Inspection·July 20, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (Photographic evidence obtained). The alarm pad and box had been moved to a different location on the dresser. During an interview on 07/19/23 at 12:09 PM, when shown the alarm pad on the dresser, and asked if Resident #20 needed it, Staff, N, CNA, stated, I don't know. The CNA said something about working other units, but was very difficult to understand. The alarm box was no longer on the dresser and no beeping was heard. The telephone-like cord was noted coming from under the bed sheets, but was not hooked up to the alarm box. Resident #20 was lying in bed. During an interview 07/19/23 at 12:14 PM, when asked if Resident #20 was a fall risk, Staff P, Licensed Practical Nurse (LPN), stated Oh yes, he tries to get up all the time. When asked what interventions were in place for the resident, the LPN stated the bed and chair alarm. The LPN stated we try to educate and encourage the use of the call light and to ask for help. When asked if she was aware of the low battery beeping and light for his alarm, the LPN stated she thought it was his alarm that needed battery changes yesterday. The LPN explained that the Social Services Director brought her the alarm yesterday, and she sent it to maintenance, as she is unable to open the back of the alarm box as she doesn't have that tiny little screwdriver. An observation with LPN at this time revealed the alarm box was hanging from the top of the bed rail, but not hooked to the pad in the bed. The LPN stated, When I don't have my regulars . this happens, as she proceeded to hook up the bed alarm. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 observation, interview, and record review, the facility failed to ensure nutritional services to meet the needs for 2 of 5 sampled residents, Residents #65 and #137. The Registered Dietician (RD) failed to do an accurate quarterly assessment for Resident #65, failed to initiate weekly weights with the identification of a significant weight loss, and failed to follow up with the physician on his recommendation for an appetite stimulant. The RD failed to ensure timely interventions for Resident #137, who had a significant weight loss. Residents Affected - Few The findings included: Review of the facility's Policy, titled, for Weight Assessment and Intervention documented, in part, the following: 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, the nursing will immediately notify the Dietitian. 4) The Dietitian will respond within 72 hours of receipt of notification. Care Planning 10) Individualized care plans shall address, to the extent possible: p. The identified causes of weight loss; q. Goals and benchmarks for improvement; and r. Time frames and parameters for monitoring and reassessment. This policy also described a significant weight loss as 5% or more in one month, 7.5% or more in 3 months, or 10% or more in 6 months. 1. Review of the record revealed Resident #65 was admitted to the facility on [DATE]. Review of the current Minimum Data Set (MDS) assessment, dated 07/04/23, documented the resident had a Brief Interview for Mental Status (BIMS) score of 15, on a 0 to 15 scale, indicating the resident was cognitively intact. This MDS documented the resident's weight as 107 pounds and the resident had had a significant weight loss. Review of the current weight revealed Resident #65 had a current weight of 103.5 pounds. On 12/05/22, the resident weighed 131.1 pounds, and on 06/05/23 the resident weighed 107.1 pounds (the dates utilized by the RD during his last assessment, indicated Resident #65 had a significant weight loss of 18.31% in the past 6 months). Review of the nutritional assessment dated [DATE], completed by the RD, documented the quarterly review with a non-significant weight loss trend since in April 2023 of 3.4%, and a 90-day weight loss of 6.7%. This assessment documented a net significant weight loss of 21.8% over the past year. This assessment continued and documented the RD changed the Ensure to Med Pass (a protein supplement) to three times daily (Note this had been done on 04/12/23, not with this assessment), along with magic (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 Residents Affected - Few cup twice daily (Note Resident #65 had an order for magic cup three times daily since 02/16/23) to help with trending weight loss which it seems to have slowed down recently. This assessment continued with the weight loss is still concerning with a BMI (body mass index which should be over 20) now less than 20. Appetite stimulant recommended per RD as resident continues to lose weight despite aggressive supplement support and meal/snack intakes. Goal: Halt weight loss and promote weight gain back to desired BMI of 23. Current BMI = 19.59. This nutritional assessment lacked a six-month weight calculation, which was part of their policy in order to determine significant weight loss, which would be 10% or more in the 6-month timeframe. During an observation and interview on 07/17/23 at 12:24 PM, Resident #65 stated she had lost a significant amount of weight but was ok with her current weight. The resident appeared quite thin. On 07/20/23 at 9:21 AM, Resident #65 was just finishing her breakfast. She was fed by Staff R, Certified Nursing Assistant (CNA), who confirmed she ate her yogurt and sausage, encompassing about 25% of her meal. A magic cup was not observed on the breakfast tray, and the CNA confirmed it was not served with her breakfast, but usually was provided with lunch. During an interview on 07/20/23 at 10:11 AM, the RD was shown his nutritional