of the census list provided by the facility on 08/28/23 showed there were 49 residents in the 300 Unit, 47 in the 100 Unit, 47 in the 200 Unit, and 38 in the 400 Unit. Review of the Diabetic snack list provided by the facility showed that 16 residents had diabetic snacks ordered at night (bedtime) in the 300 Unit. The mealtimes for dinner and breakfast provided by the facility's Administrator showed the following: the dinner meal cart on the [NAME] (300 unit) Wing Cart 2 showed from 6:15 PM to 6:30 PM; and the breakfast meal cart on the [NAME] Wing Cart 2 showed 8:15 AM to 8:25 AM. In an observation conducted on 08/28/23 at 5:50 PM, the first meal cart arrived at the 300 Unit (West) at 6:05 PM, and the second dinner cart arrived at the 300 Unit (West) at around 6:00 PM. At 6:05 PM, the dinner trays were taken into Resident #39's and Resident #138's rooms. The last meal tray on the 300's Unit was given at 6:30 PM. In an observation conducted on 08/29/23, the first meal cart arrived at the 300 Unit (West) at 8:35 AM; and at 9:00 AM, the second meal cart arrived at the 300 Unit. Further observations showed that at 9:06 AM, the breakfast trays were taken into Resident #39 and Resident #138 rooms. This was about 15 hours between the dinner meal and the breakfast meal. In this observation, Resident #138 said that she kept her cake (dessert) from the night before to have something to eat between dinner and breakfast. Record review showed Resident #138 was admitted to the facility on [DATE]. The Quarterly Minimum Data Set (MDS) dated [DATE] showed that Resident #138 had a Brief Interview of Mental Status (BIMS) score of 13, indicating the resident is cognitively intact. Resident #39 was admitted on [DATE], and the Quarterly MDS dated [DATE] showed a BIMS score of 10, indicating moderate cognitive impairment. In an interview conducted on 08/28/23 at 1:04 PM with Resident #138, the resident stated she eats her dinner at around 6:00 PM to 6:30 PM. The breakfast meal may be at 9:00 AM and sometimes not until 10:00 AM the next day. She further stated she asks for a snack between meals but was told by staff that it was only for residents who have Diabetes. She gets hungry between meals and tries to drink (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 32 of 40 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 08/31/2023 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 0809 more water to get full. Level of Harm - Minimal harm or potential for actual harm In an interview conducted on 08/28/23 at 1:10 PM, Resident #39 stated she eats her dinner from around 6:00 PM to 6:30 PM. The breakfast tray may be at 9:00 AM and sometimes not until 10:00 AM the next day. She further stated she asked for a snack between meals but was told that it was only for residents who have Diabetes. Residents Affected - Few In an interview conducted on 08/28/23 at 5:55 PM, Staff C, Certified Nursing Assistant, stated the snacks cart arrives from the kitchen around 6:30 PM to 7:00 PM. It will have the residents' names on the specific snacks, and some snacks will not have any residents' names on them, in case other residents want snacks. She further stataed the snacks are placed in the pantry room in each Unit. Record review showed that Resident #92 was admitted to the facility on [DATE], and the MDS, dated [DATE], showed a BIMS score of 15, indicating the resident is cognitively intact. In an interview conducted on 08/28/23 at 6:10 PM, Resident #92 stated that dinner is usually served between 6:00 PM and 6:30 PM. The breakfast is sometimes at 10:00 AM, and they hardly have any snacks at night. And when he asked for snacks, he was only given crackers. An interview was conducted on 08/28/23 at 6:43 PM, in the central kitchen, with Staff D, Dietary Aide, who stated that he was making bulk snacks for the different units. Staaff D stated each bulk tray has the following: 5 ½ peanut butter and jelly sandwiches, 10-15 either cookies or graham crackers, six apple sauces, five pieces of fruit, and three single yogurts. In an interview conducted on 08/28/23 at 6:48 PM, the Dietary Manager stated that four bulk snack trays are taken into each Unit (100, 200, 300, and 400) and placed in the pantry room. Other snacks are also given, which are specific to the residents' names and room numbers. In an interview conducted on 08/31/23 at 9:00 AM, Staff E, Licensed Practical Nurse, stated that she does not work the night shift, but the Diabetic residents must get a night snack and that it is given to them after dinner labeled with their name and room number. In an interview conducted on 08/31/23 at 9:22 AM, the Dietary Manager stated that the facility's nursing staff and the Administrator would request the number of snacks that are needed in each of the 4 Units. She stated she has been sending the same number of snacks to each Unit. When