Health inspection·October 5, 2023

F 0657 representative of non-compliance with the resident's dietary restrictions. Level of Harm - Minimal harm or potential for actual harm Review of Resident #38's active care plan on file titled Altered Means of Nutrition initiated on 04/13/23 and revised on 07/21/23 included interventions as: periodic evaluation of possibly resuming oral intake . The care plan did not include interventions or address resident's representative of non-compliance with the resident's dietary restrictions. Residents Affected - Few Review of Resident #38's active care plan on file titled Altered Means of Nutrition initiated on 04/13/23 and revised on 07/21/23 included interventions as: periodic evaluation of possibly resuming oral intake . The care plan did not include interventions or address resident's representative of non-compliance with the resident's dietary restrictions. Review of Resident #38's active care plan on file titled Diabetes initiated on 09/09/20 and revised on 07/21/23 included and added on interventions as: .re-direct and educate wife on consistency and negative impact . The care plan did not specify what consistency the wife needed to be re-directed and educated. Review of Resident #38's active care plan on file titled Activities of Daily Living initiated on 07/21/23 and revised on 07/21/23 did not include interventions or address resident's representative of non-compliance with the dietary restrictions. Review of Resident #38's active care plan on file titled Communication Difficulties initiated on 07/21/22 and revised on 07/21/23 did not include interventions or address resident's representative of non-compliance with the resident's dietary restrictions. Review of Resident #38's active care plan on file titled Cognitive Loss/Dementia initiated on 07/21/22 and revised on 07/21/23 did not include interventions or address in resident's representative of non-compliance with the resident's dietary restrictions. Review of Resident #38's Interdisciplinary Care Plan Conference Record dated 07/21/22 documented .spoke with sister .under action plan: wife brings wrong consistency of food. Redirection/Teaching done through sister in law . Review of Resident #38's Interdisciplinary Care Plan Conference Record dated 10/20/22 documented .spoke with sister .under action plan: wife requires redirection with meals brought from home . Review of Resident #38's Interdisciplinary Care Plan Conference Record dated 01/19/23 documented .spoke with sister . The conference record had no documentation under the action plan section. Review of Resident #38's Interdisciplinary Care Plan Conference Record dated 04/19/23 documented .complaint with encouragement .see rehabilitation screen . The conference record had no documentation under the action plan section. The care plan conference lack documentation of the resident's representative being part of the conference. Review of Resident #38's Interdisciplinary Care Plan Conference Record dated 04/27/23 documented .see rehabilitation screen . The conference record had no documentation under the action plan section. The care plan conference lack documentation of the resident's representative being part of the conference. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 2 of 16 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 10/05/2023 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #38's Interdisciplinary Care Plan Conference Record dated 07/27/23 documented .spoke with sister .see rehabilitation progress screen .family refused PEG tube . The conference record had no documentation under the action plan section. The review of Resident #38's Interdisciplinary Care Plan Conference Record from January through July 2023 did document any mention of the resident's wife compliance with the resident's dietary restrictions. Review of Resident #38's Therapy Screening Form dated 04/13/23 documented status: readmit .therapy evaluation recommended ST (speech therapy) No .comments: no ST warranted at this time; no changes noted . Review of Resident #38's Therapy Screening Form dated 04/19/23 documented status: care plan update .therapy evaluation recommended ST (speech therapy) section was left blank . comments: continue with POC (plan of care) established for this certification period. Review of Resident #38's Therapy Screening Form dated 04/27/23 documented status: care plan update .therapy evaluation recommended ST (speech therapy) section was left blank . comments: continue with POC (plan of care) established for this certification period. Review of Resident #38's Therapy Screening Form dated 07/27/23 documented status: care plan update .therapy evaluation recommended ST (speech therapy) No . comments: skilled therapy interventions not indicated at this time. Rehab team will continue to monitor . Review of Resident #38's nurses notes documented the