Inspection·March 10, 2022

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of the facility's census-by-room #'s documentation, dated 03/06/22 revealed that there are five (5) residents currently under quarantine and residing in these rooms, beginning with Resident# 91, Resident #293, Resident #294, Resident #295, and ending with Resident #296, all with a documented diagnosis of COVID + and currently under observation in the facility's North wing Mauve Unit. Resident #293, Resident #294, Resident #295, and Resident #296; were all newly admitted from the hospital as: COVID +. Photographic evidence obtained. During an in-person family interview conducted with the spouse of Resident #91 on 03/07/22 at 1:11 PM, he divulged to this surveyor that his spouse was recently diagnosed as being COVID +, and was currently residing in the facility. However, he further indicated to this surveyor, that this would bother him if the resident's diagnosis were to be publicly identified/broadcasted/exposed, during her illness. Record review revealed Resident #91 was re-admitted to the facility on [DATE] with diagnoses which included Dementia, Hypertensive Heart Disease, Major Depressive Disorder, Generalized Anxiety Disorder and COVID-19. She had a Brief Interview Mental Status (BIMS) score of 11 (moderately impaired). Resident #91 had been transferred over from another unit in this facility as COVID + on 03/03/22. An interview was conducted with Resident #91's nurse, Staff F, a Registered Nurse (RN), on 03/09/22 at 11:18 AM in which she was asked, why was this medical diagnostic information recorded on the bulletin board, in this manner, and she acknowledged that this diagnosis should never have been recorded on the bulletin board for these residents. She was also asked whether or not this information should have been recorded in such a highly visible manner which disregards the resident's rights to privacy and confidentiality and she reiterated, no, absolutely not. An interview was conducted with Resident #91's Staff G, (RN)/Unit Manager, Mauve Unit Room #'s 101-A to 133-B, 03/09/22 at 11:21 AM in which she was asked, why was this medical diagnostic information recorded on the bulletin board in this manner, and she acknowledged that these specific resident rooms should not have been recorded on the public bulletin board. She was also asked if this information should be recorded in such a highly visible manner which disregards the resident's rights to privacy and confidentiality and she further reiterated that this should not have been recorded on the public bulletin in this manner, at any time. Further record review indicates that isolation precautions are in place related to COVID + infection for the resident's diagnosis COVID +, with all pertinent information captured in the facility care plans for each of the residents noted/listed above. The recorded main hallway bulletin board diagnosis of COVID + was not removed, until after surveyor inquisition/intervention. The Director of Nursing (DON) interview on 03/09/22 at 11:25 AM further acknowledged and recognized that Resident #91 as well as the four (4) other resident's residing in the Mauve unit, should not have had their specific medical diagnostic information recorded on the bulletin board, in such a highly visible and public manner, identifying their COVID + status. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105475 If continuation sheet Page 2 of 14 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 105475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Terrace of Delray Beach Nursing and Rehabilita 5430 Linton Blvd Delray Beach, FL 33484 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to transmit the Discharge Minimum Data Set (MDS) Assessment within 14 days after completion for 1 of 1 residents reviewed for MDS Assessment (Resident #1). Residents Affected - Some The findings included: Review of the facility's policy titled, Electronic Transmission of the MDS, documented the following: All MDS assessments and discharge and reentry records will be completed and electronically encoded into our facility's MDS information system and transmitted to Centers for Medicare & Medicaid Services' (CMS) Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing system in accordance with current Omnibus Budget Reconciliation Act (OBRA) regulations governing the transmission of MDS data. Review of the facility's policy titled, Resident Assessment Instrument (RAI) OBRA - Required Assessment Summary, dated October 2019, documented that discharge assessments are to be transmitted no later than 14 calendar days after the MDS completion date. Review of Section A of the Discharge MDS dated [DATE] documented that Resident #1 was discharged to hospice on 11/10/21. During an interview conducted on 03/09/22 at 9:45 AM, the MDS Director stated that Resident #1 was discharged to hospice on 11/10/21 and that his Discharge MDS had been completed. When asked about transmission, the MDS Director reviewed Resident #1's Discharge MDS and stated that his Discharge MDS was still open and had not been transmitted. She then electronically signed and transmitted Resident #1's Discharge MDS in the presence of the surveyor. This showed that the Discharge MDS had not been transmitted until 4 months after Resident #1 had been discharged from the facility. When asked why the Discharge MDS had not been transmitted, the MDS Director stated, I usually leave it open so everyone else can fill in their information, I don't know what happened. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105475 If continuation sheet Page 3 of 14 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 105475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Terrace of Delray Beach Nursing and Rehabilita 5430 Linton Blvd Delray Beach, FL 33484 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** 2) During an initial observational tour conducted on 03/07/22 at 10:13 AM, Resident #38 was noted as having long, dirty, un-trimmed and unkempt fingernails on both hands. Photographic evidence obtained of Resident #38's long, dirty, un-trimmed and unkempt fingernails. Record review revealed Resident #38 was admitted to the facility on [DATE] with diagnoses which included Cerebral Infarction, Occlusion and Stenosis of Unspecified Carotid Artery, Dysphagia and Generalized Muscle Weakness. He had a Brief Interview Mental Status score of moderately impaired. Residents Affected - Few During a brief interview conducted with Resident #38, who is non-verbal, but able to nod his head and use hand gestures, indicated that his fingernails were too long and he also indicated that he had made a staff member aware of this some time ago, but nothing had been done. During a second observational tour conducted on 03/07/22 at 2:20 PM Resident #38 was still noted as having long, dirty, un-trimmed and unkempt fingernails on both hands. During a third observational tour conducted on 03/08/22 at 10:07 AM Resident #38 was still noted as having long, dirty, un-trimmed and unkempt fingernails on both hands. During a fourth observational tour conducted on 03/08/22 2:10 PM Resident #38 was still noted as having long, dirty, un-trimmed and unkempt fingernails on both hands. During a fifth observational tour conducted on 03/09/22 at 10:53 AM Resident #38 was still noted with long, dirty, un-trimmed and unkempt fingernails on both hands. An interview was conducted with the Activities Director on 03/09/22 at 11:28 AM, in which he stated that his department does both fingernail polishing and filing only for both the short-term and long-term male and female residents, every Thursday, at a minimum. The Activities Director stated that he has two (2) activities assistants (both of which are also CNAs), who randomly go throughout the facility to ask the residents if they would like to have fingernail care done. He added that his department is not allowed to cut any of the resident's fingernails. The Activities Director went on to say that the resident's assigned CNA should be cleaning and caring for their fingernails; he stated that if anyone in his department were to see any residents with long, untrimmed fingernails, that they would inform/notify that resident's assigned CNA to let them know to follow-up. The Activities Director revealed that his department had not provided fingernail care service to Resident #38. The Director also acknowledged that Resident #38's fingernails were all long, dirty, untrimmed and unkempt. An interview was conducted with Staff E, a certified nursing assistant (CNA) on 03/09/22 at 12:10 PM, in which she revealed that she had not provided fingernail care to Resident #38, and she acknowledged that it is the responsibility of the CNAs to clean and trim the residents fingernails. She further acknowledged that Resident #38's fingernails were long, sharp, untrimmed, and unkempt. An interview was conducted with Staff F, a Registered Nurse, (RN) on 03/09/22 at 1:52 PM, regarding Resident #38's long, unkempt nails and she also acknowledged that Resident #38's fingernails were long, sharp, untrimmed and unkempt. Record review of Resident #38's Monthly CNA ADL (Activities of Daily Living) Flowsheet Record, dated 03/06/22 thru 03/09/22 revealed that resident's (ADL)s for Personal Hygiene indicated that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105475 If continuation sheet Page 4 of 14 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 105475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Terrace of Delray Beach Nursing and Rehabilita 5430 Linton Blvd Delray Beach, FL 33484 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 resident was signed off as having received full/complete personal care; however, this was not done. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #38's Care plan initiated on 02/11/22, indicated Focus: Self care Deficits requires extensive assistance with grooming, total assistance with dressing, bathing, and toileting. Interventions: Encourage resident to partake in self care .Goal: Resident #38 will improve to groom, dress, bathe and use toilet per extensive assistance of one (1) person. Residents Affected - Few Further record review of the Minimum Data Set (MDS) sections A and G for Resident #38 dated 01/20/22 for Functional Status indicated that the resident requires extensive one (1) person physical assistance. On 03/09/22 at 2:07 PM, an interview was conducted with Staff G, a Registered Nurse/Licensed Practical Nurse Unit Manager (RN/LPN/UM) and with the Assistant Director of Nursing (ADON), for the Mauve Unit, regarding Resident #38's fingernails being long, sharp and untrimmed and agreed that it is the responsibility of the CNAs to clean and trim the residents nails and they further acknowledged that the resident's fingernails were long and that they should have been cleaned/trimmed/cut. On 03/09/22 at 2:10 PM, an interview was conducted with the Director of Nursing (DON) regarding Resident #38's fingernails being long, sharp and untrimmed and she also acknowledged that it is the responsibility of the CNAs to clean and trim the residents nails and she further acknowledged that the resident's fingernails were long and that they should have been cleaned/trimmed/cut. Based on observations, interviews, and record review, the facility failed to provide fingernail grooming for 2 of 2 sampled residents reviewed for Activities of Daily Living (Resident #73 and Resident #38). The findings included: Review of the facility's policy titled, Nail Care, documented the following: Observe condition of resident nails during each time of bathing. Note cleanliness, length, uneven edges, and hypertrophied nails. Review of the Certified Nursing Assistant (CNA) job description documented the following: The CNA is responsible for providing resident care and support in all activities of daily living and ensures the health, welfare, and safety of all residents. Essential duties and responsibilities consisted of providing assistance in personal hygiene. 1. Review of the record documented that Resident #73 was admitted to the facility on [DATE] with diagnoses which included: Hypothyroidism, Hypertensive Heart Disease, and Anemia. Review of Section C of the Quarterly Minimum Data Set (MDS) dated [DATE] documented that Resident #73 had a Brief Interview for Mental Status of 13, which indicated that she was cognitively intact. Review of Section G of the Quarterly MDS dated [DATE] documented that Resident #73 required extensive assistance with one person physical assist for personal hygiene. Review of the Care Plan dated 03/22/21 documented that Resident #73 had a self-care performance deficit due to inability to perform activities of daily living independently. Interventions were to provide nail care as needed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105475 If continuation sheet Page 5 of 14 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 105475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Terrace of Delray Beach Nursing and Rehabilita 5430 Linton Blvd Delray Beach, FL 33484 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an observation conducted on 03/07/22 at 10:36 AM, Resident #73 was observed with fingernails that were about a half inch past the tips of her fingers. Resident #73 stated, I asked someone last week to cut my nails and they said they would but they never came back. During an observation conducted on 03/08/22 at 8:58 AM, Resident #73 was still observed with fingernails that were about a half inch past the tips of her fingers. Resident #73 stated, My nails still need to be cut, they didn't do it yet. During an observation conducted on 03/08/22 at 1:12 PM: Resident #73 was still observed with fingernails that were about a half inch past the tips of her fingers. When asked if anyone attempted to cut her fingernails today she stated, Nope. During an observation conducted on 03/08/22 at 3:45 PM, Resident #73 was still observed with fingernails that were about a half inch past the tips of her fingers. During an observation conducted on 03/09/22 at 8:53 AM, Resident #73 was still observed with fingernails that were about a half inch past the tips of her fingers. During an observation conducted on 03/09/22 at 10:25 AM, Resident #73 was still observed with fingernails that were about a half inch past the tips of her fingers. When asked about her fingernails, Resident #73 stated that she still wanted them cut and that no one had come to cut them. During an observation conducted on 03/09/22 at 12:28 PM, Resident #73 was still observed with fingernails that were about a half inch past the tips of her fingers. When asked if anyone attempted to cut her fingernails today she stated that no one had come to cut them. During an interview conducted on 03/09/22 at 12:35 PM, Staff B, Certified Nursing Assistant (CNA), stated that CNAs were responsible for cleaning residents' fingernails and that