Inspection·August 24, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some were protruding in a manner that exposed the rotten wood in the door frame and were not securing the door inside of the frame. There was what appeared to be fecal matter smeared on the toilet seat and in the bottom of the toilet bowl in the shared bathroom. In room [ROOM NUMBER], the arms of the wheelchair for Resident in bed B (window bed) were damaged to the point that the foam underneath the covering was exposed. In room [ROOM NUMBER], there was an accumulation of debris on the floor, and the floor was dirty between the beds, the bathroom floor was heavily soiled. The covering of the push bars on the emergency exit doors that led to the ALF unit of the facility was worn and the push bar on the left door was not secured in a manner that could cause skin tears and injuries to the fingers. In room [ROOM NUMBER], the wall mounted air conditioning unit was not fully secured in the opening, creating a gap around the unit that was large enough to accommodate the migration of pests. In room [ROOM NUMBER], the brackets underneath the television were rusted and the wall was damaged at the baseboard by the armoire of Bed A. There was an accumulation of dust in the vents of the air conditioning unit. During an environmental tour of the facility, on 08/24/23 11:25 AM, accompanied by the Regional Director of Environmental and Maintenance and the Housekeeping and Laundry Director, the Regional Director of Environmental and Maintenance and the Housekeeping and Laundry Director acknowledged understanding of the concerns. 2). During an observation in room [ROOM NUMBER], on 08/21/23 at 3:26 PM, it was noted that the room felt warm. During an interview with the resident in Beds A and C, both with Brief Interview for Mental Status scores of 15, indicating 'cognitively intact', the resident in the C bed stated, It has been a problem for years. they came in and cleaned it about a month ago. Maintenance would take it out of the wall, hose it down and place it back in the wall. It was effective for a little while, but only for a couple of weeks. They say that there is nothing that they can do about it. At the time of the interview and observation, the temperature in the room was 81 degrees Fahrenheit (F), taken using a state issued ambient air thermometer. During an observation of the resident's room, on 08/22/23 at 11:28 AM, the resident in C bed stated, it is the best that it has been for a while. The temperature in the room was 78 degrees F, taken using a state issued ambient air thermometer. During an observation in room [ROOM NUMBER], on 08/22/23 at approximately 2:30 PM, the temperature in the room was 81 degrees F, taken using state issued ambient air thermometer. A Maintenance Report Log at nurse's station, documented on 08/22/23 resident voiced concern, Room needs a fan AC not working. During an interview, on 08/24/23 at 10:09 AM, with the Social Services Director, when asked about the concern with the air conditioning unit in the room, the Social Services Director replied, I went in there yesterday and on Monday. I told Maintenance and the Assistant Administrator and Maintenance (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 2 of 20 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 08/24/2023 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some went in the room and the unit was turned off, so he turned it back on and said that it was okay. When asked if the residents voiced that it was 'okay' she stated that she was not aware if it was 'okay' as voiced by the residents or based on Maintenance opinion. During an interview and environmental tour, on 08/24/23 11:25 AM, accompanied by the Regional Director of Environmental and Maintenance and the Housekeeping and Laundry Director, when the concern was brought to the attention of the Regional Director of Environmental and Maintenance, he stated, I was not aware, it is a quad (referring to the room being designed to have 4 residents residing). I am going to add a mini split to the unit and that should fix the problem. The tonnage of the unit is not appropriate for that room. 4) During an interview on 08/23/23 at 1:48 PM Resident #365 stated, this morning during my bed bath Staff A, a CNA, (Certified Nursing Assistant) washed me with cold water. The resident stated, I had my bed bath at 4:30 AM because I was going out of the facility for dialysis, and I had to be at my appointment by 6:30 AM. Resident #365 stated she asked Staff A why her bed bath water was cold and Staff A replied, because that is all we have to use. On 08/23/23 at 2:03 PM the Regional Maintenance Director was interviewed concerning the water being cold at 4:30 AM. The Maintenance Director stated the hot water was turned off at 8:00 AM on 08/23/23. He stated, he turned the water off because the mixing valve was not working due to calcium buildup in the line. The hot water was turned off to complete a water flush of the lines. The Regional Maintenance Director stated, If someone had a bed bath with cold water at 4:30 AM this morning, then someone wasn't running the water long enough to get the water warm. He stated, there were no problems with the hot water at 4:30 AM. On 08/23/23 at approximately 2:35 PM the DON was made aware of Resident #365's complaint of the bed bath being completed with cold water and the interview obtained with the Regional Maintenance Director. 