following: *10/25/22- resident's wife observed bringing grape to feed resident. Care conference conducted with wife, responsible party sister, Administrator, Dietary manager, Assistant Director of Nursing, MDS Coordinator, Rehab Director will continue to monitor consistency of food wife brings in . *04/17/23- .wife in facility feeding resident. Resident noted coughing while being fed by wife. Care conference conducted with wife, sister, Director of Nursing and Administrator. Wife via translation was educated on how to feed resident, PEG placement was recommended, wife stated she will talk later to resident prior to making the decision to place a PEG *06/01/23- .;poor appetite for breakfast but consumed 100% of lunch. Wife educated on resident diet is puree but feeds resident regular food . Further review of Resident #38's nurses notes for July, August and September 2023 did not address Resident #38's wife compliance with the resident's dietary restrictions. Review of Resident #38's Dietitian note dated 08/31/23 documented spouse requested double entrees for meals .continue to monitor . The note did not address education to the resident's wife related to following dietary restrictions. Review of Resident #38's Dietitian note dated 09/04/23 documented will continue to monitor . The note did not address education to the resident's wife related to following dietary restrictions. On 10/02/23 at 11:48 AM, in room dining observation was conducted at the facility's central unit. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 3 of 16 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 10/05/2023 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 0657 Level of Harm - Minimal harm or potential for actual harm Observation revealed Resident #38 in bed being fed by a visitor. The resident was alert and eating without difficulty. Attempted to interview the visitor, since the resident did not answer questions asked by the surveyor during the initial tour to the central unit. The visitor stated she was the resident's wife, a language barrier was noted, resident's wife was talking in a language that the surveyor did not understand. The resident's wife asked to call the resident's sister and provided her telephone number. Residents Affected - Few On 10/03/23 at 12:05 PM, observation revealed Resident #38's room door closed, wife in the room and feeding the resident with the facility's prepared puree food. The wife stated that he ate ham and she pointed out the bread edges placed on top of the table. On 10/03/23 at 12:35 PM, an interview was conducted with the facility's Director of Rehabilitation (DOR). The DOR was asked to provide Resident #38's last Speech Therapist evaluation. On 10/03/23 at 12:52 PM, a second interview was conducted with the DOR who stated that Resident #38 was picked up by Speech Therapy on 02/28/23 and discharge from therapy on 03/20/23. The DOR stated the resident was discharged on a Pureed diet with nectar thick liquids. The DOR added that the resident's wife was always in the facility to feed him. The DOR stated the resident had Dysphagia and was to eat small amounts, double swallow and alternate between solids and liquids as per the Speech Therapist. The DOR stated that the resident's wife had been trained, had conference with other family members on what to feed and what not to feed the resident. The DOR added the staff had called resident's sister on how important was to feed him the right diet to avoid Aspiration Pneumonia. The DOR stated at one point, they were monitoring what the resident's wife was bringing into the building because she was bringing oranges to him. The DOR stated the resident's family were educated and reinforced on what he needed to eat. The DOR was asked to submit documentation related to Resident #38's last re-screened by the Speech Therapist and the last swallowing study. On 10/03/23 at 1:44 PM, an interview was conducted with the DOR who stated resident #38's last swallowing study was done on 12/22/22 and the last care plan screening was done on 07/27/23. The DOR stated the resident's last hospital stay was on 04/05/23 and was readmitted to the facility on [DATE]. The DOR stated that the resident's last speech therapist screening documented that it was not necessary to evaluate the resident for therapy. The DOR added that the resident's family was part of the care plan. The DOR confirmed that Resident #38 continued to be on a Pureed diet with nectar thick liquids meaning that the staff had to add thickening to his liquids. On 10/04/23 at 8:59 AM, an interview was conducted with Resident #38. The resident stated he married in 2000 and that he was a diabetic and knew not to eat sweets. The resident was asked if he had choked while eating and stated he coughed up blood once. The resident was asked regarding eating ham sandwich and stated he had no problem