Health inspection·February 8, 2024

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The Social Services Assistant stated Resident #67 was severely cognitively impaired. The Social Services Assistant stated that the resident had a POA who was to take care of the DNR form. The Social Services Assistant was apprised that the resident's DNR was not signed by the POA who referred the surveyor to the Director of Social Services. On 02/06/24 at 3:32 PM, an interview was conducted with the Director of Social Services (DSS) who stated that Resident # 67's POA was the person who had to sign the DNR form. The DSS stated she would call the resident's POA today to discuss the DNR and obtain a new form signed by POA. During an interview on 02/07/24 at 9:17 AM, the DSS stated Resident #67's POA was coming on 02/07/24 to sign the DNR form. On 02/07/24 at 9:19 AM during an interview, the administrator was apprised that Resident # 67's DNR was not signed by the POA. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 2 of 37 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 02/08/2024 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, record and policy review, the facility failed to develop care plans for 2 of 3 sampled residents reviewed for Peripherally Inserted Central Catheter (PICC) lines, Resident #89 and Resident #557; and failed to develop care plans for residents with a Left Ventricular Assist Device (LVAD) for 1 of 1 sampled resident reviewed for a LVAD, Resident #87. The findings included: The facility's policy, titled, Comprehensive Care Plans, implemented 11/28/17, revealed, in part, The comprehensive care plan will describe, at a minimum, the following: The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. 1. Record review revealed Resident #89 was admitted to the facility on [DATE]. The resident was readmitted on [DATE] with a Peripherally Inserted Central Catheter (PICC) line to the right upper arm for Osteomyelitis, with other diagnoses that included Chronic Obstructive Pulmonary Disease (COPD) and Pressure Ulcer of sacral region. Review of the Medicare 5- day Minimum Data Set (MDS) assessment dated [DATE] documented a Brief Interview for Mental Status (BIMS) score of 3, indicating severe cognitive impairment. Review of the resident's care plan revealed no care plan for the PICC line or the antibiotic. On 02/08/24 at 3:03 PM, it was discussed with Staff I, MDS Coordinator, regarding the lack of a care plan for the PICC line and antibiotic. She acknowledged there should have been a care plan for the PICC line and the antibiotic. 2. Record review for Resident #87 revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Encounter for Orthopedic Aftercare following Surgical Amputation, Atrial Fibrillation, Presence of Heart Assist Device. Dependence on Renal Dialysis, and Type 2 Diabetes Mellitus. Review of the MDS for Resident #87 dated 01/22/24 revealed in Section C a BIMS score of 15, indicating cognition was intact. Review of the Physician's orders for Resident #87 revealed an order dated 01/25/24 to cleanse the left lower quadrant Ventricular Assist Device (LVAD) site with normal saline, pat dry, and cover with border dressing every night. Review of the record for Resident #87 revealed no care plan for the LVAD (Left Ventricular Assistive Device). On 02/06/24 at 9:00 AM, an observation was made of Resident #87, who was sitting on the edge of his bed. There was a black bag next to the bed with a cord that went under the resident's shirt. An interview was conducted on 02/06/24 at 9:00 AM with Resident #87, who was asked about the black bag with the cord that went under his shirt. He stated he has a LVAD, it runs on 2 battery packs, he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 3 of 37 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 02/08/2024 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few has a total of 8 battery packs, and the batteries not being used were kept on the charger at all times. The resident then lifted his shirt to show where the device was connected to his abdomen that had a border dressing with no date. He said he checks it at least once a day every day, proceeded to show the surveyor what he checks, and that he gets a green light. An interview was conducted on 02/06/24 at 9:19 AM with Staff M, Registered Nurse (RN), who was asked if she is familiar with the LVAD, who stated 'yes one of our residents has one'. When asked about a care plan for the LVAD, she said she there should be one. 3. Record review for Resident #557 revealed the resident was originally admitted to the facility on [DATE] with the most recent readmission on [DATE] with diagnoses that included: Sepsis, Urinary Tract Infection, Guillain-Barre Syndrome, Paraplegia, and Obesity. Review of the MDS for Resident #557 dated 02/05/24 revealed in Section C a BIMS score of 15, indicating a cognition was intact. Review of the Physician's orders for Resident #557 revealed an order dated 01/29/24 to change the PICC dressing every 72 hours on Thursdays for hygiene. Review of the Care Plans for Resident #557 revealed no care plan for the PICC line. On 02/05/24 11:44 AM, observation of Resident #557's left arm PICC line that was in place revealed a clean dry intact dressing dated 01/29/24. An interview was conducted on 02/05/24 at 11:44 AM with Resident #557 who stated he is receiving Vancomycin and Rocephin for a Urinary Tract Infection (UTI), and he has a PICC line. An interview was conducted on 02/07/24 at 1:30 PM with Staff N, RN, who was asked how often a PICC line dressing is changed. She said she would have to look in the resident's chart, and was unable to answer the question in general. When asked about Resident #557's PICC line, she said she noticed the dressing needed to be changed based on the date and said it would be changed today. When asked how often the PICC line dressing is changed, she looked in Resident #557's chart and said it is supposed to be changed every 72 hours (3 days) on Thursdays. When asked to clarify if it is every 72 hours or every Thursday, she acknowledged the order was confusing. When asked if there was a care plan for the PICC line, she said there should be one. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 4 of 37 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 02/08/2024 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 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 record review and interviews, the facility failure to administer antibiotic therapy in a timely manner for 1 of 1 sampled resident, Resident #505, as evidenced by not administering the antibiotic on 09/16/23 for two consecutive doses as ordered; and failed to ensure physician orders were followed for residents with a Left Ventricular Assistive Device (LVAD), as evidenced by lack of accurate monitoring, calulating and documentation of mean arterial pressure (MAP) for 1 of 1 sampled residents, Resident #87. Residents Affected - Few The findings included: 1. Review of Resident #505's clinical record documented an admission on [DATE] with a discharge on [DATE]. The resident's diagnoses included Cellulitis of Left Lower Limb, Fracture of Left Patella with subsequent encounter for Closed Fracture with Routine Healing, and Acute Embolism and Thrombosis of Unspecified Deep Veins of Unspecified Lower Extremity. Review of Resident #505's Minimum Data Set (MDS) admission assessment dated [DATE] documented a Brief Interview of Mental Status (BIMS) score of 15 indicating the resident had intact cognition. The assessment documented the resident received an antibiotic 7 days prior to the assessment. Review of Resident #505's care plan, titled, I am on antibiotic therapy (Linezolid) related to (skin and soft tissue) infection initiated on 09/18/23, had an intervention to include administer antibiotic medications as ordered by physician . Review of Resident #505's hospital discharge medication list dated 09/15/23 documented, Linezolid 600 milligram (mg) every 12 hours for 15 doses - last time this was given on 09/15/23 at 10:17 AM . Review of Resident #505's physician orders dated 09/15/23 documented, Linezolid (antibiotic) Oral tablet 600 mg (Linezolid) give 1 tablet by mouth two times a day for skin and soft tissue infection. This physician order was reordered on 09/18/23 as, Linezolid Oral Tablet 600 MG (Linezolid) Give 1 tablet by mouth two times a day for Cellulitis Left Lower extremity for 12 Administrations until finished. Review of Resident #505's September 2023 Medication Administration Record (MAR) documented Linezolid Oral tablet 600 mg (Linezolid) give 1 tablet by mouth two times a day for skin and soft tissue infection start date 09/15/23 at 9:00 PM. Further review of the resident's September MAR documented that Linezolid was administered on 09/15/23 at 9:00 PM and was not administered on 09/16/23 for the 9:00 AM and 9:00 PM doses as scheduled and as per physician order. Review of Resident #505's Staff M, Registered Nurse (RN), note dated 09/16/23 at 3:52 PM documented, Linezolid Oral Tablet 600 MG Give 1 tablet by mouth two times a day for skin and soft tissue infection. Not Given, Pharmacy made aware. The note documented, Show on Shift Report Show on 24 Hour Report. Review of Resident #505's nursing note dated 09/16/23 at 11:51 PM documented, Linezolid Oral Tablet 600 MG Give 1 tablet by mouth two times a day for skin and soft tissue infection. Awaiting on delivery, pharmacy called, NP (Nurse Practitioner) notified. The note documented Show on Shift Report (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 5 of 37 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 02/08/2024 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 0684 Show on 24 Hour Report. Level of Harm - Minimal harm or potential for actual harm Review of Resident #505's nursing note dated 09/17/23 at 4:29 AM documented, in part, .resident had numerous questions in regard to the antibiotic treatment .resident was informed that an approval from insurance was needed .resident feels her condition is too critical for a delay in sending the medication .pharmacy calls facility stating the antibiotic has a contraindication to one of the resident's current medication. Physician was contacted and stated no changes .pharmacy was recontacted with the doctor's decision, awaiting medication from the pharmacy . Residents Affected - Few On 02/08/24 at 11:38 AM, an interview was conducted with Staff M, RN, who stated medications for new admission are taken from the Pyxis system (an automated medication dispensing system). Staff M stated she recalled Resident #505 and that on 09/16/23, a Saturday, the resident's ordered antibiotic was not in the Pyxis system in either wing. Staff M added she then called the weekend supervisor to make him aware of that, who instructed her to call the pharmacy to get the antibiotic. Staff M stated she did not have the antibiotic to administer to the resident on 09/16/23 for the 9:00 AM dose. Staff M added the medication was not delivered on her shift. On 02/08/24 at 9:17 AM, an interview was conducted with the Director of Nursing (DON) who stated the facility changed the pharmacy provider in 01/2024. The DON was asked if she had heard of any residents not getting their antibiotic therapy as ordered in the last 5 months. The DON stated she had not. The DON was apprised that Resident #505 did not receive the Linezolid antibiotic twice on 09/16/23 after receiving the initial dose upon admission. The DON stated new admissions can come at any time of the day or night. The DON stated if a new resident comes in and needs antibiotic therapy, the nurse can start the initial dose provided it is in house (Emergency kit/ Pyxis system). The DON stated nursing staff had been trained on how to use the Pyxis/Emergency kit. The DON stated that if the antibiotic tablets were not in the Pyxis system, they needed to order before the cut off time and that they could get them at 6:00 PM or on the midnight pharmacy run. The DON added that if they needed the medication right the way, she would contact the Director of Pharmacy and ask for a special run. On 02/08/24 at 1:51 PM, an interview was conducted with the DON who stated she remembered Resident #505 because they bonded. The DON stated she did not know why there was a break on the resident's antibiotic therapy administration on 09/16/23. The DON read nursing note for 09/17/23 at 4:29 AM and stated she did not know why the pharmacy did not communicate the information regarding antibiotic contraindication or insurance approval with her. The DON stated it was not mentioned in the quality meeting about issues with Resident #505 not receiving her antibiotic as ordered. The DON was apprised that the nursing notes for 09/16/23 day and evening shift were checked off to show on the 'shift and 24 report'. The DON stated she was not aware of the payment issue for Resident #505's Linezolid antibiotic and added it was a fluke. 