Inspection·February 22, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Residents #143's and Resident #146's physician orders revealed no physician orders for oxygen therapy. On 02/21/2024 at 10:40 AM. In an interview with the Environmental Services Director was asked: What is the routine for housekeeping services for cleaning resident rooms, enteral pumps and equipment? The Environmental Services Director stated Every day the pumps and poles are to be checked with daily cleaning. We have a multi-surface cleaner to clean them. We did an in-service on 2/14/2024 about environmental cleaning techniques. Basically, cleaning techniques for how to clean the room from cleanest to dirtiest. On 02/21/2024 at 11:09 AM. In an interview Staff E, LPN (Licensed Practical Nurse) was asked if the oxygen concentrator was on or off, and which resident has orders for oxygen? Staff E, LPN stated: The oxygen concentrator is on and working. It's dusty and it needs to be cleaned. Staff E LPN reviewed the medical chart for Resident #143 and Resident #146 and stated: Both residents do not have physician orders for oxygen. On 02/21/2024 at 11:29 AM. In an interview Staff A, Nurse Manager, was asked about the two enteral feeding pumps that were found with dried enteral liquid in room [ROOM NUMBER], the dirty oxygen concentrator that was on but there were no orders for either of the residents. When Staff A was asked what the routine for cleaning enteral feeding pumps and oxygen concentrator. Staff A stated: These medications and feeding liquid can be so sticky. I will discuss this with the Housekeeping Director. Sometimes, the resident is on as-needed oxygen for three days and the order expires. The nurse is to remove the nasal cannula tubing and the oxygen concentrator from the room. A safe environment is for everyone. I'm going to do an in-service with nurses and certified nursing assistants. If you see something, you need to report it. So, the job can be done. I will talk with all of them. Review of document titled general environmental cleaning techniques. The identification of high touch surfaces and items in each patient care area is a necessary prerequisite to the development of cleaning procedures as theses will often differ by room and facility. Perform assessment and observations of workflow in consultation with clinical staff in each patient care area to determine key high touch areas. Common high touch surfaces include, iv poles, counters where medications and supplies are prepared, patient monitoring equipment. Review of document titled; Spot check of staff revealed a checklist of steps: proper cleaning chemicals uses and areas to clean in the room. Sprays down appropriate areas to clean and lets the chemical sit for at appropriate time. Wipe dry all chemically treated areas. Floor is mopped thoroughly with fresh disinfectant. Review of facility policy titled Cleaning and disinfecting residents room. Revised August 2013. The purpose of this procedure is to provide guidelines for cleaning and disinfecting residents' rooms. In the section titled general guidelines: 1) housekeeping surfaces (e.g. floors, tabletops) will be cleaned on a regular basis, when spills occur and when these surfaces are visibly soiled. 2) Environmental surfaces will be disinfected (or cleaned) on a regular basis (e.g. daily, three times per week) and when surfaces are visibly soiled. 3) Manufacturer's instructions will be followed for proper use of disinfecting products. Review of facility's policy titled Cleaning and disinfection of resident care items and equipment. The policy statement stated resident care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC (Centers for Disease Control) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 2 of 14 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 02/22/2024 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 FORM CMS-2567 (02/99) Previous Versions Obsolete recommendations for disinfection and the OSHA (Occupational Safety and Health Administration) Bloodborne Pathogens Standard. In section titled policy interpretation and implementation. B) Semi critical items consist of items that may come in contact with mucous membranes or non-intact skin. Such devices should be free from all microorganisms, although small numbers of bacterial spores are permissible. C) Noncritical items are those that come in contact with intact skin but not mucous membranes. 2) Non -critical environmental include surfaces bed rails, bedside table. 