3) An observation of personal care for Resident #106 was made on 08/23/23 beginning at 9:08 AM with Staff C, Certified Nursing Assistant (CNA). The CNA washed her hands leaving the water running, donned gloves, and went to get the basin from the table at the resident's bedside. The surveyor felt the running water and it was cold to the touch. The CNA returned to the bathroom and filled the basin, and the surveyor again tested the water in front of the CNA, but did not say anything. The water was still cold. Upon returning to the resident's bedside, Resident #106 requested his face to be washed. As soon as thr CNA placed the washcloth onto the resident's face he stated, Oh that's cold. The CNA said something that was inaudible and continued to wash his face. Staff C continued with the care, utilizing the same basin of cold water, to include peri-care (washing the resident's private areas). During an interview after the observation, when asked how the water temperature was for his bath, Resident #106 stated it was fine. When asked why he said it was cold when his face was washed, the resident stated because I was cold. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #106 had a Brief Interview for Mental Status (BIMS) score of 9, on a 0 to 15 scale, indicating he had some cognitive impairment. The surveyor went immediately into rooms 200 through 206, and upon turning on the hot water faucets in each bathroom, there was no water. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 3 of 20 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 08/24/2023 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 08/23/23 at 9:25 AM, Staff D, one of the Licensed Practical Nurses (LPNs) for the unit confirmed she knew there was no hot water in room [ROOM NUMBER], as she had washed her hands earlier that morning, but she was unaware of the lack of hot water in the other rooms. During an interview on 08/23/23 at 9:35 AM, when asked if there was any current water concerns, the Maintenance Director stated they were currently flushing out the hot water lines, so there was no hot water on the 200 unit, but he had relayed the message to management, including the Director of Nursing (DON), so that staff could provide hot showers in the common shower room on the other unit. The DON was present at the time of the interview, and when asked if she knew of the water issue on the 200 unit, the DON stated she had not been informed. The Maintenance Director stated, So there was a communication issue. The Maintenance Director explained he had identified an emergent concern with the main mixing valve of the hot water tank, that necessitated the flushing of the lines. The DON was made aware of the provision of care to Resident #106, using cold water, along with the resident's comment of Oh, that's cold, and agreed the CNA should have stopped the care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 4 of 20 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 08/24/2023 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, grievance review, and policy review, the facility failed to report 2 of 2 credible allegations of misappropriation of property to the State Agency and Law Enforcement, affecting 2 of 2 sampled residents (Resident #51 and #76). The findings included: Review of the policy titled, Investigating Incidents of Theft and/or Misappropriation of Resident Property revised December 2006 documented, 2. Misappropriation of resident property is defined as the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent. 4. Should an alleged or suspected case of misappropriation of resident property be reported, the facility Administrator, or his/her designee, will notify the following persons or agencies within two (2) hours of such incident, as appropriate: a. State Licensing and Certification Agency; . d. Adult Protective Services as required; e. Law Enforcement Officials as required . 1) During an interview on 08/21/23 at 11:25 AM, Resident #51 reported that the head of the facility at which he resided previously, was spending his check, and had cashed his credit card. Resident #51 further stated the manager of the previous facility was spending his food stamps. Resident #51 stated he had told the Social Services Director (SSD) at this current facility. Review of the record revealed Resident #51 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS) assessment dated [DATE] documented Resident #51 had a Brief Interview for Mental Status (BIMS) score of 9, on a 0 to 15 scale, indicating he had some cognitive impairment. Further review of this MDS revealed it was very important for Resident #51 to take care of his personal belongings or things. Review of a written grievance, completed by the SSD, dated 08/21/23 documented, the resident complained that the group home manager had his ID, debit card, and food stamp card. This grievance documented a resolution on 08/22/23 that the SSD had contacted the group home manager on 08/14/23 to return the cards, with the resident present, and that she had agreed to do so. Additional comments on this grievance documented, Call placed again on 08/21/23 to (name of group home manager) with no response. Writer educated Pt (patient) on DCF (Department of Children and Families/Adult Protective Services) referral as to date 08/22/23 cards have not been received via mail. Brother was notified with DCF referral made and not accepted. SSD recommended he report to the police or have his brother take him to pick cards up personally in which he agreed. A progress note dated 08/21/23 by the SSD documented the group home manager had been contacted the previous week to return the resident's Food Stamp Card, ID, and his check debit card. This note documented the items had not been received, and the resident was educated on reporting to DCF for financial abuse, which he agreed to do so. A progress note dated 08/22/23 by the SSD revealed the referral had been made regarding financial exploitation by the previous group home manger, and the case was not accepted. This note documented the resident was informed and the recommendation was made for the resident to have his brother take him to the group home to retrieve his ID, bank card, and food stamp card or report it to the police. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 5 of 20 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 08/24/2023 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 08/23/23 at 11:46 AM, the SSD confirmed she had only reported the financial exploitation to DCF. During a subsequent interview on 08/24/23 at 9:00 AM, when asked why she called DCF, the SSD stated the group home manager had all of the resident's cards, and had promised to return them. The SSD stated they gave her five days to do so, she had not return them, and so she called the event into DCF. When asked why she did not call the police, the SSD stated because He didn't agree to it. When asked why she did not report it to the State Agency, the SSD did not have an answer, but stated, I understand. During an interview on 08/24/23 at 10:28 AM, the Administrator stated she was aware the SSD had notified DCF regarding the group home manager's failure to return the resident's items. When asked if she had called law enforcement or reported the event to the State Agency, the Administrator stated she had not done either. 2) During an interview on 08/21/23 at 4:25 PM, Resident #76 revealed his stuff goes missing, like his credit cards and phone charger, when he goes to dialysis. The resident stated he had to cancel three of the credit cards. Resident #76 stated the Certified Nursing Assistants (CNAs) go through his stuff. The resident appeared upset and stated this happened often. During a subsequent interview on 08/22/23 at 3:05 PM, the mother of Resident #76 stated that about six months ago his clothes, shoes, and debit cards had gone missing. The mother stated that the clothing and shoes would eventually show back up, but that the debit cards had to be canceled and replaced at least three times. Resident #76 reported the cash app card and the express debit card keep coming up missing when he goes to dialysis. Resident #76 stated he reported the missing cards to the Unit Manager, Social Services Director (SSD), and Director of Nursing (DON). When asked what happened when he reported the missing cards, Resident #76 stated they tell him they will work on it and find out what happened. Review of the record revealed Resident #76 was originally admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS) assessment dated [DATE] documented Resident #76 had a Brief Interview for Mental Status (BIMS) score of 15, on a 0 to 15 scale, indicating the resident was cognitively intact. Resident #76 recieved dialysis treatments on Mondays, Wednesdays, and Fridays, outside of the facility. Review of the Grievance Logs from March 2023 to present revealed the following: 05/15/23 - Missing food/snack items 06/23/23 - Missing shoes Review of the Abuse Log for 2023 lacked any entry related to missing credit/debit cards or misappropriation of property for Resident #76. During an interview on 08/23/23 at 11:41 AM, the SSD was asked about any missing items for Resident #76. The SSD stated that just yesterday the resident agreed to a lock box for his room. When asked about any credit/debit card issues, the SSD reported that months ago the resident had a credit card that he couldn't access. When asked about any missing credit cards, the SSD stated she would have to review the grievances. Review of the Grievance Log at that time lacked any description of missing credit/debit cards. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 6 of 20 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 08/24/2023 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of a grievance dated 05/15/23 documented missing clippers, club crackers, Little [NAME] buddy's, Little [NAME] donut sticks, popcorn, and missing debit cards. The resolution dated 05/30/23 was that the clippers were found. Other listed items were ordered from a local store and scheduled for delivery. This grievance documented the Social Worker assisted the resident in replacing missing debit cards. Review of a grievance dated 08/22/23 documented that debit cards, snacks, and a cell phone charger were reported missing by the resident. The resolution dated 08/22/23 was to have Activities keep his snacks in their office and the staff to be educated on using the resident's personal belongings. This grievance lacked any resolution to the missing debit cards. During an interview on 08/24/23 at 8:55 AM, with a side-by-side review of the 05/15/23 grievance, the SSD reported the missing debit cards were found in the residents pockets when they did the laundry. The SSD also stated Resident #76 went to her office and staff reordered the cards for him. The SSD agreed this information was not documented on the grievance forms. During an interview on 08/24/23 at 10:33 AM, when asked about Resident #76 and missing items to include credit/debit cards, the Administrator stated Resident #76 misplaces a lot of stuff, but the cards were found in the laundry. The Administrator denied any knowledge of an allegation of theft or that the cards were stolen. Upon review of the grievances, the Administrator agreed the reports lacked documentation that the cards had been found in the laundry. The Administrator confirmed she did not report the missing credit/debit cards to any agency or to law enforcement. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 7 of 20 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 08/24/2023 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, grievance review, and policy review, the facility failed to investigate 1 of 2 credible allegations of misappropriation of property affecting 1 of 2 sampled residents (Resident #76). Residents Affected - Few The findings included: Review of the policy titled, Investigating Incidents of Theft and/or Misappropriation of Resident Property revised December 2006 documented, 2. Misappropriation of resident property is defined as the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent. 3. The investigation shall consist of at least the following: a. An interview with the person(s) reporting the missing items; b. An interview with any witnesses that may have knowledge of the missing items; c. An interview with the resident (as medically appropriate); . e. A review of the resident's personal inventory record to determined if the missing items were recorded on the report; f. Interviews with staff members (on all shifts) having contact with the resident during the past 48 hours; g. Interviews with the resident's roommate, family members, and visitors; . i. A search of the resident's room for the missing items. During an interview on 08/21/23 at 4:25 PM, Resident #76 revealed his stuff goes missing, like his credit cards and phone charger, when he goes to dialysis. The resident stated he had to cancel three of the credit cards. Resident #76 stated the Certified Nursing Assistants (CNAs) go through his stuff. The resident appeared upset and stated this happened often. During a subsequent interview on 08/22/23 at 3:05 PM, the mother of Resident #76 stated that about six months ago his clothes, shoes, and debit cards had gone missing. The mother stated that the clothing and shoes would eventually show back up, but that the debit cards had to be canceled and replaced at least three times. Resident #76 reported the cash app card and the express debit card keep coming up missing when he goes to dialysis. Resident #76 stated he reported the missing cards to the Unit Manager, Social Services Director (SSD), and Director of Nursing (DON). When asked what happened when he reported the missing cards, Resident #76 stated they tell him they will work on it and find out what happened. Review of the record revealed Resident #76 was originally admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS) assessment dated [DATE] documented Resident #76 had a Brief Interview for Mental Status (BIMS) score of 15, on a 0 to 15 scale, indicating the resident was cognitively intact. Resident #76 went out of the facility to dialysis treatments on Mondays, Wednesdays, and Fridays. Review of the Grievance Logs from March 2023 to present revealed the following: 05/15/23 - Missing food/snack items 06/23/23 - Missing shoes Review of the Abuse Log for 2023 lacked any entry related to missing credit/debit cards or misappropriation of property for Resident #76. During an interview on 08/23/23 at 11:41 AM, the SSD was asked about any missing items for Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 8 of 20 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 08/24/2023 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #76. The SSD stated that just yesterday the resident agreed to a lock box for his room. When asked about any credit/debit card issues, the SSD reported that months ago the resident had a credit card that he couldn't access. When asked about any missing credit cards, the SSD stated she would have to review the grievances. Review of the Grievance Log at that time lacked any description of missing credit/debit cards. Review of the grievance dated 05/15/23 documented missing clippers, club crackers, Little [NAME] buddy's, Little [NAME] donut sticks, popcorn, and missing debit cards. The resolution dated 05/30/23 was that the clippers were found. Other listed items were ordered from a local store and scheduled for delivery. The Social Worker assisted the resident in replacing missing debit cards. Review of the grievance dated 08/22/23 documented that debit cards, snacks, and a cell phone charger were reported missing by the resident. The resolution dated 08/22/23 was to have Activities keep his snacks in their office and the staff to be educated on using the resident's personal belongings. The resolution for this grievance lacked any mention of the debit cards. During an interview on 08/24/23 at 8:55 AM, during a side-by-side review of the 05/15/23 grievance, the SSD reported the missing debit cards were found in the residents pockets when they did the laundry. The SSD also stated Resident #76 went to her office and staff reordered the cards for him. The SSD agreed this information was not documented on the grievance forms. When asked if the credit/debit cards, that went missing while the resident was at dialysis, was reported to any State Agency or law enforcement, the SSD stated it was not. When asked if she did any type of investigation, to include any witness statements from staff, the SSD stated she would need to check with nursing. As of the Exit Conference conducted on 08/24/23, no evidence of an investigation into the missing cards had been provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 9 of 20 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 08/24/2023 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview and record review, the facility failed to complete a Level II PASSAR (Preadmission Screening and Resident Review) for 1 of 1 sampled residents reviewed, as required according to the information documented on the resident's Level I PASSAR Screening (Resident #54). Residents Affected - Few The findings included: Resident #54 was admitted to the facility on [DATE] with diagnoses which included Dementia, Anxiety Disorder, Chronic Psychosis, and Bipolar II Disorder. A review of Resident #54's Level I PASSAR indicates in Section I that this resident had Mental Illness related to diagnoses of Anxiety Disorder, Bipolar Disorder, Depressive Disorder, and Mood Affective Disorder. In Section II of the Level I PASSAR, it is documented that Resident #54 has a secondary diagnosis of Dementia and the Primary Diagnosis is a Serious Mental Illness. According to the directions listed on the PASARR worksheet, a Level II should be completed if the individual has a primary or secondary diagnosis of Dementia, or related neurocognitive disorder, and a suspicion or diagnosis of a Serious Mental Illness, Intellectual Disability, or both. A Level II PASRR may only be terminated by the Level II PASRR evaluator in accordance with 42 