Health inspection·February 2, 2022

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few * Review Advance Directives prior to medical decisions being made in order to ensure that resident's wishes are followed and the proper representative is making decisions for the resident. A review of the resident's paper-based health record and electronic health record revealed that there was no physician's order for a DNR and no documentation regarding the resident's Advance Directive that would be sent with the resident upon transfer from the facility. 2. Record review revealed Resident #42 was initially admitted on [DATE] and readmitted for current stay on [DATE], According to Resident #42's most recent complete assessment, a Quarterly MDS, dated [DATE], Resident #42 was not assessed for cognition due to 'Resident is rarely / never understood'. Resident #42's care plan, dated [DATE], documented, I do not have Advance Directive at this time. The goal of the care plan was documented as, I wish to be resuscitated Interventions to the care plan were documented as: *Review Advance Directives with resident / representative quarterly and as needed. *Interdisciplinary Team will be aware of resident's wishes when providing care and treatment *Treat resident as a FULL CODE and Initiate CPR as needed. A review of Resident #42's paper-based health record revealed an Advanced Directive, dated [DATE]. In the section of Resident #42's face sheet, titled, 'Advanced Directives', it documented, there are no Advanced Directives selected for this resident. On the resident's form AHCA 5002-3008 in the section for Advance Care Planning, there is no indication of the resident or representative choosing any Advance Directive. Resident #42's records documented that the resident's [family member] is 'Emergency contact and Power of Attorney. Further review of the resident's paper-based and electronic health records revealed that the resident did not have a Physician order for 'DNR'. A Social Services progress note, dated [DATE], documented, At this time resident remains full code. A Social Services progress note, dated [DATE], documented, Writer receive DNR for resident and DNR is add to resident file. During an interview, on [DATE] at 8:01 AM with the MDS Coordinator, when asked about the Resident #17 Advance Directive, the MDS Coordinator replied, If you would collapse right here (pointing at the floor in front of the nurse's station), I can look over there (pointing at the charts) or have somebody grab the chart and there will be a red dot on the outside of the chart that means that the resident is a DNR. The MDS Coordinator looked in the resident's paper-based chart and confirmed that there was no DNR for Resident #17. The MDS coordinator said, Social Services are the ones that make sure that everything is in place. They do the care plans for the resident and set up the packets that would go to the hospital. During the interview, the MDS Coordinator confirmed that there were no physician's orders for Resident #42 to have a DNR. On [DATE] at 9:35 AM, and again on [DATE] at 4:21 PM, this surveyor atttempted to reach out to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 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 0578 Resident #42's representative, was unsuccessful and unable to leave a message. 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: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0584 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observations and interviews, the facility failed to maintain a safe, clean, comfortable, and homelike environment in residents rooms. Residents Affected - Few The findings included: Review of facility policy, titled, Maintenance, with a revised date of 11/15/21, revealed maintenance work orders shall be completed in order to establish a priority of maintenance services. In order to establish a priority of Maintenance services, work orders must be filled out and forwarded to the Maintenance Director. Work order request should be placed in the appropriate file basket at the nurses' station. Work orders are picked up daily. Emergency requests will be given priority in making necessary repairs. If maintenance unable to repair, vendor will be called. 1. On 01/30/22 at 9:47 AM, an observation was made of Resident #408's floor by her bed. There was a thick dark substance (where the grout would be) around the square tiles. Photographic evidence obtained. 2. On 01/30/22 at 12:02 PM, an observation was made in Resident #67's room. The floor had a thick dark colored substance (where grout would be) around some of the square tiles. Photographic evidence obtained. 3. On 01/30/22 at 9:51 AM, an observation was made in Resident #80's room of the baseboard next to the air conditioning unit and the wall above the air conditioning unit showed they were in disrepair. Photographic evidence obtained. 4. On 01/30/22 at 11:30 AM, an observation was made in Resident #107's room. The wall behind the headboard of the bed has many black marks, and the trim on her nightstand was half off the nightstand. Photographic evidence obtained. During a tour of facility on 02/02/22 at 11:47 AM with Maintenance Director, he agreed with the findings, and stated that the dark lines on floor were glue from when the flooring had been replaced. He stated they will start to get these items corrected. During an interview conducted on 02/02/22 at 12:03 PM with Maintenance Director when asked what the process was when a resident or staff member identify concerns that require maintenance, he stated that the staff member fills out a work order sheet and puts it in the maintenance book at the nursing station (there is a maintenance book at each nursing station), maintenance department makes rounds every day to check the maintenance request. They have 5 staff members in the maintenance department, and they can handle most concerns immediately. If they are not able to handle the concern, they call a vendor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to include point of care nursing staff in the care planning process for 10 of 34 sampled residents, Residents #17, #96, #42, #38, #86, #43 and #94, reviewed for care plans. The findings included: During an interview, on 02/01/22 at 8:01 AM, with the MDS (Minimum Data Set) Coordinator, when asked about point of care staff's participation in the care plan meetings and care planning process, the MDS Coordinator replied, I can't just take an aide or a nurse off of the floor for a care plan meeting. 