Inspection·May 25, 2023

F 0561 as somewhat important. Level of Harm - Minimal harm or potential for actual harm Review of Resident's #26's ADLs care plan dated 3/19/2021 documented the resident has a self-care deficit related to central cord syndrome and other co-morbidities. He requires extensive assistance with dressing and hygiene and total assistance with the rest of ADL's; Goal: Resident will be kept clean, dry and odor free daily to prevent skin breaks and maintain dignity thru next review date; Interventions: Provide shower/bath as scheduled; Resident requires total assistance with 2 staff support with transfers; Honor resident's preference as best as possible; Ensure privacy and maintain dignity and transfer with a [ ] transfer lift utilizing safety precaution with assist of 2 persons. Residents Affected - Few Review of the Shower Schedule for Resident #26 was on Monday, Wednesday and Friday on the 7AM-3PM shift. Review of the Certified Nurse Assistant (CNA) Task Flow Sheet for Resident #26 dated 5/1-24/23 documented the following: 1) The resident received showers on 5/01/23, 5/05/23, 5/08/23, 5/10/23, 5/15/23, 5/19/23, 5/22/23 and 5/24/23. The resident received a full bed bath on the following days: 5/03/23, 5/12/23 and 5/17/23 and 2) The Bathing Self Performance: How resident takes full-body bath/shower, sponge bath and transfers in/out of tub/shower required total dependence with one person physical assist. Interview with Staff B, Certified Nursing Assistant (CNA) on 5/25/23 at 8:12 AM. She stated, He can wash his face and I transfer him with a [ ] transfer lift. I give him a shower and bed bath. I give him a shower two times a week and other times a bed bath. His shower schedule is Monday and Thursday. When I give him shower, he gets in the shower chair but the shower chair wheel is hard to push and not working. I can't push it and then I end up giving him a bed bath. I told the nurse and the DON about the shower chair wheel not working. They all know about the shower chair and they are supposed to be ordering it. Interview and record review with Staff C, Registered Nurse (RN) on 5/25/23 at 8:35 AM. She stated, He is alert and oriented times three. He is extensive care for ADLs with [ ] transfer lift for transfers. The shower schedule is in the computer but there is no time listed in there. They give him a bed bath and no shower. Interview and record review with the Director of Nursing (DON) on 5/25/23 at 10:40 AM. She stated, The cna have the shower schedule. It is on the task screen of the resident that they are taking care of. His shower schedule is Monday, Wednesday and Friday on 7-3 shift. The resident is receiving showers. If the shower chair is not working, there are other shower chairs here that the cna can use. Interview with Resident #26 and the Director of Social Services on 5/25/23 at 11:58 AM. The resident revealed to the Director of Social Services that he has not received a shower in months and has only received bed baths. He has not been put in a shower chair and taken to the shower. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105331 If continuation sheet Page 2 of 8 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 105331 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura Rehab and Nursing Center 1800 N E 168th Street North Miami Beach, FL 33162 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that a hand splint was worn to prevent a worsening right hand contracture for one (Resident #67) out of six residents reviewed for position and mobility out of nine residents with contractures. There were a total of 79 residents residing in the facility at the time of this survey. The findings included: Record review of the Splinting Policy and Procedure (Reviewed January 2023) documented: Policy: Splinting is used to protect joints and surrounding soft tissue. This can be accomplished by maintaining joints at position of rest, preventing positions that contribute to contracture and/or deformity, protecting the system of arches within the hands and feet and increasing or maintaining range of motion (ROM) in the joint and General Goals: To protect joints and surrounding soft tissue, to increase extremity function and to maintain ROM. An initial observation of Resident #67 was conducted on 5/22/23 at 9:51 AM. The resident was sitting up in a low bed with bilateral one half side rails and watching television. The resident's right hand was contracted and no splint was observed on the resident's hand. Second observation of Resident #67 was conducted on 5/23/23 at 7:27 AM. The resident was sitting up in a low bed with bilateral one half side rails, eating breakfast and watching television. The resident's right hand was contracted and no splint was observed on the resident's hand. Third observation and interview with Resident #67 was conducted on 5/23/23 at 1:02 PM. The resident was sitting up in a low bed with bilateral one half side rails and watching television. The resident's right hand was contracted and no splint was observed on the resident's hand. Attempted to interview the resident but she did not answer. Review of the Demographic Face Sheet for Resident #67 documented the resident was admitted on [DATE] with diagnosss of cerebral palsy, respiratory failure, hemiplegia affecting right dominant side, congestive heart failure, functional quadriplegia, insomnia, anxiety