Inspection·April 21, 2022

F 0561 Level of Harm - Minimal harm or potential for actual harm 01/21/22-01/31/22: Resident #18 received a shower on 01/22/22 (Friday); she received a partial or complete bed bath on other days. Scheduled for 13 showers and had 1 shower for the month of January. 02/01/22-02/28/22: Resident #18 received a shower on 02/21/22 (Monday); she received a partial bed bath and complete baths on other days. Scheduled for 12 showers and had 1 shower for the month of February. Residents Affected - Few 03/01/22-03/31/22: Resident #18 received a shower on 03/08/22 (Tuesday), 03/10/22 (Thursday), 03/12/22 (Saturday), 03/19/22 (Saturday), and 03/22/22 (Tuesday). She received a partial or complete bed bath on other days. Scheduled for 14 and had 6 showers for the month of March. 04/01/22-04/20/22: Resident #18 a shower on 04/02/22 (Saturday), 04/05/22 (Tuesday), 04/09/22 (Saturday), 04/12/22 (Tuesday), 04/16/22 (Saturday) and 04/19/22 (Tuesday). She received partial or complete baths on other days. Scheduled for 8 showers and had 6 showers for the month of April. During an interview on 04/20/22 at 11:55 AM with the ADON (Assistant Director of Nursing), he stated that the CNAs (Certified Nursing Assistant) fill out a shower sheets after each shower that the resident receives and then the nurse signs off on it. During an interview on 04/20/22 at 12:14 PM with Staff I, CNA, confirmed there was a shower schedule on the wall on each unit; Everyone gets a showers 3 days a week; Resident #18 is scheduled for a shower on Tuesday, Thursday, and Saturdays on the 7:00 AM-3:00 PM shift; Every time we shower the resident, we fill out a shower sheet; and she gave Resident #18 a shower yesterday but did not fill out shower sheet but documented it in the computer. During an interview on 04/20/22 at 12:46 PM with Staff L, MDS Coordinator, she pulled up Resident #18's care plan. She acknowledged that the ADL Care Plan documented that daughter requested for her mother to get a shower every day and this has been in effect since 06/14/19. During an interview on 04/21/22 at 8:07 AM with Staff J, Nurse Unit Manager, Staff J stated that Resident #18 was care planned for daily showers in 2019. The resident has had multiple room changes and the shower schedule changes for each hallway. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 2 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of the Policy and Procedure, titles, Fall Risk Assesment, dated as revised December 2017, did not document when a Fall Risk Assessment should be completed. Review of Resident #42's electronic records revealed the resident was admitted to the facility on [DATE], with diagnoses to include Spinal Stenosis, Lumbar Region, COPD (Chronic Obstructive Pulmonary Disease), Major Depressive Disorder, Generalized Anxiety, Psychosis, Insomnia, Speech Disturbances. Review of Resident #42's Quarterly MDS (Minimum Data Set) revealed resident has a BIMS (Brief Interview of Mental Status) of 99, which indicated the resident was unable to complete the interview and speech is rarely and never understood. She required extensive assist for bed mobility, locomotion on and off unit, dressing, eating, toilet use, and personal hygiene, and extensive assist two person for transfers. Review of the physician order, dated 08/31/21, prescribed a chair alarm every shift. Review of Resident #42's care plan documented the resident at risk for potential injury related to falls due to generalized muscle weakness, decreased endurance, dementia with severe cognitive loss, history of chronic UTI's (Urinary Tract Infection), bowel and bladder incontinence, psychiatric medication use, poor safety awareness, attempts to get up unassisted. The resident had a history of falls prior to admission. The care plan interventions for falls included a chair alarm every shift, to return to bed for rest period after breakfast and lunch, when patient is agreeable to do so, when in bed put at lowest functional position with wheels locked, non-skid footwear with transfers, ambulation, provide a safe environment, encourage rest periods, observe for potential drug related side. Further review of the electronic records revealed no 'Fall Risk Assessment' was completed since resident was admitted to facility on 08/27/21. Observations on 04/19/22 at 8:05 AM, revealed Resident #42, sitting in hallway, with no chair alarm observed on her wheelchair (w/c). On 04/19/22 at 8:45 AM, Resident #42 was sitting in her wheelchair eating breakfast in her bedroom, no chair alarm noted to wheelchair. On 04/20/22 at 2:07 PM, Resident #42 sitting in her w/c in the hallway, no chair alarm observed to w/c. During an interview with Resident #42's family member on 04/18/22 at 6:21 PM, he said when he brought my mom in at time of admission, he told the nurse that she has a history of falling, would get out of bed and fall, she needed a bed alarm, and they did not give her one and she fell. During an interview on 