1. Review of Resident #17's 'Interdisciplinary Care Plan Meeting Record' for the resident's admission MDS, dated [DATE], revealed that the documented staff attendees included; Social Services, Physical Therapy Assistant, the Registered Dietitian (RD/LD) and Activities. It was noted that there were no point of care staff documented as being in attendance or having participated in the care planning process or meeting. 2. Review of Resident #96's 'Interdisciplinary Care Plan Meeting Record' for the resident's Quarterly care plan, dated 09/09/21, as well as the resident's Quarterly care plan, dated 12/09/21, revealed that the documented staff attendees included: Social Services, Actvities and RD/LD. It was noted that there were no point of care staff documented as being in attendance or having participated in teh care plannning process or meeting. 3. Review of Resident #42,s 'Interdisciplinary Care Plan Meeting Record' for the resident's Quarterly care plan, dated 12/09/21, revealed that the documented staff atendees included: Social Services, Activities and RD/LD. It was noted that there were no point of care staff documented as being in attendance or having participated in the care planning process or meeting. 4. Review of Resident #38's 'Interdisciplinary Care Plan Meeting Record' for the resident's Quarterly care plan, dated 09/09/21, as well as the resident's Quarterly care plan, dated 12/09/21, revealed that the documented staff attendees included: Social Services, RD/LD, Activities, and a representative from Vitas Hospice. It was noted that there were no point of care staff documented as being in attendance or having participated in the care planning process or meeting. 5. Review of Resient #86's 'Interdisciplinary Care Plan Meeting Record' for the resident's Annual Reassessment, dated 04/08/21, revealed that the documented attendees included: Social Services, Activities, RD/LD, and a Unit Manager. The record documented that the attendees for the resident's Quarterly Care Plan meeting included: Activities and RD/LD. The record documented the attendees for the resident's Quarterly Care Plan Meeting that the attendees included: Social Services, Activities, a Unit Manager and RD/LD. It was noted that there were no point of care staff documented as being in attendance or having participated in teh care planning process or meeting. 6. Review of Resident #43's 'Interdisciplinary Care Plan Meeting Record' for the resident's Quarterly care plan, dated 03/15/21, revealed that the documneted attendees included: RD/LD, Social Services and Activities. The record documented the attendees for the resident's Annual Reassessment (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some included: RD/LD, Social Services, Activities and a Unit Manager. The record documented the attendees for the Resident's Quarterly Care Plan included: social Services, RD/LD Activities and a Unit Manager. It was noted that there were no point of care staff documented as being in attendance or having participated in the care planning process or meetings. 7. Record review of the Interdisciplinary Team (IDT) Care Plan Conference Summary for Resident #16, dated 11/11/21, documented attendees via signature of staff who attended the conference, that included the Registered Dietitian, Unit Manager, Activities Assistant and Social Services Coordinator. There was no point of care staff, that included a Nurse responsible for direct resident's care and a direct care Certified Nursing Assistant (CNA), documented as having attended or who provided input to the development of the resident's care plan. 8. Record review of the IDT Care Plan conference Summary for Resident #94, dated 12/14/21, documented attendees via signatures of the staff who attended the conference that included the Registered Dietitian, a Minimum Data Set (MDS) Coordinator, Activities Assistant and Social Services Coordinator. There were no other point of care staff, including a Nurse responsible for direct resident's care and a direct care CNA, documented as having attended or who provided input to the development of the resident's care plan. 9. Record review of the IDT Care Plan conference Summary for Resident #153, dated 12/14/21, documented attendees via signatures of the staff who attended the conference that included the Unit Manager, a Minimum Data Set (MDS) Coordinator and Social Services Coordinator. There were no other point of care staff, including a Nurse responsible for direct resident's care and a direct care CNA, documented as having attended or who provided input to the development of the resident's care plan. 10. Record review of the IDT Care Plan conference Summary for Resident #157, dated 01/18/22, documented attendees via signatures of the staff who attended the conference that included the Minimum Data Set (MDS) Coordinator and Dietician. There were no other point of care staff, including a Nurse responsible