Inspection·September 23, 2022

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the room had a resident in room and room floor remained with debris and garbage in corner of room that was observed prior to new admit. room [ROOM NUMBER]-D: The floors had debris all over the floor. room [ROOM NUMBER]: Was unoccupied and had clean linen on bed, closet was full of the previous resident's belongings of briefs, towels, and socks, an opened liquid soap in bathroom, walker, fan, wheelchair footrests on floor, and fake flowers on the side table by window. A pill was observed on floor. the room became occupied with a new admit / resident on 09/22/22 and what was observed prior to the room being occupied remained in room after newly admitted resident occupied room. The newly admitted resident was asked if walker was hers and she stated no. room [ROOM NUMBER]-W: The resident stated he has seen roaches in his room this past Saturday. None were observed by surveyor, but the surveyor did observe a live lizard running around room. The resident stated the toilet has not been cleaned in days, and the curtain between beds is stained. room [ROOM NUMBER]-P: The floors were dirty and stained, and the wheelchair back rest was torn. room [ROOM NUMBER]-W: The wheelchair arm rests were torn on both sides. On 09/19/22 at 1:50 PM, a wheelchair with two broken armrests, (one armrest wrapped with a dirty ACE wrap to keep the padding on) was identified in room [ROOM NUMBER] by the resident's family. The wheelchair was removed and shown to the Regional Nurse who readily acknowledged the issue and removed the wheelchair from the floor to dispose of it. On 09/23/22 at 11:52 AM, the wall molding behind the resident's bed was observed to be attached only by the paint at the top of the wood and ready to fall off the wall. 300 Unit: On 09/20/22 at 10:30 AM, in room [ROOM NUMBER], the floor between the window and bed and the floor between the first bed and the bathroom, as well as the base molding, were dirty. On 09/21/22 at 9:45 AM, the bathroom side of the door had something dried on it and both handrails in the bathroom were covered with rust. The Director of Environmental Services was present and verbalized the entire floor needed to be stripped and redone. On 09/21/22 at 10:18 AM, the grab bars in the bathroom of room [ROOM NUMBER] were found to be rust covered. The siderail on the window side of the resident's bed was found to be rusty and dirty. The tube feed pole was full of rust and the legs of the pole were dirty with unknown dried liquids. The floor around the tube feed pole was also dirty and the base molding and wall were dirty and damaged. 100 Unit: On 09/21/22 at 12:55 PM, the hand grip / padding on one of side rails of bed 127W was found to be deteriorated to the point of it being all sticky and in a condition that could not possibly be disinfected. The other side rail on the same bed had rust and another unknown substance. Photographic Evidence Obtained of all issues described above. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 2 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0609 Level of Harm - Minimal harm or potential for actual harm Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on interview, record review and policy review, the facility failed to report an alleged resident to resident act of aggression for 1 of 1 sampled resident reviewed for abuse (Resident #22). Residents Affected - Few The findings included: Resident #22 was initially admitted to the facility in May of 2017 with Diabetes, Anxiety Disorder, Acute Embolism and Thrombosis (blood clots) of right leg, and an eye infection. Additional diagnoses of Major Depressive Disorder, Delusional Disorders, Schizoaffective Disorder, and Bipolar Disorder as they were diagnosed. The most recent comprehensive assessment from July of 2022 revealed a BIMS (Brief Interview for Mental Status) score of 08 of 15 points which indicated a moderate cognitive decline. Some assistance was required with most ADLs (Activities of Daily Living) due to retinal detachment in right eye, however he is ambulatory and of substantial height and weight. Resident #22 had a history of behaviors, threats and hallucinations at this facility. On 09/20/22 during record review, a progress note written by Staff L, Registered Nurse (RN), on 07/31/22 at 8:24 AM documented: Time 12:50 AM (Resident #22) was involved with an incident with his roommate (Resident #42) stating that his roommate was playing loud music and listening to the TV loud. Resident #42 stated that Resident #22 threw the wheelchair over him while lying in bed. At 1:08 AM Resident #42 called the police himself, reporting the incident. The survyeor requested the investigation and state report of the administrator. A State immediate report was produced on 09/21/22 with a file date of 09/20/22. On 09/21/22 at 5:00 PM, during an interview with the Nurisng Home Administrator (NHA), she said she was unaware of the incident until the report was requested. The Nursing Home Administrator immediately initiated an investigation. On 09/22/22 at 3:09 PM, during an interview with Staff A, an Licensed Practical Nurse (LPN)/Unit Manager, she said she was called to the facility because of the incident and arrived around 11:50 PM. The police were present and suggested the residents be separated. Staff A reported speaking with the NHA about it the next morning but neither of them were aware of the threats made, only that it was a disagreement. Staff A also reported in the same interview, Resident #22 telling her he wanted to hit his roommate, but he didn't because he knew he would get in trouble. On 09/22/22 at 11:52 AM, a voicemail message was left on Staff L's cell phone requesting a call back for an interview. As of this writing, he has not returned the call. During an interview with the NHA on 09/23/22 at 8:45 AM, she said she was out of town that week with an Interim Director Of Nurses in place who is no longer employed there. The NHA acknowledged the lack of investigation and required reporting of resident-to-resident aggression. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 3 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to initiate a Level I PASRR and refer appropriately for a Level II PASRR upon the development of behaviors and aggression for 1 of 1 sampled resident (Resident #22). The findings included: Resident #22 was initially admitted to the facility in May of 2017 with diagnoses that included Diabetes, Anxiety Disorder, Acute Embolism and Thrombosis (blood clots) of right leg, and an eye infection. Additional diagnoses were added on 08/15/17 (Major Depressive Disorder); 10/02/17 (Delusional Disorders); 10/10/18 (Schizoaffective Disorder) and 09/14/20 (Bipolar Disorder). The most recent comprehensive assessment from July of 2022 revealed a BIMS (Brief Interview for Mental Status) score of 08 of 15 points which indicated a moderate cognitive decline. Some assistance was required with most ADLs (Activities of Daily Living) due to retinal detachment in right eye, however he is ambulatory and of substantial height and weight. On 09/19/22 during record review for a Level II PASRR (Preadmission Screening and Resident Review), it was noted the original PASRR I from the hospital in May of 2017 was incomplete. There was no new PASRR located and with psychiatric behaviors and aggression, no Level II PASRR was present. Further record review noted behaviors and aggression started in August of 2017. Staff documented periods of confusion, hallucinations, delusions, threatening to kill staff, barricading the room door to prevent anyone from entering, throwing urinal/urine and swinging his walker around. On 08/24/17, Social Services (SS) documented the end of his short-term stay for rehabilitation at which time the resident should be referred / transferred to a facility with a psychiatric license due to his age (less than [AGE] years old) and psych issues. SS wrote: He needs to move to another facility as soon as possible where his needs can be better met. In October of 2021, Resident #22 was documented as screaming at the staff and people around him. He threw a glass of water in a staff member's face. The resident was sent to acute care for more intensive psychiatric care. More recently, in July of 2022, a former roommate alleged Resident #22 threw a wheelchair over his bed while he was in the bed and the roommate called the police. On 09/20/22 at 12:35 PM during an interview with the Social Services Director (SSD), he confirmed he had searched the electronic record and the paper chart, and he was unable to find an updated Level I PASRR. At 1:22 PM, the SSD confirmed that based on Resident #22's diagnoses, facility history of aggression and behaviors, a new Level I should have been completed and he should have been referred for a Level II PASRR assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 4 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to complete a baseline care plan for 2 of 30 sampled residents reviewed, Resident #20 and #25. The finding included: 1. Record review for Resident #20 revealed an admissiond to the facility on 6/22/22. The resident Brief Interview for Mental status (BIMS) is 03, indicitive of sever cognitive impairment. The pertinent diagnosis included Fracture neck of left femur. Further review of the resident's electronic medical record (eMR) and the paper chart revealed that there was not a completed base line care plan. 2. Record review for Resident #25 revealed an admission to the facility on [DATE]. The resident's BIMS was 15, indicitvie of an intact cognition. The pertinent diagnosies included Atherosclerotic Heart Disease. Further review of the resident' e-MR and paper chart revealed that there was not a completed baseline care plan. On 6/22/22 at10:35 AM, an interview was conducted with Staff-F, who stated that he looked for the Residents #20 and # 25 baseline care plan in their eMR and the paper chart but the baseline care plans were not found. