Inspection·February 24, 2022

F 0557 clothes. The resident stated she reported this to someone but did not remember the name of the person. Level of Harm - Minimal harm or potential for actual harm On 02/22/22 at 3:06 PM, observation revealed Resident #86 in her room, lying in bed and wearing an institutional gown. Subsequently, an interview was conducted with Staff N, a Certified Nursing Assistant (CNA) assigned to the resident. Staff N stated she works the day shift and provided Resident #86's morning care and changed her gown. Staff N was asked why she put a gown on the resident and stated the resident did not have any clothes. Staff N added she was working when the resident came in and recalled that she did not bring any clothes or any pocketbook. Staff N was asked what they do when a resident does not have clothes and stated they do have a section of donated clothes, but they did not have any women's tops. Staff N added she will need to go to the laundry to get clothes for the resident. Staff N was asked when she will go to the laundry and stated, I guess tomorrow. Residents Affected - Few On 02/22/22 at 4:06 PM, a side-by-side review of Resident #86's Inventory of Personal Belongings dated 01/07/22 was conducted with Staff M, a Licensed Practical Nurse (LPN). The Inventory sheet documented resident had one dress, one ladies' suit, glasses and two sport jackets. During an interview with Staff M, LPN, she stated that she was not aware that Resident #86 did not have any clothes. On 02/22/22 at 4:16 PM, observation revealed Resident #86 in her room and wearing an institutional gown. An interview was conducted with the resident assigned CNA, Staff O stated that she will change Resident #86's gown this evening. A side-by-side review of the resident private closet space and nightstand was conducted with Staff O. The review revealed empty shelves, and two basins in her nightstand. No resident clothes or personal belongings were observed in her room. Staff O stated Resident #86 was moved from another room and she did not know what happened to her belongings. On 02/24/22 at 11:24 AM, an interview was conducted with the facility's Director of Social Services (DSS). The DSS stated that on 02/18/22 they received a grievance from Resident #86's daughter regarding medical reasons and dietary concerns, but never mentioned any clothing issues. The DSS stated she was not aware that the resident did not have any clothes. The DSS was apprised that Resident#86 closet was bare, no clothes in the closet and that the resident was wearing a gown for two days. During the interview, the DSS made a call to the residents' contact listed (friend). The resident's friend stated she brought two sweat jacket one blue and one black. On 02/24/22 at 11:57 AM, a side-by-side review of the facility's donated/nameless rack of clothes was conducted with the Director of Environmental (DOE). The rack was full of female tops and a few pants. The DOE stated he had not heard from anyone regarding Resident #86's missing clothes. A side-by-side review of Resident #86 Inventory Personal Belongings form was conducted with the DOE and DSS. They stated they did not know where the residents' clothes were. On 02/24/22 12:39 PM, observation revealed Resident #86 sitting up in a chair and being assisted for lunch by Staff N, CNA. Further observation revealed the resident was dressed up with a pink top and pink pants. The resident was asked if she was glad, she had clothes, not a gown, today and stated Yes. During an interview, Staff N stated the resident had some clothes in her closet. A side-by-side review of Resident #86's private closet space was conducted with the DSS. The review then revealed two tops in the closet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 2 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. 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, it was determined that based on the comprehensive assessment, the facility failed to provide necessary care and services that included the assistance and supervision of independent eating for 1 (Resident #29) of 6 sampled residents reviewed for nutrition. Residents Affected - Few The findings included: During the observation of the lunch meal on 02/22/22 at 12:30 PM, it was noted that the meal tray served to the room of Resident #29, who was alert with confusion. Staff noted to set the tray up for the resident on the bedside table. Further observation noted the resident was able to feed self but was not eating. It was further noted that staff did not supervise or assist resident during the meal and the resident was noted to eat less than 25 % of the meal . During the observation of the breakfast meal on 02/23/22 at 8:30 AM, it was noted that the meal tray was served to the room of Resident #29. The resident was noted to be in bed , awake and alert, but with confusion. Observations conducted from 8:30 AM through 9 AM noted that the resident was not eating and at no time did staff offer supervision or assistance during the meal. Resident #29 was noted to eat less than 10% of the meal. Specifically, the resident drank only the orange juice and failed to consume any of the entree, cereals, milk, or nutritional supplement drink. During the observation of lunch meal 02/23/22 at 12:15 PM, it was noted a meal tray was served to the room of Resident #29. The resident was noted to be sitting up in bed but alert with confusion. The meal tray left on the over-bed table by CNA. Continued observation noted no staff assistance or supervision with lunch meal. Resident #29 was noted to consume less than 10 % of meal. Review of clinical record of Resident #29 noted the following: Date Of admission: [DATE] Diagnoses: Fractured Left Femur/Artificial Hip Joint/Pressure Ulcer Left Heel, Dementia/Mood Disorder/and Contracture of Left Knee. Review of the MDS (Mininmum Data Set) quarterly assessment dated [DATE], revealed the following: Section C: BIMS (Brief Interview of Mental Status) score of 10, indicating moderately impaired cognition. Section D: No Mood Issues *Section G ; Eating- Supervision with meals Section K : No Swallow Disorders/ 65/113# Review of current physician orders: 8/31/21- Mechanical Soft Diet (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 3 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 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 0676 10/12/21= House Supplement 120 ml TID Level of Harm - Minimal harm or potential for actual harm 2/14/22 - Health Shake - with Meals 9/25/21 - Offer a Bedtime Snack Residents