for direct resident's care and a direct care CNA, documented as having attended or who provided input to the development of the resident's care plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to ensure 1 of 3 sampled residents, Resident #123, reviewed for positioning and mobility with contractures, was provided with splints to prevent further decrease in range of motion. The findings included: A review of the facility's policy titled, Rehabilitation Splinting, dated 1010/21, showed that prolonged immobility from splinting or positioning could produce limitations in joint Range of Motions and, ultimately, joint stiffness and immobility. Record review showed that Resident #123 was admitted on [DATE] with a diagnosis to include Parkinson's Disease. Record review showed a physician's order, dated 11/18/21, for Resident #123 to always utilize the right-hand palm protector and remove it for hygiene and reapply. An Occupational Therapy evaluation, dated 01/18/22, showed that Resident #123 needed a right-hand protector to prevent loss of range of motion, skin breakdown, and contracture. In an observation conducted on 01/30/22 at 9:35 AM, Resident #123 was noted in bed. Closer observation showed that he was asleep with no staff in the room. He was not wearing a right-hand palm splint as ordered. In an observation conducted on 01/30/22 at 10:30 AM, Resident #123 was noted in bed. Closer observation showed that he was asleep with no staff in the room. He was not wearing a right-hand palm protector as ordered. In an observation conducted on 01/30/22 at 12:01 PM, Resident #123 was noted in bed. Closer observation showed that he was awake with no staff in the room. He was not wearing a right-hand palm protector as ordered. In an observation conducted on 01/30/22 at 2:55 PM, Resident #123 was noted in bed. Closer observation showed that he was awake with no staff in the room. He was not wearing a right-hand palm protector as ordered. In an observation conducted on 01/31/22 at 8:35 AM, Resident #123 was noted in bed. Closer observation showed that he was awake and not wearing a right-hand palm protector as ordered. In an interview conducted on 02/01/22 at 9:18 AM, Staff A, Registered Nurse (RN), stated that Resident #123 has been wearing his hand splints daily and that she is responsible for making sure that he has them on every day. She further stated that restorative would also help place the splints on the residents when she cannot. When asked if Resident #123 had them on this morning, she said 'no'. Staff A-RN also stated that she did not go over the resident's treatments yet, so she did not place the splint on Resident #123. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete In an interview conducted on 02/01/22 at 9:30 AM, Staff B, Certified Nursing Assistant (CNA), stated that Resident #123 has an order for a splint. It is the responsibility of the nurses, restorative, as well as her, to make sure that the splints are placed on the residents. When asked if Resident #123 had his splint on this morning, she said 'no'. She further stated that since Resident #123 did not get washed this morning, she did not place the splint on him. Staff B-CNA further stated that she would put the splint on Resident #123 after she cleaned him. Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to accurately assess nutritional status and provide a nutritional supplement for 2 of 10 sampled residents reviewed for nutrition, Resident #88 and Resident #49. Residents Affected - Few The finding included: 1. Record review showed that Resident #88 was readmitted on [DATE] with diagnoses to include Heart Failure and Dementia. Review of the Minimum Data Set (MDS) dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 05, indicating severe cognitive impairment. Section G of the MDS for eating showed that the resident required supervision with setup only. The nutrition care plan, initiated on 04/23/21, showed that Resident #88 is at risk for altered nutrition related to requiring a therapeutic diet. It further showed that weight would be maintained. In an observation conducted on 01/30/22, at 10:10 AM, Resident #88 was noted in her bed. Closer observation showed no nutritional supplement at the bedside. In an observation conducted on 01/30/22 at 12:35 PM, Resident #88 was in the room eating her lunch. Closer observation showed that she only ate 20% of her lunch meal. There were no nutritional supplements noted on the tray or bedside. In an observation conducted on 01/31/22, at 10:10 AM, Resident #88 was noted in her bed. Closer observation showed no nutritional supplement at the bedside. In an observation conducted on 02/01/22 at 7:55 AM, Resident #88 was observed eating independently. At 8:10 AM, Resident #88 ate about 50% of her breakfast meal. In an observation conducted on 02/01/22 at 12:01 PM, Resident #88 was observed in her room, eating her lunch meal with no assistance from staff. Closer observation showed no nutritional supplements on the tray. At 12:22 PM, Resident #88 had eaten 25% of her lunch meal. Continued observation showed Staff C, Restorative Certified Nursing Assistants (RCNA), in the room feeding Resident #88 her lunch meal. In the observation, Staff C-RCNA stated that she sometimes helps Resident #88 with her meals and that she needs help and encouragement with her meals. At 12:33 PM, Resident #88 had eaten 50% of her lunch meal and seemed to be very accepting of Staff C-RCNA assisting her with her meal. Review of the 'Weight book' at the nurse's station showed that Resident #88 was 154 pounds in June 2021; and in September 2021, the resident had dropped to 139 pounds. This showed a 15 pounds (#) weight loss in 4 months. A review of the Medication