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 5 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to conduct care plan conferences for 2 of 30 sampled residents reviewed for care plan conferences, Resident #25 and #42. The fndings included: 1. Record review for Resident #25 revealed an admission to the facility on [DATE]. The resident's Brief Interview for Mental Status (BIMS) was 15, indicitvie of an intact cognition. The pertinent diagnosies included Atherosclerotic Heart Disease. Further record review revealed there was no evidence that the resident had attended a care plan conference. On 09/20/22 at 11:09: 00AM, an interview was conducted with Resident #25 who stated she had not attended a care plan conference / meeting since she was admitted . 2. Record review of Resident #42's EMR and paper chart revealed an adnission on 04/27/22. The resident BIMS was documented as 15, indicating intact cognition. On 09/20/22 at 12:00 PM, an interview was conducted with Resident #42, who stated he did not attended care plan conference. On 09/20/22 at 12:20PM, a request was made of the Director of Nursing (DON) for doumentation / evidence of Residents #25 and #42's care plan conference / meeting. She could not locate any documentation of care plan conference for either of the 2 residents. On 09/23/22 12:12 PM , an interview was conducted with the Administrator, who stated the staff was not conducting the Quarterly Care plan conferences / meetings since she started working at the facility couple of months ago. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 6 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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** Based on observation, interview, policy review and record review, the facility failed to secure indwelling catheter for 1 of 1 sampled resident reviewed for catheters, Resident #1; failed to monitor and address critical lab results for 1 of 1 sampled resident for critical lab reviews, Resident #62; failed to provide care and services, including assessments post injury, for 1 of 1 sampled residents reviewed for injury of unknown origin, Resident #26; and failed to order a repeat MRI for 1 of 1 sampled resident reviewed for ordered diagnostics testing, Resident #75. Residents Affected - Few The findings included 1. Record review and observation revealed Resident #1 is bed bound without use of his arms and legs. He is also non-verbal and unable to make his needs known due to a severe cognitive impairment. The resident's related diagnoses included Parkinsons, Seizure Disorder, Neuromuscular Dysfunction of Bladder, Obstructive and Reflux Uropathy, BPH (Benign Prostatic Hyperplasia) and Chronic UTIs (Urinary Tract Infections) for which he currently receives prophylactic antibiotics. On 09/19/22 at 9:43 AM, morning care with bed bath was observed for Resident #1, with Staff C, Certified Nursing Assistant (CNA). The resident had an indwelling urinary catheter and no device to secure the catheter was in place causing tension on the catheter. Staff C, providing care, said she had been off work for three days and didn't know why the resident didn't have that device. On 09/21/22 at 10:00 AM, personal hygiene and skin assessment were observed with Staff B, Registered Nurse (RN) and Staff C. The entry site for the suprapubic catheter revealed mild tissue damage and redness. There was no device to secure the catheter to prevent tension to the site or to the bladder internally present. Staff C said she had been unable to find anything to properly secure the catheter two days prior when it was discussed. The resident was then turned from side to side for care and a skin assessment. When moving the catheter drainage bag back and forth, the outflow of blood-tinged urine began to stream into the catheter tubing. The Regional Nurse was present and agreed the lack of a catheter stability device was an issue and she would obtain one for this resident. 2. Review of the facility policy, titled, Radiology and other Diagnostic Services and Reporting, dated 11/2020 and revised 11/23/2021, documented: Promptly notify the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist of laboratory results that fall outside the clinical reference range. On 09/20/22 during record review, a recent hospitalization for Resident #62 occurred on 07/29/22. Further review of the resident's record revealed the resident takes Coumadin, a blood thinner that requires frequent monitoring for therapeutic and unsafe drug levels in the blood. A blood sample is drawn to test the PT/INR (Prothrombin Time / International Ionized Ration) level which calculates blood clotting time. Normal INR values for persons taking oral anticoagulants, like Coumadin (Warfarin) should be 2.0 - 3.0; or slightly higher for an actual blood clot (2.5 - 3.5); and normal PT results should be 9.6-12.2 seconds. On 07/26/22 at 5:00 AM, a blood sample to test the resident's level was drawn. The lab report indicated the facility was notified of the abnormal/critical PT of 70.1 and an INR of 7.2 value on 07/26/22 at 1:45 PM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 7 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 Review of the resident's progress notes and physician orders did not reveal any acknowledgment of the critical lab result on 07/26/22, 07/27/22, or 07/28/22. Review of the resident's Medication Administration Record (MAR) showed she continued to receive the scheduled Coumadin for three more days on 07/26/22, 07/27/22 and 07/28/22, despite an abnormally high level. An additional PT/INR blood sample was drawn at 5:00 AM and lab documentation indicated the facility was notified of an even higher critical INR result of >8.0 at 1:30 PM. Staff F, an LPN (Licensed Practical Nurse), documented in the progress notes: lab results discussed with MD; new order received and noted. Staff A-LPN, also noted in the record that she made multiple attempts to contact a primary care provider for notification and orders however she was unable to do so. The NHA (Nursing Home Administrator) and Clinical Manager were notified, and the resident was transferred to the hospital on [DATE] sometime after 3:50 PM. She did not return to the facility until 08/03/22. On 09/22/22 at 9:10 AM during an interview with Staff F-LPN, he said if we have an abnormal or critical PT/INR we usually get an order to hold for two days, redo labs and then resume (the medication). Review of the closed paper record and the current paper record did not reveal any hand-written orders to hold the coumadin. Review of the resident's care plan showed a care focus area for anticoagulant therapy related to a history of DVT (Deep Vein Thrombosis) or PE (Pulmonary Embolism). One intervention listed is Labs as ordered. Report abnormal lab results to the MD (Medical Doctor), however it was not initiated until 08/29/22 after this incident with hospitalization occurred. 