Health inspection·March 7, 2024

F 0550 Staff C, Registered Nurse was in the room attending the resident's roommate. Level of Harm - Minimal harm or potential for actual harm On 03/06/24 at 2:23 PM, observation revealed the Assistant Director of Nursing (ADON) entered Resident #21's room and confirmed a strong foul smell in the room. Observations revealed Resident #21 continue rubbing her hands vigorously and had brown matter on her hands. Subsequently, the ADON was informed of the resident having brown matter on her hands. The ADON acknowledged and called in Staff A, Certified Nursing Assistant assigned to the resident. Residents Affected - Few On 03/06/24 at 2:41 PM, observation revealed Staff A, Certified Nursing Assistant (CNA) entered resident #21's room, searched the resident closet and pulled blue pads and was observed cleaning the resident's hands with a blue pad. At 2:49 PM, Staff A left the room and left the resident in the room sitting in a wheelchair. On 03/06/24 at 3:06 PM, Further observation revealed the strong foul smell was stronger in the room and near Resident #21. The resident continued rubbing her hands vigorously. At 3:09 PM, observation revealed the resident wheeling herself in the room up and down with her unbutton pants. Furthermore, observation revealed a blue color pad under the pants. Consequently, the ADON was asked to have Resident #21's brief checked due to the strong offensive odor, stool like smell. On 03/06/24 at 3:13 PM, observed the ADON was not able to reposition Resident #21's bed down. On 03/06/24 at 3:23 PM, observation revealed Staff I, CNA came in to change the resident and stated the bed needed to be fixed and left the room. Continuing observation revealed Resident #21 moving around the room in wheelchair, shuffling her feet, appeared to be uncomfortable. On 03/06/24 at 3:26 PM, observations revealed Resident #21 wheeling herself out of her room into the hallway and with unbutton pants. The resident wheeled herself about 15 feet away from her room. Subsequently, observation revealed the ADON looking for Resident #21's assigned CNA, Staff I. On 03/06/24 at 3:31 PM, observations revealed Staff I, CNA and Staff J, CNA entered Resident #21's room . Staff I and Staff J placed the resident in bed without using a mechanical lift as per care plan. The resident's wheelchair had brown matter on the wheelchair arm rest. Further observation revealed the resident was attempting to pull her brief off. Staff J told the resident relax, we are to change it. During an interview, Staff J acknowledged the resident was uncomfortable. Staff I pulled the resident's pants down and stated, what a mess. Observation revealed the resident's pants had brown matter on the back of the pants. The resident had a brief and a blue pad tucked in the front area. The brief had a large amount of paste brown stool with a strong offensive odor. Staff I was not aware that the resident needed to be changed. On 03/07/24 at 9:38 AM, an interview was conducted with the ADON who stated that Staff A, CNA should had cleaned and changed Resident # 21's brief before she left the facility. On 03/07/24 at 9:42 AM, a joint interview was conducted with the DON and Staff A, CNA. Staff A was asked why she did not change Resident # 21's brief before she left her in room. Staff A stated she could not put the resident back in bed by herself. Staff A was asked why you did not ask for help and replied, I couldn't find nobody. On 03/07/24 at 1:34 PM, during an interview, the Director of Nursing (DON) was asked to submit the facility's policy related to Incontinence Care and stated the facility did not have one. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 2 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interview, the facility failed to honor residents' choices for 2 of 2 residents with preferences for eating in the dining room, Residents #80, and 88. The findings included: The facility's Mealtimes and Delivery Schedule documented: Main Dining Room Seating Schedule Breakfast: 7:10 AM to 7:20 AM 1). Resident #80 was admitted to the facility on [DATE]. According to the resident's most recent complete assessment, an Annual Minimum Data Set (MDS), dated [DATE], Resident #80 had a Brief Interview for Mental Status (BIMS) score of 15, indicating the resident was cognitively intact. Resident #80's diagnoses at the time of the MDS. During an interview with Resident #80, on 03/04/24 at 8:09 AM, in the Main Dining Room, it was noted that the resident had his breakfast on the table in front of him and that there was no staff in the dining room. During an observation of breakfast being served to the residents in their rooms, on 03/05/24 at 8:03 AM, Resident #80 was noted to be in the Main Dining Room with his breakfast on the table in front of him. During an observation of breakfast being served to the 100 unit, on 03/06/24 at 7:44 AM, Resident #80 was observed in the Main Dining Room and did not have a breakfast