2. Review of the facility's protocol, titled, Nursing Protocols for Resident with Left Ventricle Assistive Devices (LVAD), with a date of 01/16/24, included: Monitor MAP (Mean Arterial Pressure) every shift with the cuff left in the room (Manual brachial cuff device) Do NOT USE the vital sign auto machine to obtain his MAP. Adequate blood pressure (typically, a MAP between 60mmhg and 90 mmhg) helps maintain sufficient pump flow. Commonly prescribed antihypertensive drugs include vasodilators, beta blockers, angiotensin-converting enzyme (ACE) inhibitors. Always monitor heart rate and blood pressure when giving these medications. Record review revealed Resident #87 was admitted to the facility on [DATE] with diagnoses that included: Encounter for Orthopedic Aftercare Following Surgical Amputation, Atrial Fibrillation, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 6 of 37 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 02/08/2024 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 0684 Presence of Heart Assist Device, Dependence on Renal Dialysis, and Type 2 Diabetes Mellitus. Level of Harm - Minimal harm or potential for actual harm The MDS for Resident #87 dated 01/22/24 revealed in Section C, a Brief Interview of Mental Status score of 15, indicating an intact cognitive response. Residents Affected - Few Review of the Physician's orders for Resident #87 revealed an order dated 01/16/24 for full set of vital signs every shift. Review of the Physician's orders for Resident #87 revealed an order dated 02/06/24 to monitor mean arterial pressure (MAP) every shift using manual cuff only (kept at bedside) and record first sound parameters between 100-110 mmhg without doppler 40 mmhg must be subtracted from the reading. Normal flow 60-90 mmhg every shift for monitor and notify MD if lower than 60 mmhg use record LVAD only. Review of the blood pressures for Resident #87 from 02/01/24 to 02/05/24 were documented as: 02/01/24 at 1:15 AM, 127/71 mmhg 02/01/24 at 4:34 PM, 1/1 mmhg (as documented by Staff M, RN) 02/02/24 at 3:04PM, 108/66 mmhg 02/02/24 at 10:37 PM, 115/64 mmhg 02/03/24 at 4:01 AM, 110/62 mmhg 02/03/24 at 3:04 PM, 123/76 mmhg 02/03/24 at 5:30 PM, 120/66 mmhg 02/04/24 at 12:40 AM, 115/75 mmhg 02/04/24 at 2:04 PM, 1/1 mmhg (as documented by Staff M, RN) 02/04/24 at 5:05 PM, 118/70 mmhg 02/05/24 at 12:06 AM, 122/80 mmhg 02/05/24 at 12:40 PM, 1/1 mmhg (as documented by Staff M, RN) 02/05/24 at 6:52 PM, 130/776 mmhg This revealed nursing staff were not accurately documenting the MAP correctly. On 02/06/24 at 9:00 AM, an observation was made of Resident #87 who was sitting on the edge of his bed. There was a black bag next to the bed with a cord that went under the resident's shirt. On the nightstand, there was a charging device with 6 battery-type of boxes in the charging device. An interview was conducted on 02/06/24 at 9:00 AM with Resident #87 who was asked about the black bag with the cord that went under his shirt. He stated he has a LVAD (Left Ventricular Assistive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 7 of 37 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 02/08/2024 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Device). He further stated the device runs on 2 battery packs. He has a total of 8 battery packs, and they are kept on the charger at all times. The resident then lifted his shirt to show where the device was connected to his abdomen that had a border dressing with no date. When asked if the dressing was changed, he said yes, every day. He said he checks it every day at least once a day. An interview was conducted on 02/06/24 at 9:19 AM with Staff M, RN, who was asked if she is familiar with the LVAD. She said yes one of our residents has one. When asked if she does any sort of checks for the device, she said the resident is alert and he checks it. She said she looks at the batteries to make sure they are on the charger and the device gets a green light. When asked if she received any in-service on the LVAD she said yes and she was familiar with the LVAD (prior to the resident being admitted to the facility). When asked about the blood pressure, she stated it has to be done manually with the blood pressure cuff in the resident's room. Staff M stated you don't use a stethoscope, you just look at the needle on the dial and when the needle jumps that is the MAP (Mean Arterial Pressure). When asked where this is documented in the resident's chart, she said it is under the blood pressures, but you cannot just document 1 number (the MAP is only 1 number, not 2 numbers). An interview was conducted on 02/06/24 at 9:40 AM with the Director Of Nursing (DON) who was asked about residents with a LVAD. She stated she made a protocol and in-serviced the nurses. When asked if the staff monitor the LVAD, she said they check the green light and make sure the batteries are being charged. When asked about the blood pressure, she stated they cannot do a regular blood pressure for the resident, and they cannot use an automatic blood pressure machine. She said the resident has a manual blood pressure cuff at the bedside and the nurse will check the blood pressure with the manual cuff and when the needle on the dial first jumps that is the MAP. The nurse will then document this MAP on the resident's chart under blood pressures. She stated the normal MAP is between 60-90. The nurses were not calculating or documenting the MAP as specified by the physician order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 8 of 37 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 02/08/2024 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Record review showed Resident #70 was admitted to the facility on [DATE] with diagnoses of protein-calorie malnutrition, colon cancer, and lung cancer. Residents Affected - Few Review of the Physicians' orders, dated 11/03/23, revealed the following: Boost (nutritional supplement) three times a day for weight management, Chocolate flavor Boost 237 milliliters (one bottle). The Significant Change Minimum Data Set (MDS) assessment, dated 12/07/23, revealed Resident #70 has a Brief Interview of Mental Status (BIMS) score of 15, indicating cognition was intact. An interview was conducted on 02/05/24 at 9:40 AM with Resident #70 who was noted in bed with the breakfast tray at the bedside out of reach. When asked why he was not eating, he stated that he was waiting for staff to assist him with his breakfast tray. Resident #70 stated that he had lost about 50 pounds and that he has cancer. He then asked the surveyor if any staff was noted at the nurse's station to help him with his breakfast meal. Continued observation at 10:32 AM, an hour and a half later, revealed the meal tray was still at the bedside untouched. At 10:35 AM, Staff A, Licensed Practical Nurse (LPN), went into Resident #70's room and pushed the side table with the breakfast tray closer to Resident #70, so he could reach his meal. In an observation conducted on 02/05/24 at 11:00 AM, Resident #70 had eaten 10% of his oatmeal but did not touch anything else. When asked why he was not eating, he said he was in pain, was tired and that he asked Staff A for Boost when she gave him the pain medication around 10:30 AM. An interview was conducted on 02/05/24 at 11:30 AM with Resident #70, who stated Staff A still needed to bring his Boost supplement and asked the surveyor if they could speak to the nurse regarding his supplement. In an observation conducted on 02/05/24 at 12:35 PM, Resident #70 was noted in the room eating his lunch meal. At 12:55 PM, Resident #70 had eaten 10% of his meal and asked the surveyor if they could bring him another bottle of Boost. Review of the Medication Administration Record (MAR) revealed that on 02/05/24, the Boost was given at 9:00 AM, 1:00 PM, and another one at 5:00 PM. Review of the weight log showed the following weights for Resident #70: 140 pounds dated 11/07/23, 140 pounds dated 11/14/23, no weight recorded on 12/15/23, and no weight recorded on 01/10/24. The nutrition risk assessment dated [DATE] revealed the following: Resident #70 is consuming between 25% to 100% of his meals. He has diagnoses that could cause unavoidable weight and loss of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 9 of 37 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 02/08/2024 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few appetite. It further showed that Resident #70 was in hospice and was receiving Boost supplements three times a day. Resident #70 will be followed and monitored with adjustments as needed. In an interview conducted on 02/06/24 at 1:30 PM with Resident #70, he stated that it is easier for him to drink the Boost supplements than to eat the food. When asked by the surveyor if he would drink more than 3 Boost supplements a day if offered, he said yes. Review of the care plans for Resident #70 did not show that any care plan was initiated for nutrition. An interview was conducted on 02/07/24 at 3:07 PM with the facility's Dietitian who stated she did not notice that Resident #70 did not have a care plan for nutrition and that she is in charge of the nutrition care plan for all residents. The facility's Dietitian reported that she should have followed up on Resident #70's nutritional status sooner and acknowledged that the last follow-up note was completed on 12/07/23. Based on observations, interviews, and record review, the facility failed to provide nutritional interventions and assessments in a timely manner for 2 of 5 sampled residents reviewed for nutrition, Resident #15 and Resident #70. The findings included: Review of the facility's policy, titled, Weight Height Monitoring Policy, with a reviewed date of 11/28/23, included: In accordance with the resident's comprehensive assessment, the facility will ensure that all residents maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition suggests otherwise or not aligned with the resident preferences. The facility will obtain heights and measure/monitor weights upon admission, on Day 3 post admission by Restorative, weekly and monthly to assure communication and timely interventions to support or reverse weight gained or lost. Weight can be a useful indicator of nutritional status. Significant unintended changes in weight (loss or gain) or insidious weight loss (gradual unintended loss over a period of time) may indicate a nutritional problem. 