assessment of 07/03/23, and was asked what happened to the recommended appetite stimulant. The RD was unable to find the order, and stated to Staff B, RN/Unit Manager, Did I say I was going to follow up with (name of doctor) about the appetite stimulant? The Unit Manager stated, Yes, you did, but I can text him now; I'll take care of it. When asked about weekly weights, the RD stated if there was a significant weight loss, the resident would be put on weekly weights, but he was not sure of the specifics because he was fairly new and would check with restorative. The RD was asked to provide their nutrition policy that included information on significant weight loss and weights. The RD was also asked about the magic cup that was ordered three times daily with meals, but not provided on that morning's breakfast tray. The RD stated he does not generally order the magic cup for the breakfast meal as it is like ice cream, and stated the meal ticket system would have the magic cup as twice daily, with lunch and dinner. On 07/20/23 at 10:36 AM, the RD returned with the policy. Upon review of the 6-month weights, the RD agreed Resident #65 had had an 18.31% weight loss in 6 months and should have been put on the weekly weight schedule. 2. Resident #137 was admitted to the facility on [DATE] with diagnoses that included Cerebral Infarction, Bipolar Disorder with psychotic features, Vascular Dementia with other behavioral disturbance, Mood Disorder, Major Depressive Disorder, Hemiplegia and Hemiparesis following Cerebral Infarction affecting right dominant side, Muscle Weakness, Cognitive Communication Deficit, Hyperlipidemia, Hypertension, Atrial Fibrillation, Seizures, and Gastrointestinal hemorrhage. The facility's Policy, titled, Weight Assessment and Intervention stated, in part: 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, the nursing will immediately notify the Dietitian. 4) The Dietitian will respond within 72 hours of receipt of notification. Care Planning (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 10) Individualized care plans shall address, to the extent possible: Level of Harm - Minimal harm or potential for actual harm p. The identified causes of weight loss; q. Goals and benchmarks for improvement; and Residents Affected - Few r. Time frames and parameters for monitoring and reassessment. On 06/13/23, the resident weighed 226 lbs. On 06/13/23, the resident weighed 226 lbs. On 07/01/23, the resident weighed 203 pounds which is a -10.18 % Loss. On 07/09/23, the resident weighed 200 pounds which is a -11.50 % Loss. No further weights were recorded since 07/09/23. On 07/19/23 at 10:15 AM, during an interview with Registered Dietitian (RD), he stated that he began working for this facility in February 2023. He acknowledged the significant weight loss for Resident #137. The RD was asked to provide all the documentation related to Resident #137's nutritional assessment and any interventions put into place. On 07/19/23, the RD submitted a Nutritional Evaluation for Resident #137 completed on 05/09/23. This evaluation documented the following: Resident meets criteria for malnutrition / altered hydration r/t [related to] MNA [monthly nutrition assessment] score, comorbidities, decline in functional status; recent stroke, hx [history] of dysphagia. [Resident #137] presented to the ER [Emergency Room] for psych eval r/t suicidal ideation. He has PMHx [prior medical history] of major neurocognitive disorder, dementia, dysphagia, bipolar, stroke. Residents spouse [spouse's name] reports that he had gastric bypass surgery ~3 yrs ago and a stroke back in February of this year. [Spouse] reports lowest weight after gastric bypass was ~213#. He then gained weight back to ~230#. After the stroke in February 2023 and went back down to 213# per spouse report. Weight loss of ~17#/7.3%/~90 days noted. He has history of dysphagia post stroke. Spouse reports that he was on mechanical diet for ~4-5 weeks after but has been on regular diet since. Facility SLP [speech/language pathology] evaluated resident today and upgraded diet to regular. RD will monitor facility intakes and weights to determine need for oral nutrition supplement. Resident is lactose intolerant and is limited to the supplements he likes. Care plan initiated. There was no further assessment completed by the RD after 07/01/23 when Resident #137's weights showed a significant weight loss of 10.18% within 19 days (06/13/23 - 07/01/23), and 11.5% within a months' time (06/13/23 - 07/09/23). Review of the MDS Entry Assessment completed on 05/20/23 documented that Resident #137 required supervision / set up for eating. There were no swallowing issues or weight loss noted at this time. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 Residents Affected - Few An updated MDS Assessment completed on 07/05/23 noted that Resident #137 required supervision / touch assistance for eating. The Care Plan for Resident #137 showed the following areas of concern related to nutrition: 07/06/23 Speech Therapy Evaluation - Problem: Impaired chewing and/or swallowing skills which affects: nutrition intake, and weight loss. Requires modified diet due to: pharyngeal skills impairment and cognitive impairments. Requires Modified diet: Regular textures and nectar thick liquids. 