Inspection·May 4, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on records review and interview, the facility failed to develop and implement a comprehensive person-centered care plan for activities that included measurable objectives and timeframes to meet the needs for 1 of 3 sampled residents, Resident #103, reviewed for psychosocial needs. The findings included: Record review documented Resident #103 was admitted to the facility on [DATE] with diagnoses to include Nontraumatic Subdural Hemorrhage and Respiratory Failure. Review of the Minimum Data Set assessment (MDS), section C dated 03/31/23, revealed the Brief Interview for Mental Status (BIMS) score could not be assessed, indicating severe cognitive impairment. On 05/01/23 at 10:44 AM, Resident #103 was observed in bed with no personal sensory stimulation equipment in the room. On 05/02/23 at 11:42 AM, Resident #103 was observed in bed with no activities. There were no sensory stimulation in his personal space. Review of the comprehensive care plans dated 02/10/23 and updated 04/07/23 revealed there was no plan for activities. There were no documented records of ongoing activities. During an interview with the Activity Director (AD) on 05/03/23 at 2:35 PM, she said that she did not have Resident #103 listed as a person requiring 1:1 activity. She also said family visitation is the only type of ongoing activity Resident #103 was having. When questioned about the Resident's plan of care for activities, the AD said that she did not know Resident #103 did not have a plan for activities. She said when the resident was first admitted to the facility, he could not to do anything. She said the resident has a granddaughter who told her that the resident likes light jazz music. The AD said she would implement an activity plan for the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 2 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of clinical record of Resident #45 documented an admission of 06/04/20 with diagnoses that included Atrial Fibrillation, Muscle Wasting and Atrophy, Dysphagia, Cognitive Communication Deficit, Lack of Coordination, and Convulsions, Residents Affected - Few Review of the current Physician Orders revealed: 04/24/23 - Weighted Utensils and Lip Plate 04/24/23 - No Added Salt Diet 03/16/23 - Patient to continue with use of Inner Lip Plate and Weighted Utensils during meals to Promote Independence. Review of current quarterly MDS dated [DATE] documented: Usually Understood and Understands with Brief Interview for Mental Status (BIMS) score of 4, indicating severe cognitive impairment; Feeling Down, required supervision and only set up with eating and is on a mechanically altered diet. Review of current care plans dated 02/12/23 documented: Problem: Nutritional Risk d/t [due to] Convulsions and Muscle Wasting Approach: Adaptive Device; Lip Plate & Weighted Utensils. Observation of the lunch meal on 05/01/23 in the Main Kitchen at 11:45 AM noted Resident #45's meal tray ticket documented: Weighted Utensils - Lip Plate - NAS Diet [no added salt]. Observation of the resident's tray noted only a built-up weighted spoon, no weighted knife, and a regular meal plate was provided. The Lip Plate was noted to be heavily stained yellow in color. Further observation noted that 3 of 3 adaptive lip plates were also heavily stained and no new plates were in supply. Interview with the Director of Therapy on 05/01/23 noted the kitchen had an inadequate supply of adaptive eating utensils and scoop plates. Interview with the Director of Skilled Therapy on 05/02/23 revealed that she has reviewed the supply of adaptive eating equipment (silverware, plates, etc.) and new purchases have been made, but there was an insufficient supply of weighted and built-up utensils, lip plates, and divided plates. During the observation of the breakfast meal on 05/03/23 at 9 AM, it was observed the meal tray was served to the room of Resident #45. Review of the resident's Meal Tray Ticket documented: Lip Plate, Weighted Utensils, and No Added Salt Diet. Review of the resident's meal tray noted that only a weighted fork and spoon were provided, and a weighted knife was not included on the tray. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 3 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with the resident at this time noted some cognitive deficit, however she stated she would like a weighted knife with meals. Continued observation noted that a knife should be included for the resident to be able to independently butter toast, apply jelly to toast and cut the omelet into bite size pieces. It was noted during the observation, the resident had severe hand tremors and gripping issues. It was observed that the resident attempted to open the milk and juice containers without success. The tray was removed without the resident drinking any of the tray beverages (milk, orange juice, water). During the observation, the surveyor requested the Director of Therapy to come to the resident's room to observe the resident issues. The director stated the resident is required to receive weighted fork, knife, and spoon with all meals. The Director also stated there is an adequate supply in the dietary department. The surveyor also inquired why the resident was not assessed and receiving adaptive weighted drinking cups that would be easier for the resident to grasp and control the sever tremors. The Director stated the resident would be screened for additional adaptive eating and drinking equipment and it had been some time since the resident's last adaptive eating equipment screening. On 05/03/23, the Therapy Director submitted an Occupational Therapy Screening form dated 05/03/23 that documented the resident's need and agreement for additional adaptive equipment. The form documented the purchase of Sippy Cups and Two Handled Weighted Mugs that are designed to help residents with weak grasp and unsteady hands. It was further discussed that the screening should be conducted more frequently than quarterly due to the resident's severe tremors and to maintain the resident's independence with eating and drinking. During an observation of the lunch meal on 05/03/23 at 1:00 PM, it was noted the resident received a Sippy Cup until the weighted Sippy Cups were delivered. The resident's juice was noted to be in the Sippy Cup and resident was noted to be drinking without difficulty grasping