1. The facility will utilize a systemic approach to optimize a resident's nutritional status. This process includes: a. Identifying and assessing each resident's nutritional status and risk factors. b. Evaluating/analyzing the assessment information. c. Developing and consistently implementing pertinent approaches. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 10 of 37 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 02/08/2024 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 0692 d. Level of Harm - Minimal harm or potential for actual harm Monitoring the effectiveness of interventions and revising them as necessary. Residents Affected - Few 1. Record review revealed Resident #15 was admitted to the facility on [DATE] with the most recent readmission on [DATE]. The diagnoses included: Dementia, Anxiety Disorder, Gastroparesis, Myasthenia Gravis, Sjogren syndrome, Systemic Lupus Erythematosus, and Schizoaffective Disorder Review of the Minimum Data Set (MDS) for Resident #15 dated 11/11/23 revealed in Section C a Brief Interview of Mental Status (BIMS) score of 15, indicating cognition is intact. In Section K, it was documented the resident's height as 61 inches (5'1) and the weight in pounds as 100, weight loss of 5% or more in the last month or loss of 10% or more in last 6 months was answered yes, not on a physician-prescribed weight-loss regimen. Review of the weights for Resident #15 revealed the following: On 08/16/23, the resident weighed 115.8 pounds. For the month of September 2023, there were no weights. On 10/10/23, the resident weighed 100.0 pounds. This indicated from 08/16/23 to 10/10/23, the resident had a 13.64 % weight loss. On 08/16/23, the resident weighed 115.8 pounds and on 10/10/23, the resident weighed 100.0 pounds which is a -13.64 % weight loss. Review of the Physician's orders for Resident #15 revealed an order dated 11/13/23 for NAS (No Added Salt) diet, Regular texture, Regular / Thin consistency. Review of the Care Plan for Resident #15 dated 04/29/21 with a focus on the resident is at nutritional risk: As evidenced by: Therapeutic diet, mechanically altered texture, h/o [history of] poor appetite PTA, c/o [complaint of] nausea Related to: Disease process / condition, Constipation. The goals were resident desires her laboratory values to be within desired limits (per physician) by the next review date, and she desires her weight to remain +/- 5% current weight through next review date. The interventions included: Weights monthly and as needed. No sig. wt. [significant weight] change seen One inconsistence in wt. seen, reweigh the patient. 25-100% Poor to fair intake. Review of the Nutrition / Dietary Note for Resident #15 dated 05/31/23 revealed: Resident readmit to the facility s/p [status post] hospitalization Diagnoses; Dementia, Gastroparesis, Hypokalemia, HTN [Hypertension], HLD [Hyperlipidemia] Resident refuses for weight checkup. Diet; Reg [Regular] diet, Reg. Text. Reg. thin consistency, PO [oral] Intake : poor Various intake noted in chart 25-76% she refuses to eat meal sometimes, Meds; Ondansetron, Amlodipine, Statin, Colace, Pantoprazole, Losartan, Megace, Tramadol, No recent labs; Recommendation; Boost x 2 daily, She likes ginger ale; snack in between. Request to reweight. Will monitor any change in weight, po intake skin. Will follow as needed. Review of the Weight Change Note for Resident #15 dated 06/02/23, Refused; on 05/08/23, Refused weight. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 11 of 37 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 02/08/2024 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Standard of Care (SOC) Noted dated 08/09/23 included: Resident with adequate po intake consuming 75% or more of all meals. No significant wt (weight) loss noted at this time. Current wt within desirable range. Review of the Plan of Care Note for Resident #15 dated 08/31/23 included: Dietitian met with care plan team for resident's quarterly review. Contacted POA [power of attorney] regarding resident's current nutritional status. Resident continues to be weighed. POA stated Last known weight at hospital in 123lbs (pounds). Review of the Nutrition Risk Assessments for Resident #15 revealed the last Nutrition Risk / Assessment was completed on 03/06/23. Review of the Notes for Resident #15 revealed no notes related to diet/nutrition or weight loss were documented after 08/31/23. An interview was conducted on 02/05/24 at 1:00 PM with Resident #15 who was asked if she had been trying to lose weight, she said no. When asked about being weighed, she stated she does not like to be weighed. An interview was conducted on 02/06/24 at 11:00 AM with Staff I, MDS Coordinator (MDSC), who acknowledged there were no dietary / nutrition notes or assessments since August of 2023. The MDSC stated she is responsible for the care plan meetings and to make sure the assessments are in the residents' chart. She stated there was a period of time when they were 'with no RD' but did not remember the dates. She acknowledged the RD did not attend the care plan meeting for the resident on 08/31/23. An interview was conducted on 02/07/24 at 2:45 PM with the Registered Dietician (RD) who stated she has worked at the facility for 3 months and 2 weeks full time and is leaving on 02/16/24. She stated she was a covering as the Registered Dietician when the RD would go on vacation or if the dietician had left. The last time the dietician left was maybe 5 months ago around August or September. She mainly would fill in the MDS sections. The RD stated a significant weight loss is 5% in 30 days, 7.5% in 90 days, or 10% in 180 days. The RD stated the restorative aides give her the weights for the resident on a weight sheet, monthly weights are given monthly and weekly weights are given to her weekly. She puts the weights in the chart, and she will print out the last 6 months to see if a resident has any significant weight loss. The RD stated there is no issue with residents being weighed. If a resident has weight loss, she would put interventions in place, such as appetite stimulant, supplements, or weekly weights. Nutritional assessments are done on admission and quarterly, and then annually. When asked about Resident #15, the RD stated if the resident refused her weights, she would simply put a zero in for the weight. The RD acknowledged the resident was not weighed on 10/23/23, 11/14/23, and 12/15/23. She said she would talk to the resident to encourage her to get weighed and she would ask restorative aides to try to reweigh the resident. The RD acknowledged she did not put in any notes for this. She stated the other RD would have identified significant weight loss on 08/16/23 as 16% weight loss in 30 days. The last nutrition assessment completed for Resident #15 was completed on 03/10/23. The RD stated she missed an assessment in November 2023 and the resident had missed an additional nutrition assessment before she started working at the facility. The weight for the resident on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 12 of 37 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 02/08/2024 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 0692 Level of Harm - Minimal harm or potential for actual harm 10/10/23 was 100 pounds which was a 13.6# weight loss in 60 days. She stated that for a lot of these weights, she did not have time to address them because she had just started and was trying to get caught up and she missed the significant weight loss in October, and also missed her nutritional assessment as well. She was trying to catch up on the assessments that were not done prior to her starting at the facility and putting a system in place for the weights to be put into the resident's records. Residents Affected - Few The RD acknowledged she did not address the significant weight loss for the resident in October and therefore did not put any interventions in place to address the weight loss. When asked about care plans, she said she would attend the care plan meetings. For the care plan meeting on 12/04/23, she was on vacation for a week and did not attend the 2 care plan meetings scheduled for that week. The RD stated there was no RD covering her for when she was on vacation for the week in December 2023. An interview was conducted on 02/08/24 at 3:30 PM with Resident #15 who was asked if she had been trying to lose weight, she said no, but knows she lost some weight and had put it back on recently. When asked if she refused to be weighed at times, she said she hates to get on the scale so yes, she sometimes refuses. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 13 of 37 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 02/08/2024 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Record review of Resident #67's clinical record documented an admission on [DATE] and no readmissions. The resident's diagnoses included Adult Failure To Thrive, Alzheimer's Disease, Hemiplegia and Hemiparesis following Cerebral Infarction, Vascular Dementia, Severe with other Behavioral Disturbance and Urinary Tract Infection. Residents Affected - Few Review of Resident #67's MDS annual assessment dated [DATE] showed a BIMS score was not conducted due to the resident is rarely/never understood. The resident had severe cognition impairment. The assessment documented under Functional Abilities & Goals that the resident was dependent on the staff to complete the activities of daily living (ADLs). Review of Resident #67's MDS annual assessment dated [DATE] showed a BIMS score was not conducted due to the resident is rarely/never understood. The resident had severe cognition impairment and was totally dependent on the staff to complete the ADLs. Review of Resident #67's care plan, for I am on antibiotic therapy .related to Urinary Tract Infection, initiated on 01/26/24, had an intervention to change (Midline) dressing .every 72 hours .monitor (Midline) insertion site every shift for any changes in appearance . Resident #67's physician order dated 01/25/24 documented, Insert Midline .for leukocytosis (infection) for 10 days. Resident #67's physician order dated 01/26/24 documented Change (Midline) dressing 24 hours after initial insertion; then every 72 hour every evening shift every 3 day(s) for hygiene change every 72 hours. Resident #67's physician order dated 01/25/24 documented, Ceftriaxone 1 gram intravenously every 24 hours for Urinary Tract Infection for 7 days. Resident #67's physician order dated 01/29/24 documented, Meropenem 500 milligrams intravenously every 8 hours for Urinary Tract Infection for 7 days. Review of Resident #67's February 2024 Treatment Administration Record (TAR) documented the resident's Midline dressing was changed on 02/04/24 evening. On 02/07/24 at 10:02 AM, a side-by-side review of Resident #67's Midline dressing was conducted with Staff O, Licensed Practical Nurse (LPN). Staff O stated the resident's Midline dressing on the upper right arm was not dated and it was supposed to be changed. Staff O added it was changed but was not dated. On 02/07/24 at 2:45 PM, an interview was conducted with Staff O who stated she worked on 02/04/24 evening shift and did not change Resident #67's Midline dressing that was scheduled for 02/04/24 evening. Subsequently, a side-by-side review of the resident February 2024 TAR was conducted with Staff O. Staff O was apprised that she documented that she did change the resident's dressing when she did not do it. Staff O was asked why she did not do the change as scheduled and did not answer. Based on observation, interviews, record and policy review, the facility failed to maintain (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 14 of 37 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 02/08/2024 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 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Peripherally Inserted Central Catheter (PICC) lines in a sanitary manner for 3 of 3 sampled residents reviewed for PICC lines, Residents' #67, #89, and #557. The findings included: The facility's policy, titled, PICC/Midline/CVAD Dressing Change implemented 11/28/17, revealed It is the policy of this facility to change peripherally inserted central catheter (PICC), midline or central venous access device (CVAD) dressing, weekly or if soiled, in a manner to decrease potential for infection and/or cross-contamination. 