Health inspection·September 22, 2022

F 0550 Level of Harm - Minimal harm or potential for actual harm Review of Section C of the Minimum Data Set (MDS) assessment dated [DATE] documented that Resident #34 had a Brief Interview for Mental Status of 4, which indicated that she was severely cognitively impaired. Review of Section G of the MDS dated [DATE] documented that Resident #34 had for bed mobility and dressing a self-performance of extensive assistance with support of one person, transfer had a self-performance of extensive assistance with support of two persons. Residents Affected - Few Review of the Care Plan for Resident #34 dated 02/28/22 with a focus on resident has potential for impaired or inappropriate behaviors related to (r/t) Cognitive loss, Depression, Schizophrenia, Bipolar, refusing labs and noncompliance with care or treatment regime. Goals where resident will have no evidence of behavior problems by review date. Interventions included were to administer medications as ordered. Monitor/document for side effects and effectiveness. Anticipate and meet the resident's needs. Explain all procedures to the resident before starting and allow the resident to adjust to changes. Intervene as necessary to protect the rights and safety of others. Approach/Speak in a calm manner. Divert attention. Remove from situation and take to alternate location as needed. Monitor behavior episodes and attempt to determine underlying cause. During an interview conducted on 09/19/22 at 1:10 with Staff O Certified Nursing Assistant, when asked if Resident #34 feeds herself, she stated yes, she ate all her breakfast in her wheelchair then she started to go cuckoo and the resident put herself back into bed. She also stated that the resident is continuously taking all her clothes off. 2. Record review for Resident #456 revealed that the resident was admitted on [DATE], with diagnoses which included Anxiety Disorder, Quadriplegia, non-Hodgkin lymphoma. Review of Section C of the Minimum Data Set (MDS) assessment dated [DATE] documented that Resident #456 had a Brief Interview for Mental Status of 15, which indicated that he had an intact cognitive response. Review of Section G of the MDS dated [DATE] documented that Resident #456 had bed mobility self-performance of extensive assistance with support of two persons, transfer, dressing, and personal hygiene all had a self-performance of extensive assistance with support of one person. Review of the Care Plan for Resident #456 dated 08/29/22 with a focus the resident has an activities of daily living (ADL) self-care performance deficit. Goals were for the resident to improve current level of function through the review date. The interventions included check nail length and trim and clean on bath day and as necessary. Report any changes to the nurse. Provide sponge bath when a full bath or shower cannot be tolerated. Encourage the resident to fully participate possible with each interaction. On 09/19/22 at 10:00 AM, an observation was made of Resident #456 lying in bed wearing a hospital gown and a bag of clothing in a clear bag labeled patient belongings on the dresser. During an interview conducted on 09/19/22 at 10:00 AM with Resident #456, when asked if he prefers to wear a hospital gown, he replied no, they need to do my laundry all my clothes are dirty in the bag on the dresser. When asked if he had mentioned it to the staff about his dirty laundry needing to be washed, he said yes (did not know who he spoke to). He then stated I have no choice but to wear a hospital gown. During an interview conducted on 09/20/22 at 2:30 PM with Resident #456 he stated the facility still did not wash his dirty clothes, but someone brought him donated clothing to wear. He stated they brought me a pair of sweatpants that are a bit snug with him wearing a brief and he would prefer to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 2 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0550 wear his own clothes. He stated this is better than wearing the hospital gown. Level of Harm - Minimal harm or potential for actual harm During an interview conducted on 09/22/22 at 11:30 AM with Staff A Certified Nursing Assistant (CNA) when asked how long she has been with the facility, she stated she has been with the facility for 18 years. When asked about resident's dirty clothes, she stated the CNAs put the dirty laundry for residents in a yellow bin in the soiled utility room at least once daily or more often as needed. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 3 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. On 09/19/22 at 10:25 AM during the initial screening process, Resident #58 stated that he wanted to receive showers but no one gave him showers. He stated that he always gets bed baths. Resident #58 was admitted to the facility on [DATE]. His diagnoses included Quadriplegia, Spinal Instabilities of Cervical Region, and Neuromuscular Dysfunction of Bladder. Resident #58 had a Brief Interview of Mental Status of 15 per quarterly Minimum Data Set (MDS) with an assessment reference date of 06/15/22. This indicated the resident is cognitively intact. Residents Affected - Few An interview was conducted with Staff L, a certified nurses aide (CNA) on 09/21/22 at 8:40 AM. Staff L stated that Resident #58 can't go in the shower, he does not balance, it would take 2 persons to lift him and there isn't a shower chair that would keep his balance. She stated that she gives him bed baths and she takes care of him when she is working. She also stated that he never asked her for a shower. An interview was conducted with Staff K, Registered Nurse (RN) Infection Control Interim, on 09/21/22 at 11:42 AM. Staff K stated that the facility does have a special shower chair that could be used for Resident #58. She stated that she will go around the facility now to make sure every CNA was aware of the chair. 3. A record review showed that Resident #62 was initially admitted to the facility on [DATE] and readmitted on [DATE]. Diagnoses of acute kidney failure, fibromyalgia, and obesity. In an interview conducted on 09/19/22 at 9:50 AM, Resident #62 stated that she had not received any showers in months and had only had two real showers since the start of this year. She is supposed to be getting two showers weekly but is only getting wipe-downs every morning. She tells the staff that she wants a shower in the shower room, and they tell her that they are too busy or that they will give her a shower when they are done with the other residents. Resident #62 said that she no longer puts on a fight and asks for showers as she used to in the past. The Minimum Data Set (MDS) assessment dated [DATE] showed that Resident #140 has a Brief Interview of Mental Status (BIMS) score of 15, which is cognately intact. Resident #140 is totally dependent on bathing with two people's assistance. The Care plan 09/10/22 showed that Resident #62 requires staff assistance for all her Daily Living activities. A chart review showed that Resident #62 prefers showers on Mondays, Wednesdays, and Fridays. Further review of the Certified Nursing Assistants (CNAs) documentation for showers and baths showed that from 08/23/22 to 09/16/22, Resident #62 only received bed baths. No other documentation showed that Resident #62 received an actual shower in the shower room. An interview conducted on 09/20/22 at 10:40 AM with the facility's Director of Nursing stated that they do not follow the shower schedule book and that showers are given according to specific resident preferences. She further noted that it is documented in the task section of the electronic system by the CNAs. In an interview conducted on 09/21/22 at 3:11 PM with Staff F, Certified Nursing Assistant, she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 4 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated that to give Resident #62 a shower, she needed 3 staff members to help her with the task. She further said that Resident #62 asks for showers every other week but does not get them very often because they do not have enough staff to complete the task. Based on observations, interviews, and record review, the facility failed to provide showers as preferred by resident for 4 out of 34 sampled residents (Resident #29, #456, #62, and #58). The findings included: Review of the facility's policy titled, Bathing/Showering, with a revised date of 09/01/17, documented the following: Assistance with showering and bathing will be provided at least twice a week and as needed (PRN) to cleanse and refresh the resident. The resident shall be asked on admission to establish a frequency schedule for bathing. This schedule will take precedence over the twice a week and PRN cleansing. The resident's frequency and preferences for bathing will be reviewed at least quarterly during care conference. 1. Record review for Resident #29 revealed the resident was admitted to the facility on [DATE], with diagnoses which include Cerebral Atherosclerosis, Generalized Anxiety Disorder, Major Depressive Disorder, Abnormal Posture, and Muscle Weakness. Review of Section C of the Minimum Data Set (MDS) assessment dated [DATE] documented that Resident #29 had a Brief Interview for Mental Status score of 14, which indicated that she had an intact cognitive response. Review of Section F of the MDS dated [DATE] documented that it is very important for Resident #29 to you to choose between a tub bath, shower, bed bath, or sponge bath. Review of Section G of the MDS dated [DATE] documented that Resident #29 had bed mobility self-performance of extensive assistance with support of two persons, transfer self-performance activity occurred only once or twice with support of two persons, dressing self-performance of total dependence with support of one-person, personal hygiene self-support of limited assistance with support of one person. Review of the Care Plan for Resident #29 dated 02/04/20 with a focus on the resident is a long-term care (LTC) resident, she has a diagnosis (dx) of Cerebral Atherosclerosis. She is dependent on staff with activities of daily living (ADLs), transfers, and safety management. Goals were for the resident will receive appropriate staff support and the resident will maintain at current level of function through the review date. Interventions included provide sponge bath when a full bath or shower cannot be tolerated. The resident is totally dependent on (1) staff to provide bath/shower as necessary. The resident is extensive assistance on (2) staff for repositioning and turning in bed as necessary. Review of care plans for Resident #29 revealed that there was no care plan for the resident refusing showers. Record review of progress notes for Resident #29 for the past 12 months does not reveal any documentation of the resident refusing showers. Record review for Resident #29 revealed in bathing/shower task from 08/08/22/22 to 09/20/22, the resident has not had a shower only bed baths. On 09/19/22 at 10:41 AM, an observation was made of Resident #29's hair which was stringy and unkept. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 5 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview conducted on 09/19/22 at 10:40 AM with Resident #29, she stated she would like for them to wash her hair, but they do not wash her hair in the bed. She stated she would love to have a shower and have her hair washed, but the staff do not get her out of bed and into a chair to take her to the shower room. She said they rarely get her out of the bed, the last time she was out of bed was about 2-3 weeks ago. When asked if the staff is aware she wants to have a shower to wash her hair, she stated I tell them all time. During an interview conducted on 09/21/22 at 11:40 AM with Staff K Director of Nursing/ Infection Control Interim when asked about showers/hair washing for Resident #29, she stated that the resident is on shower schedule for Mondays and Thursdays on the day shift, the Certified Nursing Assistants are to let nurse know if the resident refuses a shower. She also stated that the resident has a care plan for refusing showers. When asked if they have a shower schedule for residents, she stated that the resident has behaviors and will state she wants a shower and then when staff try to take her to get a shower the resident will change her mind. 2. Record review for Resident #456 revealed that the resident was admitted on [DATE]. Diagnoses included Anxiety Disorder, Quadriplegia, non-Hodgkin lymphoma. Review of Section C of the Minimum Data Set (MDS) assessment dated [DATE] documented that Resident #456 had a Brief Interview for Mental Status score of 15, which indicated that he had an intact cognitive response. Review of Section G of the MDS dated [DATE] documented that Resident #456 had bed mobility self-performance of extensive assistance with support of two persons, transfer, dressing, and personal hygiene all had a self-performance of extensive assistance with support of one person. Review of the Care Plan for Resident #456 dated 08/29/22 with a focus on the resident has an Activities of Daily Living (ADL) self-care performance deficit. Goals were for the resident to improve current level of function through the review date. The interventions included check nail length and trim and clean on bath day and as necessary. Report any changes to the nurse. Provide sponge bath when a full bath or shower cannot be tolerated. Encourage the resident to fully participate possible with each interaction. Review of Section C of the Minimum Data Set (MDS) assessment dated [DATE] documented that Resident #456 had a Brief Interview for Mental Status score of 15, which indicated that he had an intact cognitive response. Review of Section F of the Minimum Data Set (MDS) assessment dated [DATE] documented that when asked how important it for you is to choose between a tub bath, shower, bed bath or sponge bath, his response was very important. Review of Section G of the MDS dated [DATE] documented that Resident #456 had bed mobility self-performance of extensive assistance with support of two persons, transfer, dressing, and personal hygiene all had a self-performance of extensive assistance with support of one person. Review of the Care Plan for Resident #456 dated 08/29/22 with a focus on the resident has an activities of daily living (ADL) self-care performance deficit. Goals were for the resident to improve current level of function through the review date. The interventions included check nail length and trim and clean on bath day and as necessary. Report any changes to the nurse. Provide sponge bath when a full bath or shower cannot be tolerated. Encourage the resident to fully participate possible with each interaction. Review of the Certified Nursing Assistant (CNA) Tasks for ADL-Bathing dated 08/26/22- 09/21/22 documented that the resident has only received a bed bath, he has never received a shower. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 6 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0558 Level of Harm - Minimal harm or potential for actual harm On 09/19/22 at 10:00 AM an observation was made of Resident #456 lying in bed with stringy dirty looking hair, with hair stubble on his face and wearing a very wrinkled hospital gown. During an interview conducted on 09/19/22 at 10:00 AM with Resident # 456 he stated he would like a shower, he has not had one since he has been here, stated he has been in the facility for about 3 weeks. Residents Affected - Few During an interview conducted on 09/20/22 at 2:30 PM with Resident # 456 he stated he still has not had a shower and he has told numerous staff several times since being admitted . During an interview conducted on 09/22/22 at 11:30 AM with Staff A Certified Nursing Assistant (CNA) when asked how long she has been with the facility she stated she has been with the facility for 18 years. When asked how often residents get washed, she said every day. When asked how often a resident gets a shower she replied when the resident wants one. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 7 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to maintain a safe, clean, and comfortable homelike environment throughout the facility, which also specifically included Resident #34 and #456. The findings included: 1.On 09/19/22 at 10:50 AM, an observation was made of the shower room, across from room [ROOM NUMBER], it was noted that the door lock to the shower room was not working. Inside the shower room there were missing tiles on the bottom of the wall below the shower handles. Inside the shower room there was a gallon jug with a liquid substance in a holder on the wall. The holder was rusty and dripping a brown substance. In the shower room there was a toolbox-like mechanism mounted to the wall containing a combination lock which was unlocked and hanging on the box. Inside the unlocked box was a spray bottle with Virex II256, (photographic evidence obtained). 2. On 09/19/22 at 1:10 PM, an observation was made in Resident #34's room of the window blinds with many slats broken, the nightstand and dresser were very worn on the edges on top of the furniture (photographic evidence obtained). 3. On 09/20/22 at 12:30 PM, an observation in the bathroom located inside of the facility kitchen there were 2 ceiling vents that were dirty with caked up dust, the door into bathroom toilet was dirty and rusted (photographic evidence obtained). 4. On 09/21/22 at 9:20 AM, an observation was made in the weight room, next to room [ROOM NUMBER] of a roll-on stationary scale with the top layer of the scale peeling, 2 dirty ceiling vents with bubbling paint around both vents, roach type bugs in all stages of life were in the corner of the weight room near some cardboard boxes that were next to the stationary scale (photographic evidence obtained). 5. On 09/21/22 at 9:30 AM, an observation was made in the center wing nutrition room, labeled charting room on the outside door. Inside the nutrition room it contained an Ice O Matic machine that is supposed to dispense water and ice, there was a sign on the machine that stated the ice maker is broken. The machine dispenses water only. The drip pan for the water dispenser of the Ice O Matic machine had a white crusted substance. The floor behind the Ice O Matic machine had brownish-orange spots and was littered with garbage (photographic evidence obtained). 6. On 09/22/22 at 11:00 AM, an observation of wooden baseboard located next to soiled utility room on east wing near nursing station was cracked and had holes it also made a hollow sound when touched with toe of surveyor's shoe (photographic evidence obtained). 7. During an interview conducted on 09/19/22 at 10:00 AM with Resident #456, the resident stated he has seen tiny reddish ants on his over bed table and on his bed earlier this week. On 09/20/22 at 2:30 PM in Resident #456's room there was an unknown flying insect flying around the room. During an interview conducted on 09/20/22 at 2:30 PM with Resident #456 there was a flying insect flying around. When resident was asked about the flying insect, he stated there were several of them earlier, he stated he had killed about 3-4 of them earlier that day. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 8 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 09/22/22 at 12:10 PM an environmental tour was conducted with the Regional Plant Operations Director and the Housekeeping Supervisor. During an interview conducted on 09/22/22 at 12:40PM with Housekeeping Supervisor she stated, all rooms are cleaned each day. They schedule more time for cleaning if needed for more labor-intensive areas that need a deep cleaning. Housekeeping is alerted word of mouth from staff to about areas that need additional attention for cleaning. If linens have rip/hole or stain, they are put into the trash. She stated she makes rounds every day to check on the housekeeping staff to make sure they are cleaning all areas. During an interview conducted on 09/22/22 at 12:45 PM with the Regional Plant Operations Director, it was stated that the facility has 3 maintenance assistants, and the most senior maintenance assistant does round once or twice a week to check the units. As he makes rounds, he makes notes of what needs to be addressed and divides the items that need to be addressed amongst the 3-maintenance staff. There is a work order binder at each nursing station and maintenance staff check binders several times a day and schedule projects to be done with priority on call bells and air conditioning. They work with nursing to try to accommodate the resident the best they can for maintenance issues in a resident's room. The Regional Plant Operations Director makes rounds every other week (sometimes weekly) at the facility. The facility has a Tels maintenance program that is in the process of being implemented. They are trying to have it put into the kiosk system that the staff currently use, then everybody will have access even the CNAs. All major items such as generator and air conditioning maintenance are implemented in the Tels system. 