as he had the previous two observations. During an interview with Resident #80, on 03/06/24 at 08:09 AM, when asked about not having his breakfast, Resident #80 stated that he takes all meals in the Dining Room. Resident #80 further stated they will only allow residents to eat in the Dining Room during lunch because there is no CNA (Certified Nurse's Assistant) or nurse in the dining room. We have to have breakfast and dinner in our rooms because there is no staff to watch us in case we choke. I don't understand why it would matter that I eat in the Dining Room or my room because there is no one in my room if I choke. On 03/06/24 at 8:16 AM, Resident #80 returned to the unit and confronted the Social Services Director about eating in the dining room. Resident #80 was upset about not being able to have his breakfast in the Dining Room. During an interview, on 03/06/24 at 8:25 AM, with Staff K, UM/LPN, when asked about Resident #80 eating breakfast in the Dining Room, Staff K replied, There is no supervision in the Dining Room, and we don't leave the resident unsupervised in the dining room. I wasn't aware that he was there for breakfast. On 03/06/24 at 8:35 AM, Resident #80 was observed in the dining room after confronting the Social (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 3 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Services Director. Resident #80 stated that he had refused breakfast and ordered a meal to be delivered from Door Dash (a food delivery company) that was on the table in front of him. It was noted that there were no staff members in the Dining Room at the time of the interview and observation. During an interview, on 03/06/24 at 10:04 AM, with the Social Services Director, when asked about Resident #80 not being served breakfast in the Dining Room, the Social Services Director replied, I went to the nurse, because I didn't know why either. During the observations and interviews with Resident #80, it was noted that Resident #80 was eating the meals independently. 2). Resident #88 was admitted to the facility on [DATE]. According to the resident's most recent complete assessment, a Quarterly MDS, dated [DATE], Resident #88 had a BIMS score of 15. Resident #88's diagnoses at the time of the assessment included: Hypertension, Diabetes, Anxiety Disorder, Muscle Wasting and Atrophy, Lack of Coordination, Morbid Obesity, Polyneuropathy, Insomnia. During an observation of the lunch meal, on 03/06/24 at approximately 1:00 PM in the main dining room, Resident #88 was sitting at a table with Resident #80. When asked about having breakfast in the Dining Room, the resident stated that she would have breakfast in the Dining Room but did not due to concerns that the breakfast meal would be served later than it already is. During the interview, Resident #88 was noted to be eating the meal independently. During an interview with the Registered Dietitian, on 03/07/24 at 11:52 AM, when asked about residents' preferences for having breakfast in the Main Dining Room, the Registered Dietitian replied, During food committee, I ask, and no one has ever said nothing. They are always telling us that they want to, and I tell them that it is open for Breakfast, Lunch and Dinner, we just need somebody to be there in the dining room. During an interview with the Director of Nursing (DON), on 03/07/24 at 3:00 PM, when asked about residents eating breakfast in the Dining Room, the DON replied, they can, that needs to be in-serviced. I brought it up with the administrator before and then nobody wanted to eat in the Dining Room. The nurses are assigned for lunch and dinner. They said that they wanted to open the Dining Room for lunch and dinner. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 4 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 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 observations, interviews and record reviews, the facility failed to resolve grievances regarding the timing of meal deliveries voiced by residents and members of the Resident Council. Residents Affected - Few The findings included: The meal delivery schedule documented the following schedule for the breakfast and lunch meals: Breakfast Wing 1 Short Hall, Rooms 101 to 112 at 7:20 AM to 7:35 AM Wing 2 Short Hall, Rooms 201 to 212 at 7:35 AM to 7:45 AM Wing 1 Long Hall, Rooms 113 to 126 at 7:45 AM to 7:55 AM Wing 2 Long Hall, Rooms 213 to 226 at 7:55 AM to 8:10 AM Lunch Wing 1 Short Hall, Rooms 101 to 112 at 11:30 AM to 11:40 AM Wing 2 Short Hall, Rooms 201 to 212 at 11:40 AM to 11:50 AM Wing 1 Long Hall, Rooms 113 to 126 at 11:50 AM to 12:00 PM Wing 2 Long Hall, Rooms 213 to 226 at 12:00 PM to 12:10 PM On 03/04/24 at 7:38 AM, during the initial kitchen tour, Staff were in the process of preparing the food to be served for the breakfast meal for that day and no meals had left the kitchen to be served to the residents. Staff did not begin plating the meal until approximately 8:00 AM. On 03/04/24 