05/09/23 Nutritional Status - Problem: [Resident #137] meets criteria for malnutrition / altered hydration related to MNA score, comorbidities, decline in functional status; recent stroke, hx of dysphagia. (Last reviewed 06/11/23). No other nutritional interventions were found in the care plan. Resident #137's dietary orders were reviewed. Resident #137's diet was to include no added salt, regular consistencies, with nectar thick liquids, crush meds, ordered 07/06/23. Dietary liberties on special occasions, ordered 05/15/23. Monthly weights once between 1st and 7th of month, ordered 06/06/23. There were no updates to the orders for weights considering the significant weight loss noted on 07/01/23. Health Shakes with meals (8:30 AM, 12:30 PM, 5:30 PM) were ordered on 07/11/23. Even though greater than 10% weight loss was noted on 07/01/23, the Health Shakes were not ordered until 07/11/23. General Order dated 05/17/23 noted that Resident required assistance with eating each shift; however, the MDS documented Resident #137 required supervision with eating. On 07/19/23 at 12:30 PM, a lunch observation was made of Resident #137. The resident was observed sitting in his wheelchair in the day room on unit 300. One Certified Nursing Assistant (CNA), working in the day room, set up the resident's tray by opening his vanilla shake and mixing thickeners into his beverages. Resident #137 was seen picking up his coffee cup with his left hand and drinking from the cup; however Resident #137 could not use his eating utensil (fork) to get the food from his plate to his mouth, as he kept trying to use his right hand to do so. Resident #137 spent 10 minutes (from 12:30 PM - 12:40 PM) trying to get the mandarin orange segments out of small cup and into his mouth. He was trying to pour out the segments into his mouth, but the segments would not come out of the cup. After 10 minutes, one of the segments came out of the cup and went into the resident's mouth. At 12:42 PM, a second CNA came by and used the resident's fork to put a bite of meat onto the fork and fed it to the resident. When the aide left, the resident tried to pick up the fork to use it, but it immediately fell out of his hand and onto the floor. The second aide noticed that I was observing Resident #137 during his meal. At 12:45 PM, the second aide came back and sat down beside Resident #137 and began assisting him by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 feeding him his meal. The resident was seen accepting each bite offered by the CNA. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 obtain a physician order for oxygen for 1 of 2 sampled residents reviewed for respiratory care, Resident #61, failed to document oxygen administration, and change of oxygen tubing for 1 of 2 sampled residents observed for respiratory care, Resident #32, and failed to have a respiratory care plan for 2 of 2 sampled residents observed for respiratory care, Residents #32 and #61. Residents Affected - Few The findings included: Review of the facility's policy, titled, Oxygen Administration with a revised date of December 2021, documented, in part: 'The purpose of this procedure is to provide guidelines for safe oxygen administration. Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. After completing the oxygen setup or adjustment, the following information should be recorded in the resident's medical record: 1. The date and time that the procedure was performed. 2. The name and title of the individual who performed the procedure. 3. The rate of oxygen flow, route, and rationale. 4. The frequency and duration of the treatment. 5. The reason for p.r.n. (as needed) administration. 6. All assessment data obtained before, during, and after the procedure. 7. How the resident tolerated the procedure. 8. If the resident refused the procedure, the reason(s) why and the intervention taken. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 0695 9. Level of Harm - Minimal harm or potential for actual harm The signature and title of the person recording the data. ' Residents Affected - Few 1. Record review for Resident #32 revealed the resident was admitted to the facility on [DATE] with the most recent readmission on [DATE]. The resident's diagnoses included: Hemiplegia and Hemiparesis following Cerebral Infarction Affecting Left Non-dominant Side, Obesity, Anxiety Disorder, Type 2 Diabetes Mellitus, Chest Pain, and Atherosclerotic Heart Disease of Native Coronary Artery Without Angina Pectoris. Review of the [NAME] Data Set (MDS) for Resident #32 dated 07/03/23 revealed in Section C a Brief Interview of Mental Status (BIMS) score of 8 of 15, indicating moderate cognitive impairment. Review of the Physician's Orders for Resident #32 revealed an order dated 02/09/23 for oxygen at 2 liters per minute via nasal canula for shortness of breath as needed. Review of the Medication Administration Record / Treatment Administration Record (MAR/TAR) for Resident #32 for June 2023 and July 2023 revealed no documentation of oxygen being administered. Review of the Care Plans for Resident #32 revealed no care plans for respiratory care or oxygen use. An observation was conducted on 07/17/23 at 11:32 AM of Resident #32 sitting up in bed with oxygen at 2 liters per minute via nasal canula, with no date on tubing. An observation was conducted on 07/18/23 at 1:20 PM of Resident #32 sitting up in bed wearing oxygen at 2 liters per minute via nasal canula with no date on the tubing. An observation was conducted on 07/19/23 at 3:15 PM of Resident #32 sitting in wheelchair in her room wearing oxygen at 2 liters per minute via nasal canula with no date on the tubing. An observation was conducted on 07/20/23 at 10:10 AM of Resident #32 sitting up in bed wearing oxygen at 2 liters per minute via nasal canula with no date on the tubing. An interview was conducted on 07/19/23 at 3:15 PM with Resident #32 who was asked if she needed her oxygen all of the time. She