8) During the initial tour of the facility conducted on 09/19/22 at 7:48 AM, the surveyor noted multiple stained ceiling tiles in the hallways of the facility. There were nine stained ceiling tiles between rooms [ROOM NUMBERS], eight stained ceiling tiles between rooms [ROOM NUMBERS], one stained ceiling tile outside the doorway of a room labeled Beauty Parlor on the South Wing of the facility, and one stained ceiling tile outside the fire door (near the nurse's station) on the South Wing of the facility. Photographic evidence was obtained of the stained ceiling tiles. A tour of the facility was conducted on 09/22/22 by another surveyor with facility management and these ceiling tiles were noted during this tour. 9) During the observation of the first meal pass at the facility conducted on 09/19/22 at 8:00 AM on the South Wing of the facility, the surveyor observed Staff U, Social Services removing an uneaten breakfast tray from Resident #417's room. Staff U dropped the breakfast tray on the floor, spilling scrambled eggs onto the floor of the hallway outside of the resident's room. Staff U immediately called housekeeping to clean up the spilled eggs and placed a Wet Floor sign next to the scrambled eggs on the floor. The surveyor had continued observations that morning (9:30 AM, 10:18 AM, 10:25 AM) of the scrambled eggs on the floor outside of Resident #417's room. The surveyor also overheard two staff members commenting about the scrambled eggs being on the floor during these additional observations. The surveyor observed a housekeeping staff member cleaning up the scrambled eggs from the floor on 09/19/22 at 10:30 AM. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 9 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 7. A chart review showed that Resident #108 was admitted to the facility on [DATE] with a diagnosis of altered mental status and muscle weakness. Residents Affected - Few In an observation conducted on 09/19/22 at 11:00 AM, Resident #108 was noted in bed. Closer observation showed that Resident #108's nails were long and jagged, past the tip of the finger, with a brown substance underneath the fingernails. In an observation conducted on 09/20/22 at 10:20 AM, Resident #108 was noted in bed. Closer observation showed that Resident #108's nails were long and jagged, past the tip of the finger with a brown substance underneath the fingernails. In this observation, Resident #108 was asked by Surveyor if he wanted his fingernails trimmed, and the Resident said yes. The Minimum Data Set (MDS) assessment dated [DATE] showed that Resident #108 has a Brief Interview of Mental Status (BIMS) score of 08, which is slight to moderate cognitive impairment. In an interview conducted on 09/21/22 at 3:00 PM, Staff E, Certified Nursing Assistant, stated that she cuts the Resident's fingernails every week or every two weeks, depending on how fast the fingernails grow. When asked why she did not cut Resident #108's fingernails, she said he refused every time. When Surveyor asked if she documented that Resident #108 refused fingernail care, she said no. Staff E did say that she told the nurse every time he declined fingernail care. In this interview, the Surveyor asked Staff E to accompany her to Resident #108's room. Resident #108 was asked if he wanted his fingernails cut, and he said, any time you are ready, I am ready. Staff E then proceeded to cut Resident #108's fingernails. A review of the Care Plan dated 07/01/22 showed that Resident #108 has a self-care performance deficit and needs his nails length trimmed and cleaned on bath days and as necessary. Continued review did not show that Resident #108 refuses fingernail care. 5. Record review for Resident #15 revealed that the resident was admitted on [DATE] with most recent readmission on [DATE]. The diagnoses included Chronic Respiratory Failure, Lack of Coordination, Muscle Weakness, Major Depressive Disorder, Type 2 Diabetes, and Hemiplegia and Hemiparesis Following Cerebrovascular Disease Affecting the Right Dominant Side. Review of Section C of the Minimum Data Set (MDS) dated [DATE] documented that Resident #15 had a Brief Interview for Mental Status of 14, which indicated that he was intact cognitive response. Review of Section G of the MDS dated [DATE] documented that Resident #15 Bed mobility self-performance of extensive assistance with support of two persons, transfer self-performance of activity only occurred only once or twice with support of two persons, eating self-performance of independent with support of set up. Record review of care plan for Resident #15 dated 11/20/18 with a focus on resident is a long-term care (LTC) resident and has an activity of daily living (ADL) self-care performance deficit related to (r/t) incontinence, Limited mobility, Hypertension (HTN), Cerebrovascular Accident (CVA), Peripheral Vascular Disease (PVD), Atrial Fibrillation (AFIB), and generalized weakness. He is dependent on staff for ADLs, transfers, and safety management. Will continue to monitor and proceed with plan of care. Goals were to receive appropriate staff support with bed mobility, transfers, eating, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 10 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few dressing, incontinence management, and personal hygiene and to maintain current level of function through the review date. Interventions included check nail length and trim and clean on bath day and as necessary. Report any changes to the nurse. On 09/19/22 at 10:25 AM, an observation of Resident #15's fingernails long and jagged with brownish-black substance under the nails (photographic evidence obtained). On 09/20/22 at 2:50 PM, an observation was made of Resident #15's fingernails which continued to be at least approximately 1/2-inch past tips of fingers with jagged edges and brownish-black substance under the fingernails. During an interview conducted on 09/19/22 at 10:30 AM with Resident #15 when asked about his nails, he stated he likes them shorter, but the staff is so busy. 6. Record review for Resident #29 revealed the resident was admitted to the facility on [DATE]. Diagnoses included Cerebral Atherosclerosis, Viral Hepatitis C, Generalized Anxiety Disorder, Major Depressive Disorder, Abnormal Posture, and Muscle Weakness. Review of Section C of the Minimum Data Set (MDS) dated [DATE] documented that Resident #29 had a Brief Interview for Mental Status of 14, which indicated that she had an intact cognitive response. Review of Section F of the MDS dated [DATE] documented that Resident #29 How important is it to you to choose between a tub bath, shower, bed bath, or sponge bath? Answer: very important. Review of Section G of the MDS dated [DATE] documented that Resident #29 had bed mobility self-performance of extensive assistance with support of two persons, transfer self-performance activity occurred only once or twice with support of two persons, dressing self-performance of total dependence with support of one-person, personal hygiene self-support of limited assistance with support of one person. Review of the Care Plan for Resident #29 dated 02/04/20 with a focus on the resident is a long-term care (LTC) resident, she has a diagnosis (dx) of Cerebral Atherosclerosis. She is dependent on staff with activities of daily living (ADLs), transfers, and safety management. Goals were for resident will receive appropriate staff support and the resident will maintain at current level of function through the review date. Interventions included provide sponge bath when a full bath or shower cannot be tolerated. The resident is totally dependent on (1) staff to provide bath/shower as necessary. The resident is extensive assistance on (2) staff for repositioning and turning in bed as necessary. On 09/19/22 at 10:41 AM, an observation was made of Resident #29's fingernails, they are long extending about a 1/2 inch paste the tips of her fingers, they were jagged with a pinkish-brown substance under the nails (photographic evidence obtained). On 09/20/22 at 09:00 AM, an observation was made of Resident #29's fingernails extending approximately 1/2 inch past the tips of her fingers with a pinkish-brown substance underneath, the edges were jagged. During an interview conducted on 09/19/22 at 10:40 AM, Resident #29, stated they do not trim her nails as often as she would like them to be trimmed. When asked when was the last time she had them trimmed she stated about 2-3 weeks ago, they grow fast. During an interview conducted on 09/22/22 at 11:30 AM with Staff A Certified Nursing Assistant (CNA) when asked how long has she been with the facility, she stated she has been with the facility for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 11 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 18 years. She stated the CNAs clean the nails but not every day, they have a special CNA who is on light duty that cuts the residents nails, their hair and their beards if needed. The light duty CNA works 5 days a week. The CNA who is assigned a resident will let the light duty CNA know when the resident's nails need to be cut. During an interview conducted on 09/22/22 at 11:40 AM with Staff W Registered Nurse (RN) when asked how long she has been with the facility she stated she was a CNA for 6-7 months at the facility and since she has obtained her nursing license she has been with the facility for about 1 month as an RN. When asked who is responsible to cut the residents fingernails, she stated I don't know. Based on observations, interviews, and record reviews the facility failed to ensure proper nail care for 7 of 34 sampled residents (Resident # 131, 143, 420, 411, 29, 15, 108). The findings included: 1. During the initial tour of the facility conducted on 09/19/22 at 10:05 AM, the surveyor asked Resident #131 if the staff had cut her fingernails since she had been admitted to the facility. Resident #131 held out her hands to show her long fingernails to the surveyor and said, no, how much?. Photographic evidence of fingernails obtained. Resident #131 was admitted to the facility on [DATE]. Resident #131 had a medical history of a fractured leg, diabetes, obesity, muscle weakness, atrial fibrillation with a cardiac defibrillator, heart disease, and depression. An admission Minimum Data Set (MDS) assessment was done on 08/15/22. This MDS documented Resident #131 had a Brief Interview of Mental Status (BIMS) score of 8, which indicates she had moderate cognitive impairment. For functional status, she required extensive assistance of two or more staff members for bed mobility, transfers; total dependence of one staff member for locomotion; extensive