Health inspection·May 17, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm that the meal trays need to be passed out one table at a time but that it is not done. She further said that the trays on the meal cart arrive sporadically with no specific order. In an interview conducted on 05/17/23 at 3:30 PM, with the facility's Director of Nursing, she was informed of the findings. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 2 of 30 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 05/17/2023 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 0583 Keep residents' personal and medical records private and confidential. 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 secure residents' records for 3 of 45 sampled residents (Residents #9, #34, and #83). Residents Affected - Few The findings included: Review of the facility's policy titled Confidentiality of Personal and Medical Records with no date implemented, no date revised, included the following: This facility honors the resident's right to secure and confidential personal and medical records. This includes the right to confidentiality of all information contained in a resident's records, regardless of the form of storage or location of the record. Personal and medical records include all types of records the facility might keep on a resident, whether they are medical, social, fund accounts, automated, or other. Keep confidential is defined as safeguarding the content of information including written documentation, video, audio, or other computer stored information from unauthorized disclosure without the consent of the individual. Paper notes or reminders with resident's personal or medical information shall not be left unattended or viewable by unauthorized persons. 1. Record review for Resident #83 revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Diabetes Mellitus, Bipolar Disorder, Dementia. Review of the Minimum Data Set (MDS) for Resident #83 dated 03/10/23 revealed in Section C the resident had a Brief Interview of Mental Status score of 10, indicating the resident had moderate cognitive impairment. On 05/15/23 at 1:20 PM an observation was made of a Controlled Drug Declining Inventory Sheet for Resident #83 located face up on the wooden desk adjacent to the D-wing nursing station. 2. Record review for Resident #9 revealed the resident was admitted to the facility on [DATE] with the most recent readmission date being 10/20/22 with diagnoses that included: Multiple Sclerosis, Chronic Pain Syndrome. Review of the Minimum Data Set (MDS) for Resident #9 dated 03/03/23 revealed in Section C the resident had a Brief Interview of Mental Status score of 15, indicating the resident had an intact cognitive response. On 05/16/23 at 8:12 AM an observation was made of a Physician's Standard Written Order for a urinary catheter for Resident #9 which was vertical in a horizontal folder on top of a wooden desk located adjacent to the E-wing nursing station (Photographic Evidence Obtained). 3. Record review for Resident #34 revealed the resident was admitted to the facility on [DATE] with the most recent readmission date being 03/22/23 with diagnoses that included: Chronic Obstructive Pulmonary Disease, Diabetes Mellitus, Dysphagia, Depression, Generalized Anxiety Disorder, and Hemiplegia and Hemiparesis Affecting Right Dominant Side. Review of the Minimum Data Set (MDS) for Resident #34 dated 05/14/23 revealed in Section C the resident had a Brief Interview of Mental Status score of 15, indicating the resident had an intact cognitive response. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 3 of 30 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 05/17/2023 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 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete On 05/16/23 at 8:10 AM an observation was made of an admission Record Face Sheet for Resident #34 located face up on the wooden desk adjacent to the E-wing nursing station (Photographic Evidence Obtained). During an interview conducted on 05/16/23 at 9:00 AM with Staff M, Licensed Practical Nurse (LPN) Unit Manager, who was standing next to the wooden desk, he then turned over the admission Record Face Sheet for Resident #34. When asked why he turned the resident's admission Record Face Sheet face down, he stated it is just a reflex. Event ID: Facility ID: 105441 If continuation sheet Page 4 of 30 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 05/17/2023 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 Residents Affected - Some 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Record review for Resident #96 revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Diabetes, Major Depressive Disorder, and Anxiety Disorder. Review of the Minimum Data Set (MDS) for Resident #96 dated 05/06/23 revealed in Section C the resident had a Brief Interview of Mental Status (BIMS) score of 15 indicated the resident had an intact cognitive response. During an observation conducted on 05/14/23 between 11:00 AM to 1:00 PM the exterior door located at the East end of E-wing unit was opened 15 times with a very loud alarm sounding each time the door was opened. An interview was conducted on 05/14/23 at 12:59 PM with Resident #96 who was awake and lying in her bed. When asked if the East E-wing exterior door alarm disturbs her, she said sometimes it does at night. It happens so often that I do not jump every time it goes off like I used to. 3. Record review for Resident #2 revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Insomnia, Hemiplegia and Hemiparesis Following Cerebral Infarction Affecting Right Dominant Side, Diabetes and Major Depressive Disorder. Review of the Minimum Data Set (MDS) for Resident #2 dated 03/10/23 revealed in Section C the resident had a Brief Interview of Mental Status (BIMS) score of 14 indicated the resident had an intact cognitive response. An interview was conducted on 05/14/23 at 1:06 PM with Resident #2, who was sitting in her wheelchair in her room. When asked if the East E-wing exterior door alarm disturbs her, she stated yes it goes off all the time. When asked if it goes off during the night, she stated it is all through the day and several times in the night, it even wakes her up in the middle of the night. An interview was conducted on 05/17/23 at 8:10 AM with the Administrator who stated she has been with the facility for 3 years. When asked which staff enter the building through the East E-wing exterior door, she stated it is only the staff from the maintenance department, the housekeeping department and the laundry department who enter through the East E-wing exterior door. When asked how often those staff members enter through the East E-wing exterior door, she stated all through the day and sometimes at night. When asked if the loud alarm sound that goes off when entering the East exterior E-wing door disturb the residents, she stated, We have to have the alarm to keep the residents safe so they cannot get out. When asked again if the East E-wing exterior door alarm disturbed any of the residents, she did not answer the question. Based on observation, interview, and record review, it was determined that the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly and comfortable interior for 2 of 4 residential wings (D and E Wing), and maintain comfortable sound levels (Resident #2, and #96). The