Affected - Few 8/31/21 - Nursing Restorative Programs as indicated Review of Weight History: *Surveyor requested weight (wt) on 02/23 = 97# 2/11/22 = 99.6# 2/7/22 =101.2# 1/17/22 =106# 12/15/21 = 110.3# 10/28/21=112.2# 10/14/21=115# 9/29/21=120# BMI (Body Mass Index)= 16.6 Progress Notes: 2/14/22 - Wt=99, BMI=16.6, 3-Day Calorie revealed only 50% of calories intake and 65% of Protein intake, Nutritional needs not being met. Will add health shakes. Review of a current care plan dated 12/3/21 noted the problem of Alternation on Nutrition and intervention included : *supervision with meals. On 02/23/22 an interview was conducted with the Director of Nursing (DON) to review Resident #29 nutritional status and lack of assistance and supervision with meals. The DON stated she was unaware of weight loss and lack of assistance and supervision with eating of Resident #29. The DON also stated that there is not a Nursing Restorative Eating Program for residents who require supervision and assistance with meals. The DON further stated that the resident will be brought to the Main Dining Room (MDR) for all meals and staff will be in-serviced to provide Resident #29 encouragement, supervision, and assistance with meals. Observation of the breakfast meal on 02/24/22 noted the resident brought in the MDR for supervision and assistance with the meal. It was noted that the resident consumed 50% of the meal and consumed 100% of the nutritional House Supplement. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 4 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 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 0679 Provide activities to meet all resident's needs. 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 ensure 5 of 5 sampled residents reviewed for Activities, Resident #60, Resident #89, Resident #112, Resident #131 and Resident #439, were offered and provided with preferred activities, as evidenced by Resident #60, Resident #89, Resident #112, Resident #131 and Resident #439 not provided with activities of their choice. Residents Affected - Few The findings included: Review of the facility Individual Activities and Room Visit Program policy states in part, 'Individual activities are provided for individuals who have conditions or situations that prevent them from participating in group activities . The activities program provides individualized activities consistent with the overall goals of an effective activities program. The activities offered are reflective of the resident's individual activity interests, as identified in the Activity Assessment, progress notes and the resident's Comprehensive Care Plan It is recommended that residents on full room visit program receive, at a minimum, three room visits per week. Typically a room visit is ten to fifteen minutes in length.' 1) Review of the clinical record for Resident #112 revealed an admission date of 06/22/20 with diagnoses to include cerebral vascular accident, Parkinson's disease, dementia, and depression. Review of the clinical record for Resident #112 revealed on 12/19/21 he was having difficulty swallowing and his diet was changed to puree consistency with thickened liquids. Further review of the clinical record revealed on 12/21/21 the resident became lethargic and short of breath and was transferred to the hospital for evaluation. Resident #112 had a 10 day hospital stay and was readmitted to the facility on [DATE], now with a feeding tube inserted. Review of a Nursing Narrative Note dated 01/11/22 documented 'Resident is awake and responsive. Confusion noted. 1st day post re-admit. G tube feeding in progress, tolerating well.' Review of the clinical record for Resident #112 revealed the tube feedings were ordered to infuse via a feeding pump from 2:00 PM through 8:00 AM, for a total of 18 hours daily. Review of an Activity/Recreation Progress Note dated 01/13/22, documented 'Resident return 01/10/22. Resident return diagnosis AMS (altered mental status). Resident resting comfortable, TV as tolerated/stimulation, will visit for assistance and needs to and from activities as tolerated, will continue with activity goals and approaches.' Review of an Activities admission Evaluation dated 01/13/22, 3 days after Resident #112 was readmitted to the facility from the hospital, documented 'Resident likes TV, rest as tolerated.' Review of Resident #112's Activities/Recreational Care Plan stated under Interventions: Keep resident informed of activities calendar/schedule; Take time to talk/visit resident as tolerated; TV on in room as tolerated/stimulation; Visit to maintain trust. Review of the One to One Activity list documented Resident #112 to receive one to one in room visits. Review of the Activity Recreation Progress Notes for February 2022 revealed documentation of only 2 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 5 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 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 0679 one to one room visits conducted on 02/18/22 and 02/15/22. Level of Harm - Minimal harm or potential for actual harm On 02/21/22 at 10:00 AM, Resident #112 was observed in his bed by the window with the privacy curtain drawn between his bed and his roommates preventing the resident from having a view out of the room. The exterior window blinds were closed preventing the resident from having a view of the outside, and the room lights were off. There was no television on or music playing. Residents Affected - Few On 02/21/22 at 12:30 PM, Resident #112 was observed in his bed with the privacy curtain drawn between the beds, the exterior window blinds closed and the lights off. There was no television on or music playing. On 02/21/22 at 3:10 PM, Resident #112 was observed in his bed with the privacy curtain drawn between the beds, the exterior window blinds closed and the lights off. There was no television on or music playing. The tube feeding was observed at this time to be infusing via a feeding pump. On 02/22/22 at 9:30 AM, Resident #112 was observed in his bed with the privacy curtain drawn between the beds, the exterior window blinds closed and the lights off. There was no television on or music playing. On 02/22/22 at 11:30 AM, Resident #112 was observed in his bed with the privacy curtain drawn between the beds, the exterior window blinds closed and the lights off. There was no television on or music playing. 