assistance of one staff member for personal hygiene. Review of Resident #131's care plans revealed there was no care plan in place regarding the resident being dependent on staff for activities of daily living. During review of Resident #131's notes, there were no nursing or behavioral notes found regarding Resident #131 being offered or refusing nail care. An observation was made on 09/21/22 at 11:22 AM of the activities calendar hanging by the nurse's station on the South Hallway. On 09/04/22, 09/10/22, 09/11/22, 09/17/22, 09/18/22, 09/24/22, 09/25/22 it stated pretty nails was offered as an activity for the residents on these days. An interview was conducted with Resident #131 on 09/21/22 at 11:35 AM. The surveyor asked if she had received nail care during the survey week. The resident stated she had not. When the surveyor asked if the staff had informed her of or invited her to participate in the pretty nails activity on 09/04/22, 09/10/22, 09/11/22, 09/17/22 or 09/18/22, she stated they had not. An interview was conducted with Staff K, interim DON on 09/21/22 at 12:00 PM. The surveyor asked if the pretty nails activity noted on the activities calendar is an activity that the residents have to pay for or if it is offered to all residents. She stated it is offered to all residents in the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 12 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. During the initial tour of the facility conducted on 09/19/22 at 10:05 AM, it was noted by the surveyor that Resident #143's nails appeared long and jagged, extending past the tips of her fingers. Photographic evidence obtained. Resident #143 was admitted to the facility on [DATE]. Resident #143 had a medical history of a stroke with left sided weakness, muscle wasting, atrial fibrillation with a pacemaker, cerebral aneurysm, and bilateral foot drop. An admission Minimum Data Set (MDS) assessment was done on 08/31/22. It showed Resident #143 had a Brief Interview of Mental Status (BIMS) score of 9, which indicates she had moderate cognitive impairment. For functional status, Resident #143 required total dependence of two or more staff members for bed mobility, transfers; total dependence of one staff member for locomotion, dressing, toileting, personal hygiene; extensive assistance of one staff member for eating meals. Resident #143 had a care plan in place regarding her being dependent on staff for activities, but there was no care plan in place regarding her being dependent on staff for activities of daily living. During review of Resident #143's notes, there were no nursing or behavioral notes found regarding Resident #143 being offered or refusing nail care. An interview was attempted with Resident #143 on 09/19/22 at 10:05 AM. Resident #143 was unable to answer the surveyor's questions regarding the care at the facility and specifically nail care being offered by the staff. An observation was made on 09/21 22 at 11:22 AM of the activities calendar hanging by the nurse's station on the South Hallway. On 09/04/22, 09/10/22, 09/11/22, 09/17/22, 09/18/22, 09/24/22, 09/25/22 it stated pretty nails was offered as an activity for the residents on these days. An interview was conducted with Staff K, Interim DON on 09/21/22 at 12:00 PM. The surveyor asked if the pretty nails activity noted on the activities calendar is an activity that the residents have to pay for or if it is offered to all residents. She stated it is offered to all residents in the facility. 3. During the initial tour of the facility conducted on 09/19/22 at 10:40 AM, the surveyor noted Resident #420 had long, jagged fingernails that extended past the tips of her fingers. When asked if the staff had offered to trim her nails since being admitted to the facility, she stated no, but I would like them to be trimmed. Resident #420 was admitted to the facility on [DATE]. Resident #420 had a medical history of surgical/slow healing leg wound, skin infection, chronic pain syndrome, depression, bipolar, anxiety, insomnia, hepatitis C, and ADHD. An admission Minimum Data Set (MDS) was in progress at the time of the survey. There was no Brief Interview of Mental Status (BIMS) score or functional status documented on the MDS. Resident #420 had a care plan in place regarding her being dependent on staff for activities and activities of daily living. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 13 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During review of Resident #420's notes, there were no nursing or behavioral notes found regarding Resident #420 being offered or refusing nail care. An observation was made on 09/21/22 at 11:22 AM of the activities calendar hanging by the nurse's station on the South Hallway. On 09/04/22, 09/10/22, 09/11/22, 09/17/22, 09/18/22, 09/24/22, 09/25/22 it stated pretty nails was offered as an activity for the residents on these days. An interview was conducted with Resident #420 on 09/21/22 at 11:41 AM. The surveyor asked if she had received nail care during the survey week. The resident stated she had not. When the surveyor asked if the staff had informed her of or invited her to participate in the pretty nails activity on 09/11/22, 09/17/22 or 09/18/22, she stated they had not. An interview was conducted with Staff K, Interim DON on 09/21/22 at 12:00 PM. The surveyor asked if the pretty nails activity noted on the activities calendar is an activity that the residents have to pay for or if it is offered to all residents. She stated it is offered to all residents in the facility. 4. During the initial tour of the facility conducted on 09/19/22 at 10:48 AM, the surveyor noted that Resident #411 had long, jagged fingernails that reached past her fingertips. An interview was conducted at that time and Resident #411 complained to the surveyor that her fingernails were long, and she would like someone at the facility to cut them. Resident #411 was admitted to the facility on [DATE]. Resident #411 had a medical history of falls, diabetes, depression, and hypertension. An admission Minimum Data Set (MDS) was in progress at the time of the survey. There was no Brief Interview of Mental Status (BIMS) score or functional status documented on the MDS. Resident #411 had a care plan in place which stated, the resident has an ADL self-care performance deficit and for an intervention, it stated check nail length and trim and clean on bath day and as necessary. Report any changes to the nurse. During review of Resident #411's notes, there were no nursing or behavioral notes found regarding Resident #411 being offered or refusing nail care. An observation was made on 09/21/22 at 11:22 AM of the activities calendar hanging by the nurse's station on the South Hallway. On 09/04/22, 09/10/22, 09/11/22, 09/17/22, 09/18/22, 09/24/22, 09/25/22 it stated pretty nails was offered as an activity for the residents on these days. An interview was conducted with Resident #411 on 09/21/22 at 11:25 AM. The surveyor asked if she had received nail care during the survey week; she stated she had not. When the surveyor asked if the staff had informed her of or invited her to participate in the pretty nails activity on 09/17/22 or 09/18/22, she stated they had not. An interview was conducted with Staff K, Interim DON on 09/21/22 at 12:00 PM. The surveyor asked if the pretty nails activity noted on the activities calendar is an activity that the residents have to pay for or if it is offered to all residents. She stated it is offered to all residents in the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 14 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of facility Licensed Practical Nurse job description on 09/22/22 at 2:34 PM dated September 2018 documented Purpose of your Job Position: As an Nspire Healthcare Clinical Nurse I-LPN, you are entrusted with the responsibility of caring for our residents, families, co-workers, visitors and all others; as well as demonstrating in all interactions, Nspire Healthcare's core values. The primary purpose of your position is to provide direct nursing care to the residents and to supervise the day-to-day nursing activities performed by nursing assistants .Job Function: As Clinical Nurse I-LPN, you are delegating the administrative authority, responsibility and accountability necessary for carrying our your assigned duties. Responsible for providing direct resident care in accordance with established plans .Duties and Responsibilities: 2. Provide regular resident status updates to appropriate personnel .4. Conduct and document a thorough evaluation of each resident's medical status upon admission and throughout the resident's course of treatment .18. Perform routine nursing services for residents as directed. Residents Affected - Few Resident #115 was admitted to the facility on [DATE] with diagnoses which included Diabetes Mellitus Type 2, Hemiplegia and Hemiparesis following Cerebrovascular Disease affecting left non-dominant side, Unspecified Lack of Coordination, Hypertension, Parkinson's Disease, Schizophrenia, Generalized Anxiety Disorder, Major Depressive Disorder and Unspecified Glaucoma. She had a Brief Interview Mental Status (BIM) score of 04 (severely impaired). Resident #115 was admitted to Vitas Hospice Care on 04/28/22 with a diagnosis of Cerebral Infarction. During an observational screening tour conducted on 09/19/22 at 9:43 AM Resident #115 was noted with long, sharp, jagged, discolored and untrimmed toenails on both feet. Additionally, Resident #115's right great toe had some black matter noted underneath the toenail. Photographic evidence was obtained of Resident #115's long, sharp, jagged, discolored and untrimmed toenails on both feet; with the right great toe having some black matter noted underneath the toenail. On 09/19/22 at 3:38 PM Resident #115 was still noted with long, sharp, jagged, discolored and untrimmed toenails on both feet and the right great toe still had some black matter noted underneath the toenail. On 09/20/22 at 11:37 AM Resident #115 was still noted with long, sharp, jagged, discolored and untrimmed toenails on both feet and the right great toe still had some black matter noted underneath the toenail. On 09/20/22 at 2:14 PM Resident #115 was still noted with long, sharp, jagged, discolored and untrimmed toenails on both feet and the right great toe still had some black matter noted underneath the toenail. On 09/21/22 at 11:45 AM Resident #115 was still noted with long, sharp, jagged, discolored and untrimmed toenails on both feet and the right great toe still had some black matter noted underneath