Inspection·July 20, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #11's care plan, titled, Resident requires assist with activities of daily living related to Dementia, Limited Mobility ., and revised on 04/10/23, documented an intervention that read .assist with meals . On 07/17/23 at 12:47 PM, observation revealed Resident #11was alert and sitting up in bed being fed by Staff L, Certified Nursing Assistant (CNA). Further observation revealed Staff L was standing, next to the resident's left side, while feeding the resident. Further observation revealed a chair across from Resident #11's bed. The resident was not interviewable. On 07/19/23, an attempt was made to interview Staff but she was not available. On 07/20/23 at 9:01 AM, an interview was conducted with Staff M, CNA, who stated that the staff were supposed to seat down while feeding a resident. On 07/20/23 at 9:04 AM, an interview was conducted with Staff N, CNA, who stated that they were supposed to seat down while feeding a resident. On 07/20/23 at 9:06 AM, an interview was conducted with Staff O, Licensed Practical Nurse (LPN), who stated that the staff were supposed to seat down while feeding a resident. Staff O stated that Staff L and Resident #3's PDA were not available for an interview. On 07/20/23 at 1:02 PM, an interview was conducted with the Director of Nursing (DON) regarding the above findings. The DON stated the PDA was not the facility's staff and was allowed to assist Resident #3 with meals and added that the PDA was ultimately responsible for the resident but the facility staff were supposed to do the resident's care. The DON stated the PDA had been in the facility before and knows that she is to seat down while feeding the resident. The DON stated a PDA was like a family member. The DON stated the PDA was a CNA and that the facility educated them on assistance with feeding. The DON was asked to submit a copy of the facility's policy related to assistance with dining / feeding and PDA responsibilities and training. At the end of the survey (07/20/23), the DON had not submitted a copy of the facility's policy related to assistance with dining / feeding and PDA responsibilities and training provided to them. On 07/20/23, 3:40 PM during an interview, the Administrator was apprised of findings related to feeding residents while standing. The Administrator stated that the PDA had to follow the facility's protocols. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 2 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 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 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. Level of Harm - Minimal harm or potential for actual harm Based on interviews, observations and record reviews, the facility failed to appropriately respond to and resolve grievances in a timely manner, for 7 of 7 sampled residents in attendance during a meteting with members of the Resident Council. Residents Affected - Few The findings included: The facility's policy, titled, Grievances/Complaints Filing dated 03/13/23, documented, in part, the following: Policy Statement Residents and their representatives have the right to file grievance, either orally or in writing, to the facility staff or to the agency designated to hear grievances (e.g., the State Ombudsman). The Administrator and staff will make prompt efforts to resolve grievances to the satisfaction of the resident and/or representative. Policy Interpretation and Implementation 1. Any resident, family member, or appointed resident representative may file a grievance or complaint regarding care, treatment, behavior of other residents, staff members, theft of property, or any other concerns regarding his or her stay at the facility. Grievances also may be voiced or filed regarding care that has not been furnished. 2. Residents, family, and resident representatives have the right to voice or file grievances without discrimination or reprisal in any form, and without fear of discrimination or reprisal. 3. All grievances, complaints or recommendations stemming from resident or family groups concerning issues of resident care in the facility will be considered. Actions on such issues will be responded to in writing, including a rationale for the response. 4. Upon admission, residents are provided with written information on how to file a grievance or complaint . 8. Upon receipt of a grievance and/or complaint, the grievance officer will review and investigate the allegations and submit a written report of such findings to the administrator within five (5) working days of receiving the grievance and/or complaint. During a review of the Resident Council Meeting minutes, on 07/18/23 at 10:45 AM, with permission (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 3 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 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 0565 granted by the Resident Council President, the following concerns were noted: Level of Harm - Minimal harm or potential for actual harm June 2023 'Old Business: Meals are running late at times.' May 2023 'Old Business: Meals are running late.' Residents Affected - Few April 2023 'Dietary: Meals are getting later.' The schedule of mealtimes that is posted on the units and at the Main Dining Room documented the following schedule: Breakfast - 7:45AM to 9:00 AM *Cart 1 to the second floor 7:55 AM to 8:00 AM *Cart 2 to the third floor 8:05 AM to 8:10 AM *Cart 3 to the second floor 8:15 AM to 8:20 AM *Cart 4 to the third floor 8:25 AM to 8:30 AM Lunch - 11:45 AM to 1:00 PM *Cart 1 to the third floor 11:55 AM to 12:00 PM *Cart 2 to the second floor 12:05 PM to 12:10 PM *Cart 3 to the third floor 12:15 PM to 12:20 PM *Cart 4 to the second floor 12:25 PM to 12:30 PM Dinner - 4:45 PM to 6:00 PM *Cart 1 to the third floor 4:50 PM to 4:55 PM *Cart 2 to the second floor 5:05 PM to 5:10 PM *Cart 3 to the third floor 5:15 PM to 5:20 PM *Cart 4 to the second floor 5:25 PM to 5:30 PM a. During observations of food carts being sent from the kitchen, on 07/18/23, beginning at 12:14 PM, the following was observed by this surveyor: At 12:14 PM, the first cart left the kitchen to go to the third floor West. At the time that the cart arrived on the unit, staff were already serving vegetable soup in the main dining room to the 14 residents that were seated at the tables. At 12:36 PM, the meal cart for the second floor [NAME] Unit left the kitchen. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 4 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 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 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview with members of the Resident Council, on 07/18/23 at 3:40 PM, when asked about the concerns voiced in prior meetings regarding the meals not being served on time, all of the residents in attendance (7) agreed that the meals being served late was still a problem. Resident #14, with a Brief Interview for Mental Status (BIMS) score of 11 of 15, indicating the resident was moderately cognitively impaired, stated, dinner doesn't come until 6:00 PM Resident #14 further stated, If you eat in the dining room, supper is at 4:30 [PM]. If you eat in your room, it will be around 6:00 (PM). We got our breakfast at 8:30 [AM] this morning. They just say they'll take care of it. Sometimes, the meals will be on the floor and the CNAs don't deliver them and they just sit there. Resident #1, with a BIMS score of 15, indicating the resident was cognitively intact, stated, Breakfast doesn't come until 9:00 AM or 9:30 AM. During observations of breakfast carts being sent from the kitchen to the units, on 07/19/23, beginning at 7:57 AM, the following observations were made: At 7:57 AM, the first cart left the kitchen being taken to the second floor East Unit. At 8:02 AM, a meal cart was observed at the second floor nurse's station with the ADON [Assistant Director Of Nursing] overseeing 3 CNAs [Certified Nursing Assistant] delivering the meals to the residents in their rooms. At 8:19 AM, a meal cart was on the third floor [NAME] and staff began serving to the residents in their rooms. At 8:37 AM, a meal cart arrived to the second floor East Unit. At 9:03 AM, the last meal served to the residents in their rooms on the second floor East Unit. At 9:17 AM, the last meal was served to the residents in their rooms on the third floor East Unit. During an interview, at the conclusion of the breakfast observations, with the Diet Tech, the Diet Tech stated that the meal schedule that was posted in the Main Dining Room and the dining rooms on the units was the time that the meal carts were to leave the kitchen and not the time that the meals are served. b. During observation of lunch, on 07/19/23 at 1:03 PM, the last was meal was served from cart on the second-floor East unit. c. During an observation of the carts leaving the kitchen and being sent to the units, on 07/20/23 beginning at 7:59 AM, the following observations were made: At 7:59 AM, the first cart left the kitchen for second floor [NAME] unit. At 8:11 AM, the second cart left the kitchen for the third floor [NAME] Unit. At 8:50 AM, the last cart left the kitchen for the third floor East Unit. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 5 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 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 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview, on 07/20/23 at 9:02 AM, with the Administrator and Activity Director, the Administrator stated, A new food delivery system will be starting August 2 [2023] that I mentioned at the meeting yesterday (referring to the Resident Council meeting that was scheduled for that 07/19/23), that is one of my QAPIs (PIP) [Quality Assurance and Performance Improvement / Performance Improvement Plan] that we started because they (the residents) were complaining that the food was cold. The pellet system that we had was broken, so they have to warm up the pellets in the oven so they can have hot food. It has been on order for 3 months (referring to the pellet warmer). An interview was conducted on 07/20/23 at 9:26 AM, with the vendor from Aladdin/TempRite (kitchen equipment vendor), the Administrator, the Dietitian, the Dietary Tech and Staff T, Dietary Aide. The vendor confirmed that the new pellet warmer had been ordered in April [2023] and stated, It takes 3 months to get one built. The Administrator stated, the pellet warmer would work for a while and then would stop working and then we would get it repaired and it would stop working again. This has all been going on since the new one has been ordered. We tried different avenues, originally, when they [residents] were complaining the food was cold. We strategized to took care of the cold food. Yesterday, [during Resident Council] they said that the food wasn't cold. When there were specific residents with a concern, we would put their meal on a different cart. The Dietary Tech stated, the first cart leaves the kitchen at 7:45 AM and the last care leaves the kitchen at 9:00 AM. During an interview, on 07/20/23 at 2:37 PM, the Administrator stated, They had the PIP going to heating the pellets up in the oven was a slow process. I read that it happened at times [referring to the concerns voiced during the interview with members of the Resident Council], I wasn't seeing that it was consistent. Yesterday, Resident #1 was the only one that spoke up. They were monitoring the tray line [referring to the Dietary Tech and Staff T] PIP to ensure that they were leaving the floor at the appropriate times to get to the residents. They should be doing random audits for compliance, they did it once a week. They did some breakfast, some lunch and some dinner. The audits showed that they were timely. Staff T would go up to the residents and would go and talk to them during the Food Committee meetings and Resident Council. When asked about following up with the residents to ensure that the meals were delivered timely, the Administrator stated that there was no follow-up with the residents. During an interview, on 07/20/23 at 2:45 PM, with the Dietitian and the Dietary Tech, the Dietary Tech stated that during the audits of the carts leaving the kitchen, all of the carts left the kitchen on time, according to the schedule. When asked if the timing of removing the meals from the carts and delivering to the residents was considered, the Diet Tech stated that it was not part of the audits. When asked about follow-up with the residents that voiced concerns, the Diet Tech stated that there was no follow-up. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 6 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 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 observation, interviews and record review, the facility failed to provide fingernail grooming for 2 of 2 sampled residents, Residents #16 and #38. Residents Affected - Few The findings included: Review of the facility's policy, titled, Fingernails/Toenails, Care of published on 05/19/23, documented, in part, the purposes of this procedure are to clean the nail bed, to keep nails trimmed, and to prevent infections .proper nail care can aid in the prevention of skin problems around the nail bed .trimmed and smooth nails prevent the resident from accidentally scratching and injuring his or her skin .documentation: the following information should be recorded in the resident's medical record: the date and time that nail care was given . 1. Review of Resident #16's clinical record documented an admission on [DATE] and diagnoses that included Sepsis, Cellulitis, Depression, and Chronic Conjunctivitis of Right Eye. Review of Resident #16's Minimum Data Set (MDS) annual assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 0 of 15 indicating the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed 'from extensive to total assistance from the staff to complete the activities of daily living' (ALDs). Review of Resident #16's care plan, titled, Resident has self-care deficit related to Sepsis, initiated on 07/06/21 and revised on 07/07/23, documented ' .requires extensive assistance with ADLs, dressing, bathing, hygiene, meals .' On 07/17/23 at 10:48 AM, observation revealed Resident #16 lying in bed, eyes were open, non-verbal, and non-interviewable. The resident was observed bringing her left-hand fingernails into her mouth. The fingernails were approximately 1/4 inch past the tips of her fingers. Closer observation revealed dark residue underneath her fingernails. Further observation revealed the resident's right hand had a contracture (hand was closed, unable to open it) and the fingernails were approximately ½ inch long, jagged and digging into the palm's skin. The observation revealed a skin scratch next to the resident's right wrist. The resident was not wearing any arm sleeves to protect the skin from scratches. On 07/18/23 at 8:59 AM, observation revealed Resident #16 lying down in bed, and being fed by Staff E, Certified Nursing Assistant (CNA). Staff E stated the resident did not talk. Further observation revealed the resident continued to have long and jagged fingernails on both hands. On 07/18/23 at 10:25 AM, observation revealed Resident#16 continued to have long and jagged fingernails on both hands. On 07/18/23 at 2:43 PM, an interview was conducted Staff B, CNA, who said she was responsible to clean and file the residents' fingernails. Staff B added she would not cut, but would tell the nurse, if she sees the fingernails were long. On 07/18/23 at 2:55 PM, an interview was conducted with Staff C, CNA who stated she saw that Resident #16's fingernails were long and filed them today. She stated it is common sense that if we see (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 7 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 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 them long, you have to file them. Staff C stated she did the resident's fingernails maybe two weeks ago. Level of Harm - Minimal harm or potential for actual harm On 07/18/23 at 3:42 AM, interview was conducted with Staff O, Licensed Practical Nurse (LPN), who stated that all CNAs were responsible to clean and file the resident's fingernails. A side-by-side review of photographs of Resident #16's fingernails was conducted with Staff O. Residents Affected - Few Photographic Evidence Obtained. 2. Review of Resident #38's clinical record documented an admission on [DATE], a readmission on [DATE] and diagnoses that included Pneumonia, Chronic Pain, Psychosis, Anxiety, Epilepsy, Cerebral Infarction, Legal Blindness, Hemiplegia (paralysis) of the Left side and Diabetes Mellitus, type II. Review of Resident #38's MDS annual assessment dated [DATE] documented a BIMS score of 0 of 15 indicating the resident had severe cognition impairment. The assessment documented under Functional Status that the resident was totally dependent on the staff for completing the activities of daily living including personal hygiene (washing / drying her hands). Review of Resident #38's care plan, titled, .self-care deficit related to diagnoses of Stroke with left Hemiplegia, Diabetes Mellitus, legally blind, initiated on 09/28/21 and revised on 05/29/23, documented an intervention that read requires extensive assistance with .hygiene. On 07/17/23 at 12:07 PM, observation revealed Resident #38 lying in bed. The resident was non-verbal, and non-interviewable. Closer observation revealed the resident's right hand was resting on a soft palm device, with a large yellowish stain on it. Further observation revealed the resident's fingernails were approximately ¼ inch long with dark residual underneath her nails. Further observations revealed the resident's call device was resting next to her linens and around her abdomen area and had yellowish stains on the bell and the cord. On 07/18/23 at 10:25 AM, observation revealed Resident #38 lying in bed. The resident continued to have her right hand resting on a soft palm device, with a large yellowish stain on it. Further observation revealed the resident's fingernails continued to be long and with dark residue underneath her nails. On 07/18/23 at 3:04 PM, an interview was conducted with Staff E, CNA, who stated she works the 3:00 PM to 11:00 PM shift and her duties were to bathe the resident, assist with dinner, toileting, do some activities, cut their fingernails, and wash their hair and shave if needed. A side-by-side observation of Resident #38's fingernails was conducted with Staff E who confirmed that the resident fingernails were long. Further observation revealed the resident did not have the right-hand palm soft device on as previously observed. On 07/18/23 at 3:06 PM, an observation of Resident #38 fingernails was conducted with Staff D, CNA, who confirmed the resident's fingernails were long. Staff D stated that the 3:00 PM to 11:00 PM shifts' CNAs were supposed to check on the