Inspection·March 17, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the bathroom, he is often unable to remember or be able to reach the outside door to close it. He also nodded his head yes to indicate that he did have a BM yesterday. Resident #58 further nodded his head yes in understanding, when asked by this surveyor whether or not he preferred privacy when utilizing the bathroom facilities. On 03/15/23 at 11:53 AM simultaneous interviews were conducted with both Staff F and with Staff G in which they acknowledged that privacy and dignity should have been provided to the resident. During a subsequent interview conducted on 03/15/23 at 2:28 PM with, the Occupational Therapist, she also acknowledged that privacy and dignity should have been provided to the resident. 2) Resident #41 was re-admitted to the facility on [DATE] with diagnoses which included Dysphagia, Morbid Obesity, Peripheral Vascular Disease, Anxiety Disorder and Hypertension. She had a Brief Interview Mental Status (BIM) score of 15 (cognitively intact). During an interview, conducted on 03/14/23 at 11:11 AM, this Surveyor was engaged in conversation with Resident #41 regarding some missing items, the Maintenance Technician, Staff H, requested to enter Resident #41's room, at the time, in order to check on the hot water temperature. Resident #41 then proceeded to try and explain to him some concerns she had about some people who came into her room and sat in her wheelchair and broke it. Staff H, stated that the resident always has a tendency to say something of this nature. Staff H, went on to say that once her wheelchair brake was broken, he did fix it. However, as the resident was speaking to him, Staff H, looked away, dismissing what the resident was trying to say/explain to him. This Surveyor was disturbed by the apparent lack of listening and understanding of the resident's concerns by this Maintenance Technician. Staff H, stated to the Surveryor, she is just confused and crazy, and even made a circular motion gesture with his right hand next to his ear as if to indicate that the resident is crazy, directly in front of this Surveyor. An interview was conducted on 03/15/23 at 1:37 PM with Staff H, regarding his earlier comment and gesture referring to Resident #41; he acknowledged that this should not have been done. The DON further recognized and acknowledged on 03/15/23 at 1:37 PM, that all residents should be treated and referred to in a dignified and respectful manner at all times. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 2 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 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 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was noted that 1 of 3 sampled residents (Resident #299) did not receive a notification of Medicare non-coverage (NOMNC) 48 hours prior to termination of skilled rehabilitation services. Residents Affected - Few The findings included: On [DATE] at 9:21 AM, three residents were selected for the Beneficiary Notification review. Review of the Skilled Nursing Facility Protection Notification Review showed that Resident #299's skilled rehabilitation services started on [DATE] and ended on [DATE]. However, Resident #299 did not sign the Notification of Medicare Non-Coverage (NOMNC). The admission records showed Resident #299's diagnoses included: Primary Osteoarthritis; History Of Falling; Rhabdomyolysis; Pain In Right Hip. Section G of the Minimum Data Set (MDS) dated [DATE], documented that Resident #299 required extensive assistance for bed mobility, dressing, personal hygiene, and locomotion on unit. She required limited asssitance for transfer, and toilet use, total dependence for bathing, and supervision for eating. Resident #299's skilled services started on [DATE] and the last covered day was on [DATE]. After termination of skilled services by the facility staff, Resident #299 remained at the facility. On the Notification of Medicare Non-Coverage (NOMNC), the Social Worker (SW) noted on [DATE] that the Resident's son was notified by phone. There was no evidence provided to show that the Resident or her authorized representative had received the NOMNC 48-hours before termination of skilled services. During an interview with the SW on [DATE] at 9:31 AM, she stated that she used to work in a hospital setting. She stated that the NOMNC procedure from the hospital is not the same as that of the nursing home. She said that before skilled services was discontinued, she spoke with Resident #299's son, but she did not send a letter. The SW further reported that the phone communication with the Resident's son occurred the day of benefits termination or on [DATE]. Consequently, the time to appeal the benefits termination had already expired. Resident #299 was observed in bed on [DATE] at 10:14 AM awake and alert. She said that she was going home today and was happy about that. That information was in reality incorrect. Resident #299 had no discharge plan in place. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 3 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to perform adequate fingernail care for 1 of 1 resident's reviewed for fingernail care (Resident #27). Residents Affected - Few The findings included: Review of the facility policy titled Care of Fingernails/Toenails, dated February 2018 revealed the following: Nail care includes daily cleaning and regular trimming. This policy also stated all fingernail care should be documented in the resident's chart, including the date and time, the name and title of the individual who administered the care, the condition of the resident's nails and nail bed, any difficulties in cutting the nails, and any problems or complaints made by the resident. During the initial tour of the facility conducted on 03/13/23 at 11:30 AM, the surveyor observed that Resident #27 had long, jagged fingernails which were caked with orange/brown matter. Resident #27 stated she would like for her fingernails to be cut. When asked when the staff cut them last, Resident #27 could not provide an answer except that it should be happening soon. It should be noted, it appeared to the surveyor that Resident #27's fingernails had not been cared for in over two weeks. Resident #27 was admitted to the facility on [DATE]. Resident #27 had a medical history significant for a bone infection related to a sacral pressure ulcer, hydrocephalus, chronic nerve pain, heart disease, seizures, falls, muscle weakness, and high blood pressure. A Significant Change Minimum Data Set (MDS) was completed on 01/09/23. This MDS documented Resident #27 had a Brief Interview of Mental Status (BIMS) score of 13, which indicates she was cognitively intact. This MDS also documented Resident #27 required extensive assistance of staff for personal hygiene needs. Review of Resident #27's Care Plans revealed there was a care plan in place regarding actual impaired skin integrity. This care plan included an intervention which stated, Avoid scratching and keep hands any body parts from excessive moisture; keep fingernails short. An interview was conducted with Resident #27 on 03/15/23 at 11:28 AM. During this interview, the surveyor observed that Resident #27's fingernails remained long, jagged, and caked with orange/brown matter. When the surveyor asked if the staff had addressed her fingernails, she stated they had not. An interview was conducted with Staff B, Certified Nursing Assistant (CNA) on 03/16/23 at 8:32 AM. When asked what staff are responsible for resident fingernail care, she stated the CNAs are responsible for this task. When asked how often the CNAs performs fingernail care on the residents, she stated the residents receive fingernail care on Fridays. When asked where the CNAs document the fingernail care, Staff B stated the CNAs document in a computer system called POC [Point of Care]. The surveyor asked if the CNAs POC system transfers to the nurses PCC [Point Click Care] system. Staff B stated it did, but that it did not specify if fingernail care was done. She stated it only documents that general care were done. When asked if Staff B would perform the fingernail care for Resident #27, Staff B stated the care would be performed the next day. An interview was conducted with the facility Assistant Director of Nursing (ADON) on 03/16/23 at 4:30 PM. She stated that it is the CNAs responsibility to perform fingernail care on the residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 4 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 She stated it was not possible to print the CNA charting showing when fingernail care were last performed. Level of Harm - Minimal harm or potential for actual harm A secondary interview was conducted with Resident #27 on 03/17/23 at 9:42 AM. The surveyor observed that Resident #27's fingernails appeared to be freshly cut. Resident #27 confirmed that the staff had performed fingernail care for her that morning. Resident #27 stated she was happy to have her fingernails cleaned and cut. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 5 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 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 Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on interview, observation, and record review, the facility failed to provide a leg band for an indwelling urinary catheter (Resident #52, Resident #55, Resident #202, and Resident #205). Residents Affected - Few The findings include: The facility policy titled Catheter Care, Urinary, taken from the Nursing Services Policy and Procedure Manual for Long-Term Care, revised September 2014, has steps describing the proper way to perform care. Step 18 states Secure Catheter utilizing a leg band. According to the American Journal of Nursing article, Techniques for Stabilizing Urinary Catheters. Stabilizing indwelling urinary catheters dramatically reduce adverse events such as accidental dislodgement as well as tissue trauma and inflammation induced by excessive traction of the tubing or drainage bag. 1. On 03/16/23 at 2:46 PM, an observation of urinary catheter care for Resident #55 was made of Staff E, a Licensed Practical Nurse (LPN). Staff E performed the care competently except for step 18 where she failed to secure the catheter as expected. The nurse indicated that hanging the catheter bag from a hook on the lower part of the bed frame was sufficient. 2. On 03/16/23 at 3:50 PM, an observation was made of Resident #202. The resident was sleeping in bed with an indwelling catheter attached to tubing and a drainage bag. The drainage bag was suspended from a hook on the bed frame. Resident #202 did not have a leg band or other device to stabilize the catheter tubing. 3. On 3/16/23 at 3:55 PM, an interview was conducted with Resident #205. Resident #205 stated he has a leg bag during the day, and he has two bands to keep the leg bag secure. Resident #205 stated at night the facility did not put a leg band on to hold the tubing in place they just hung the bag from the bed frame by a hook. 4. On 03/16/23 at 4:05 PM, an observation was made of Resident #52, who was sleeping in bed with an indwelling catheter attached to tubing and a drainage bag. The drainage bag was suspended from a hook on the bed frame, connected to the drainage bag. Resident #52 did not have a leg band or other device to stabilize the catheter tubing. 