the toenail. Her CNA today is: [NAME], CNA, working in the facility for 1 week. Record review revealed on 11/20/18 the physician's order documented for Podiatry as needed dated 11/20/18. There was documentation provided and reviewed for Resident #115 indicating that she had been last seen in the nursing home by the Podiatrist on 07/07/22, in which he documented that Resident #115's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 15 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0687 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few toenails were Dystrophic, thickened and discolored 1st-5th bilaterally .slight pain on palpation to the Dystrophic, thickened and discolored toenails. Slight pain with debridement of the Dystrophic, thickened and discolored toenails. Diagnostic Assessment: Dystrophic/Hypertrophic toenails 1st-5th bilaterally and Onychomycosis toenails 1st-5th bilaterally. Plan: .Debridement of the Dystrophic/Hypertrophic toenails Recommend topical Jublia solution if the Dystrophic/Hypertrophic toenails persist .and Patient to be seen on a (PRN) as needed basis. Computerized record review of the facility's information for Resident #115, indicate that she has been covered consistently under Hospice-Vitas from 01/08/22 through 08/10/22. Record review of Resident #115's Vitas Hospice Nursing-Updated Comprehensive assessment dated [DATE] and 06/30/22 revealed that Resident #115 had a self-care deficit/functional limitation related to Activities of Daily Living (ADLs) in which it was documented that she was Dependent for (personal) care. Further record review of Resident #115's Vitas Hospice Home Health Aide/Homemaker Note dated 04/18/22 documented for foot care/ nail care .bathe and inspect the feet. On 09/21/22 at 12:22 PM an observational interview was conducted with Staff R, a Vitas Hospice visiting Registered Nurse (RN) regarding Resident #115's long, sharp, jagged, discolored and untrimmed toenails on both feet. She acknowledged that Resident #115 did have long, sharp, jagged, discolored and untrimmed toenails on both feet. However, Staff R stated that Vitas Hospice does not manage Resident #115's Podiatry care. She said that per the resident's facility's doctor's request, Vitas can then call in a Podiatry consult. On 09/21/22 at 12:30 PM an observational interview was conducted with Staff S, a Certified Nursing Assistant (CNA), in which she acknowledged that Resident #115's toenails were long, sharp, jagged, discolored and untrimmed toenails on both feet and she stated that she had not informed the nurse of this for Resident #115. On 09/21/22 at 12:38 PM an observational interview was conducted with Staff M, a Licensed Practical Nurse (LPN)/ Unit Manager (UM) of the East wing, in which also acknowledged that Resident #115's long, sharp, jagged, discolored and untrimmed toenails on both feet and she added that the resident was seen by Podiatry about two (2) months ago. Subsequently, a telephone call was received on 09/21/22 at 1:18 PM from the Podiatrist office regarding Resident #115, the Podiatrist indicated that due to the resident's insurance status/limitations, he is only allowed to visit and treat the resident no sooner than about a period of sixty (60) days in order to be reimbursed by her insurance for services. There was no documentation in the resident's facility's nursing progress notes dated 03/01/22 through 09/21/22 to indicate nor make reference to Resident #115's toenails being long, sharp, jagged, discolored and untrimmed on both feet. In fact, Resident #115's (ADL) care plan revised on 02/05/22 indicated that Resident #115 requires assistance with all (ADLs). She is under Hospice care with potential for further decline. Staff to continue to anticipate needs and provide care for symptom relief with Hospice support Intervention: Personal hygiene, resident requires total assistance by one (1) staff with personal hygiene .Resident #115 has Diabetes Mellitus care plan revised 07/21/21 Intervention: Refer to Podiatrist/foot care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 16 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0687 nurse to monitor/document foot care needs and to cut long nails. Level of Harm - Minimal harm or potential for actual harm During an interview conducted on 09/22/22 at 10:16 AM with the Assistant Director of Nursing (ADON), she acknowledged that Resident #115's name was not on the current Podiatrist Follow-up List nor on the Cut Toenails List, located on the East wing, and there was no reference to any concerns or issues with Resident #115's long, sharp, jagged toenails documented in the nursing progress notes from March 2022 till September 2022. The (ADON) also indicated that the nurses could have always requested an on-site Podiatry visit, in between consults, since the facility does not do toenail care; this was not done. Residents Affected - Few Based on observation, interview, and record review, it was determined that the facility failed to ensure that Resident #146 and Resident #115 received proper follow-up treatment and care to maintain good foot health for 2 of 2 sampled residents observed for Activities of Daily Living (ADLs), Resident #106 and #115. The findings included: A review of the facility policy titled Podiatry, revised on 08/21/2017, showed that Podiatry consultations are available to residents and that any team member may ask the attending Physician to request the Podiatry consultation. Once the consult order is written or transmitted verbally, the License nurse will make the referral. 1. A chart review showed that Resident #146 was admitted to the facility on [DATE] with diagnoses of weakness, muscle wasting, and depressive disorder. In an interview conducted on 09/19/22 at 10:10 AM, Resident #146 stated that he has been waiting to see the Podiatrist and that he was told that they would make the appointment for him, but it ' s been very long. The Minimum Data Set (MDS) dated [DATE] showed that Resident #140 has a Brief Interview of Mental Status (BIMS) score of 13, which is cognately intact. A review of the Physician ' s assistant notes dated 08/09/22, 08/04/22, and 06/03/22 showed that Resident #146 has a left foot with a fractured bone and is given orders for No Weight Bearing, and he wants to see a Podiatry regarding this. A chart review showed an order for a Podiatry consultation dated 05/03/22. Further chart review showed a patient referral order for a Podiatrist dated 02/21/22 that was never done for Resident #146. In an interview with Staff B, the Registered Nurse, on 09/20/22 at 1:30 PM, stated that orders for Podiatry consultations are placed in a communication binder in the nurses ' station and are picked up by nursing staff. In this interview, the facility ' s Assistant Director of Nursing said that they also have an in-house Podiatrist that comes into the facility every other Thursday. When asked why Resident #146 did not have his Podiatry consultation, she did not know. In an interview conducted on 09/2022 at 1:45 PM, Staff C, Unit Clerk, stated that she checks the consultation status in the electronic system, or nurses will print out the consultation sheets and place it in a communication folder in the unit. When asked regarding Resident #146, she said that he could not see the Podiatrist because of insurance issues, but he was placed on the list this month for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 17 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0687 the in-house Podiatrist to see him when he comes into the facility. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 18 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to adjust the tube feeding regimen to meet a resident's caloric and protein needs, failed to follow the tube feeding order, and failed to prevent the development of a new pressure ulcer for 1 of 1 sampled resident (Resident #30) reviewed for tube feedings. The findings included: A review of the facility's policy titled Enteral Feeding revised on 11/12/18 showed that the nurse administers enteral feeding when volume control is indicated and as ordered by Physician. A chart review showed that Resident #30 was initially admitted to the facility on [DATE] and readmitted again on 09/09/22, with a medical history of Diabetes, Dysphagia, and Intracerebral Hemorrhage. He was recently readmitted to the facility on [DATE] after having to go out to the hospital on [DATE] for Hypoxia and Tachycardia. In an observation conducted on 09/19/22 at 8:07 AM, Resident #30 was noted in his bed. The tube feeding bottle was with Jevity 1.5 (tube feeding formulary) at 70 milliliters (ml) an hour and running at 70 ml an hour. Closer observation showed that the tube feeding bottle started at 8:00 AM on 09/18/22 and was almost empty at the observation time. The tube feeding bottle has a 1000 ml capacity. This showed that Resident #30 only received a total volume of 1000 ml and not a total volume of 1400 as per MD orders. Continued observation on 09/19/22 at 12:49 PM showed a tube feeding bottle with no start time but had a start date of 09/19/22. It ran at 70 ml an hour and was at the 1000 ml mark out of a 1000 ml capacity bottle. An observation conducted on 09/19/22 at 1:46 PM showed Resident #30 in his bed. The tube feeding was not running, and that tube feeding bottle was noted at the 1000 ml mark out of a 1000 ml capacity bottle. In an observation conducted on 09/20/22 at 10:20 PM, Resident #30 was noted in bed. Closer observation showed a tube feeding bottle that was started on 09/20/22 at 9 AM at 70 ml an hour. The tube feeding mark was at 1000 ml out of the 1000 ml capacity bottle. This showed that no tube feeding was infused for an hour and a half. A review of Physicians' orders showed the following: a one-time a day Jevity 1.5 at 70 ml an hour up between 12:00 PM to 1:00 PM, down when the total volume of 1400 ml infused daily dated 09/10/22. Prostat oral liquid to give 30 ml once daily for wound healing dated 09/10/22. A review of the weight log showed the following weight history: on 05/19/22, he weighed 261 pounds; on 06/29/22, he weighed 255.2 pounds; on 09/09/22, a weight of 223.2 pounds and on 09/19/22, a weight of 230.0 pounds. A review of the Nutrition assessment dated [DATE], a day after Resident #30 was readmitted from the hospital, showed the following: Resident #30 is on enteral feeding with a current weight of 223.2 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 19 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few pounds. The current tube feeding order provides 2100 calories and 89 grams