1. Resident #89 was admitted to the facility on [DATE], and readmitted on [DATE] with a Peripherally Inserted Central Catheter (PICC) line to the right upper arm for Osteomyelitis. Other documented diagnoses included Chronic Obstructive Pulmonary Disease and Pressure Ulcer of sacral region. Review of the Medicare 5-day Minimum Data Set (MDS) assessment dated [DATE] documented a Brief Interview for Mental Status (BIMS) score of 3, indicating severe cognitive impairment. On 02/05/24 at 8:55 AM, an observation of the resident's PICC line dressing was conducted during the initial screening process. The dressing was labeled with a date of 01/28/24. On 02/06/24, another observation was made of Resident #89's PICC line dressing. It was still labeled 01/28/24 and was bloody. Photographic Evidence Obtained. Review of the resident's Medication Administration Record (MAR) for February 2024 revealed no antibiotic or flushes to the PICC line were scheduled for February 2024. Review of the nursing progress note dated 02/06/24 revealed Picc line removed to right upper arm foul odor and pus noted informed .(Physician's Assistant) PA wound care consult in placed. Interview with the Director of Nurses (DON) on 02/07/24 at 1:19 PM revealed she was unaware there was a problem with Resident #89's PICC line and she would look into it. On 02/07/24, a Health Status note revealed, Resident observed with PICC line still in place. IV [intravenous] antibiotic completed 01/30/2024, flush orders completed on 01/31/2024. PICC site assessed, no pain or swelling, no redness or discoloration and no drainage observed at the site. MD [Medical Doctor] notified order received to discontinue PICC line, CBC [complete blood count], blood culture of site. On 02/07/24 at 4:00 PM, the PICC line concern was discussed with the Director of Nursing (DON). She stated the CBC was completed and the white blood cell count was improved from the last blood test dated 01/29/24. The blood culture will not be ready until 02/12/24. The DON revealed the PICC line should have been discontinued within 2 days after the antibiotic was finished which was 01/30/24. On 02/08/24 at 5:00 PM, the DON revealed that batch orders are put in the computer for PICC lines but for some reason the order for the dressing change was not put in for Resident #89 so her dressing was not changed weekly. 2. Record review for Resident #557 revealed the resident was originally admitted to the facility on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 15 of 37 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 02/08/2024 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 0694 Level of Harm - Minimal harm or potential for actual harm [DATE], with a most recent readmission of 01/29/24 with diagnoses that included: Sepsis, Urinary Tract Infection (UTI), Guillain-Barre Syndrome, Paraplegia, and Obesity. Review of the MDS assessment, dated 02/05/24, for Resident #557 revealed in Section C, a Brief Interview of Mental Status (BIMS) score of 15, indicating cognition was intact. Residents Affected - Few Review of the Physician's orders for Resident #557 revealed an order dated 01/29/24 to change PICC (Peripherally Inserted Central Catheter) dressing every 72 hours on Thursdays for hygiene. Review of the Care Plan for Resident #557 revealed there was no PICC care plan implemented. On 02/05/24 11:44 AM, observation of Resident #557 revealed the left arm PICC line was in place with a dressing that was clean, dry, intact and dated 01/29/24. An interview was conducted on 02/05/24 at 11:44 AM with Resident #557 who stated he is receiving Vancomycin and Rocephin for UTI. He said he has a PICC line, and the dressing should be changed today. An interview was conducted on 02/08/24 at 3:00 PM with Staff I, MDS Coordinator (MDSC) who acknowledged there was no care plan implemented for a PICC for Resident #557. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 16 of 37 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 02/08/2024 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 0697 Provide safe, appropriate pain management 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 observations, interviews, and record review, the facility failed to address residents' pain in a timely manner for 1 of 1 sampled resident reviewed for Pain, Resident #70. Residents Affected - Few The findings included: Review of the facility's policy, titled, Pain Management, implemented on 11/28/2017, showed the following: The facility must ensure that pain management is provided to residents who require such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the resident's goals and preferences. To help a resident attain or maintain their highest practicable level of well-being and to prevent or manage pain, the facility should recognize when the resident is experiencing pain. Record review showed that Resident #70 was admitted to the facility on [DATE] with diagnoses to include Protein-Calorie Malnutrition, Colon Cancer, and Lung Cancer. Review of the Physicians' orders revealed the following: -On 12/01/23, an order for Morphine Sulfate (pain medication), 15 milligrams, one tablet by mouth every 12 hours for severe pain. - On 11/05/23, an order for Oxycodone (pain medication), 10 milligrams, every 4 hours as needed for pain. Review of the Significant Change Minimum Data Set (MDS) dated [DATE] revealed Resident #70 has a Brief Interview of Mental Status (BIMS) score of 15, indicating cognition is intact. Section J of this MDS showed that Resident #70 is in constant pain. In an interview conducted on 02/05/24 at 9:40 AM, Resident #70 stated that he was in pain and was waiting on his pain medication. He further said that the pain medication was not given to him at the scheduled times, which was twice a day at 9:00 AM and 9:00 PM. In an interview conducted on 02/05/24 at 10:39 AM, Resident #70 stated Staff A, Licensed Practical Nurse (LPN), had just given him his pain medication (Morphine), which was scheduled for 9:00 AM. Review of the Medication Administration Audit Report revealed the following: -On 02/05/24, the Morphine medication that should have been given at 9:00 AM was given at 10:28 AM. -On 02/05/24, the Morphine medication that should have been given at 9:00 PM was given at 11:03 PM. -On 02/01/24, the Morphine medication that should have been given at 9:00 PM was given at 10:23 PM. -On 02/01/24, the Morphine medication that should have been given at 9:00 AM was given at 2:12 PM. -The Morphine medication that should have been given at 9:00 PM was given at 12:12 AM (next day). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 17 of 37 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 02/08/2024 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The care plan initiated on 12/21/23 revealed Resident #70 was at risk for pain and the pain would be reduced by the interventions put in place. Continued reviewing of the care plan showed the nurse would administer and monitor the effectiveness of the routine pain medication. In an observation conducted on 02/06/24 at 8:31 AM, Resident #70 was in bed waiting on his breakfast tray. In this observation, Resident #70 said that he has pain everywhere and that he is waiting on his pain medication (Morphine) that was supposed to be given at 9:00 AM. An interview was conducted on 02/06/24 at 1:21 PM with Staff H, Registered Nurse / RN, who stated Resident #70's pain level is around 6 to 8 levels out of 10. Before giving Resident #70's his pain medication, she would always ask him about his pain level. When asked when the Morphine medication is given for Pain, Staff H said it is given twice daily at 9:00 AM and at 9:00 PM. Interview was conducted with Director of Nursing (DON) regarding the pain on 02/06/24 at 3:20 PM, who stated that regarding pain management, she expects the nursing staff to administer pain medication and assess the pain level as well. When asked about the medications' timing, she said it is usually one hour before and one hour after the scheduled medication time. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 18 of 37 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 02/08/2024 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 observations, interviews, and record review, the facility failed to ensure that dialysis services were consistent with professional standards of practice for 1 of 1 sampled resident reviewed for dialysis (Resident #62), as evidenced by inproper hand hygiene during observation of dialysis services and not providing the correct fluid restriction as per physician orders. Residents Affected - Few The findings included: Record review revealed Resident #62 was admitted to the facility on [DATE] with diagnoses that included End-Stage Renal Disease, Type 2 Diabetes, and dependence on renal dialysis. Review of the physician's orders revealed a diet for regular texture and regular/thin consistency with 1200 fluid restriction diet. Dietary: 240 milliliters (8 ounces) with breakfast, 120 milliliters (4 ounces) with lunch, and 300 milliliters (10 ounces) with dinner. In-house hemodialysis every Monday, Wednesday, and Friday. In an observation conducted on 02/05/24 at 12:30 PM, Resident #62 was in his room with the lunch tray. Closer observation showed a lunch tray with 4 ounces of juice and 8 ounces of milk from the morning breakfast tray at the side table. In this observation, Resident #62 was asked if he was on a fluid restriction, and he said yes. Resident #62 reported that he did not know how much fluid restriction he was on for each meal, but the facility needed to be on top of it. In an observation conducted on 02/06/24 at 8:30 AM, Resident #62 was in the room with the breakfast tray. The meal ticket was noted with the following: regular, No