findings included: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 5 of 30 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 05/17/2023 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 Residents Affected - Some 1) During the environmental tours conducted during resident screenings on 05/14/23 and environment tour on 05/15/23 at 1:30 PM accompanied with the Director of Maintenance, the following were noted: D- Wing: D#1: The bathroom floor grout and tiles were heavily stained and in disrepair, razor located on bathroom sink, room floors soiled and stained, and bathroom door exterior in disrepair. D#2: Room floors soiled with areas of black stains , and numerous black scuff marks to room walls. D#3: Bathroom floor grout and tiles heavily stained, room baseboards exterior were soiled and in disrepair, and room couch exterior has several stained areas. D#6: Bathroom floor grout and tiles heavily stained, overbed light cord missing (B Bed), and window blinds were in disrepair. D#7: Entry door exterior in disrepair, room baseboards in disrepair and stained, and room walls in disrepair and peeling paint. D#8: Bathroom floor grout and tiles were heavily stained. D#11: Room base boards were cracked and in disrepair. D#13: Bathroom floor grout and tiles heavily stained, and exterior of over-bed table (Bed A) was cracked and rusted. D#14: Bathroom floor grout and tiles were heavily stained, room base boards in disrepair, and exteriors of overbed tables (X 2) were rusted and in disrepair. D#18: Bathroom floor grout and tiles were heavily stained. D#22: Bathroom floor grout and tiles were heavily stained. Soiled Utility Room: The exterior of the entry door was heavily worn and peeling paint. Kitchen Pantry: The room floor was stained and heavily soiled. E Wing: E#14: Bathroom toilet continuously running. E#19: Bathroom floor grout and tiles heavily stained and worn, room dresser missing drawer handles. E#20: Bathroom floor grout and tiles heavily stained and worn. Over-bed table exterior disrepair with sharp edges. E#21: Bathroom floor grout and tiles heavily stained and worn. E#22: Bathroom floor grout and tiles heavily stained and worn. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 6 of 30 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 05/17/2023 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 Hallway Handrails: The wall hand rail next to room [ROOM NUMBER] was loose and separating from the wall. Following the enviroment tour the findings were confimed with the Director of Mainteance who stated the issues would be discussed with the administration team. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 7 of 30 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 05/17/2023 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined based on their comprehensive assessment that the facility failed to provide necessary care, services and adaptive eating equipment to maintain independence in self feeding for 2 (Resident' #75, and #83) of 11 residents sampled for nutrition review. Residents Affected - Few The findings included: 1) During the observation of the lunch meal on 5/14/23 and 05/16/23 it was noted Resident #75 was being totally fed by CNA (Certified Nursing Assistant) Staff. Observation of the resident noted that she was awake and answering question with some cognitive deficit. The CNA designated the resident as a total feed. A review of the resident's meal tray ticket documented: Soft & Bite Sized Diet - Plate Guard & Right Curved Utensil. The CNA further stated that the adaptive eating equipment is not being used for the resident. The issues was brought to the attention of the Director of Skilled Therapy who stated that the resident would be assessed for the use of adaptive eating equipment. Review of clinical record of Resident #75 noted: Date of admission: [DATE] Diagnoses: Parkinson's Disease , Spastic Paraplegia, Dementia. Current Physician Orders: 3/31/23 - Soft & Bite-Sized (SB6) Diet, Plate Guard, Right Curved Utensil. This diet order and adaptive equipment was revised on 5/16/23. 10/25/22 - MVI with Min QD. 10/25/22- Vitamin C 500 mg QD. MDS: 3/21/23 Sec B: Usually Understood/Understands Sec C: BIMS =5 ( Some Cog Deficit) Sec D: Insomnia, Sec G: Eat = Extensive Assist- One Person Assist Sec K: 62 inches / 148 pounds Therapeutic Diet (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 8 of 30 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 05/17/2023 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 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a second interview with the Director of Skilled Therapy on 5/17/23, she stated the resident was rescreened on 05/16/23 by the Occupational Therapist. The screening revealed that the resident is able to feed self with the use of Plate Guard and Curved Utensil. She further stated that both a Right handed Spoon and Fork should have been sent and that the resident should not be fed by staff but be assisted with the use of the adaptive eating equipment. The Director summitted a copy of the 05/16/23 Therapy Screening. It was further dicussed that the resident's ability to self-feed was being diminished by the staff totally feeding meals without participation of Resident #75. Weight History: 5/4/23 = 141 4/19/23 = 145.9 2/8/23 = 147 Height = 62 BMI= 25.9 Nutrition Progress Notes: 5/10/23 - NO documentation concerning self feeding or use of adaptive eating equipment. 3/19/23 - Requires feeding assistance. Care Plan Review: dated 3/17/23 * Moderate Nutritional Risk < NO documented intervention of use of adaptive eating equipment use with meals. * Self Care Deficit < Requires assistance with eating and requires use of Plate Guard and Built-Up & curved utensils. 2) During the observation of the breakfast meal on 05/16/23 at 8 AM, it was noted the tray was served to the room of Resident #83. A review of the resident meal tray card documented: Pureed, Diabetic, Honey Thick Liquids, and Sippy Cup. It was also documented that all Blenderized Food be provided in Mugs. Further observation of the breakfast tray noted that a Sippy Cup was not on the meal tray and the resident was fed by staff. The blenderized food was in bowls that would not allow the resident to drink from mugs that should have been provided. A second breakfast observation conducted on 5/17/23 at 8:30 AM again noted the tray was served to the room of Resident #83. Observation of the tray noted that only one Sippy cup was provided for 2 tray beverages (Honey Thick OJ and Milk). It was noted that the Thickened OJ was poured into the one Sippy Cup for the resident to drink however, the resident drank the thickened milk from the carton with a straw. The Charge Nurse was informed by the surveyor that a Sippy Cup must be provided for each (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 9 of 30 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 05/17/2023 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 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few tray beverage for drinking, and blenderized foods in mugs for the resident to self feed. The nurse confirmed with the surveyor that the Dietary Department provided only one Sippy Cup for 2 tray beverages. The issue of the lack of Sippy Cups and blenderized foods not being provided on meal trays was discussed with the Corporate Dietitian on 05/17/23 at 9 AM. Photographic