said, 'mostly it is at night but for the past couple of days she has been using it during the day too.' An interview was conducted on 07/20/23 at 11:00 AM with Staff A, Licensed Practical Nurse (LPN), who stated she has been with the facility for almost 1 year. When asked if Resident #32 uses oxygen she stated 'yes, as needed mostly at night'. When asked if the resident was using oxygen today, she said 'yes'. When asked how long the resident had been ordered oxygen, she said 'she has been using the oxygen for as long as she has been working at the facility (about 1 year)'. An interview was conducted on 07/20/23 at 11:11 PM with Staff B, Registered Nurse (RN Unit Manager), who was asked if Resident #32 uses oxygen, stated 'yes'. When asked how often the oxygen tubing is changed, she said it is changed weekly and it would be on the MAR/TAR for the nurse to document the tubing was changed. When asked where the nurse documented that the resident using oxygen, she stated it would be documented on the MAR/TAR if the resident is using the oxygen. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Staff B acknowledged there was no order for the oxygen tubing to be changed and she also acknowledged there was no care plan for respiratory or oxygen for the resident. 2. Record review for Resident #61 revealed the resident was admitted to the facility on [DATE] with the most recent readmission on [DATE]. The resident's diagnoses included: Heart Failure, Hypertensive Heart Disease With Heart Failure, and Generalized Anxiety Disorder. Review of the MDS for Resident #61 dated 06/14/23 revealed in Section C a BIMS score of 15 of 15, indicating an intact cognitive response. Review of the Physician's Orders for Resident #61 revealed no orders for oxygen. Review of the Physician's Orders for Resident #61 revealed no orders to change oxygen tubing. Review of the Care Plans for Resident #61 revealed no care plans for Respiratory or oxygen. Review of the Nurse Progress Note for Resident #61, dated 07/14/23, included: 'continued cough and dyspnea noted new orders obtained from ARNP [Advanced Registered Nurse Practitioner] chest x-ray 2 views and O2 (oxygen) at 2 liters via nasal canula [N/C] prn [as needed] to maintain SPO2 [O2 saturation]'. Review of the Nurse Progress Note for Resident #61, dated 07/15/23, included: 'Patient alert, with episode of coughing observed, with mild congestion, schedule meds administered well tolerated. PRN Robitussin administered somewhat effectively. vitals stable. Rested in bed throughout the shift. Staff Will continue to monitor'. Review of the Nurse Progress Note for Resident #61, dated 07/16/23 at 1:43 AM, included: 'Resident in bed with HOB [head of bed] elevated to improve breathing, wearing O2 at 2L/min via N/C for SOB [shortness of breath]. O2 sat 95%, Resp 20/min. Occasional moist cough with crackles to BLL [bilateral lower lung] upon auscultation. Medicated with Geri-Tussin 10 mls as per order with fair effect. Call placed to Medical imagine to check on C [chest] X-Ray result. Result received via fax, no infiltration, no effusion, no acute findings identified. Result faxed to Dr [name] office. Will continue to monitor and provide safety'. An observation was conducted on 07/17/23 at 11:07 AM of Resident #61 in bed with oxygen at 4 liters via nasal canula with no date on tubing. An observation was conducted on 07/18/23 at 1:10 PM of Resident #61 lying in bed with oxygen at 4 liters via nasal canula, with no date on tubing. An observation was conducted on 07/19/23 at 3:00 PM of Resident #61 lying in bed with family members at bedside. Upon closer observation, the resident had oxygen at 4 liters via nasal canula, with no date on the tubing. An observation was conducted on 07/20/23 at 10:00 AM of Resident #61 lying in bed with family at bedside. Upon closer observation, the resident had oxygen at 5 liters via nasal canula, with no date on the tubing. An interview was conducted on 07/20/23 at 10:05 AM with Resident #61's son who was asked how long (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few his mother had been using the oxygen. He stated since Friday and she really needs it, she is now on hospice. An interview was conducted on 07/20/23 at 11:00 AM with Staff A, Licensed Practical Nurse (LPN), who stated she has been with the facility for almost 1 year. When asked if Resident #61 used oxygen she stated 'yes, as needed mostly at night'. When asked if the resident was using oxygen today, she said 'yes'. An interview was conducted on 07/20/23 at 11:11 PM with Staff B, Registered Nurse (RN Unit Manager), who was asked if Resident #61 uses oxygen, she said 'yes, she has had it since Friday' (07/14/23). When asked if there was a physician order for oxygen, she acknowledged there was no order for oxygen. When asked if there was an order for oxygen tubing to be changed, she acknowledged there was no order for the oxygen tubing to be changed. When asked about a care plan for respiratory or oxygen, she acknowledged there was no care plan for respiratory or oxygen. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on record review and interview, facility staff failed to follow-up on a pharmacy request for a physician clarification related to an ordered medication for 1 of 38 sampled residents (Resident #206). Residents Affected - Few The findings included: Review of the record revealed two current orders, both dated 06/07/23, for the medication Budesonide, a 3 mg (milligram) tablet, for Resident #206. One order was for the tablet to be given once daily, while the second order was for the medication to be given three times daily. Budesonide is a class of medication called corticosteroids that works by decreasing inflammation (swelling) in the digestive tract. Review of the Medication Administration Record (MAR) for Resident #206 revealed both orders had been entered into the electronic medical record (EMR), and Resident #206 received the 3 mg tablet daily at 9 AM, for the daily dose, and at 6 AM, 2 PM, and 10 PM for the three times daily dose. Review of a progress note dated 06/19/23 at 7:42 PM documented Resident #206 did not receive the budesonide, as the drug was currently unavailable. This note further documented that the pharmacy was contacted, and the nurse was advised the medication was received on 06/07/23, and it was too soon to refill. The nurse documented there were multiple orders on file, the order needed to be clarified, and the Assistant Director of Nursing (ADON) was made aware. During an interview on 07/18/23 at 2:08 PM, when asked the usual dose for the 3 mg tablet form of budesonide, upon research of the drug, the Consultant Pharmacist stated 9 mg daily or 3 mg three times daily. During a side by side review of the record, when shown the two orders, the Consultant Pharmacist had no answer, but stated he would look into it. During a side by side review of the record on 07/18/23 at 2:44 PM, Staff A, LPN, who entered both orders, recalled the daughter told her that Resident #206 was previously on the budesonide four times a day, but that she wanted it three times daily, with a one time as needed dose each day. Staff A stated she spoke with the resident's physician, who agreed with the three times daily routine dosage, and one as needed dose daily. Upon review of the orders and the MAR, the LPN agreed Resident #206 had received the budesonide daily at 6 AM, 9 AM, 2 PM, and 10 PM, which was not the intent of the physician. The LPN stated she entered the daily as needed dose incorrectly into the system, further stating she was kind of new with that particular EMR system. During a subsequent interview on 07/19/23 at 1:29 PM, the Consultant Pharmacist provided a copy of the three times daily order dated 06/07/23 from the pharmacy that documented, Please clarify dose and relation to duplicate medication for QD (daily) dosing. The Consultant Pharmacist stated it was faxed to the facility, but the facility staff do not have a record of this or know what happened. During an interview on 07/20/23 at 3:36 PM, when asked if he recalled anything about the budesonide 3 mg tablet for Resident #206, the physician stated he did not. The physician was shown the two orders, the daily dose that was signed by his nurse practitioner, and the three times daily dose that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 remained unsigned. The physician again stated he did not recall any conversation about the Level of Harm - Minimal harm or potential for actual harm medication, asked if she received the medication four times daily and had no further comment. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. 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, facility staff failed to follow through with an ordered laboratory test for 1 of 1 sampled resident (Resident #128). Residents Affected - Few The findings included: Record review revealed Resident #128 was initially admitted to the facility on [DATE], and readmitted on [DATE], with diagnoses including: anemia and malnutrition. The 5 day minimum data set (MDS) assessment, reference date 06/12/23, recorded a BIMS score of 14, indicating Resident #128 was cognitively intact. This MDS recorded mood of Feeling tired or having little energy. No behavior exhibited. This MDS indicated Resident #128 required extensive assistance with activity of daily living (ADLs). Review of Resident #128's record revealed a Physician order for a laboratory (LAB) test, dated 07/07/23, for complete blood count (CBC). Further review of Resident #128's records lacked evidence of the CBC test result. It was revealed that on 06/24/23, an order for CBC was completed which showed low red blood cell (2.54, range is 4.40 5.80), low hemoglobin (7.9, range is 13.8 17.2), low hematocrit (23.4%, range is 41.0 50.0%) and high red cell distribution width (17.9%, range is 9.0 15.0%). Upon further review of records, under the lab section ancillary order review, it indicated on 07/04/23 the test was not performed. On 07/20/23 at 2:12 PM, a side by side review of Resident #128's records and interview were held with Staff F, Registered Nurse (RN), who searched for the lab result unsuccessfully. She voiced the records showed the phlebotomist (a person who draw blood) came on 07/08/23 to obtain the lab. The summary indicated the lab was not performed. Staff F then called the laboratory in the surveyor's presence. Staff F revealed the lab representative stated, they weren't able to obtain the lab, they called the facility to notify them, there was no response. The representative added the laboratory had no lab test result for July of 2023 for Resident #128. Review of nutritional assessment dated [DATE] indicated Resident (#128) had altered labs. He was sent to the hospital on [DATE] for critical low hemoglobin and hematocrit labs of 6.9/17.1. Review of the comprehensive care plan with a start date of 03/24/23, and a reviewed / revised date of 06/11/23, indicated Resident #128 met the criteria for malnutrition / altered hydration, decline in functional skills and altered labs. Intervention included: Monitor labs. On 07/20/23 at 3:21 PM, another interview was conducted with Staff F, who was asked why the CBC was ordered on 07/07/23, who voiced it was ordered as