residents' fingernails. Staff D added that she did not have time to do the resident's fingernails (Resident #38) but would do it before she leaves her shift today. On 07/18/23 at 3:33 PM, an interview was conducted with Staff F, CNA, who stated her duties were to make rounds with the (outgoing) 7:00 AM to 3:00 PM shift CNA, to check on the residents and made (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 8 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 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 her aware of what needs to be done for the resident. Staff F stated her duties also included: resident's repositioning, check their fingernails and to file them if needed. She added that most of the time the nurses will tell everybody to do the residents' nails. Staff F stated she had 9 residents assigned to her on 07/17/23 including Resident #38 and she did not do the residents' fingernails. Staff F stated she did not notice that Resident #38's fingernails were long and needed to be cleaned and filed. Residents Affected - Few On 07/18/23 at 3:42 AM, interview was conducted with Staff O, LPN, who stated that all CNAs from all shifts were responsible to clean and file the residents' fingernails. On 07/18/23 at 4:07 PM, an interview was conducted with Staff G, LPN, who stated that every shift CNA is supposed to clean and trim the residents' fingernails. On 07/20/23 at 12:35 PM during an interview, the Director of Nursing (DON) was apprised of the above findings. The DON stated that she cleaned Resident #38's call device and added that a new soft palm hand device for the resident was ordered on 07/18/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 9 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - 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, the facility failed to obtain a physician order for the follow-up care and removal of nasal sutures for 1 of 5 sampled residents observed, Resident #42; failed to follow physician's orders for application of bilateral [NAME] sleeves for 2 of 5 sampled residents observed, Resident #16 and Resident #42; failed to ensure that staff changed dressings in accordance with professional standards and per physician's orders for 4 of 5 sampled residents observed, Resident #16, Resident #21 Resident #66 and Resident #205; and failed to identify, document, and follow-up with the status of a resident's visible skin condition on the anterior chest for 1 of 5 sampled residents observed, Resident #205. Residents Affected - Few The findings included: Review of the facility policy and procedure, provided by Director of Nurse (DON) on 07/20/23 at 3:54 PM, titled, Wound Care, published 05/19/23, documented, in part, in the Policy Statement: The purpose of this procedure is to provide guidelines for the care of wounds to promote healing. Preparation: 1. Verify that there is a physician's order for this procedure. 2. Review the resident's care plan to assess for any special needs of the resident .Documentation: The following information should be provided in the resident's medical record: 1. The type of wound care given. 2. The date and time the wound care was given. 3. The position in which the resident was placed. 4. The name and title of the individual performing the wound care. 5. Any change in the resident's condition. 6. All assessment data .7. How the resident tolerated the procedure. 8. Any problems or complaints made by the resident related to the procedure. 9. If the resident refused the treatment and the reason (s) why. 10. The signature and title of the person recording the data. Reporting: .2. Report other information in accordance with facility policy and professional standards of practice. Review of the facility policy and procedure provided by the DON on 07/20/23 at 3:47 PM, titled, Medication and Treatment Orders, published 03/13/23, documented, in part, in the Policy Statement: Orders for medications and treatments will be consistent with principles of safe and effective order writing. Policy Interpretation and Implementation .2. Only authorized, licensed practitioners, or individuals authorized to take verbal orders from practitioners, shall be allowed to write orders in the medical record .7. Verbal orders must be recorded immediately in the resident's chart by the person receiving the order and must include the prescriber's last name, credentials, the date and the time of the order. Review of facility's un-dated 'Registered Nurse (RN) job description' on 07/20/23 at 1:45 PM provided by the DON [Director Of Nursing] documented, in part, Purpose of your job position: Duties include: .Document resident care services by charting in resident medical record and department records Assure quality of care by adhering to the Department of Health (DOH) standards of practice and facility standards of care . Review of facility's undated 'Licensed Practical Nurse (LPN) job description' on 07/20/23 at 1:56 PM provided by the DON documented, in part, Purpose of your job position: Overview of Role The licensed practical nurse is a staff nurse who provides direct, primary nursing care to residents and delegates and supervises the care provided by certified nursing assistants Major Responsibilities: Administrative 3. Receives and records physician's orders .11. Administers treatments and other direct care .c. Identifies and promptly communicates adverse drug reactions . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 10 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 1. Resident #42 was admitted to the facility on [DATE] with diagnoses that included Parkinson's Disease, Diabetes Mellitus Type II, Dysphagia, Hemiplegia right dominant side and Epilepsy. He had a Brief Interview Mental Status (BIMS) score of 15, indicating cognitive was intact. During an observation conducted on 07/17/23 at 10:04 AM, Resident #42 was observed with some blue-colored intact sutures in place on the bridge of his nose. The sutures did not appear infected or red. On 07/17/23 at 10:15 AM, an interview was attempted with Resident #42, in which he was asked about the presence of the sutures on the bridge of his nose, but he was unable to provide any more information other than to mention that he vaguely remembered having 'had a fall a little while ago, somewhere'. During a second observation conducted on 07/17/23 at 4:24 PM, Resident #42 was noted to still have some blue-colored intact sutures there in place on the bridge of his nose. During a third observation conducted on 07/18/23 at 10:10 AM, Resident #42 was noted to still have some blue-colored intact sutures there in place on the bridge of his nose. During a fourth observation conducted on 07/18/23 at 4:00 PM, Resident #42 was noted to still have some blue-colored intact sutures there in place on the bridge of his nose. During a fifth observation conducted on 07/19/23 at 12:05 PM, Resident #42 was noted to still have some blue-colored intact sutures there in place on the bridge of his nose. The sutures did not appear infected or red. Photographic Evidence Obtained. Review of Resident #42's hospital's consultation note, dated 04/24/23, documented that Resident #42 tripped and fell at home with his walker and sustained a laceration to his nose with subsequent nasal bone fractures. There was no notation relating to the presence of nasal sutures. Review of the Advanced Registered Nurse Practitioner (ARNP) admission progress dated 05/03/23 had no notation relating to the presence of nasal sutures. Further record review of Resident #42's three (3) weekly skin evaluations, dated 07/02/23, 07/06/23 and 07/13/23, all indicated that Resident #42's skin was intact, at baseline, with no new skin areas noted. Following admission to the facility on [DATE] at 3:43 AM, Staff R, LPN, had previously identified and documented that Resident #42 has multiple bruises to upper and lower body, including face and sclera. Bruises are dark purple, slight greenish and yellowish in color. there was no indication of nasal sutures. On 05/02/23, the care plan documented that Resident #42 has an 'actual potential for skin breakdown related to decreased mobility / daughter stated resident has a behavior of picking at his skin. Approaches: Skin assessment by licensed nurse per facility protocol. Goal: Will minimize risk for skin breakdown through next review date Any noted skin interruptions will resolve without signs and symptoms of infection daily through next review date'. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 11 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 07/19/23 at 1:32 PM, an interview was conducted with Staff P, Licensed Practical Nurse (LPN), who, when he was asked the following, responded: When asked, was the resident admitted to the facility with the nasal sutures in place, the nurse stated that he wasn't sure and said that he would have to check. When asked, how long have nasal sutures been in, the nurse stated that he would not know this. When asked, what were they put in place for, Staff P stated that he did not know. When asked, where the physician's orders for care and removal of the nasal suture were located, Staff P stated that he did not know, but that he would check the resident's chart. Staff P acknowledged that the nasal sutures were in place and stated there was no physician's orders in the record for the care and removal of the nasal sutures. On 07/19/23 at 1:52 PM, an interview was conducted with the Assistant Director of Nursing (ADON). The ADON stated the resident was admitted to the facility with the nasal sutures in place but would have to research the record for how long the sutures were in place, why the resident had sutures, and let the surveyor know. The ADON stated she would notify the physician. She acknowledged that the nasal sutures were in place, and stated there was no physicians' orders in the record for the care and removal of the nasal sutures (admitted [DATE]). A side-by-side record review was conducted with Staff P, that revealed it was not documented that on the facility's weekly skin assessment evaluations dated 07/02/23 thru 07/13/23, or in the nursing progress notes dated 07/15/23 through 07/18/23, of the existence of Resident #42's nasal sutures. The nursing progress notes only documented that Resident #42 had a 'nasal bridge incision without dressing, no drainage noted'. There were no interventional follow-up orders for subsequent suture removal. There was a physician order dated 07/12/23 for 'Nose Incision - Monitor for s/s [signs / symptoms] of infection every shift for 3 Days'. There is no order recorded for the care and removal of Resident #42's nasal sutures. On 07/19/23 at 3:25 PM, an interview was conducted with the DON. The DON stated she would have to review the resident's entire chart to see if the resident was admitted with the nasal sutures, why the resident had nasal sutures, if there were physician orders for care and removal of the nasal suture, and if there was a current plan for the nasal sutures. The DON acknowledged the nasal sutures were in place and she further indicated that there were no physicians' orders on file for the care and removal of the nasal sutures. The record revealed that a physician order was not written for nasal suture removal, until after surveyor intervention. 2. Resident #42 was admitted to the facility on [DATE] with diagnoses which included Parkinson's Disease, Diabetes Mellitus Type II, Dysphagia, Hemiplegia right dominant side and Epilepsy. The record documented BIMS score of 15 (cognitively intact). Following admission to the facility on [DATE] at 3:43 AM, Staff R, LPN, had identified and documented that Resident #42 has multiple bruises to upper and lower body, including face and sclera. Bruises are dark purple, slight greenish and yellowish in color. The record documented a physician order dated 05/09/23 for Geri sleeves to both arms every shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 12 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm On 07/17/23 at 10:04 AM, during an observation, Resident #42 was observed with a dime-sized reddened ecchymotic-like bruise to his uncovered and exposed right outer upper arm approximately two to three (2-3) inches above his right elbow. Observation revealed there were no Geri sleeves in place on the resident's arms as ordered, and no Geri sleeves at resident's bedside. Residents Affected - Few Photographic evidence was obtained. During further observations conducted on 07/17/23 at 4:02 PM, 07/18/23 10:11 AM, 07/18/23 at 4:00 PM, and 07/19/23 at 12:05 PM, Resident #42 was still observed with a dime-sized reddened ecchymotic-like bruise to his uncovered and exposed right outer upper arm approximately two to three (2-3) inches above his right elbow. No Geri sleeves were observed to the arms as ordered for each shift. Photographic Evidence Obtained. On 05/02/23, the care plan documented Resident #42 had an actual-potential for skin breakdown related to decreased mobility / daughter stated resident has a behavior of picking at his skin. Approaches: Skin assessment by licensed nurse per facility protocol .Geri sleeves to arms. Goal: Will minimize risk for skin breakdown through next review date Any noted skin interruptions will resolve without signs and symptoms of infection daily through next review date. On 07/19/23 at 1:31 PM, an interview was conducted with Staff P, Licensed Practical Nurse (LPN), in which he was asked the following questions: Does the resident currently have a dime-sized reddened ecchymotic-like bruise to his uncovered and exposed right outer upper arm approximately two to three (2-3) inches above his right elbow, with no Geri sleeves observed to both arms on the resident. Staff P acknowledged, yes; Is there a physician's order for application of bilateral Geri sleeves every day shift for this resident and the nurse acknowledged, yes; What date was it obtained, and he responded 05/09/23; What are the Geri sleeves ordered for, and the nurse stated to protect the arms from friction, etc. Staff P acknowledged that there was a Geri sleeves order for bilateral arms written for the resident dated 05/09/23. He confirmed that the Geri sleeves were not on the resident as ordered. On 07/19/23 at 2:02 PM, an interview was conducted with the ADON in which she was also asked the above questions. The ADON responded as Staff P to the questions. The ADON also acknowledged that there was a Geri sleeves order for the resident's bilateral arms that was written 05/09/23. She indicated that the resident's Geri sleeves should have been applied as ordered in order to avoid further impairment of skin integrity. On 07/19/23 at 3:29 PM, an interview was conducted with the DON in which she was asked the same above questions. The DON responded as did Staff P and the ADON. When asked what the Geri sleeves were ordered for, the DON stated, for an added layer of protection. The DON further acknowledged that there was a Geri sleeves order for bilateral arms written for Resident #42 dated 05/09/23. She further stated there was no documentation in the record to reflect that the resident's Geri sleeves were applied to his skin as ordered to avoid further impairment of skin integrity. A side-by-side record review was conducted with Staff P and with the ADON in which it was documented there was a physician's order for bilateral Geri sleeves and documented on the Treatment Administration Record (TAR) for Resident #42 dated 05/09/23. The Geri sleeves were not observed applied to the resident during three (3) days of the four (4) day survey. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 13 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Resident #42's Geri sleeves were not applied, until after surveyor intervention. Level of Harm - Minimal harm or potential for actual harm 3. On 07/17/23 at 10 AM, an observation revealed Resident #205 had a clear Opsite right upper abdominal quadrant dressing in place, which was moistened and discolored in appearance, not clean, not properly covering site and not dated. The dressing was not maintained and not patent with the right lower corner crumpled edges curled, loosened and lifting up and not flattened out to create a solid, secure barrier for the previous Jackson Pratt (JP) drainage site. Residents Affected - Few Photographic Evidence Obtained. On 07/17/23 at 4:18 PM, during a second observation, Resident #205 was observed with the Opsite clear dressing, still not patent with right lower corner crumpled edges curled, loosened and lifting up and not flattened out. On 07/17/23 at 4:25 PM, during an interview, Resident #205 stated he had an appointment scheduled with the general surgeon for tomorrow to see his right upper quadrant dressing site. He added that his friend was unavailable to accompany him to this appointment which had to be changed to a later date this month when his friend will be able to take him to his appointment. On 07/18/23 at 4:26 PM and 07/19/23 at 12:18 PM, during additional observations, Resident #205 was still observed with the Opsite clear dressing still not patent now with the left and right lower corner crumpled edges curled, loosened and lifting up and not flattened out. On 07/19/23 at 1:47 PM, an interview was conducted with Staff P, in which he was asked about the resident's dressing. He stated that he was aware of the current condition of the resident's right quadrant dressing site. He voiced that he didn't do anything about it at the time. During an interview conducted on 07/19/23 at 2:20 PM with the ADON, she was asked if she was aware of current condition of the resident's right quadrant dressing site. She did not comment on the current condition of the dressing site. She stated that she would have to look into this and follow-up. Review of the Baseline care plan of 07/08/23, completed by Staff Q, (RN)/Minimum Data Set (MDS) Coordinator, revealed it only documented Resident #205's current/recent skin integrity issue, as JP [Jackson Pratt] drainage on right side, at the time. Further side-by-side record review with Staff P, and with the ADON, did not reveal there were physician orders obtained for the care, management and follow-up of the resident's right side previous Jackson Pratt (JP) drainage site, now the Opsite right upper quadrant abdominal dressing. Resident #205's right upper abdominal quadrant dressing site was not changed, treated and properly dated, until after surveyor intervention. During an interview conducted on 07/19/23 at 3:10 PM with the DON she was asked if she was aware of current condition of the resident's right quadrant dressing site. Her only comment regarding this was that the name and phone number of a Wound Care Specialist was listed on the resident's profile sheet. There was no other documentation recorded in the resident's file to indicate that this Wound Care Specialist had been contacted or notified on behalf of the resident's skin dressing condition. The DON stated she would have to look into this and follow-up. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 14 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 4. Resident #205 was originally admitted to the facility on [DATE] and re-admitted to the facility on [DATE] with diagnoses that included Paroxysmal Atrial Fibrillation, Hypertension, Malignant Neoplasm Bladder, Malignant Neoplasm of Colon and Malignant Neoplasm of Prostate. He had a Brief Interview Mental Status (BIM) score of 10 of 15, indicating moderately cognitive impairment. An observation was conducted on 07/17/23 at 9:55 AM. Resident #205 was observed having a reddened raised dime-sized, misshaped, crusty area to the center of his chest. The area did not appear to be infected. Photographic Evidence Obtained. On 07/17/23 at 10 AM, an interview was conducted with Resident #205. The resident stated he had mentioned to the facility staff about the skin condition on his chest that had been there for some time. He stated that since being in the facility, nothing has been done about it and he is concerned that no doctor has been in to look at it yet. During a second observation conducted on 07/17/23 at 4:18 PM, Resident #205 was still observed with the reddened, crusty dime-sized area to his center chest, as well as the right upper abdominal quadrant dressing site that was still undated, moistened, discolored in appearance, not clean and observed to not have been changed. During additional observations conducted on 07/18/23 at 4:25 PM and 07/19/23 at 12:15 PM, Resident #205 was still observed with the reddened, crusty dime-sized area to his center chest, as well as the right upper abdominal quadrant dressing site still with an undated dressing which was moistened, discolored in appearance, not clean and observed to not been changed. At these times, the resident stated that the area to his chest was now oozing clear liquid, which is getting on his shirts, and was itching, tender and uncomfortable. The wound did not appear to be infected at this On 07/19/23 at 1:47 PM an interview was conducted with Staff P, when asked if he was aware of the reddened, crusty dime-sized area to the resident's center chest, replied, 'no'. During an interview conducted on 07/19/23 at 2:13 PM with the ADON, when asked if she was aware of the reddened, crusty dime-sized area to the resident's center chest, she replied, 'no'. On 07/08/23, review of the Baseline care plan, completed by Staff Q, RN/MDS Coordinator, documented the presence and existence of Resident #205's current skin integrity issues as, 'open area on middle chest'. A side-by-side record review with Staff P and the ADON revealed no evidence that there were physician orders obtained for the care, management and follow-up for Resident #205's anterior chest skin condition. Resident #205's reddened, crusty dime-sized area to his center chest skin area was not treated and dressed until after surveyor intervention. During an interview conducted on 07/19/23 at 3:10 PM with the DON, when asked if she was aware of the reddened, crusty dime-sized area to Resident #205's center chest, stated that the name and phone number of a Wound Care Specialist was listed on the resident's profile sheet. There was no other documentation recorded in the resident's record to indicate that the Wound care Specialist had been (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 15 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm contacted or notified on behalf of the resident's skin wound or dressing condition. The DON added that she would have to look into this and follow-up. 4. Review of Resident #16's clinical record documented an admission on [DATE] with diagnoses that included Sepsis, Cellulitis, Depression, and Chronic Conjunctivitis of Right Eye. Residents Affected - Few Review of Resident #16's MDS annual assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 0 of 15, indicating the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed from extensive to total assistance from the staff to complete the activities of daily living ALDs). Review of Resident #16's clinical record revealed a lack of a written physician order for a dry dressing for the resident's left elbow. Review of Resident #16's physicians order dated 07/02/21 documented Geri-sleeves to bilateral upper extremities may remove daily and check skin integrity and for daily hygiene care. Review of Resident #16's physicians order dated 10/24/22 documented Geri-sleeves to bilateral upper extremities for protection may remove for skin checks and hygiene. Review of Resident #16's July 2023's MAR (Medication Administration Record) lacked written documentation related to the dry dressing care administration. Review of Resident #16's July 2023's TAR (Treatment Administration Record) lack written documentation of the application of the Geri-sleeves sleeves to the resident's arms from 07/01/23 to 07/18/23 during the day and evening shift. Further review revealed the application of the Geri-sleeves sleeves during the night shift from 07/01/23 to 07/18/23. On 07/17/23 at 10:48 AM, observation revealed Resident #16 in bed, awake and starring at the surveyor, unable to answer questions asked. Further observation revealed the resident had an undated dry dressing on her left elbow and no Geri-sleeves to either arm was noted. On 07/18/23 at 8:59 AM, observation revealed Resident #16 in bed, awake, non-verbal. Further observation revealed the resident continued to have an undated dry dressing on her left elbow and no Geri-sleeves were noted to her arms. Further observation revealed Staff E, CNA, was feeding the resident. Staff E stated the resident did not speak. On 07/18/23 at 10:25 AM, a side-by-side observation of the undated dry dressing on Resident #16's left elbow was conducted with the DON. The DON stated that Staff O, LPN, does rounds with the Wound Care Specialist. The DON stated that Resident #16 did not have a wound. The DON was apprised that the undated dry dressing had been in place since 07/17/23. On 07/20/23 at 12:40 PM, during an interview, the DON stated she did remove Resident #16's dry dressing to her left elbow and noted coagulated blood. The DON added, it was very dry. The DON stated the facility did not have any Geri-sleeves in house until 07/19/23. 5. Review of Resident #21's clinical record documented an admission on [DATE] with a readmission on [DATE]. The resident's diagnoses included Osteomyelitis of Sacral and Sacrococcygeal Area, Dementia, Sepsis, Dysphagia (difficulty swallowing) Epilepsy, Neuropathy and Closed fracture of Right Lower (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 16 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Leg. Level of Harm - Minimal harm or potential for actual harm Review of Resident #21's MDS admission assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 3 of 15, indicating the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed extensive assistance from the staff to complete the activities of daily living. Residents Affected - Few Review of Resident #21's physician's orders dated 07/12/23 documented, apply skin prep to scabs on right upper arm daily for 7 days- stop date 07/19/23. Further review revealed a lack of a physician's order for the resident's left upper arm dressing change. Review of Resident #21's July's TAR revealed the lack of written documentation that the resident's received care to the left upper arm. On 07/17/23 at 11:18 AM, observation revealed Resident #21 in bed with an undated dry dressing on her left upper arm above the elbow. Attempted to interview the resident who stated that she was slow. The resident was unable to state the last time her left upper arm dressing was changed. During the interview, observation revealed Staff A, LPN, came into the resident's room. Staff A was asked about Resident #21's undated left upper arm dry dressing and replied she had not worked for the last two days and did not know why the resident had the dressing on her left upper arm. Subsequently, observation revealed Staff A removed the resident's dressing. Further observation revealed the dressing was covering a scab on the Resident #21's left upper arm approximately two inches above the antecubital (elbow) area. During, an interview, Staff A stated she was going to contact the physician because she did not see an order for dressing changes to the left upper arm. On 07/18/23 at 10:22 AM, a side-by-side review of Resident #21's left upper arm's dressing was conducted with the DON. The review revealed a dry dressing dated 07/17/23. The DON was apprised that on 07/17/23 during initial survey observations, it was noted that Resident #21 had an undated dry dressing on her left upper arm and Staff A placed a new dry dressing on 07/17/23. Subsequently, an interview was conducted with Staff H, LPN, who stated she did Resident #21's skin check (today) 07/18/23 and did not pay attention to the dressing on the resident's left upper arm because she thought it was the laboratory staff who placed it when blood was drawn on yesterday (07/17/23). Staff H was asked when she would remove the dressing from the laboratory and replied she would remove it on 07/19/23. On 07/18/23 at 10:40 AM, observation revealed Staff H (LPN) and Staff O (LPN) gathered two skin prep, one silicone super-absorbent dry dressing and non-stick dry dressing. Staff H proceeded to performed hand hygiene and donned gloves, then removed Resident #21's dressing dated 07/17/23. Staff H stated that the resident had a scab on her left upper arm. Observation revealed Staff O wiped the resident's upper arm scab with the skin prep and stated she will leave the scab open to air. During an interview at this time, Staff O stated she knew Resident #21 was getting skin prep to the left arm. Staff O was apprised that the physician order documented skin prep to the right arm, and there was not a physician order for the resident's left arm scab care. On 07/18/23 11:15 AM, a joint interview was conducted with Staff A (LPN) and Staff O (LPN). Staff A confirmed that she saw Resident #21's undated dressing on 07/17/23 and that she cleaned the resident's left upper arm scab with normal saline and placed a call to the physician. Staff A stated she informed the evening nurse to follow up with the physician and had not heard about a new order. 