Inspection·December 2, 2021

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to provide fingernail care for 4 of 4 sampled residents, observed for activities of daily living, Residents #20, #33, #28, and #58. Residents Affected - Few The findings included: Review of facility policy, titled, Care of Fingernails / Toenails, with a revision date of October 2020, revealed the purposes of this procedure are to clean the nail bed, to keep nails trimmed, and to prevent infections. Steps in the procedure included gently, remove the dirt from around and under each nail with an orange stick, do not trim nails below the skin line or cut the skin, trim fingernails in an oval shape and toenails straight across. Documentation included the following information should be recorded in the resident's record: the date and time that nail care was given, the name and title of the individual(s) who administered the nail care, any difficulties in cutting the resident's nails, any problems or complaints made by the resident with his/her hands or feet or any complaints related to the procedure, if the resident refused the treatment, the reason(s) why and the intervention taken, the signature and title of the person recording the data. Reporting included notify the supervisor if the resident refuses the care. 1. Record review for Resident #20 revealed the resident was admitted on [DATE]with diagnoses, in part, that included: Inflammatory Spondylopathy Cervical Region, Congestive Heart Failure, Spondylosis Lumbar Region, Atherosclerotic Heart Disease, Impingement Syndrome of Right Shoulder, Type 2 Diabetes Mellitus with Diabetic Polyneuropathy and Diabetic Retinopathy, Mild Cognitive Impairment, Muscle Weakness and Need for Assistance with Personal Care. Review of the Quarterly Minimum Data Set assessment (MDS), dated [DATE], revealed: in section C, a brief interview for mental status (BIMS) score of 12, indicating moderate impairment, in section G, Toilet use / Self-Performance is total dependence on staff of two plus persons, Personal hygiene / Self-Performance is total dependence on staff with two persons assistance. Record review for Resident #20's care plan reviewed and/or revised on 09/15/21 revealed a focus on the resident having a self-care deficit and is unable to perform activities of daily living (ADL's) without assistance due to decline in function related to hospital stay with a goal of the resident being able to perform ADL's with task segmentation and cueing as evidenced by improvement in functional ability status by next review date. Interventions on the care plan included: encourage to care for personal needs to promote as much independence as possible for level of function, involve in decision making process, praise all efforts, provide assistance with hygiene and grooming, assist with toileting dressing and bathing as needed, provide materials and assistance needed to preform ADLs, physical therapy, occupational therapy, speech therapy (PT/OT/ST) as ordered, report any deterioration in status to physician, and transfer with assist of staff. Record review for Resident #20 revealed no documentation or evidence of fingernail care (clipping and/or cleaning) being completed or refused by the resident from 08/01/21 to 12/01/21. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105277 If continuation sheet Page 2 of 10 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 105277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stuart Rehabilitation and Healthcare 1500 SE Palm Beach Rd Stuart, FL 34994 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On/11/29/21 at 10:05 AM, an observation was made of Resident #20's dirty, long, jagged edged fingernails and were with a brownish substance under the fingernails. During an interview conducted on 11/29/21 at 10:07 AM with Resident # 20 when asked about his fingernails, he stated, of course I want them cut, nobody here will do it, so my wife must do it, or I try to do them myself and it is very hard for me. He stated that sometimes the staff dress him but mostly he must do it himself. He stated he has no plan of action; he wants to get up and walk again. During an interview conducted on 11/30/21 at 10:16 AM with Resident #20 's spouse, who was visiting with the spouse, when asked about the resident's fingernail care, she stated, he cannot do his fingernails so I trim his fingernails, but the staff should keep his nails clean. 