5. On 03/16/23 at 4:15 PM, an interview was conducted with the Director of Nursing (DON) regarding the lack of leg bands for indwelling urinary catheters for the residents observed and interviewed. The DON was surprised that the nurse did not place a leg strap for Resident #55. The DON was concerned to learn there were four residents who did not have leg straps for indwelling urinary catheters. The DON stated that she knew that there were supplies for the leg straps. The DON stated she did not know why the nurses were not using the straps. The DON agreed that leg straps should always be used to stabilize indwelling urinary catheters. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 6 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 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 0699 Provide care or services that was trauma informed and/or culturally competent. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of policy and procedure, observation, interview and record review, it was determined that the facility failed to provide Trauma Informed Care for 1 of 1 sampled residents, Resident #41. Residents Affected - Few The findings included: Review of the facility policy and procedure Trauma Informed and Culturally Competent Care, revised 08/29/22, documented: Trauma Informed Care (TIC) is an approach to delivering care that involves understanding, recognizing, and responding to the effects of all types of trauma. A trauma-informed approach to care delivery recognizes the widespread impact and signs and symptoms of trauma in residents, and incorporates knowledge about trauma into care plans or trauma-informed approach. We believe that Trauma Informed Care should not only meet professional standards but are delivered using multi-disciplinary approaches which are culturally competent and account for individual experiences and preferences and address the needs of trauma survivors by minimizing triggers and/or re-traumatization .As a result, principles of trauma-informed care must be addressed and applied purposefully in our health care settings at Life space Policy for Trauma Survivors: 1. Trauma Survivors will receive culturally competent, trauma-informed care in accordance with professional standards and state and federal regulatory requirements .2. We will utilize a multi-pronged approach to identifying a resident's history of trauma as well as his or her cultural preferences .3. Thorough assessment and interdisciplinary care planning are essential to providing quality care and culturally competent services 4. It is important to be aware of the impact of culture and culture preferences in the provision of care, and development of the resident's individualized plan of care Resident #41 was re-admitted to the facility on [DATE] with diagnoses which included Dysphagia, Morbid Obesity, Peripheral Vascular Disease, Gastroesophageal Reflux Disease, Osteoarthritis, Atrial Fibrillation, Chronic Kidney Disease, Atherosclerotic Heart Disease, Colostomy Status, Anxiety Disorder, Hypertension and Neuromuscular Dysfunction of the Bladder. She had a Brief Interview Mental Status (BIM) score of 15 (cognitively intact). On 06/27/19, 09/16/20, 08/09/22 and 09/09/22, Resident #41's four (4) care plans only documented the following four (4) different types of behaviors: 1) On 06/27/19---Behaviors (accusing staff of stealing or breaking things, calling staff inappropriate names, screaming that there are bombs under her bed and they are setting off missiles sometimes being negative and inappropriate verbally and lashing out during care---goal was to help demonstrate effective coping skills. 2) On 09/16/20---Periods of Hallucination, Paranoia and thinking that others are laughing at her and says that there were two ladies passing by her and screaming. The goal was for fewer episodes of behaviors; she is on medication for Anxiety Xanax 0.25mg 1 tablet every four (4) hours as needed and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 7 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 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 0699 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 3) and 4) On 08/09/22 x2, respectively,---Creating stories, verbally abusive to staff, threatening to get them fired, repeatedly calling 911 saying that she is on a 15th floor apartment needing help. During a Colostomy Care Observation conducted on 03/15/23 at 12:23 PM, Resident #41 proceeded to disclose the following information, to both Surveyors present. She proceeded to relay a series of multiple differing accounts, to include all of the following events: 1) About her childhood when she was escaping [NAME] and how she got displaced from her parents. She said that a lady helped her and returned her back to her parents, who had been residing in a concentration camp. She also showed the antique doll which she says she had during that time frame while she was going through these events. 