a follow up from the previous lab on 06/24/23, as the red blood cell, hemoglobin and hematocrit were low from the previous LAB results. On 07/17/23 at 11:08 AM, an interview was conducted with Resident #128, who stated he didn't feel good, he felt woozy, feeling weak, and dizzy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide dental services for 1 of 1 sampled resident reviewed for dental services, Resident #40. Residents Affected - Few The findings included: Resident #40 was admitted to the facility for skilled care from an acute care hospital on [DATE] with diagnoses that included: Metabolic encephalopathy, Hydrocephalus, unspecified and Hypotension. A scheduled 5-day Minimum Data Set (MDS) with an assessment reference date of 06/23/23 revealed his Brief Interview for Mental Status was 14 of 15, which indicated he was cognitively intact. On 07/17/23 at 9:53 AM during the initial tour of the facility, an interview was conducted with Resident #40 who stated he has no teeth and wanted to see a dentist. On 04/11/23 a social service note in the Electronic Health Record stated the resident has no dentition, states he is interested in seeing a dentist to fabricate dentures. On 07/19/23 at 1:53 PM, an interview was conducted with the Social Service Director (SSD). The SSD stated at the time of the note, the resident did not have Medicaid and they were waiting for insurance. Interview with the Business Office Manager on 07/20/23 at 1:29 PM revealed the resident has MCNA dental (a government dental insurance) which means he had to go to a provider outside of the facility. On 07/19/23, he was put on a list for dental service after surveyor intervention. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Record review documented Resident #89 was admitted to the facility on [DATE]. Review of the BIMS done on 06/21/23 during a quarterly Minimum Data Set, documented a score of 13 of 15, indicating the resident was cognitively intact. The diagnoses included: Diabetes Mellitus, Hyperlipidemia, and Hypertension. On 07/19/23, the food cart for breakfast came to the 500 unit at 8:45 AM. At 9:13 AM, two surveyors intercepted the tray going into Resident #89's room. On the tray was scrambled eggs with ham, 2 pieces of bacon, one slice of toast, oatmeal, orange juice, milk and coffee. An interview was conducted with Resident #89 at 9:15 AM. The resident stated his food is always cold. He stated he 'doesn't want to eat eggs that have anything mixed in them. Boiled eggs are ok. Does not drink milk and he does not like oatmeal.' At 9:18 AM, the RD came into the room and heard the resident did not like eggs. The RD stated, You don't like eggs? He brought a replacement tray to the room which had scrambled eggs on it with 2 sausages. The resident stated he would 'like to eat the sausages but he could take the eggs back'. The resident stated he would like hot cakes. Review of the resident's meal ticket documented the dislikes of cheese and eggs (Photographic evidence obtained). Based on observations, interviews, and record review, the facility failed to accommodate resident food preferences for 3 of 17 cognitively intact sampled residents, Residents #46, #91, #89. The findings included: Review of the facility's policy, titled, Resident Food Preferences with a revised date of December 2022, included, in part: Nutritional assessments will include an evaluation of individual food preferences. The resident's food preferences, likes/dislikes will be documented on the resident tray card. This will include special dietary instructions or limitations such as altered food consistency and caloric restrictions. 1. Record review for Resident #46 revealed the resident was admitted to the facility on [DATE] with most recent readmission on [DATE]. The resident's diagnoses included: Spinal stenosis, thoracic region, Type 2 Diabetes Mellitus, and Morbid (Severe) Obesity, Review of the Minimum Data Set (MDS) for Resident #46 dated 06/12/23 revealed in Section C, a Brief Interview of Mental Status (BIMS) score of 15 of 15, indicating an intact cognitive response. Review of the Physician's Orders for Resident #46 revealed an order dated 01/21/20 for 'No added salt, no concentrated sweets, regular texture, thin liquids.' Review of the Care Plan for Resident #46 revealed a care plan dated 07/05/22 with a problem of: Resident is at nutritional / dehydration risk related to status post right below the knee amputation, atherosclerosis, type 2 Diabetes Mellitus, smoker and obese. The resident chooses not to follow therapeutic diet restrictions, history of compromised skin integrity related to diabetes / peripheral artery and vascular disease. The goal was for the resident to maintain adequate nutritional status as evidenced by no undesired weight changes, no sign / symptom of malnutrition and dehydration, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few consuming an average of 50-100% of meals through next review date. The approaches included: Assess resident's food preferences; and Offer available substitutes if the resident has problems with the food being served. During an observation conducted on 07/19/23 at 8:56 AM of meal tray being delivered to Resident #46's room, the meal tray consisted of 1 (not 2) fried egg, 1 slice of toast cut in half, 1 slice of bacon, 2 orange wedges with peel, and 1 cup of coffee; and 1 container of cold milk. There were no grits on the meal tray. The meal ticket for Resident #46 listed special request as fried eggs x2, grits, orange slices, listed beverages at coffee, and milk. An interview was conducted on 07/17/23 at 10:22 AM with Resident #46 