04/21/22 at 8:15 AM, with Staff R, LPN she stated that Resident #42 fell while she was in the hallway, she kept trying to get up and by the time I got to her she fell. During an interview on 04/21/22 at 10:18 AM with Staff K, Certified Nursing Assistant / CNA, Staff K said she put resident in the wheelchair, and puts the alarm on the chair that is on her bed and vice versa. She acknowledged that the resident did not have a chair alarm on her wheelchair today (04/21/22) and went to get one from supply room, which they had to order over a week ago. Staff K siad she did not put the resident in the wheelchair the last few days but acknowledged she did not check (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 3 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the wheelchair for the alarm. She said the resident is usually in the chair when she comes in at 7:00 AM. She stated she is a fall risk. During an interview on 04/21/22 at 11:00 AM with Staff J, Unit Manager, Staff J stated they looked for a Fall Risk Assessment and was unable to find any assessment. She acknowledged that they should be completed on admission and quarterly, but wasnt sure about after a fall. A 'John's Hopkins Fall Risk Assessment Tool' was then completed for Resident #42 on 04/21/22 at 11:46 AM, by Staff J, Unit Manager. Resident #42 fall risk score was 21, greater that 13 or above, indicating the resident was at high fall risk. Based on observation, interview and record review, the facility failed to developed care plans for residents who was assessed with high elopement risk and a resident with exit seeking behaviors for 2 of 2 sampled residents reviewed for wandering, Resident #16 and #57; and failed to ensure care and services were provided per care plans and physician orders related to chair alarms and that fall risk assessments were completed for 1 of 2 sampled residents reviewed for falls, Resident #42. The findings included: 1. Record review revealed Resident #16 was admitted to the facility on [DATE] with diagnoses that included Alzheimer's disease. Review of clinical records revealed a quarterly elopement risk assessment, dated 02/04/22, that recorded a total elopement risk score of 16.0, indicating high elopement risk. Additional record review lacked evidence of documentation by the attending nurse (Staff M) regarding the exit seeking behavior on 04/18/22. The quarterly minimum data set (MDS) assessment reference date 02/04/22 recorded a brief interview for mental status score (BIMS) score of 03 indicating resident #16 was cognitively impaired. This MDS documented moods of feeling or appearing down, depressed, or hopeless. This MDS also recorded Resident #16 did not exhibit wandering behaviors. There was no evidence of care plan in place for the elopement risk. On 04/18/22 at 8:28 AM and at 8:32 AM, Resident #16 was observed constantly crying, she was exit seeking, and wandering around the 300 unit. On 04/18/22 at 8:51 AM, Resident #16 was observed pushing at the exit door. Staff M, a Licensed Practical Nurse / LPN, tried to redirect her with resistance. On 04/18/22 at 9:24 AM, Resident #16 was observed pushing at the exit door. On 04/20/22 at 1:15 PM, Resident #16 was observed pacing and wandering at the 300 unit aimlessly, she was noted crying. On 04/21/22 at 12:34 PM, a side-by-side review of Resident #16's records was conducted with both MDS coordinators (Staff G and Staff H, both were LPNs) and the Assistant Director of Nursing (ADON) being present. All agreed there should be a care plan in place to reflect the high elopement risk. They've acknowledged there was no care plan in place. The MDS coordinators revealed they will update the care plan. 2. Clinical record review revealed Resident #57 was admitted to the facility on [DATE], with diagnoses included Psychotic Disorder. Review of the Significant change MDS assessment, reference date 03/07/22, recorded a BIMS score of 05, indicating Resident #57 was cognitively impaired. The elopement risk assessment, dated 03/04/22, recorded a total elopement risk score of 22.0 indicating a high elopement risk. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 4 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 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 0656 Level of Harm - Minimal harm or potential for actual harm Further clinical record review for Resident #57 revealed a progress note, dated 03/11/22 at 12:07 AM, that documented Resident #57 was 'alert and responsive. Up and down the hallway. Exit seeking. Trying to open back door to leave and calling the other residents to follow her. Redirected for behavior issues.' There was no evidence of care plan in place to reflect Resident #57's status of exit seeking behaviors. Residents Affected - Few On 04/21/22 at 12:41 PM, an interview was held with both MDS coordinators (Staff G and H) and the ADON, a side-by-side review of Resident #57's records were conducted with them. They had agreed there was no care plan