Inspection·June 26, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On [DATE] at 10:48 AM, observation of Percutaneous Endoscopic Gastrostomy (PEG) tube care for Resident #243 performed by Staff M, Registered Nurse (RN). Staff M, Registered Nurse gathered peg tube supplies, knocked on Resident #243's door provided privacy, explained the care that will be provided, provided privacy, washed hands, put on gloves, gown and face mask. Staff A removed the old peg tube dressing dated [DATE] and discarded it in a red biohazard bag, removed soiled gloves and put on a new pair of gloves; cleaned the skin around the peg site three times and discarded the soiled gauzes. Staff A, RN removed soiled gloves, put on a new pair of gloves, and applied new peg tube dressing; Staff A, RN removed the gloves, gown and face mask and discarded them in the red biohazard bag . Residents Affected - Few Review of Resident #243's clinical records revealed the resident was admitted to the facility on [DATE]; medical diagnoses included but not limited to Gastronomy Status and Dysphagia. Review of Resident # 243's Physician Orders for [DATE] revealed an order for enteral feeding every 24 hours . Review of Care Plan for Resident #243 dated [DATE] revealed the resident is at high nutritional and hydration risk .with diagnosis and past medical history of dependence for enteral nutrition. Goals include providing local care to tube site as ordered and monitoring signs and symptoms of infection. Registered dietitian consult as needed. Interview on [DATE] at 11:07 AM, Staff M, RN stated: After removing gloves during care, I must wash my hands and then put on new gloves anytime you are changing gloves, hand hygiene is very important. On [DATE] at 03:10 PM, the Nursing Supervisor revealed: Staff always needs to wash hands or use hand sanitizer after removing soiled gloves and before donning new ones . Interview on [DATE] at 10:11 AM, Staff O, Certified Nursing Assistant (CNA) revealed Hand hygiene should be done frequently. It should be done before and after one is in contact with a patient, and when changing gloves. It is essential in our work to prevent any type of infection . On [DATE] at 09:25 AM during a facility tour an empty antibiotic intravenous (IV) bag with uncapped tubing hanging on IV pole was observed in a resident's room on the first floor of the North Wing unit (photographic evidence). On [DATE] at 12:18 PM another facility tour the empty antibiotic IV bag with uncapped tubing was observed hanging on IV pole in the same resident's room on the first floor North Wing (Photographic evidence). On [DATE] at 05:37 PM, a third facility tour was conducted and the empty antibiotic IV bag with uncapped tubing was observed hanging on IV pole in the same resident's room on the first floor's North Wing unit (Photo evidence). Interview on [DATE] at 02:22 PM, the Director of Nursing (DON) revealed: When IV bags are empty, they should be discarded immediately along with the IV tubing as well. IV tubing should be dated, and tubing port should be capped when not in use. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 2 of 4 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 06/26/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on [DATE] at 09:18 AM, Staff N, Licensed Practical Nurse (LPN) revealed: I would follow hand hygiene any time before and after touching a resident and before and after using gloves. We should also make sure to always use aseptic technique when handling IV bags and tubing. IV tubing ports should always be capped when not in use or thrown away upon completion or when they are expired. Review of the facility's policy titled: Infection Prevention and Control Program dated 12/2023 Policy states: An infection prevention and control program (IPCP) is established and maintained to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. 7. Prevention of Infection a. Important facets of infection prevention include: 1. identifying possible infections or potential complications of existing infections. 2. instituting measures to avoid complications or dissemination. 3. educating staff and ensuring that they adhere to proper techniques and procedures. 4. communicating the importance of standard precautions and respiratory hygiene to visitors and family members. 7. implementing appropriate enhanced barrier and transmission-based precautions when necessary. Based on observations reviewed and interview, the facility failed to implement infection prevention and control practices as evidence by respiratory equipment left exposed next to a rat trap and other non-clinical items on a chair in Resident #97's room and staff failure to perform hand hygiene between glove changes. These deficient practices potentially increases the risk for contracting and spreading diseases. There were 257 residents residing in the facility at the time of the survey. The findings included: On [DATE] at 9:59 AM, Resident #97 was observed in bed, a pungent fecal like odor was noted in the room, a nebulizer machine with tubing and mask, was observed uncovered beside a rat trap on a chair. Observations on [DATE] at 12:06 PM, the resident remained in bed the uncovered nebulizer equipment remained on the chair in the same location next to the rat trap. Review of Resident #97's clinical records revealed the resident was admitted on [DATE]; clinical diagnoses include Chronic Obstructive Pulmonary Disease (COPD). Review of physician's order for [DATE] revealed an order dated [DATE] for Ipratropium-Albuterol Inhalation Solution, to be administered via nebulizer every 6 hours as needed. Review of the Annual Minimum Data Set (MDS) dated [DATE] indicate the resident is cognitively intact, requires assistance for hygiene care and transfers. Review of Resident # 97's care plan with start date [DATE] and completion dated [DATE] indicate: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 3 of 4 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 06/26/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Administer nebulizer treatments as ordered, monitor effectiveness and potential side effects, observe signs of respiratory infection or distress, and maintain oxygen saturation monitoring and proper positioning. Interview [DATE] at 2:17 PM, Staff A, Registered Nurse (RN) reviewed the photographic evidence and revealed the respiratory supplies should be kept in a labeled, closed bag and must be dated. Residents Affected - Few On [DATE] at 2:58 PM, Staff B, RN supervisor acknowledged the identified concerns and revealed the nebulizer supplies must not be left uncovered on furniture and must be stored properly to prevent contamination. Review of the facility's policy titled Cleaning and Disinfection of Resident-Care Items and Equipment classifies respiratory therapy equipment as semi-critical and requires cleaning and disinfection per CDC (Centers for Disease Control and Prevention) and OSHA (Occupational Safety and Health Administration) standards. The policy mandates that these items must be stored and maintained in a manner that prevents cross-contamination and microbial growth. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105510 If continuation sheet Page 4 of 4