or spillage. The resident stated she likes the new cup. Based on observations, interviews, and records review, the facility failed to provide adaptive equipment to maintain, restore or improve the functional abilities of 2 of 4 sampled residents, Resident #45 and Resident #103, as evidenced by: no splint for Resident #103, and no weighted utensils and lip plate for Resident #45. The findings included: 1. Review of the Minimum Data Set (MDS) dated [DATE], for Resident #103, under section G (functional Status) and G0110 for ADL (Activities of Daily Living) Assistance documented the resident was totally dependent on staff for all ADLs. Review of the care plan dated 04/17/23 revealed: RANGE OF MOTION: The Resident has a risk or actual limitations in Range of Motion as evidenced by; Requires Splinting Application to left hand (resting hand splint). The Resident: Will have none to minimal pain, discomfort at acceptable level, Limitation will not interfere with daily functions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 4 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0676 Will remain free of injuries or complications related to limitations of range of motion. Level of Harm - Minimal harm or potential for actual harm Will minimize the risk of complications related to splint application. Residents Affected - Few Will minimize risk of complications related to fracture, such as contracture formation, embolism and immobility. Splint type: resting hand splint_ Apply to: left hand. Staff will apply the splint at __ am/pm Remove at __am/pm (no times indicated), (Remove for bathing or personal care activities). Provide hand hygiene with routine care and prior to application and upon removal of hand splint. The care plan also noted that: If resident removed splint, encourage resident to maintain splint application per recommended duration and inform of the benefits and negative outcomes of removal. Observe fingernails for appropriate length, skin condition to extremity(s), under splint upon splint removal and report areas of concern. The care plan dated 02/10/23 also documented that staff should apply the splint daily on Resident #36 to prevent range of motion (ROM) decline. On 05/01/23 at 10:13 AM, Resident #103's left hand fingers were observed to be contracted. The resident had difficulty opening the hand when asked to do so. Subsequent observations to Resident #36's room revealed the following for Resident #103: 05/01/23 at 1:24 PM, no splint observed. 05/02/23 at 2:14 PM, no splint observed. 05/03/23 at 10:27 AM, left hand fingers observed contracted with no evidence of splints. 05/03/23 at 1:14 PM, no splint observed in place. On 05/03/23 at 10:27 AM, the South Unit Nurse Manager confirmed the resident had a plan of care to wear a splint on the left arm. Review of the completed tasks record for application of the Splint, for the month of April 2023, showed the splint was applied only four times. In the month of May 2023, it showed the splint was applied on 05/01/23 and 05/02/23 during the 11:00 PM to 7:00 AM shift, as evidenced by the documentation time of 22:48 hours (10:48 PM) and 22:55 (10:55 PM) respectively. On 05/03/23 at 1:39 PM, the North Wing Nurse Manager stated they have two CNAs responsible for Restorative Care, as well as all the other certified nursing assistants (CNAs). She said they are supposed to document in the POS when the services are rendered. On 05/03/23 at 1:53 PM, the Unit Manager stated that even though the time to apply the splint is not noted in the plan of care, staff knew they were supposed to render the services during daily during the day. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 5 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Resident 103 was admitted to the facility on [DATE] with diagnoses that included Nontraumatic subdural Hemorrhage and Respiratory Failure. Residents Affected - Few Review of the MDS, section C, dated 03/31/23, revealed the resident had severe impaired cognition and the BIMS score could not be assessed. Review of the record documented a physician order for oral care, dated 02/24/23, of: Use Peridex Mouth/Throat Solution 0.12 % (Chlorhexidine Gluconate (Mouth-Throat)). Give 15 ml by mouth every day and evening shift for Gingivitis Rinse and spit out. On 05/01/23 at 10:49 AM, Resident #103 was observed in bed with a contracted left hand. Resident #103 could not open his hand when requested to do so. Further investigation of the hand revealed that Resident #103's fingernails were untrimmed containing dark matters at the base of the nails bed. It was observed that no oral hygiene care was completed for the resident. The resident's gums were bleeding. The top incisors teeth were covered in blood. On 05/02/23 at 11:44 AM, Resident #103 had not received oral hygiene care as evidenced by bleeding gum observed. On 05/03/23 at 10:10 AM, Resident #103 was observed in bed, his mouth was unclean with visible glue-like saliva, and his lips were very dry. Review of the medication administration record (MAR) for the month of April 2023 showed that all staff documented oral care was provided daily as ordered. Observation of the bottle containing the treatment for the month of May 2023 indicated that the full bottle of Peridex contained 473 ml of the treatment. Photographic Evidence Obtained. Observation on 05/03/23 of the Peridex bottle being used and dated 04/01/23, showed that the bottle was almost half full. Based on the physician order (POS), staff were to use 30 ml daily, and the bottle should have been empty in 16 days. There was no indication the resident refused treatment on any given day. During oral hygiene observation performed by Staff G on 05/03/23 at 10:26 AM, it was noted that Staff G used three spongy swabs to clean the resident's mouth. She cleaned the resident's mouth with the swabs, but the resident retained the swabs in his teeth from time to time and refused to release them. The nurse was asked why she did not give the ordered 15 ml of the Peridex solution. Staff G answered that she did not want to place the content into the resident's mouth because he had a feeding tube. After surveyor intervention, Staff G retracted and administered the solution as ordered. Before administering the solution, Staff G and the surveyor asked the resident who had great difficulty vocalizing words, if he wanted the solution in a cup. After many attempts