Health inspection·August 24, 2023

F 0584 linens covered in dried blood. The privacy curtain was also noted to have areas of dried blood. Level of Harm - Minimal harm or potential for actual harm Photographic Evidence Obtained Residents Affected - Some (e) room [ROOM NUMBER] - The bathroom floor tiles noted to have numerous large cracks. One of two-bathroom lights were not working. (f) room [ROOM NUMBER] - The bathroom floor was noted to have large area of dried brown matter around the toilet area. (g) The clean linen storage room located on the second floor located between the Windsor and [NAME] Units noted the floor littered with trash, dust, dirt, and debris. The floor was also noted to have large areas of black stains. Photographic Evidence Obtained (h) room [ROOM NUMBER] - The doors of the room closet had fallen off of their track, privacy curtain stained, and large area of room peeling wallpaper. (i) [NAME] Community Shower Room - ceiling vent heavily soiled and and surrounding wall area mold type matter. (j) [NAME] Corridor - Windows located at the end of hall noted to be laden with green algae type matter. (k) [NAME] Nurse Bathroom - bathrooms lights located over hand washing sink were not working. * All environment findings were reviewed and acknowledged with the Administrator on 08/23/22. Based on observations and interviews, the facility failed to provide a safe and clean environment in resident rooms and common areas, as well as failed to maintain laundry equipment in a repair. The findings included: 1) On 08/21/23 at 9:30 AM, an observation was conducted inside the first-floor soiled utility room where the laundry shoot is located, it was noted that the ceiling vent was covered with dust, debris, and moldlike substance, there were stains on the ceiling, corner of wall had plaster and paint missing, the covering behind the wire shelf was pulling away from the wall, the wall behind the covered garbage container was dirty, and the sink was dirty, the laundry shoot was rusted and dirty (Photographic Evidence Obtained). 2) On 08/21/23 at 9:40 AM, an observation was conducted of the drainage behind the washing machines which had a buildup of debris on the sides that was approximately 2 inches thick (Photographic Evidence Obtained). 3) On 08/21/23 at 9:44 AM, an observation was conducted in the laundry area of 1 of 3 working dryers which had a torn lint trap liner. There was lint like debris around the inside of the window of 1 of the 3 working dryers. All 3 working dryers had melted debris on the inside drums (Photographic Evidence Obtained). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 2 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 - Some 4) On 08/21/23 at 9:55 AM, an observation was conducted in the laundry area of the window ledge located next to one of the personal washing machines was crumbling with large chucks of the ledge missing (Photographic Evidence Obtained). 5) On 08/21/23 at 10:00 AM, an observation was conducted in the laundry area of 2 out of the 4 ceiling lights that had either missing or burnt-out light bulbs, and 1 of ceiling light cover was broken with plastic missing (Photographic Evidence Obtained). 6) Next to the washing machines, the raised platform for the laundry chemicals was covered with a white substance and the floor next to the raised platform was dirty (Photographic Evidence Obtained). During an interview conducted with the Director of Maintenance who stated he has been working at the facility for about 32 years. When asked about the drainage behind the washing machines, he said they clean that area once a month or more often as needed. An interview conducted with the Staff C, a Laundry Aide who stated she has worked for the facility for about 6 years. When asked about the crumbling window sill next to the personal washer, she said it may have been like that for about a month. When asked if she ever reported it to maintenance, she said they must know because they come in here. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 3 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record and policy review; the facility failed to administer a psychotropic medication ordered upon admission for 1of 2 sampled residents reviewed for admission orders (Resident #299). Residents Affected - Few The findings included: The facility's policy titled, Physician Services published 10/20/2022 revealed the The medical care of each resident is supervised by a licensed physician. Supervising the medical care of residents includes prescribing medications and therapy. Resident #299 was admitted to the facility on [DATE] at 4:00 PM, per admission evaluation. He had a Brief Interview of Mental Status score of 12, per a social service evaluation dated 08/20/23. This indicated the resident is mildly impaired in his cognition. Medical diagnoses included Anemia, Dysphagia due to Throat Cancer, Anxiety, and Pneumonitis. On 08/21/23 at 11:55 AM, Resident #299 was interviewed and stated he was upset and anxious because he did not get his Xanax the past couple of nights. A review of the physician orders revealed the physician ordered Alprazolam Oral Tablet 0.25 mg (milligrams) *Controlled