Health inspection·December 8, 2022

F 0550 Resident #281: MDS of 12/05/22 - Section C: BIMS Score = 15 (Cognitively Intact). Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 2 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Failed to provide adaptive call light Residents Affected - Few Resident #282 FTag Initiation 12/07/22 01:00 PM Int w resident #282 during screening on 12/5 and continued interview on 12/6 noted that the resident was alert and interviewable. The resident repeated stated to the surveyor on both interviews that he lies in bed all day. Specifically stated that since admission 2 weeks ago he has remained in bed and wants to get out of bed daily and into the wheelchair. The resident stated he has expressed this to staff but honered his request. 12/7/ - resident stating to surveyor that staff are refusing to utilize the Hoyer lift to aasist from bed to chair. Interview with charge Nurse =E. [NAME] - no doc of refusing transfer to chair Review of clinical record noted: DOA: 11/22/22 DOB: [DATE] Dx: Cerebral Infarction, Hemiplegia & Hemiparesis, Intracranial Hemorrhage, Adult Failure to Thrive, Pro-Cal Malnutrition, Aphasia, Dysphagia, Heart Failure, Malaise, NOtes: 12/6 - Alert & Oriented- denies pain, offered to get ooB and declined many times. 11/29- shower offered - declined still refuses, 11/23- Stated roommate was going to hurt him- supervisor made aware. 11/23 = Roommate was threatening to stabb him w a fork, Roommate was making too much noise, * Request grievance & incident log MD Orders: MD NOtes: 12/5 - restless-agitated, c/o poor sleep , depressed-sad, restless, hostile, insomnia, irritability, 11/27 - Behavioral change, agitated - poor sleep, calling roomate names and had TV on all night , (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 3 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0558 family support, reco melatonin, roomate changed ??? Level of Harm - Minimal harm or potential for actual harm 11/23 Wound_ redness to sacrum , Blanchable 11/23 - Stabdards of Care - Residents Affected - Few no wounds - redness sacrum , bilateral heels, groin, Pureediet- Nectar Thck , Based on interview, observations and records review, the facility failed to ensure that 1 of 2 sampled residents (Resident #102) received an adaptive call light to notify staff of her needs. The findings included: Review of the electronic clinical record revealed that Resident #102 was diagnosed with Cerebral Infarction due to Unspecified Occlusion or Stenosis Of Right Middle Cerebral Artery; Hemiplegia, Unspecified Affecting Left Nondominant Side; and Other Reduced Mobility. On 12/05/22 at 1:21 PM, during an interview with Resident #102, she said that her neck, right elbow, and shoulder were hurting her. She was asked to use her call light to request for assistance. She said that her call light was too far away. Observation conducted during the conversation showed the call light was on the floor on the right side of the resident's bed. Photographic Evidence Obtained. The call light was then placed in the Resident's right hand, and she was asked to press on it. She tried but was unable to press on the balloon to activate the call light. On 12/05/22 at 1:31 PM, the Certified Occupational Therapy assistant (COTA), Employee P, who was present during the interview was asked to have the resident reevaluated for functional ability to use a different call bell. Employee P said that she would report it to the physical therapy (PT) department. Employee P was also asked to reposition the resident and to place a wedge on the resident's right side to ease her discomfort. At 12/05/22 at 1:44 PM, Employee P, assisted by a Certified Nursing Assistant Employee Q, repositioned Resident #102 on the bed. Employee Q, when asked, stated she had bathed the resident at 10:00 AM and had also repositioned her at around 12:00 PM. On 12/07/22 at 2:32 PM, during a follow-up observation in Resident #102's room, it was noted that she did not have another call light that she could use. The balloon call bell was placed under her blanket on her right side. Resident #102 could not reach or use it. At about 2:40 PM on 12/07/22, Employee P (COTA) stated she had reported the call light concern to the PT department and that they were to reevaluate the resident. Employee P stated that she did not know whether the reevaluation was already completed but she would inquire. Review of the Therapy Assessment Notes, dated 12/05/22, revealed a summary of Skills performed with Resident #102 that read: Therapist repositioned patient in bed to ensure proper joint/postural alignment while in bed. Therapist also provided patient with wedge for pressure relief; nursing (NSG) staff informed. Therapist (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 4 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facilitated patient in grasp/release activity with right upper extremity (R UE) to promote functional use of R UE for activity of daily living (ADL) participation. Therapist completed progress report with patient, reviewed progress towards short term/long term (ST/LT) goals, and barriers to progress. Patient in agreement with continued POC. The Therapist also documented that she facilitated patient in left upper extremity (LUE) passive range of motion (PROM) with gentle prolonged stretch in all joints and planes for increased joint mobility, prevention of further contractures, and in preparation for orthotics wear. The Therapist guided patient in RUE [right upper extremity] AROM [Active ROM] in all joints and planes with gentle prolonged stretch in R [right] wrist and hand in preparation for orthotic wear. The PT notes also revealed that Resident #102 received application of R hand grip orthotic with a tolerance of 3 hours secondary to complaints of pain in RUE. Resident #102 complained of chronic generalized pain during the session. The care plan (CP), dated 09/26/22, outlined that Resident #102 was at risk for falls and/or fall related injury due to her weakness, immobility, use of medications, generalized weakness, and limited endurance. She was non ambulatory, used a wheelchair (w/c) as primary mode of locomotion, and received psychotropic meds. Therefore, Resident #102: -Risk of falls would be minimized with staff intervention thru the next review date. -Risk of fall related injuries would be minimized with staff intervention thru the next review date. -Bed would be placed in low position in locked position -The Call bell would be placed in reach when Resident #102 is in the room Staff would: -Keep the bed in low position -Keep call light within reach -PT/OT would screen as indicated. On 12/08/22 at 11:01 AM, the resident was again observed without an adaptive call light. Employee P was reinterviewed and reported that she had informed her supervisor of Resident #102's need for a physical reevaluation for call light usage. During an interview with the Physical Therapy (PT) Director on 12/08/22 at 12:25 PM, he stated that Resident #102 was actively receiving occupational therapy (OT) and PT. He said that he was informed about the resident's need to be reevaluated for a different call light. He indicated that an assessment was not yet done. The PT Director said that he would immediately reevaluate the resident. On 12/08/22 at 1:27 PM, the PT Director reported that they reassessed the resident and determined (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 5 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0558 that she was able to use a different kind of bell. He said that a Desk Bell was subsequently provided to the resident. 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: 105119 If continuation sheet Page 6 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and records review, the facility failed to ensure protection of 1 of 1 sampled resident's, Resident # 328, personal property from loss or theft. The findings included: Review of the electronic Census record showed that Resident # 328 was admitted to the facility on [DATE] and discharged from the facility on [DATE]. Review of the Social Service notes, dated [DATE] revealed that the resident's daughter and wife had reported missing a kindle and electric shaver which belonged to the resident. The notes showed that Staff searched the storage room, but the items were not located. A gift card was issued on [DATE] to the family. The Social Worker (SW) noted that the missing items were not on the inventory sheet. On [DATE] at 11:36 AM, Resident #328's family member reported that they made multiple calls to the facility to retrieve Resident #328's personal properties left at the facility subsequent to Resident #328's discharge from the facility. According to Resident #328's relatives, the list of items left behind at the facility included: Various clothing items, a brand-new Kindle, an electric shaver, a portable charger, and a wall cell phone charger, which had been misplaced and were never returned to the family. In an interview with the Social Worker (SW) on [DATE] at 2:46 PM, she said she had documented only the two missing items reported to her. The SW said that none of the items (clothes, chargers) were documented on the inventory sheet. The SW worker also reported that she was informed that Resident #328 had expired. The SW also stated because the resident's belongings were not on the inventory sheet, no one knew exactly what the resident had as personal properties. The SW reported that the family members had called multiple times requesting Resident #328's personal items but they received no positive answers for two months. There was no documentation of the number of times the family member had called. The SW also mentioned that the family members was upset that Resident #328's personal properties were misplaced or lost. Review of Resident #328's care plan (CP) for activities documented that Resident #328 preferred individual in-room activities and communications with wife, family members using personal cell phone. The Inventory list did not reflect that Resident #328 had a cellular phone. Review of the inventory sheet, dated [DATE] documented the resident was admitted to the facility with no belongings. The document was signed by the resident's representative and the facility representative. The form was not updated to at least reflect that the resident had a cell phone. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 7 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of policy and procedure, observation, interview and record review, it was determined that the facility failed to provide care and services in accordance with activities of daily living: nail grooming for 1 of 1 sampled resident's observed, Resident #60. Residents Affected - Few The findings included: Review of the facility policy and procedure on 12/07/22 at 2:30 PM, titled, Care of Fingernails/Toenails, provided by the Director of Nursing (DON), revised February 2018, documented, in part: Purpose: The purposes of this procedure are to clean the nail bed, to keep nails trimmed, and to prevent infections. Preparation: 1. Review the resident's care plan to assess for any special needs of the resident .General Guidelines: 1. Nail care includes daily cleaning and regular trimming. 2. Proper nail care can aid in the prevention of skin problems around the nail bed .Documentation: The following information should be recorded in the resident's medical record: 1. The date and time that nail care was given. 2. The name of the individual (s) who administered the nail care. 3. The condition of the resident's nails and nail bed 7. The signature and title of the person recording the data. Review of facility licensed nurse or CNA job description on 12/07/22 at 2:45 PM, dated 01/01/15, indicated, in part, that the Purpose of Your Job Position: The primary purpose of you position is to provide each of your assigned residents with routine daily nursing care and services in accordance with the resident's assessment and care plan and any other duties that may be directed by your supervisor Administrative Functions: Record all entries on flow sheets, notes, charts and computer programs in an informative and descriptive manner Personal Nursing Care Functions: Assist residents with nail care (i.e. clipping, trimming, and cleaning the finger or toenails) Resident #60 was admitted to the facility on [DATE] with diagnoses which included Rhabdomyolysis, Parkinson's Disease, Anemia and Hypertension. He had a Brief Interview Mental Status (BIM) score of 13 (cognitively intact). Record review of the Resident #60's personal care plan, initiated 02/21/21 and revised 08/22/22, indicated Focus: Activities of Daily Living (ADL): Resident #60 has a self-care deficit with dressing, grooming, bathing as evidenced by needs assistance with personal care tasks and mobility skills, ADL needs .Interventions: .provide hands on assistance with dressing, grooming, bathing as needed .Goal: .[Resident #60] will have clean, neat appearance daily through the next review date .Resident #60's fingernail care had not been done, on the dates from 12/05/22 through 12/07/22, until after surveyor inquisition / intervention. Further record review of the Minimum Data Set (MDS) sections A, C and G, dated 11/08/22, for Resident #60 Indicated that he required extensive assistance with personal hygiene. During an initial observation conducted on 12/05/22 at 10:05 AM, Resident #60 was observed with long, dirty sharp, unkempt and jagged fingernails on both hands. Photographic Evidence Obtained. On 12/05/22 at 10:12 AM, a brief interview was conducted with Resident #60 in which he was asked if he prefers his fingernails long or if he would like to have his fingernails to be trimmed and cut. The resident replied he remembers telling someone here about trimming his fingernails once but nothing happened. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 8 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm During a second observation conducted on 12/05/22 at 12:55 PM, Resident #60 was still observed with long, dirty sharp, unkempt and jagged fingernails on both hands. During a third observation conducted on 12/06/22 at 11:22 AM, Resident #60 was still observed with long, dirty sharp, unkempt and jagged fingernails on both hands. Residents Affected - Few During a fourth observation conducted on 12/06/22 at 2:52 PM, Resident #60 was still observed with long, dirty sharp, unkempt and jagged fingernails on both hands. During a fifth observational tour conducted on 12/07/22 at 10:41 AM, Resident #60 was still observed with long, dirty sharp, unkempt and jagged fingernails on both hands. Review of the Resident #60's Monthly CNA (Certified Nursing Assistant) ADL (Activities of Daily Living) Flowsheet record, dated 11/24/22 through 12/06/22 revealed that resident's (ADL)s for Personal Hygiene indicated that the Resident #60 had fingernail care provided, when in fact, this was not done. An interview was conducted with the Activities Director (AD) on 12/07/22 at 10:45 AM. The AD stated that her department has been doing fingernail polishing and filing for all the residents in the facility during daily rounds, by either one (1) of her three (3) activities assistants or done by herself. She added that her department is not allowed to cut or clip any of the resident's fingernails and if her staff were to see a resident with long, dirty fingernails that she would alert the nurse of the wing or unit involved and to let them know to follow-up with the resident. The AD said that her department had not provided any nail care services to Resident #60. The Director also acknowledged that Resident #60's fingernails were all long, dirty, sharp, jagged, untrimmed and unkempt. An interview was conducted with Staff A, Certified Nursing Assistant (CNA), on 12/07/22 at 11:37 AM. She stated they had not provided fingernail care to Resident #60, and that it is the responsibility of the CNAs to clean and trim the residents' fingernails. She further acknowledged that Resident #60's fingernails were long, dirty, sharp, jagged, untrimmed and unkempt. An interview was conducted with Staff B, a Licensed Practical Nurse (LPN), on 12/07/22 at 11:41 AM, regarding Resident #60's long, unkempt nails. Staff B also agreed that Resident #60's fingernails were long, dirty, sharp, jagged, untrimmed and unkempt. On 12/07/22 at 11:46 AM, an interview was conducted with Staff E, LPN/Unit Manager (UM) for the North wing, regarding Resident #60's fingernails being long, sharp and untrimmed. She agreed that it is the responsibility of the CNAs to clean and trim the residents nails. She further acknowledged that the resident's fingernails were long and that they should have been cleaned / trimmed / cut. On 12/07/22 at 2:20 PM, an interview was conducted with the (DON) regarding Resident #60's fingernails being long, sharp and untrimmed. She acknowledged that it is the responsibility of the CNAs to clean and trim the resident's nails and the resident's fingernails were long and that they should have been cleaned / trimmed / cut. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 9 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, observations and records review, the facility failed to comprehensively assess 1 of 1 sampled resident (Resident #39) to determine her needs for hearing aids; and failed to promptly identify Resident #39's need for reading glasses and ensure an ophthalmological evaluation was performed timely. Residents Affected - Few The findings included: Review of the electronic clinical record showed Resident #39 was diagnosed with Unspecified Hearing Loss, Unspecified Ear Primary Diagnosis Present on admission of 02/10/22. The resident had diagnoses to include Major Depressive Disorder, Recurrent, In Remission, Unspecified effective 09/15/22. Review of the Physicians' order showed no evidence for hearing aids services. Review of the Minimum Data Set (MDS) dated [DATE] and updated 04/01/22, 09/01/22 and 11/22/22 presented conflicting data in relation to Resident #39's current noticeable visual and hearing deficits. The last updated MDS, dated [DATE], Section B (Hearing) documented that Resident #39 had no hearing aid, in Section B1000 her vision was adequate, and in section B1200, it was documented that she wore no corrective lenses. Review of a Nursing progress notes, dated 11/02/22 at 16:29 PM, documented that Resident #39 was alert, responsive, and hard of hearing. On 12/06/22 at 10:16 AM, while attempting to conduct an interview with Resident #39, it was observed that Resident #39 had serious difficulty understanding what the surveyor was conveying. Even though the surveyor addressed the resident loudly, the resident could not hear what was being said. Resident #39 said that she did not have her hearing aid. Resident #39 said that she partially was deaf in the right ear and totally deaf in the left ear. Review of the care plan (CP), dated 03/15/22, documented it is the Resident's wish to return to the community. The CP revealed that the