3. Review of the policy, titled, Abuse, Neglect and Exploitation, instructed all employees will be trained during orientation and again with annual education on the reporting process for abuse or neglect, including injuries of unknown sources. Under the Identification of Abuse section physical injury of a resident, of unknown source is identified as a possible indicator of abuse. The Investigation of Alleged Abuse section instructs staff to focus the investigation on determining if abuse, and/or mistreatment has occurred, the extent, and causes and to provide a complete and thorough documentation of the investigation. The Reporting/Response section instructs all alleged violations to the Administrator, state agency, adult protective services, and all other required agencies within specified timeframes: immediately but not later than 2 hours after the allegation is made if the events that cause the allegation involve abuse or result in serious bodily injury or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury. It also includes reporting to the state licensing authorities as indicated. On 09/20/22, during record review, it was documented Resident #26 had a fall with major injury on 09/02/22. Resident #26 was originally admitted to the facility on [DATE] with Dementia, Anxiety, Malnutrition, Schizophrenia, Poly-osteoarthritis, Mood Disorder, and disorders of bone density and structure and osteoporosis. The most recent comprehensive assessment showed a BIMS (Brief Interview for Mental Status) score of 00/15, indicating severe cognitive impairment. The resident required extensive assistance for bed mobility, transfers, eating and personal hygiene and is totally dependent for dressing, toileting, and bathing. Review of the fall investigation report completed by the regional nurse for 09/02/22 revealed the resident was found on the floor in the restroom. The resident was unable to verbalize what happened and that the resident was assessed and returned to the bed by Hoyer Lift. No injury was noted at that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 8 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 time and there was no complaint of pain. Level of Harm - Minimal harm or potential for actual harm Review of the statement by Staff M-CNA revealed she provided personal hygiene at midnight and started her next round at 2:00 AM. That is when she found her on the wet floor laying on her back and notified the nurse. On 09/26/22 at 3:39 PM, during a phone interview with Staff-M, she said she does rounds at 11:00 PM when she starts her shift. She checked on Resident #62 who is the third resident she sees when she does her rounds and did not provide any hygiene care or brief change. She said Resident #26 is mostly continent and tries to get to the bathroom timely to prevent using the brief or incontinence episodes. Staff-M tells the resident to stay in bed and not to get up without help but because she is confused, she doesn't always listen. When Staff-M started rounds again at 2:00 AM, she found the resident on the floor, outside the bathroom near the bed. Her brief was off, and the floor was wet with urine. The resident was conscious, and Staff-M went immediately to get the nurse. She did now know his name and said it was the first time she had seen him in the building. She said the male nurse said, lets pick her up and put her back in bed. Without a mechanical lift, the two staff members picked her up and put her back into her bed. Staff-M verbalized the nurse did not do any assessment or attempt to ask the resident any questions. Staff-M asked the resident what happened; however the resident was not able to speak any words and only uttered some sounds. Staff-M said she did not tell anyone else about the fall until Staff-A, LPN/Unit Manager asked her the following evening after 11:00 PM about the incident. She had not seen the male nurse since that night. Residents Affected - Few Review of the statement from Staff-K, RN, assigned to care for Resident #26, revealed she was on her break when the resident was found on the floor. When she returned to the unit, she did her room rounds and the patient was in her bed without any signs of discomfort or distress. She was never told about the resident being found on the floor by the other nurse, Staff L, RN. On 09/26/22 at 3:35 PM during an interview with Staff K, she confirmed the facts in her written statement as true and she had no further information about it. On 09/22/22 at 11:45 AM during an interview with Staff-B, RN, who cared for the resident on 09/02/22 after 7:00 AM said the previous nurse, Staff-K, did not tell her the resident fell. She said at approximately 7:30 AM, the CNA told her the resident was in pain, yelling and screaming. Staff-B assessed the resident's left arm, and it was swollen which was different from the day before. Staff-B notified Staff-A, LPN/Unit Manager, of the pain and swelling and then asked the DOR (Director of Rehabilitation) to look at the arm. The DOR agreed it was not swollen like that the day before. Review of the EHR (Electronic Health Record) for Resident #26 did not reveal any documentation about the injury (of unknown origin), no physical assessment, and no neurological assessment or periodic neuro checks as should be completed after a an unwitnessed found of floor by the nursing staff. The ARNP (Advanced Registered Nurse Practitioner) saw the resident only for wrist pain, ordered an x-ray, ice packs and pain relief. The x-ray results for the left wrist revealed the same injury incurred from a previous fall at this facility on 06/24/22. On 09/22/22 at 2:46 PM during an interview with Staff-A, LPN/Unit Manager, she was asked to see Resident #26 by Staff-B after shift change on 09/02/22. She said the resident was not herself because she was lying quietly under the sheet and her vocalizations were quieter than normal. She noted significant swelling to the left wrist and the resident was holding her left arm with her right hand, guarding it. Staff-A began asking all staff members if they knew what happened to the resident, but no one was aware of any reason for the injury. It wasn't until after 11:00 PM when she spoke with Staff-M who informed her the resident was found on the floor at 2:00 AM, twenty-one hours earlier. Staff-A and Staff-D, the staffing coordinator, made several phone calls to Staff-L to get a statement from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 9 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 him but since this shift on 09/02/22, Staff-L has not returned any calls and has not returned to the facility. His agency was notified that he was not allowed to return to the facility. On 09/22/22 at 11:52 AM, a voicemail message for Staff-L was left on his cell phone requesting a call back. As of 09/28/22 at 4:45 PM, the call has not been returned. On 09/23/22 at 10:18 AM during a phone interview with Resident #26's daughter / primary contact, she reported coming into the facility at approximately 2:00 PM on 09/02/22. When she saw her mother's wrist, she described it as swollen and deformed and that it didn't look good at all. The daughter had been there the day before and said the wrist/arm was not at all in that condition. The daughter then requested the resident be sent to the hospital because of the new injury and pain. She also said she had not been notified by phone prior to arrival at the facility and speaking with the nurse. The resident was transported to the hospital around 6:00 PM per her daughter. Resident #26 was taken to the closest hospital and then transferred again very late on 09/02/22 or very early on 09/03/22 to another hospital due to a lack of orthopedic staff available (per daughter). The second facility's records report the resident's fractures were acute and not chronic and during the physical exam in the ED (Emergency Department) noted LLE (left lower extremity) rotated and shorter compared to right'. The CT scan showed a comminuted fracture (broken into more than two pieces and not aligned) of the left hip with scattered fracture fragments. The left wrist was noted as a significantly displaced comminuted fracture of the distal radius with medial displacement. Surgical repair was not recommended due to age and cognitive decline and the resident returned to the facility on [DATE]. On 09/23/22 at 8:45 AM during an interview with the NHA (Nursing Home Administrator), the NHA was informed of the lack of reporting the resident being found on the floor, the absence of nursing assessments and follow up, no nursing assessments, incomplete investigation, the lack of cooperation of the RN responsible for the resident at the time of the incident, and the injury of unknown origin not identified as a fall for sixteen hours. The NHA acknowledged the discrepancies. 