Inspection·June 29, 2023

F 0550 clean him up. Level of Harm - Minimal harm or potential for actual harm During this observation, there were two additional residents in the main hallway of the unit who witnessed this back-and-forth interaction. Residents Affected - Few Review of Resident #62's Minimum Data Set (MDS) revealed he had a Brief Interview of Mental Status (BIMS) score of 9, indicating he was moderately cognitively impaired. This MDS documented Resident #62 required extensive assistance of one staff member for toilet use and limited assistance of one staff member for personal hygiene. An interview was attempted with Resident #62 on 06/28/23 at 8:20 AM regarding the interaction the prior evening. When the surveyor asked Resident #62 if he was upset or bothered by the interaction and having to wait for care, he shrugged his shoulders and did not verbally respond. 2) During the initial tour of the facility conducted on 06/26/23 at 10:10 AM, Resident #26 voiced to the surveyor that the staff often did not have washcloths during the dayshift and that the staff used regular bath towels to clean her in the mornings. She stated this upset her. Resident #26 also said she was not showered regularly by the staff and only received bed baths. Resident #26 was admitted to the facility on [DATE]. Resident #26 had a medical history significant for Falls, Shortness of Breath, Weakness, and Heart Disease. An Annual MDS was completed on 04/15/23. This MDS documented Resident #26 had a BIMS score of 13, indicating she was cognitively intact. This MDS documented Resident #26 required extensive assistance of one staff member for dressing and personal hygiene. Review of the CNA task documentation for Showers revealed Resident #26 was scheduled Monday, Wednesday, and Friday on the 3:00 PM-11:00 PM shift for showers. However, further review of this task sheet for the date range of 05/29/23 to 06/26/23 revealed Resident #26 received only one shower on 06/14/23. On all other days, the staff documented no or not available. A follow up interview was conducted with Resident #26 on 06/28/23 at 11:40 AM. She stated that the washcloths were still an issue and blankets are as well. She stated this still bothers her and that she thinks there is an issue in the laundry room. An interview was attempted with Staff F, CNA on 06/28/23 at 11:47 AM. When asked if she had noticed an issue with lack of washcloths on the unit during the dayshift hours, she refused to answer. She stated, you can ask another CNA. An interview was conducted with Staff G, CNA on 06/28/23 at 11:50 AM. When asked if she had noticed an issue with lack of washcloths on the unit during the dayshift hours, she stated Yes, sometimes. But I do not work with the residents much. I work more at the desk. An interview was conducted with the Environmental Services Director on 06/28/23 at 3:50 PM regarding the complaint of lack of washcloths. The Environmental Services Director stated the facility had received a shipment of washcloths during the survey week, indicating there was a lack of washcloths for the facility. He provided the surveyor with order receipts from 05/01/23 and 06/01/23 and explained he had ordered 50 dozen washcloths these two months. When asked where the washcloths are going/why he needs to order so many each month, the Environmental Services Director stated he cannot confirm (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 2 of 26 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 06/29/2023 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 0550 where the washcloths are going, but that he continues to order more to keep up with the demand. He stated he will order more on 07/05/23. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 3 of 26 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 06/29/2023 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations and interviews, the facility failed to promote and facilitate self-determination for 2 of 2 sampled residents (Resident #33 & #111). Specifically, assist the resident in choices for getting out of bed for Resident #33; the facility failed to provide showers for resident per shower schedule/preferences and failed to properly use the mechanical (Hoyer) lift for Resident #111. The findings included: Review of the facility's policy titled Requesting, refusing, and/or Discontinuing Care or Treatment revised on 12/2016 documented resident have the right to request, refuse .if a resident requests .refuses care .determine why .try to address the resident's concerns and discuss alternative options .detailed information relating to the request, refusal .will be documented in the residents medical record .documentation .shall include date and time of the care or treatment attempted .type of care .resident's response and stated reasons (s) for request .refusal . Review of the facility's policy titled Lifting Machine, Using a Mechanical revised on 07/2017 documented .staff must be trained and demonstrate competency using the specific machines or devices utilized in the facility .make sure the battery is charged .lift the resident 2 inches from the surface .only lift as high as necessary to complete the transfer . Review of the facility's policy titled Bath, Shower, Tub revised on 02/2018 documented .documentation .the date and time the shower/tub bath was performed .if resident refused the shower/tub bath, the reason(s) why and intervention taken .notify the supervisor if the resident refuses the shower/tub bath .report other information in accordance with facility policy and professional standards of practice. Review of the facility's policy titled Activities of Daily Living (ADLs), Supporting revised on 03/2018 documented .appropriate care and services will be provided for residents who are unable to carry out ADLs independently .including appropriate support and assistance with: mobility (transfer .)the resident's response to interventions will be monitored, evaluated and revised as appropriate. 1) Review of Resident #33's clinical record documented an admission to the facility on [DATE] with no readmissions. The resident's diagnoses included Osteoarthritis, Type 2 Diabetes Mellitus With Diabetic Neuropathy, Metabolic Encephalopathy (a problem in the brain caused by a chemical imbalance in the blood), Blindness-One Eye, Hypertensive Heart Disease Without Heart Failure, Anorexia, Cellulitis, Edema, Insomnia and Major Depressive Disorder. Review of Resident #33's Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 14, indicating the resident had no cognition impairment. The assessment documented under Functional Status that the resident was total dependent on the staff to complete the activities of daily living (ADLs). Review of Resident #33's care plan titled [resident #33] has ADL deficit and require assistance with ADLs due to decreased mobility .metabolic encephalopathy .anorexic .diabetes with neuropathy, blind in left eye, history of cellulitis and other comorbidities initiated on 03/16/23 and revised on 06/09/23. The care plan interventions included .Out of bed to w/c (wheelchair) daily as tolerated . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 4 of 26 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 06/29/2023 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 0561 Level of Harm - Minimal harm or potential for actual harm Review of Resident #33's active care plans and progress notes available from 05/31/23 to 06/26/23, it was revealed there was no documentation the resident was refusing to get out of bed. Review of Resident #33's Certified Nursing Assistant (CNA) tasks did not document or address the resident's choice to get out of bed. Residents Affected - Few On 06/26/23 at 11:01 AM, observation revealed Resident #33 in bed and her eyes were closed. On 06/26/23 at 1:00 PM, observation revealed Resident #33 in bed. An interview was conducted with Resident #33 who stated she had been in the facility since March 2023 and had not been out of bed. The resident stated she was told that there was not a Hoyer (mechanical lift) pad for her. The resident stated she would like to get out of bed, sit and get fresh air. On 06/27/23 at 11:05 AM, observation revealed Resident #33 in bed. On 06/27/23 at 2:05 PM, observation revealed Resident #33 in bed. On 06/27/23 at 2:49 PM, observation revealed Resident #33 in bed and accompanied by visitors. On 06/27/23 at 3:58 PM, a joint interview was conducted with Resident #33's son and his cousin. The son stated he and his nephew had talked to a lot of people in the facility regarding getting the resident out of bed and it was not happening. He added that even the insurance company had talked to facility's staff about it. The son stated the resident's nephew was coming every day and he would like to wheel the resident out to get fresh air, but she is always in bed. The son was asked what the reason was given about not getting the resident out of bed and replied that he was told that there was not enough help to get Resident #33 out of bed. During the interview, the resident stated again she would like to get out of bed but the staff did not do it today (06/27/23). On 06/27/23 at 4:06 PM, an interview was conducted with Staff M, Licensed Practical Nurse (LPN) who stated some residents do not tolerate being out of bed. Staff M stated that all residents are out of bed at least every other day and added that most of residents were out of bed every day. Staff M was asked about Resident #33 and stated the resident was alert, followed commands, able to state her needs, and occasionally she had some delusions or hallucinations. Staff M stated the resident does not refuse care and sometimes refused to get out of bed. Staff M added because of the resident's health condition, she slumps in the chair, but was getting out of bed every day. Staff M was apprised that Resident #33 was not out of bed on 06/26/23 and 06/27/23. Staff M replied she did not know why the resident was not out of bed and added may be because the resident had visitors on 06/27/23. Staff M added that she told every CNA that all resident that were able to sit, need to be out of bed and in a chair. Staff M stated Resident #33 was total care and the CNA needed to wait until another CNA was available to help. Staff M was apprised that Resident #33's son visiting was asking for the resident to be put out of bed since she had been in the unit and had not been done. Subsequently, a joint interview was conducted with Resident #33, her son and Staff M in the room. The resident's son agreed with Staff M on getting the resident out of bed at the time. Staff M stated she will have the CNA get the resident out of bed now. On 06/27/23 at 4:25 PM, an interview was conducted with Staff N, CNA assigned to Resident #33. Staff N stated the resident was very nice and did not refuse care. Staff N was informed that the family and the resident wanted to be out of bed. Staff N replied the resident was very hard to get out of bed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 5 of 26 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 06/29/2023 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 06/28/23 at 8:07 AM, an interview was conducted with Staff P, CNA who stated that nursing will tell her which resident needs to get out of bed. Staff P stated some residents get out before breakfast and some after breakfast. Staff P stated they could get total care residents out of bed. Staff P stated Resident #33 a lot of times said she wanted to stay in bed and that she had told the nurse. On 06/28/23 at 8:26 AM, an interview was conducted with Staff Q, CNA assigned to Resident #33. Staff Q stated she get helps from another CNA because Resident #33 could not turn by herself. Staff Q stated that she has transferred the resident out of bed before, using the mechanical lift. Staff Q stated she took care of the resident last week, but did not get her out of bed, and did not recall the reason. On 06/28/23 at 10:34 AM, an interview was conducted with the Director of Rehabilitation (DOR) who stated Resident #33 was on therapy caseload from 03/09/23 to 04/26/23, and was discharged to Restorative Care for range of motion. The DOR stated he recommended a mechanical (hoyer) lift for transfers and a high back chair for the resident. The DOR stated the resident was total dependent for sitting and bed mobility and there was no limitation, for the staff to use the hoyer lift to get the resident out of bed. The DOR stated he had not heard any issue on getting Resident #33 out of bed and added the fact that the resident was total assist, was not a contraindication to use the hoyer lift or to get her out of bed. The DOR added that is why the use of the hoyer lift was recommended On 06/28/23 at 1:58 PM, an interview was conducted with Staff R, CNA who stated that she and another CNA got Resident #33 out of bed using the hoyer lift with no difficulty. The resident had been sitting in the chair for about 1 hour and had not requested to go back to bed. Subsequently, an interview was conducted with Resident #33 who stated she was comfortable sitting in the chair and was waiting for her son to come. On 06/29/23 at 9:18 AM, an interview was conducted with the Director of Nursing (DON) who stated that the facility protocol was for the resident to get out of bed. The DON stated the staff automatically will offer to take them out of bed. The DON stated the staff had not reported any issues transferring or getting Resident #33 out of bed. The DON stated the CNA should report if any issues to the nurse, so the nurse can put it on the 24 hour report. The DON was apprised of Resident #33 staying in bed on 06/26/23 and 06/27/23 and the resident voiced to surveyor that she had requested to be out of bed. 2) Review of Resident #111 clinical record documented an admission on [DATE] with no readmissions. The resident's diagnoses included Malignant Neoplasm of Female Breast, Morbid (Severe) Obesity, Chronic Embolism and Thrombosis of Other Specified Veins, Essential (Primary) Hypertension, History of Falling, Pathological Fracture In Neoplastic Disease and Reduced Mobility. Review of Resident #111's Minimum Data Set (MDS) annual assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 15, indicating the resident had no cognition impairment. The assessment documented under Functional Status, the resident was totally dependent on the staff for transfers from bed to chair and back. Review of Resident #111's care plan titled Resident prefers .shower bed for showers as opposed to shower chair and resident will decline showers at times due to this . initiated on 05/15/23. Review of Resident #111 care plan titled Resident has ADL deficit and require assistance with ADLs due to decreased mobility, non-ambulatory . initiated on 05/04/22, documented interventions as .out (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 6 of 26 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 06/29/2023 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 0561 of bed daily to wheelchair daily as tolerated .transfer via Hoyer lift with assist of 2 . Level of Harm - Minimal harm or potential for actual harm Review of Resident #111's active care plans and progress notes available from 05/03/23 to 06/28/23 did not document the residents was refusing to get showers. Residents Affected - Few Review of the facility town hall meeting dated 02/23/23 and 04/14/23, topics included Hoyer lift revealed Staff T, CNA, was not in attendance. Review of the facility's In-service titled Proper placement of the Hoyer lift battery on charger dated 12/17/22 revealed Staff S, CNA and Staff T were in attendance. On 06/26/23 at 11:25 AM, an interview was conducted with Resident #111 who stated that she gets out of bed daily around 12 noon and back to bed around 5:00 PM. The resident stated that on 02/03/23 the Hoyer (mechanical) lift was not working, and she got stuck in the Hoyer lift pad for about 30 minutes before they could get her back in the bed. The resident stated that the Hoyer lift (mechanical lift) would not go down. The resident stated that the DON was informed. The resident added that on 05/09/23 while she was on the lift pad after being raised from the bed, the lift would not go up anymore. The CNA changed the