Inspection·July 31, 2025

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few pressure and post treatment reactions. In an interview with Staff B, on 07/31/25 at 3:33 PM, she was asked why she did not take the resident's vital signs and lung sounds after providing the treatment this morning, and responded, she was so busy and had to attend to another resident. 2) Record review revealed Resident #92 was admitted to the facility on [DATE] with diagnoses that included Obstructive and Reflux Uropathy, Generalized Muscle Weakness, Urinary Retention with Chronic Indwelling Urinary Catheter, Urinary Tract Infection, Communication Deficit, and Chronic Obstructive Pulmonary Disease. Review of the most recent Minimum Data Set (MDS) assessment, under Section C revealed a Brief Interview of Mental Status (BIMS) score of 6 indicating Resident #92 had severe cognitive impairment. Review of physician orders dated 02/13/25 documented orders as, Ipratropium-Albuterol solution 0.5-2.5 (3 MG per 3 mL), give 1 vial, to inhale orally two times a day. An observation on 07/28/25 at 10:45 AM revealed a nebulizing treatment machine on top of Resident #92's bedside drawer that had an electrical safety inspection due date of 05/2024. It was revealed that the last inspection was on 05/2023. In an interview with Staff B, an RN on 07/31/25 at 9:35 AM, when she was asked who is responsible for maintaining and cleaning the nebulizing machine, she responded, The maintenance staff cleans and checks them, but I do not know how often they do them. In an interview with Staff D, Life and Safety Coordinator on 07/31/2025 at 2:53 PM. she stated the last inspection of all respiratory equipment was done on May 31, 2025, and that nebulizing machine must have been missed by the staff for Resident #92. This surveyor provided her with the name and the serial number of the nebulizing machine, but this staff could not locate the machine from her list. She asked where this resident was in the facility so she could inspect the nebulizing treatment machine. Resident #92's room number was provided to Staff D. 3) Record review revealed Resident #156 was admitted to the facility on [DATE] with diagnoses that included Acute Gastric Ulcer with Perforation, Absolute Glaucoma, Generalized Muscle Weakness and Chronic Obstructive Pulmonary Disease with Acute Exacerbation. Review of the most recent Minimum Data Set (MDS) assessment, dated 04/28/25, revealed under Section C of the Brief Interview of Mental Status (BIMS) revealed a score of 7, indicating Resident #156 had severe cognitive impairment. Section O revealed a no response for C1 or oxygen therapy, indicating Resident # 156 was not receiving oxygen therapy. Review of the physician order dated 12/04/24 documented oxygen at 2 Liters per minute via nasal cannula. Another order dated 02/03/25, documented Ipratropium Albuterol solution 0.5 -2.5, 3 MG per 3 ml, inhale orally every 4 hours as needed for shortness of breath or wheezing via nebulizer. An additional review of physician's orders revealed there were no orders for care and maintenance related to oxygen therapy supplies, and nebulizing treatment supplies. Review of the July 2025 Medication Administration Record (MAR) revealed Ipratropium Albuterol solution 0.5 -2.5, 3 MG per 3 ml, inhale orally every 4 hours as needed for shortness of breath or wheezing via nebulizer were administered to Resident # 156, as indicated by Nurses' initials, and check marks on the following dates and times: 07/0525 at 12:46 PM, 07/08/25 at 5:28 PM, 07/12/25 at 9:14 PM, and 07/14/25 at 4:53 PM. Further review revealed that there was no July 2025 MAR documentation for the administration of oxygen therapy at 2 Liters per minute as ordered. There was also no documentation for the care and management of oxygen therapy supplies and nebulizing treatment supplies. During an observation conducted on 07/28/25 at 10:26 AM, Resident #156's nebulizing treatment tubing and mask were attached to the machine on top of the bedside table. The tubing was undated, the plastic bag containing the face mask was undated. The resident was wearing oxygen at 2 liters per minute. The oxygen tubing was dated 07/26/25, and the oxygen concentrator had an electrical inspection date tag of 05/25. During another observation conducted on 07/29/25 at 12:33 PM, it was noted the nebulizing therapy supplies were on top of the bedside table. The tubing was undated and the plastic bag containing the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105255 If continuation sheet Page 2 of 12 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 105255 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John Knox Village of Pompano Beach 700 SW 4th Street Pompano Beach, FL 33060 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete face mask was undated. In an interview with Resident #156's private aide on 07/29/25 at 12:44 PM, she stated the resident has not been using the nebulizing treatment for a while. When asked if the facility staff store the nebulizing treatment supplies inside the bedside drawer, she responded that she always sees it on top of the bedside drawer. In an interview conducted with Staff B, on 07/31/2025 at 9:10 AM, when asked for the care and management of nebulizing therapy supplies, she responded, The nebulizing tubing is changed every Sunday, and labelled with a date. The nebulizing treatment and supplies are washed and dried after treatment and stored inside a plastic bag and labelled with a date. The plastic bag is then kept in the resident's bedside drawer. When she was asked if the care and management of oxygen therapy and nebulizing therapy supplies are all documented by Nurses, she responded, Yes, Nurses document them all in the MAR according to the doctor's orders. Event ID: Facility ID: 105255 If continuation sheet Page 3 of 12 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 105255 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John Knox Village of Pompano Beach 700 SW 4th Street Pompano Beach, FL 33060 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 policy review, interviews and record reviews, the facility failed to follow the professional standards of practice regarding following physician orders of not taking blood pressure (BP) on the left arm for 1 of 1 sampled dialysis resident (Resident #9). The facility also failed to follow the physician order for fluid restriction for 1 of 1 sampled dialysis resident (Resident #9). The findings include: Review of a facility policy titled, Dialysis Care and Services, undated, revealed that elder guests who require dialysis receive such care and services consistent with professional standards of practice, the comprehensive person-centered care plan, and the elder's guest's goals and preferences. Record review revealed Resident #9 was admitted to the facility on [DATE] with diagnoses that included Metabolic Encephalopathy, End Stage Renal Disease (ESRD), and Dependence on Renal Dialysis. Review of the quarterly Minimum Data Set (MDS) assessment, dated 07/08/25, documented under Section C of the Brief Interview of Mental Status (BIMS) revealed a score of 12, indicating Resident #9 had moderate cognitive impairment. Review of a physician's order dated 02/07/25 revealed the following: no blood pressure (BP) on left arm every shift. Review of the nursing care plan revealed an ESRD focus, a goal that Resident #9 will remain free from discomfort or further complications related to renal dialysis and hemodialysis, and an intervention to not use the access site to take blood pressure every shift. An additional record review of the nursing weekly assessment dated [DATE] revealed Staff B, Registered Nurse (RN), took Resident #9's Blood Pressure (BP) on the left arm. A further review of the electronic health record (EHR) revealed from 05/25 until 06/25, nursing staff documented that the BP was taken during the following morning and afternoon hours using Resident #9's left arm: 05/01/25 at 8:20 AM, while this resident was sitting, documented by Staff B, RN. 05/08/25 at 9:52 AM, while this resident was sitting, documented by Staff B, RN. 05/13/25 at 9:56 AM, while this resident was lying, documented by Staff K, LPN (Licensed Practical Nurse). 05/15/25 at 12:35 PM, while this resident was sitting. 05/29/25 at 09:40 AM, while this resident was sitting, documented by Staff B, RN. 05/30/25 at 4:16 PM, while this resident was sitting, documented by Staff B, RN. 06/08/25 at 10:12 AM, while this resident was lying, documented by Staff K, LPN. 06/09/25 at 4:46 PM, while this resident was lying, documented by Staff K, LPN. 06/10/25 at 9:33 AM, while this resident was lying, documented by Staff K, LPN. 06/12/25 at 09:31 AM, while this resident was sitting, documented by Staff B, RN. 06/21/25 at 3:37 PM, while this resident was sitting, documented by Staff B, RN. In an interview conducted with Staff K, (LPN) on 07/30/25 at 11:00 AM, she stated that Nurses do not take BP on the left arm of Resident #9. When asked if she documents what elder's arm she uses during BP monitoring, she stated she documents in PCC (EHR), and she uses the right arm. She stated that only Nurses take the BP readings and complete the BP documentation in PCC. In an interview conducted with the Nurse Educator on 07/30/25 at 3:33 PM, when he was asked about the professional standards for a resident receiving dialysis treatment, responded BP must not be taken on the arm where dialysis access site is located. When he was shown the Nurses' BP documentation for Resident #9 in the EMR, he confirmed that Resident #9's BP readings were taken on the left arm in May and June 2025 based on Nurses' documentation in the EMR. In an interview conducted with Staff B, RN on 07/31/25 at 11:00 AM, when asked about BP monitoring of an elder on dialysis, she responded, The BP is not taken on the dialysis site. When asked if she documents what site she uses during BP monitoring, she responded, Yes, I document in PCC the elder's' arm I use to take the elder's BP. A computerized record review on 07/31/25 at 2:40 PM revealed the following physician orders dated 02/19/24 as follows: Fluid restriction: 7 PM-7 AM Shift, Med Pass at 9 PM of 120 ml, Med Pass at 6:30 AM of 60 ml, with a total of 180 ml every night shift. Fluid Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105255 If continuation sheet Page 4 of 12 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 105255 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John Knox Village of Pompano Beach 700 SW 4th Street Pompano Beach, FL 33060 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Restriction: 7AM-7 PM Shift Med Pass at 8 AM of 120ml for Breakfast, Nepro 240 ml for Lunch, 240 ml Med Pass at 2 PM, 60 ml Med Pass at 5 PM, and 120 ml for dinner, for a total of 1,020 ml everyday shift. On 2/21/25, an additional Fluid Restriction order revealed:1200 ml per day, diet regular texture, thin consistency, See orders for fluid breakdown per shift. Review of the nursing care plan dated 04/01/24 revealed the resident is at risk for dehydration or potential fluid deficit related to fluid restriction. The interventions included educating the resident/family/caregivers on importance of fluid intake. Review of a document titled, Task: Nutrition, how many ccs (cubic centimeter) did the resident consume with the meal?, submitted by the Registered Dietician (RD) and the DON on 07/30/25 at 3:30 PM revealed Resident #9's daily fluid consumption: On 7/17/25 =400, 400, 120 = 920 (cc/centimeter) (ml/milliliters) On 7/18/25 =8, 8, 500= 516 cc. On 7/19/25=240, 60 = 300 cc. On 7/20/25= 8, 8, 60= 76 cc. On 7/21/25= 240, 240, 60=40 cc. On 7/22/25=220, 220, 240=680 cc. On 7/23/25=8,8,60= 76 cc. On 7/24/25=8,8, 240=256 cc. On 7/25/25= 8,8, 240=256 cc. On 7/26/25=220,280,60=60 cc. On 7/27/25=280,220,60=560 cc. On 7/28/25=8,8,60=76 cc. On 7/29/25=120,120,120=360 cc. On 7/30/25=8 cc. The above daily fluid consumption of Resident #9 did not follow the physician orders for fluid restriction of 1200 ml per day. In an interview conducted with Staff L, CNA, on 07/31/2025 8:39 AM, when asked if she documents the fluid intake of residents, she responded, Yes, I document in PCC (EMR) under the task section. When asked how she documents the fluid consumed by residents for breakfast, she responded, I document like 240 ml for 1 glass of fluid, as she pointed at an empty glass obtained from one resident's meal tray. In an interview conducted with Staff B, RN, on 07/31/25 at 9:35 AM, when asked how she documents the amount of fluid consumed by a resident on fluid restriction, she responded that she documents the medications with the amount of fluid provided to the resident. She added that she documents in the nursing progress notes, and she reminds the CNAs to follow the fluid restriction orders. She added that she checks and verifies the CNA's documentation of the amount resident's fluid intake are under the task section of the POC. When she was asked about the unit of measurement the facility staff use in documenting the resident's fluid intake, she responded, The CNA she works with document in ml or in cc. Event ID: Facility ID: 105255 If continuation sheet Page 5 of 12 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 105255 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John Knox Village of Pompano Beach 700 SW 4th Street Pompano Beach, FL 33060 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to follow the approved menu for substitutions for residents with orders for mechanically altered diets for 3 of 27 sampled residents with orders for mechanical soft diets (Resident #18, #178 and #182). The findings included:Record review revealed the approved menu for the lunch meal on 07/28/25 documented that residents with orders for Mechanical Soft textures were to be served three-bean salad in place of coleslaw. The approved menu for the breakfast meal on 07/29/25 documented that residents with orders for Mechanical Soft textures were to be served bite sized sausage patties in place of bacon strips 1. Resident #178 was admitted to the facility on [DATE]. According to the resident's admission Evaluation, with a reference date of 07/23/25, Resident #178's cognition was documented as ‘Alert and lethargic', with unclear speech and was ‘sometimes' able to understand. The assessment documented that the resident was dependent