4. Facility Policy, titled, Radiology and other Diagnostic Services and Reporting, dated 11/2020 documented, The facility must provide or obtain radiology and other diagnostic services to meet the needs of its residents. Record review for Resident #75 documented an admission date of 05/10/22 with diagnoses that included Heart Disease, Kidney Disease and Obesity. A Minimum Data Set Resident Assessment, dated 08/17/22, documented Resident #75 as cognitively intact, requiring extensive assistance for all activities of daily living except eating which required supervision only. On 09/19/22 at 10:25 AM, Resident #75 stated he had a back problem and was supposed to have a Magnetic Resonance Imaging (MRI) done. He stated the staff is aware but has not made his appointment. On 08/24/22, the Physicians Progress Note for Resident #75 documented, Patient seen today, MRI not done, facility too small to accommodate w/c (wheelchair). Nurse to re-schedule MRI at an acute care hospital [Name provided]. Prescription written for MRI. Staff to make transport arrangement for MRI. On 09/21/22 at 10:35 AM, the Regional Nurse Consultant stated the repeat MRI for Resident #75 had not been ordered. On 09/22/22 at 8:46 AM, Staff-F stated the repeat MRI was not ordered until yesterday. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 10 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and policy review, the facility failed to ensure documentation of informed consent, entrapment assessment, benefit of use, failed alternatives, and mattress compatibility prior to installation and use of side rails for three of three sampled residents observed (Resident #1, #26 and #237). The findings included Review of the facility policy, titled, Proper Use of Bed Rails, implemented 11/2020 and revised 07/25/22, documented: Appropriate alternative approaches are attempted prior to installing or using bed rails. If bed rails are used, the facility ensures correct installation, use, and maintenance of the rails. The policy definition of a bed rail is taken directly from the regulation and defines a bed rail as an adjustable metal or rigid plastic bars that attach to the bed. They are available in a variety of types, shapes, and sizes ranging from full to one-half, one-quarter, or one-eighth lengths. Also, some bed rails are not designed as part of the bed by the manufacturer and may be installed on or used along the side of a bed. Examples of bed rails include, but are not limited to side rails, bed side rails, safety rails grab bars and assist bars. Additional policy review required a resident assessment to include at minimum; medical diagnosis, conditions, symptoms and behaviors, size and weight, sleep habits, medications, acute medical or surgical interventions, underlying medical conditions, existence of delirium, ability to toilet self safely, cognition, communication, mobility in and out of bed and risk of falling. The assessment must include an evaluation of alternatives attempted prior to the use of bed rails and how these alternatives failed to meet the resident's needs. The policy further necessitates evaluation of the resident's risk from using a bed rail including falls, entrapment and other potential injuries that could be sustained; whether the side rail is a barrier to safely exiting the bed or a restraint; decline in resident function, skin integrity, decline in activities of daily living, and any psychosocial outcomes such as dignity, altered self-esteem and isolation. The assessment should also include the resident's risk of entrapment between the bed rail and mattress or in the bed rail itself. The policy section on Informed Consent read: Informed consent from the resident or representative prior to installation and use of bed rails. The minimum information required for consent includes what medical needs would be addressed by the use of bed rails; how the resident would benefit from use and the likelihood of the benefits; the resident's risks from use of the bedrails and how the rails will be mitigated, and alternatives tried that failed and alternatives considered but not attempted because they were not appropriate. Once informed consent is obtained, a physician order for the specified bed rail(s), diagnoses, condition, symptom, or functional reason for use of the bed rail will be obtained. Alternatives include but are not limited to roll guards, foam bumpers, lowering the bed, concave mattresses and should only be attempted if appropriate and safe. If no appropriate alternatives are identified, the medical record should include evidence of the following: the purpose for which the bed rail was intended and evidence that alternatives were tried and unsuccessful; assessment of the resident, the bed, the mattress and rail for entrapment risk (which includes ensuring bed dimensions are appropriate for resident's size/weight) and risk/benefits were reviewed with the resident or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 11 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0700 representative and informed consent was given before installation or use. Level of Harm - Minimal harm or potential for actual harm The section Installation and Maintenance of Bed Rails instructs the facility to assure the correct installation and maintenance of bed rails prior to use. This includes checking with the manufacturer(s) to ensure the bed rails, mattress, and bed frame are compatible. Rails should be selected and placed to discourage climbing over rails; Ensure the beds dimensions are appropriate for the resident by confirming the rails are appropriate for the size and weight of the resident using it; installing the rails using the manufacturer's instructions and specifications to ensure a proper fit.; Ensuring the bed frame, bed rail and mattress do not leave a gap wide enough to entrap a resident's head or body, regardless of mattress width, length and or/depth. Checking bed rails regularly to make sure they are still installed correctly and have not shifted or loosened over time. Observing ongoing precautions such as following manufacturer's equipment alerts and recalls and increasing resident supervision, especially with the use of air-filled mattress or therapeutic air-filled beds that may present a different entrapment risk than rail entrapment. Conducting routine preventative maintenance of beds and bed rails to ensure they meet current safety standards and are not in need in repair. Residents Affected - Few For bedrails that are incorporated or pre-installed, the facility will determine whether or not disabling the bed rail poses a risk for the resident. The facility will follow manufacturer's recommendations/instructions regarding disabling or tying rails down. The facility will continue ongoing monitoring and supervision including necessary treatment and care to the resident who has bed rails in accordance with professional standards of practice and the resident's choices. This should be evidenced in the resident's records, including the care plan, at minimum: the type of specific direct monitoring and supervision provided during the use of the bed rails including documentation of the monitoring; the identification of how needs will be met during use of the bedrails; ongoing assessment to assure that the bed rail is used to meet the resident's needs; ongoing evaluation of risks; identification of who may determine when the bed rail will be discontinued and the identification and interventions to address any residual effects of the bed rail. The responsibilities of ongoing monitoring and supervision are specified as follows: direct care staff will be responsible for care and treatment in accordance with the plan of care; a nurse assigned to the resident will complete reassessments in accordance with the facility's assessment schedule but not less than quarterly, upon a significant change in status, or a change in the type of bed/mattress/rail. The IDT (interdisciplinary team) will make decisions regarding when the bed rail will be used or discontinued or when to revise the care plan to address any residual effects of the bed rail. The maintenance director/designee is responsible for adhering to a routine maintenance and inspection schedule for all bed frames, mattresses, and bed rails. 