battery twice and did not work. On 05/30/23 the staff got a third lift and none of them worked. The resident was told that the lift battery needed to be charged up. The resident added that on 06/25/23, the mechanical lift stopped while the staff was trying to put her back in bed. The resident added that by 5:00 PM her legs are hurting and she could not wait to get back in the bed. On 06/27/23 at 2:45 PM, an interview was conducted with Staff L, CNA, who stated there were no issues with the (mechanical) Hoyer lift. On 06/27/23 at 2:30 PM, observation revealed Resident #111 sitting up in a wheelchair in the dining room. An interview was conducted with the resident who stated that today (06/27/23) while the staff was trying to get her out of bed, the mechanical lift would not go up and the staff had to change the battery twice. The resident added she would like for the surveyor to investigate why she was not getting showers. The resident stated that she has had only two showers since she had been in the facility and added that the facility did not have a shower chair for her. On 06/28/23 at 8:26 AM, an interview was conducted with Staff Q, CNA, who stated that sometimes the hoyer lift battery is low, she changes it and it works or will get another hoyer lift battery. On 06/28/23 at 10:34 AM, an interview was conducted with the Director of Rehabilitation (DOR) who stated the facility's mechanical lift can hold a resident weighing up to 600 pounds. On 06/28/23 at 11:07 AM, observation revealed Resident #111 in bed. An interview was conducted with the resident who stated she had not had her morning care done, but will be done soon. On 06/28/23 at 11:23 AM, observation revealed Staff O, CNA from the north wing, came to Resident #111's unit and removed the hoyer lift from the wing. There were no other lifts noted on the unit to transfer Resident #111. On 06/28/23 at 11:41 AM, an interview was conducted with Staff U, RN (Registered Nurse) who stated he had not heard that Resident #111 did not get a shower on Monday. Staff U stated that the resident showers were scheduled for Monday, Wednesday and Friday night shift. Staff U was apprised that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 7 of 26 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 06/29/2023 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident reported not getting the showers as scheduled. A side by side review with Staff U of the resident's care plan was conducted and he stated he did not know what shower bed means. Staff U stated he was not aware of any issues with the hoyer lift. On 06/28/23 at 11:59 AM, observation revealed Staff S, CNA came out of Resident #111's room. An interview was conducted with Staff S who stated the resident did not get a shower today. A side by side review of the shower list was conducted with Staff S who stated Resident #111 was to get a shower from the 3-11 shift CNA. Staff S added she gave a full bed bath, no shower today to the resident. Staff S stated she uses the Hoyer lift to get Resident #111 out of bed and went to get the lift from the south wing. On 06/28/23 at 12:15 PM, observation revealed Staff S, CNA and Staff T, CNA attempting to transfer Resident #111 via mechanical (Hoyer) to the wheelchair. Observation revealed Staff S and Staff T placed the lift sling and started to raise the resident up, then the lift stopped while the resident was suspended in the air. Staff T asked Staff S to get another battery for the lift. Staff S went out of the room and returned with another battery for the hoyer lift. Staff T put the battery in place and stated that it did not work. Staff T instructed Staff S to get another lift. Staff S returned to the resident's room with another lift. Staff T told Staff S that the lift she brought will not work either because it was the lift to take the residents weights. While in the room waiting for a mechanical lift, an interview was conducted with Staff T, who stated they had to change the lift battery like twice a week while having the resident on the lift pad waiting to be transferred out of the bed. During the interview, Resident #111 interjected and stated that the lift had not worked Monday, Tuesday and today this week and added that it was happening a lot. Staff T stated the lift battery was getting charged in the room and that Staff S went to the third floor wing to get another battery. Staff T was attempting to get the lift emergency latch released to bring Resident #111 down in the bed, but was not able to do it because the battery was not working. At 12:31 PM, Staff T stated that maintenance came and checked the lift and it worked fine but did not know why it does not work for Resident #111. Further, observation revealed Resident #111 was suspended on the mechanical lift pad above her bed for approximately 15 minutes before the staff was able to lower her down to the bed awaiting for another lift to get the resident out of bed for lunch. The resident was late for lunch. On 06/28/23 at 12:43 PM, the surveyor asked the Administrator if she was aware of the hoyer lift issues and stated that there was some issues the other day and she will check with maintenance. On 06/28/23 at 5:12 PM, an interview was conducted with Staff V, CNA who stated that she worked the 3:00 -11:00 PM shift. Staff V was asked which residents she was planning to provide a shower for during her shift today and replied that she did not have any. Staff V added that the showers were always done by the 7- 3:00 PM CNAs. A side by side observation of the shower room was conducted with Staff V which revealed an extra-large shower chair in the room. On 06/29/23 at 8:27 AM, a joint interview was conducted with the DON and the Director of Maintenance (DOM). The DOM stated the mechanical lifts were working properly and added it was about In-servicing the people. The DOM stated all CNA's were educated about bringing the bed down, then moving the resident away from the bed to the chair. The DOM stated the CNA's were to follow instructions given to them on how to use the lift. The DOM added the CNA's were trying to please the resident. The DON stated the lift's battery was to be charged, the CNA's were to follow the instructions given by DON and not instructions given by the resident. The DON stated that on 06/28/23 and when it happened again on 06/29/23, the CNA's were supposed to lower the bed, then move the resident over. The DON stated there was a sensor that will not let the lift work. The DOM stated there was one lift in particular (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 8 of 26 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 06/29/2023 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that should be used with Resident #111. The DOM further stated the facility had six (6) lift and one lift should be kept in the resident's wing. The DON added that on 06/29/23, she brought the Director of Rehabilitation to the wing to educate the CNA's on how to use the lift with Resident #111. On 06/29/23 at 8:54 AM, a joint interview was conducted with the DON and the Assistant Director of Nursing (ADON). The ADON stated that before the staff mentioned a concern that the shower chair was too small for Resident #111. The DON stated that the resident sent her a picture on 06/04/23 of a shower bed. The DON stated she sent it to the Administrator. The DON and the ADON stated that the shower bed was too big for the facility's shower rooms. The DON was apprised that the resident was care plan for a shower bed. The DON was asked if anyone had gone over the shower bed not available or what was the plan. The DON stated a bigger chair was ordered today (06/29/23) for Resident #111. The DON stated the resident was transferred to the current wing on 07/05/22. The DON and ADON were apprised that the resident reported that she had only one shower since the transfer to the current wing. The ADON stated Resident #111 had a shower this morning and an extra-large shower chair was used. The ADON stated the resident was fine. The DON stated that the CNA documentation did not reflect when Resident #111's last shower was given. On 06/29/23 at 