Inspection·February 8, 2024

F 0641 hospital, 911 was called and the resident was transferred to the hospital. Level of Harm - Minimal harm or potential for actual harm Review of the Minimum Data Set (MDS) assessment dated [DATE] documented Resident #95 was discharged home. Residents Affected - Few During an interview on 02/07/24 at 10:57 AM, the MDS Coordinator agreed the MDS dated [DATE] was incorrectly coded. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 2 of 11 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 02/08/2024 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 Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Based on record review and interview, the facility failed to initiate a level II PASARR assessment for 1 of 5 sampled residents reviewed for psychotropic medications, Resident #2. Residents Affected - Few The findings included: Record review revealed Resident #28 latest admission to the facility was on 11/30/21. During a prior admission to the facility in 2017, a level I Pre-admission Screening and Resident Review (PASARR) dated 03/03/17 documented that Resident #28 had no diagnoses of intellectual disability and mental illness, and a PASSAR level II was not warranted. On 06/16/22, the record showed Resident #28 was diagnosed with a Bi-Polar Disorder. On 10/01/22, Resident #28 was diagnosed with Dementia. The record revealed Resident #28 was subsequently diagnosed with Unspecified Psychosis Not Due to a substance or known physiological condition, Psychotic Disturbance, Mood Disturbance, And Anxiety Disorder. Review of Resident #28's record and electronic record on 02/06/24 revealed no evidence of a completed level II PASARR. In section D of the minimum data set (MDS) assessment, titled, Mood dated 12/04/23, it was documented that Resident #28 experienced depressed mood and felt down and hopeless 10-12 days during the review period. In section C, a Brief Interview for Mental Status (BIMS) documented Resident #28 had a score of 5 of 15, indicating a severe cognitive deficit. Since there was no Level II PASARR, it was difficult to know what specialized mental services Resident #28 would benefit from. On 02/07/24 at 2:03 PM, the Social Service Director stated requests to complete level II PASARRs would normally come to the social service office. They would go on the portal to request it, and based on the information reviewed, a level II PASARR should have been requested on behalf of Resident #28. The Social Services Director said that he would immediately initiate a request for a level II for Resident #28. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 3 of 11 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 02/08/2024 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide a specialty air mattress, provide appropriate wound care and ensure adequate pain medication prior to wound care for 1 of 1 sampled resident, Resident #8, who had a facility acquired pressure ulcer. Residents Affected - Few The findings included: Record review revealed Resident #8 was admitted to the facility on [DATE]. Review of the resident's comprehensive assessment dated [DATE] documented the resident was cognitively intact, and had a facility acquired stage 4 pressure ulcer. Resident #8 was care planed for a sacral pressure ulcer, with Interventions that included an air mattress to offload pressure. An observation of wound care was conducted on 02/08/24 at 11:00 AM with the resident's Primary Care Nurse, Staff Z, Licensed Practical Nurse (LPN), and the Unit Manager. During the wound care, Resident #8 kept complaining about her buttocks hurting. Staff Z stated she premedicated the resident with Tylenol prior to wound care. After Staff Z removed the dressing and cleaned the resident's sacral wound, the resident moved her hand and placed it on the sacral wound area, again stating that it hurts right here (contaminating the cleaned wound and area). The area surrounding the open wound on the resident's buttock was noted to be reddened. Staff Z continued to place the ordered ointment to the surface of the wound and surrounding area (did not place the ointment inside the hole of the wound). After Staff Z completed wound care, and assisted the resident to roll on her backside, the resident again stated, it hurts so bad. Further observation of Resident #8's bed revealed there was no air mattress. Staff Z and the unit manager confirmed the resident should be on an air mattress to offload pressure. Staff Z also stated she would check with the doctor to see if Resident #8 could have something stronger than Tylenol for the pain. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 4 of 11 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 02/08/2024 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of the policy, titled, Catheter Care, revised 01/06/23, described, in part, the cleansing of the female followed by, 12. With a new moistened cloth, starting at the urinary meatus moving out, wipe the catheter making sure to hold the catheter in place so as to not pull on the catheter. This policy lacked instructions related to an anchor for the catheter tubing. Review of the record revealed Resident #148 was admitted to the facility on [DATE], from the hospital after being treated for a Urinary Tract Infections (UTI) with Sepsis, and admitted to the facility with an indwelling urinary catheter. Review of the current Minimum Data Set (MDS) assessment dated [DATE] documented Resident #148 had an indwelling urinary catheter and was dependent on staff for all care. Review of the current care plan dated 01/31/24 documented Resident #148 had an indwelling catheter related to Obstructive Uropathy. This care plan instructed to provide catheter care twice daily and as needed. This care plan lacked any intervention related to securing the catheter tubing to prevent dislodgement and further infection. An observation on 02/05/24 at 10:46 AM revealed Resident #148 in bed. The urinary catheter bag was noted at the bedside with drainage that had cloudy urine noted in the tubing. Photographic Evidence Obtained. An additional observation on 02/06/24 at 10:07 AM revealed cloudy urine in the tubing of the catheter. Photographic Evidence Obtained. Resident #148 lacked any type of anchoring device to keep the catheter tubing from pulling, to prevent dislodgement and or further infection. On 02/07/24 at 9:40 AM, while at the entrance to the resident's room, when asked if she had completed personal care for Resident #148, Staff A, Certified Nursing Assistant (CNA) stated yes. Upon entering the room, the CNA was in the midst of providing personal care. Resident #148 was uncovered from above the waist downward, with no brief. The water in the bathroom sink was running and there was no basin of water or supplies at the bedside. A large towel was stuffed between the resident's thighs and had been used to clean up a bowel movement (BM), as the CNA stated the resident had a large BM all over herself. An anchor dated 02/06/24 was noted on the resident's right thigh and a new Foley bag dated 02/06/24 was noted. Staff A then proceeded to obtain a water basin and liquid soap from the bottom of the resident's closet, donned four pairs of gloves on each hand, obtained water in the basin and proceeded to provide personal care. The CNA used one wash cloth to each side of the resident's thighs, and then down the middle, turning the cloth over, and then rinsed the resident using the end of a towel. The CNA removed the gloves periodically throughout the process. The CNA then turned the resident onto her side, used the same end of the towel to clean her back side, front to back, and dried the resident with the other end of the towel. The CNA placed the clean adult brief on the resident, placed a pad below the resident, and completed her task. The CNA failed to clean the urinary catheter tubing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 5 of 11 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 02/08/2024 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An interview was conducted on 02/07/24 at 9:59 AM, with the CNA and when asked if she cleaned the actual urinary catheter tubing for Resident #148, the CNA did not answer. When asked again if she cleaned the catheter tubing in any way, the CNA did not answer. On 02/07/24 at 10:02 AM, Staff A, CNA, informed the surveyor she was going to clean Resident #148 again as she was nervous and just forgot to clean the catheter. During the observation of the care, upon removal of the adult brief, another large loose bowel movement was noted. The CNA removed most of the BM with the adult brief, and then took a soapy washcloth and appropriately cleaned the sides and front area of the resident. There was obvious BM on parts of the cloth. The CNA then grabbed the catheter tubing about 5 or 6 inches from the insertion site and started to wipe the tubing from the insertion site, pulling outward on the tubing as she cleaned, using the same dirty washcloth. The surveyor asked the CNA to obtain a clean washcloth for the catheter tubing. The CNA obtained a clean washcloth and again placed the washcloth at the insertion site pulling outward on the tubing, as she held the tubing about 5 or 6 inches away from the insertion site. When asked if she could secure the catheter at the insertion site and clean outward, the CNA was unable to do so and or did not understand. On 02/07/24 in the early afternoon, the Director of Nursing (DON) was made aware of the observations. During an interview on 02/08/24 at 12:12 PM, when asked about the use of an anchoring device for an indwelling urinary catheter, the North Unit Manager stated they use them. The Unit Manager was made aware of the lack of anchoring device for Resident #148 during observations on 02/05/24 and 02/06/24. 