resident had hearing deficits being hard of hearing (HOH), but there was no indication that the resident wore any assistive device (i.e., hearing aids). The CP updated on 12/02/22 revealed the following: Resident #39 had an alteration in communication ability related to (r/t): (specify) as evidenced by (AEB): is HOH. The plan outline that: o Resident #39 will maintain current level of communication ability thru the next review date. o Resident will respond appropriately to simple, direct communication thru the next review date o Resident will have daily needs met thru staff anticipation thru the next review date. Staff will: o Face resident when speaking and speak in clear, direct tones o Speak in louder tones when in a loud setting (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 10 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0685 o Repeat/rephrase messages as needed if resident misses part of intended message Level of Harm - Minimal harm or potential for actual harm o Speak to resident in simple, direct terms o Ask resident yes/no questions Residents Affected - Few o Allow resident adequate time to respond; provide cues prn resident displays difficulty finding words. o Ask resident to repeat verbalization & validate as needed o Keep call light within reach; respond to communicated needs prn [as needed] o Observe for changes in hearing, speech, communication; notify physician as needed. Review of Social Service notes, dated 04/14/22 at 16:16 PM, showed staff knew that Resident #39 wore a hearing aid, as evidence by the following: social worker assistance and this nurse changed batteries in Hearing aid. Hearing Aid place in right ear, resident state it works very well. Review of the MDS, dated [DATE], showed the resident used the hearing aid in completion of the assessment. The MDS, dated [DATE], did not reflect that Resident #39 wore a hearing aid. The Quarterly MDS, dated [DATE], was completed without evidence of hearing aid. Section B revealed Resident 39 had minimal difficulty hearing. During interview with Resident #39 on 12/07/22 at 11:58 AM, she said that in order to talk to her, one must write the message on a board/paper. Resident #39 said that she was legally blind in the right eye and had poor vision on the left one. She stated that she needed to go to the eye doctor. She added that her hearing aids were misplaced in the facility. She concluded saying that she really needed her hearing aids. Interview with Certified Nursing Assistant / CNA, Staff Q, on 12/07/22 at 12:06 PM reported that she is familiar with Resident #39. Staff Q said with caution, I think she (Resident #39) had a hearing aid. She also said that she was not sure what had happened to the hearing aid. She recalled that Resident #39 had told her that she had a hearing aid. Staff Q ensued and affirmed that she was going to ask the unit manager whether Resident #39 still had the hearing aid. Interview with Staff P, Certified Occupational Therapy Assistant (COTA), on 12/07/22 at 11:57 AM revealed that Resident #39 is hard of hearing, and she was not sure what had happened to her hearing aid. She said the resident used to be in a different room and was recently transferred to her current room. Employee P also stated that I believe the resident's hearing aids are lost. In interview with Staff R, Licensed Practical Nurse (LPN), on 12/07/22 at 12:38 PM, Staff R said that she has been working at this facility a long time. She said that Resident #39 moved to the room a week ago, after she returned from the hospital. The resident used to be in room [ROOM NUMBER] and was transferred to this room on December 1, 2022. Staff R stated that the resident used to have a hearing aid. She said that she is not sure whether the family member has it. When asked whether she had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 11 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0685 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few looked for it or reported it, Staff R said that she did not look for it or report it to anyone. Staff R said that she did not know whether Resident #39 had difficulty reading. She said that she did not know the resident had visual impairment. In interview with Unit Manager, Staff E, on 12/07/22 at 12:52 PM, Staff E stated she has been working at this facility since May 2022. She said Resident #39 is alert, oriented, and able to make her needs known and was admitted with a hearing aid. She stated Resident #39 had visual and hearing deficits and she also had difficulty hearing even with the hearing aid. She said that on 12/06/22, they discussed Resident # 39 plan of care and wanted to discuss the matter with the resident's son, but he did not attend the CP meeting. Staff E said that she was not sure when the hearing aid got lost. Staff E stated the resident recently returned to the facility after she went to the hospital on [DATE]. Staff E added that during Resident #39's last Telehealth with her physician, an endocrinologist, on 09/22/22, the resident had her hearing aid on, but the hearing was not working properly. Staff E reported that Resident #39 wore the hearing aid on the right ear. She said that the MDS Coordinator was present during the CP meeting. Staff E also stated she makes her round every morning to ensure that the residents are okay but she was not aware the resident did not have her hearing aid. Staff E stated that she did not discuss the resident's hearing deficit or visual impairment with the Social Worker. Staff E also said during the last telehealth visit, Resident #39's physician had told her that the hearing problem was ongoing for a long time and that the only thing that could resolve the resident's hearing problem would be an implant. Staff E also recalled that one day when she brought the resident's purse to her to look for the batteries for the hearing aid, she noticed the resident was feeling rather than looking in the purse for the battery and at that point, she suspected that the resident had visual impairment. She said that happened in May 2022, when she first met Resident #39. On 12/07/22 at 1:39 PM, Staff S, one of the MDS Coordinators, stated they had a CP meeting on 12/06/22 to discuss the resident's plan of care. She said that the resident's authorized representative (AR) was not present, but she contacted him via phone to discuss the CP. The AR requested that the resident have an eye consult. During an interview with the MDS Coordinator on 12/07/22 at 3:19 PM, she stated that Resident # 39's son brought in the hearing aid for the Resident on March 31, 2022. She said during her last MDS assessment, she asked the resident if she was able to read something and the resident said yes and she was able to. Staff S stated, when I conducted the last assessment, I believe I gave her a menu to read. She also said that she usually carries a book or a magazine during the MDS assessment. Staff S said that she might have given the resident one to read but she was not sure. Review of the 11/19/22 assessment noted that there was no indication that the resident wore hearing aids although it was noted that she did wear one during the assessment in April 2022. Staff S said that she has been able to talk to the resident in louder tone. She said that she will do a change of condition MDS. During a follow-up interview with the MDS Coordinator on 12/08/22 at 9:21 AM, she stated she did go back to the resident and she was able to converse with Resident #39 speaking with a loud tone of voice. She stated that the resident was able to hear what she told her. She also stated an auditory consult was initiated on 12/07/22. The MDS Coordinator stated she found out that the resident does have a Cochlear implant according to hospital records reviewed. She said that she stood very close to the resident when she spoke to her. She also said that she will have the resident vision assessed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 12 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, interviews and the facility's policy review, the facility failed to ensure that residents received care and services for the provision of parenteral fluids consistent with professional standards of practice for 1 of 1 sampled resident reviewed for Intravenous Antibiotic (IV) therapy, Resident #178, as evidenced by failure to change the IV Access Line dressing per the facility's policy and the facility's Intravenous (IV) Access Line Maintenance Protocol; failed to administer / infuse IV antibiotic in the pharmacy prescribed timeframe; and failed to have physician orders for IV flushes to maintain the IV-line which were being administered by the nurses. Residents Affected - Few The findings included: 1. Review of the facility's policy, titled, Midline Dressing Changes, revised on April 2016, documented in part, .change midline catheter dressing 24 hours after catheter insertion, every 5- 7 days . Review of the facility's policy titled Intravenous Administration of Fluids and Electrolytes provided by the Director of Nursing (DON), revised on April 2016 documented a physician's order is necessary to give intravenous fluids . Review of Resident #178's clinical record documented an admission to the facility on [DATE] with no readmissions noted on file. The resident's diagnoses included Osteomyelitis (an infection in a bone) Primary Diagnosis, Pyogenic (related to the production of pus) Inflammation of bone, Infection and Inflammatory Reaction due to internal Fixation Device of Spine, Malignant