Inspection·February 16, 2023

F 0623 hospital] via emergency as ordered. Private aid at site. Spouse [name] ade aware. Level of Harm - Potential for minimal harm The facility was not able to provide documentation or evidence that the Ombudsman was notified of the discharge. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 2 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 observation, record review and interview, the facility failed to ensure timely personal care and assist with feeding for 3 of 3 sampled residents (Resident #26 #79, and #59), reviewed for Activities of Daily Living(ADL's). Specifically, eating and incontinent care. Residents Affected - Few The findings included: 1) During an interview on 02/13/23 with the daughter of Resident #26, she expressed concern about the resident not receiving assistance to eat her meals. During the interview, the daughter indicated she can communicate with her mom through her mom's gestors and hand movements. Review of the record revealed the resident was admitted to the facility on [DATE] and readmitted on [DATE]. Resident #26 has diagnosis to include Parkinson's Disease and Rheumatoid Arthritis. The resident was admitted to hospice services on 11/24/22. On 02/14/23 at 8:55 AM the resident was observed in her wheelchair beside her bed with her breakfast tray. The resident was attempting to eat however she was not able to get the food onto her spoon. On 02/14/23 at 9:00 AM Staff J, a Licensed Practical Nurse (LPN) arrived in the room and questioned Resident #26 why she wasn't eating. The resident motioned with her spoon from the food to her mouth. The surveyor asked Resident #26 if this meant she needed help to eat her breakfast. The resident gave a thumbs up to indicate she needed help. On 02/16/23 at approximately 9:10 AM Resident was sitting in her wheelchair beside her bed. The breakfast tray was positioned in front of her and she was attempting to eat with her spoon and was unable to get any food on her spoon. No one was in the room to assist Resident #26 with eating. The plan of care was reviewed for Resident #26. The plan of care for ADL's (Activities of Daily Living) revealed the resident requires extensive assist by one staff to eat. Review of the Minimum Data Set (MDS) assessment dated [DATE], documented Resident #26 has a Brief Interview for Mental Status (BIMS) score of 12 on a 0 to 15 scale, which indicates the resident was moderately impaired. The MDS also documented the resident needs extensive assistance by one staff to eat. On 02/16/23 at 8:30 AM, an interview was conducted with the Director of Nursing who stated they want the resident to do as much as she can for herself, and they will cue her to eat on her own. Review of the Plan of Care and the MDS reveal the resident is extensive assist by one staff for eating. 2) On 02/13/23, an interview was conducted with Resident #79. She stated she gets her diaper changed at 5:00 AM and they never change it until 2:00 PM or 2:30 PM. She stated this is the reason I have UTI's (urinary tract infection). She stated the facility is very understaffed. They need more help. On 02/15/22 at 9:00 AM, an interview was conducted with Resident #79 who stated she called for help last night from 2:00 AM until 5:00 AM. She stated no one answered the call bell. She stated she then used the phone to try to reach someone at the desk for help. She stated the phone rang busy for 1 hour and after an hour it just kept ringing. She stated she needed help repositioning her arm and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 3 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few she needed her diaper changed. She stated she had spoken to the night nurse about her concerns for her incontinent care. She stated she doesn't know anyone's name because they come into your room and never introduce themselves. She stated they usually only change her diaper every 8 hours and that is not enough. She stated no one has spoken to her about her concerns for her incontinent care. Record review revealed Resident #79 was admitted to the facility on [DATE] with diagnosis to include Hemiplegia and Hemiparesis following cerebral infarct affecting left non dominant side, pain and muscles spasms. The personal history of UTI's diagnosis was added on 12/22. Review of the current MDS assessment dated [DATE] documented Resident #79 had a BIMS of 15, indicating she was alert and oriented and cognitively intact for decision making. The MDS also documents the resident is extensive assist with bed mobility and toileting. Review of the Plan of Care for Resident #79 revealed the resident requires extensive assist by 1 staff to turn and reposition in bed. The plan of care indicates the resident has bowel and bladder incontinence and the resident is to be checked every two hours for assistance with toileting. 3) An interview was conducted with Resident #59 on 02/13/23 at 9:39 AM. The resident stated the facility does not care. She stated it takes 4-5 hours on overnight shift to get her diaper changed. She stated the employees have told her they do not have enough staff to get to her diaper change at night. On 02/15/23 at 8:22 AM, the resident was interviewed. She stated she had waited 5 ½ hours last night for anyone to come in and change her diaper. She stated they finally changed her at 6:00 AM. She stated she could not locate her call button and no one checked on her to see if she needed her diaper changed. On 02/16/23 at 9:50 AM, the resident stated she had needed her diaper changed from 1:00 AM and they finally checked on her at 6:30 AM. She stated at night she is unable to locate her call button. Resident stated that she had shared her concerns for her incontinent care with the night nurse however nothing has