Inspection·February 16, 2023

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Wound Care Specialist progress note dated 01/17/23 documented Resident #80 facility acquired pressure ulcer to the Mid-back and to the sacrum. The progress note documented Patient on: Pressure relieving mattress or low air loss bed: No. Wheel chair cushion: Yes . facility staff was educated on ongoing treatment, consistent use of offloading devices . Plan of care discussed with facility staff . Further review of the WCS progress notes dated 01/24/23, 01/31/23, 02/07/23 and 02/14/23 documented that Resident #80 did not have a LAL pressure relieving mattress as recommended by the WCS on initial evaluation on 12/20/22. Observations on 02/13/23, 02/14/23 and 02/15/23 at multiple times of the day, revealed Resident #80 in bed laying on a regular blue bed mattress and not an LAL mattress as recommended on 12/20/22. On 02/15/23 at 8:05 AM, a side by side review of Resident #80's wound care record/history was conducted with the facility's Wound Care Nurse (WCN). The WCN stated the resident developed an in-house sacrum and Mid-back pressure ulcer wound on 01/08/23. A side by side review of the WCS note dated 12/20/22 was conducted with the WCN. The WCN confirmed that the WCS recommended an LAL mattress. The WCN stated she was not sure if the resident had the mattress or not. The WCN confirmed the resident did not have a physician order on file for an LAL mattress as recommended. On 02/15/23 at 9:16 AM, observation revealed Resident #80 sitting in a wheelchair in his room. An interview was conducted with the resident who stated he was uncomfortable. Subsequently, a side by side review of the resident's mattress was conducted with the facility's Wound Care Nurse (WCN) who confirmed that Resident #80 did not have a LAL Mattress as requested on 12/20/22. The WCN stated that she usually request an air mattress (LAL) for residents with stage III pressure ulcer and when the WCS request it. The WCN stated she will check with the maintenance department to see if the have an LAL mattress. The WCN stated she did not know why Resident #80 did not have an LAL mattress. On 02/15/23 at 10:45 AM, an interview was conducted with the facility's Director of Nursing (DON) who stated Resident #80's air mattress (LAL) was malfunctioning and were waiting for maintenance to get another one. The DON was asked to submit evidence and documentation of the mattress date of placement and removal and re-ordering of the mattress. On 02/16/23 at 1:42 PM, an interview was conducted with the facility's Director of Maintenance (DM). The DM stated that the facility has certain air mattresses in the building that the facility owned. The DM stated that nursing comes to him, tell him name, weight, type of mattress and he will tell them if they have one or not. The DM stated that currently all air mattresses were on the floor. The DM stated the last one went to Resident #80 on 02/16/23, today. The DM added that Central Supply came to him saying that they need to order one, but they had one in house. The DM was asked if he had a request for Resident #80 air mattress prior to 02/16/23 and he stated he did not. The DM added he was not aware of the resident needing an air mattress. The DM stated the resident got the mattress in less than 30 minutes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 2 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, record review and policy review, the facility failed to provide restorative services for 1 of 1 residents sampled for position and mobility (Resident #117). The findings included: The facility's policy issued and revised on 03/02/19 titled Specialized Rehabilitative and Restorative Services revealed the facility will provide restorative services such as but not limited to walking, transfer training, bowel and or bladder training, bed mobility, Range of Motion (ROM), splint and brace .when necessary as indicated by the assessment of the interdisciplinary team. An interview was conducted with Resident #117 on 02/13/23 at 2:15 PM. He stated his left shoulder was hurting him. He had a fall a couple of weeks ago and it hurt when his left shoulder was moved. He continued to say that he had Physical Therapy a couple of weeks ago but now no one was working with him to move his left shoulder. Resident #117 was admitted to the facility on [DATE] from an acute care hospital. The Minimum Data Set (MDS) admission assessment with an assessment reference date of 12/16/22 revealed his Brief Interview for Mental Status (BIMS) score was 15 indicating he was cognitively intact. His medical diagnoses included Cerebral Infarction with left-sided Hemiplegia, Malignant Neoplasm of the Larynx and Anxiety Disorder. The care plan for Resident #117 included a focus of will participate in restorative nursing services with interventions that included nursing rehab/restorative AROM (active range of motion) (RUE) right upper extremity and PROM (passive range of motion) LUE (left upper extremity). The Director of Rehabilitation was interviewed on 02/15/23 at 11:15 AM regarding Resident #117. She stated that the resident was being seen for impairment and a decrease in ROM (range of motion)for the left shoulder. He received physical and occupational therapy from 12/09/22 through 02/02/23 then was placed on restorative nursing. An interview was conducted with the MDS Coordinator who is also the Restorative Nurse regarding restorative therapy for Resident #117 on 02/15/23 at 1:00 PM. She stated that she received the referral for restorative this morning and she will put it on the schedule. The referral was dated 02/02/23. A subsequent interview was conducted with the Director of Rehabilitation on 02/15/23 at 3:05 PM which revealed she gave the referral to the restorative nurse this morning. It was with her papers and she forgot to give it to the nurse until today. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 3 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide nutritional assessments and interventions in a timely manner and failed to prevent significant weight loss and pressure ulcer development for 2 of 4 residents reviewed for nutrition (Resident #80 and Resident #75). Residents Affected - Few The findings included: A review of the facility's policy titled Weight Management dated 03/2/2019 showed the following: 1. All Residents admitted to the facility will be weighed on admission. 2. Residents will be weighed monthly unless otherwise ordered by the physician or deemed necessary by the dietician and the interdisciplinary team. 3. Monthly weights will be completed each month. 4. Dietary will evaluate all weights each month. 5. A reweigh will be obtained for any weight change of +/- 5 pounds from the previous weight unless the physician has ordered other parameters. 1. Resident #80 was admitted on [DATE] with diagnoses of Parkinson, Cerebral infarction, and Muscle Weakness. The Minimum Data Set (MDS) dated [DATE] showed that Resident #80 has a Brief interview of Mental Status (BIMS) score of 15, which indicated he is cognitively intact. Section G of the MDS showed that for eating, Resident #80 is with limited assistance and one person's assist. Admitting order was noted for Consistent Carbohydrate, No Added Salt (CCD, NAS) diet Regular texture dated 12/14/22. Health Shake (nutritional supplement) one time a day for nutrition support at lunch was ordered on 12/20/22, 6 days after his admission to the facility. In an interview conducted on 02/13/23 at 5:25 PM with Resident #80, he stated he cannot eat well with his hands and cannot use his right hand for eating. He tries to eat with his left hand but with incredible difficulty. He further said he is right-handed, wants to eat well, and has a great appetite but needs help during meals. Resident #80 said that he is also very restless at night, constantly moving his legs nonstop and not sleeping at night. According to Resident #80, he told multiple staff in the past that he needs help cutting his food and that he wanted softer food choices with sauces. In an observation conducted on 02/13/23 at 5:38 PM, Resident #80 was in his room with the dinner tray. Closer observation showed a fish sandwich, cut pieces of fish, rice, a slice of tomato, chocolate pudding, and juice. In this observation, Resident #80 had difficulties attempting to lift the food with the fork and tried alternating lifting the food with the spoon on the tray. He only used his left hand and could not lift the bun with the utensils or his bare hands. At one point, he let go of the utensils and lifted that piece of fish with his bare hands. Continued observation showed some food on Resident #80's bedding, and the bun was untouched, with most of the rice on the plate. Resident #80 said to the Surveyor, I could not eat the bun or the rice. During the entire meal, Resident #80 was frustrated and asked the Surveyor if they could help him with his tray. In an interview conducted on 02/14/23 at 8:17 AM, Resident #80 was noted in his room with the breakfast tray. When asked by Surveyor how he was doing this morning he said that he was restless all night with twitching and could not sleep. He then pointed at his breakfast tray and said, they just dropped the food and walked away. The breakfast tray was noted with scrambled eggs, toast, oatmeal, and a carton of milk. Resident #80 was observed attempting to pick up the eggs with his left hand and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 4 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 - Actual harm Residents Affected - Few alternating between the spoon and the fork. Some of the scrambled eggs fell on his lap as he attempted to eat. The milk carton was noted with no cups or straw, and the 4 ounces of juice had a straw in it. In this observation, Resident #80 attempted to cut the toast into smaller pieces and place them into the oatmeal bowl. He poured milk on top of the bread and waited for the bread to soften. He then said that it is easier to eat the bread softer since the toast was too hard. He had difficulty eating the toast inside the oatmeal bowl and stopped to rest between bites. Resident #80 looked at the Surveyor and said it is tiring to eat on my own. In an observation conducted on 02/14/23 at 12:20 PM, the lunch tray was brought into Resident #80's room and was left at the bedside. Closer observation showed a lunch tray with chunks of grilled chicken, beans, coleslaw, slices of oranges, and whole wheat bread. In this observation, Resident #80 stated that he would not be able to eat the grilled chicken because it is too hard to chew and lift off the plate. He further said, everything needs to be chopped, it looks good, but I cannot eat it .He proceeded to eat a few spoons of the beans, and the coleslaw but did not eat any of the bread or the grilled chicken. He then asked Surveyor if they can help open the wrapping around the orange container so he can eat some of the oranges. At 12:46 PM, Staff B, Registered Nurse, came into the room and asked Resident #80 if he needed help with his lunch meal. Resident #80 said that he would not be able to eat the grilled chicken since it was too hard to chew and it did not have a sauce. Staff B said to the Surveyor I told the kitchen multiple times that he needed his food chopped and that he loves barbecue sauce, but they do not listen. She then asked Resident #80 if he wanted his chicken chopped, and he said, no, take it away. I'm afraid I am going to choke. A change of diet meal ticket dated 12/25/22 showed an order to change the diet to Regular Texture Mechanical that was never changed in the diet system or current orders. An order was noted for wound care consultation for a right buttock open area dated 01/08/23, which was addressed on 01/17/23, nine days later. A Review of the Weekly Wound Evaluations dated 01/17/23 01/24/23 and 01/31/23, all showed that Resident #80 had an unstageable Pressure ulcer in the sacrum area which was in-house acquired. The care plan dated 12/15/22 showed the following: Resident #80 has a nutritional problem or potential nutritional problem related to Parkinsons, and Cerebral Infarction. The Resident will maintain adequate nutritional status as evidenced by maintaining weight within (5) % of (180), having no signs and symptoms of malnutrition, and consuming at least (51-75) % of meals daily through the review date. Observe for signs of dysphagia: Pocketing, Choking, Coughing, Drooling, holding food in the mouth, several attempts at swallowing, refusing to eat, appears concerned during meals. Observe/report any muscle wasting or significant weight loss: 3 lbs in 1 week, >5% in 1 month, >7.5% in 3 months, >10% in 6 months. Occupational therapy to screen and provide adaptive equipment for feeding as needed. Provide and serve supplements as ordered. Provide and serve diet as ordered. Monitor intake of meals and weight per facility protocol. A review of the Nutrition Comprehensive Evaluation and Risk Screen dated 12/20/22, which was completed six days after his admission, showed that the Resident's admission weight was 180 pounds. In this note, Resident #80's meal intake was between 50 to 100%, and his Usual Body Weight was noted between 174 pounds to 175 pounds. It further showed that Resident #80 was at risk for developing pressure ulcers and it was recommended to provide 1 can of Health Shake (nutritional supplement) once a day to give an extra 200 calories and 6 grams of protein daily. A review of the weights showed that Resident #80 had an admission weight of 180 pounds on 12/14/22, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 5 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 180.1 pounds on 01/20/23, and a weight of 135.6 pounds on 02/09/23. That is 44.5 pounds of weight loss, a severe 24.7 percent weight loss in 3 weeks. Level of Harm - Actual harm Residents Affected - Few A review of the Wound Care Doctor's evaluation dated 01/31/23 showed to maintain adequate nutrition and hydration and medication/supplement as per Primary Care Recommendations to promote wound healing. In this note, the Wound care Doctor requested a Dietary/Nutrition consult dated 12/27/22, which was not addressed. It was noted that Resident #80 had in-house pressure wounds to his mid-back, Sacrum, Left leg lateral, and Right leg medial. A review of the Wound Care Doctor's evaluation dated 02/07/23 showed to maintain adequate nutrition and hydration and medication/supplement as per Primary Care Recommendations to promote wound healing. Further review of the orders did not show that any wound healing supplements or extra nutritional supplements were ordered for Resident #80. An interview conducted on 02/14/23 at 9:47 AM with the Food Service Director who stated that he sees the residents, obtains food preferences, and attends the care plan meetings. Staff F, Dietary Technician, comes in once a week on Tuesdays, and Staff J, Registered Dietitian, comes in a few times a month. For any assessments that need to be addressed right away, they will call Staff J and Staff F on the phone, and they can complete the assessments remotely. When asked about nutrition consultations, he said that Nursing would contact him or Staff F to inform them of any pending dietary consultation. The Food Service Director participates in the care plan meeting twice weekly to discuss the residents' nutritional status. Weights are taken on admission and monthly after that, and Nursing will notify of any weight loss, and any nutritional supplement recommendations will be placed in the system by nursing. Staff F oversees tracking all weight loss and weight gain trends. An interview conducted on 02/14/23 at 10:55 AM with Staff F, Dietary Technician, who stated that she comes to the facility once a week for 7 hours and that the Consultant Dietitian comes to the facility 2 to 3 days a month. She will complete all the assessments due for the day and any of the new Resident's Initial Nutrition Assessments. The nursing staff and the Director of Nursing will contact her for any recommendations for the high nutritional-risk residents admitted on the days she is not here. Staff F said that she could also complete assessments remotely when needed. As soon as she can visit the facility, she looks at admission reports and looks for any high-risk parameters they may have. She then meets with the Director of Nursing for any pending dietary consults or any high-risk changes that are needed follow-up on. The weights reports are reviewed as well for any significant weight loss changes. The wound rounds are done on Tuesdays, and she will check any residents with new wounds. Staff F stated that the Director of Nursing would also contact her for any significant weight loss, that is, 5% in 30 days, 7.5% in 90 days, and 10% in 180 days. When asked what is considered as high nutritionally risk residents, she said any residents with malnutrition, failure to thrive, pressure wounds, dialysis, tube feeding, and any residents who come in with poor intake. For nutritional supplements, she likes to order the Health Shake, which has 200 calories and 6 grams of protein per can, and the Frozen Threat, which provides 300 calories and 9 grams of protein. When asked about weights, she said that the staff takes the weight on residents upon admission and then monthly after that. For any weight discrepancies, she will ask the Director of Nursing to retake the weights. The Dietitian Consultant reviews any of the high-risk residents, and she uses a system to identify the high-risk residents in the facility. Staff F reported that the 7 hours a week in the facility is enough to see all residents. When asked about the timing of assessments, she said that they are done on admission, quarterly, and as needed. According to Staff F, Residents with Parkinson's disease have higher caloric needs due to their exuberated movements that cause them to burn extra calories. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 6 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 - Actual harm Residents Affected - Few After Surveyor's intervention, a Dietary progress note dated 02/14/23 showed that Resident #80 is underweight for his age. Resident #80 had significant weight losses of 44.5 pounds (24.7%) x 3 weeks and 44 pounds (24.4%) x 2 months since admission. She further stated the admission weight was likely an error because Resident #80 reported a Usual Body Weight of 145 pounds. A protein supplement of 30 milliliters (ml) once a day to provide (100 kcal, 17g protein), zinc 1 50 milligrams once a day x 30 days for nutrition support. Liberalizing diet to regular related to advanced age with tray set up and assistance as needed was recommended. Resident requesting additional supplement, recommend Health Shake with all meals to providing an additional (600 kcal, 18g protein). The Resident asked for extra sauce/gravy with meals and reports difficulties using utensils. This was the first time additional nutritional interventions and protein supplements were implemented since Resident #80's admission on [DATE]. The resident's weight was not taken to verify accuracy after this note that was completed on 02/14/23. An interview conducted on 02/15/23 at 11:03 AM with Staff K, Occupation Therapy Assistant, who stated Resident #80 was seen by therapy in the past but is no longer on caseload. His latest Occupational Therapy (OT) ended on 02/10/23. She further said that Resident #80 would need frequent rests between therapy. In this interview, she was asked to reassess Resident #80 for his ability to eat on his own. In an interview conducted on 02/15/23 at 2:30 PM with the Director of Rehab, she stated Resident #80 was reassessed and was picked up for OT again. The assessment on 02/15/23 showed that Resident #80 must be set up, with food cut up, and positioned correctly in bed or chair at the midline. The Resident was recommended a tablespoon instead of a teaspoon, and he easily fatigues when sitting in the chair to feed himself and requires longer breaks. The Speech Therapy Evaluation, dated 02/15/23, revealed that Resident #80 has a physical impairment that is associated with functions deficit and that without therapeutic interventions, the Resident is at risk for further decline and weight loss. In an interview conducted on 02/16/23 at 8:55 AM, Staff H, License Practical Nurse, stated that the Certified Nursing Assistants assigned to the residents take the weights when needed. An interview conducted on 02/16/23 at 9:11 AM with the Director of Nursing, she stated that there is a specific Restorative Certified Nursing Assistant, that takes the weights on all residents. In an observation conducted on 02/16/23 at 11:20 AM, Staff I, a Certified Nursing Assistant, was observed taking the weight on Resident #80 as requested by Surveyor. Resident #80 was taken to the standing scale room accompanied by Staff H, a Licensed Practical Nurse. Staff I stated that the weight of Resident #80's wheelchair is 47.6 pounds, including the legs and the cushion. Continued observation showed that Resident #80's weight was noted at 177 pounds. This showed a current weight of 129.4 pounds by taking the weight of 177 pounds minus the weight of the wheelchair, which was 47.6 pounds. This is an additional 4.6 percent weight loss from 135.6 to 129.4 in one week. In an interview on 02/16/23 at 12:15 PM, Staff J, Registered Dietitian, stated that he only comes into the facility two times a month for about 20 hours. He first checks with the Administrator and the Nursing team for any residents who needed to be seen, as well as the Unit Managers. He looks over residents who are at high risk nutritionally, such as residents on tube feeding, dialysis and any residents admitted with pressure wounds. He always makes sure that on the days that he comes in it is on the days that Staff F is working as well. Staff J said that he does not have the wound care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 7 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 - Actual harm Residents Affected - Few report, and it was told to him verbally by the nursing staff. Any consultations are given to him verbally or handwritten while in the facility. Staff F is responsible for trending weight loss because she is here more often. He will look over any assessment with weight loss for residents with a pressure ulcer, on tube feeding, or on dialysis. For any weight discrepancies, he will ask the Director of Nursing for a reweigh on that Resident. Sometimes reweigh may be taken differently than asked and may be taken the next day. According to him, the best practice is to see high-risk residents at least once a month for a follow-up. 2. Resident #75 was readmitted to the facility on [DATE] with diagnoses of adult failure to thrive, unspecific dementia, and anemia. In an observation conducted on 02/13/23 at 12:05 PM, the lunch tray arrived at Resident #75's room and was placed at the bedside. Staff set up the tray for Resident #75 and left the room. The meal ticket showed an order for No Added Salt (NAS) Regular diet with chopped meat. The tray had food items: breaded pork chops 2-3 inches in size, spinach, sweet potatoes, and 4 ounces of apple juice. No nutritional supplements were noted on the tray. Continued observation at 12:26 PM showed that Resident #75 was eating on his own and only ate a few bites of his lunch meal. In an observation conducted on 02/13/23 at 5:10 PM, the dinner tray was brought into Resident #75's room. The staff set up the tray and left the room. Closer observation showed a dinner tray with chopped fish, mashed potatoes, and a health shake. At 5:28 PM, the Resident was noted in the room eating his dinner tray without assistance from staff. Food was noted all over the tray, with an intake of 75% of the dinner meal. In an observation conducted on 02/14/23 at 12:20 PM, showed that Resident #75 received his lunch tray in the room. At 1:00 PM, he only ate about 50% of his lunch meal. The Nutrition Comprehensive Evaluation dated 11/29/22, almost two weeks after Resident #75 was admitted , showed the following: weight of 129 pounds taken from the admission date of 11/16/22. Resident #75 was at risk for pressure ulcers with a skin tear to the right forearm. At risk for varied intake related to dementia and it was recommended to provide one can of Health Shake (nutritional supplement) at lunch. The supplement would provide an extra 200 calories and 6 grams of protein daily for support. In this note, Resident #75's weight was to be monitored times four weeks with the intake of meals. A month later, a Dietary Progress note dated 12/27/22 showed that nursing staff informed that Resident #75 has varying intake, and his diet was downgraded to a Mechanical Soft. Intake was noted between 26 to 100 percent, and in this note, it was recommended to increase the Health Shake to two times a day which was six weeks after Resident #75's admission. It further showed to monitor weights and intake, and the next weight that was taken was only on 02/09/23. The weight log showed 129 pounds on 11/16/22, and the next weight taken was not after four weeks but over 85 days later, which was recorded at 113.2 pounds. This showed a 12.3 percent weight loss in less than three months which is severe weight loss. The MDS dated [DATE] showed that Resident #75 had a BIMS score of 03 which is severe cognitive impairment, and under section G for eating, it showed that Resident #75 eats independently with set up only. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 8 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 - Actual harm Residents Affected - Few The care plan initiated on 11/29/22 showed the following: Resident #75 has a nutritional problem or potential nutritional problem related to Dementia, Anemia, and Dysphagia. The Resident will maintain adequate nutritional status as evidenced by maintaining weight within (5) % of (129#), having no signs of malnutrition, and consuming at least (51-75) % of meals daily through the review date. Observe/report signs of malnutrition: Emaciation (Cachexia), muscle wasting, significant weight loss: 3 lbs in 1 week, >5% in 1 month, >7.5% in 3 months, >10% in 6 months-the Clinical Dietitian to evaluate and make diet change recommendations and weigh per facility protocol order. Progress note, dated 2/16/2023, seven days after Resident #75's severe weight loss, showed that Resident #75 has been in close observation due to weight loss. Reweigh has been done, and there is still a significant weight loss. The dietary supervisor and Nurse Practitioner were made aware and asked to reevaluate the resident for weight loss. Another Dietary progress note completed on 2/16/23 showed the following: Resident #75's Body Mass Index (BMI) dropped from 22.8 to 20.4, which is underweight for his age. He also had a significant weight loss of 13.8# (10.7%) x 3 months. Weight loss may be contributed to an overall decline in status, discussed with nursing. A speech consult was in place, and his diet was downgraded to Puree on this date. Resident eats meals independently after tray set up, consumed 76-100% of meals, and occasionally <75%; however, suspect intakes are not meeting nutritional needs. On this note, the Clinical Dietitian increased the Health Shake supplements to 3 times a day and added another Frozen treat supplement for lunch for further nutrition support. It further showed to Initiate weekly weight x 4 weeks. These interventions were put in place three months after Resident #75's admission. In an interview conducted on 02/16/23 at 5:00 PM with the Administrator, he was informed of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 9 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to follow Physician orders for tube feeding for 1 of 1 resident reviewed for tube feeding (Resident #113). The findings included: Resident #113 was readmitted on [DATE], transferred to the hospital on [DATE], and was readmitted again on 01/23/23. Diagnoses included dysphagia, acute respiratory failure and anemia. An order was noted for enteral feeding with Isosource 1.5 at 55 ml an hour, on at 4:00 PM and off at 12:00 PM dated 01/23/23. In an observation conducted on 02/13/23 at 10:00 AM, Resident #113 was in the room with the tube feeding off. The tube feeding bag was noted with Isosource 1.5 (tube feeding formulary), which started on 02/12/23 at 4:00 PM the day before. At the time of the observation, the tube feeding was at the 300 milliliters (ml) mark out of a 1000 ml capacity bottle. In this observation, Staff V, Certified Nursing Assistant (CNA), stated that she just stopped the tube feeding for daily care and that she will restart the tube feeding once she is done. The tube feeding that started at 4:00 PM the day before should have been almost done at around 10:00 AM and not at the 300 ml mark, as noted. In an interview conducted on 02/13/23 at 11:30 AM with Staff V, she said she provided care for 30 minutes and restarted the tube feeding at 10:30 AM. In an observation conducted on 02/13/23 at 2:30 PM, Resident #113 was noted in the room with the tube feeding running in place. Closer observation showed that the same tube feeding bag was at the 200 ml mark out of a 1000 ml capacity bottle. In an observation conducted on 02/13/23 at 4:13 PM, the Resident was noted in bed with the tube feeding on hold. Closer observation showed that the same tube feeding bag was at the 200 ml mark out of a 1000 ml capacity bottle. In an observation conducted on 02/13/23 at 5:00 PM, the Resident was noted in bed with the tube feeding on hold. Closer observation showed that the same tube feeding bag was at the 200 ml mark out of a 1000 ml capacity bottle. In an observation conducted on 02/13/23 at 5:30 PM, the Resident was noted in bed with the tube feeding on hold. Closer observation showed that the same tube feeding bag was at the 200 ml mark out of a 1000 ml capacity bottle. In an observation conducted on 02/14/23 at 7:30 AM, the Resident was noted in bed with the tube feeding on hold. Closer observation showed that the tube feeding bag was at the 1000 ml mark out of a 1000 ml capacity bottle. In an observation conducted on 02/14/23 at 8:20 AM, the Resident was noted in bed with the tube feeding on hold. Closer observation showed that the tube feeding bag was at the 1000 ml mark out of a 1000 ml capacity bottle. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 10 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm The weights log showed the following weights recorded for Resident #113: on 01/20/23, he was at 128 pounds. On 01/24/23, he was noted at 126.2 pounds; on 02/09/23, he was noted at 122.4 pounds, a severe weight loss of 9 percent in less than three weeks. Further review of the medical chart did not show a Clinical Dietitian, interventions addressing the weight loss, or the tube feeding progress after Resident #113 readmission on [DATE]. Residents Affected - Few The care plan dated 01/18/23 showed that Resident #113 requires tube feeding related to dysphagia. Provide tube feeding and water flushes and see doctor ' s orders for tube feeding orders. RD to evaluate as needed quarterly. It further showed that Clinical Dietitians evaluate and monitor caloric intake, estimate needs, and make recommendations for changes to tube feeding as needed. A follow-up nutrition progress note dated 02/14/23 showed that Resident #113 had a significant weight loss of 24.6 pounds in 6 months, which is a 16.7 percent weight loss. It further showed that the tube feeding was running with no intolerances. In this note, Staff F, Dietary Technician, recommended providing Proheal critical care wound supplement three times a day. The progress note dated 02/11/23 revealed that Resident #113 had a right dorsal foot wound, an open blister to the left dorsal foot, and an open blister to the left posterior leg. The Medication Administration Record for February 2023 showed that Resident #113 was given the tube feeding as per Physician's orders on 02/13/23 and 02/14/23. A progress note dated 02/15/23 revealed that Resident #113 removed his peg tube and was transferred to the hospital. An interview conducted on 02/16/23 at 8:50 AM with Staff G, License Practical Nurse (LPN), she stated that she prefers that the Certified Nursing Assistants come to her, so she can turn the tube feeding off for care and not do it themselves. Staff G reported that most tube feedings are stopped at 10:00 AM for morning care and resume at 2:00 PM. In an interview conducted on 02/16/23 at 9:11 AM, the Director of Nursing stated that the Nurse is the only one allowed to turn the tube feedings on and off, and if the Resident needs care, then the assigned Certified Nursing Assistant will let the Nurse know. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 11 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0697 Provide safe, appropriate pain management 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** 2) Review of the facility's policy titled Admissions Orders revised on 03/02/19 documented .The admitting orders will be transcribed to the admission Physician Order Sheets (POS) once the orders are clarified or entered into the facility electronic medical record . Residents Affected - Few Review of Resident #377's clinical record documented an admission to the facility on [DATE] with no readmissions. The resident diagnoses included Encounter for other Orthopedic aftercare, Displaced Bicondylar Fracture of Unspecified Tibia, and Subsequent Encounter for Closed Fracture with Routine Healing. Review of Resident #377's Minimum Data Set (MDS) 5 days admission assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 15, indicating that the resident has no cognition impairment. The assessment documented under Functional Status that the resident needed supervision to limited assistance with his Activities of Daily Living (ADLs) from the nursing staff. Review of Resident #377's care plan titled Resident #377 has potential/actual pain symptoms as evidenced by (Left) Nondisplaced Tibial Plateau Fracture, Bilateral Knee Pain / Generalized Pain initiated on 02/04/23 and revised on 02/13/23. The care plan included the following interventions: Administer medications as per MD (Medical Doctor) orders. Review of Resident #377's physician order dated 02/04/23 documented Morphine Sulfate Oral Tablet mg (milligrams) Give 15 mg by mouth two times a day for pain. Physician order dated 02/04/23 documented Oxycodone HCl Oral Tablet 10 mg Give 10 mg by mouth every 6 hours as needed for pain. Review of Resident #377's February 2023 Medication Administration Record (MAR) documented a chart code #9 for the resident's Morphine Sulfate 15 mg scheduled at 9:00 AM and 9:00 PM on 02/11/23, 02/12/23 and on 02/13/23 at 9:00 AM. The chart code #9 was equal to other/see nurse notes. Review of the nurse notes dated 02/11/23 at 9:13 AM documented Morphine Sulfate 15 mg give two times a day for pain-waiting on pharmacy to deliver. No further nurses follow up notes was on file related to communicating with the resident's physician or the pharmacy. Review of the nurse note dated 02/12/23 2:31 PM documented on order. No further nurse follow up notes was on file related to communicating with the resident's physician or the pharmacy. Review of the nurse note dated 02/13/23 10:49 AM documented Morphine Sulfate 15 mg give two times a day for pain. None available from pharmacy script for signature. Further review revealed that Resident #377 last Morphine Sulfate 15 mg medication was given on 02/10/23 at 9:00 PM. The review revealed that Resident #377 did not have pain management as per physician orders on 02/11/23, 02/12/23 as scheduled every 12 hours and on 02/13/23 at 9:00 AM. Furthermore, review revealed Resident #377 received Morphine Sulfate 15 mg at 9:00 PM and Oxycodone 10-325 mg at 7:00 PM on 02/13/23. Review of Resident #377's Controlled Medication Utilization Record for Morphine Sulfate ER 15 mg tablets was conducted. The review revealed that on 02/05/23 the pharmacy delivered 12 tablets of Morphine Sulfate ER 15 mg. The first tablet was removed on 02/05/23 at 9:00 AM and the last tablet was removed on 02/10/23 at 9:00 PM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 12 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #377's Controlled Medication Utilization Record for Morphine Sulfate ER 15 mg tablets was conducted. The review revealed that on 02/13/23 the pharmacy delivered 12 tablets of Morphine Sulfate ER 15 mg. The first tablet was removed on 02/13/23 at 9:00 PM. Review of Resident #377's Controlled Medication Utilization Record for Oxycodone-acetaminophen 10-325 mg tablets was conducted. The review revealed that on 02/05/23 the pharmacy delivered 24 tablets of Oxycodone-acetaminophen 10-325 mg. The first