eating it. The resident was asked if he was told what to eat or not and stated Yes and added no sweets because of his diabetes. On 10/04/23 at 10:45 AM, during Resident #38's wound care observation, Staff B, Certified Nursing Assistant (CNA) who was assisting the Wound Care Nurse, stated that the resident's wife came every day around 11:30 AM and brings him food. On 10/04/23 at 12:40 PM, observation revealed multiple residents eating in the dining room and Staff C, CNA, Staff D, CNA and the Wound Care Nurse (WCN) assisting the resident with their meals and providing supervision. Observation revealed Resident #38 sitting in the dining room table accompanied by his wife and his mother. The resident was being fed the facility's puree meal by his wife. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 4 of 16 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 10/05/2023 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation revealed a container of soup with colored spiral like noodles on top of the dining table next to Resident #38. Subsequently, at 12:46 PM, observation revealed Resident #38's wife feeding the resident with the soup spiral noodles that was on top of the table. The wound care nurse was in the dining room close to the resident's table. Consequently, a joint interview was conducted with Staff C, CNA and the WCN in the dining room. Staff C and the WCN stated that Resident #38's wife has been told many times not to feed the resident food from home and she does not listen. The WCN stated it is documented that she does not listen and continues to feed the resident with food from home. Staff C stated she just informed Staff A, LPN (today) of the resident's wife feeding him with her food. On 10/04/23 at 12:45 PM, an interview was conducted with Staff A, LPN who stated that Resident #38's wife had been educated about not to bring food to the resident but kept doing it. Staff A stated that there was documenting on the nurses notes. Consequently, a side by side review of Resident #38's clinical record was conducted with Staff A. The review revealed one (1) nurses notes dated 06/15/23 that addressed Resident #38's wife feeding the resident with the wrong diet. Review of nurses notes for July and August 2023 lacked evidence of nursing documentation of the resident's wife of non-compliance with the resident physician order for a pureed diet. Further review of Resident #38's active care plans on file lacked evidence of a care plan related to behavior of non-compliance by the resident's wife related to dietary restrictions (puree food). On 10/05/23 at 9:18 AM, a side by side review of Resident #38's clinical record was conducted with the MDS Coordinator. The review revealed the resident's last assessment dated [DATE] documented a mechanical therapeutic diet. Continued side by side review of the resident's active care plan in his clinical record revealed a care plan for Altered Means of Nutrition and Swallowing Difficulties revised on 07/21/23, and Nutritional Status revised on 08/03/23. The MDS Coordinator stated that the resident was difficult when the staff were doing the care, was non-compliance, the family brings soup, family was very involved and care planning was done with the resident's sister, Assistant Director of Nursing (ADON) the nurse, CNA (Certified Nurses Assistant), MDS, Social Worker, Dietary Manager and the Rehabilitation Director. The MDS Coordinator was asked about a behavior or non-compliance care plan related to the resident's wife bringing wrong food to the resident like ham. The MDS Coordinator stated she was not aware of that and replied she will definitely have to care plan for behavior of non-compliance and will keep educating the resident and the family. On 10/05/23 at 9:54 AM, a joint interview was conducted with the MDS Coordinator and Staff H, Physical Therapy Assistant (PTA) who was filling in for the DOR. Staff H was apprised regarding Resident #38's wife feeding him with soup with noodles in the dining room on 10/04/23. Staff H stated she was not aware of that. She was apprised that the WCN and two CNA's observed the resident's wife feeding him with soup. Staff H stated, Thank you for letting me know . Staff H stated that the family had been educated about following a pureed diet. Staff H was asked to submit Education/Training provided to the family regarding food/diet to given to the family. Staff H was asked to see if the Resident #38 could be evaluated/rescreened today by the Speech Therapist. On 10/05/23 at 9:59 AM, an interview was conducted with the Social Services Director (SSD) who stated she spoke with Resident #38's wife via google translator on 10/04/23 after she was seen feeding the resident with a regular diet. The SSD stated that the Dietary Manager will puree the food she brings in if she lets him know. The SSD stated the facility communicates with the resident's sister who speak very well English and translate to the wife. The SSD stated she had not completed a waiver and was not sure if nursing had done it or not. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 5 of 16 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 10/05/2023 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 10/05/23 at 10:05 AM, an interview was conducted with the Director of Nursing (DON) who stated that Resident #38's wife and his family had been educated regarding his pureed diet and not to bring regular food. The DON stated that the wife continues to feed the resident with the wrong diet. The DON was asked to submit written documentation related to the family being educated about his pureed diet and not bringing regular food. The DON stated this has been happening since the resident came back from the hospital. The wife was encouraged to come to feed him because he was not eating. The DON was apprised that a non-compliance care plan had not been initiated. On 10/05/23 at 10:47 AM, an interview was conducted with the Speech Therapist (ST) who stated she went to see Resident #38 and he was sleeping, so she was unable to screen him. The ST stated she will recommend for a swallowing study since it has been a long time since he had one done. She was apprised that the resident was seen eating spiral type noodles soup and ham sandwich. On 10/05/23 at 2:37 PM, during an interview, the Administrator was asked to submit the facility's policy regarding non-compliance by a resident or representative. The Administrator stated the facility had a process, not a policy for non-compliance which it was educate, re-educate, redirect and document, whatever the issue was. The Administrator added that the process included the Medical Director, each issue was individualized and that Resident #38 wife's sister in law was helping with translation. The Administrator was apprised that there was not a non-compliance or Behavior care plan initiated for Resident #38 and according to the staff the issue has been happening for a while. The Administrator was asked to provide documentation related to teaching the resident's wife, his family related to the behavior of bringing and feeding the resident with the wrong food. On 10/05/23 at 3:49 PM, an interview was conducted with the DOR and Staff H, PTA. They both were asked regarding education/training provided to Resident #38's wife/representative regarding his dietary restrictions. Staff H stated the MDS Coordinator told her that the surveyor was okay with the information she provided. The DOR stated that the interdisciplinary team, during the care plan meeting, was educating the resident's spouse verbally, not in writing. The DOR stated a family member was on the phone. The DOR stated they did not have any written documentation on educating the residents' wife related to feeding him with the wrong diet. Based on observation, interview and record review, the facility failed to implement a care plan for incontinence after completing assessments that determined the resident to be incontinent for 1 of 2 sampled residents reviewed for incontinent care, (Resident #285); and the facility failed to implement a care plan and provide education related to the risk of noncompliance with a resident's dietary orders for 1 of 1 resident reviewed for wound care, (Resident #38). The findings included: Resident #285 was admitted to the facility on [DATE]. According to an admission Minimum Data Set (MDS) asssessment, dated 09/29/23, Resident #285 had a Brief Interview for Mental Status score of 13, indicating the resident as 'cognitively intact'. The assessment documented that the resident was 'frequently incontinent' of urine and 'occasionally incontinent' of bowel. Resident #285's diagnoses at the time of the assessment included: Depression, Psychotic disorder, fracture of shaft of left ulna, convulsions , open wound to the left upper arm fracture of right lower leg, Bipolar II disorder. Resident #285's baseline care plan, dated 09/12/23, documented that the resident was 'Continent of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 6 of 16 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 10/05/2023 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 0657 bladder' and 'Continent of bowel'. Level of Harm - Minimal harm or potential for actual harm Resident #285's care plan for Incontinence, dated 09/12/23 was blank. Residents Affected - Few A progress note, dated 09/13/23 at 6:35 AM, documented Slept most of the shift, is continent of B&B function. A progress note, dated 09/26/23 at 6:25 AM, documented No aggressive behavior. Incontinent of B&B. During an interview, on 10/02/23 at 12:55 PM, with Resident #285, the resident stated, They are telling me that I have to wear a diaper when I don't need one. I have been to the bathroom and use the bathroom [ROOM NUMBER] times. I don't pee that often. During an interview, on 10/04/23 at 1:01 PM, with Staff I, CNA , when asked about the need for Resident #285 to use incontinent briefs, Staff I replied, sometimes she poo and pee in the diaper sometimes twice during my shift. This morning, she won't let me help her she wanted to do everything herself. During an interview, on 10/04/23 at 1:08 PM, with Staff F, LPN, when asked about the need for Resident #285 to use incontinent briefs, Staff F replied, sometimes she is, sometimes she will aske you to take you to the bathroom, sometimes she will do it on herself. When she came in, she was doing it on herself. Now, she will ask for help to the bathroom. During an interview, on 10/04/23 at 1:12 PM, with the MDS Coordinator, when asked about Resident #285 being incontinent, the MDS Coordinator replied, Sometimes she has accidents. Sometimes she tells us she has to go and sometimes it slips her mind. When asked about lack if evidence of having a care plan for incontinence care, the MDS Coordinator confirmed that care plans are based on the assessments and acknowledged that the resident was assessed as being incontinent. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 7 of 16 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 10/05/2023 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure 1 of 1 sampled resident received ordered pain medications (Resident #83). Residents Affected - Few The findings include: Review of the Facility's policy for pain management revealed that pain medication will be administered as per physician's order. On [DATE], record review revealed Resident #83 was admitted to the facility on [DATE]. The admitting diagnoses included: convulsions, displaced fracture of sixth cervical vertebra; schizoaffective disorder bipolar type; Depressive disorder and Acute Severe Pain (generalized). On [DATE], it was documented that Resident #83 was discharged from the facility to the hospital, due to unbearable pain. Review of the Medication Administration Record (MAR) for [DATE] revealed the following orders: Gabapentin CAP 300 mg (for Neurontin) one capsule by mouth three times daily (TID) for Neuropathic pain initiated on [DATE]. Acetaminophen Tablet 325 mg two tablets (650 mg) by mouth every 4 hours as needed for pain (to be given for mild moderate or severe pain) Max 3 gm APAP / 24 HRS), effective [DATE]. Starting on [DATE], there was an order given for Tramadol 50 mg ,ordered to be taken by mouth every 8 hours as needed for pain. There was no evidence the PRN medications were administered since the MAR slots for those medications were blank. The order to screen the Resident #83's pain level every shift was from the first of October to the 25th day of October. Review of the MAR revealed staff documented that Resident #83 experienced no pain, except for the first and second day of that month. The Nurses' Progress Notes (NPNs) dated [DATE] at 10:00 AM, documented that pain medication was administered and was effective. On [DATE] at 11:00 AM, staff documented that an X-Ray was taken, and the CD was placed in the resident's chart. On [DATE] at 12:30 PM, the NPNs documented that the X-Ray result was received and were within normal limit (WNL). It documented that Resident #83 still complained of pain (mourning). The Nurse Practitioner was informed and ordered Tramadol 50 mg, to be taken by mouth every 8 hours as needed for pain. There was no indication on the MAR that the PRN Tylenol for pain or the Tramadol were administered to the resident. On [DATE], the NPNs documented that Resident #83 complained of generalized pain. The Advanced Practical Registered Nurse (APRN) ordered that the resident be transferred to the hospital for further evaluation. Interview with the Minimum Data Set (MDS) Coordinator on [DATE] at 11:32 AM revealed that the resident did not return to the facility, and that he had expired. She confirmed the resident used to complain of pain. The Unit Manager (UM) stated on [DATE] at 12:53 PM that Resident #83 did not like taking Tylenol and possibly this was why the PRN Tylenol was not given. She also stated that she did not know why the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 8 of 16 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 10/05/2023 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 0697 tramadol was never given or offered. There was no documentation that the resident ever refused Tylenol. Level of Harm - Minimal harm or potential for actual harm Review of the Care Plan (CP) updated [DATE] revealed that Resident #83 was prescribed analgesics. There was no documentation in the CP that Resident #83's behavior of refusal for a particular pain medication was documented, as the nurse manager had reported. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 9 of 16 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 10/05/2023 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to ensure controlled substance medication reconciliation was accurate for 2 of 2 sampled residents reviewed during the controlled substance record review on the facility's west wing (Resident #35 and #186). The findings included: 1) Review of Resident #35's clinical record documented an admission to the facility on [DATE] and readmission on [DATE]. The resident's diagnoses included Diabetes Mellitus Type 2 with Peripheral Angiopathy, Pressure Ulcer of right Heel and Low Back Pain. Review of Resident #35's Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 10 indicating that the resident had moderate cognition impairment. The assessment documented under Functional Status that the resident needed extensive assistance from the staff to complete the activities of daily living. Review of Resident #35's physician orders dated 04/26/23 documented Tramadol (a controlled substance for pain) 50 milligrams (mg) give one tablet every six (6) hours as needed for pain. On 10/03/23 at 2:07 PM, a side by side review of Resident #35's Medication Monitoring/Control Record sheet for Tramadol 50 mg tablets was conducted with Staff F, Licensed Practical Nurse (LPN). The review revealed that Tramadol 50 mg one (1) tablet was removed from the controlled substance box on 09/25/23, 09/28/23 and on 09/29/23. On 10/03/23 at 2:31 PM, during an interview, Staff G, Registered Nurse (RN)/Evening Supervisor was asked to submit Resident #35's September 2023 Medication Administration Record (MAR). A side by side review of Resident #35's 2023 September MAR and the resident's Medication Monitoring/Control Record sheet for Tramadol 50 mg tablets was conducted with Staff G. The review revealed that the Tramadol 50 mg removed from the controlled substance box 09/25/23, 09/28/23 and on 09/29/23 was not documented on the resident's MAR as being administered. Staff G stated that the nurses were to document any controlled substance removed from the controlled substance box in the MAR after being administered. Subsequently, an interview was conducted with Staff F, LPN who stated that controlled substances were to be documented on the MAR also. Staff G and Staff F confirmed that Resident #35's controlled substance removed from the controlled substance box were not documented as being administered on the resident's MAR. Further review of Resident #35's Medication Monitoring/Control Record sheet for Tramadol 50 mg tablets documented that Tramadol 50 mg tablets were removed from the controlled substance box on 09/03/23, 09/07/23, 09/08/23, and on 09/21/23. Review of the resident's September 2023 MAR revealed that Tramadol tablets removed from the controlled substance during the month of September 2023 were not documented on the resident's MAR as being administered. 2) Review of Resident #186's clinical record documented an admission to the facility on [DATE]. The resident's diagnoses included Alcohol Abuse, Major Depressive Disorder, Atherosclerosis of Aorta, Peripheral Vascular Disease and Suicide Attempt. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 10 of 16 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 10/05/2023 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #186's physician orders dated 09/27/23 documented Percocet ( a controlled substance for pain) 5/325 mg one (1) tablet every six (6) as needed for pain. On 10/03/23 at 2:10 PM, a side by side review of Resident #186's Medication Monitoring/Control Record sheet for Percocet 5/325 mg tablets was conducted with Staff F, Licensed Practical Nurse (LPN). The review revealed that Percocet 5/325 mg one (1) tablet was removed from the controlled substance box on 09/30/23. On 10/03/23 at 2:33 PM, a side by side review of Resident #186's September 2023 MAR was conducted with Staff G, RN/Evening supervisor. The review revealed that Percocet 5/325 mg removed from the controlled substance box on 09/30/23 at 5:25 PM was not documented on the resident's MAR has been administered. Staff G stated that the nurses were to document the controlled substance medications in both places, the MAR and the Medication Monitoring/Control Record sheet. On 10/03/23 at 2:45 PM, during an interview, Staff F confirmed that Resident #186's Percocet tablet removed from the box on 09/30/23 was not documented on the resident's September MAR has been administered. On 10/05/23 at 3:15 PM, during an interview the Director of Nursing was apprised of the controlled substance reconciliation findings discussed with Staff G, Evening Supervisor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 11 of 16 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 10/05/2023 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure that administered antipsychotic drugs had a clinically documented diagnosis for use for 1 of 5 sampled residents (Resident #79) reviewed for unnecessary medication. Residents Affected - Few The findings included: Resident #79's clinical record review revealed that he was admitted to the facility on [DATE]. The admitting diagnoses included: Acute Cystitis hematuria. Cognitive Communication Deficit; Alzheimer's disease unspecified; Chondrocostal Junction Syndrome ([NAME]); Unspecified Glaucoma; muscle weakness generalized; and difficulty in walking. The Physicians orders (POs) dated 07/28/2023 revealed the following orders: Risperidone tab 0.5 mg, Take one half tablet by mouth twice daily for Schizophrenia. Sertraline tab 50 mg, Take one tablet by mouth once daily. The diagnosis of Schizophrenia was not listed on the Resident's Face Sheet. Section I of the Minimum Data Set (MDS) assessment titled diagnosis, dated 08/03/2023 did not document Schizophrenia as a diagnosis. Section N of the MDS showed that Resident #79 received antipsychotic medications on a routine basis. Review of the Care Plan (CP) dated 07/21/2023 documented that Resident #79 exhibited Anxiety behavior, Agitation; inappropriate behavior related to Alzheimer's/Dementia; Unpleasant mood and restlessness are manifested in the resident's behavioral pattern, and he was prescribed antipsychotic med (Risperidone). However, Schizophrenia was not documented as a diagnosis. Review of the Nurses Progres Notes documented that the resident exhibited disruptive behavior, confusion related to Alzheimer's/ Dementia. On 07/25/2023, the resident was sent to the hospital and returned to the facility with a diagnosis of urinary tract infection (UTI). There was no documentation that the resident's behaviors were related to the diagnosis of Schizophrenia. On 10/04/23 at 9:56 AM, the MDS Coordinator stated that she has been working at this facility for many months. She acknowledged that upon admisson Resident #79 was very confused. She said that the resident was sent to the hospital on [DATE] and returned to the facility on [DATE] with new prescriptions for Buspar 5 mg as needed and Risperdal (take 0.5 mg tablets (25 mg) by mouth once daily. She said that however when the resident returned to the facility, the Buspar was discontinued, but the Risperidone 0.5 mg was not discontinued. The MDS Coordinator added that she was waiting for the Physician's consultation report to update the MDS with the diagnosis of Schizophrenia. She stated that she forgot to go back to update it. She indicated that since she could not confirm the reason for the psychotropic medication, she also did not update the MDS and the Care Plan to reflect the diagnosis of Schizophrenia. On 10/05/23 at 11:16 AM, the Director of Nursing (DON) reported that when the resident first came to the facility, he did not have a diagnosis of Schizophrenia. She revealed that the Risperidone 0.5 mg was prescribed for psychosis due to the resident's altered mental status. However, after he returned to the facility from the hospital, he was readmitted with a script that documented Risperidone for Schizophrenia and the Pharmacy continued to document Schizophrenia. The psychiatric consult did not indicate that Resident #79 had a diagnosis of Schizophrenia. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 12 of 16 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 10/05/2023 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 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Review of the Medication Regimen Review (MRR) for the months of July 2023 and August 2023 were completed with no recommendations made. On 09/29/2023, the Pharmacist recommended that a Gradual Dose Reduction (GDR) for Risperdal 0.25mg which started since 07/29/2023 for Schizophrenia. However, the diagnosis of Schizophrenia was not a documented diagnosis for Resident #79. On 10/04/2023, the primary care physician accepted the recommendation and ordered that the Risperdal 0.25 mg BID be discontinued. Event ID: Facility ID: 105296 If continuation sheet Page 13 of 16 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 10/05/2023 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to prepare, serve, and store food in a manner in accordance with professional standards for food safety. Residents Affected - Some The findings included: 1). During the initial kitchen tour, on 10/03/23 at 9:44 AM, accompanied by the Certified Dietary Manager (CDM) the following were observed: a. There was an accumulation of ice from the fan guard directly over food items in the reach in freezer. b. The gasket on the reach in freezer was damaged in a manner that is not easily cleanable. c. There was an accumulation of residue inside of the fryer cabinet. d. The concentration of the quaternary ammonia used for sanitizing food and non-food contact surfaces was over 400 parts per million. The CDM demonstrated that the problem was with the dispenser at the three compartment sink used for manual ware washing was not dispensing properly. e. There was an accumulation of ice from the cooling unit in the walk in freezer. f. The gasket on the inside of the walk in cooler door was damaged in a manner that makes it not easily cleanable. g. A portion of the floor and wall juncture by the walk in cooler was damaged. At the conclusion of the initial kitchen tour, the CDM acknowledged understanding of the concerns. 