activities was responsible for cutting residents' fingernails. When asked what she would do if a resident stated that they wanted their fingernails cut, Staff B stated that she would inform activities so that they could cut the resident's fingernails. She further stated that if she saw a resident's fingernails needed to be cut, she would report it to activities. During an interview conducted on 03/09/22 at 12:36 PM, the Activities Director reported that the CNAs were responsible for cleaning and cutting fingernails. The Activities Director stated that an activity called Pretty Nails was held every Thursday where the activities assistants would file or paint residents' fingernails. He further stated that the activities assistants would go to resident rooms and ask if their fingernails needed to be done. During an interview conducted on 03/09/22 at 12:45 PM, the Director of Nursing (DON) stated that activities was responsible for coloring and cleaning residents' fingernails and that CNAs were responsible for cleaning and filing residents' fingernails. She further stated, If CNAs notice that nails are long during care, they will ask the resident for permission to cut their nails and if they get permission, they would be able to cut their nails. The DON reviewed the Care Plan dated 03/22/21 in Matrix (electronic charting system) with the surveyor and stated that there was no documentation in the Care Plan showing that Resident #73 refused nail care. The DON then reviewed all progress notes dated 01/11/22 - 03/01/22 in Matrix and stated that there was no documentation showing that Resident #73 refused nail care. Subsequent to the interview, and at the request of the surveyor, the DON accompanied the surveyor into Resident #73's room. The DON asked Resident #73 if she wanted her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105475 If continuation sheet Page 6 of 14 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 105475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Terrace of Delray Beach Nursing and Rehabilita 5430 Linton Blvd Delray Beach, FL 33484 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few fingernails cut. Resident #73 stated that she wanted her fingernails cut and that she had been asking staff to cut her nails for the past week and that no one had come to cut them. The DON acknowledged that Resident #73's fingernails were long and needed to be cut. During an interview conducted on 03/09/22 at 1:06 PM, Staff D, Activities Assistant stated that Resident #73 would sometimes refuse nail care. The Activities Director stated that nail care refusals would be documented in the in-room visits in Activity Attendance Sheet. Review of the Activity Attendance of Participation Sheet dated February 2022 showed that there was no documentation that Resident #73 refused nail care. Review of the Activity Attendance of Participation Sheet dated March 2022 showed that there was no documentation that Resident #73 refused nail care. During an interview conducted on 03/09/22 at 1:15 PM, Staff C, Activities Assistant, acknowledged that the Activity Attendance of Participation Sheet for February 2022 and March 2022 did not have any documentation that Resident #73 refused nail care. Staff C stated that activities would not specifically document refusal of nail care during in-room visits in the Activity Attendance of Participation Sheets. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105475 If continuation sheet Page 7 of 14 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 105475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Terrace of Delray Beach Nursing and Rehabilita 5430 Linton Blvd Delray Beach, FL 33484 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and review of policy and procedure, it was determined that the facility failed to 1) secure over-the-counter and prescription medications left at the resident's bedside dresser table/stand for 2 of 97 residents observed, (Resident #30 and Resident #15) 2) facility failed to ensure that it properly disposed of loose resident pill medications in three (3) of six (6) medication carts during a Medication Storage Observation of Medication cart #1 and Medication cart #3 on the Transitional Care Unit (TCU) unit and Medication cart #2 on the Mauve unit; and, 3) facility failed to properly discard an expired stock bottle of liquid Peroxide medication in one (1) of three (3) treatment carts observed, Mauve unit Treatment cart. The findings included: Review of the un-dated facility policy and procedure on [DATE] at 1:23 PM for Medication Storage provided by the (DON) indicated that Purpose: To ensure proper storage, labeling and expiration dates of medications, biologicals, syringes and needles .Guidelines: 2. Facility should ensure that medications and biologicals are stored in an orderly manner in cabinets, drawers, carts .General Storage Procedure: .3.2 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 4. Facility should ensure that medications and biologicals that: (1) have an expired date on the label; . , are stored separate from other medications until destroyed or returned to the supplier .9. Facility should ensure that resident medication and biological storage areas are locked and do not contain non-medication/biological items 13. Bedside Medication Storage: 13.1 Facility should not administer/provide bedside medications or biologicals without physician/prescriber order and approval by the Interdisciplinary Care Team and Facility Administration. 