Drug* Give 0.25 mg via PEG-Tube at bedtime for anxiety, ordered 08/18/23 at 22:48 to be started on 08/19/23. (Alprazolam is the generic name of Xanax, an anti-anxiety drug). On 08/19/23 a nursing progress note revealed the Alprazolam was not administered. Alprazolam 0.25 mg was not administered /held on 08/19/23, 08/20/23, 08/21/23, and 08/22/23 without an order to hold the medication. A nursing progress note dated 08/22/23 documented the Alprazolam 0.25 mg was waiting for delivery. A review of the medications in the Omnicell (emergency medications) revealed 10 tabs of Alprazolam 0.25 mg in the inventory. A review of Resident #299's social service care plan revealed Resident is at risk for mood indicators secondary to diagnosis of depression and anxiety that both have pharmaceutical intervention as well as changing health with an intervention of Administer psychotropic meds as ordered. An interview was conducted with the Director of Nurses (DON) on 08/23/23 at 4:00 PM. It was discussed regarding the resident having an order for Alprazolam, it was not given and there was no physician order to hold it. The resident also had an order for Lorazepam (an anti-anxiety drug) which was given. The DON was not able to tell this surveyor why Alprazolam was held and why the resident had 2 orders for anti-anxiety medications, and why the Alprazolam was not administered on 08/19/23 - 8/22/23, when it was in the Onicell inventory. Further record review revealed Resident #299 was discharged to hospice on 08/23/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 4 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 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. Based on observation, records review, and interviews, the facility failed to follow the order and facility protocol for enteral feeding for 1 of 1 sampled residents reviewed for tube feeding (Resident #50). Residents Affected - Few The findings included: Review of the facility for enteral feeding documented in part, the following: 1) Staff caring for residents with feeding tubes are trained on how to recognize and report complications associated with the insertion and or use of a feeding tube, such as: e) Esophageal swelling, strictures, fistulas; and f) clogging of the tube. On 08/21/23 at 12:15 PM, it was observed that Resident #50 was lying in bed. The tube feeding meal for Resident #50 was attached to the pole, but the pump was off. According to the writing on the bag, the feeding started on 08/20/23, no time indicated. There were 600 ml out of 1000 ml left to be infused. Photographic Evidence Obtained. On 08/21/23 at approximately 1:41 PM, meals were observed on Resident #50's bedside table, placed before the resident while she sat on the bed. Resident #50 was not feeding herself. Soon after the surveyor left the resident's room, the second-floor Unit Nurse Manager entered the resident's room and was observed feeding the resident. On 08/21/23 at 1:45 PM, the surveyor interviewed the Nurse Manager (NM) to inquire about Resident #50's ability to feed herself. The NM reported that Resident #50 feeds herself, at times, but they must monitor her to ensure she continues to perform the task independently; if she does not, they assist to feed her. On 08/22/23 at 12:27 PM, the tube feeding meal, Jevity 1.5 Cal. 1500 cal/1000 ml was observed hanging on the pole, and running at 80 ml/hr. The date and time written on the bag were 08/22/23 at 6:00 AM. There as 800 ml/1000 left to be infused. Photographic Evidence Obtained. Review of the physician's orders documented: a) 06/12/23: Pleasure Feeds diet, Mechanically Altered Ground texture, Thin Liquids consistency may have chopped texture sandwiches and desserts. b) 07/21/23: Enteral Feed every shift Jevity 1.5/960ml continuous feed @80ml/hr x12hr or until total volume is infused; with 720ml water flush at 60ml/hr x12hr via PEG tube. START FEEDING AND FLUSHES AT 8 PM until completely infused. Provided daily: ~1440kcal, ~1450ml fluid, ~61g pro Enteral Feed. Based on the physicians' orders, if the tube feeding started at 8:00 PM on 08/20/23, on 08/21/23 during the first observation, there should have remained zero content in the bag by 8:00 AM, there were 600 ml remaining in the bag. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 5 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 During the second observation, there should have been 520 ml remaining and not 800 ml. The order was to run the feeding from 8:00 PM and to 6:00 AM. Review of the Nurses progress notes dated 8/22/23 documented no reasons why the continuous feeding for Resident #50 was discontinued or interrupted. There was no justification why the order was not followed. Residents Affected - Few Review of Resident #50's weight record for the last six months revealed the following: 08/03/23 92.0 Lbs Mechanical Lift 07/13/23 92.0 Lbs Mechanical Lift 07/05/23 91.0 Lbs Mechanical Lift 06/05/23 90.0 Lbs Mechanical Lift 05/23/23 90.0 Lbs 05/16/23 89.0 Lbs 05/12/23 89.0 Lbs 05/06/23 90.0 Lbs (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 6 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 04/18/23 Level of Harm - Minimal harm or potential for