trying to understand Resident # 103's answer, it was finally depicted that Resident #103 wanted to shake the medication in his mouth and wash his mouth as ordered. After this cleaning, Resident #103's words became clearer and he said, I have been brushing my teeth for 50 years, I know how to do it. Resident #103 thanked the surveyor for intervening and ensuring that oral care was performed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 6 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview with Staff J, Certified Nursing Assistant (CNA) on 05/03/23 at 11:36 AM, who has been working at the facility for two and half years, she said she usually works 11:00 PM - 7:00 PM, and today is the first time she has worked the day shift for this week. She said that she was assigned to care for Resident #103. She stated she has not yet cared for him, and they are supposed to complete their morning assignment by 11:00 AM. Staff J added that it varied from day to day and on whether the residents are manageable or whether there are no other interferences with their assignments. The findings were discussed with the administration staff during the exit meeting on 05/04/23. There was no additional information provided. Based upon interview, record review, and observation, the facility failed to provide fingernail care for 2 of 2 sampled residents observed for Activities of Daily Living (ADLs), related to lack of fingernail care for Resident #103, and Resident #315. The findings included: The facility Policy and Procedure, titled, ADL [Activities of Daily Living]: Assistance, effective date July 2022, had 3 steps. Step three listed the ADLs that staff may perform for or with the resident. Item d. listed Nail Care. 1. Record review documented Resident #315 was admitted on [DATE]. The Minimum Data Set (MDS) admission assessment was completed 04/18/23 that documented Resident #315 had a Brief Interview for Mental Status (BIMS) score of 14 of 15, indicating Resident #315 was cognitively intact. In Section G of the MDS, ADLs, under Item J, Personal Hygiene, Resident #315 was identified as needing extensive assistance with a one person assist. Review of the care plan for Resident #315 documented a focus, titled, SKIN INTEGRITY RISK: The resident has an actual impairment to skin integrity r/t [related to] skin tear to left lower leg. The first intervention listed: Avoid scratching and keep hands and body parts from excessive moisture. Keep fingernails short. On 05/02/23 at 10:24 AM, during an interview, it was observed that Resident #315 had long fingernails with dirt under the nails. When asked if he would like to have his nails trimmed and cleaned, Resident #315 stated he would like that. On 05/03/23 at 10:06 AM, Resident #315 still had long fingernails with dirt beneath the nails. On 05/04/23 at approximately 11:15 AM, a brief visit with Resident #315 revealed the resident still had untrimmed fingernails with dirt under the nails on the edge of the nail bed. On 05/04/23 11:34 AM, an interview was conducted with Staff G, Licensed Practical Nurse (LPN), who stated the nurse is supposed to do assessments on the resident and should determine if the fingernails and toenails needed to be trimmed. Staff G stated that for diabetics, the nails are not to be trimmed. Staff G clarified that she meant fingernails can be trimmed by the nurses, but diabetics needed a podiatrist to provide toenail care as part of the regular monthly recommended foot check for injuries and infections. On 05/04/23 at 11:45 AM, the Regional Nurse Consultant confirmed the fingernail trimming is the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 7 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0677 responsibility of the nursing staff and should not require a request from the resident to provide the care. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 8 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0679 Provide activities to meet all resident's needs. 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 records review, the facility failed to provide ongoing person-centered activities designed to meet the interest and the psychosocial well-being of 3 of 20 residents, Residents #35, #36 and #103, reviewed for activities. Residents Affected - Few The findings included: 1. Record review for Resident #35 documented diagnoses to include Dementia, unspecified, Major Depressive Disorder, and Schizoaffective Disorder. Review of the care plan dated 03/02/23 documented an outlined activity plan that included: Activities: The resident needs encouragement to pursue activities of choice. Little interest or pleasure in doing things, prefers to stay in room. o Resident will participate in activities of choice/ will accept materials for in room type activities. o Encourage to participate with activities of choice o Prefers/ would benefit from: General Activities Program o Prefers / would benefit from: In Room Activities o Preferred Activity Times: Morning o Preferred Activity Times: Afternoon o Preferred Activity Times: Evening o The resident's preferred activities are: Resident enjoys walking around the facility for exercise, going outside for fresh air, watching television and listening to country music. She also loves dogs and playing cards. o Provide the resident with materials for individual activities upon request. o Provide activities calendar monthly. o The resident prefers the following radio stations: Country music, TV stations: Popular stations. o Observe for psychosocial and mental status changes - document and report as Indicated. During two days of observations, the resident was not observed engaged in any activities: On 05/02/23 at 10:33 AM, Resident #35 was observed in her room alone, and she had no roommate, no television (TV) and no radio. Upon asking, she stated she would be interested in watching TV. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 9 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0679 On 05/02/23 at 2:12 PM, Resident #35 was observed in her room lying in bed and doing nothing. Level of Harm - Minimal harm or potential for actual harm On 05/03/23 at 1:56 PM Resident #35 was observed in her room sitting on the side of the bed watching the floor and wall. Residents Affected - Few On 05/03/23 at 2:29 PM, during an interview with the Activity Director (AD), she said 'I am going to tell you upfront; I do not document when I see the residents.' The AD further stated she has not done or offered any activities to Resident #35 lately, because of Resident #35's attention span was limited.' The AD stated when Resident #35 listens to music, she settles down and feels relaxed. The AD stated she only has one radio available that she can use, so she could give it to Resident #35. The AD also stated she was not sure whether Resident #35 had any family members. 