Inspection·November 18, 2022

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete she called the election office and they said it was too late to come out to the facility. The Activities Director stated she was not aware of the deadline. The only way a resident could vote was by absentee ballot. If residents did not receive an absentee ballot, they weren't able to vote. The Activities Director stated Resident #225 was a resident that had expressed interest in voting. The Activities Director stated she was not aware of which residents received an absentee ballot. The Activities Director stated she assisted one resident who had received an absentee ballot who requested assistance. She did not inquire if any of the residents wanted/needed assistance with absentee ballots. Event ID: Facility ID: 105510 If continuation sheet Page 2 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and policy review, the facility failed to provide showers per resident request for 1 of 251 sampled residents screened in the initial pool (Resident #121). The findings included: The facility's policy titled Standards and Guidelines: SG Showers/Bathing issued 03/08/10 and revised 03/27/21 revealed It will be the standard of this facility to assure that showers/bathing are offered to residents at least 2 times weekly or per resident/representative preference unless specifically ordered otherwise by the physician or care planned otherwise. Refusals for showers/bathing should be reported to the licensed nursing staff . On 11/15/22 at 11:29 AM, Resident #121 was interviewed during the initial screening process. Resident #121 was observed in a hospital type gown, lying in bed. The resident stated that he would like to get dressed when he got out of bed. He also stated that he never got a shower. He was given a bed bath but would like a shower ideally everyday. Resident #121 was initially admitted to the facility on [DATE] with diagnoses that include Type 2 Diabetes, Hemiplegia, and Cerebral Infarction. His quarterly Minimum Data Set with an assessment reference date of 09/04/22 revealed his Brief Interview for Mental Status was 14 out of 15 which indicated he was cognitively intact. On 11/18/22 at 10:26 AM the resident was again observed in bed in a hospital type gown. He stated he had not had a shower since he was last interviewed and would still like to be showered. On 11/15/22 at 10:35 AM, Staff K, a Certified Nursing Assistant (CNA) was asked about the shower schedule for Resident #121. She stated that he is scheduled for a shower twice a week and she has given him showers. She also stated that if he refused, she would give him a bed bath. On 11/18/22 at 12:25 PM, this surveyor entered the resident's room with Staff H, a Licensed Practical Nurse (LPN). This surveyor asked Resident #121 with Staff H present if he had been given showers. Resident #121 stated that he has not had a shower and would like one everyday if he could. Resident #121 stated that he is fine being in bed with a hospital gown on, but when he is going to an activity he would like to be dressed. Staff H stated that she was unaware that the resident wanted a shower but was not given one. On 11/18/22 at 12:35 PM, during an additional interview, Staff K stated that she did not know that she is supposed to inform the nurse if a resident refuses a shower. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 3 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide a safe, clean, comfortable, and homelike environment for 9 out of 36 sampled residents (Residents #11, #27, #63, #105, #129, #146, #203, #255, #459). Review of the facility's policy titled Work Orders, Maintenance with no date included the following: To establish priority of maintenance service, work orders must be filled out electronically using an online application such as TELS and forward to the Maintenance Director. It shall be the responsibility of the department directors and employees to fill out and submit work orders to the Maintenance Director. Work orders are reviewed daily. Emergency or critical work orders would be called in to the Maintenance Director. Emergency requests will be given priority. On 11/15/22 at 9:54 AM an observation of vent with missing slats coated with dust across from the shower room near the 2 South Nursing Station. On 11/15/22 at 10:15 AM an observation was made in Resident # 203's room of the floor under the air conditioning unit was black and the baseboard next to the air-conditioning unit was pushed in (Photographic Evidence Obtained), ceiling tiles near the window had stains, the main light for the room had a burnt out light bulb, the bathroom had plaster above the sink and 3 areas of mismatched paint on the walls, and part of the linoleum next to the shower was missing and concrete was showing. On 11/15/22 at 10:30 AM an observation was made in the shower room located near the 2 South Nursing Station that had black mold-like substance on the tile on the walls, loose tiles, and a hole near the shower faucet. On 11/15/22 at 10:50 AM an observation was made in Resident #105's room of the air conditioning vent dusty, and dirty with a black mold-like substance (Photographic Evidence Obtained), ceiling tiles in the bathroom stained, and just outside of the room on both sides of the door the bumper guard near the floor was missing the end piece and had sharp edges exposed. On 11/15/22 at 10:53 AM an observation was made in Resident #459's room of mismatched paint/plaster above sink and the light over the sink had no light switch or pull cord. On 11/15/22 at 10:55 AM an observation of Resident #129's room air conditioning vent was dirty and soiled with debris and dust (Photographic Evidence Obtained),baseboard located by the window were coming away from the wall (Photographic Evidence Obtained), multiple areas on the walls had plaster and mismatched paint the areas were as follows: above the head of the bed, across from the foot of the bed, and under the window (Photographic Evidence Obtained), the bathroom had stained ceiling tiles (Photographic Evidence Obtained), the floor next to the tub was missing flooring and appeared to be down to concrete (Photographic Evidence Obtained), and mismatched paint above the sink (Photographic Evidence Obtained) On 11/15/22 at 11:00 AM an observation was made in Resident #146's room of an overwhelming pungent musty mildew-like smell upon entering the room, the air conditioning vent was dirty with a black mold-like substance (Photographic Evidence Obtained), and ceiling tiles in the corner by the window were stained. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 4 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 On 11/15/22 at 11:35 AM an observation was made of Resident #63's bathroom with the tile around the tub having a yellow mold-like substance. On 11/15/22 at 2:08 PM an observation of ceiling vent covered with dust and debris in the hallway next to room [ROOM NUMBER]. Residents Affected - Few On 11/15/22 at 4:57 PM an observation of Resident #225's room with a large gap between the air conditioning vent and the wall. On 11/16/22 at 9:00 Am an observation at 1 South Nursing Station of missing corner paneling on desk. On 11/16/22 at 11:40 AM an observation of dripping ceiling air conditioning vent by 1 South Nursing Station. On 11/16/22 at 11:45 AM an observation of broken floor near the exit door located by room [ROOM NUMBER]. On 11/16/22 at 12:00 PM an observation of dirty door that leads to the smoking patio near 1 South Nursing Station. On 11/16/22 at 1:20 PM an observation of broken door molding across from the Admissions Office near the 1 North Nursing Station. On 11/17/22 at 8:30 AM an observation was made in Resident #11's room of a missing ceiling tile behind the entrance door (Photographic Evidence Obtained), and caution tape across the shower entrance into the shower and the ceiling above the shower has a hole around a possible old light fixture with capped wires coming out (Photographic Evidence Obtained). On 11/17/22 at 8:50 AM an observation was made in Resident #27's room of a greenish-gray mold-like substance on the wall by the window (Photographic Evidence Obtained), air conditioning vent has black mold-like inside the vent (Photographic Evidence Obtained), and 2 stuffed animals on top of overbed light. During an interview conducted on 11/15/22 at 10:20 AM with Staff S Certified Nursing Assistant (CNA) when asked how long the walls have been with plaster and mismatched paint in Resident #203's room he said they were working on it this weekend. During an interview conducted on 11/15/22 at 10:23 AM with Staff W Environmental Services Housekeeper, when asked how often each room is cleaned, she stated 3-4 times a day sometimes more. When asked how often the floors are mopped, she replied at least once a day. When asked how long the linoleum has been missing from the floor in the bathroom next to the shower in Resident #203's bathroom, she said about 3 or 4 months ago when they replaced the tub with a shower. During an interview conducted on 11/17/22 at 9:00 AM with Resident #27 when asked how long the wall under the window has been discolored, she stated it started about a month ago and gets worse every time it rains. During an interview conducted on 11/17/22 at 11:05 AM with the Director of Maintenance, when asked (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 5 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few how long he has been with the facility, he replied, he has been with the facility for 3.5 years. The maintenance department consists of himself, 2 painters and 3 maintenance staff members. He stated that all routine maintenance issues/concerns go through the TELS system (computerized reporting for maintenance issues), and all staff have access to the TELS system. They have had the TELS system since before he started working with the facility. The facility does not keep records or have access to a work order history, it will only show what issues are open. They Keep a schedule of refurbishing program for the entire facility including what has been completed each room and what needs to be done for each room. During a tour of the facility conducted on 11/18/22 at 9:00 AM with the Director of Maintenance he stated that some of the issues identified, he was not aware of. He explained that he was checking on one of his painters and discovered that they were painting rooms with mismatched paint and told the painter to stop until they had the correct color of paint to match the existing paint on the walls. During an interview conducted on 11/18/22 at 9:45 AM with the Director of Maintenance, he stated they have a restoration refurbishing program that has been in progress for 1 year, they started with the more common areas first and this included changing out the ceiling lights, ceiling tiles and painting, the rehab gym. He estimates that approximately 45-50 rooms are completed including changing tubs to flat showers, but the floors next to the new showers are not completely restored. In the process of covering the walls in the dining rooms with a paneling (FRP boards a type of paneling). He may have an issue with a maintenance staff member that needs to be a little more detailed. He stated he thinks he may need additional staff beside the 2 they just hired recently. He is the only maintenance staff that goes into the TELS system, he will assign the various issues/concerns to specific maintenance staff and prints out sheets for each individual maintenance staff member. The staff member hands this into the Director of Maintenance daily so he can keep track of what is completed and what is still outstanding. He said some staff are not computer literate and will hand him slips of paper with identified maintenance issues/concerns, he then enters them into the TELS system. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 6 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. A review of the facility's policy Standards and Guidelines: Restorative Nursing Program, dated 12/01/16, and revised 03/27/21, documented: It will be the standard of this facility to provide restorative nursing services to residents that require them to attempt to maintain or improve function or as ordered by the physician. Restorative Programs include Range of motion (active and passive), splint or brace assistance, bed mobility, transfers, walking, dressing and/or grooming, communication, amputation/prosthesis care, or eating and/or swallowing. Residents Affected - Few Record review revealed Resident #225 was admitted to the facility on [DATE]. A comprehensive assessment, dated 10/15/22, documented the resident was cognitively intact, and required extensive one-person assist with bed mobility. The assessment further documented transfers out of bed did not occur. Resident #225 was care planned for participating in restorative nursing program. Interventions included to provide restorative programs/interventions as ordered/indicated and refer to therapy as necessary. Resident #225 was further care planned for at risk for falls related to weakness, immobility, and generalized muscle weakness and impaired balance related to muscle wasting. Interventions included staff to assist with transfers, and to utilize mechanical lift with assist of 2 for transfers. A review of Resident #225's orders revealed an order dated 07/08/22; May participate in restorative program as needed and as tolerated. An interview was conducted with Resident #225 on 11/17/22 at 9:00 AM. Resident #225 stated he does not get therapy. Resident #225 further stated he does not get out of bed. He was told he could not get out of bed due to the wounds on his buttocks. A review of Resident #225's records did not reveal any documentation of the resident need to stay in bed. A review of the resident's wound care notes documented the resident up to chair with cushion. An interview was conducted with Staff T, a Registered Nurse, on 11/17/22 at 1:00 PM. Staff T stated she was not aware Resident #225 did not get out of bed. Staff T further stated the resident's wounds were improved. A side-by-side interview was conducted with Resident #225 by Staff T and surveyor on 11/17/22 at 1:30 PM. Resident #225 stated he had not been out of bed to a chair since admission to the facility. Resident #225 further stated he was going out of his mind just lying there. An interview was conducted with the Director of Rehabilitation on 11/18/22 at 9:00 AM. The Director stated Resident #225 had received occupational therapy from 09/14/22-10/12/22, working on bed mobility. The Director stated he was told verbally by wound care not to get Resident #225 up to chair. The Director acknowledged no documentation for the resident to not get up to chair. The Director further acknowledged the weekly wound care notes for Resident #225 documented up to chair with cushion. An interview was conducted with Staff E, Restorative Aid, on 11/18/22 at 10:00 AM with the Director of Rehabilitation present. Staff E stated Resident #225 refused restorative therapy. Staff E (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 7 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 acknowledged there was no documentation of resident #225 refusing restorative care. Level of Harm - Minimal harm or potential for actual harm An interview was conducted with Resident #225 on 11/18/22 at 10:30 AM with the Director of Rehabilitation and Staff E. Resident #225 again stated he had not received any kind of therapy and was just wasting away in bed. The Director of Rehabilitation stated they would get Resident #225 out of bed to a chair and would evaluate for therapy services. Residents Affected - Few An observation of Resident #225 was conducted on 11/18/22 at 12:00 PM. Resident #225 was observed sitting up in a high back chair in his room. Resident #225 looked at surveyor and said: Thank you, thank you. Based on interviews, observations, and record review, the facility failed to provide fingernail grooming (Resident #10 and Resident #94) to assist with dining (Resident #94) and failed to provide care and services to prevent a decline in the range of motion (Resident #117, Resident #231, and Resident #225) for 5 of 5 sampled residents for Activities of Daily Livings (ADLs). The findings included: A review of the facility's policy titled ADL Care and Assistance, revised on 03/27/21, showed that the following: each Resident will be assessed/evaluated upon admission or shortly after for their level of resident ability/function and staff assistance required to perform ADLS safely. The Minimum Data Set (MDS) assessment is an example of an assessment/evaluation of the level of resident ability/function and staff assistance required to perform ADLs. Each ADL should be provided at the level of assistance that promotes the highest practicable level of function for the Resident while ensuring the needs and desired goals. ADL assistance needs should be reflected in the person-centered plan of care. 1. In an observation conducted on 11/15/22 at 9:30 AM, Resident #10 was noted in bed. Closer observation showed jagged, long uneven fingernails with an unidentified brown matter underneath the fingernails. In an observation conducted on 11/15/22 at 2:00 PM, Resident #10 was noted in bed. Closer observation showed jagged, long uneven fingernails with an unidentified brown matter underneath the fingernails. In an observation conducted on 11/16/22 at 2:00 PM, Resident #10 was noted in bed. Closer observation showed jagged, long uneven fingernails with an unidentified brown matter underneath the fingernails. In an observation conducted on 11/16/22 at 4:00 PM, Resident #10 was noted in bed. Closer observation showed jagged, long uneven fingernails with an unidentified brown matter underneath the fingernails. Resident #10 was admitted to the facility on [DATE] with diagnoses of hyperlipidemia, depression, and mild protein-calorie malnutrition. The MDS assessment dated [DATE] showed that Resident #10 had a Brief Interview of Mental Status (BIMS) score of 03, which is severely cognitively impaired. Section G for eating showed that Resident #10 needed total assistance and one person's assist. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 8 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 The care plan showed that Resident #10 has a self-care deficit with dressing, grooming, and bathing, as evidenced by the need for assistance with personal care tasks and mobility skills. Cognitive deficit related to dementia, impaired mobility, and generalized weakness. The Resident participates with ADLs with cues from staff. It further showed to provide hands-on assistance with dressing, grooming, and bathing as needed. Residents Affected - Few 2. In an observation conducted on 11/15/22 at 1:07 PM, the lunch tray arrived for Resident #94 and was placed on her side table. Staff left the tray at the bedside and walked out to help pass other lunch trays. At 1:15 PM, Resident #94's tray was about 5% consumed, and no staff was noted in the room assisting her with the lunch meal. Continued observation at 1:29 PM showed that Resident #94's tray was left 95% untouched. In an observation conducted on 11/15/22 at 1:07 PM, Resident #94 was noted in her room. Closer observation showed long-jagged fingernails with unidentified brown matter underneath the fingernails. In an observation conducted on 11/16/22 at 9:40 AM, Resident #94 was noted in her room. Closer observation showed long-jagged fingernails with unidentified brown matter underneath the fingernails. In an observation conducted on 11/17/22 at 9:10 AM, Resident #94 was noted in her room. Closer observation showed long-jagged fingernails with unidentified brown matter underneath the fingernails. In an observation conducted on 11/16/22 at 9:40 AM, Resident #94 was noted in her room with the breakfast tray in front of her. She was observed eating one tablespoon of the eggs, but everything else on the tray was untouched. The closer observation did not show any staff in the room assisting her with her breakfast meal. At 9:50 AM, the tray was taken out of her room. In an observation conducted on 11/17/22 at 9:10 AM, Resident #94 was noted in her room with the breakfast tray on the side table, and the Resident was noted asleep. At 9:30 AM, Resident #94 was awake, but the breakfast tray was untouched. A review of the chart showed that #94 was readmitted on [DATE] with diagnoses of acute respiratory failure, type 2 diabetes, and dementia. A review of the Minimum Data Set (MDS) dated [DATE] showed that Resident #94 is cognitively severely impaired. Under section G for eating, it showed that Resident #94 is for supervision with set up only. The care plan showed that Resident #94 has a self-care deficit with dressing, grooming, and bathing, as evidenced by the need for assistance with personal care tasks and mobility skills. Cognitive deficit related to impaired mobility, generalized weakness, and limited endurance. It further showed to assist with nail shaping, keep nails short and clean and provide hands-on assistance with dressing, grooming, and bathing as needed. In an interview conducted on 11/17/22 at 11:43 AM, Staff F, a Licensed Practical Nurse (LPN), stated that the fingernail grooming is done by the Certified Nurse Assistance that is assigned to the Resident. It is usually done during daily care or as needed. In an interview on 11/17/22 at 11:46 AM, Staff G, a Certified Nursing Assistant, stated that activities usually involve fingernail grooming. If the Resident stays in bed and does not attend activities, she will do the fingernail grooming as needed as part of her daily care. In this interview, the surveyor asked Staff G to accompany her to Resident #94's room. Staff G was asked if she thinks (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 9 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 Resident #94's fingernails needed grooming and cleaning, and Staff G said yes. When asked why it was not done, Staff G stated that Resident #94 does not like her fingernails trimmed. When asked if it is documented in the electronic charting or in the daily care notes, Staff G said no. Staff G then stated, let me do it now and see if Resident #94 will let me trim and clean her fingernails. Continued observation showed that with some encouragement, Resident #94 allowed Staff G to trim and cut her fingernails. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 10 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to assess for safety of smoking for 1 of 2 sampled residents (Resident #217). The findings included: A review of the facility's policy Safe Smoking, dated 10/01/2004, and revised 03/27/21, documented: Electronic vapor cigarettes will be addressed and accommodated per the same guidelines as for actual cigarettes. A safe Smoking Screen is performed on admission for a resident who wishes to smoke. Resident #217 was admitted to the facility on [DATE]. An admission comprehensive assessment dated [DATE] documented the resident had mild cognitive impairment and required limited to extensive one to two-person assist with activities of daily living. The assessment further documented the resident did not use tobacco. Record review revealed a care plan dated 11/15/22, documented Resident #217 desires to smoke. Resident has been assessed as able to smoke independently. A review of a Smoking Evaluation form dated 11/14/22 revealed the document was not completed/blank for Resident #217. An interview was conducted with Resident #217 on 11/18/22 at 9:00 AM. The resident stated will go out to smoke around 11:00 AM. An interview was conducted with the Unit Manager (UM) on 11/18/22 at 9;30 AM. Surveyor questioned the UM if Resident #217 was evaluated for safe smoking. The UM stated he would get back to me. On 11/18/22 at 12:00 PM, the UM approached surveyor and stated Resident #217 did not smoke. Surveyor, accompanied by the UM went to the patio. Resident #217 was observed smoking an electronic cigarette. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 11 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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** 2. Resident #194 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident was cognitively intact and required supervision with set-up help only for activities of daily living. The resident was always continent of bladder. Record review revealed Resident #194 was transferred out to the hospital on [DATE] for a fall with injury. Resident was readmitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident required extensive two-person assist for bed mobility and had an indwelling catheter (urinary catheter). Resident #194 was care planned for alteration in elimination, requires staff assist with toileting, continent of bladder due to [brand] indwelling urinary catheter, dated 10/29/22. Reason was documented as urinary retention. A review of Resident #194's orders revealed an order dated 11/14/22 to insert/maintain indwelling catheter for a diagnosis of BPH (enlarged Prostate). An interview was conducted with Staff T, Unit Manager, on 11/17/22 at 1:20 PM. Staff T stated Resident #194 had an indwelling urinary catheter due to urinary retention from the hospital. Staff T acknowledged Resident #194 did not require an indwelling urinary catheter prior to hospitalization. Staff T further acknowledged there was no urologist consult for Resident #194 or attempts to discontinue the indwelling urinary catheter. Based on record review, observations and interviews, the facility failed to assess for removal of indwelling urinary catheter when clinical condition demonstrates that catheterization is not necessary for 1 of 2 sampled resident for indwelling urinary catheter (Resident #212 and #194). The findings included: Review of the facility's policy titled, Standards and Guidelines: SG (Standards and Guidelines) Indwelling Catheters, with a revised date of 03/27/21, included the following: It will be the standard of this facility to provide appropriate documentation for use and care for indwelling catheters of the resident's that have the indication for use beyond 14 days. Under Guidelines included: 1. Indication for Indwelling Catheter use: Urinary retention that cannot be treated or corrected medically or surgically, for which alternative therapy is not feasible. Contamination of Stage III or IV pressure ulcers (or greater) with urine which has impeded healing. Terminal illness or severe impairment, which makes positioning or clothing changes uncomfortable, or which is associated with intractable pain. 2. Information of the indication of use should be supported in the clinical record for use of indwelling catheters exceeding 14 days. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 12 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 3. An indwelling catheter that does not fall into one of the supporting categories above should be discontinued and removed. 14. Use of the indwelling catheter should be reflected in the resident-centered plan of care. Review of the facility's policy titled, Standards and Guidelines: Prevention of Catheter Associated Urinary Tract Infections (CAUTIs), with a revised date of 03/27/21, included the following: It is the policy of this facility that indwelling catheters are only utilized with written rationale for the use, consistent with evidence-based guidelines (e.g., acute urinary retention, bladder outlet obstruction, neurogenic bladder or terminally ill for comfort measures). Under Guidelines included: 1. Catheters are removed as soon as possible and are not used for the convenience of resident care personnel. 2. Intermittent catheterization should be used rather than indwelling catheter whenever possible. Under Catheter Insertion and Care included: 9. Recognize and assess for complications and their causes. Maintain a record of any catheter-related problems. 10. Attempt to remove the catheter as soon as possible when no indications exist for its continuing use. On 11/15/22 at 1:50 PM an observation was made of Resident #212 having an indwelling catheter in a privacy bag hanging on the side of the bed. Record review for Resident #212 revealed the resident was admitted to the facility on [DATE] and included the following diagnoses: Encounter for Attention to Tracheostomy, Type 2 Diabetes Mellitus, Generalized Anxiety Disorder, Morbid (Severe) Obesity, Epilepsy, Other Acute Kidney Failure, and Personal History of Other Malignant Neoplasm of Bronchus and Lung. Review of Section C of the Minimum Data Set (MDS) dated [DATE] revealed that Resident #212 had a Brief Interview for Mental Status of 15, which indicated that she had an intact cognitive response. Review of Section G of the MDS dated [DATE] revealed that Resident #212 had a bed mobility, dressing, eating, toilet use, and personal hygiene all had a self-performance of total dependence with support of 1-person physical assistance, transfer self-performance of activity did not occur with support of ADL (Activity of Daily Living) activity itself did not occur. Review of the Physician's Orders revealed that Resident #212 had an order dated 08/16/22 for catheter care q shift (every shift) with an end date of 09/13/22. . Review of the Physician's Orders revealed that Resident #212 had an order dated 08/16/22 to change catheter drainage bag as needed for leaking or cloudiness with an end date of 09/13/22. Review of the Physician's Orders revealed that Resident #212 had an order dated 08/16/22 to change indwelling catheter for leakage or blockage with an end date of 09/13/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 13 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 Review of the Physician's Orders revealed that Resident #212 had an order dated 08/16/22 to insert/maintain indwelling catheter (16 French) with an end date of 08/17/22. Review of the Physician's Orders revealed that Resident #212 had an order dated 08/17/22 to insert/maintain indwelling catheter (16 French) for Dx (Diagnosis) Sacrum Ulcer Stage 4 with an end date 09/13/22. Review of the Physician's Orders revealed that Resident #212 had an order dated 09/13/22 to insert/maintain indwelling catheter (20 French) for Dx Retention of Urine with end date of 09/13/22. Review of the Physician's Orders revealed that Resident #212 had an order dated 11/16/22 to D/C (Discontinue) [] catheter and monitor for voiding one time a day for no criteria for use. Review of the Comprehensive Nursing Evaluation for Resident #212 dated 08/16/22 revealed under Section 9. Skin Integrity included the following: Sacrum scars, Left thigh (rear) redness, Abdomen surgical scars, other discoloration of the legs, Other fragile skin. Under Section 12. Genitourinary/ Gastrointestinal/ Reproductive included the following: Urinary Device Use: [indwelling urinary catheter]. Review of the Daily Skilled Note for Resident #212 dated 08/17/22 revealed under Systems - Genitourinary urinary device in use [] left unchecked. Under Systems - Resident response to treatments and Additional Comments included [] catheter in place no s/s (signs and/or symptoms) of bleeding or infection. Review of the Skin & Wound - Total Body Skin Assessment for Resident #212 dated 08/17/22 revealed the number of new wounds was 0. Record review of nursing documentation for Resident #212 08/17/22 to 08/30/22 does not reveal any documentation of the resident having an indwelling urinary catheter, or an indwelling urinary catheter removal, insertion, assessment, or catheter care provided. Review of the Daily Genitourinary Skilled Note for Resident #212 dated 08/31/22 revealed under Systems Genitourinary included the following: Urinary device in use: Has [] catheter. Nursing interventions: Irrigated catheter per orders. Catheter care provided. Incontinence care provided. Review of the Narrative Nurses note for Resident #212 dated 09/13/22 with an effective date of 09/12/2022 included: Noticed [] catheter came out from patient. Called the doctor to notify him of the status of the catheter. The doctor advised to reinsert the catheter. Verified the catheter size and proceed to reinsert a new catheter. At this time there is no leakage and catheter placement has been verified. Review of the Daily Skilled Note for Resident #212 dated 09/13/22 revealed under Systems - Genitourinary Urinary device in use: has a [] catheter, urinary device is patent and draining; free from complications. Review of the Daily Skilled Note for Resident #212 dated 09/14/22 revealed under Systems - Genitourinary Urinary device in use: has a [] catheter. Complications related to urinary device included: Urinary device is patent and draining free from complications and Complications with urinary device observed (but not further described). Interventions included: Catheter care provided. Incontinence (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 14 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 care provided. Level of Harm - Minimal harm or potential for actual harm Review of the Care Plan for Resident #212 with initial date of 08/30/22 and a most recent revised date of 11/17/22 that had a focus on The resident has an alteration in elimination AEB (As Evidenced By): is incontinent of bowel and bladder; impaired mobility r/t (related to) Diagnoses (Dx): Morbid Obesity, and Kidney Failure, requires staff assist with toileting/incontinence care needs, is at risk for constipation r/t impaired mobility. Goals included: Resident will be clean, dry, and odor free daily thru the next review date. Resident will have adequate bladder function thru catheter and will remain free from complications r/t use of device thru the next review date. Resident will remain free from sx/sx (signs and symptoms) of UTI (Urinary Tract Infection) thru the next review date. Resident will have a regular bowel movement at least q (every) 3 days thru the next review date. The interventions included: Administer medications as ordered; observe for effectiveness and for SEs (side effects). Check resident upon arising, and at HS (hour of sleep) for incontinence; perform incontinence care prn (as needed). Observe for sx/sx of UTI; report to physician if noted. Observe for the presence of stool, amount of stool, color and consistency that might indicate constipation/infection. Labs as ordered, report results to physician. Schedule urology appointments as needed. Observe for changes in bowel/bladder function; update physician if noted. Residents Affected - Few During an interview conducted on 11/17/22 at 8:10 AM with Staff X Registered Nurse Unit Manager, when asked what time is good to schedule observation of catheter care for Resident #212, she stated that the catheter had been discontinued and removed last night (11/16/22). Staff X went on to say that when a resident was admitted with an indwelling catheter; they verify if the resident meets criteria and if not, they get an order to have the catheter removed, the resident does not meet criteria at this time, so it was removed. During an interview conducted on 11/17/22 at 8:20 AM with the Director of Nursing (DON), she approached surveyor to inform that when a resident is admitted with an indwelling catheter they check to see if the resident meets criteria to have an indwelling catheter (i.e., Stage IV sacral wound). During an interview conducted on 11/17/22 at 4:50 PM, Staff U Registered Nurse (RN) was asked about Resident #212's indwelling urinary catheter, Staff U revealed that the indwelling urinary catheter was discontinued yesterday (11/16/22). She added that she took it out in the morning, and she documented it in the progress notes. During an interview conducted on 11/17/22 at 4:55 PM with Staff V float Certified Nursing Assistant (CNA) when asked when she last took care of Resident #212, she stated about 2 weeks ago. When asked if she remembered if the resident had an indwelling urinary catheter, she said yes. During an interview conducted on 11/18/22 at 9:00 AM with Staff X Registered Nurse Unit Manager, regarding the indwelling urinary catheter for Resident #212, she stated that she had misunderstood about the discontinued date for the indwelling urinary catheter for Resident #212, and it was discontinued on 08/16/22 not 11/16/22. Surveyor informed Staff X Registered Nurse Unit Manager that an indwelling urinary catheter had been observed by the surveyor on 11/15/22 and during an interview with Staff U Registered Nurse (RN) she had stated that she removed the indwelling urinary catheter for Resident #212 on 11/16/22. Staff X Registered Nurse Unit Manager insisted that Resident #212 did not have an indwelling urinary catheter and has not had one since it was discontinued/removed on 08/16/22. During an interview conducted on 11/18/22 at 10:30 AM with the Director of Nursing (DON), she stated that Resident #212 was admitted to the facility on [DATE] with an indwelling urinary catheter. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 15 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 FORM CMS-2567 (02/99) Previous Versions Obsolete When a resident is admitted with an indwelling catheter and there is no reason for the catheter, it is removed per facility protocol/policy. No physician order is needed to remove the indwelling urinary catheter since this is their protocol/policy. The DON stated that on 08/17/22 the indwelling urinary catheter for Resident #212 was removed. She acknowledged that the nurse removing the indwelling urinary catheter should document that the indwelling urinary catheter was removed and there was no documentation that the indwelling urinary catheter was removed for Resident #212. The DON stated that on 09/13/22 staff entered an order to insert indwelling urinary catheter for Resident #212, and then entered an order to discontinue the indwelling urinary catheter the same day (09/13/22). The DON then changed her statement and said that the indwelling urinary catheter that Resident #212 was admitted with (on 08/16/22) was never removed as it should have been as per their facility protocol on 08/17/22. She also stated that there was an order dated 08/17/22 to discontinue the indwelling urinary catheter and again stated that the indwelling urinary catheter was not removed from the resident per physician order and their protocol. The DON stated that on 09/12/22 the indwelling urinary catheter came out of Resident #212 per nursing documentation and the nurse documented that she obtained an order to reinsert the indwelling urinary catheter on 09/13/22. Event ID: Facility ID: 105510 If continuation sheet Page 16 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, observations, and record review, the facility failed to provide nutritional assessments in a timely manner and failed to ensure the accuracy of admission/monthly weights for 4 of 8 residents reviewed for nutrition (Resident #94, Resident #40, Resident #128, and Resident #54). Residents Affected - Few The findings included: 1. In an observation conducted on 11/15/22 at 1:07 PM, the lunch tray arrived for Resident #94 and was placed on her side table. Staff left the tray at the bedside and walked out to help pass other lunch trays. At 1:15 PM, Resident #94's tray was about 5% consumed, and no staff was noted in the room assisting her with the lunch meal. Continued observation at 1:29 PM showed that Resident #94's tray was left 95% untouched. In an observation conducted on 11/16/22 at 9:40 AM, Resident #94 was noted in her room with the breakfast tray in front of her. She was observed eating one tablespoon of the eggs, but everything else on the tray was untouched. The closer observation did not show any staff in the room assisting her with her breakfast meal. At 9:50 AM, the tray was taken out of her room. In an observation conducted on 11/17/22 at 9:10 AM, Resident #94 was noted in her room with the breakfast tray on the side table, and Resident #94 was noted asleep. At 9:30 AM, Resident #94 was awake, but the breakfast tray was untouched. A review of the chart showed that Resident #94 was readmitted on [DATE] with diagnoses of acute respiratory failure, type 2 diabetes, and dementia. A review of the Minimum Data Set (MDS) dated [DATE] showed that Resident #94 is cognitively severely impaired. Under section G for eating, it showed that Resident #94 is for supervision with set up only. The care plan showed that Resident #94 is at risk for an alteration in nutrition and hydration related to muscle wasting/atrophy, eating disorder, heart failure, dysphagia, cognitive communication deficit, and a history of being underweight. She requires a mechanically altered diet and requires assistance to complete meals at times. A dietary progress note dated 08/04/22 showed that Resident #94 would receive a house supplement three times a day to increase the nutritional density of intake. A review of Resident #94's weights showed the following: a weight of 106.7 pounds on 09/12/22, a weight of 110 pounds on 10/10/22, and a weight of 108.4 pounds on 11/16/22. A Dietary profile dated 10/20/22 showed the following: Resident #94 is on a Pureed diet with a good intake of meals. Her weight was documented at 110 pounds. It further showed that Resident #94 is eating 75% to 100% of her meals and is at risk for unintended weight loss. Resident #94 needs total assistance with eating. The Certified Nursing Assistants' intake of meals showed that on 11/16/22, Resident #94 ate 75-100% of her breakfast meal and not the 10% or less she ate during the Surveyor's observation. (Photographic evidence obtained). It was also documented that for lunch on 11/16/22. She ate 75-100% of her breakfast meal and not the 10% or less she ate during the Surveyor's observation. (Photographic evidence obtained). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 17 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an observation conducted on 11/17/22 at 11:20 AM, Staff D and Staff E, Restorative Certified Nursing Assistants, were asked by surveyor to take a new weight recording on Resident #94. Using a mechanical lift, the first recorded weight showed that Resident #94 was at 100.2 pounds, and the second recorded weight showed that Resident #94 was at 99.8. This showed a significant discrepancy in weight from 108.2 pounds on 11/16/22 to 99.8 pounds a day after. This showed that Resident #94 had a weight loss of about 10 pounds in one month. Staff E stated that he was taught how to use the mechanical lift but was still determining if it was the correct way to obtain accurate weight on residents. A review of the mechanical lift direction of use showed that the method that Staff E and Staff D used to take the weights on Resident #94 in the past before 11/17/22 was incorrect and did not follow the recommended instructions for use. In an interview conducted on 11/17/22 at 12:00 PM with Staff C, the Registered Dietitian stated that she questioned some weight discrepancies in the past but was unsure why. Staff C further acknowledged all findings. Review of the facility's policy titled Standards and Guidelines: Weighing/Weight Loss Protocol, revision date 03/05/21 revealed the following: New admits and readmissions will be weighed upon within the first ten days, monthly and/or as ordered by the physician. Monthly weights will be completed by the nursing department. Weekly and daily weights may be obtained per RD [registered dietitian] or physician orders in order to monitor clinical status of a resident requiring closer monitoring and intervention. An interview was conducted on 11/16/22 at 4:35 PM with Staff P, Registered Dietitian and Staff O, Corporate Dietitian. Staff P stated she documents the assessments on all of the high-risk residents and the admissions; she clarified that a high-risk resident is any resident on dialysis or tube feeding. Staff P said Staff C, Registered Dietitian works part time and documents the quarterly assessments on any resident who is not considered to be high-risk. When asked how quickly she must do her initial assessment on newly admitted residents, Staff P stated, it depends on how long it takes for the CNAs to do the weights; but that she has a maximum of seven days to document her initial assessment. Staff O stated it takes an average of three to four days for the Certified Nursing Assistants (CNAs) to obtain a resident's initial weight after admission and that it could take longer if a resident is admitted over a weekend. An interview was conducted on 11/16/22 at 4:54 PM with the facility's DON. She stated there is a Restorative CNA who is responsible for obtaining resident's weights. When asked who documents the resident's weights in the computerized chart, she stated the weights are documented by either herself or her assistant. She said when a resident is readmitted to the facility, the resident is weighed per facility policy-an initial weight is obtained, then weekly weights for three weeks, then the resident is changed to monthly weights if there are no concerns. 2) During the initial tour of the facility conducted on 11/15/22 at 11:36 AM by a fellow surveyor, it was noted that Resident #40 had suffered weight loss. Resident #40 was initially admitted to the facility on [DATE] and was readmitted on [DATE]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 18 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #40 had a medical history significant for a brain injury, falls, high blood pressure, Schizophrenia, and psychosis. A Quarterly Minimum Data Set (MDS) was completed on 10/09/22. This MDS documented Resident #40 had a Brief Interview of Mental Status (BIMS) score of 6, which indicates Resident #40 had moderate cognitive impairment. Resident #40 was discharged to the hospital on [DATE] and was readmitted to the facility on [DATE]. There was no admission weight obtained until 01/19/22. Review of Resident #40's physician orders revealed there was an order written on 11/22/21 for Obtain weight upon admission then weigh weekly x 4 and then weigh monthly. An admission Dietary Profile was documented on 11/23/21. Under the section titled Dietary Narrative Note, the dietitian wrote, last weight obtained was 227.6 pounds on 10/13/21. This indicated the dietitian used a weight that was more than one month old for her initial assessment when Resident #40 was readmitted to the facility. 3) During the initial tour of the facility conducted on 11/15/22 at 10:25 AM by a fellow surveyor, it was noted that Resident #128 appeared thin. Resident #128 was initially admitted to the facility on [DATE] and readmitted on [DATE]. Resident #128 had a medical history significant for Alzheimer's, falls, depression, and a swallowing disorder. An admission Minimum Data Set (MDS) was done 09/05/22. This MDS documented Resident #128 had a Brief Interview of Mental Status (BIMS) score of 99, which indicates Resident #128 had severe cognitive impairment. Resident #128 was discharged to the hospital on [DATE] and was readmitted to the facility on [DATE]. There was no admission weight obtained until 09/12/22. Review of Resident #128's physician orders revealed there was an order written 08/29/22 for Obtain weight upon admission then weigh weekly x 4 and then weigh monthly. An admission Dietary Profile was documented on 09/08/22. Under the section titled Weight, the dietitian wrote, 98.6 pounds (07/15/22). This indicated the dietitian used a weight that was more than one month old for her initial assessment when Resident #128 was readmitted to the facility. 