6. Review of Resident #66's clinical record documented an admission on [DATE] with diagnoses that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 17 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 included Chronic Obstructive Disease, Diabetes Mellitus Type II, Hypertension, and Anxiety. Level of Harm - Minimal harm or potential for actual harm Review of Resident #66's MDS quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 14 of 15, indicating that the resident had no cognition impairment. The assessment documented under Functional Status that the resident needed supervision from the staff to complete most activities of daily living except for toilet use and personal hygiene where the resident needed extensive assistance. Residents Affected - Few Review of Resident #66's clinical record lacked documentation of a physician's order for the resident's left upper arm dressing. On 07/17/23 at 11:04 AM, an interview was conducted with Resident #66, who stated she had been in the facility for two months. Observation revealed an undated dry dressing, that was loose and dirty, on the resident's left upper arm, above the elbow. The resident stated that she had the dressing on for a couple of days and probably needed to be changed. Further observation revealed Resident #66 pulling the dressing and the skin was fixed (stuck) to the gauze. The resident stated she hit her skin against the doorknob and got skin breakdown. On 07/17/23 at 11:25 AM, an interview was conducted with Staff A, LPN, who stated she should know the resident by now. A side-by-side review of Resident #66's physician orders was conducted with Staff A, who stated there was not a physician orders for the resident's dry dressing. Subsequently, a side-by-side review of Resident #66's dry dressing was conducted with Staff A, who stated the dressing looked like it needed to be changed and was dirty. On 07/17/23 at 11:31 AM, observation revealed Staff A, LPN, entered Resident #66's room, performed hand hygiene, donned gloves and removed the resident's undated dry dressing on the left upper arm. Continued observation revealed a healing skin tear and the removed gauze had small amount of slight green and brownish drainage. During dressing removal, Resident #66 was guiding, telling Staff A how to pull the dressing from the top to so she will not hurt her. Further observation revealed a new skin tear above the healing skin tear. Staff O stated a non-stick gauze had been placed and the resident's skin ripped off when she pulled the gauze. Observation revealed Staff A left the resident's room to gather wound care supplies. Observation revealed Resident #66's new skin tear was bleeding and the resident was applying pressure with a napkin. At 11:37 AM, Staff A returned to Resident #66's room, donned gloves, brought in non-adherent gauze, soaked the non-adherent gauze with normal saline solution, placed the gauze over the new open skin tear, then with the same non-adherent gauze, cleaned the skin tear, applied a clean non-adherent gauze to the open skin and covered the non-adherent gauze with a dry dressing (kling roll). Staff O stated she would call the doctor. Continued observation revealed Staff A removed her pair of gloves, reached into her uniform pocket with both hands and retrieved a pair of scissors and without disinfecting the scissors, proceeded to cut the dry dressing (kling roll). Continued observation revealed Staff A placed the pair of scissors and her ink pen on top of the resident's linens, and then placed them in her pocket after use. On 07/18/23 at 11:18 AM, during an interview, Staff A was apprised of the concerns regarding her dressing change for Resident #66 on 07/17/23. Staff A confirmed that she left the resident with an open wound that she should have had the dressing supplies with her before she removed the old dressing. Staff A stated her scissors were clean and was apprised that she should disinfect them before and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 18 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 after use. Level of Harm - Minimal harm or potential for actual harm On 07/18/23 at 11:45 AM, during an interview, the DON was apprised of Resident #66 having an undated dressing noted on 07/17/23. The DON was apprised that Staff A ripped off the resident skin above the healing skin tear while removing the dry dressing. The DON was apprised of skin tear observation concerns related to Resident #66's dressing change performed by Staff A. Residents Affected - Few 7. 3) Review of Resident #66's clinical record documented an admission on [DATE] with diagnoses that included Chronic Obstructive Disease, Diabetes Mellitus Type II, Hypertension, and Anxiety. Review of Resident #66's Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 14 of 15 indicating the resident had no cognition impairment. Review of Resident #66's physician orders dated 04/10/23 documented, Accucheck before meals and at bedtime. Review of Resident #66's physician orders dated 05/08/23 documented, Humalog 100 unit per millimeter KwikPen: administered subq (subcutaneously) per sliding scale . Humalog / Lispro is[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 19 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of policy and procedure, observation, interview and record review, the facility failed to obtain physicians' orders for oxygen therapy administration for 1 of 1 sampled resident observed for Oxygen use, Resident #42. Residents Affected - Few The findings included: Review of the facility policy and procedure on 07/20/23 at 1:30 PM, titled, Oxygen Administration provided by the Director of Nursing (DON), documented in part, in the Policy Statement: Purpose: The purpose of this procedure is to provide guidelines for safe oxygen administration. Preparation: 1. Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration .Documentation: After completing the oxygen setup or adjustment, the following information should be recorded in the resident's medical record: 1. The date and time that the procedure was performed. 2. The name and title of the individual who performed the procedure. 3. The rate of oxygen flow, route, and rationale. 4. The frequency and duration of the treatment. 5. The reason for as needed (P.R.N.) administration. 6. All assessment data obtained before, during, and after the procedure. 7. How the resident tolerated the procedure 9. The signature and title of the person recording the data . Review of the facility policy and procedure on 07/20/23 at 3:47 PM, titled, Medication and Treatment Orders provided by the DON, published 03/13/23, documented, in part, in the Policy Statement: Orders for medications and treatments will be consistent with principles of safe and effective order writing. Policy Interpretation and Implementation .2. Only authorized, licensed practitioners, or individuals authorized to take verbal orders from practitioners, shall be allowed to write orders in the medical record .7. Verbal orders must be recorded immediately in the resident's chart by the person receiving the order and must include the prescriber's last name, credentials, the date and the time of the order. Review of facility undated Registered Nurse (RN) job description on 07/20/23 at 1:45 PM, provided by the DON, documented, in part, Purpose of your job position: Duties include: Medication administration and treatments Assure quality of care by adhering to the Department of Health (DOH) standards of practice and facility standards of care Review of facility undated Licensed Practical Nurse (LPN) job description on 07/20/23 at 1:56 PM provided by the DON documented, in part, Purpose of your job position: Overview of Role The licensed practical nurse is a staff nurse who provides direct, primary nursing care to residents and delegates and supervises the care provided by certified nursing assistants Major Responsibilities: Administrative 3. Receives and records physician's orders .11. Administers treatments and other direct care. a. Prepares and administers medications as prescribed. b. Observes and evaluates resident's responses to medications. c. Identifies and promptly communicates adverse drug reactions. Resident #42 was admitted to the facility on [DATE] with diagnoses that included Parkinson's Disease, Diabetes Mellitus Type II, Dysphagia and Hemiplegia following other Cerebrovascular Disease affecting right dominant side and non-tractable Epilepsy. The record documented a Brief Interview Mental Status (BIMS) score of 15 of 15, indicating cognition was intact. During an observation conducted