2) She has no other family here in this Country and she is all alone; she also said that she had an Apple I-pad when she was first admitted to the facility in October 2022 (in which the resident stated that the previous Administrator provided the I-pad to her), until it broke. She went on to say that she was aware that her nephew took it with him to get repaired in [NAME], which she felt that the facility had. However, she added that she had never received it. Resident #41 elaborated the fact that she believed that the Ipad had been missing for about 3-4 months, when in fact, it was in [NAME] with her nephew getting repaired. Resident #41 explained that her nephew told her that he had a friend in Miami who mailed the Ipad from there to this facility, for her about 3 days ago. Resident #41 stated that she felt that the CNAs assigned to her a few days ago, had come into her room taunting her that the I-pad Mail package had actually came in, but she said they told her that they would not give it her. Resident indicated that they never told her what happened to it. 3) Resident #41 gave a brief account of how she was missing various jewelry items to include large sums of money upwards of maybe $800 or so. During an interview conducted on 03/16/23 at 10:32 AM with Staff I, a Registered Nurse (RN)/Minimum Data Set (MDS) Coordinator, in which she stated that she first became aware of Resident #41's accounting of her memories of her childhood trauma, over a twenty (20) minute time frame, following some current events shown on T.V. (to include a possible Earthquake). Staff I explained how Resident #41 continued to speak at length about her childhood, how she escaped [NAME], got displaced from her parents, how a strange lady helped her and returned her back to her parents, who had been residing in a concentration camp. Staff I also indicated that Resident #41 showed her the [AGE] year old antique doll which she says she had with her during that time frame while she was going through these events. Finally, Staff I stated to this Surveyor that she did bring all of the above information to the Team, who in turn, informed her that they were already aware of this. An interview was conducted on 03/17/23 at 11:42 AM with the Social Services Director, in which she stated that she was recently made aware, just prior to this survey, that Resident #41 had voiced her experiences of Childhood Trauma/Holocaust Survivor. The Social Services Director acknowledged that nothing was done, at the time, nor did she reveal this information to any of the staff members. She also further acknowledged that she would be the person, in general, who would be responsible for completing the Resident Admission/Evaluation which included only a handwritten single general question on the back of the form indicating, Have you suffered any traumatic events? According to the Social Services Director, she acknowledged that there was no documentation in Resident #41's facility record, since the policy became effective 10/24/22, to indicate that this (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 8 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 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 0699 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident ever received any assessment regarding her history of trauma, nor were any triggers identified related to her childhood trauma, and she further acknowledged that, Resident #41was not care-planned for this; only for behaviors. Record review indicated that there was no documented evidence to show that Resident #41's care plan reflected a multi-disciplinary approach to address the issue of Trauma Informed Care subsequent to her re-admission to the facility in October 2022; it only addressed Resident #41's Behaviors. Further record review revealed that the facility was utilizing an Admit/Discharge Form which only included the following question written on the back of the form, Have you suffered any traumatic events? which would indicate there has not been any current formal system in place to address the resident's needs, with no indication as to exactly when it was implemented. The facility had not delivered care and services, nor utilized approaches, which were culturally-competent, to account for her experiences and preferences. Neither did the facility address the needs of this trauma survivor by recognizing triggers and/or minimizing re-traumatization for this resident, subsequent to her re-admission to the facility in October 2022 During an interview conducted on 03/17/23 at 11:13 AM with the DON, in which she said that since the new regulation came into effect October 2022, the resident clinical assessment now has a section to assess for Trauma Informed Care, for all new admissions. However, she stated that the facility did not initiate Trauma Informed Care for Resident #41, subsequent to her re-admission in October 2022. The DON further recognized and acknowledged that on 03/17/23 at 10 AM, that Resident #41, a Holocaust Survivor, should have been receiving the necessary care and services to meet her needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 9 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of policy and procedure, observation and interview, it was determined that the facility failed to ensure that it secured and locked up four (4) over-the-counter (OTC) medications for the sampled residents observed, Resident #58, Resident #34, Resident #347 and Resident #28. The facility failed to discard a loose, ¼ sized portion of a pill in 1 of 5 Medication Carts, in the Gulfstream Locked Alzheimer's/Dementia Unit. And, failed to promptly discard an expired OTC stock dry mouth moisturizing medication in 1 of 4 Medication rooms, in the Gardens Unit. The findings included: Review of the facility policy and procedure titled Storage and Expiration Dating Medications, Biologicals revised 01/01/22, documented in the Policy Statement: Applicability. This policy sets for the procedure relating to the storage and expiration dates of medications biologicals, syringes and needles. Procedure 2. Facility should ensure that medications and biologicals are stored in an orderly manner in cabinets, drawers, carts, refrigerators/freezers of sufficient size to prevent crowding Facility should ensure that medications and biologicals that: (1) have an expiration date on the label; .or (3) have been contaminated or deteriorated, are stored separately from other medications until destroyed or returned to the pharmacy or supplier .Bedside Medication Storage 13.1 Facility should not administer/provide bedside medications or biologicals without a Physician/Prescriber order and approval by the Interdisciplinary Care Team and Facility administration 15. Facility should ensure that medications and biological for expired or discharged or hospitalized residents stored separately, away from use, until destroyed or returned to provider. 