4) During the initial tour of the facility on 11/15/22 at 10:30 AM conducted by a fellow surveyor, it was noted that Resident #54 appeared thin. Resident #54 was admitted to the facility on [DATE]. Resident #54 had a medical history significant for a stroke, a swallowing disorder, respiratory failure, seizures, high blood pressure, and muscle weakness. A Quarterly Minimum Data Set (MDS) was completed on 10/28/22. This MDS documented Resident #54 had a Brief Interview of Mental Status (BIMS) score of 99, which indicates Resident #54 had severe cognitive impairment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 19 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During the initial record review, it was noted by the surveyor that Resident #54 was admitted from the hospital on [DATE], but no admission weight was obtained until 08/01/22. An Initial Nutrition Risk Evaluation was documented on 07/26/22. Under the section titled Comments, the dietitian wrote, Weight record from [NAME] 05/03/22: 128 pounds. This indicated the dietitian used a hospital weight from more than two months prior to the documented initial assessment. Further review of Resident #54's record revealed there were no Dietary Profiles documented after the Initial evaluation on 07/26/22. An interview was conducted with Staff C, Registered Dietitian on 11/17/22 at 12:52 PM. Staff C independently reviewed Resident #54's chart and agreed that a Quarterly Assessment should have been documented in October. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 20 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on record review, observations and interviews, the facility failed to provide proper tracheostomy care for 1 of 1 resident reviewed for tracheostomy care, Resident #212. Residents Affected - Few The findings included: Review of the facility's written procedure titled Trach Care Competency Check List, undated, revealed the following: Apply sterile gloves. The dominant hand will remain sterile. With non-dominant hand, remove oxygen source. Then unlock and remove inner cannula. Place tracheostomy collar over outer cannula. Quickly clean the inside and outside of the inner cannula with brush. With sterile gloved hand, replace inner cannula and lock in place. Replace tracheostomy collar. Observation of tracheostomy care on 11/18/22 at 10:10 AM for Resident #212. The surveyor obtained consent from the resident prior to the start of tracheostomy care. The staff members involved in Resident #212's tracheostomy care were Staff L, Respiratory Therapist, Staff M, Respiratory Therapist, and Staff N, Respiratory Nurse. The surveyor asked Staff L who normally performs tracheostomy care and respiratory medication treatments for the residents. Staff L stated it is always the respiratory therapists who perform these tasks, not the nursing staff. Prior to entering the room, Staff L, Staff M, and Staff N donned isolation gowns; they each already had masks and shields on their faces. Upon entering the room, the surveyor noted there were tracheostomy care supplies present on a bedside table inside the room, wrapped in a bag. Staff L stated they had gathered these supplies. The surveyor asked Staff L to list the supplies on the table. Staff L stated there was a package of gauze, a split gauze (a special gauze pad which is manufactured with a cut down the middle so it can safely fit around the tracheostomy without obstructing the resident's ability to breath properly), inner cannula (which fits inside the tracheostomy tube), normal saline solution, and a new tracheostomy collar (a fabric device which holds the tracheostomy in place in the resident's neck). Staff L and Staff M washed their hands and donned gloves. Staff L then cleaned his stethoscope with an alcohol swab and Staff M cleaned a pulse oximeter(to check Resident #212's oxygen level) with an alcohol swab. Staff L wrapped the end of his stethoscope in a surgical (non-sterile) glove and listened to the resident's lung sounds. Staff M checked Resident #212's oxygen level-it was 95% at 10:30 AM. Staff L then washed his hands and changed his gloves, donning surgical gloves. Staff L then removed the old gauze from under Resident #212's tracheostomy at 10:32 AM. Staff L said Resident #212 needed to be suctioned but noted he did not have a suction catheter kit available in the room. Staff N left the room and obtained a suction catheter kit at 10:33 AM. Staff L washed his hands and changed his gloves, donning 1 surgical glove and 1 sterile glove, and removed the tracheostomy mask (the device that delivers oxygen into the tracheostomy). Staff L then suctioned Resident #212's tracheostomy one time at 10:36 AM. The tracheostomy mask was left off at this time. Staff M washed her hands and donned new gloves. Staff M poured normal saline solution into a sterile container so Staff L could flush the suction tubing. The tracheostomy mask was placed back on the tracheostomy site at 10:40 AM. Staff L and Staff M washed their hands and donned new surgical gloves. Staff L removed the tracheostomy mask from the tracheostomy site and removed the old inner cannula at 10:42 AM. The tracheostomy mask was left off at this time. Staff L washed his hands and donned new surgical gloves. Staff L (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 21 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few then removed the new sterile inner cannula from its packaging and told the surveyor that, since he would not be touching the sterile end of the inner cannula that he did not need to wear sterile gloves for this part of the procedure. Staff L then placed the new inner cannula with the non-sterile gloves at 10:45 AM. The tracheostomy mask was placed back on the tracheostomy site at this time. Staff L washed his hands and donned surgical gloves. Staff L then opened a kit containing sterile gauze and sterile gloves. Staff M washed her hands and donned surgical gloves. Staff L dumped the contents of the kit onto a sterile cloth and Staff M poured normal saline solution into a sterile box. Staff L soaked gauze in the normal saline solution and used this to clean the skin around the tracheostomy site at 10:50 AM. Staff L and Staff M removed the old tracheostomy collar and placed a new tracheostomy collar at 10:52 AM. Staff L placed a new split gauze under the tracheostomy site at 10:57 AM and then placed extra gauze around the site to keep Resident #212's clothes clean from secretions. The surveyor found the use of surgical (non-sterile) gloves during the changing of the tracheostomy inner cannula to be an issue during this observation of tracheostomy care. There were also two instances lasting three to four minutes each where Resident #212's oxygen was left off during the tracheostomy care. Both issues go against the facility's procedure for tracheostomy care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 22 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. 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 follow infection control guidelines as per Centers for Disease Control and Prevention (CDC) recommendations during the disconnection of dialysis treatment for 1 of 1 Resident Observed during dialysis (Resident #8). Residents Affected - Few The findings included: A review of the Centers for Disease Control and Prevention (CDC) recommendations, titled Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, Showed the following: Use an alcohol-based hand rub or wash with soap and water for the following clinical indications: Immediately before touching a patient, before performing an aseptic task (e.g., placing an indwelling device) or handling invasive medical devices. Before moving from work on a soiled body site to a clean body site on the same patient, after touching a patient or the patient's immediate environment, after contact with blood, body fluids, or contaminated surfaces, and immediately after glove removal. https://www.cdc.gov/hicpac/recommendations/core-practices.html#anchor_1556561902. A record review showed that Resident #8 was admitted on [DATE] with a heart failure end-stage renal disease diagnosis and is dependent on renal dialysis. Further review showed an order for In House Dialysis on Monday, Wednesday, and Friday dated 11/08/22. In an observation conducted on 11/16/22 at 12:16 PM in the dialysis treatment room, Resident #8 was getting ready to be disconnected from her dialysis treatment via Central Venous Catheter (CVC). Staff A, a Registered Nurse (RN), was observed with clean gloves touching the dialysis machine and then touching Resident # 8's bloodlines with the same gloves. She touched the dialysis machine again, removed her gloves, and practiced hand hygiene before placing on a new pair of gloves. Staff A touched the dialysis machine again and then handled Resident #8's bloodlines with the same dirty gloves. Staff A removed her dirty gloves, picked a new pair of gloves, placed them down on the glove box, practiced hand sanitation, and lifted the same pain of gloves again. She continued touching Resident #8's bloodlines. She repeated that same routine, touching the cleaned glove, placing them down, sanitizing her hands, and putting the same clean gloved back on before touching Resident #8's bloodlines. In an interview conducted on 11/16/22 at 12:40 PM, Staff B, Registered Nurse Dialysis Supervisor, stated that she noticed that Staff A removed her dirty gloves, picked a new pair of gloves, placed them down on the glove box, practiced hand sanitation, and lifted the same pain of gloves again before touching Resident #8's bloodlines. She said that she would have to reeducate Staff A on this infection control practice to ensure she did not repeat the same mistake. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 23 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, observations and interviews, the facility failed to secure unattended medications in the medication refrigerator for 1 out of 8 nursing stations, the facility failed to properly secure medication and treatment carts for 2 out of 16 carts, the facility failed to ensure proper disposal of medications during 1 medication administration observation. The findings included: Review of the facility's policy titled Standards and Guidelines: Medication Storage, revised 10/24/22, revealed the following: The facility shall not use discontinued, outdated or deteriorated medications, drugs or biologicals. Compartments containing medications, drugs, and biologicals shall be locked when not in use and trays or carts used to transport such items shall not be left unlocked if out of a nurse's view. Medications will be destroyed following FDA, State and Local requirements. Review of the facility's policy titled Standards and Guidelines: Medication Documentation, revised 03/03/21, revealed the following: For routine disposition, facility is required to utilize a chemical dissolution drug disposal system which is safe and minimizes environmental impact. Facility should adhere to the use and container disposal instructions provided with the disposal system. 1) An observation was made on 11/17/22 at 8:20 AM with Staff F during a medication administration observation. The resident had refused her Iron Sulfate tablet during the medication administration. Staff F left the medication in a medication cup and took it back to the medication cart. Once at the cart, she poured five milliliters of water into the cup that contained the Iron tablet. She stated the water was to help soften the pill. After two minutes, Staff F then poured the water into the trash can and disposed the tablet into the sharp's container on the side of the medication cart. 2) An observation was made on 11/16/22 at 10:55 AM while entering room [ROOM NUMBER], the surveyor noted a medication cart outside the room was unlocked. The surveyor turned to obtain photographic evidence of the unlocked cart, but a passing staff member locked the cart before a picture could be taken. 