2. Record review revealed Resident #36 was admitted to the facility on [DATE], with diagnoses that included Dementia and Benign Prostatic Hyperplasia. Review of the Minimum Data Set assessment (MDS), section C, revealed Resident #36 was rarely understood, and had a Brief Interview for Mental Status (BIMS), indicating severe cognitive impairment. Review of the care plans (CP) for this resident, dated 03/30/23, revealed no plan for activities. On 05/01/23 at 10:42 AM, Resident #36 was observed in bed lying down. The resident had no access to television (TV) for sensory stimulation. There was no TV in the room. On 05/02/23 at 11:42 AM, Resident #36 was observed in bed lying in the same position. There wee no stimuli, and no activities observed. On 05/03/23 at 2:40 PM, the Activity Director (AD) was asked if she had an activity program for Resident #33. The AD said that she did not have Resident #36 listed as a person requiring 1:1 activity. She stated that family visitation is the only type of activity she knows that Resident #36 had. The AD stated when Resident #36 was first admitted to the facility, he could not do anything. She said the resident had a granddaughter who had reported the resident enjoyed light jazz music. There was no plan developed to ensure Resident #36 listened to music and there was no documentation of the resident's activity preference in the CP. The AD further stated she needed guidance and assistance to carry out the responsibility of ensuring the residents receive e required activity. She said the assistant activity position has been eliminated making it difficult for her to efficiently carry out her responsibility. She also stated she did not know that Resident #36 did not have an activity CP. The AD stated she did not know what Resident #33's preferences were for activities. 3. Resident #103 was admitted to the facility on [DATE] with the diagnoses that included Nontraumatic Subdural Hemorrhage; Respiratory Failure, and Cognitive Communication Deficit. Review of the MDS, section C, dated 03/31/23, revealed the resident had severe impaired cognition with a BIMS score that could not be assessed. Review of the CP dated 02/10/23 and 04/07/23 showed there were no plans for activity scheduled for Resident #103. There were no documented records of ongoing activities. On 05/03/23 at 2:35 PM, the Activity Director stated she did not have Resident #103 listed as a person requiring 1:1 activity. She stated she has not provided any ongoing activities for Resident #103. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 10 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to adequate supervision and assistance to prevent smoking accidents, for 1 of 1 sampled resident, Resident #20. The findings included: Review of facility's Policy and Procedure, titled, Smoking/Tobacco Use (Effective October 2021, documented, in part: Employee Expectation: < Monitor residents in the smoking area. < Ensure appropriate adaptive smoking equipment is available and in use for residents as care planned. < Clean smoking apron after each use Procedure: < Initiate and complete admission data Collection and Initial Plan of Care Quarterly Date Collection Form Smoking Safety: < Staff member assigned to the smoking area will monitor the area to conduct walking rounds to observe and intervene for safety issues and to provide oversite and intervention when appropriate. < Provide the smoker with assistance and safety devices indicated. < Donning a smoking apron that is deemed necessary by the IDT. < The assigned staff member should intervene in resident issues that arise. Care Plan: < Review quarterly at a minimum. Review of clinical record of Resident #20 on 05/02-03/23, noted the resident was admitted on [DATE] with diagnoses that included Lack of Coordination, Muscle Weakness, Schizoaffective Disorder, Extrapyramidal and Movement Disorder, Dementia and Psychosis. Review of the current Minimum Data Set assessment (MDS), dated [DATE], documented a Brief Interview for Mental Status of 11, indicating moderate cognitive impairment. The current Care Plan dated 03/02/23 included: < Current Smoker: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 11 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 * Resident to wear apron at all times during smoking Level of Harm - Minimal harm or potential for actual harm * Smoke with Apron * Smoking materials kept by facility staff Residents Affected - Few * Supervised Smoking at all times. The current Smoking Assessment, dated 03/29/23, included: Smokes Cigarettes Can hold independently. Smoking Apron required at all times. Safe to smoke. On 05/01/23 at 9 AM, Resident #20 was observed to be in wheelchair on the smoking patio. The resident had a lite cigarette and was noted to have strong, violent jerking and flailing motions with the 'cigarette hand' while smoking. The ashes were noted falling down on the resident's chest area and lap. Resident #20 had a smoking apron on, but the apron did not cover the lap, as it was pulled all the way to the resident's right side. The designated staff (Staff A) did not make any interaction with the resident to correct the apron issues. Photographic Evidence Obtained. A second observation conducted on 05/02/23 at 9 AM noted the resident was observed again on smoking patio. Staff A, on smoking patio, lit the resident's cigarette and the resident wheeled himself to the outer edge of patio. Staff A did not ensure the resident had donned a smoking apron to cover the resident. Resident #20 was again noted to be violently waving and flailing the cigarette and banging it on his leg, Ashes were noted over resident chest and lap. Photographic Evidence Obtained. The Director of Nursing (DON) was requested to come to the smoking patio to view resident with the surveyor. The DON confirmed that a smoking apron was not applied to Resident #20 per smoking assessment. Interview with Staff A, at time of observation, stated that she gave the resident's apron to the laundry on 05/01/23 for washing and did not get the apron back from laundry. Staff A further stated there are no extra aprons available for smokers who require a smoking apron. On 05/03/23 at 11 AM, Resident #20 again was observed on the smoking patio with a smoking apron only covering the right leg leaving the left leg exposed. Continued observation noted designated staff failed to cover resident's legs and chest with apron. Resident #20 was noted to have severe jerking of arms during smoking resulting in ashes falling to his chest and leg areas. Photographic Evidence Obtained. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 12 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation, and record review, the facility failed to perform catheter care using appropriate professional technique, for 1 of 1 sampled resident, Resident #315. The findings included: The facility used a competency checklist instead of a policy/procedure to ensure perineal care/catheter care is performed correctly. The competency checklist step 5 stated: Cleans top of over bed table and places a barrier on tabletop. Step 9 indicates the staff is to perform hand hygiene. Steps 10 through 12 discuss positioning of the resident and preparing the wash basin with warm water. Step 13 verifies that staff has put on gloves. Step 14 verifies that staff has covered the resident with a bed sheet or bath towel. Step 15 indicated the staff is to place a protective barrier under the resident's buttocks. For a male resident the checklist indicates that the perineal area should be dried using a blotting motion from top to bottom. Resident #315 was admitted to the facility on [DATE] with an indwelling catheter with diagnosis of Obstructive and Reflux Uropathy. Resident #315 had a BIMS (Brief Interview for Mental Status) score of 14 of 15, which indicated the resident was cognitively intact. On 05/02/23 at 10:23 AM, an observation revealed Resident #315 had an indwelling urinary catheter attached to a bedside drainage bag without a device to anchor the tubing to the resident's leg. When questioned about the lack of anchoring device, Resident 315 stated that he thought he had one when he was at the hospital, but he had not had a device since being admitted to the facility. On 05/03/23 at 10:06 AM, an observation of catheter care was conducted with Staff J, Certified Nursing Assistant (CNA), performing the task. Staff J explained to the resident that she was going to provide perineal and catheter care. Staff J washed her hands for 15 seconds, put on clean gloves and proceeded to prepare for the Catheter Care. According to the competency checklist, the clean gloves were to be applied after the supplies were placed and the wash basin of warm water had been placed on the over bed table with a barrier in place. Staff J removed the bagged towels, washcloths, and liquid soap stored in Resident #315's closet. Staff J placed the bag on Resident #315's bed. Staff J placed two paper towels on the top of the overbed table without wiping the table with disinfectant. The paper towels were placed on either end of the table and did not cover the entire surface. Staff J placed the towels, washcloths, and soap on the table next to the paper towel on the left as facing the table. Staff J repositioned Resident #315 in a comfortable position and adjusted the resident's bed to a good working height. Staff J opened the resident's diaper, and did not place a barrier under the resident as per the competency checklist. Staff J failed to cover the resident with a bath blanket or bed sheet as per the competency checklist. Staff J prepared a wash basin with warm water and placed the basin on the overbed table between the clean towels and the paper towel on the right end of the overbed table. Staff J performed perineal care using appropriate technique. Staff J proceeded to wash around the urinary meatus and the catheter tubing away from the meatus as required. Staff J disposed of the dirty water and replaced it with clean water. Staff J removed her gloves and put on clean gloves without washing her hands. Staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 13 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few J rinsed the perineal surfaces and catheter tubing with the clean water with proper technique. Staff J did not dry the perineal area as per the competency checklist. Staff J placed a new diaper on the resident and repositioned the resident in bed as required. Resident #315 asked Staff J about a leg anchor for the catheter tubing. Staff J told the resident she would ask the nurse to fix the problem. An observation of the drainage tubing revealed an anchoring device attached to the tubing with what appeared to be glue on the back surface. The device was not affixed to Resident #315's leg. On 05/03/23 at approximately 11:15 AM, an interview was conducted with the Director of Nursing (DON). During the interview, the DON disclosed the facility does not have a Policy / Procedure for Catheter Care only a competency checklist. The DON provided the competency checklist which was reviewed at that time. The DON agreed that Staff J did not follow the competency checklist correctly. The DON also agreed that a leg anchor is important to reduce the chance of injury related to tension on the drainage tubing. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 14 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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** Based on review of policy and procedure, observation and interview, the facility failed to ensure that it secured the resident's medications for 2 of 5 sampled medications carts observed, the North and South medication carts; failed to secure loose pills in one (1) of five (5) medications carts observed [NAME] medication cart; failed to discard expired wound care dressing in one (1) of three (3) treatment carts, [NAME] wing; and failed to discard expired Sunscreen lotion in Central Supply Room. The findings included: Review of the facility policy and procedure on [DATE] at 2:30 PM, titled, Medication Storage, provided by the Director of Nursing (DON), reviewed 2007, documented, in part, in the Policy Statement: Storage of Medication - Policy: Medications and biologicals are stored properly, following manufacturer's or provider pharmacy recommendations, to maintain their integrity and to support safe effective drug administration. The medication supply shall be accessible only to the licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. Procedures: .3. In order to limit access to prescription medications, only licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications (such as medications aides) are allowed access to medication carts. Medication rooms, cabinets and medication supplies should remain locked when not in use or attended by persons with authorized access .14. Outdated, contaminated, discontinued or deteriorated medications and those in containers that are cracked, soiled, or without secure closure are immediately removed from stock, disposed of according to procedures for medication disposal ., and reordered from the pharmacy , if a current order exists. 