Neoplasm of Vertebral Column, Pseudomonas (Aeruginosa) (Mallei)(Pseudo mallei) (a bacterial Infection), Type 2 Diabetes Mellitus, Neuromuscular Dysfunction of Bladder, Colostomy Status and Arthrodesis Status (the uniting of two bones at a joint). Review of Resident #178's physician orders, dated 11/23/22, documented, Avycaz (an antibiotic) Solution Reconstituted 2.5 (2-0.5) GM (Ceftazidime-Avibactam) Use 2.5 gram intravenously every 8 hours for Pseudomonas (infection) until 01/07/23. Review of the resident clinical record lacked evidence of a physician order for IV flushes before and after IV administration as per facility protocol. Continue review revealed the lack of a physician order for IV dressing changes as per facility protocol. Review of Resident #178's November and December 2022 Medication Administration Record (MAR) and Treatment Administration Record (TAR) lacked documentation of the resident's IV catheter site monitoring or dressing changed. Review of Resident #178's Minimum Data Set (MDS) admission's assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 13, indicating the resident had no severe cognition impairment. The assessment was in progress. Review of Resident #178's care plan, titled, Resident has the potential for complications related to active infection and/or IV ABT (antibiotic), initiated on 11/24/22 documented interventions that included administer antibiotics as ordered; observe for effectiveness, observe IV site . Review of Resident #178's Comprehensive Nursing Evaluation, signed and dated 11/23/22, documented, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 13 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0694 Level of Harm - Minimal harm or potential for actual harm Resident is not receiving IV medications. The evaluation did not address the resident's IV line, dated 11/20/22, upon on admission. Review of Resident #178's admission Wound and Skin Evaluation dated 11/23/22, lacked documentation of the resident's IV line in place. Residents Affected - Few Review of Resident #178's Daily Skilled Note, dated 11/23/22 and signed on 11/24/22, documented, resident currently has IV-access present, has a PICC [peripherally inserted central catheter] (IV) line on right arm, IV is being utilized for IV medication .IV site intact .administered IV medication as ordered . Review of Resident #178's nurses' note, dated 11/22/22, documented that his medications were verified with the resident's physician. Review of the resident nurses notes, dated 11/25/22, 11/28/22 and 11/29/22, addressed that Resident #178's had an IV line for IV antibiotics. On 12/05/22 at 1:07 PM, an interview was conducted with Resident #178 who stated that he had an infection and was on antibiotics three (3) times a day. Observation revealed an IV line on the resident's right arm, and the IV dressing was dated 11/20/22. The resident stated that he had not declined for the dressing to be changed and replied that they (staff) had not even asked about changing it. Further observation revealed a 250 ml saline bag connected to a bottle of Avycaz with approximated 100 cc of solution left to be infused hanged on an IV pole. The bag was connected to the resident's IV line via a dial flow set at 150 ml per hour. Observation revealed an IV machine at the IV pole. During the interview, Resident #178 stated that the machine was not working, was beeping a lot and they starting to use the dial flow. On 12/06/22 at 8:39 AM, observation revealed Resident #178 in bed and awake. During an interview, the resident stated that the IV antibiotic was hung early this morning, but he did not know the time. On 12/06/22 at 10:05 AM, an interview was conducted with Staff I, Licensed Practical Nurse (LPN) who stated the IV line dressing was to be changed every seven (7) days. Consequently, a side-by-side review of Resident #178's IV dressing was conducted with Staff I, who confirmed that the resident's IV dressing was dated 11/20/22. Staff I stated that the dressing should had been changed before. Staff I added that maybe it was not on the MAR for the dressing to be changed. On 12/06/22 at 10:50 AM, an interview was conducted with the facility's Director of Nursing (DON). The DON stated the facility's Midline (IV) catheter policy was to change the IV dressing every 5-7 day. The DON was apprised that Resident #178 Midline IV dressing was dated 11/20/22. On 12/07/22 at 11:40 AM, an interview was conducted with Staff F, LPN, who stated she checked the Resident #178's IV line dressing on 12/05/22 and it was intact, no redness. Staff F was asked when the IV line dressing was supposed to be changed and stated she was not sure. Staff F stated she did not know the facility's policy and added that she was a new nurse. 2. Review of the facility's protocol, titles, PharmScript Intravenous (IV) Access Line Maintenance Protocol, effective 12/01/18, documented under flush protocols for Midline catheter administer 10 ml (millimeters) of normal saline before and after each IV medication . The protocol documented under site maintenance: transparent dressing changes weekly and as needed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 14 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility's policy, titled, Intravenous Administration of Fluids and Electrolytes, provided by the Director of Nursing (DON), revised on April 2016, documented, a physician's order is necessary to give intravenous fluids . Review of Resident #178's clinical record documented an admission to the facility on [DATE] with no readmissions noted on file. The resident's diagnoses included Osteomyelitis (an infection in a bone) Primary Diagnosis, Pyogenic (related to the production of pus) Inflammation of bone, Infection and Inflammatory Reaction due to internal Fixation Device of Spine, Malignant Neoplasm of Vertebral Column, Pseudomonas (Aeruginosa) (Mallei)(Pseudo mallei) (a bacterial Infection), Type 2 Diabetes Mellitus, Neuromuscular Dysfunction of Bladder, Colostomy Status and Arthrodesis Status (the uniting of two bones at a joint). Review of Resident #178's Minimum Data Set (MDS) admission's assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 13, indicating that the resident had no severe cognition impairment. The assessment was in progress. Review of Resident #178's care plan, titled, Resident has the potential for complications related to active infection and/or IV ABT (antibiotic), initiated on 11/24/22 included interventions to administer antibiotics as ordered; observe for effectiveness, observe IV site . Review of Resident #178's physician orders, dated 11/23/22, documented, Avycaz (an antibiotic) Solution Reconstituted 2.5 (2-0.5) GM (Ceftazidime-Avibactam) Use 2.5 gram intravenously every 8 hours for Pseudomonas (infection) until 01/07/23. Review of Resident #178's antibiotic label from the pharmacy documented IV- Avycaz .in 250 ml of normal saline, infuse intravenously at 125 ml per hour over 2 hours every 8 hours for Pseudomonas until 01/07/23 . Review of the Resident #178's clinical record lacked evidence of a physician order for IV flushes before and after IV administration as per facility protocol. Review of Resident #178's November and December 2022 Medication Administration Record (MAR) and Treatment Administration Record (TAR) lack documentation of the IV flushes before and after IV antibiotic administration. The resident's MAR dated 12/06/22 documented, Avycaz Solution Reconstituted 2.5 (2-0.5) GM (ceftazidime-Avibactam) Use 2.5 gram intravenously, initialed as administered by Staff R, Licensed Practical Nurse (LPN). On 12/05/22 at 1:07 PM, an interview was conducted with Resident #178 who stated that he had an infection and was on antibiotics three (3) times a day. Further observation revealed a 250 ml saline bag connected to a bottle of Avycaz with approximated 100 cc of solution left to be infused, hung on an IV pole. The bag was connected to the resident's IV line via a dial flow set at 150 ml per hour. Further observation revealed an IV machine at the IV pole. During the interview, Resident #178 stated that the machine was not working, was beeping a lot and they starting to use the dial flow. On 12/06/22 at 8:39 AM, observation revealed Resident #178 in bed and awake. During an interview, the resident stated that the IV antibiotic was hung early this morning and he did not know the time. Review of the IV antibiotic bag pharmacy label documented IV-Avycaz 2-0.5 mg (milligrams) in 250 ml of 0.9% NS (normal saline) .infuse IV at 125 ml per hour over two (2) hours every eight (8) hours . Further review of the resident's IV bag revealed a label dated 12/06/22 and timed at 5:00 AM. At (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 15 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 8:39 AM, the 250 ml IV antibiotic bag had approximately 100 cc of the solution in the bag left to be infused. The IV antibiotic bag was still connected to Resident #178's IV line via a dial flow set to be delivered at 125 ml per hour (photographic evidence). The IV antibiotic solution was dripping three hours after it was connected. On 12/06/22 at 10:05 AM, a side-by-side review of Resident #178's was conducted with Staff I, Licensed Practical Nurse (LPN). The review revealed the resident's IV antibiotic bag was connected to his IV line. The IV antibiotic bag was empty. Staff I confirmed that the resident IV antibiotic bag was dated 12/06/22 and timed at 5:00 AM. Staff I was asked for how long was the IV antibiotic was supposed