CFR 483.128(m)(2)(i) or 42 CFR 483,128(m)(2)(ii). Section III of PASSR worksheet documents this is not a Provisional Admission. Section IV of PASSR worksheet documents the individual may be admitted to a Nursing Facility because there was no diagnosis or suspicion of Serious Mental Illness or Intellectual Disability indicated. Level II PASRR evaluation not required. This statement is not correct based on the previous information contained in Sections I, II, and II. This Form was completed by the Social Services Director on 10/12/22. On 08/23/23 at 9:19 AM, an interview was conducted with the Social Services Director (SSD) regarding the Level I PASSAR for Resident #54. She stated she would research to check the status of the Level II PASSAR. She thought she had initiated a Level II, but wasn't sure. On 08/23/23 at 10:21 AM, the SSD stated, I cannot find any documentation that a Level II was completed. The Level I PASRR worksheet was reviewed with the SSD, and she was shown the statement outlining the requirements for the Level II PASSAR. The SSD acknowledged that Resident #54 met the requirements for a Level II PASSAR to have been initiated. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 10 of 20 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 08/24/2023 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 appropriate care and services were provided for 1 of 1 sampled residents with an indwelling urinary catheter, (Resident #106) who was diagnosed with two urinary tract infections (UTIs), while residing at the facility. The findings included: Review of the policy titled, Urinary Catheter Care dated September 2014 documented, Purpose: The purpose of this procedure is to prevent catheter-associated urinary tract infections. Maintaining Unobstructed Urine Flow . 3. The urinary drainage bag must be held or positioned lower than the bladder at all times to prevent the urine in the tubing and drainage bag from flowing back into the urinary bladder. Infection Control . 2b. Be sure the catheter tubing and drainage bag are kept off the floor. Steps in the Procedure . 3. fill the wash basin one-half full of warm water. 7. Wash the resident's genitalia and perineum thoroughly with soap and water. Rinse the area well and towel dry. 8. Pour wash water down the commode. This policy continues to instruct staff to then cleanse the urinary catheter from the insertion site outward. Review of the record revealed Resident #106 was admitted to the facility on [DATE] with an urinary drainage device. The resident pulled out the drainage device on 07/20/23, and it was replaced on 07/26/23 due to difficulty in urinating. Review of the Minimum Data Set (MDS) assessment dated [DATE], documented the use of the indwelling catheter, needing the extensive assistance of one staff to care for the catheter, and no UTI in the past 30 days. Review of the orders revealed the initiation of antibiotics for Resident #106 related to UTIs on 07/27/23 and 08/21/23. During an interview on 08/21/23 at 10:48 AM, the adult son of Resident #106 explained his father had a UTI along with treatment for the UTI at the hospital. The son stated his father was admitted to the facility with an urinary catheter, it came out, and was put back, as his father was unable to urinate. The son explained the facility added an antibiotic to his father's medications as he had another UTI. During an observation of Resident #106 on 08/22/23 at 10:20 AM, it was noted that the urinary drainage bag was lying entirely on the floor, along with part of the catheter tubing (Photographic Evidence Obtained). During an observation on 08/23/23 at 9:08 AM, Staff C, Certified Nursing Assistant (CNA), obtained cold water from the bathroom faucet and filled the water basin. The water was felt by the surveyor and Resident #106 voiced it was cold. Staff C proceeded to wash the resident's face, underarms, indwelling catheter tubing from the insertion site outward, peri-area (private area), and buttock, in that order. Although the CNA did use numerous wash clothes throughout the process, the CNA used the same basin of water for the entire process. During a wound care observation on 08/23/23 at 10:22 AM, upon entering the room with the wound care physician, Resident #106's tubing for the indwelling urinary catheter was observed coming out of the bottom of the adult diaper, and then out the top of the shorts above the waist level, allowing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 11 of 20 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 08/24/2023 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 urine to drain back into the bladder. Level of Harm - Minimal harm or potential for actual harm During an interview on 08/24/23 at 9:29 AM, the Director of Nursing (DON) was shown the photograph of the urinary drainage device directly on the floor, and was informed of the surveyor's observations during personal care by Staff C, CNA, and the incorrect tubing placement noted before the wound care observation. The DON agreed with the observed concerns. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 12 of 20 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 08/24/2023 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to reassess and implement nutritional interventions in a timely manner after a significant weight loss and continued decline for 1 of 6 sampled residents reviewed for weight loss (Resident #54). Residents Affected - Few The findings included: A review of the facility's policy for Weight Assessment and Intervention (Revised September 2008) documented: Weight Assessment 3. Any weight change of 5% or more since the last weight assessment will be retaken the next day for confirmation. If the weight is verified, nursing will immediately notify the dietitian in writing. Verbal notification must be confirmed in writing. 4. The dietitian will respond within 24 hours of receipt of written notification. 