1. On 09/19/22 at 9:43 AM, bilateral siderails were observed in the up position in use for Resident #1. On 09/20/22 at 12:54 PM, side rails were again observed up and in use and again on 09/21/22 at 12:18 PM for Resident #1. Resident #1 is bed bound without use of his arms/hands and legs. He is also non-verbal and unable to make his needs known due to a severe cognitive impairment. Related diagnoses included Parkinsons, Seizure Disorder, , Atrial Fibrillation and involuntary leg movements. The most recent comprehensive assessment from 09/22 documented a continuously present altered level of consciousness. He required maximum assistance from staff with all activities of daily living and he is unable to use the side rails to reposition himself in bed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 12 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0700 Level of Harm - Minimal harm or potential for actual harm Review of the resident's record did not identify any physician order, informed consent, risk of entrapment assessment. care plan focus or interventions until 09/21/22 after surveyor intervention and request for documentation. The current facility Bed Rail Safety Review does not meet compliance requirements to assess risk for entrapment. There were no IDT (Interdisciplinary team) decisions for side rail use or Informed Consent located in the record. Residents Affected - Few 2. Resident #26 was originally admitted to the facility on [DATE] with Dementia, anxiety, malnutrition, schizophrenia, poly-osteoarthritis, mood disorder, and disorders of bone density and structure and osteoporosis. The most recent comprehensive assessment showed a BIMS (Brief Interview for Mental Status) score of 00/15 indicating the most severe cognitive decline possible. The resident requires extensive assistance for bed mobility, transfers, eating and personal hygiene and is totally dependent for dressing, toileting, and bathing. Due to cognitive decline and physical disability, she is unable to use side rails for repositioning in bed. Review of the resident's record did not identify any physician order, informed consent, risk of entrapment assessment, care plan focus or interventions until 09/20/22 after surveyor intervention and request for documentation. The current facility Bed Rail Safety Review does not meet compliance requirements to assess risk for entrapment. There were no IDT decisions for side rail use or Informed Consent located in the record. On 09/19/22 at 9:49 AM, Resident #26 was observed in the bed with bilateral side rails in the up position for use with the bed low to the ground. On 09/20/22 at 11:24 AM, both side rails were observed up on the bed and the bed in low position again. 3. Resident #237 was admitted on [DATE] with diagnoses to include Diabetes Type II, Acute and Chronic Respiratory Failure with Hypercapnia and Hypoxia, Atrial Fibrillation, Severe Obesity, Obstructive Sleep Apnea, Depression, Anxiety, and a history of falls including 09/19/22 as she was found on the floor in the bathroom of her room. Due to date of admission, the comprehensive assessment and comprehensive care plan were not yet completed. A Bed Rail Safety Review was completed on 09/21/22 after surveyor requested the documentation. The current facility Bed Rail Safety Review does not meet compliance requirements to assess risk for entrapment. There were no IDT decisions for side rail use or Informed Consent located in the record. On 09/19/22 at 1:55 PM, during a meeting with Resident #237 and her family in the resident's room, bilateral side rails were in the up position for use. On 09/23/22 at 11:50 AM, the side rails were in the up position for use. On 09/22/22 at 4:30 PM during an interview with the DON (Director of Nursing) and the Regional Nurse, they confirmed there is no other consent, assessment, or other documentation other than the Bed Rail Safety Review in the electronic chart. The discrepancy was acknowledged by both the DON and the Regional Nurse. On 09/23/22 at 10:00 AM during an interview with the Director of Maintenance, he confirmed there are no regular bed or side rail maintenance checks per manufacturer's instructions or otherwise and he does not measure air or other specialty mattresses for gaps in the zones of entrapment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 13 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and interview, the facility failed to provide behavioral monitoring for residents on antipsychotics for 2 of 6 sampled residents, Resident #10 and Resident #65; and failed to monitor side effects and administer medication in a timely manner for Resident #65. Residents Affected - Few The findings included: A review of the Policy and Procedures for Behavior Monitoring with an implementation date of 01/20 and revised 11/21 revealed residents who exhibit behavioral concerns may require behavior monitoring. Facility will monitor behaviors per their plan of care. 1. Upon admission of a new resident, behavior monitoring shall be initiated for residents who exhibit behavioral concerns. 2. Any behavioral interventions shall be included on the baseline care plan. 3. Information regarding the resident's behavior may be gathered from the resident and family members, and/or the comprehensive assessment 4. Behaviors shall be documented clearly and concisely in the medical record. 5. Behaviors shall be identified, and approaches should be included in the comprehensive plan of care. 6. The plan of care shall be reviewed at least quarterly and revised as needed. 1. Record review for Resident #65 revealed an admission to the facility on [DATE] with diagnoses to include Anxiety Disorder, Recurrent Unspecified Hallucinations, Unspecified Dementia with Behavioral Disturbances, and Schizoaffective Disorder. Review of the Resident #65's MDS (Minimum Data Set) quarterly, dated 08/11/22, documented her BIMS (Brief Interview for Mental Status) score was 2, indicating cognition is severely impaired. Review of Resident #65's physician orders documented Seroquel Tablet 50 mg (milligrams) to give 50 mg by mouth two times a day related to Major Depressive Disorder, Remeron Tablet 15 mg give 0.5 tablet by mouth at bedtime for Depression and appetite stimulation, Depakote Sprinkles Capsule Delayed Release Sprinkle 125 MG give 250 mg by mouth two times a day for dementia with behaviors, Ativan Tablet 0.5 MG give 1 tablet by mouth every 8 hours for anxiety, Percocet Tablet 5-325 mg give 1 tablet by mouth every 4 hours as needed for pain every 4-6 hours as needed for pain, Eldertonic Liquid Give 15 cc by mouth before meals for weight loss poor appetite. Further review of the physician orders documented to 'observe and document' side effects and behaviors for antipsychotic medications and antianxiety medications. Care Plans included documentation of the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 14 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0744 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few -psychotropic medication Seroquel related to Behavior management with interventions to include administer psychotropic medications as ordered by physician and to monitor for side effects and effectiveness every shift. -Resident #65 had a diagnosis of Hallucinations, Depression, and Anxiety. She has behavior problems related to screaming and crying out and tearful, at times refuses care with hitting staff. Her interventions included to administer medications as ordered. Monitor/document for side effects and effectiveness. -Resident #65 uses anti-anxiety medication: Ativan related to Anxiety Disorder. her interventions included are to administer Anti-Anxiety medications as ordered by physician. Monitor for side effects and effectiveness every shift. Observations were made on 09/19/22 at 2:04 PM of Resident#65 in the North unit dining area. She was observed sitting in her wheelchair crying, pulling at her hair and singing. Staff stated those are her behaviors and she does that all the time. A review of the Behavioral monitoring sheets in the Electronic Medical Record revealed for the month of August and September 2022 the behaviors exhibited are not being filled out. The following dates on the behavioral monitoring sheets were left blank: a. Antianxiety medication observes for restlessness. Document Y if resident has behaviors and N if the resident does not have behaviors. If Y document in the progress notes, start date 08/20/22 at 0700 (7:00 AM): 08/20/22, day and evening shifts 08/21/22, evening shift 08/26/22, evening and night shifts 08/28/22, night shift 08/29/22, evening shift 08/30/22, day shift 09/01/22, days, evening, and night shifts 09/02/22, day shift 09/05/22, day and night shifts 09/06/22, day and evening shifts 09/07/22, evening and night shifts 09/08/22, day shift (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 15 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0744 09/09/22, evening shift Level of Harm - Minimal harm or potential for actual harm 09/10/22, day shift 09/12/22, day, evening, and night shifts Residents Affected - Few 09/13/22, night shift 09/14/22, day, evening, and night shifts 09/15/22, day, evening, and night shifts 09/16/22, day and evening shifts 09/17/22, day and evening shifts 09/18/22, day, evening, and night shifts 09/19/22, evening and night shifts 09/20/22, day, evening, and night shifts 09/21/22, day, evening, and night shifts 09/22/22, day, evening, and night shifts. b. Antipsychotic Medication observe for delusions, hallucinations and/or paranoia. Document Y if the resident is having behaviors