to be infused and Staff I proceeded to read the pharmacy label and stated, infused over two hours. Staff I stated she was not sure if it was hanged at 5:00 AM. Staff I stated that outgoing nurse did not report any issued or problem with the resident's IV line. Staff I was apprised that around 8:39 AM today (12/06/22) the IV bag had about 100 cc left to be infused. Staff I stated that once the IV was hang, they check on it. Staff I was apprised of the lack of monitoring of Resident #178's IV antibiotic that was hanged at 5:00 AM and was supposed to be infused over two hours and was still had 100 ml left to be infused three hours after connection. Staff I stated that the resident's IV antibiotic scheduled was every eight hours at 6:00 AM, 2:00 PM and 10:00 PM. On 12/06/22 at 10:22 AM, observation revealed Staff I, LPN retrieved a 10 cc normal saline syringe, alcohol pads, entered Resident #178's room, performed handwashing and donned gloves. Staff I wiped the IV port with an alcohol pad then proceeded to flush the resident IV line port. Staff I stated she flushed the line with 5 cc of normal saline solution. On 12/06/22 at 2:01 PM, observation of Resident 178's IV medication administration performed by staff I, LPN was conducted. Staff I retrieved an IV Bag labeled 250 cc of IV Avycaz 2-0.5 mg, labeled to be administered in 2 hours, q 8 hrs (hours) at 125 ml/hr. Staff I primed the IV tubing, wiped the purple IV line port with alcohol pad and then flushed the IV line with 10 cc of saline solution. Staff I stated that the order stands 10 cc of normal saline and not 5 cc like she did before during the disconnection in the morning. On 12/07/22 at 11:40 AM, an interview was conducted with Staff F, LPN who stated that Resident #178's IV pump was not working as per the night shift nurse on 12/05/22, therefore she used the dial flow. Staff F believed that someone was made aware of the machine not working. On 12/07/22 at 3:07 PM, an interview was conducted with the facility's Consultant Pharmacist (CP). The CP was apprised that Resident #178's IV antibiotic was hanged at 5:00 AM on 12/6/22 and that three hours later, at 8:39 AM, there was approximately 100 ml to be infused and the pharmacy label read to be infused over two (2) hours. The CP stated she will speak with the DON. On 12/08/22 at 11:28 AM, an interview was conducted with the DON. The DON was apprised that Resident #178's IV antibiotic was hanged on 12/06/22 at 5:00 AM and continue to drip at 8:39 AM when it was supposed to be infused for two hours (Photographic Evidence Obtained and was presented to DON). The DON stated that the 5:00 AM on the label meant the hanging time. The DON stated that the day shift nurse, Staff I, LPN, told her that the resident was closing his right arm and that the resident did not want to use the pump because it keeps him awake. The DON was asked for other alternative and replied that the IV site could have been changed, explained to the resident the necessity of using the pump so the antibiotic could be infused in a timely manner. The DON stated that in the future the need to use the pump and document why it is not used. The DON stated that she did not see any nurse note related to Resident #178's IV infusion been late, no notification to the physician. The DON was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 16 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few apprised that on 12/06/22 during medication administration observation for Resident #178, Staff I used the pump to infuse the resident IV antibiotic scheduled for 2:00 PM, the antibiotic was infused in two hours with no problems. The DON was asked to arrange a call with the nurse who hanged resident IV on 12/06/22 at 5:00 AM. On 12/8/22 at 11:45 AM, during an interview, the DON stated that it is common practice to flush before and after a medication is given via Midline (IV line). The DON added that the common practice is to flush the IV line with 10 cc (cubic centimeters) of saline solution. The DON was asked where the nurses document the residents' IV flushes administration and stated the flushes are not documented unless, the line was not in use. The DON stated she had never seen a physician order for saline flushes given before and after a medication been given via an IV line and added it was a common practice. The DON was asked how she can ensure that the nurses are flushing the IV line and what amount of cc are the nurses to use. The DON stated it was a common practice to use the 10 cc saline flush syringe and that the nurses did not need a physician order to flush an IV line that was been use for medication administration. On 12/08/22 at 12:14 PM, an interview was conducted with Staff N, LPN who stated that if a resident has an IV line, he will flush the line with 10 cc of saline and check the dressing for signs and symptoms of infection. Staff N was asked if he needed a physician order to flush a resident IV line and stated that he does need a physician order and if he did not see an order, he would be calling the doctor. On 12/08/22 at 12:26 PM, an interview was conducted with Staff G, LPN who stated that she will flush the resident IV line before and after the medication administration with 10 cc of normal saline. Staff G stated that she needed a physician order to do flush the IV line. Staff G stated that if she did not have a physician order, she will call to get one. On 12/08/22 at 12:27 PM, an interview was conducted with Staff B, LPN who stated that he will flush the IV line with normal saline 30 cc before and after medication administration. Staff B stated he did not need to have a physician order for the IV flush and added that it is common practice to flush before and after medication administration. On 12/08/22 at 12:31 PM, an interview was conducted with Staff O, LPN stated he will flush a resident's IV line with normal [NAME] 10 ml before and after the medication administration. Staff O stated that there always a physician's order for flushes and added that he will call the doctor if there is not an order for IV flush. On 12/08/22 at 12:36 PM, an interview was conducted with Staff I, LPN who stated they have to have a physician's order for IV-line flushes. Staff I was apprised that Resident #178 did not have a physician order for IV flushes before and after his IV antibiotic administration. On 12/08/22 12:43 PM, a joint interview was conducted with the DON and the Regional Nurse Consultant (RNC). The DON and the RNC were apprised that nurses' interviews revealed that they need a physician order to do IV line flushes before and after medication administration. The DON was apprised that one nurse stated that he will flush the IV with 30 cc of normal saline. The DON was apprised that one nurse flushed the line with 5 cc of normal saline after IV antibiotic administration. The RNC stated that the facility had to match the Midline (IV line) protocol with the physician orders. The RNC confirmed that the nurse had to have a physician order to flush the IV line. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 17 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete On 12/08/22 at 2:46 PM, a telephone interview was conducted with Staff R, LP, who stated he worked on 12/06/22. Staff R stated he hung Resident #178's IV antibiotic whenever the record (MAR) turned orange (meaning the MAR's computerized screen turned to a color alerting the nurse that he can administer the medication) and did not recall the time connected. Staff R was asked why he did not connect the resident to the IV pump and stated that he was informed the resident's IV pump was not working by the relieving nurse. Staff R added that he checked with another nurse and was told the same thing. Staff R was asked at what rate was the medication to be infused and stated that he did not remember, who stated it was supposed to go at 125 ml per hour but 'don't quote me'. Staff R stated he did not recall how many cc's the IV bag had but there was a small bag and a bigger bag. Staff R stated he flushed the IV line with 10 cc of prefilled saline syringe before and after the IV medication and did not have any problems with the IV site and the IV was dripping when he left about 7:30-7:40 AM. Staff R stated that he passed it over to the incoming nurse that the IV was still dripping. Staff R stated if the bag had 250 ml and it was connected at 125 ml per hour, the infusion should have been finished in two hours. Staff R was apprised that at 8:39 AM, Resident #178's IV antibiotic (connected at 5:00 AM) had approximately 100 ml left to be infused, which was three hours after connection. Staff R did not respond. Event ID: Facility ID: 105119 If continuation sheet Page 18 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0732 Post nurse staffing information every day. Level of Harm - Minimal harm or potential for actual harm Based on review of policy and procedure, interview, and record review, it was determined that the facility failed to ensure that it maintained eighteen (18) months' worth of daily nurse staffing data, as recorded. Residents Affected - Few The findings included: Review of the facility policy and procedure on 12/07/22 at 2:30 PM, titled, Posting Direct Care Daily Staffing Numbers, provided by the Director of Nursing (DON), revised July 2016, documented in part, Policy Statement: Our facility will post, on a daily basis, for each shift, the number of nursing personnel for providing direct care to resident . 