02/22/22 at 2:45 PM, Resident #112 was observed in his bed with the privacy curtain drawn between the beds, the exterior window blinds closed and the lights off. There was no television on or music playing. The tube feeding was observed at this time to be infusing via a feeding pump. On 02/23/22 at 10:08 AM, Resident #112 was observed in his bed with the privacy curtain drawn between the beds, the exterior window blinds closed and the lights off. There was no television on or music playing. On 02/23/22 at 12:00 PM, Resident #112 was observed in his bed with the privacy curtain drawn between the beds, the exterior window blinds closed and the lights off. There was no television on or music playing. On 02/23/22 at 2:00 PM, Resident #112 was observed in his bed with the privacy curtain drawn between the beds, the exterior window blinds closed and the lights off. There was no television on or music playing. On 02/23/22 at 4:40 PM, Resident #112 was observed in his room up in a gerichair. The window blinds were open, however the privacy curtain was drawn between the 2 beds. There was no television on or music playing. The tube feeding was observed at this time to be infusing via a feeding pump. On 02/24/22 at 9:12 AM, Resident #112 was observed in his bed with the privacy curtain drawn between the beds, the exterior window blinds closed and the lights off. There was no television on or music playing. On 02/24/22 at 11:20 AM, Resident #112 was observed in his room up in a gerichair. The window blinds were closed, however the privacy curtain was open. There was no television on or music playing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 6 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 02/24/22 at 11:10 AM, an interview was conducted with the Director of Activities and Activity Assistant Staff P and Activity Assistant Staff Q. The Director of Activities stated she does the best she can as she has to cover all 3 floors with a census of 150 residents. She stated Staff P and Staff Q sometimes have to accompany residents going out of the facility on appointments so it sometimes just leaves her running from floor to floor to cover activities. An inquiry was made about Resident #112 who has been observed in his room with no sensory stimulation for the past 4 days to which she stated with him she reads to him and plays music from her phone as he does not have a radio and she will turn the television on for him. An inquiry was made who turns the TV on to which she stated either her or the aides will do it. The Director of Activities was apprised for the past 4 days the resident has been observed in his room with the blinds closed, the privacy curtain drawn, lights out with no television or music playing. The Director of Activities stated she does the best she can but it is a big facility and she cannot be everywhere, she is running all day. An inquiry was made if Resident #112 participated in activities outside of his room prior to the feeding tube being inserted in January 2022, to which she stated he did go to more activities, he would be out of his room more but not since he got the feeding tube. The Activities Director, Staff P and Staff Q all stated they do what they can with what they have. On 02/24/22 at 11:25 AM, an interview was conducted with Licensed Practical Nurse (LPN) Staff B on the North unit where Resident #14 resides. She stated the resident has been on different floors of the facility, and in the hospital and has only been on this unit for a couple of weeks. She stated she remembers him somewhat from before he went to the hospital and remembers he did go out of his room more when he did not have the feeding tube, but since the feeding tube he does not get out of his room. 2) On 02/21/22 at 1:35 PM, during observation, it was noted that Resident #60 was on Transmission Based Precautions. Record review revealed Resident #60 had a Minimum Data Set (MDS) Quarterly assessment completed on 11/13/21. At the time of that assessment she had a BIMS (Brief Interview of Mental status) of 11/15, mild cognitive deficits. On 02/22/22 at 2:44 PM, Resident #60 was observed sleeping, therefore an interview was conducted with Staff R, a Licenced Practical Nurse (LPN). The surveyor raised the concern of Resident #60 not having in room [ROOM NUMBER]:1 activities. Staff R stated that as long as the activities staff used the appropiate Personal Protection Equipment (PPE) then there should be no reason Resident #60 to not have 1:1 activities. On 02/23/22 at 1:43 PM, an interview was conducted with Resident #60. Resident #60 stated that she gets magazines once in a while from her daughter but nobody from the facility has ever come to see her to offer books or other entertainment. Further record review revealed two Activity Recreation notes posted to Resident #60 record these notes follow: 02/23/22, 07:13: Activity/Recreation progress notes Note Text: Resident upcoming care plan review, care plan updated, Resident activity pursuit no change, resident likes in her room her own leisure time, TV as desire, resting, phone conversations w/ family and friends may read her book/ spiritual book, visits for assistance and needs talk to resident offer and encourage out of room activities music, bingo, coffee soc, exercise and more, offer puzzles, magazines, coloring papers w/ markers, do take resident out to see her resident sister that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 7 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 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 0679 Level of Harm - Minimal harm or potential for actual harm lives in the facility on center hall I sit them in the MDR (Main dining room) to talk/call other family w/ assistance, will continue to offer and encourage activity participation, will continue with activity goals and approaches. 02/9/22, 07: Activity/Recreation progress notes Residents Affected - Few Note Text: Resident alert, assist resident out to sit/ visit with resident's sister room [ROOM NUMBER]A in the MDR on 02/07/22 w/ assist back to their rooms. These were the only notes found related to activities provided. 