4. Record review revealed Resident #148 was admitted to the facility on [DATE] after a hospitalization for a Urinary Tract Infection (UTI) with sepsis. Review of the orders and Medication Administration Records (MARs) revealed the following: On 01/31/24, a physician order documented for amoxicillin-potassium clavulanate (an antibiotic), 875 - 125 mg (milligrams) to be given every 12 hours for increased white blood cells until 02/06/24 at 8:59 AM for 7 days, to start on 01/31/24 at 9:00 AM. This order was discontinued at 2:42 PM. The first dose was provided on 01/31/24 at 9 AM. On 01/31/24, a physician order documented for amoxicillin-potassium clavulanate, 875 - 125 mg to be given every 12 hours for UTI until 01/31/24 at 11:59 PM for 7 days was written to start on 01/31/24 at 9:00 PM. This order was documented as completed and this dose was given on 01/31/24 at 9 PM. On 02/01/24, a physician order documented for amoxicillin-potassium clavulanate 875-125 mg to be given every 12 hours for a UTI until 02/06/24 at midnight for 7 days to start on 02/01/24 at 9:00 PM. Review of the corresponding MAR revealed the antibiotic was not given on 02/01/24 at 9 AM, but was started at 9 PM, and then administered twice daily through 02/05/24 at 9 PM. Because of the multiple electronic orders, the facility failed to ensure the provision of the antibiotic on 02/01/24 at 9 AM, and thus Resident #148 only received 13 of 14 ordered doses. Review of the progress notes lacked any documented reason for the missed dose. During a side-by-side review of the record and interview on 02/08/24 at 11:35 AM, Staff B, Licensed Practical Nurse (LPN), agreed there was a missing dose and was unsure as to why it was missed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 6 of 11 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 02/08/2024 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a side-by side review of the record and interview on 02/08/24 at 12:12 PM, the North Unit Manager agreed there was a missing dose and was unsure as to why it was missed. 5. Record review revealed Resident #149 was admitted to the facility on [DATE]. During an interview on 02/05/24 at 1:01 PM, the resident's daughter explained her mother had been hospitalized with a UTI, but was unsure about the status of the antibiotic. Review of the record revealed a physician order dated 01/31/24 for Cefdinir capsule (an antibiotic) 300 mg to be given twice daily for a UTI for 7 days, and to start on 01/31/24 at 9:00 PM. There were no other orders for the Cefdinir in the record. Review of the January 2024 MAR revealed the Cefdinir was not administered on 01/31/24 at 9 PM, with a corresponding progress note that documented the medication was on order. Review of the February 2024 MAR revealed the Cefdinir was administered to Resident #149 on 02/01/24 at 9 AM, but was not administered on that day at 9 PM. The corresponding progress note again documented the antibiotic was on order. Further review of the two MARs revealed Resident #149 only received 12 of 14 scheduled doses of the antibiotic. During an observation on 02/08/24 at 11:48 AM of the Pyxis (the facility's automatic medication dispensing machine) and interview, Staff B, LPN, confirmed the Cefdinir was available at the facility and that staff should pull the medication from the Pyxis if the antibiotic had not been delivered by the pharmacy. Based on observation, interview, and record review, the facility failed to obtain a urology consult for a resident with frequent Urinary Tract Infections in a timely manner for 1 of 3 sampled residents reviewed for activities of daily living (ADLs), Resident #17; failed to assess a resident for catheter removal in a timely manner for 1 of 3 sampled residents reviewed for catheters, Resident #77; failed to ensure proper peri and Foley (indwelling urinary catheter) care for 1 of 3 sampled residents reviewed for catheters, Resident #148; and failed to ensure complete administration of ordered antibiotics for 2 of 2 sampled residents reviewed for infection, Residents #148 and #149. The findings included: 1. Resident #17 was admitted to the facility on [DATE]. review of the comprehensive assessment dated [DATE] documented the resident had moderate cognitive impairment and was always incontinent of bladder and bowel. Resident #17 had a care plan for at risk for complications due to being incontinent of urine and bowel. Record review revealed a physician's order for a urologist consult for frequent Urinary Tract Infections (UTIs) dated 10/18/23. Further record review did not reveal if the resident had seen a urologist as ordered. An interview was conducted on 02/07/24 at 12:40 PM with Resident #17's representative at the bedside. The representative stated the communication with the facility was poor. The representative stated Resident #17 gets frequent UTIs, and was supposed to see a urologist for evaluation. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 7 of 11 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 02/08/2024 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few representative stated Resident #17 was told she had an appointment one day, she got up, got dressed and sat there waiting, but no one came. The representative stated she does not know what happened and has not heard anything more about an appointment. An interview was conducted on 02/07/24 at 12:40 PM with the Unit Manager (UM), who was questioned about the urologist appointment for Resident #17. The UM acknowledged the resident had an order from 10/18/23 to see a urologist. The UM stated he knew the resident had an appointment with a urologist, but did not know when or what happened. The UM stated medical records handles appointments. An interview was conducted on 02/07/24 at 2:00 PM with the Medical Records staff member, who was questioned about the urologist appointment for Resident #17. The Medical Record's staff stated she had to check her appointment book and get back to surveyor. She later confirmed there was no information about a urologist consult in Resident #17's records. On 02/08/24 at 9:00 AM, a follow-up interview was conducted with the medical records staff member, who stated Resident #17 had a urologist appointment on 01/19/24, but transportation did not show up. She further stated Resident #17 now has a urology appointment on 02/09/24. 2. Record review revealed Resident #77 was admitted to the facility on [DATE] with diagnoses that included Obstructive / Reflux Uropathy (narrowing or blockage of the urinary tract). The comprehensive assessment dated [DATE] documented the resident was cognitively intact and had an indwelling catheter. Record review revealed Resident #77 had a fall at the facility and was transferred to the hospital on [DATE]. The resident did not have a catheter prior to being transferred to the hospital. Resident #77 was readmitted to the facility on [DATE]. The resident had a physician order dated 01/12/24 to follow up with urology in 1-2 weeks. Further record review did not reveal any evidence of a urology appointment. On 02/08/24 at 11:45 AM, an interview was conducted with Resident #77. The resident stated he did not know why he has a catheter. He did not have one before. The resident further stated he was surprised they have not taken it out, as he does not want to get an infection. On 02/08/24 at 12:00 PM, an interview was conducted with the UM, who confirmed Resident #77 came back to the facility with a catheter. There was no plan in place to remove the catheter. On 02/08/24 at 2:00 PM, an interview was conducted with the Medical Records staff member who stated Resident #77's last visit with the urologist was 12/08/23, prior to his hospitalization. The Medical Records staff member stated there was no appointment set up for the resident post discharge from the hospital. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 8 of 11 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 02/08/2024 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 Residents Affected - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. During a random observation of the lunch meal for Resident #54 on 02/07/24 at 12:53 PM, the resident had just received her lunch. Upon uncovering the lunch plate, rice with shrimp, mixed vegetables, and a breadstick were noted. When asked how many shrimp she was served, Resident #54 identified four shrimp within the rice. The resident stated it tasted 'ok', but again confirmed there were only four shrimp. 2. Resident #17 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident had moderate cognitive impairment. An observation of lunch was conducted on 02/07/24 at 12:40 PM. The resident was observed with 3 small shrimp in shrimp fried rice on her tray. The resident's representative was at her bedside. The representative stated she counted the shrimp, and that was not enough protein to sustain the resident. An interview was conducted with an anonymous staff member on 02/08/24 at 1:45 PM. The anonymous staff member stated the resident got 3 shrimp because state was there. They usually get 1. Based on observation, interview, and review of menus and recipes, the facility failed to provide a sufficient amount of protein for 1 of 1 meal specifically reviewed for portion sizes (the lunch meal on 02/08/24). The findings included: 1. A test tray was ordered from the kitchen for the lunch meal service on 02/08/24 at 11:35 AM. The menu for this meal included shrimp fried rice, with the shrimp being the only protein for the meal. Observation of the test tray revealed four shrimp mixed into the rice. Review of the recipe for this meal revealed the shrimp, vegetables, and rice were to be prepared separately, then combined into a large mixing bowl. The portion size was documented as four ounces of the shrimp fried rice using a #8 dipper (serving ladle). The recipe lacked any method to ensure a proper protein portion. During an interview on 02/08/24 at 12:55 PM, when asked how many ounces of protein should each resident receive for this lunch meal, the Dietary Manager stated three ounces. When asked how many shrimp would be included in a three-ounce portion, the Dietary manager stated he did not know. When asked how the portions were provided to the residents for this meal, the Dietary Manager stated the recipe documents to mix together the shrimp and rice, and to provide a #8 scoop of the entree. When asked again the number of shrimp or how he could ensure a proper protein portion, the Dietary manager could not provide an answer. Upon request to weigh the four shrimp that were served at the lunch test meal tray, the four shrimp weighed one and one-half ounce (1.5 ounces). The Dietary Manager acknowledged the lack of sufficient protein. 