Health inspection·March 2, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm resident with respect and dignity and care for each resident in a manner and in an environment that maintains or enhances his or her quality of life, recognizing each resident's individuality and protecting the rights or each resident; Policy Explanation and Compliance Guidelines: 1) All staff members involved in providing feeding assistance to residents promotes and maintains resident dignity during mealtimes, 5)All staff will be seated, while feeding a resident. Residents Affected - Few Based on observations, record reviews, and interviews, the facility failed to ensure residents are treated with respect and dignity for three residents (Resident #87, Resident #104, Resident #143) out of three residents who were observed during dining, as evidenced by staff members were observed standing while feeding residents. This deficient practice has a potential to affect 24 residents who need assistance with eating of the 154 resident who eat orally. The findings included: 1) During observation on 02/27/2023 at 08:24 AM, Resident #87 was in bed, alert. The Certified Nursing Assistant (CNA), Staff D sanitized her hands then proceeded to set up the resident's breakfast tray, the resident's bed was in a low position and Staff D, CNA was standing up while feeding the resident. When the surveyor asked Staff D if this was how she usually positioned herself to help residents who needed assistance with eating, she stated sometimes this is how I feed the residents, standing up. On 02/28/2023 at 08:09 AM, Resident #87 was observed in bed, alert, the bed was in low position and the breakfast tray already served. Staff E, CNA was assisting the resident, she verbalized to resident what she was going to be doing and when the resident asked what was for breakfast Staff E let the resident know what was on her tray. Staff E washed her hands, then she proceeded to help the resident with breakfast and remained standing while feeding the resident. Record review of Resident #87's Minimum Data Set (MDS)-Quarterly, admit date : [DATE] revealed: Section C for Cognitive Status with a Brief Interview of Mental Status (BIMS) score of 11 out of 15 indicating the resident is moderately impaired cognitively. Section G for Functional Status documented for eating that the resident requires total dependence with one-person to physically assist. Section I - Active Diagnosis indicated: Parkinson's disease, Malnutrition (protein, calorie), risk of malnutrition. Review of Resident #87's physician's orders revealed order dated 2/10/2023 for Speech Therapy clarification order: Speech Therapy Skilled services 3 times per week for 90 days for dysphagia treatment, therapeutic trials . mastication exercises . Review of tasks for Activities of Daily Living (ADL) indicated for Eating Resident #87 required total assistance .Full staff performance .Eating Support provided. One-person physical assist. Review of the Nutrition/Dietary Note dated 6/3/2022 revealed that Resident #87's appetite is good, requires assistance with meals. Snack accepted. Resident has own teeth with some missing. No reports of difficulty chewing or swallowing. Resident need for assistance due to vision impairment . Resident is able to feed self slowly however assistance is provided with every meal and supplements/nourishment. During an interview on 03/01/2023 at 02:43 PM, Staff D, CNA stated: when I feed a resident, I wash my hands and introduce myself, then I state that I am here to assist with breakfast, I offer the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0550 Level of Harm - Minimal harm or potential for actual harm breakfast, and if their head is low, I let them know that I am going to raise their head then I present what is on the tray. I honor their desires for what they would like to eat or drink, then I sit down close to the residents' bed to feed them. She continued and stated, the day that you were here, what happened was that I know that I am supposed to pull up a chair and sit close to the resident to feed her, I am sorry, I thought you were going to interview her, and I did not use the chair but after you left. Residents Affected - Few 2) On 02/27/2023 at 08:05 AM, Resident #104 was observed in bed alert and noted with all teeth missing. The bed was elevated with bilateral rails up, there was a chair at the bedside. The CNA, Staff A was observed standing up while feeding the resident. On 02/28/2023 at 08:14 AM, Resident #104 was observed in bed, breakfast was served and Staff B, CNA was standing up while feeding Resident #104. On 03/01/2023 at 11:53 AM, observed CNA, Staff C setting up the lunch tray for Resident #104, Staff C lowered the bed's side rail, lowered the bed, and continued setting up the resident's tray. Staff C began feeding resident while standing up. After the surveyor asked if this was how she usually assisted residents with feeding, Staff C proceeded to get a chair, sat down, and continued to feed Resident #104. Review of Resident #104's Minimum Data Set (MDS)-Quarterly, admit date : [DATE] revealed in Section C for Cognitive Status a BIMS score of 99 meaning the resident was unable to complete the interview. Section G- Functional Status indicated for eating that the resident required extensive assistance with one-person to physically assist. Section I for Active Diagnosis indicated the resident has Non-Alzheimer's Dementia, Anemia, Coronary artery disease (CAD) and Hypertension. Section O- for Special Treatments, Procedures and Programs indicated the resident received Occupational Therapy, Therapy start date05/26/2022 and therapy end date-06/24/2022, Training and Skill Practice In: Eating and/or swallowing-0 minutes. Review of physician orders for Resident #104 revealed that the resident had an order dated 12/2/2022 for head of bed elevated at all times every shift and an order dated 12/2/2022 for aspiration precaution every shift. Review of Resident #104's Care Plan with start date 12/29/2022 and target completion date 1/6/2023 revealed that Resident #104 has self-care deficit and needs limited to total staff assistance to perform and complete Activities of Daily Living's secondary to her impaired mobility .Osteoporosis, Dementia, Hypothyroidism and Anemia . Diet with interventions as follows: My chewing/swallowing status is: Impaired, My diet order: Mechanical Altered, Requires Assistance with Meals. Review of tasks for Activities of Daily Living (ADL) revealed for Eating-total assist - full staff performance, one-person physical assist. Interview with Staff A, CNA on 03/01/2023 at 02:51 PM, when asked about the facility's protocol when feeding a resident; Staff A stated when assisting a resident with feeding, I introduce myself, I let them know what I am doing, I proceed with the feeding after set up, I am usually at bedside, facing her frontwards with the tray on the table, I was standing up at the time you were in the room. If I am in the dining, I am in eye level with them, and [Resident's #104] bed was up high when you were in the room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete On 03/02/2023 at 09:12 AM during an interview with Registered Nurse (RN) Unit Manager for 2 East-, when asked about overseeing the CNAs, she stated I oversee the floor, when the trays comes to the floor, nurses passes them to the CNAs, we serve the residents who are independent with eating first, and lastly, we serve the ones that need assistance with eating as they require more time, we give them their meal and assist them at that time. We do respect their dignity by knocking on doors, washing hands, and when it comes to feeding them, we pull up a chair and sit next to them after positioning them. We give them time to eat, and the CNAs speak to them as they are giving them their meal, and telling them what they are doing. With residents with impaired vision, definitely they have to say what they are giving them. When I am on the floor, I make rounds to make sure that they are correctly positioned. Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Based on record review and interview, the facility failed to ensure a resident's clinical record contained documentation that the resident was provided with written information regarding the right to formulate an advanced directive for three (Resident # 133, Resident #143, Resident #122) out of seven residents whose clinical records were triggered and reviewed for written evidence of provision of information regarding formulating an advanced directive. There were a total of 171 residents residing in the facility at the time of this survey. The findings included: Record review of the facility's Advanced Directives Policy and Procedures dated 3/01/2021 documented: Policy-It is the policy of this facility to honor Advance Directives in accordance to State and Federal regulations; Procedure: 4) The facility will provide each adult individual, at the time of the admission as a resident, with written information concerning the nursing home's policies respecting advance directives and provide documentation of the existence of an advance directive within the medical record. 1) Record review of Resident # 133's demographic face sheet noted admission date was 10/28/2022. Review of Resident # 133's clinical record showed no written documentation related to advance directives. On 3/03/2023 at 1:26 PM, the Social Services Director was asked about the advance directives for Resident #133. The Social Services Director stated, His responsible party sent via email to the facility the Durable Power of Attorney but never signed the document. We have been trying to get the document signed but she won't sign the form. We don't have any advance directives for this resident. 2) Record review of Resident #143's demographic face sheet noted admission date was 9/13/2021. Review of Resident # 143's clinical record showed no written documentation related to advance directives. On 3/03/2023 at 1:31 PM, the Social Services Director was asked about the advance directives for Resident #143. The Social Services Director stated, We don't have any advance directives for this resident. 3) Record review of Resident #122's demographic face sheet noted admission date was 7/17/2020. Review of Resident #122's clinical record showed no written documentation related to advance directives. On 3/03/2023 at 1:32 PM, the Social Services Director was asked about the advance directives for Resident # 122. The Social Services Director stated, We don't have any advance directives for this resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure the electronic transmittal requirements for the Minimum Data Set was implemented related to a resident discharge return not anticipated for 1 (Resident #156) out of 1 sampled for resident assessment. Residents Affected - Few Record review of Resident #156's clinical records revealed the resident was admitted to the facility on [DATE] and discharged to an Acute Care hospital on [DATE]. Medical Diagnoses included, but were not limited to, Sepsis, Unspecified Organism, Type 2 Diabetes Mellitus without Complications, Malignant Neoplasm of prostate, Hypothyroidism Unspecified, Bipolar Disorder, Current Episode Mixed, Unspecified Extended Spectrum Beta Lactamase (ESBL) Resistance, Dysphagia, Oropharyngeal Phase, Other Abnormalities of Gait and Mobility and Fracture of unspecified Metatarsal Bone(s), Left Foot. Review of Resident #156's Care Plan initiated on 09/21/2022 and completed on 10/02/2022 revealed the resident desired to return home. Goal: The resident and his daughter will verbalize satisfaction with discharge arrangements. Intervention: Coordinate transportation home. Interview the resident/family about discharge. Secure the discharge orders, durable medical equipment, and refer to home health. Review of nursing notes dated 10/01/22 timestamped 23:57 revealed a call received from Resident # 156's daughter who stated that her father was having an episode of hypoglycemia. The resident was assessed by this nurse blood sugar reading was 146 mg/dl (milligrams (mg) per deciliters (dL)), blood pressure was 112/66, pulse 120, oxygen saturation 96%, temperature 97.7. The resident also stated that his speech is slurred due to his episodes of hypoglycemia. However, the resident's daughter stated that she feels her father had a stroke. Call placed to Nurse Practitioner (ARNP) made aware of the resident condition and daughter concerns new order received to transfer the resident to the hospital as per daughter agreement, discharge order, MDS (Minimum Data Set). The resident was transferred to a local hospital. Reason(s) for Transfer: Other -- possible stroke. Transfer was unplanned. Code status is Do Not Resuscitate. Personal belongings sent with resident. Record review of Discharge Return not Anticipated Minimum Data Set (MDS) Section A dated 09/20/2022 revealed the resident was discharged to an acute hospital. Record review of Discharge Return Not Anticipated MDS Section C for cognitive status dated 09/20/2022 revealed the Brief Interview for Mental Status Summary Score was 08 out of 15 meaning the resident is moderately cognitively impaired. Record review of Discharge Return Not Anticipated MDS Section G dated 09/20/2022 revealed the resident needed extensive assistance for bed mobility, dressing and personal hygiene. 03/01/2023 at 11:09 AM, the MDS Coordinator stated that it was never submitted . It was completed but not transmitted, I will check out the transmittal reports to see what happened. He was an HMO (Health Maintenance Organization) and on 10/01/2022 became Medicaid. She continued, it was a date error. On 03/01/2023 at 12:21 PM, the MDS Coordinator stated she checked her records and the Discharge return not anticipated assessment dated [DATE] was not transmitted, she transmitted it today (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0640 03/01/2023. Level of Harm - Minimal harm or potential for actual harm Review of the facility's policy and procedures titled, MDS Assessment Completion and Accuracy revision date 9/2020 states: Electronic Transmission and Validation: Residents Affected - Few 1. Quarterly Assessments will be transmitted within 14 days of completion date. 2. Comprehensive assessments will be transmitted within 14 days of Care Plan completion date. 3. The MDS Coordinator will transmit the file and print the initial and final Validation Report. 4. The MDS Coordinator will facilitate the correction of any fatal errors immediately and retransmit the assessment until an accepted Validation Report is received. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 5) Observation of Resident #133 on 3/01/2023 at 12:50 PM revealed the resident sitting on the side of his bed, eating lunch and watching television. Residents Affected - Few Record review of the Demographic Face Sheet for Resident #133 documented the resident was admitted on [DATE] with a diagnosis of diabetes mellitus, hypertension, cerebral infarction, chronic obstructive pulmonary disease, dementia, major depressive disorder and psychotic disorder. Review of the Minimum Data Set (MDS) admission Assessment for Resident #133 dated 11/04/2022 documented the resident's Mental Status (BIMS) Summary Score had a BIMS Summary Score of 06 out of 15 indicating cognitive impairment, the resident required extensive assistance with one person physical assistance for ADLs (Activities Daily Living) and Preadmission Screening and Resident Review (PASRR), the resident was not considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition. The resident was not evaluated for PASRR Level II. Review of the Physician's Order Sheet (POS) for January 2023, February 2023 and March 2023 documented the resident received Quetiapine Fumarate 25mg (milligrams) tab (tablet) give 0.5 tab PO (by mouth) HS (at night) related to major depressive disorder. Review of the Care Plans for Resident #133, written 10/28/2022 documented the resident received a psychotropic medication. Review of the PASRR for Resident # 133 documented the PASRR Level I was completed on 7/22/2022, the diagnoses were not checked and a Level II was not completed. Interview with the Social Services Director on 3/02/2023 at 1:33 PM. She stated, PASRR Level I was completed on 7/22/2022 and the diagnoses were not checked. That is the reason the Level II was not done. 6) Observation of Resident # 51 on 2/28/2023 at 11:08 AM revealed the resident lying in bed asleep with television on and bilateral hand splints. Record review of the Demographic Face Sheet for Resident # 51 documented the resident was admitted on [DATE] with a diagnosis of Parkinson's disease, dementia, diabetes mellitus, hypertension, psychosis, major depressive disorder and psychotic disorder. Review of the Minimum Data Set (MDS) Annual Assessment for Resident # 51 dated 4/20/2022 documented the resident's Mental Status (BIMS) Summary Score had a BIMS Summary Score of 10 out of 15 indicating cognitive impairment, the resident required extensive assistance to total dependence with one person physical assistance for ADLs (Activities Daily Living) and Preadmission Screening and Resident Review (PASRR), the resident was not considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition. The resident was not evaluated for PASRR Level II. Review of the Physician's Order Sheet (POS) for January 2023, February 2023 and March 2023 documented the resident received Duloxetine HCL (hydrochloric acid) cap (capsule) DR (delayed release) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0645 Level of Harm - Minimal harm or potential for actual harm Particles 30 mg 1 cap PO one time a day for depression related to recurrent depressive disorders and Nuplazid cap 34 mg 1 cap PO one time a day for psychotic disorder. Review of the Care Plans for Resident # 51, written 6/29/2019 documented the resident received a psychotropic medication. Residents Affected - Few Review of the PASRR for Resident # 51 documented the PASRR Level I was completed on 7/01/2019, the diagnoses were not checked and a Level II was not completed. Interview with the Social Services Director on 3/02/2023 at 1:37 PM. She stated, PASRR Level I was completed on 7/01/2019 and the diagnoses were not checked. That is the reason the Level II was not done. 7) Observation of Resident # 54 on 3/01/2023 at 12:21 PM revealed the resident sitting in a wheelchair wearing glasses and eating lunch in the third floor dining room. Record review of the Demographic Face Sheet for Resident # 54 documented the resident was admitted on [DATE] with a diagnosis of dementia, diabetes mellitus, hypertension, Schizoaffective disorder, major depressive disorder, insomnia, restlessness and agitation, psychosis and anxiety disorder. Review of the Minimum Data Set (MDS) Annual Assessment for Resident # 54 dated 1/07/2023 documented the resident's Mental Status (BIMS) Summary Score had a BIMS Summary Score of 11 out of 15 indicating mild cognitive impairment, the resident required limited to extensive assistance with one person physical assistance for ADLs (Activities Daily Living) and Preadmission Screening and Resident Review (PASRR), the resident had been evaluated by level II and determined to have serious mental illness and/or mental retardation or a related condition. Review of Resident #54's Physician's Order Sheet (POS) for January 2023, February 2023 and March 2023 documented the resident received Divalproex Sodium DR 50mg tab 1 tab PO BID (twice a day) for Schizoaffective disorder, Quetiapine Fumarate 100 mg tab 1 tab PO HS for psychosis, Quetiapine Fumarate 50mg tab 1 tab PO HS for psychosis and Fluoxetine HCL 40 mg cap 1 cap PO one time a day for major depressive disorder. Review of the Care Plans for Resident # 54, written 1/08/2021 documented the resident received psychotropic medications. Review of the PASRR for Resident # 54 documented the PASRR Level I was completed on 12/30/2020, the diagnoses were not checked and a Level II was not completed. Interview with the Social Services Director on 3/02/2023 at 1:38 PM. She stated, PASRR Level I was completed on 12/30/2020 and the diagnoses were not checked. That is the reason the Level II was not done. Based on observations, interview, and record review the facility failed to ensure the Preadmission Screening and Resident Review (PASRR) Level II for serious mental illness (SMI) or intellectual disability (ID) was requested at the time of admission for resident one (Resident #94) and Level I PASRR was not completed for six residents (Resident # 21, Resident # 133, Resident #36, Resident # 51, Resident # 74, and Resident #54) out of seven residents whose PASRR was reviewed. This deficiency had the potential to affect 172 residents residing in the facility at the time of the survey. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0645 The findings included: Level of Harm - Minimal harm or potential for actual harm 1) Observation of Resident # 94 on 02/27/2023 at 8:24 AM; revealed the resident seated on her bed having breakfast. Resident #94 asked what the surveyor was doing at her room and yelled at the staff. Residents Affected - Few When explained the reason for the surveyor being in the room the resident asked the surveyor to get out of the room. Resident was noted very anxious. Observation of Resident # 94 on 03/01/2023 at 10:15 AM, revealed the resident was lying on her bed watching television, no anxiety or distress noted. The resident did not answer any of the questions asked. Record review of the clinical records for Resident # 94 revealed the resident was admitted to the facility on [DATE] and readmitted on [DATE]. Clinical diagnoses include, but not limited to, Acute Embolism and Thrombosis of Unspecified Deep Veins of left Lower Extremity; Major Depressive Disorder, Recurrent, Unspecified; Generalized Anxiety Disorder; Anxiety Disorder, Unspecified and Bipolar Disorder, Unspecified. Record review of Resident # 94's PASRR Level I dated 07/11/2022 revealed identification of a serious mental diagnosis under 1 A. Section I.B was not checked for Serious Mental Illness (SMI). Section II: Other Indications for