to reflect Resident #57's exit seeking behaviors and elopement risk. After the surveyor spoke to the MDS staff, they had generated a care plan on 04/21/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 5 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 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, record review and policy review, the facility failed to ensure proper care and services for 1 of 3 sampled residents reviewed, Resident #73, who had an indwelling urinary catheter, as evidenced by staff failed to ensure proper anchoring of the catheter tubing and failed to maintain the catheter tubing off the floor to prevent urinary tract infections (UTI). Staff also failed to provide personal care as per facility policy. Resident #73 had a recent UTI. The findings included: Review of the policy, Urinary Catheter Care revised September 2014, documented, General Guidelines: . Infection Control: 2b. Be sure the catheter tubing and drainage bag are kept off the floor. Changing Catheters: . 2. ensure that the catheter remains secured with a leg strap to reduce friction and movement at the insertion site (Note: Catheter tubing should be strapped to the resident's inner thigh.) This policy further instructed the steps in the care include to first wash the resident's genitalia and perineum thoroughly with soap and water, rinse, and towel dry. Staff are then to obtain fresh water and provide care to the urinary catheter. Review of the record revealed Resident #73 was admitted to the facility on [DATE]. Resident #73 was admitted to the hospital on [DATE] and return to the facility on [DATE] with a urinary catheter related to an obstruction and inability to urinate. Review of the admission Minimum Data Set (MDS) assessment, dated 03/22/22, documented Resident #73 had a Brief Interview for Mental Status (BIMS) score of 03, indicating he was severely cognitively impaired. This same MDS documented Resident #73 had an indwelling catheter and needed the extensive assistance of one person for personal hygiene. Review of the physician orders revealed Resident #73 had a Urinary Tract Infection as the resident was provided the antibiotic Cipro from 03/24/22 through 03/29/22. During an observation on 04/18/22 at 10:59 AM, Resident #73 was noted in bed. A urinary catheter bag was noted hanging from the bed. Resident #73 showed the surveyor his thighs and there was no leg strap or anchor holding the tubing. An observation on 04/20/22 at 11:46 AM revealed Resident #73 sitting up in his wheelchair awaiting lunch. The urinary catheter bag was noted hanging from the bottom on the wheelchair with the urinary catheter tubing lying directly on the floor. A leg strap was noted on the resident's right leg, but the catheter tubing was not secured by the thigh strap. The tubing was not under or within the strap. A subsequent observation on 04/20/22 at 11:56 AM revealed Resident #73 eating lunch. The urinary catheter tubing remained directly on the floor. Photographic evidence obtained. An observation of personal care for Resident #73 was made on 04/21/22 beginning at 9:59 AM with Staff N, a Certified Nursing Assistant (CNA). The urinary catheter tubing was noted loosely under the leg strap, but not secured in any way. Staff N cleaned the urinary catheter tubing first, then proceeded to cleanse the genitalia and perineum. During care, the CNA asked Resident #73 to turn onto his left side. The urinary catheter tubing and urinary drainage bag was on the resident's right side and hanging on the right side of the bed. When the resident turned onto his side, the Foley (catheter) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 6 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 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 FORM CMS-2567 (02/99) Previous Versions Obsolete tubing was pulled and stretched. After the care, the CNA stated she was done and covered the resident back up. When asked the purpose of the leg strap, the CNA stated it was to hold the bag. The CNA was asked to get a nurse for observation and assistance. Staff Q, a Unit Manager, and Staff F, the Infection Control Preventionist, came into the room. The Unit Manager agreed the urinary catheter tubing was not secured and showed the CNA how to use the leg strap to secure the catheter tubing. When asked if it is ok to have the tubing on the floor, the CNA stated, Oh no, of course not. Staff N stated she had been assigned Resident #73 this week. Event ID: Facility ID: 105300 If continuation sheet Page 7 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 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 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation and interview, the facility failed to have nurse staffing information posted at the beginning of each shift for 6 of 6 days (from 04/16 through 04/21/22). Residents Affected - Some The findings included: On 04/18/22 at 7:05 AM, observed staffing hours posted at the front lobby, dated 