evidence was provided to the Dietitian and it was discussed that the Sippy Cups and Food in mugs were assessed for the resident to maintain independent eating ability. The Dietitian confirmed the surveyors findings. During an interview conducted with the Director of Skilled Therapy on 05/16/23 and 05/17/23, it was revealed by the Director that the resident had some ablity to self feed however staff were feeding the resident for all meals, and the resident was losing the ability to participate in self feeding. Review of the clinical record of Resident #83 on 05/17/23 noted the following: Date of admission: [DATE] Diagnoses: Muscle Wasting Atrophy, Hemiplegia/Hemiparesis, Dysphagia. Current Physician orders: 3/31/23: Pureed Diet, Honey Thick Consistency,Blend Foods to Nectar and place in Mugs, Sippy Cup for Beverages MDS: 3/10/23 Sec B: Understood/Understands Sec C: BIMS=10 Sec D: Mood Issues Sec G: * Supervision / Set Up1 Staff Sec K: 69 inches / 171 pounds Mechanically Altered Diet Weight History: 5/5/23 = 170 2/1/23 = 171 1/6/23 = 175 Height = 69 BMI= 25.2 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 10 of 30 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 05/17/2023 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 0676 Nutrition Progress Notes: NO updated note from physician order dated 3/31/23 for the resident to receive Sippy Cup with beverages and blenderized foods in mugs. Level of Harm - Minimal harm or potential for actual harm Care Plan : 3/13/23 Residents Affected - Few * Risk for Nutritional Decline < NO update for Sippy Cups and Blenderized Foods in Mugs. * Self Care Deficit - Asssit With Eating - NO update for Sippy Cups and Blenderized Foods in Mugs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 11 of 30 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 05/17/2023 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 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, interview, and record review, the facility failed to assist during dining for 2 of the 2 sampled residents reviewed for Activities of Daily Living (ADLs) (Resident #68 and Resident #142). Residents Affected - Few The findings included: 1. In an observation conducted on 05/16/23 at 9:10 AM, Resident #68 was noted in her room. Closer observation showed Staff E, Certified Nursing Assistant (CNA), setting up the tray and cutting the food into smaller pieces for Resident #68. In this observation, Staff E stated that Resident #68 could eat independently. Continued observation at 10:30 AM showed that Resident #68 did not eat any of her breakfast tray. No staff was noted in the room. (Photographic evidence obtained). In an observation conducted on 05/17/23 at 9:10 AM, Resident #68 was noted in bed with the breakfast tray in front of her. Staff D, Certified Nursing Assistant, was observed cutting and setting up the breakfast tray for Resident #68. In this observation, Staff D stated that Resident #68 is blind and needs help with her meals. Continued observation at 9:20 AM showed that Resident #68 did not eat any of her breakfast tray, and no staff was noted in the room. (Photographic evidence obtained). A record review showed Resident #68 was admitted on [DATE] with diagnoses of Heart Failure, Dysphagia, and Chronic Pulmonary Edema. The Quarterly Minimum Data Set (MDS) dated [DATE] showed that Resident #68 has a Brief Interview of Mental Status (BIMS) score of 05, which is moderate to severe cognitively impaired. Section G of the MDS for eating showed that Resident #68 needed extensive assistance with one person assists for eating. The care plan, initiated on 01/17/23, showed that Resident #68 is at high nutritional risk due to poor intake, feeding assistance, and a recent weight decline. A review of the weight log showed that Resident #68 was 96 pounds on 03/07/23 and dropped to 91 pounds on 05/04/23. 2. Resident #142 was admitted to the facility on [DATE] with diagnoses of Dehydration, Acute Renal Failure, and Muscle Weakness. The Quarterly MDS dated [DATE] showed that Resident #142 has a BIMS score of 04 which is severe cognitive impairment. Section G, for eating, showed that he needs extensive assistance with one person assist. In an interview conducted on 05/14/23 at 1:00 PM, Resident #142's wife stated that she is concerned about her husband, who is always asleep and is not awake enough to eat or drink. She further said he has a Urinary Tract Infection and was told he is on Contact Isolation. In an observation conducted on 05/14/23 at 1:40 PM, the Resident was noted asleep in the room. In this observation, Resident #142's wife stated that Resident #142 lost 6 pounds recently. She further said she keeps asking the staff to bring him his meals. In an observation conducted on 05/15/23 at 9:35 AM, Resident #142 was noted in his room asleep. At 10:00 AM, no breakfast tray was brought into the room, and the Resident was noted asleep. At 10:30 AM, the Resident was still sleeping, and no breakfast tray was brought into the room. Continued observation showed that breakfast was completed in the G Unit, and all trays were passed out. Reviewing the weights log showed that Resident #142 was 132 pounds on 04/19/23 and dropped to 124.6 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 12 of 30 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 05/17/2023 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 0677 pounds on 05/16/23. That is 5.6% significant weight loss in one month noted. Level of Harm - Minimal harm or potential for actual harm A progress note dated 5/11/2023 showed that Resident #142 noted food falling out of the mouth, poor lip closure, and drooling. He requires continuous reminder cues to swallow and that Nursing will remain supportive and assist with feeding. Residents Affected - Few The Care plan initiated on 03/28/23 showed that Resident #142 is at moderate risk nutritionally, with a reported 25 percent to 50 percent of meal completion. In an interview conducted on 05/17/23 at 3:30 PM, with the facility's Director of Nursing, she was informed of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 13 of 30 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 05/17/2023 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Resident #167 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident was cognitively intact and required extensive 1-2 person assist with activities of daily living. Residents Affected - Few Record review revealed Resident #167 was readmitted to the facility post hospitalization on 04/25/23. A progress note dated 04/26/23 by the wound care nurse (WCN) documented: Post admission skin check of female admitted from acute care hospital with primary diagnosis of AFTERCARE JOINT REPLACEMENT reveals, IV (intravenous) access to right upper arm, indwelling Foley catheter, drain to left knee with frank blood, Negative Pressure [PREVENA - disposable wound vac] Wound Vac Therapy to left knee at 125mmhg draining serous exudate in moderate amount and canister is now half full and is projected to fill up prior to appointment with surgeon on Monday, ace wrap to left leg from above knee to just above toes. A progress note dated 04/27/23 by WCN documented: Negative Pressure Wound therapy in progress on left knee alone with suction drainage disc, ace wrap intact and functioning within normal limits, brace/splint in place. A review of Resident #167's