asked if she was told by nursing staff that the number of snacks that were sent on the floor was not enough for most residents, she said no. In an interview conducted on 08/31/23 at 8:00 AM, with the Director of Nursing, she was told of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 33 of 40 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 08/31/2023 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 6. On 08/28/23 at 4:32 PM, medication administration observation for Resident #15 was performed by Staff S, Licensed Practical Nurse (LPN). Staff S stated that Resident #15 had one tablet to give and one powder to apply under the resident's breast. Observation revealed Staff S pulled a bottle of Nystatin (antifungal) Powder 100,000 units bottle from the treatment cart. Staff S returned to the medication cart and retrieved one tablet of Ezetimibe (for high cholesterol)10 mg. At 4:38 PM, Staff S, LPN walked to Resident #15's room, hand carrying the medication cup containing the Ezetimibe tablet and the Nystatin bottle. Staff S entered the resident's room to find out that the resident's was not in her room. Residents Affected - Some Observation revealed Staff S started to talk to Resident #15's roommate who was in the room and Stff S was holding the medication cup with her left thumb flexed into the medication cup. Staff S continued talking to the roommate, then was observed placing the bottom of the bottle of Nystatin inside the medication cup that contained Resident #15's Ezetimibe tablet. Further observation revealed, Staff S walked out of the resident's room, placed the Nystatin bottle and the medication cup containing the Ezetimibe tablet inside her uniform pocket. Staff S stated Resident #15 was in the hallway and proceeded to wheel the resident into the room. During an interview, Staff S stated that the resident refused the administration of the Nystatin powder. Staff S pulled the medication cup from her pocket and assisted Resident #15 to take the Ezetimibe tablet. Staff S then walked out of the resident's room to the treatment cart, pulled the Nystatin powder bottle from her uniform pocket and without disinfecting it, placed the bottle in a drawer in the treatment cart with other resident's medications. 7. On 08/28/23 at 4:52 PM, medication administration observation for Resident #9 was performed by Staff S, LPN. Observation revealed Staff S poured 30 millimeters (ml) of Protein liquid, walked to the resident's room and repositioned the resident's bed using the bed control remote. Observation revealed Staff S donned gloves without performing hand hygiene previously and with gloved hand opened the bathroom door retrieved a paper towel, returned to Resident #9's beside and administered the resident's Protein liquid. Further observation revealed Staff S removed the pair of gloves, walked out of the resident's room without performing hand hygiene, then placed her hands into her uniform pocket. Staff S, LPN was not available for an interview. On 08/31/23 at 4:45 PM, during an interview, the Director Of Nursing was apprised of the findings during the medicaion observation pass. Based on observations, interviews, and record review, the facility's staff failed to encourage and ensure that residents practiced hand hygiene before eating meals for 5 of 5 sampled residents observed during mealtimes, Resident #127, Resident #123, Resident #133, Resident #138, and Resident #39. This had the potential to affect 49 residents that are on the 300 unit. The facility also failed to follow proper infection control standards during medication administration observation for 2 of 7 sampled residents, Resident #15 and Resident #9. The findings included: Review of the facility's policy, titled, Handwashing/hand Hygiene, dated 05/18/23, documented that the facility considers hand hygiene the primary means to prevent the spread of infections. It further directs using hand washing or alcohol-based hand rub before and after eating or handling food. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 34 of 40 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 08/31/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an observation conducted on 08/28/23 at 12:15 PM on the 300 unit, the first meal cart arrived. Staff started passing out the trays to the individual resident rooms and did not encourage or ask the residents to practice hand hygiene before eating their meals. The second meal cart arrived on the 300 unit, and staff started passing out the trays to the individual rooms without asking residents to practice hand hygiene. Continued observation showed that the lunch meal tray was brought to Resident #127's room at 12:20 PM, and staff was not observed encouraging or asking Resident #127 to wash his hands before eating his lunch meal. A lunch meal tray was brought to Resident #123's room at 12:23 PM, and the staff was not observed encouraging or asking Resident #123 to wash his hands before eating his lunch meal. Resident #133's lunch meal was brought to the resident at 12:35 PM, and the staff was not observed encouraging or asking Resident #133 to wash his hands before eating his lunch meal. In an observation conducted on 08/28/23 at 5:45 PM on the 300 unit, the first meal cart arrived. Staff started passing out the trays to the individual resident rooms and did not encourage or ask the residents to practice hand hygiene before eating their meals. The second meal cart arrived on the 300 unit, and staff started passing out the trays to the individual resident rooms without asking residents to practice hand hygiene. 