Health inspection·January 26, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 01/24/23 at 10:47 AM, an interview was held with Staff H, CNA, who stated she did not have enough time to care for the residents, but she tried her best. She stated, sincerely you can't provide care at 100% to the residents, we provide care at 40-70% sometimes 90%. She voiced the facility was short staffed. 3. Review of the quarterly minimum data set (MDS) dated [DATE] indicated Resident #98 required extensive assistance one person assist with bed mobility, transfer, and locomotion on unit, total dependence by one staff assistance with locomotion off unit, extensive assistance one person with dressing, limited assistance by one person with eating, extensive assistance by one staff assistance with toilet use, total dependence assistance one person with personal hygiene. Observation of Resident #98 on 01/24/23 at 11:18 AM revealed the surveyor went in room [ROOM NUMBER] and the resident in the window bed was lying in bed flat with yellowish / white mucous-like substance coming from her mouth and on her chin. The resident stated what happened and was trying to wipe her mouth with her hand. There was additional mucous like substance on her blankets. The surveyor pressed call light for help. The call light was not in the resident's reach. At 11:27 AM, the surveyor went to look for help since the call light was not responded to. There were no staff in the halls or at the nurse's station. On 01/26/23 at 9:06 AM, an interview was held with the Nursing Home Administrator (NHA) in the presence of the Director Of Nursing (DON) and the Regional Nurse Consultant. They were made aware of the residents' concerns relating to the residents' lack of care. On 01/26/23 at 9:50 AM, while the surveyor was going to the first floor, the surveyor heard a beeping sound, that indicated a resident had activated the call system, to call staff. The surveyor noted Resident #79's call light was on. At that time, the surveyor stood at the nursing station to monitor the call light, the light at the top of the resident's room entrance door was on. There was a staff member, Staff J, Certified Nursing Assistance (CNA) / clinical support specialist, sitting at the nursing station. Staff J did not acknowledge the call light. The first-floor unit manager was noted walking on the first floor. She came to the nursing station and left without acknowledging the call light. At 10:01 AM, the DON, who came to the nursing station, sat at the nursing station and asked Staff J to go and answer the call light. During this time, the surveyor had informed the DON, the surveyor was monitoring the call light, and had observed that staff had not acknowledged the call light. 4. Review of the quarterly minimum data set (MDS) dated [DATE] indicated Resident #79 required extensive assistance one person assist with bed mobility, total dependence by 2+ staff assistance with transfer, total dependence by one staff assistance with locomotion on and off unit, extensive assistance one person with dressing, supervision assistance by one person with eating, total dependence by one staff assistance with toilet use, extensive assistance one person with personal hygiene. On 01/26/23 at 11:42 AM, an interview was held with Resident #79, who voiced the facility did not have enough staff to respond timely to her needs. She stated, she has stayed in dirty adult brief for 4 hours sometimes. Resident #79 continued to state, the staff did not answer her call light in a timely manner. During the interview Resident #79 became upset and raised her voiced a couple of times. She indicated that, she currently has a migraine, and she hasn't seen the nurse yet, she hasn't received her morning medications yet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 2 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to ensure 6 of 28 sampled residents reviewed received treatment and care in accordance with professional standards of practice and the residents' comprehensive person-centered care plans as evidenced by the following: Residents Affected - Few 1. Failure to provide barrier cream as ordered, and failure to conduct skin checks per facility protocol (Resident #20); 2. Failure to provide barrier cream, heel prep, and prescribed topical cream as ordered; failure to conduct skin checks per facility protocol (Resident #90); 3. Failure to conduct skin checks per protocol for Resident #59; 4. Failure to apply ordered geri-sleeves each day for Resident #98; 5. Failure to apply ordered hand split for Resident #107; and 6. Failure to provide medications as ordered for Resident #31. The findings included: A review of the facility policy, titled, Skin Care and Wound Management, effective October 2014, Revised