disorder and major depressive disorder. Review of the Minimum Data Set (MDS) 5-day Assessment for Resident #67 dated 4/08/23 documented the resident's Mental Status (BIMS) Summary Score had a BIMS Summary Score of 99 out of 15 indicating severe cognitive impairment and the resident was not able to make her needs known. The resident required total dependence assistance with one person physical assist for ADLs (Activities of Daily Living) and had upper and lower extremities impairment on both sides. Review of the Physician's Order Sheet (POS) for April 2023, May 2023 for Resident #67 documented the following: Patient to wear resting hand splint on right hand. Apply after AM care. Remove at bed time for ADLs, ROM, rest and as needed by floor CNA (Certified Nursing Assistant). Check skin before and after removal and as needed. The order was revised on 4/20/23. Review of Resident #67's Resting Hand Splint care plan dated 4/25/23 documented the resident to wear resting hand splint on right hand; Goal: Resident will not develop skin breakdown while using (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105331 If continuation sheet Page 3 of 8 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 105331 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura Rehab and Nursing Center 1800 N E 168th Street North Miami Beach, FL 33162 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 0688 splint thru next review date; Interventions: Apply resting hand splint on right hand. Level of Harm - Minimal harm or potential for actual harm Fourth observation of Resident #67 was conducted on 5/24/23 at 11:12 AM. The resident was sitting up in a low bed with bilateral one half side rails and watching television. The resident's right hand was contracted and a right hand splint was noted. Residents Affected - Few Fifth observation of Resident #67 was conducted on 5/25/23 at 11:03 AM. The resident was sitting up in a low bed with bilateral one half side rails and watching television. The resident's right hand was contracted and a right hand splint was noted. Review of the Certified Nurse Assistant (CNA) Task Flow Sheet for Resident #67 dated 5/23-24/23 documented the following: 1) Patient to wear resting hand splint on right hand. Apply after AM care. Remove at bed time for ADLs, ROM, rest and as needed by floor CNA. Check skin before and after removal and as needed and 2) There was no documentation dated from 4/20/23 to 5/22/23 that the resident wore the resting hand splint on her right hand. Documentation was only noted on 5/23-24/23. Interview with Staff B, Certified Nursing Assistant (CNA) on 5/25/23 at 8:06 AM. She stated, She is total care. She wear a hand splint. I put it on when I finish washing her in the morning. She wears the hand splint everyday. I put in the computer system, when I put the hand splint on. Sometimes she say it hurts. I let the nurse know and they take it off. The CNA was asked about the lack of documentation in the CNA Task screen in the computer starting on 4/20/23 until 5/23/23 concerning the hand splint being put on the resident. The CNA paused and did not provide a response to why the documentation was not in the CNA Task on the computer. Interview with Staff C, Registered Nurse (RN) on 5/25/23 at 8:23 AM. She stated, She is alert and oriented times one. She is total care. She wears a splint on the right hand. She wears a splint everyday. Interview and record review with the Director of Nursing (DON) on 5/25/25 at 10:30 AM. She stated, She has an order to wear the splint and it was ordered on 4/20/23. The DON confirmed there was no documentation noted from 4/20/23-5/22/23 when the order was written to wear resting hand splint on the resident's right hand in the CNA Task computer screen. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105331 If continuation sheet Page 4 of 8 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 105331 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura Rehab and Nursing Center 1800 N E 168th Street North Miami Beach, FL 33162 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 observation, record review and interview, the facility failed to maintain an accurate record for one (Resident #26) out of one resident reviewed for choices and preferences. The resident did not receive showers as documented in the medical record. There were a total of 79 residents residing in the facility at the time of this survey. The findings included: Observation and interview with Resident #26 on 5/22/23 at 10:11 AM revealed the resident sitting up in bed, watching television. When asked do you choose whether you take a shower, tub or bed bath he stated, They only give me bed baths and I prefer showers. At least give me a shower once a month. It's been three years since I had a shower. Review of the Demographic Face Sheet for Resident #26 documented the resident was admitted on [DATE] with a diagnoses to include central cord syndrome, fusion of spine cervical region, hypertension, bipolar disorder, mood disorder and anemia. Review of the Minimum Data Set (MDS) Annual Assessment for Resident #26 dated 10/27/22 documented the resident's Mental Status (BIMS) Summary Score had a BIMS Summary Score of 15 out of 15 indicating no cognitive impairment and the resident was able to make his needs known. The resident required extensive assistance with one person