Administration Record (MAR), for the month of December 2021 and January 2022, showed no physician order for any nutritional supplements (such as, House Shakes). A follow-up nutritional progress note, dated 12/08/21, three months after Resident #88's weight loss, showed the following: Staff H, Clinical Dietitian (CD), reported that Resident #88 was eating 50 percent (%) to 75 % of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 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 her meals. She further recommended a House Shake twice a day, a nutritional supplement for additional weight and protein support for Resident #88. In an interview conducted on 02/02/22 at 9:50 AM, with Staff H-CD, she reported that she placed the House shake supplements for Resident #88 in the meal tracker, which is the foodservice system that the kitchen uses. When asked as to why the House shake supplements are not part of Resident #88's orders, she did not know. Staff H-CD reported that she was supposed to place the House Shake as an order in the Sigma electronic system which she did not. When asked as to why she did not order the House shake twice a day as recommended on her latest follow-up note on 12/08/21, she did not know. She then said to the surveyor should I order it now. 2. Record review showed that Resident #49 was admitted on [DATE] with diagnoses that included Nutrition Deficiency, Anorexia and Dementia. The MDS, dated [DATE], showed that Resident #49 has a BIMS score of 02, indicating severe cognitive impairment. A review of the Physician's orders, dated 09/23/20, showed an order for House shakes 4 ounces 3 times a day. It further revealed that the resident was on a Dysphagia Pureed diet. A review of the monthly weight log at the nurse's station showed that Resident #49's weight was 128 pounds in April 2021, and in August 2021, the weight had dropped to 109 pounds. A Medical Nutrition Therapy Assessment, dated 08/13/21, showed that Resident #49 was eating 25 percent to 50 percent of her meals. It further showed that her weight had dropped to 109 pounds with a 13 percent loss. Staff H-CD provided no additional nutritional supplements. Progress notes, dated 09/21/21 by the Clinical Dietitian, due to a dietary consultation, showed that Resident #49 had a poor appetite and was eating 50 percent of her meals but liked to drink more. In this note, the Dietitian recommended an extra nutritional supplement of Resource 2.0 twice a day since Resident #49 was drinking more than eating. A review of the MAR showed a physician order, dated 09/21/21, for Resource 2.0 twice a day, which was a month after the weight loss was identified for Resident #49. In an interview conducted on 02/01/22 at 11:01 AM, Staff A, Registered Nurse (RN), stated that Resident #49 likes the Resource 2.0 supplements and will drink 100% of them daily. She further noted that Resident #49 likes to drink more than eat her meals. A review of the MAR for January 2022 showed that Resident #49 drank almost 100 percent of the Resource 2.0 nutritional supplements daily. In an interview conducted on 02/02/22 at 11:50 AM, with Staff H-CD, she did not know why the additional supplements were ordered a month after for Resident #49's weight loss. In an interview with the facility's Administrator on 02/02/22 at 12:30 PM, she acknowledged all findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 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 observations, interviews and record review, the facility failed to follow physician orders and provide tube feedings for 1 of 3 sampled resident, Resident #14, reviewed for tube feeding. The findings included: Record review showed that Resident #14 was re-admitted to the facility on [DATE] with diagnoses that included: Dysphagia, Gastroesophageal Reflux Disease, Type 2 Diabetes Mellitus, Hypertension, Altered Mental Status and Alzheimer's Disease. Review of Section C of the Minimum Data Set (MDS), dated [DATE], documented that Resident #14 had a Brief Interview for Mental Status score of 05, which indicated that he was severely cognitively impaired. Review of Section K of the MDS, dated [DATE], documented that Resident #14 was on a tube feeding while a resident in the facility. Review of the Physician's orders, dated 01/14/22, documented Resident #14 was to receive Nutren 2.0 at 65 milliliters (ml) per hour for 16 hours with a start time of 4:00 PM and an end time of 8:00 AM. Review of the Care Plan, dated 12/22/21, documented Resident #14 had altered nutrition / hydration related to dependence on percutaneous endoscopic gastrostomy (PEG) for nutrition / hydration needs. Interventions on the care plan included: to provide tube feeding as ordered. During an observation conducted on 01/31/22 at 7:11 AM, Resident #14 was observed lying awake in his bed. Resident #14's tube feeding was running at 65 ml per hour with a bag of Nutren 2.0 which was dated 01/30/22. Closer observation showed that there was about 250 ml out of 1000 ml of formula remaining in the bag. This showed that about 750 ml of formula had been infused and that Resident #14 had only received 750 ml (1,500 calories) out of 975 ml (1,950 calories) from his physician ordered tube feeding regimen. During a subsequent observation conducted on 01/31/22 at 8:35 AM, Resident #14's tube feeding pump was off and his bag of tube feeding formula had been removed from the tube feeding pole. During an observation conducted on 02/01/22 at 7:12 AM, Resident #14 was sleeping in his bed. Resident #14's tube feeding was running at 65 ml per hour with a bag of Nutren 2.0 which was dated 01/31/22 at 4:00 PM. Closer observation showed that there was about 350 ml out of 1000 ml of formula remaining in the bag. This