Inspection·March 7, 2024

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few filing, will be provided on a regular schedule (such as weekly on Wednesday 3-11 shift.) Nail care will be provided between scheduled occasions as the need arises .6. Principles of nail care: a. Nails should be kept smooth to avoid skin injury 7. Procedure: Document completion of task, any complications, or if resident refuses. Record review revealed Resident #116 was re-admitted to the facility on [DATE] with diagnoses which included Gastrostomy Tube, Hydrocephalus, Muscle Wasting and Atrophy, Sepsis, Seizures, Anemia, Hypertension, Respiratory Failure and Major Depressive Disorder. She had a Brief Interview Mental Status (BIM) score of 99 (severely impaired). During an initial observational tour conducted on 03/04/24 at 10:39 AM, Resident #116 was observed with long, dirty, sharp, jagged, unkempt fingernails on both hands. During a second observational tour conducted on 03/04/24 at 4:22 PM, Resident #116 was observed with long, dirty, sharp, jagged, unkempt fingernails on both hands. During a third observational tour conducted on 03/05/24 at 9:56 AM, Resident #116 was observed with long, dirty, sharp, jagged, unkempt fingernails on both hands. During a fourth observational tour conducted on 03/05/24 at 3:29 PM, Resident #116 was observed with long, dirty, sharp, jagged, unkempt fingernails on both hands. During a fifth observational tour conducted on 03/06/24 at 10:05 AM, Resident #116 was still observed with long, dirty, sharp, jagged, unkempt fingernails on both hands. Record review of Resident #116's Monthly CNA ADL (Activities of Daily Living) Task Flowsheet Record dated 02/22/24 thru 03/06/24 revealed that the resident required total dependence and full staff performance with personal hygiene. Record review of Resident #116's Care plan initiated on 08/17/21 and revised 08/17/21 indicated, Focus: Activities of Daily Living (ADL). Resident #116 has an ADL self-care performance deficit related to Hydrocephalus, Encephalopathy, Respiratory Failure, Anemia; impaired cognition, communication and mobility. Interventions: Bathing/Showering: Check nail length and trim and clean on bath day and as necessary. Report any changes to the nurse .She is dependent on staff for proper nail care. Goal: Resident #116 will receive appropriate staff support through the review date. However, Resident #116's fingernail care had not been done, on the dates from 03/04/24 thru 03/06/24. Further review of the Minimum Data Set (MDS) assessment of sections A, C and GG dated 02/08/24 for Resident #116 indicated that she is totally dependent for all ADLs. During a telephone interview, conducted with Resident #116's husband on 03/06/24 at 10:43 AM, regarding his wife's care and services in the facility. He revealed that sometimes the facility does not take proper care of his wife's fingernails which does concern him. He said that he remembers telling a staff member about this some time ago, but nothing happened. He reiterated that he would like his wife's fingernails to be cleaned and trimmed and kept that way. An interview was conducted with Staff L, a certified nursing assistant (CNA), on 03/06/24 at 11 AM, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 2 of 11 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 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 in which she revealed that they had not provided fingernail care to Resident #116. She said that it is the responsibility of the CNA's to clean and trim the resident's fingernails. She further acknowledged that Resident #116's fingernails were long, dirty, sharp, untrimmed, and unkempt. An interview was conducted with Staff M, a Licensed Practical Nurse (LPN) on 03/06/24 at 11:05 AM, regarding Resident #116's nails and she also agreed that Resident #116's fingernails were long, dirty, sharp, untrimmed and unkempt. On 03/06/24 at 11:10 AM, an interview was conducted with Staff N, an (LPN) Unit Manager (UM), for the [NAME] wing, regarding Resident #116's fingernails. She confirmed that it is the responsibility of the CNA's to clean and trim the resident's nails. Staff N further acknowledged that Resident #116's fingernails were long, dirty and that they should have been cleaned, trimmed and cut. An interview was conducted with the Activities Director on 03/06/24 at 10:17 AM in which he stated that his department has been doing Pretty Nails on specified weekends for any resident that request it. Which involves basic clipping, removing and new fingernail polish of their choice and filing for the residents, by either one (1) of his two (2) activities assistants. However, he added that the department is not allowed to cut any of the resident's fingernails. He added that if his staff were to see a resident with long, dirty fingernails that he or his staff would alert either the Nurse or the CNA of the wing or unit involved and let them know to follow-up with the resident. The Activities Director said that his department had not provided any nail care services to Resident #116, during her facility stay. The Director also acknowledged that Resident # 116's fingernails were all long, dirty, untrimmed and unkempt. There was no documented evidence in any of the records reviewed, indicating that Resident #116 had refused any personal (ADL) care nor exhibited any type of behaviors. On 03/06/24 at 11:58 AM, an interview was conducted with the Director of Nursing (DON) regarding Resident #116's fingernails being long, dirty, sharp and untrimmed. She also acknowledged that it is the responsibility of the CNA's to clean and trim the resident's nails and she further acknowledged that the resident's fingernails were long and that they should have been cleaned, trimmed and cut. Photographic Evidence Obtained. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 3 of 11 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide an ongoing activities program for 1 of 2 sampled residents reviewed for activities (Resident #140). Residents Affected - Few The findings included: Record review revealed Resident 140 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident was cognitively intact and was dependent on staff for activities of daily living. Further record review revealed Resident #140 was care planned as dependent on staff for activities. It was documented the resident would be provided with daily individualized, group or self-centered activity programs for cognitive stimulation and for social interaction. The resident was informed of the daily activity events and encouraged to participate in the daily individualized activities of her interests/choice while social distancing and wearing a mask at all times. Activity calendar of events explained to the resident and provided. Interventions included: Invite to scheduled activities; Introduce resident to residents with similar background, interests and encourage/facilitate interaction; and resident needs assistance/escort to Community Life functions. An interview was conducted with Resident #140 on 03/05/24 at 8:45 AM. The resident stated she wanted to get out of bed in the wheelchair. The resident further stated she sees other residents in the hallway in their wheelchairs. The resident stated she was bored just lying in bed watching television. The resident further stated she used to get out of bed when she was receiving physical therapy (PT), but had not been out of bed since PT stopped. Resident #140 was observed in bed all day on 03/06/24, watching TV and sleeping. An interview was conducted with the Unit Manager (UM) on 03/07/24 at 11:00 AM. The UM stated Resident #140 gets out of bed with therapy, and would sit in the hallway in a wheelchair. An interview was conducted with the Director of Rehabilitation on 03/07/24 at 11:15 AM. The Director stated Resident #140 ended physical therapy and occupational therapy on 02/02/24. An interview was conducted with the Activity Director on 03/07/24 at 3:00 PM. The Activity Director stated Resident #140 would be able to attend activities if the resident was out of bed in a wheelchair. A review of the Certified Nurse Assistant (CNA) tasks revealed the last documented time the resident was out of bed was on 02/15/24 and 02/22/24. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 4 of 11 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to obtain urine specimen as ordered for 1 of 12 sampled residents with indwelling urinary catheters (Resident #321). The findings included: Record review revealed Resident #321 was readmitted to the facility on [DATE]. Her diagnoses included Type 2 Diabetes, Congestive Heart Failure and Acute Kidney Failure. Her Brief Interview of Mental Status (BIMS) score was 14 on the 5-day Minimum Data Set (MDS) with an assessment reference date of 02/29/24. This indicated the resident was cognitively intact. On 03/07/24 at 10:15 AM an interview was conducted with Resident #321. She stated she was not feeling well today and she had burning where her Foley catheter was located. Record review revealed a physician's order dated 03/04/24 for a urinalysis and a urine culture. The medical record did not reveal any results from that order. On 03/07/24 at 10:35 AM, an interview was conducted with Staff P, Unit Manager, regarding where the results of the urinalysis and urine culture were. Staff P viewed the lab book and next to the urinalysis and urine culture it read not collected. Staff P stated the technician wrote in that book. Staff P stated he did not know why the urine was not collected for Resident #321, since there were no progress notes indicating why. An interview was conducted with the Director of Nursing (DON) on 03/07/24 at 11:31 AM who stated Resident #321's urine was not collected as ordered and she asked the nurse to collect it today. The Surveyor informed the DON that the resident was complaining of burning and discomfort in the peri area and she (DON) stated she will inform the Nurse Practitioner. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 5 of 11 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 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 0712 Ensure that the resident and his/her doctor meet face-to-face at all required visits. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure physician visits were performed as required for 2 of 2 sampled residents reviewed for physician visits (Resident #29 and #81). Residents Affected - Few The findings included: 1) Record review for Resident #29 revealed the resident was originally admitted to the facility on [DATE] with a readmission on [DATE]. The diagnoses included: Other Toxic Encephalopathy, Chronic Obstructive Pulmonary Disease, Post Traumatic Stress Disorder, and Epilepsy. Review of the Minimum Data Set (MDS) assessment for Resident #29 dated 02/09/24 revealed in Section C a Brief Interview of Mental Status score of 15, indicating intact cognitive response. Review of the Physician Progress Notes for Resident #29 from 11/02/23 to 03/04/24 revealed the resident was seen by Staff J, Physician Assistant, on 11/27/23, 11/30/23, 12/19/23, 12/21/23, 01/04/24, 01/08/24 and the resident had not been seen by the primary physician. An interview was conducted on 03/06/24 at 9:00 AM with the Assistant Director of Nursing (ADON) who stated she has worked at the facility since 11/13/23. When asked when does the primary physician comes to see a resident, she said the primary physician visits a resident within 72 hours of admission or readmission and then monthly. The primary physician also visits the resident annually to complete a history and physical (H&P). The ADON stated the nurse practitioners and physician assistants are often in the building and are usually in the facility at least weekly. When asked where the primary physician, the nurse practitioner, and physician assistant's document, she stated they are in the residents' chart under miscellaneous. When asked who monitors the primary physician visits to ensure they are completed for the residents, she stated that would be medical records. During an interview conducted on 03/07/24 at 10:00 AM with Resident #29, who was asked if she has been visited in the facility by Staff B, Primary Physician, she said she does not recall seeing that doctor, but she sees a lot of doctors and does not know all of their names. During an interview conducted on 03/07/24 at 12:05 PM with Staff B, Primary Physician, who stated he typically rounds on Wednesdays and sometimes on Fridays. On Wednesdays he will typically see the newly admitted residents. He said he works with his physician assistant who does visits as well. When asked how often he sees a resident, he said he will see the resident for episodic care and the required visits. When asked how often the required visits are, he said he thinks he is supposed to see the resident every 120 days, new admissions are within 72 hours. He alternates routine visits with his physician assistant every 60 days but stated he does not always get to see all of the residents every 60 days. When asked how the documentation of visits is entered into the residents' chart, he said he does not enter documentation directly into the facility's system, his documentation is sent to the facility either by fax or email, and the facility uploads it to the resident's chart. 2). Review of the record for Resident #81 revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Major Depressive Disorder Recurrent, Morbid (Severe) Obesity, and Chronic Pain Syndrome. Review of the Minimum Data Set assessment for Resident #81 dated 12/20/23 revealed in Section C, a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 6 of 11 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 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 0712 Brief Interview of Mental Status Score of 15 indicating a cognitive response. Level of Harm - Minimal harm or potential for actual harm Review of the Primary Physician's Progress Notes for Resident #81 from 06/21/22 to 03/04/24 revealed the resident was seen by the Staff K Primary Physician on 06/29/22 and the resident was seen by Staff J, Physician Assistant (PA) on 06/23/22, 08/01/22, 08/04/22, 08/09/22, 10/12/22, 11/28/22, 02/15/23, 05/01/23, 07/28/23, 08/01/23, 09/29/23, 12/07/23. This indicated the resident was not seen by the primary physician at least once every 30 days for the first 90 days after admission, and at least once every 60 thereafter or every 120 days alternating with the PA. Residents Affected - Few During an interview conducted on 03/06/24 at 2:30 PM, Medical Records Coordinator revealed she just started at the facility 2 weeks ago and she is the only person who works in the department. Part of her duties are monitoring primary physician visits. She stated the primary physician needs to visit each resident monthly. The Nurse Practitioner or physician assistants (PA) can visit the residents in place of the primary physician. The primary physician needs to see the resident at least every 60 days and the nurse practitioner or the PA can see the resident on the alternating months with the primary physician. The PA or nurse practitioner may see the resident more often if needed. The primary physician and nurse practitioner or PA document on their own paperwork and these documents are sent directly to medical records via email and the medical record coordinator will then upload the document into the specific residents' chart and it will show up in miscellaneous and is labeled progress notes. She stated all documents sent to her prior to yesterday have been uploaded to the residents' charts. When asked how she knows which residents have been seen by the primary physician for the month or which residents are due to be seen by the primary physician, she stated they have a program on the dashboard (behind the seen), and they are able to tell which residents are due to be seen by a physician. If residents need to be seen she will contact the physician either by phone or by email