1) Resident #58 was re-admitted to the facility on [DATE]. He had a Brief Interview Mental Status (BIM) score of 12 (moderately impaired). During the facility tour conducted on 03/13/23 at 11:19 AM, Resident #58's room was observed to have a full syringe of OTC Normal Saline Midline IV 10ml flush solution with an expiration date of 06/30/25 sitting atop his bedside table. It was accessible and exposed to other residents, employees and visitors. Photographic evidence was obtained. 2) Resident #34 was re-admitted to the facility on [DATE]. She had a Brief Interview Mental Status (BIM) score of 12 (moderately impaired). During the facility tour conducted on 03/13/23 at 11:25 AM, Resident #34's room was observed to have a used/open OTC bottle of Systane Lubricant Eye Drops with an expiration date of 08/24 sitting atop her bedside table. It was accessible and exposed to other residents, employees and visitors. Photographic evidence was obtained. On 03/14/23 at 10:44 AM, Resident #34's room was still observed to have a used/open OTC bottle of Systane Lubricant Eye Drops sitting atop her bedside table. On 03/15/23 at 11:24 AM, Resident #34's room was still observed to have a used/open OTC bottle of Systane Lubricant Eye Drops sitting atop her bedside table. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 10 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 3) Resident #347 was admitted to the facility on [DATE]. She had a Brief Interview Mental Status (BIM) of 15 (cognitively intact). On 03/13/23 at 11:40 AM, during the facility tour conducted of Resident #347's room, it was observed to have a used/open OTC bottle of Tums expiration date 09/25 sitting atop her bedside table. It was accessible and exposed to other residents, employees and visitors. Photographic evidence was obtained. On 03/14/23 at 10:30 AM Resident #347's room was still observed to have a used/open OTC bottle of Tums sitting atop her bedside table. 03/15/23 at 11:17 AM Resident #347's room was still observed to have a used/open OTC bottle of Tums sitting atop her bedside table. 4) Resident #28 was admitted to the facility on [DATE] with diagnoses which included Hyperlipidemia, Overactive Bladder, Vitamin D Deficiency, Macular Degeneration, unspecified, Vitamin B12 Deficiency, Hypertensions and Seborrheic Dermatitis. She had a Brief Interview Mental Status (BIM) score of 11 (moderately impaired). A facility tour was conducted on 03/13/23 at 11:13 AM of Resident #28's room in which it was observed that there was a used/open OTC Tube of Triad Hydrophilic zinc-oxide based Wound Dressing with an expiration date 09/2023, located on the top of the resident's shared bathroom sink counter. It was accessible and exposed to other residents, employees and visitors. Photographic evidence was obtained. On 03/14/23 at 10:17 AM, Resident #28's room, was still observed as having a used/open Tube of OTC Triad Hydrophilic zinc-oxide based Wound Dressing located on the resident's shared bathroom sink counter. 03/15/23 at 11:09 AM Resident #28 was still observed as having a used/open Tube of OTC Triad Hydrophilic zinc-oxide based Wound Dressing located on the resident's shared bathroom sink counter. An interview was conducted on 03/15/23 at 11:52 AM with Resident #58, Resident #34, Resident # 347, and Resident #28's nurse, Staff F, a Registered Nurse (RN), regarding the OTC Normal Saline Midline flush solution, the Systane Lubricant Eye Drops, the bottle of Tums and the Tube of OTC Triad Hydrophilic zinc-oxide based Wound Dressing observed each of the Resident's bedside table or on their sink, and he acknowledged that none of the OTC medications should have been there. 5) During a Medication Storage Observation conducted on 03/15/23 at 1:10 PM with the Assistant Director of Nursing (ADON) and with Staff J, an RN, for Gulfstream Locked Alzheimer's Dementia Unit Medication Cart, it was noted that there was 1/4 size portion of an unidentified loose white pill in the bottom of the 3rd drawer of the Gulfstream medication cart. Photographic evidence was obtained. 6) During a Medication Storage Observation conducted on 03/15/23 at 1:46 PM with the ADON, of the Medication Room Gardens Unit, it was noted that there was an OTC spray bottle of Biotene Dry Mouth Moisturizing Spray Floor stock located on the shelf with an expiration date of 02/23. Photographic evidence was obtained. On 03/15/23 at 2:17 PM the Director of Nursing (DON) acknowledged and recognized that none of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 11 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm residents self-administer any of their own medications and neither were any of them assessed to be able to do so. The DON further indicated that none of the OTC medications should have been left at any of the resident's bedsides and said that all resident medications should be kept locked/secured at all times with any expired medications promptly discarded; this was not done. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 12 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure residents were offered proper hand hygiene during meal times on 4 of 4 units observed during meal times and the facility failed to follow proper infection control during peri and wound care for 1 of 1 resident's observed for wound care (Resident #27). Residents Affected - Few The findings included: Review of the facility policy titled Handwashing/Hand Hygiene, dated August 2015 revealed the following: Residents, family members, and/or visitors will be encouraged to practice hand hygiene through the use of fact sheets, pamphlets, and/or other written materials provided at the time of admission and/or posted throughout the facility. It was noted during the review of this policy that there were no instructions for the staff to provide hand hygiene for residents prior to meal consumption. Review of the facility policy titled Wound Care, dated October 2010 revealed the following: Wash tissue around the wound that is usually covered by the dressing, tape or gauze with antiseptic or soap and water. Review of the facility policy titled Perineal Care, dated February 2018 revealed the following: Wash the rectal area thoroughly, wiping from the base of the labia towards and extending over the buttocks. 1) During the initial meal observation conducted at the facility on 03/13/23 at 12:45 PM, an observation was conducted on the 400 Unit that the staff distributing the lunch meal trays to the residents did not offer or perform hand hygiene for any residents. During the Day One Team Meeting conducted on 03/13/23 at 2:15 PM, it was discussed that the other surveyors also did not observe hand hygiene being offered or performed for the residents on the other three units. An additional observation was conducted on 03/14/23 at 9:10 AM on the 400 Unit that the staff distributing the breakfast meal trays to the residents did not offer or perform hand hygiene for any residents. An additional observation was conducted on 03/15/23 at 12:32 PM on the 400 Unit that the staff distributing the lunch meal trays to the residents did not offer or perform hand hygiene for any residents. An interview was conducted on 03/14/23 at 9:20 AM with Resident #43 regarding hand hygiene before meals. Resident #43 stated the staff does not wash her hands prior to meals. It was noted that Resident #43 had a Brief Interview of Mental Status (BIMS) score of 13, which indicates she was cognitively intact. An interview was conducted on 03/14/23 at 9:23 AM with Resident #75 regarding hand hygiene before meals. Resident #75 stated the staff does not wash her hands prior to meals. It was noted that Resident #75 had a BIMS score of 13, which indicates she was cognitively intact. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 13 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 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 An interview was conducted on 03/14/23 at 9:26 AM with Resident #302 regarding hand hygiene before meals. Resident #302 stated the staff doe does not wash his hands prior to meals. It was noted that Resident #302 had a BIMS score of 15, which indicates he was cognitively intact. An interview was conducted with Staff B, Certified Nursing Assistant (CNA) on 03/14/23 at 10:00 AM regarding resident hand hygiene before meals. Staff B stated she did not wash or offer hand hygiene prior to meals. She only passes the trays to the residents. An interview was conducted with Staff C, CNA on 03/14/23 at 10:13 AM. Staff C stated she did not offer the resident's hand hygiene prior to delivering their meal trays. An interview was conducted with the facility's Assistant Director of Nursing (ADON) on 03/16/23 at 4:15 PM. The surveyor discussed the concerns regarding the lack of resident hand hygiene during mealtimes. The ADON stated she was upset by this because she has done in-services with the staff regarding the importance of hand hygiene for the residents. The surveyor asked for documentation of the in-services provided to the staff regarding this topic. The ADON provided paperwork from an in-service conducted on 01/25/23-the in-service was titled call lights, ADLs, and patient care for the entire patient (head to toe grooming) and it documented that the education was provided by the Director of Nursing. The in-service roster documented that 25 staff members were present for this in-service. The paperwork did not specify what grooming was discussed during this in-service. This was the only in-service documentation the ADON was able to provide regarding this topic. 2) During the initial tour of the facility conducted on 03/13/23 at 11:30 AM, Resident #27 stated she had a pressure ulcer on her sacrum. When asked if she was able to get up to a wheelchair or to the bathroom for care, Resident #27 stated she was bedbound. Resident #27 was admitted to the facility on [DATE]. Resident #27 had a medical history significant for a bone infection related to her sacral pressure ulcer, hydrocephalus, chronic nerve pain, heart disease, seizures, falls, muscle weakness, and high blood pressure. A Significant Change Minimum Data Set (MDS) was completed on 01/09/23. This MDS documented Resident #27 had a Brief Interview of Mental Status (BIMS) score of 13, which indicates she was cognitively intact. This MDS also documented Resident #27 required extensive assistance of staff for personal hygiene needs. Review of Resident #27's Care Plans revealed there was a