9:34 AM, an interview was conducted with the Director of Social Services (DSS) who stated Resident #111 prefers a shower bed and she care planned for the resident's preference. The DSS stated she had explained to the resident that the facility did not offer the shower bed because of the space. The DSS was apprised that an active care plan for a shower bed, that was not available, was noted in the resident's electronic care plan record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 9 of 26 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 06/29/2023 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to provide housekeeping and maintenance service in residential room areas (First Floor & Third Floor), and the the commercial laundry area. The findings included: 1) During resident screenings conducted by the surveyors on 06/26/23 and environment tour conducted on 06/29/23 at 10 AM, accompanied with the facility's Director of Housekeeping and Director of Maintenance, the following were noted: room [ROOM NUMBER] - The large room window shade/covering was noted to be heavily soiled and large stained areas; and the bathroom floor noted to be stained and soiled. room [ROOM NUMBER] - Room floor heavily soiled and stained. room [ROOM NUMBER]: Exteriors of resident overbed tables (2) noted to be in disrepair and exposed areas of raw wood. Heavy urine odor in room. room [ROOM NUMBER]: Room floor heavily soiled and stained, and room entry door frame in disrepair. room [ROOM NUMBER]: Light fixture cover located over room sink noted to be in disrepair and resident belongings (Hip Protectors) found in plastic bag over the light fixture. room [ROOM NUMBER]: Five ceiling tiles located over the window bed were noted to be soiled, stained and water damaged. 2) A tour of the facility's laundry room was conducted with the Environmental Services Director, the Maintenance Director, the Maintenance Assistant, the Laundry Floor Tech, the Corporate Consultant for Maintenance/Building, and the Director of Nursing on 06/28/23 at 3:55 PM. The tour began in the soiled laundry room, where the Environmental Services Director and the Laundry Floor Tech explained the laundry was brought from the units in large black plastic covered bins. In the soiled laundry room, there were two exhaust fans, one which vented to the roof and one which vented to the wall. Both exhaust fans, open-and-shut louvers, and the surrounding walls/ceilings were laden in dust, dirt, and black substances. Photographic evidence obtained. In the main laundry area, there were four washing machines present. Two of the washing machines had signs which read Out of Order. The Environmental Services Director explained that one of the washing machines (he stated was used for residents' personal clothing) was being repaired because the chemical dispensing mechanism was broken. He stated they had ordered the needed part and they were waiting for the part to arrive, which was approximately one to two weeks away. He stated the other washing machine was broken and they were waiting for a replacement but did not know when that was arriving. The Corporate Consultant for Maintenance/Building explained that the facility had received a quote to fix this washing machine but that the repair was going to cost over $10,000. He further stated the fix was not guaranteed, so the facility bought a new washing machine instead and were waiting for it to be delivered. The Environmental Services Director was able to provide the receipts for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 10 of 26 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 06/29/2023 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some quote to fix and for the new/already purchased machine (please note, this receipt shows the ETA on the new machine is approximately 8-14 weeks). In the main laundry area were also four dryers present. One of the dryers had a sign which read Out of Order. The Environmental Services Director explained that this dryer had been out of order for a few months, and the facility did not plan to fix or replace it. Of the three working dryers, 1 of the 3 had a torn/ripped gasket. This same dryer also had a lint trap filter which was torn. All 3 dryers had lint traps which were not adequately cleaned, and each had large amounts of lint present on the lint trap filters, walls, and corners along with coins, a razor cover, food pieces, a button, and an artificial fingernail. Photographic evidence obtained. The surveyor explained to the facility team that this was a fire hazard and that it was extremely important to clean out and repair the ripped filter. The surveyor also noted that the Lint Trap Clean Out Log was pre-timed, the staff had signed off 4:00 PM, 5:00 PM, and 6:00 PM, indicating that the lint traps had been cleaned at these times. However, it was not 4:00 PM, yet when the tour was being conducted. Observation above the third working dryer, it was noted there was ducting for the air conditioning unit. This ducting was full of condensation. Further examination showed the unit was dripping condensation fluid onto the floor/area surrounding the dryer. The surveyor explained to the staff that this was potentially contaminating the clean/dry clothes and linens that were being taken out of this dryer and the staff working in the laundry room. The surveyor also stated this dryer should not be used until the condensation issue was resolved. Photographic evidence obtained. There was also an air conditioning air intake filter which was open to air and surrounded by a large, rust covered metal sheath, which was rusted and deteriorating. The Corporate Consultant for Maintenance/Building stated this metal sheath needed to be replaced, as it was deteriorating. Photographic evidence obtained. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 11 of 26 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 06/29/2023 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, the facility failed to provide care and services to ensure self feeding ability did not diminish for 3 (Resident's #123, #133, and #451) of 8 sampled residents reviewed for nutrition. Residents Affected - Few The findings included: 1) Observation of the breakfast meal on 06/28/23 at 8:45 AM noted the tray served to the room of Resident #451. Resident #451 was observed to be alert with confusion , and noted sitting in wheelchair with the breakfast tray on the overbed table. Further observation noted that the overbed table was too far for the resident to reach. This was due to the frame of the wheelchair and overbed table did not permit the tray to come any closer to the resident. Further observation over the next 20 minutes noted that no nursing staff entered the room to assist or supervise the resident with eating the breakfast meal. During the observation the resident was noted to only drink a few sips of milk via straw. It was noted that the tray was taken away from the resident without consuming the pureed foods and only sips of milk. An attempt to observe the resident for the lunch meal of 06/28/23 noted that the resident's son had taken her out of the facility during the lunch meal time. It was unknown if the resident consumed any foods while with the son. On 06/29/23 at 9 AM, it was again noted the Pureed breakfast tray was delivered to the room of Resident #451. It was also noted again that the resident could not reach the meal tray due to the frames of the overbed table and the resident's wheel chair. It was also noted again the resident did not receive any assistance or supervision during the meal. The resident consumed only a few sips of milk and the tray was taken away from the resident without any consumption of the pureed foods. During the observation the surveyor requested the facility's Occupational Therapist, who was across the hallway, to observe the breakfast meal of Resident #35. The therapist confirmed that the meal tray had been set up too far for the resident to eat independently due to the frames of the overbed table and the resident's wheelchair. The therapist also confirmed that the resident took only sips of milk, before