5. The dietitian will review the unit weight record by the 15th of the month to follow individual weight trends over time. Negative trends will be evaluated by the treatment team whether or not the criteria for significant weight change has been met. 6. The threshold for significant unplanned an undesired weight loss will be based on the following criteria [where percentage of body weight loss = (usual weight-actual weight)/ (usual weight) X 100]: a. 1 month - 5% weight loss is significant; greater than 5% is severe. b. 3 months - 7.5% weight loss is significant; greater than 7.5% is severe. c. 6 months - 10% weight loss is significant; greater than 10% is severe. Resident #54 was admitted to the facility on [DATE] with diagnoses which included Encephalopathy, Diabetes Mellitus 2, Cardiovascular Disease, Hypertension, Hyperlipidemia, Atrial Fibrillation, Chronic Obstructive Pulmonary Disease, Gastroesophageal reflux disease, Vitamin D deficiency, Dementia, Anxiety Disorder, Chronic Psychosis, and Bipolar II Disorder. Review of Resident #54's record revealed the following: On 05/02/23, the resident weighed 178 lbs. On 06/01/23, the resident weighed 167 lbs., which was a loss of 6.18% of her weight in 1 month. This loss signifies a severe weight loss, per facility policy. On 07/05/23, the resident weighed 161 lbs., and On 08/07/12, the resident weighed 155 lbs., which was a loss of 12.92% in 3 months. This is another (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 13 of 20 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 08/24/2023 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 0692 severe weight loss for this resident, per facility policy. Level of Harm - Minimal harm or potential for actual harm The annual Minimum Data Set (MDS) Assessment completed on 06/21/23 did not document any significant weight loss. Residents Affected - Few A review of Resident #54's Care Plan, completed on 06/27/23, documented, .at risk for malnutrition, receives a therapeutic diet .recent significant weight loss. Wt flux noted since admission. No other interventions noted. The dietary orders in place for Resident #54 were: 1) NCS/NAS diet Regular texture, Regular Fluid consistency, Fortified Foods with all meals (01/05/23) 2) Nutritional Treat/Snack with meals for Prevention of malnutrition 4oz, three times a day with all meals (03/20/23) 3) Health Shake with meals for Prevention of Malnutrition 4 oz three times a day with all meals (08/18/23) The first 2 orders were put into place before the severe weight loss occurred from 05/02/23 to 08/07/23. These interventions were not working because severe weight loss occurred after their institution. There were no changes to the interventions after 05/02/23 until 08/23/23. Observations of Resident #54 during lunch meal at approximately 12:30 PM each day were as follows: On 08/21/23, Resident #54 sent her lunch meal back and told them she only wanted a ham sandwich. The Health Shake was also sent back. Resident consumed her sandwich independently without assistance. On 08/23/23, Resident #54 sent her lunch meal back and requested a sandwich. Resident consumed her sandwich independently without assistance. It was unknown if her health shake was consumed during her meal. On 08/23/23 at 12:50 PM - Interview with the CNA providing assistance at lunch in Memory Care revealed: This resident (Resident #54) always sends her tray back and asks for a sandwich. She didn't drink her health shake. She said she didn't want it. Staff documented in CNA Tasks in electronic records that Resident drank 50% of health shake for lunch on 08/23/23. However record review revealed, on 08/24/23, Resident #54 sent her lunch back. She told CNA that she didn't want it. The lady sitting with her at the table said, Why do you always complain about your meal without trying it. It is really good. You never eat what is brought to you. When the resident received her sandwich, she ate it without any assistance. Resident was not seen consuming the health shake. A review of the nutrition progress notes from May 2023 - August 2023 revealed the following nutritional note on 05/19/23: Meds: Valproic acid, Carvedilol, Famotidine, Amiodarone, Furosemide (wt flux expected), sennosides, Rifaximin, Levothyroxine Sodium, Zofran, Cholecalciferol, Mirtazapine, Ferrous Sulfate, Lactulose, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 14 of 20 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 08/24/2023 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 0692 Clonazepam, Seroquel, Cranberry Tablet, Metamucil. Level of Harm - Minimal harm or potential for actual harm Diet: No Concentrated Sweets/No Added Salt/reg/reg with fortified foods Supplements: nutritional treat with meals 4oz Residents Affected - Few NKFA [no known food allergies] Chewing and Swallowing: no s/sx (signs or symptoms) noted PO (by mouth) intake: varied Feeding ability: varied Ht: 6'2 CBW: 177.8# BMI: 32.5, obese IBWR: 99-121# Adjusted BW: 135#, 61kg 1 month hx: 171.4# 3 months hx: 160.4# 6 months hx: 161# [Weight loss] Significant, Undesirable, Unplanned Reason for Weight Change: wt flux since admission per varied PO intake. Res/Family/IDT informed of wt change. On 08/23/23 a nutritional note was added after surveyor began investigating Resident #54's weight loss. The Nutritional assessment dated [DATE] documents the following: Note Text: *Sig wt loss [significant weight loss] Meds: Valproic acid, Carvedilol, Famotidine, Amiodarone, Furosemide (wt flux expected), sennosides, Rifaximin, Levothyroxine Sodium, zofran, Cholecalciferol, Mirtazapine, ferrous sulfate, lactulose, Clonazepam, Seroquel, Cranberry Tablet, Metamucil, Sennosides. Diet: No Concentrated Sweets/No Added Salt/reg/reg with fortified foods Supplements: health shake with meals NKFA [No known food allergies] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 15 of 20 