physician orders revealed an order dated 05/02/23 documented: Cleanse surgical incision to left knee with normal saline, pat dry, and apply Granufoam and connect to NEGATIVE PRESSURE THERAPY with wound vac at 125mmhg continuously, change dressing Mondays and Thursdays and PRN (as needed) every day shift for Surgical incision/wound AND as needed for Surgical incision/wound. A review of Resident #167's medication administration record (MAR) revealed the wound vac was documented as not completed by Staff P, a registered nurse on due dates of 05/04/23, 05/08/23, 05/11//23, until the order was discontinued on 05/15/23. A review of Resident #167's physician orders revealed an order dated 05/11/23 for dry dressing changes every day until incision dry every day shift. A review of Resident #167's MAR revealed that the dressing changes were documented as not completed on 05/11/23 and 05/12/23 by Staff P. An interview was conducted with the WCN on 05/17/23 at 10:00 AM. The WCN stated she assessed Resident #167's wound vac after the resident's return to the facility on [DATE], and again on 04/27/23 after the wound vac was changed by the surgeon. The WCN further stated she did not recall doing any dressing changes with the resident's wound vac, and verified there was no correlating documentation. An interview was conducted with Staff P on 05/17/23 at 10:15 AM. Staff P confirmed she documented wound care/dressing changes as not completed. Staff P further stated she did not recall if the wound care/dressing changes were done as ordered for Resident #167. Staff P further confirmed there was no correlating documentation. Based on interview, record review and facility policy review, the facility failed to follow through with physician's order for blood sugar monitoring for 1 of 1 resident reviewed (Resident #162), and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 14 of 30 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 05/17/2023 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility failed to provide wound care as ordered for 1 of 2 residents reviewed for wound care (Resident #167). The findings included: 1. The facility's policy, titled 'Residents' Rights Regarding Treatment and Advance Directives', implemented on 05/09/23, documented the following: 11. Should the resident refuse treatment of any kind, the facility will document the following in the resident's chart: a. What the resident refused. b. The reason for the refusal. c. The advice given to the resident about the consequences of refusing. d. The offering of alternative treatments. e. The continuation of providing all other services. 12. Any servics that would be otherwise required, but are refused, will be documented in the resident's comprehensive care plan. Resident #162 was admitted to the facility on [DATE]. According to the resident's most recent assessment, a Significant Change Minimum Data Set (MDS), dated [DATE], Resident #162 had a Brief Interview for Mental Status score of 15, indicating 'cognitively intact'. Resident #162's diagnoses at the time of the assessment included: Hypertension, Peripheral Vascular Disease, Diabetes Mellitus, Arthritis, Osteomyelitis, Cellulitis of left toe, Candidal Stomatitis, Abnormalities of gait and motility. Documentation by facility nursing staff described Resident #162 as alert and oriented times three. Resident #162's orders included: Metformin HCI Tablet 1000 Mg - give one tablet by mouth two times a day for Diabetes - 12/23/22. Insulin Glargine Solution - Inject 20 units subcutaneously at bedtime for Diabetes related to Type 2 Diabetes Mellitus with foot ulcer - 12/24/22. Humulin R Solution 100 unit/Ml (Insulin Regular Human) - inject per sliding scale subcutaneously one time a day for Diabetes related to Type 2 Diabetes Mellitus with diabetic neuropathy - 04/25/23. Humulin R Solution 100 unit/ml (Insulin Regular Human) - inject per sliding scale before meals and at bedtime - 12/22/22 with an end date of 04/24/23. Resident #162's care plan, initiated on 12/23/22, documented, (Resident) has Diabetes Mellitus. The goals of the care plan included: * Resident will be free from any s/sx of hyperglycemia through the review date - with a target date (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 15 of 30 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 05/17/2023 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 0684 of 06/30/23. Level of Harm - Minimal harm or potential for actual harm * Resident will have no complications related to diabetes through the review date - with a target date of 06/30/23. Residents Affected - Few * Resident will be free from any s/sx of hypoglycemia through the review date - with a target date of 06/30/23. Interventions to the care plan included: * Diabetes medication as ordered by doctor. Monitor/document for side effects and effectiveness. * Dietary consult for nutritional regimen and ongoing monitoring. * Educate regarding medications and importance of compliance. Have resident verbally state an understanding. * Fasting Serum Blood Sugar as ordered by doctor. * If infection is present, consult doctor regarding any changes in diabetic medications. A review of Resident #162's Mediation Administration Record (MAR) for the month of April, 2023, showed that staff documented that resident refused to have blood sugar measurements taken via Accucheck (fingerstick method) every morning since the order was written to start on 04/25/23. Review of Progress Notes beginning on 04/25/23 revealed the following: On 04/26/23 at 06:38, Resident is AAOX3 (alert and oriented times 3), refused to have blood sugar check at this time stated he is going to have his DR stop AM BS. Resident #162 had a blood glucose reading of 100 on 05/09/23. The Medication Administration Record showed on that day that the resident refused to have blood sugar checked. During an interview, on 05/16/23 at 11:10 AM with Staff J, LPN, when asked what is done when a resident's vital signs are taken, Staff J replied, temperature, respiration, bp (blood pressure) pulse, pain level and oxygen, accucheck for diabetic residents When asked about monitoring blood sugars for Resident #162, Staff J replied, With him, I don't check on my shift I don't have an order on my shift to check it. He refused his accuchecks when on my shift and would say that his level are always fine. I spoke with the doctor, and he decreased the times that we were doing the accucheck. When he refuses, it should be in a progress note. During an interview, on 05/16/23 at 2:37 PM, with Staff O, LPN, when asked about taking residents' vital signs, Staff N replied, BP, (blood pressure) pulse, respirations, temperature, O2. Staff N further stated that taking vital signs does not include blood sugars unless there is an order. During an interview, on 05/17/23 at 7:51 AM, with Staff K, LPN, when asked about monitoring Resident #162's blood sugar, Staff K replied, he refuses blood sugars, he is alert and oriented time 3. He says that he doesn't want to do the morning one. When he came, he was low around 96 to 98. In the daytime he has it done when he eats. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 16 of 30 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 05/17/2023 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview, on 05/17/23 at 8:30 AM, with Staff N, LPN, when asked about the protocol for residents refuse to have vitals and blood sugars checked, Staff M stated that she would document it in the residents' record. Staff M further stated that she would reapproach the resident and try again and document it in the residents' record. During a follow up interview with Resident #162, on 05/17/23 at 9:10 AM, when asked about refusing accuchecks, Resident #162 replied, I was told that they were going to stop doing the Accuchecks because my fingers were turning black. When asked who had told him they were going to stop, Resident #162 replied, by one of the nurses, I don't recall who, around April early (first couple of weeks in April) I don't get insulin before breakfast, I get metformin after breakfast, and they did an A1C blood test this morning. It has always been a little on the high side, but not exceptionally high. Resident #162 further stated that the nurses do not offer or attempt to take blood sugars and that he had never refused vitals and/or accuchecks. There was no documentation of staff attempting to educate the resident on the risk of refusing vital signs and blood sugar levels and no documentation of staff attempting to reapproach the resident after refusing. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 17 of 30 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 05/17/2023 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 0712 Ensure that the resident and his/her doctor meet face-to-face at all required visits. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure that residents are seen by a physician at least every 60 days for 2 residents reviewed for physician's services (Resident #69 and #145). Residents Affected - Few The findings included: 1. Record review for Resident #69 revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Ulcerative Colitis, Anxiety Disorder, Bipolar Disorder, Major Depressive Disorder, Generalized Anxiety Disorder, Insomnia, Acute Pain Due to Trauma, and Dysphagia. Review of the Minimum Data Set (MDS) for Resident #69, dated 04/27/23 revealed in Section C a Brief Interview of Mental Status (BIMS) score of 13 indicating the resident had an intact cognitive response. Record review for Resident #69 revealed the resident was not seen by a physician, physician assistant, nurse practitioner, or clinical nurse specialist from 01/11/23 to 04/24/23 (greater than 60 days). 2. Record review for Resident #145 revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Cerebral Infarction, Unspecified Psychosis Convulsions, Diabetes, Anorexia, Major Depressive Disorder, Dysphagia, Dementia, Generalized Anxiety Disorder, and Pain. Review of the Minimum Data Set (MDS) for Resident #145, dated 03/09/23 revealed in Section C a Brief Interview of Mental Status (BIMS) could not be performed due to the resident is rarely/never understood. Record review for Resident #145 revealed the resident was not seen by a physician, physician assistant, nurse practitioner, or clinical nurse specialist from 11/26/22 to 03/06/23 (greater than 60 days). During an interview conducted on 05/16/23 at 1:20 PM with the Director of Nursing (DON) who stated she has been with the facility since 2/13/23. When asked how often a resident is required to be seen by the Physician or Nurse Practitioner, she stated the resident needs to be seen for a visit at least once a month by the physician or nurse practitioner. When asked about the physician for Resident #69 and #145 (same physician for both residents), she stated he is in the facility at least twice a week. She went on to say if the attending physician for any resident is not seeing the resident at least once a month, they try to contact the physician to inform them that the resident needs to be seen. If they are unable to contact the attending physician, the Medical Director will be notified, and the Medical Director could take over and visit the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 18 of 30 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 05/17/2023 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record and policy review, the facility failed to store and dispose of medication in a secure manner affecting 2 of 7 residents observed during medication administration (Residents #46 and #116). The findings included: The facility's policy titled Storage of Medications and Biological Products dated 3/22 stated All medications and biological products will be stored in locked compartments under proper temperature controls. The facility's policy titled Destruction of Expire or Discontinued Medications dated 7/21 and revised 3/22 stated Wasted single doses of medication for disposal should be disposed of in a manner that limits access to them by unauthorized personnel or residents. On 05/14/23 at 9:53 AM, Staff A, Registered Nurse (RN) was observed during a medication administration pass. As Staff A was preparing medication for Resident #116, a Lasix 20 milligram (mg) pill popped out of the bingo card and fell onto the top of medication cart. Staff A picked up the Lasix pill and placed it in the garbage can attached to the cart. Lasix is a diuretic and packaged in a card called a bingo card. This surveyor asked Staff A if that was the policy of the facility to place wasted pills in the garbage can and she replied that it was not. She stated that it was supposed to be put in a plastic bag and destroyed with a chemical to dissolve the pill. On 05/14/23 at 9:59 AM, Staff A prepared medication for Resident #46. While preparing the medications, Staff A left her cart, did not lock it, and walked into the resident's room. There was a housekeeper in the hallway at that time. Staff A came out of the room [ROOM NUMBER] seconds later and finished preparing Resident #46's medication. She went in the room again to administer the medications. She placed the medication that was in separate paper souffle cups on the resident's bedside table which was in front of him while he was in bed. She walked away to sanitize her hands for 15 seconds and did not look at the pills which were in front of the resident. Also in the room were the resident's roommate and a visitor. At 10:25 AM, this surveyor asked Staff A to look again at the order for Gabapentin which said to give two pills. She stated that she gave one instead of two and walked back into the resident's room to give another Gabapentin. She left the keys to the medication cart in the cart lock when she walked into the resident's room to give the other Gabapentin. Discussed with Staff A if she should have left her keys in the cart and unlocked and she responded that she was not supposed to. Discussed with the Director of Nurses on 05/15/23 at 1:50 PM. She stated that Staff A should not have left her cart unlocked, she should not have left medication unattended in front of a resident, and should not have thrown medication in a garbage can. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 19 of 30 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 05/17/2023 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, it was determined that the facility failed to prepare pureed foods by methods that conserve nutritive value, flavor, and appearance that potentially affected 7 of 31 residents with physician ordered Pureed Diet (Residents #83, #110, #114, #120, #132, 135, and #248). Residents Affected - Few The findings included: During the initial kitchen/food service conducted on 05/14/23 at 8:45 AM accompanied with the [NAME] (Staff H), it was noted numerous pans of cooked left over foods were in Reach-in refrigerator #1 that included: Third Pan Pureed Vegetables: 30 portions : Soupy Consistency (Dated 05/14/23). Half Pan of Cooked Spaghetti- 30 portions (Dated 05/11/23). Half Pan Cooked Chicken Legs - 20 portions (No date). Half Pan of Cooked French Toast - 20 portions (Dated 05/14/23). Half Pan Cooked Scrambled Eggs - 25-30 portions (Dated 05/14/23). Half Pan Cooked Hamburger Patties: 20 portions (Dated 05/12/23). 1) Further observation and interview with Staff H noted the pan of vegetables to be slightly warm. Staff H stated that the pan consisted of Pureed Broccoli (25 portions) that was thoroughly cooked at approximately 6 AM, then pureed, then placed into the reach-in refrigerator. Staff H proceeded to state at approximately 10 AM the pan of pureed Broccoli is then reheated, and then placed on the hot steam table until lunch meal service at approximately 11:30 - 12 PM. Further interview with Staff H revealed that he was unaware that prolonged cooking and heating of vegetables would result in vitamin, mineral, nutrient loss and as well as appearance , taste ,and palpability. Staff H stated that he has never been trained or in-serviced concerning the proper techniques of cooking vegetables to maintain nutrient level, taste, and appearance. He stated that pureed vegetables are prepared the same way on a daily basis. * On 05/14/23 at 12 PM the surveyor requested to taste the pureed Broccoli on the steam table that was intended for the lunch meal. The vegetable were of a thin soup consistency and were off green in color. The taste test noted no flavor of a broccoli vegetable. Staff H declined to taste the pureed Broccoli with the surveyor at his request. A meeting was held to review the pureed vegetable with the Consultant Dietitian on 05/15/23. The Dietitian stated that staff cooks have been in-service on proper preparation of regular and pureed vegetables but refuse to change their food preparation habits . 2) During the continued interview with Staff H on 05/14/23 at 9 AM, it was revealed the left over cooked French Toast, would be pureed, re-cooked, and reserved to purred diets on 05/15/23. The surveyor requested that the leftovers be discarded and fresh food be prepared and served to residents with physician ordered Pureed Diets. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 20 of 30 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 05/17/2023 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 3) During the continued interview with Staff H on 05/14/23 at 9 AM, it was revealed the leftover chicken , beef, scrambled eggs, and beef patties would be pureed, re-cooked, and reserved to residents with physician ordered pureed diet during the week on 05/14/23. The surveyor requested that the leftovers be discarded and fresh food be prepared and served to physician ordered Pureed Diets. A review of the facility Diet Census for 05/15/23 noted that there were currently 31 residents with a physician ordered pureed diet of which many were assessed to be at nutritional risk that included sampled Residents #83, ##110, ##114, #120, #132, #135, and #248. * Photographic evidence was obtained of all left over foods noted on 05/14/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 21 of 30 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 05/17/2023 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined that the facility failed to prepare pureed foods in a safe and proper form for 7 of 31 sampled residents on puree diets (Residents #83, #110, #114, #120, #132, 135, and #248) and failed to provided thickened liquids as per physician order for Resident #120. The findings included: 1) Observation of the approved menu for the lunch meal of 05/16/23 noted Pureed Diet (PU4) were to receive 4 oz Pureed [NAME] (PU4) and 4 oz of Pureed Vegetables (PU4) . During the observation of the lunch meal in the main kitchen on 5/16/23 at 11:45 AM , it was noted that the Pureed [NAME] and Pureed Vegetable to be sticky, grainy, and to have pieces of food that were visible to the naked eye. At the request of the surveyor the pureed rice and vegetables were tasted to ensure a smooth consistency. The test revealed that there were large pieces of the rice grain and vegetables in the pureed mixture. Interview with key staff noted that the cook (Staff H) failed to taste pureed foods on a daily basis to ensure that the pureed mixture was smooth and free of piece of foods. Further interview with Staff H on 05/16/23 noted that he was unaware that the all pureed foods are required to be smooth in consistency for residents with diagnoses of Dysphagia. Further stated no training on the preparation of pureed foods. The surveyor requested that the Pureed [NAME] and vegetables be further pureed until the proper consistency was obtained prior to serving. Following the observation the surveyor requested a copy of the Pureed PU4 Diet from the facility's approved diet manual from the Director of Skilled Therapy and the Speech Therapist. On 05/17/23 the Director of Skilled Therapy submitted a copy of the Pureed Level 4 Diet form the Eat Right -Nutrition Care Manual that had been designated for use by the facility. A review of the Pureed Level 4 Diet noted documentation that the diet is prescribed for residents with chewing or swallowing of food. The diet requires a texture of foods that are smooth and lump free and should not be firm or sticky. A review of the Food Group - Grains, documented that [NAME] is not recommended for Pureed PU4 Diet. Further interview with the Director noted that she and the Speech Therapist was unaware that pureed rice was being served to residents with physician ordered Pureed PU4 Diet. A review of the facility's Diet Census for 05/16/23 noted that there were currently 31 residents with physician ordered Pureed PU4 Diet. Of the 31 residents it was noted that it included Sampled Residents #83, #110, #114, #120 , #132, #135 , and #248. 2) During the observation of the breakfast meal on 05/16/23 at 8:45 AM, it was noted that the meal tray was delivered to the room of Resident #120. A review of the resident's meal tray ticket at the time of the observation noted : Pureed Diet (PU4), Honey Thickened Liquids. Observation of the meal noted regular orange juice (4 ounces) , whole milk (8 ounces) , and coffee (8 ounces). Continued observation noted that none of the fluids were thickened to Honey consistency and the CNA in the room stated that the fluids are required to come from dietary pre-thickened except for the coffee. The CNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 22 of 30 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 05/17/2023 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some stated that she will have to thicken the liquids with powdered packaged thickener. Further observation noted that the resident thickened the 3 beverages with 2 packages of the powdered thickener. A review of the Thick & Easy Beverage Thickening Powder noted directions that a whole package of thickener needs to be added to 4 ounces of liquid. Following the observation it was discussed with the D Wing Charge Nurse that an insufficient amount of thickener was used for the beverages of Resident #120. It was discussed that a total of 5 packets of the