upon staff for all activities of daily living (ADLs). Resident #178's diagnoses upon admission included: Metabolic Encephalopathy, Dysarthria following Cerebrovascular disease, DM (Diabetes Mellitus), COPD (Chronic Obstructive Pulmonary Disease), fracture of shaft of right tibia and patella, Acute Embolism and Thrombosis of left Femoral Artery, Myocardial infarction, Rheumatoid arthritis, Spinal stenosis, Radiculopathy of cervical region, GERD (Acid Reflex), Sepsis, Paroxysmal atrial fibrillation, Presence of Cardiac Pacemaker, Hearing loss bilateral, Dementia, Hypertension, Hyperlipidemia, Heart failure, Dysphagia, Iron Deficiency Anemia. The admission Assessment documented, Resident is not capable of understanding/contributing to/making his/her own plan of care Resident #178's Baseline care plan, with a reference date of 07/24/25 documented:I am at risk for an alteration in my nutrition and hydration status.Goal: I will have no significant weight changes and will remain adequately hydrated through the next review date.Interventions:Provide my diet as orderedHave my food preference discussed as neededI need assistance with meals Resident #178's diet orders included:Regular diet, Mechanical Soft Bite size texture, Thin consistency - 07/24/25 1a. During an observation of the lunch meal served on the Orchid unit (2200 unit), on 07/28/25 at 1:04 PM, Resident #178 was served a side of cole slaw in a bowl instead of the three bean salad that was on the menu as a substitute for the cole slaw based on the resident's diet order. During an interview at the time of the observation, Staff I, Cook, stated that she was unable to communicate with Resident #178 due to being deaf and stated that she was unaware of the order for Mechanical soft Bite Size texture foods. 1b. During an observation of breakfast on the Orchid Unit, on 07/29/25 at 8:45 AM, Resident #178 was served intact bacon strips instead of the bite sized sausage pattie that was on the menu as a substitute for the bacon based on the resident's diet order. During an interview, at the time of the observation, Staff J, [NAME] stated that she was not aware of the order for Mechanical Soft and bite-sized texture. During an interview, on 07/29/25 at 8:50 AM, the Speech Language Pathologist (SLP) acknowledged that the intact bacon is not safe for someone with orders for Mechanical Soft texture foods. 2. Record review revealed Resident #18 was admitted to the facility on [DATE]. According to the resident's most recent complete assessment, a Significant change Minimum Data Set, with a reference date of 07/12/25, documented Resident #18 had a Brief Interview for Mental Status score of 12, indicating a moderate cognitive impairment. The assessment documented that Resident #18 required ‘supervision or touching assistance' for eating. Resident #18's diagnoses at the time of the assessment included: Cancer, Atrial fibrillation, Heart failure, Hypertension, Gastro-esophageal Reflux disease (GERD, Benign prostatic hyperplasia, Hyperlipidemia, Depression, Chronic lung disease, Muscle weakness, Dysphasia, Cognitive communication deficit, Need for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105255 If continuation sheet Page 6 of 12 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 105255 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John Knox Village of Pompano Beach 700 SW 4th Street Pompano Beach, FL 33060 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete assistance with personal care and Presence of cardiac pacemaker. Resident #18's diet orders included:Mechanical Soft Bite Size - May have bacon - 06/05/25 with a revision date of 07/08/25. During an observation of lunch served on the Orchid unit, on 07/28/25 at 1:04 PM, Resident #18 was served a bowl of cole slaw instead of the three-bean salad that was on the menu as a substitute for the cole slaw based on the resident's diet order. During an interview, on 07/29/2025 8:50 AM, with the SLP, when asked about residents with orders for mechanical soft bite sized textures being served cole slaw, the SLP stated that the cole slaw would be fine for residents. During an interview, 07/30/25 at 3:00 PM with Staff H, Registered Dietitian, when asked about cole slaw and bacon strips being served to residents with orders for Mechanical Soft and bite sized foods, Staff H replied, Residents with Mechanical soft orders should not be served raw crunchy vegetables, the extension says 3-bean salad. 