Inspection·September 15, 2022

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Record reviewed documented Resident #33 was initially admitted to the facility on [DATE]. The resident's diagnoses included End Stage Renal Disease, Dependence of Renal Dialysis and Type 2 Diabetes Mellitus without Complications. Review of the Minimum Data Set (MDS) quarterly assessment with assessment reference date (ARD) 06/28/22, documented the resident's Brief Interview for Mental Status (BIMS) was 13 of 15, indicating the resident was cognitively intact. The Electronic Health Record (EHR) revealed the resident was receiving dialysis in the facility. A review of the dialysis communication note, dated 09/12/22, revealed a shunt location of a right leg catheter. A review of the Medication Administration Record (MAR) revealed the resident was scheduled to receive medications at 9:00 AM at which time he was in dialysis. Review of the care plan for dialysis revealed under interventions / tasks to: Adjust medication to accommodate dialysis, date initiated 08/15/17 and revised on 06/17/21; Encourage me to go for the scheduled dialysis appointments at .Dialysis, date initiated 08/15/17 and revised 06/17/21; and Monitor dialysis catheter dressing every shift to right chest tessio every shift, dated initiated 02/24/21 and revised on 06/17/21. An interview was conducted on 09/14/22 at 2:37 PM with the interim Director of Nurses / Minimum Data Set Coordinator who agreed the care plan was not updated to reflect the current status of Resident #33. Based on observations, interviews, and record reviews, the facility failed to develop care plans for 3 of 24 sampled residents reviewed: Resident #102 and Resident #357 related to hemodialysis and impaired vision; and Resident #33 related to revising the dialysis care plan. The findings included: Review of the facility's policy, titled, Comprehensive Care Plans, implemented on 11/28/22, documented the following: it is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with residents' rights, that includes measurable objectives and timeframes to meet the resident's medical, nursing, and mental need that are identified in the residents' comprehensive assessment. 1. Record review for Resident #102 revealed the resident was admitted on [DATE] with diagnoses of End-Stage Renal Disease (ESRD) and Dependence on Dialysis. A review of the Physician's orders documented an order for In-House Hemodialysis with [name] dialysis centers every Monday, Wednesday, and Friday, dated 04/27/22. A review of the Minimum Data Set (MDS), dated [DATE], documented Resident #102 had a Brief (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 2 of 11 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 105237 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Oaks Nursing and Rehabilitation 7751 W Broward Blvd Plantation, FL 33324 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 0656 Interview of Mental Status (BIMS) score of 15, which is indicative of intact cognition. Level of Harm - Minimal harm or potential for actual harm In an interview conducted on 09/13/22 at 8:11 AM, Resident #102 stated that she receives dialysis in the facility three times a week. Residents Affected - Few Review of the care plans for Resident #102, that was initiated on 04/28/22, did not show any care plan with goals and interventions initiated for dialysis. In an interview conducted on 09/14/22 at 2:38 PM with the Director of Nursing, she stated that residents on dialysis would have a care plan in place for dialysis. When asked if she knew that Resident #102 did not have a care plan for dialysis, she said no. 2. Record review for Resident #357 revealed the resident was admitted on [DATE] with the following diagnoses: End Stage Renal Disease, Unspecified Glaucoma and Type 2 Diabetes Mellitus. Review of Section B of the Minimum Data Set (MDS), dated [DATE], documented that Resident #357's vision was impaired. Review of Section C documented that the resident had a Brief Interview o Mental Status score of 15 which indicated intact cognitive response. Review of Section G revealed functional status of bed mobility and transfer both had self-performance of extensive assistance with support of one person, dressing had a self-performance of limited assistance with support of one person, eating and personal hygiene both had self-performance of supervision with support of one person. Review of the physician's orders showed that Resident #357 had a physician order, dated 08/01/2,2 for NAS/NCS (no added salt / no concentrated