tablet was removed on 02/05/23 at 8:30 AM and the last tablet was removed on 02/12/23 at 1:12 AM. Review of Resident #377's Controlled Medication Utilization Record for Oxycodone-acetaminophen 10-325 mg tablets was conducted. The review revealed that on 02/13/23 the pharmacy delivered 26 tablets of Oxycodone-acetaminophen 10-325 mg. The first tablet was removed on 02/13/23 at 7:00 PM. On 02/13/23 at 10:18 AM, observation revealed Resident #377 sitting in a recliner wheelchair in front of the facility's Seaside Unit's nurses station and next to the medication cart manned by Staff O, Registered Nurse (RN). Surveyor asked Resident #377 how he was doing and he stated terrible, no pain medications since Saturday. The resident stated he had a broken knee and was getting morphine for pain before coming to the facility. The resident stated the last time he was medicated for pain was on Saturday midnight and was told that they will order the medications. On 02/13/23 at 10:24 AM, an interview was conducted with Staff O, RN who stated she was given report this morning that Resident #377's pain medications were not in the facility. Staff O added that she understood the medications were ordered. Staff O stated that a prescription needed a signature from the Nurse Practitioner. Staff O stated she spoke with Supervisor/Assistant Director of Nursing (ADON) and will call her back. Staff O stated that the medication was a controlled substance and was not in the facility's emergency kit (E-Kit). Consequently, a side by side review with Staff O of Resident #377 MAR was conducted and documented last dose of Oxycodone (pain medication) 10 mg was administered on 02/12/23 at 1:11 AM. Staff O was asked for the resident controlled substance medication record and stated Resident #377 was out of pain medication (controlled substances). Staff O was asked to state the facility's process related to ordering controlled substances for the residents and stated she did not remember the process. On 02/13/23 at 10:42 AM, an interview was conducted with Resident #377 in his room. The resident stated he came in to the facility last week because he broke his left knee and had a hairline fracture. The resident stated he was getting physical therapy. The resident stated that he had an accident at 5:00 AM (02/13/23), was having pain and could not get to the bathroom fast enough. The resident stated the last pain medication was given around 1:00 AM on Sunday. Resident #377 stated the nurses were supposed to order the medication on Friday and they did not do it. The resident added he did not have any pain medication on Sunday (02/12/23 during the day). The resident stated the nurse gave him a couple of Tylenol and did not do it. Resident #377 was asked if he had been seen by the facility's pain management provider and stated no one from the facility had spoken with him about pain management. The resident added that he had a previous scheduled appointment with his own outside pain management doctor that he may need to cancel because he was in the facility. The resident stated having a pain level of 12 from a scale of 0-10 (0-no pain and 10-worse pain). On 02/13/23 at 10:56 AM, an interview was conducted with the facility's ADON. A side by side review of Resident #377 February 2023 MAR was conducted with the ADON. The ADON stated she will call the Director of Nursing (DON). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 13 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 02/13/23 at 11:15 AM, a side by side review of Resident #377's February 2023 MAR was conducted with the DON. The DON stated she was off on 02/10/23 and was not aware of the resident not having pain medications. The DON stated the resident had not been seen by the pain management doctor. The DON stated the pain management doctor was not in on 02/10/23 and the nurses needed a prescription for Resident #377's medications for pain. The DON stated that the pain management doctor comes to the facility every week. On 02/13/23 at 11:22 AM, during an interview, the DON stated she will call the pharmacy to find out the status of the resident's medication reorder. A joint interview via telephone was conducted with the DON and the facility's pharmacy technician. The Pharmacy Technician stated that Resident #377 had four (4) remaining tablets of Percocet. The technician stated she did not have a script for Oxycodone or Morphine. The Pharmacist Technician stated the Percocet 10/325 mg- 24 tablets were sent on 02/04/23 to the facility and the Morphine Sulfate 15 mg-12 tablets were sent on 02/04/23. During the interview, the DON stated that it was not acceptable to not administer Resident #377 pain medication as ordered. The DON stated the nurses should have sent a script to the pharmacy for a new order of the resident's controlled substances. The DON was asked for the pain management doctor's note and stated she did not see any pain management note in the resident's file. The DON was asked to state the facility's reordering process for controlled substance. The DON stated the nurses need to find out if the resident has a script or not for reordering. If they don't, they need to notify pain management. The attending physician does write a script within the first 30 days of admission, after that it is pain management responsibility. The DON stated the nurses are not supposed to run out of the resident's medications and added the nurses call the pharmacy to get authorization to pull medications from the E-kit. If they do not have a script, they need to call pain management. The DON stated she e-mailed the script to the attending nurse practitioner this morning to refill controlled substances. On 02/13/23 at 11:55 AM, a side by side review of the facility's E-Kit on the 3rd floor was conducted with the DON. The E-kit did not have any controlled substance in the kit. During the survey, the DON was asked multiple times to submit the resident's pain management provider progress note and all controlled substance record to conduct a side by side review with the DON and it was not submitted. On 02/16/23 at 5:28 PM, an interview was conducted with Staff W, LPN who stated that he did Resident #377's admission and called the pharmacy and the Nurse Practitioner for a prescription because the resident came in to the facility from a hospital without pain prescriptions. Staff W added when he came on the next day there was no medication for pain for Resident #377. Based on observation, interviews, record and policy review, the facility failed to provide pain management in a timely manner for 2 of 5 residents sampled for pain management (Resident #117 and #377). The findings included: 1) The facility's policy titled Pain Management Program issued and revised on 03/02/19 reveals the facility shall provide adequate management of pain to ensure that residents attain or maintain the highest practicable physical, mental, and psychosocial well-being. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 14 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #117 was admitted to the facility on [DATE] from an acute care hospital. The Minimum Data Set (MDS) admission assessment with an assessment reference date of 12/16/22 revealed his Brief Interview for Mental Status (BIMS) score was 15 indicating he was cognitively intact. His medical diagnoses included Cerebral Infarction with left-sided Hemiplegia, Malignant Neoplasm of the Larynx and Anxiety Disorder. An interview was conducted with Resident #117 on 02/13/23 at 2:15 PM. He stated his left shoulder was hurting him. He had a fall a couple of weeks ago and it hurt when his left shoulder was moved. He continued to say that he had Physical Therapy a couple of weeks ago but now no one was working with him to move his left shoulder. A review of the nursing progress notes for Resident #117 revealed on 02/07/23 that he was seen by the NP (Nurse Practitioner) today new order received for X-ray bilateral shoulder for pain. An additional interview with conducted with the resident on 02/16/23 at 10:55 AM. He was observed rubbing his left shoulder and stated to this surveyor that he has pain there. He stated that he was recently bathed and dressed and his left shoulder hurts when the staff dresses him. An interview was immediately conducted with Staff G, a Licensed Practical Nurse. Staff G was asked if Resident #117 had any medication for pain since he was having pain in his shoulder now. Staff G reviewed the physician orders and stated that he did not have any pain medication ordered. She stated that the residents usually have an order for acetaminophen but he didn't have an order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 15 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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, interviews and record review, the facility failed to ensure controlled substance medication reconciliation was accurate for 4 of 6 sampled residents reviewed during the controlled substance record review at the facility's Seaside, 1st floor East and 2nd floor East Units, for Residents #51, #60, #377 and #381. The finding included: Review of the facility's policy titled General Dose Preparation and Medication Administration revised on 01/01/22 documented .document the administration of controlled substance in accordance with applicable law .after medication administration, facility staff should .document necessary medication administration/treatment information . 1) On 02/16/23 at 8:04 AM, a side by side review of the facility's 1st floor East Medication cart's controlled substance records was conducted with Staff G, Licensed Practical Nurse (LPN). The review revealed Resident #51's Controlled Medication Utilization Record (CMUR) for Oxycodone 10 mg (milligrams) every 8 hours as needed for pain. During the review, Staff G, LPN stated once she administer a controlled substances she will document it in the residents medication administration record (MAR) . On 02/16/23 at 3:12 PM, a side by side review of Resident #51's January 2023 MAR and Controlled Medication Utilization Record (CMUR) for January 2023 was conducted with the facility's Director of Nursing (DON). The review revealed that on 01/02/23 at 9:55 AM, one tablet of Oxycodone mg was removed by Staff N, Licensed Practical Nurse (LPN) from CMUR received on 12/17/22. Further review revealed that on 01/02/23 at 9:38 AM, same day, Staff N, same nurse, removed one tablet of Oxycodone 10 mg from the residents CMUR received on 12/10/22. Continued review revealed that on 01/06/23 at 9:00 AM one tab of Oxycodone 10 mg was removed by Staff G, LPN from Resident #51's CMUR received from the pharmacy on 12/10/22. Further review revealed that on 01/06/23 at 10:06 AM one tablet of Oxycodone 10 mg was removed by Staff N, LPN from the resident's CMUR received on 12/17/22. An inquiry was made about the Oxycodone removed from Resident #51' CMUR on the same day by same shift by two different nurses (Staff G and Staff N) for the same resident. The DON stated the nurses are to document controlled substances administered in the residents MAR. On 02/16/23 at 3:56 PM, a joint interview was conducted with the DON, Staff G, LPN and Staff N, LPN. Staff N stated that she was documented the date as she normally will do in her country as the day first and the month second. The DON stated that she educated Staff G and Staff N to document dates in the United States format. 