3. Resident #182 was admitted to the facility on [DATE]. According to the resident's admission assessment, with a reference date of 07/25/25 documented, Resident #182 was alert and oriented, with clear speech and able to understand. Resident #182's baseline care plan, with a reference date of 07/26/25 documented that the resident required extensive assistance for eating. Resident #182's diagnoses upon admission included: Anemia, Urinary Tract Infection, Hyperlipidemia, Hypertension, Epigastric pain, Acute Kidney failure, Benin prostatic hyperplasia. Resident #182's diet orders included:Mechanical Soft Bite size texture - 07/25/25 During an observation of breakfast on the Orchid unit, on 07/29/2025 8:45 AM, Resident #182 was served intact bacon instead of the mechanical soft and bite sized sausage pattie that was on the menu as a substitute for the bacon based on the resident's diet order. During an interview at the time of the observation, Staff J stated that she was not aware of the resident's diet orders. During an interview, on 07/29/2025 at 8:50 AM, with the SLP, when asked about being served the intact bacon, the SLP stated, he is on a mechanical soft and thin liquids. I noticed that he did have bacon when I sat down with him. I can use it as a PO (by mouth) trial. He just came in. He is not supposed to get bacon. Event ID: Facility ID: 105255 If continuation sheet Page 7 of 12 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 105255 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John Knox Village of Pompano Beach 700 SW 4th Street Pompano Beach, FL 33060 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to provide the correct diet consistency for the Mechanical Soft diet for 3 of 3 sampled residents reviewed for Nutrition (Resident #32, Resident #177 and Resident #162).The findings included:1. Record review revealed Resident #32 was admitted to the facility on [DATE] with diagnoses of Parkinsons Disease without Dyskinesia and Chronic Obstructive Pulmonary Disease. The admission Medicare - 5 Day Minimum Data Set (MDS) assessment dated [DATE] revealed that the resident's Brief Interview of Mental Status (BIMS) score was 13, which indicates intact cognition.A review of physician orders dated 07/14/25 revealed the following: Regular diet, Mechanical Soft Ground/Moist texture and thin consistency.In an observation conducted on 07/28/2025 1:00 PM, this surveyor observed that Resident #32's meal tray consisted of a chopped crispy fish sandwich. The bread was cut into two triangular pieces without borders.2. Record review revealed that Resident #177 was admitted to the facility on [DATE] with diagnosis of orthopedic aftercare and displaced intertrochanteric fracture of left femur. The Discharge Return Not Anticipated /End of PPS Part A Stay Minimum Data Set (MDS) assessment dated [DATE] revealed that the resident's Brief Interview of Mental Status (BIMS) score was 12, which indicates mild cognitive impairment.A review of physician orders dated 07/21/25 revealed the following: Regular diet, Mechanical Soft Ground/Moist texture, thin consistency.In an observation conducted on 07/28/2025 at 1:07 PM, this surveyor observed that Resident #177's meal tray consisted of a soup and an entire slice of bread with borders of which the resident had already taken one bite. 3. Record review revealed that Resident #162 was admitted to the facility on [DATE] and discharged on 07/28/2025 with diagnosis of metabolic encephalopathy and anemia. The admission /Medicare - 5 Day Minimum Data Set (MDS) dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score is 10, which indicates moderate cognitive impairment.A review of physician orders dated 05/27/25 revealed the following: Regular diet, Mechanical Soft Ground/Moist texture, thin consistency.In an observation conducted on 07/28/2025 at 12:49 PM, this surveyor observed that Resident #162's meal tray consisted of big chunks of pear, chopped breaded fish and 2 slices of bread cut in half.In an interview conducted on 07/30/2025 at 3:00 PM with Staff H, Registered Dietitian stated that the breading on the fish is flaky and thin, not fried but baked. The fish comes precooked for any diet. Staff H explained that mechanical soft diets should be cut in bite size. When asked about the fish meal that was served to the residents with orders for mechanical soft, Staff H stated that sandwiches should be cut into bite sized pieces. Event ID: Facility ID: 105255 If continuation sheet Page 8 of 12 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 105255 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John Knox Village of Pompano Beach 700 SW 4th Street Pompano Beach, FL 33060 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to follow the standards or transmission-based precautions for 1 of 3 sampled residents for nebulizing therapy (Resident # 96), for 1 sampled resident for gastrostomy tube feeding (Resident #63), and for 1 of 2 sampled residents reviewed for urinary care (Resident #138). The facility additionally failed to initiate Enhanced Barrier Precautions (EBP) for 1 of 3 sampled residents (Resident #9). The