actual harm 94.0 Lbs 04/13/23 Residents Affected - Few 95.0 Lbs 04/04/23 97.0 Lbs 03/21/23 95.0 Lbs 03/08/23 95.0 Lbs 03/03/23 98.0 Lbs The care plan dated 05/30/23 documented the following: ADL (activities of daily living) Self-Care Deficit R/T (related to) Asp. PNA (Aspiration Pneumonia), Dementia, Generalized Weakness/ decrease ability to perform self-care. The Goals included: o ADL needs will be met daily as evidenced by well groomed, neat/clean, comfortable o Assist to turn and reposition, shifting weight to enhance circulation o Encourage to perform self-care and provide only assistance that is needed to complete task. o Explain all procedures and purpose prior to performing task and encourage self-performance o Invite, encourage, to actively participate during one to one sessions to stimulate memory with Christian songs, touching manipulatives, for enjoyment and to diverting the resident from pulling her tube out and unsafely standing up. The dietary plan of care dated 05/30/23 documented the following: [Resident #50] required tube feeding for nutritional support r/t Dementia and Dysphagia dx (diagnosis), Average Meal Intake < (less then) 25% pleasure trays, Significant Weight Loss, mechanically altered diet, severe cognitive impairment, diarrhea at times. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 7 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 The Goals included: Level of Harm - Minimal harm or potential for actual harm o Resident will exhibit no signs or symptoms of aspiration by next review date. o Resident will maintain weight with no further loss by next review date. Residents Affected - Few o Resident will be free from abnormal bowel movement by next review date. o Resident will tolerate tube feeding without complications such as: aspiration, infection, abdominal pain/distention, dehydration, diarrhea, constipation/fecal impaction, vomiting by next review. Staff will: o Maintain the head of resident's bed (HOB)at 30 - 45 degrees 30 - 60 minutes after bolus feeding. o Monitor and report signs/symptoms of aspiration o Monitor and report signs/symptoms of dehydration o Monitor labs when available - report abnormal data to physician/provider promptly o Monitor tolerance of tube feeding o Monitor weight monthly/weekly o Provide mouth care as needed o Provide tube feeding as ordered o Provide water flush as ordered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 8 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 o Level of Harm - Minimal harm or potential for actual harm Provide water flush with medications per nursing policy Residents Affected - Few An interview was conducted with Staff F, Registered Nurse, on 08/22/23 at 2:14 PM. Staff F stated the discontinued tube feeding observed on 08/21/23, (dated 8/20/23), was placed by the night shift who worked on 08/20/23. Staff F said the feeding machine had stopped from time to time, and she had to restart it. She said that she restarted the machine three times today, (on 08/22/23). After she flushed it the last time, it did not stop again. Staff F explained that she did not recall the exact time the machine stopped, but it was early morning. When asked if that was the protocol to follow for a defective feeding machine, Staff F answered, they would change the machine if the situation persisted. She stated the machine worked fine after the third time. She stated the machine was supposed to run until the full 960 ml was infused. An interview was conducted with the Director of Nursing (DON) on 08/23/23 at 11:52 AM. The DON revealed that Resident #50 was not at the time participating in therapy (which would be a reason to stop the machine). She said that Resident # 50 had a habit of pulling out her tube feeding which was documented and verified in the Care Plan, but the resident had not done so lately. The DON stated the resident moves a lot in bed and that could have caused the infusion flow of the tube feeding to stop. She said that staff are supposed to continuously check on the resident during enteral feeding to make sure that the feeding is not interrupted. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 9 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2) Resident #297 was admitted to the facility on [DATE] at 5:33 PM from an acute care hospital. Admitting diagnoses included, Aftercare following joint replacement surgery, Hypothyroidism and Type 2 Diabetes Mellitus. Her Brief Interview for Mental Status score was 15, per the Medicare 5 day Minimum Data Set with an assessment reference date of 08/22/23. This indicated the resident was cognitively intact. On 08/22/23 at 9:30 AM during preparation for medication administration with Staff G, Registered Nurse, only 2 medications could be located in the medication cart. Alogliptin Benzoate Oral Tablet 25 milligrams (mg) 1 tablet one time a day was not given 08/21/23 and 08/22/23. Losartan Potassium 100mg tablet was not given on 08/21/23. Zonisamide Oral Capsule 100mg which is an anticonvulsant was not given on 08/20/23, 08/21/23, and 08/22/23. Nateglinide tablet 120mg to be given three times a day for diabetes was not given on 08/20/23, 08/21/23 at 9:00 AM and 1:00 PM and 