July 2017 stated in part: Page 4. The Skin Grid-Other will be completed upon identification of impaired skin at admission, at hospital return, at the time a surgical wound, venous stasis wound, diabetic wound, burn, skin tear, laceration, abrasion, rash, MAD (moisture associated dermatitis), or any other significant skin condition is found. The skin grid will be updated no less than every seven (7) days until the skin condition/wound is healed. One site will be documented per page with additional information documented as a narrative nurse's note. The weekly Skin Sweep will be used by the licensed nurse to conduct a skin inspection at the time of admission, upon hospital return, and no less than every seven (7) days. A skin inspection will also be completed before and after a leave of absence from the center and if time permits before a hospital transfer. In addition, the CNA will document results of daily skin inspection per facility protocol and report any changes or areas of concern to the nurse and/or physician. 1. Resident #20 was admitted to the facility on [DATE] with diagnoses that included morbid obesity and leg edema. Review of the Minimum Date Set (MDS) assessment dated [DATE], Resident #20 is frequently incontinent of bowel and bladder, and she required extensive assistance with all activities of daily living (ADLs). On 01/23/23 at 11:24 AM, Resident #20 was observed in bed. The resident's legs and feet were noted to be swollen. In interview with the resident, the resident stated she spends a lot of time in bed and at night she often sits in wet diapers because staff don't always change her right away. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 3 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated, I have a rash on my butt and it itches. The staff are supposed to put cream on my butt, but they hardly ever do it. A review of Resident #20's electronic Treatment Administration Record (eTAR) for January 2023 documented Resident #20 is supposed to have skin check every Wednesday. On 01/11/23 and 01/25/23, there was no evidence that skin checks were completed. The January 2023 eTAR documented Heel prep to be completed ever day shift. It was not documented as completed on 01/02/23, 01/03/23, 01/09/23, 01/15/23, 01/16/23, 01/19/23, 01/20/23, 01/24/23 and 01/25/23. Barrier cream was to be applied to coccyx and sacral every shift. On the following dates and shifts for January 2023, there were no staff initials documenting the barrier cream was applied as ordered: 01/01/23, evening shift 01/02/23, day and evening shift 01/03/23, day and evening shift 01/09/23, day and evening shift 01/12/23, evening shift 01/15/23, day shift 01/16/23, day, evening, and night shift 01/19/23, day and evening shift 01/20/23, day shift 01/23/23, evening shift 01/24/23, day and evening shift 01/25/23, day shift. On 01/25/23 at 9:49 AM, an interview was conducted with Staff C, Licensed Practical Nurse (LPN), who stated, Aides would be the ones responsible for putting on barrier cream when changing the resident's adult diapers. Review of Resident #20's care plan, dated 12/20/22, documented Resident #20 is at risk for alteration in skin integrity related to: Immobility, Use of blood thinning medication. One of the interventions documented in the care plan was Protective skin care as ordered; skin checks as per facility protocol. A review of the facility's skin check protocol stated that skin checks are to be completed as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 4 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 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 0684 ordered and not less than every 7 days. Level of Harm - Minimal harm or potential for actual harm A review of Resident #20's electronic record revealed no Skin checks / assessments were completed in January 2023, only 1 skin grid assessment was done in December (12/21/22), and only 2 Skin checks were completed in November (11/20/22 and 11/02/22). There were no documented skin assessments done in October or September 2022. Residents Affected - Few 2. Resident #90 was admitted to the facility on [DATE] with diagnoses that included Dementia, Muscle Weakness, difficulty in walking, Osteoarthritis and Rheumatoid Arthritis. Review of the MDS, dated [DATE], documented, Resident is extensive assist with all ADLs, except for eating, and she is always incontinent of bladder and frequently incontinent of bowel. On 01/23/23 at 12:20 PM, Resident #90 was observed lying in her bed watching television. The resident stated she had a rash in her groin area (lower abdomen) and it really bothers her. She said the staff do not put any cream on her. Review of January 2023 eTAR showed an order for Clotrimazole-Betamethasone Cream 1-0.05 %, Apply to Right thigh and groin topically every day shift for Redness Until Healed (Order Date 01/09/23). There were no staff initials showing this cream was applied on 01/14/23. Review of the eTAR for Resident #90 documented that skin prep to heels was to be completed every evening shift beginning 04/05/22. There were no staff initials showing heel prep was done on 01/20/23. Additional review showed 'Barrier Cream was to be applied to Buttock, Coccyx and Sacral every shift' beginning 04/05/22. There were missing initials signifying application of Barrier Cream on day shift on 01/07/23 and 01/14/23; and on evening shift on 01/20/23. 