PASRR Screen Decision-Making Question # 3-A Psychiatric treatment more intensive than outpatient care. (e.g., partial hospitalization or inpatient hospitalization) Yes. Section III: PASRR Screen Provisional admission or Hospital Discharge Exemption revealed it was not provisional admission. Record review of orders dated 01/16/2023 revealed the resident was receiving Venlafaxine HCL Tablet Extended Release 24 Hour 150 milligrams. Give 1 tablet by mouth one time a day for Depression. Orders dated 02/23/2023 revealed the resident was receiving Xanax Oral Tablet 0.5 milligrams (Alprazolam)1 tablet by mouth two times a day related to Generalized Anxiety Disorder. Orders dated 02/23/2023 revealed the resident was receiving Risperidone Tablet 0.5 milligrams, 1 tablet by mouth at bedtime related to Bipolar Disorder, Unspecified. Review of Medication Administration Record for the month of February 2023 revealed the resident received Risperidone tablet 0.5 milligrams, Venlafaxine HCL tablet Extended Release 150 milligrams, and Xanax Oral Tablet 0.5 milligrams (Alprazolam) as ordered. Review of the Medicare-5 Days Minimum Data Set (MDS) Section C for Cognitive Patterns dated 01/20/2023 revealed the resident's Brief Interview for Mental Status (BIMS) Summary Score was 15 of 15 indicating the resident is cognitively intact. Review of the Medicare-5 Days MDS Section I for Active Diagnosis dated 01/20/2023 revealed the resident's diagnosis were Anxiety, Depression and Bipolar Disorder. Review of Medicare-5 Days MDS Section N for Medications dated 01/20/2023 revealed the resident was receiving Antidepressant 4 days in a week. (Assessment Reference Date ARD was 01/20/2023). Record review of Nurses Notes dated 02/15/2023 at 4:19 PM revealed: Resident observed screaming and yelling at staff and throwing pillows. psychiatry called, new order received to administer Risperidone 0.25 milligrams one time only and to continue to monitor resident's behavior. order carried as received from physician, call light within reach, nursing monitoring in prioress. Record review of Psychotropic Medications Care Plan initiated on 07/11/2022 and next review date (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 03/29/2023 revealed the resident is at risk for drug related side effects due to use of psychotropic medication: Antianxiety, Antidepressant and Anti-psychotic (02/15/2023). Goal: The resident will remain free of drug related side effects through next review date. Interventions: Assess for fall risk and precautions needed. Encourage activities as tolerated. Licensed Nurse to follow/up behavior monitoring sheet. Medicate as ordered. Psychiatrist consult/evaluation as needed. Monitor behavior and mood every shift and document. Monitor for adverse side effects of drugs (lethargy, dizziness, increase in confusion, gait disturbance). Monitor for behavior/mood changes. Notify Social Worker about any change in behavior pattern. Observe for decline in function. Report changes to physician as needed. Interview with Staff G, a Licensed Practical Nurse (LPN) on 03/02/2023 at 08:05 AM. Staff G reported that Resident # 94 was doing well, but is agitated and anxious sometimes. The resident screamed and yelled at the staff sometimes, but after the medications were administered she is doing better. Staff G reported that she monitored the resident for mood and behavior changes before the medications are administered. During an interview with the Social Services Director on 03/02/2023 11:33 AM. The Social Worker who has a masters degree reported that when a resident will be admitted her responsibility is to check the Level I PASRR form. When she completed the Level I PASRR for this resident she did not realize the resident had diagnosis of serious mental illness and behaviors. The Social Worker acknowledged the discrepancy and stated she will request the Level II PASRR for Resident #94. 2) Observation of Resident # 21 on 02/27/2023 at 7:20 AM. Resident was noted to be on contact precautions due to Shingles. Wearing Personal Protective Equipment (PPE) the surveyor entered the room. Resident #21 was asleep and showed no sign of distress. Observation of Resident # 21 on 03/02 2023 at 10:05 AM. Wearing the PPE the surveyor entered the resident's room. Resident #21 was lying on her bed and awake. The Resident spoke in Russian, and she got frustrated when the surveyor could not understand her. Record review of the clinical records for Resident # 21 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses include, but not limited to, Cellulitis of Left Lower Limb; Type 2 Diabetes Mellitus with Diabetic Neuropathy, Unspecified; Major Depressive Disorder, Recurrent, Unspecified; Psychotic Disorder with Delusions due to Known Physiological Condition; Restlessness and Agitation; Anxiety Disorder, Unspecified; Unspecified Mood (Affective) Disorder. Record review of Level I Preadmission Screening of Resident Review (PASRR) dated 01/25/2022 Section I Screen Decision Making Section A was not marked to indicate if the resident had diagnosis of serious mental illness. Section IV PASRR Screen Completion indicated the resident had no mental illness or suspicion. The form revealed the resident was not a provisional admission. Record review of orders dated 01/21/2023 revealed the resident was receiving Fluoxetine HCL Capsule 10 milligrams by mouth one time a day for depression unspecified related to Major Depressive Disorder, Recurrent, Unspecified. Orders dated 01/21/2023 revealed the resident was receiving Quetiapine Fumarate Tablet 25 milligrams. Give 0.5 tablet by mouth every 12 hours related to Psychotic Disorder with Delusions Due to Known Physiological Condition. Record review of Medication Administration Record for the month of February 2023 revealed the resident was receiving Fluoxetine HCL Capsule 10 milligrams as ordered and Quetiapine Fumarate tablet 25 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0645 milligrams as ordered. Level of Harm - Minimal harm or potential for actual harm Record review of Annual Minimum Date Set (MDS) Section A Identification Information dated 01/07/2023 revealed the resident was not currently considered by the state Level II PASRR process to have serious mental illness and/or intellectual disability or a related condition. Residents Affected - Few Review of the Medicare-5 Days Minimum Data Set (MDS) Section C for Cognitive Patterns dated 01/25/2023 revealed the resident's Brief Interview for Mental Status (BIMS) Summary Score was 03 out of 15 indicating the resident has severe cognitive impairment. Review of the Medicare-5 Days MDS Section I for Active Diagnosis dated 01/25/2023 revealed the resident's diagnosis were Anxiety, Depression and Psychotic Disorder. Review of Medicare-5 Days MDS Section N for Medications dated 01/25/2023 revealed the resident was receiving antidepressant and antianxiety medications seven (7) days in a week. Record review of Care Plan initiated on 01/24/2022 and next review date 04/07/2023. The resident is at risk for drug related side effects due to use of psychotropic medications. Antipsychotic, antianxiety (discontinued), antidepressant. For the diagnosis of: Anxiety, Depression, Psychosis, Mood Disorder. Goal: The resident will remain free of drug related side effects through next review date. Interventions: Assess for fall risk and precautions needed. Encourage activities as