and N if the resident does not have behaviors. If Y document in the progress notes every shift. Start date 08/20/22 0700. The following days were not filled out: 08/20/22, day and evening shifts 08/21/22, evening shift 08/26/22, evening and night shifts 08/28/22, night shift 08/29/22, evening shift 08/30/22, day shift 09/01/22, day, evening, and night shifts 09/02/22, day shift 09/05/22, day and night shifts 09/06/22, day and evening shifts (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 16 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0744 09/07/22, evening and night shifts Level of Harm - Minimal harm or potential for actual harm 09/08/22, day shift 09/09/22, evening shift Residents Affected - Few 09/10/22, day shift 09/12/22, day, evening, and night shifts 09/13/22, night shift 09/14/22, day, evening, and night shifts 09/15/22, day, evening, and night shifts 09/16/22, day and evening shifts 09/17/22, day and evening shifts 09/18/22, day, evening, and night shifts 09/19/22, evening and night shifts 09/20/22, day, evening, and night shifts 09/21/22, day, evening, and night shifts 09/22/22, evening and night shifts. c. Review of the Physician's Orders documented for side effects for Antianxiety: indicate letter if observed; A=Sedation, B=Drowsiness, C=Ataxia, D=Dizziness, E=Nausea, F= Vomiting, G=Confusion, H=Headache, I=Blurred Vision, J=Skin Rash, N=None; If side effects present document in progress notes and notify the doctor every shift related to Anxiety Disorder; Further review of the MAR/TAR (medication / Treatment Administration Record) revealed the following days did not have any documentation: 08/20/22, day and evening shifts 08/21/22, evening shift 08/26/22, evening and night shifts 08/28/22, night shift 08/29/22, evening shift 08/30/22, day shift 09/01/22, day, evening, and night shifts (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 17 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0744 09/02/22, day shift Level of Harm - Minimal harm or potential for actual harm 09/05/22, day and night shifts 09/06/22, day and evening shifts Residents Affected - Few 09/07/22, evening and night shifts 09/08/22, day shift 09/09/22, evening shift 09/10/22, day shift 09/12/22, day, evening, and night shifts 09/13/22, night shift 09/14/22, day, evening, and night shifts 09/15/22, day, evening, and night shifts 09/16/22, day and evening shifts 09/17/22, day and evening shifts 09/18/22, day, evening, and night shifts 09/19/22, evening and night shifts 09/20/22, day, evening, and night shifts 09/21/22, day, evening, and night shifts 09/22/22, evening and night shifts. d. Side effects for Antipsychotic: Indicate letter if observed A=Sedation, B=Drowsiness, C= Dry Mouth, D=Constipation, E= Blurred Vision, F= EPS, G= Weight Gain, H=Edema, I= Postural Hypotension, J= Sweating, K= Loss of Appetite, L-Urinary Retention N=None. If side effects present document in progress notes and notify doctor every shift related to Unspecified Dementia with Behavioral Disturbances, Schizoaffective Disorder and Hallucinations. Start date 08/20/22. The following days were blank with no documentation. 08/20/22, day and evening shifts 08/21/22, evening shift 08/26/22, evening an night shifts (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 18 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0744 08/28/22, night shift Level of Harm - Minimal harm or potential for actual harm 08/29/22, evening shift 08/30/22, day shift Residents Affected - Few 09/01/22, day, evening and night shifts 09/02/22, day shift 09/05/22, day and night shifts 09/06/22, day and evening shifts 09/07/22, evening and night shifts 09/08/22, day shift 09/09/22, evening shift 09/10/22, day shift 09/12/22, day, evening and night shifts 09/13/22, night shift 09/14/22, day, evening and night shifts 09/15/22 day, evening and night shifts 09/16/22, day and evening shifts 09/17/22, day and evening shifts 09/18/22, day, evening and night shifts 09/19/22, evening and night shifts 09/20/22, day, evening and night shifts 09/21/22, day, evening and night shifts 09/22/22, day, evening and night shifts Review of the MAR (Medication Administration Record) reveal that Resident#65 had a physician's order for Seroquel, Ativan, Eldertonic Liquid, Synthroid, and Remeron that were not documented as administered on the dates below: -Ativan 0.5 mg 1 tab by mouth every 8 hours for Anxiety: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 19 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0744 Level of Harm - Minimal harm or potential for actual harm 08/18/22 (2200), the box that documents it was given is blank, does not have a nurse's initials in it showing it was given. The Medication Monitoring / Control Record does not show that it was given. -Eldertonic Liquid (B complex Minerals) Give 15 cc by mouth before meals (three times a day) for weight loss and poor appetite: Residents Affected - Few 08/01/22, (1130 & 1830) 08/02/22, (1130 & 1630) 08/08/22, (0630) 08/10/22, (1130) 08/11/22, (1630) 08/12/22, (1130) 08/15/22, (1130 & 1630-#5 08/22/22, (1130 & 1630) All dates have code 4 which means there is a nursing note, except 08/15/22 had a code 5 which means to hold/RN note. 09/10/22, (0630 time and date not filled in, no reason why it was not given) 09/13/22, (1130-code 4 but no note why it was not given). -Seroquel Tab 50 mg give 50 mg by mouth twice daily related to major depressive disorder, all dates and times had a code 4 documenting there is a nurses note why it was not given: 08/12/22, (0900 (9 AM)-medication reordered & 1700 (5 PM)-not available for administration) 08/15/22, (0900-medication reordered) 09/07/22, (0900-documented medication ordered) 09/08/22, (0900-medication ordered & 1700-no note in progress notes on why it was not given, 09/09/22, (0900-no note in progress note on why it was not given & 1700 (5 PM)-note- called and spoke to [name provided] and stated it will be on next run; 08/10/22 (0900-medication ordered). -Remeron tab 15 mg give 0.5 mg by mouth at bedtime for Depression, order date 08/23/22 at 0212 not given: 08/23/22, at 2100 (9:00 PM) 08/24/22, 2100 both dates are blank with no reason for why it was not given (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 20 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0744 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 08/28/22, (2100 documented code 4, see progress note, does not say what medication in progress note but documented not available, reordered). During an interview on 09/22/22 at 7:07 AM with the DON (Director of Nursing), she reviewed the MAR and progress notes for Resident #65 but when asked if she acknowledged the findings, she stated that she won't acknowledge what the surveyor showed her but stated she would look into it. During an interview on 09/22/22 at 11:00 AM, with the Consultant Pharmacist, she reviewed the MAR and progress notes for Resident #65 and stated that we have nurses that are not aware how to acknowledge receipt in Point Click Care. She stated she is aware of these concerns and that training and audits are being done. Some of the medications are stocked items, like the vitamins. The agency nurses are not aware which are medications are onsite and which are having to be ordered. We have a high turnover, we train them and then they leave, it is difficult to train nurses who leave after 4 days of working in facility. We teach the nurses how to find the supplies. She stated that this concern has been going on in this facility for 4 months. During an interview on 09/22/22 at 11:45 AM, Staff B, RN (Registered Nurse) was asked about documenting and monitoring behaviors for Resident #65. She stated that she does not document for behaviors and doesn't know how and where it would be. During an interview on 09/23/22 at 11:00 AM with the DON, she was asked about Resident #65 behaviors monitoring sheet. She reviewed them and stated that when the resident is admitted and if they have behaviors, it is documented on dashboard which is a report for us, if the behaviors escalate. She acknowledged that there are gaps in the behavioral monitoring sheets but stated that doesn't mean it wasn't observed. During an interview on 09/23/22 at 11:18 AM with Staff O, LPN (Licensed Practical Nurse), when asked if a resident had behaviors, Staff-O stated, 'we go to the TAR (Treatment Administration Record) under behaviors, we fill it out every shift, we go to the behavior tab and click on the behavior.' 