Inspection·December 3, 2025

F 0584 and the main dining room, she responded that she would ask the Maintenance Director. Nothing had been submitted to the Surveyor. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 2 of 5 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 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 observations, record reviews, and interviews, the facility failed to follow the professional standards of practice for ensuring medications and treatments were administered according to doctor's orders for 2 of 2 sampled residents (Residents #4 and #6). The findings included: During an entrance conference with the Director of Nursing (DON), and Staff A, Licensed Practical Nurse, on 12/02/25 at 9:30 AM, they were asked to provide the medication administration policy.1) Resident #4 was admitted to the facility on [DATE] with diagnoses that included Muscle Wasting and Atrophy, Essential Primary Hypertension, and Unspecified Disorders of the Muscle.A review of recent Minimum Data Set (MDS) assessment dated [DATE] documented a Brief Interview of Mental Status (BIMS) score of 15, indicating Resident #4 had good cognitive function. A review of physician order dated 07/14/24 documented Lyrica, 150 milligrams (mg), give one tablet every 6 hours for nerve pain. A review of the Medication Administration Record (MAR) for November 2025 documented on 11/30/25 that Lyrica was administered at 6:00 PM and at 7:00 PM by 2 different Nurses based on initials in the Controlled Drug Declining Inventory Sheet and according to interviews with Staff A, Licensed Practical Nurse (LPN), and Staff C, Registered Nurse (RN). During an interview conducted with Staff A, LPN, on 12/03/25 at 11:20 AM, she stated that the Nurse administered the medication at 6:00 PM on 11/30/25, and another Nurse administered the above medication at 7:00 PM indicating the physician order was not followed. During an interview conducted with Staff C, RN on 12/03/25 at 1:00 PM, she stated that based on the Medication Administration Record (MAR) for Resident #4, it documented that the medication was administered to him at 6:00 PM on 11/30/25 by a Nurse with different initials from the Nurse who administered the same medication on 11/30/25 at 7:00 PM. She added that the physician order was not followed. 2) Resident # 6 was admitted to the facility on [DATE] with diagnoses that included Respiratory Failure, Malignant Neoplasm of Supra glottis, Dysphagia, Oropharyngeal Phase, and Tracheostomy Status. A review of Medication Administration Record (MAR) sent electronically by the DON on 12/05/25 documented Resident #6 had orders for tracheostomy care daily as follows: Cleanse site with normal saline, pat dry and cover with drain sponge daily and as needed. Additional review of MAR documented that from 12/01/25 until 12/03/25, the order was not followed due to absence of check marks and nurse's initials parallel to the order. In an interview conducted with Staff C, RN on 12/03/25 at 1:08 PM, when she was asked if they stored solutions, and biologicals at resident's bedside, she responded, no. When she was asked if a tracheostomy care physician order must be followed by staff she responded yes. When she was asked how would staff know that a tracheostomy care order was followed and done by staff, she responded that parallel to the order are Nurse's initials and check marks. Event ID: Facility ID: 105219 If continuation sheet Page 3 of 5 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 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 0940 Develop, implement, and/or maintain an effective training program for all new and existing staff members. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, and interviews, the facility failed to follow State Law and the professional standards of practice for Intravenous (IV) therapy, for 1 of 4 sampled residents (Resident #1). The findings included: In the State of Florida, for an LPN to administer IV Therapy, they must meet the requirements of the Florida Board of Nursing (FBON) and Rule 64B9-12 Florida Administration Code (Administration of Intravenous Therapy by Licensed Practical Nurses). The required course to become IV Certified is no less than 30-hours, and administered by a FBON approved provider. Resident #1 was admitted to the facility on [DATE] with diagnoses that included Infection and Inflammatory Reaction due to Internal Right Knee Prosthesis, subsequent encounter; Muscle Wasting and Atrophy; Methicillin Resistant Staphylococcus Aureus (MRSA) Infection of the Unspecified Site; and Encounter for Other Orthopedic Care. A review of Minimum Data Set (MDS) assessment dated [DATE], under Section C of the Brief Interview of Mental Status (BIMS) revealed a score of 15 indicating Resident #1 had no cognitive impairment. A review of orders dated 07/19/25 revealed Daptomycin intravenous solution, use 650 milligram (mg) IV for infection, one time a day for wound until 08/27/25. During an entrance conference on 12/02/25 at 9:30 AM with the Director of Nursing (DON) and Staff A, Licensed Practical Nurse (LPN), they were asked to provide certification, education and training for IV therapy of all LPNs working in the facility. They were also asked for the sign-in sheet of all staff who attended training and in services for infection control, and the medication administration policy. The DON responded, we will provide them. A review of Resident #1's August 2025 Medication Administration Record (MAR) revealed that Daptomycin 650 mg IV was administered by Licensed Practical Nurses (LPNs) based