physical assist for ADLs (Activities of Daily Living) and required total dependence with support provided for bathing. When asked while you are in this facility, how important is it to you to choose between a tub bath, shower, bed bath or sponge bath, he was coded as somewhat important. Review of the Shower Schedule for Resident #26 was on Monday, Wednesday and Friday on the 7AM-3PM shift. Review of the Certified Nurse Assistant (CNA) Task Flow Sheet for Resident #26 dated 5/1-24/23 documented the following: 1) The resident received showers on 5/01/23, 5/05/23, 5/08/23, 5/10/23, 5/15/23, 5/19/23, 5/22/23 and 5/24/23. The resident received a full bed bath on the following days: 5/03/23, 5/12/23 and 5/17/23 and 2) The Bathing Self Performance: How resident takes full-body bath/shower, sponge bath and transfers in/out of tub/shower required total dependence with one person physical assist. Interview with Staff B, Certified Nursing Assistant (CNA) on 5/25/23 at 8:12 AM. She stated, He can wash his face and I transfer him with a [ ] transfer lift. I give him a shower and bed bath. I give him a shower two times a week and other times a bed bath. His shower schedule is Monday and Thursday. When I give him shower, he gets in the shower chair but the shower chair wheel is hard to push and not working. I can't push it and then I end up giving him a bed bath. I told the nurse and the DON about the shower chair wheel not working. They all know about the shower chair and they are supposed to be ordering it. Interview and record review with Staff C, Registered Nurse (RN) on 5/25/23 at 8:35 AM. She stated, He is alert and oriented times three. He is extensive care for ADLs with [ ] transfer lift for transfers. The shower schedule is in the computer but there is no time listed in there. They give him a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105331 If continuation sheet Page 5 of 8 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 105331 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura Rehab and Nursing Center 1800 N E 168th Street North Miami Beach, FL 33162 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 bed bath and no shower. Level of Harm - Minimal harm or potential for actual harm Interview and record review with the Director of Nursing (DON) on 5/25/23 at 10:40 AM. She stated, The cna have the shower schedule. It is on the task screen of the resident that they are taking care of. His shower schedule is Monday, Wednesday and Friday on 7-3 shift. The resident is receiving showers. If the shower chair is not working, there are other shower chairs here that the cna can use. Residents Affected - Few Interview with Resident #26 and the Director of Social Services on 5/25/23 at 11:58 AM. The resident revealed to the Director of Social Services that he has not received a shower in months and has only received bed baths. He has not been put in a shower chair and taken to the shower. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105331 If continuation sheet Page 6 of 8 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 105331 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura Rehab and Nursing Center 1800 N E 168th Street North Miami Beach, FL 33162 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to comply with infection control standards as evidenced by Staff A LPN failing to perform hand hygiene during wound care for one resident (Resident #23) out of 5 residents who have pressure ulcers. Residents Affected - Few The findings included: On 05/25/23 at 09:28 AM, during an observation of wound care with Staff A Licensed Practical Nurse (L.P.N) for Resident #23. Staff A LPN prepped supplies and dated border gauze. Staff A LPN entered room, placed supplies on disposable mat on over-bed table. Staff A LPN pulled table to restroom and washed hands. Staff A LPN put on gloves and removed the dirty dressing. It was revealed that there were two wounds near each other. The left buttock wound revealed a superficial skin layer was removed with pink tissue. The sacrum wound was deep with pale greenish tissue and pink to red areas. The Resident's toileting pad was clean and a urinary catheter was present. Staff A LPN cleaned the left buttock with normal saline, patted dry and applied calcium alginate. Staff A LPN began to go to the sacrum wound, cleaned it with normal saline, patted dry, applied metrogel, then calcium alginate. Staff A LPN covered both wounds with border gauze. Staff A LPN rolled up used supplies in disposable mat and threw them in red bag. Staff A LPN took off gloves and washed hands in restroom. Staff A LPN used paper towel to grab the red bag and threw it in a red bag lined box in the soiled utility/biohazardous room. Staff A washed her hands in the soiled utility/ biohazardous room and went to the computer to chart the wound care completed for Resident #23. On 05/25/23 at 10:05 AM, in an interview with Staff A LPN after the wound care treatment for resident #23. When Staff A, LPN was asked, Tell me about resident #23 and her wounds. Staff A LPN stated, The Resident is incontinent of bowel and bladder. She is immobile, rigid and stays in a straight position. The Resident has a urinary catheter due to her wounds. When asked, Tell me your wound care procedure steps that you performed on [Resident #23] Staff A LPN stated, The Patient was positioned in bed. I cleaned