who stated the food is always cold and often missing items he has ordered or requested. An interview was conducted on 07/19/23 at 10:10 AM with the Registered Dietician (RD), who stated he has been with the facility for 5 months, and with the Consultant Dietician who has been with and helping in the facility for 3 or 4 years. The RD stated that he just wanted to follow-up on the likes and dislikes (preferences) for residents who are put directly into the SNOW system for the kitchen and that system does not interface with the Matrix system for the residents. The SNOW system does not maintain a history of likes and dislikes. When the RD was asked how often the likes and dislikes (preferences) are reviewed for the residents, he stated they are reviewed minimally with quarterly reviews. He added that he will update the like/dislikes (preferences) more often as needed. The RD said he just did an in-service with the kitchen staff to double check the meal tickets for each resident and check with the next kitchen staff member to make sure they are double checking the meal tickets to make sure the items on the tray are correct and match the meal ticket. 2. Record review for Resident #91 revealed the resident was admitted to the facility on [DATE] with the most recent readmission date of 05/25/23 with diagnoses that included: Hemiplegia and Hemiparesis Following Cerebral Infarction Affecting Left Non-dominant side, Type 2 Diabetes Mellitus, Generalized Anxiety Disorder, and Morbid Obesity. Review of the Minimum Data Set (MDS) for Resident #91 dated 06/08/23 revealed in Section C, a BIMS score of 15, indicating an intact cognitive response. Review of the Physician's Order for Resident #91 revealed an order dated 02/27/23 for no concentrated sweets, no added salt, regular texture, thin liquids. Review of the care plan for Resident #91 dated 02/28/23 with a problem on resident is at malnutrition / hydration risk related to acute disease process and decline in functional skills. The goal was for resident to maintain weights =/- 3 pounds with encouragement of weight loss through food choices using selective menus; and Maintain meal / supplement intakes of 51-100% through next review date. The interventions included diet as ordered - encourage / monitor / assist / adjust; offer / encourage fluid consumption during hours awake and follow MD orders as indicated. An observation was conducted on 07/19/23 at 9:20 AM of Resident #91 who was sitting up in her bed with her breakfast meal tray in front of her on the overbed table. On the meal tray, there were 2 fried eggs, an English muffin, a slice of bacon, a cup of cut watermelon, and a cup of coffee. There were no utensils, no condiments, no butter or jelly, no milk or juice. The resident's meal ticket listed bacon, English muffin, fresh fruit, fried eggs x2, 2% milk, coffee, and orange juice. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An interview was conducted on 07/19/23 at 9:24 AM with Resident #91 who was asked how her breakfast was, and she replied, the aide had to get me some silverware, they forgot to send me some. An interview was conducted on 07/19/23 at 9:25 AM with Staff D, Certified Nursing Assistant (CNA), who stated she has been working at the facility for 20 years. Staff D stated Resident #91 had no silverware on her tray and had to go to the kitchen to get some. She said when she returned with the silverware, the resident wanted butter on her English muffin and she had to get butter and orange juice because the resident did not have any butter or juice on her tray. An interview was conducted on 07/19/23 at 10:10 AM with the Registered Dietician (RD) and the Consultant Dietician. The RD stated that he just wanted to follow-up on the likes and dislikes (preferences) for residents are put directly into the SNOW system for the kitchen and that system does not interface with the Matrix system for the residents. The SNOW system does not maintain a history of likes and dislikes. When the RD was asked how often the likes and dislikes (preferences) are reviewed for the residents, he stated they are reviewed minimally with quarterly reviews. He added that he will update the like / dislikes (preferences) more often as needed. The RD said he just did an in-service with the kitchen staff to double check the meal tickets for each resident and check with the next kitchen staff member to make sure they are double checking the meal tickets to make sure the items on the tray are correct and match the meal ticket. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 ensure accuracy of records for 2 of 38 sampled residents, Residents #206 and #65. The findings included: Review of the policy, titled, Charting and Documentation, revised [DATE], documented, in part, All services provided to the resident, or any changes in the resident's medical or mental condition, shall be documented in the resident's medical record. 