Health inspection·January 10, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2. An observation conducted on 01/09/24 at 8:15 AM revealed a broken handrail between rooms [ROOM NUMBERS] and a broken hand sanitizer dispenser between rooms [ROOM NUMBERS]. Numerous broken ceiling tiles were also noted throughout the second floor. 3. A linen cart was noted on the first floor during the environmental tour conducted on 01/09/24 at 8:20 AM. Inside were clean bed linens that were placed next to dirty gloves, stuffed in what appeared to be an incontinent brief plastic bag. In an interview conducted on 01/09/24 at 4:00 PM with the facility's Administrator, she was told of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 2 of 7 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 01/10/2024 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 - 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 provide nutritional interventions in a timely manner to prevent significant weight loss for 3 of 3 residents reviewed for nutrition (Resident #5, Resident #7, and Resident #6). Residents Affected - Few The findings included: A review of the facility's policy titled Weight Management revised on 03/02/2019 showed the following: Residents will be weighted monthly unless otherwise ordered by the physician or deemed necessary by the dietician and or the interdisciplinary team. Monthly weights will be completed each month. Dietary will evaluate all weights each month. A re-weight will be obtained for any weight change of +/- 5 pounds. from the previous weight unless other parameters have been ordered by the physician. The physician and the resident or resident representative will be notified by the resident's nurse of any significant unexpected and or unplanned weight changes. 1) On 12/01/23, Resident #5 was admitted to the facility with a medical history of Encephalopathy, Major Depressive Disorder, Bipolar Disorder, Acute Respiratory Failure, Insomnia, Dysphagia, and Contracture of Left Hand. An admission Minimum Data Set (MDS) dated [DATE] revealed that Resident #7 had a Brief Interview of Mental Status (BIMs) score of 15 which indicated that he is cognitively intact. Section GG revealed that Resident #7 required substantial assistance for eating and all his Activities of Daily Living (ADLs). Review of Resident #7's Weight and Vitals Summary report revealed that on 12/01/23 his weight was 130 pounds and on 01/05/24 he was 112.2 pounds. This showed a significant weight loss of 13.69 percent in a little over a month. Review of the Physician's orders revealed Regular diet Pureed (L1) texture, Nectar consistency dated 12/02/23; Frozen Nutritional Treat, one time a day for nutrition dated 12/05/23; Dietary Consult dated 12/13/23 (which was not addressed); Health shake two times a day breakfast/dinner dated 12/29/23; Calorically Dense Oral Supplement three times a day for nutrition support 120 ml dated 01/05/24; Verify Head of Bed (HOB) is elevated a minimum of 30 degrees as resident tolerates every shift dated 01/05/24. Review of the Mini Nutritional assessment dated [DATE] revealed Resident #5's Body Mass Index (BMI) of 20.4 which is underweight for his age. He presented with buccal and temporal wasting (clinical signs of malnutrition). Resident #5 intake is mostly 76-100 percent, which should meet nutritional requirements, however, he would benefit from weight gain due to underweight body status. The recommendation was for a frozen nutritional treat during lunch for an addition of 290 Kilocalorie a day for nutritional support. Staff F, Certified Dietary Manager (CDM) Progress Note dated 12/28/23 revealed a phone call with Resident #5's mother. The mother expressed concern about her son's weight and why the facility is not providing nutritional supplements. Staff F stated that Resident #5 does have nutritional shakes with each meal and currently no weight loss has been noted. In addition, Staff F stated that the goal is to prevent weight loss. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 3 of 7 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 01/10/2024 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 - Minimal harm or potential for actual harm Review of the Point of Care (POC) Summary for percentage of meals consumed by Resident #5 revealed that between 12/11/23 and 01/05/24, the Certified Nursing Assistant (CNA) noted 63 meals with the following: one meal consumed 0-25%, 19 meals consumed 26-50%, 27 meals consumed 51-75%, 12 meals consumed 76-100%, and 4 meals were refused. This showed that Resident #5 consumed between 47.2 and 71% of his 63 meals in about a month. Residents Affected - Few On 01/09/24 at 1:26 PM, an interview was conducted with Staff F. She stated that as per facility's policy, the weight of the resident is done upon admission, weekly for the first month and then monthly thereafter. Staff F stated that the nursing staff are responsible for obtaining all the weights (weekly and monthly) and then the dietary technician follows up with notes and recommendations. She stated that Staff D (Dietary Technician) does the nutritional assessments, but she is out sick and is being covered by Staff E (Dietary Technician) who is familiar with the facility. In addition, Staff F explained