sweets) regular texture, thin consistency. Record review for Resident #357 revealed the resident did not have a care plan for impaired vision. On 09/12/22 at 1:50 PM, an observation was made of Resident #357 with an untouched (uneaten) lunch in front of her and the resident's right eye remains shut constantly. The meal ticket on the resident's tray does not indicate what food is on the plate (it is blank). On 09/14/22 at 8:52 AM, an observation was made of Resident #357 receiving her breakfast tray. Staff I, [NAME] Unit secretary, brought the resident her breakfast but did not identify what was on the tray or the location of the food / beverage. During an interview conducted on 09/12/22 at 1:55 PM with Resident #357, when asked if she did not like her lunch or would prefer something else, she stated she does not know what food is on the plate. She stated that she is vision impaired, and nobody tells her what food is on her plate. During an interview conducted on 09/14/22 at 8:55 AM with Staff I [NAME] Unit secretary, when asked if she had provided the breakfast tray to Resident #357, she stated 'yes'. When asked if she was aware of the resident having any visual impairment, she stated 'none that she is aware of'. During an interview conducted on 09/14/22 at 9:00 AM with Resident #357, when asked if Staff I [NAME] Unit secretary, who brought her breakfast tray into her, had identified what was on her tray or the location of the items, she stated 'no'. After informing the resident of what food was on her tray, she stated they did not bring me tea today, and she would need milk for her hot cereal. During an interview conducted on 09/14/22 at 12:45 PM with the Registered Dietician (RD), who has (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 3 of 11 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 105237 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Oaks Nursing and Rehabilitation 7751 W Broward Blvd Plantation, FL 33324 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 0656 been with the facility for 5 months, when asked if a resident with impaired vision had this indicated on the meal ticket, she stated there is not an option for this to be put on the meal ticket. 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: 105237 If continuation sheet Page 4 of 11 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 105237 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Oaks Nursing and Rehabilitation 7751 W Broward Blvd Plantation, FL 33324 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of the clinical records documented Resident #20 was admitted to the facility on [DATE] with diagnoses to include Sepsis, Unspecified Organism; and Acute Infections. On the admission of 60/09/22, diagnoses included Secondary Pulmonary Arterial Hypertension (HTN); Cardiovascular And Coagulations Acute On Chronic Diastolic (Congestive) Heart Failure; Cardiovascular And Coagulations; Type 2 Diabetes Mellitus (DM); Chronic Kidney Disease (CKD); Acute Kidney Failure; Dementia, Psychotic Disturbance, Mood Disturbance and Anxiety; Gastrostomy; Acute Respiratory Failure With Hypoxia; Pressure Ulcer Of Right Heel, Unstageable; Pressure Ulcer Of Left Heel, unstageable; Other Abnormalities Of Gait And Mobility; Muscle Weakness (Generalized); Hyperlipidemia, and Urinary Tract Infection. Review of the care plan, dated 06/06/22, showed that the resident was malnourished as evidenced by Nutritional Screening Tool Malnourished, She is NPO (nothing by mouth), Patient has low body weight / BMI, Medical History of DM/HTN, CKD, dyslipidemia, and dementia. Review of the physician's orders, dated 09/01/22, revealed the following: 'Enteral feeding two times a day, Auto flush at 60ml/hr. via peg tube, On at 4pm, Off at 2pm'. This indicated the resident should have been on continuous feeding from 4:00 PM until 2:00 PM or 10 hours: [10 hrs. x 60 ml/hr=600 ml]. The resident's weights were recorded weights as: 09/10/22 at 14:22 (2:22 PM) - 101.0 pounds (lbs) (Manual) 08/11/22 at 9:07 (AM) - 90.0 lbs (Manual) 07/01/22 at 13:00 (1 PM) - 89.8 Lbs (Manual) 06/24/22 at 15:24 (3:24 PM) - 88.4 lbs (Manual) 06/20/22 at 8:54 (AM) - 85.2 lbs (Manual) 06/12/22 at 10:22 (AM) - 87.0 lbs (Manual) 06/03/22 at 21:22 (9:22 PM) - 87.8 lbs Mechanical Lift (Manual) 6/3/2022 at 21:08 (9:08 PM) - 87.8 lbs. Mechanical Lift On 09/12/22 at 1:38 PM, Resident #20 was observed being fed via a G-tube. The feeding bag was observed at 800 ml / cc out of 1000 ml. It was hung at 7 AM and was infusing at 60 cc / hr. The observation revealed there should be approximately 600 ml remaining in the bag (if 1 hour was taken out for care). On 09/13/22 at 11:30 AM, the resident's feeding bag was infusing at 60 ml/hr. The notation on the feeding bag showed that it started at 4:00 AM, At 11:30 AM, there were still approximately 690 cc left in the bag. At 11:00 AM, there should have been 450cc [60 x 7.5 = 450 cc] infused and 550 ml left instead of 690 ml. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 5 of 11 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 105237 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Oaks Nursing and Rehabilitation 7751 W Broward Blvd Plantation, FL 33324 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 0693 Level of Harm - Minimal harm or potential for actual harm On 09/14/22 at 10:21 AM, the resident was observed in bed and the tube feeding was read as infusing at a rate of 60 ml/hr. The information written on the feeding bag showed that It was connected at 11:20 PM on 9/13/2022. At 10:21 AM on 9/14/2022 the amount left was 600 ml. There should have been 400 mls [1000-660 = 400 ml] left in the bag rather than 600 ml or at least 540 ml if staff stopped the feeding for 1 hour to provide care. Residents Affected - Few During an interview with the resident's nurse, an LPN on 09/14/22 at 10:30 AM, the nurse reported that she did not know what happened to the feeding. She said that she had not connected the feeding tube nor had she disconnected it. Based on observations, interviews, and record review, the facility failed to assure that enteral nutrition had been followed by the practitioners' orders for 3 of 4 sampled residents, Residents #14, #66, and #20, reviewed for tube feeding. The findings included: 1. A review of the facility's policy, titled, Enteral Nutrition Support Feeding Accuracy and Hydration Maintenance, revised on 09/14/22, documented the following: it is a policy of this facility to ensure accurate administration and adequate nutrition and hydration of all enteral nutrition support for all residents. Record review documented Resident #14 was readmitted to the facility on [DATE] with diagnoses that included Cerebral Ischemia, Hydrocephalus, Dementia, Gastrostomy Status, and Major Depressive Disorder. The resident had a Brief Interview Mental Status (BIMS) score that indicated the resident was severely impaired. Resident #14's care plan of 06/05/22 documented that Resident #14 is at nutritional risk as evidenced by: Enteral nutrition support via (PEG), history of Abnormal labs, Chewing / Swallowing problem, Nothing by Mouth (NPO), Related to Disease process / condition and resident requires the use of a feeding tube. Related to insufficient caloric intake, dysphagia, and cognition. Interventions include administering nutritional support / tube feeding formula and flushes as ordered (see current physician orders/MAR): Tube feeding, Vitamin supplement, supplement . Provide diet as instructed, and Dietitian to monitor adequacy or tube feeding formula and free-water flushes at least quarterly. On 02/07/22, Resident #14's physician's order documented for: 'two (2) times a day for Dysphagia Jevity 1.5 (tube feeding formula) at 50 milliliters (ml) times 22 hours via PEG (percutaneous endoscopic gastrostomy), total volume = 1100 ml; on at 4:00 PM and off at 2:00 PM'. During an initial observation on 09/12/22 at 11:40 AM, a tube feeding (TF) bottle (Jevity 1.5 kcal) was noted in Resident #14's room, not running. Closer observation showed that the tube bottle was started on 09/12/22 at 7:00 AM at 50 ml an hour. The (TF) in the room showed that it was on the 1500 ml mark out of a 1500 ml bottle; the (TF) timing was off by 4 hours and 40 minutes at the time of this observation. The tube feeding running as per MD order should have been at the 1300 ml mark out of a 1500 ml bottle. During a second observation on 09/12/22 at 2:58 PM, Resident #14 was observed with her (TF) off at this time. The resident's spouse was sitting at the resident's bedside. Resident #14's spouse stated to this surveyor that the resident's (TF) 'was off now for about 2-3 hours until they turn it on again'. Resident #14's spouse was asked very briefly if this was something that would bother /concern (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 6 of 11 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 105237 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Oaks Nursing and Rehabilitation 7751 W Broward Blvd Plantation, FL 33324 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 0693 Level of