3) Resident #89 was admitted to the facility on [DATE]. Resident #89 had a Quarterly MDS assessment on 01/22/22. At the time of the MDS assessment Resident #89 had a BIMS of 14/15, indicating minimumly cognitively impaired. On 02/22/22 at 11:10 AM, an interview of Resident #89 was conducted. When asked about Activities, Resident #89 stated that she is unable to partake in physical activities related to her respiratory health. Resident #89 stated that she gets tired easily, but the activities people do not even stop in for a conversation. Resident #89 stated she would like an in room visit once in a while. On 02/22/22 at 3:19 PM, a follow-up interview was conducted with Resident #89 regarding activities. Resident #89 stated that other than the surveyor, no one has come in and spent 5 minutes speaking with her. On 02/23/22 at 2:07 PM, an additional interview regarding activities was conducted with Resident #89. Resident #89 denied activities offered in the room and expressed that out of room activities are too tiring for her, as related to her respiratory issues. Record review for Activites for Resident #89 revealed the following Activity/Recreation progress note: 01/25/22, 07:32: Activity/Recreation progress notes Note Text: Resident upcoming care plan review, care plan updated, Resident activity pursuit no change, resident continue to be alert in room / bed resting TV as desire, phone conversations, with resident own leisure time and choice of activities and doing in her room, visits for assistance and needs, offer face time, invite and encourage out of room activities music, bingo, exercise, blackjack and more, puzzles, cards, books, magazines, fresh air outside patio, will continue with activity goals and approaches. This was the most recent Activity/Recreation progress note in Resident #89's record. 4) Resident #439 was admitted to the facility on [DATE] and at the time of the survey the comprehensive assessment for admission had not been completed. On 02/21/22 at 2:27 PM, an interview was conducted with Resident #439. At the time of the interview, Resident #439 stated that the activities department does not visit. Stated she is lonely because her husband is out of the country. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 8 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 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 0679 Level of Harm - Minimal harm or potential for actual harm On 02/23/22 at 3:00 PM, an additional interview regarding activities was conducted with Resident #439. Resident #439 denied having activities offered in the room and expressed that she was not interested in activities at that time because she was feeling very anxious. Record review revealed the following Activity/Recreation Progress notes: Residents Affected - Few 02/23/22, 9:44: Activity/Recreation progress notes Note Text: Visit 02/22/22 Visit to sit and talk with resident as rest w/ TV, talk with resident to encourage out of room activities music, bingo, patio soc and more, let resident know staff will assist her to and from, resident say OK and she will see continue to talk with resident offer magazines, puzzles, books. 02/15/2022, 10:45: Activity/Recreation progress notes Resident admitted [DATE] Resident alert and oriented, TV as desire, talk to resident about food menu offer assistance, resident say later, TV unit on floor when feeling better, activities as desire with assistance, will continue with activity goals and approaches. view On 02/24/22 at 11:53 AM, an interview was conducted with the Activities Director regarding activites for Resident #60, #89, and #439. The Activities Director stated that she tries to provide in room visits at least 2x a week. When asked about documentation to support activities being provided, the Activities Director stated that all of her documentation was done in PCC (Point Click Care). When it was noted that documentation found was limited to one weekly entry or less for each resident, the Activities Director claimed she had visitied more often but agreed that without docmentation this could not be proven. 5) Review of the clinical record for Resident #131 revealed an admission date of 01/03/22 with diagnoses to include cerebral hemorrhage with right sided weakness, depression, aphasia (inability to verbally communicate) and dysphagia (inability to swallow). Resident #131 receives all her nutrition and hydration needs through a feeding tube with feedings commencing at 2:00 PM and concluding at 8:00 AM for a total of 18 hours daily. Review of a Minimum Data Set (MDS) significant change resident assessment dated [DATE] documented under Section C Cognition, a Brief Interview for Mental Status (BIMS) score of 99 indicating severely impaired cognition. Under Section G, Functional Status documents the resident requires extensive assistance with Activities of Daily Living and is dependent on staff for all care and activities. Review of her Care Plan completed on 02/05/22 revealed that Resident #131 is to be included in her choice of activities including resting/interacting with recreational/staff as desired/tolerated with the interventions list including encourage friendships, invite/assist to and from activities, keeping her informed of activities available, television on in room as desired, and visiting with staff and family members. On 02/21/22 at 11:05 AM, Resident #131 was observed in her bed by the window with the privacy curtain drawn around the bed, the exterior window blinds closed and no television or music on and no staff or family at the bedside. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 9 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an observation conducted on 02/21/22 at 3:16 PM, it was noted that Resident #131 continued to be in bed, now with her family member at her bedside. However, the privacy curtain continued to be drawn around the bed and the exterior window blinds were closed. In an interview conducted with Resident #131's family member on 02/21/22 at 3:16 PM, she stated she tries to visit every other day, further stating she has never seen the resident up in the chair, pointing to the wheelchair next to the resident's bed, and she would like to see Resident #131 up in the chair more often and participating in activities. In an observation conducted on 02/22/22 at 10:15 AM, it was noted that Resident #131 was in bed with the privacy curtain drawn around her bed, the exterior window blinds closed and no television or music on and no staff or family at the bedside. In an observation conducted on 02/22/22 at 2:50 PM, it was noted that Resident #131 was still in bed with the privacy curtain drawn around her bed, the exterior window blinds closed and no television or music on and no staff or family at the bedside. In an observation conducted on 02/23/22 at 10:12 AM, it was noted that Resident #131 was in bed with the privacy curtain drawn around her bed, the exterior window blinds closed and no television or music on and no staff or family at the bedside. In an observation conducted on 02/23/22 at 2:00 PM, it was noted that Resident #131 was up in the