that the policy she stated earlier is from another facility she worked at and has not seen this facility's policy. On 01/09/24 at 1:59 PM, an interview was conducted with Staff E. She stated that this is her first time at this facility and has no knowledge of the facility's policy for weights. She also stated that she covers clinical work, plus any new admission and high-risk residents. When asked about how she obtains the list for weekly weights, she stated that she gets the list from Staff D. On 01/09/24 at 2:06 PM, a phone interview was conducted with Staff D. She stated that she believes that the facility's policy is to weigh residents upon admission and monthly thereafter. In addition, she stated that if a resident has a poor intake or the weight declines then weekly weights would be done. Staff D stated that she does not participate in the Care Plan for the residents. When asked about Resident #5 and why she did not request weekly weights, she stated that Resident #5's intake upon admission was 76-100%. But when she noticed that Resident #5's intake decreased, she ordered an additional supplement twice a day (only on 12/29/23, which was almost a month after Resident #5's initial admission assessment). An interview was conducted on 01/09/24 at 5:03 PM with Staff H, Certified Nursing Assistant (CNA). She stated that she provided daily care for Resident #5 and assisted him with feeding and fluid intake. Staff H stated that Resident #5 preferred more fluids than eating the food and he always required assistance for both drinking and eating. In addition, she stated that he would eat about 25-30% of his food. On 01/10/24 at 10:11 AM, an interview was conducted with Staff G, Speech Therapist. She stated that Resident #5 was under general precautions for dysphasia, which include: having simple sips of liquids, with the goal to tolerate drinking with a straw and not experiencing signs and symptoms of aspiration; during meals to sit upright at a 90-degree angle if tolerated. Staff G stated that she would assess Resident #5 usually during breakfast or lunch and saw him 10 times in December. During the time she was with the resident, Staff G stated that Resident #5 consumed 0-30% of his meals. On 01/10/2024 at 11:33 AM, interview conducted with the Director of Nursing (DON), She stated that Resident #5 had a history of aspiration pneumonia when admitted to the facility from the hospital. In addition, she stated that this was why it was important to place an order to make sure bed is elevated 30 degrees, in order for resident to eat safely and not aspirate (order was placed on 01/05/24). In this interview, the DON was made aware of the findings. 2) In an interview conducted on 01/09/24 at 8:22 AM, Resident #7 reported that she lost weight but (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 4 of 7 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 01/10/2024 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 could not say how much. Level of Harm - Minimal harm or potential for actual harm A chart review showed that Resident #7 was admitted to the facility on [DATE] with diagnoses of Dementia, Hyperlipidemia, and Mood Disturbances. The Weights and Vitals Summary showed the following weight history: 161.8 pounds on 09/23/23, 160.8 pounds on 11/03/23, 138.4 pounds on 12/01/23, and 127.6 pounds on 01/05/24. This showed that Resident #7 had a significant weight loss of 13.9% in one month from 11/03/23 to 12/01/23. It further showed a significant weight loss of 20.1% in two months from 11/3/23 to 01/05/24. Residents Affected - Few The Order Summary Report revealed the following: an order for Health Shake, one time a day dated 12/01/23, Speech consultation dated 12/01/23 (which was not addressed), Psych consultation for appetite stimulant dated 01/01/24 (which was not addressed), and calorically dense oral supplements three times a day dated 01/05/24. A review of the Quarterly MDS dated [DATE] showed that Resident #7 had a BIMS score of 08, which is moderate to severe cognitive impairment. Section GG showed that Resident #7 was able to eat independently. A progress note by the Director of Nursing dated 12/01/23 revealed that Resident #7 had a decrease in appetite and showed no interest in food. The nutrition progress note dated 12/01/23 revealed that Resident #7 presented with significant weight loss of 13.9% in 30 days. It further showed that Resident #7's meal intake is mostly between 26% and 50%. Estimated caloric needs were between 1548 and 1689 calories a day. BMI was noted at 21.7, which was underweight for the age category. In this note, Staff D recommended a nutritional supplement once a day that only added 200 calories a day. The nutrition progress note dated 01/05/24 revealed a new significant weight loss of 7.8% in one month, with a new BMI of 20, which was underweight for age. Her intake is between 26% and 100% of meals, which does not meet her nutritional needs. In this progress note, Staff D is recommending a calorically dense oral supplement three times a day. A review of the care plan that was initiated on 09/22/23 on admission did not show a nutrition care plan section that was started by the dietary staff. In an interview conducted on 01/10/24 at 1:00 PM, Staff D stated that