showed that about 650 ml of formula had been infused and that Resident #14 had only received 650 ml (1,300 calories) out of 975 ml (1,950 calories) from his Physician ordered tube feeding regimen. During a subsequent observation conducted on 02/01/22 at 8:33 AM, Resident #14's tube feeding pump was off and his bag of tube feeding formula had been removed from the tube feeding pole. During an interview conducted on 02/01/22 at 12:22 PM, Staff W, Licensed Practical Nurse (LPN), stated that nurses were responsible for hanging, starting, and stopping tube feedings. Staff W-LPN stated the facility did not reuse the same bags of tube feeding formula and residents on tube feeding (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 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 would get a new bag of formula each day. When asked about Resident #14, Staff W-LPN stated that the resident gets Nutren 2.0 at 65 ml per hour for 16 hours with his tube feeding starting at 4:00 PM and ending at 8:00 AM. She further stated that the resident tolerated his tube feeding well. Staff W-LPN stated that Resident #14's tube feeding went up yesterday at 4:00 PM and was removed by her this morning at 8:00 AM. She further stated that she normally follows the physician's orders and takes Resident #14's tube feeding down at 8:00 AM. During an interview conducted on 02/02/22 at 11:48 AM, Staff H, Registered Dietitian (RD), stated that Resident #14 was to receive Nutren 2.0 at 65 ml per hour for 16 hours with his tube feeding starting at 4:00 PM and ending at 8:00 AM. Staff H-RD stated Resident #14 tolerated his tube feeding well. The surveyor informed Staff H-RD that Resident #14's tube feeding was not being provided as per the physician's orders. Staff H-RD acknowledged the surveyor's findings. At the request of the surveyor, a weight was taken for Resident #14. Staff H-RD stated that Resident #14's weight was taken today with a Hoyer lift and that he weighed 128 pounds (lbs.). A review of weights was conducted with Staff H-RD, which showed that Resident #14 weighed 139 lbs on 01/11/22, and 128 lbs on 02/02/22. This showed that Resident #14 experienced a 7.9% weight loss within a 3-week timeframe. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 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, record review and policy review, the facility failed to label oxygen tubing per the facility policy for 5 of 5 sampled residents reviewed for respiratory care, Residents #153, #508, #510, #512 and #146; and failed to follow physician's orders to provide oxygen therapy for Resident #153. Residents Affected - Few The findings included: A review of the Policy titled, Care of Oxygen Equipment, dated 08/03 and revised 08/04 and 08/19 documented that the oxygen tubing shall be labeled with the resident's name, date and nurse's initials. Additional review of the facility policy titled, Care of Oxygen Equipment, revised in August of 2019, showed the following: Routine oxygen equipment, which is used continuously or as necessary and which includes the supply tubing, mask, and cannula shall be changed every Sunday during the 11-7 shift. The policy also states that the oxygen tubing shall be labeled with residents name, date, and nurse's initials. 1. During observation on 01/30/22 at 1:12 PM for Resident #153, the resident was lying in her bed resting with oxygen on 2 liters/nasal cannula. Observation of the tubing revealed no label indicating when the tubing was changed or needed to be changed. 2. Record review showed Resident #153 was admitted to the facility on [DATE] with diagnoses that included Hypertension, Type 2 Diabetes and Anxiety Disorder. Review of the quarterly Minimum Data Set (MDS) assessment, dated 09/07/21, showed the resident had a Brief Interview of Mental Status (BIMS) of 3, which indicated severe cognitive impairment. Record review revealed Resident #153 had a physician order, dated 11/04/21 for 'Oxygen 2 Liters Continuous'. On 01/31/22 at 10:15 AM, observation revealed Resident #153 in the E-wing hallway across from the nurse's desk in a wheelchair. The resident stated that she couldn't breathe. Resident #153 was observed with no oxygen on and no oxygen canister next to her. This surveyor notified staff that the resident was stating that she could not breathe. Staff Q, Registered Nurse (RN), took the resident back to her room to apply oxygen. On 02/01/22 at 9:35 AM, another observation was made of the resident in her room without oxygen while she was in her wheelchair. On 02/02/22 at 10:00 AM, an interview was conducted with the Unit Manager of the E-wing regarding Resident #153 not having oxygen tubing labeled on 01/30/22 and not having oxygen applied on 01/31/22 and 02/01/22. The Unit Manager stated that the order for continuous oxygen was discontinued. The order was then reviewed with the Unit Manager and it revealed the physician's order for continuous oxygen had been discontinued on 02/01/22 at 12:06 PM after the observations were made. 3. Record review showed Resident #146 was admitted to the facility on [DATE]. Review of the physician orders showed that on 01/20/22, oxygen was ordered to run at 2 liters per minute via nasal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 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 cannula (the tubing that delivers oxygen into the resident's nose) for shortness of breath PRN (as needed). There was also an order to change the oxygen tubing every Sunday on the 11:00 PM-7:00 AM shift. An observation was conducted on 01/30/22 at 10:00 AM of Resident #146 in his room in bed with the oxygen on and the tubing without a label indicating when it was last changed or needed to be changed. Residents Affected - Few 4. Record review showed Resident #512 was admitted to the facility on [DATE]. Review of the physician orders showed that on 01/18/22, oxygen was ordered to run at 2L/min via nasal cannula for shortness of breath, and also an order to change the oxygen tubing every Sunday on the 11:00 PM-7:00 AM shift. An observation was conducted on 01/30/22 at 9:45 AM of Resident #512 in her room in the chair with the oxygen on and the tubing without a label indicating when it was last changed or needed to be changed. 