on 07/17/23 10:08 AM, Resident #42 observed resting in bed watching (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 20 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm T.V. (television) with the head of the bed elevated and with Oxygen 3 liters infusing for via nasal cannula via oxygen concentrator. During an observation conducted on 07/18/23 10:30 AM, Resident #42 still observed resting in bed with Oxygen 3 liters infusing via nasal cannula via Oxygen concentrator. Residents Affected - Few During an observation conducted on 07/18/23 at 2:50 PM, Resident #42 still observed resting in bed with Oxygen 3 liters infusing via nasal cannula via Oxygen concentrator. On 07/18/23 at 2:54 PM, an interview was conducted with Staff P, Licensed Practical Nurse (LPN), regarding Resident #42's order for oxygen. Staff P acknowledged that Resident #42 did have Oxygen infusing at three (3) liters via nasal cannula through an Oxygen concentrator without a physician's order. Staff P confirmed there should have been an physician order in place for Oxygen administration. On 07/18/23 at 3:16 PM during an interview with the Assistant Director of Nursing (ADON), she acknowledged Resident #42 had Oxygen infusing at three (3) liters via nasal cannula through an Oxygen concentrator, and she confirmed there should have been a physician order for such. A side-by-side record review of the facility's electronic computer system and the paper / hard copy chart was conducted with Staff P and the ADON. It was revealed that there was no physician order found in the records for Oxygen at three (3) liters to infuse via nasal cannula through an Oxygen concentrator for Resident #42. The Oxygen use was not documented in the Baseline care plan or the physicians' orders documentation section for Resident #42 dated 05/03/23. The record revealed there was no Oxygen therapy administration order for Resident #42 for the past two (2) months or more, during the resident's stay. A physician's order for the Oxygen therapy administration to be delivered at two (2) liters via nasal cannula Oxygen concentrator, was not obtained, until after surveyor intervention. On 07/18/23 at 3:40 PM, the DON recognized and acknowledged that a physician's order for the Oxygen therapy administration should have been obtained, and this had not been done. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 21 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of Resident #94's clinical record documented an admission on [DATE] with diagnoses that included Hypertension, Diabetes Mellitus type II, Cerebral Infarction and Toxic Encephalopathy. Review of Resident #94's Minimum Data Set (MDS) admission assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 12 of 15, indicating that the resident had moderate cognition impairment. Review of Resident #94's physicians' order dated 05/14/23 documented, Lacosamide 100 mg, give two tablets twice a day. a. Review of Resident #94's Medication Monitoring / Control Record for Lacosamide 100 mg (2 tablets), a controlled substance medication, documented that one tablet was removed from the controlled substance box on 05/20/23 at 7:30 PM, 05/21/23 at 9:00 PM, 05/28/23 at 8:00 AM. Review of Resident #94's May 2023's MAR documented Lacosamide 100 mg (2 tablets) was scheduled for 8:00 AM and 8:00 PM. The review revealed that Lacosamide 100 mg (2 tablets) was not documented on the resident's MAR, as being administered on 05/20/23 at 7:30 PM, 05/21/23 at 9:00 PM, 05/28/23 at 8:00 AM. b. Review of Resident #94's Medication Monitoring / Control Record for Lacosamide 100 mg (2 tablets) medication, documented that one tablet was removed from the controlled substance box on 06/05/23 at 8:00 PM, 06/08/23 at 8:00 PM, 06/10/23 at 8:00 PM, 06/12/23 at 8:00 PM, 06/14/23 at 8:00 AM, and 06/20/23 at 7:40 PM. Review of Resident #94's June 2023's MAR revealed that Lacosamide 100 mg (2 tablets) was not documented on the resident's MAR as being administered on 06/05/23 at 8:00 PM, 06/08/23 at 8:00 PM, 06/10/23 at 8:00 PM, 06/12/23 at 8:00 PM, 06/14/23 at 8:00 AM, and 06/20/23 at 7:40 PM. c. Review of Resident #94's Medication Monitoring / Control Record for Lacosamide 100 mg (2 tablets), a controlled substance medication lacked documentation of the controlled substance being removed from the box on 06/02/23 at 8:00 PM, 06/04/23 at 8:00 AM, 06/04/23 at 8:00 PM, and 06/05/23 at 8:00 PM. Review of Resident #94's June 2023's MAR documented Lacosamide 100 mg (2 tablets) was scheduled for 8:00 AM and 8:00 PM. The review revealed that Lacosamide 100 mg was documented on the resident MAR as being administered on 06/02/23 at 8:00 PM, 06/04/23 at 8:00 AM, 06/04/23 at 8:00 PM, and 06/05/23 at 8:00 PM. d. Review of Resident #94's Medication Monitoring / Control Record for Lacosamide 100 mg (2 tablets), a controlled substance medication, documented that one tablet was removed from the controlled substance box on 07/14/23 at 9:30 PM, and 07/15/23 at 5:30 PM. Review of Resident #94's July 2023's MAR documented Lacosamide 100 mg (2 tablets) scheduled for 8:00 AM and 8:00 PM. The resident's MAR documented that Lacosamide has been administered on 07/14/23 at 8:00 PM, the time did not match the time documented on the Medication Control Record (9:30 PM), and on 07/15/23 was not documented on the MAR as administered. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 22 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 07/19/23 at 10:10 AM, a side-by-side review of Resident #94's Medication Monitoring / Control Record for Lacosamide 100 mg (2 tablets), dated 07/14/23 to 07/18/23, was conducted with Staff O, LPN, and the Consultant Pharmacist (CP). Staff O was asked to submit Resident #94's Medication Monitoring / Control Record for Lacosamide 100 mg (2 tablets) dates from 07/05/23 to 07/14/23. During the review, Staff O and the CP were apprised that Resident #94 did not received his Lacosamide 100 mg two tablets as ordered on 07/14/23, 07/15/23, 07/16/23. On 07/19/23 at 11:35 AM, during an interview, Staff O, LPN, stated the nurses were to document in both places, on the Monitoring / Control Record and on the resident's MAR. Staff O confirmed that Resident #94's MARs and control record were not reconciled or matching. Staff O was asked to submit was Resident #94's the Medication Monitoring / Control Record for Lacosamide 100 mg (2 tablets) for the month of May and June 2023 and the MARs. The review revealed the lack of Lacosamide 100 mg (2 tablets), a controlled substance medication reconciliation, for Resident's 94's Medication Monitoring / Control Record and the resident's May, June, July 2023's MAR as required. On 07/20/23 at 11:26 AM, an interview was conducted with the Consultant Pharmacist who stated she was looking for the Medication Monitoring / Control Record for Lacosamide 100 mg (2 tablets) dates from 07/05/23 to 07/14/23. The CP was apprised of the lack of Resident #94's incorrect controlled substance reconciliation. The CP was apprised that Resident #94 did not received his Lacosamide 100 mg two tablets as ordered on 05/16/23, 05/17/23, 05/18/23, 05/19/23, 05/20/23, 05/21/23, 06/07/23, 07/14/23, 07/15/23, 07/16/23 as per review of the Resident's Medication Monitoring / Control Record. On 07/20/23 at 12:45 PM, during an interview, the DON was asked again to submit Resident #94's Medication Monitoring / Control Record for Lacosamide 100 mg (2 tablets) dates from 07/05/23 to 07/14/23. The DON stated they were looking for it. The DON stated she was aware of the lack of controlled substance reconciliation for Resident #94. On 07/20/23, at the end of the survey at approximately 6:00 PM, Staff O, the DON, or the Consultant Pharmacist had not submitted the Medication Monitoring/Control Record for Lacosamide 100 mg (2 tablets) dates from 07/05/23 to 07/14/23 as requested on 07/19/23. Based on interview, record review and observation, the facility failed to accurately reconcile controlled medications for 3 of 6 sampled residents reviewed for controlled medication administration, Residents #94, #71, and #11. The findings included: 1. On 07/20/23 at 11:57 AM, a side-by-side random review of controlled substance administration was conducted with Staff K, Registered Nurse (RN). The review was done for the medication cart for 3W (3rd floor west) and Resident #11. The medication reviewed was for Tramadol 50 mg tablets, give 1 tablet by mouth twice daily for non-acute pain. A printed copy of the Medication Administration Record (MAR) for July 2023 was provided for Resident #11. The medication was scheduled for 8:00 AM and 8:00 PM. On the Medication Monitoring / Control Record, there were entries from 07/01/23 to 07/19/23 for both the morning and nighttime doses. For 07/20/23, there was an entry for the morning dose. The MAR from 07/01/23 to 07/04/23 and again on 07/19/23, had no entries documented for the 8:00 PM dose times. There were no dosages recorded for 07/06/23, 07/08/23, and from 07/12/23 to 07/15/23. The morning dose was not recorded for 07/07/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 23 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Photographic Evidence Obtained. Level of Harm - Minimal harm or potential for actual harm 2. On 07/20/23 at 1:07 PM, a side-by-side review of controlled substance administration was conducted with Staff I, Licensed Practical Nurse (LPN). The review was done for the medication cart for 3E (3rd floor east) and Resident #71. The medication