1. Review of the record revealed Resident #206 was admitted to the facility on [DATE] and expired at the facility on [DATE]. The following inconsistencies or lack of documentation was identified: A progress note dated [DATE] at 7:32 PM and [DATE] at 5:55 AM, documented Resident #206 remained on droplet isolation. The record lacked any documentation of the need for droplet isolation. A progress note dated [DATE] at 5:55 AM, documented the oxygen saturation level for Resident #206 was 90% on room air. The vital sign record documented an oxygen saturation level of 90% on [DATE] at 11:14 PM. An interview was conducted on [DATE] at 5:22 PM, with Staff I, night Licensed Practical Nurse (LPN), who stated he must have either put the head of the bed up and the saturation level went back up on [DATE], or it was a typo. Staff I agreed there were no documented interventions or resolution to that saturation level of [DATE]. A progress note dated [DATE] at 8:07 AM by Staff I, LPN, documented, COVID test negative. Notified daughter. During an interview on [DATE] at 5:22 PM, Staff I, night LPN, stated he did a rapid COVID test, and it was negative, which was confirmed by the ADON (Assistant Director of Nursing). The record lacked any documented COVID test result from Staff I. During a phone interview on [DATE] at 3:27 PM, the daughter of Resident #206 stated she was at the facility on [DATE] and was informed her mother had a temperature of 101 degrees Fahrenheit (F), that staff were unsure of the reason, but were providing Tylenol. Review of the vital sign record documented Resident #206 had a low-grade fever of 99.4 degrees on [DATE] at 12:20 AM, but lacked any documented fever of 101 F. degrees, and lacked any documented order or provision of Tylenol. During a phone interview on [DATE] at 3:27 PM, the daughter of Resident #206 voiced Staff I assured her the ADON would initiate a transfer to the hospital for her mother on the morning of [DATE]. The record lacked this conversation. During an interview on [DATE] at 2:12 PM, Staff G, Certified Nursing Assistant (CNA), stated she recalled Resident #206, and had worked with her a couple of times. The CNA volunteered that on the day the resident passed, she had noted she was sweating and didn't look too good, so she put the air conditioner on and washed her up, and the resident felt better. Staff G stated she told Staff H, LPN, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 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 105410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Port St Lucie Rehabilitation and Healthcare 7300 Oleander Ave Port Saint Lucie, FL 34952 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 that she was sweaty and wasn't feeling well, because she could not find the ADON. The record lacked any documentation related to the CNA's report of diaphoresis (being sweaty). 2. On [DATE], the COVID-19 negative results completed by Staff I, night LPN, for Resident #206 was requested from the Director of Nursing (DON). On [DATE] at 1:25 PM, the surveyor entered the 'Nursing Administration' offices on the way to the MDS (Minimum Data Set) office. which was located at the back of the Nursing Administration office area. Upon entering the offices, the DON and ADON were standing at the front desk, and the ADON was in the process of signing a COVID-19 test result. On [DATE] at 2:02 PM, the DON provided the COVID-19 negative test result for Resident #206. When asked why this test, dated [DATE], was not signed by Staff I, LPN, who stated and documented in the progress notes that he completed the test, the DON stated, He did the test and it was witnessed by the ADON, but he did not fill out the paper. When asked if they just now filled out and signed the COVID-19 test result, as the surveyor walked into the Nursing Administration area, the DON stated yes, because Staff I had not filled out the paper and the ADON had witnessed the test. Further review of this test result documented it was completed by the ADON and witnessed by the DON. On [DATE] at 2:28 PM, the ADON came to the surveyor and confirmed she did justt fill out the COVID-19 paperwork for Resident #206, as witnessed by the surveyor. The ADON stated she also did a COVID-19 test on Resident #206 that morning to ensure the negative results. This intervention was not documented in the medical record. 3. Review of the orders for Resident #65 documented as of [DATE] that the resident was to receive a magic cup as a nutritional supplement three times daily with each meal. A progress note dated [DATE] documented by the Registered Dietician (RD) revealed he changed the frequency of the magic cup to twice daily. The physician's order was not changed. On [DATE] at 9:21 AM, Resident #65 was just finishing her breakfast. She was fed by Staff R, CNA, who confirmed she ate her yogurt and sausage, encompassing about 25% of her meal. A magic cup was not observed on the breakfast tray, and the CNA confirmed it was not served with her breakfast, but usually was provided with lunch. During an interview on [DATE] at 10:11 AM, the RD confirmed he had changed the magic cup to twice daily, as he doesn't usually provide the magic cup for breakfast as it is like ice cream. The RD stated he must have not changed the physician's order, although he had changed it to twice daily in the meal ticket documentation system, so the resident was only getting it at lunch and dinner. Review of the corresponding Medication Administration Records (MARs) for Resident #65 revealed the nurses were continuing to document the provision and consumption values of the breakfast magic cup, even though the resident had not received it for breakfast since [DATE]. During an interview on [DATE] at 10:41 AM, Staff Q, LPN, who had signed off on the Medication Administration Record (MAR) that Resident #65 had consumed all of the magic cup at breakfast, was asked how she would know if a resident consumed their magic cup when provided with a meal. The LPN stated she would have to observe the meal or ask the CNA. When asked if Resident #65 had a magic cup that morning, the LPN stated she did not know yet. When asked why she already documented that it had been 100% consumed, the LPN had no answer. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105410 If continuation sheet Page 20 of 20