3. An observation and interview conducted with Resident #59 on 01/23/23 at 12:25 PM revealed the resident had a scabbed over skin tear / abrasion on the right forearm. The resident stated he received this skin tear about 2 weeks ago when a staff member was doing care and twisted his arm. Review of Resident #59's record did not reveal any documentation related to the skin tear to the right arm. There were no weekly skin checks documented in the nurse's notes for the current month of January 2023. Review of the Certified Nursing Assistants' (CNAs) documentation did not reveal any skin tears or open areas for the past 30 days. Review of Resident #59's care plans revealed, in part, the resident is at risk for alteration in skin integrity related to immobility and the use of blood thinner medication and he was to have skin checks as per facility protocol. In an interview with the facility Risk Manager on 01/26/23 at 10:00 AM, she stated that a report was done for this resident for a skin tear during care, but it is dated May 2022, and she did not have a recent incident reported for this resident. 4. An observation on 01/23/23 at approximately 9:15 AM revealed Resident #98 lying in bed, with her eyes open, and was non-verbal. Multiple bruises were noted on her arms. Record review revealed she had a diagnosis of thrombocytopenia (a condition characterized by abnormally low levels of platelets in the blood) which is a coagulation disorder that causes easy bruising. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 5 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Further review of the record revealed this resident was to have Geri sleeves (a sleeve designed to protect arms from friction and shearing) applied to both arms daily and removed at night. The Geri sleeves were not noted to be on the resident during the day on 01/23/23. A review of the care plans for this resident revealed a care plan for Geri sleeves on and off as ordered, initiated on 08/28/22. Additional observations of Resident #98 on 01/23/23 at 11:18 AM and 2:45 PM revealed no Geri sleeves on the resident's arms. Observations on 01/24/23 at 8:45 AM and 2:30 PM revealed no Geri sleeves on the resident's arms. Also, observations on 01/25/23 at 9:05 AM and approximately 1:30 PM revealed no Geri sleeves on the resident's arms. An interview with Staff A, LPN on 01/25/23 at 1:30 PM, revealed she was not sure about the Geri sleeves for Resident #98. Staff A stated she thought that PT (physical therapy) or OT (occupational therapy) would put those on or possibly the CNA's. Staff A further stated she does not document anything she does not do. Staff A stated she knows this resident does not have the Geri sleeves on today. 5. An observation for Resident #107 on 01/23/23 at 9:40 AM revealed the resident was lying in bed with her eyes open. She would not respond when spoken to and would turn her head away. She was noted to be on her right side and no devices were noted. Record review revealed this resident was to have an orthosis applied to her left hand daily on every shift. There was an additional order for a palm protector to the right hand. This resident had an ADL care plan in place with interventions, in part, of the left-hand orthosis daily as tolerated initiated on 04/25/22, and for the left palm protector daily as tolerated to prevent contractures initiated on 06/28/22. The resident was additionally observed daily during the survey by this surveyor on 01/23/23 at 3:00 PM, on 01/24/23 at 8:38 AM and approximately 2:00 PM, on 01/25/23 at 8:45 AM, 11:40 AM, and approximately 1:15 PM, and on 01/26/23 at 10:00 AM. The resident did not have the orthosis or palm protector on her left hand during any observations. In an interview with Staff B, LPN, on 01/25/23 at 1:15 PM, it was revealed that she was unaware of the status of the orthosis for Resident #107. Staff B looked on the resident and searched the room for the orthosis and it was not in the room. Staff B stated possibly it went to laundry to be cleaned. An interview with the Rehabilitation Director on 01/25/23 at 2:35 PM revealed Resident #107 is not on the therapy case load. The Director stated she would check the rooms and orders to make sure the devices are there. If not, they can get the devices needed for the resident. A subsequent interview with the Rehabilitation Director on 01/25/23 revealed the resident did not have the device in her room and the palm protectors have been ordered. 