facility also failed to follow its own appearance policy regarding wearing false and polished fingernails for 3 of 3 sampled residents (Resident #96, Resident #138, and Resident #9). The findings include:The findings included: A review of facility's policy titled, Nebulizer Therapy, undated, revealed the following:It is to be administered by nursing staff as directed using proper techniques and standard precautions. [NAME] gloves and other personal protective equipment (PPE) as needed to comply with standard or transmission-based precautions (5).Disassemble and rinse the nebulizer with sterile or distilled water and allow air to dry (16).Wash hands before handling the equipment (#3 on Care of equipment). A review of Center for Medicaid and Medicaid Services (CMS) guidelines for feeding tube revealed the following:Using universal precautions and clean technique and following the manufacturer's recommendations when stopping, starting, flushing, and giving medications through the feeding tube.Ensuring the cleanliness of the feeding tube, insertion site, dressing (if present) and nutritional product.https://www.cms.gov/Medicare/Provider-Enrollment-and Certification/Survey Certification Gen Info /Info/Downloads/CMS-20093-T: ube-Feeding The Center for Disease Control and Prevention (CDC) revealed that Enhanced Barrier Precautions are recommended for residents with indwelling medical devices or wounds, who do not otherwise meet the criteria for Contact Precautions, even if they have no history of MDRO colonization or infection and regardless of whether others in the facility are known to have MDRO colonization.This is because devices and wounds are risk factors that place these residents at higher risk for carrying or acquiring a MDRO and many residents colonized with a MDRO are asymptomatic or not presently known to be colonized.https://www.cdc.gov/long-term-care-facilities/media/pdfs/enhanced-barrier-precautions-sign-P.pdf An additional review of facility's policy titled, Appearance (Human Resources) , undated, revealed the following:The purpose is to create a real home environment by dressing appropriately while maintaining a safe atmosphere.The guiding principles included:Fingernails must always be kept trimmed and clean.If false or polished fingernails are worn by colleague, the colleague must wear a pair of disposable gloves at times while working. 1) A record review revealed Resident # 96 was admitted to the facility on [DATE] with the diagnoses that included Presence of Cardiac Pacemaker, Hypertension, Hypothyroidism, and Facial Weakness following Non-Traumatic Intracerebral Hemorrhage. A review of a physician order dated 04/10/24, documented Ipratropium Albuterol solution 05.-2.5 {(3 mg (milligram) per 3 ml (milliliters)}, 1 vial, inhale orally three times a day for wheezing, During an observation conducted on 07/31/25 at 8:45 AM, Resident #96 was observed alone in the room while receiving nebulizing treatment. She was positioned upright, with a pillow under knees. A few minutes later, Staff B, Registered Nurse (RN) came in on 07/31/25 at 8:51 AM. She stated she just started the treatment a few minutes ago. When she was asked if she must stay in the room with a resident who is receiving nebulizing treatment, she responded that she stepped out to check on another resident. She added that she usually stays with the residents during the 15-minute treatment. When the treatment was completed on 07/31/25 at 9:27 AM, Staff B, RN, without performing hand washing, took the mask from the resident's face wearing no PPE like a pair of gloves. With long nails, she held the nebulizing treatment face mask, went directly into Resident #96's bathroom and started to look for a bottle of distilled water. When she did not find Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105255 If continuation sheet Page 9 of 12 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 105255 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John Knox Village of Pompano Beach 700 SW 4th Street Pompano Beach, FL 33060 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few one, she took 2 pieces of paper and placed them under the bottom part of the face mask, while the part that touched the resident's face was exposed to air. She went out of resident's room and travelled the hallway, until she arrived at an office where Narcotic Medications and a refrigerator were kept.With face mask on left hand, she used her right hand to search for a key from her scrub uniform to open the locked refrigerator. The face mask touched both the outside and the inside of the refrigerator, while Staff B, RN was searching for a bottle of distilled water. The Director of Nursing (DON), who was standing at the doorway, went inside the Narcotic Medication room and placed a stethoscope