1. Record review documented Resident #127 was admitted to the facility on [DATE]. The quarterly Minimum Data Set (MDS) dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 14 (indicating the resdient is cognitively intact) and that he needed extensive assistance with personal hygiene. An interview was conducted on 08/28/23 at 12:36 PM with Resident #127 who stated that facility staff do not encourage or remind him to wash his hands before eating his meals. He further said that they do not have a small mini hands sanitizer that he can use or any wipes that are given on the meal trays. 2. Resident #123 was admitted to the facility on [DATE]. The MDS dated [DATE] showed a BIMS score of 15, indicating the resident is cognitively intact. It further revealed that the resident needed extensive assistance with personal hygiene. An interview conducted on 08/28/23 at 12:40 PM with Resident #123 stated that facility staff do not encourage or remind him to wash his hands before eating his meals. He further said that they do not have a small mini hands sanitizer that he can use or any wipes that are given on the meal trays. 3. record review documented Resident #133 was admitted to the facility on [DATE]. The MDS dated [DATE] showed a BIMS score of 13, indicating the resident is cognitively intact, and required limited assistance with personal hygiene. In an interview conducted on 08/28/23 at 12:43 PM, Resident #133 stated that he has been in this facility for the last seven months and was never told even once that he needed to wash his hands before eating his meals. He was also never reminded or encouraged to wash his hands. 4. Record review documented Resident #138 was admitted on [DATE]. The quarterly MDS dated [DATE] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 35 of 40 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 08/31/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm showed a BIMS score of 13, indicating the resident is cognitively intact. It further showed that she needs extensive assistance with personal hygiene. In an interview conducted on 08/28/23 at 1:04 PM, Resident #138 stated that she was never told or encouraged to wash her hands before eating her meals. Residents Affected - Some In an interview conducted on 08/29/23 at 9:00 AM with Resident #138, she stated that she had a box of wipes in her room that she could use to clean her hands before meals. The resident stated the staff took away the pack of wipes last night. 5. Record review showed Resident #39 was admitted on [DATE]. The Annual MDS dated [DATE] showed a BIMS score of 10, indicating moderate cognitive impairment. It further revealed that she needed extensive assistance with personal hygiene. In an interview conducted on 08/28/23 at 1:10 PM, Resident #39 stated that she was never told or encouraged to wash her hands before eating her meals. In an interview conducted on 08/31/23 at 9/05 AM, Staff F, Certified Nursing Assistant, stated that for the alert and oriented residents, she would remind them and ask them to practice hand hygiene before eating their meals. For the residents who are not able to practice hand hygiene, she would clean their hands for them. In an interview conducted on 08/31/23 at 10:55 AM, Staff H, Certified Nursing Assistant, stated that for the alert and oriented residents, she would remind them and ask them to practice hand hygiene before eating their meals. For residents who could not practice hand hygiene, she would use wipes or washcloths to clean their hands. In an interview conducted on 08/31/23 at 8:00 AM with the Director of Nursing, she was told of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 36 of 40 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 08/31/2023 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 0926 Have policies on smoking. 