at approximately 12:30 PM, lunch arrived to the Wing 1 Short Hall - one hour after the scheduled time. On 03/05/24 at 8:03 AM, Breakfast arrived on the Wing 1 Short Hall, Rooms 100-112 - more than 30 minutes after the scheduled time. On 03/05/24 at 8:23 AM, Breakfast arrived on the Wing 1 Short Long Hall, Rooms 113-126 - more than one half hour after the scheduled time. During a meeting with member of the Resident Council, on 03/05/24 at 2:15 PM, when asked about grievances, Resident #58 replied, The grievances are supposed to be written by the Activities Director and then he goes to Social Services and they don't do anything, it is just paperwork. Resident #94 stated, Last week it was 9:30 for Breakfast and 7:30 PM for Dinner. The Food Service Manager meets with us once a month and we have told him that the meals are late. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 5 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 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 03/06/24 at 9:53 AM with the Social Services Director, when asked about grievances from the Resident Council, the Social Services Director replied, It is a different person (referring to the Activities Director). If there is a grievance that comes up, she would write it up as a grievance for the individual resident and for the group, she would do one as a group. When asked about the grievances voiced regarding the meals being served late, the Social Services Director replied, I can't' say that I am familiar with that. 03/06/24 at 11:05 AM, this Surveyor returned to the kitchen for the follow up tour. Upon entering the kitchen, the Food Services Manager(FSM) stated that the kitchen would not be ready to take temperatures and assemble the food on the plates for another 15-20 minutes. On 03/06/24 at 11:23 AM, this Surveyor returned to the kitchen for the follow up tour. Upon entering the kitchen, the kitchen staff were observed taking the temperature of the commercially processed meatballs in a six inch deep full-sized hotel pan that were part of the meal being served for lunch. The temperature of the meatballs was 111 degrees Fahrenheit, and the meatballs were placed back into the convection oven for further heating. At the conclusion of the tour and observations, the Food Service Manager was asked about the grievances voiced by the residents regarding meals being served late, the Food Service Manager replied, Each day, we deliver to a different unit first, we like to mix things up a little. Today, we are going to the unit 2 short hall first and tomorrow we will serve a different unit first. On 03/06/24 at 12:43 PM, the first cart arrived on the Wing 2 Short Hall for the lunch meal - nearly one hour after the scheduled time. During an interview with the Registered Dietitian, on 03/07/24 at 11:52 AM, when asked about the delivery of the meals from the kitchen to the unit the Registered Dietitian replied, I just got here in the end of November, I wasn't aware of the changing of the meal schedule. When asked about the grievances voiced by residents and the Resident Council, the Registered Dietitian replied, I do audits in the kitchen for sanitation, we do audits, I haven't documented them. We are watching the temperatures of the storerooms, look at the cleanliness of the floors, physical environment, emergency food, reach in logs and temperatures, cleanliness, food temperature logs. I observe tray line once a month or so - the compliance with the meal ticket, condiments, supplements, thickened liquids, fluid restrictions, following diet consistencies. Review of the Grievance Log revealed no grievances by or on behalf of the Resident Council related to the meals being served late. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 6 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 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 fingernails grooming for 2 of 2 sampled residents, Residents #11 and #44, observed for nail grooming. Residents Affected - Few The findings included: Review of the facility's Job Description for Certified Nursing Assistants provided by the Director of Nursing documented direct care responsibilities .provides nail and hair care . 1) Review of Resident #11's clinical record documented an admission on [DATE] and no readmissions. The resident diagnoses included Tremors Secondary Parkinsonism, Encephalopathy (a problem in the brain), Lack of Coordination, Muscle Weakness, Glaucoma, and Major Depressive Disorder. Review of Resident #11 Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 15 indicating the resident had no cognition impairment. The assessment documented under Functional Abilities and Goals that the resident needed partial to moderate assistance from the staff to complete most activities of daily living (ADLs). Review of Resident #11's care plan titled ADL: The resident has an ADL self-care performance deficit-Disease Process Parkinson's initiated on 06/29/23 and revised on 