3. Facility Policy, titled, Behavior Monitoring, dated 11/2020, documented, Behaviors shall be documented clearly and concisely in the medical record. Behaviors shall be identified, and approaches should be included in the comprehensive plan of care. Record review for Resident #10 documented an admission date of 06/08/22 with diagnoses that included Lung Disease, Diabetes, Heart Disease and Dementia. A Minimum Data Set Resident Assessment (MDS) on 09/12/22 documented Resident #10 with mild cognitive impairment. Physicians Orders documented an order for Quetiapine (antipsychotic drug) 50 milligrams at bedtime for Dementia with Psychosis. On 06/09/22, the care plan for Reisdent#10 documented, Monitor for continued need of medication as related to behavior and mood. Monitor for changes in mental status and functional level and report to MD (physician) as indicated. Monitor for side effects and consult physician and or pharmacist as needed. On 06/15/22, the Consultant Pharmacist's Medication Regimen Review for Resident #10 documented the resident is receiving an antipsychotic agent but lacks documentation in the medical record to support its use. On 08/24/22, the care plan for Resident #10 documented, Monitor for behaviors and document q (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 21 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0744 (every) shift. Level of Harm - Minimal harm or potential for actual harm On 09/22/22 at 3:19 PM, Staff B, Registered Nurse, after record review, stated no behavior monitoring was being done for Resident #10. Residents Affected - Few On 09/22/22 at 3:22 PM, the Regional Nurse Consultant confirmed that no ongoing behavior monitoring was being done other than on the nurses skilled notes for Resident #10. The last skilled nursing note that referenced behaviors was on 09/01/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 22 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0803 Level of Harm - Minimal harm or potential for actual harm Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on interview record review and interview, the facility failed to follow the dietitian signed menus for 4 of 6 sampled residents reviewed for food concerns, Residents #14, #25, #35 and #42. Residents Affected - Few The findings included: 1. On 09/19/22 at 12:15 PM, during the lunch meal observation in the residents' rooms, Resident #25, #35, and #42, stated that the menu that was posted for dinner on Sunday, 09/18/22, read, Tomato Soup and Grilled Cheese Sandwich. The residents said that they were served 1 slice of white bread cut in two with a piece of Cheese in the middle and the sandwich was not grilled. Residents #25, #35 and #42 stated that they asked for the alternate meal but was not offered or given it. On 09/19/22 at 3:00 PM, an interview was conducted with the Regional Certified Dietary Manager to inform him of the residents' concerns. He stated that he is going to have a meeting with the cook and all the employees. On 09/23/22 at 1:45PM, during an interview with the Regional Certified Dietary Manager, he showed the surveyor a grilled cheese sandwich and told me that was the way the grilled cheese sandwich should have been served. The Regional Dietary manager also informed the surveyor that he had an in-service training with the dietary staff to show them how to prepare and serve a grilled cheese sandwich. 2. Record review for Resident #10 documented an admission date of 06/08/22 with diagnoses that included Lung Disease, Diabetes, Heart Disease and Dementia. A Minimum Data Set Resident Assessment on 09/12/22 documented Resident #10 with mildly impaired cognition and independent for eating. A physician's order on 09/01/22 documented a carbohydrate controlled regular texture diet. The dinner menu provided by the facility for 09/18/22 documented. Creamy Tomato Soup, Grilled Cheese on White, Marinated Cucumber Salad, Sliced Peaches and Whole Milk. The care plan dated 08/28/22 documented Resident #10 had a nutritional problem related to current medical conditions and to, Provide, serve diet as ordered. On 09/19/22 at 8:45 AM, Resident #10 stated the food is terrible and pointed to a sandwich in a bag on his bedside table. He stated, Two pieces of white bread with a piece of cheese in a bag, that was it, that was dinner. They said grilled cheese were on the menu, but this is what I got, a sandwich in a bag, not grilled and nothing else. On 09/22/22 at 1:15 PM, the Regional Dietary Director brought to the surveyors a grilled cheese sandwich and stated that is what the residents should have gotten Sunday night. He stated that is not what they received it and he had spoken to the kitchen staff about how to grill ten sandwiches at a time. He said the issue has been addressed and education done. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 23 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to maintain accurate resident records for 2 of 6 sampled residents, Resident #65 and Resident #79. The findings included: 1. Record review for Resident #65 revealed an admission to the facility on [DATE] with diagnoses to include Anxiety Disorder, Recurrent Unspecified Hallucinations, Unspecified Dementia with Behavioral Disturbances, and Schizoaffective Disorder. Review of the Resident #65's MDS (Minimum Data Set) quarterly, dated 08/11/22, documented her BIMS (Brief Interview for Mental Status) score was 2, indicating cognition is severely impaired. Review of Resident #65's physician orders documented Seroquel Tablet 50 mg (milligrams) to give 50 mg by mouth two times a day related to Major Depressive Disorder, Remeron Tablet 15 mg give 0.5 tablet by mouth at bedtime for Depression and appetite stimulation, Depakote Sprinkles Capsule Delayed Release Sprinkle 125 MG give 250 mg by mouth two times a day for dementia with behaviors, Ativan Tablet 0.5 MG give 1 tablet by mouth every 8 hours for anxiety, Percocet Tablet 5-325 mg give 1 tablet by mouth every 4 hours as needed for pain every 4-6 hours as needed for pain, Eldertonic Liquid Give 15 cc by mouth before meals for weight loss poor appetite. Further review of the physician orders documented to 'observe and document' side effects and behaviors for antipsychotic medications and antianxiety medications. Review of the MAR (Medication Administration Record) revealed the following medications were not documented in the MAR as given or why it was not given, and the box is blank under where the nurse would document she gave it, and there were no progress notes for these dates: -Ativan 0.5mg 1 tab PO (orally) every 8 hours for Anxiety: 08/02/22 at (1400 [2 PM] & 2200 [10 PM]), the MAR is not filled in but the medication Monitoring / Control Record documented it was given. 09/07/22 (2200), the MAR is not filled in but medication Monitoring / Control Record documented it was given. 09/10/22 (0600), the MAR does not document if it was given. The Medication Monitoring / Control Record does not show it been given. -Eldertonic Liquid (B complex Minerals) Give 15cc by mouth before meals for weight loss poor appetite: 09/10/22 0630, the MAR does not document if it was given -Synthroid Tablet 50 MCG give 50MCG by mouth one time daily for Hypothyroidism: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 24 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 09/10/22 at 0600 (6 AM), the MAR was not filled in. Level of Harm - Minimal harm or potential for actual harm -Remeron 15 MG give 0.5mg tablet by mouth at bedtime for depression and appetite stimulation: 08/24/22, the MAR was not filled in. Residents Affected - Few 2. Review of Resident #79's medical records revealed Resident #79 was admitted to the facility on [DATE] with most recent readmit on 06/13/22 with diagnoses to include Type II Diabetes Mellitus, Protein-Calorie Malnutrition, Peripheral Vascular Disease, Absence of Right Leg Below Knee. Review of the MAR (Medication Administration record) revealed multiple days of medications not given or failing to document it was given for the following orders: -Accuchecks twice daily at 0630 AM and 4:40 PM: 09/10/22, the MAR is blank on this date with no reason on why it was not done. -Eldertonic Liquid (B Complex-Minerals) give 15ml by mouth before meals for malnutrition 6:30 AM, 11:30 AM & 4:30 PM: 09/10/22, 6:30 AM - MAR is blank with no note on reason not given 08/01/22, 11:30 AM & 4:30 PM documents a code of 4 which means other/see nurses note 08/02/22, 11:30 AM & 4:30 PM documents a code of 4 which means other/see nurses note. Progress note document 'on back order'. 08/05/22, 11:30 AM documents a code of 4 which means other/see nurses note. Progress note document 'on back order'. 08/10/22, 11:30 AM documents a code of 4 which means other/see nurses note. Progress note documents medication but not why it was not given. 08/12/22, 11:30 AM documents a code of 4 which means other/see nurses note. Progress note documents medication but not why it was not given. 