Harm - Minimal harm or potential for actual harm him if Resident #14's (TF) was not infusing properly, and he responded by saying, yes. It was noted that only 50 ml had been infused with 1450 cc remaining in the (TF) bottle. The (TF) timing was now off by 6 hours. Photographic Evidence Obtained of Resident #14's 1450 ml (TF) bottle of Jevity 1.5 kcal. Residents Affected - Few During a third observation on 09/13/22 at 9:37 AM, Resident #14 was observed with the same (TF) bottle, dated 09/12/22, still hanging and infusing at 50 ml an hour with only 700 ml infused and 800 ml remaining in the bag. The (TF) bottle, that was hung at 7 AM yesterday at 50 ml an hour, should have been completed at around 5:00 PM yesterday with a new bottle of (TF) being hung at that time. Photographic Evidence Obtained of Resident #14's 800 ml (TF) bottle of Jevity 1.5 kcal During the fourth observation on 09/13/22 at 12:06 PM, Resident #14 was observed sitting up in her Gerichair with the same (TF) bottle, dated 09/12/22, still hanging and infusing at 50 ml with still only 800 ml infused and 700 ml remaining in the bag. Photographic Evidence Obtained of Resident #14's 700 ml (TF) bottle of Jevity 1.5 kcal. During the fifth observation on 09/13/22 at 2:27 PM, Resident #14 was still observed sitting up in her Gerichair with the same (TF) bottle dated 09/12/22, still hanging and infusing at 50 ml with now only 900 ml infused and 600 ml remaining in the bag. Photographic Evidence Obtained of Resident #14's 600 ml (TF) bottle of Jevity 1.5 kcal. An interview was conducted on 09/13/22 at 2:02 PM with Staff G, Licensed Practical Nurse (LPN), regarding the following questions: When was the (TF) hung, and she replied, 09/12/22 at 7:00 AM at 50 ml an hour. What was the order and she replied that the order is for two times a day for Dysphagia Jevity 1.5 @ 50 ml an hour x 22hr via PEG, total vol=1100ml. On 4:00 PM Off 2:00 PM via Percutaneous Endoscopic Gastrostomy tube (PEG). Was it running this morning when you started your shift, and she answered, Yes. Was/has the resident been tolerating the tube feeding well, and she replied, Yes. The nurse also acknowledged that the same (TF) bottle from yesterday at 7:00 AM was still hanging in the resident's room and should not have been. An interview was conducted on 09/13/22 at 2:30 PM with Nichola Fray, LPN, Unit Manager, working in the facility for ten months, regarding Resident #14's (TF) inconsistent infusion volume, and she acknowledged that the (TF) volume should be infused have been greater and that the same (TF) bottle from yesterday at 7 AM was still hanging up in Resident #14's room and it should not have been. An interview was conducted on 09/13/22 at 3:35 PM with the facility's Clinical Dietitian regarding Resident #14's (TF) inconsistent infusion volume. She acknowledged that the (TF) volume infused should have been greater and that the same (TF) bottle from yesterday at 7:00 AM that was still hanging (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 7 of 11 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 105237 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Oaks Nursing and Rehabilitation 7751 W Broward Blvd Plantation, FL 33324 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few up in Resident #14's room, and it should not have been. The current (TF) bottle was not discarded and a new one started until after the surveyor inquisition / intervention. 2. Record review for Resident #66 documented the resident was readmitted to the facility on [DATE] with diagnoses to include Type 2 Diabetes and Dysphagia. A physician order noted for tube feeding formulary (Glucerna 1.5) to be running at 60 milliliters (ml) an hour times 22 hours starting at 4:00 PM and off at 2:00 PM dated 07/19/22. In an observation conducted on 09/12/22 at 10:30 AM, Resident #66 was noted in bed. The tube feeding was noted with Glucerna 1.5 running at 60 ml an hour, starting at 4:00 AM. Closer observation showed that the feeding was at the 750 ml mark out of a 1000 ml capacity bottle. This showed that only 250 ml was infused in 6.5 hours and not the 390 ml that should have been infused as per the above order. In an observation conducted on 09/12/22 at 12:45 PM, Resident #66 was noted in bed. The tube feeding with Glucerna 1.5 ran at 60 ml an hour, starting at 4:00 AM. Closer observation showed that the feeding was at the 600 ml mark out of a 1000 ml capacity bottle. This showed that only 400 ml was infused in about 9 hours, not the 540 ml that should have been infused as per the