3) Non-critical items require cleaning followed by either low or intermediate level disinfection following manufacturer's instructions. Event ID: Facility ID: 105510 If continuation sheet Page 3 of 14 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 02/22/2024 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to accurately code the Minimum Data Set (MDS) for one resident (Resident # 263) out of one resident MDS assessment that was reviewed at the time of survey. There were 266 residents residing in the facility at the time of survey. Residents Affected - Few The findings included: Review of Resident #263's admission Record revealed the resident was admitted to the facility on [DATE] and discharged on 11/24/2023. Medical diagnosis included, but not limited to, Diabetes mellitus (DM), chronic obstructive pulmonary disease and cerebral infarction. Review of Discharge Return not Anticipated Minimum Data Set (MDS) dated [DATE] revealed the resident was discharged to Short-term/General Hospital. Review of the Care Plan initiated on 07/07/2023 with revision dated 01/02/2024 indicated: [Resident #263] is here for long term placement due to resident/representative desire to remain in long term facility. Goal: Resident's Psychosocial needs will be met daily with assistance from staff through the next review. Interventions: Encourage socialization with peers in the facility. Review of Social Services progress note dated 11/22/2023 and time stamped documented: Discharge Activity Planning: Resident and daughter are requesting discharge to an Assisted Living Facility (ALF). Resident requested to be discharged after Thanksgiving. Resident will be provided medication scripts and discharge folder on discharge date . Review of Discharge Summary progress note dated 11/24/2023 time stamped 12:49 documented: Resident is discharged from the facility to an Assisted Living Facility (ALF) in stable condition with all her belongings and regular medications accompanied by two family 's members with good attitude. Skin is intact, no edema. Vitals are in normal limit. During an interview on 02/21/2024 at 12:20 PM, the MDS Coordinator stated she has been in charge of MDS for 12 years. Oh my God, I see this was my mistake, I will fix it, I'm sorry. Review of the facility's MDS Policy and Procedure revealed: Resident assessment Policy Statement A complete assessment of every resident's needs is made at intervals designed by Omnibus Budget Reconciliation Acts (OBRA), and Palliative Performance Scale (PPS) requirements. Policy Interpretation and Implementation: OBRA-Required Assessments - Are Federally Mandated, and therefore, must be performed for all residents of Medicare and/or Medicaid certified nursing home. PPS Assessments - Provide information about the clinical condition of beneficiaries receiving part A Skilled Nursing Facility (SNF)-level care in order to be reimbursed under SNF PPS for both SNFs and Swing Bed providers. OBRA required assessments conducted for all residents in the facility: Discharge Assessment (return anticipated and return not anticipated). The interdisciplinary team uses the Minimum Data Set (MDS) from currently mandated by federal and state regulations to conduct the resident assessment. All (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 4 of 14 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 02/22/2024 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 0641 persons who have completed any portion of MDS resident assessment form must sign the document attesting to the accuracy of such information. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 5 of 14 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 02/22/2024 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 observations, interviews, and record review the facility failed to provide devices for an accident-free environment for one out of nine sampled residents (Resident#32). There were 266 residents residing in the facility at the time of survey. The findings included: On 02/19/2024 at 8:28 AM in room [ROOM NUMBER] bed A, Resident #32 was observed lying in bed. One floor mat was located on the right side of the bed. (see photo evidence) On 02/20/2024 at 9:18 AM in room [ROOM NUMBER] bed A, Resident #32 was observed lying in bed. One floor mat was located on the right side of bed. (see photo evidence) On 02/21/2024 at 3:03 PM in room [ROOM NUMBER] bed A, Resident #32 was observed lying in bed. One floor mat located on right side and left side of bed. Record review of demographic face sheet revealed Resident #32 was admitted to the facility on [DATE] with diagnosis that included Hemiplegia and Hemiparesis affecting left dominant side, Seizure, and Glaucoma. Record review of Resident #32's Quarterly Minimum Data Set (MDS) dated [DATE], section C for cognitive patterns revealed a Brief Interview for Mental Status (BIMS) score of 15 on a scale of 0-15, indicated no cognitive impairment. Section E for Behaviors revealed no potential indicators of psychosis, no behavioral symptoms or rejection of care. Section GG for Functional Status revealed Resident #32 required substantial assistance for transferring and rolling from left to right on the bed. Section J for Pain Management revealed Resident#32 had one fall since admission. Review of Resident #32's Care Plan with initial date of 3/31/2022 and revision date of 12/5/2023 for risk for falls related to weakness. Interventions