Inspection·December 9, 2021

F 0585 Level of Harm - Minimal harm or potential for actual harm and turning red in the face, while describing the situation. Resident #5's family member stated Resident #5 was very upset when he called and told her of the event. Resident #5 and his family member stated they told the nurse about what happened the next day. Resident #5 stated he had not heard anything back from the facility. Residents Affected - Few An interview was conducted with the Director of Nursing (DON) on 12/09/21 at 12:00 PM. The DON stated Resident #5, along with a family member, informed her that the resident was left sitting in a wheelchair soiled for 2 hours on 12/05/21. The DON stated the incident occurred last week, prior to her working at the facility. Then she stated she is looking into it. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 2 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and review of policy and procedure, the facility failed to ensure that it provided grooming related to nail care for 2 of 3 sampled residents observed, Resident #246 and Resident #247. Residents Affected - Few The findings included: Review of facility job description on 12/08/21 at 1:41 PM for Certified Nursing Assistant (CNA) provided by the DON created September 2018 indicated the following: Certified Nursing Assistant The primary purpose of your job position is to provide each of your assigned residents routine daily nursing care and services in accordance with the resident's assessment and care plan, and as may be directed by your supervisors .The (CNA) works under the direction of licensed personnel to provide quality resident care in accordance with applicable regulations Provide direct care in accordance with treatment plans, as directed by the Director of Clinical Services/Assistant Director of Clinical Services/Clinical Nurse . Review of facility policy and procedure on 12/08/21 at 1:52 PM for Care of Nails provided by the (DON) revised 09/01/17 indicated Policies and Procedures Trim fingernails. Clean nails . 1. Resident #246 was re-admitted to the facility on [DATE] with diagnoses that included Severe Persistent Asthma with (acute) exacerbation, Anemia, Diabetes Mellitus Type II, Morbid Obesity, Hypertension and need for assistance with personal care. Record review of the Resident #246's Monthly (CNA) Activities of Daily Living (ADL) Flowsheet Record dated 12/05/21 through 12/07/21 revealed that Resident #246's (ADL)s for Personal Hygiene indicated that the resident is total dependence-full staff performance. Record review of the Resident #246's care plan, revised 12/06/21, indicated Problem: 1) The resident has Diabetes Mellitus nails should always be cut straight across, never cut corners. File rough edges with emery board. 2) Resident was admitted with edema right upper extremity with blister Doppler ultrasound done in the hospital---negative for Deep Vein Thrombosis (DVT) avoid scratching and keep hands and body parts from excessive moisture. Keep fingernails short. During a tour conducted on 12/06/21 at 11:14 AM, Resident #246 was noted to have long, sharp, dirty, unkempt fingernails on both hands. On 12/06/21 at 11:16 AM, an interview was conducted with the resident who said that she does not like her fingernails to be like this and remembers mentioning this to someone since she was admitted , but nothing was done, and they are still too long. Photographic evidence obtained of Resident #246's long, sharp, dirty, unkempt fingernails. On 12/06/21 at 4:04 PM, Resident #246 was observed with long, sharp, dirty, unkempt fingernails on both hands. On 12/07/21 at 9:30 AM, Resident #246 was observed with long, sharp, dirty, unkempt fingernails on both hands. On 12/08/21 at 9:51 AM, Resident #246 was observed with long, sharp, dirty, unkempt fingernails on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 3 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 both hands. Level of Harm - Minimal harm or potential for actual harm An interview was conducted with Staff I, a certified nursing assistant (CNA) on 12/08/21 at 12:06 PM, which revealed that Staff I-CNA had not provided fingernail care to Resident #246. She said that it is the responsibility of the CNAs to clean and trim the residents' nails. She further acknowledged that this resident's fingernails were long, sharp, dirty, and unkempt. Residents Affected - Few An interview was conducted with Staff J, a Registered Nurse (RN), on 12/08/21 at 12:10 PM, regarding Resident #246's long, unkempt nails. Staff J-RN acknowledged that Resident #246's fingernails were long, sharp, dirty, and unkempt. Resident #246's fingernail care had not been done, on the dates from 12/06/21 through 12/08/21, until after surveyor inquisition / intervention. 