above order. In an observation conducted on 09/13/22 at 8:30 AM, Resident #66 was noted in bed. The tube feeding was noted with Glucerna 1.5 running at 60 ml an hour with a start date of 09/13/22 and no start time noted. Closer observation showed that the feeding was at the 800 ml mark out of a 1000 ml capacity bottle. In an observation conducted on 09/14/22 at 7:00 AM, Resident #66 was noted in bed. The tube feeding was noted with Glucerna 1.5 running at 60 ml an hour with a start date of 09/14/22 and no start time noted. Closer observation showed that the feeding was at the 700 ml mark out of a 1000 ml capacity bottle. The tube feeding should have been at the 640 ml mark taking into consideration the 1 hour that was taken off for the morning care. In an interview conducted on 09/14/22 at 7:00 AM, Staff B, Licensed Practical Nurse (LPN), stated that he started the tube feeding bottle around 12:00 AM and stopped it for 1 hour for morning care. He further said that Resident #66 is tolerating her tube feeding well. The care plan, dated 08/10/22, documented to 'administered the tube feeding formula and flushes as ordered by physician orders'. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 8 of 11 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 105237 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Oaks Nursing and Rehabilitation 7751 W Broward Blvd Plantation, FL 33324 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews and policy review, the facility failed to provide medication as scheduled on dialysis days for 1 of 2 sampled residents reviewed for dialysis (Resident # 33). Residents Affected - Few The findings included: The facility's policy, titled, Hemodialysis, implemented 11/28/17, revealed Timely medication administration (initiated, held, or discontinued) by the nursing home and/or dialysis facility. Resident #33 was initially admitted to the facility on [DATE], with diagnoses that included End Stage Renal Disease (ESRD), Dependence of Renal Dialysis and Type 2 Diabetes Mellitus (DM) without Complications. The resident's Brief Interview for Mental Status (BIMS) was 13 according to the Minimum Data Set (MDS) quarterly assessment with assessment reference date (ARD) 06/28/22, indicating the resident was cognitively intact. The Electronic Health Record (EHR) revealed the resident was receiving dialysis in the facility. On 09/13/22 at 10:36 AM, the Medication Administration Record (MAR) was reviewed for Resident #33, that revealed the resident was scheduled to receive Miralax Powder, Nepro supplement, Renal Vitamin Tablet and Pro-Stat supplement at 9:00 AM daily. On 09/14/22 at 10:53 AM, an interview was conducted with Staff D, Registered Nurse (RN) unit manager. This surveyor asked Staff D at what time Resident #33 leaves his room for dialysis. She stated that he gets to dialysis in the morning. His start time for dialysis is 7:45 AM and he is picked up around 7:30 AM. It usually takes 3-4 hours and he comes back to his room before lunch. An interview was conducted with Staff F, Licensed Practical Nurse (LPN) on 09/14/22 at 11:01 AM. She stated that the resident gets his medication a little before 7:00 AM and will get the 9:00 AM medications when he returns from dialysis. She stated that she never questioned the timing of the medication on dialysis days. She only works 2 days a week on this hallway. An additional interview was conducted with Staff D regarding timing of medication given on dialysis days. Staff D stated that she was not aware that the nurses were giving 9:00 AM medications late. She stated she will call the physician to change the timing of the 9:00 AM medications on dialysis days if that is what the physician wants to do. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 9 of 11 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 105237 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Oaks Nursing and Rehabilitation 7751 W Broward Blvd Plantation, FL 33324 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide food items that accommodated the preferences of 2 of 3 sampled residents during dining observations, Resident #102, and Resident #46. The findings included: 1. Record review for Resident #102 revealed an admission on [DATE] with diagnoses to include End Stage Renal Disease (ESRD) and dependence on Dialysis. A review of the physician's orders showed an order for In-House hemodialysis with [name] dialysis centers every Monday, Wednesday, and Friday, dated 04/27/22. Review of the Minimum Data Set (MDS), dated [DATE], documented that