on the initials documented in Medication Administration Record (MAR). The LPNs' initials were confirmed by DON and Staff A, LPN on 12/2/25 at 1:00 PM. When the DON was asked if this surveyor can interview any of the LPN staff on the list, she responded they are not working today. When she was asked if this surveyor may interview them over the telephone, she responded, sure, we will find their numbers and will give them to you. No telephone numbers were provided for this surveyor. During an interview conducted on 12/02/25 at 11:30 AM with Staff B, Registered Nurse (RN), when she was asked if the LPNs in the facility administer IV medications for residents, she responded, yes. When she was asked if she accompanied the LPNS during IV administration, she responded, they go by themselves because they give IV therapy to their assigned residents, and I have my own assigned residents. On 12/02/25 at 12:50 PM the DON was asked again for the certification, education and training of all LPNs, and the sign in sheet of training and in-services for all staff, she responded that she is still gathering the paperwork. She was reminded to provide the other requested paperwork during the entrance conference. She was informed that the electronic access to this surveyor had stopped. An interview was conducted on 12/02/25 at 1:30 PM with DON and Staff A, LPN, who confirmed that the initials on the MAR for Resident #1 belong to some LPNs. They were both asked for the education, training and certification of all LPNs on the list and they told this surveyor that they will bring them later. On 12/02/25 at 3:00 PM, two RNs were asked if one of them can direct this surveyor to a resident with an IV therapy, they both responded, the resident was asleep, but the next shift Nurse might accompany the surveyor. When this surveyor approached the next shift nurse, Staff A, LPN, stated that the LPN was preparing for the change of shift, but she will call the surveyor when she is done. Staff A, LPN was asked by this Surveyor to print the MAR of the resident who is receiving IV therapy and she responded, sure. She was reminded that this surveyor has no access to residents' record. She was again asked for electronic access. On 12/02/25 at 5:00 PM, the DON was asked again for the education, training and certification of Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105219 If continuation sheet Page 4 of 5 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105219 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 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 0940 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete all the LPNs in the facility, she responded, I am still gathering the documents. She was reminded about the infection control training sign in sheet for all staff, and electronic access for residents' record. On 12/02/25 at 5:30 PM, when the DON was asked for the certification, education and training for IV therapy of all LPNs in the facility, she responded that only Registered Nurses give IV therapy, so there are no certifications required for all the LPNs. She was asked to provide the medication policy of the facility and the sign-in sheet for all the recent infection control training provided for all staff, she responded, yes, we will provide them. She was also asked for electronic access to residents' record. On 12/02/25 at 5:45 PM, Staff A, LPN, was asked for the IV therapy observation with an LPN, she responded, the resident does not get the IV therapy until 8 PM, and the staff are helping residents for dinner. She was asked to provide this surveyor with the MAR of the resident with IV therapy. She was also asked additional information like the name of the resident, and the order for IV therapy. This surveyor waited until 6:20 PM, but no paperwork was provided. There was no electronic access provided to this surveyor after 12:50 PM on 12/02/25. This surveyor kept asking Staff A, LPN, for access to residents' EHR (Electronic Health Record), she stated, yes, but no access was provided since 12:50 PM on 12/02/25. On 12/03/25 at 10:00 AM, the DON was asked again for the education, training and certification for IV therapy of all LPNs, she responded, we told you yesterday that LPNs do not administer IV therapy, so they do not have education training and certification. During an interview conducted with Staff A, LPN on 12/03/25 at 11:15 AM, when she was asked how she would know a medication was administered to a resident, she responded that the nurse's initials are documented parallel to the name of the medication, the date and the time the medication was administered. When she was asked again for facility's medication policy, she responded, the DON will give it to you. When she was asked if nurses are allowed to document their initials on MAR for the medications they did not administer to a resident, she responded, no. During an interview conducted with Staff C, RN on 12/03/25 at 12:30 PM, when she was asked how she would know a medication was administered to a resident, she responded, the initials of the one who administered the medication are documented on the MAR parallel to the name of the medication, date and time it was administered. On 12/03/25 at 3:00 PM, the DON was asked for the certification of all LPNs and she responded, LPNs do not administer IV medications here, so they do not have IV certifications. They were informed that there are Medication Administration Records which demonstrated the IV medication was administered by a LPN. Event ID: Facility ID: 105219 If continuation sheet Page 5 of 5