02/13/24. The care plan interventions included: anticipate needs, assist with personal hygiene . On 03/04/24 at 8:34 AM, initial tour to the facility's wing 1 was conducted. Observation revealed Resident #11 siting up in a wheelchair in his room and having involuntary fast movements (tremors) to his right hand. An interview was conducted with the resident who stated he had been in the facility for 6 months. Observation revealed the resident had elongated fingernails approximately ½ inch with black matter underneath the nails. The resident stated he had asked many times to get his nails cut and no one had done it. The resident added he had a nail clipper and pointed out to the nail clipper on top of the night stand. On 03/06/24 at 7:59 AM, observation revealed Resident #11 continues to have long fingernails with black matter underneath. Subsequently, a side by side review of the resident's fingernails was conducted with Staff C, Registered Nurse (RN) who stated the resident had not asked her to do his nails. Staff C was apprised of observation since 03/04/24 revealed his fingernails long and with black matter. Staff C stated it will be done today. On 03/06/24 at 8:01 AM, a side-by-side review of Resident #11 fingernails was conducted with Staff B, Certified Nursing Assistant (CNA). Staff B stated she offered the resident fingernails care on 03/05/24 and he refused. On 03/06/24 at 8:08 AM, an interview was conducted with Staff F, CNA who stated the CNAs were responsible to do the resident's fingernails, clean and trim them. On 03/06/24 at 8:49 AM, an interview was conducted with Staff E, CNA who stated that on every Tuesday she goes around the units and check on the residents to see if they need to be shaved, checks the fingernails and cut and clean those that needed to be done. Staff E stated she had informed the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 7 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 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 Residents Affected - Few Director of Nursing (DON) of those residents that refuse fingernails care. Staff E was asked if she did check on resident's fingernails on 03/05/24 and stated she did not because she had to help on the floor. Staff E added that Resident #11 refused fingernails care the prior week. On 03/06/24 at 9:24 AM, an interview was conducted with the DON who was apprised of Resident #11 elongated fingernails with black matter underneath observed since the beginning of the survey on 03/04/24. The DON stated it was the CNA job duties to do the residents fingernail care. The DON added if the resident refuses care, the CNA was supposed to go to the nurse who can reinforce with the resident and nurse then document in the clinical record. The DON stated that a couple of days a week Staff E CNA gets a census list from her and she had asked her to do an audit, to see who needed fingernail care and offer it. The DON added this was a backup plan separate to the CNA plan of care under the task report. The DON was apprised of no refusal of fingernails care was documented in the resident's clinical record. The DON confirmed Staff E did not do resident's fingernails care on 03/05/24. Subsequently, a side-by-side review of Resident #11's nail care CNAs task report from 02/06/24 to 03/05/24 was conducted with the DON. The task report did not document Resident #11 refusal of nail care. Furthermore, review revealed Staff A, CNA documented that she provided nail care on 02/29/24, 03/02/24 and 03/03/24. The DON stated Resident #11's nurses progress notes documented that the resident refused care but not specific to fingernail care. On 03/07/24 at 10:15 AM, an interview was conducted with Staff C, RN who stated she was not aware that Resident #11 refused fingernails nail care. Staff C added she will reinforced the care with the resident if she was informed. 2) Review of Resident #44's clinical record documented an admission on [DATE] and no readmissions. Review of Resident #44's MDS quarterly assessment dated [DATE] documented a BIMS score of 15 indicating that the resident had no cognition impairment. The assessment documented under Functional Abilities and Goals that the resident needed supervision and touching assistance from the staff to complete the activities of daily living. Review of Resident #44's medical diagnoses included Muscle Wasting and Atrophy, Glaucoma, and Cellulitis of Left Lower Limb. Review of Resident #44's care plan titled ADL: The resident has an ADL self-care performance deficit initiated on 04/10/23. The care plan interventions included: assist with personal hygiene . On 03/04/24 at 8:00 AM, observation revealed Resident #44 up sitting by the edge of the bed wearing a pair of dark black sunglasses. An interview was conducted with the resident who stated that the staff needs to be educated about the safety of the blind. Observation revealed Resident #44 fingernails elongated approximately ½ inch and jagged. The