6. On 01/25/23 at 8:05 AM, an interview was conducted with Resident #31. She stated she had not received her medication for sleep. The Medication Administration Record (MAR) was reviewed for Resident #31. The resident is ordered Temazepam Capsule 15 mg at bedtime for sleep. The MAR indicated the medication was not available for Resident #31 on 01/22/23, 01/23/23 and 01/24/23. An interview was conducted on 01/25/23 at approximately 10:45 AM with the Director of Nursing (DON). The unavailable medication for Resident #31 was discussed with the DON who stated Resident #31's medication is always available in the facility's emergency medication kit. She stated there is always (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 6 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 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 0684 Level of Harm - Minimal harm or potential for actual harm someone in the facility with access to the emergency medication kit. She stated the nurses who were working on 01/22/23, 01/23/23 and 01/24/23 were aware of the availability of the Temazepam in the emergency medication kit. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 7 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility failed to complete Dialysis Center Communication care forms for 4 of 4 sampled residents reviewed for dialysis, Residents #30, #118, #96 and #66. Residents Affected - Few The findings included: The facility form, titled, Dialysis-Palm Garden Communication Form, is used for the residents who are leaving the facility for dialysis treatment. There is an A, B and C section located on the form. The facility nurse is to complete Section A of the form prior to the resident(s) leaving the facility for dialysis. Section B is filled out by the Dialysis Nurse and Section C is filled out by the facility nurse when the resident returns to the facility. The documentation for Section A is to include departure time, vital signs, last blood sugar if insulin dependent, last weight, date of last weight, dietary concerns, if the resident had wounds, medications given prior to dialysis and special instructions or information. There is a section for a signature and date. The documentation in Section C is to include the time the resident returned to the facility, post dialysis weight, vital signs, if the resident is having pain, the presents of the bruit and thrill, the site location, any bleeding, redness or edema at the sight. Section C has an area for the date and signature of the nurse completing Section C. 1. Resident #30 had an order on 12/09/22 for Dialysis appointments on Monday, Wednesday and Friday. Resident #30's communication forms for dialysis were reviewed. On 01/02/23, 01/04/23, 01/06/23 and 01/11/23, Section C was blank and contains no information, no date or signature. 2. Resident #118 had an order for dialysis on 12/14/22 for dialysis appointments on Monday, Wednesday and Friday. Resident #118's communication forms for dialysis were reviewed. On 01/02/23, 01/06/23, 1/11/23 and 01/13/23, Section C was blank and contained no information, no date and no signature. 3. Resident #96 had an order on 01/05/23 for dialysis treatment on Tuesday, Thursday and Saturday. Resident # 96's communication forms for dialysis were reviewed. On 01/12/23 and 01/14/23, Section C was blank and contained no required information, signature or date. 4. Resident #66's communication form for dialysis was reviewed for 12/31/22. Section A only contained the departure time and the vitals for this resident. The rest of Section A was blank, and no signature or date were documented. Section C was also blank and contained no documentation of information, signature or date. On 01/26/23 at 8:00 AM, the missing documentation of the Dialysis Center - Palm Garden Communication Form for the residents was reviewed with the Director of Nursing (DON). On 01/26/23 at approximately 9:00 AM, the Administrator stated the facility does not have a policy for the Dialysis Center-Palm Garden Communication Form. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 8 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on record review and interview, the facility failed to ensure the narcotic reconciliation was accurate for 2 of 6 sampled resident, Residents #28 and #31. Residents Affected - Few The findings included: On 01/25/23 at 1:05 PM, a medication storage observation was conducted with Staff B, Licensed Practical Nurse (LPN). The observation was conducted on the second floor Cart #1. A random narcotic count was done. Resident #28 was ordered Oxycodone HCL 5 mg tablets to be given every 6 hours for pain, as needed. The document, titled, Controlled Medication Utilization Record, was reviewed for Resident #28. The Controlled Medication Utilization record documented the time medication was removed from the narcotic storage. The Medication Administration Record (MAR) was reviewed. The MAR documented the time the removed narcotic was administered to the resident. On 12/13/22 at 12:55 PM, on 12/16/22 at 3:45 PM and on 01/20/23 with (no time recorded) the resident's medication Oxycodone 5 mg was removed from the narcotic storage and the MAR failed to provide evidence the medication was administered to the resident. On 01/25/23 at 1:36 PM, a medication storage observation was conducted with Staff C, Licensed Practical Nurse (LPN). The observation was conducted on the first floor Cart #1. A random narcotic count was done. Resident #31 was ordered Oxycodone-Acetaminophen 5-325 mg to be given every 6 hours as needed for pain. The Controlled Medication Utilization Record and the MAR were reviewed for Resident #31. The medication Oxycodone-Acetaminophen 5-325 mg was removed on 01/20/23 at 2:00 PM and signed out on the Controlled Medication Utilization Record and the MAR failed to provide evidence the medication was administered to the resident. On 01/25/22 at approximately 3:00 PM, the findings were discussed with the Director of Nursing (DON). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 9 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, policy review and interview, the facility failed to ensure the medication review recommendations by the consultant pharmacist were addressed by the prescribing physician for 1 of 5 sampled resident reviewed for unnecessary medications. (Resident (#59) The findings included: A review of the facility policy, titled, Medication Regimen Review (MRR), effective date 12/01/07 and last revised 03/03/20, stated, in part, the following: 7. Facility should encourage Physician/Prescriber or other responsible parties receiving the MRR and the Director of Nursing (DON) to act upon the recommendations contained in the MRR. 7.1 For those issues that require Physician/Prescriber intervention, the facility should encourage Physician/Prescriber to either accept and act upon the recommendations contained within the MRR or reject all or some of the recommendations contained in the MRR and provide an explanation as to why the recommendation was rejected. 7.2 The attending physician should document in the residents health record that the identified irregularity has been reviewed and what, if any, action has been taken to address it. 7.2.1 If the attending physician has decided to make no change in the medication, the attending physician should document the rationale in the residents' health record. 8. Facility should alert the Medical Director where MRR's are not addressed by the attending physician in a timely manner. 11. The attending physician should address the consultant pharmacists' recommendations no later than their next scheduled visit to the facility to assess the resident, either 30 or 60 days per applicable regulation. Record review for Resident #59 revealed the resident was admitted to the facility on [DATE] with diagnoses including, but not limited to, Psychosis, Anxiety, Alzheimer's, Depression, Schizophrenia, and Bipolar Disorder. The resident's medications included the following: Sertraline HCl Tablet 100 MG (milligrams) Give 1 tablet by mouth in the morning for Depression. Primidone Tablet 50 MG Give 1 tablet by mouth two times a day for Seizure. Lamotrigine Tablet 150 MG Give 1 tablet by mouth two times a day for Bipolar Disorder maintenance. Gabapentin Capsule 300 MG Give 1 capsule by mouth three times a day for neuropathy. Donepezil HCl Tablet 5 MG Give 1 tablet by mouth at bedtime for Dementia. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 10 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the monthly medication regimen review revealed in July 2022, there was a note to clarify the use of two doses of Sertaline in the medical record. This medication was changed to one dose, but documentation of a response for the rationale was not located in the record by the physician. In September 2022, there was a recommendation to increase the donepezil from 5 mg to 10 mg. This was never addressed by the prescribing physician and the resident remained on 5 mg. In November 2022, there was a recommendation to attempt a GDR (gradual dose reduction) of Lamotrigine 150 mg from twice per day to once per day. A note written by the Director Of Nursing (DON) is on the form stating the