04/15/22. On 04/20/22 at 8:30 AM, observed staffing hours posted at the front lobby, dated 04/19/22 On 04/21/22 at 8:25 AM, there was no evidence of staffing hours posted at the front lobby. On 04/21/22 at 8:26 AM, an interview was held with the receptionist. She revealed the staffing hours are usually posted by the human resources (HR) at 8 AM, when the business office is open. She revealed that HR hasn't posted the staffing hours yet. On 04/21/22 at 3:26 PM, an interview was held with the Director of Nursing (DON) and the Assistant Director of Nursing (ADON). They were made aware of the concern regarding the posting of the staffing hours. The DON voiced there was a nurse supervisor on the 11 PM-7AM shift, and moving forward, she would have the 11PM-7AM staff post the staffing hours prior to the beginning of the next shift (which started at 7:00 AM). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 8 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, record review and interview, the facility failed to ensure accurate reconciliation of controlled medications for 6 of 6 sampled residents reviewed for medication reconciliation, Residents #168, #170, #94, #171, #96, and #34. The findings included: Review of the policy, Controlled Substances, dated December 2012, documented, 4. an individual resident controlled substance record must be made for each resident who will be receiving a controlled substance. This policy further describes the needed documentation on each controlled substance record. Review of the policy, Administering Medications, dated December 2012, documented, 19. The individual administering the medication must initial the resident's MAR (Medication Administration Record) on the appropriate line after giving each medication and before administering the next ones. 1. An observation of the Split Medication Cart for the 100 and 200 halls was made on 04/19/22 at 2:20 PM with Staff O, a Licensed Practical Nurse (LPN). 1a. Review of the Medication Monitoring / Control Record received on 04/17/22 for Resident #168 revealed the physician order for Oxycodone (a controlled pain medication) 5 mg (milligrams) to be given every six hours as needed. Review of this record documented one Oxycodone was removed from the medication cart on 04/17/22 at 9:00 PM. Review of the corresponding Medication Administration Record (MAR) lacked documented evidence of the administration of the Oxycodone. This was confirmed by Staff O, the LPN. 1b. Review of the Medication Monitoring / Control Record received on 04/06/22 for Resident #170 revealed the order for Morphine (a controlled pain medication) 15 mg to be given every six hours as needed. Review of this record documented one tablet of the Morphine was removed on 04/06/22 at 6:30 AM, 04/06/22 at 11:30 AM, 04/05/22 at 5:00 PM, 04/07/22 at 10:00 AM, 04/16/22 at 8:00 AM, 04/08/22 at 8:00 AM, and 04/18/22 at 2:00 PM. Review of the corresponding MAR lacked documented evidence of the administration of these morphine tablets to the resident. An interview with Staff O, the LPN, confirmed when a nurse provided a controlled medication to a resident, they should document both on the Medication Monitoring/Control Record and the corresponding MAR. 2. An observation of the '200 hall back medication cart' was made on 04/19/22 at 3:15 PM with Staff P, an LPN. 2a. Review of the Medication Monitoring / Control Record received on 03/24/22 for Resident #94 revealed the order for Ativan (a medication for anxiety) 0.5 mg to be given every six hours as needed. Review of this record documented one Ativan was removed from the medication cart on 04/17/22 at 8:00 AM and 04/18/22 at 8:34 PM. Review of the corresponding MAR lacked documented evidence of the administration of the Ativan. This was confirmed by Staff P, the LPN. 2b. Review of the Medication Monitoring / Control Record received from the pharmacy on an unknown / (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 9 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few not documented date, but initiated use on 04/18/22, for Resident #171 revealed the order for Ativan (a medication for anxiety) 0.5 mg to be given three times daily as needed. Review of this record documented one Ativan was removed from the medication cart on 04/18/22 at 6:00 PM. Review of the corresponding MAR lacked documented evidence of the administration of the Ativan. An interview with Staff P, the LPN, confirmed when a nurse provided a controlled medication to a resident, they should document both on the Medication Monitoring/Control Record and the corresponding MAR. 3. On 04/18/22 at 10:12 AM, during the medication storage review, on the 300 Memory Care unit, 2 residents were randomly selected for narcotic reconciliation review. 