13.2 Facility should store bedside medications or biologicals in a locked compartment within the resident's room. 1) During an observational room tour conducted on [DATE] at 10:02 AM of Resident #30's room, it was noted that there was a partially used over-the-counter (OTC)/Medicated tube of Unipro Barrier Cream consisting of Vitamins A, D and E with an expiration date of 01/2023. The medication tube was observed atop of Resident #30's bedside dresser table/stand, unsecured and accessible to other residents, staff members and visitors. Record review revealed Resident #30 was re-admitted to the facility on [DATE] with diagnoses which included Non-traumatic Intracerebral/Intraventricular Hemorrhage, Psychotic Disorder with Delusions, Major Depressive Disorder, Dementia and Adult Failure to Thrive. He had a Brief Interview Mental Status (BIMS) score of 6 (severely impaired). Photographic evidence obtained of the (OTC)/Medicated tube of Unipro Barrier Cream consisting of Vitamins A, D and E. On [DATE] at 10:23 AM it was noted that there was a used (OTC)/ Medicated Unipro Barrier Cream tube containing Vitamins A, D and E and it was still observed atop Resident #30's bedside dresser table/stand. On [DATE] at 2:22 PM it was noted that there was a used (OTC)/Medicated Unipro Barrier Cream tube (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105475 If continuation sheet Page 8 of 14 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 105475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Terrace of Delray Beach Nursing and Rehabilita 5430 Linton Blvd Delray Beach, FL 33484 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 containing Vitamins A, D and E still observed atop Resident #30's bedside dresser table/stand. Level of Harm - Minimal harm or potential for actual harm On [DATE] at 10:17 AM it was noted that there was a used (OTC)/Medicated Unipro Barrier Cream tube containing Vitamins A, D and E still observed atop Resident #30's bedside dresser table/stand. Residents Affected - Few Further record review of Resident #30's Medication Administration Record (MAR) for the month of [DATE] did not indicate that the (OTC)/Medicated Unipro Barrier Cream tube containing Vitamins A, D and E, was ordered for this resident. 2) During a subsequent observational room tour conducted on [DATE] at 10:07 AM of Resident #15, it was noted that there was a partially used prescription tube of Hydrocortisone 10 cream 1% with an expiration date of 08/21. The medication tube was observed atop Resident #15's bedside table, unsecured and accessible to other residents, staff members and visitors. Record review revealed Resident #15 was re-admitted to the facility on [DATE] with diagnoses which included Malignant Neoplasm Pancreas, Diabetes Mellitus Type II, Atrial Fibrillation, Hypertensive Heart Disease and Major Depressive Disorder. She had a Brief Interview Mental Status (BIM) score of 14 (cognitively intact). (Photographic evidence obtained of partially used prescription tube of Hydrocortisone 10 cream 1% at resident's bedside). On [DATE] at 10:37 AM it was noted that there was a used Hydrocortisone 10 prescription cream 1%, still observed atop Resident #15's bedside table. Record review of Resident #15's Medication Administration Record (MAR) for the month of [DATE] revealed that only Lotrisone Cream 1- 0.05 % (Clotrimazole Betamethasone), was ordered for Resident #15 and not Hydrocortisone 10 cream. An interview was conducted with Staff F, a Registered Nurse, (RN) on [DATE] at 2:10 PM, regarding both tubes of medication cream left at Resident #30 and Resident #15's bedside dresser tables and she acknowledged that neither of these medications should have been left at the bedside. 3) During an initial Medication Storage Observation conducted on [DATE] 12:41 PM with the Assistant Director of Nursing (ADON), for the facility's Transitional Care Unit (TCU) medication cart #1 along with Staff H, a Licensed Practical Nurse (LPN), it was noted that there was one (1), loose, oval shaped white pill located at the bottom of the second drawer in the (TCU) medication cart #1. During a second Medication Storage Observation conducted on [DATE] at 12:52 PM with the (ADON) of the (TCU) medication cart #3 with Staff I, an (LPN), it was again noted that there was one (1), loose, oval shaped white pill located at the bottom of the second drawer in (TCU) medication cart #3. During a third Medication Storage Observation conducted on [DATE] at 1:36 PM with the (ADON) of the facility's Mauve unit Medication cart #2 with Staff F, an (RN) It was noted that there was one (1) and one-half (1/2), loose, oval shaped white pills located at the bottom of the second drawer in the Mauve unit medication cart #2. 