5. Record review showed Resident #508 was admitted to the facility on [DATE]. Review of the physician orders showed that on 01/27/22, oxygen was ordered to run at 2L/min continuously for shortness of breath. There was also an order to change oxygen tubing every Sunday on the 11:00 PM-7:00 AM shift. An observation was conducted on 01/30/22 at 9:30 AM of Resident #508 in his room in bed with the oxygen on and the tubing without a label indicating when it was last changed or needed to be changed. 6. Record review showed Resident #510 was admitted to the facility on [DATE]. Review of the physician orders showed that on 01/31/22, oxygen was ordered to run at 2L/min via nasal cannula PRN for shortness of breath. There was also an order to change the oxygen tubing every Sunday on the 11:00 PM-7:00 AM shift. An observation was made on 01/30/22 at 09:15 AM of Resident #510 in his room in bed with the oxygen on and the tubing was without a label indicating when it was last changed or when it needed to be changed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 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. Based upon observation, interview, and record review, the facility failed to ensure medication and treatment carts were locked and attended by licensed staff; and failed to secure medications which were left unattended by licensed staff on top of a medication cart. The findings included: Review of facility policy titled, 5.3 Storage and Expiration Dating of Medications, Biologicals, with a revision date of 01/01/22. Procedure 3.3, revealed the facility should ensure that all medications and biologicals, including treatment items, are securely stored in a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors. 1. During a tour of facility on 01/30/22 at 8:59 AM, an observation was made of the E-wing west medication cart. On top of the medication cart, there was a medicine cup filled with what appeared to be applesauce and crushed medications covered with a drinking cup unattended. Photographic evidence obtained. During an interview conducted on 01/30/22 at 9:05 AM with Staff R, Licensed Practical Nurse (LPN) and Night Supervisor Relief, was asked about the cup on top of the cart. She stated it looked like applesauce and maybe some crushed medications. She said it should not be there, but that she did not have anything to do with it, but it was Staff S-RN. During an interview conducted on 01/30/22 at 9:07 AM with Staff S-RN, when she was asked if the cup was filled with applesauce and crushed medications, she stated 'yes'. She stated she had forgotten and left them there (on the medication cart). 2. During a tour of facility on 01/30/22 at 9:09 AM, an observation was made of the treatment cart. The cart was unlocked and unattended on the E-wing by licensed staff. The cart contained Diclofenac Sodium Topical Gel, Silver sulfadiazine cream that had no cap, and a pair of scissors. During an interview conducted on 01/30/22 at 09:12 AM with Staff T-RN when asked if the treatment cart is normally left unlocked, she stated 'no'. When asked why it was left unlocked and unattended, she stated she was not sure, maybe somebody forgot to lock it. 3. On 01/31/22 at 2:40 PM, an observation of the E-wing medication cart revealed it was left unlocked and unattended. A resident was observed nearby the cart. During an interview conducted on 01/31/22 at 2:42 PM with Staff U-LPN, he confirmed that he left the cart unlocked. He stated he must have forgot to lock it because a resident was calling for help and he rushed to the resident and just forgot to lock the cart. 4. On 02/02/22 at 8:45 AM, an observation was made of treatment cart on E-wing. The cart was left unlocked and unattended for the second time during this survey. The treatment cart was left unlocked and unattended for 7 minutes while several staff members walked past the cart, until the RN-MDS (Registered Nurse - Minimum Data Set) Coordinator asked surveyor if she needed something. Photographic evidence obtained. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 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 FORM CMS-2567 (02/99) Previous Versions Obsolete During an interview conducted on 02/02/22 at 8:52 AM with Staff V-RN / MDS Coordinator, when asked about the lock protruding from the E-wing treatment cart, she stated it looked unlocked. She opened a drawer which confirmed that it was unlocked. Inside the treatment cart there was Ciclopirox 8% Solution, 2 Diclofenac Sodium topical gel 1%, Ketoconazole 2% cream, and Clotrimazole and Betamethasone cream. During an interview conducted on 02/02/22 at 9:54 AM with the Assistant Director of Nursing (ADON), when asked about medication treatment carts and medication carts, she stated they should be always locked when unattended. Additionally, she stated that medications should never be left on the medication cart unattended. Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to prepare, store and handle foods in a sanitary manner to prevent foodborne illness and in accordance with professional standards. Residents Affected - Many The findings included: The facility's policy for Proper recording and notification of walk-in temperatures, documented, When recording the temperature of the walk-i or reach-in coolers if the temperature is above 41 degrees corrective action must be taken which includes immediately notifying the account manager or the assistant manager as well as notifying maintenance. Food items cannot be used until it's determined that they are still within the proper temperature range and not in the danger zone. If in the danger zone food items may have to be discarded. 1. During the initial kitchen tour, on 01/30/22 at 8:56 AM, accompanied by the District Manager (DM), the Account Manager / Certified Dietary Manager (CDM), and Staff I-Cook, the following were noted: a) Cleaned and sanitized utensils were stored in a drip container with the 'food and mouth contact surfaces' not inverted to prevent staff from contact with those surfaces. b) A metal wire shelf, used for storing cleaned and sanitized wares, according to Staff J-Cook, was noted to be rusty. c) The concentration of the quaternary ammonia used as a chemical sanitizer that was in the sanitizing compartment of the four compartment sink for manual ware washing, was less than the required 200 parts per million (PPM). The compartment was drained and re-filled and tested again and again the concentration was less than the required 200 ppm. The compartment was drained again and refilled again and the concentration of the sanitizer was tested and was at 200 PPM. d) The concentration of quaternary ammonia in a red bucket on a shelf in the food service / processing area was less than the required 200 ppm. e) The coving at the floor / wall juncture behind the four compartment ware-washing sink was not sealed to the wall, creating an area that is uncleanable, and with the potential to harbor pests. f) The blade of the bench-mounted manual can opener was noted to have some rust and was encrusted with food residues. g) The underside of an industrial stand mixer was noted to be encrusted with food residues h) The interior of the fryer cabinet in the food service area was noted to be encrusted with oil / grease / residue. i) There was a pool of oil / grease / residue on the floor under the fryer and oven / range. j) Cutting boards that were stored on a shelf with cleaned and sanitized wares were noted to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 heavily scored and stained. Level of Harm - Minimal harm or potential for actual harm k) Inside of the ice machine, there was an accumulation of a black mold-like substance. Residents Affected - Many l) The door handles, the temperature control nob and the time control nob on the convection oven were encrusted with food residue m) The bulk sugar container had a crack in the top of the container, creating an uncleanable area. n) A 22 quart bulk container that was labeled Split pea contained a thickener, according to Staff I-cook. o) A 2-cup measuring cup used for scooping the thickener out of the bulk container of, according to Staff I-cook, was encrusted with residues. p) The handles of the Continental reach in cooler were noted to be encrusted with food residues. q) The exterior walls and doors and interior of the doors of the walk-in cooler, walk in freezer and walk in dairy cooler were noted to be pitted and damaged as well as the handles being encrusted. r) The temperature of the walk-in cooler, according the thermometer inside of the cooler, was 55 degrees Fahrenheit (F) s) The internal temperature of beef that was sliced and placed in a 2-inch-deep full sized hotel pan in the walk-in cooler and dated 01/29/22 was 48 degrees F. Staff I-cook reported that the sliced beef was for the meal to be served at lunch on this day. The internal temperature of a commercially processed and approximately 5-pound piece of ham was 55 degrees F. The internal temperature of a commercially processed and approximately 5-pound piece of turkey was 55 degrees F. The internal temperature of turkey sandwiches that were dated 01/29/22 was 52 degrees F. The internal temperature of bone-in chicken that was in a 2-inch-deep full sized hotel pan marinating and to be cooked and used to make this day's lunch, was 58 degrees F. The internal temperature of an approximately 7-pound piece of raw pork that was in original wrapping was 58 degrees F. The internal temperature of 5-pound packages of raw pork sausage was 57 degrees F. The internal temperature of a half of a sliced watermelon was 58 degrees F. t) There was an accumulation of dust on the fan guards of the cooling unit and the ceiling inside of the walk in cooler and the walk in dairy cooler. u) The temperature of the water during the wash cycle in the mechanical ware washing machine was 120 degrees F. The data plate that is attached to the machine documented that the water temperature should be 140 degrees F. At the conclusion of the tour, the Account Manager / CDM and the District Manager stated understanding of the concerns. During an interview with the Maintenance Director, on 01/31/22 at approximately 10:00 AM, the Maintenance Director reported that the cooling unit on the outside of the facility that controls the walk-in cooler temperature had stopped working sometime over the night before, due to the cold. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During a follow up interview with the Account Manager / CDM and the District Manager (DM), on 02/02/22 at 10:14 AM, when asked what staff should do when that temperature of the walk-in cooler is elevated, the Account Manager/CDM replied, He called maintenance and he said that nobody was here. Usually they get here between 8:30 and 9:00. When asked of the daily routine for the staff that do the line checks and document the temperatures of the walk-in cooler, the Account Manager/CDM replied, When they come in in the morning, they go in the cooler and look at the thermometer and record the temperature on the log. When asked if the cooler temperature was reported to them after being documented by Staff I-cook, the Account Manager/CDM and the DM replied that it had not been reported. 