of protein a day. Resident #30 estimated needs were noted for 2100 to 2520 calories and 101 to 126 grams of protein. In this assessment, the facility's Clinical Dietitian estimated Resident #30's needs using his Adjusted Body weight and recommended a protein supplement daily for an added 17 grams of protein. She further stated that Resident #30 would maintain adequate nutritional status in the absence of unplanned weight loss. The Clinical Dietitian's tube feeding recommendations met the lower end of Resident #30's needs for calories and protein daily. The current tube feeding rate with the additional protein supplement provides 106 grams of protein out of the 126 grams of protein estimated on the higher end of the protein needs, which is 84 percent of protein needs. A review of the Medication Administration Record for Resident #30 showed that the protein supplement was only started on 09/12/22, which was 3 days after his readmission to the facility. A progress note written on 07/28/22 by the Clinical Dietitian showed that Resident #30 had a stage 3 sacrum pressure ulcer, and she recommended providing Prostat protein supplement to 3 times a day. At the time, Resident #30 ate by mouth and was not on tube feeding. The care plan dated 08/19/22 showed that Resident #30 requires tube feeding related to dysphagia, and the Clinical Dietitian to evaluate as needed and monitor caloric intake and estimated needs, and make recommendations for changes to tube feeding as required. It further showed that Resident #30 is at risk for developing pressure ulcers related to fragile skin. A review of the wound care doctor note dated 09/12/22, which was 3 days after Resident #30's readmission, showed the following: Resident #30 has wound #1 with inferior sacrum wound stage 4 that has a length of 3 centimeters, a width of 3 centimeters and depth of 1 centimeter. Wound #2 was noted with superior sacrum stage 3 has a length of 4 centimeters, a width of 5 centimeters, and a depth of 0.2 centimeters. A review of the wound care doctor's note dated 09/19/22 showed the following: Resident #30 has wound #1 with inferior sacrum wound stage 4 that has a length of 2.5 centimeters, a width of 3 centimeters, and a depth of 1 centimeter. Wound #2 was noted with superior sacrum stage 3 has a length of 5 centimeters, a width of 0.2 centimeters, and a depth of 0.2 centimeters. A new wound that developed was assessed as wound #3 on the left lateral buttocks stage 3, which has a length of 6 centimeters, a width of 1 centimeter, and a depth of 0.1 centimeters. An interview with the Clinical Dietitian on 09/21/22 at 9:43 AM stated that any residents who is admitted or readmitted to the facility with a stage 3 pressure ulcer and above she would assess the protein needs using a range of 1.2 to 1.5 multiplied by the body weight. She further stated that when evaluating tube feeding needs on residents with stage 3 pressure ulcers and above, she will use the higher end of their needs for protein and calories. When asked why she only recommended one scoop of protein supplement daily and not twice a day or higher, she agreed with the Surveyor that it should have been more. When asked why she estimated the tube feeding needs to meet the lower end of the needs for Resident #30, she reported that Resident #30 was readmitted from the hospital. She did not want to overfeed the Resident and kept him at the lower end of needs and see if he gained weight before increasing his caloric and protein needs. Surveyor expressed concerns that Resident #30 developed a new wound since his readmission. In an interview conducted on 09/21/22 at 10:36 AM with Staff B, the Registered Nurse stated that Resident #30 tolerates his tube feeding with no issues. She further noted that the tube feeding may be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 20 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few on hold for daily care and wound care, but it resumed to meet the 1400 ml of formulary in 24 hours. She further said that Resident #30 was on pleasure feeding in the past before he was readmitted from the hospital. In an interview conducted on 09/21/22 at 12:15 PM, Staff D, Certified Nursing Assistant, stated that she takes the weight for Resident #30 using a Hoyer lift. She takes off the sling's weight from that total reading on the scale. Staff D provides the list of all weights to the Clinical Dietitian of the Director of Nursing. In this interview, Staff D was observed taking the weight on Resident #30 using the Hoyer lift. The new weight for Resident #30 was noted at 126.2, which was 4 pounds weight loss from his weight of 230 pounds two days ago. In an interview conducted on 09/22/22 at 1:00 PM, with the Director of Nursing she was told of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 21 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0732 Post nurse staffing information every day. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, record review and review of policy and procedure, it was determined that the facility failed to ensure that it visibly posted and correctly dated the Nurse Staffing Information form, for 2 of 4 days during the current Recertification survey. Residents Affected - Few The findings included: Review of the facility policy and procedure on 09/22/22 at 12:30 PM titled Daily Nursing Staffing Form provided by the Director of Nursing (DON) reviewed 09/2017 documented in the Policy Statement: Post beginning of each shift in a prominent place that is readily accessible to residents and visitors. During an initial observational tour conducted on Monday 09/19/22 at 7:40 AM and again on Monday 09/19/22 at 8:10 AM, it was noted by two (2) Agency for Healthcare Administration (AHCA) surveyors, that there was no Nurse Staffing Information form visibly posted at the front receptionist desk. On 9/20/22 at 11:12 AM, it was observed that there was a Nurse Staffing Information form posted at the front desk for Tuesday, September 20th. However, the posted Nurse Staffing Information form still documented the previous days date of Monday, September 09/19/22. In fact, it was noted that the Nurse Staffing Information form was either not posted or incorrectly dated for two (2) of four (4) days, at the facility's front receptionist desk. The (DON) indicated that there is only one Nurse Staffing Information form posted at the front receptionist desk for the facility and she acknowledged and recognized that it should be visibly posted for residents and visitors and should be correctly dated; this was not done. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 22 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and review of policy and procedure, it was determined that the facility failed to 1) ensure that it kept its Wound Care Treatment Cart locked and secured during wound care for 3 of 3 sampled residents observed, Resident #102, Resident #73 and Resident #154, and for 1 of 4 Treatment Carts observed, East wing Treatment cart; and 2) facility failed to ensure that it secured medications at the bedside for 1 of 34 sampled residents during an observational tour, Resident #109. The findings included: Review of the facility policy and procedure on 09/22/22 at 12:40 PM titled LTC Facility's Pharmacy Services and Procedures Manual provided by the Director of Nursing (DON) revised 07/21/22 documented in the Policy Statement: Applicability: This policy 5.3 sets forth the procedures relating to the storage and expiration dates of medications, biologicals, syringes and needles .Facility should ensure that all medications and biologicals, including treatment items, are securely stored in a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors. 1. During an initial observation conducted on 09/19/22 at 8:40 AM, it was first observed that there was an unlocked/unattended Treatment cart on the East wing outside of Resident #102's room, it was accessible to other residents, staff members and visitors for a time period of more than ten (10) minutes while the Wound Care doctor, was assisted by Staff T, a Certified Nursing Assistant (CNA), both treating Resident #102 inside of her room, with the door closed. There were several other staff members and residents in the vicinity of the unlocked/un-attended East wing Treatment cart. Resident #102 was admitted to the facility on [DATE] with diagnoses which included Heart Failure, Diabetes Mellitus Type II, Hypertension, Chronic Kidney Disease stage III and a Cardiac Pacemaker. She had a Brief Interview Mental Status (BIM) score of 08 (moderately impaired). On 09/19/22 at 8:50 AM during a second observation, it was again noted that there was an unlocked/unattended Treatment cart on the East wing outside of Resident # 73's room, it was also accessible to other residents, staff members and visitors for a time period of more than ten (10) minutes while the Wound Care doctor, was assisted by Staff T, both treating Resident #73 inside of her room, with the door closed. There were several other staff members and residents in the vicinity of the unlocked/un-attended East wing Treatment cart. Resident #73 was re-admitted to the facility on [DATE] with diagnoses which included Diabetes Mellitus Type II, Degenerative Disease of Nervous System, Atrial Fibrillation, Hypothyroidism, Anxiety Disorder, Major Depressive Disorder, Hypertension and Glaucoma. She had a Brief Interview Mental Status (BIM) score of 11 (moderately impaired). Finally, during a third observation on 09/19/22 at 9:02 AM, it was once again noted that this same unlocked/unattended Treatment cart was now located on the Center wing just outside of Resident # 154's room, it was also accessible to other residents, staff members and visitors for a time period of more than ten (10) minutes while the Wound Care doctor, was assisted by Staff T, both treating the Resident # 154 inside of her room, with the door closed. There were several staff members and residents in the vicinity of the unlocked/un-attended East wing Treatment cart. Resident #154 was re-admitted to the facility on [DATE] with diagnoses which included Acute Respiratory Failure, Encephalopathy, Dysphagia, Contracture of right knee, left knee and left foot, Major Depressive Disorder, Anxiety (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 23 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Disorder, Alzheimer's Disease and Hypertension. He had a Brief Interview Mental Status (BIM) score of 6 (severely impaired). An interview was conducted with Staff T, a Certified Nursing Assistant (CNA) on 09/21/22 at 1:41 PM, regarding the unlocked/un-attended