3a. This review revealed that Resident #96 had an order of Morphine 15 mg 0.5-tab (half) every 6 hours as needed for pain. Review of the April 2022 MARs lacked evidence of this order. The medication monitoring / control record documented that the Morphine was removed from the cart on 04/01/22 at 8:03 AM, 04/02/22 at 9:42, 04/03/22 at 5:55 PM, 04/04/22 at 09:44, 04/05/22 at 10 AM, and 04/06/22 at 10:20 AM. On 04/21/22 at 3:16 PM, an interview was held with the Director of Nursing (DON). The DON acknowledged the finding and confirmed this medication (Morphine 15 mg) did not exist on the April 2022 MARs. She voiced that the staff were administering the mediation using the medication monitoring / control record, although the order was not written on the MARs. 3b. Review of Resident #34's Medication Monitoring / Control Records, during the medication storage review, revealed a physician order for Lorazepam 1 mg topically (via skin) every 6 hours as needed. The April 2022 MARs were compared against the medication monitoring / control record that revealed discrepancies with documentation. Review of the medication monitoring / control record revealed Lorazepam was signed out 6 times, for the removal of the Lorazepam. Review of the April 2022 MARs revealed the nurses had signed only three times that it was administered. On 04/21/22 at 3:20 PM, an interview was held with the DON who acknowledged the findings regarding the discrepancies between the MARs and the medication monitoring / control record for Resident #34. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 10 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 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 - Many 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide a menu with a variety of choices of protein for the breakfast meals, affecting Residents #74 and #168; and failed to prepare meals according to the approved recipe and the approved menu, with the potential to affect all residents that eat foods prepared in the kitchen. The census at the time of the survey was 112, with 107 residents eating foods prepared in the kitchen. The findings included: 1. A review of the menu for the week during the survey (04/18-21/22), which was Week 4 of a 4-week cycle, revealed the following: For breakfast on Sunday 04/17/22, Tuesday 04/19/22, Friday 04/22/22, the menu showed that residents would be served 'Scrambled Eggs', as the only source of protein for the meal. For breakfast on Monday 04/18/22, the menu showed that the residents would be served 'Scrambled Eggs with Cheese', as the only source of protein for the meal. For breakfast on Wednesday 04/20/22, the menu showed that the residents would be served 'Western Egg Bake' (scrambled eggs with green peppers), as the only source of protein of the meal. For breakfast on Thursday 04/21/22 and Saturday 04/23/22, the menu showed that the residents would be served 'Egg of Choice', as the only choice of protein for the meal. For dinner on Saturday 04/23/22, the menu showed that the residents would be served 'Egg Salad Sandwich', as the only source of protein for the meal. Review of the remaining 3 weeks of the 4-week menu cycle revealed the following: Week 1 - 'Scrambled Eggs', as the only source of protein for the breakfast meal on Sunday through Wednesday and Friday and Saturday; and 'Egg of Choice', as the only source of protein for the breakfast meal on Thursday. Week 2 - 'Egg of Choice', as the only source of protein for the breakfast meal on Monday and Wednesday; and 'Scrambled Eggs', as the only source of protein for the breakfast meal on Monday and Wednesday thru Saturday. Week 3 - 'Scrambled Eggs', as the only source of protein for the breakfast meal on Sunday, Tuesday, Thursday and Saturday; and 'Egg of Choice' as the only source of protein for the breakfast meal on Monday, Wednesday and Friday. 1. Resident #74 was initially admitted to the facility on [DATE] and most recently readmitted on [DATE]. According to the resident's most recent complete assessment, a Significant Change in Status Minimum Data Set (MDS), dated [DATE], Resident #73 had a Brief Interview for Mental Status (BIMS) score of 07, indicating 'severe impairment'. During an interview on 04/19/22 at 9:39 AM, when asked about the food being served by the facility, Resident #74 replied, I can't eat all of the scrambled (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 11 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 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 eggs, I don't got no appetite for them. If I could get that straight and my money, I'll be alright. Level of Harm - Minimal harm or potential for actual harm 2. Resident #168 was admitted to the facility for current stay on 04/01/22. According to the most recent complete assessment, an admission (MDS), dated [DATE], Resident #168 had a BIMS score of 15, indicating 'cognitively intact'. During an interview with Resident #168, on 04/18/22 at 10:03 AM, when asked about the food served in the facility, Resident #168 replied, (the) food is terrible and small portions. During a follow up interview with Resident #168, on 04/21/22 at 8:40 AM, when asked to elaborate the concerns with the