08/22/23 at 9:00 AM. An interview was conducted with Staff G on 08/22/23 at 9:45 AM as to where these medication were. Staff G stated she usually works nights and was not familiar with these medications for Resident #297. On 08/22/23 the Nurse Practitioner who was in the facility was notified that Resident #297 was not going to be given Alogliptin Benzoate Oral Tablet 25 mg, Losartan Potassium, Zonisamide Oral Capsule, and Nateglinide tablet 120mg at 9:00 AM. A review of the nursing progress notes revealed neither the Physician or Nurse Practitioner was notified of the non administration of the medication on 08/20/23 or 08/21/23. This was discussed with the Director of Nurses on 08/22/23 at 11:30 AM. Based on observation, interview, and record review, the facility failed to provide medications to meet the needs for 1 of 13 sampled residents reviewed during medication reconciliation of controlled substances (Resident #349); and failed to provide medications to meet the needs for 1 of 7 sampled residents observed for medication administration (Resident #297). The findings included: Record review for Resident #349 revealed the resident was originally admitted to the facility on [DATE] with the most recent readmission date of 03/15/23 with diagnoses that included: Type 2 Diabetes Mellitus with Other Skin Complications, Recurrent Depressive Disorders, and Anxiety Disorder. Review of the Minimum Data Set assessment for Resident #349 dated 08/18/23 revealed in Section C a Brief Interview of Mental Status score of 11, indicating moderate cognitive impairment. Review of the Physician's Orders for Resident #349 revealed an order dated 03/31/23 for Alprazolam 0.25 mg given 1 tab by mouth two times a day for anxiety. Review of the Physician's Orders for Resident #349 reveled an order dated 03/31/23 for Pregabalin 25 mg given 1 by mouth one time a day for pain. Review of the Medication Administration Note for Resident #349 dated 08/23/23 at 5:25 PM included: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 10 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Pregabalin Oral Capsule 25 mg give 25 mg by mouth one time a day for pain. Resident did not receive medication error. ARNP (Advanced Registered Nurse Practitioner) made aware. Review of the Medication Administration Note for Resident #349 dated 08/23/23 at 5:23 PM included: Alprazolam Oral Tablet 0.25 MG Give 0.25 mg by mouth two times a day for anxiety. Resident did not receive made error. ARNP made aware. Review of the Care Plan for Resident #349 dated 03/22/22 with a focus on potential for side effects related to the use of anti-anxiety required for diagnoses of anxiety/agitation. The goals were to have no behavior symptoms through the next review date. The interventions included: Medicate as ordered. Review of the Care Plan for Resident #349 dated 03/22/22 with a focus on the resident has a potential for alteration in comfort related to decreased mobility and neuropathy. The goals were to verbalize effective pain management as evidenced by decrease in pain score to 1-2 by next review date. The interventions included: Medicate as ordered and notify physician if pain is not relieved. During a medication cart review conducted on 08/23/23 at 3:05 PM with Staff F, Registered Nurse (RN) she stated that she has worked at the facility for 1 year. Resident #349's medication reconciliation sheet was reviewed for the medication Alprazolam 0.25 mg which listed the amount remaining was 15, however, there were actually 16 remaining. Resident #349's medication reconciliation sheet was reviewed for the medication Pregabalin 25 mg which listed the amount remaining was 10 however, there were actually 11 remaining. During an interview conducted on 08/23/23 at 3:15 PM with Staff F who was asked if she had performed a medication reconciliation count of the controlled substances in the cart at the beginning of her shift, she said yes. When asked if she administered the medication Alprazolam 0.25 mg for Resident #349, she said yes. When asked if she had signed off on the Electronic Medication Record for Resident #349 as giving the same medication, she said yes. When asked if she was sure she gave the medication in question, she looked at the next medication reconciliation sheet for the same resident for the medication Pregabalin 25 mg and stated maybe I forgot to pop the medications and give them. When she was shown the medication reconciliation sheets for the medications in question for Resident #349, she said she really thinks she did not give the medications and immediately informed the Unit Manager. During an interview conducted on 08/23/23 at 3:30 PM with Resident #349 who was asked if she received her medications Alprazolam and Pregabalin earlier today, she said I honestly do not know, I would assume so when I got all of my other medications. The resident was anxious and stated she would be very upset if she did not get the medications that she needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 11 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. 