2. Record review for Resident #28 revealed an admission of 02/18/21 with the most recent re-admission on [DATE], with diagnoses, in part, that included: Type 2 Diabetes Mellitus with Diabetic Neuropathy, Type 2 Diabetes Mellitus with Diabetic Peripheral Angiopathy without Gangrene, Chronic Pain Syndrome, Osteoarthritis, and Dementia with behavioral disturbance. The significant change MDS, dated [DATE], revealed: in section C, a brief interview for mental status score of 10, indicating moderate impairment, In section E, revealed under, Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being, the behavior occurred 1 to 3 days, In section G, for Bed mobility / Self-Performance the resident required total dependence with support of 2 plus persons from staff; Dressing / Self-Performance documented total dependence with support of two plus persons; Eating / Self-Performance was total dependence with support of one-person; and Personal hygiene / Self-Performance was total dependence with support of two plus persons. Review of the care plan, dated 03/05/21 for Resident #28 revealed a focus on the resident requiring staff assistance with bathing, dressing, toileting, hygiene, and mobility needs r/t (related to) increased weakness; the ADL skills may fluctuate related to behaviors and mood; and a goal that the resident would maintain her current level of function in bed mobility, transfers, dressing, toilet use and personal hygiene through the review date as evidenced by nursing documentation. Interventions on the care plan included: Resident requires staff assistance with bathing / showering; Resident requires staff assistance to reposition and turn in bed; Resident requires staff assistance to dress; Resident requires staff assistance with personal hygiene and oral care; Physical therapy, occupational therapy (PT/OT) evaluation and treatment as per MD orders; Resident requires staff assistance to use toilet; and Resident requires staff assistance with transfers. Record review for Resident #28 revealed a progress note, dated 09/07/21, that the resident returned from MD (physician) appointment with new orders to increase frequency of treatment (tx) to fingers from daily to twice a day; and Staff to cut resident's nails shorter. A progress note, dated 09/09/21, revealed the resident refused to have her fingers clipped at this time and insisted to be helped back to bed; the resident was assisted back to bed and fluids were provided. Another progress note, dated 09/09/21, revealed: 'Nails were carefully cut short, cleaned, and filed. Resident tolerated it well. Tx (treatment) applied to affected nails.' (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105277 If continuation sheet Page 3 of 10 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 105277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stuart Rehabilitation and Healthcare 1500 SE Palm Beach Rd Stuart, FL 34994 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm There were no progress notes that documented if the resident had received fingernail care or had been offered and refused fingernail care from 09/10/21 to 11/06/21 or from 11/15/21 to 12/01/21. On 11/29/21 at 10:40 AM, an observation made of Resident #28's fingernails revealed them to be long with blackish / brown substance under the nails. Photographic evidence obtained. Residents Affected - Few During an interview on 11/29/21 at 10:40 AM with Resident #28, she stated she does not like her nails that long and said they are very dirty. When asked if anyone cleans her fingernails, she said occasionally. 3. Record review for Resident #33 revealed an admission of 03/30/82 with no re-admissions. The diagnoses included, in part: Hemiplegia and Hemiparesis following Cerebrovascular Disease Affecting Left non-dominant Side, Abnormal Posture, generalized Muscle Weakness, Unspecified Psychosis Contracture of Right and Left Hand and Wrist, Left Ankle, Left Foot and Hallucinations. Review of the Quarterly MDS, dated [DATE], revealed: In section C, a BIMS score of 0, indicating severe cognitive impairment; In section G, Eating/Self-Performance required supervision and set up. Resident #33's care plan with a reviewed / revised date of 09/28/21, revealed a focus on the resident required staff assistance with bathing, dressing, toileting, hygiene, and mobility needs, r/t to multiple contractures and hemiplegia due to (d/t) cerebral vascular accident (CVA). The resident's ADL performance fluctuated at times related to the CVA with a goal of the resident's needs being anticipated and met daily through the review date by nursing / CNA documentation and being well groomed. Interventions on this care plan included the resident required staff assistance with bathing / showering three times weekly and as needed (PRN); the resident required staff assistance to reposition and turn in bed; the resident required staff assistance to dress; the resident was independent with eating, after set up assistance was provided; encourage to participate with self-care to the best of resident's ability; the resident required staff assistance with personal hygiene and oral care; evaluation and treatment as per MD orders; restorative nursing program as ordered, splints as tolerated; the resident required staff assistance for incontinence care; and the resident required staff assistance with transfers, may require mechanical lift and assist of 2 at times. Record review for Resident #33's progress note, dated 09/27/21, revealed a Quarterly Review that included: care plan was reviewed and updated today; remains severely impaired for cognition; needs are anticipated and met by staff; is out of bed (OOB) daily; dressed and as well-groomed as she will allow; will refuse specific care tasks at times, and will, at times, refuse to wear shoes or socks; refuses