3. During an interview conducted on 02/07/24 at 12:44 PM, Resident # 78 showed the surveyor his lunch plate and reported that he ate 5 shrimp. There were no other shrimp observed on his plate. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 9 of 11 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 02/08/2024 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to provide palatable, attractive, and appetizing meals to ensure residents' satisfaction, as evidenced by sampling of a test tray and 9 of 30 sampled residents voiced concerns regarding the quality of the food, Residents #4, #5, #37, #78, #74, #57, #9, #45, and #65. Residents Affected - Some The findings included: 1. During an observation of the lunch meal on 02/05/24 at 12:30 PM in the main dining room, Residents #4, #5, and #37, each stated they sometimes just request a sandwich or cold cereal for their meal because they did not enjoy the meals. 2. A test tray was ordered from the kitchen for the lunch meal service on 02/08/24 at 11:35 AM. The menu for this meal included shrimp fried rice, mixed vegetables, and a bread stick. When the surveyor(s) sampled the food, it was noted that the shrimp fried rice and vegetables were bland and tasteless, and the breadstick was tough and difficult to chew. 3. During a resident interview conducted on 02/05/24 at 10:01 AM regarding the quality of the food, Resident #78 stated, The chicken is as hard as a rock. Resident #78 stated that his friend often brought him meals from outside of the facility because he did not enjoy the food served to him. During a resident interview conducted on 02/06/24 at 09:50 AM regarding the quality of the food, Resident #74 said, Breakfast is good .lunch and dinner is lousy, and I don't eat much of it. During a resident interview conducted on 02/06/24 at 10:58 AM regarding the quality of the food, Resident #57 said, The food ain't good .the options are worse than what we are given. 4. An interview was conducted on 02/07/24 at 2:00 PM with the Resident Council Meeting members. Nine (9) residents participated in the discussion. Eight (8) of the nine participants voiced complaints about the food. Resident #4 said, We complained about the food. Resident #23 said, I'm here three-months and every day is the same food. Resident #52 said, We complain about the food all the time. They are not listening. Resident #84 stated that the food was bad in her current unit as well an in her previous unit. Residents #9, #45, #57, and #65, concurred with the previous statements. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 10 of 11 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 02/08/2024 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 0917 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure each resident has 1) at least one window to the outside in a room; 2) a room at or above ground level; 3) adequate bedding; 4) furniture that meets the resident's needs; or 5) adequate closet space. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, observations and record reviews, the facility failed to provide individual closet space for 1 of 1 sampled resident, Resident #347, whose room lacked an individual closet space with clothes racks and shelves, accessible to the resident. The findings included: Review of the record revealed Resident #347 was admitted to the facility on [DATE]. During an interview with Resident #347 on 02/05/24 in the hallway before lunchtime, the resident stated she did not have a closet in her room and has been waiting for one since she had arrived. Observation of Resident #347's bedroom, conducted on 02/05/24 at 1:46 PM, revealed the room was not equipped with an individual closet or a wardrobe unit. Photographic Evidence Obtained An interview was conducted with the Director of Maintenance on 02/08/24 (Thursday) at 4:26 PM in his office. When asked about the missing closet or wardrobe unit in the room that was provided to Resident #347, he stated that he did not have knowledge of it and had no explanation for the lack of a closet in the resident's room. When questioned about having maintenance records to refer to, he stated that he had none in his office. The Director of Maintenance and the surveyor then went to the Administrator who he said would know the answers to these questions, but the Administrator was not available. The Director of Maintenance then went with the surveyor to the North Nurses' Station where he retrieved a loose-leaf binder containing maintenance record forms. A side-by-side review of the maintenance log was conducted which lacked an explanation or information as to why Resident #347 was without a closet for six-days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105494 If continuation sheet Page 11 of 11