2. Resident #247 was admitted to the facility on [DATE] with diagnoses that included Facial Weakness following unspecified Cerebrovascular Disease, Atrial Fibrillation, Atherosclerotic Heart Disease, Diabetes Mellitus Type II, Hypertension, Morbid (severe) Obesity, Cardiomyopathy and Personal History of Benign Neoplasm of the Brain. Record review of the Resident #247's Monthly (CNA) (ADL) Flowsheet Record dated 11/30/21 through 12/07/21 revealed that Resident #247's ADLs for Personal Hygiene indicated the resident is total dependence-full staff performance. Record review of the Resident #247's care plan dated 12/06/21 indicated the following: Problems 1) The resident has an Activities of Daily Living (ADL) self-care performance deficit related to impaired balance, limited mobility and Stroke---encourage the resident to participate to the fullest extent possible with each interaction. 2) Resident has potential/actual impairment to skin integrity related allergies, impaired mobility, incontinence and anticoagulant use Avoid scratching and keep hands and body parts from excessive moisture. Keep fingernails short. During a tour conducted on 12/06/21 at 1:22 PM, Resident #247 was noted to have long, sharp, untrimmed fingernails on both hands. During a brief interview conducted on 12/06/21 at 1:26 PM with Resident #247, she said she would like to have her fingernails shaped up, but she doesn't understand why they don't do that here. Photographic evidence obtained of Resident #247's long, sharp, untrimmed fingernails. On 12/06/21 at 4:12 PM, Resident #247 was again observed with long, sharp, untrimmed fingernails on both hands. On 12/07/21 at 9:38 AM, Resident #247 was observed with long, sharp, untrimmed fingernails on both hands. On 12/08/21 at 9:53 AM, Resident #247 was observed with long, sharp, untrimmed fingernails on both hands. An interview was conducted with Staff I, a (CNA) on 12/08/21 at 12:06 PM. Staff I-CNA acknowledged that she had not provided fingernail care to Resident #247. Staff I-CNA said that it is the responsibility of the CNAs to clean and trim the residents' nails. She further acknowledged that this (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 4 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 resident's fingernails were long, sharp, untrimmed. Level of Harm - Minimal harm or potential for actual harm An interview was conducted with Staff J, an (RN) on 12/08/21 at 12:10 PM, regarding Resident #247's long, unkempt nails. Staff J-RN acknowledged that Resident #247's fingernails were long, sharp, and untrimmed. Residents Affected - Few Resident #247's fingernail care had not been done, on the dates from 12/06/21 through 12/08/21, until after surveyor inquisition / intervention. An interview was conducted with the Activities Director on 12/08/21 at 11:38 AM who stated that her department has been doing fingernail polishing and filing with an emery board for the residents who mainly come out for Activities on some Sundays, depending upon a list provided by the (CNAs) and was performed by the activities weekend coordinator. She added that her department is not allowed to cut any of the resident's fingernails. The Activities Director said that her department has not received any requests for nor have they provided nail care services to Resident #246 since her re-admission to the facility, nor for Resident #247 since her admission to the facility. The Director also acknowledged that Resident #246 and Resident #247's fingernails were all long, untrimmed and unkempt. On 12/08/21 at 12:41 PM, an interview was conducted with the Director of Nursing (DON) regarding Resident #246 and Resident #247's long, sharp and untrimmed fingernails. The DON acknowledged that it is the responsibility of the CNAs to clean and trim the residents' nails. She further acknowledged that all of the residents' fingernails were long and that they should have been cleaned / trimmed / cut, and this had not been done. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 5 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide ongoing activities for 2 of 3 sampled residents reviewed for activities, Resident #20 and Resident #62. Residents Affected - Few The findings included: 1. Resident #20 was admitted to the facility on [DATE]. A Comprehensive assessment dated [DATE] documented the resident had moderate cognitive impairment and required extensive 1 to 2 person assist with activities of daily living (ADL). Resident #20 was currently care planned as non-verbal and required physical assistance to and from activities, and also with completing activity tasks. Interventions on this care plan included the resident will attend / participate in activities of choice, the resident will maintain involvement in cognitive stimulation and social activities, and the resident needed assistance / escort to activity functions. On 12/06/21 at 10:00 AM and 2:00 PM, Resident #20 was observed sleeping in bed wearing a hospital gown. On 12/07/21 at 9:00 AM, 12:00 PM, and 2:00 PM, Resident #20 was observed sleeping in bed wearing a hospital gown. On 12/08/21 at 10:00 AM, 2:00 PM, and 4:00 PM, Resident #20 was observed sleeping in bed wearing a hospital gown. An interview was conducted with Staff Z, a Licensed Practical Nurse (LPN), on 12/08/21 at 11:30 AM. Staff Z-LPN stated Resident #20 did not get out of bed unless he had somewhere to go. Staff Z-LPN further stated Resident #20 did not like to sit up in a chair, and would try to get out of the chair. An interview was conducted with the Activities Director (AD) on 12/09/21 at 11:50 AM. The AD stated Resident #20 did not attend activities due to the resident being in bed. The AD further stated Resident #20 was not on the 1:1 activity program. Review of Resident #20's Daily Recreation / Activity Participation Document log revealed the last documented activity the resident participated was on 08/30/21. 2. Resident #62 was admitted to the facility on [DATE]. A Comprehensive Assessment, dated 11/05/21, documented the resident had mild cognitive impairment and required total 1 to 2 person assistance with activities of daily living. Resident #62 was currently care planned for being dependent on staff for social and emotional well being. Intervention on this care plan included: to encourage resident to participate in group activities, respect resident choices in regard to limited / no activity participation, and staff will offer him one on one room visits and provide tactile and sensory stimulation. On 12/06/21 at 10:00 AM and 2:00 PM, Resident #62 was observed sleeping in bed wearing a hospital gown. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 6 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Level of Harm - Minimal harm or potential for actual harm On 12/07/21 at 9:00 AM, 12:00 PM, and 2:00 PM, Resident #62 was observed sleeping in bed wearing a hospital gown. On 12/08/21 at 10:00 AM, 2:00 PM, and 4:00 PM, Resident #62 was observed sleeping in bed wearing a hospital gown. Residents Affected - Few An interview was conducted with Staff Z-LPN, on 12/08/21 at 11:30 AM. Staff Z-LPN stated Resident #62 was able to make needs known. Staff Z-LPN further stated the resident would refuse to get out of bed. An interview was conducted with the Activities Director (AD) on 12/09/21 at 11:50 AM. The AD stated Resident #62 did not attend activities due to the resident being in bed. The AD further stated Resident #62 was not on the 1:1 activity program. Review of Resident #62's Daily Recreation/Activity Participation Document log revealed the last documented activity the resident participated was on 08/30/21. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 7 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 interview and record review, the facility failed to transfer a resident with a change in condition in a timely manner for 1 of 2 sampled residents reviewed for hospitalizations, Resident #20. Residents Affected - Few The findings included: Resident #20 was admitted to the facility on [DATE]. A Comprehensive assessment dated [DATE] documented the resident had moderate cognitive impairment and required extensive 1 to 2 person assist with activities of daily living. Record review revealed an physician order, dated 09/05/21, to transfer Resident #20 to the hospital. Review of the Progress Notes, dated 09/05/21 at 6:31 PM, for Resident #20's revealed a Medical Practitioner's Note, that documented: 'Spoke with (family member) whom states concern of (resident) whom she spoke with earlier - slow/slurred speech. Called and spoke with nurse and (resident) via facetime - slurred speech and slow to response noted after neurological assessment. V/S (vital signs) stable. Patient to be sent out for neurology work-up / evaluation.' A Progress Note, dated 09/05/21 at 6:35 PM, documented: 'After dinner resident asked nurse to call his (family member). Resident then spoke to (family member). (Family