Inspection·June 16, 2022

F 0584 Level of Harm - Minimal harm or potential for actual harm room [ROOM NUMBER]: The bathroom wall had a large area of disrepair and was rusted. The toilet seat was noted to be loose and falling off. room [ROOM NUMBER]: The room window was noted to have missing blind slats (3), were not opening or closing, and were not providing privacy for the residents. Residents Affected - Some room [ROOM NUMBER]: The room window was noted to have missing blind slats (3), were not opening or closing, and were not providing privacy for the residents. room [ROOM NUMBER]: Room window blinds were not opening and closing. Three window blind slats missing and not providing the residents personal privacy. Room#21: The bathroom toilet was not working and was off-line with the opening to the toilet drain. room [ROOM NUMBER]: The toilet required re-caulking to the floor, the bathroom walls were in disrepair with areas of peeling paint. The room window was noted to have missing blind slats (2), were not opening or closing, and were not providing privacy for the residents. The room walls were noted to be heavily soiled and areas of dried matter. The room sink was noted to be missing from the room. room [ROOM NUMBER]: The drawers (6) to the nightstand (D-bed) were falling out and could not be inserted in the dresser properly. The bathroom walls were in disrepair and had areas of peeling paint. The toilet seat was the wrong size (needed to be oblong). room [ROOM NUMBER]: The over-bed light cord (D-bed) was missing. The interior of the toilet bowl was heavily scratched due to drain snaking. The room window was noted to have missing blind slats (3), were not opening or closing, and were not providing privacy for the residents. room [ROOM NUMBER]: The room window (2) was noted to have missing blind slats (4) and were not opening or closing and were not providing privacy for the residents. The exterior of the bathroom door required repainting. The bathroom was in disrepair and was noted with peeling areas of paint. room [ROOM NUMBER]: The room window was noted to have missing blind slats (4), were not opening or closing, and were not providing privacy for the residents. The wall area behind the head of the bed (D-bed) was in disrepair and damaged. The toilet seat was not anchored securely and was falling off. A live bug (roach) observed in room area. room [ROOM NUMBER]: The room window was noted to have missing blind slats (3), were not opening or closing, and were not providing privacy for the resident. The toilet seat exterior was heavily stained. A large live bug (roach) observed in the bathroom. room [ROOM NUMBER]: The room windows (2) were noted to have missing blind slats (4), were not opening or closing and were not providing privacy for the residents. Large crack/hole in ceiling above the D-bed. The over sink light was not working. A live bug (roach) was noted in resident room. room [ROOM NUMBER]: The room window was noted to have missing blind slats (4) and were not opening or closing and were not providing privacy for the residents. Room walls were in disrepair and required re-painting. room [ROOM NUMBER] - The toilet requires re-caulking to the floor. The underside of the toilet seat (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 2 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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 0584 was noted to be broken . Level of Harm - Minimal harm or potential for actual harm Following the 06/14/22 observation, the findings of the tour was confirmed with the Regional Maintenance Director and Administrator. The Director stated that staff were failing to document housekeeping/maintenance issues in the Maintenance Log Book that are located on each of the 2 nurses stations. Residents Affected - Some 2.) On 06/13/22 at 10:18 AM, Resident #41 reported that the bathroom in her room smelled very bad. She said that it has not been repaired for a long time. Resident #21 said that she went to another undisclosed bathroom in order to use the bathroom (bowel movement & unirate). Resident #21 did not provide the exact alternate bathroom location she used when asked to claritfy. On 06/13/22 at 1:54 PM Resident #40 (Resident #41's roommate), reported that the bathroom has not functioned for about two weeks. She stated that it smelled very bad. On 06/13/22 at 2:17 PM, Resident #36, who is also Resident #40 and 41's roommate also reported that the bathroom has been out of order for a while and that it smells terrible in there. She further reported that it smells even with the bathroom door closed. Review of the Minimum Data Set assessment for Resident #36, revealed a Brief Interview for Mental Status (BIMS) score of 8/15, Resident #40's BIMS score was 2/15, and Resident #41 BIMS score was 6/15. The clinical records of Resident #36 showed an admission date of 3/17/2016, and diagnoses of Schizophrenia. Section E (Behaviors) revealed that Resident 336 exhibited verbal aggression towards others. The MDS (Minimum Data Set) assessment documented the resident's BIMS (Brief Interview for Mental Status) score was 8, indicating moderate cognition impairment. Resident #40's clinical records showed that she was admitted to the facility on [DATE], with diagnoses of