to inform them. The Medical Records Coordinator acknowledged there were no primary physician progress notes (documentation) for Resident #29 or Resident #81. During an interview conducted on 03/07/24 at 10:10 AM with Resident #81 who was asked how often he is seen by Staff B Primary Physician, the resident stated he has never seen that doctor. The resident said he has seen the doctor assistant several times but never the actual doctor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 7 of 11 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to follow their own menu planning national guidelines, which has the potential to affect 41 residents on a regular diet, and failed to provide food that accommodates resident allergies, intolerances, and preferences: for 3 of 48 residents on East Unit during in-room dining observations (Resident #115, Resident #95, and Resident #370). The findings included: 1). A review of the nutritional menu planning guidelines provided by the facility titled: Healthy U.S.-Style Dietary Pattern at the 2,000-Calorie Level, With Daily or Weekly Amounts From Food Groups, Subgroups, and Component revealed to provide 2 to 2.5 cups of fruits per day. A review of the regular diet week one menu cycle revealed the following servings for fruits: Sunday provides 1.5 cups of fruits and not the recommended servings of 2 cups of fruits, Monday provides 1.5 cups of fruits and not the recommended 2 cups of fruits, Tuesday provides 2 cups of fruits, Wednesday provides 1.5 cups of fruits and not the recommended 2 cups of fruits, Thursday provides 1.0 cup of fruits and not the recommended 2 cups of fruits, Friday provides 1.0 cup of fruits and not the recommended 2 cups of fruits, and Saturday provides 1.0 cups of fruits and not the recommended 2 cups of fruits. A review of the regular week three menu cycle (menu cycle during recertification survey) revealed the following servings for fruits: Sunday provided 1.5 cups of fruits and not the recommended 2 cups of fruits, Monday provided 1.0 cups of fruits and not the recommended 2 cups of fruits. Tuesday provides 1.0 cups of fruit and not the recommended 2 cups of fruit, Wednesday provides 1.0 cups of fruit and not the recommended 2 cups of fruits, Thursday provides 1.0 cups of fruits and not the recommended 2 cups of fruits, Friday provides 1.0 cup of fruits and not the recommended 2 cups of fruits and Saturday provides 1.0 cup of fruits and not the recommended 2 cups of fruits. In an interview conducted on 03/07/24 at 10:11 AM with Staff F, the Registered Dietitian stated the menus are changing quarterly and are still in the winter menu cycle, and the next one coming up is the spring menu cycle. She explained the Corporate Dietitians go over the menu to ensure that it follows the national guidelines that the facility uses. She acknowledged that the facility's menus do not follow the national guidelines for the servings of fruits. 2). Record review revealed that Resident #370 was readmitted to the facility on [DATE] with diagnoses of Type 2 Diabetes and Chronic obstructive pulmonary disease. The 5-day Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview of Mental Status (BIMS) score of 15, which is cognitively intact. In an interview conducted on 03/05/24 at 8:43 AM, Resident #370 stated that he never gets the correct food items on his meal trays. Resident #370 said that he did not receive bananas, cold cereal, or eggs on his breakfast tray this morning. Closer observation revealed a meal ticket with the following: Concentrated Carbohydrate Diet (CCD), No Added Salt (NAS), no eggs, 8 ounces of milk, one slice of toast, 6 ounces of cold cereal, 4 ounces of juice, 6 ounces of coffee/tea, and one medium banana. The breakfast tray consisted of 4 ounces of orange juice, one toast, 8 ounces of milk, and 6 ounces of oatmeal. The breakfast tray did not have any eggs, bananas, or cold cereal. Resident #370 stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 8 of 11 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that he is not allergic to eggs and did not know why it said no eggs on the meal ticket. He further reported that he usually gets eggs only once a week with his breakfast meals. (photographic evidence obtained). 3). Record review revealed Resident #95 was admitted to the facility on [DATE] with a diagnosis of cognitive communication deficit. The annual MDS dated [DATE] revealed that Resident #95 has a BIMS score of 10, which is low cognitively impaired. In an observation conducted on 03/06/24 at 10:00 AM, Resident #95 was in his room eating breakfast. The meal ticket showed the following: regular dysphagia advance, lactose intolerance, and allergies to dairy. Closer observation showed a breakfast meal tray consisting of biscuits, sausage gravy, hashbrowns, hot cereal, orange juice, and 8 ounces of whole dairy milk. Resident #95 stated in this observation that he sometimes gets regular milk cartons on his breakfast trays. When asked if he was allergic to milk products, he said he did not know. 4). Resident #115 was admitted to the facility on [DATE] with diagnoses of major depression and anxiety disorder. The Quarterly MDS dated [DATE] showed a BIMS score of 15. In an observation conducted on 03/06/24 at 8:12 AM, Resident #115 was noted eating his breakfast tray in his room. In this