East wing Treatment cart, during three (3) resident wound care doctor treatment visits and she acknowledged that the East wing Treatment cart had been left unlocked and unattended while she and the Wound Care Doctor were inside of the resident's closed room door, while providing care and services to the resident. An interview was conducted with Staff M, a Licensed Practical Nurse (LPN)/ Unit Manager (UM) East wing), on 09/21/22 at 1:54 PM regarding the unlocked/un-attended East wing Treatment cart, during three (3) resident wound care doctor treatment visits and she further acknowledged that the East wing Treatment cart had been left unlocked and unattended while she and the Wound Care Doctor were inside of the resident's closed room door, while providing care and services to the resident. The Assisted Director of Nursing (ADON) and the (DON) on 09/21/22 at 2 PM further acknowledged and recognized that the unlocked/un-attended East wing Treatment cart must be kept locked at all times during wound care doctor treatment visits; this was not done. 2. Record Review for Resident #109 revealed the resident was admitted on [DATE] with most recent readmission on [DATE]. Diagnoses included Rheumatoid Arthritis, Lack of Coordination, Contracture of Right Hand, and Muscle Wasting. Review of Section C of the Minimum Data Set (MDS) dated [DATE] documented that Resident #109 had a Brief Interview for Mental Status of 14, which indicated that she had an intact cognitive response. Review of Section G of the MDS dated [DATE] documented that Resident #109 had a bed mobility self-performance of extensive assistance with support of two persons, transfer self-performance of total dependence with support of two persons, dressing self-performance of extensive assistance with support of two persons, personal hygiene self-performance of limited assistance with support of one person. Review of the Physician's Orders showed that Resident #109 did not have an order for Voltaren arthritis pain topical gel medication. Review of the Care Plans for Resident #109 revealed there was no care plan for self-administering medications at the bedside. On 09/19/22 at 10:55 AM observation of Resident #109's room revealed a tube of Voltaren arthritis pain topical gel medication on the over bed table (photographic evidence obtained). On 09/20/22 at 2:55 PM an observation in Resident #109's room of Voltaren arthritis pain topical gel medication on the over bed table. During an interview conducted on 09/20/22 at 2:55 PM with Resident #109, when asked about the Voltaren arthritis pain topical gel medication on the over bed table the resident stated, it is for my knees, the nurses put it on me, the nurse today won't put it on for me she said because she does not have an order for it. Resident stated, the doctor told me I could use it. During an interview conducted on 09/20/22 at 3:00 PM with Staff Y, Registered Nurse (RN) when asked about the Voltaren arthritis pain topical gel medication on Resident #109's over bed table, she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 24 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete stated that she never saw any Voltaren arthritis pain topical gel medication at the resident's bedside. When Staff Y went with the surveyor to the resident's room and saw the Voltaren arthritis pain topical gel medication on the overbed table she said oh. When Staff Y was asked if the residents can have medications at the bedside, she stated the residents can just put over-the-counter medications in their drawer. During an interview conducted on 09/21/22 at 3:30 PM with Staff Y when asked if Resident #109 still the Voltaren arthritis pain topical gel has medication at her bedside, she said no we put it away and got an order from the physician to give her the medication. Event ID: Facility ID: 105495 If continuation sheet Page 25 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure resident's received proper meal preferences for 2 of 2 sampled residents (Resident #417, and #408). Both residents had complaints that their meal choices were not being followed; one of the two residents was routinely served meals she could not eat due to celiac disease and lactose intolerance. The findings included: 1. During the initial tour of the facility conducted on 09/19/22 at 8:00 AM, the surveyor noted Resident #417 refused her original breakfast tray and asked for gluten free toast instead. Staff U, Social Services (who had brought her breakfast tray to her) removed the original breakfast tray and made Resident #417 gluten free toast per her request. An interview was conducted with Resident #417 on 09/19/22 at 12:35 PM. Resident #417 stated that she had celiac disease and lactose intolerance, and she was consistently brought food that she could not consume. When asked by the surveyor if she has spoken to any staff members at the facility about this issue, she stated she had spoken to a dietitian multiple times, but the kitchen continued to send her eggs, food covered with gravy, and ice cream-all of which she had told the dietitian she could not consume due to her dietary restrictions. She said a friend brought her gluten free bread, protein shakes, and fruit cups from outside the facility and these items were what she had been eating for all of her meals due to the kitchen consistently sending the wrong foods. During this interview, Resident #417's lunch tray was brought to the bedside. She stated this was the first time she was served a tray with foods she could eat-mashed potatoes and peas. There were also glazed carrots on the plate which Resident #417 said she would not eat because she did not know what was in the glaze. During this interview and observation, the surveyor noted the meal ticket on the tray documented no eggs, no meat, no milk and gluten free. Resident #417 was admitted to the facility on [DATE]. Resident #417 had a medical history of sepsis, nausea/vomiting, low blood pressure, neuropathy, depression, and gastric acid reflux. It was noted by the surveyor during the initial record review that there was no documentation in the Medical History or Allergies sections of the electronic chart of the presence of celiac disease or lactose intolerance. An admission Minimum Data Set (MDS) assessment was in progress at the time of this survey. There was no Brief Interview of Mental Status (BIMS) score documented in this MDS. However, the surveyor noted during the initial interview that Resident #417 was alert and oriented and able to answer all questions without difficulty. During review of Resident #417's Care Plan, it was noted by the surveyor that there was no care plan in place regarding her dietary preferences. Review of the physician orders for Resident #417 revealed an order was written on 09/16/22 for a gluten free diet. Review of the notes in Resident #417's chart revealed the dietary department had not written any note at the time of this survey. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 26 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During review of the Diet History and Food Preferences Assessment, dated 09/13/22, the surveyor noted that see mealtracker was documented in the Likes/Dislikes section and in the Beverage Preferences section. Under Food Allergies/Intolerances, gluten was documented but not lactose. The surveyor requested the mealtracker to be printed by the Registered Dietitian. A Food Preference Assessment, undated, was provided on 09/21/22 at 10:26 AM by the Registered Dietitian. This document showed Resident #417's dislikes included dishes with gravy, eggs in all forms, all forms of hot cereal, shrimp, hamburger steak/beef, pork products, and dairy products. An interview was conducted on 09/20/22 at 8:45 AM with Resident #417 regarding what foods were provided on her breakfast tray that morning. Resident #417 stated she received oatmeal on her tray; she told the surveyor she would not eat the oatmeal because she did not trust that it was gluten free. She told the surveyor she asked a staff member to toast her gluten free bread and the staff member refused, stating they were not allowed in the kitchen to toast her bread. She said she told the staff member that someone had made her toast the day before, but they continued to refuse her request. During this interview, Resident #417 showed the surveyor a picture of her tray which included the meal ticket which documented no eggs, no meat, no milk and gluten free. An interview was conducted with the facility's Registered Dietitian on 09/21/22 at 10:30 AM. The surveyor asked her to explain how the food dislikes are displayed on the resident's meal tickets. She stated that since some residents have a lot of preferences, they often condense the preferences so the kitchen staff gets a smaller list. She specified that the kitchen staff does not have access to the whole list of preferences for each resident. When asked how often the residents are interviewed about their food preferences, she stated the residents are interviewed on admission, quarterly, and if a complaint is made to staff about their meals. When asked specifically about Resident #417's concerns, the Registered Dietitian confirmed that she had spoken to her multiple times regarding the concerns but did not realize it was still an issue. The Registered Dietitian was able to show the surveyor the meal tickets for the 3 meals on 09/21/22-all of the meal tickets documented no eggs, no meat, no milk and gluten free. An interview was conducted with Resident #417 on 09/21/22 at 11:15 AM. She stated her lunch and dinner meals on 09/20/22 were mashed potatoes with vegetables and no gravy, so she was able to eat these meals with no issue. However, for breakfast on 09/21/22, she was served 2 strips of bacon and hot cereal, despite both of these foods being on her dislikes list. In this interview, Resident #417 stated she was going to be discharged to home that day. 2. During the initial tour of the facility conducted on 09/19/22 at 8:35 AM, the surveyor noted Resident #408 was not eating her breakfast tray. During the initial interview conducted on 09/19/22 at 10:18 AM, Resident #408 told the surveyor that the quality of the food at the facility was poor and the staff provided no food alternatives when she asked for them. Resident #408 was admitted to the facility on [DATE]. Resident #408 had a medical history of falls, broken arm and leg, neuropathy, chronic obstructive pulmonary disease, heart disease, anxiety, depression, and gallbladder removal. An admission Minimum Data Set (MDS) was in progress at the time of this