1. On [DATE] at 11:30 AM, it was observed, the North wing medication (med) cart which contained twenty-four (24) residents' medications, was unlocked with no nurse in attendance or in view of the cart. The med cart was accessible to residents, staff members and visitors. Photographic Evidence Obtained. An interview was conducted on [DATE] at 11:32 AM with Staff F, Licensed Practical Nurse (LPN), who acknowledged that she had not locked the medication cart on the North wing. 2. On [DATE] at 12:08 PM, during an Accucheck Observation, it was observed that after Staff G, LPN had completed the procedure, she walked back into the resident's room to inform her that she did not need insulin coverage. She did not lock the medication cart #1 on the South wing, which contained twenty-two (22) residents' medications and were accessible to residents, staff members and visitors. Photographic Evidence Obtained. An interview was conducted on [DATE] at 12:10 PM with Staff G, who acknowledged that she had not locked the medication cart on the South wing. 3. On [DATE] at 1:29 PM, a Medication Storage Observation of the [NAME] wing Medication cart was conducted with both Staff H, LPN, and with the Director of Nursing (DON). It was observed that there was a one-half (½) size unidentified, loose white pill located at the bottom of the 7th drawer of the Medication cart. Photographic Evidence Obtained. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 15 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 4. On [DATE] at 1:51 PM, a Medication Storage Observation was conducted with Staff H and the DON of the [NAME] wing Treatment cart. It was observed that the cart contained Hydrogel Saturated gauze 4 x 4 hydrating wound dressing containing 25mg of Hydrogel with an expiration date of 07/22. Photographic Evidence Obtained. During a brief interview conducted on [DATE] at 1:58 PM with both Staff H and the DON, both acknowledged that the expired Hydrogel Saturated gauze 4 x 4 hydrating wound dressing containing 25mg of Hydrogel should have been discarded. 5. On [DATE] at 2:01 PM, a Medication Storage Observation was conducted with the DON, of the Central Supply closet where it was observed that there was an expired bottle of Good Sense Sunscreen Lotion, which had an expiration date of 11/19. Photographic Evidence Obtained. An interview was conducted on [DATE] at 2:09 PM with the DON, who acknowledged the medication carts should have been kept locked at all times, the loose pill in the medication cart drawer, the expired Hydrogel gauze in the Wound Care Treatment cart and the expired bottle of Good Sense Sun Screen Lotion in the Central Supply room, should all have been promptly discarded. This was not done. The medication carts were not locked, the loose pill, expired Hydrogel gauze and the expired bottle of Good Sense Sun Screen Lotion, were not all discarded, until after surveyor intervention. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 16 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0790 Provide routine and 24-hour emergency dental care 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 observation and record review, the facility failed to provide ongoing dental services to 1 of 1 sampled resident, Resident #103. Residents Affected - Few The findings included: Record review revealed Resident #103 was admitted to the facility on [DATE] with diagnoses that included: Nontraumatic Subdural Hemorrhage; Respiratory Failure; and cognitive communication deficit. Review of the Minimum Data Set assessment (MDS), section C dated 03/31/23, revealed the resident had severe impaired cognition. A Brief Interview for Mental Status score could not be determined. On 05/01/23 at 10:45 AM, Resident #103 was observed with noticeable bleeding gum and concerning dental hygiene issue. Further observation conducted on 05/03/23 at 11:19 AM showed evidence of blood in the resident's mouth and blood covered Resident #103's upper incisors. Review of the Medication observation record for the month of April and May 2023 revealed that staff performed daily oral hygiene as recommended by the resident's physician (morning and night). Review of the Nurses' progress notes revealed no documentation of Resident #103's dental issue or bleeding of his gum. Review of the Social Services (SSD) progress notes, dated 03/23/23, documented: SSD spoke with son on 03/21 regarding dad's insurance coverage and possibility of having to pay privately if/when no longer covered by D . SSD called D . today, 03/23 to verify that Pt [patient] is still covered under this plan. They ensured that he is in fact covered and there is no projected date of DC [discharge] as of right now. SSD informed BOM [business office manager] of this info [information] and will continue to monitor and F/U[follow-up] accordingly. There was no indication that staff discussed dental care with the resident's family members. The care plan dated 02/16/23 did not address dental care. The care plan dated 04/17/23 did not address dental care. During an interview with the Director of Social Services on 05/03/23 at 3:19 PM, she said that the family has not requested dental services. She stated that no one reported to her that the resident had bleeding gum. She also stated that the hygienist will be in the facility on the 9th of May and the Dentist will be in the 17th of May. The SSD said that she will make sure that they see the resident to address the concern. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 17 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, interview, and record review, the facility failed to prepare an approved menu in advance and follow an approved menu to ensure the residents' nutritional needs are met for 109 facility residents in the facility, that included potentially 30 of 30 sampled residents. The findings included: 1. During the observation of the lunch meal in the main kitchen on 05/01/23 at 11 AM, the surveyor requested the approved menu for the lunch meal from the cook (Staff B). The cook replied there was not an approved menu for any of the 4-week menu cycle. The cook stated the entree for the lunch meal was Swedish Meatballs and the alternative entree was stuffed shells. The cook also stated the required entree protein serving portion of the meatballs was 3 ounces and Staff B did not know the protein portion of the Stuffed Shells. The surveyor requested the standardized recipe for the preparation of the Swedish Meatballs and Stuffed Shells. The cook stated the entrees were fully prepared frozen and required heating. The cook also stated that meatballs required a gravy to be prepared and added to the meatballs. During the observation of the tray line, the cook stated that 3 meatballs was a standard portion to meet the 3-ounce entree protein portion. A review of the meatball packaging nutrient analysis noted documentation that 3 meatballs provided only a total 12 grams. An interview with the facility's Consultant Dietitian at the time of the tray line observation was held to discuss that a 3-ounce portion of meatballs should provide 21 grams of Protein (1 ounce = 7 grams). The Dietitian stated he was unaware the frozen meatball entree provided on 12 grams instead of the required 21 grams of cooked protein. The Dietitian also stated there was not an approved menu for the cook and facility kitchen staff to follow to ensure that the nutritional needs of the residents were being met. The Dietitian stated there are menu production sheets to follow, however they could not be located. 2. On 05/02/23, the Dietary Manager submitted an approved cycle menu to the surveyor. A review of the approved menu for the lunch meal of 05/02/23 noted a 6-ounce portion of Turkey Noodle Bake to be served to the physician-ordered regular diets, mechanically altered and therapeutic diets. Interview with the Dietary Manager noted that 3 ounces of cooked turkey protein was to be included in each entree serving. The surveyor requested the standardized recipe that was to be utilized in the preparation of the Turkey Noodle Bake. Following the surveyors request, it was noted that a recipe was not available for the preparation of the entree. Further interview with the Dietary Manager at the time of the meal observation revealed that 18 pounds of diced Turkey was purchased and utilized for the preparation of the Turkey Noodle Bake. A calculation of the turkey protein was conducted with the Dietary Manager, and it was noted that 112 servings of the entree provided only 2.5 ounces of Turkey protein per portion. It was further discussed that 3 ounces of Turkey protein was required as per the approved menu. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 18 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to accommodate individual food preferences for 5 of 5 sampled residents, Residents' #10, #13, #40, #55, and #86. The findings included: 1. Review of clinical record of Resident #10 on 05/03/23, revealed an admission date of 03/30/12 with diagnoses to include DDiabetes Mellitus Type 2 (DM 2), Chronic Kidney Disease, and Left & Right Leg AKA (Above knee amputations). Review of the Minimum Data Set assessment (MDS) of 01/30/23 documented: Sec B: Understood and Understands. Sec C: Brief Interview for Mental Status (BIMS) of 6, indicating severe cognitive impairment. Sec D: Mood - Poor Appetite, Trouble Concentrating, Sec G: Eat = Supervision/Set Up Only Sec K: NO Swallow Disorder Therapeutic Diet. Review of the updated MDS - Annual / Significant Change assessment, dated 05/23/23 noted: Sec C: BIMS Score changed to a 12. Observation and interview conducted with Resident #10 on 05/03/23 at 9:00 AM, noted the resident to be alert, oriented and able to make own decisions. The resident received a Renal Diet tray for the breakfast meal. The resident stated she would not eat the facility food for many of the meals served, stating is just no good. The resident further stated she has been a resident in the facility for over 10 years and has requested Grits, Scrambled Eggs, Butter and coffee for the breakfast meal on a daily basis. The resdient said there have been so many changes in the dietary department that her food preferences are documented on the meal tray cards and are not followed. The resident further stated she would like the breakfast foods (Grits, scrambled eggs, butter, and coffee) and some of her lunch and dinner meals. The resident stated she is served coffee for all meals and must request tea from staff for all meals. She stataed she often has to order food to be delivered from outside restaurants. Further review of the meal tray card noted that 8-ounces of coffee are documented for all 3 meals each day. Following the interview with Resident #10 on 05/03/23, the surveyor requested the Dietary Manager (DM) to visit the resident's preference. The DM recorded that the resident's food and beverages preferences are changed for the resident's meal tray ticket to reflect the resident's preferences. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 19 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #10 also stated she has Dialysis on Tuesdays, Thursdays, and Saturdays and she leaves the facility at 5:00 AM on these days. She stated she request no foods or fluids to be sent with her to dialysis, and further stated she gets very nauseated during dialysis and can't eat or drink. 2. Review of clinical record for Resident #13 revealed an admisssion of 04/30/21 and a readmission of 02/05/23, with diagnoses to include: COPD (Chronic Obstructive Pulmonary Disese), Depressive Disorder, Anxiety, and Schizoaffective Disorder. The documented diet of 02/05/23 was NAS (No Added Salt). Review of the MDS dated [DATE] documented: Sec C: BIMS=15, indicating no cognitive impairment. Sec G: Supervision with Eating / Set Up Only. Observation of the lunch meal on 05/01/23 at 12:15 PM in the main dining room noted that the Resident #13 was served entrée Swedish Meatballs. Further observation and review of the resident meal ticket noted documentation the resident does not eat beef and requested the entree of Stuffed Shells for the lunch meal. The resident was noted to not eat the meats ball and stated to the surveyor that it was too late to be served the shells. Resident #13 stated that food preference are not being followed on a daily basis. 