4) On [DATE] at 1:24 PM A Medication Storage Observation was conducted with the (ADON) of the Mauve Treatment Cart, and it was noted that there was one (1) , expired stock bottle of Hydrogen Peroxide solution dated 02/2022 located in the bottom drawer of the Mauve Treatment Cart. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105475 If continuation sheet Page 9 of 14 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 105475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Terrace of Delray Beach Nursing and Rehabilita 5430 Linton Blvd Delray Beach, FL 33484 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 On [DATE] at 1:30 PM, simultaneous, individual interviews were conducted with Staff H, an (LPN), Staff I, an (LPN), Staff F, an (RN) and with the (ADON) and all acknowledged that the resident's pill medications should have been promptly discarded along with the expired stock liquid Hydrogen Peroxide bottle solution. The Director of Nursing (DON) further acknowledged and recognized that the medications should not have been left at the resident's bedsides, the pills in the bottom of the medication carts along with the expired liquid medication should have all been promptly discarded; this was not done. Event ID: Facility ID: 105475 If continuation sheet Page 10 of 14 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 105475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Terrace of Delray Beach Nursing and Rehabilita 5430 Linton Blvd Delray Beach, FL 33484 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. Based on observations, interviews, and record review, the facility failed to prepare pureed foods in a safe form for the breakfast meal on 03/08/22 for 9 of 9 residents on pureed diets which affected 2 sampled residents (Resident #20 and Resident #293). The findings included: Review of the facility's form titled Pureed - Dysphagia Level 1 documented the following: The pureed consistency is planned according to the regular consistency, but the texture is modified to a smooth, pudding-like texture for all food items. Pureed recipes are needed for each item that requires addition of fluid and mechanical manipulation to achieve a pudding-like, smooth, lump-free, puree consistency. Review of the approved breakfast menu for pureed diets for 03/08/22 showed that the following item was to be served: pureed sausage patty. Review of the facility's Diet Order Census dated 03/08/22 documented that 9 residents (including 2 sampled residents: Resident #20 and Resident #293) were to receive a pureed texture diet. During an observation of the breakfast tray line on 03/08/22 at 7:40 AM, the pureed food items were observed on the tray line. Closer observation of the pureed sausage patty revealed that the mixture was lumpy and had visible chunks of sausage patty. At the request of the surveyor, the pureed sausage patty was plated. Using a plastic spoon, the surveyor pressed down on the mixture and identified that the lumpy, visible chunks of sausage patty were firm. When asked about pureed diets, the Certified Dietary Manager (CDM) stated that pureed diets should be smooth in texture. The CDM stated that the pureed sausage patty was made by putting the sausage patties into the blender. He further stated, Because it's made from a sausage patty with fillers, there's going to be lumps in it. The only way to get it 100% would be to put it through a strainer. During an interview conducted on 03/08/22 at 1:20 PM, the Director of Rehabilitation stated that the facility had regular diets, mechanical soft diets, and pureed diets. According to her, pureed diets should be smooth in consistency and should not contain any pieces of solids. During an interview conducted on 03/08/22 at 1:29 PM, Staff A, Speech Pathologist, stated that the facility had regular diets, mechanical soft diets, and pureed diets. According to her, pureed diets would be smooth in consistency so that there would be no chewing involved so that it would be easier for a patient with oral dysphagia. When asked if pureed sausage with firm lumps would be considered pureed, Staff A said no. During an interview conducted on 03/09/22 at 8:12 AM, the Dietary Consultant stated that the facility had regular diets, mechanical soft diets, and pureed diets. She stated, Pureed is smooth, almost like baby food consistency. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105475 If continuation sheet Page 11 of 14 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 105475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Terrace of Delray Beach Nursing and Rehabilita 5430 Linton Blvd Delray Beach, FL 33484 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record review, the facility failed to maintain food safety requirements with storage, preparation, and distribution in accordance with professional standards for food service safety which included: failure to maintain sanitary conditions and failure to maintain adequate holding temperatures. The findings included: During the initial tour of the kitchen conducted on 03/07/22 at 8:47 AM, accompanied by the [NAME] Supervisor, the following was noted: 1. Three light bulbs over the dishwashing area were out. 2. A moderate amount of flying black pests that resembled fruit flies were observed in the dishwashing area. 3. One box of Styrofoam cups, 2 boxes of Styrofoam soup bowls, and 1 box of plastic lids were stored on top of plastic milk crates next to the ice machine. The [NAME] Supervisor stated that these items were delivered 3 days ago and acknowledged that they should not have been stored on plastic milk crates that were not designed to be easily cleanable for shelving. 4. One white storage bin containing white powder was missing a label identifying the product. The [NAME] Supervisor acknowledged that a label was missing. 5. In the food preparation area, about 50 plastic lids were loose and stored in a plastic bin that contained an accumulation of debris. 6. In the back food preparation area, a scoop was stored inside of a 22 quart container of brown sugar. 7. Two lights outside the walk-in refrigerator area were out. 8. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105475 If continuation sheet Page 12 of 14 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 105475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Terrace of Delray Beach Nursing and Rehabilita 5430 Linton Blvd Delray Beach, FL 33484 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 Two lights in the food preparation area were out. Level of Harm - Minimal harm or potential for actual harm 9. Residents Affected - Many In the walk-in refrigerator, two packages of a tan/pink food product that resembled meat were missing labels identifying the products and use by dates. Closer observation showed that one of the packages was turning blue. 10. In the walk-in refrigerator, the following items were missing a label identifying the use by dates: 1 tray containing hotdogs and hamburgers, 1 tray containing cheese slices, lettuce leaves, and sliced tomatoes, and 1 tray containing sliced onions and lettuce leaves. 11. In the walk-in refrigerator, two 5 pound bags of lettuce were open and uncovered. Closer observation showed that there was brown liquid in the bottom of the bags. 12. In the walk-in freezer, 1 package containing 2 pizza crusts was open and uncovered. 13. In the dry storage area, one 117 ounce can of Bush's Baked Beans was dented and one 108 ounce can of Pitted Prunes was dented. The [NAME] Supervisor stated that if there was a visible dent, the can was supposed to be moved to the designated cart for dented cans. 14. In the dry storage area, one 50 pound bag of granulated sugar was open and uncovered. 15. In the dry storage area, one 0.5 ounce bag of Classic Lay's chips was opened, empty, and stored on top of food items. 16. In the food preparation area, approximately 50 Styrofoam bowls were stored on a shelf and were not covered or inverted. The [NAME] Supervisor acknowledged that the bowls needed to be covered or inverted. During an interview conducted on 03/08/22 at 7:35 AM, the Certified Dietary Manager (CDM) acknowledged the surveyor's findings. During an observation of the lunch tray line conducted on 03/09/22 at 11:41 AM, the following was noted: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105475 If continuation sheet Page 13 of 14 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 105475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Terrace of Delray Beach Nursing and Rehabilita 5430 Linton Blvd Delray Beach, FL 33484 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 17. Level of Harm - Minimal harm or potential for actual harm At the request of the surveyor, Staff K, Cook, calibrated the facility's digital thermometer. The CDM then checked the temperatures of the cold items on the breakfast tray line. The temperature test revealed that the temperature of the 4 ounce carton of chocolate Mighty Shake (nutritional supplement) was at 53.1 degrees Fahrenheit (F), the temperature of the 4 ounce carton of vanilla ReadyCare (nutritional supplement) was at 49.8 degrees F, and the temperature of the 8 ounce carton of Dairy Pure low-fat milk was at 46 degrees F. It was noted that these items were stored in a plastic bin with ice. Closer observation showed that these items were stored on the left side of the bin where there was not enough ice to cover them. The CDM acknowledged that the temperatures of the chocolate Mighty Shake, vanilla ReadyCare, and Dairy Pure low-fat milk were not at the regulatory temperature of 41 degrees F or below. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105475 If continuation sheet Page 14 of 14