care plan in place which documented Resident #27 had a stage 4 sacral pressure ulcer that was present when she was admitted to the facility. Review of the Skin and Wound Notes revealed Resident #27's sacral pressure ulcer had not made improvements in measurement in the last 4 months. According to the Skin and Wound Note written on 12/06/22 at 11:18 AM, the wound measurements were 5.8 centimeters (cm) long x 3.1 cm wide x 1.0 cm deep. According to the Skin and Wound Note written on 01/04/23 at 3:01 PM, the wound measurements were 6.0 cm long x 3.0 cm wide x 0.9 cm deep. According to the Skin and Wound Note written on 02/02/23 at 1:44 PM, the wound measurements were 6.0 cm long x 3.0 cm wide x 2.0 cm deep. According to the Skin and Wound Note written on 03/10/23 on 11:41 AM, the wound measurements were 6.0 cm long x 3.5 cm wide x 2.5 cm deep. An observation of wound care was conducted on 03/16/23 at 8:05 AM with Staff A, Registered Nurse (RN), Staff D, RN, and Staff B, Certified Nursing Assistant (CNA). The surveyor obtained consent from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 14 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 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 FORM CMS-2567 (02/99) Previous Versions Obsolete Resident #27 prior to the start of the wound care. Staff A gathered all the wound care supplies and all the staff members donned isolation gowns prior to entering Resident #27's room. The wound care was started at 8:35 AM. Staff D and Staff B removed Resident #27's pillows and turned her to her right side. Staff A removed Resident #27's incontinence brief and it was noted that she had a large amount of stool present. Staff B obtained incontinence wipes and gave them to Staff A. Staff A used the incontinence wipes to remove some of the stool from Resident #27's buttocks. However, it was noted by the surveyor that there was a fair amount of stool left on Resident #27's buttocks, visible under the tape of the sacral wound dressing. After washing her hands and changing her gloves, Staff A then removed the old wound dressing from Resident #27's buttocks, revealing the stool that had not been removed initially. Staff A performed wound care on Resident #27's sacral pressure ulcer without removing the remaining stool from the buttocks. Staff A removed the remaining stool with the incontinence wipes after the wound care was completed, before placing the new dressing over the wound. The remaining stool had the potential to contaminate the wound area, which has the potential to cause infection and impair healing. Event ID: Facility ID: 105335 If continuation sheet Page 15 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. 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 records review, it was determined that the facility failed to ensure the normal functioning of the Call Light System in 1 of 4 units (The Garden), to prevent confusion between the system dysfunctional status (emitting continuous beep) and alerts coming from Residents' activated call lights. Residents Affected - Few The findings included: On 03/14/23 at 09:51 AM, it was observed that the call light monitoring system panel, on the Garden Unit, was emitting a continuous audible sound. A look at the board revealed three distinct messages. It showed room [ROOM NUMBER] light was activated. At the same time, the board indicated that there were two lamps of the system that were faulty. Employee N who stood at the nursing station, in the unit (Garden), ignored or was oblivious to the beep/sounds, although the noise was disturbing. Soon after, a certified nursing assistant (CNA) was also observed coming by the nursing station, away from the location of room [ROOM NUMBER]. She too ignored the call light signal. A few minutes later, this writer walked over to room [ROOM NUMBER] and discovered that the call light was answered by another unidentified worker. The Resident informed that his issue was addressed. On 03/14/23 at 10:09 AM, this writer activated the call light in the bathroom of room [ROOM NUMBER]. After taken a picture of the board and waiting for a while, this writer asked Employee N who stood by the nursing station whether the call light was functional. Employee N replied, after taking a glimpse at the call light monitor, let me check the call light in room [ROOM NUMBER]. A few minutes later or at 10:13 AM, Employee N returned to the nursing station and said, let me call maintenance for them to check the system. During an interview with Employee O, one of the Maintenance Workers, on 03/14/23 at 10:27 AM, he reported that he returned to work yesterday or on 3/13/2023. Employee O informed that the call light system was not working properly before he left for his week-long vacation. He said that the code 8163 that was shown on the board meant that a light was out. He informed that they had contacted the company contracted to repair the system. A technician came to repair the issues, but he could not repair it. Duing an interview with the DON on 03/14/23 at 3:58 PM, she said that the construction workers had done something to the call light system causing it to beep, but the beep was not related to an issue with any specific room. She said that the staff at Poinciana had explained to her that the continuous sound of the call light system was not coming from a room, but it was another issue which she had discussed with Maintenance. Consequently, she acknowledged that she did not conduct any education with the nursing staff on being proactive and more alert in detecting the sound produced by the residents' activated call light and that of the