Inspection·February 16, 2022

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 conduct quarterly fall risk assessments for 1 of 3 sampled residents reviewed for accidents, Resident #54. The findings included: Review of the facility's policy, titled, Clinical Guideline - Fall Management, revised on 03/01/20, documented the following: Residents to be evaluated for fall risk on admission / re-admission, quarterly, significant change, and following a fall. Review of the record showed that Resident #54 was re-admitted to the facility on [DATE] with diagnoses that included: Unspecified Fall, History of Falling, Blindness in One Eye, Unsteadiness on Feet, and Muscle Weakness. Review of Section C of the Minimum Data Set (MDS), dated [DATE], documented Resident #54 had a Brief Interview for Mental Status score of 14, which indicated that she was cognitively intact. Review of Section J of the MDS, dated [DATE], documented that Resident #54 had one fall since admission / prior assessment. Review of the Care Plan, dated 11/22/21, documented Resident #54 was at a high risk for further falls; and interventions were to follow the facility fall protocol. Review of the Fall Log, dated January 2022, documented that Resident #54 had a fall on 01/25/22. Review of the Fall Risk Evaluations showed that evaluations were completed for Resident #54 on 04/03/20, 01/25/22, and 02/01/22. During an interview on 02/15/22 at 8:55 AM, Resident #54 stated that she had a fall while in the facility about 1 month ago. When asked how she fell, Resident #54 stated that her doctor increased her pain medications, which caused her to feel dizzy and she fell over while trying to get out of bed. During an interview on 02/16/22 at 10:27 AM, the Director of Nursing (DON) stated that fall risk assessments were conducted for all residents upon admission and were updated on a quarterly basis and following a fall. According to her, fall risk assessments would be documented under the assessments tab in PointClickCare (electronic charting system). When asked about the fall risk assessments for Resident #54, the DON confirmed that fall risk assessments were completed on 04/03/20, 01/25/22, and 02/01/22. She further stated that Resident #54's fall risk assessments were to be updated every 4 months and that the system would tell you when they are due. The DON then confirmed that Resident #54 did not have any fall risk assessments between 04/03/20 and 01/25/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105519 If continuation sheet Page 2 of 8 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 105519 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Plantation 6931 W Sunrise Blvd Plantation, FL 33313 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** During observations, interviews and record reviews, the facility failed to secure 1of 6 medication carts observed; and failed to secure medications that were observed at the bedside for 3 of 78 sampled residents observed during the initial screening process, Residents #5, #43, and #81. The findings included: Review of policy, titled, Medication Storage in the Facility, dated April 2018, revealed medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. Procedure B) only licensed nurses, pharmacy personnel and those lawfully authorized to administer medications (such as medication aides) permitted to access medications. Medication rooms, carts, and medication supplies are locked when not attended by persons with authorized access. Review of policy, titled, Self-Administration of Medication at Bedside, with a revision date of 08/22/17, revealed the resident may request to keep medications at bedside for self-administration in accordance with Resident Rights. Criteria must be met to determine if a resident is both mentally and physically capable of self-administering medication and to keep accurate documentation of these actions. Procedures included verify physician's order in the resident's chart for self-administration under consideration, complete self-administration of medications evaluation, if kept at bedside, the medication must be kept in a locked drawer. 1. During an observation on 02/15/22 at 11:54 AM, the A-wing medication cart on second floor was with the bottom right drawer extended out of the front of the medication cart about 6-8 inches. This drawer contained ipratropium bromide solution 6 boxes, fluticasone propionate 1, budesonide 1, Pulmicort 1, menthol 5% patch 1. There were no residents observed in hallway. During an interview conducted on 02/15/22 at 11:58 AM with Staff C-LPN (Licensed Practical Nurse)when asked about the open drawer to the medication cart, she stated I did not realize it was not pushed in all the way when I locked the cart. 2. Record review for Resident #5 was admitted on [DATE] with the most recent readmission on [DATE], diagnoses included Chronic Obstructive Pulmonary Disease, Acute and Chronic Respiratory Failure and Morbid Obesity. The annual minimum data set (MDS), dated [DATE], revealed in section C, a brief interview of mental status (BIMS) score of 15 indicating intact cognitive response. There was no physician order for self-administration, nor was there a completed self-administration of medication evaluation, and medications were not locked at the bedside. An observation was made on 02/13/22 at 10:57 AM in Resident #5's room during medication pass of an open package with 1 ampule of Ipratropium Bromide and Albuterol Sulfate inhalation solution 0.5mg and 3mg/3ml that was sitting on the resident's nightstand. During an interview conducted on 02/13/22 at 11:00 AM with Resident #5 when asked about the ampule of Ipratropium Bromide and Albuterol Sulfate inhalation solution on her bedside table, she said I (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105519 If continuation sheet Page 3 of 8 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 105519 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Plantation 6931 W Sunrise Blvd Plantation, FL 33313 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 have no idea what you are talking about. Level of Harm - Minimal harm or potential for actual harm During an interview conducted on 02/13/22 at 10:58 AM with ADON (Assistant Director of Nursing)when asked about the ampule of Ipratropium Bromide and Albuterol Sulfate solution at the bedside for Resident #5, she stated it should not be there, it must have been left by the night shift. Residents Affected - Few 3. Record review for Resident #43 was admitted on [DATE] with most recent readmission on [DATE] with diagnoses that included Parkinson's Disease, Acquired absence of Right Above the Knee, Dementia, Acquired absence of Left Leg below Knee. The quarterly minimum data set (MDS), dated [DATE], revealed in section C a brief interview for mental status (BIMS) score of 15 indicating intact cognitive response. There was no physician order for self-administration, nor was there a completed self-administration of medication evaluation, and medications were not locked at the bedside. An observation was made on 02/13/22 at 10:20 AM in Resident #43's room on his dresser a tube of hydrocortisone cream. During an interview conducted on 02/13/22 at 10:23 AM with Resident #43 when asked about the tube of hydrocortisone cream, he stated the staff put the cream on the end of my legs because I have phantom pain sometimes and it cools them down. During an interview conducted on 02/15/22 at 9:15 AM with Staff C-LPN, Staff C-LPN stated none of her residents are supposed to have medications at the bedside. When shown the medications for Resident #43, she stated again I never saw this here. During an interview conducted on 02/15/22 at 9:25 AM with Staff D-CNA (Certified Nursiong Assistant) when asked about cream at the bedside, she stated she only puts on cream for incontinence care and lotion for dry skin, I never put on any medicated cream, that is the nurses' job to put it on the resident, I do my job, and they (nurses) do their job. 4. Record review for Resident #81 was admitted on [DATE] with most recent admission on [DATE] with diagnoses that included Paraplegia, Anxiety, Syringomyelia and Syringobulbia, Lack of coordination, Acute Kidney Failure. The 5-day MDS, dated [DATE], revealed in section C, a BIMS score of 15, indicating intact cognitive response. There was no physician order for self-administration, nor was there a completed self-administration of medication evaluation, and medications were not locked at the bedside. An observation was made on 02/13/22 at 10:14 AM in Resident #81's room of a bottle of BHR Arthritis Pain Relief in a basket on the resident's bed. During an interview conducted on 02/13/22 at 10:20 AM with Resident #81 when asked about the bottle of arthritis pain relief, she stated she has it in case she needs it. When she was shown the medications at the bedside for Resident #81, she stated I never saw those there before. During an interview conducted on 02/15/22 at 9:15 AM with Staff C-LPN, Staff C-LPN stated none of her residents are supposed to have medications at the bedside. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105519 If continuation sheet Page 4 of 8 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 105519 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Plantation 6931 W Sunrise Blvd Plantation, FL 33313 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 - Many 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 and failure to maintain adequate holding temperatures. The findings included: 1. During the initial tour of the kitchen conducted on 02/13/22 at 8:48 AM, accompanied by the Food Service Director (FSD), the following were noted: a. At the request of the surveyor, the FSD checked the chemical concentration of the sanitation bucket located near the 3 compartment sink using the facility's test strips. The concentration was recorded between 0-150 parts per million (ppm). The FSD stated that the chemical concentration should have been around 200 ppm and that he had not had any issues with the sanitizer before. He then emptied and refilled the bucket with sanitizing solution and re-checked the chemical concentration. The concentration was still recorded between 0-150 ppm. b. At the request of the surveyor, the FSD checked the chemical concentration of the sanitation bucket located underneath the hot holding table using the facility's test strips. The concentration was recorded between 0-150 ppm. c. At the request of the surveyor, the FSD checked the chemical concentration of the sanitation bucket located underneath the hot holding table using the facility's test strips. The concentration was recorded between 0-150 ppm. d. At the request of the surveyor, the FSD checked the chemical concentration of the sanitation bucket located underneath the microwave using the facility's test strips. The concentration was recorded between 0-150 ppm. e. At the request of the surveyor, the FSD checked the chemical concentration of 2 sanitation buckets located underneath the coffee machine using the facility's test strips. The concentrations were recorded at 0 ppm. He then emptied and refilled one bucket with sanitizing solution and re-checked the chemical concentration. The concentration was still recorded at 0 ppm. The FSD then acknowledged that the concentrations of all sanitation buckets were too low to sanitize food contact surfaces. f. In the dry storage area, twenty 46 fluid ounce Sahara Burst apple juice cartons had a use by date of 01/29/22, seven 