resident was asked if he had his fingernails done and replied that was in his priority list for today and added that he asked for his fingernails to be cut many times. The resident pointed out to his left hand index finger, jagged nail. The resident added that at one time he made an outside appointment to have his nails done in a timely matter. The resident stated that he asked and the staff tells him, later 2-3 days later, not done. The resident added that the 3-11:00 PM shift aide told him that they won't do it to wait for day shift. On 03/06/24 at 7:51 AM, observation revealed Resident #44 sitting in a wheelchair. An interview was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 8 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 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 conducted with the resident who stated they cut his fingernails but still having a problem with two of them. Observation revealed two fingernails were jagged. On 03/06/24 at 8:01 AM, an interview was conducted with the Regional Nurse who stated the CNAs were responsible to do the resident's fingernails cleaning and trimming. Residents Affected - Few On 03/06/24 at 8:02 AM, an interview was conducted with Staff A, CNA, assigned CNA, who stated she had not done Resident #44 fingernails and added that sometimes he refuses. Staff A was apprised of the resident fingernails were noted long on Monday (03/04/24) and that he had requested to be cut. Staff A stated that long time ago when she was the activities aide, she did the resident's fingernails and added the CNAs were responsible to do it. On 03/06/24 at 8:39 AM, a side by side review of Resident #44 fingernails was conducted with Staff A, CNA. Subsequently, an interview was conducted with the resident who stated and pointed out to two fingernails that were cut but were not filed and were jagged. During the review, Staff A stated that the resident had not asked her to do his fingernails. Staff A was asked why she did not offer to do his nails and stated she will do it today. On 03/06/24 at 8:49 AM, an interview was conducted with Staff E, CNA who stated that on Tuesday 03/05/24, she did not check on resident's fingernails as done every Tuesday because she had to help on the floor. Staff E was asked if she checked on Resident #44's fingernails on Tuesday 02/27/24 and replied she did not. Staff E stated Resident #44 had not refused fingernails care for her before. On 03/06/24 at 9:20 AM, an interview was conducted with Staff G, RN who stated the residents fingernails were done by the activities lady, but the CNA can do them too, if they see it needs to be done. On 03/06/24 at 9:21 AM, an interview was conducted with Staff H, CNA who stated the activities CNA will do the resident's fingernails or she can do it to. On 03/06/24 at 9:50 AM, an interview was conducted with the DON who was apprised of Resident #44's elongated, jagged fingernails. A side-by-side review of the resident's nail care CNAs task report from 02/06/24 to 03/05/24 was conducted with the DON. The task report did not document Resident #44 refusal of nail care. Furthermore, review revealed Staff A, CNA documented that she provided nail care to Resident #44 on 02/29/24 and 03/03/24. The report documented that Staff B, CNA provided nail care to resident #44 on 02/26/24, 02/27/24 and on 03/02/24. On 03/06/24 at 10:15 AM, during a joint interview with the Regional Nurse and the DON were asked to submit the facility's policy related to Activities of Daily Living (ADLs), fingernail grooming. The Regional Nurse stated they did not have a policy on ADLs or nail care. On 03/06/24 1:38 PM, an interview was conducted with the MDS Coordinator who stated Resident #44 had severe vision impairment, was blind and needed the staff to do his fingernails. The MDS Coordinator stated she was not aware of the resident refusal of nail care and that the resident was not care planned for refusal of it. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 9 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 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 observations, interviews, and record review, the facility failed to follow the Physician's orders for wound treatment and to provide wound care in a timely manner for 1 out of 1 resident reviewed for wound care (Resident #95). Residents Affected - Few The findings included: On 01/15/24, Resident #95 was admitted to the facility with a medical history of Polyneuropathy, Type 2 Diabetes Mellitus, Hypertension, Anxiety Disorder, and Protein-Calorie Malnutrition. On 01/30/24, Resident #95 was hospitalized due to possible infection related to the wound on the right foot. On 02/05/24, she returned from the hospital with the following diagnosis, right great toe amputation, leukocytosis, and osteomyelitis. An admission Minimum Data Set (MDS) dated [DATE] revealed that Resident #95 had a Brief Interview of Mental Status (BIMs) score of 02, which indicated that she had severe