resident has psych notes for behaviors which contradict a reduction. Further review did not reveal any response by the prescribing physician or psychiatrist. An order by the primary physician was noted, dated 12/21/22 for a psych consult for medication review. There was no evidence of a psych consult being scheduled. In an interview with the DON on 01/25/23 at approximately 10:30 AM, it was revealed they are attempting to do everything electronically and the physicians are not writing on the MRR forms but documenting in the EMR. The DON stated she would locate this documentation. The DON provided some weekly psychotherapy notes for Resident #59, but the notes did not address any medication. In an interview with Social Services Director (SSD) on 01/26/23 at 1:40 PM revealed she did not see a psych consult for a medication review scheduled or any notes from a medication review by psych. The SSD stated she would check with the DON and medical records to see if it waiting to be uploaded to the system. At approximately 2:10 PM, the DON stated he [the resident] was seen weekly by psych and she could provide the psychotherapy notes. The surveyor informed her the psychotherapy notes she provided did not address medications and that the prescribing physician should be responding to the recommendations for the residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 11 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to have a medication error rate of less than 5%, as evidenced by the medication rate was 7.4% percent. Two (2) medication errors were identified while observing a total of 27 opportunities, affecting Residents #59 and #285. Residents Affected - Few The findings included: 1. On 01/23/23 at 10:52 AM, observation of medication administration was conducted with Staff D, agency Licensed Practical Nurse (LPN), who was administering medications to Resident #59. Staff D administered the following medications to Resident #59, that included: Fluticasone 1 spray in each nose, Primidone 50 mg 1 tablet by mouth, Torsemide 20 mg 1 tablet by mouth, Sertraline 100 mg 1 tablet by mouth, Lamotrigine 150 mg 1 tablet by mouth, Finasteride 5 mg 1 tablet by mouth, Gabapentin 300 mg 1 tablet by mouth, and Lidocaine patch 4% applied to the left knee. After the administration, the surveyor returned to the medication cart, reviewed the scheduled medications in the computer, during which time, it was revealed that Staff D, had omitted the following medications: Rivarobaxin 20 mg ordered once daily (Xarelto, a blood thinner), Calcium Vit D 600-200 mg (supplement), and Cholecalciferol (Vitamin D3) Tablet 1000 unit (supplement). When the surveyor inquired about the omitted medications, Staff D revealed the Rivarobaxin 20 mg was on order, and it was not available in the cart. The surveyor advised Staff D to check the emergency medication kit (E-kit) for the Rivarobaxin 20 mg. Staff D revealed she did not have access to the emergency medication kit. At 11:21 AM, Staff D found another nurse (Staff F, LPN) to assist her in getting into the medication room and the E-kit (a Pyxis machine, which is an automated dispensing machine provided to secure medication storage) at the 400-medication (med) room, in search for the medication. At 11:26 AM, after Staff F had made multiple unsuccessful attempts to obtain the Rivarobaxin 20 mg, Staff F found the Director of Education to assist her in the med room in search for the Rivarobaxin 20 mg. Staff D and the surveyor were also present in the medication room at the time. Staff F and the Director of Education found 2 (10mg) of Xarelto (Rivarobaxin) from the pyxis machine. At 11:47 AM, the medications were administered to Resident #59. On 01/24/23 at 8:32 AM, an interview was held with the Regional Nurse Consultant who asked, 'how was medication administration yesterday'. The surveyor explained the scenario above. The Regional Nurse Consultant agreed with findings. She acknowledged the problem. 2. On 01/26/23 at 9:14 AM, observation of medication administration was conducted with Staff C, LPN, who was administering medications to Resident #285. Staff C administered the following medications to Resident #285, that included: Gabapentin 300 mg 1 tablet by mouth, Amlodipine 10 mg 1 tablet by mouth, Baclofen 10 mg 1 tablet by mouth, Docusate 100 mg 1 tablet by mouth, Folic acid 1 mg 1 tablet by mouth, Lisinopril 20-25 mg 1 tablet by mouth, Metoprolol 50 mg 1 tablet by mouth. After the administration, the surveyor returned to the medication cart, reviewed the scheduled medications in the computer, during which time, it was revealed that Staff C had omitted to administer the Rivarobaxin 20 mg (Xarelto, a blood thinner). Staff C had 7 pills in the medication cup. When the surveyor inquired about