3. Record Review noted the resident is the responsible party for decisions, the date of admission was 11/11/16 with a readmisssion of 02/0123, and diagnoses that included Pro-Cal Malnutrition, and Morbid Obesity. Review of the MDS of 04/13/23 documented: Sec B: Understood & Understands Sec C: BIMS = 13 (alert and oriented) Sec G: Eat - Supervision / Set Up Only. Observation of Resident #40 in the Main Dining Room on 05/04/23 at 12:00 PM noted the resident was not served an entree and only received Linguini Pasta. Review of Resident's #40 Meal Card documented Peanut Butter Sand [Sandwich] for lunch meal. the resident stated to surveyor at time of observation that food preferences and Meal Ticket are often not followed. 4. Review of clinical record documented an admission of 06/07/19, with diagnoses to include DM2, Protein-Calorie Malnutrition, and Anemia. The physician orders documented: 03/28/22 - CCHO/NAS/Mechanical Soft 03/28/22 - Large Portions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 20 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During the observation of the lunch meal in the Main Dining Room on 05/01/23 at 12 PM, it was noted the Resident #55 had a documented meal ticket to receive a Consistent Carbohydrate (CCHO) / No Added Salt / Mechanical Soft Diet, and Fortified Foods. Further observation and review of the resident's Meal Ticket documented: 4-ounce Magic Cup (weight loss) and 8-ounces of Whole Milk. Further observation noted the resident did not receive the Magic Cup or Whole Milk with the meal. The Fortified Food of Mashed Potatoes was also not served. The resident stated to the surveyor that food preferences are not being followed on a regulars basis. The resident stated that he comes to the dining room to be able to choose foods being served to his preferences. Further review of the meal tray ticket for Resident #55 noted no documentation on tray card of large portions and or extra fluids. 5. Review of Record documented: 09/26/22 - CCHO - Consistent Carbohydrate /NAS, Review of MDS of 2/10/23, Quarterly assessment, documented Sec C: BIMS = 14 (alert and oriented) Sec D: Trouble concentrating. Sec G: Supervision/Set Up Receives a Therapeutic Diet. During the observation of the lunch meal in the Main Dining Room on 05/01/23 at 12:45 PM, it was noted the Resident #86 was served the entrée of Swedish meatballs. Further observation noted that the resident was refusing to eat the meatballs. Review of the resident's meal ticket for the lunch meal documented no meatballs and requested the lunch alternate of Stuffed Shells. The resident stated that meal / food preferences are not followed on a regular basis. She stated she likes to come to the dining room for meals to be able to receive food preferences. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 21 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety that potentially affected 109 of the 113 facility residents and included 30 of 30 sampled residents. The findings included: 1. During the initial kitchen/sanitation tour conducted on 05/01/23 at 9:00 AM and accompanied with the Dietary Manager (DM), the following were noted: (a) A chemical test of cleaning cloth buckets noted 1 of 3 did not contain the required level of Quaternary chemical as per regulatory requirement (200 PPM). Photographic Evidence Obtained. (b) The internal cavity and internal door of the convection oven were covered with a black carbon substance and were not being cleaned on a regular basis. The DM stated the oven should have been cleaned over the last weekend. Photographic Evidence Obtained. (c) Observation of the walk-in refrigerator noted that 12 food storage shelves were heavily rust laden. It was discussed with the DM that the shelving was in need of replacement. Photographic Evidence Obtained. (d) Three of 3 food preparation skillets / pans were noted to have a heavily worn interior and Teflon surface was worn. It was discussed with the DM that the Teflon and carbon is coming into contact with foods during each use of the pans. The surveyor requested that the pans be discarded and replaced. Photographic Evidence Obtained. (d) Observation of 3 of 3 Inner Lip Adaptive Eating Plates were heavily stained a yellow color and were being used on a daily basis. Staff were aware of the issue, but no attempts had been made to replace the adaptive plates. It was also noted that Built-Up and Weighted Forks (3) and Spoons (4) were heavily worn, cracked, and in need of replacement. Photographic Evidence Obtained. 2. Observation of lunch meal on 05/02/23 at 11:30 AM noted the dessert of Banana Cream Pie (93 servings) pie had a brown liquid dripping from the bottom and side of each pie serving, and poor appearance. The surveyor requested the Dietary Manager observe the pie servings and agreed with the surveyor's findings. It was discussed that the pie serving could be rancid and has possible be frozen, thawed, and refrozen prior to thawing prior to serving. The surveyor recommended to the Dietary Manager that the pie servings not be served due to the potential of food borne illness. Photographic Evidence Obtained. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 22 of 23 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 105572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pompano Health and Rehabilitation Center 51 W Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm 3. During the observation of the breakfast meal in the main kitchen on 05/03/23 at 7:30 AM with the Dietary Manager utilizing the facility's calibrated digital thermometer, test temperatures were done. The temperature testing revealed that hot foods were not being held on the steam table at the regulatory required temperature of 135 degrees Fahrenheit (F) or more. The temperatures were recorded as follows: Residents Affected - Some - Pureed Bread (made with milk) held in steamtable = 121 degrees F (25 servings). -Slurry Bread (made with milk) held in steam table at 102 degrees F (20 servings). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105572 If continuation sheet Page 23 of 23