gerichair in the common area on the 1st floor North Wing watching television with other residents. Resident #131 was observed to be following persons walking by with her eyes. In an observation conducted on 02/24/22 at 11:20 AM, it was noted that Resident #131 was in bed with the privacy curtain drawn around her bed, the exterior window blinds closed and no television or music on and no staff or family at the bedside. A review of the One-to-One Activities log revealed Resident #131 was not included in the list of residents who were receiving one to one in room visits. A review of Resident #131's clinical record revealed no documentation from the activities department. An interview was conducted with the Activities Director and Staff P and Staff Q, Certified Nursing Assistant (CNA) Activity Assistants on 02/24/22 at 11:10 AM. The Activities Director stated she is the only official activities staff member in the facility and that Staff P and Staff Q are occasionally able to help her with her duties. She further stated it is difficult for her to manage as one person for a census of 150 residents on 3 floors, as the two Activity Assistants are often pulled from activities to work as CNAs or leave the facility with residents when they go to outside appointments. She stated when this happens, she is often the only person conducting activities with the residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 10 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observations, interviews, and record reviews, the facility staff failed to provide a safe smoking environment for 5 of 8 residents identified by the facility as being smokers, which included sampled Residents #75, #129, #87, #81 and #120. The census at the time of the survey was 150. The findings included: Review of the facility's policy titled Smoking Policy, not dated, documented the following: Unsupervised smoking is prohibited on facility grounds by any resident; all smoking by residents is supervised by a staff member; Residents requiring assistance will have their cigarettes and lighter/matches secured by the smoking attendant and the smoking attendant will take the smoking materials out to the patio and assist the resident with the smoking activity and light the cigarettes; Residents requiring assistance will be required to wear a smoking apron and utilize any adaptive device that enhances safety of the smoking activity; Residents independent in smoking per assessment will secure cigarettes and lighters/matches at all times. An interview was conducted with Staff G, Certified Nursing Assistant (CNA)/smoking attendant on 02/22/22 at 11:18 AM. Staff G-CNA showed the surveyors her list of approved smoking residents, only 1 of which was unsafe to smoke alone, (Resident #75) and who must wear a smoking apron while on the smoking patio. She stated she keeps Resident #75's cigarettes in a cart, along with extra lighters and smoking aprons. She says it is ok for each of the safe residents to keep their own cigarettes and lighters or matches in their rooms. Staff G-CNA said she sits on the smoking patio from 8:00 AM to 4:00 PM, Monday through Friday, and takes her break when the residents go inside the facility for their lunch time. An interview with Resident #129 was conducted in the resident's room on 02/22/22 at 9:30 AM. Resident #129 stated that she is able to go to the smoking patio anytime throughout the day. She stated that she keeps her cigarettes and lighter in a Pringles potato chip container which she keeps on her bedside table. Record review noted that a smoking assessment was last completed for Resident #129 on 02/03/22. The assessment stated Resident #129 is independent and safe at smoking activities. An observation was made on 02/23/22 at 9:22 AM. The surveyors noted there was no smoking attendant on the smoking patio. There was 1 resident, Resident # 87 (identified by Staff H, Licensed Practical Nurse (LPN), who was at the nursing station) out on the patio, smoking. The smoking attendant's cart was not seen on the patio. Staff H-LPN stated Staff G-CNA was feeding a resident her breakfast at that time. When asked, Staff H said it is ok for safe residents to keep cigarettes and lighters in their rooms. An interview was conducted on 02/23/22 at 9:32 AM with Staff G, CNA/smoking attendant, when surveyors observed her removing her cart from the unit break room and washing her hands. When asked, she said that as long as the residents are assessed as being safe smokers, they are allowed to be on the smoking patio unattended. She said she feeds the same resident (Resident #64) her breakfast every morning. When asked who conducts the smoking assessments for each resident to determine which residents are safe or unsafe, Staff G-CNA said the assessments are done by the Assistant Director Of Nursing (ADON). Staff G-CNA also stated she is always observing the residents and gives daily and weekly updates and expresses any concerns she has about residents' safety on the smoking patio to the ADON. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 11 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An observation was made on 02/23/22 at 4:37 PM of 4 residents (including Resident #75 who was not wearing a smoking apron) on the smoking patio with no smoking attendant present; the smoking cart was not present on the patio. A secondary observation made at 4:44 PM revealed the smoking attendant was still not present on patio. A third observation made at 5:05 PM revealed there was still no smoking attendant on the patio and at this time Resident #75 had obtained a cigarette and lighter from another resident and was smoking with no attendant present or smoking apron donned. The surveyor intervened and told Staff H, LPN. Staff H-LPN called the ADON on the phone and said out loud, Oh, so there is nobody to supervise the patio at night time? Staff H-LPN brought Resident #75 inside from the patio and took her to her room. An interview was conducted with Resident #75 on 02/23/22 at 5:07 PM. She stated she got the lighter from Resident #81 but did not specify where the cigarette came from. Record review noted that a smoking assessment was last completed for Resident #75 on 02/03/22. The assessment stated the resident was an unsafe smoker due to the ollowing: not being able to light her own cigarette, not smoking safely (does not keep ash or lit material from falling on self, does not remain alert/awake while smoking, and has potential to be a danger self or others while smoking), and cannot communicate why oxygen