included: Bilateral floor mats. PT (Physical Therapy) screen: Currently on therapy caseload, will reassess functional mobility, maintain bilateral floor mats. Keep bed in low position and locked position. Keep call bell in reach when in room. Perform frequent checks of resident. Review of physician orders revealed orders to keep bed in lowest position and bilateral mats to floor when resident is in bed dated 10/19/2023. Review of the Incident Log, listed Resident #32 on 10/19/2023. Review of Nursing Note dated 10/19/2023 indicated [Resident #32] was observed next to his bed sitting on the floor pad, he was able to verbalize I slid from the bed. no apparent injury noted. On 02/20/2024 at 9:35 AM, Registered Nurse (RN), Staff A revealed Resident #32 has an order for bilateral floor mats. She is not sure why only one floor mat was present, and she will follow up with rehab to reevaluate Resident #32. On 02/21/2024 at 4:55 PM Staff C, Certified Nursing Assistant (CNA) stated: I am not aware that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 6 of 14 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 02/22/2024 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 [Resident #32] needs floor mats. [Resident #32] is a good resident and follows direction. Level of Harm - Minimal harm or potential for actual harm On 02/21/2024 at 5:15 PM, Staff B, RN stated that she is aware that the resident has a physician order for bilateral floor mats when in bed for fall precaution. I do rounds to ensure floor mats are in place and if I notice a floor mat is missing, I notify housekeeping to bring a floor mat. I will reinforce with [Staff C] that [Resident #32] requires floor mats on each side of bed for safety. Residents Affected - Few On 02/21/2024 at 5:45 PM the Director of Nurses (DON) stated: Floor mats are for resident's safety and to prevent injuries. we are not following orders when a resident's order says bilateral floor mats and there is only one floor mat in place. I will investigate to find the reason why only one floor mat was in place. Moving forward I will complete an in-service with licensed staff about following doctor's orders for floor mats and the reason for using floor mats. I will speak to housekeeping to ensure if they remove floor mats for cleaning that they replace them. Review of the facility's Policy and Procedure entitled, Falls and Fall Risk, Managing revised March 2018. Policy Statement: Based on previous evaluations and current data, the staff will identify interventions related to the resident's specific risks and causes to try to prevent the resident from falling and to try to minimize complications from falling. Resident-Centered Approaches to Managing Falls and Fall Risk: 1. The staff, with the input of the attending physician, will implement a resident-centered fall prevention plan to reduce the specific risk factor(s) of falls for each resident at risk or with a history of falls. Review of Policy and Procedure entitled, Safety and Supervision of Residents revised July 2017 Policy statement: Our facility strives to make the environment as free from accident hazards as possible. Resident safety and supervision and assistance to prevent accidents are facility-wide priorities. Policy Interpretation and Implementation: Individualized, Resident-Centered Approached to safety: 4. Implementing interventions to reduce accident risks and hazards shall include the following: a. Communication specific intervention to all relevant staff; d. Ensuring that interventions are implemented. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 7 of 14 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 02/22/2024 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, records reviewed, and interviews. The facility failed to obtain physician's orders for oxygen treatment for Resident #211. This practice could affect 266 residents who were residing at the facility at the time of the survey. Residents Affected - Few The findings include: On 02/19/2024 at 12:18 PM. In an observation and interview of Resident #211. It was observed that the resident was on two liters of oxygen via nasal cannula. (See photo evidence). Resident #211 stated the nurse from the night shift had changed the nasal cannula tubing earlier that morning. Observation on 02/20/2024 at 09:43 AM, revealed Resident #211 was not in the room but the nasal cannula tubing was on the bed and the oxygen concentrator was on at two liters. Record review of physician orders revealed no orders for oxygen therapy for Resident #211. On 02/21/2024 at 11:21 AM. In an interview with Staff F, LPN (Licensed Practical Nurse). When Staff F was asked where Resident #211 was and if the resident had physician orders for oxygen treatment. Staff F stated, [Resident #211] is downstairs at Bingo. Sometimes [Resident #211] will place the oxygen on or off per request. Staff F reviewed the medical chart and stated: I'm not seeing any oxygen orders for [Resident #211]. On 02/21/2024 at 11:51 AM. In an interview with the Staff A, Nurse Manager. When asked, When residents are on oxygen do they need physician orders. Are there any physician orders for oxygen for [Resident #211]? Staff A stated: Yes, and reviewed Resident #211's medical chart. The Nurse manager stated: I will talk to the resident's physician to receive an order for oxygen. On 02/21/2024 at 02:09 PM. In an interview with the Nurse Manager, it was stated I talked to the nurse who put the oxygen orders in, and they said it was in the medical record. I told the nurse it wasn't there. I received an order from the physician for oxygen at two liters and the pulse oxygen machine as needed for oxygen saturation lower than 92% Record review of Resident #211 medical diagnosis revealed cerebral infarction (Stroke). Record review of physician orders revealed no orders for oxygen administration except to change the oxygen cannula every Sunday and as needed. Review of the care plan revealed Resident #211 had potential for complications of respiratory distress related to the diagnosis of episode of shortness of breath. Interventions were oxygen saturation as ordered. Administer oxygen as ordered. Goal was Resident #211 will remain free from signs and symptoms of respiratory distress through the next review. Record review of Minimum Data Set, dated [DATE] revealed in section C: Cognitive patterns, the brief interview of mental status was a 15 suggesting Resident #211 was cognitively intact. In section J: Health conditions, no to shortness of breath. In section O: Special treatments, procedures, and programs No to oxygen therapy. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 8 of 14 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 02/22/2024 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 Review of facility's policy titled oxygen administration with revision date of October 2010 documented: The purpose of this procedure is to provide guidelines for safe oxygen administration. In section titled preparation, 1.) verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. Residents Affected - Few Class III FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 9 of 14 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 02/22/2024 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, record review and interview the facility failed ensure accuracy in the reconciliation in the accounting of all controlled substances for 2 out of 2 residents whose narcotic records were reviewed (Resident#150 and Resident#76). There were 262 residents residing in the facility at the time of survey. The findings included: Observation on 02/21/2024 at 12:30 PM on the second-floor south station, cart 2. During Controlled Substance count with Staff D, Registered Nurse (RN), it was revealed during the counting of the controlled substances sheet for Resident #76's, Medication: Methadone, Dosage: 5 mg (milligram) tablet; indicated on the last line of sheet that the person giving the medication: Staff D, Date: 2/20/2024, Time: 5:00PM, Amount on hand: 22, Amount given: 1, Amount remaining: 21. (see photo evidence). Review of the physical bingo card for the Methadone 5 mg for Resident #76, count was 20. Observation on 02/21/2024 at 12:32 PM on the second-floor south station cart 2. Controlled substances count with Staff D, Registered Nurse (RN) revealed the controlled substances sheet for Resident#150 Lorazepam, Dosage: 1mg tablet. Noted on the Last line of the sheet indicated the Person giving: Staff D, Date: 2/20/2024, Time: 5:00 PM, Amount on hand: 14, Amount given: 1, Amount remaining: 13. (see photo evidence). Review of the physical bingo card for Resident #150 indicated the count was 12. On 02/21/2024 at 12:35 PM Staff D, RN stated she administered the narcotics at 9:00 AM and did not reconcile narcotics because she was busy. She is aware she should sign out narcotics at the time she administers it to the resident. On 02/21/2024 at 4:29 PM the Director of Nursing (DON) stated: Before a nurse administers a narcotic, the nurse verifies the physician order and then reconciles the narcotic administered on the counting-controlled substances sheet. It is not appropriate for a nurse to administer a narcotic at 9:00 AM and sign-out the narcotic at 12:30PM on the counting-controlled substances sheet. I will investigate this situation and complete an in-service with all nursing staff to reinforce the time frame for signing out narcotics. It is important to sign out narcotics at the time of administration because we must make sure we are following doctor's orders to meet the resident's needs and to make a nurse is not diverting medication. Review of the facility's Policy and Procedure entitled Controlled Substances revised April 2019. Policy Statement: The Facility complies with all laws, regulations, and other requirements related to handling, storage, disposal, and documentation of controlled medications. Policy Interpretation and Implementation: 8. Controlled substances are reconciled upon receipt, administration, disposition, and at the end of each shift. 