8. Records of staffing information for each shift will be kept for a minimum of eighteen (18) months or as required by state law (whichever is greater) . During an interview conducted on 12/05/22 at 12:10 PM with the Staffing Coordinator, she was asked whether or not the facility had maintained the full required 18-month daily nurse staffing data. She stated she had not maintained the full schedule, in either paper or computerized form, dating back from between June 2021 through December 2021. The Staffing Coordinator recognized and acknowledged that there were six (6) months of the daily nurse staffing data that were unaccounted for. She acknowledged they should have been there and maintained for the full eighteen (18) months, but they were not. Record review was conducted of the facility's 18-months daily nurse staffing data provided from January 2022 until December 2022. It was noted that the other six (6) months, prior to January 2022, were missing/not there. A side-by-side record review was conducted with Staffing Coordinator, in which it was noted / indicated that the only daily nurse staffing data that was available and maintained in the facility are dated from January 2022 until December 2022; which was only twelve (12) of the eighteen (18) months requirement. The DON further recognized and acknowledged on 12/06/22 at 9:35 AM that the 18-month daily nurse staffing data should have been maintained, and it was not maintained. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 19 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 8. Review of Resident #40's clinical record documented an admission on [DATE] with no readmissions noted on file. The resident's diagnoses included Anemia, Heart Failure, Diabetes Mellitus, and Urinary Tract Infection (UTI). Review of Resident #40's Minimum Data Set (MDS) admissions assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 11, indicating the resident had moderate cognition impairment. The assessment documented under Functional Status the resident needed extensive assistance from the staff for her activities of daily living (ADLs). Review of Resident #40's December 2022 Treatment Administration Record (TAR) documented a physician order for Cleanse Sacro gluteal daily and as needed with soap and water, pat to dry, apply Zinc Oxide daily and leave open to air. one time a day, order date 11/12/2022. Resident #40 did not have a Self-Medication Administration care plan. Review of Resident #40's physician order did not include an order for Dermovate cream. There was not a physician order to keep medications at the bedside. On 12/05/22 at 12:04 PM, observation revealed Resident #40 in her room, sitting up in a recliner and accompanied by her daughter. Further observation revealed two bottles of Vicks Vapor Rub, a tube of Dermovate 0.05%cream, and a tube of Balmex-zinc oxide 11.35 in a plastic ziplock bag on top of the side table. (Dermovate is a brand of medicine that contains the active ingredient clobetasol propionate. This is a steroid medication which is used in the treatment of eczema and other inflammatory skin conditions like psoriasis. Cream and ointment forms are available and it is a prescription-only medicine). During an interview, the resident stated her daughter brought in the cream because her bottom was hurting and it is better. The resident stated that the Vicks Vapor Rub belongs to her daughter and that she was not using it. On 12/06/22 at 10:45 AM, observation revealed Resident #40 sitting up in the recliner. Further observation revealed the plastic ziplock bag with the Vicks Vapor Rub and the cream noted on top of the side table had been removed from the table. During an interview, the resident was asked about the plastic bag and stated that they probably put them in the drawer. The resident gave the surveyor permission to check the drawer. Observation revealed the zip lock plastic bag with two bottles of Vicks Vapor Rub, a tube of Dermovate 0.05%cream, and a tube of Balmex-zinc oxide 11.35 and Vitamin D ointment in a plastic ziplock bag in the resident's dresser's drawer. Photographic Evidence Obtained. On 12/06/22 at 5:01 PM, a side-by-side review of Resident #40's medications in her dresser's drawer was conducted with Staff, H, LPN. Staff H stated that she did not know if the medication in the ziplock bag came from the facility or not. During the review, Resident #40 stated again in Spanish that the Vicks Vapor Rub was her daughters. Staff H stated that those meds were not supposed to be in the resident's room. Staff H bagged all the medications, removed them form the resident's room and stated she would call her son about it. Based on observation, interview, record review and review of policy and procedure, it was determined that the facility failed to ensure it secured and locked over-the-counter (OTC) expired and prescription medications for 5 of 5 residents observed during an observational room tour, Resident #80, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 20 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Resident #77, Resident #68, Resident #230 and Resident #40; failed to ensure it kept its facility emergency crash cart locked and secured; failed to ensure it disposed of an expired stock medication in the South wing Treatment cart; and failed to ensure it secured loose unidentified medication pills for 1 of 6 observed medication carts during the Medication Storage Observation for the North wing medication cart. Residents Affected - Some The findings included: Review of facility policy and procedure on 12/07/22 at 2:30 PM, titled, Storage of Medications, provided by the Director of Nursing (DON), revised date 08/2020, documented in part: Policy: Medications and biologicals are stored safely, securely and properly, following manufacturer's recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. Procedures: General Guidance .2. Only to licensed nurses personnel, pharmacy personnel, or staff members lawfully authorized to administer medications (such as medication aides) are permitted to access medications. Medication rooms, carts, and medication supplies are locked when they are not attended by persons with authorized access . 8. Outdated, contaminated or deteriorated medications and those in containers that are cracked, soiled or without secure closures are immediately removed from inventory, disposed of according to procedures for medication disposal, and reordered from the pharmacy if a current order exists . 6. The nurse will check the expiration date of each medication before administering it. 7. No expired medication will be administered to a resident. 8. All expired medications will be removed from the active supply and destroyed in accordance with facility policy, regardless of amount remaining. 1. Resident #80 was originally admitted to the facility on [DATE] with diagnoses that included Alcoholic Myopathy, Diabetes Mellitus Type II and Anxiety Disorder. He had a Brief Interview Mental Status (BIM) score of 13, indicating the resident was cognitively intact. During observation conducted on 12/05/22 at 10:51 AM of Resident #80's room, it was noted there was a used tube of prescription Premethrin Cream 5% medication at the resident's bedside which was visible and unsecured on bedside dresser top accessible to other residents, employees and visitors. Photographic evidence obtained. During a brief interview with Resident #80 on 12/05/22 at 10:51 AM, the surveyor inquired of Resident #80 regarding the tube of prescription Premethrin Cream 5% medication on his bedside top who replied that he applies this cream when he has an itchy rash. On 12/05/22 at 2:02 PM, during a second observation, it was again noted there was a used tube of prescription Premethrin Cream 5% medication atop the resident's bedside dresser. On 12/06/22 at 10:36 AM, during a third observation, it was noted there was a used tube of prescription Premethrin Cream 5% medication atop the resident's bedside dresser. On 12/06/22 at 2:18 PM, during a fourth observation, it was noted there was a used tube of prescription Premethrin Cream 5% medication atop the resident's bedside dresser. On 12/07/22 at 10:09 AM, during a fifth observation, it was again noted there was a used tube of prescription Premethrin Cream 5% medication atop the resident's bedside dresser. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 21 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some An interview was conducted on 12/07/22 at 12:40 PM with Resident #80's nurse, Staff F, Licensed Practical Nurse (LPN), regarding the tube of prescription Premethrin Cream 5% medication on Resident #80's bedside dresser top and she acknowledged the tube of prescription Premethrin Cream 5% medication should not have been there. During an interview conducted on 12/07/22 at 12:45 PM with Staff G, LPN / Unit Manager UM, for the North wing, she indicated this resident does not self-administer any of his own medications and neither was he assessed to be able to do. A side-by-side record review of the hard copy chart and the computerized Point-Click-Care (PCC) medical record for Resident #80 was conducted with Staff G, in which it was noted that neither of the records had evidence the resident had any self-assessment completed in order for him to be to administer his own medications. There was no order on the Resident # 80's Medication Administration Record (MAR) for this over-the-counter (OTC) medication to be administered to this resident. The tube of prescription Premethrin Cream 5% medication was not removed from this resident's bedside, until after surveyor inquisition / intervention. 