the omitted medication, Staff C revealed the Rivarobaxin 20 mg was on order, and it was not available in the cart. The surveyor advised Staff C to check the Pyxis machine for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 12 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the medications. The surveyor alerted the first-floor unit manager (UM) to come over to the medication cart and explained the findings. During this time, the UM instructed Staff C that she needed to go to the pyxis machine (E-kit) to retrieve the medication. The UM and Staff C went upstairs to the second floor to obtain the medication. At 10:07 AM, the surveyor asked Staff C if she had obtained the medication (Rivarobaxin 20 mg) from the pyxis machine. Staff C stated no, not yet, she was having issues with her fingerprint, she still did not have access to the pyxis. Event ID: Facility ID: 105607 If continuation sheet Page 13 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview the facility failed to ensure accurate documentation for the care provided to residents for 5 of 28 sampled residents reviewed (Residents #12, #21, #59, #98, and #107). The findings included: 1. Record review revealed the resident was admitted to the facility on [DATE]. The resident had been seen by a dentist per facility request on 10/03/22 and her dentures were evaluated at that time. The top denture was fitting appropriately with dental adhesive and the bottom denture did not fit well due to bone loss. The tissues were noted as healthy and the dentures were cleaned. Review of the resident's MDS (Minimum Date Set) revealed a quarterly assessment, dated 12/14/22, with a BIMS (Brief Interview for Mental Status) of 12 which implies mildly impaired cognition. Further review of the record revealed denture care was being done by the Certified Nursing Assistants (CNA's). A look back of 30 days revealed the denture care was provided on: January 25, 23, 18, 17, 16, 15, 14, 12, 11, 10, 9, 8, 7, 6 5, 4, 3, 2, 1, 2023 and December 29 and 28, 2022. The dentures were not observed in the resident's mouth during the survey from 01/23-26/23. An observation of Resident #12 was completed in 01/24/23 at 9:15 AM. It was noted that the resident had no teeth and there were no dentures located on her table or in the bathroom. An interview was attempted with the resident but she shook her head no. On 10/26/23 at 10:22 AM, an interview with Resident #12 revealed she has not worn her dentures in a very long time. She stated the dentist came and told her she would have to use glue. She does not like the glue so she does not wear them and would like dentures that fit better. The resident stated her denture were in the drawer. They were found located in her bedside table in the back corner under other belongings. 2. In an interview with Resident #59 on 01/23/23 at 11:59 AM, the resident stated he was not getting his showers as scheduled. He was to get showered 3 days per week. Record review for Resident #59 revealed the resident was admitted to the facility on [DATE]. The record revealed he was to get showers every Monday-Wednesday- Friday. There was an order noted that the resident was to have Ketoconazole Shampoo 2% applied to his scalp every Tuesday and Friday during his showers twice per week. Shower documentation was reviewed revealing the resident had a shower on the following dates in the past 30 days: December 28, 30, 2022 and January 6, 18, and 23, 2023. Review of the Medication Administration Record (MAR) revealed the shampoo was applied to his scalp on [DATE], and January 13, 17, and 20, 2023. In an interview with Staff B, Licensed Practical Nurse (LPN) on 01/26/23 at 10:28 AM, it was revealed that the nurses do not apply the shampoo to the resident, but this is done when the CNA does the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 14 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 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 0842 shower. Level of Harm - Minimal harm or potential for actual harm An interview with Staff I, Certified Nursing Assiostant (CNA) on 01/26/23 at 10:30 AM revealed the CNAs document the showers and baths on the tablets. This shows up in the tasks in the electronic medical record (EMR). Staff I further stated they can only apply the shampoo to the resident head if he gets in the shower. Resident #59 does refuse care frequently, so if he does not want a shower he gets a bed bath and it is documented under bed bath. If he refuses all types of bathing it is documented under refusal. Residents Affected - Few The documentation for applying the shampoo to the residents scalp is inaccurate due to the shampoo only being applied on shower days. 3. An observation on 01/23/23 at approximately 9:15 AM revealed Resident #98 lying