the tray was taken away by staff. The surveyor requested that the Therapist re-screen the resident for eating and possible admission into the facility's Restorative Dining Program. During the review of the clinical record of Resident #451 on 06/28-29/23, the following were noted: Date of admission: [DATE] Diagnoses: Toxic Encephalopathy/ Muscle Weakness, Dysphagia, Schizoaffective Disorder, Altered Mental Status, and Anemia, Current Physician Orders: 5/27/23 - Pureed Diet (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 12 of 26 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 06/29/2023 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 5/09/23 - Health Shake With meals Level of Harm - Minimal harm or potential for actual harm 6/26/23 - House Supplement Every Day 6/29/23 - Reacrit 10000 Unit -Inject IM (Intramuscular) Every Thursday Residents Affected - Few Weight History: 6/29/ = 116 pounds 6/18/ =121 pounds 5/09/23 = 120 pounds 4/11/23 = 134 pounds Height = 63 BMI (Body Mass Index)=20.5 IBWR (Ideal Body Weight Range): 112-136 pounds Current MDS (Minimum Data Set) Assessment: 5/16/23 Section B: Makes self Understood Sec C: BIMS (Brief Interview of Mental Status) Score =6 (Cognitive Impairment) Sec G: ADL (Activities of Daily Living) - Eat: Limited Assist and Supervision - By One person c K: Nutrition - 63/134 /IV, /Mechanical Soft Diet Sec M; No Pressure Ulcer Nutrition Progress Notes: 6/26/23 - Wt =115.8 - 4 % wet loss in 30 days - BMI=20.5, . Encourage consumption of a balanced diet , increase House Supplements to TID (Three times daily) 5/9/23- Son requesting supplement with meals due to poor intake, 5/11/23 - Weight = 121 pounds which represents a 10% weight loss in 30 days. Poor intake despite appetite stimulant. Review of Current Care Plan (4/11/23): Risk for Alteration In Nutrition and hydration due to poor PO (by mouth) intake, poor lab values. On 06/29/23 following the observation and record reviews the nutritional status of Resident #135 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 13 of 26 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 06/29/2023 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few were discussed with the facility's Administration. The failure of staff to properly set up meals in room, failure of staff to provide supervision and assistance with meals and weight loss was discussed. 2) Observation of the breakfast meal on 06/28/23 noted that Resident #133 was attempting to self feed while in bed with the tray on the overbed table. Further observation noted the resident was not positioned properly in bed to reach the meal tray and eat independently. Resident #133 was noted to be spilling foods when attempting to eat independently and was noted to spill milk when attempting to drink directly from the milk carton. During the meal observation, it was noted that no staff came into the room and attempted to reposition the resident, nor assist and supervise the resident with the meal. The resident was noted to eat less than 50 % of the meal prior to staff removing the meal tray. Following the observation, the surveyor met with the Director of Skilled Therapy to discuss Resident #133 and request the the resident be screened for adaptive eating equipment (scoop plate and Sippy Cups) and positioning during meals. On 6/28/23, the Occupational Therapist submitted documentation to the surveyor which noted that the resident was screened and required a Scoop Plate, Sippy Cups, and Proper Positioning Assistance with all meals. Observation of the breakfast meal on 06/29/23 at 9 AM noted the Occupational Therapist (OT) in the room working with Resident #133 for positioning and adaptive eating equipment. It was noted during the observation the the resident was issues only 1 Sippy cup for 2 tray beverages. The OT stated that physician orders were obtained for the Scoop Plate, Sippy Cups, and further stated that facility failed to provide an additional Sippy Cup on the tray (2 beverages /one cup provided) . The resident was noted to eat 75% of the breakfast meal with the assistance of the OT. A review of the clinical record of Resident #133 on 06/28-29/23 noted the following: Date Of admission: [DATE] Diagnoses: 6/10/23- Deep Tissue Injury (sacral area) 6/20/23- Hypocalemia 6/20/23- Anemia 4/28/23- Altered Mental Status 4/28/23 - Severe Protein Calorie Malnutrition Weight History: 6/21/23 - 105# (pounds) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 14 of 26 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 06/29/2023 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 6/03/23- 108# Level of Harm - Minimal harm or potential for actual harm 5/10/23 - 111# 5/01/23 - 116 # Residents Affected - Few BMI 17.5 (Underweight) 65 Inches Tall Weight Range 126-154 pounds Current Physician Orders: 06/12/23 - No Added Salt/ Mechanical Soft Diet New - 6/28/23 - Patient with Lip Plate & 2-handled cup at all meals Current MDS (06/13/23): Sec B: Understood & Understands Sec C; BIMS=13 (cognitively intact) Sec G: Eat - Assist with meals by one person Sec K : No Swallow Issues, 65/106#- Resident with weight loss and not on prescribed wt loss regimen Sec M: Pressure Ulcer-1 Unstageable Following the meal observation and review of the clinical record of Resident #133 on 06/29/23, the resident was discussed with the Administrative Staff. It was discussed regarding the resident's weight loss, failure to properly position during meals and assist the resident with meals, and the need of adaptive eating and drinking equipment to continue to self feed independently. 3) During the observation of the lunch meal in the Main Dining Room on 06/28/23 at 8:30 AM, it was noted that Resident #123 was seated at a table alone. Continued observation noted that the resident was served a No Added salt/Mechanical Soft breakfast tray. During the observation, it was noted that the resident was eating the Sausage Gravy and Oatmeal with her hands. The resident was noted with confusion and the foods were noted to be slipping through her fingers onto the the tray, onto the front clothing, and onto her face. The surveyor brought this observation to the attention of the Infection Control Preventionist (ICP), who was in the dining room area at the time of the breakfast meal service. The surveyor also contacted the Director of Skilled Therapy and requested that the resident be screened for potential adaptive eating and drinking equipment and the Nursing Restorive Dining Program. Record review was conducted on 06/28/23 and noted a current physician ordered originally dated 04/14/23 for the resident to attend Nursing Restorative Dining program for the breakfast and lunch meals (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 15 of 26 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 06/29/2023 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 daily. Level of Harm - Minimal harm or potential for actual harm Interview conducted with the Nursing Director of Restorative Services on 06/28/23, noted that she discontinued the order without speaking and permission by the attending physician. The nurse further stated she thought the resident was improving with independence in eating and discontinued the resident from the Restorative Dining Program. The nurse also stated she made a mistake and should have continued the resident in the program and also speak to the attending physician. Residents Affected - Few A second interview with the Director of Skilled Therapy on 06/29/23 noted to state and submit documentation that Resident #133 will be re-admitted back into Resorative Dining Program. It was also documented in the screening that the resident was admitted for Occupational Therapy for the next 30 days (06/28/23 - 07/27/23) for shoulder strengthening and self feeding independence. It was also documented that the resident requires Built-Up Spoon, and Lip Plate with Restoritive Dining meals. A second review of the resident's clinical record on 06/28-29/23 noted the following: Date Of admission: [DATE] Diagnoses: Dementia,Depression, Anemia, and Chronic Kidney Disease. Current physician orders: 04/14/23 - Restorative dining