2. Resident #77 was admitted to the facility on [DATE] with diagnoses that included Parkinson's Disease, Diabetes Mellitus Type II, Hypertension, Anxiety Disorder and Peripheral Vascular Disease. She had a Brief Interview Mental Status (BIM) score of 14 (cognitively intact). On 12/05/22 at 11:13 AM, during an observation of Resident #77's room, it was noted there was a used bottle of (OTC) Refresh Optive eyedrops, visibly sitting on the resident's bedside table with an expiration date of 02/22, which was unsecured on bedside dresser top accessible to other residents, employees and visitors. Photographic Evidence Obtained. During a brief interview with Resident #77 on 12/05/22 at 11:13 AM, the surveyor inquired of Resident #77, regarding the bottle of (OTC) Refresh Optive eyedrops on the bedside table, who replied that she uses the eyedrops when she needs them. An interview was conducted on 12/07/22 at 12:53 PM with Resident #77's nurse, Staff F, regarding the bottle of (OTC) Refresh Optive eyedrops observed on Resident #77's bedside table, who acknowledged the medication bottle should not have been there. During an interview conducted on 12/07/22 at 1:05 PM with Staff G, she indicated this resident does not self-administer any of her own medications and neither was she assessed to be able to do so. A side-by-side record review of Resident #77's hard copy chart and the computerized Point-Click-Care (PCC) medical record was conducted with Staff G, which indicated that neither chart had evidence the resident had a self-assessment completed in order for her to be to administer her own medications. 3. Resident #68 was admitted to the facility on [DATE] with diagnoses which included Cutaneous Abscess of Chest Wall, Anemia, Dysphagia, Chronic Kidney Disease and Hypertension. He had a Brief Interview Mental Status (BIM) score of 15, indicating intact cognition. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 22 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 12/05/22 at 1:48 PM, during an observational room tour for Resident #68, it was noted there was a used tube of Nystatin cream 100,000 units prescription cream medication visibly sitting on the resident's dresser / bureau with an expiration date of 02/22, which was visible and unsecured on bedside dresser top accessible to other residents, employees and visitors. Photographic Evidence Obtained. During a brief interview with Resident #68 on 12/05/22 at 2:11 PM, the surveyor inquired of Resident #68, regarding the tube of Nystatin cream 100,000 units prescription cream medication bedside dresser table, who replied that he applies this cream for the rash on his bottom [buttocks]. An interview was conducted on 12/07/22 at 11:30 AM with Resident #68's nurse, Staff B, LPN, regarding the tube of Nystatin cream 100,000 units prescription cream medication observed on Resident #68's bedside table. He acknowledged the medication tube should not have been there. During an interview conducted on 12/07/22 at 11:51 AM with Staff E, LPN / Unit Manager (UM), for the North wing, she indicated this resident does not self-administer any of his own medications and was not assessed to be able to do so. A side-by-side record review of Resident #68's hard copy chart and the computerized Point-Click-Care (PCC) medical record was conducted with Staff E, which indicated that neither chart had evidence the resident had any self-assessment completed in order for him to administer his own medications. The tube of Nystatin cream 100,000 units prescription cream was not removed from this resident's bedside, until after surveyor inquisition / intervention. 4. Resident # 230 was admitted to the facility on [DATE] with diagnoses which included Chronic Obstructive Pulmonary Disease, Pulmonary Fibrosis, Diabetes Mellitus Type II, Heart Failure, Hypertension and Syncope and Collapse. She had a Brief Interview Mental Status (BIM) score of 13 (cognitively intact). On 12/06/22 at 10:44 AM during an observation of Resident #230's room, it was noted that there was a used container of Blue Super Strength EMU cream located atop her bedside table with an expiration date of 04/2023. Photographic Evidence Obtained. During a brief interview with Resident #230 on 12/06/22 at 10:44 AM, the surveyor inquired of Resident #230 regarding the container of Blue Super Strength EMU cream located atop her bedside table who replied that she asks the staff to apply it to her feet when needed for her painful Neuropathy. During a second observation conducted on 12/06/22 at 2:21 PM, it was noted there was still a used container of Blue Super Strength EMU cream located atop her bedside table with an expiration date of 04/2023. During a third observation conducted 12/07/22 10:10 AM, it was noted there was still a used container of Blue Super Strength EMU cream located atop her bedside table with an expiration date of 04/2023. An interview was conducted on 12/07/22 at 1:15 PM with Resident #230's nurse, Staff F, regarding the container of Blue Super Strength EMU on Resident #230's bedside table, who acknowledged the medication container should not have been there. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 23 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview conducted on 12/07/22 at 1:20 PM with Staff G, she indicated this resident does not self-administer any of her own medications and was not assessed to be able to do so. A side-by-side record review of Resident #230's hard copy chart nor her computerized Point-Click-Care (PCC) medical record was conducted with Staff G which indicated that neither chart had evidence the resident had any self-assessment completed in order for her to be to administer her own medications. There was no order on the Resident #230's Medication Administration Record (MAR) for this OTC medication to be administered to this resident. The container of Blue Super Strength EMU OTC was not removed from this resident's bedside, until after surveyor inquisition / intervention. 5. During observation in the hallway conducted on 12/05/22 at 2:04 PM, it was noted that the facility's main front lobby Emergency crash equipment cart, containing intravenous (IV) starter kits, a bottle of Normal Saline solution with an expiration date of 10/12/23, a Glucometer machine, Blood Pressure (BP) cuff, Oxygen tubing, IV tubing, catheter kits, sponges and respiratory suction cuts and Trach cuffs and other sterile packaged emergency items, was observed to be unlocked, exposed and accessible to residents, staff and visitors. Photographic Evidence Obtained. 6. During a Medication Storage Observation conducted on 12/07/22 at 1:50 PM with the Director Of Nursing (DON), there was an expired tub of muscle & joint Vanishing gel stock medication, dated 11/22, in the South wing Treatment cart. Photographic Evidence Obtained. 7. During a Medication Storage Observation conducted on 12/07/22 at 2:00 PM with the DON, there were two (2) unidentified white pills, one (1) circular and one (1) oval shaped, located in the second and third drawers on the bottom of the North Medication cart. Photographic Evidence Obtained. On 12/07/22 at 2:20 PM, the DON further acknowledged and recognized that the (OTC) and prescriptions medications found in the resident's rooms, the facility Emergency carts, and the treatment carts, should have all been locked and secured to include no medications left at the residents' bedsides. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 24 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 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 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined the facility failed to provide lab services to meet the needs on 1 of 1 sampled resident, Resident #99, reviewed for labs. Residents Affected - Few The findings included: During an environment tour conducted on 12/07/22 at 1:00 PM accompanied with the Corporate Maintenance Director, the specimen refrigerator located in the Soiled Utility Room located in South [NAME] Unit was observed. Further investigation of the refrigerator noted what appeared to be a Urine specimen. A review of the Lab [company name] Sheet that was with specimen collection tube noted it was documented as urine (UA) for Resident #99. Further review of the lab sheet did not document a date that the urine specimen was collected. A review of the specimen tube noted the urine was documented as collected on 12/05/22. The surveyor requested of the Corporate Nurse to investigate why the specimen had not been collected by the lab on 12/05/22. Following the request, the Corporate Nurse submitted documentation and stated the attending physician ordered a one time UA C&S (Urine Analysis-Culture & Sensitivity) for Resident #99 on 12/5/22. The Corporate Nurse stated the facility failed to notify their laboratory vendor [Company Name] of the specimen order and to pick up the specimen for analysis. A call was placed to the attending physician on 12/07/22 and a new ordered was received for a UA C&S. A review of the clinical record of Resident #99 noted: Date of admission: [DATE] Diagnoses: Urinary Tract Infection (09/21/22). Review of Physician Progress notes, dated 12/05/22, confirmed that a Urine UA C&S was ordered on 12/05/22. A 12/07/22 documentation noted the order was not followed for 12/05/22 and a new order was received on 12/07/22. A review of Pharmacy documentation noted the resident was receiving Apixaban 5 mg BID (twice daily) was originally ordered on 10/10/22 for diagnosis of DVT (Deep Vein Thrombosis) Prophylaxes. It was further noted the order documented the medication was put on hold on 12/07/22 through 12/21/22. On 12/08/22, the surveyor was informed by the Corporate Nurse the urine specimen had been picked up by the lab on 12/07/22 but there were no results report as of yet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 25 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, interview and record review, it was determined the approved Pureed Diet menu did not meet nutritional needs and was not followed for 14 facility residents with physician ordered Pureed Diets, which included 3 of 3 sampled Residents #28, #88, and #167. The findings included 1. During review of the approved menu for the lunch meal of 12/05/22 and breakfast meal of 12/06/22, the following was noted to be documented: Lunch Meal (12/05/22): 4 ounces Pureed Dinner Roll (pureed diet) 4 ounces Chocolate Pudding (pureed diet) 1 Tsp [teaspoon] Chopped Parsley (garnish) No documentation of an alternate purred vegetable. Breakfast Meal (12/06/22) Slivered [NAME] Onions (garnish). 