reviewed was Ativan (Lorazepam) 0.5mg tablets, give 1 tablet by mouth twice daily. Ativan (Lorazepam) is an antianxiety medication. The order for the medication changed on 07/03/23 from a dose of 0.25 mg (1/2 tablet) to a dose of 0.5 mg (1 tablet). A printed copy of the Medication Administration Record (MAR) for July 2023 was provided for Resident #71. The medication was scheduled for 8:00 AM and 8:00 PM. The medication was documented on the Medication Monitoring / Control Record for 07/06/23, where a new log was created for the new medication dose. The MAR for 07/04/23 revealed no 8:00 AM entry for the current dose. On 07/07/23, a dose was document on the MAR for the discontinued dose and the new dose. On 07/06/23, the 8:00 AM does was not captured on the MAR. On 07/14/23, the 8:00 PM does was not captured on the MAR. Residents Affected - Few Photographic Evidence Obtained. On 07/20/23 at approximately 2:00 PM, an interview was conducted with the Director of Nursing (DON) to discuss the above 2 findings. The Administrator was present. When the discrepancies were presented, the DON explained that the old electronic health record system sometimes had problems of blocking data entry from the nurses. The DON was asked if there were any other ways the nurses documented medication administration. The DON stated that she was not sure. The DON was informed that medication reconciliation of controlled medications is required to ensure these medications are being provided to the residents and not diverted away from the residents. The DON stated she understood the information provided but was unable to supply evidence of the controlled medications being pulled, administered, and documented as ordered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 24 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure residents' medications were properly supervised and stored, for 2of 6 sampled residents (Resident #21 and #66), as evidenced by medications being left unattended on the residents' bedside table and on top of the 300 west wing medication cart during a Medication Administration Observation. The findings included: Review of the facility's policy, titled, Storage of Medications, published on 03/13/23, documented, the facility stores all drugs .in a safe, secure .manner . 1. Review of Resident #21's clinical record documented an admission on [DATE] with a readmission on [DATE]. The resident's diagnoses included Osteomyelitis of Sacral and Sacrococcygeal Area, Dementia, Sepsis, Dysphagia (difficulty swallowing), Epilepsy, Neuropathy and Closed fracture of Right Lower Leg. Review of Resident #21's Minimum Data Set (MDS) admission assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 3 of 15, indicating the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed extensive assistance from the staff to complete the activities of daily living (ADLs). Review of Resident #21's physician orders dated 07/06/23 documented, Pantoprazole 40 milligrams (mg) take 1 packet via PEG (tube feeding) 2 times daily before meals, Ascorbic Acid 500 mg give 1 tablet by mouth twice a day, and Creon DR 12,000 unit capsule give 1 tablet by mouth 3 times a day with meals. [CREON (pancrelipase) is a prescription medicine used to treat people who cannot digest food normally because their pancreas does not make enough enzymes.] Review of Resident #21's July 2023 Medication Administration Record (MAR) documented Pantoprazole Sodium 40 mg 1 packet via PEG 2 times daily before meals scheduled times 8:00 AM, 5:00 PM; Ascorbic Acid 500 mg give 1 tablet by mouth twice a day scheduled times 8:00 AM and 5:00 PM; Creon DR 12,000 unit capsule give 1 tablet by mouth 3 times a day with meals scheduled times 7:30 AM, 11:30 AM and 4:30 PM. On 07/18/23 at 4:31 PM, medication administration observation for Resident #21 performed by Staff J, Licensed Practical Nurse (LPN), was conducted. Staff J stated the resident gets all medications via PEG tube. Observation revealed Staff J poured Ascorbic Acid 500 mg into a pouch and then crushed the medication and poured it back into the medication cup, retrieved a packet of Pantoprazole Delayed Release oral suspension 40 mg. Staff J attempted to open the packet with her hand and was not able to. Staff j then walked away from the medication cart to the treatment cart approximately six feet away from the medication cart. Observation revealed Staff J left the crushed medication on top of the cart unattended. Staff J returned to the medication cart and stated that she was looking for scissors to open the Pantoprazole packet. Staff J was observed securing the medication cart and left the area to go to the nurses station. Continued observation revealed the crushed medication continued to be on top of the medication cart and unattended. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 25 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few At 4:39 PM, continued observation revealed Staff J returned to the medication cart and opened the Pantoprazole packet and poured the beads into a medication cup. Staff J opened the medication cart and poured Creon one capsule 12,000 unit into a medication cup. Staff J proceeded to enter Resident #21's room with the 3 medication cups on a faom tray, placed on the top of the bedside table, wheeled the table to the bathroom and performed hand hygiene. Observation revealed Staff J donned gloves, flushed Resident #21's tube feeding with 30 millimeters (ml) of water, administered the Ascorbic Acid medication via PEG tube, flushed the tube and administered the Pantoprazole beads, flushed the tube then attempted to open the Creon capsule and the capsule dissolved in her gloved hand. Staff J proceeded to remove her soiled gloves, walked to the medication cart and pulled another Creon capsule and poured it into a medication cup. Staff J walked away from the medication cart to the resident's room. Observation revealed Staff J performing hand hygiene in the resident's room. An inquiry was made regarding where the Creon capsule was. Staff J stated she took it out, then walked out of the resident's bathroom to the medication cart. Staff J stated she left the Creon medication on top of the medication cart. The medication was unattended on top of the medication cart. The medication cart was parked in the hallway and residents, staff and visitor walked by the cart. During an interview, Staff J stated that she was not supposed to leave the medication unattended. 2. Review of Resident #66's clinical record documented an admission on [DATE] with diagnoses that included Chronic Obstructive Disease, Diabetes Mellitus Type II, Hypertension, and Anxiety. Review of Resident #66's Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 14 of 15, indicating the resident had no cognition impairment. The assessment documented under Functional Status that the resident needed supervision from the staff to complete most activities of daily living except for toilet use and personal hygiene where the resident needed extensive assistance. Review of Resident #66's physician orders dated 04/10/23 documented, Accucheck before meals and at bedtime. Review of Resident #66's physician orders dated 05/08/23 documented Humalog 100 unit per millimeter KwikPen: administered subq (subcutaneously) per sliding scale . On 07/19/23 at 12:18 PM, a medication administration observation started for Resident #66 performed by Staff K, Registered Nurse (RN). Staff K performed hand hygiene, retrieved a foam tray and gathered the following: Lispro-Insulin KwikPen, Pen needle, a pair of gloves and alcohol pads and walked to the resident's room at 12:27 PM. Observation revealed Staff K proceeded to administer the resident's insulin on her left arm and placed the insulin Pen on top of the foam tray on the bedside table. Further observation revealed Staff K walked away from Resident #6's bedside, went to the bathroom, leaving the insulin Pen and the used pen needle on top of the table unattended. Staff K retrieved a paper towel, come out of the bathroom, wrapped the insulin pen with the paper towel, placed in on top of table again, and walked away from it, leaving the insulin pen unattended, went to the bathroom, and performed hand hygiene. Further observation revealed Resident's #66's roommate had a visitor in the room. Staff K returned to medication cart. A joint interview was conducted with Staff K, RN and Staff D, Certified Nursing Assistant (CNA), who voiced the resident usually eats her breakfast at 11:00 AM and lunch at 2:00 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 26 of 27 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 105205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Savoy at Fort Lauderdale Rehabilitation and Nursin 2121 E Commercial Blvd Fort Lauderdale, FL 33308 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 PM. Level of Harm - Minimal harm or potential for actual harm On 07/19/23 at 12:42 PM, an interview was conducted with Staff K, RN who confirmed that she left the insulin pen on top of the table, away from her sight, while she went to wash her hands. Staff K stated she was supposed to keep the insulin pen with her. Residents Affected - Few On 07/20/23 at 11:26 AM, during an interview, the facility's Consultant Pharmacist was apprised of the findings. On 07/20/23 at 12:45 PM, during an interview, the Director of Nursing was apprised of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105205 If continuation sheet Page 27 of 27