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, it was determined that the facility failed to provide special drinking equipment while consuming meals for 3 (Resident #30, #92, and #94) of 3 sampled residents. Residents Affected - Few The findings included: 1) During the observation of the lunch meal on 08/21/23 at 12:15 PM, it was noted that the meal tray card of Resident #30 documented to provide 2 Handled Cup With Lid for tray beverages. Observation of the lunch meal tray noted that only 1 adaptive drinking cup was sent for the 3 beverages (Cranberry Juice (2) and Water) on the meal tray. The surveyor brought the issues to the attention of the Charge Nurse who stated the adaptive cups lessen spillage during independent drinking and called the dietary department for additional adaptive cups. Observation of the breakfast meal on 08/22/23 at 9:30 AM noted that the meal tray included a carton of milk, however an adaptive 2-handled cup with lid was not included on the meal tray. It was noted that Resident #30 was required to drink directly from the milk carton resulting in spillage during drinking. Interview conducted with Resident #30 at the time of the observation noted to state that she requires all beverages to be in adaptive 2-handled mug with lid to prevent spillage during drinking of beverages. Resident #30 further stated she has 3 -4 beverages per meal and only receives 1 adaptive mug on the meal trays . During the review of the clinical record of Resident #30 on 08/21/23, the following were noted: Date Of admission: re-admission [DATE] Diagnoses: Paraplegia, Depressive Disorder, Protein-Calorie malnutrition, Bipolar II Disorder Current Physician orders: 02/01/23 - Divided plate and 2-handle mug with lid all meals 04/12/23: No Added salt Diet MDS (Minimum Data Set) assessment: 06/13/23 (Annual) Sec B: Understood 7 Understands Sec C : BIMS = 14 Sec G ; Eat - Independent Sec K : No Swallow Disorder Current Care Plan: 06/20/23 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 12 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 0810 < Problem - Nutritional Problem Level of Harm - Minimal harm or potential for actual harm * Intervention - Provide Adaptive Eating Equipment # Compartment Plate and 2-Handled Mug with Lid for all meals Residents Affected - Few Review of Occupational Discharge summary dated [DATE] documented that Resident #30 stated that tremors are getting worse and had spillage during meal times, and requires 2-handled cup with lid and plate guard with all meal. 2) During the observation of the lunch meal on 08/21/23, it was noted that the meal tray was served to the room of Resident #92. Further observation noted the resident's meal tray card documented: Divided Plate, and Spill Proof Cup with Lid and Handle. Observation noted that only one adaptive drinking cup had been provided for 3 beverages (coffee, milk, and juice). Resident noted to have confusion and spillage while drinking from a regular cup, Observation of the breakfast meal on 08/22/23 at 8:30 AM noted the ,meal tray served to the room of Resident #92. Further observation noted again that only 1 adaptive drinking cup had been provided for 3 beverages (juice, coffee, and milk). The surveyor informed the Chargé Nurse who stated she was unaware that only 1 adaptive cup was being provided for multiple beverages included on the meal tray . Review of clinical record of Resident #92 noted the following: Date Of admission: [DATE] Diagnoses: Dementia, Cognitive Deficit, and Dysphagia. Current MD (Medical Doctor) Orders include: 07/26/23 - Divided plate with all meals 07/26/23 - Spill proof cup/lid and handle with all meals 07/07/23 - Only spoon with all meals - unable to differentiate functions of fork and knife 06/08/23 - Mechanically Altered Chopped Texture diet MDS assessment: 7/22/23 Quarterly Sec B: Sometimes understood/Rarely Understands Sec C: BIMS =3 (Cognitively Impaired) Sec G: Eat = Supervision with Set Up Sec K ; No swallow Disorder, 59/95#- Mechanically Altered Diet Nutrition Progress Notes: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 13 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 0810 7/8/23 - Underweight, advanced dementia, Intake 75-100%, Level of Harm - Minimal harm or potential for actual harm 06/08/23 - Requires adaptive equipment during meals, 01/10/23 - Adaptive equipment to facilitate eating . Residents Affected - Few Current Care Plan - 08/01/23: < Nutritional Problem * Intervention - Provide Spill proof cup/lid and handle with all meals . Weight History: 08/04/23 - 98 # 04/03/23 = 96 # 09/08/22 = 100 # 07/06/22 = 106# Ht = 59 BMI=19.8 (Underweight) Review of Occupational Therapy discharge documentation dated 03/22/23 noted that Resident #92 requires spill proof cup with lid and handles with all meal. 3) During the observation of the lunch meal on 08/22/23 at 12:30 PM, it was noted that the meal tray was delivered to the room of Resident #94. Further observation noted the meal tray card to document Spill Proof Cup with Lid and Handle. Observation of the meal tray noted that only one adaptive cup had been provided for 3 beverages (juice, milk, and water). Resident #94 noted to be assisted by staff for feeding and was spilling beverages from regular cup. During the observation of the breakfast meal on 08/22/23 