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 conduct proper admission, readmission, and quarterly smoking assessments for 10 of 10 sampled residents, reviewed for smoking safety, and as identified by the facility as smokers. Residents Affected - Some The findings included: Review of the facility's policy, titled, Smoking Policy-Residents, published 05/19/23, included, in part, the following: Resident smoking status is evaluated upon admission. A resident's ability to smoke safely is re-evaluated quarterly, upon significant change, and as determined by the staff. The facility provided a Smoker List upon request during the Entrance Conference conducted on 08/28/23. Of the residents named on this list, 10 remained as active residents of the facility. The following are the 10 identified residents who smoke who were found to have discrepancies in smoking assessments, either upon admission, readmission, or quarterly: 1. Resident #422 was admitted to the facility on [DATE]. An admission MDS was done on 08/28/23. This MDS documented Resident #422 had a Brief Interview for Mental Status (BIMS) score of 15, indicating he was cognitively intact. Resident #422 had a medical history significant for Fracture of Left Femur. During tour of the facility conducted on 08/28/23, the surveyor observed a carton of cigarettes in Resident #422's room. The surveyor interviewed Resident #422 and he confirmed that he was a current smoker. Review of the Smoker List provided by the facility revealed Resident #422 was not included on the list. There was no Smoking Assessment found for Resident #422. No Care Plan was found regarding smoking status. An admission Assessment, which included a smoking history, was done on 08/24/23 and documented Resident #422 was not a smoker. An interview was conducted with the facility's Director of Nursing (DON) on 08/29/23 at 3:00 PM. The DON stated that all smoking residents were assessed and found to be safe smokers. The surveyor explained that a resident who smokes was identified that was not included on the provided Smoker List. She stated she was unaware that Resident #422 was a smoker, but she would ensure that an assessment was completed. 2. Resident #75 was admitted to the facility on [DATE] and was readmitted on [DATE]. An admission Minimum Data Set (MDS) was done on 07/15/23. This MDS was In Progress at the time of this survey and did not document a Brief Interview of Mental Status (BIMS) score for Resident #75. Resident #75 had a medical history significant for Type 2 Diabetes Mellitus, Hemiplegia following a Cerebral Infarction, Poly osteoarthritis, Anemia, and Hypertension. An Initial Smoking Assessment was done on 11/27/18 and a Smoking Assessment was done on 06/01/23. A Care Plan was documented on 11/26/18 which stated, smokes with partner at times with supervision. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 37 of 40 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 08/31/2023 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 0926 There was an additional care plan written on 07/11/23 which stated, resident chooses to smoke. Level of Harm - Minimal harm or potential for actual harm These assessments and care plans do not correlate with the policy of admission, readmission, and quarterly assessments. Residents Affected - Some 3. Resident #31 was admitted to the facility on [DATE]. There was no MDS found in the electronic chart (due to a recent change in charting systems). Resident #31 had a medical history significant for Major Depressive Disorder, Generalized Anxiety Disorder, Type 2 Diabetes Mellitus, Chronic Obstructive Pulmonary Disease. Smoking Assessments were done on 09/26/13 and 06/02/23. A Care Plan was documented and undated, which stated, resident chooses to smoke. These assessments and care plan do not correlate with the policy of admission, readmission, and quarterly assessments. 4. Resident #119 was admitted to the facility on [DATE]. A Quarterly MDS was done on 07/11/23. This MDS documented Resident #119 had a BIMS score of 8, indicating she was moderately cognitively impaired. Resident #119 had a medical history significant for Type 2 Diabetes Mellitus, Cerebral Infarction, Dementia, Mixed Anxiety Disorder, and Epileptic Seizures. Review of the Smoking Assessments revealed they were done on 03/31/22 and 06/02/23. A Care Plan was documented, and undated, which stated, resident chooses to smoke. There was an additional care plan written on 03/31/22, which stated, resident smokes with supervision - escort resident to and from outside with a goal of resident will be able to smoke safely in designated areas by the next review date of 09/25/23. These assessments and care plans do not correlate with the policy of admission, readmission, and quarterly assessments. 