for breakfast and lunch 06/28/23 - Submitted Order to re-enter Restorative Dining program 2/10/23- No Added Salt, Mechanical Soft Diet 2/07/23- House Supplement 120 cc BID (twice daily) Weight History: 6/6/23- 95# Height: 60 inches Weight Range: 102 -1243# BMI 18.6 (Underweight) Current MDS dated [DATE]: Sec C: BIMS =5 (Cognitive Impairment) Sec G: Eat - Requires Supervision with Meals Sec K: Nutrition - 60/90#, Therapeutic Diet , Review of Care Plan for Risk for Alteration in Nutrition & Hydration dated 02/07/23 failed to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 16 of 26 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 06/29/2023 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete updated on 04/14/23, for the resident to be included into the Restorative Dining Program for all Breakfast & Lunch meals. Following the observations, interviews, and record review, a meeting was held by the surveyor with the facility's Administrative Staff on 06/29/23. The findings of Resident #123 were discussed that included, failure to follow physician orders for the resident to be enrolled in the Restorive Nursing Dining Program, failure to assess for adaptive eating and drinking equipment, and the nutritional status of the resident. Event ID: Facility ID: 105298 If continuation sheet Page 17 of 26 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 06/29/2023 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide necessary services to maintain good nutrition for 1 (Resident #135) of 8 sampled residents, who is unable to self feed. Residents Affected - Few The findings included: During the initial screening of Resident #135 on 06/26/23, it was noted that the resident receives nutrition via Enteral Feeding and also eats foods by mouth. Attempts to interview the resident during the screening noted that she was alert with cognitive deficit. A review of the clinical record of Resident #135 on 06/26-27/23 noted the following: Date Of admission: [DATE] Diagnoses: : Anemia, Cerebral Infarction, Dementia, Abnormal Weight Loss, Failure to Thrive, Congestive Heart Failure, and Gastro Hemorrhage. Current Physician Orders: 06/3/23: Enteral Feed of Jevity 1.5 at 75 cc/hr x 16 hours on at 6pm off at 10am 05/2/23: Pleasure Food Pureed At Lunch & Dinner. 06/03/23: Flush Peg with 150 ml Water Every 4 Hours * Weight History: 06/22/23: 101# 05/19/23: 104# 05/05/23: 109 # 04/19/23: 111# Height: 60 inches Weight Range: 122-148# BMI (Body Mass Index) 19.8 (Underweight) *Current MDS (Minimum Data Set) Assessment (6/17/23) Section B: Sometimes Understands/Understood Section C: BIMS (Brief Interview for Mental Status) Score 00 (Unable to Obtain- Cognitive Deficit) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 18 of 26 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 06/29/2023 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 0677 Section G: Eat = Total Dependence by One person Level of Harm - Minimal harm or potential for actual harm Section K: 60'/102#, Feeding Tube, Mechanically Altered Diet * Current Care Plan (06/17/23) Review : Residents Affected - Few < Resident at risk for complication from Enteral Feeding to meet nutritional needs, - Receives Pleasure Foods for Lunch & Dinner. < The care plan did not document which Pleasure Foods were to be included. * Review of facility's Approved Diet Manual (Next Level) did not locate documentation concerning the following and foods to included on a Pleasure Food Diet. During the observation of the lunch meal on 06/28/23, it was noted that the resident's Lunch meal tray was located by the surveyor at 1:15 PM. Further observation noted that the resident was not in the room and the lunch tray was delivered to the empty room at 1:45 PM. Interview with the CNA at the time of the tray delivery it was stated to the surveyor that the resident was in the Physical Therapy Room. The CNA was also unaware that a meal tray had been delivered to the room and stated she will get the resident from the therapy room and bring her to the room for the lunch meal. During the observation of the lunch meal in the room of Resident #135 on 06/28/23 at 2 PM, a review of the Resident's Meal Tray Card noted the following documentation: < Pureed Diet (No Restriction) < Pureed Foods to include: P- Beef Stroganoff, P- Noodles, P-Green Peas, P-Cake, Milk, Juice < Note: Mashed Potatoes & Gravy, Pureed Soup, and Pudding. < The ticket did not document Pleasure Foods Only. Observation conducted by the surveyor noted that none of the pureed foods were included on the tray, no milk, no pureed soup, and the only foods included on the lunch meal tray were; Mashed Potatoes & Gravy, Pudding, and Diet Juice. Further observation of the lunch meal noted that Resident #135 required total Feed by staff and consumed 100% of the Mashed Potatoes & Gravy, Pudding, and Juice. Following the meal observation an interview was conducted with the Director of Skilled Therapy who stated that skilled staff was unaware that the resident received a food tray to eat by mouth and it was an error that the resident was brought to therapy during the service of the lunch meal. Interview with the Food Service Director (FSD) on 06/28/23 stated that the tray ticket failed to document Pleasure Foods and a Pureed meal was not to be sent. The FSD stated he was not aware why only the Mashed Potatoes 7 Gravy and Pudding were the only foods sent, and further stated that the Pureed Soup failed to be served on the lunch. tray. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 19 of 26 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 06/29/2023 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 0677 Interview with the facility's Speech Therapist on 06/29/23 noted the following: Level of Harm - Minimal harm or potential for actual harm < Resident #135 currently is not on case load but hasbeen treated in past and the Enteral Feeding is partly due to inadequate intake of nutrition via PO (mouth). Residents Affected - Few < The resident currently receive nutrition via Enteral Feeding and foods by mouth. < Stated the resdient is safe to consume all Pureed foods. < Resident meals should not be restricted to Mashed Potatoes & Gravy and Pudding. < Dietary Department should be sending all pureed foods that were schedule for the meal. < No reason why the meals were restricted to only lunch and dinner meals. Pureed breakfast meals should be included. During the survey conducted from 06/26/-29/23 the facility's Registered Dietitian was not available for interview. A review of past and current Dietary Progress Notes revealed there was no documentation of why the resident was not receiving all pureed foods during meal; or why the meals were restricted to only Lunch & Dinner; and why only pleasure foods of Pureed Soup, Mashed Potatoes & Gravy, and Pudding were included. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 20 of 26 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 06/29/2023 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide quality care in a timely manner for 1 of 1 sampled residents reviewed for Quality of Care, Resident #402. The failure existed due to the untimely removal of staples which were present in Resident #402's scalp for approximately 25 days. Residents Affected - Few The findings included: During the initial tour of the facility conducted on 06/26/23 at 10:50 AM, Resident #402 was observed lying awake in his bed with his wife at his bedside. Resident #402 was unable to answer the surveyor's questions, but his wife agreed to be interviewed. She stated Resident #402 had suffered a fall at home on [DATE] and was admitted to the hospital, where he had two staples placed for a scalp laceration sustained during the fall. She stated the hospital had instructed her to have Resident #402 see his primary care doctor or return to the hospital emergency department in one week for removal of the staples. She further stated since Resident #402 was admitted to the facility, she had been unable to have the staples removed and was instead told by multiple staff members that Resident #402 needed to seek help elsewhere. She stated she was told