Schizophrenia and other diseases. In the quarterly assessment of the MDS, section E (Behavior) dated 3/23/2022, she is identified as exhibiting no physical or verbal behaviors towards staff or others. The resident's BIMS score was documented as 6, indicating severe cognitive impairment. Resident #41's clinical records revealed she was admitted to the facility on [DATE]. Her admitting diagnoses include non-Alzheimer's Dementia, Schizophrenia, and anxiety disorder, etc. In section E of the MDS dated [DATE], the documented revealed that the resident exhibited no physical aggression toward others, no hallucination and no delusion. The resident's BIMS score was documented as 6, indicating severe cognitve impairment. Observation conducted immediately after the residents' interviews on 06/13/22 at 10:19 AM revealed a serious hazardous environmental concern. The bathroom toilet door was unlocked. The toilet bowl was removed from the toilet drain leaving the drain/sewer line exposed and uncovered. Urine and feces-like materials were observed on the bathroom floor exhalating a nauseating and unbearable odor. During an interview conducted on 06/13/22 at 2:15 PM with Staff E, a Certified Nursing Assistant (CNA), she confirmed that she reported the information regarding the bathroom being out of order for a long time, or for about two weeks, she clarified. She expressed concern and reported I feel bad for the residents. I feel bad that they were treated that way. An interview with staff F, a Licensed Practical Nurse (LPN), on 06/15/22 at 10:45 AM, revealed that Resident #40 is incontinent of bowel and bladder and complies with care when staff takes time to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 3 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some explain to her the benefit of cooperating, although at times, she can be difficult. Staff F further reported that the shared bathroom was out of order for about one or two weeks. She said that the residents' bathroom gets occasionally clogged up, but it gets repaired. During an interview with Staff G, a housekeeper on 06/15/22 at 11:34 AM, she reported that she has been working at the facility for a long time. Staff G said that they tried to fix the bathroom, but it was difficult to do so. Staff G said that it may have been one or two weeks since the bathroom was not working. She said that one of the maintenance workers was out sick and the other maintenance worker could not repair the bathroom by himself. She explained that she had to use a heavy chemical to clean up the room because it was very dirty and smelled bad. Staff G reported that since the residents could not go anywhere else to use the bathroom, the residents did their needs on the bathroom's floor. During an interview with the Administrator on 06/15/22 at 11:27 AM, she reported that the toilet in question got clogged up and it was being repaired on Monday when the Surveyors arrived at the facility. They had to use a snake tool to unclog it, and they found briefs and clothing items in the toilet, she continued. The Administrator said that they have ongoing issues with the bathrooms because of the population they serve. She added that the problem is not so much the bathroom, but the residents. When questioned about the condition of the bathroom of Resident #36, 40 and 41, she said that she could not tell the surveyor how long the bathroom has been out of order. During an interview with the Maintenance Director on 06/15/22 at 11:55 AM, he said that he has been working at this facility for a long time. He said that he is the Regional Maintenance Director and that they had informed him about the bathroom on Monday afternoon 6/13/2022, at around 1:00 or 2:00 PM. He said that they usually encourage the workers to maintain a log of the identified issues related to maintenance. He also said that the issue of the bathroom in question was documented in the maintenance log (document obtained). He reported that there was a blockage in the line. As soon as he received the work order, he was able to proceed with his workers and were able to retrieve the items that were clogging the pipes. He said that they had to remove the toilet to repair it. He also informed that the residents' bathroom is the last bathroom at the end of the sewer line. when residents' flush cups or diapers or tissues in the other bathrooms, those items can clog the bathroom of Resident #36, 40, and 41. He reported that he usually reminded the Maintenance supervisor to lock the bathroom doors when issues like that occur, while repairs are in progress. However, he was not aware that the particular bathroom door was not locked and that the bathroom was not cleaned up. Review of the work order for the bathroom in question revealed an entry for the bathroom repair documented on 6/13/2022 and the repair was completed on 6/14/2022. 