Health inspection·March 13, 2025

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record reviews, the facility failed to ensure their medication error rate were 5% or lower as evidenced by an error rate of 13.89 % out of 36 opportunities. There were 83 residents residing in the facility at the time of survey. Residents Affected - Few The findings included: On 03/11/25 at 11:07 AM, a medication observation was completed with Staff B, LPN on the North medication cart#4 for Resident#379. Staff B, LPN revealed Resident #379 takes medicine by mouth in a whole form. Staff B, LPN performed hand hygiene and verified each medication according to the physician's order and placed the following medications into a cup: 1) Bumetanide 2 mg (milligram) tablet 2) Calcium Acetate capsule 667 mg 2 capsules 3) Carvedilol 25 mg tablet by mouth (blood pressure 140/70, heart rate 68) 4) Ferrous sulfate tablet 325 mg Staff B, LPN I was asked if this was the prescribed time to administer the medications and Staff B, LPN replied, No. The medications are scheduled to be given at 9:00 AM so the time frame is 8:00 AM to 10:00 AM. I did not administer the medications as yet because I was busy with other duties. Vancomycin is not in stock because it was ordered by the physician at midnight last night. I will call the doctor and pharmacy to follow up. On 03/11/25 at 11:40 AM Staff B, LPN spoke to the physician and the consultant pharmacist about medication unavailability and revealed the medication will be in facility in an hour. During a medication reconciliation, the March 2025 physicians orders sheet was reviewed and revealed the following medications were due at 9:00 AM: Ferrous Sulfate Tablet 325 (65 Fe) mg tablet by mouth one time a day for supplementation related to Anemia, Calcium Acetate (Phos Binder) Oral Capsule 667 mg (Calcium Acetate (Phosphate Binder) 2 capsule by mouth two times a day for Other disorder, Bumetanide Tablet 2 MG Give 1 tablet by mouth two times a day related to Edema, Carvedilol Tablet 25 mg 1 tablet by mouth two times a day for Hypertension related to Essential hypertension Hold for Systolic Blood pressure less than 110 or Diastolic BP less than 60 and Vancomycin HCl Oral Suspension 50 MG/ML (Vancomycin HCl) 2.5 ml by mouth four times a day related to Enterocolitis due to Clostridium Difficile for 10 Days. On 03/13/25 at 1:07 PM The Director of Nursing stated, The time frame to administer medications is an hour before to an hour after. Record review of a policy titled, Preparation and General Guidelines revised December 2019 revealed IIA2: MEDICATION ADMINISTRATION-GENERAL GUIDELINES. Policy: Medications are administered as prescribed in accordance with good nursing principles and practices and only by legally authorized to do so. Personnel authorized to administer medications do so only after they have been properly oriented to the facility's medication distribution system (procurement, storage, handling and administration). The facility has sufficient staff and a medication distribution system to ensure safe (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105153 If continuation sheet Page 2 of 5 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 105153 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pinecrest Center for Rehabilitation and Healing 13650 NE 3rd Court North Miami, FL 33161 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 0759 administration of medications without unnecessary interruptions. Level of Harm - Minimal harm or potential for actual harm B. Administration Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 1. Medications are administered within [60 minutes] of scheduled time, except before, with or after meal orders, which are administered [based on mealtimes]. Unless otherwise specified by the prescriber, routine medications are administered according to the established medication administration schedule for the facility. Event ID: Facility ID: 105153 If continuation sheet Page 3 of 5 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 105153 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pinecrest Center for Rehabilitation and Healing 13650 NE 3rd Court North Miami, FL 33161 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. Based on observations, interviews and record review facility failed to ensure proper storage of medication and biologicals for five residents (Residents #381, #62, #47, #12 and #65) as evidenced by observations of bottled pills inside a plastic bag at Resident 381's bedside, a bottle labeled Zicam (cold remedy) at the Resident # 62's bedside, a tube labeled Zinc Oxide Ointment at the Resident#12's bedside two bottles labeled Acetic Acid Irrigation Solution at Resident # 47's bedside and a bingo card of discontinued medication for Resident#65. There were 83 residents residing in the facility at the time of survey. The findings included: On 03/10/25 at 7:43 AM Resident #381 was observed in bed . A plastic bag of bottled pills was observed on the nightstand next to the resident. Staff D, Licensed Practical Nurse (LPN) was notified. Staff D, LPN entered room and removed the plastic bag of medications and educated Resident#381. During an interview on 03/10/25 at 7:45 AM Staff D, LPN stated, I do rounds each morning to make sure the residents are stable and no items that can harm the residents are resent. I did round this morning, but I did not see the medications. No meds are allowed meds at bedside. 2) On 03/11/25 at 7:30 AM Resident #47 was observed in bed with no apparent distress. A bottle of medication was observed on the side table next to the resident. The assigned nurse was notified, entered the room and the removed a bottle labeled Zicam and educated the resident. On 03/11/25 07:32 AM Staff E, LPN was asked about the protocol for medication storage and stated, I round every hour to check the condition of the residents and the environment for safety and infection control. This medication cannot be at the bedside. 3) On 03/11/25 at 7:42 AM Resident#12 was observed in bed a box labeled Zinc Oxide Ointment was observed inside a plastic bag on the side table next to the resident. The assigned nurse was notified. Staff D, LPN entered the room and removed the box from the side table stated, It should be inside the drawer not on side table. 4) On 03/12/25 at 9:35 AM During medication observation for Resident #47 with Staff C, RN an observation was made of two bottles labeled Acetic Acid Irrigation Solution 0.25 % on the nightstand next to the resident. After the medication administration was completed, Staff C, RN asked if it was within protocol for Resident #47 to keep the bottles at the bedside. On 03/12/25 at 2:31 PM Staff C, RN stated, The solution is to be kept in the medication cart. I removed it from the room and placed it inside the medication cart. 5) On 03/12/25 at 8:44 AM, Staff C, RN acknowledged the presence of a bingo card with prescribed medications for Resident #65 labeled Hydroxyzine HCI Tablet 50 mg by mouth every 6 hours as needed for agitation related to restlessness with pills in cart. Staff C, RN revealed the medication was discontinued and should not be kept in medication cart. Record review of a Physician Order Sheet for Resident #47 revealed 10/9/24- Hydroxyzine HCl Oral (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105153 If continuation sheet Page 4 of 5 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 105153 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pinecrest Center for Rehabilitation and Healing 13650 NE 3rd Court North Miami, FL 33161 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 Tablet 50 MG (Hydroxyzine HCl) Give 1 tablet by mouth every 6 hours as needed for Agitation related to Restlessness and Agitation discontinued on 11/20/24. On 03/12/25 at 11:44 AM The Pharmacist Consultant stated, If a medication is discontinued it should be removed from the cart and sent back to pharmacy or destroyed. Residents Affected - Some Record review of a policy titled, Medication Storage In The Facility revised January 2018 revealed Policy: It is the policy of this facility to ensure all medications housed on our premises will be stored in the pharmacy and/or medication rooms according to the manufacturer's recommendations and sufficient to ensure proper sanitation, temperature, light, ventilation, moisture control, segregation, and security. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105153 If continuation sheet Page 5 of 5