to allow hair to be cut but will allow staff to brush hair and secure it off of face or trim the ends at times; has a history of hallucinations but not experiencing any hallucinations currently; and they (family) visit when they can and provide personal needs, as does staff. Review of the notes from 08/02/21 to 12/01/21, except for progress note date 09/27/21, revealed there was no documentation about fingernails being cleaned / trimmed or that the resident refused to have her fingernails cleaned / trimmed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105277 If continuation sheet Page 4 of 10 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 105277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stuart Rehabilitation and Healthcare 1500 SE Palm Beach Rd Stuart, FL 34994 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 11/29/21 at 10:30 AM, an observation was made of Resident # 33's fingernails being long and with brownish/black substance under the fingernails. 4. During an attempted interview with Resident #58 on 11//29/21 at 10:30 AM, it was discovered that the resident was non-verbal. The record revealed Resident #58 was admitted [DATE] with a most recent re-admission date of 06/09/21. The diagnoses included, in part: Central Subluxation of Right Hip, Muscle Weakness (generalized), Need for Assistance with Personal Care, Major Depressive Disorder, Delusional Disorders, Intervertebral Disc Degeneration, Lumbar Region, Pain, and Glaucoma. The MDS, dated [DATE], revealed: In section C, a brief interview of mental status score of 13, indicating intact cognitive response; In section F, Dressing / Self-Performance required total dependence on staff, Dressing / Support required one person assistance and personal hygiene / Self-Performance required total dependence of one person assist. The care plan, with a reviewed / revised date of 10/26/21, had a focus on: Resident has a self-care deficit and is unable to perform activities of daily living (ADL's) without assistance due to decline in function related to hospital stay a goal of Resident will be able to perform ADLs with task segmentation and cueing as evidenced by (AEB) improvement in functional ability status by next review date. The care plan interventions included: encourage to care for personal needs to promote as much independence as possible for level of function, involve in decision making process, praise all efforts, provide assistance with hygiene and grooming, assist with toileting dressing and bathing as needed; Provide materials and assistance needed to preform activities of daily living; physical therapy, occupational therapy, speech therapy (PT/OT/ST) as ordered; Report any deterioration in status to physician; and Transfer with assist of one staff. Review of Resident #58's progress notes of 10/08/21 revealed, in part: 'Resident is sitting up in her wheelchair with a pleasant affect and propels self on the unit. Cognition remains the same, alert, and oriented x3 with encouragement needed for all meals. Resident's needs are being met by the facility and mood is stable. Resident has delusional episodes, Is kind and cooperative. Resident's skin turgor is good with no signs or symptoms of dehydration noted. PO (oral) supplements given and taken well. ROM (range of motion) in RUE (right upper extremity) is limited. Therapy referral has been issued. Brisk cap refill is present in all fingers and toes. Fingers to left hand/both feet are deformed due to arthritis. Review of the record revealed there were no other progress notes that documented fingernail care provided, or documented fingernail care was refused from 08/01/21 to 12/01/21. On 11/29/21 at 10:20 AM, an observation of Resident #58 revealed the fingernails were long, jagged and with a brownish substance underneath the fingernails. The left hand was contracted. During an interview conducted on 11/29/21 at 10:22 AM with Resident # 58 when asked about her fingernails, she stated that she does not like them that long, she likes them just past the flesh of her finger and they need to be cut. When asked if staff cut and clean her nails, she stated nobody does them and she stated she cannot do them herself. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105277 If continuation sheet Page 5 of 10 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 105277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stuart Rehabilitation and Healthcare 1500 SE Palm Beach Rd Stuart, FL 34994 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm During an interview conducted 11/30/21 at 3:20 PM with Staff D-CNA (certified nursing assistant), she stated the CNAs are also responsible for inspecting the fingernails and if the fingernails are not clean as some residents put their nails in their food, the CNAs clean under the nails with a cuticle stick and/or brush. Throughout the day, we check the residents' fingernails to see if they are dirty, if they are dirty, we offer to clean their hands and nails. Residents Affected - Few During an interview conducted on 12/01/21 at 9:05 AM with Staff E-CNA when asked who is responsible for clipping