46 fluid ounce Sahara Burst apple juice cartons had a use by date of 01/28/22. g. In the walk-in refrigerator, 2 plastic bags of pureed food items were missing a label identifying the products and expiration dates, 1 pan of chicken was missing a label identifying the expiration date, and one opened package of bacon was missing a label identifying the expiration date. The FSD reviewed the package of opened bacon with two surveyors and stated that he could not find the expiration date. 2. Review of the facility's recipe titled, Baked Peach Slices Puree, dated 06/23/20, documented the following: If served cold, chill to 41 F or lower and hold at 41 F or lower for service. If served (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105519 If continuation sheet Page 5 of 8 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 105519 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Plantation 6931 W Sunrise Blvd Plantation, FL 33313 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 - Many warm, reheat to a minimum temperature of 165 F or higher. Hold at a minimum required temperature or higher for service. Follow hot holding temperature of 135 F or 140 F based on facility policy. During an observation of the lunch tray line conducted on 02/15/22 at 11:42 AM, the FSD calibrated the facility's digital thermometer and checked the temperatures of the lunch items at the request of the surveyor. The temperature test revealed that the temperature of the baked peaches was 72 degrees Fahrenheit (F) and that the temperature of the pureed baked peaches was 69 degrees F. This showed that the baked peaches and pureed baked peaches were not at the regulatory temperature of 41 degrees F or below or 135 degrees F or above. When asked how the baked peaches were prepared, Staff A-Cook, stated that the peaches were baked in the oven and then placed in individual serving cups on a utility cart around 7:30 AM - 8:00 AM. When asked, Staff A-Cook stated that she did not know if the baked peaches were kept in a cooler or hot holding unit. According to her and the FSD, the baked peaches were to be served at room temperature. Staff B, Dietary Staff, stated that she was the one who prepared the baked peaches and pureed baked peaches. According to her, the peaches were baked in the oven, placed in individual serving cups, and stored on a utility cart in the food preparation area. Staff B-Dietary Staff confirmed that the baked peaches had been left out at room temperature since about 8:30 AM and had not been kept in a cooler or hot holding unit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105519 If continuation sheet Page 6 of 8 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 105519 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Plantation 6931 W Sunrise Blvd Plantation, FL 33313 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 0838 Level of Harm - Potential for minimal harm Residents Affected - Some Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. Based on record review and interview, the facility failed to conduct a review of the Facility Assessment Tool annually and with all of the necessary participants. The findings included: During a review of the Facility Assessment Tool, on 02/15/22 at approximately 3:00 PM, it was noted that the Tool documented the last date of assessment as 'August 31, 2020 Updated'. It was noted that the Tool documented that the last time it was reviewed by QA/QAPI Committee was 'September 2020'. The Tool documented in the section for 'Persons (names/titles) involved in completing the assessment, participation by: * The Director of Nursing, with a hire date of 09/13/21 * The Social Services Director, with a hire date of 10/25/21 * The MDS Coordinator, with a hire date of 07/27/21 * The Food Service Manager, with a hire date of 10/25/21 * Activities, with a hire date of 01/31/22. During an interview with the Administrator, on 02/16/22 at 8:43 AM, when the concerns regarding the timing and participants documented in the facility assessment were brought to her attention, the Administrator stated that she was not aware of the requirement for the Facility Assessment to be reviewed annually. The Administrator acknowledged that the staff documented as having completed that assessment were not employed by the facility or parent company. The Administrator stated, I just update the names when they are hired and add the to it (The Assessment Tool). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105519 If continuation sheet Page 7 of 8 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 105519 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Plantation 6931 W Sunrise Blvd Plantation, FL 33313 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide the influenza vaccine to a resident who consented to receive the influenza vaccine for 1 of 5 sampled residents reviewed for influenza and pneumonia vaccinations, Resident #4. Residents Affected - Few The findings included: Resident #4 was admitted to the facility on [DATE] with diagnoses that included COVID-19, Hypertension and Cellulitis. A review of the medical record for Resident #4 revealed a signed Informed Consent for the Influenza vaccine, dated 11/06/21. An interview was conducted with the Director of Nursing (DON) on 02/15/22 at 3:00 PM regarding the status of the influenza vaccine for Resident #4 that the resident consented for. The DON stated that she will look into it because the immunization is not in the resident's chart. On 02/15/22 at 3:20 PM, the DON stated Resident #4 had not received the influenza vaccine and acknowledged that he should have received it when he consented to it. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105519 If continuation sheet Page 8 of 8