2. During an observation of the lunch tray line conducted on 02/01/22 at 11:14 AM, the Food Service Director (FSD) calibrated the facility's digital thermometer to check the temperatures of the items on the tray line. The temperature test revealed that the temperature of the spiced pears was 72 degrees Fahrenheit (F). It was noted that the spiced pears were stored in individual bowls on a sheet pan rack cart. The FSD acknowledged that the temperature of the spiced pears were not at the regulatory temperature of 41 degrees F or below or 135 degrees F or above and stated that the spiced pears were to be served at room temperature. When asked about the cooking process, the FSD stated that the spiced pears take 15-30 minutes to prepare. Staff M-Cook, stated that she finished cooking the spiced pears around 5:00 AM - 5:30 AM and that since then, they had been kept in dry storage at room temperature. Review of the recipe titled, Pears, Spiced, documented the following procedures: (1) Drain fruit. (2) Combine brown sugar, margarine, lemon juice, and cinnamon. (3) [NAME] and stir over medium heat until mixture is bubbly. (4) Add pears to sugar mixture. [NAME] uncovered until pears are hot. Stir occasionally. Serve warm or chilled. In an interview conducted on 02/01/22 around 11:30 AM, the FSD and District Manager stated that the spiced pears recipe instructed to serve the pears at room temperature. The surveyor informed the FSD and District Manager that the recipe instructed to serve the spiced pears warm or chilled. When asked, the FSD and District Manager stated that 'serve warm' meant that the spiced pears could be served at room temperature. The District Manager further stated that if the spiced pears were to be served hot, the recipe would say to serve hot and would also specify the temperature (in degrees) that they needed to be served at. The surveyor informed the FSD that the spiced pears needed to be served at the regulatory temperature of 135 degrees F or above or 41 degrees F or below. The FSD asked why and then asked the surveyor to speak with the District Manager. The surveyor then informed the District Manager that the spiced pears needed to be served at the regulatory temperature of 135 degrees F or above or 41 degrees F or below. The District Manager acknowledged the surveyor's findings and stated that the spiced pears needed to be switched out. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 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 105441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Health & Rehabilitation Center 4800 N Nob Hill Rd Sunrise, FL 33351 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 observations, record review, and interviews, the facility failed to correctly document the necessary care and services to 1 of 34 sampled residents, Resident #157, as evidenced by lack of communication between facility staff that ensured physician orders were correctly documented related to application of TED hose for the resident. The findings included: Record review revealed Resident #157 was admitted to the facility on [DATE] with diagnoses that included Peripheral Vascular Disease, Diabetes Type 2 and Hypertension. Further review, revealed a physician's order, dated 01/07/20, to apply knee high TED hose bilateral to lower extremities on in the AM (morning) and off at night. Review of care plan for Resident #157, dated 01/13/22, and titled, Potential for increased skin breakdown, revealed an intervention for 'Knee high TED hose bilateral lower extremities on in the AM and off at night'. TED hose are stockings that help prevent blood clots and swelling in legs. TED hose are a type of compression hose. Observations conducted on 01/30/22 at 11:36 AM; 01/31/22 at 10:43 AM; and on 02/01/22 at 9:53 AM of Resident # 157 revealed him to be lying in his bed with no compression hose on. An interview conducted with the alert and oriented resident on 02/01/22 at 9:55 AM revealed he will wear them, but he can't get them on. It was explained to the resident that the Certified Nursing Assistant (CNA) / staff could put them on for him. Staff P- CNA (Certified Nursing assistant), who was present in the room at the time of the interview, stated they are in the top drawer, but he refuses. This surveyor asked the resident if he would wear the TED hose and he replied that he would and said to the CNA that she could put them on now. Observation of the resident at this time revealed Resident #157 was already dressed and ready to transfer into the chair and it would be difficult to apply the TED hose at this time, so they were not applied. Staff P-CNA was asked if she was informing the nurse that Resident #157 is not wearing the compression hose. She stated that she is not informing the nurse and does not know if the nurse is aware that she is not applying the TED hose. Review of the Treatment Administration Record (TAR) for 01/30/22 and 01/31/22 revealed the nurses were documenting that the resident was wearing the support hose. An interview was conducted on 02/01/22 at 9:48 AM with Resident #157's physician regarding the support hose for the resident. The physician stated that the resident is wearing the support hose for edema and is able to take them off, he is aware that he refuses to wear them, but he was not going to discontinue the order for TEDS hose at this time. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 20 of 20