2) On 02/16/23 at 8:35 AM, a side by side review of the facility's Seaside North Medication cart's controlled substance record was conducted with Staff M, LPN. The review revealed Resident #381's CMUR for Oxycodone-acetaminophen 10-325 mg every 6 hours as needed for acute pain. The CMUR documented that on 02/15/23 at 10:00 AM one tablet of Oxycodone-acetaminophen was removed. Review of the resident's MAR revealed that Oxycodone-acetaminophen removed on 02/15/23 at 10:00 AM was not documented in the resident's MAR as administered on 02/15/23 at 10:00 AM. During the review, Staff M stated that after the administration of a controlled substance medication, the nurses are to document it in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 16 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 residents medication administration record (MAR). Level of Harm - Minimal harm or potential for actual harm 3) On 02/16/23 at 8:45 AM, a side by side review of Resident #377's controlled substance record was conducted with Staff M, LPN. The review revealed the resident's CMUR Oxycodone-acetaminophen 10-325 mg tablets every 6 hours as needed for pain. The CMUR documented that on 02/06/23 at 5:30 AM, 02/07/23 at 6:00 AM, 02/07/23 at 9:00 AM, 02/07/23 at 11:00 PM, 02/08/23 at 10:0 AM, 02/08/23 at 11:09 PM, 02/09/23 at 5:50 AM, 02/09/23 at 12 noon, 02/10/23 (no time noted), 02/10/23 at 11:23 PM, and 02/11/23 at 11:30 AM, one tablet of Oxycodone-acetaminophen 10-325 mg was removed from the controlled substance box on those dates and times. Residents Affected - Few Review of Resident #377's February 2023 Medication Administration Record (MAR) lacked documentation that any of these doses were administered to the resident. 4) On 02/16/23 at 9:33 AM, a side by side review of the facility's 2nd floor East Medication cart's controlled substance records was conducted with Staff N, LPN. The review revealed Resident #60's CMUR for Oxycodone-acetaminophen 5-325 mg every 4 hours as needed for acute pain. The resident's CMUR documented that on 02/15/23 at 9:30 PM one tablet of Oxycodone-acetaminophen was removed. Review of the resident's MAR revealed that Oxycodone-acetaminophen removed on 02/15/23 at 9:30 PM was not documented in the resident's MAR as administered on 02/15/23 at 9:30 PM. During the review, Staff N stated that after the administration of a controlled substance medication, the nurses are to document it in the residents medication administration record (MAR). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 17 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined the medication error rate was 10.81 percent. Four (4) medication errors were identified while observing a total of 37 opportunities, affecting Residents #82, #380, and #91. Residents Affected - Few The findings included: Review of the facility's policy titled General Dose Preparation and Medication Administration revised on 01/01/22 documented .prior to preparing or administering medications .staff should follow facility's infection control policy (e.g., handwashing) .prior to administration of medications, facility staff should take all measures required by the facility .verify each time a medication is administered that it is the correct medication, at the correct dose .as set forth in facility's medication administration schedule .after medication administration, facility staff should .document necessary medication administration/treatment information . 1) On 02/13/23 at 4:40 PM, medication administration observation for Resident #82 performed by Staff T, Licensed Practical Nurse (LPN) was conducted. Staff T stated Resident #82 gets Midodrine (a medication for low blood pressure- hypotension). Observation revealed Staff T entered Resident #82's room performed hand hygiene, donned gloves, placed a wrist blood pressure cuff on the resident's right wrist. Staff T stated the resident's blood pressure was 113/77 and the pulse was 94 and that she will check the physician order for blood pressure range. Staff T read out loud Resident #82's physician order for Midodrine give 2 tablets for hypotension. Staff T stated that the resident's blood pressure was normal and added that it was not that low to get the Midodrine 5 mg (milligrams) for hypotension. Staff T stated that she was not going to give Midodrine for hypotension to Resident #82. A side by side review of the resident's Staff T documentation was conducted. Staff T documented Midodrine not administered. Review of Resident #82's clinical record documented an admission to the facility on [DATE] and a readmission on [DATE]. The resident diagnoses included Hypotension, Hemiplegia and Hemiparesis, Dysphagia, Atrial Fibrillation, Narcolepsy, Seizures, and Gastrostomy Status. Review of Resident #82's physician order dated 12/13/22 documented Midodrine HCL 5 mg give 2 tablets via G-tube three times a day for hypotension. The physician order did not include blood pressure parameters to hold the medication. On 02/15/23 at 11:40 AM, a side by side review of Resident's February 2023 Medication Administration Record (MAR), physician orders for February 2023 and Staff T medication administration note for 02/13/23 was conducted with the facility's Director of Nursing (DON). The DON stated there was a note from Staff T regarding Resident #82's blood pressure medication held due to low blood pressure. The DON stated that Staff T did not document communicating with the practitioner regarding holding the medication and that there was not a physician order with blood pressure parameters to hold the medication. Consequently, a joint telephonic interview with the resident's Nurse Practitioner and the DON was conducted. The Nurse Practitioner stated she did not receive a call from Staff T, LPN and was not aware of Resident #82's blood pressure on 02/13/23 around 4:40 PM. The Nurse Practitioner added the nurses should have blood pressure parameters. The DON confirm that Staff T did not follow physician orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 18 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2) On 02/14/23 at 8:32 AM, medication administration observation for Resident #380 performed by Staff B, Registered Nurse (RN) started. At 08:36 AM, Staff B stated that the computer was not working and that she knew what medications Resident #380 was taken. Staff B asked the facility's Assistant Director of Nursing (ADON), who stated the internet was down. Staff B stated she was going to prepare Resident #380's medication. Observation revealed Staff B did not have Resident #380's Medication Administration Record (MAR) to be able to prepare his medications. Further observation revealed Staff B poured into a medication cup the following medications: Allopurinol 100 mg, Sevelamer 800 mg and Midodrine 10 mg for Resident #380. On 02/14/23 at 8:41 AM, the ADON approached Staff B and surveyor and stated that the desktop computer was working. The ADON added that Staff B had to go to the desk to get the resident's medication information. On 02/14/23 at 8:43 AM, observation revealed Staff B carrying Resident #380 pre-poured medications to the nurses station and placed it on top of the nurses station. On 02/14/23 at 8:44 am, an interview was conducted with the DON and was asked what was plan B if there was not internet for Staff B to access the resident's medications administration record (MAR). The DON stated that Staff B, RN needed to find a computer that was working and print the resident's MARs. On 02/14/23 at 8:45 AM, Staff B logged into the desk computer and printed Resident #380's electronic MAR scheduled list. On 02/14/23 at 8:47 AM, Observation revealed Staff B, RN returned to the medication cart and discarded the pre-poured medication into the Drug buster container. Staff B then without performing hand hygiene, proceeded to pour Resident #380's medications as follows: Sevelamer 800 mg (one tab). Observation revealed Staff B dropped the tablet on top of the medication cart, then took the tablet with her un-sanitized, bare hand and put it into the medication cup. Staff B continue to pour other medications as Clopidogrel 75 mg, Allopurinol 100 mg, and Levetiracetam 500 mg. Staff B was asked how many tablets she had into the medication cup and stated four(4). On 02/14/23 at 8:56 AM, observation revealed Staff B entered Resident #380's room and without performing hand hygiene, proceeded to assist the resident taking his medications. Staff B then performed 5 seconds hand hygiene in the resident's room bathroom and returned to the medication cart and documented on the paper record. On 02/14/23 at 9:08 AM, during an interview, Staff B, RN stated that Resident #380 did not have Famotidine (a medication for Gastric Reflux). Staff B was asked what she would do then and stated she will document awaiting from pharmacy or borrow from another resident then replace it. During the interview, Staff B was approached by Staff U, LPN who informed Staff B to check the facility's emergency kit (E-Kit) for Famotidine. On 02/14/23 at 9:10 AM, observation revealed Staff B, RN entered the facility's Seaside unit's medication room, unlocked the facility's E-Kit and started to look for Famotidine. Staff B stated she had never used that thing referring to the E-Kit. Staff B added she did not even know how to find it. Observation revealed the ADON entered the medication room and stated that Famotidine was an over the counter medication (OTC). Staff B stated I have to come back to lock that thing referring to the E-Kit. Staff B left the medication room without locking the E-Kit. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 19 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 02/14/23 at 9:16 am, observation revealed Staff B, RN returned to the medication cart and without performing hand hygiene, proceeded to look for Famotidine in the medication cart. Staff B retrieved a bottle of Omeprazole 20 mg (OTC) bottle from the medication cart and stated it is the same as Famotidine. Further observation revealed Staff B dropped the Omeprazole tablet on top of the medication cart and with her un-sanitized, bare hand she picked up the tablet and put into the medication cup. Staff B entered Resident #380's room and assisted the resident with medication administration. Review of Resident #380's clinical record documented an admission on [DATE] with no readmission. The resident diagnoses included End Stage Renal Disease (ESRD), Heart Disease, and Gastro-Esophageal Reflux Disease (GERD). Review of Resident #380's Minimum Data Set (MDS) Admissions Assessment (In Progress) dated 02/07/23 documented a Brief Interview of the Mental Status (BIMS) score of 15 indicating that the resident had no cognition impairment. Review of Resident #380's physician order dated 02/02/23 documented Sevelamer HCL oral tablet 800 mg give 1600 mg with meals for ESRD. Physician order dated 02/02/23 documented Famotidine oral tablet 10 mg give one tablet two times a day for GERD. Review of the Resident #380's clinical record revealed that Staff B administered the wrong dose of Sevelamer, one tablet instead of two, of 800 mg. Staff B also administered Omeprazole 20 mg instead of Famotidine 10 mg as ordered. On 02/15/23 at 10:22 AM, during an interview, the DON was apprised of Staff B, RN administered to Residents #380 a wrong medication and wrong dose as mentioned above. The DON stated Staff B was removed from the medication cart on 02/14/23 and was re-educated. 3) On 02/14/23 at 8:58 AM, medication administration observation for Resident #91 performed by Staff B, RN started. Staff B entered the resident's room with the facility's wrist blood pressure machine and placed the machine cuff on Resident #91's right wrist. Staff B stated the resident's blood pressure was 92/71 and the pulse was 67. Observation revealed Staff B walked out of the resident's room without performing hand hygiene after checking his blood pressure. Continue observation revealed Staff B unlocked her personal cell phone and stated, I have not heard from that person in a long time. Staff B continues without performing hand hygiene, returned to the desktop computer and printed Resident #91's MARs. Observation revealed Staff B, RN returned to the medication cart and without performing hand hygiene, proceeded to pour the following for Resident #91: Trelegy Inhaler, Allopurinol 100 mg, Aspirin 81 mg, Clear lax 17 grams, Pantoprazole 40 mg and Entresto 24-26 mg. During the observation, Staff B stated that she was going to hold Metoprolol 25 mg because of the resident's low blood pressure. On 02/14/23 at 9:27 AM, Staff B entered Resident #91's room, assisted the resident with his medication administration. Review of Resident #91's clinical record documented an admission to the facility on [DATE] with no readmissions. The resident diagnoses included Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure, Atherosclerotic Heart Disease, Atrial Fibrillation, and Essential (Primary) Hypertension. Review of Resident #91's Minimum Data Set (MDS) admissions assessment dated [DATE] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 20 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few documented a Brief Interview of the Mental Status (BIMS) score of 15 indicating that the resident had no cognition impairment. The assessment documented under Functional Status that the resident needed extensive assistance from the staff to complete his ADLs. Review of Resident #91's physician order dated 01/18/23 documented Metoprolol oral tablet Extended Release (ER) 25 mg give 0.5 tablet one time a day for Hypertension. The physician order did not include blood pressure parameter to hold the medication. Review of the nurses progress note lack evidence regarding Staff B communicating or notifying to the practitioner Resident #91's low blood pressure. On 02/15/23 at 10:32 AM, during an interview, the DON was apprised of the findings. The DON confirmed there was not documentation in Resident #91's clinical record related to Staff B communicating to the practitioner his low blood pressure and that she held his Metoprolol on 02/14/23 morning dose. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 21 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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** 5) On [DATE] at 9:10 AM, observation revealed Staff B, RN entered the facility's Seaside unit's medication room, unlocked the facility's E-Kit and started to look for Famotidine. Staff B stated she had never used that thing referring to the E-Kit. Staff B added she did not even know how to find it. Observation revealed the facility's Assistant Director of Nursing (ADON) entered the medication room and told Staff B that Famotidine was an over the counter medication (OTC). Staff B stated I have to come back to lock that thing referring to the E-Kit. Staff B left the medication room without locking the E-Kit. On [DATE] at 9:45 AM, a side by side observation of the facility's Seaside medication room and the E-kit was conducted with Staff U, LPN and the ADON. Staff U acknowledged the E-kit was not locked, and stated Staff B should have locked it before she left the room. 6) Review of Resident #91's clinical record documented an admission to the facility on [DATE] with no readmissions. The resident diagnoses included Chronic Obstructive Pulmonary Disease (COPD) and Heart Failure. Review of Resident #91's physician order dated [DATE] documented Albuterol Sulfate Inhalation Nebulization Solution (Albuterol Sulfate) one puff inhale orally every 4 hours as needed for COPD. Further review of the resident's physician order lacked evidence of an order for Self-Administration of Albuterol or for Resident #91 to have the inhaler in his room unsecured. Review of Resident #91's Minimum Data Set (MDS) admissions assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 15 indicating that the resident has no cognition impairment. The assessment documented under Functional Status that the resident needed extensive assistance from the staff to complete his activities of daily living (ADLs). Resident #91's care plan review revealed no care plan for Self-Administration of Medications. Further review revealed a care plan titled The resident has altered respiratory status .COPD initiated on [DATE]. The care plan lack documentation of self-administration of Albuterol inhaler. On [DATE] at 12:14 PM, observation revealed Resident #91 sitting in his room. Further observation revealed an inhaler with an outside pharmacy label on top of the resident's table (photographic evidence obtained). An interview was conducted with the resident who stated that he uses his rescue inhaler every day and added that he could use it every two (2) hours if he needed to. The resident was asked if he was evaluated/assessed by the nurse to have the inhaler in his room and stated No. The inhaler had a pharmacy label that read Albuterol Sulf 90 mcg 1 puff inhale orally every 4 hours as needed for COPD. On [DATE] at 8:58 AM, medication administration observation for Resident #91 performed by Staff B, RN started. At 9:27 AM, Staff B entered Resident #91's room, assisted the resident with his medication administration. Staff B acknowledged an Albuterol Inhaler canister on top of the resident table and asked the resident so, they allow you to have it? The resident smiled and stated, I needed it. Subsequently, an interview was conducted with Staff B who Resident #91 was allowed to have the rescue inhaler in his room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 22 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 On [DATE] at 12:32 PM, an interview was conducted with Staff L, Licensed Practical Nurse (LPN) who stated that the facility did not have any resident doing self-medications administration. Staff L stated the nurses were responsible to administer the residents medications. On [DATE] at 10:35 AM, an interview was conducted with the Director of Nursing (DON). The DON stated Resident #91 had been very restless not having his inhaler, he feels it is not safe not to have it with him. The DON stated the resident was educated; the nurse who worked with him last week gave the inhaler back to the resident. The DON added the resident can be very persistent. The DON stated Resident #91 had not been assessed to have a rescue inhaler at bedside. 7) Review of Resident #27's clinical record documented an admission to the facility on [DATE] with a readmission on [DATE]. The resident diagnoses included Acute Respiratory Failure, Functional Quadriplegia. Review of Resident #27's physician order dated [DATE] documented Wound Care cleanse sacrum with normal saline, pat dry then apply skin prep to peri-wound and zinc to the wound bed, cover with bordered foam dressing. Further review of the resident's physician order lacked evidence of an order for Self-Administration of wound care with wound care supplies observed in his room unsecured. Review of Resident #27's Minimum Data Set (MDS) admissions assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 15 indicating that the resident has no cognition impairment. The assessment documented under Functional Status that the resident needed extensive assistance from the staff to complete his activities of daily living (ADLs). Resident #27's care plan review revealed no care plan for Self-Administration of Medications. Further review revealed a care plan titled The resident has altered respiratory status .COPD initiated on [DATE]. The care plan lack documentation of self-administration of Albuterol inhaler. On [DATE] at 12:34 PM, observation revealed Resident #27 in sitting in a wheelchair in his room. An interview was conducted with the resident who stated that the facility's nurse did his wound care every other day. Observation revealed a basket that contained the following: one Therahoney gel tube, one full bottle of Iodine solution, one tube of Zinc oxide 20%, one wound cleanser bottle and dry dressing gauzes (wound care supplies). On [DATE] at 8:19 AM, a side by side review of Resident #27's wound care supplies basket in his room was conducted with the facility's Wound Care Nurse (WCN). The basket contained a bottle of Iodine solution, one opened xeroform gauze packaging, multiple skin prep pads, alcohol pads, one tube of zinc oxide 20%, one 2%- Chlorhexidine gluconate cloth, and a bottle of wound cleanser. The WCN stated that Resident #27's wife was a nurse and had been told not to bring supplies in and she keeps bringing them in. The WCN stated that the facility keeps removing them. The WCN stated the resident's sacrum wound healed. On [DATE] at 10:21 AM, observation revealed Resident #27 in bed with visitors. A joint interview was conducted with the resident's daughter and his wife. An inquiry was made regarding the basket with wound care supplies. The resident's wife stated that she brought the supplies from home and that she was applying the betadine (iodine solution) to his leg and it was working she added. The resident's wife showed surveyor Resident #27's lower extremities and the skin showed light brownish/yellowish color. The wife stated that the facility was aware that she was applying the betadine to his leg. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 23 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 On [DATE] at 10:38 AM, an interview was conducted with the DON who stated Resident #27's wife had been resistant about having medications (wound care supplies) at bedside. The DON stated the wife and the daughter get angry when she talks to them about removing the supplies from the room. The DON added that the supplies were probably brought over the weekend. 8) Review of Resident #52's clinical record documented an admission to the facility on [DATE] with a readmission on [DATE]. The resident diagnoses included Heart Disease, Paraplegia, Depression, Anxiety Disorder, Pain and Dry Eye. Review of Resident #52's physician order dated [DATE] documented Wound Care cleanse sacrum with normal saline, pat dry then apply skin prep to peri-wound and zinc to the wound bed, cover with bordered foam dressing. Further review of the resident's physician order lacked evidence of an order for Self-Administration of wound care with wound care supplies observed in his room unsecured. Review of Resident #52's Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 15 indicating that the resident has no cognition impairment. The assessment documented under Functional Status that the resident needed extensive assistance from the staff to complete his activities of daily living (ADLs). Resident #52's care plan review revealed no care plan for Self-Administration of Medications. On [DATE] at 12:40 PM, Observation revealed Resident #52 lying in bed. The resident was awake and alert but declined to be interviewed. Further observation revealed multiple over the counter medications (OTC) in his room unsecured. The following medications observed in the resident's room included: one Asper cream Lidocaine spray bottle, one tube of MG 217-maximum strength 3% [NAME]-acid formula (for Psoriasis), Medicated multi-symptom cream, Max strength Hydrocortisone cream and 2 bottles of Lubricant eye drops. All OTC medications were opened. On [DATE] at 11:05 AM, a side by side review with Staff L, LPN, of Resident #52's medications in his room was conducted (Photographic evidence obtained). Staff L stated the resident orders medications online. Staff L added that even hospice orders medications for him and he gets them directly. Staff L added Resident #52 was different and won't let you take his medications away from him. Staff L stated the resident was alert and had not been assessed to do self-administration of medications. Staff L stated Resident #52 was not capable to do self-administration of medications. On [DATE] at 10:43 AM, an interview was conducted with the DON who stated Resident #52 orders stuff online that the facility staff does not know about it. The DON added the resident claimed he ordered things to have them handy in case he needs them. The DON stated she had been working on the situation since she came in to the facility three and half months ago. On [DATE] at 2:31 PM, an interview was conducted with the MDS Coordinator who stated she was not aware of Residents #27, #52 and #91 with medications at the bedside. The MDS Coordinator stated she was not aware of the resident's self-administration of medication assessment and that there was not a care plan for any of the residents. On [DATE] at 12:25 PM, an interview was conducted with the facility's Minimum Data Set (MDS) Coordinator who stated she was not aware of any resident who needed to be care planned for Self-Administration of Medications The MDS Coordinator stated the resident had to be assessed to make sure the resident know what the medication was and how to use it. The MDS Coordinator added then nursing will let (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 24 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 her know so she can care plan for it. Level of Harm - Minimal harm or potential for actual harm 9) On [DATE] at 8:35 AM, a side by side review of the facility's Seaside north medication cart was conducted with Staff M, LPN. The review revealed nine (9) and a half loose tablets/capsules in the cart's second and third drawer. Staff M stated that the tablets/capsules are not supposed to be loose