08/15/22, 11:30 AM & 4:30 PM documents a code of 4 which means other/see nurses note. Progress note documents medication but not why it was not given. 08/22/22, 11:30 AM & 4:30 PM documents a code of 4 which means other/see nurses note. Progress note documents medication but not why it was not given. -Gabapentin Capsule 300 mg, give 1 capsule by mouth three times daily for Neuropathy, Give at 6:00 AM, 2:00 PM and 3:22 PM: 08/02/22, 2:00 PM & 10:00 PM, the MAR is blank with no reason why it was not given 08/18/22, 10:00 PM, the MAR is blank with no reason why it was not given (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 25 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 09/10/22, the MAR is blank with no reason why it was not given Level of Harm - Minimal harm or potential for actual harm -Pantoprazole Sodium Tablet Delayed Release 20MG give 1 tablet by mouth one time daily for GERD (Gastroesophageal Reflux Disease): Residents Affected - Few 09/10/22 MAR is blank with no reason why it was not given. -Fluticasone Proplonate Suspension 50 MCG/ACT 1 inhalation in both nostrils at bedtime for allergies: 09/09/22 9:00 PM documents a code of 4 which means other/see nurses note. Progress note document 'medication ordered from [name]'. -Diclofenac Sodium Tablet Delayed Release 75 mg give 75 mg by mouth two times a day related to Type II Diabetes: 09/07/22 documents a code of 4 which means other/see nurses note progress note documents 'medication ordered'. -Potassium Chloride ER Tablet Extended Release give 1 tablet by mouth one time a day for supplement: 09/21/22, 9:00 AM documents a code of 4 which means other/see nurses note. Progress note documents 'medication unavailable'. -Rivaroxaban (Xarelto) Tablet 15 mg give 1 tablet by mouth two times a day for A-Fib. Give at 9:00 AM and 9:00 PM: 09/08/22, 9:00 PM documents a code of 4 which means other/see nurses note. Progress note documents 'medication on order'. 09/09/22, 9:00 AM documents a code of 4 which means other/see nurses note. Progress note documents 'medication on order'. 09/13/22, documents a code of 4 which means other/see nurses note. Progress note documents 'nurse tried to order medication and was told by Pharmacist that the resident had been on medication since June and resident need to stop the twice daily to 20 mg by mouth once a day. ARNP [advanced registered nurse practitioner] called and ordered given for 20 mg daily'. During an interview on 09/22/22 at 7:07 AM with the DON (Director of Nursing), she reviewed the MAR and progress notes for Residents #65 and Resident#79. When asked if she acknowledged the findings, she stated that she won't acknowledge what the surveyor showed her but stated she would look into it. During an interview on 09/22/22 at 11:00 AM, with the Consultant Pharmacist, she reviewed the MAR and progress notes for Resident #65 and Resident #79. She stated that we have nurses that are not aware how to acknowledge receipt in Point Click Care. She stated she is aware of these concerns and that training and audits are being done. Some of the medications are stocked items, like the vitamins. The agency nurses are not aware which are medications are onsite and which are having to be ordered. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 26 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm We have a high turnover, we train them and then they leave, it is difficult to train nurses who leave after 4 days of working in facility. We teach the nurses how to find the supplies. She stated that this concern has been going on in this facility for 4 months. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 27 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0885 Report COVID19 data to residents and families. Level of Harm - Potential for minimal harm Based on interview and record review, the facility failed to notify residents' representatives and family members of new positive Covid-19 cases in a timely manner. Residents Affected - Many The findings included: Review of the facility policy, titled, Covid-19 and Covid19 Vaccine Reporting, Implemented 11/2020 and last revised 05/31/22, documented: Residents, their representatives, and families are notified of the conditions inside the facility related to Covid-19 by 5:00 PM the next calendar day following the occurrence of either: A single confirmed infection of Covid-19 or three or more residents or staff with new-onset of respiratory symptoms that occur within 72 hours of each other. On 09/21/22 at 1:30 PM, during the Infection Control interview with the Nursing Home Administrator (NHA), she reported the method of notification for a new Covid-19 positive case is a paper letter sent out by 5:00 PM the next day. She added they try to get it mailed out the same day as the positive test results. On 09/21/22 at 5:00 PM, during a conversation with the Regional Nurse, she said there may be an e-mail blast sent out by the Business Office Manager as is done to notify staff. Documentation of the electronic notification of families was requested. Multiple attempts were requested through the end of the survey for the email documentation but none was provided by the facility. On 09/23/22 at 10:30 AM, a family member of Resident #26 was asked about Covid-19 notification and how she received the information. She said she receives a letter weekly and has never received an email or a phone call. On 09/23/22 at 9:00 AM, during an interview with the NHA, she confirmed the paper letter is the only method they have for notification to resident's families of new Covid-19 cases. When informed of the regulatory requirement, the NHA acknowledged the discrepancy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 28 of 29 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 105494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Royal Palm Beach Health and Rehabilitation Center 600 Business Park Way Royal Palm Beach, FL 33411 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to maintain a pest free environment for 2 of 2 sampled residents, Residents #6 and #57. Residents Affected - Few The findings included On 09/19/22 at 9:15 AM, Resident #6's bed was observed unmade. Bleach stains were visible as well as a large, saturated area with the odor of urine. Upon closer inspection, what initially looked like small tears in the cover were small black bugs with wings. Photographic Evidence Obtained. On 09/20/22 at 9:30 AM, the bed was observed again, unmade in a similar condition only with more bugs. Photographic Evidence Obtained. Staff H, a Patient Care Assistant (PCA), was in the room putting pillowcases on pillows. She stated, it's always like that cause he urinates in the bed a lot, they are on his tray when he eats too. On 09/20/22 at 10:25 AM, a third observation was made of the same issue, with housekeeping outside the room. The Nursing Home Administrator (NHA), the Regional Nurse, Regional Director of Clinical Services and the Director of Nursing were brought to the room shown the mattress. The issue was acknowledged and the NHA ordered an immediate removal of both mattress in the room and a deep cleanof the room. The mattress was wrapped and removed to the dumpster. One of the bugs was observed on the freshly made bed of Resident #57 and on the divider curtain between the beds. The bugs were also observed on the wall over the headboard of Resident #6 and in the bathroom shared by the two residents. Photographic Evidence Obtained. Resident #6 was in the room during this time and attempted to speak but he is unable to verbalize words. When asked if he had any insect bites, he was able to communicate he did not. Review of the resident's recent lab work and vital signs did not reveal any signs of infection and his body weight is stable. Skin assessments completed on 08/10/22, 08/18/22 and 08/25/22 were negative for insect bites. A new skin assessment for insect bites was requested however the nursing staff reported the resident declined the assessment. On the same day at 10:45 AM, during an interview with Staff N, a CNA, she confirmed she was made aware of the issue earlier this morning by Staff H, PCA, and asked housekeeping to clean the room. Staff N said she had not seen the bugs until this day. On 09/21/22 at 9:50 AM Staff E, CNA, reported she saw the bugs on the mattress last week and reported it to housekeeping and added they have been working on it. Nursing staff conducted an audit of the mattresses for all other incontinent residents, but no other insect issues were identified. A review of the pest control documentation showed generalized treatments on 08/26/22, 09/16/22, 09/19/22 and on 09/20/22 specifically for this issue. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 29 of 29