Added Salt (NAS), liberalized protein, No Concentrated Sweets (NCS), double protein, fluid restriction, 4 ounces of milk, and 4 ounces of juice. The meal plate was noted with the following food items: double portion of eggs, toast, cereal, 4 ounces of juice, and 8 ounces of milk (not the 4 ounces of milk as per fluid restriction). In this observation, Staff T, Certified Nursing Assistant (CNA), was observed in the room pouring some of the 8 ounces of milk into Resident #62's cereal. The care plan initiated on 09/20/22 revealed the following: Communicate with the dialysis center on an ongoing basis to maintain continuity of care, and the nurse will ensure that the dialysis access site/ AV (arteriovenous) shunt or graft is checked before and after dialysis treatments. In an observation conducted on 02/07/24 at 7:45 AM, Resident #62 was preparing for the hemodialysis artery fistula connection in the dialysis room. Staff B, the patient care technician, was observed washing his hands and placing on a clean pair of gloves. He then opened the cabinet door to pull out a sanitary disposable pad with the same gloves. He put clean supplies on the clean pad and wiped the access site on Resident #62's left arm. Staff B removed his gloves and placed a new pair without practicing hand hygiene. He then wiped the sweat from his forehead with his arm and part of his gloved hand and continued with the same dirty gloves to connect the dialysis tubing to Resident #62's left arm. During this observation, Staff B did not practice hand hygiene between changing gloves. An interview was conducted on 02/07/24 at 8:40 AM with Staff C, Unit Clerk, who stated that when a resident goes to dialysis, a communication sheet is filled out. The facility fills out the first part before dialysis, the dialysis company fills out the second part of the form, and the nurse fills out the third part when the residents return from dialysis. Staff C reported that all communication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 19 of 37 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 02/08/2024 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 sheets are loaded onto the electronic system. Level of Harm - Minimal harm or potential for actual harm Review of the electronic system revealed that the last communication dialysis sheet entered the electronic system was 01/31/24. Further review of the dialysis binder located at the nurse's station showed that on the day of the dialysis treatment dated 02/05/24, the pre-dialysis treatment was completed by the facility nurse, the dialysis center information was completed by the dialysis staff, but the facility staff filled no post dialysis information after the dialysis. Residents Affected - Few In an interview conducted on 02/07/24 at 12:30 PM with Staff B, he acknowledged that he did not practice hand hygiene between glove use when going from a dirty area to a clean area. In an interview conducted on 02/08/24 at 12:51 PM, the facility's Registered Dietitian stated that for any residents on fluid restrictions, she would break down the specific number of fluids that are allocated for breakfast, lunch, dinner, and the nursing staff. The last person on the tray line oversees checking the meal trays to ensure that the correct fluids are provided accordingly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 20 of 37 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 02/08/2024 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 0712 Ensure that the resident and his/her doctor meet face-to-face at all required visits. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure physician visits were performed as required for 1 of 1 sampled resident reviewed for physician visits, Resident #76. Residents Affected - Few The findings included: Review of the facility's policy, titled, Physician Visits and Physician Delegation, with a reviewed / revised date of 11/28/23, included the following: It is the policy of this facility to ensure the physician takes an active role in supervising the care of the residents. The Medical Record personnel to track due dated of physician visits. The resident must be seen at least once every 30 calendar days for the first 90 calendar days after admission and at least every 60 days thereafter by a physician or physician delegate as appropriate by law. At the option of the physician, required visits in SNFs (Skilled Nursing Facilities), after the initial visit, may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner or clinical nurse specialist that is acting within scope of practice defined by State law and under the supervision of the physician. Record review revealed Resident #76 was originally admitted to the facility on [DATE] with the most recent readmission on [DATE]. The diagnoses included Osteomyelitis of Vertebra Sacral and Sacrococcygeal Region. Review of the Minimum Data Set (MDS) assessment for Resident #76 dated 12/23/23 revealed in Section C, a Brief Interview of Mental Status score of 15, indicating an intact cognitive response. Review of the Medicine Progress Notes for Resident #76 from 01/03/22 to 01/15/24 revealed the last time the resident was seen by the primary care physician was on 03/03/22. The review also revealed the resident was seen monthly by the ARNP (Advanced Registered Nurse Practitioner) from 04/12/23 to 01/15/24. There was no documentation of physician visits during this time period. Review of additional information provided by the facility noted the resident was seen by the ARNP on 01/05/23 and 02/13/23; and by the PA-C (Physician Assistant) on 04/02/23. There was no evidence of a visit for the month of 03/2023. During an interview conducted on 02/05/24 at 9:43 AM with Resident #76, he stated the doctor does not come in to see him or talk to him, he is only seen by the nurses. During an interview conducted on 02/07/24 at 1:30 PM with the Director of Nursing (DON) who was asked how often the physician visit residents. The DON stated the resident is seen within 72 hours of admission by the physician, then the resident is seen by the Physician's Assistant (PA) or the Advanced Practice Registered Nurse (APRN) every 30 days. When asked how often the physician visits the resident the DON stated the physician comes every other month alternating with the PA or the ARNP. An interview was conducted on 02/08/24 at 12:00 PM with the Director of Therapy / Administrator of PCC, who stated she has been helping the Medical Records department partially for the past few weeks since they no longer have Medical Record personnel. When asked how often a physician visits with a resident, she stated every 30 days for the first 90-day period, then it is every 60 days thereafter. When asked how she keeps track of when the physician visits the resident, she stated there is only (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 21 of 37 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 02/08/2024 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 0712 Level of Harm - Minimal harm or potential for actual harm 1 physician who comes to the facility, who just came in January (2024), and then he will come again in February 2024. When asked if he sees every resident each time he visits, she said she is not aware of that. When asked who keeps track of how often the physician sees a resident, she said the physician keeps track of his own schedule of which residents he sees. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 22 of 37 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 02/08/2024 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record and policy reviews, the facility failed to initiate care plans with interventions regarding the diagnosis of Trauma/Post Traumatic Stress Disorder (PTSD) in a timely manner for 1 of 1 sampled resident reviewed for Trauma, Resident #86. The findings included: A review of the facility policy, titled, Trauma Informed Care, dated 11/28/2017, revealed that the facility would ensure residents who are trauma survivors receive culturally competent trauma-informed care in accordance with professional standards of practice. Record review revealed Resident #86 was admitted on [DATE] with diagnoses of Trauma/Post Traumatic Stress Disorder (PTSD) and Muscle Weakness. The Minimum Data Set (MDS) assessment dated [DATE] showed Resident #86 has a Brief Interview of Mental Status (BIMS) score of 11, indicating intact cognition. In an interview conducted on 02/07/24 at 10:46 AM, Resident #86 stated that someone came to his house in [another country] and shot his wife to death in front of him. He was then taken away and held in a remote place for 16 days by unidentified men. He feels constant guilt after what happened and that he still has nightmares at times. Review of the hospital records dated 11/20/23 revealed Resident #86 has been suffering from PTSD symptoms of being kidnapped from a year ago. The care plan initiated on Resident #86's admission did not show that a care plan with interventions was initiated regarding Trauma/PTSD. In an interview conducted on 02/07/24 at 9:40 AM, the Director of Nursing (DON) stated when Resident #86 was admitted to the facility, the hospital records revealed that he suffered a post-traumatic experience. The DON stated they were not treating PTSD since Resident #86 was in the facility for rehab and not for treatment of PTSD. In an interview conducted on 02/07/24 at 11:22 AM with the Director of Social Services (DSS), the DSS stated when a resident is admitted to the facility with a history of trauma/PTSD, they have to make sure that a mental health professional sees them. A care plan would then be created with interventions in place. When Resident #86 was admitted to the facility, another social worker assessed the resident. The Director of Social Services stated that a psychiatrist and psychology consults were in place, but no care plan for Trauma/PTSD with interventions was ever created. In an interview conducted on 02/07/24 at 11:35 AM with Staff E, Registered Nurse (RN), stated Resident #86 still gets up at night, around 2:00 PM to 3:00 PM, looking for his wife. He then remembers she was killed in front of him. In an interview conducted on 02/07/24 at 12:20 PM, Staff J, Medical Doctor, stated Resident #86 still has symptoms with flashbacks of what happened to him in [another country]. Resident #86 is still (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 23 of 37 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 02/08/2024 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 0742 Level of Harm - Minimal harm or potential for actual harm afraid that this may happen again and that he will be kidnapped again. Staff J reported Resident #86 would benefit from psychosocial intervention and monitoring symptoms of flashbacks. Record review revealed that a care plan was initiated for a traumatic experience dated 02/07/24, after the surveyor's intervention. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 24 of 37 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 02/08/2024 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. On 02/06/24 at 9:08 AM, a medication pass was observed with Staff H, RN. Resident #70 was scheduled to receive Midodrine oral tablet 10milligrams (mg) by mouth but the nurse held (did not administer) the medication. The surveyor asked Staff H why she did not administer the Midodrine to Resident #70, who responded 'because his blood pressure was 127/85, which was normal and held it because of nursing judgement'. Staff H was asked if the physician put parameters on the medication and she stated that there were no parameters. She stated if the systolic blood pressure was below 100, she would have given the medication. Residents Affected - Few On 02/06/24 3:24 PM, an interview was conducted with the Director of Nurses (DON). This surveyor explained to the DON that Staff H held Midodrine without an order and did not call the physician when she did this. This was acknowledged by the DON on 02/07/24 at 9:14 AM who confirmed the nurse should not have held the medication without parameters and should have called the physician. Based on observation, interview, and record review, the facility failed to ensure the medication error rate was not 5 percent or greater. The medication error rate was 12% percent, 3 medication errors were identified while observing a total of 25 opportunities, affecting Residents #70 and #77. The findings included: Review of the facility's policy, titled, Medication Administration, with a reviewed date of 11/28/23, included: Medications are administered by licensed nurses, or other staff who are legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice, in a manner to prevent contamination or infection. Administer within 60 minutes prior to or after scheduled times unless otherwise ordered by physician. Administer medication as ordered in accordance with manufacturer specifications. Review of the Drug label Information at the following website provided by the Consulting Pharmacist: DailyMed - BUDESONIDE AND FORMOTEROL FUMARATE DIHYDRATE aerosol (nih.gov) included the following: 1. Breathe in (inhale) deeply and slowly through your mouth. Press down firmly and fully on the top of the counter on the BUDESONIDE AND FORMOTEROL FUMARATE DIHYDRATE INHALATION AEROSOL inhaler to release the medicine (see Figures 3 and 4). 2. Continue to breathe in (inhale) and hold your breath for about 10 seconds, or for as long as is comfortable. Before you breathe out (exhale), release your finger from the top of the counter. Keep the BUDESONIDE AND FORMOTEROL FUMARATE DIHYDRATE INHALATION AEROSOL inhaler upright and remove from your mouth. 3. Shake the BUDESONIDE AND FORMOTEROL FUMARATE DIHYDRATE INHALATION AEROSOL inhaler again for 5 seconds and repeat steps 7 to 9. After using your BUDESONIDE AND FORMOTEROL FUMARATE DIHYDRATE INHALATION AEROSOL inhaler 1. After use, close the mouthpiece cover by pushing until it clicks in place. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 25 of 37 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 02/08/2024 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 0759 Level of Harm - Minimal harm or potential for actual harm 2. After you finish taking BUDESONIDE AND FORMOTEROL FUMARATE DIHYDRATE INHALATION AEROSOL (2 puffs), rinse your mouth with water. Spit out the water. Do not swallow it. Review of the Drug label Information at the following website provided by the Consulting Pharmacist: DailyMed - VENTOLIN HFA- albuterol sulfate aerosol, metered (nih.gov) included the following: Residents Affected - Few How to use your VENTOLIN HFA inhaler Follow these steps every time you use VENTOLIN HFA. Step 1. Make sure the metal canister fits firmly in the plastic actuator. The counter should show through the window in the actuator. To take the cap off the mouthpiece, squeeze the sides of the cap and pull it straight out. Look inside the mouthpiece for foreign objects and take out any you see. Step 2. Hold the inhaler with the mouthpiece down and shake it well. Step 3. Breathe out through your mouth and push as much air from your lungs as you can. Step 4. Put the mouthpiece in your mouth and close your lips around it. Push the top of the metal canister firmly all the way down while you breathe in deeply and slowly through your mouth. Step 5. After the spray comes out, take your finger off the metal canister. After you have breathed in all the way, take the inhaler out of your mouth, and close your mouth. Step 6. Hold your breath for about 10 seconds, or for as long as is comfortable. Breathe out slowly as long as you can. 1. Record review revealed Resident #77 was admitted to the facility on [DATE] with diagnoses that included: Acute Bronchitis and Neurocognitive Disorder with Lewy Bodies. Review of the Minimum Data Set for Resident #77 dated 12/19/23 revealed in Section C a Brief Interview of Mental Status score of 4 indicating severe cognitive impairment. Review of the Physician's Orders for Resident #77 revealed an order dated 09/20/23 for Budesonide-Formoterol Fumarate Inhalation Aerosol 80-4.5 MCG/ACT (Budesonide-Formoterol Fumarate Dihydrate) 2 puff inhale orally two times a day for SOB (Shortness of Breath) Rinse mouth with water and spit back into cup after use. Review of the Physician's Orders for Resident #77 revealed an order dated 10/18/23 for Ventolin HFA Inhalation Aerosol Solution 108 (90 Base) MCG/ACT (Albuterol Sulfate) 2 puff inhale orally every 4 hours as needed for Wheezing / Shortness of Breath related to Unspecified Asthma. On 02/05/24 at 8:45 AM, during an observation of medication administration with Staff M, Registered Nurse (RN), for Resident #77, medications were administered that included: Budesonide inhaler 80/4.5mcg 2 puffs. The nurse administered the inhaler upside down, did not shake the inhaler between puffs or have the resident rinse her mouth with water and spit out the water after rinsing. The nurse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 26 of 37 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 02/08/2024 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 0759 also administered the Albuterol (Ventolin) inhaler 2 puffs via inhaler with the inhaler upside down. Level of Harm - Minimal harm or potential for actual harm An interview was conducted on 02/05/24 at 8:55 AM with Staff M, RN, who was asked if she administered the inhalers upside down, she stated she did not know the inhalers were upside down when she administered them. When asked if she needed to shake either inhaler between the 2 puffs, she said she was unsure. When asked if the resident needed to rinse her mouth and spit the water out after administration of either inhaler, she said she did not think so. When the nurse looked at the instructions on the bag for the Budesonide inhaler, she acknowledged the instructions included to rinse mouth with water and spit back into cup after use. Residents Affected - Few An interview was conducted on 02/06/24 at 10:15 AM with the Consultant Pharmacist (CP) who stated he has been a pharmacist for 21 years and has worked at the facility for 1 month. When asked about Budesonide-Formoterol Fumarate Inhalation Aerosol 80-4.5 MCG and Ventolin HFA Inhalation Aerosol Solution 108 (90 Base) MCG/ACT (Albuterol Sulfate), if they can be administered upside down, he stated there is nothing in the prescribing information about that so he felt it would not really make a difference. When asked what the Drug label Information stated for each of the mentioned inhalers, he stated it does not say. After reviewing the Drug label Information for each of the inhalers with the CP, he acknowledged the manufacturers Drug Label Information for each inhaler said specifically to administer the inhalers in the upright position. When asked if the dosage would be accurate for each inhaler if not administered in an upright position, he stated he would have to reach out to the manufacturers. After reaching out to the manufacturers, he was only able to get in touch with one of the manufacturers which was for the Budesonide-Formoterol Fumarate Inhalation Aerosol 80-4.5 MCG, and they could not say that the dose would be accurate if it was not administered as instructed in the Drug label Information. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 27 of 37 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 02/08/2024 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations and interviews, the facility failed to remove expired over-the-counter (OTC) medications from the Central Supply cabinet; failed to remove expired over-the-counter medications from 1 of 3 medication carts observed (medication cart #2-West Wing); failed to secure medications at the beside for Resident #94; and failed to ensure that 1 of 2 treatment cart was locked when unattended (West Wing treatment cart). The findings included: Review of the facility's policy, titled, Medication Storage, implemented on 11/28/17, documented, in part: it is the policy of this facility to ensure all medications housed on our premises will be stored .medication rooms .and to ensure proper .seclusion and safekeeping .all drugs and biologicals will be stored in locked compartments (i.e. medication crats, cabinets, drawers, medication rooms) unused medications: .all medication rooms are routinely inspected by the consultant pharmacist for discontinued, outdated .medications . 1. On 02/07/24 at 4:01 PM, a side-by-side review of the facility's central supply room was conducted with the Central Supply Clerk. The review revealed two bottles of Pain relief / Acetaminophen 500 milligrams/15 millimeters with an expiration date of 12/23 and one bottle of Saline Nasal Spray with an expiration date of 11/2023. The Central Supply Clerk stated she was responsible to check the medications expiration dates and did not notice those were expired. 2. On 02/08/24 at 11:58 AM, a side-by-side review of the facility's [NAME] Wing medication cart #2 was conducted with Staff M, Registered Nurse (RN). The review revealed a bottle of Vitamin E 180 microgram with an expiration date of 11/2023 and a bottle of Melatonin 1 milligram with a faded expiration date. Staff M stated she had no residents taking Vitamin E at the time of the review. Staff M stated the bottle was labeled as opened on 11/25/23. Further review of the medications cart revealed one round white loose pill at the bottom of the second drawer. During the review, Staff M stated expired medications and loose pill should not be in the cart. During an interview, on 02/08/24 at 3:01 PM, the Director of Nursing was made aware of the findings. 3. On 02/05/24 at 7:23 AM, an observation of the treatment cart noted it to be unattended by nursing staff, and unattended with multiple medications, a pair of bandage scissors, and needles across from room [ROOM NUMBER]. Photographic Evidence Obtained. An interview was conducted on 02/05/24 07:27 AM with Staff K, RN, who stated she has worked at the facility for 5 months and just started her shift today at 7:00 AM. The RN acknowledged the treatment cart was unlocked and said it should always be locked. An interview was conducted on 02/05/24 at 7:28 AM with Staff L RN, who stated she has worked at the facility for 10 months. She stated she worked the 11:00 PM to 7:00 AM shift last night and did not use the treatment cart. She stated mostly it is the wound care nurse who uses the treatment cart. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 28 of 37 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 02/08/2024 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 4. Record review revealed Resident #94 was admitted to the facility on [DATE] with diagnoses that included: Multiple Fractures of Ribs, Left Side Subsequent Encounter for Fracture with Routine Healing, Rhabdomyolysis, and Injury of Head. Review of the Minimum Data Set (MDS) assessment for Resident #94 dated 11/28/23, noted a Brief Interview of Mental Status score of 13, indicating an intact cognitive response. Review of the Physician's orders for Resident #94 revealed no order for Chlorhexidine Gluconate oral rinse 0.12%. Review of the Self Administration of Medication Assessment for Resident #94 dated 11/21/23 documented the resident is not capable of administering medications. On 02/05/24 at 11:05 AM, an observation was made of Resident #94 lying in bed with a bottle of Chlorhexidine Gluconate oral rinse 0.12% on the nightstand. On 02/06/24 at 9:00 AM, an observation was made of Resident #94 lying in bed with a bottle of Chlorhexidine Gluconate oral rinse 0.12% on the nightstand. On 02/07/24 at 11:05 AM, an observation was made of a bottle of Chlorhexidine Gluconate oral rinse 0.12% on the nightstand in the room of Resident #94 (the resident was not in the room at this time). An interview was conducted on 02/05/24 at 11:05 AM with Resident # 94 who stated she got the rinse yesterday and she is supposed to do it twice a day. She does it herself, but she is not sure where the measure cup is to know how much to use. An interview was conducted on 02/07/24 at 11:08 AM with Staff N, RN, who stated she has worked at the facility for almost 1 year. When asked if Resident #94 could have medications at the bedside she stated I don't think so, but I would have to check the resident's chart. Staff N acknowledged the Chlorhexidine Gluconate oral rinse 0.12% at the bedside and removed the medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 29 of 37 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 02/08/2024 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 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to provide an arbitration agreement that explicitly grants the resident or their representative the right to rescind the contract within 30 calendar days of signing it for 2 of 3 sampled residents reviewed for arbitration, Residents #76 and #3. Residents Affected - Few The findings included: 1. Record review showed Resident #76 was initially admitted to the facility on [DATE]. He was later discharged on 04/21/22 and readmitted again on 05/25/22. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that Resident #76 has a Brief Interview of Mental Status (BIMS) score of 15, indicating intact cognition. Continued record review showed Resident #76 signed an arbitration agreement on 09/14/21, after September 16, 2019. The arbitration agreement signed by Resident #76 did not show they had the right to rescind the contract within 30 calendar days of signing it. An interview was conducted on 02/08/24 at 8:35 AM with Resident #76, who stated he did not remember signing the arbitration agreement or having staff explain what he was signing. He further stated staff did not tell him he had the right to rescind the agreement within 30 calendar days of signing it. 2. Record review revealed Resident #3 was initially admitted to the facility on [DATE]. He was later discharged on 09/30/23 and readmitted on [DATE]. The MDS assessment dated [DATE] showed that Resident #3 had a BIMS score of 15, indicating intact cognition. Further record review revealed Resident #3 signed an arbitration contract on 04/17/23. It further showed that Resident #3 had seven days (not the required 30 days) to rescind the agreement after signing it. An interview was conducted on 02/08/24 at 11:15 AM with the facility's Director of Nursing, who stated that when residents are discharged after meeting criteria with a return not anticipated, they are considered fully discharged . If they return to the facility later, they are considered newly admitted residents. She further acknowledged that Resident #3 was discharged on 09/30/23 and admitted as a new resident on 01/10/24; and because he was discharged on 09/30/23, the record showed that a return was not anticipated. An interview was conducted on 02/08/24 at 11:29 AM with Staff G, admission Coordinator, who stated the arbitration agreement is part of the admission process. When residents get admitted to the facility, she gives them the admission packet and asks them if they want her to go over the information or let them read it themselves, and she will come back later. She then makes sure that the residents sign all the appropriate sections. Staff G reported that when residents get readmitted again, she will keep/use the admission paperwork that was completed and signed in their prior admissions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 30 of 37 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 02/08/2024 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to maintain communication with hospice, as it relates to the resident's coordinated plan of care and services, to ensure each entity is aware of their responsibilities for 1 of 1 resident reviewed for hospice (Resident #70); and failed to accurately identify a resident's services for 1 of 1 sampled resident reviewed for Hospice services, Resident #76. The findings included: 1. Review of the facility's policy, titled, Coordination of Hospice Services and End of Life Care, implemented on 11/28/2017, revealed the following: The facility maintains written agreements with hospice providers that specify the care and services to be provided and the process for hospice and nursing home communication of necessary information regarding the resident's care. The facility and hospice provider will coordinate a care plan and implement interventions per the resident's needs, goals, and recognized standards of practice in consultation with the resident's attending physician/practitioner and resident's representative to the extent possible. Record review showed that Resident #70 was admitted to the facility on [DATE] with diagnoses to include Pprotein-Calorie Malnutrition, Colon Cancer, and Lung Cancer. Review of the Significant Change Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #70 has a Brief Interview of Mental Status (BIMS) score of 15, indicating intact cognition. Section O of this MDS did not show that Resident #70 was coded on hospice care. Review of the Physician's order revealed an order for hospice consultation, which was dated 11/30/23. There was no order noted to admit Resident #70 to hospice services. The facility care plan initiated on 12/01/23 revealed the following: Resident #70 is with terminal care related to cancer. Uploading notes by hospice staff, weekly visits by hospice staff, and Certified Nursing Assistance visits twice a week. The hospice binder in the nurse's station revealed the following: a hospice visit communication from the Registered Nurse [RN] dated 12/01/23 with no other communication visits since 12/01/23. The hospice binder did not show any hospice care plans or delegation of responsibilities between the hospice and the facility. An interview was conducted on 02/06/24 at 1:21 PM with Staff H, RN, who was asked if Resident #70 was in hospice, and she said yes. She further noted that she communicates with the hospice staff by phone. Staff H reported that the hospice staff come into the facility 2 to 3 times a week, and all communication visit forms are placed in the hospice binder at the nurse's station. Staff H proceeded to show the surveyor the hospice binder on the floor. An interview was conducted on 02/06/24 at 1:40 PM with the facility's Director of Nursing (DON) who stated that a hospice binder islocated in the nursing unit. When the hospice nurse comes into the facility for the weekly visits, communication visit notes are placed inside the binder. An interview was conducted on 02/06/24 at 1:50 PM with Resident #70, who stated the hospice -Certified Nursing Assistant (CNA) comes in to see him once or twice a week, and the hospice nurse comes to see him once every two weeks. Resident #70 stated that they need to be consistent with their visits. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 31 of 37 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 02/08/2024 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 0849 Level of Harm - Minimal harm or potential for actual harm An interview was conducted on 02/06/24 at 2:17 PM with Staff I, MDS Coordinator, who stated the hospice staff will place their visits and communication sheets in the hospice binder located in the units. She further said that hospice staff were given access to the facility's electronic system and that all their notes should be uploaded to the electronic system. Staff, I further acknowledged that no hospice care plans or visits were loaded into the electronic system. Residents Affected - Few Review of the progress notes revealed a note dated 12/05/23 that the hospice nurse would see Resident #70 3 times per week. A hospice certification and plan of care provided by the director of nursing, which was after the Surveyor's interventions, revealed the following: a nursing plan of care that meets the patient's needs will be established. An interview was conducted on 02/08/24 at 5:00 PM with the Director of Nursing (DON). The DON was informed of the concern about missing documents regarding the hospice care plan and visit communication forms. 2. Record review revealed Resident #76 was originally admitted to the facility on [DATE] with the most recent readmission on [DATE]. The diagnoses included Osteomyelitis of Vertebra Sacral and Sacrococcygeal Region. Review of the Minimum Data Set (MDS) for Resident #76 dated 12/23/23 revealed in section O, hospice while a resident, is documented as 'no'. Review of the banner at the top of the Electronic Medical Record (EMR) for Resident #76 revealed Special instructions: HOSPICE. Review of the care plan for Resident #76, with an initiate date of 09/22/23 and a revised date of 01/09/24, with a focus on: I am on oxygen therapy as needed via nasal cannula. I am under Hospice services, decline is expected. The goal was for the resident to have no s/s (signs/symptoms) of poor oxygen absorption through the review date. The interventions included Change residents position every 2 hours to facilitate lung secretion movement and drainage. An interview was conducted on 02/08/24 at 3:00 PM with Staff I, MDS Coordinator (MDSC), who was asked about the special instructions: Hospice in the banner at the top of Resident #76's EMR. She said the resident is no longer on hospice services. Staff I stated the resident had a significant change MDS completed on 09/22/23 due to no longer receiving hospice services. Staff I stated she does not enter special instruction into the banner at the top of a resident's EMR. When asked about the care plan for Resident #76 that documented the resident is under Hospice services, she acknowledged the care plan was not updated to reflect the resident was no longer on hospice services. An interview was conducted on 02/08/24 at 10:15 AM with the Business Office Manager (BOM) who stated he has worked at the facility since 2007. When asked if he entered any special instructions: Hospice into the banner at the top the Resident #76's EMR, he said 'no he has never done that'. An interview was conducted on 02/08/24 at 10:19 AM with Staff Admissions Coordinator / Director of Activities who stated she has worked at the facility for 2 