changed Record review revealed Resident #59 was admitted to the facility 03/11/22 with a diagnosis of Parkinson's Disease. Review of the MDS dated [DATE] documented Resident #59 has a BIMS score of 15, which indicates the resident was alert and oriented and cognitively intact for decision making. The MDS also documented the resident needs extensive assist of one person for toileting, personal hygiene and dressing. The plan of care for Resident #59 documents the resident is incontinent of bowel and bladder and to check and change disposable brief as required. On 02/16/23 at 2:45 PM, an interview was conducted with Staff K, a Certified Nursing Assistant (CNA) she stated she turns, and positions residents every 2 hours. She stated she changes the residents diapers every 3 hours. On 02/16/23 at 3:00 PM, an interview was conducted with Staff G, a CNA concerning resident care. She stated she turns, positions and changes the residents every 2 hours. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 4 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure padded bed side rails were provided & properly used for 2 of 4 sampled residents reviewed for accidents, both of whom had a history of seizures (Residents #10 and #15). The findings included: 1) Review of the record revealed Resident #10 was admitted to the facility on [DATE]. Review of the current care plan initiated on 11/04/20 revealed Resident #10 was at risk for seizure related injuries related to conversion disorder with seizures or convulsions. An intervention dated 02/09/22 revealed the use of bilateral upper half padded side rails for safety. An order dated 10/16/17 documented the use of two padded side rails for safety. The current Minimum Data Set (MDS) assessment dated [DATE] confirmed the diagnosis of seizures. During an observation on 02/13/23 at 10:26 AM, Staff A, Certified Nursing Assistant (CNA), had just finished providing personal care for Resident #10, and left the room, leaving the resident in the bed. A half side rail, located along the middle portion of the resident's left side, was raised and a blue padded mat was noted hooked to the side rail by a Velcro strap, and hanging down from the rail along the outer aspect of the bed and to the floor (Photographic Evidence Obtained). At this time the right side rail was positioned up as a quarter rail at the head of the bed, and lacked any type of pad. A supplemental observation on 02/13/23 at 12:27 PM revealed Resident #10 still in bed with the side rail padding still improperly placed on the left side, and none on the right. An observation on 02/14/23 at 9:11 AM revealed Resident #10 in bed with the left side rail pad hooked in the same manner as the previous day, but more was on the floor as the bed was slightly lower than the day before. The right side rail remained without any pad. An observation on 02/15/23 at 10:24 AM revealed Resident #10 in bed. Both side rails lacked any padding (Photographic Evidence Obtained). During an interview on 02/16/23 at 10:52 AM, when asked about the blue pads in the room of Resident #10, Staff A, CNA, stated she put the pads on the side rails when the resident was in bed. When the surveyor informed the CNA, who had worked with Resident #10 throughout the survey, of the observations as noted above, the CNA had no response. During an interview on 02/16/23 at 10:57 AM, Staff B, agency Registered Nurse (RN), confirmed the order for the bilateral padded side rails. When notified of the surveyor's observations as noted above, the RN agreed the pads should have been utilized and placed properly on the side rails for resident safety. 2) Review of the record revealed Resident #15 was admitted to the facility on [DATE]. Review of the current care plan initiated on 09/27/22 and corresponding orders, documented the use of padded quarter side rails for safety, for a diagnosis of seizures. Review of the current MDS dated [DATE] confirmed the diagnosis of a seizure disorder. A Quarterly Device/Enabler/Restraint evaluation dated 12/29/22 also documented seizure precautions with the use of padded quarter side rails while in bed for safety, related to the diagnosis of seizures. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 5 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An observation on 02/13/23 at 11:34 AM revealed Resident #15 in bed with both upper side rails raise, and without padding. Two side rail pads were noted on edge, leaning against the wall (Photographic Evidence Obtained). A supplemental observation on 02/13/23 at 3:39 PM revealed the resident in bed, side rails raised, and the pads in the same location against wall. On 02/14/23 at 10:02 AM and on 02/15/23 at 10:20 AM, Resident #15 was in bed with the side rails raised and the side rail pads in the same location against the wall. During the continued interview on 02/16/23 beginning at 10:57 AM, Staff B, agency Registered Nurse (RN), confirmed the order for the bilateral padded side rails. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 6 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to implement a new order for increased water flushes via enteral (tube feeding) means, for 1 of 2 sampled residents, who was ordered the increase related to an electrolyte imbalance (Resident #1). The findings included: Review of the record revealed Resident #1 was admitted to the facility on [DATE]. Further review of the record revealed the resident received all food and fluids via a tube. A physician progress note dated 02/13/23 revealed an elevated sodium level with a plan that increased the water flushes with the PEG feeding (percutaneous endoscopic gastrostomy/surgical placement of a feeding tube). The tube feeding water flushes had recently been increased to 150 ml (milliliters) every 4 hours. A Registered Dietician's (RD) progress note dated 02/14/23 documented to increase the tube feeding water flushes to 200 ml every 4 hours due to elevated BUN (Blood urea nitrogen), a lab value related to a person's hydration status, identified with repeat laboratory tests. This note also documented the RD was to monitor hydration status, tube feed intake, weight trends, and labs. A current order dated 02/14/23 documented the increase of fluids to 200 ml every four hours via the tube feeding route was to begin at of 4 PM that same day. An observation on 02/15/23 at 9:59 AM revealed Resident #1 in bed with the head of the bed elevated. The tube feeding pump was set at 150 ml every four hours for the water flush (Photographic Evidence Obtained). On 02/16/23 at 10:05 AM, Staff C, Registered Nurse (RN), had just finished administering medications via the tube, and started to walk away. When asked the rate of the water flush via the pump, Staff C verified it was set for 150 ml every four hours. The surveyor left and proceeded to the nurse's station, when Staff C arrived and asked her coworker, Staff B, agency RN (who was training the newly hired nurse, Staff C) to verify the water flush order. Staff B verified the current order, that was to be initiated on 02/14/22, was for the increased water flush of 200 ml every four hours. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 7 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4) Resident #5 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident had mild cognitive impairment and required extensive to total two-person assist with activities of daily living. An interview was conducted with Resident #5 with family at bedside. The resident stated they do not have enough people to help get people out of bed in a timely manner. The resident's family member referred to yesterday 02/15/22 when the resident was supposed to be out of bed in order to go to physical therapy at 10:00 AM. Resident #5 and family member stated they did not get him out of bed until after lunch, after 1:00 PM. The resident and his family member stated they just don't have enough staff to take care of our needs. Things like that happen on a regular basis. Based on interview, observation, record review, policy review, the facility failed to ensure sufficient staffing for 2 (4 North and 4 South) of 5 resident units, affecting the provision of care and services for the residents. The findings included: The facility policy titled LNMR Staffing, Sufficient and Competent Nursing and revised August 2022, documents in part: #6 Staffing numbers and the skill requirement of direct care staff are determined by the needs of the residents based on each resident's plan of care, the resident assessments and the facility assessment. 1) During an interview on 02/13/23 with the daughter of Resident #26, she expressed concern about the resident not receiving assistance to eat her meals. Review of the record revealed the resident was admitted to the facility on [DATE] and readmitted on [DATE]. Resident #26 has diagnosis to include Parkinson's Disease and Rheumatoid Arthritis. The resident was admitted to hospice services on 11/24/22. On 02/14/23 at 8:55 AM the resident was observed in her wheelchair beside her bed with her breakfast tray. The resident was attempting to eat however she was not able to get the food onto her spoon. On 02/14/23 at 9:00 AM Staff J, a Licensed Practical Nurse (LPN) arrived in the room and questioned Resident #26 why she wasn't eating. The resident motioned with her spoon from the food to her mouth. The surveyor asked Resident #26 if this meant she needed help to eat her breakfast. The resident gave a thumbs up to indicate she needed help. On 02/16/23 at approximately 9:10 AM Resident was sitting in her wheelchair beside her bed. The breakfast tray was positioned in front of her and she was attempting to eat with her spoon and was unable to get any food on her spoon. No one was in the room to assist the Resident #26 with her eating. The plan of care was reviewed for Resident #26. The plan of care for ADL's (Activities of Daily Living) revealed the resident requires extensive assist by 1 staff to eat. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 8 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 02/16/23 at 8:30 AM an interview was conducted with the Director of Nursing who stated they want the resident to do as much as she can for herself, and they will cue her to eat on her own. Review of the Plan of Care and the MDS revealed the resident is extensive assist by one staff for eating. 2) On 02/13/23 an interview was conducted with Resident #79. She stated she gets her diaper changed at 5:00 AM and they never change it until 2:00 PM or 2:30 PM. She stated this is the reason I have UTI's (urinary tract infection). She stated the facility is very understaffed. They need more help. Review of record revealed Resident #79 was admitted to the facility on [DATE] with diagnosis to include Hemiplegia and Hemiparesis following cerebral infarct affecting left non dominant side, pain and muscles spasms. The personal history of UTI's diagnosis was added on 12/22. Review of the current MDS assessment dated [DATE] documented Resident #79 had a BIMS of 15 indicating she was alert and oriented and cognitively intact for decision making. The MDS also documents the resident is extensive assist with bed mobility and toileting. Review of the Plan of Care for Resident #79 revealed the resident requires extensive assist by 1 staff to turn and reposition in bed. The plan of care indicates the resident has bowel and bladder incontinence and the resident is to be checked every two hours for assistance with toileting. 