thickener need to be used that included; juice (1 packet), milk (2 packets), and coffee (2 packets). The Charge Nurse stated that all beverages on meal tray were to come from dietary department pre-thickened to their respective thickening order. It was also discussed that the resident's personal refrigerator contained 4 -8 ounce containers of juice that were not thickened to Honey consistency. During a meeting with the facility's Registered Dietitian, Diet Technician, and Corporate Food Manager on 05/16/23 at 11 AM, it was noted that all beverages should have been purchased pre-thickened and powdered thickener should not be utilized. A review of the facility's policy for Thickened Liquids (Implemented, 10/15/22 and Revised 03/10/23) noted the following: Policy - The facility provides commercially-prepared thickened liquids , as prescribed, to residents who require them. #7 (a) - Do not thicken liquids in the facility, even with products designed for this purpose. Use only pre-thickened commercially prepared liquids in the desired consistency. Interview with the Director of Skilled Therapy on 05/15/23 noted that she was unaware that nursing staff was thickening liquids within the facility and further stated that the facility requires only the use of commercially prepared thickened liquids. Review of clinical record of Resident #120 on 05/16/23 noted the following: Date of admission : re-admission [DATE] Diagnoses: Dysphagia, Alzheimer's Disease Current Physician Orders: 3/31/23: Pureed Diet - Honey Thick Consistency 10/25/22 - Resource 2. 0 120 ml TID 11/11/22 - Health Shake BID 3/13/23 - Fortified Foods Q Monday/Wed/Fri 3/12/23 - Fortified Cereal Every Day * Review of resident's breakfast meal tray card on 05/16/23 noted no documentation of the Fortified Cereal and was not included on the resident's meal tray. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 23 of 30 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 05/17/2023 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 0805 Current MDS: 2/21/23 Level of Harm - Minimal harm or potential for actual harm Sec B: Sometimes Understood/Understands Sec C: NO BIMS-resident does not understand Residents Affected - Some Sec K: 69/102 #-Weight Loss - not prescribed Mechanically Altered Diet Weight History: 5/5/23 = 107 4/5/23 = 107 2/28/23 = 105 2/7/23 = 108 BMI= 15.9 Height = 69 Nutrition Note : 3/11/23: Progressive decline. Pureed diet with Honey Thick Liquids and Fortified Cereal every morning. Review of Current Care Plan * High Risk for Nutritional Decline > Provided as order liquids to Honey < Fortified Cereal Every Day 3. A record review showed that Resident #149 was admitted to the facility on [DATE] with diagnoses of Dementia, Anxiety, and Obstructive Pulmonary Disease. The Quarterly Minimum Data Set (MDS) dated [DATE] showed that Resident #149 is severely cognitively impaired. Section G for eating showed supervision with set up only. A diet order was noted for Soft & Bite-Sized SB6 texture, Regular/Thin consistency, dated 03/31/23. In an observation conducted on 05/15/23 at 9:52 AM, Resident #149 was in Unit G's dining room, eating her breakfast tray independently. Closer observation showed a meal tray with scrambled eggs, a cut-up bite-size biscuit, and a large piece of hashbrown that was not cut into bite-size pieces. 4) A record review showed that Resident #144 was readmitted to the facility on [DATE] with diagnoses of Pulmonary Disease and Diabetes. The annual MDS dated [DATE] showed that Resident #144 has a Brief Interview of Mental Status (BIMS) score of 03, which is severe cognitive impaired. Section G for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 24 of 30 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 05/17/2023 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the MDS showed for eating, Resident #144 is with supervison and set up only. A diet order was noted for Soft & Bite-Sized SB6 texture, Regular/Thin consistency, dated 03/31/23. In an observation conducted on 05/15/23 at 9:38 AM, Resident #144 was in Unit G's dining room, eating her breakfast tray independently. Closer observation showed a meal tray with scrambled eggs, a cut-up bite-size biscuit, and a large piece of hashbrown that was not cut into bite-size pieces. In an interview conducted on 05/17/23 at 10:09 AM with Staff C, Speech Language pathologist, she was asked by the Surveyor to explain the Soft & Bite-Sized SB6 texture, Regular diet. She stated that this is a level 6 diet that has a soft bite-size consistency. Everything on the plate needs to be cut up to bite size pieces. Staff C reported that the meals should come out of the kitchen cut up already, especially the bread and the vegetables. In an interview conducted on 05/17/23 at 3:30 PM, with the facility's Director of Nursing, she was informed of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 25 of 30 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 05/17/2023 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined that the facility failed to follow physician orders for 2 (Resident's 147 and #248) of 2 residents with physician ordered Fluid Restriction diets (Residents #142 and #248). The findings included: 1) Observation of the breakfast meal on 5/16/23 at 8 AM, noted the meal tray served to the room of Resident #147. Review of the meal tray ticket at the time of the observation noted Renal/Diabetic Diet. Further observation noted that the tray was to include Apple Juice (4 ounces) and Whole Milk (8 ounces), however the fluids were not included on the tray and no water was noted to be at bedside. Further review noted that the meal tray ticket did not document a physician ordered Fluid Restriction. Interview with the Certified Nursing Assistant in the room stated the resident received dialysis and the fluids were taken off the tray. The issues was discussed with the D Wing Charge Nurse who stated she was unaware that the tray fluids were being removed from the resident meal tray. Review of clinical record of Resident #147 noted the following: DOA: 5/1/23 Diagnoses: Diabetes, Pulmonary Disease, Fluid Overload, Altered Mental Status, and Chronic Kidney Disease Current Physician Orders: 5/2/23 ; Renal Diet, Diabetic Diet, 5/3/23 : Dialysis -M/W/F 5/2/23 : 1000 ml Fluid Restriction Nursing = 540 ml Dietary = 460 ml Current MDS: 5/4/23 Section C; BIMS Score=9 Section G: Supervision with Eating Sec K: 66/152# Therapeutic Diet Assessment : (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 26 of 30 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 05/17/2023 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 0808 5/10/23 - dehydration: Level of Harm - Minimal harm or potential for actual harm 5/2/23 - Nutrition: Nutritional Risk - Fluid Rest/therapeutic diet Residents Affected - Few * No Breakdown of Fluid Restriction for dietary meals. 5/16/23 : Maintain Fluid Rest - Fiction Nursing: 540 (240/240/60) Dietary : 460 ML * No Breakdown of fluid restriction of dietary meals. Interview with the facility's Registered Dietitian and Registered Diet Technician on 5/16/23 noted the dietary allotment of 460 ml /day was not broken down for the amount the resident was to receive for the Breakfast, Lunch and Dinner meals. Further stated that the resident selects and receives own desired fluids amounts and it is unknown how much fluids the resident is being server on the meal trays. 