tolerated. Licensed Nurse to follow/up behavior monitoring sheet. Medicate as ordered. Psychiatrist consult/evaluation as needed. Monitor behavior and mood every shift and document. Monitor for adverse side effects of drugs (lethargy, dizziness, increase in confusion, gait disturbance). Monitor for behavior/mood changes. Notify Social Worker about any change in behavior pattern. Observe for decline in function. Report changes to physician as needed. The Behavior Care Plan initiated on 05/28/2022 documented the resident was noted with aggressive behavior, attempting to bite and punch the nurse. On 06/03/2022 Resident refused to have x-rays done. Resident refused to see the physician. Goal: Resident will exhibit less episode of fighting and biting behavior through the next review. Interventions: Assess the reason for the resident's behavior. Attempt to redirect the resident. Leave the resident alone until she is calmed down. Record review of Psychiatric Follow Up consultation dated 02/16/2023 revealed the resident was seen. Staff reports no concerns or complains. continue with same medication. Follow up in 3 months. Interview with Staff F, a Licensed Practical Nurse (LPN) on 03/02/2023 at 08:34 AM. Staff F reported that the resident is doing well. The resident is in contact precautions due to shingles and will be monitored to discontinue the precautions. The resident is not aggressive, but sometimes she gets frustrated because she speaks only Russian, and we must find a translator; otherwise the resident is pretty good. Staff F stated that the resident is monitored before her medications are given for mood and behavior. Interview with the Social Services Director on 03/02/2023 at 11:33 AM; revealed when a resident will be admitted she is in charge of checking the Level I PASRR form. The Social Services Director reported that when she completed the Level I PASRR and printed it at that time the Section I-A did not come out, and she is going to try to find the state agency website to see if it can be seen and she will call the state agency to see why it doesn't come out even if she writes the resident's diagnosis. Record review of Policies and Procedures for PASRR issued 03/2021 revealed Policy: It is the policy of the facility to assure that all residents admitted to the facility receive a Pre-admission Screening and Resident Review, in accordance with State and Federal Regulations. Procedure: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 3-Preadmission Screening for individuals with a mental disorder and individuals with intellectual disability. The facility will not admit, on or after January 1, 1989, any new resident with: a. Mental disorder, unless the State mental health authority has determined, based on an independent physical and mental evaluation performed by a person or entity other than the State mental health authority, prior to admission: I. That, because of the physical and mental condition of the individual, the individual requires the level of services provided by a nursing facility. 3) On 02/27/2023 at 08:32 AM, observed Resident #36 sleeping in bed, bedrail on right side of bed was up. On 02/28/2023 at 10:49 AM, observed Resident #36 out of bed in wheelchair, she was alert. Review of Resident # 36's Level I PASRR (Preadmission Screening and Resident Review) dated 7/1/2014 under Section I: Section I: PASRR Screen Decision Making: A: Mental Illness (MI) or suspected MI (check all that apply) - No diagnosis checked (Anxiety Disorder, Depressive Disorder, and Psychotic Disorder not checked). Resident #36 has diagnosis of: Psychotic Disorder with Delusions Due to Known Physiological Condition. Review of Resident #36's admission Minimum Data Set (MDS)-Annual dated 10/20/2022, admit date : [DATE], Section C-Cognitive Patterns revealed a BIMS score of 06 out of 15 indicating the resident has severe cognitive impairment. Section A-Identification Information: Preadmission Screening and Resident Review (PASRR)-Is the resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition? No. Section I- Active Diagnosis: Non-Alzheimer's Dementia, Psychotic disorder (other than schizophrenia). Section N-Medications: Medications Received- A. Medication received: Days: Antipsychotic: 7, A. Did the resident receive antipsychotic medications since admission/entry or reentry or the prior OBRA (Omnibus Budget Reconciliation Act) assessment, whichever is more recent? 1. Yes, Antipsychotics were received on a routine basis only, B. Has a gradual dose reduction (GDR) been attempted? Yes, C. Date of last attempted GDR: 06/20/2022, D. Physician documented GDR as clinically contraindicated: No. Review of Resident # 36's Physician Orders revealed an order dated 6/11/2020 for psychological evaluation and treatment with the Doctor of Psychology (PSYD) due to being at risk for social isolation, decline in mood, behavior and cognition related to COVID-19 Pandemic. There was an order dated 10/28/2020 for Psychiatric consult with the doctor for behavioral services to rule out hallucinations. Review of the resident's progress notes for the Initial Diagnostic Interview [company name] on Behavioral Health dated 06/24/2020 revealed that Resident #36 has a diagnosis specifier of adjustment disorder with depressed mood dated 6/19/2020, Recommendations: None. Psychotherapy Recommendations: None selected. Ongoing assessment :None selected. Further psychological testing is needed to assess. Psychiatric evaluation for medication management. Review of progress note with an effective date of 1/20/2023 revealed that Resident #36 had a follow up psychiatric evaluation with documented reason for visit noted for medication management. Documentation indicated : Patient's chart was reviewed. Patient was assessed and discussed with staff. Patient discussed in GDR on 12/18/22, accepted for discontinuation for Seroquel. Progress Notes: 1. Seroquel 25 mg (milligrams) (take 1/2) PO (by mouth) twice a day (every 12 hours), Behavioral Services will follow up with patient for 12 weeks . Psychotherapy 5 minutes counseling/coordination of care and medication management. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of physician note dated 4/27/2021 revealed that Resident #36 was noted crying in her room that every night and noted this young man keeps coming in her room and removing her things. She also reported that her glasses are missing it was reported to social services. Note dated 4/22/2021 revealed that Resident #36 was noted crying in her room saying that people keep troubling her in her room at nights and that they took away her garbage bin. But, the resident's garbage bin was observed on the floor next to her bed. Physician order note dated 2/19/2021 revealed that the Advanced Registered Nurse Practioner (ARNP) for Psychology was on the unit and the resident was seen and evaluated, order received for Quetiapine 25mg at bedtime and 12.5 mg in mornings . Interview with the Social Services Director on 03/02/2023 at 11:26 AM, revealed when residents came to the facility, she is the one checking the PASRR forms. The Social Services Director stated For section 1A for [Resident # 36's] Level I PASRR there is nothing checked, there is an oversight on my part, it should be checked. I need to correct that. 4) On 02/27/2023 at 07:57 AM, observed Resident #74 sleeping in bed with bilateral rails up. Review of Resident #74's Level