food, Resident #168 replied, very bland, same breakfast, it never changes, powdered eggs and they put a couple of scoops on your plate, I requested omelets and they screw that up. Its always the same liquid or powder eggs. You get no fresh fruit. It's a very predictable menu - It's the same thing every day. Residents Affected - Many During an interview, on 04/20/22 at 1:21 PM, with the Assistant Kitchen Manager, when the concern was brought to her attention, the Assistant Kitchen Manager stated that the menu was approved by Registered Dietitian (RD) from a consultant company. This surveyor requested contact information for the third party consultant company. During an interview with an RD from the third-party consultant company, on 04/21/22 at 10:30 AM, when asked about the repetition of eggs on the menu as the only source of protein being served to the residents, as documented on the 4-week menu cycle, the RD replied, with our menus, eggs are a staple on the menu We use eggs as a base item for the menu and if they want something else, it should be on the menu. Eggs are used because they are the source of protein for the morning meal. 2. The menu for the meal documented that the residents were to be served 'Teriyaki Chicken, Seasoned Broccoli, Rice'. During the follow up kitchen tour, on 04/20/22 at 11:25 AM, accompanied by the Food Service Director and the Assistant Kitchen Manager, it was noted that there was no 'Seasoned Broccoli' as the menu had documented. It was noted the Teriyaki Chicken had large pieces of broccoli mixed into the item. When Staff C, Cook, was asked about the broccoli and why it was not offered as a side, as the menu had suggested, Staff C replied, I made it about a month ago and the Administrator said that next time it should be put in the Chicken Teriyaki, instead of on the side. When asked if the change in the recipe was approved by the consultant RD, Staff C stated that he did not know. The recipe for the Teriyaki Chicken did not include Broccoli as an ingredient. During an interview, on 04/20/22 at 10:50 AM, with a Consultant RD from a third-party consultant company, when asked about the change in the recipe for the Chicken Teriyaki and the Broccoli, the RD replied all were meant to be served separately. That has been a pattern with the facility since we have been working with them. We will work on getting that changed with them. We write the menus, and the facility has the ability to reach out to us to make changes in the menu. During an interview with the Administrator, on 04/21/22 at 12:48 PM, when asked about altering the menu for the teriyaki chicken by adding the broccoli directly to the portion, the Administrator replied, when they first served it, it was not pleasing or palatable looking, it was based on the menu and he (the cook) and the Assistant Kitchen Manager, I said, 'why can't it look like this (referred to a recipe with picture found by using Google). 3. On 12/21/22 at 12:05 PM, the survey team requested a test lunch tray based on residents' response to the meal being served. The meal consisted of Shephard's Pie and 'Chuckwagon Corn'. The recipe for the Shephard's Pie, as approved by a third-party RD consultant company, documented that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 12 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 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 - Many recipe was to be 'Fresh whole carrots' and 'Frozen peas' as the only vegetables in the serving. The Shephard's Pie that was served to the residents and as a test tray to the survey team contained carrots, peas, green beans and corn (green beans and corn are not listed as ingredients in the recipe). The recipe for the 'chuckwagon corn' included Frozen whole kernel corn, Chopped onion, Diced red peppers, [NAME] pepper, frozen and diced. It was noted by the survey team that the 'Chuckwagon Corn' did not include onion, red pepper or green pepper. During an interview with Staff C, [NAME] and the Assistant Kitchen Manager, on 04/21/22 at 12:50 PM, when asked about the recipes for the Shephard's Pie, Staff C stated that he used a frozen '4-way blend' of vegetable to make the Shephard's Pie, that included carrots, corn, green beans and corn. When asked about the lack of red peppers, green peppers and onion in the Chuckwagon Corn, Staff C stated that he did not have red and green peppers and not enough onion to make as the recipe had dictated. When asked if the change in the recipe had been approved by an RD, Staff C stated that he did not know. The Assistant Kitchen Manager stated that the facility was working with the third-party consulting company to have the menu changed and the menus approved based on the meals that were in question, but have not been approved at the time of the interviews and observations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 13 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 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, interview