in bed, with her eyes open, and was non-verbal. Multiple bruises were noted on her arms. A record review revealed she had a diagnosis of thrombocytopenia (a condition characterized by abnormally low levels of platelets in the blood) which is a coagulation disorder that causes easy bruising. Further review of the record revealed this resident was to have Geri sleeves (a sleeve designed to protect arms from friction and shearing) applied to both arms daily and removed at night. The Geri sleeves were not noted to be on the resident during the day on 01/23/23. A review of the care plans for this resident revealed a care plan for Geri sleeves on and off as ordered, initiated on 08/28/22. Additional observations of Resident #98 on 1/23/23 at 11:18 AM and 2:45 PM revealed no Geri sleeves. On 01/24/23 at 8:45 AM and 2:30 PM revealed no Geri sleeves. On 01/25/23 at 9:05 AM and approximately 1:30 PM, observation revealed no geri-sleeves were on the resident's arms. An interview with Staff A, LPN on 01/25/23 at 1:30 PM, revealed she was not sure about the Geri sleeves for Resident #98, and further stated she does not document anything she does not do. Staff A stated she knows this resident does not have the Geri sleeves on today. A review of the Treatment Administration Record (TAR) for Resident #98 revealed the Geri sleeves are documented as being placed on every day shift and removed every night shift for the month of January 2023 from 01/01/23 through 01/24/23. On 01/25/23 at 1:45 PM, an interview with the DON revealed CNA's would put the Geri sleeves on and it would be documented in the tasks. The DON looked in tasks and it was not in the CNAs' tasks to be completed. The DON was informed the Geri sleeves were not on for the entire survey, but documented they were being put on and taken off every day. The DON reviewed the record and agreed the Geri sleeves were signed as being put on and taken off as ordered. 4. An observation for Resident #107 on 01/23/23 at 9:40 AM revealed the resident was lying in bed with her eyes open. She would not respond when spoken to and would turn her head away. She was noted to be on her right side and no devices were noted. Record review revealed the resident was to have an orthosis applied to her left hand daily on every shift. There was an additional order for a palm protector to the right hand. This resident had an ADL (Activity of Daily Living) care plan in place with interventions in part of the left-hand orthosis daily as tolerated initiated on 04/25/22 and for the left palm protector daily as tolerated to prevent contractures initiated on 06/28/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 15 of 16 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 105607 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of West Palm Beach 300 Executive Center Drive West Palm Beach, FL 33401 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The resident was additionally observed daily during the survey by the surveyor on 01/23/23 at 3:00 PM, on 01/24/23 at 8:38 AM and approximately 2:00 PM, on 01/25/23 at 8:45 AM, 11:40 AM, and approximately 1:15 PM, and on 01/26/23 at 10:00 AM. The resident did not have the orthosis or palm protector on her left hand during any observations. A review of the TAR for January 2023 revealed documentation that the orthosis was applied to the resident every day on each shift with the exception of 01/06/22 day shift, 01/9/22 day and evening shifts, 01/22/22 evening shift, 01/24/22 day shift, and 01/25/22 stated to 'see nurses notes'. This was after surveyor intervention. 5. Resident #21 was readmitted to the facility on [DATE]. The resident's diagnosis included in part: Aphasia, Dementia, Psychotic Disorder with Delusions, History of Falls, Generalized Anxiety Disorder and Mitral Valve Insufficiency. On 11/24/22 Resident #21 received a BIMS (Brief Interview for Mental Status) of zero (0), indicating Resident #21 was severely impaired cognitively. Review of the record for Resident #21 revealed she did not have any natural teeth or any dentures. The care plan for the resident indicated the resident was edentulous (no teeth). Review of the record for Resident #21 revealed the residents care documented in the task from 12/27/22 until 01/25/23 indicate the resident was receiving denture care 1-2 times a day. On 01/25/23 at 3:00 PM, an interview was conducted with Staff K, Certified Nursing Assistant (CNA), in Resident #21's room. She was asked if the resident had any teeth or any dentures. She stated she did not have any teeth or any dentures. Staff K stated Resident #21 eats a pureed diet. She stated she has never had any dentures during her stay at the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105607 If continuation sheet Page 16 of 16