Resident #102 had a Brief Interview of Mental Status (BIMS) score of 15, which is cognitively intact. Reivew of the physician orders documented a diet order for regular texture, thin consistency, for diet liberal renal; 1200 cc fluid restriction: 360 milliliters (ml) with breakfast, 240 ml with lunch and dinner dated 05/02/22. In an interview conducted on 09/13/22 at 8:11 AM, Resident #102 stated that she is not getting her hot tea with her breakfast tray every morning. Her favorite meal is breakfast, and she likes extra grits and eggs on her tray. Resident #102 stated tha staff never tells her what food is on the tray or where it is situated since she is blind and cannot see. In this interview, Staff A, Certified Nursing Assistance, brought the breakfast tray into the room. She placed the tray on the side table near Resident #102 and set up the tray for the resident. Resident #102 asked Staff A if she could bring her coffee, and Staff A said, you get coffee every day. Staff A said, you get juice and coffee but no water. Resident #102 requested extra grits, and Staff A went out of the room to get the extra grits. A closer observation of the meal ticket for Resident #102 showed instructions for hot tea but no extra portions for eggs or grits and was dated 09/14/22. The breakfast tray had one serving of eggs, one serving of grits, and no hot tea. Photographic Evidence Obtained. In an interview conducted on 09/13/22 at 8:15 AM, Resident #102's roommate stated that they never gave Resident #102 extra protein or eggs and proceeded to give Resident #102 her portion of eggs. Review of the meal ticket, which was provided by the facility's Clinical Dietitian showed that for Resident #102, the following was noted: for the section under food likes, it had double portions of eggs with hot tea and double protein, which was dated 09/13/22 and 09/14/22. In an interview with the facility's Clinical Dietitian on 09/14/22 at 12:44 PM, she stated that she has been in this facility for the last five months. Food preferences are placed in a food program called Optima. The Food Service Manager will visit the patients and input the choices into the system. She will also collect some of the food preferences. It is then generated on the meal ticket, and the dietary aides can see it on the meal ticket and provide the correct food choices on the tray. The options will show on all three meals with the dislike and likes on the meal tickets. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 10 of 11 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 105237 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broward Oaks Nursing and Rehabilitation 7751 W Broward Blvd Plantation, FL 33324 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. Record review documented that Resident #46 was admitted to the facility on [DATE] with diagnoses to include Anxiety Disorders and Cerebral Infarction. The MDS, dated [DATE], dpcumented a BIMS score of 09, a moderate cognitive impairment. In an observation conducted on 09/14/22 at 8:06 AM, Staff C, Registered Nurse, pulled the breakfast tray for Resident #65 from the meal cart and asked the Director of Social Services to bring the tray to Resident #65. The Director of Social Services was observed giving the tray to Resident #46 instead of Resident #65. A closer observation of the breakfast tray showed eggs, juice, and sausages. The Director of Social Services set up the tray for Resident #46 and asked if she needed anything else. Resident #46 stated that she did not eat the eggs on the breakfast tray and instructed the Director of Social Services to bring her 2 portions of cereal and regular milk. The Social Service Director went out of the room and returned a few minutes later with the 2 portions of cereal and the milk. At 8:10 AM, the Director of Social Services told the surveyor, I gave Resident #46 the wrong tray. A closer observation of the breakfast tray showed eggs, juice, and sausages. In an interview conducted on 09/14/22 at 8:15 AM with Staff C, the Registered Nurse stated that she is aware that the Director of Social Services gave Resident #46 the breakfast tray that was supposed to be for Resident #65. She further stated that she educated the Director of Nursing on the mistake. A review of the meal tickets that the facility's Clinical Dietitian provided showed that Resident #46 had the following: food dislikes showed eggs and juice, and instructions to give corn flakes or frosted flakes (cereals) daily. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 11 of 11