3) An interview was conducted with Resident #59 on 02/13/23 at 9:39 AM. The resident stated the facility does not care. She stated it take 4-5 hour on overnight shift to get her diaper changed. She stated the employees have told her they do not have enough staff to get to her diaper change at night. On 02/15/23 at 8:22 AM the resident was interviewed. She stated she had waited 5 1/2 hours last night for anyone to come in and change her diaper. She stated they finally changed her at 6:00 AM. She stated she could not locate her call button and no one checked on her to see if she needed her diaper changed. On 02/16/23 at 9:50 AM the resident stated she had needed her diaper changed from 1:00 AM and they finally checked on her at 6:30 AM. She stated at night she is unable to locate her call button. Resident stated that she had shared her concerns for her incontinent care with the night nurse however nothing has changed The Resident was admitted to the facility 03/11/22 with a diagnosis of Parkinson's Disease. Review of the MDS 12/15/22 documents Resident #59 has a BIMS score of 15, which indicates the resident was alert and oriented and cognitively intact for decision making. The MDS also documents the resident needs extensive assist of one person for toileting, personal hygiene and dressing. On 02/14/23 at 8:10 AM, an interview was conducted with Staff G, a Certified Nursing Assistant, (CNA) She stated they need more help with the residents. She stated she only works day shift and it is very tiring. Most of her residents are total care. 02/14/23 at 10:30 AM, an interview was conducted with Staff F, a Licensed Practical Nurse (LPN). She stated she is caring for 30 Residents and today she has 4 CNA's however sometimes she only has 2-3 CNA's to assist with care. She stated that Sundays are the hardest because they usually only have 2 CNA's. She stated she works 8 hour shifts and she is unable to complete her work within the 8 hours. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 9 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 02/15/23 at 7:30 AM, an interview was conducted with staff H, a CNA. She stated she has worked at the facility for many years. She stated there is never enough time to complete her assignment. She stated she always stays late to finish up her charting. On 02/15/23 at 7:43 AM, an interview was conducted with Staff I, a CNA. She stated they do not have enough staff to meet the needs of the residents in the amount of time they work. On 02/16/23 at 8:30 AM, an interview was conducted with the Director of Nursing (DON). She stated she is attempting to hire additional staff. On 02/16/23 at 2:45 PM, an interview was conducted with Staff K, a Certified Nursing Assistant (CNA) she stated she turns, and positions residents every 2 hours. She stated she changes the residents diapers every 3 hours. On 02/16/23 at 3:00 PM, an interview was conducted with Staff G, a CNA concerning resident care. She stated she turns, positions and changes the residents every 2 hours. The facility provided a document with the list of residents living in the facility who require 2-person assistance. Review of the document revealed the census of the facility is 108 and 40 of the residents are 2 person assist and 3 residents are 1-2 person assist. 5) A review of the Resident Council Meeting minutes, on 02/15/23 at 8:10 AM, revealed the following concerns were noted: a. During the Resident Council Meting on 09/26/22: In the section for 'Old Business Not resolved': Dining room is open at 8:00 AM but CNAs not available to start service. In the section for 'New Concerns/Grievances': Residents would like staff to have call bells answered and request resolved in a timely manner. and b. During the Resident Council Meeting on 11/28/22: In the section for 'New Concerns': Sometimes no staff in sitting area Not enough staff on weekends. c. During the Residnet Council Meeting on 12/26/22: In the section for 'Old Business not resolved: Sometimes staffing shortages on weekends. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 10 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0725 d. During the Resident Council Meeting on 01/23/23: Level of Harm - Minimal harm or potential for actual harm In the section for 'Old Business/concerns not resolved, documented': Sometimes staff shortages on the weekends. Residents Affected - Few During an interview, on 02/15/23 at 2:25 PM, with active members of the Resident Council, including Resident #4, with a Brief Interview for Mental Status (BIMS) score of 10 (moderately impaired), Resident #18, with a BIMS score of 9 (moderately impaired), Resident #35, with a BIMS score of 10(moderately impaired), and Resident #77, with a BIMS score of 15 (cognitively impaired), when asked about staffing concerns documented in the Resident Council Meeting Minutes, all of the 4 attendees agreed that the staffing concerns had not been resolved. Resident #4 stated, Especially on Saturday and Sunday, they should have 4 (referring to CNAs). Resident #4 further stated that residents have had to wait excessive amount of time for staff to respond to the call lights - the other 3 attendees acknowledged and agreed with the statement. Resident #35 stated, I have Parkinson's and sometimes with a bad tremor and I have some of the staff say, 'just try and you will be able to do it. They want me to walk, because they are not very happy to wheel me to lunch and I can't do more than I do. there is a limit to my action. One said to me ' i have asked you so many times and why can't you walk, you just want people to wait on you. Resident #77 stated, I have to use the lift to get out of bed, I had to wait. On the weekends, it is always short, lucky if there are two aids and they tell me that I have to stay in the bed all day because there is only 2 aides. for what I am paying for a partial room, they should be able to hire more aides. Resident #4 added Every Saturday and every Sunday they tell us 'we have 15 people to take care of.' they complaint about how much they are getting paid. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 11 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure that its medication error rates are not 5 percent or greater; the medication error rate was 8%. Two (2) medication errors were identified while observing a total of 25 opportunities, affecting Resident #257. Residents Affected - Few The findings included: A medication administration observation was conducted on 02/15/23 at 9:00 AM, with Staff Z, a Registered Nurse, for Resident #257. Staff Z was observed pouring 5 milliliters (ml) of iron in a medicine cup. The labeling on the iron medication was 5 ml/220 mg. Staff Z, after gathering up the rest of the resident's medications, stated the resident was out of her Prednisone. Staff Z stated she would check the emergency kit for the medication. Staff Z returned with 2 pills of Prednisone 5 mg each (total 10 mg). Staff Z proceeded to administer a total count of 8 pills, and 3 liquids, verified together with the surveyor. A medication reconciliation was conducted with the medications Staff Z administered to Resident #257, and the resident's orders on 02/15/23 at 10:15 AM. A review of Resident #257's orders revealed an order dated 01/16/23 for Ferrous Sulfate Liquid (iron) 325 mg twice a day at 9:00 AM and 9:00 PM (220 mg administered). An additional order dated 01/16/23 for Prednisone 1 mg every other day at 9:00 AM (10 mg administered). An interview was conducted with Staff Z on 02/15/23 at 10:30 AM. Staff Z acknowledged the errors. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 12 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 observation, interview, and policy review, the facility failed to ensure safe medication storage on 1 of 5 resident units (3S), as evidenced by two observations of an unlocked and unattended medication cart on two separate occasions (on 02/13/23), and observation of an unlocked and unattended treatment cart for at least 45 minutes on 02/13/23. The findings included: Review of the policy Medication Storage in the Facility dated April 2018 documented, B. Medication rooms, carts, and medication supplies are locked when not attended by persons with authorized access. On 02/13/23 at 9:57 AM, the treatment cart on the 3S unit was noted unlocked and unattended. The 3S unit was a locked unit for memory impaired residents, with a centrally located common area and nurse's station. The unlocked treatment cart was pushed up against a wall in the common area with the drawers facing outward (Photographic Evidence Obtained). At the time of this observation, eleven residents were noted in the common area. Two nurses were observed at a medication cart, approximately 15 to 20 feet away, and also in the common area. The two nurses were engaged in the morning medication pass for the residents. Both nurses were focused on the medication cart and electronic record, leaving the cart intermittently to administer medications, and returning to the medication cart. The Assistant Director of Nursing (ADON) walked through the common area between the two carts, but did not notice the unlocked treatment cart. At 10:03 AM the Director of Nursing (DON) was on the unit and in the common area, but did not notice the unlocked and unattended treatment cart. Staff E, agency Registered Nurse (RN), passed right by the unlocked treatment cart to go down the 317-324 hallway, and did not notice the unlocked treatment cart. During an interview on 02/13/23 at 10:08 AM, upon surveyor introduction, Staff E, agency RN, stated it was her first day at the facility, and last night's nurse had stayed to help for awhile. During the continued observation on 02/13/23 at 10:15 AM, the night nurse had gone into a resident room while Staff E continued with the morning medication pass. Staff E left the medication cart unlocked and unattended in the common area, and walked down the hallway nearest the elevators. At 10:16 AM the night nurse returned to the medication cart, noticed it was unlocked, and upon return of Staff E, the night nurse reminded her to lock the cart when she left. An observation on 02/13/23 at 10:44 AM revealed the treatment cart remained in the same location, unlocked and unattended, with multiple residents in the common area. Different staff were in and out of the common area throughout the day, but there were times that the area was unattended by any staff. An observation at 11:12 AM revealed the treatment cart was now locked. The treatment cart was used for wound care for all residents of the 3S unit and contained wound supplies and medications. The treatment cart was observed being used for the provision of wound care by a direct care nurse on at least two occasions during the survey week. On 02/13/23 at 3:29 PM, the 3S medication cart was pushed up against the nurse's station, with the drawers facing out toward the common area, and it was noted unlocked again (Photographic Evidence (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 13 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 Obtained). Staff E, RN, was sitting behind the desk working on her computer. At 3:32 PM when asked if there was any reason she had left the medication cart opened twice that day, Staff E jumped up and ran around the nurse's station stating, I left the cart opened? When asked again why she left the medication cart opened, the RN stated, No reason . just busy . and this is my first day. When told about the unlocked and unattended treatment cart that same morning, the RN was unaware, but agreed