cognitive impairment. Review of Section GG revealed that Resident #95 required assistance for most of her Activities of Daily Living (ADLs). Section M revealed that Resident #95 was at risk of developing Pressure ulcers or injuries and had an infection of the foot. Review of the Care Plan dated 01/26/24 documented that Resident #95 had Skin integrity risk. Goals were to have no complications and have minimize causative factors of discoloration areas through the next review. Interventions included follow facility protocols for treatment and monitor and document location, size, and treatment of skin. Review of the physician's orders revealed: Apply to right great toe topically every day shift, every 2 days for wound healing s/p (status post) R (right) great toe amputation cleanse affected area with n/s (normal saline), pat dry, apply Betadine, cover with Adaptic, 4 x 4 gauze, wrap with kerlix, secure with ace wrap AND apply to R great toe topically as needed for wound healing s/p R great toe amputation dated 02/06/24 (which was discontinued and revised on 03/06/24). Further review of the Physician's orders dated 03/06/24, cleanse right great toe with n/s, apply Betadine-soaked gauzed cover with dry dressing, wrap with rolling gauze, every day shift every 2 day(s) for wound care and as needed for wound care. In an observation conducted on 03/04/24 at 09:56 AM, Resident #95 was observed in bed, under the covers with her right foot dangling out of the bed. Upon closer observation of the foot revealed that the right foot was wrapped with a soiled gauze dressing dated 03/02/24 and signed by 7-3 Shift (Photographic evidence obtained). On 03/05/24 at 09:20 AM, an observation of Resident #95's right foot revealed the same soiled gauze dressing observed on 03/04/24 (Photographic evidence obtained). Review of the March 2024 Treatment Administration Record (TAR) for Resident #95 revealed the scheduled treatment for the right great toe amputation was for every two days and as needed (PRN). Further review revealed that treatment was done on 03/01/24, and the 03/03/24 treatment was left blank with no further documentation. In addition, the PRN order revealed that no treatment was done on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 10 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 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 03/02/24. Level of Harm - Minimal harm or potential for actual harm On 03/05/24 at 12:18 PM, an interview was conducted with Staff G, Registered Nurse (RN). She stated that she is usually the day shift nurse and has done the wound care for Resident #95's foot. She stated that Resident #95 tends to rub her feet together and the bandages move. She didn't change it on Monday (03/04/24) because the treatment was not scheduled to be done that day. In addition, she stated that she was not aware that Resident #95's bandage was dirty. Residents Affected - Few On 03/06/24 at 12:40 PM, an interview was conducted with the Director of Nursing (DON). She stated that on Tuesdays she assesses and performs the treatments for all the residents with wounds in the facility. She stated that yesterday she noticed the bandages had not been changed for Resident #95, and that the treatment was about a day late. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 11 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews and record review, the facility failed to provide foods in accordance with professional standards for food safety. Residents Affected - Some The findings included: 1). During the initial kitchen tour, on 03/04/24 at 7:38 AM, accompanied by the Food Service Manager, the following was noted: a. There was an accumulation of ice on the cooling unit in the walk in freezer. b. The wall under and behind the steamer was damaged. c. There was an accumulation of dust and debris inside of the vents of the air conditioning unit. At the conclusion of the initial tour, the Food Service Manager acknowledged understanding of the concerns. 2). During the follow up tour, on 03/06/24 at 11:23 AM, the following was noted: a. Staff L, [NAME] dropped a ladle on the floor. The [NAME] picked up the ladle and went to the three compartment sink and began to wash the utensil in the wash basin. The [NAME] then rinsed the ladle and then swished the ladle in the sanitizer, without completely submerging in the sanitizer and then placed the utensil on the drying rack with other cleaned and sanitized utensils. The cook then removed the ladle to use for food service. This surveyor instructed Staff L to properly wash, rinse and sanitize the ladle before being used. During the observation, the [NAME] did not perform hand hygiene. b. Staff L was observed handling soiled utensils with gloved hands the [NAME] proceeded to dry the gloves on her hands with paper towel and began handling cleaned and sanitized utensils and clean and sanitized pans. The [NAME] was instructed by this surveyor to stop and remove the