next to the refrigerator on 07/31/25 at 9:30 AM. Staff B, RN picked up the stethoscope. With no distilled water on hand, Staff B went back inside Resident #96's room on 07/31/25 at 9:31 AM. She was still holding the face mask up, exposing it to air and without wearing PPE gloves. She used the sink's tap water to rinse the nebulizing face mask, without PPE gloves. She placed the mask inside a plastic bag after drying it with paper towels. She performed hand hygiene. She then went to her computer and typed something. In an interview with Staff B, RN on 07/31/25 at 3:05 PM, when she was asked the nursing standards of care post nebulizing treatment, she responded, I forgot something. When she was asked what she forgot, she did not answer. When she was asked if they were allowed to wear long nails without gloves while performing resident's care, she did not respond. 2) A record review revealed Resident #63 was admitted to the facility on [DATE] with diagnoses that included Traumatic Hemorrhage of Cerebrum, Cerebrovascular Disease, Aphasia and Dysphagia following Cerebral Infarction, Gastroesophageal Reflux Disease without Esophagitis and Flaccid Hemiplegia affecting Right Dominant Side. A review of recent Minimum Data Set (MDS) assessment, dated 07/11/25, under Section C of the Brief Interview of Mental Status (BIMS), revealed a score of 00 indicating Resident #63 had severe cognitive impairment. A record review of physician's orders dated 7/17/25 revealed enteral feed three times a day for supplement. During an observation conducted on 07/31/25 at 09:38 AM, Staff B, an RN performed hand washing after informing Resident #63 and his wife that she would administer feeding through the gastrostomy tube (G-tube). Staff B, RN was observed with long fingernails and without PPE gloves while she prepared Resident #63's medications to be administered via G-tube. On 07/31/25 at 9:50 AM, Staff B, an RN disinfected the bedside table using a drop of hand sanitizer and a paper towel. She placed paper towels on the table and placed all her medications and feeding supplies on top. She disinfected the bell and the diaphragm of the stethoscope using an alcohol pad. She did not cleanse the stethoscope's tubing. Staff B, RN performed hand hygiene and donned PPE gloves, and gown, then raised Resident #63's head up at about 45-degree angle. Staff B, an RN auscultated the 4 quadrants of the abdomen and listened to bowel sounds. She did not clean the G tube surrounding areas and the G- tube itself after abdominal auscultation. Staff B, RN connected the [NAME] syringe to the end tip of Resident #63's G-tube. She aspirated stomach contents without first performing disinfection of the G tube tip on 07/31/25 at 10:12 AM. She performed the G- tube feeding. After 237 ml (milliliters) of Glucerna feeding was completed, Staff B, an RN did not clean the tip of G-tube, or the site around it. She covered Resident #63 with a blanket and lowered the resident's bed closer to the ground. She stated she was done with G-tube feeding on 07/31/25 at 10:25 AM. In an interview with Staff B, an RN outside the resident's room on 07/31/25 at 10:26 AM, when she was asked why she did not clean the surrounding areas and the G-tube itself before and after feeding, she did not respond. In an interview with the Nurse Educator on 07/28/25 at 2:00 PM, he stated that all facility staff attended the mandatory in-service which included infection control and prevention. He added that the facility follows the recommended Center for Disease Control and Prevention (CDC) guidelines for residents with G-tube, urinary catheter and wounds. He added that staff were in-serviced regarding standard (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105255 If continuation sheet Page 10 of 12 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 105255 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John Knox Village of Pompano Beach 700 SW 4th Street Pompano Beach, FL 33060 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few precautions and EBP. 3) Record review revealed Resident #9 was admitted to the facility on [DATE] with diagnoses that included Metabolic Encephalopathy, End Stage Renal Disease (ESRD), and Dependence on Renal Dialysis. A review of quarterly Minimum Data Set (MDS) assessment dated [DATE] under Section C of the Brief Interview of Mental Status (BIMS) revealed a score of 12, indicating moderate cognitive impairment. A review of physician order dated 07/22/25 revealed cleanse skin abrasion to left upper arm with normal saline, pat dry, skin prep applied to peri-wound, Medi honey to wound bed, cover with dry dressing. A further record review of an older physician order dated 05/08/25 revealed the following: mild bleeding from access site (post dialysis) can be expected. For