years and just stepped into the role as Admissions Coordinator today. She stated she had a week and a half with the Admissions Coordinator who no longer works at the facility. When asked if the Admissions Department puts any special (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 32 of 37 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 02/08/2024 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete instructions: Hospice into the banner at the top of the residents EMR, she said she is not sure, she has not had a resident admitted with hospice, and she would have to ask the Business Office. An interview was conducted on 02/08/24 at 10:27 AM with the Director of Therapy (DOT) / Administrator of PCC (type of EMR program) who stated she has worked at the facility since 2014. When asked about the special instructions: Hospice in the top of the banner in Resident #76's EMR, she said the special instructions would be driven by orders or assessments, it is not something that can manually be edited (entered or deleted). If a resident has an order for hospice that may generate the special instruction on the banner for the resident and when the order is discontinued, the special instruction would automatically be removed. When asked about the special instructions for Resident #76, the DOT/Administrator of PCC acknowledged the resident had the special instruction of hospice but is no longer receiving hospice services since 09/08/23. Event ID: Facility ID: 105237 If continuation sheet Page 33 of 37 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 02/08/2024 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide influenza and pneumococcal immunizations as required for 5 of 5 sampled residents, reviewed for immunizations, Residents #89, #87 #76, #94, and #557. Residents Affected - Few The findings included: Review of the facility's policy, titled, Influenza Vaccination, with a reviewed date of 10/15/23, included: It is the policy of this facility to minimize the risk of acquiring, transmitting, or experiencing complications from influenza by offering our residents, staff members, and volunteer workers annual immunization against influenza. Influenza vaccinations will be routinely offered annually from October 1st through March 31st unless such immunization is medically contraindicated, the individual has already been immunized during this time period or refuses to receive the vaccine. Review of the facility's policy, titled, Pneumococcal Vaccine Series, with a reviewed date of 10/15/23, included: It is our policy to offer our residents, staff, and volunteer workers immunization against pneumococcal disease in accordance with current CDC (Center for Disease Control) guidelines and recommendations. Each resident will be assessed for pneumococcal immunization upon admission. Self-report of immunization shall be accepted. Any additional efforts to obtain information shall be documented, including efforts to determine date of immunization or type of vaccine used. Each resident will be offered a pneumococcal immunization unless it is medically contraindicated, or the resident has already been immunized. Following assessment for any medical contraindications, the immunization may be administered in accordance with physician-approved standing orders. 1. Record review for Resident #89 revealed the resident was admitted to the facility on [DATE]. There was no documentation that the Influenza, or the Pneumococcal vaccine was offered, accepted, or declined in the resident's medical record. 2. Record review for Resident #87 revealed the resident was admitted to the facility on [DATE]. There was no documentation that the Influenza vaccine was offered, accepted, or declined in the resident's medical record. 3. Record review for Resident #76 revealed the resident was originally admitted to the facility on [DATE], with the most recent readmission on [DATE]. In the medical record for the resident, under the immunization tab, it was revealed Pneumococcal dose 1 and dose 2 were refused. There was no supporting documentation of a signed declination for the Pneumococcal dose 1 or dose 2. Also, in the medical record under the immunization tab, it revealed the Influenza vaccine was last refused 09/14/21 and there was no documentation of the Influenza vaccine was offered, accepted, or declined in the 2023-2024 influenza season. 4. Record review for Resident #94 revealed the resident was admitted to the facility on [DATE]. There was no documentation that the Influenza or Pneumococcal vaccine was offered, accepted, or declined in the resident's medical record 5. Record review for Resident #557 revealed the resident was originally admitted to the facility on [DATE] and most recently readmitted on [DATE]. There was no documentation that the Influenza or Pneumococcal vaccine was offered, accepted, or declined in the resident's medical record (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 34 of 37 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 02/08/2024 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 0883 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An interview was conducted on 02/06/24 at 2:15 PM with the Infection Preventionist (IP) who stated she has been at the facility for 3 years. She stated the Covid vaccine is offered on admission, and when an updated vaccine comes out, they will offer it to residents. She stated the Influenza vaccine is offered annually starting in October to March and on admission during flu season. All residents in the facility have been offered the flu (Influenza vaccine). The Pneumococcal vaccine is offered on admission and when the flu vaccine is offered annually during flu season from October to March as long as the resident is eligible for a pneumococcal vaccine. All acceptance or refusal of all vaccines (Influenza, Pneumococcal and Covid) are uploaded to the resident's chart. An interview was conducted on 02/08/24 at 1:21 PM with the Infection Preventionist (IP) who was asked about the Influenza and Pneumococcal vaccines for Resident #89. The IP acknowledged there was no documentation in the resident's record of the Influenza or Pneumococcal vaccine being offered, accepted, or declined. When asked about the Influenza vaccine for Resident #87, she acknowledged there was no documentation in the resident's chart for the Influenza vaccine being offered, accepted, or declined. When asked about Resident #76, she acknowledged there was no documentation in the resident's record of the refusal of the Pneumococcal vaccine and acknowledged there was no documentation of the influenza vaccine being offered or refused for the 2023-2024 influenza season. When asked about Resident #94, she acknowledged there was no documentation in the resident's record of the Influenza or Pneumococcal vaccine being offered, accepted, or declined. When asked about Resident #557, she acknowledged there was no documentation in the resident's record for the Influenza or the Pneumococcal vaccines being refused. The IP stated she verifies weekly for all residents on Florida Shots to see if they have had any vaccination. She said she does not necessarily routinely document if a resident has had any history of vaccines as identified on Florida shots. She said she is behind in uploading documentation of consents to the resident's charts. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 35 of 37 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 02/08/2024 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 0887 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to offer COVID-19 immunization as required for 4 of 5 sampled residents for immunizations, Residents #89, #87, #94 and #557. The findings included: Review of the facility's policy, titled, Covid-19 Vaccination, with a reviewed date of 08/04/23 included: It is the policy of this facility to minimize the risk of acquiring, transmitting, or experiencing complications from Covid-19 (SARS-CoV-2) by education and offering our residents and staff the Covid-19 vaccine. Covid-19 vaccinations will be offered to residents and staff, when supplies are available, as per CDC and/or FDA guidelines unless such immunization is medically contraindicated, the individual has already been immunized during this time period or refuses to receive the vaccine. 1. Record review for Resident #89 revealed the resident was admitted to the facility on [DATE]. There was no documentation of the Covid vaccine being offered, accepted, or declined in the resident's medical record. 2. Record review for Resident #87 revealed the resident was admitted to the facility on [DATE]. There was no documentation of the Covid vaccine being offered, accepted, or declined in the resident's medical record. 3. Record review for Resident #94 revealed the resident was admitted to the facility on [DATE]. There was no documentation of the Covid vaccine being offered, accepted, or declined in the resident's medical record. 4. Record review for Resident #557 revealed the resident was originally admitted to the facility on [DATE] most recently readmitted on [DATE]. There was no documentation of the Covid vaccine being offered, accepted, or declined in the resident's medical record. An interview was conducted on 02/06/24 at 2:15 PM with the Infection Preventionist (IP) who stated she has been at the facility for 3 years. She stated the Covid vaccine is offered on admission, and when an updated vaccine comes out, they will offer to resident. Influenza is offered annually starting in October to March and on admission during flu season. All residents in the facility have been offered the flu (Influenza) vaccine. The Pneumococcal vaccine is offered on admission and when the flu vaccine is offered annually during flu season from October to March as long as the resident is eligible for a pneumococcal vaccine. All acceptance or refusal of all vaccines (Influenza, Pneumococcal and Covid) are uploaded to the resident's chart. An interview was conducted on 02/08/24 at 1:21 PM with the Infection Preventionist (IP) who was asked about the Covid vaccine for Resident #89. The IP acknowledged there was no documentation in the resident's record of the Covid vaccine, being offered, accepted, or declined. When asked about the Covid vaccine for Resident #87, she acknowledged there was no documentation in the resident's chart for the Covid vaccine being offered, accepted, or declined. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105237 If continuation sheet Page 36 of 37 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 02/08/2024 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 0887 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete When asked about Resident #94, she acknowledged there was no documentation in the residents record for the Covid vaccine being offered, accepted, or declined. When asked about Resident #557, she acknowledged there was no documentation in the resident's record for the Covid vaccine being refused. The IP stated she verifies weekly for all residents on Florida Shots to see if they have had any vaccination. She said she does not necessarily routinely document if a resident has had any history of vaccines as identified on Florida shots. She said she is behind in uploading documentation of consents to the resident's charts. Event ID: Facility ID: 105237 If continuation sheet Page 37 of 37