that he could not see his primary care doctor because the facility doctor would be covering those services, but that doctor would not remove the staples and told her to take him to see an orthopedist. At the orthopedic doctor's office, she was again told that that doctor would not remove the staples and told her to take him to see a neurologist. She stated she attempted to make Resident #402 an appointment with a neurologist but was told the next available appointment would be in August. She stated she was very frustrated by this situation and asked the surveyor for assistance in this matter. Record review revealed Resident #402 was admitted to the facility on [DATE]. Resident #402 had a medical history significant for Weakness, Falls, Heart Failure, Shortness of Breath, and Diabetes. An admission Minimum Data Set (MDS) assessment was completed on 06/13/23. This MDS documented Resident #402 had a Brief Interview of Mental Status (BIMS) score of 3, indicating he was cognitively impaired. There were no Care Plans or Physician Orders in place regarding care for the staples in Resident #402's scalp. The admission Comprehensive Nursing Evaluation completed on 06/10/23 did not document the staples. The Narrative Nurses Note written on 06/11/23 at 4:16 PM documented 2 metal staples noted to right side of head status post laceration to head. A Narrative Nurses Note written on 06/21/23 at 12:34 PM documented Telephone call to [name of doctor] answering service to request order to remove staples from resident's head message left on voicemail. However, no further action was taken after this note was written. An interview was conducted with Staff D, Licensed Practical Nurse (LPN) on 06/28/23 at 9:37 AM. Staff D said she was aware of the staples in Resident #402's scalp but did not know the status of them or when/how they were to be removed. When the surveyor asked about the Nurses Note written on 06/21/23, Staff D stated she was unaware that another nurse had left a voicemail for the doctor on that day. Staff D further stated Resident #402 was taken to a doctor's appointment earlier and she thought (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 21 of 26 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 06/29/2023 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that doctor would have written an order to remove the staples. Staff D stated she would call the facility doctor and ask for an order to remove the staples from Resident #402's scalp. A secondary interview was conducted with Staff D, LPN on 06/28/23 at 10:59 AM. Staff D stated she spoke to the facility doctor and received an order to remove the staples. She said the wound care nurse was going to come to Resident #402's room and remove the staples. This telephone call was not completed until the surveyor's intervention. An observation was conducted on 06/28/23 at 11:05 AM of Staff W, Registered Nurse (RN) at Resident #402's bedside to remove the staples. An interview was conducted with Staff E, RN on 06/28/23 at 11:14 AM. Staff E stated she was the Wound Care Nurse at the facility. She further stated it was her job as the Wound Care Nurse to conduct the initial skin assessment on all new admissions. She stated the Certified Nursing Assistants (CNA's) were responsible for checking the resident's skin every day with daily care, and that the nurses were responsible for conducting the weekly skin checks. She said if a resident has changes noted to their skin, the CNAs and nurses report the changes to her, and she follows up as needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 22 of 26 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 06/29/2023 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide adequate catheter care for 1 of 1 sampled residents reviewed for Catheter Care, (Resident #401), as evidenced by, lack of privacy, use of gloved hands to close the privacy curtain and door and then using the same gloves to begin cares, use of sterile gloves to search the resident's room for supplies, not having supplies ready/available for use, removing the sterile gloves and using regular/clean gloves to perform the rest of the catheter change, keeping the regular/clean gloves in the pocket for use, lack of catheter securing device. The findings included: Review of the facility's policy titled Catheter Care, Urinary, revised in September 2014 documented the following: The purpose of this procedure is to prevent catheter-associated urinary tract infections. Following aseptic insertion of the urinary catheter, maintain a closed drainage system. If breaks in aseptic technique occur, replace the catheter and collecting system using aseptic technique and sterile environment. Ensure that the catheter remains secured with a leg strap to reduce friction and movement at the insertion site. During the initial tour of the facility conducted on 06/26/23 at 10:17 AM, Resident #401 stated he has had a urinary catheter in place, since his last hospitalization. Record review revealed Resident #401 was admitted to the facility on [DATE]. Resident #401 had a medical history significant of Obstructive Uropathy, Weakness, Paraplegia, Heart and Respiratory Failure, and Diabetes. An admission Minimum Data Set (MDS) assessment was completed on 04/15/23. This MDS documented Resident #401 had a Brief Interview of Mental Status (BIMS) score of 15, indicating he was cognitively intact. This MDS documented the presence of the indwelling catheter. There was a Care Plan in place regarding Resident #401 having the indwelling catheter. Review of the Physician Orders revealed an order was written on 04/14/23 for May change the catheter: 16F/ 10ML every 6 weeks and as needed for blockage or leakage unless otherwise instructed. as needed AND every night shift every 42 day(s) for Prophylaxis. Review of the Treatment Administration Record (TAR) revealed Resident #401's catheter had last been changed on 05/18/23. It also documented the catheter was due to be changed on 06/29/23. An interview was conducted with Resident #401 on 06/28/23 at 11:40 AM. He stated he did not remember the last time the catheter was changed. He told the surveyor he was comfortable with a catheter care observation and possible catheter change observation to be conducted on 06/29/23. An interview was conducted with Staff K, Licensed Practical Nurse (LPN), on 06/29/23 at 9:34 AM. Staff K confirmed on the TAR that Resident #401 was due to have his catheter changed on the night shift on 06/29/23. She stated she was comfortable performing the catheter change and care for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 23 of 26 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 06/29/2023 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 0690 surveyor to observe. Level of Harm - Minimal harm or potential for actual harm Catheter care observation was conducted with Staff K on 06/29/23 at 11:10 AM. Staff K gathered her supplies prior to the start of the catheter care. Staff K dated the catheter bag prior to entering the room. When Staff K entered Resident #401's room, she washed her hands. She then donned clean gloves and used disinfecting wipes to clean Resident #401's bedside table. She then washed her hands again and donned clean gloves. She began to open the sterile catheter kit but was stopped by the surveyor and reminded to close the room door and privacy curtain which she did while wearing her gloves. With the same gloves on, Staff K then opened Resident #401's incontinence brief and the surveyor noted there was no catheter securing device on his leg. She then used a 3 milliliter (mL) syringe and removed the water from the 10mL catheter balloon. She laid a towel on Resident #401's abdomen. Staff K then removed the catheter and placed the catheter/tubing/bag into the garbage can. She then removed her gloves and opened the sterile catheter kit. She then put on her sterile gloves and placed the sterile drape under Resident #401's scrotum, using the sterile gloved hands to position the drape. Staff K then realized she did not have any peri-care wipes to perform perineal care, so with her sterile gloves still on, she began