when she identified the significant weight loss on 12/1/23, she provided Resident #7 with one nutritional supplement daily and updated her meal tickets and meal preferences. She further said that Resident #7 is eating her lunch in the dining room to monitor her intake and provide likes and preferences as needed. When asked why she did not follow weekly weights after the significant weight loss was identified on 12/1/23, she did not answer. When asked as to why she did not address the poor appetite with the doctor until 1/1/24, she did not know. In an interview conducted on 01/10/24 at 12:15 PM, Staff K, a Certified Nursing Assistant, stated that Resident #7 does not eat lunch at times but prefers soups and grilled cheese sandwiches. In an observation conducted on 01/10/24 at 1:11 PM, Resident #7 was observed eating lunch in her room and not in the dining room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 5 of 7 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 01/10/2024 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 - Minimal harm or potential for actual harm Residents Affected - Few A review of the food preferences electronic system showed that a grilled cheese sandwich was only added as a food preference on 01/09/24. 3) Record review revealed that Resident #6 was readmitted to the facility on [DATE] with diagnoses of Type 2 Diabetes, Anemia, and Chronic Kidney Disease. The Weights and Vitals Summary showed the following weight history: 170.4 pounds on 06/05/23, 169.2 pounds on 07/03/23, 163.4 pounds on 08/04/23, 161.8 pounds on 09/05/23, 160.2 pounds on 10/02/23, 158 pounds on 11/03/23, 151.4 pounds on 12/12/23 and 152 pounds on 01/05/23. This revealed a significant weight loss of 10.1% in 5 months. A review of the nutrition progress note dated 08/29/23 revealed that Resident #6's weight loss was attributed to recent abnormal labs and some decreased intake was noted. It further showed that Resident #6 had a history of saying that she could lose some weight. It further showed to monitor monthly weights, labs, and meal intake. A review of the Nutrition Comprehensive Evaluation Screen dated 10/27/23 revealed the following: The weight loss may have contributed to the occasional decreased intake noted. Resident #6's intake of meals is between 51% to 100%, occasionally less than 50% intake of meals. It further showed that Resident #6's diet is adequate to meet her nutritional needs. The continued review showed no nutritional follow-up notes or assessments after 10/27/23. The Order Summary Report revealed an order for Consistent Carbohydrate Regular diet, which was dated 10/05/22. Lasix (diuretic) tablets 20 milligrams one time a day dated 10/05/22. In an interview conducted on 01/09/24 at 4:50 PM, using Google Translate (a translation application), Resident #6 was asked the following questions by Surveyor: Was your weight loss intentional? She answered no. She was asked if her weight loss was desired, and she said no. She was asked if she was happy with her weight loss and said no. She was asked if she had a poor appetite and said yes. She was asked if she knew how much weight she lost, and Resident #6 proceeded to write on a piece of paper 188-152, indicating the large amount of weight she lost. She was asked if she would like nutritional supplements, and she said yes. The care plan dated 11/10/23 revealed the following: Resident #6 has nutritional risk related to a history of Type 2 Diabetes and Anemia. She requires diuretic use, which may negatively impact her hydration status. Goals in place were noted to consume adequate nutrition to meet estimated needs upon each review, monitor weights per facility protocol, and for the Dietitian to evaluate and make changes/recommendations as needed. In a phone interview conducted on 01/10/23 at 11:20 AM with Staff D, the Dietetic Technician stated that she follows up on all residents as needed and that in the past, Resident #6 reported that she wanted to lose weight. When the Surveyor asked why she did not address the significant weight loss on 12/12/23, she did not answer. When the Surveyor asked why she did not address the significant (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 6 of 7 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 01/10/2024 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 weight loss on 01/05/24, she did not respond. Level of Harm - Minimal harm or potential for actual harm In an observation conducted on 01/10/24 at 9:10 AM, Resident #6 was noted asleep in her bed. Closer observation showed that she ate most of her breakfast meal but did not touch any of her oatmeal. Residents Affected - Few An interview was conducted on 01/10/24 at 9:20 AM with Staff I, Certified Nursing Assistant, who stated that Resident #6 eats breakfast and dinner in her room and lunch meal in the dining room. She further said that she eats well with no issues. An interview conducted on 01/10/24 at 9:20 AM with Staff J, Certified Nursing Assistant, stated that Resident #6 eats 100% of her meals if she likes her food and will only eat between 50 to 75% if she does not like the meals. When asked if she lost weight, Staff J said no. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105521 If continuation sheet Page 7 of 7