cannot be used while smoking. The assessment stated Resident must be supervised by staff, volunteer, or family member at all times when smoking. An interview was conducted with Resident #120 on the smoking patio on 02/23/22 at 5:25 PM. He stated he spends all day, every day sitting and smoking on the patio. He stated that every day after 4:00 PM the smoking patio is without a staff member as an attendant. When asked about Resident #75, he said that as long as someone is with her on the patio, Resident #75 is fine. When asked to clarify if there must be a staff member present on the patio at all times, he stated anyone can watch Resident #75, the other residents look out for her. Review of the facility smoking time schedule revealed smoking on the designated smoking patio is allowed unrestricted between 8:00 AM and 8:00 PM daily. A smoking attendant is scheduled to cover the smoking patio from 8:00 AM to 4:00 PM, leaving the smoking patio without staff supervision from 4:00 PM to 8:00 PM daily. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 12 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2). Review of the facility's policy titled Self-Administration of Medications revised in December 2016 documented .self-administered medications must be stored in a safe and secure place, which is not accessible by other residents .staff shall identify and give to the charge nurse any medications found at the bedside that are not authorized for self-administration . Review of Resident #84's clinical record documented an admission on [DATE] with no readmission. The resident diagnoses included, Fracture of Second Lumbar Vertebra, Anxiety, Depression, Spondylolisthesis (condition in which one vertebra slips out of place onto the bone below it) of Lumbar Region and Dislocation of L4/L5 Lumbar Vertebra. Review of Resident #84's Minimum Data Set (MDS) annual assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 15 of 15 indicating that the resident has no cognition impairment. The assessment documented under Functional Status the resident needed limited to extensive assistance with her activities of daily living (ADL) including dressing, bathing and toileting. Review of Resident #84's care plan revised on 01/26/22 titled Resident #84 has ADL deficit and require assistance with ADLs due to decrease mobility, status post fall, weakness and unsteady gait. Resident has diagnosis of low back pain; lumbar fracture and anxiety. Resident #84's care plan titled, Desire to self-administer medication: eye drops, initiated on 12/6/2021 and revised on 01/26/22. The care plan did not include self-administration of the over-the-counter medication/gel BioFreeze. Review of Resident #84's clinical record revealed no active physician orders for BioFreeze gel self-medication administration. A physician order for Xalatan Solution 0.005 % (Latanoprost) eye drops, instill 1 drop in both eyes at bedtime for Glaucoma read May Keep at Bedside Self Administration. On 02/21/22 at 11:55 AM, observation revealed Resident #84 in her room sitting up in a wheelchair. Further observation revealed an unlabeled bottle of prescription eye drops (Latanoprost) inside a plastic cup on top of the resident table. An interview was conducted with the resident who stated she uses her eye drops every night around 9:30 PM for both eyes and the nurses are aware. She stated she had been doing that for a longtime. She stated the nurses had a bottle at one point but believe they were out of it. During the interview, the resident complaint of both hands pins and needles pain and having difficulty holding on to things when eating. The resident added that her son brought her and showed the surveyor an opened Biofreeze gel tube for her hands pain. (Photographic evidence). On 02/22/22 at 2:33 PM, observation revealed Resident #84 in her room and the unlabeled bottle of prescription eye drops (Latanoprost) inside a plastic cup continued to be on top of the resident's table, plus the tube of BioFreeze gel in top of her bed. She stated the nurses are aware that she uses her eye drops every night. On 02/22/22 at 3:51 PM, observation revealed Resident #84 in her room. A side-by-side review of the resident's Biofreeze gel tube and eye drops bottle at her bedside was conducted with Staff M, a Licensed Practical Nurse, (LPN). Observation revealed Staff M taking a picture of the gel tube and left it at the resident bedside. Staff M then proceeded to the nurse's station. A side-by-side review (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 13 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with Staff M of the resident's physician orders was conducted. Staff M stated there was not a physician order for Resident #84 Biofreeze gel. Staff M stated they should have an order for it, and she should be assessed for self-administration of the medication. On 02/24/22 at 2:49 PM, during an interview with the Director of Nursing (DON) and the Regional Consultant Nurse, they were apprised that Resident #84 had a tube of Biofreeze gel on her table or her bed for over two days and there was not a physician order for it and the staff did not note it. The DON stated a physician order was obtained on 02/23/22. They were apprised of the resident's eye drop bottle at her bedside did not have a pharmacy label. The DON replied that the medications should have a label. 3). Review of Resident #1's, clinical record documented an admission on [DATE] with no readmission. The resident diagnoses included in part Intrahepatic Bile Duct Carcinoma, Malignant Neoplasm of Pancreas, Gastroesophageal Reflux Disease (GERD) and Depression. Review of Resident #1's care plan titled, Resident has ADL (activities of daily living) deficit and requires assistance with ADLs due to weakness .malnutrition and multiple comorbidities initiated on 02/24/22. Review of Resident #1's February 2022 Medication Administration Record (MAR) documented Pancrelipase Creon (medication that helps to improve food digestion in certain conditions) capsule delayed release, give 1 capsule orally before meals related to Malignant Neoplasm of Pancreas, order dated 02/13/22. Further review revealed Staff L's initials entered for 02/23/22 before lunch dosing. On 02/21/22 at 10:45 AM, observation revealed Resident #1 in bed. An interview was conducted with the resident. The resident was alert, oriented to person, place and time. Resident #1 was able to make her needs known. On 02/21/22 at 12:27 PM, while interviewing Resident #1's roommate, Staff L, a Registered Nurse (RN) entered the resident's