at 8:45 AM, it was again noted that only 1 Spill proof Cup with Handle and Lid had been provided for 3 tray beverages ( juice, coffee, and milk). Review of clinical record of Resident #94 noted the following: Date Of admission: [DATE] Diagnoses: Arthritis, ASHD, Current Physician Orders include: 07/26/23 - Spill Proof cup/lid and handle with all meals (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 14 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 0810 07/28/23 - Divided plate with all meals Level of Harm - Minimal harm or potential for actual harm 02/16/22 - Regular Diet 06/16/21 = Liquid Protein 30 ml BID (twice daily) Residents Affected - Few 06/01/22 - Ensure Plus 240 ml BID Weight History: Weight Loss: 08/04/23 = 115# 07/20/23 = 113# 05/06/23 = 120 02/06/23= 127 Height = 63 BMI = 20.4 MDS assessment: 05/19/23 Sec B ; Understood & Understands Sec C: BIMS = 12 (moderately impaired cognition) Sec G: Eat = Independent - One person assist Sec K : NO Swallow Disorder , 63/120#, Care Plan: 05/30/23 < Potential For Nutritional Problem * Intervention - Provide Adaptive Equipment with All Meals Current Nutrition Note: 07/07/23 - Requires adaptive equipment -independent and assist with meals, triggers for significant wt (weight) loss 5.8% in 30 days Review of Occupation Therapy Discharge note dated 06/23/23 notated that Resident #94 required use of divided plate, built-up utensils, and spill proof cup with lid and handle. Review of Occupation Therapy Note dated 08/23/23 documented that Resident's #94's divided plate and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 15 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 0810 built-up utensils have been discontinued, but noted to require Spill Proof Cup with Lid and Handle. Level of Harm - Minimal harm or potential for actual harm Interview conducted with the Director of Skilled Therapy on 08/23/23 noted that she was unaware that the dietary department was providing only 1 adaptive drinking cups with resident meals. It was confirmed with the Director that an adaptive drinking cup is to be provided for each beverage included on the meal trays. Residents Affected - Few Interview with the Food service Director (FSD) on 08/23/23 noted that the dietary department was only providing 1 adaptive drinking cup with meal trays. FSD stated he was unaware that an adaptive drinking cup should be provided for each beverage included on the meal trays . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 16 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for potentially 141 of the 145 facility residents that included; elimination of potential use of dented cans of food, maintenance of refrigeration units, maintenance of exhaust hoods, proper cleaning and maintenance of food preparation equipment, proper labeling and dating of opened food packages, and maintaining regulatory chemical levels in the 3-compartment sink. The findings included: During the initial observation tour of the main kitchen on 08/21/23 at 8:45 AM, and accompanied with the Food Service Director (FSD) and Administrator, the following were noted: (a) The door gaskets of Reach-in refrigerator #1 (Traulsen) were noted to have a build-up of a black mold substance and the front of the unit was full of condensation. It was discussed with the FSD that the gaskets were old and door was not shutting tightly resulting the condensation issues. Photographic Evidence Obtained. (b) The exhaust hood which is located over the major food preparation equipment was noted to be soiled and had large areas of peeling paint. It was discussed with the Administrator that the hood unit was not being properly maintained for cleanliness and paint exterior. Photographic Evidence Obtained. (c) The bench mounted commercial can opener was noted to be soiled and rust laden. The blade was old, and the exterior was in disrepair. It was discussed with the FSD that the opener is not being cleaned and sanitized on a daily basis and the opener blade is in need of replacement. The surveyor requested that the unit be properly cleaned and blade replacement prior to continued use. Photographic Evidence Obtained. (d) The interior of Convection Oven #1 was noted to have a thick layer of black carbon within the cavity and on the doors (2). The FSD stated that the oven had not been cleaned on a regular basis Photographic Evidence Obtained. (e) Observation of the dry/can storage room noted that there was a #109 can of Cut Sweet Potatoes that had 2 large dented areas. The can was noted to be bulging from the bottom indicating a potential contamination . The surveyor requested that the can be removed from the rack immediately. The FSD stated that the can should have been located to the dented can rack. Photographic Evidence Obtained. 