3.) During an initial room screening tour conducted on 06/13/22 at 9:50 AM, upon first entry into Resident #74's room, it was noted that there was a strong, offensive, foul-smelling odor emanating throughout Resident #74's bedroom. Resident #74 was observed holding her nose and fanning her hand in the air. It was subsequently revealed that there was a substantial amount of very foul smelling, unflushed stool/bowel movement located in the toilet bowl in Resident #74's bathroom, which was located right next to where Resident #74 was seated, in her wheelchair. Photographic evidence obtained. Resident #74 was re-admitted to the facility on [DATE] with diagnoses which included Parkinson's Disease, Paranoid Schizophrenia, Hypertension, Schizoaffective Disorder, Dementia, Atherosclerotic Heart Disease and Dysphagia. She had a Brief Interview Mental Status (BIM) score listed of 14, indicating intact cognition. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 4 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some An interview was conducted with Resident #74 on 06/13/22 at 9:52 AM, in which she stated that she had been smelling something bad in her room for some time, but did not know what it was or what it could be. The strong, foul smell in the resident's room was offensive to both the resident and to the surveyor. On 06/13/22 at 11:10 AM it was still observed that there was a substantial amount of unflushed stool/bowel movement in Resident #74's toilet in her bathroom right next to where Resident #74 was seated, in her wheelchair. It was noted that there were several facility staff members observed as entering and exiting Resident #74's room, over the course of an hour and ten minutes, leaving her bathroom toilet bowl still remaining filled and unflushed with Human bowel movement waste, with Resident #74 sitting nearby in her wheelchair, adjacent to and just outside of the bathroom door. An interview was conducted with Staff A, a Certified Nursing Assistant (CNA) on 06/15/22 at 2:02 PM, regarding the unflushed toilet bowl which she acknowledged that the photographic evidence obtained revealed that Resident #74's toilet bowl was filled with stool/bowel movement. An interview was conducted with Staff C, a Licensed Practical Nurse (LPN) regarding the unflushed toilet bowl which she acknowledged that the photographic evidence obtained revealed that Resident #74's toilet bowl was filled with stool/bowel movement. The Director of Nursing (DON) further acknowledged the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 5 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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 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, interview, record review and review of policy and procedure, it was determined that the facility failed to provide care and services in accordance with activities of daily living; specifically nail grooming for 1 of 1 sampled residents observed, Resident #32. Residents Affected - Few The findings included: Review of the facility policy and procedure for Care of Fingernails/Toenails provided by the Director of Nursing (DON) revised October 2010, indicated Purpose: The purposes of this procedure are to clean the nail bed, to keep nails trimmed and to prevent infections General Guidelines: 1. Nail care includes daily cleaning and regular trimming. 2. Proper nail care can aid in the prevention of skin problems around the nail bed .4. Trimmed and smooth nails prevent the resident from accidentally scratching and injuring his or her skin 6. Stop and report to the nurse supervisor if there is evidence of ingrown nails, infections, pain or if nails are too hard or too thick to cut with ease. Review of facility licensed nurse job description dated 2003 indicated Purpose: The primary purpose of your job position is to provide each of your assigned residents with routine daily nursing care and services in accordance with the resident's assessment and care plan, and as may be directed by your supervisors .Administrative Functions: Record all entries on flow sheets, notes, charts, etc. in an informative and descriptive manner Report all changes in the resident's condition to the Nurse Supervisor/Charge Nurse as soon as practical. During an initial observational tour conducted on 06/13/22 at 10:24 AM, Resident #32 was observed with long, sharp, dirty, unkempt fingernails on both hands in which Resident #32's fingernails were observed to be firmly pressed into the palms of his hands, at that time. Photographic evidence obtained. Resident #32 was re-admitted to the facility on [DATE] with diagnoses which included Acute Respiratory Disease, Alzheimer's Disease, Adult Failure to Thrive, Gastrostomy Tube placement, Hypertension and Major Depressive Disorder. He had a Brief Interview Mental Status (BIMS) score, indicating severe cognitive impairment. Photographic evidence obtained. During a second observational tour conducted on 06/13/22 at 2:27 PM, Resident #32 was observed with long, sharp, dirty, unkempt fingernails on both hands. During a third observational tour conducted on 06/14/22 at 9:31 AM, Resident #32 was observed with long, sharp, dirty, unkempt fingernails on both hands. During a fourth observational tour conducted on 06/15/22 at 9:09 AM, Resident #32 was observed with long, sharp, dirty, unkempt fingernails on both hands. Record review of the Resident #32's two (2) incomplete paper Certified Nursing Assistant (CNA) Activities of Daily Living (ADL) Bath Work Sheet/Flowsheet Records dated 02/14/22, 02/25/22, 03/12/22, 04/04/22, 04/07/22, 04/21/22 and 04/30/22 revealed that nail care for this resident was not checked off as being provided for any of the above dates. There were no other paper CNA Bath Work Sheet records available for review. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 6 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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 Further record review revealed there were no recent documented Social Service notes nor nurses' notes reflected or made any references to resistance to care by this resident. The Interdisciplinary care plan dated 04/21/22 did not address any type of behaviors exhibited by this resident, during his facility stay. Record review of eight (8) different licensed nursing staff notes covering a period of over four (4) months dated: 03/18/22, 03/25/22, 04/01/22, 04/11/22, 04/16/22, 05/06/22, 05/20/22 and 06/04/22, all revealed that Resident #32 exhibited no abnormal behaviors and his physical and mental status remained stable. Record review of Resident #32's Baseline Care plan dated 05/25/21 for nail care indicated for staff assistance. Nonetheless, Resident #32's fingernail care had not been done, on the dates from 06/13/22 thru 06/15/22; until after surveyor inquisition/intervention. Further record review of the Minimum Data Set (MDS) sections A, C and G dated 04/07/22 for Resident #32 indicated the resident functional status was total dependence for ADL's. An interview was conducted with Staff A, a Certified Nursing Assistant (CNA) on 06/15/22 at 9:50 AM, in which she revealed that she had not provided fingernail care to Resident #32, and said that it is the responsibility of the CNA's to clean and trim the resident's fingernails. However, she said that usually the Activities Department will do the nail care. She further acknowledged that the resident's fingernails were long, sharp, dirty and unkempt on both hands. An interview was conducted with Staff B, a Licensed Practical Nurse (LPN) on 06/15/22 at 9:59 AM, regarding Resident #32's long, unkempt nails. Staff B, also said that it is the responsibility of the CNA's to clean and trim the resident's fingernails. However, she also concurred that usually the Activities Department will do the nail care. Staff B further acknowledged that Resident #32's fingernails were long, sharp, dirty and unkempt on both hands. An interview was conducted with the Activities Director on 06/15/22 at 10:06 AM, in which she stated that she does fingernail polishing, washing of fingernails and filing for all of the residents, to include clipping the ends of the fingernails for both the men and women. She added that if she had observed a resident with long, dirty fingernails that she would alert either the Director of Nursing and/or the Social Worker to let them know to follow-up with the resident. The Activities Director said that her department provided nail care service to Resident #32 on 06/03/22. She stated that the resident remained calm, still and non-resistive, while his fingernail care was being provided with no behaviors reported. The Director also acknowledged that Resident #32's fingernails were all long, sharp, dirty and unkempt. On 06/15/22 at 10:57 AM, an interview was conducted with the Director of Nursing (DON) regarding Resident #32's fingernails being long, sharp, and untrimmed. She also acknowledged that it is the responsibility of the CNA's to clean and trim the resident's nails and she further acknowledged that the resident's fingernails were long, sharp and dirty and that they should have been cleaned/trimmed/cut. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 7 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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 observation, interview and record review, the facility failed to provide treatment and care in accordance with professional standards of practice that included ensuring following physician orders for 1 of 1 sampled residents (Resident #12), reviewed for dialysis. Residents Affected - Few The findings included: Review of the facility's policy and procedure for Administering Medications on 06/16/22 noted the following policy interpretation and implantations: 1) Medications must be administered in accordance with the orders, including any required time frame. 2) Medications must be administered within one (1) hour of their prescribed time, unless otherwise specified. 3) If a drug is withheld, refused, or given at a time other than the scheduled time, the individual administering the medication shall initial and circle the MAR (Medication Administration Record) space provided for that drug and dose. 4) If a dosage is believed to be inappropriate the person administering the medication shall contact the resident's attending physician or the facility's Medical Director to discuss the concerns. During the review of the clinical record of Resident #12, it was noted a date of admission of 11/27/20 with diagnoses of End Stage Renal Disease, and protein-Calorie malnutrition. It was also noted that the resident receives Dialysis 3 times per (Monday/Wednesday/Friday) and leaves the facility at 10 AM to dialysis for a chair time of 12:30 PM and returns from dialysis at 6:30 PM. Review of physician medication orders dated 2/4/21 for Renavealla (Phosphorus Binder) 800 mg TID (three times daily) with food. Further review noted on 04/20/22 change to Sevelemar (Phosphorus Binder) 800 mg with food TID. During the review of the June 2022 Medication Treatment Record (MAR), it was noted that the 1 PM dose of Sevele[DATE] mg was circled as not administered on 6 of 7 dialysis dates (06/3,6, 8,10, 13, and 15/22). Further review of the June 2022 MAR noted no documentation of the back side of the MAR for description as to why the medication was not administered on these dates. An interview with the Staff C (medication nurse) on 06/16/22 at 10:00 AM, review noted to state the the rational to not administer the medication was not documented as per facility policy. Staff C further stated that Resident #12 not in the facility at 1 PM on dialysis days. A review of the May 2022 MAR of Resident #12 was reviewed and was noted the resident went to scheduled dialysis on 13 dates, however, it was only documented that on 3 dates (06/2, 6, and 9/22) that the Renvella dose was not administered due to being out to the dialysis center. A review of the April 2022 MAR noted 6 dialysis dates since the physician's order of 04/15/22. However, none of the 7 dates (4/18,20,22, 22,25,27, and 29/22 that the medication was circled as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 8 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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 administered did not have documentation of the reason the the medication was held. Level of Harm - Minimal harm or potential for actual harm Following the review, the issue of the medication was discussed with the Director of Nursing (DON) on 06/16/22 at approximately 11:00 AM. Following the DON's review the following were noted: Residents Affected - Few 1) Medication nurses failed to follow facility medication administration policy and procedures to document on the MAR why a medication was not administered as per physician order. 2) Medication nurses failed to contact the DON and/or attending physician to notify that the resident was not in the facility for the scheduled 1 PM dose of Revalla/Sevela[DATE] mg on dialysis days and request a medication clarification order. On 06/16/22 at 3:00 PM, the DON informed the surveyor that a clarification order had been obtained form the attending physician and noted that the 1 PM does on dialysis day was discontinued. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 9 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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 0687 Provide appropriate foot care. 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 provide podiatry care to 1 of 1 sampled residents (Resident #36). Residents Affected - Few The findings included: On 06/13/22 at 9:09 AM, Resident #36 reported that her toenails have not been trimmed. Observation thereafter revealed that the left medial tarsal nails of Resident #36's right foot was extremely long and discolored, and the other toenails of both feet were also untrimmed (photographic evidence retained). Review of a synopsis of the Person-Centered Care Plan (PCP) undates, revealed that Resident #36 always took pride in dressing well; she wanted to take care of herself; she liked to wash herself in the morning; she cared about her appearance. The Comprehensive Care Plan (CP) updated on 4/6/2022 revealed that the resident was non-compliant with care. The MDS Coordinator reported on 06/14/22 at 1:16 PM, that the Resident has been non-compliant with her medications. Review of section I showed that the resident was diagnosed of Paranoid Schizophrenia, hypertension. Depressive episodes, Unspecified lack of coordination, Cognitive Communication deficit. Section C of the MDS revealed that she obtained a score of 8/15 on the brief interview for mental status BIMS, indicating moderate impaired cognition. Review of the Minimum Data Set (MDS) assessment and subsequent interview with the MDS Coordinator on 06/14/22 at 1:52 PM, revealed that Resident # 36 was independent of bed mobility, transfer, balance and walking, gait and locomotion. She required supervision for dressing, she ate independently, and required extensive assistance x1 person for toileting. Resident #36 also required extensive assistance for personal hygiene, and bathing. She did not use a wheelchair as verified in Section G of the MDS dated [DATE]. During a follow-up interview with the MDS Coordinator on 06/16/22 at 10:06 AM, she reported that they had scheduled the resident multiple times to see a podiatrist, but she refused. She said that the resident spat on the Podiatrist during his last visit to see the resident. The MDS Coordinator could not provide evidence that Resident # 36 had refused to have her toenails trimmed nor the podiatrist scheduled appointment records. There was also no indication in the behavior plan that Resident # 36 spat on the Podiatrist during their last appointment. However, to confirm that this issue had occurred, the MDS Coordinator asked and insisted that the surveyor witness incognition in her interview with the resident. During an interview with Resident #36 on 06/16/22 at 10:15 AM, the MDS Coordinator asked the resident if she wanted to have the nails trimmed, the Resident replied yes. The MDS asked Resident # 36, did you ever see the Podiatrist? The resident said that she saw the Podiatrist once. The MDS Coordinator stated to the resident that you have been refusing to have your toenails cut. The resident questioned, who said that? and ensued I have not refused to have my nails trimmed. Then, she urged the MDS Coordinator to look at her nails. After the interview, the MDS Coordinator stated to the surveyor what can I say, it is her words against mine. It was noted that Resident #36 was very coherent and expressive during interview. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 10 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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 0687 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Thereafter, the MDS Coordinator dilligently seached the Clinical record to see when Resident #36 had refused the toenail care, but she could not find any specific record. There was no evidence in the Nursing Progress Notes from January 2022 to June 2022 that the resident had refused to have her nails trimmed or cut. During interview, Staff B, a Licensed Practical Nurse (LPN) reported on 06/16/22 at 10:31 AM, that Resident #36 has the habit of refusing care; but she was not sure whether she had refused to have her toenails trimmed. She said that the Podiatrist comes to the facility once a week and usually make a list of residents who require podiatry care and verbally informed the Podiatrist about the residents to be seen. Staff B informed that they kept no records of the list. She also said that because the resident had often refused care, they might have overlooked Resident #36. She stated after looking at the resident's toenails I cannot believe how we missed that. Review of the MDS section E dated 3/20/2022 showed that Resident #36 exhibited no abnormal behaviors, no physical aggression towards others, no behaviors that placed the resident at risk for physical illness or injury, no behaviors that significantly interfere with the resident's participation in activities or social interactions, and no behaviors that significantly interfere with the resident's care. Furthermore, the record showed in section E0800 that Resident #36 rejected no evaluation of care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve her goals for health and well-being. During a meeting with the Administrator on 6/16/2022 at 12:35 PM, the Administrator and the facility's owner provided a copy of the policy on dignity which stipulated that: 1) Residents shall be treated with dignity and respect at all times. 2) Treated with dignity means the resident will be assisted in maintaining and enhancing his or her self-esteem and self-worth. 3) Residents shall be groomed as they wish to be groomed (hair styles, nails, facial hair, etc.). Before the exit meeting on 6/16/2022 at approximately 2:30 PM, the Administrator provided additional information regarding the resident's consistent refusal of her medications, and at times of her care. However, none but one of the Nurses' Progress notes she provided, which was added to the record and retroactively dated 6/3/2022 showed that the resident refused podiatry care. The note dated 6/3/2022 was written to reflect that Resident #36 refused Podiatry care and preferred her nails long. This documentation was produced after the fact. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 11 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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. Based on observation, record review, and interview, the facility failed to ensure splints were applied as indicated in the physician's order and the Physical Therapy (PT) order, to prevent further decrease in range of motion (ROM), for 1 of 2 sampled residents (Resident # 55), The findings included: On 06/13/22 at 12:43 PM, Resident #55 was observed in bed with no splint in place. The resident's hands and feet were noted to be contracted. Review of the Minimum Data Set (MDS) assessment section G, dated 4/23/22, revealed that Resident #55 required total assistance with all Activities of Daily Living (ADLS). The MDS also showed that the resident had limitation on the left upper extremity. Section O of the MDS revealed that the resident had an order to receive active range of motion (AROM) and splint within the facility's Restorative Nursing program. Review of the MDS section C dated 4/23/2022 outlining cognitive mental patterns revealed that Resident #55's cognition was severely impaired and rarely made decisions. On the Brief Interview for Mental Status (BIMS), no score was documented. The assessment was not possible given Resident #55's low cognitive ability, according to the MDS Coordinator. Section E of the MDS showed that Resident #55 exhibited no abnormal behaviors. During an interview with the MDS Coordinator on 06/14/22 at 1:50 PM, she confirmed that a splint was ordered for the resident after she underwent a significant change during which Resident #55 received a peg tube. Review of the Physician's order for the month of June 2022 revealed a handwritten order for staff to apply a right-hand splint and right elbow extension for the resident, as tolerated. On 06/14/22 at 2:04 PM, the resident was observed wearing the right-hand splint however, she was not wearing the right elbow splint. During an interview with Staff D, a Registered Nurse (RN) on 06/14/22 at 02:14 PM, she reconfirmed that Resident # 55 was supposed to wear the right-hand splint and the right elbow splint. Review of a document titled, Therapy to Restorative Nursing Communication dated 3/8/2022 obtained from the Physical therapist Assistant (PTA), revealed that Resident #55 needed to 1) perform both upper extremities and lower extremities passive range of motion (PROM) exercises in all planes x 10 x1-2 sets or as tolerated. 