5. Resident #13 was admitted to the facility on [DATE]. A Quarterly MDS was done on 08/04/23. This MDS documented Resident #13 had a BIMS score of 15, indicating she was cognitively intact. Resident #13 had a medical history significant for Chronic Obstructive Pulmonary Disease, Insomnia, Tachycardia, and Gastric Reflux. An admission Assessment, which included a smoking history, was done on 11/02/21. The Smoking Assessments were done on 04/11/22 and 04/07/23. A Care Plan was documented on 11/02/21 and updated on an unknown date which stated, resident is a cigarette smoker and smokes with supervision with a goal of resident will be able to smoke safely in designated areas by the next review date of 09/25/23. These assessments and care plans do not correlate with the policy of admission, readmission, and quarterly assessments. 6. Resident #216 was admitted to the facility on [DATE]. A Quarterly MDS was done on 07/21/23. This MDS documented Resident #216 had a BIMS score of 15, indicating he was cognitively intact. Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 38 of 40 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 08/31/2023 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 0926 #216 had a medical history significant for Heart Failure, Major Depressive Disorder, Type 2 Diabetes Mellitus, Cardiomyopathy, and Peripheral Vascular Disease. Level of Harm - Minimal harm or potential for actual harm A Smoking Risk Form was documented on 08/15/23. Residents Affected - Some No Care Plan was found regarding smoking status. This assessment and lack of care plan does not correlate with the policy of admission, readmission, and quarterly assessments. 7. Resident #109 was admitted to the facility on [DATE] and was readmitted on [DATE]. A Quarterly MDS was done on 08/18/23. This MDS documented Resident #109 had a BIMS score of 14, indicating he was cognitively intact. Resident #109 had a medical history significant for Heart Failure, Aphasia following Cerebral Infarction, Syncope, Generalized Anxiety Disorder, Major Depressive Disorder, Chronic Obstructive Pulmonary Disease, and Psychosis. No Smoking Assessment was found for Resident #109. A Care Plan was documented on 06/13/23 which stated, cigarette smoker and smokes independently. This care plan and lack of assessments do not correlate with the policy of admission, readmission, and quarterly assessments. 8. Resident #11 was admitted to the facility on [DATE] and was readmitted on [DATE]. A Quarterly MDS was done on 07/17/23. This MDS documented Resident #11 had a BIMS score of 14, indicating he was cognitively intact. Resident #109 had a medical history significant for Chronic Obstructive Pulmonary Disease, Atherosclerotic Heart Disease, Asthma, Type 2 Diabetes Mellitus, and Heart Attack. No Smoking Assessment was found for Resident #11. A Care Plan was documented on 07/07/23 which stated, chooses to smoke. This care plan and lack of assessments do not correlate with the policy of admission, readmission, and quarterly assessments. 9. Resident #26 was admitted to the facility on [DATE]. A Quarterly MDS was done on 03/13/23. This MDS documented Resident #26 had a BIMS score of 14, indicating he was cognitively intact. Resident #26 had a medical history significant for Insomnia, Major Depressive Disorder, Type 2 Diabetes Mellitus, and Bipolar Disorder. The Smoking Assessments were done on 10/18/21 and 06/10/23. A Care Plan was documented on 10/18/21 and updated on an unknown date which stated, smokes with supervision with a goal of resident will be able to smoke safely in designated areas by next review date of 09/26/23. These assessments and care plans do not correlate with the policy of admission, readmission, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 39 of 40 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 08/31/2023 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 0926 quarterly assessments. Level of Harm - Minimal harm or potential for actual harm 10. Resident #92 was admitted to the facility on [DATE]. A Quarterly MDS was done on 12/12/22. This MDS documented Resident #92 had a BIMS score of 15, indicating he was cognitively intact. Resident #92 had a medical history significant for Insomnia, Chronic Obstructive Pulmonary Disease, Bipolar Disorder, Anxiety Disorder, Major Depressive Disorder, and Type 2 Diabetes Mellitus. Residents Affected - Some An admission Assessment, which included a smoking history, was done on 06/11/19. A Smoking Assessment was done on 06/07/23. A Care Plan was documented on 06/12/19 which stated, smokes with supervision and an updated care plan was written on 07/12/23 which stated, resident chooses to smoke. These assessments and care plans do not correlate with the policy of admission, readmission, and quarterly assessments. An interview was conducted with the facility's DON on 08/31/23, in which the DON was told the lack of assessments and care plans was an identified issue. The DON asked the surveyor to give her time to review the old facility policy and resident's charts. She approached the surveyor later in the day and stated she was unable to find additional information or documentation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105089 If continuation sheet Page 40 of 40