2) During a follow-up observation tour of the main kitchen on 08/22/23 at 11:30 AM, the following were noted: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 17 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 (f) it was noted that a #10 can of Fruit Cocktail was on the food preparation table and was intended for the dinner meal dessert of 08/22/23. Observation of the can noted a visible large dent on the top corner of the can. Interview with the FSD revealed that staff were unaware that dented cans should not be utilized for resident meals. Staff stated that the can was located on the storage shelf rack that are intended for resident use. Residents Affected - Some Photographic Evidence Obtained. (g) Observation of the food preparation table noted that commercial foods were not documented with an opening date. The commercial foods included: Potato Pearls (57 ounces package) and Lemon & Pepper Seasoning Salt (28-ounce package). Photographic Evidence Obtained. (h) Observation of food preparation cutting boards noted that 1 (yellow board) of 5 boards exterior was heavily worn with cutting grooves and areas of black mold type substance. Photographic Evidence Obtained. (i) Observation noted that the 3-compartment was being utilized for the washing of food preparation equipment. At the surveyors request a est was conducted to ensure regulatory level of chemical in the sanitizing sink. The test performed by the FSD noted inadequate level of Quaternary sanitizing chemical. Photographic Evidence Obtained. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 18 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observations and interviews the facility failed to assure that staff handle, store, process, and transport laundry to prevent the spread of infection and failed to implement a surveillance plan to accurately identify, track, and report a Covid outbreak infection. Residents Affected - Some The findings included: Review of the facility's policy titled, Laundry and Bedding, Soiled with a published date of 05/18/23 included: Soiled laundry/bedding shall be handled, transported, and processed according to best practices for infection prevention and control. Under Transport 6. Clean linen is protected from dust and soiling during transport and storage to ensure cleanliness. Under Section Laundry Processing 3. When using fans in laundry processing areas, the ventilation does not flow from soiled processing areas to clean laundry areas. 8. If laundry chutes are used, they are designed and maintained so as to minimize dispersion of aerosols from contaminated laundry (e.g., no loose items in the chute and bags are closed before tossing into the chute). Review of the facility's policy titled, FL Covid-19 Resident and Staff Testing: with a revised date of 11/2022 included under Section I Reporting Test Results 2. Facilities must continue to report Covid-19 information to CDC's National Healthcare Safety Network. 1) On 08/21/23 at 9:30 AM, an observation was made In the first-floor soiled laundry room where the laundry shoot is located had a bin under the laundry shoot with a dirty mop head pad, an empty mesh personal clothing bag a used glove and debris (Photographic Evidence Obtained). 2) On 08/21/23 at 9:35 AM, an observation was made in the first-floor soiled laundry room where the laundry shoot is located had a bin for soiled housekeeping supplies. In this bin was an unbagged dirty mop head, a bag of dirty mop heads, several pieces of used personal protective equipment (gloves), and debris (Photographic Evidence Obtained). 3) On 08/21/23 at 9:40 AM, an observation was made inside the laundry washer/dryer area of a large pedestal fan covered with dust-like debris blowing over the uncovered clean laundry being transferred from the washers to the dryers (Photographic Evidence Obtained). 4) On 08/21/23 at 9:45 AM, an observation was made inside the laundry washer/dryer area of the lids for the 2 washers used for personal laundry were rusty and dirty (Photographic Evidence Obtained). 5) On 08/21/23 at 9:50 AM, an observation was made inside the laundry washer/dryer area of 2 of the wire laundry transport carts were rusted where the laundry is placed (Photographic Evidence Obtained). During an interview conducted on 08/21/23 at 9:35 AM with the Director of Housekeeping (DOH) who stated the staff are not supposed to place any housekeeping cleaning materials, unbagged materials or personal laundry down the laundry shoot. The DOH stated sometimes when the bags come down the laundry shoot the bags get ripped. During an interview conducted on 08/21/23 at 9:43 AM with Staff C, Laundry Aide, who stated she has been working at the facility for 6 years. When asked how often the pedestal fan is cleaned, she stated it is cleaned 3 times a day and the lint traps for the dryers are cleaned every 2 hours. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 19 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 6) Review of the line listing provided to surveyor (copies of Covid-19 Outbreak Surveillance Line List Form) it was unclear when or with whom the outbreak started. These forms did not clearly indicate what the symptoms were, if any for residents/staff and test results were not attached. For Resident #147 his electronic medical record revealed the resident had tested positive for Covid on 07/25/23. Resident #147 was not included on the line list report to DOH (Department of Health) for 07/25/23 nor was it reported late on 07/26/23. There is no record of when staff test positive, what symptoms they have, or when they start to isolate themselves or when they return to work. During an interview conducted on 08/22/23 at 2:00 PM with the Assistant Director of Nursing/Infection Preventionist (ADON/IP) who stated their last covid outbreak started on 08/04/23 with a resident, another resident tested positive on 08/09/23. Both of the residents were placed in isolation for 10 days. During an interview conducted on 08/23/23 at 12:30 PM with the Director of Nursing who was covering in the absence of the Infection Preventionist who stated she has worked at the facility for 14 months. who stated she was unable to determine when the Covid outbreak started prior to 08/04/23. When asked about when the outbreak started that included 07/25/23, she does not have the date. The DON stated the IP would have reported an outbreak to the DOH. The DON stated even though she does not recall the date, she did recall that it started with a resident who had got it from his wife was a visitor. The DON stated the IP would have done contact tracing for the initial outbreak (date unknown) and they would have immediately tested the roommate if the resident had one regardless if symptomatic or not and any close contact staff member regardless if symptomatic or not. Then they would continue in outbreak mode They would have tested symptomatic resident and symptomatic staff. The DON confirmed that Resident #147 tested positive for covid on 07/25/23 while in the facility and it was not reported to DOH. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 20 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 0914 Provide bedrooms that don't allow residents to see each other when privacy is needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to provide ceiling suspended curtains, to provide total visual privacy for 2 of 145 residents. Residents Affected - Few The findings included: 1) Record review for Resident #7 revealed the resident was originally admitted to the facility on [DATE] with the most recent readmission on [DATE] with diagnoses included: End Stage Renal Disease and Dependence on Renal Dialysis. Review of the Minimum Data Set for Resident #7 dated 07/01/23 revealed in Section C a Brief Interview of Mental Stats score of 13 indicating a cognitive response. During an observation conducted on 08/21/23 at 11:10 AM Resident #7 was not in her semi-private room and there was no privacy curtain for Resident #7. During an observation conducted on 08/22/23 at 10:15 AM of Resident #7 was lying in her bed in her semi-private room with no privacy curtain for the resident. During an observation conducted on 08/23/23 at 9:40 AM of Resident #7's semi-private room and there continued to be no privacy curtain for the resident. During an interview conducted on 08/22/23 at 10:15 AM with Resident #7 who was asked about the missing privacy curtain, she said she was not sure when the privacy curtain went missing. 2) Record review for Resident #21 revealed the resident was originally admitted to the facility on [DATE] with the most recent readmission on [DATE], with diagnoses that included Type 1 Diabetes Mellitus with Diabetic Neuropathy, Morbid (Severe) Obesity Due to Excess Calories, Bipolar Disorder, and Major Depressive Disorder. Review of the Minimum Data Set for Resident #21 dated 07/13/23 revealed in Section C a Brief Interview of Mental Status score of 11 indicating moderate cognitive impairment. During an observation on 08/21/23 at 11:17 AM there was no privacy curtain for Resident #21 who is in a semi-private room. During an observation on 08/22/23 at 10:00 AM of no privacy curtain for Resident #21 who is in a semi-private room. During an observation on 08/23/23 at 9:30 AM of no privacy curtain for Resident #21 who is in a semi-private room. During an interview conducted on 08/21/23 at 11:15 AM with Resident #21, she complained that she has no privacy curtain, and it bothers her. When asked how long the privacy curtain has been missing, she said a long time. She told someone when it first happened, but the curtain was never replaced. During an interview conducted on 08/23/23 at 9:30 AM with Resident #21 who was asked how it makes (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 21 of 22 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 105506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encore at Boca Raton Rehabilitation and Nursing Ce 7300 Del Prado Circle South Boca Raton, FL 33433 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 0914 her feel that she does not have a privacy curtain, she said It really bothers me. Level of Harm - Minimal harm or potential for actual harm During an interview conducted on 08/24/23 at 11:15 AM with the Director of Housekeeping, she stated the process for cleaning the privacy curtains is usually performed by the AM (morning) floor tech and they are usually back up the next day, sometimes he is not able to get the privacy curtains back up right away. When asked when the privacy curtains will be replaced with a clean one when the old one is removed, she said no, we do not have any spare privacy curtains, but we do now. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105506 If continuation sheet Page 22 of 22