gloves and perform hand hygiene. c. Staff M, [NAME] was observed as she dropped serving utensils on the floor. The [NAME] picked up the utensils with gloved hands and then placed on the cutting board attached to the hot holding unit. The cook then removed the gloves and placed them in direct contact with the food contact surface of a clean and sanitized set of tongs that were intended to be used to plate the meal. As the [NAME] was beginning to use the set of tongs that had been in contact with the contaminated gloves, this surveyor informed her of the observation and the [NAME] was instructed to replace it with a clean and sanitized utensil. d. The handle of a spatula had been melted in a manner that created an uncleanable surface. At the conclusion of the follow up kitchen tour, the Food Service Manager, Staff L and Staff M acknowledged their understanding of the concerns. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 12 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations and interviews, the facility failed to perform appropriate hand hygiene during room dining observation in wing 2 as evidenced by not performed hand hygiene between residents meal tray delivery; and failed to prevent potential of cross contamination during Trach Care and Tube Feeding pump re-setting as evidenced of reaching to a uniform pocket with a gloved hand. Residents Affected - Few The findings included: Review of the facility's policy titled, Hand Hygiene effective 10/2021 provided by the Regional Nurse documented .employees must wash their hands .under the following conditions: .before and after entering isolation precautions .before and after assisting a resident with meals .after contact with a resident with infectious diarrhea including .Clostridium (infection) Difficile (hand washing with soap and water) . 1) On 03/04/24 at 8:55 AM, dining observation was conducted of the facility's wing 2 residents room dining service. On 03/04/24 at 9:03 AM, Observation revealed Staff B, CNA entered Resident #26's room to deliver his meal tray. Staff B placed the tray on top of the table, repositioned the resident's bed using the bed control, then proceeded to pour sugar on the hot cereal. Staff B came out of Resident #26's room and without performing hand hygiene, Staff B opened the trays cart and retrieved Resident #41's meal tray. Staff B entered the resident's room, placed the tray on the table, and then repositioned the bed using the bed control. Staff B then came out of Resident #41's room without performing hand hygiene and walked to the coffee cart and retrieved a cup of coffee for Resident #41 and delivered it. Staff B continued to open the meal cart without hand hygiene and pulled Resident #11's meal tray and delivered the tray. Staff B then left the area without performing hand hygiene and pushed the coffee cart away from the area. On 03/04/24 at 9:15 AM, observation revealed Staff A, CNA, setting up Resident #70's tray. Staff A stated the resident was blind and ate by himself after he was set up. At 9:16 AM, Staff A opened the meal cart and pulled Resident #66's meal tray. Resident #66 was on Contact Precautions due to Clostridium Difficile infection. Staff A entered the resident's room, did not don a gown or gloves. Staff A placed Resident #66's tray on top of the table, and without wearing gloves, retrieved the bed control and repositioned the bed. Staff A then went to the room sink placed the tip of her fingers without soap under the running water, then dry her hands. Continue observation revealed Staff A, without hand hygiene, opened the meal cart, pulled Resident #60's meal tray, delivered his tray, then peeled his banana, opened the mighty shake container and opened the room blinds. At 9:22 AM, observations revealed Staff A came out of Resident #60's room, roommate of Resident #66, without performing hand hygiene, opened the meal cart, retrieved a carton of milk from a tray, and delivered the milk to Resident #60. Dining observation revealed Staff A on 03/04/24 at 9:23 AM, performed hand hygiene with hand sanitizer, opened the meal cart and retrieved Resident #4's meal tray, delivered the tray and repositioned the resident's bed using the bed control. Staff A came out of the resident's room without performing hand hygiene. Staff A then entered Resident #21's room and removed a gown the resident had over her clothes. Staff A left the room without performing hand hygiene, then opened the meal cart and retrieved Resident #36's meal tray. At 9:30 AM, Staff A entered Resident #36's room, the resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 13 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few requested to be moved up in bed to eat. Staff A left the room to get help and returned to the room. Staff A and the Staffing Coordinator entered the room and without hand hygiene they both donned gloves and move the resident up in the bed. Observation revealed Staff A removed her gloves, walked towards