survey. This MDS shows Resident #408 had a Brief Interview of Mental Status (BIMS) score of 13, indicating she was cognitively intact. During review of Resident #408's Care Plans, the surveyor noted there were no care plans in place (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 27 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0806 regarding food preferences. Level of Harm - Minimal harm or potential for actual harm Review of the physician orders for Resident #408 revealed an order was written on 09/12/22 for a regular diet. Residents Affected - Few Review of the notes in Resident #408's chart revealed the dietary department had not written any note at the time of this survey. During review of the Diet History and Food Preferences, dated 09/13/22, the surveyor noted that see mealtracker was documented in the Likes/Dislikes section and in the Beverage Preferences section. The surveyor requested the mealtracker to be printed by the Registered Dietitian. A Food Preference Assessment, undated, was provided on 09/21/22 at 10:26 AM by the Registered Dietitian. It shows this resident's dislikes were all pork products. An interview was conducted with the facility's Registered Dietitian on 09/21/22 at 10:30 AM. The surveyor asked her to explain how the food dislikes are displayed on the resident's meal tickets. She stated that since some residents have a lot of preferences, they will often condense them to the kitchen staff gets a smaller list. She specified that the kitchen staff does not have access to the whole list of dislikes for each resident. When asked how often the residents are interviewed about their food preferences, she stated the residents are interviewed on admission, quarterly, and if a resident complains to staff about their meals they will be interviewed again. An interview was conducted with Resident #408 on 09/21/22 at 11:20 AM. She stated that she was interviewed about her preferences only on admission but that no staff had asked her since that time. She said she does not eat pork products because she is Jewish, but there are no other dislikes that she told the facility staff about. She said the quality of the food was poor and the staff did not offer other options, even when she asked or did not eat any food off her tray; she said she often had friends bring her food from outside the facility because she felt the facility's food did not meet her needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 28 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview and record review, the facility failed to provide appropriate beverages to a resident who was prescribed by the Physician to have nectar-thickened consistency liquids for 1 out of 1 sampled residents (Resident #140). The findings included: A chart review showed that Resident #140 was readmitted to the facility on [DATE] with diagnoses of chronic obstruction pulmonary disease, dementia, and epilepsy. In an observation conducted on 09/19/22 at 12:51 PM, Resident #140 was noted in bed with the covers over his head. A closer look at his lunch meal ticket showed the following: Regular nectar thick liquids, no added salt diet, and 4 ounces of nectar thick cranberry juice. The tray was noted with 4 ounces of orange juice that was not nectar thickened. At around 1:45 PM, Staff A, Certified Nursing Assistant, brought an 8 ounces cup of coffee for Resident #140. She placed it on the meal cart and walked out of the room. The closer observation did not show that the coffee was thickened with the appropriate fluid consistency as per the Doctor's order. At 2:05 PM, Resident #140's tray was still untouched at the bedside, and Resident #140 was sleeping. In an observation conducted on 09/20/22 at 8:10 AM, Resident #140 was noted in his bed. Closer observation showed that he had 4 ounces cup of water at the bedside that was not thickened. Resident #140 asked Surveyor for a cup of coffee during this observation. In an observation conducted on 09/20/22 at 9:20 AM, Resident #140 was in bed eating his breakfast meal. Closer observation showed the following: 4 ounces of thickened juice, 6 ounces of thickened milk, and 8 ounces of coffee that was not thickened with the appropriate fluid consistency. A review of the Physicians' orders showed an order for a regular texture diet, nectar thickened fluids consistency, dated 08/19/22. The Minimum Data Set (MDS) dated [DATE] showed that Resident #140 has a Brief Interview of Mental Status (BIMS) score of 09, which is slight to moderate cognitive impairment. In an interview conducted on 09/20/22 at 9:30 AM with Staff A, Certified Nursing Assistant, she stated that she did not give Resident #140 the cup of coffee and that the kitchen oversees placing the coffee on the resident's trays. Surveyor stated that she observed her giving Resident #140 a cup of coffee the day before. In an interview conducted on 09/20/22 at 9:35 AM with the facility's Assistant Director of Nursing, she acknowledged that Resident #140 received a coffee that was not thickened with the correct liquids. In this interview, Resident #140 was observed drinking coffee in his room. An interview conducted on 09/22/22 at 1:00 PM with Staff V, Speech Language Pathologist, stated that she evaluated Resident #140 at the bedside during dining on 08/19/22 and noticed that he was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 29 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 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 0807 coughing when drinking his fluids. She changed his diet order to thickened liquids on 08/19/22 but did not do a note or an assessment on Resident #130. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 30 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interviews, and record review, the facility failed to keep food safety requirements with storage, preparation, and distribution that is by professional standards for food service safety, including holding cold foods at regulatory temperature, failure to adequately cover facial hair, foods not dated and labeled, and failure wear a hairnet in the food production area. The findings included: In an observation conducted on 09/12/22 at 7:58 AM, the following was noted in the central kitchen: The right-side hood was missing one light bulb. 1. The Delfield reach-in refrigerator had a discolored and worn-out gasket (photographic evidence obtained). 2. The dry storage area room was noted to with stains and debris all over the floor underneath the racks (photographic evidence obtained). 3. Staff G and Staff H, Maintenance staff, were noted in the food production area not wearing a facial covering or a hairnet. 4. The staff I, the Laundry Manager, was noted in the food production area not wearing a hairnet. In this observation, she acknowledged that she needed to wear a hairnet before going into the kitchen. 5. In an observation conducted on 09/20/22 at 9:36 AM, in the Center wing pantry room, the ice machine was noted to be with a green slimy substance that was draining down into the ice machine reservoir (photographic evidence obtained). 6. In an observation conducted on 09/21/22 at 11:55 AM, personal keys were noted during the tray line for lunch (photographic evidence obtained). In an interview conducted on 09/19/22 at 9:00 AM with the District Dietary Manger he was told of the findings on the first visit conduced in the main kitchen. 7. Review of the facility's policy titled, HCSG Policy 019 Food Storage: Cold Foods, with a revised date of 04/2018, documented the following: All Time/Temperature Control for Safety (TCS) foods, frozen and refrigerated, will be appropriately stored in accordance with the guidelines of the FDA Food Code. All foods will be stored wrapped or in covered containers, labeled and dated. During an observation conducted on 9/20/22 at 12:25 PM of a hairbrush with multiple hairs attached and saltshaker that were placed on a ledge in the kitchen over food preparation table (photographic evidence obtained). During an interview conducted on 09/21/22 at 12:30 PM with the Kitchen Account Manager, who has been with the facility for 8 months. When asked when resident's personal items are sent back to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 31 of 32 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 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Nursing and Rehabilitation Center 4200 Washington St Hollywood, FL 33021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm kitchen on the dirty meal tray where are they stored until returned to the resident. He stated they are sent back to the resident right away (same day). 8. During an observation conducted on 09/19/22 at 8:25 AM of a medication cart on the west wing with an opened applesauce dated 09/18/22 not on ice or cooler bin (photographic evidence obtained). Residents Affected - Few During an observation conducted on 09/19/22 at 11:00 AM of a medication cart at east nursing station had opened and undated applesauce sitting on top of medication cart not n ice or in a cooler bin (photographic evidence obtained) During an interview conducted on 09/21/22 at 10:20 AM with the Kitchen Account Manager, when asked about how the applesauce is stored on the medication carts, he stated the kitchen sends out black insulated cooler bins for the staff to put ice in to keep opened applesauce in. During an interview conducted on 09/22/22 at 11:40 AM with Staff W Registered Nurse (RN) when asked how long she has been with the facility she stated she was a CNA or 6-7 months and an RN for about 1 month. When asked about the open apple sauce dated 09/22/22 (not on ice) how long does it sit on the medication cart, she stated for 1 day, when asked if it needs to be kept on ice, she stated no. During an interview conducted on 09/22/22 at 11:50 AM with Staff X Registered Nurse (RN) she has been with the facility for 1 year. When asked about open applesauce on the medication cart, she stated it stays on the cart for an 8-hour shift and then it is thrown away. When asked if it needs to be on ice, she said no, not if it is fresh. 9. During an observation conducted on 0919/22 at 8:34 AM in the west wing nourishment room there were 10 containers of facility made pudding with no date. During an interview conducted on 09/21/22 at 10:20 AM with the Kitchen Account Manager, when asked about how the facility made puddings in the nourishment rooms. He stated that the facility made puddings cups are supposed to have a date on each of the lids and they should be discarded after 3 days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 32 of 32