dysfunctional call light system panel. The facility's Executive Director (ED) said on 03/15/23 at 9:44 AM that they have a contract with a company to replace the entire call light system. He said that a technician from that company came to the facility last night, on 3/14/2023, but he could not locate the cause of the call light beeping and which light bulb they had to replace. He also provided a contract signed by the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 16 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete representative and the contractor to replace the call light system. It was noted that the contract was signed since 2021. On 03/16/23 at 10:15 AM - 03/16/23 10:30 AM, the call light system panel at the nursing station in The Garden Unit was still not functioning efficiently. The call light monitoring system still emitted a continuous monotonous beep and simultaneously a distinct sound when the residents' call lights are activated causing confusion. Event ID: Facility ID: 105335 If continuation sheet Page 17 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 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 0924 Put firmly secured handrails on each side of hallways. Level of Harm - Minimal harm or potential for actual harm Based on observation, interviews, and records review, the facility failed to ensure that the residents had access to handrails in 4 of 5 units of the facility (Garden, Poinciana, Cobblestone, & Gulfstream). Residents Affected - Many The findings included: Observations conducted on 03/12/23 to 03/14/23 from 9:00 AM to 12:20 PM revealed that all handrails at the facility were removed. The facility was undergoing renovation. Further inquiries revealed that out of five units at the facility, four were residents occupied, and none of the four units had handrails affixed or secured on the walls. During an interview with the Administrator on 03/14/23 at 3:28 PM, he informed that the repairs had started on February 14, 2023. The facility's objectives were to replace the light fixtures, to repaint the walls, and replace the handrails. He said that they were currently in the process of repainting and replacing the wall papers. The painting should take about two to three weeks, he added. The light fixture upgrades were completed. He also reported that all residents were notified by mail or during the resident council meetings and or posted signs throughout the facility. On 03/15/23 at 9:08 AM subsequent to a conversation with the Administrator and the Executive Director on 03/14/2023 questioning the removal of the handrails, the handrails were reinstalled on one side of the hallways the night of 3/14/2023. The Administrator informed that they ordered new handrails, and they would not be delivered until later this month. During an interview with the Executive Director on 03/15/23 at 9:40 AM, he said that the new handrails were already on site. They were waiting for the painting job to be completed before reinstalling all of them up. He later brought a document dated 3/15/2023 which indicated that the handrails will be completely reinstalled on Thursday 3/ 2023. Later that day at 11:20 AM, the Administrator retuned with a corrected letter showing that the new handrails will be installed on Thursday 3/23/2023. On 03/16/23 at 10:45 AM, it was observed that all the handrails were not reinstalled. The handrails were placed only on one side of the walls throughout the entire facility except the Yellowstone unit which is closed. Interview was conducted with the Activity Director on 03/17/23 at 9:47 AM. He said that he received no complaints from the residents regarding noise at the facility. The Assistant Director of Nursing (ADON) informed on 03/17/23 at 9:50 AM that no one had complained to her about noise, before or during the renovation. She added that none of her team members had reported any residents' complaints to her about issue of noise. During an interview with the Director of Nursing (DON) on 03/17/23 9:55 AM, she said that none of the residents complained to her about environmental noise or nuisance. What she heard was that the facility will look nice once the work are completed. In a follow-up interview with the Administrator on 03/17/23 at 9:59 AM, he reiterated that the project started on 2/14/2023. The first part was to remove the wallpapers, one side at a time. He said they did not send any letters to the residents informing them of the renovations. What they did was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105335 If continuation sheet Page 18 of 19 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 105335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades Health and Rehabilitation Center 2105 SW 11th Court Delray Beach, FL 33445 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 0924 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete that they spoke to the residents at the Residents' council meeting, informed many residents and their representatives (family members) from the Poinciana Unit, and they also posted signs throughout the entire facility to let residents know about the ongoing renovation. The repairs were scheduled to be done during office hours, from 9:00 AM to 5:00 PM. He continued and said that the work started before the recertification survey, but since the survey they had to suspend all works. The Administrator informed that they had to work on Tuesday in the evening to reinstall some of the handrails that were removed, following the team's questioning regarding the missing handrails. Event ID: Facility ID: 105335 If continuation sheet Page 19 of 19