2). During an observation of the unit pantry, on 10/05/23 at 8:53 AM, accompanied by the CDM, there was an accumulation of debris inside of the opening in the back of the counter mounted reach in cooler where the compressor was located. The CDM stated that nursing was responsible for maintaining the pantries. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 14 of 16 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 10/05/2023 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to maintain communication with Hospice to ensure continuity of care for 1 of 1 sampled resident reviewed for Hospice (Resident #29). The findings included: The contract for [name of hospice company] with the facility, initiated 03/05/21, documented the following: In Section 2.1.4, Delineation of Roles. 2.1.4.1 In the provision of care to Hospice Patients, the Facility shall be responsible for: Providing Services as contained in the Hospice Plan of Care Communicating to designated [name of hospice company] personnel any changes in the Hospice Patient's condition, including the Hospice Patient's reaction to treatment and recommendations for appropriate modifications to the Hospice Patient's Hospice Plan of Care. 2.1.4.2 In the provision of care to Hospice Patients, [name of hospice company] shall be responsible for: Development of a Hospice Plan of Care. In Section 2.1.5, Medical Records Documentation: [name of hospice company] shall coordinate with Facility to ensure documentation of Services is completed as applicable for Hospice Patients. In Section 2.1.7 Plan of Care, [name of hospice company] shall establish, modify as appropriate, and provide Facility with a copy of a Hospice plan of Care for each Hospice Patient admitted to Facility. Resident #29 was initially admitted on [DATE]. Review of the Significant Change Minimum Data Set (MDS), dated [DATE], documented Resident #29 had a Brief Interview for Mental Status (BIMS) score of 09, indicating the resident was moderately cognitively impaired. Resident #29's diagnoses at the time of the assessment included: Anemia, Hypertension, Hemiplegia, Schizophrenia, Sequelae following cerebrovascular disease, Contracture to left wrist, Spastic hemiplegia, Dysarthria following cerebrovascular disease, Dysphagia, Major depressive disorder with psychotic symptoms, and GERD (gastroesophageal reflux disease). Resident #29 was admitted to Hospice on 08/19/23. It was determined that due to the resident not being able to give reasonable answers that Resident #29 was not interviewable. During a review of Resident #29's paper-based health record, it was noted there was no documentation of services provided by Hospice staff, with the exception of an initial certification, dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 15 of 16 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 10/05/2023 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 08/20/23 and the Care Plan Review documents, dated 09/05/23 and 09/18/23. Further review of Resident #29's paper-based health record revealed that there was no other documentation of a care plan for Hospice that included goals and interventions. During an interview, on 10/04/23 at 10:10 AM with the ADON (Assistant Director Of Nursing), it was noted there were no notes and no care plan. The ADON called the Hospice Nurse who is now enroute to the facility. The ADON confirmed the resident was on Physical Therapy (PT) and Occupational Therapy (OT) with Hospice, and they are here almost every evening. The ADON confirmed hospice were here at the end of his shift. He said he had met with Speech, OT and PT, usually in the evenings. He said he had observed them doing therapy for 20 minutes and sitting with him. The ADON said they do their job and they never come back to give a report. During an interview, on 10/04/23 at 10:55 AM, with the Hospice Registered Nurse (RN), when asked about a Hospice care plan, the Hospice RN replied, the plan of care review, we do every 2 weeks, we accept the patient. if there are no major changes, we just communicate verbally with the ADON, she is the main nurse, the nurse assigned to the patient. When asked about documentation of services provided to the resident, the Hospice RN replied, my notes are six pages. I always communicate with the ADON via text, and I always communicate with her when I am here. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105296 If continuation sheet Page 16 of 16