the exit door of Resident #36's room and without soap, placed the tips of her fingers under running water for approximately 3 seconds. Observation revealed no soap canister by the sink. Staff A then placed sugar on the resident's hot cereal, opened the carton of milk by sticking her finger into the carton. At 9:36 AM, Staff A left the resident's room without performing hand hygiene. Observation revealed a hand sanitizer canister outside Resident #36's room. Staff A stated she was going to get a cup of coffee for Resident #36. At 9:42 AM, Staff A returned to Resident #36's room and without performing hand hygiene, proceeded to feed the resident. On 03/04/24 at 9:51 AM, Staff A, CNA left Resident #36's room with the meal tray, placed the tray in the cart and did not performed hand hygiene. On 03/06/24 at 8:20 AM, observation revealed Staff B, CNA leaving room [ROOM NUMBER] after delivering a tray and stated, I need hand sanitizer and walked to the nurses station. Subsequently, an interview was conducted with Staff B who stated she had to do hand sanitizer after delivering a tray. Staff B was asked why she did not do hand hygiene after delivering trays on 03/04/24 and replied, I forgot. On 03/06/24 at 9:01 AM, an interview was conducted with Staff A, CNA who stated she used the hand sanitizer down the hall during meal delivery. Staff A was apprised that on Monday (03/04/24) while she was passing meal trays, she did not do hand sanitation between residents. Staff A stated she did. Staff A was apprised that she rinsed her hand with water only because there is not soap container by the sink in Resident #36's room. Staff A replied her hands were not dirty. On 03/06/24 at 9:33 AM, during an interview the DON was asked to submit the facility's Hand Hygiene policy. The DON and ADON were apprised of the lack of hand hygiene during dining observation on 03/04/24. Consequently, a side-by-side review of Resident 336's room was conducted with the DON. The DON stated the sink in the resident's room was the eye emergency station. The DON confirmed there was no soap by the sink. 2) Review of Resident #72, clinical record documented an admission on [DATE] and no readmissions. The resident diagnoses included Gastrostomy Status, Hepatic Failure, Chronic Respiratory Failure With Hypoxia, Protein-Calorie Malnutrition, Dysphagia, Cognitive Communication Deficit, and Encephalopathy. Review of Resident #72's quarterly Minimum Data Set (MDS) assessment dated [DATE] documented a Brief Interview of the Mental Status the resident was not unable to complete the interview, had severe cognition impairment. Review of Resident #72 physician order dated 10/20/22 documented every shift Enteral Feed: Jevity 1.5 Cal Continuous via tube to infuse at a rate of 65millimeters per hour . Start at 2 PM . On 03/06/24 at 2:14 PM, observation revealed Resident # 72 feeding formula off with 900 ml left in the bottle. The bag was labeled 03/06/24 at 7:28 AM. On 03/06/24 at 2:16 PM, observation revealed Staff C, RN with gloved hands, restarted Resident #72's feeding formula. During an interview, Staff C reached into the uniform pocket with her right (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 14 of 15 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 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Raton Rehabilitation Center 755 Meadows Road Boca Raton, FL 33486 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few gloved hand. Staff C was apprised regarding reaching her pocket with a gloved hand after restarting the machine and stated she was distracted. 3) Review of Resident #160's clinical record documented an admission on [DATE] and no readmissions. The resident diagnoses included Tracheostomy Status, Gastrostomy Status, Aphasia following a Cerebrovascular Disease. Review of Resident #160's physician order dated 03/01/24 documented Tracheostomy care daily and as needed . On 03/06/24 at 2:23 PM, observation of Resident # 160 tracheostomy care performed by Staff C, RN assisted by the Assistant Director of Nursing (ADON) was conducted. Staff C performed hand hygiene, donned gloves, and proceeded to performed the resident's tracheostomy care. Staff C cleaned the tracheostomy surroundings area, changed the cannula and the mask, then with gloved left hand reached into her uniform pocket to get a pen, changed the tracheostomy collar, and reached her uniform pocket again with her right gloved hand and retrieved a marker. On 03/06/24 at 3:06 PM, observation concluded and subsequently a joint interview was conducted with Staff C and the ADON. Staff C was apprised of entering her pocket with a gloved hand twice. Staff C opened her eyes wide and stated she had a clean hand and a dirty hand. Staff C was apprised she entered her unform pocket with both hands. The ADON acknowledged the findings. The ADON stated she was not supposed to entered the pocket with a glove on. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 15 of 15