mild bleeding, reinforce pressure dressing, for major bleeding from access site, apply pressure to insertion site and contact dialysis center. During a review of nursing progress notes dated 07/21/25, it revealed Resident# 9 returned from dialysis appointment. The Intravenous (IV) site with dry, intact dressing. Bruit and thrill presence at left arteriovenous (AV) fistula. A review of nursing care plan revealed Resident #9 had large skin tears to left lower leg, left upper arm, and right upper extremity, but there was no care plan for EBP. During an observation conducted on 07/29/25 at 12:16 PM, Staff G, Certified Nursing Assistant (CNA) was mixing and stirring juices on the kitchen counter. She was observed not wearing PPE gloves and her fingernails were long. Staff G did not perform hand hygiene after juice preparation. She poured the juice into cups, touched a plastic bag, and a microwave handle, then gave the juice to Resident #9 and the resident next to her. During another observation conducted on 07/29/25 at 1:37 PM, Resident #9 was observed with dressings on both lower legs, and discoloration on right lower dorsal arm. During another meal preparation observation and interview conducted on 07/30/25 at 12:12 PM, Staff G, CNA was observed with long fingernails about 1.5 inches from the nail edge and was not wearing gloves while mixing and stirring juices. When she was asked if Staff are allowed to have long nails without gloves while preparing meals in the kitchen, she did not respond. IIn an interview with the Nurse Educator on 07/30/25 at 3:15 PM, he confirmed that dialysis shunt or fistula is not accessed by facility staff so there is no reason for the resident to have EBP. In an interview with the Infection Control Nurse on 07/30/25 at 3:20 PM, she confirmed that there is no EBP for Resident #9, because the dialysis site is not accessed by the facility staff. 4) Record review revealed Resident #138 was admitted to the facility on [DATE] with diagnoses that included Parkinson's Disease without Dyskinesia without mention of fluctuations, Reflex Neuropathic Bladder, Acute Kidney failure with Tubular Necrosis, and Vascular Dementia. A record review of a physician order dated 7/02/25 revealed EBP every day and every night shift.Another physician order dated 7/29/25 revealed to change the supra pubic site daily with normal saline, pat dry, and cover with split gauze. During a urinary care observation conducted on 07/31/25 from 1:19 PM until 2:08 PM with Staff C, RN, it was revealed that she was wearing long fingernails which were about 1.5 inches from the end tip of the nail bed.Staff C, RN donned gloves without performing hand hygiene, then opened the gauze sponges on top of the table.After assembling the supplies, Staff C, RN had difficulty tying the PPE gown, that she left the back top part open and loose. Several times during the urinary dressing change, the PPE gown's top part kept going down on her chest, exposing her scrub uniform.Staff C, RN kept re-adjusting and fixing the top part of the PPE gown, using the same gloves while performing urinary dressing change for Resident # 138. When the split dressing was applied to the top of the suprapubic catheter, Staff C, RN had difficulty applying the tape, so she decided to remove her gloves, exposing her long fingernails. Staff performed hand hygiene and stated, I just washed my hands, and I will not put on gloves. With no PPE gloves, Staff C, RN touched the top part of PPE gown to re-adjust it again closer to her neck.When the urinary dressing care was completed on 07/31/25 at 2:02 PM, Staff C (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105255 If continuation sheet Page 11 of 12 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 105255 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John Knox Village of Pompano Beach 700 SW 4th Street Pompano Beach, FL 33060 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete with no PPE gloves, lowered resident's bed using the bed control. She also touched the call light button, and resident jacket's top portion. She proceeded to close the red bag with all the discarded and used dressing supplies and placed it inside a big red container. Without performing hand hygiene, she gathered the unused dressing supplies and returned them inside Resident #138's medicine cabinet. She also touched the used white towel with bare hands and placed it inside the hamper. When she was asked why she decided to not wear PPE gloves while securing the tape on resident's lower abdominal area, she stated, I kept on ripping the gloves. When she was asked if staff are allowed to wear long fingernails, she did not respond first, then stated, No, on 07/31/25 at 2:08 PM. Event ID: Facility ID: 105255 If continuation sheet Page 12 of 12