3) An observation was made on 11/18/22 at 7:06 AM while entering the facility, the surveyor noted an unlocked treatment cart next to the 2 North nurse's station. A second observation was made at 7:27 AM of this treatment cart in the same location, still unlocked. The surveyor alerted Staff Z, who was in the nurse's station and confirmed that it was her treatment cart. Staff Z promptly locked the cart after the surveyor intervened. 4) On 11/15/22 at 10:00 AM an observation was made of a locked medication refrigerator located at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 24 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the 2 South Nursing Station. Staff T Registered Nurse (RN) Nurse Manager unlocked the medication refrigerator for surveyor to review for any expired medications. Staff T Registered Nurse (RN) Nurse Manager then walked away, completely out of the sight of the surveyor and the unlocked medication refrigerator. During an interview conducted on 11/15/22 at 10:05 AM with Staff T Registered Nurse (RN) Nurse Manager when asked why she walked away from the unlocked medication refrigerator, she said I was just putting something away. Event ID: Facility ID: 105510 If continuation sheet Page 25 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 - Many 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, it was determined that the facility failed to follow the resident's approved menu for the Regular diets (Resident #189 and Resident #92). This could affect all residents receiving Regular, consistency diets (145 residents). The findings included: A review of the facility's cycle menu showed that on 11/15/22, the following was provided: the Regular Diet consistency had 3 ounces of honey-glazed ham,4 ounces of red cabbage, and 4 ounces of seasoned roasted potatoes. The Diet Type Report provided by the facility showed that 145 residents are on a Regular diet consistency. In an observation conducted on 11/15/22 at 1:40 PM, Resident #189 was noted in his room with the lunch tray at his bedside. Closer observation showed a lunch meal that had the following: a slice of glazed ham, purple cabbage, and roasted potatoes. In this observation, Resident #189 stated that the ham is so small that he is not sure that it weighs 3 ounces. A chart review showed that Resident #189 was admitted on [DATE] with type 2 diabetes and sleep apnea diagnoses. An order was noted for a Regular texture diet dated 08/11/21. The Minimum Data Set (MDS) dated [DATE] showed that Resident #189 had a Brief Interview of Mental Status (BIMS) score of 15, which was cognitively intact. A chart review showed that Resident #92 had an order for a Regular texture diet dated 11/09/21. In an observation conducted on 11/15/22 at 1:50 PM, Resident #92's lunch tray was observed with the following: a piece of glazed ham with a slice of pineapple on top, purple cabbage, and roasted potatoes. Closer observation showed a small thin slice of the glazed ham that did not look like it was 3 ounces in size. Surveyor then asked to take the weight of the sliced ham using the facility's food scale. The facility's Food Service Director asked Surveyor if she could put the sliced pineapple with the ham before taking the weight. Surveyor explained that pineapple is not considered a protein food. The Food Service Director placed the sliced ham on the scale, which showed a weight of 1 ounce. In this observation, she was asked if the glazed ham that was served for lunch today was sliced and measured before serving to ensure that it was 3 ounces per slice; she said no. she stated that she did not take the weight of each sliced glazed ham before placing them on the tray line. The Food Service Director stated that she used the food slicer to cut the glazed ham, and it was set at number 3 for three ounces. She was under the impression that the number 3 was used for a 3-ounce measuring size. The Food Service Director reported that all the sliced ham that was served for lunch on 11/15/22 was sliced using the number 3 on the slicer. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 26 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to honor the residents food preferences, and food intolerances for 3 of 3 residents reviewed for foods (Resident #189, Resident #192, and Resident #100). The findings included: In an observation conducted on 11/15/22 at 9:00 AM, Resident #189 was in the room when his breakfast tray arrived. The tray was noted with over easy-cooked eggs, sausage patty, and a large piece of bread approximately 3 inches long. Closer observation showed a Regular carton of 2% milk and 8 ounces of juice. The meal ticket on the tray showed that Resident #189 was lactose intolerant and liked Sunnyside-up eggs. In this observation, Resident #189 stated that he did not like how they cooked his eggs and wanted his eggs sunny side up. He pointed to the Regular milk and said that he was lactose intolerant and that they always make a mistake and bring him Regular milk. He then picked up the large piece of bread on his tray and said, see, it is hard as a rock. In an observation conducted on 11/16/22 at 9:25 AM, Resident #189 was eating his breakfast. Closer observation showed that his tray had Regular 2% milk, scrambled eggs, and a biscuit. The meal ticket on the tray showed to provide lactose intolerance milk when available. In an observation conducted on 11/18/22 at 1:00 PM, Resident #189 was in his room with a lunch tray that had another resident's meal ticket. In this observation, Resident #189 stated that they gave him the wrong tray and proceeded to call staff to let them know. A chart review showed that Resident #189 was admitted on [DATE] with diagnoses of type 2 diabetes and sleep apnea. An order was noted for a Regular texture diet dated 08/11/21. The Minimum Data Set (MDS) dated [DATE] showed that Resident #189 had a Brief Interview of Mental Status (BIMS) score of 15, which was cognitively intact. In an interview conducted on 11/15/22 at 11:00 AM with Resident #192, he stated that he asked in the past to be placed on a low-diet meal, but they keep bringing him the same food choices that his roommate gets. He further said that the kitchen always sends foods that he likes and that they never honor his food preferences. Resident #192 said that there are fruit flies in his room daily and that he told them about it, but nothing has been done. A chart review showed that Resident #192 was admitted on [DATE] with diagnoses of diabetes, morbid obesity, and kidney failure. The order was noted on 12/21/21 for a No Added Salt, Controlled Carbohydrate diet. The MDS dated [DATE] showed that Resident #192 had a BIMS score of 15 out of 15, which is cognitively intact. In an interview conducted on 11/15/22 at 10:10 AM with Resident #100, he stated that the facility's food is not good and that it is always cold. They never honor his food choices and that they make mistakes on his tray all the time. A review of the MDS dated [DATE] showed that Resident #100 had a BIMS score of 15 out of 15, which is cognitively intact. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 27 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete An interview conducted on 11/18/22 at 10:03 AM with the facility's Food Service Director stated that she recently made changes to the menu selection and that they are in the process of making changes. She further stated that they have been short staff in the kitchen for some time and have many new staff members who are still learning the process. Therefore, she is on the tray line herself daily. According to her, one person on the tray line is assigned to ensure that the food on the tray is the same as the prescribed diet and food preferences. Event ID: Facility ID: 105510 If continuation sheet Page 28 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. Based on observations, interviews, and record review, the facility failed to provide the correct food consistencies for the Mechanical Soft Diets for 2 of 2 residents during dining observations (Resident #10 and Resident #167). This has the potential to affect 38 residents on the Mechanical Soft diet. The findings included: A review of the facility's cycle menu showed that on 11/15/22, the following was provided: the Regular diet consistency had honey-glazed ham, red cabbage, and seasoned roasted potatoes. The Mechanical soft diet had ground honey-glazed ham, red cabbage, and mashed potatoes. The Diet Type Report provided by the facility showed that 38 residents are on a Mechanical soft consistency diet. In an observation conducted on 11/15/22 at 8:45 AM, Resident #10 was noted in the room with her breakfast tray in front of her. Closer observation showed a breakfast meal with a large piece of bread approximately 3 inches long that was untoasted and hard to the touch. It also had a ground sausage patty and scrambled eggs. The meal ticket on the tray showed that Resident #10 was on a Mechanical soft diet. In an observation conducted on 11/15/22 at 1:30 PM, Resident #10 was noted eating her lunch in her room. Closer observation showed a tray that had the following: ground glazed ham, purple cabbage, and roasted potatoes that were about 2 inches in size and hard to the touch. The meal ticket on the tray showed that Resident #10 was on a Mechanical soft diet. In an observation conducted on 11/15/22 at 9:10 AM, Resident #167 was noted in his room waiting on the breakfast meal. The tray arrived with the following foods: a large piece of bread approximately 3 inches long that was untoasted and hard to the touch. It also had a ground sausage patty and scrambled eggs. In an interview conducted on 11/17/22 at 9:28 AM with Staff Y, the Speech Therapist stated that a Mechanical soft diet consistency needs to have ground meat and maybe a smooth texture like mashed potatoes. If any vegetables are served, they need to be cut and chopped and soft to the touch. She also said that if potatoes are served on a Mechanical diet, they need to be soft to the touch and cut easily through with a fork. When asked about the large piece of bread that was observed on some of the trays, she stated that the bread needs to be soft and easy to chew. Staff Y further reported that they only have one type of Mechanical soft diet in this facility. When asked if she participated in the menu selection for the different diet consistencies, she said no. During an interview conducted on 11/18/22 at 10:03 AM, the facility's Food Service Director stated that she recently made changes to the menu selection and that they are in the process of making changes. the facility's Food Service Director also reported that the Speech Therapist must tell them which level of mechanical soft they need to give certain residents and that any special modifications will be put under the note section of the meal ticket. When asked why all residents on the Mechanical soft diet on 11/15/22 received roast potatoes with honey glazed ham and not the mashed potatoes specified under the Mechanical soft diet, the facility's Food Service Director revealed that she did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 29 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0808 not know. She further acknowledged that she did not know that mashed potatoes was noted under the Mechanical soft diet section. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 30 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 and interviews, the facility failed to maintain food safety requirements with storage, preparation, and distribution in accordance with professional standards for food service safety, which included: failure to maintain sanitary conditions in the main kitchen, failure to date and label all food items, and failure to dispose of expired foods, in the central kitchen. The findings included: In a tour conducted on 11/15/22 at 8:30 AM in the main kitchen, the following was noted: In the dry storage area, 12 bottles that were 46 ounces each of Cranberry juice had a used-by date of 08/16/22, which expired over three months (photographic evidence obtained). In the dry storage area, five large, dented cans were 6.56 pounds each (photographic evidence obtained). The dry storage area's floor was noted with debris and dirt. One large garbage can was pointed out with the lid wholly opened and empty food boxes near it (photographic evidence obtained). A large Thickener bin was noted with the scoop inside (photographic evidence obtained). The food production area was noted with raw food that was placed on a cardboard box near a dirty hand mixer. The food mixer was noted with debris and rust around the edges (photographic evidence obtained). The reach in refrigerator was noted with food items that were noted dated or labeled edges (photographic evidence obtained). The food production area was noted with cleaning supplies, broom, and dustpan. One large skillet was noted with debris and unidentified matter that was oily to the touch. Three large pots were noted with debris and unidentified matter that was oily to the touch. An interview conducted on 11/18/22 at 10:03 AM with the facility's Food Service Director stated that she recently made changes to the menu selection and that they are in the process of making changes. She further said that they have been short-staff in the kitchen for some time and have many new staff members who are still learning the process. In an interview conducted on 11/18/22 at 2:30 PM, the facility's Administrator was told of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 31 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations and interviews, the facility failed to maintain a medical record that is complete and accurate for 1 out of 2 sampled residents with an indwelling urinary catheter. (Resident #212). The findings included: Review of the facility's policy titled, Standards and Guidelines: SG (Standards and Guidelines) Indwelling Catheters, with a revised date of 03/27/21, included the following: It will be the standard of this facility to provide appropriate documentation for use and care for indwelling catheters of the resident's that have the indication for use beyond 14 days. Under Guidelines included: 8. Staff will provide daily catheter care or as ordered by the physician and/or needed. Catheter care should be provided in a manner that promotes infection control and maintenance of the insertion site. 13. Pertinent information regarding care and changes in condition related to the indwelling catheter should be documented in the clinical record. 14. Use of the indwelling catheter should be reflected in the resident-centered plan of care. Record review for Resident #212 revealed the resident was admitted to the facility on [DATE] and included the following diagnoses: Encounter for Attention to Tracheostomy, Type 2 Diabetes Mellitus, Generalized Anxiety Disorder, Morbid (Severe) Obesity, Epilepsy, Other Acute Kidney Failure, and Personal History of Other Malignant Neoplasm of Bronchus and Lung. Review of Section C of the Minimum Data Set (MDS) dated [DATE] revealed that Resident #212 had a Brief Interview for Mental Status of 15, which indicated that she had an intact cognitive response. Review of Section G of the MDS dated [DATE] revealed that Resident #212 had a bed mobility, dressing, eating, toilet use, and personal hygiene all had a self-performance of total dependence with support of 1-person physical assistance, transfer self-performance of activity did not occur with support of ADL (Activity of Daily Living) activity itself did not occur. Review of the Physician's Orders revealed that Resident #212 had an order dated 08/16/22 for catheter care q shift (every shift) with an end date of 09/13/22 . Review of the Physician's Orders revealed that Resident #212 had an order dated 08/16/22 to change catheter drainage bag as needed for leaking or cloudiness with an end date of 09/13/22. Review of the Physician's Orders revealed that Resident #212 had an order dated 08/16/22 to change indwelling catheter for leakage or blockage with an end date of 09/13/22. Review of the Physician's Orders revealed that Resident #212 had an order dated 08/16/22 to insert/maintain indwelling catheter (16 French) with an end date of 08/17/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 32 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Physician's Orders revealed that Resident #212 had an order dated 08/17/22 to insert/maintain indwelling catheter (16 French) for Dx (Diagnosis) Sacrum Ulcer Stage 4 with an end date 09/13/22. Review of the Physician's Orders revealed that Resident #212 had an order dated 09/13/22 to insert/maintain indwelling catheter (20 French) for Dx Retention of Urine with end date of 09/13/22. Review of the Physician's Orders revealed that Resident #212 had an order dated 11/16/22 to D/C (Discontinue) [indwelling urinary catheter] and monitor for voiding one time a day. There were no criteria for use. Review of the Comprehensive Nursing Evaluation for Resident #212 dated 08/16/22 revealed under Section 9. Skin Integrity included the following: Sacrum scars, Left thigh (rear) redness, Abdomen surgical scars, other discoloration of the legs, Other fragile skin. Under Section 12. Genitourinary/ Gastrointestinal/ Reproductive included the following: Urinary Device Use: [] catheter. Review of the Daily Skilled Note for Resident #212 dated 08/17/22 revealed under Systems - Genitourinary urinary device in use (indwelling urinary catheter) left unchecked. Under Systems - Resident response to treatments and Additional Comments included indwelling urinary catheter in place no s/s (signs and/or symptoms) of bleeding or infection. Review of the Skin & Wound - Total Body Skin Assessment for Resident #212 dated 08/17/22 revealed the number of new wounds was 0. Record review of nursing documentation for Resident #212 08/17/22 to 08/30/22 does not reveal any documentation of the resident having an indwelling urinary catheter, or an indwelling urinary catheter removal, insertion, assessment, or catheter care provided. Review of the Daily Genitourinary Skilled Note for Resident #212 dated 08/31/22 revealed under Systems Genitourinary included the following: Urinary device in use: Has catheter. Nursing interventions: Irrigated catheter per orders. Catheter care provided. Incontinence care provided. Review of the Narrative Nurses note for Resident #212 dated 09/13/22 with an effective date of 09/12/2022 included: Noticed [indwelling urinary catheter] came out from patient. Called the doctor to notify him of the status of the catheter. The doctor advised to reinsert the catheter. Verified the catheter size and proceed to reinsert a new catheter. At this time there is no leakage and catheter placement has been verified. Review of the Daily Skilled Note for Resident #212 dated 09/13/22 revealed under Systems - Genitourinary Urinary device in use: has a [indwelling urinary catheter], urinary device is patent and draining; free from complications. Review of the Daily Skilled Note for Resident #212 dated 09/14/22 revealed under Systems - Genitourinary Urinary device in use: has a [indwelling urinary catheter]. Complications related to urinary device included: Urinary device is patent and draining free from complications and Complications with urinary device observed (but not further described). Interventions included: Catheter care provided. Incontinence care provided. Review of the Treatment Administration Records (TARS) for Resident #212 from 08/16/22 to 11/16/22 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 33 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 revealed catheter care was provided every shift from 08/16/22 to 08/31/22. Level of Harm - Minimal harm or potential for actual harm Review of the Care Plan for Resident #212 with initial date of 08/30/22 and a most recent revised date of 11/17/22 that had a focus on The resident has an alteration in elimination AEB (As Evidenced By): is incontinent of bowel and bladder; impaired mobility r/t (related to) Diagnoses (Dx): Morbid Obesity, and Kidney Failure, requires staff assist with toileting/incontinence care needs, is at risk for constipation r/t impaired mobility. Goals included: Resident will be clean, dry, and odor free daily thru the next review date. Resident will have adequate bladder function thru catheter and will remain free from complications r/t use of device thru the next review date. Resident will remain free from sx/sx (signs and symptoms) of UTI (Urinary Tract Infection) thru the next review date. Resident will have a regular bowel movement at least q (every) 3 days thru the next review date. The interventions included: Administer medications as ordered; observe for effectiveness and for SEs (side effects). Check resident upon arising, and at HS (hour of sleep) for incontinence; perform incontinence care prn (as needed). Observe for sx/sx of UTI; report to physician if noted. Observe for the presence of stool, amount of stool, color and consistency that might indicate constipation/infection. Labs as ordered, report results to physician. Schedule urology appointments as needed. Observe for changes in bowel/bladder function; update physician if noted Residents Affected - Few On 11/15/22 at 1:50 PM an observation was made of Resident #212 having an indwelling urinary catheter in a privacy bag hanging on the side of the bed. During an interview conducted on 11/17/22 at 8:10 AM with Staff X Registered Nurse Unit Manager, when asked what time is good to schedule observation of catheter care for Resident #212, she stated that the catheter had been discontinued and removed last night (11/16/22). She went on to say that when a resident was admitted with an indwelling catheter. She stated that they verify if the resident meets criteria and if not, they get an order to have the catheter removed, the resident does not meet criteria at this time, so it was removed. On 11/17/22 at 8:20 AM, the Director of Nursing (DON) approached the surveyor to inform that when a resident is admitted with an indwelling catheter they check to see if the resident meets criteria to have an indwelling catheter (i.e., Stage IV sacral wound). During an interview conducted on 11/17/22 at 4:50 PM with Staff U Registered Nurse (RN) when asked about Resident #212's indwelling urinary catheter, she stated the indwelling urinary catheter was discontinued yesterday (11/16/22). She added that she took it out in the morning, and she documented it in the progress notes. During an interview conducted on 11/17/22 at 4:55 PM with Staff V float Certified Nursing Assistant (CNA) when asked when she last took care of Resident #212, she stated about 2 weeks ago. When asked if she remembered if the resident had an indwelling urinary catheter, she said yes, the resident had a [indwelling urinary catheter]. During an interview conducted on 11/18/22 at 9:00 AM with Staff X Registered Nurse Unit Manager, regarding the indwelling urinary catheter for Resident #212, she stated that she had misunderstood about the discontinued date for the indwelling urinary catheter for Resident #212, it was discontinued on 08/16/22 not 11/16/22. Surveyor informed Staff X Registered Nurse Unit Manager that an indwelling urinary catheter had been observed by the surveyor on 11/15/22 and during an interview with Staff U Registered Nurse (RN) she had stated that she removed