both carts should be locked when unattended. Observations of the 3S unit during the survey week revealed at least two of the 30 cognitively impaired residents, Resident #71 and Resident #84, were observed independently mobile throughout the unit. Resident #71 was transferred into the 3S unit on 11/16/22. Review of the Minimum Data Set (MDS) assessment dated [DATE] documented the resident as severely cognitively impaired, with a Brief Interview for Mental Status (BIMS) score of 3, on a 0 to 15 scale. Resident #71 was usually in her wheelchair, but was seen by the surveyor independently ambulating from the common area to the nurse's station on one occasion, and from the common area into the staff bathroom in the nurse's station on another occasion. Resident #84 was admitted to the facility into the 3S unit on 01/22/22. Review of the MDS dated [DATE] documented the resident as cognitively impaired with a BIMS score of 5. On at least two occasions during the survey, the resident was noted independently wheeling herself from her room into the common area, the dining room, and back. Because of the location of this resident's room, she would pass by the nurse's station in front of where the medication cart was stored, in order to get to the common area or dining room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 14 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0808 Level of Harm - Minimal harm or potential for actual harm Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. Based on observation, interview, and record review, the facility failed to follow ordered therapeutic diet for 1 of 4 sampled residents reviewed for a special diet (Resident #257). Residents Affected - Few The findings included: On 02/15/23 at 9:30 AM, Resident #257 was observed coughing, and her private duty aid (PDA) was heard yelling at the resident to spit it out. Upon entering the resident's room, the resident was observed spiting out pieces of bacon into a napkin. A review of Resident #257's meal ticket on her breakfast tray revealed a diet of mechanical soft food order. Staff Z, a Registered Nurse, came into the resident's room, looked at the strips of bacon on the resident's tray and said the resident was not supposed to have that. An interview with Speech Pathology (ST) was conducted at Resident #257's bedside on 02/15/23 at 10:06 AM. SP stated the resident should not be eating bacon on a mechanical soft diet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 15 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2) Resident #28 was identified as being on Transmission Based Precautions (TBP) because of a wound infection. The resident was admitted to the facility on [DATE] and developed a pressure ulcer of the left heel on 01/30/23. A wound culture was ordered and completed. Residents Affected - Few Review of the laboratory results revealed an MRSA (Methicillin Resistant Staph Aureus) infection that was reported to the facility on [DATE] at 11:31 AM. This report identified which antibiotics were sensitive (meaning appropriate for use), with clindamycin on the report as appropriate for treatment. Review of the physician orders revealed the clindamycin was not ordered or initiated until 02/07/23, five days after the reported infection. Review of the wound care physician's visit report dated 02/06/23 documented the antibiotic choice was clindamycin. During an interview on 02/15/23 at 2:54 PM, when asked the process for receipt of abnormal culture results, Staff F, Licensed Practical Nurse (LPN), explained when a report comes in, they speak with the physician to report the findings and to see if they want any additional orders. When asked what happened with the wound culture for Resident #28 and the delay in antibiotic ordering and use, Staff F stated she was not sure what happened, but she was the one who contacted the physician on the day the clindamycin was ordered (02/07/23). Staff F confirmed she worked on the resident's unit on 02/02/23, 02/03/23, 02/05/23, and 02/06/23, but again stated she did not know how that culture result was missed. Based on interview and record review, the facility failed to ensure antibiotic stewardship for antibiotic use for 1 of 1 sampled residents reviewed for antibiotic stewardship (Resident #76); and failed to provide antibiotics for infected wound in a timely manner for 1 of 1 sampled residents (Resident #28). The findings included: A review of the facility's policy titled, Antibiotic Stewardship Policy, dated 03/02/21, documented the purpose for our Antibiotic Stewardship Program is to monitor the use of antibiotics in our residents. When a culture and sensitivity (C&S) is ordered, lab results and current clinical situation will be communicated to the prescriber as soon as available to determine if antibiotic therapy should be started, continued, modified, or discontinued. 1) An observation was conducted of Resident #76 on 02/14/22 at 11:00 AM. The resident was observed sitting up in bed with a private duty aid (PDA) at his bedside. Resident #76 had a loud coarse wet sounding cough. The PDA stated the resident had had that cough for some time. Record review revealed Resident #76 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident had severe cognitive impairment. A review of Resident #76's orders revealed an order dated 11/19/22 for nebulizer/breathing treatment every 4 hours as needed for cough. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 16 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0881 Orders dated 02/10/23 for cough syrup every 4 hours as needed for cough/congestion for 7 days. Level of Harm - Minimal harm or potential for actual harm Orders dated 02/10/23 for Azithromycin (antibiotics) for a total of 5 days. A progress note dated 02/12/23 documented antibiotics for cough with no adverse reaction noted. No fever. Residents Affected - Few Further review of Resident #76 did not reveal any documentation of any indication for the need for antibiotics. No documented fever or abnormal labs. There was no documentation of Resident #76's condition. A review of Resident #76's Medication Administration Record (MAR) did not reveal any breathing treatments administered for a cough. Furthermore, no cough syrup was administered to the resident for a cough. An interview was conducted with Staff F, a Licensed Practical Nurse, on 02/16/23 at 11:43 AM. Staff F stated the resident's family member was complaining about a cough. Staff F notified medical staff, and received an order for antibiotics. Staff F stated she was not aware of the ordered breathing treatment as needed for cough, or she would have given the medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 17 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and policy review, the facility failed to ensure provision of the influenza (flu) and/or pneumococcal (pneumonia) immunizations for 3 of 5 sampled residents (Resident #21, #78, and #97). Resident #97 was admitted to the facility after November 30th and before March 31st, and the facility failed to ensure the influenza vaccine was administered within 5 days of admission. The facility failed to assess all three residents for the pneumococcal vaccine within 5 working days of admission and provide it within 30 days of admission, as per their own policy. Residents Affected - Few The findings included: Review of the policy Influenza Vaccine revised October 2019 documented, 1. Between October 1st and March 31st each year, the influenza vaccine shall be offered to residents and employees, unless the vaccine is medically contraindicated or the resident or employee has already been immunized. 2. Employees hired or residents admitted between October 1st and March 31st shall be offered the vaccine within five (5) working days of the employee's job assignment or the resident's admission to the facility. Review of the policy Pneumococcal Vaccine revised October 2019 documented, 1. Prior to or upon admission, residents will be assessed for eligibility to receive the pneumococcal vaccine series, and when indicated, will be offered the vaccine series within thirty (30) days of admission to the facility unless medically contraindicated or the resident has already been vaccinated. 2. Assessments of pneumococcal vaccination status will be conducted within five (5) working days of the resident's admission if not conducted prior to admission. 1) Review of the record revealed Resident #21 was admitted to the facility on [DATE]. The family representative for Resident #21 consented to the receipt of the pneumococcal vaccine on 09/15/22. Review of the record lacked any evidence of administration of that vaccine. During an interview on 02/16/23 at 9:35 AM, the Staff Developer/Interim Infection Control Preventionist (ICP) explained Resident #21 had infections in September and December that prevented them from administering the vaccine at that time, but agreed as of the survey, Resident #21 still had not received the Pneumococcal vaccine, and had no reason for the delay. 2) Review of the record revealed Resident #78 was admitted to the facility on [DATE]. Review of the record lacked any information related to the offering or administration of the influenza and pneumococcal vaccines. The Interim ICP was asked to locate and provide the information. During an interview on 02/16/23 at 9:28 AM, the Interim ICP provided documentation of consent for both vaccines as of 12/04/22, more than 5 days after admission to the facility. The Interim ICP further stated Resident #78 had a virus the end of December (12/29/22), which would have excluded her from receiving the vaccines at that time, but agreed to the continued lack of administration of both vaccines. 3) Review of the record revealed Resident #97 was admitted to the facility on [DATE]. Further review of the record lacked any information related to the offering or administration of the influenza and pneumococcal vaccines. During an interview on 02/16/23 at 12:34 PM, the Interim ICP provided evidence Resident #97 had consented to receive both vaccines upon admission to the facility, explained the orders were not written and or entered into the electronic system, and thus the resident did not receive either vaccine. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 18 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0885 Report COVID19 data to residents and families. Level of Harm - Potential for minimal harm Based on interview and record review, the facility failed to proactively notify residents, their representatives, and families of any positive COVID-19 cases, by 5 PM the next calendar day following the occurrence, for the past two outbreaks reported by the facility (12/29/22 and 02/10/23). Residents Affected - Many The findings included: During an interview on 02/13/23 at 1:40 PM, the Staff Developer/Interim Infection Control Preventionist (ICP) explained the facility's last resident COVID-19 outbreak began on 12/28/22, resulting in eleven positive residents, all residing on one unit. The ICP explained that no staff were positive at that time. This was confirmed by the Resident COVID-19 infection log that documented positive residents on 12/29/22, 12/30/22, and 01/04/23. Review of the Employee COVID-19 Tracking Log revealed one positive staff member, Staff M, Registered Nurse (RN), as of 02/10/23. The Interim ICP stated the Nursing Home Administrator (NHA) would be responsible for the notification to the residents, their representatives, and families. During an interview on 02/15/23 