I PASRR (Preadmission Screening and Resident Review) dated 7/1/2014 under Section I: Section I: PASRR Screen Decision Making: A: Mental Illness (MI) or suspected MI (check all that apply) - no diagnosis checked (Anxiety Disorder, Depressive Disorder, and Psychotic Disorder not checked). Resident #74 has diagnosis of: Major Depressive Disorder, Recurrent, Unspecified and Unspecified Psychosis Not Due to a Substance or Known Physiological Condition, and Anxiety Disorder, Unspecified. Record review of Resident # 74's admission Minimum Data Set (MDS)-Medicare -5 Day dated 1/17/2022 and Annual dated 06/29/2022, admit date : [DATE], Section C-Cognitive Patterns revealed a BIMS score of 15 out of 15 indicating the resident is cognitively intact. Section A-Identification Information: Preadmission Screening and Resident Review (PASRR)-Is the resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition? No. Section IActive Diagnosis: Depression (other than bipolar). Psychotic disorder (other than schizophrenia). Section N-Medications: Medications Received- A. Medication received: Days: Antipsychotic: 7, C. Medication received: Days: Antidepressant: 7, A. Did the resident receive antipsychotic medications since admission/entry or reentry or the prior OBRA assessment, whichever is more recent? 1. Yes, Antipsychotics were received on a routine basis only, B. Has a gradual dose reduction (GDR) been attempted? No, D. Physician documented GDR as clinically contraindicated: No. Review of Resident # 74's physician orders revealed that Resident #74 had an order dated 2/23/2023 for Celexa Oral Tablet 10 MG (Citalopram Hydrobromide), 1 tablet by mouth in the morning related to Major Depressive Disorder, Recurrent, Unspecified. Order dated 2/20/2023 for Psychiatric consult for diagnosis of Major Depressive Disorder, Anxiety, Insomnia and Unspecified Psychosis. Review of Resident #74's progress notes revealed Social Services Note dated 12/16/2022 for referral to psychiatric follow up-diagnoses of: Insomnia, Major Depressive Disorder, Anxiety and Unspecified Psychosis. Social Services Note dated 7/27/2022- Note Text: Refer to psychiatric consult for medication management; diagnosis major depressive disorder, unspecified psychosis. During an interview with the Social Services Director on 03/02/2023 at 11:26 AM, she stated when I pick the diagnosis in the system and indicate what the diagnosis is, it does not come out when I try (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0645 Level of Harm - Minimal harm or potential for actual harm to print, when they have diagnosis and I select the option, I can select it in the system, but it does not come up when printing, section 3 comes up, section 4 comes up but as to why it does that, I don't know, this is something I need to find out, why the diagnoses are not printing up. When I upload the documents to the electronic health records, under documents the diagnoses are not showing, even though I picked them when uploading the document, they do not show in the system as if I clicked them. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 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 observation, record review and interview, the facility failed to ensure a resident's comprehensive care plan was followed related to the use of splints for a resident with a left hand contracture for one (Resident #130) out of one resident reviewed for position and mobility out of thirty-eight residents with contractures. There were a total of 171 residents residing in the facility at the time of this survey. The findings included: An initial observation of Resident # 130 was conducted on 2/27/2023 at 09:44 AM. The resident was sitting in a reclining chair with the television on, tube feeding machine on and had a left hand contracture. No splint or hand roll was observed in the resident's hand. Second observation of Resident # 130 was conducted on 2/28/2023 at 11:01 AM. The resident was sitting in a reclining chair with the television on, tube feeding machine on and had a left hand contracture. No splint or hand roll was observed in the resident's hand. Third observation of Resident #130 was conducted on 3/01/2023 at 12:40 PM. The resident was sitting in a reclining chair with the television on, tube feeding machine on and had a left hand contracture. No splint or hand roll was observed in the resident's hand. Record review of the Demographic Face Sheet for Resident #130 documented the resident was admitted on [DATE] with a diagnosis of cerebral infarction, chronic obstructive pulmonary disease, dementia, mood affective disorder, major depressive disorder, hypertension, Hemiplegia, gastrostomy status and contracture left hand. Review of the Physician's Order Sheet (POS) for January 2023, February 2023 and March 2023 for Resident #130 documented for splinting the resident was issued a left hand orthotic to continue with schedule of on after a.m. care off at h.s. (hour of sleep), may remove for hygiene care, ROM (range of motion) and pressure relief. The order was revised on 3/28/2022. Review of Resident # 130's ADL (activities of daily living) care plan dated 4/26/2021 documented the resident was at risk for further contractures and further decline in function; Goal: Will tolerate ROM/positioning for comfort daily through next review date; Intervention: Splinting: Resident issued a left hand orthotic to continue with schedule of on after a.m. care off h.s., may remove for hygiene care, ROM and pressure relief. Review of the Restorative Treatment Recommendations for Resident number 130 dated 4/14/2022 documented: Splint/brace on left hand/wrist after a.m. care and off at night h.s. for contracture management. Fourth observation of Resident # 130 was conducted on 3/02/2023 at 10:14 AM. The resident was sitting in a reclining chair with the television on, tube feeding machine on and had a left hand contracture. No splint or hand roll was observed in the resident's hand. Record review of the facility's Restorative Programs Policy and Procedure (Issued December 2020) documented: Policy-It is the policy of this facility to provide maintenance and restorative services (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few designed to maintain or improve a resident's abilities to the highest practicable level. Policy Explanation and Compliance Guidelines-1) Physical functioning of all residents will be assessed in accordance with the facility's assessment protocols and 2) The interdisciplinary team, with the support of and guidance from the physician, will assure the ongoing review, evaluation and decision making regarding the services needed to maintain or improve resident's abilities in accordance with the resident's comprehensive assessment, goals and preferences. Interview with Staff I, Nurse LPN (Licensed Practical Nurse) was conducted on 3/02/2023 at 10:54 AM. She stated, The resident is alert and oriented by one, requires total care for ADLs, has a contracture of the left hand and has an order for a splint on the left hand. Interview with Staff J, CNA (Certified Nursing Assistant) was conducted on 3/02/2023 at 11:09 AM. She stated, I always put the splint on his left hand but the splint was dirty and they sent it to be washed. Interview with Staff L, Nurse RN (Registered Nurse) Unit Manager on 3/02/2023 at 11:24 AM. She stated, He has an order for the splint, not aware that he was not wearing the splint. I will follow up with the laundry about the splint and talk to therapy to supply an extra one. Interview with the Director of Nursing (DON) on 3/02/2023 at 2:00 PM. She stated, The resident has a left hand contracture. He has an order for a splint. The expectation when they have an order for a splint, is the resident should be wearing the splint. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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, interview and record review, the facility failed to ensure that a left hand splint was worn to prevent worsening hand contracture for one (Resident #130) out of one resident reviewed for position and mobility out of thirty-eight residents with contractures. There were a total of 171 residents residing in the facility at the time of this survey. The findings included: Record review of the facility's Restorative Programs Policy and Procedure (Issued December 2020) documented: Policy-It is the policy of this facility to provide maintenance and restorative services designed to maintain or improve a resident's abilities to the highest practicable level. Policy Explanation and Compliance Guidelines-1) Physical functioning of all residents will be assessed in accordance with the facility's assessment protocols; 2) The interdisciplinary team, with the support of and guidance from the physician, will assure the ongoing review, evaluation and decision making regarding the services needed to maintain or improve resident's abilities in accordance with the resident's comprehensive assessment, goals and preferences; 4) All residents will receive maintenance restorative nursing services as needed, by certified nursing assistants and 5) Residents, as identified during the comprehensive assessment process will receive services from restorative aides when they are assessed to have a need for such services. These services may include: b) Splint or brace assistance. An initial observation of Resident # 130 was conducted on 2/27/2023 at 09:44 AM. The resident was sitting in a reclining chair with the television on, tube feeding machine on and had a left hand contracture. No splint or hand roll was observed in the resident's hand. Second observation of Resident # 130 was conducted on 2/28/2023 at 11:01 AM. The resident was sitting in a reclining chair with the television on, tube feeding machine on and had a left hand contracture. No splint or hand roll was observed in the resident's hand. Third observation of Resident # 130 was conducted on 3/01/2023 at 12:40 PM. The resident was sitting in a reclining chair with the television on, tube feeding machine on and had a left hand contracture. No splint or hand roll was observed in the resident's hand. Record review of the Demographic Face Sheet for Resident # 130 documented the resident was admitted on [DATE] with a diagnosis of cerebral infarction, chronic obstructive pulmonary disease, dementia, mood affective disorder, major depressive disorder, hypertension, hemiplegia, gastrostomy status and contracture left hand. Review of the Minimum Data Set (MDS) Quarterly Assessment for Resident #130 dated 11/23/2022 documented the resident's Mental Status (BIMS) Summary Score had a BIMS Summary Score of 07 out of 15 indicating cognitive impairment and the resident was not able to make his needs known. The resident required total dependence assistance with one person physical assist for ADLs (Activities of Daily Living) and had upper extremity and lower extremity impairment on both sides. Review of the Physician's Order Sheet (POS) for January 2023, February 2023 and March 2023 for Resident # 130 documented for splinting the resident was issued a left hand orthotic to continue with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 schedule of on after a.m. care off at h.s. (hour of sleep), may remove for hygiene care, ROM (range of motion) and pressure relief. The order was revised on 3/28/2022. Review of Resident # 130's ADL (activities of daily living) care plan dated 4/26/2021 documented the resident was at risk for further contractures and further decline in function; Goal: Will tolerate ROM/positioning for comfort daily through next review date; Intervention: Splinting: Resident issued a left hand orthotic to continue with schedule of on after a.m. care off h.s., may remove for hygiene care, ROM and pressure relief. Review of the Restorative Treatment Recommendations for Resident # 130 dated 4/14/2022 documented: Splint/brace on left hand/wrist after a.m. care and off at night h.s. for contracture management. Fourth observation of Resident #130 was conducted on 3/02/2023 at 10:14 AM. The resident was sitting in a reclining chair with the television on, tube feeding machine on and had a left hand contracture. No splint or hand roll was observed in the resident's hand. Interview with Staff I, Nurse LPN (Licensed Practical Nurse) was conducted on 3/02/2023 at 10:54 AM. She stated, The resident is alert and oriented by one, requires total care for adls, has a contracture of the left hand and has an order for a splint on the left hand. Interview with Staff J, CNA (Certified Nursing Assistant) was conducted on 3/02/2023 at 11:09 AM. She stated, I always put the splint on his left hand but the splint was dirty and they sent it to be washed. Interview with Staff L, Nurse RN (Registered Nurse) Unit Manager on 3/02/2023 at 11:24 AM. She stated, He has an order for the splint, not aware that he was not wearing the splint. I will follow up with the laundry about the splint and talk to therapy to supply an extra one. Interview with the Director of Nursing (DON) on 3/02/2023 at 2:00 PM. She stated, The resident has a left hand contracture. He has an order for a splint. The expectation when they have an order for a splint, is the resident should be wearing the splint. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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. Based on observation, record review and interview, the facility failed to properly store medications. This affected 1 (Resident #91) out of 1 residents observed for Glucose Monitoring. This practice has the potential to affect the 154 residents admitted to the facility. The findings included: 1. During observation of medication Cart B on 2 [NAME] on 02/27/2023 at 10:47 AM with Staff M, a Registered Nurse, to observe Glucose Monitoring for resident #91. Staff B was observed to clean the glucose monitoring equipment before use and the residents glucose level was 208. Staff B cleaned the glucose monitoring equipment after it was used. Staff B prepared 2 units of insulin and took the insulin syringe and supplies to the resident's bedside. Resident #91 was sitting on the side of the bed. Staff B left the insulin at the bedside and went into the bathroom to wash her. Staff B could not see the medication while she was in the bathroom. Staff B came out of the bathroom, put on gloves and administered the insulin into resident #91's left lower abdomen. Continued observation of the cart revealed 3 unidentified pills at the bottom of the cart drawer. 