the left buttock with normal saline. Patted dry. Applied calcium alginate. Then I cleaned the sacrum with normal saline. Patted dry. Applied Metrogel. Applied Santyl and calcium alginate on top. Secured both wounds with bordered gauze. When asked, Did you change your gloves at any time after you cleaned the wounds? No, I did not. When asked, When were you supposed to change your gloves and wash your hands? Staff A LPN stated, After I clean the dirty wound and after I clean the wound. When asked, Did you use one glove throughout the procedure? Staff A stated, Yes. Staff A stated, Can I do it (wound care) again? I was so nervous. On 05/25/23 at 01:18 PM, in an interview with the Director of Nursing (D.O.N). When asked, What are your expectations for wound care treatment? The D.O.N stated, Make sure the wound is treated. Follow the physician's orders. The Nurse to sign off when wound care is complete. Wash hands before/after the procedure and after changing gloves. The Nurse can also sanitize her hands after she is done. Review of Physician's orders for May 2023 revealed, a urinary catheter due to wound care. Wound care treatment orders were of the following: Calcium Alginate external to apply to left buttock topically everyday. Wound care orders were to cleanse left buttock with normal saline and cover with gauze island border dressing. Santyl External Ointment and Metronidazole External Gel 1 % were to apply to sacrum topically everyday. Wound care orders were to cleanse sacrum with normal saline, apply calcium alginate, and cover with island gauze dressing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105331 If continuation sheet Page 7 of 8 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 105331 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura Rehab and Nursing Center 1800 N E 168th Street North Miami Beach, FL 33162 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review for resident #23 revealed, Medical diagnoses includes pressure ulcer to sacral region unstageable, pressure ulcer to left buttock and pressure ulcer of sacral region stage 3. In the minimum data set, Medicare 5 day entry dated 4/30/2023. In section C for Cognitive patterns, brief interview of mental status was unable to be determined. In section G for functional status, bed mobility was extensive assistance with one-person physical assist. Transferring was total dependent with two+ person's physical assist. Eating was extensive assistance with one-person physical assist. Toileting was total dependent with one-person physical assist. In section H for bowel and bladder, Yes to has an indwelling catheter and was incontinent of bowel. In section J for health condition, for pain, Yes to receiving scheduled pain medication regimen. In section K for nutrition status, No to unknown weight loss or weight gain. In section M for skin conditions, one Stage 2 and one stage 3 pressure ulcer is present. Review of Resident #23's care plan revealed, Resident has an actual skin breakdown. On 4/12/23, left buttock wound was a stage 2 pressure ulcer. On 4/26/23, stage 3 sacrum pressure ulcer changed to unstageable. On 5/17/23, sacrum wound worsened to stage 4 and left buttock wound is a stage 3. Date initiated on 03/23/2023 and revision on 05/22/2023. A goal included Resident's wound will manifest signs of healing in 14 days. Interventions included was turn and re-position every hour or as per protocol. Wound assessment weekly to determine progress or deterioration of wound. Observe for signs and symptoms of wound infection and intervene accordingly. Provide pressure relief device in bed. On Air Mattress. In review of the facility's policy titled, Wound care last revision on January 2023. It stated the purpose of this procedure is to provide guidelines for the care of wounds to promote healing. It is noted in step 2, wash and dry your hands thoroughly. In step 5, wash and dry your hands. In step 16, wash and dry your hands thoroughly. In step 23, wash and dry your hands thoroughly. In review of the facility's policy titled, Standard Precautions last reviewed on January 2023. The policy statement stated standard precautions are used in the care of all residents regardless of their diagnoses or suspected or confirmed infection status. Standard Precautions presume that all blood, body fluids, secretions, and excretions (except sweat), non-intact skin and mucous membranes may contain transmissible infectious agents. It is noted in section one (1) Hand hygiene and (B) hand hygiene is performed with alcohol-based hand rub or soap and water: (1) before and after contact with the resident; (2) Before performing an aseptic task; (3) after contact with items in the resident's room; and (4) after removing PPE. In section C, it stated Hands are washed with soap and water whenever; (2) after direct or indirect contact with dirt, blood or body fluids; (3) after removing gloves; and (4) before eating and after using the restroom. In section (2) Gloves, ( e ) gloves are changed as necessary, during the care of a resident to prevent cross-contamination from one body site to another (when moving from a dirty site to a clean one and (h) After gloves are removed, wash hands immediately to avoid transfer of microorganisms to other residents or environments. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105331 If continuation sheet Page 8 of 8