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 08/24/2023 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 0692 Chewing and Swallowing: no s/sx noted Level of Harm - Minimal harm or potential for actual harm PO intake: 50-75% most meals Feeding ability: varied, mostly limited assistance Residents Affected - Few Ht: 62 CBW: 154.8# 8/7 BMI: 28.3, overwt but desirable for age 1 month hx: 161# 3 months hx: 177.8# 6 months hx: 171# Resident triggers for Significant, Undesirable, Unplanned weight loss of 12.9%, -23.0 Lbs. x 3 months. Reason for Weight Change: Dx dementia, variable PO intake. On diuretic with fluid losses anticipated Res/IDT/MD/family informed of wt change. Goals: Maintain wt and have no sig wt change at next review date; consume at least 50% of most meals and snacks; no s/sx of dehydration; able to maintain skin integrity. Interventions: Continue health shake 4 oz TID (three times daily) to promote additional kcals/pro needs with variable PO intake. Provide assistance at meals [to promote] additional PO intake. Continue therapeutic diet as ordered- consider liberalizing in future if PO intake < 50%. Honor food preferences when available. Monitor weight, labs, PO intake, GI and skin. Follow up prn [as needed] ***It must be noted that the Nutritional assessments in May and August both document weight fluctuations to be attributed to diuretic use. However, the resident was not prescribed, nor was not given, any diuretics from May 1 - August 23, 2023. On 08/24/23 at 10:30 AM, an interview was conducted with the Registered Dietitian. She stated, The Resident's weight loss had some desirable weight loss, and she was on a diuretic so there was some fluid loss anticipated. She is now getting mighty shakes with each meal. We reassess every 1 month-3 month and 6 months. If there is significant weight loss (>5%), the assessments would be done monthly. Also, if there was >5% weight loss, we would look at instituting weekly weights. Additional information was sent via from the RD (Registered Dietician) on 08/24/23 at 12:10 PM: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 16 of 20 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 08/24/2023 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 0692 Level of Harm - Minimal harm or potential for actual harm Resident with previous edema and diuretic. Weight loss is likely related to the resident's variable PO intake. Nutrition interventions put into place are mirtazapine with appetite stimulant side effects to promote additional PO intake on 1/6/23 and house supplement BID (twice daily) on 7/13/22, increased to nutritional treat TID on 3/20/23, but adjusted to health shakes TID on 8/18/23 d/t formulary adjustments and fortified foods on 1/5/23 with meals to supplement kcal/protein needs with suboptimal PO intake. Residents Affected - Few The RD was informed that the Resident was prescribed or given diuretics from May 1 - August 23, 2023 and had no diagnoses of edema. The RD response on 08/24/23 at 4:51 PM, After further review, the previous diuretic regimen was discontinued at the end of April, however, with a diagnosis of CHF (Congestive Heart Failure), weight fluctuations continue to be anticipated and are not uncommon for her. The RD added, Food preferences were discussed [Resident] during each assessment and her intake of meals and supplements continued to be monitored to supplement intake and promote weight stability, which didn't warrant any further interventions at the time. After response from the RD, it was still noted that the problem remained that there were no assessments and updated interventions documented after severe weight loss from May to June, and then from June until 08/07/23. Also, after severe weight loss from May 2023 to June 2023, no weekly weights were instituted to monitor weight loss more closely. Even after a 12.9% weight loss noted on 08/07/23, no weekly weights have been instituted. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 17 of 20 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 08/24/2023 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to prepare, serve and store foods under sanitary conditions. Residents Affected - Many The findings included: 1). During the initial kitchen tour, on 08/21/23 at 9:27 AM, accompanied by the Food Service Manager, the following were noted: a.) The instructions for the operation of the mechanical ware washing machine documented that the minimum water temperature was to be 120 degrees Fahrenheit and final Rinse solution should be tested 3 times daily using Chlorine test strips and recording results. For proper sanitation levels, readings should be between 50-100 ppm (parts per million) or as required by local and state health codes. During an observation of the mechanical ware washing machine, it was noted that the temperature of the wash cycle was 100 degrees F and the temperature of the rinse cycle was 110 degrees F, according to the temperature gauge installed on the machine and confirmed by use of the facility's metal stemmed probe style thermometer. During the same observation, the concentration of the chlorine based sanitizer was less than 50 parts per million, according to the test strips provided by the facility. The Food Service Manager acknowledged understanding of the concern that the wares that were washed and sanitized were not done properly based on the observation of the mechanical ware washing machine. b). Cleaned and sanitized equipment was noted to be wet nesting on the shelves in food preparation area. c). There was an accumulation of rust on the shelving underneath the slicer. d). There was an accumulation of food residues on the sharpening stones of the slicer. e). Milk crates that are not designed to be easily cleanable were being used for shelving cases of bottled water. At the conclusion of the initial kitchen tour, the Food Service Manager acknowledged understanding of the concerns. During an interview with the Administrator, on 08/21/23 at 10:15 AM, when the concerns were brought to her attention, she stated, [name of company] (a third party contracted for dietary oversight) was here on Friday and said that everything was fine. 2). During an observation of the unit pantry shared by the 300 and 400 units, on 08/23/23 at 3:15 PM, accompanied by the Food Service Manager, there was an accumulation of mold in the ice machine. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 18 of 20 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 08/24/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure a complete record for 1 of 6 sampled residents reviewed for nutrition. Specifically, Resident #55 had a nurse witnessed concern with a subsequent referral to therapy, and the record lacked any documentation of the event or follow through. The findings included: During an interview on 08/21/23 at 4:08 PM, Resident #55 voiced concern about an incident from the previous week, when she had trouble when she choked on hard rice. The resident stated she walked over to the therapy room during the incident, but nobody would hit her on the back to dislodge the food. Review of the record revealed Resident #55 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS) assessment dated [DATE] documented Resident #55 had a Brief Interview for Mental Status (BIMS) score of 15, on a 0 to 15 scale, indicating the resident was cognitively intact. Review of the orders revealed a regular diet with a regular texture and fluid consistency. Further review of the record lacked any documented evidence of the incident described by Resident #55. During an interview on 08/23/23 at 1:02 PM, when asked if she had ever worked with Resident #55, the Speech Language Pathologist (SLP) stated the resident was screened upon admission to the facility, but was not picked up on her caseload, as she recalled. When asked if she was aware of a coughing/choking incident with Resident #55 while eating rice recently, the SLP stated the resident had an isolated issue with rice last week, she waited for her (the resident) to clear it, and watched her during that time. The SLP further stated she was going to screen her again on Monday, but I saw she was scheduled to leave on Thursday. The SLP confirmed she did not do a screen or evaluation. When asked how she was made aware of the incident, the SLP stated Staff D, Licensed Practical Nurse (LPN) brought it to her attention. During an interview on 08/23/23 at 1:22 PM, when asked if she recalled a coughing or choking incident with Resident #55, Staff D, LPN, stated that last week she saw Resident #55 standing in the bathroom coughing and trying to make herself throw up. The nurse stated the resident told her it happens at home at times. The nurse stated she told the SLP about it so she could do an evaluation. When asked if she wrote a note about the incident, the nurse stated she did not, stating she wasn't choking, she was just coughing and trying to make herself throw up. Staff D confirmed she verbally told the speech therapist, and did not fill out any type of form or referral for a screening or evaluation. During an interview on 08/23/23 at 1:42 PM, when asked if he was aware of an incident of coughing or choking on rice by Resident #55 the previous week, the Director of Therapy services was unaware of the incident. When told that a nurse brought it to the attention of the SLP an incident with Resident #55 that included coughing and trying to make herself throw up, and that the SLP stated she did not follow up with an evaluation on Monday because the resident was leaving on Thursday, the Director of Therapy had no explanation, and agreed that a screening should have been completed. During an interview on 08/23/23 at 2:04 PM, the Director of Nursing (DON) agreed with the lack of documentation by Staff D, LPN. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 19 of 20 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 08/24/2023 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Potential for minimal harm Based on observation, interview, review of Quality Assessment and Assurance (QA&A) meeting sign-in sheets, and QA&A Committee Membership, the QA&A committee failed to ensure documented evidence of the participation of 2 of 3 mandated members of the committee, were in attendance at their monthly meetings (the Medical Director and Administrator or other individual in a leadership role). Residents Affected - Some The findings included: Review of the QAA Committee membership documentation revealed the QAA committee meets monthly. During an interview on 08/24/23 at 1:49 PM, the Assistant Nursing Home Administrator (NHA), who was accompanied by the NHA, was asked to locate and provide the last three QAA Committee Meeting Sign-in Sheets. Review of the 07/27/23 Meeting Sign-in Sheet lacked evidence of participation by the NHA, Assistant NHA, and the Medical Director. The NHA explained that she and the Assistant NHA were at a conference. Review of the 06/29/23 Meeting Sign-in Sheet lacked documented evidence of the NHA and the Medical Director. The NHA took the sheet and signed it as a late entry dated 08/24/23, and stated, I was there. That's my handwriting on the top of the sheet, referring to the date and the word QAPI. Review of the 05/31/23 Meeting Sign-in Sheet also lacked the signature of the Medical Director and the NHA, although the Assistant NHA was identified. The NHA again signed the sheet as a late entry. When asked how often the QA&A meetings were held, the Assistant NHA stated once monthly, usually on the forth Thursday of each month. When asked if the Medical Director attends the monthly QA&A meetings, the NHA stated he did, but agreed to the lack of documented evidence. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105300 If continuation sheet Page 20 of 20