to search Resident #401's bathroom and nightstand for wipes. She found a bath basin in the nightstand, took it to the bathroom and filled it with warm water. She then placed this bath basin next to the sterile catheter kit. Staff K then removed the sterile gloves and donned clean gloves. She then used gauze soaked in the warm water to clean Resident #401's perineal area. She then realized she did not have anything to dry Resident #401's perineal area, so she used the towel she had previously laid on his abdomen to dry him fully. Staff K then opened the packet of iodine swabs and used these swabs to clean Resident #401's meatus. She then removed her gloves, took a pair of gloves from her scrub top pocket and donned this clean (not sterile) pair of gloves. She then opened the catheter package and attached the end of the catheter to the end of the urine collection bag tubing. She then opened the lubrication packet and removed the catheter from its package and applied lubrication to the tip of the catheter. Using her right hand, Staff K advanced the catheter into Resident #401's urethra. Using her left hand, she used a 30mL syringe to add 10mL of water to the catheter balloon. Staff K did not apply a securing device to Resident #401's leg after the catheter was changed. Resident #401 stated he did not have pain during this procedure. Residents Affected - Few An interview was conducted with Staff K, LPN, on 06/29/23 at 11:40 AM. The surveyor explained the areas of concern with the catheter change and care observation, as follows: lack of privacy, use of gloved hands to close the privacy curtain and door and then using the same gloves to begin cares, use of sterile gloves to search the resident's room for supplies, not having supplies ready/available for use, removing the sterile gloves and using regular/clean gloves to perform the rest of the catheter change, keeping the regular/clean gloves in the pocket for use, and lack of catheter securing device. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 24 of 26 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 06/29/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, it was determined that the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety that included sanitation issues in the main kitchen , and sanitation issues during meal service in the main dining room. The findings included: 1) During the initial kitchen/food service sanitation tour conducted on 06/26/23 at 9 AM, accompanied with the Food Service Director (FSD), the following were noted: (a) The top of the walk-in refrigerator door frame was full of condensation. Further observation noted that the condensation was dripping down onto the floor area with the unit. The surveyor discussed with the FSD that the dripping condensation could drip onto foods and staff going in and out of the unit and result in potential food contamination. (b) Observation of the walk-in freezer noted that there was a 40 pound box of raw chicken that was not covered and exposed to the air. Further observation noted that the chicken was freezer burned and the surveyor requested that the chicken be discarded. (c) Observation of the dish machine room noted that there were 2 wall mounted commercial exhaust fans. Further observation noted that the fan covers and fan blades were dirt and dust laden. (d) Observation of a food preparation surface located against the room wall noted that there was a large electrical wall outlet The surface of the outlet was noted to be covered with dried food matter. (e) Observation of the Robot Coupe noted that the inside of the blender had a approximately one inch of fluid. (f) Observation of the Convection Oven noted that the internal cavity was laden with a thick layer of black carbon. (g) Observation of the commercial juice dispensing gun was noted to have a thck layer of dried juice matter. The surveyor discussed with the FSD the soiled dispensing gun was potentially contaminating juice coming out of the gun tip. 2) During the kitchen/food service observation tour conducted on 06/26/23 at 9 AM, second observation conducted on 06/27/23 at 7:30 AM, and 06/28/23 at 11:30 AM, the following were noted: (h) Observation conducted on 06/26/23 noted that the food preparation, food serving areas, and dish machine room had numerous (10) flying insects (flies) that were noted to be landing on prepared foods, clean food preparation and serving surfaces, and clean dishes. The surveyor discussed with the FSD that the flies are potential health issues to the residents. The FSD stated that the kitchen rear exit door is often left wide open for long periods of times during food delivery and could be the source of the fly infestation and a air curtain was needed to be installed on the exit door to eliminate the potential entry of the flies. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 25 of 26 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 06/29/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some (i) Observation conducted on 06/27/23 revealed again, numerous flies in the food preparation and serving areas. Flies were again noted to be landing directly onto prepared food, and clean food preparation and serving counter surfaces. Further observation noted that the exit door was propped open during a large food delivery. The surveyor was informed by the Director of Maintenance that a air curtain had been purchased and would be installed upon delivery. The Administrator submitted documentation to the surveyor that the pest control vendor was spraying the kitchen and the facility, to eliminate the fly infestation . (j) Observation conducted on 06/28/23 noted that the fly population in the kitchen declined however there was still a few noted in food preparation and serving areas. The surveyor was notified by the Director of Maintenance that the air curtain was installed over the exit door and the pest control company was still working daily on the fly infestation issues. 3) During the observation of the lunch meal on 06/26/23 at 12 PM, and observation of the ice cream social conducted in the main dining room on 06/26/23 at 2 PM, CNA (Staff I) was serving soup to the 18 residents in the main dining room. Further observation of Staff I noted the following: (k) Staff I was noted to be serving soup from the soup tureen without the use of clean gloves. Further observation noted Staff I to have peeling nail polish to fingers on both hands. (l) Staff I was noted to transport servings of uncovered soup bowls throughout the dining room to distances up to 40 feet. Numerous staff were noted to be walking through the dining room area while the soup was being served. (m) During the serving of the bowls of soups Staff I was noted to handle the soup by the inner lip of the bowls with bare hands that had peeling nail polish. (n) During the observation of the soup service in the main dining room it was noted that the facility's Infection Control Preventionist (ICP) was present. The surveyor requested that Staff I be observed serving the soup. The ICP confirmed all of the surveyors findings and halted the soup service to ensure that Staff I was doning and changing gloves during the meal serving, properly covering servings of of soup during transport to resident tables, and handling soup bowls by the outside exterior of the bowls while serving to the residents. The ICP also confirmed the the current soup service procedure could result in potential food contamination. 4) During the observation of the Ice Cream Social in the main dining room on 06/26/23 at 2 PM, it was noted that Staff I was serving portions of ice cream to the 10 residents in attendance. It was again noted that Staff I was serving the ice cream from a 5-gallon contained with exposed hands that had peeling nail polish. The ICP was again requested to observe Staff I and confirmed that clean gloves were not being utilized during the scooping of the ice cream and that there was potential for food contamination from the peeling nail polish. The ICP halted the Ice Cream service. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105298 If continuation sheet Page 26 of 26