the indwelling urinary catheter for Resident #212 on 11/16/22. Staff X Registered Nurse Unit Manager insisted that Resident #212 did not have an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 34 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 indwelling urinary catheter and has not had one since it was discontinued/removed on 08/16/22. Level of Harm - Minimal harm or potential for actual harm During an interview conducted on 11/18/22 at 10:30 AM with the Director of Nursing (DON), she stated that Resident #212 was admitted to the facility on [DATE] with an indwelling urinary catheter. She revealed that when a resident is admitted with an indwelling urinary catheter and there is no reason for the indwelling urinary catheter, it is removed per facility protocol/policy. No physician order is needed to remove the indwelling urinary catheter since this is their protocol/policy. She stated that on 08/17/22 the indwelling urinary catheter for Resident #212 was removed. She acknowledged that the nurse removing the indwelling urinary catheter should document that the indwelling urinary catheter was removed and there was no documentation that the indwelling urinary catheter was removed for Resident #212. The DON stated that on 09/13/22 staff entered an order to insert indwelling urinary catheter for Resident #212, and then entered an order to discontinue the indwelling urinary catheter the same day (09/13/22). The DON then changed her statement and stated that the indwelling urinary catheter that Resident #212 was admitted with (on 08/16/22) was never removed as it should have been as per their facility protocol on 08/17/22. She also stated that there was an order dated 08/17/22 to discontinue the indwelling urinary catheter and again stated that the catheter was not removed from the resident per physician order and their protocol. The DON stated that on 09/12/22 the indwelling catheter came out of Resident #212 per nursing documentation and the nurse documented that she obtained an order to reinsert the indwelling urinary catheter on 09/13/22. The DON stated that there were no orders for catheter care after 09/13/22. When the DON was asked what catheter care consists of, she stated it is checking for kinks, making sure it the tubing is patent, make sure it is covered with a privacy bag, and that the indwelling urinary catheter is still inserted, and free from complications. She also stated that the catheter care only needs to be done once a day and if it is not documented on the Treatment Administration Record, then catheter care would be documented in the Daily Skilled Notes. When asked if the daily catheter care would include cleaning the resident's body and the catheter at the site of the indwelling catheter insertion site, she stated no, the daily catheter care does not include cleaning the catheter at insertion site. The DON stated the indwelling urinary catheter that was reinserted on 09/13/22 had daily catheter care provided and that it was documented daily in the Daily Skilled Notes. She admitted that there may be a couple of Daily Skilled Notes that were not done. The DON had Staff Y MDS (Minimum Data Set) Coordinator, and Staff Z MDS (Minimum Data Set) Coordinator PRN (as needed) to assist her with locating documentation for catheter care being provided to Resident #212. Staff Y MDS (Minimum Data Set) Coordinator, and Staff Z MDS (Minimum Data Set) Coordinator PRN verified that from 09/17/22 to 11/16/22 there were 20 days with no documentation for catheter care on the TAR, Daily Skilled Notes, or Progress Notes for Resident #212 (indicating 20 out of 61 days or 33% there was no documentation for catheter care). Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 35 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0910 Ensure resident rooms meet each 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 observations, interviews, and record review, the facility failed to ensure resident's rooms are designed and equipped for adequate nursing care, comfort, and privacy of residents in a safe manner. Semi-private resident rooms measured under the required 80 square feet per resident and multiple residents complained to the surveyors of their rooms being cramped and cluttered. Residents Affected - Many The findings included: Review of a Memo provided to the surveyors by the facility's Administrator revealed the following: 81 rooms in the facility are semi-private rooms. Of these, 58 measure 157 square feet-which equates to less than the required 80 square feet per resident. These measurements do not include the bathroom or closet storage space in the rooms. During a tour of the facility conducted on 11/16/22 at 11:00 AM, it was noted by the surveyors that a number of the facility's semi-private rooms appeared to be small. It was noted in room [ROOM NUMBER] that a wheelchair between the beds was touching the side rails of each bed, indicating the space between the beds was minimal. On 11/16/22 at 11:23 AM, after obtaining consent from the Resident, the surveyors measured room [ROOM NUMBER]. The surveyors measured the room to be 153 inches long by 144 inches deep. There were 2 bedside tables present in the room which measured 19 inches by 19 inches. Taking into account the size of the bedside tables, the surveyors calculated 150.5 square feet for the room space. On 11/16/22 at 11:30 AM, the surveyors measured room [ROOM NUMBER] with the AHCA Life Safety Surveyor. The surveyors measured the room to be 12 feet by 12 feet. Taking into account the size of the bedside tables, the surveyors calculated 141.5 square feet for the room space. On 11/16/22 at 11:35 AM, the surveyors measured room [ROOM NUMBER] with the AHCA Life Safety Surveyor, the facility's Maintenance Director and the facility's Administrator. The measurements taken were 155 inches by 145 inches. Taking into account the size of the bedside tables, the surveyors calculated 154.5 square feet for the room space. All parties involved agreed these measurements do not equate to the required 80 square feet of space for each resident in a double-occupancy room. The Life Safety Surveyor explained to the Maintenance Director and the Administrator that the rooms being cluttered with belongings and wheelchairs is hazardous for the residents and the staff. When asked how many rooms in the facility have the same layout as room [ROOM NUMBER], the Maintenance Director stated all 19 rooms on the wing (152-172) have this layout, but that there may be more in the facility. Of the 19 rooms on the wing (152-172), the surveyor noted that 2 of the rooms (164 and 166) are single occupancy rooms. The surveyors asked for a map of the facility to count how many rooms have this layout throughout the facility. An interview was conducted on 11/16/22 at 11:25 AM with Resident #100. Resident #100 stated he did feel that his room was cramped and cluttered. (Photographic evidence obtained). Resident #100 stated he had a medical history of paraplegia for which he required the use of a wheelchair. Review of a Quarterly Minimum Data Set (MDS) completed 09/30/22 revealed Resident #100 had a Brief Interview of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 36 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0910 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Mental Status (BIMS) score of 15, which indicates he was mentally intact. For functional status, he required extensive assistance for bed mobility, dressing, toilet use, personal hygiene; total dependence of 2 staff for transfers. An interview was conducted on 11/16/22 at 12:03 PM with Resident #152. Resident #152 stated she did feel that her room was cramped and cluttered. ( Photographic evidence obtained). Resident #152 had a medical history of morbid obesity and a tracheostomy for which she required the use of oxygen equipment. She also required the use of a wheeled walker for ambulation. A Quarterly MDS done 11/09/22 showed Resident #152 had a BIMS score of 15, which indicates she was mentally intact. For functional status, she required supervision assistance for bed mobility, transfers, walking, dressing, toilet use, and personal hygiene. An interview was conducted on 11/16/22 at 12:09 PM with Resident #157. Resident #157 stated he did feel that his room is cramped and cluttered. ( Photographic evidence obtained). Resident #157 had a history of a traumatic brain injury, quadriplegia, seizures. A Quarterly MDS done on 09/29/22 showed Resident #157 had a BIMS score of 3, which indicates severe cognitive impairment. However, Resident #157 was able to answer all the surveyor's questions without difficulty. For functional status, he required total dependence of 2 staff for bed mobility, transfers, toilet use; total dependence of 1 staff for dressing, eating, personal hygiene. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 37 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interviews, the facility failed to ensure an effective call light system for 2 South (24 rooms). Residents Affected - Few The findings included: On 11/15/22 at 11:40 AM this surveyor entered the room of Resident #244. The resident stated that she felt wet and needed to be changed. At 11:47 AM this surveyor asked her to press her call light so staff will be aware of her needs. At 11:54 AM no staff had come yet to answer the light. This surveyor looked out in the hallway and the light above the door to the room was on. This surveyor then walked to the nurse's desk where Staff H, a Licensed Practical Nurse (LPN) was present at the desk. She was asked if she realized that a call light was on and she stated that she did not hear it ringing so the call light in that room must not be working. She then notified the Director of Maintenance. On 11/15/22 at 1:30 PM another surveyor went into room [ROOM NUMBER] and room [ROOM NUMBER] and pressed the call lights. Observed Staff H at the desk with the call bell system behind her not looking at the call bell system when the surveyor pressed the lights in rooms [ROOM NUMBERS] . The lights went on the board but there was no tone and Staff H did not look up to see if a call light was lit. The facility became aware of the lack of sound with the call lights after surveyor intervention. The Administrator was made aware. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 38 of 39 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 105510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Unity Healthcare and Rehabilitation Center 1404 NW 22nd Street Miami, FL 33142 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 0924 Put firmly secured handrails on each side of hallways. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to equip corridors with firmly secured an unbroken handrail. Residents Affected - Few The findings included: Review of the facility's policy titled Work Orders, Maintenance with no date included the following: To establish priority of maintenance service, work orders must be filled out electronically using an online application such as TELS and forward to the Maintenance Director. On 11/15/22 at 1:25 PM an observation of a loose handrail next to room [ROOM NUMBER]. On 11/15/22 at 10:20 AM an observation was made on the second floor across from the elevator of corner handrail broken with sharp edges exposed. On 11/15/22 at 10:20 AM an observation was made on the first floor across from the elevator of corner handrail broken with sharp edges exposed. During a tour of the facility conducted on 11/18/22 at 9:00 AM with the Director of Maintenance he stated that some of the issues identified, he was not aware of. During an interview conducted on 11/18/22 at 9:45 AM with the Director of Maintenance, he stated he will start working on fixing or replacing the handrails immediately. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 39 of 39