2. During the observation of the lunch meal in the Main Kitchen on 12/05/22 at 11:30, the following was noted: (a) Observation of the tray line in the main kitchen on 11/05/22 at 11:30 AM noted the Pureed Buttered Dinner Roll had not been prepared and would not be served. Once the surveyor informed the Certified Dietary Manager (CDM) there was a menu omission, an attempt was made to use white bread as the ingredient. The surveyor informed the CDM the freshly prepared buttered dinner was to be utilized for the pureed diet. (b) Observation of the tray line in the main kitchen on 11/05/22 at 11:30 AM noted the Pureed Brownie was prepared and was being served to the pureed diets. The surveyor informed the CDM the approved menu documented Chocolate Pudding for pureed diets. (c) Observation of the tray line in the main kitchen on 12/05/22 at 11:30 AM noted there was not an alternate pureed vegetable prepared for pureed diets. Interview with the CDM noted that an alternate vegetable was documented for all Regular and Therapeutic diets. Addition interview with the Registered Dietitian revealed that an error was made during the development of the Pureed Menu. (d) Observation of the tray line in the main kitchen on 12/05/22 at 11:30 AM noted the Chopped Parsley was not included on the residents' plate. It was also noted there was no pureed garnish included on the approved menu. Interview conducted with the CDM during the meal observation revealed that staff failed to prepare the garnish. Interview with the Registered Dietitian (RD) revealed that an error was made during the preparation of the approved menu for Pureed Diets (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 26 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0803 Level of Harm - Minimal harm or potential for actual harm 3. During the observation of the breakfast meal in the main kitchen on 12/06/22 at 7:00 AM noted the Slivered Onion (garnish) was not included on the residents' food plate. It was also noted that the approved menu did not document a pureed garnish for the breakfast meal. Interview conducted with the CDM during the meal observation revealed that staff failed to prepare the garnish. Interview with the Registered Dietitian revealed that an error was made during the preparation of the approved menu for Pureed Diets. Residents Affected - Few Review of the facility's Diet Census for 12/06/22 noted that there were currently 14 residents with physician ordered Pureed Diet. It was noted that sampled Residents #28, #88 and #167 had physician orders for pureed diet and were included in the 14 facility residents on ordered pureed diets. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 27 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined the facility failed to follow physician ordered therapeutic diet for Fluid Restriction for 1 of 5 sampled residents, Resident #281, reviewed for nutrition. The findings included: Review of facility's Policy & Procedures, in part, for Restricting Fluids, noted the following: General Guidelines: < Follow specific instruction (physician order) including fluid intake or restrictions. < Record fluid intake on the intake side of the intake and output record, Record fluid intake in ML's. < When placed on restricted fluid, remove the water pitcher and cup from the room. < Be sure an intake and output record is maintained in the resident's room. During the observation of the lunch meal conducted on 12/05/22 at 1:00 PM, it was noted the meal tray was delivered to the room of Resident #281. Further observation noted the meal tray ticket documented 'Mechanical Soft, Renal. Fluid Restriction 1500 cc (D:720)'. The tray ticket did not have documentation of the type and amount of fluid to be served. It was also noted the resident had a Styrofoam container of water (approximately 300 cc) on the bedside table of which the resident was noted to be drinking from. Observation of the food tray noted the resident was served coffee (6 ounces = 180 cc) and Grape juice (8 ounces =240 cc) for a meal total of 420 cc. Observation of the breakfast meal conducted on 12/06/22 at 7:30 AM again noted the tray served to the room of Resident #281. The resident was noted to be alert but unaware of diet and fluid restriction specifics. It was also noted 8 ounces (240 cc) of unidentified fluid on overbed tray table. Review of the meal tray ticket documented Fluid Restriction: 1500 cc D: 720. Ticket review again noted no specific fluids and amounts to be served on the breakfast tray. Review of the breakfast tray noted the following was served: Coffee (6 ounces = 180cc), milk (8 ounces = 240cc) and apple juice (8 ounces = 240cc) for a meal total of 680cc. Review of the dinner meal ticket for 12/6/22 noted documentation of a Fluid Restriction: 1500cc D: 720. It was also noted that there were no specific fluids and amounts to be served on the dinner tray. A calculation of the resident's meal tickets estimated by the surveyor noted Resident #281 was receiving a minimum of 2040cc of fluids on meal trays per day, which indicated the resident was receiving over 500cc of fluid above the physician order. A review of the clinical record of Resident #281 on 12/7/22 noted the following: Date of admission: [DATE] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 28 of 29 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 105119 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wilton Manors Healthcare & Rehabilitation Center 2675 N Andrews Ave Wilton Manors, FL 33311 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0808 Diagnoses: ESRD [End Stage Renal Disease] Level of Harm - Minimal harm or potential for actual harm Matrix Documented: In House Dialysis Current Physician Orders: MD Orders: Residents Affected - Few 12/02/22 - Mechanical Soft, Renal Diet 12/2/22 - Fluid Restriction - 1500ml [cc] plus / minus 300 - 720 ml provided by dietary - nursing - day = 300/evening =300, night = 180; total 780. 11/30/22 - Nova Source TID (three times a day) 11/30/22 - House Protein TID- 30 ml. Further review of the record noted the resident's physician ordered Fluid Restriction had not been calculated by meal by Registered Dietitian and the nursing Fluid Allotment had not been calculated by the MDS (Minimum Data Set) Coordinator. It was also noted that an MDS had not been completed due to the resident being admitted less than 14 days. It was noted the resident had a BIMS score of 15, indicating cognition was intact. Review of the December Medication Administration Record (MAR) for the month of December 2022 noted documentation of nursing to provide nursing per day: 30cc day shift, 300cc evening shift, and 180cc night shift, for a total of 780cc. Further review of the MAR noted documentation the resident was receiving fluids via nursing for 2 shifts only (Day & Night). There was no documentation of how much fluid the resident was administered for each shift. Interview with the Registered Dietitian and MDS Coordinator on 12/07/22 revealed the following: a. The facility's Registered Dietitian (RD) confirmed with the surveyor that the 1500cc Fluid Restriction for Resident #281 was not being followed as per physician orders. The RD stated that the resident's fluid restriction has been re-assessed. The RD submitted Dietary Progress notes, dated 12/07/22, that the 720cc of the 1500cc of fluids would include: Breakfast Meal = 240cc (cranberry juice & coffee), Lunch Meal = 240cc ((Cranberry Juice & coffee), Dinner meal = 240cc (cranberry juice & coffee). It also documented the physician's order had been clarified, no bedside water, Novasource Renal 480 cc will not be included in the fluid restriction, and Nursing will provide 780cc fluids for medication pass. The submitted documentation included that the dietary and nursing staff had been in-serviced on Fluid Restrictions. b. The MDS confirmed with the surveyor that the 1500cc Fluid Restriction had not been followed as per physician ordered. The MDS further stated that Nursing was not documenting the 780cc allotment correctly on the MAR and would make appropriate corrections to the MAR, including fluids provided and intake by the resident. The MDS stated the care plan for the fluid restriction has also been updated with the appropriate changes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105119 If continuation sheet Page 29 of 29