10. Upon Administration: a. The nurse administering the medication is responsible for recording: (1) Name of the resident receiving the medication; (2) Name, strength, and dose of the medication; (3) Time of administration; (4) Method of administration; (5) Quantity of the medication remaining; and (6) Signature of nurse administering medication. (in a timely manner) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 10 of 14 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 02/22/2024 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on record review and interview and the facility failed to demonstrate effective plan of actions were implemented to correct identified quality deficiencies in the problem area related to repeated deficient practices for F584 Safe, Clean, Comfortable, Homelike Environment, F689 Free of Accident Hazards, Supervision, Devices, F695 Respiratory/Tracheotomy Care and Suctioning. These repeated deficiencies have the potential to affect 266 residents residing in the facility at the time of survey. The findings included: Record review of the facility's survey history revealed, during a recertification survey with exit dated 11/18/2022, F584 Safe, Clean, Comfortable, Homelike Environment, F689 Free of Accident Hazards, Supervision, Devices, F695 Respiratory/Tracheotomy Care and Suctioning. were cited. Interview with Administrator and the Director of Nursing on 02/22/2024 at 01:40 PM. The Administrator and DON stated that the QAPI (Quality Assurance and Performance Improvement) meetings are held every month with the attendees are the Risk Manager, Social services, Medical Director, Complaint Officer, Infection Control, MDS coordinator and Activity Director. QAPI review of the plan that was provided by the facility indicated: Vision A Vision statement is sometimes called a picture of your organization in the future; it is your inspiration and the framework for your strategic planning. The vision of the facility is to create an environment where people are loved, valued, and dignified. Mission or Cores Principles are: Superior Quality of Care Exceptional Quality outcomes and Service delivery Caring and top performing staff Outstanding Resident and Family Satisfaction It provides the framework or context within which the company's strategies are formulated. The Facility is each resident's home. We are committed to enhancing quality of life by nurturing individuality and independence. We are growing a value-driven community while leading the way in honoring inherent senior rights and building strong and meaningful relationship with all whose lives we touch. Performance Improvement Projects (PIPs): (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 11 of 14 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 02/22/2024 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 0867 Level of Harm - Minimal harm or potential for actual harm The QAPI Committee annually prioritizes activities, endorses, or re-endorses policies and procedures, and continually monitor for improvement through the use of QAPI self-assessment. In addition, the QAPI Steering Committee will implement any PIP topics indicated by date analysis. Quality improvement activities are also developed in collaboration with the support of providers, residents, and staff. PIPs are implemented in accordance with CMA protocol for conducting PIP's including: Residents Affected - Few 1. Measurement of performance using objective quality indicator. 2. Implementation of system interventions to achieve improvement in quality. 3. Evaluation of the effectiveness of the interventions 4. Plan and initiation of activities for increasing or sustaining improvement. Implementation of new PIPs or any significant changes proposed to existing PIPs will be subject to approval. As such, reports reflecting new or charging PIPs will be submitted to the corporation and/or the Upper Management. Peer Reviews: The facility monitors provider and facility adherence to quality standards via site visits and ongoing review of complaints, adverse events, and sanctions and limitations on licensure. The purpose of the peer review program is to monitor accessibility, quality, adequacy, and outcomes of services delivered. The facility performs audits of providers to review clinical and administrative policies and procedures, clinical record's against standards, adherence to timely access to care requirements, and administrative practices for the purpose of monitoring compliance with best practice for the purpose of monitoring compliance with the facility and Rehab Center contact, including state and federal requirements. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 12 of 14 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 02/22/2024 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record review the facility failed to ensure the essential patient care equipment was in safe operating condition for three out of three residents who used mechanical lifts for transfer (Residents # 25, #464, and #129). The mechanical lift used to transfer the residents who required total assistance from the bed to the chair was not working. Residents Affected - Some The findings included: Observation on 02/21/2024 at 07:25 AM revealed that on the second floor there were six (6) mechanical lifts working to take care of 91 residents who were totally dependent on the equipment. On the first floor five mechanical lifts worked to take care of 71 residents who were totally dependent on the equipment. In total the facility had five mechanical lifts broken. On 02/20/2024 at 11:20 AM, during an interview with Resident #25 the resident revealed that he needs assistance to be transferred from his bed to the wheelchair and assistance is provided using the mechanical lift. He has to wait for a long time because on the first floor there are only a few mechanical lifts working for all the residents that need them. The other ones had been broken for a long time. Record review of the Quarterly Minimum Data Set (MDS)/ Consolidated Appropriations Act (CAAs) dated 01/29/2024 for Resident #25 revealed in Sections C for Cognitive Patterns a Brief Interview for Mental Status (BIMS) a score of 15 out of 15 indicating Resident # 25 is cognitively intact. Section GG for Functional Abilities and Goals indicated upper and lower extremity impairment on both sides and noted for Wheelchair (manual or electric)-Yes. On 02/21/2024 at 01:47 PM Resident #464 stated that she has been in the facility since February 1, 2024. They take me out every single day but, it takes very long time for them to get me out of the bed. Usually by 12:00 PM is when they get around to get me out of bed. Every single day they don't get me out of bed until 12:00 PM. Record review of the admission Minimum Data Set (MDS)/ Consolidated Appropriations Act (CAAs) dated 02/08/2024 for Resident #464 documented in Sections C for Cognitive Patterns a Brief Interview for Mental Status (BIMS) a score of 12 out of 15 that suggests the resident is moderately impaired. Section GG for Functional Abilities and Goals indicate in ADL (activities of daily living) that the resident is dependent in all areas. On 02/21/2024 at 01:59 PM Resident #129 stated: I have been in this facility for a long time, I like to get out of my bed every day, but they take too long for them to take me out of my bed to my wheelchair. Record review of the Modification of Annual Minimum Data Set (MDS)/ Consolidated Appropriations Act (CAAs) dated 12/22/2023 for Resident #129 revealed in Sections C for Cognitive Patterns a Brief Interview for Mental Status (BIMS) score of 12 out of 15 to suggest the resident is suggests the resident moderately impaired. Section GG for Functional Abilities and Goals indicate functional limitation in range of motion and impaired in both sides, Wheelchair (manual or electric)-Yes. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 13 of 14 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 02/22/2024 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 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 02/21/2024 at 08:15 AM during an interview the Maintenance Director stated that at the moment the facility has three mechanical lifts on the second floor working and five on the first floor. The facility has 12 Mechanical Lifts and 3 to stand up, in total 15. On 02/21/2024 at 08:12 AM during an interview with The Administrator revealed that the vendor that fixes the mechanical lifts came on 02/14/2024 to check on them and the facility has 15 of them, out of those 15, only 4 are not working, parts need to be replaced, and two of them need to be complete replaces. The parts were ordered, and they were expecting to receive then in the next few weeks. Record review of the order purchase of equipment revealed that the facility placed the order on 02/21/2024 at 10:06 AM, after it was brought to the administrator attention that there was some equipment not working. Record review of the Assistive Devices and Equipment Policy Statement documented: Our facility maintains and supervises the use of assistive devices and equipment for residents. Certain devices and equipment that assist with resident mobility, safety and independence are provided for residents. they may include (but not limited to): a) safety devices (grab bars, toilet rises, bedside commodes, etc.); and mobility devices (wheelchairs, walkers, and canes). Recommendations for the use of devices and equipment are based on the comprehensive assessment and documented in the resident care plan. Device condition - devices and equipment are maintained on schedule and according to manufacturer's instructions. Defective or worn devices are discarded or repaired. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 14 of 14