and record review, the facility failed to provide meals that were prepared, served and stored, in accordance with professional standards and in a manner to prevent the potential growth of pathogens that cause foodborne illness, as evidenced by observations in the kitchen and 2 unit pantries (100 and 200 units) and a food tray left in Resident #99's room for 2-2.5 hours. The findings included: 1. During the initial kitchen tour, on 04/18/22 at 7:12 AM, accompanied by the Assistant Kitchen Manager, the following were noted: a. The internal temperature of the reach-in cooler #10 was 45 degrees Fahrenheit (F). b. A stack of single use and disposable Styrofoam containers were not stored inverted in a manner to prevent physical contaminates from falling into the food contact surfaces of the containers. c. A one quart container with no handle was left inside of a bulk container of oatmeal. d. The internal temperature of a pint container of whole milk was 45*. It was noted that there were several cartons of milk that were in a bus tub with a scant amount of ice without refrigeration. The bus tub of milk cartons was removed from the line and placed in the walk-in freezer to cool. e . A glue trap that is used for pest control was positioned directly over a toaster and over and to the left of the ice machine. f. A portion of floor and wall behind the reach-in coolers were damaged, creating a significant gap at the floor and wall juncture. g. There was an accumulation of debris under the shelving in the walk-in freezer. 2. On 04/19/22 at 1:59 PM, Resident #99 was observed in bed sleeping with lunch on over bed table. During an interview with Staff D, Certified Nursing Assistant / CNA, at the time of the observation, Staff D stated that Resident #99 might want it when he wakes up. At the time of the observation, the meal had been sitting on the resident's overbed table for approximately 2 to 2.5 hours, as reported by Staff D. 3. During an observation of the unit pantries on the 100 and 200 unit, on 04/20/22 at 1:46 PM, accompanied by the Food Service Director, there was a tray of food from the lunch that was served that day, had been refused by a resident. A note, that was on the tray, implied that the meal was intended to be re-heated by staff and served to the resident. The note read that the resdient refused the meal but might want the meal later in the day. When asked how the nursing staff would be able to reheat the meal properly and to the appropriate temperature, the food Service Director stated that the nursing staff do not have thermometers that could be used to ensure that the foods that would have been reheated and could not guarantee that the meal would be reheated safely. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 14 of 15 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Martin Coast Center for Rehabilitation and Healthc 9555 SE Federal Hwy Hobe Sound, FL 33455 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 0885 Report COVID19 data to residents and families. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility failed to inform residents / representatives / families of confirmed COVID-19 cases during the most recent Covid outbreak in a timely manner, by 5 PM the next calendar day, for the outbreak on 04/14/22, that included 7 of the 112 census, Residents #14, #16, #21, #23, #57, #77, and #103. Residents Affected - Few The findings included: During the infection control review, it was revealed that the facility failed to notify residents / representatives / families of a confirmed COVID-19 case for the following sampled residents: Residents #14, #16, #21, #23, #57, #77, and #103. On 04/20/22 at 10:34 AM during an interview process with the infection preventionist (IP), a registered nurse, she revealed the facility had one staff who tested positive for COVID-19 on 04/14/22. When asked, the IP for evidence of reporting / notification to the residents / representatives / families, the IP confirmed there were no notification issued within 24 hours for the most recent COVID-19 outbreak in the facility. She revealed that she understood a COVID-19 outbreak was considered if there were three cases in the same day. She voiced she did not know if one case was considered an outbreak and needed to be reported to residents / representatives / families. On 04/21/22 at 1:00 PM, an interview was held with the Assistant Director of Nursing (ADON), who revealed that he did not know that one COVID-19 case was considered an outbreak and needed to be reported to the residents / representatives and families withing 24 hours. During records review of progress notes, dated 04/18/22, for the mentioned residents (#14, #16, #21, #23, #57, #77, and #103), it was recorded that Resident family member was informed of employee covid update from March 31, 2022, through April 8, 2022. There was no evidence of reporting for the outbreak on 04/14/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 15 of 15