2) During the observation of the breakfast meal on 05/16/23 at 8:30 AM, it was noted that the meal tray was served to the room of Resident #248 . Further observation noted the resident's meal tray ticket to document 1200 ml Fluid Restriction - 8 oz. Further review of the ticket noted: 8 ounces (240 ml) 2% Nectar Milk 4 ounces Nectar (120 ml) Apple Juice 8 ounces (240 ml) Nectar Whole Milk Total amount of fluids documented on the meal tray card and fluids served on the breakfast meal tray were 600 ml. Interview with the facility's Dietitian and DTR following the observation noted to state the the fluids documented on the resident's meal tray card were incorrect and have not been properly documented as per the amount of fluids to be served with the B/L/D meals. It was also discussed that an incorrect amount of fluids was served for the breakfast meal as 240 ml was to be served and 600 ml was actually served. Reviews of the clinical record of Resident #248 noted the following: Date Of admission: [DATE] (readmission) Diagnoses: Diabetes, Protein-Calorie Malnutrition, and Dependence of Renal Dialysis. Current MD Orders: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 27 of 30 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 05/17/2023 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 0808 5/16/23 - Nepro 240 ml BID - Nutritional Support Level of Harm - Minimal harm or potential for actual harm No documentation that the 480 ml of Nepro was part of the 1200 ml Fluid Restriction 5/12/23 - Diabetic/Pureed Residents Affected - Few 5/13/23: Proheal 30 ml QD NO documentation of the 30 ml was part of the 1200 ml Fluid Restriction 5/12/23 - Dialysis - M/W/F 5/13/23 - Renal-Vite (B and Folic ) Q-Nutrition Supplement Current MDS : 4/22/23 - Discharge/return Sec C: BIMS=14 Sec G: Supervision when eating * Staff state resident must be fed by staff Sec K: 68 inches / 204 pounds Therapeutic Diet Nutrition Assessment : 5/15/23 Diet : Pureed /Diabetic, Nectar * NO Documentation of Fluid Restriction - NO Dietary/Nursing Allotment of the 1200 ml Fluid Restriction. NO documentation of how much fluid was to be provided on the breakfast, lunch, and dinner meal trays. Current Care Plan: * Nutritional Risk : 4/12/23 Updated 5/15/23 - No documentation of the physician ordered Fluid Restriction. * ESRD No documentation of the physician ordered Fluid Restriction. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 28 of 30 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 05/17/2023 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to conduct appropriate infection surveillance testing of staff for Covid-19 in accordance with national standards and facility's policy during current outbreak of Covid-19. Residents Affected - Some The findings included: Review of the facility's policy titled Coronavirus Testing with a revised date of 03/06/23 included the following: The facility will implement testing of facility residents and staff, including individuals providing services under arrangement and volunteers, for Covid-19. Individuals with signs and symptoms of Covid-19 should be prioritized first when tested, then perform testing triggered by an outbreak investigation as follows: Testing Trigger - Newly identified Covid-19 positive staff or resident in a facility that is unable to identify close contacts. Staff - Test all staff, regardless of vaccination status, facility wide or at a group level if staff are assigned to a specific location where the new case occurred (e.g., unit, floor, or other specific area(s) of the facility). Under the heading of Testing of Staff and Residents in Response to an Outbreak Investigation , it included: Upon identification of a single new case of Covid-19 infection in any staff or residents, testing will begin immediately (but not earlier than 24 hours after the exposure, if known). Outbreak testing will be performed either through contact tracing or broad-based (e.g., facility-wide) testing. The facility may choose to conduct focused testing based on known close contacts if they can identify close contacts of the individual with Covid-19, but if the facility does not have the expertise, resources, or ability to identify all close contacts, the facility should investigate the outbreak at a facility-wide or group-level. If an expanded testing approach is taken and testing identifies additional infections, testing should be expanded more broadly. If possible, testing should be repeated every 3-7 days until no new cases are identified for at least 14 days. Review of the Covid Testing Sign In Sheets for the week of 05/07/23 to 05/17/23 revealed 163 out of 339 employees were tested, and of the 163 employees tested on ly 35 were tested twice. During an interview conducted on 05/17/23 at 9:25 AM with the Director of Nursing/Infection Preventionist (DON/IP) and the Staff Developer/Infection Preventionist in Training (SD/IP in training), they stated they both work full-time. The SD/IP in training stated they are currently in an outbreak of Covid-19 status as of 05/04/23 when a resident had symptoms of fever and aches and tested positive for Covid, and the roommate also tested positive for Covid on 05/04/22 as well. The DON/IP stated that on 05/04/23 they tested the entire F-wing (where the 2 positive residents were) and they notified the Epidemiologist at the Department of Health, who agreed with their plan to test all staff/residents for Covid twice a week. On 05/05/23, all staff and all residents in the facility were supposed to be tested. The DON/IP stated they conduct Covid testing per guidelines, and outbreak mode includes testing all residents and testing all staff members twice a week (Sunday to Saturday) and the testing continues until there is no positive residents/staff members for 14 days. Each staff member is supposed to be tested twice a week (Tuesdays and Thursdays). The night shift tests themselves and have been trained to do so. The DON/IP stated that sometimes we do not test all staff, some are PRN (as needed) or on vacation, and then they need to show a negative test result before returning to work. The DON/IP also stated the staff members who have not been tested are tested by the unit managers who have been trained on how to perform covid test. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105441 If continuation sheet Page 29 of 30 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 05/17/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete When asked how they ensure that all staff members are tested twice a week, they both stated we have the assignment sheet for the day of testing, and we test all those staff members. When asked again how they ensure they are testing all staff members twice a week the SD/IP in training stated they could compare the assignment sheets to the employee roster. When asked if they think the system they are using is working effectively, the DON/IP stated it could be a little more precise to ensure they capture all the staff including the PRN and staff who may be out for various reasons. She then went on to say we have a large building and a lot of staff. When asked who is responsible for making sure all the staff are tested twice a week during outbreak testing, she said she is the DON/IP and ultimately, she is responsible. Event ID: Facility ID: 105441 If continuation sheet Page 30 of 30