in the cart. Staff M discarded the tablets/capsules in the drug disposal canister. Residents Affected - Few 10) On [DATE] at 9:33 AM, observation revealed the facility's Seaside North Medication Cart parked in the residents hallway, unlocked and unattended. The facility's WCN walked by and confirmed that the cart was left unlocked. Observation revealed Staff O, RN walking towards the medication cart and stated she was supposed to lock it when she steps away from it. On [DATE] at 9:35 AM, an interview was conducted with Staff U, LPN who stated the medication cart was supposed to be locked when unattended. Staff U stated she trained Staff O to lock the cart when she leaves the cart. Based on review of policy and procedure, observation, interview and record review, it was determined that the facility failed to: 1) ensure that it secured the over-the-counter (OTC) medications in an empty resident room; 2) ensure that it secured an OTC medication observed during tour for Resident #46; 3) ensure that it secured an un-ordered OTC and expired prescription medication observed during tour for Resident #4; 4) ensure that it properly secured a second floor Wound Care Treatment Cart; 5) ensure that it properly secured an E-kit which was left unlocked in the Medication Room on the 300 unit; and 6) ensure that it properly secured loose pills in 2 out of 3 carts reviewed, in the Seaside North Medication cart and Second Floor East Medication Cart. The findings included: Review of the facility policy and procedure on [DATE] at 9:48 AM titled Storage and Expiration Dating of Medications, Biologicals provided by the Director of Nursing (DON) revised [DATE] documented in the Policy Statement: . This policy .sets forth the procedures relating to the storage and expiration dates of medications, biologicals, syringes and needles. Procedure: 1. Facility should ensure that only authorized facility staff, as defined by facility, should have possession of the keys, access cards, electronic codes, or combinations which open medication storage areas. 2. Facility should ensure that medications and biologicals are stored in an orderly manner in cabinets, drawers, carts .3.3 Facility should ensure that all medications and biologicals, including treatment items, are securely stored in a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors .Facility should ensure that medications and biologicals that: (1) have an expired date on the label are stored separate from other medications until destroyed or returned to the pharmacy or supplier 13. Bedside Medication Storage: 13.1 Facility should not administer/provide bedside medications or biologicals without a Physician/Prescriber order and approval by the Interdisciplinary Care Team and Facility administration. 13.2 Facility should store bedside medications or biologicals in a locked compartment within the resident's room .15. Facility should ensure that medications and biologicals for expired or discharged or hospitalized residents are stored separately, until destroyed or returned to the provider 1) During tour conducted on [DATE] at 10:43 AM and at 2:18 PM, in resident room [ROOM NUMBER]-2, it was observed that there was one (1) full bottle and one (1) used bottle of over-the-counter (OTC) Normal Saline solution observed on the bedside dresser in the room, both with an expiration date of [DATE]; the bottles were exposed, unsecured and accessible to other residents, staff members and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 25 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 visitors. Level of Harm - Minimal harm or potential for actual harm 2) Resident #46 was re-admitted to the facility on [DATE] with diagnoses which included Crohn's Disease, Major Depressive Disorder, Obsessive Compulsive Disorder. He had a Brief Interview Mental Status (BIM) score of 15 (cognitively intact). Photographic evidence obtained. Residents Affected - Few During an observational room tour conducted on [DATE] at 10:46 AM and 2:19 PM, it was observed that Resident #46's room was observed to have one (1) used cream medication tube of OTC Desitin 40% Zinc Oxide with an expiration date of 09/23, sitting atop the resident's bedside dresser in a clear plastic bag exposed, unsecured and accessible to other residents, staff members and visitors. On [DATE] at 10:45 AM and at 2:30 PM, Resident #46's room was still observed with one (1) used tube of OTC Desitin 40% Zinc Oxide sitting atop the resident's bedside dresser in a clear plastic bag. On [DATE] at 11:42 AM Resident #46's room was still observed with one (1) used tube of OTC Desitin 40% Zinc Oxide atop the resident's bedside dresser in a clear plastic bag. Side-by-side record review was conducted with Staff Q, a Registered Nurse (RN), indicated that neither Resident #46's hard copy chart nor his computerized Point-Click-Care (PCC) medical record indicated that the resident had any self-assessment completed in order for him to be able to administer his own medications. There was no order on the Resident #46's Medication Administration Record (MAR) for this OTC medication to be administered to this resident. 3) Resident #4 was admitted to the facility on [DATE] with diagnoses which included Hemiplegia and Hemiparesis following Cerebral Infarction affecting Right Dominant Side, Aphasia, Seizures. She had a Brief Interview Mental Status (BIM) score of 05 (severely impaired). Photographic evidence obtained. During an observation of the room on [DATE] at 12:49 PM, there was one (1) tube of prescription Betamethasone Dipriprionate 0.05% cream, which had an expiration date of [DATE]. Additionally, there was one (1) tube of Exederm 1% Hydrocortisone cream OTC with an expiration date of 07/23. Both tubes were in plain sight in a clear plastic bag atop the resident's bedside dresser table; exposed, unsecured and accessible to other residents, staff members and visitors. On [DATE] at 2:32 PM Resident #4's room was still observed with one (1) tube of prescription Betamethasone Dipriprionate 0.05% cream, and one (1) tube of Exederm 1% Hydrocortisone cream OTC, both still remaining in plain sight in a clear plastic bag, atop the resident's bedside dresser table. On [DATE] at 11:52 AM Resident #4's room was still observed with the two tubes of cream medications. Both cream medication tubes remained in plain sight in a clear plastic bag. However, this time, both tubes were atop the resident's roommate's bedside dresser table. Side-by-side record review was conducted with Staff Q, who indicated that neither Resident #4's hard copy chart nor her computerized Point-Click-Care (PCC) medical record indicated that the resident had any self-assessment completed in order for her to be able to administer her own medications. An interview was conducted on [DATE] at 12:10 PM with Resident #4's nurse, Staff Q, regarding the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 26 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 cream medication tubes observed on Resident #46's and Resident #4's bedside table and she acknowledged that the cream medication tubes should not have been there. There was no order on the Resident #4's Medication Administration Record (MAR) for the OTC and prescription medication to be administered to this resident. Residents Affected - Few 4) During an observation on [DATE] at 12:30 PM, of the Wound Care Treatment Cart located on the 2nd floor, it was observed that this cart was left un-locked, unattended and accessible to other residents, staff members and visitors; with no nurse in sight on the unit. The Wound Care Treatment cart houses the treatment cream medication tubes of some fifty-two (52) residents on the unit. On [DATE] at 12:10 PM the Director of Nursing (DON) further acknowledged and recognized that the OTC and prescription medications should not have been left at either of the resident's bedsides, nor should the Wound Care Treatment cart be left unlocked and unattended. She indicated that the medications should be kept locked at all times; this was not done. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 27 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0791 Provide or obtain dental services for each resident. 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 dental services in a timely manner for 1 of 1 resident reviewed for dental (Resident #75). Residents Affected - Few The findings included: A review of the facility's policy titled Dental Service, revised on 03/02/19, showed the following: It is the policy of the facility to ensure that residents obtain needed dental services, including routine dental services; to ensure the facility provides the assistance needed or requested to receive these services; to ensure the resident is not inappropriately charged for these services; and if a referral does not occur within three business days, documentation of the facility's to ensure the resident could still eat and drink adequately while awaiting dental services and the extenuating circumstances that led to the delay. Resident #75 was readmitted to the facility on [DATE] with diagnoses of adult failure to thrive, unspecific dementia, and anemia. A review of the Order Summary Report showed an order for a Dental consult dated 12/20/22, which was about one month after Resident #75's admission. In an observation conducted on 02/13/23 at 12:05 PM, the lunch tray arrived at Resident #75's room and was placed at the bedside. Staff set up the tray for Resident #75 and left the room. The meal ticket showed an order for No Added Salt (NAS) Regular diet with chopped meat. The tray had the following food items: breaded pork chops 2-3 inches in size, spinach, sweet potatoes, and 4 ounces of apple juice. No nutritional supplements were noted on the tray. Continued observation at 12:26 PM showed that Resident #75 was eating alone and only ate a few bites of his lunch meal. Resident #75 did not have any upper dentures in place and was noted with no teeth on his upper and lower mouth. In an observation conducted on 02/13/23 at 5:10 PM, the dinner tray was brought into Resident #75's room. The staff set up the tray and left the room. Closer observation showed a dinner tray with chopped fish, mashed potatoes, and a health shake. Resident #75 did not have any upper dentures in place and was noted with no teeth on his upper and lower mouth. The care plan initiated on 11/29/22 showed to maintain the resident oral/dental health: resident has no natural teeth, wears top dentures only, and will be free of infection, pain, or bleeding in the oral cavity by/through the review date. Assist resident with a denture (top) as needed. Monitor/document signs of oral/dental problems needing attention: Pain (gums, toothache, palate), Abscess, Debris in mouth, Lips cracked or bleeding, Tongue (black, coated, inflamed, white, smooth), Ulcers in mouth, Lesions. In an interview conducted on 02/15/23 at 12:10 PM with Staff D, Social Worker, she stated that she was still determining if Resident #75 had an order for a dental consultation. She said that Resident #75 has not had any dental consultation or visitation done since his admission on [DATE]. She further said that he is on her list this coming Monday for a Dental Evaluation. When asked about dental consultation/orders, she said that nursing would usually let her know if a Resident has a consultation for dental, and she will make sure that resident is placed on the list to be seen. A Dietary progress note completed on 02/16/23 showed the following: Resident #75's Body Max Index (BMI) dropped from 22.8 to 20.4, which is underweight for his age. He also had a significant weight (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 28 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0791 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few loss of 13.8# (10.7%) x 3 months. Weight loss may be contributed to the overall decline in status, discussed with nursing. A speech consult was in place, and his diet was downgraded to Puree on this date. Progress noted dated 02/16/2023 showed that Resident #75's son called back and was made aware of weight loss. He has no questions or concerns; however, he did ask about his father's dental follow-up on Monday. In an interview conducted on 02/16/23 at 5:00 PM with the Administrator, he was told of the findings and Surveyor's concerns that a dental consult was not done, which was ordered almost three months ago. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 29 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and recorded review, the facility failed to ensure the correct fluid restrictions as per Physicians orders for 1 of 1 resident reviewed for Dialysis (Resident #110). The findings included: A chart review showed that Resident #110 was readmitted on [DATE] with diagnoses of chronic kidney failure, type 2 diabetes, and dependency on dialysis. The Treatment Administration Records revealed an order for 1500 milliliters (ml) of fluid restriction, with 900 ml for meals and 600 ml provided for nursing, which was dated 01/28/23. In an interview conducted on 02/13/23 at 9:40 AM with Resident #110, he stated that he goes to dialysis on Mondays, Wednesdays, and Fridays. He further said that he was aware that he was on a fluid restriction. Closer observation showed 16 ounce Styrofoam cup with water at the bedside. In an observation conducted on 02/13/23 at 5:10 PM, the dinner trays arrived on the unit. At 5:30 PM, Resident #110's tray was placed at the bedside. Closer observation of the meal ticket did not show that Resident #110 was on any fluid restriction. In an observation conducted on 02/14/23 at 8:10 AM, Resident #110 breakfast tray was noted in the meal cart. Closer observation showed a tray with two regular milk cartons that are 8 ounces each and one container of 4 ounces of juice. This is a total of 20 ounces of fluids which is 750 ml of fluids served for breakfast. In this observation, Staff A, CNA, came into the room to provide Resident #110 with 8 ounces of coffee and placed it on the side table. This was an additional 240 ml of fluids for a total of 1000 ml just for breakfast. (Photographic evidence obtained). An interview conducted on 02/14/23 at noon with the Food Service Director stated that any residents on fluid restrictions is going to show on the meal ticket with a specific ml breakdown for each meal. He further said that once there is an order for fluid restriction, Staff F, Dietary Technician, will assess the breakdown and give him the list to input into the system that is generated on the meal tickets. In an interview conducted on 02/14/23 at 3:00 PM with Staff F, she stated that any residents who are on fluid restrictions would show on the meal ticket per meal the number of fluids and the breakdown for each meal. She further said that the orders for fluid limits are given to her by the nursing staff. The care plan 11/16/22 showed that Resident #110 is receiving dialysis and to check for fluid restrictions parameters and fluid excess, and edema. It further showed that Resident #110 has a potential fluid imbalance related to dialysis and fluid restriction. Provide fluid restrictions as per orders and no water pitcher at the bedside. A review of the Diet meal tickets for Resident #110, dated 02/15/23, showed that he was on fluid restriction, which was not on the meal tickets before 02/15/23. An interview conducted on 02/15/23 at 3:00 PM with Food Service Director stated that he had just (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 30 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few updated the meal tickets for Resident #110 with fluid restriction and acknowledged that he was unaware that Resident #110 needed to be on a fluid restriction. The Treatment Administration Records showed an order for 1500 milliliters (ml) fluid restriction, which included 840 ml for meals, with 480 ml for breakfast, 180 ml for lunch, and 180 ml for dinner, dated 02/15/23. In an interview conducted on 02/16/23 at 5:00 PM with the Administrator, he was told of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 31 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the Facility failed to notify and ensure that the arbitration agreement grants the Resident or their representative the right to rescind the Agreement within 30 calendar days of signing it for 2 of 3 residents reviewed during the Arbitration review (Resident #83 and Resident #102). Residents Affected - Few The findings included: A review of the Facility's Arbitration Agreement titled Voluntary Binding Arbitration Agreement provided by facility staff, under section F showed the following. This Agreement may be canceled by written notice sent by certified mail, return receipt requested, to the Facility's Administrator within fifteen (15) calendar days of the Resident's admission date. If alleged acts underlying the dispute are committed before the cancellation date, this Agreement shall be binding with respect to said alleged acts. If not canceled in writing, this Agreement shall be binding on this admission and all `the Resident's other admissions to the Facility without any need for further renewal. A chart review showed that Resident #83 was admitted to the facility on [DATE]. Further review revealed that she signed the arbitration agreement on 01/18/2023. The Agreement signed by Resident #83 showed that she had 15 calendar days to rescind the Agreement. A chart review showed that Resident #120 was admitted to the facility on [DATE]. Further review revealed that she signed the arbitration agreement on 01/10/2023. The Agreement signed by Resident #120 showed that she had 15 calendar days to rescind the Agreement. In an interview conducted on 02/15/23 at 11:42 AM with Staff E, Concierge, stated that she works hand in hand with admission and is responsible for the arbitration agreement part of the admission packet. She lets the residents know that an arbitration agreement is when a 3rd party person is used for a dispute that might arise between the residents and the Facility. she further tells them that it is optional to sign and that she keeps a copy of the signed contract. When asked if a resident wanted to rescind the signed Agreement and how many days they have if they change their mind, she said, I do not know. I will have to check and get back to you. In an interview conducted on 02/15/23 at 12:58 PM, Resident #83 stated that Staff E explained the Arbitration process before signing the Agreement. When asked if she was told that she could change her mind and that she had specific days to do so, she said no. In an interview conducted on 02/15/23 at 12:50 PM, Resident #120's Daughter stated that she did not remember signing anything regarding arbitration and that when her mom was admitted , everything was confusing and hectic. She said, I am sure it was explained to us when we came in. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 32 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and review of policy and procedure, it was determined that the facility failed to ensure that it practiced appropriate hand hygiene 1) after performing a blood sugar check for a resident during an Accucheck Observation for 1 of 1 sampled residents (Resident #16); and 2) Before and after medication administration; and 3) failed to disinfect reusable blood pressure equipment before and after each use with an approved EPA as per the facility's policy. Residents Affected - Some The findings included: Review of the facility's policy titled Infection Prevention and Control and Surveillance Program revised on 03/02/19 documented .hand hygiene should be performed .before and after performing any invasive procedure (e.g., finger stick blood sampling) .upon and after coming in contact with a resident's intact skin (e.g. when taking a pulse or blood pressure) .after removing gloves .all shared medical equipment will be cleaned using an EPA-approved disinfectant wipe against TB (tuberculosis) and Hepatitis B . 1) On 02/13/23 at 4:40 PM, medication administration observation for Resident #82 performed by Staff T, Licensed Practical Nurse (LPN). Staff T entered the resident's room, performed hand hygiene, donned gloves, placed the wrist blood pressure cuff in to the resident's wrist, checked the blood pressure, removed her gloves, and without performing hand hygiene, Staff T left the resident's room, walked to the medication cart, logged in to the computer without performing hand hygiene. 2) On 02/13/23 at 4:56 PM, observation of a blood glucose check for Resident #16 performed by Staff T was conducted. Staff T, LPN gather the blood glucose testing supplies, entered the resident's room and performed hand hygiene for eight (8) seconds. Staff T donned gloves, performed the resident test, removed gloves and without performing hand hygiene, walked out of the resident's room and returned to the medication cart. Staff T without performing hand hygiene logged into the computer and documented the resident's results, then donned gloves and cleaned the blood glucose meter. On 02/15/23 at 1:04 PM, an interview was conducted with the DON and was apprised of findings. The DON stated that the staff had been in-serviced many times regarding hand washing (Hand Hygiene) and that the hand washing should be done for 20 seconds. 3) On 02/14/23 at 8:29 AM, observation revealed Staff B, Registered Nurse (RN) taking Resident #380's blood pressure. Further observation revealed Staff B placed the blood pressure machine in the medication cart's drawer without disinfecting it. An interview was conducted with Staff B who stated she was going to do medication administration for the residents. 4) On 02/14/23 at 8:58 AM, medication administration observation for Resident #91 performed by Staff B, RN started. Staff B entered the resident's room with the facility's wrist blood pressure machine she used with Resident #380. Observation revealed Staff B, without performing hand hygiene and without disinfecting the blood pressure machine, placed the machine cuff on Resident #91's right wrist. Staff B stated the resident's blood pressure was 92/71 and the pulse was 67. Observation revealed Staff B performed 13 seconds hand hygiene after medication administration to Resident #91. Continue observation revealed Staff B unlocked her personal cell phone and stated, I have not heard from that person in a long time. Staff B without performing hand hygiene, returned to the desktop (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 33 of 34 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 105521 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Boca Raton, Inc. 1130 NW 15th Street Boca Raton, FL 33486 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 computer and printed Resident #91's Medication Administration Record (MARs). Level of Harm - Minimal harm or potential for actual harm On 02/14/23 at 9:36 AM, during an interview, Staff B was asked when she was supposed to clean the blood pressure machine and she stated she should have disinfected the blood pressure cuff after use and had not done it. Observation revealed Staff B retrieved an alcohol pad and cleaned the blood pressure cuff with three alcohol pad. Staff B stated she always cleans the blood pressure cuff with alcohol pads. Staff B did not perform hand hygiene after disinfecting the blood pressure cuff. Residents Affected - Some 5) On 02/14/23 at 9:43 AM, continue observation revealed Staff B continues without performing hand hygiene and proceeded to check Resident #377's blood pressure with the blood pressure cuff she cleaned with a non-approved disinfecting product. Staff B then walked to the nurses station and without performing hand hygiene, logged in to the desk computer to retrieve residents record. On 02/15/23 at 10:22 AM, during an interview, the DON was apprised of the findings. The DON stated that the nurses were to use the Sani Cloth- purple wipe to clean the blood pressure cuff, not the alcohol pad. 6) On 02/13/23 at 10:35 AM observation was made of a urinary catheter in a garbage can and tubing on the floor while Foley catheter was indwelling in Resident #121 ( photographic evidence obtained). Resident #121 was admitted to the facility on [DATE] from an acute care hospital. She was not able to do the Brief Interview for Mental Status (BIMS) due to resident never/rarely understood. She had an indwelling catheter for Neurogenic bladder. Other diagnoses included Cerebral Infarction and Type 2 Diabetes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 34 of 34