observation, Resident #115 stated that he was looking forward to receiving a banana on his tray this morning but did not get it. Resident #115 spoke to the facility Dietitian and asked her to exchange his eggs for a banana this morning. Resident #115's breakfast meal ticket revealed a regular diet with a banana when available. In an interview conducted on 03/06/24 at 8:20 AM with Licensed Practical Nurse Staff H, she was asked if a resident asks for a banana that is not on the tray, will she go into the kitchen and get it. She said we usually do. She then proceeded to walk towards the main kitchen and, five minutes later, stated that the kitchen did not have any bananas. In an interview conducted on 03/07/24 at 10:40 AM with Staff F, the Registered Dietitian stated that the last person on the tray line checks to ensure that the correct food is placed on the meal tray. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 9 of 11 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 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 observations, interviews, and record review, the facility failed to maintain the appropriate food temperatures in the reach-in refrigerators and walk-in freezer and ensure kitchen equipment was in proper working order during 1 of 3 observations/visits in the main kitchen. The findings included: During the first visit to the kitchen conducted on 03/04/24 at 8:35 AM, the following were noted: The reach-in Delfield refrigerator had an internal thermometer in the back that showed 55 degrees Fahrenheit and not the recommended 40 degrees Fahrenheit or below. The reach-in Avantco refrigerator had an internal thermometer in the back that showed 50 degrees and not the recommended 40 degrees Fahrenheit or below. The hood had one light bulb not working out of 4 light bulbs. The walk-in Freezer was noted with an internal thermometer located at the back of the Freezer, which showed a temperature of 20 degrees Fahrenheit rather than the recommended 0 degrees Fahrenheit or below. Continued observation revealed eight tubs (3 gallons each) of ice cream soft to the touch and 1.5 boxes of 48 (4 ounces) individual servings of ice cream soft to the touch. The plate warmer's left side was warm to the touch. The Surveyor could place a full hand face down on the warmer without pulling the hand away. The right side of the plate warmer was at room temperature to the touch. In this observation, the Regional Dietary Manager stated that the plate warmer needed to be restarted and then turned off and on again, waiting 10 minutes. The Surveyor then touched the left side of the plate warmer, which was still warm to the touch, and the right plate warmer, which was still at room temperature to the touch. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 10 of 11 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 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 0825 Provide or get specialized rehabilitative services as required for a resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide rehabilitative (rehab) services to prevent decline in activities of daily living for 1 of 2 sampled residents reviewed for rehab services (Residents #140). Residents Affected - Few The findings included: Record review revealed Resident #140 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident was cognitively intact and was dependent on staff for activities of daily living. Resident #140 was care planned for activities of daily living (ADL) self-care functional deficit related to seizure disorder and multiple injuries from a motor vehicle accident. Interventions included to monitor/document/report as needed any changes, any potential for improvement, and reasons for self-care deficit, expected course, and declines in function. An interview was conducted with Resident #140 on 03/05/24 at 8:45 AM. The resident stated she wanted to get out of bed in the wheelchair. The resident stated she was bored just lying in bed watching television. The resident further stated she used to get out of bed when she was receiving physical therapy (PT), but had not been out of bed since PT stopped. Resident #140 was observed in bed all day on 03/06/24, watching TV and sleeping. An interview was conducted with the Director of Rehabilitation on 03/07/24 at 11:15 AM. The Director stated Resident #140 ended physical therapy and occupational therapy on 02/02/24. A review of the PT Discharge Summary with discharge date [DATE] documented discharge Recommendations: Functional Maintenance Program/Restorative Nurse Program including positioning sitting in wheelchair 3-5 times a week. A review of the Certified Nurse Assistant (CNA) tasks revealed the last documented time the resident was out of bed was 02/15/24 and 02/22/24. An interview was conducted with the Director of Rehabilitation on 03/08/24 at 10:00 AM. The Director stated Resident #140 would be screened to evaluate if therapy would be beneficial. Resident #140 was observed sitting up in a wheelchair in her room on 03/08/24 at 12:00 PM. An interview was conducted with the Director of Rehabilitation on 03/08/24 at 12:30 PM. The Director stated there was a decline in the resident's function, and the resident would be picked back up for therapy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105495 If continuation sheet Page 11 of 11