and cleaning the residents' fingernails, he stated that it is the CNAs who are responsible for clipping and cleaning the residents' fingernails. He also stated that if the resident needs their fingernails washed, he just does it with a washcloth; and if they need to be cut, he cuts them so that just a little of the white part of the fingernail shows. He also stated that you must be careful if the resident is diabetic. During an interview conducted on 12/01/21 at 9:25 AM with Staff F-CNA when asked who is responsible for fingernail care, she stated the CNAs are responsible for the fingernail care, cutting them and cleaning them. Sometimes residents make an appointment with the activities department and the activities department will do the cutting and cleaning and polishing the fingernails. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105277 If continuation sheet Page 6 of 10 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 105277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stuart Rehabilitation and Healthcare 1500 SE Palm Beach Rd Stuart, FL 34994 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 Based on facility policy review, observation, record review and interview, the facility failed to obtain physicians orders prior to administering medication to 1 of 1 sampled resident, Resident # 417. Residents Affected - Few The finding included: Review of the facility policy, titled, Subject: Telephone, verbal, and written orders for medication, reference #6029, effective 03/01/21, stated orders given for medications and their administration shall be filled only when given by a qualified physician, surgeon, dentist, podiatrist, or other person duly licensed or authorized to prescribe by the State of Florida and who has been approved as a member of the medical staff of this facility. Per Florida Statute 464, An RN [registered nurse] must be licensed as an Advanced Practice Registered Nurse (APRN) to prescribe medications. Facility Policy, titled, 11B1: Administration Procedures for all Medications C. 1) Prior to removing the medication package from the cart; a) Check the Medication Administration Record for order. Review of the record for Resident 417 revealed an admission of 11/01/21. The record documented a Brief Interview for Mental Status (BIMS) score that indicated the resident was cognitively intact. Resident 417 has a diagnosis to include Pyothorax (presence of inflammatory fluid or pus within the chest cavity), Urinary Retention with an indwelling catheter, Anemia (low blood count), Reflux, and Hypertension. Observation of the resident on 11/30/21 at 2:30 PM, revealed Resident 417 appeared tired and pale. Resident #417 stated he was up all night with horrible diarrhea and said it poured out like water. When asked if the nurses were aware Resident 417 stated, yes, they all knew. He stated he got two doses of Imodium and that it had helped some. On 11/30/21 at 3:00 PM, Resident 417 was noted walking around in his room unassisted and confirmed again that he got Imodium earlier this morning and again this afternoon for diarrhea. Record reviews revealed: On 11/30/21 at 2:45 PM, there was no documentation of the resident's diarrhea, no physician order for Imodium and no notation of any Imodium administered to Resident 417. On 11/30/21 at 3:31 PM, Resident 417's progress note by Staff A-RN (registered nurse) documented the resident received Imodium at 7:30 AM and 13:30 PM for loose stools On 12/01/21 at 9:00 AM, the record revealed an order for Imodium 2mg two tablets to be given every 6 hours as needed. The new order was documented as received via telephone on 11/30/21 at 3:41 PM. Interviews were conducted as follows: On 11/30/21 at 3:05 PM, Staff A-RN, when asked by surveyor if Imodium was given today to Resident #417 for diarrhea, stated yes but it has not been charted yet. Staff A-RN said they have a facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105277 If continuation sheet Page 7 of 10 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 105277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stuart Rehabilitation and Healthcare 1500 SE Palm Beach Rd Stuart, FL 34994 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 standing order and she notified the doctor of the diarrhea. Level of Harm - Minimal harm or potential for actual harm On 11/30/21 at 3:30 PM, the Director Of Nurses (DON) was asked to provide the policy for facility standing orders for medications. Residents Affected - Few On 12/01/21 at 9:15 AM, the DON stated they 'did not have standing orders for Imodium, the nurse gave it without an order'. She said she re-educated the nurse on medication administration policies and obtaining physicians orders. She stated nurses receive medication administration training when hired. On 12/01/21 at 9:45 AM, Staff A-RN stated, to be honest with you, I did not call the doctor about the diarrhea until after you spoke to me yesterday at 3:05 PM. I had given him two doses of Imodium, one at 7:30 AM and 1:30 PM. I know I need a doctor's order for all medications. I am new. I thought there was a standing order, that was my mistake. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105277 If continuation sheet Page 8 of 10 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 105277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stuart Rehabilitation and Healthcare 1500 SE Palm Beach Rd Stuart, FL 34994 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure a palm guard was applied to a resident's right hand for 1 of 1 sampled resident, Resident #47, to prevent further contracture of the right hand. The findings included: Record review revealed Resident #47 was admitted to the facility on [DATE]. The admission minimum data set (MDS) assessment reference date 10/19/21 indicated a BIMS score 15 indicating Resident #47 was cognitively intact. Observations conducted of Resident #47 on 11/29/21 at 11:44 AM, 11/30/21 at 9:10 AM, 12/01/21 at 8:45 AM and 12/01/21 at 2:03 PM, revealed that on the mentioned dates and times, Resident #47 was noted with right hand contracture but was without any splint. On 12/01/21 at 1:41 PM, an interview was held with the Rehabilitation (Rehab) Director, who revealed Resident #47 was on physical therapy (PT) and occupational therapy (OT) services that had started on 10/14/21 through 11/02/21. The Rehab Director stated that OT had ordered a 'palm guard' for Resident #47, and showed that Nursing had been trained on proper donning of the palm guard. During the interview, the Rehab Director presented a document, dated 10/15/21, that documented, patient trial right hand palm guard to prevent further contracture; patient stated she was comfortable with palm guard. Nursing staff informed on proper donning and skin checks. The Rehab Director presented another document, dated 10/18/21, that documented, the resident has right hand contracture, tolerate wear of right hand palm guard, staff training on proper donning of palm guard to prevent further contracture. On 12/01/21 at 1:58 PM, a side by side review of Resident #47's records and interview was conducted with the Director of nursing (DON). She confirmed there was no evidence of a physician order for palm guard or a care plan in the computer system for nursing. The DON stated, honestly, I 've never seen her (Resident #47) with a palm guard. On 12/01/21 at 2:03 PM, an interview was held with Resident #47, and when asked about the right hand contracture, she voiced she has a disease called corticobasal degeneration (CBD) which causes her hand to be contracted. When asked about the palm guard, she voiced she hasn't worn the palm guard in weeks. When asked if there was a reason, she did not wear the palm guard, she voiced she doesn't know. The resident stated, please get the palm guard for me, and apply it to my hand. The surveyor verbalized she would inform the facility staff. On 12/01/21 at 2:06 PM, an interview was conducted with Staff B-CNA, who was the attending aide, and when asked about Resident #47's right hand contracture, she stated she was aware of the resident's contracture. She voiced she was not sure what the facility was doing about the contracture. When asked whether the resident had interventions in place for the contracture and whether the resident had palm guard available, the aide said, 'she has never seen Resident #47 wear a palm guard'. When asked what she was supposed to do for the resident in regard to the contracture, she voiced she was not sure what she was supposed to do for the resident. Staff B-CNA was made aware that the resident was requesting for the palm guard. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105277 If continuation sheet Page 9 of 10 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 105277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stuart Rehabilitation and Healthcare 1500 SE Palm Beach Rd Stuart, FL 34994 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of the care plan, dated 10/27/21, indicated Resident #47 has DDD of the lumbar region. The goal was Resident #47 will remain free of complications related to DDD (Degenerative Disc Disease / joint stiffness or decline in mobility) through the review date AEB nursing documentation. The care plan interventions included: observe for and report to MD (physician) complications related to DDD: Joint pain, Joint stiffness, usually worse on wakening, swelling, decline in mobility, decline in self-care ability, contracture formation/joint shape changes, crepitus (creaking or clicking with joint movement), and pain after exercise or weight bearing. A review of the progress note, dated 10/12/21 at 10:31 AM, documented Resident #47 had right hand fingers contraction. A review of another progress note, dated 10/13/21 at 8:14 PM, documented, 'Patient seen and examined on 10/13/21, Patient presents with Corticobasal degeneration, Parkinson's disease, Weakness and Fatigue. She has CBD disease which has caused profound increased weakness and has affected her ability to ambulate and complete ADLs including dressing and meals. She has ongoing numbness and tingling in her bilateral hands and feet.' FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105277 If continuation sheet Page 10 of 10