room with a medication cup in her hand and placed the cup on Resident #1's nightstand. The medication cup had one medication in it. Further observation revealed, Staff L left the medication cup unattended and went to the bathroom and performed hand hygiene. Staff L then returned to Resident #1 and administered the medication that she left unattended. On 02/23/22 at 11:15 AM, an interview was conducted with Staff L, RN regarding Resident #1's medication placed on her nightstand on 02/21/22 before lunch. Staff L recalled the event and stated she did not want to bring the medication into the bathroom. She was asked about the process and stated that she is supposed to keep the medications with her at all times. Staff L stated she administered one medication called CREON (Pancrelipase). On 02/24/22 at 2:49 PM, during an interview with the Director of Nursing (DON) and the Regional Consultant Nurse, they were apprised of Resident #1's medication (before lunch) was left unattended on 02/21/22. Based on observations, interviews, and record review, the facility failed to ensure medications were secured, medication carts were properly secured, medications were properly secured within the medication carts, and expired medications and medical supplies were properly disposed of based on posted expiration dates. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 14 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 The findings included: Level of Harm - Minimal harm or potential for actual harm Review of the facility's policy titled Storage of Medications, revision date 08/2020 shows that medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier and that the medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. It also states under general guidance that all expired medications will be removed from the active supply and destroyed in accordance with facility policy, regardless of amount remaining. Residents Affected - Few 1) During the initial tour of the facility on 02/21/22 at 11:33 AM, the surveyor noted a pill on the bedsheet while introducing self to Resident #16. When asked by the surveyor when she had received her medications that morning, Resident #16 stated she had gotten her pills around 11:00 AM. When asked if she knew which medication this was, she stated she did not know. Resident stated, it must have fallen out of my mouth. 2) An observation was made on 02/23/22 at 9:25 AM while the surveyor was walking past a medication cart on the 1st floor South Wing, no nurse was present; and the medication cart was parked in front of a resident's room. The surveyor observed a bottle of Multi Vitamins with minerals sitting on top of the cart, unattended. Staff H, Licensed Practical Nurse (LPN) arrived to the medication cart approximately 1 minute later, and observed the pill bottle on the cart. She groaned and got flustered, acknowledging the pill bottle was left on top of the cart unattended, put the bottle inside the cart, and locked it. 3) During a medication pass observation with Staff A, LPN on 02/23/22 at 9:39 AM for Resident #21, it was noted that Staff A left a blister packet of Risperidone 2mg tablets (antipsychotic medication) unattended on the medication cart in the hallway, when she went into the resident's room to administer medications. Upon returning to the medication cart, she was asked why the medication was left out instead of being put away, Staff A said the pack had fallen on the floor and she needed to clean it before putting it away in the medication cart. 4) An observation was made while walking through the facility on 02/23/22 at 4:38 PM. The Surveyor noted the medication cart on the 1st floor North Wing was left unlocked and unattended in the hallway. Staff B, LPN saw the surveyor note the unlocked cart and she then went to the cart immediately and locked it. 5) During a medication pass conducted with Staff D, an agency Registered Nurse (RN) on 02/23/22 at 4:55 PM for Resident #453, it was observed that the RN left the medication cart unlocked and the computer screen open, while she went into the resident's room to administer medications. The medication cart was facing into the hallway. 6) Before the medication pass with Staff E, RN on 02/23/22 at 5:07 PM, it was noted by the surveyor that inside a top drawer of the medication cart was a pill cup with 1 medication in it. Staff E saw the pill cup, gasped, and immediately put it in his pocket. When asked what it was, Staff E initially did not respond. The surveyor asked if the pill cup had been left by the previous shift, to which Staff E stated it had not been left. When asked if he had pre-poured the medication for a resident, he responded that he had. 7) When conducting a review of medication storage at the facility on 02/24/22 at 12:30 PM, it was noted that the facility keeps their over-the-counter (OTC) medications in a Central Storage Room (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 15 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm (CSR) instead of in the Medication Rooms on each wing. The surveyors were taken to the CSR by the CSR Technician. While the surveyors were checking the expiration dates of the OTC medications and medical supplies in the presence of the CSR Technician, it was noted that there were many expired medications and medical supplies in the room. Residents Affected - Few A list of the expired medications included: 6 bottles Optimum, 50 capsules per bottle printed expiration date 09/2021 1 bottle Gerimucil, 10 ounces (oz) printed expiration date 07/2021 6 bottles liquid Multi-Vitamin, 8oz printed expiration date 01/2022 1 bottle liquid Iron Supplement, 16oz printed expiration date 12/2021 1 bottle Tylenol 500 milligram (mg), 24 tablet printed expiration date 12/2021 1 bottle Aspirin 325mg, 200 tablets printed expiration date 11/2021 A list of the expired medical supplies included: Inner tracheostomy cannulas (Shiley brand) printed expiration dates: 03/21/2021 x5 04/2020 x60 06/2020 x80 10/23/2020 x20 11/30/2020 x10 03/31/2021 x20 04/2018 x10 x1 Cuffless tracheostomy set (Shiley brand) printed expiration date 12/20/2019 x36 Oxygen nasal cannula tubing (AirLife brand), 14 feet long printed expiration date 01/22/2022 x8 23 gauge 1-inch sterile syringes printed expiration date 07/31/2021 x200 25 gauge 1-inch syringes printed expiration date 02/2020 x1 Foley catheter drainage bag printed expiration date 10/2020 x2 Foley catheter drainage bag printed expiration date 10/2019 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 16 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 x3 Oxygen humidifier connectors printed expiration date 03/05/2019 Level of Harm - Minimal harm or potential for actual harm x1 Gravity drainage bag ([NAME] Close brand) printed expiration date 10/2019 Residents Affected - Few In an interview conducted with the CSR Technician during the observation, the Technician stated multiple times that he was new to the position and had not had time to go through all of the medications and medical supplies that were kept in the CSR. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 17 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, interview, and record review, it was determined that the facility failed to follow the approved menu for pureed diets that included 21 facility residents (including Resident #14) with a physician ordered pureed diet. The findings included: During the observation of the lunch meal service in the main kitchen on 02/23/22 at 11:30 AM, it was noted that the Regular dessert was Pound Cake. Further observation noted that there were no portions of Pureed Pound Cake for Pureed Diets. Interview with the Dietary Manager at the time of the observation noted that staff had failed to prepare Pureed Pound Cake. A review of the facility's Approved Menu for the lunch meal of 02/23/22 noted that a portion of Pureed Pound cake was included for the Pureed Diet. A review of the facility's Diet Census for 02/23/22 noted that the issues potentially affected 21 facility residents with current physician orders for Pureed Diet. This total number of pureed diets included sampled Resident #14. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 18 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation, interview, and record review, it was determined that the facility failed to prepare pureed food in a form designed to meet nutritional needs that included 21 facility residents (including Resident #14) with physician ordered pureed diets. The findings included: During the observation of the lunch meal service in the main kitchen on 02/23/22 at 11:30 AM, it was noted that the pureed bread and pureed fish was not prepared to the proper smooth consistency. Specifically, the pureed bread had an exterior crust and fish fibers could be seen in the pureed fish. At the request of the surveyor a taste test was was conducted of the pureed bread and fish and the findings concluded that there was a hard crust on the exterior of the pureed bread and the fish was not pureed to a smooth consistency. The Dietary Manager stated that the pureed bread was put into the oven after pureeing and resulted in a hard exterior crust, and that the fish was not pureed thoroughly to a smooth consistency. It was also discussed with the facility's Registered Dietitian at the time of observation who agreed with the surveyors findings that there was a potential of residents receiving pureed diet for chocking and aspiration. A review of the facility's Diet Census for 02/23/22 noted that the issues potentially affected 21 facility residents with current physician orders for Pureed Diets. This total number of pureed diets included sampled Resident #14. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 19 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. Based on observation, interview, and record review, it was determined that the facility failed to follow physician ordered therapeutic diets (fluid restriction) for 1 (Resident #103) of 6 sampled residents reviewed for nutrition/hydration. The findings included: During the original resident screening on 02/22/22 at 10 AM, it was noted that Resident #103 had a full 10 ounce Styrofoam cup of ice water on the bedside table. The resident stated to the surveyor that I keep telling the nursing staff that I am on a physician ordered fluid restriction and I am not supposed to have fluids (water) at my bedside. The resident further stated that staff choose to leave the water and other fluids daily my bedside and I find myself drinking from them. Further observation conducted on 02/23/22 at 8:05 AM noted Resident #3's breakfast tray was served to her room. Further observation noted an 8 ounce Styrofoam cup full of ice water with a straw and 2- opened 8 ounce cans of Gingerale on the resident's bedside table. Resident #103 again stated to the surveyor that she receives water and other fluids on a daily basis and further stated that she informs nursing staff she is on a fluid restriction and should not be served the fluids. She also stated that she is aware of her fluid restriction but drinks fluids because they are served. Resident noted during the interview to be drinking the water and gingerale. A review of the clinical record of Resident #103 noted an original admission date of 5/6/21 with a diagnoses that included Chronic Heart Failure, Pulmonary Fibrosis, and Hypokalemia. A review of the MDS for Resident #103 dated 1/17/22 documented: Section C: BIMS=14 (Cognitive Intact) Section G: ADL Eating = Supervision Required Section K: 61/148 # Current Physician Orders included: 08/4/21- No Added Salt Diet 12/17/21 - Fluid Restriction of 1800/ml day that includes Dietary Allocation = 1440 ml/day & Nursing Allocation = 360 ml/day. * NO Additional Fluids at Bedside. 7/17/21 =KCL 20 MEQ QD 8/17/21 = Zinc 220 mg QD 8/17/-Vitamin C 500 mg QD 8/17/21- Vitamin D3 1000 U QD (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 20 of 21 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 105298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Lauderdale Health & Rehabilitation Center 2000 East Commercial Blvd Fort Lauderdale, FL 33308 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete During the review of the February 2022 Medication Administration Record (MAR) of Resident #103, it was noted that the nursing documentation on the MAR did not included how the 360 ml fluids will be distributed for the 3 shifts. Interview with the Director of Nursing on 02/23/22 confirmed that nursing was to show documentation of the fluids restriction on the MAR. Additional review of the calculation of the Dietary Fluid Restiction allocation of Breakfast, Lunch, and Dinner meals was also incorrect. Specifically, the 3 meals were deficient 180 ml of fluids. Interview conducted with the facility's Registered Dieitiian on 02/23/22 confirmed the calculation error and the surveyor requested that the calculation be corrected. A corrected fluid restriction of the meals of Resident #103 was re-submitted to the surveyor on 02/23/22. Event ID: Facility ID: 105298 If continuation sheet Page 21 of 21