2. Observation of the 3 B Medication Cart on 02/27/2023 at approximately 11:15 AM with Staff N, Licensed Practical Nurse, revealed a ½ unidentified pill at the bottom of the cart. 3. Observation of Cart #1, 3rd floor Medication Cart on 2/27/2023 at approximately 11:30 AM with Staff O, Licensed Practical Nurse, revealed 1 unidentified pill at the bottom of the cart. On 02/28/2023 at 12:45 PM, the Director of Nurses (DON) was informed about the observations and the facility's policy on Medication Storage and Medication Administration was requested. During the review of the facility's policy on Labeling of Medications and Storage of Drugs and Biological dated 11/28/2019, the policy documents in the section for Policy Explanation and Compliance Guidelines: 1. All medications and biologicals will be labeled in accordance with applicable federal state requirements and current accepted pharmaceutical principles and practices. During the review of the facility's policy on Preparation and General Guidelines dated July 2016, revealed in part, Medications are administered as prescribed in accordance with good nursing principles and practices and only by legally authorized to do so. Personnel authorized to administer medications do so only after they have been properly oriented to the facility's medication distribution system (procurement, storage, handling and administration). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 ensure a thermometer was in the ice cream box. This has the potential to affect 154 out of 171 residents who eat orally residing in the facility at the time of the survey. The findings included: Record review of the facility's Dietary Food Storage Policy and Procedure (no written date) documented: Policy: It is the policy of the facility to provide care and services related to the storage of food in the dietary department in accordance to State and Federal regulation; Procedure: 10) Freezer temperatures will remain below 0 degrees Fahrenheit (F); 11) The use of a thermometer, which shows that the proper temperature is being maintained will be used. Initial kitchen observation of the ice cream box with the Food Service Director (FSD) on 2/27/2023 at 6:54 AM revealed the thermometer missing and two frozen water bottles in the bottom of the ice cream box. Interview with the FSD on 2/27/2023 at 6:55 AM. He stated, The thermometer should be in there and the water bottles should not be in there. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and policy review the facility failed to assure the garbage and refuse area was clean and expired water jugs and cardboard boxes were properly disposed and contained on the facility grounds. Residents Affected - Few The findings included: Record review of the facility's Dietary Disposal of Garbage and Rubbish Policy and Procedure (dated 3/01/2021) documented: Policy: It is the policy of the facility to provide care and services related to the disposal of garbage and rubbish in accordance with State Requirements; Procedure: 7) Garbage should not accumulate or be left outside the dumpster. Observation of the garbage and refuse area with the Food Service Director (FSD) on 2/27/2023 at 6:57 AM. The area had three garbage bins with two used for garbage and one for recyclables. There were four cartons with four one gallon water jugs of soon to be expired water in each on the ground. There were also, two cardboard boxes flattened lying on the ground. The soon to be expired waters and flattened cardboard boxes were not contained in a garbage bin. Photographic evidence submitted. Interview with the FSD on 2/27/23 at 6:58 AM. He stated, I just flattened those boxes and the water is about to expire. The boxes and water should not be on the ground. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 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 105596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Park at Aventura 18905 NE 25th Ave Aventura, FL 33180 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on observations, interview and record review, the facility failed to demonstrate effective plan of actions were implemented to correct identified quality deficiencies in problem area related to repeated deficient practices for F578 Request/Refuse/Discontinue Treatment; Formulate Advance Directives related to the facility failure to ensure a resident's clinical record contained documentation that the resident was provided with written information regarding the right to formulate an advanced directive for three residents (Resident # 122, Resident #133, Resident # 143) out of seven residents investigated, and F812 Food Procurement Store/Prepare/Serve/Sanitary as evidenced by the facility failed to ensure a thermometer was in the ice cream box. There were 171 residents residing in the facility at the time of survey. The findings included: Record review of the facility's survey history revealed, during a recertification survey with exit dated November 5, 2021, the facility was cited for Request /Refuse/Discontinue Treatment; Formulate Advance Directives was cited related to the facility failed to ensure advance directives were in place for three residents, whose clinical record showed no written documentation related to advance directives. The facility was cited for request/refuse/discontinue treatment; formulate advance directives during this survey with exit date 03/02/2023 due to the facility's failure to ensure a resident's clinical record contained documentation that the resident was provided with written information regarding the right to formulate an advance directive for three residents. (Cross Reference F578). During the survey with exit 11/05/2021, food procurement store/prepare/serve sanitary was cited due to the facility's staff failure to be knowledgeable of the low temperature dish machine and failed to ensure the three-compartment sink's chemical solution sanitizer were at the recommended concentration levels. During this survey with exit date of 03/02/2023 food procurement store/prepare serve sanitary was cited due to the facility's failure to ensure a thermometer was in the ice cream box. (Cross Reference F812). During an interview with the facility's Administrator and Director of Nursing on 03/02/2023 at 3:01 PM; The Director of Nursing (DON) stated that the Quality Assurance and Performance Improvement (QAPI) meeting is held on the last Thursday of every month. The QAPI members included the Administrator, Director of Nursing, Medical Director, Assistant Director of Nursing, Social Services Director, Activities Director, Maintenance Director, Housekeeping Director, Dietary Manager, Nurse Supervisors, Dietitian, Minimum Data Set Coordinator and Pharmacy Consultant (Quarterly). The DON reported that for the Advance Directives deficiency there will be a facility wide audit to ensure all residents were provided with written information regarding to advance directives documentation, as well as In-services education for admission staff and Social Services Department staff. The Administrator stated that the Dietary Manager was interviewed about the cooler that contained ice cream with no thermometer, and the thermometer was replaced and a log was created to record the ice cream box temperature twice a day. Also, the Dietary Manager had a teachable moment for ice cream temperatures. The Administrator also stated that he will be more involved in the kitchen movements to ensure the equipment is working properly. The DON and Administrator stated the deficiencies will be discussed in the next QAPI meeting and audited for four weeks. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105596 If continuation sheet Page 23 of 23