2) staff had to apply right hand splint and right elbow extension as tolerated to maintain joint integrity and prevent contractures. Staff had to check for redness and swelling if symptoms are noticed and remove splints and notify Nursing and Rehabilitation department. Review of the Restorative Nursing Program record (RNPR) for the month of June 2022 revealed documentation by staff that the order was followed from June 1, 2022, to June 10, 2022, as per recorded events. However, there was no documentation indicating that the facility staff performed the ordered task from June 11 to June 13, 2022. The facility provided no evidence that therapy services were to be suspended on weekends, and or that Resident #55 could not tolerate the splints. Review of the RNPR for May 2022 and June 2022 showed that the restorative and splint ordered did not exclude weekends. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 12 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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 On 06/16/22 at 9:47 AM, Resident # 55 was seen with the hand splint and the elbow splint in place. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 13 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, it was determined that the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety that could potentially effect all facility residents and 1 of 1 sampled residents selected for dialysis review, (Resident #12). The findings included; 1) During the initial Kitchen/Food Observation Tour conducted on 06/13/22 at 8:55 AM, and accompanied by the facility's Dietary Manager (DM), the following were noted: (a) Observation of the Reach-in Refrigerator #1 noted that the 5 interior shelves were in disrepair and had large areas of cracking and pieces of the shelf covering were falling off. It was discussed with the DM that there was the potential that the shelving exterior pieces could fall directly into foods being stored on the shelves. The surveyor requested that the unit not be utilized for refrigerated food storage until new shelving (5) could be be purchased and installed. (b) Observation of Reach-in Refrigerator #1 noted that the door gaskets were in disrepair and noted to have large tear areas and were becoming detached from the door. It was discussed with the DM that the temeprature of the unit would be compromised due to the gaskets; and the gaskets were in need of immediate replacement. (d) Observation of Reach-in Refrigerator #2 noted that the door gaskets were in disrepair and was noted to have large tear areas and were becoming detached from the door. It was discussed with the DM that the temperature of the unit would be compromised due to the gaskets; and the gaskets were in need of replacement. (e) Observation of the dishroom area noted that there was a large ceiling mounted air intake vent (16 X 24) located directly above the dish machine. Further observation noted that the vent was heavily dust/dirt laden and had large pieces of dust hanging down from the vent. It was discussed with the DM that the dust/dirt were ready to fall from the vent onto the dish machine and clean dishes. It was discussed with the DM that the vent required thorough cleaning by the maintenance department, prior to the next use of the dish machine. 2) During the observation of Resident #12 on 06/15/22 at 10:05 AM, it was noted that the resident was being weighed by Staff A, a nurse prior to leaving to the dialysis center. While being weighed the nurse was given the resident's dialysis snack bag that goes with Resident #12 to the dialysis. Staff A checked the bag 's content and proceeded to transport the resident to the lobby. During this time the the resident was stopped by the surveyor and reviewed the bag's content which was noted to contain: 1 package of [NAME] Crackers, an Egg Salad Sandwich, 4 oz Apple Juice, and 1 brick of Nepro (supplement). Further observation noted that the bottom compartment contained a commercial ice pack that was not frozen and was at room temperature. The surveyor requested the nurse inform the dietary department that a frozen pack was not included in the snack bag to ensure that the egg salad sandwich remained at regulatory temperature of 42 degrees F or below. A dietary representative brought a frozen commercial ice pack and stated that an error occurred to ensure that a frozen ice pack was included. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 14 of 15 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 105296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westlake Nursing and Rehab Center 440 Phippen Waiters Road Dania Beach, FL 33004 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 0812 Photographic evidence obtained for examples #1 and #2 on 06/13/22 and 06/15/22. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 15 of 15