at 10:41 AM, when asked how the residents, their representatives, and families were notified of any COVID-19 positive case, the NHA stated there was a COVID Hotline number for the residents or families to call to get an update. When asked if that meant a resident or family would need to call into the Hotline number on a daily basis to see if there were any new cases, the NHA agreed and again confirmed she updated the information on the Hotline with each new case, but does not have any method in place to call out or notify residents and families. When asked when the last update to the Hotline was made, the NHA stated with the December 2022 outbreak. When asked if she updated the Hotline with the last positive employee, Staff M, as of 02/10/23, the NHA stated she did not, as that employee had not worked on the previous day, 02/09/23 or the day she tested positive on 02/10/23, and none of the residents she cared for or staff she worked with tested positive. Review of the employee timecard for Staff M confirmed she did not work on 02/09/23 or 02/10/23, as she called in sick both days as per the ICP, but she had worked the previous three days on the 7 AM to 3 PM shift. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 19 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0886 Perform COVID19 testing on residents and staff. Level of Harm - Potential for minimal harm Based on interview and record review, the facility failed to ensure for each instance of resident COVID-19 testing, that all testing results were maintained in the resident record. Residents Affected - Many The findings included: During an interview on 02/13/23 at 1:40 PM, the Staff Developer/Interim Infection Control Preventionist (ICP) explained they were able to do contact tracing testing for the past two outbreaks, one in December 2022 that encompassed the 3S unit, and one in February 2023 that encompassed the 3N unit. When asked where in the resident record the COVID-19 results were maintained, the Interim ICP explained, if a resident was positive, a progress note would be in the Electronic Medical Record (EMR) and the actual test results are all stored together, but not in the resident's medical record. During this continued interview, the regulation was reviewed with the ICP, and she voiced understanding and agreed they had not been ensuring all testing was maintained in the resident's record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 20 of 21 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 105420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lourdes-Noreen McKeen Residence for Geriatric Care 315 S Flagler Dr West Palm Beach, FL 33401 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 0887 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and policy review, the facility failed to ensure the provision of COVID-19 vaccinations for 3 of 5 sampled Residents (Resident #21, #78, and #97). The findings included: Review of the policy Infection Control: COVID-19 Vaccination - Resident effective 10/19/20 documented, Screening - All residents prior to admission to the home, shall be screened for their COVID-19 vaccination status. Offer of Vaccination - Any resident without evidence of full vaccination status will be educated on the risks and benefits of being vaccinated for COVID-19 and offered the vaccine to be administered upon it's next availability. Evidence of this education and consent or declination will be signed, dated, and scanned to the resident's medical record. 1) Review of the record revealed Resident #21 was admitted to the facility on [DATE]. Further review of the record revealed the resident's last COVID-19 vaccination was 02/07/21, as documented by Florida Shots (a website that tracks all vaccines). The Interim Infection Control Preventionist (ICP) was asked to locate documentation of either a consent or declination for the COVID-19 bivalent booster, the most recent booster available. During an interview on 02/16/23 at 9:35 AM, the Interim ICP explained Resident #21 had infections in September 2022 and December 2022, which would make her ineligible for a COVID-19 booster at that time. When asked the process for obtaining and administering any COVID-19 booster, the ICP explained a list of residents who wish to receive the booster is maintained, and when there are enough residents and staff who want it, they have a COVID clinic to administer the vaccine. The ICP was asked when the last few COVID clinics were held, prior to their December 2022 outbreak. During a subsequent interview on 02/16/23 at 12:36 PM, the ICP stated they had COVID vaccine clinics on 10/11/22, 10/13/22, and 10/28/22. The ICP agreed that Resident #21 had been missed. 2) Review of the record revealed Resident #78 was admitted to the facility on [DATE]. Further review of the record documented consent required under the COVID vaccination information. During and interview on 02/16/23 at 9:28 AM, the ICP explained the resident got COVID-19 the end of December (12/29/22), and review of the previous COVID clinic sign up sheet on 10/28/22 did not capture Resident #78. 3) Review of the record revealed Resident #97 was admitted to the facility on [DATE]. Review of the record documented the resident refused the Bivalent booster. The ICP was asked to locate and provide the education and declination of the booster. During an interview on 02/16/23 at 9:31 AM, the ICP explained she had just spoken to Resident #97 who said she refused the Bivalent booster because she had missed the second booster and thought she did not qualify. The ICP stated she educated the resident today and she subsequently consented to receive the Bivalent booster. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105420 If continuation sheet Page 21 of 21