member) later called to nurse that (Resident #20) is not sounding right that his voice is slurred and she is worried and very concern, nurse went to reassess resident with CNA [Certified Nurse Assistant] and noted he talks in a low voice at times and told (family member) that he will be monitor at all times for any changes. ARNP (Advanced Registered Nurse Practitioner) then called and spoke to resident by asking him questions which he answered appropriated. Nurse asked if she wants to face time resident and see him, ARNP also stated he did sound slurred and called daughter to see what she wants to do. Resident V/S [vital signs] read BP [blood pressure] 102/45 P [pulse] 72, R [respirations]18, 02 sat [oxygenation] 97 [%], BS [blood sugar] 216. ARNP call back and give orders to send resident to [hospital] to eval [evaluate] and T [treat] for slurred speech. Call made to ambulance dispatcher stated will be there in 2-3 hrs [hours], call made to [hospital] ER spoke to nurse and give report.' A review of Resident #20's Progress Notes revealed another entry at 1:15 AM (on 09/06/21) that documented the resident's vital signs and that the resident was comfortable and safe. There was no documentation of the resident's neurological status. A Progress Note, dated 09/06/21 at 2:03 AM, documented: 'ambulance company en-route to facility, resident in bed resting with eyes closed breathing on room air.' A Progress Note, dated 09/06/21 at 2:14 AM, documented that Resident #20 left the facility, almost 8 hours after the initial order to transfer the resident to the hospital for a change in condition. There was no documentation of the resident's neurological status for almost 8 hours. There was no documentation that the physician was notified of the delay in transportation of Resident #20 to the hospital. An interview was conducted with Staff Y, a Registered Nurse (RN), on 12/09/21 at 1:45 PM. Staff Y-RN stated if a resident has an order to transfer to the hospital, it depends on the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 8 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 condition; You call 911, or another ambulance transportation system; If there is a change in condition, call 911; and Ambulance transportation system is slower, and gives a 2-hour window. Staff Y-RN stated Resident #20 should have been transferred out via 911. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 9 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to prevent the worsening of a pressure ulcer for 1 of 2 sampled residents reviewed for pressure ulcers, Resident #89. Residents Affected - Few The findings included: Record review revealed Resident #89 was admitted to the facility on [DATE], discharged to hospital on [DATE] for abnormal labs, was readmitted to the facility on [DATE], was discharged to hospital for on 10/22/21 for labored breathing and was readmitted on [DATE]. Resident #89 had an medical history with diagnoses to include Acute Renal Failure, Hypertension, Diabetes and Stroke. A comprehensive assessment dated [DATE] documented the resident had severe cognitive impairment and required extensive to total 1 to 2 person assist with activities of daily living. The assessment further documented the resident did not have any pressure ulcers. The resident had a foley catheter and received tube feedings for nutrition. A review of Resident #89's care plan, dated 06/23/21, revealed a care plan for the resident being at risk for potential impairment to skin integrity related to fragile skin, limited range of motion / mobility / stroke, weakness left side. The care plan, dated 11/08/21, documented Resident #89 had a sacral pressure ulcer and potential for further breakdown. A review of Resident #89's Progress Notes revealed a note dated 09/03/21 at 8:46 AM (the morning after re-admission) that documented the resident was readmitted to the facility with an open area to the sacrum. A review of Resident #89's physician orders revealed an order, dated 09/03/21, to apply Xeroform to sacrum every night shift and as needed for wound. Review of Resident #89's Treatment Administration Record (TAR) for September 2021 revealed lack of documentation or evidence that the resident received wound care treatment on 09/09/21, 09/19/21, 09/22/21, 09/25/21, 09/27/21, 09/29/21 and 09/30/21. Review of Resident #89's Treatment Administration Record (TAR) for October 2021 revealed lack of documentation or evidence that the resident received wound care treatment on 10/02/21, 10/03/21, 10/04/21, and 10/06/21. Review of Resident #89's physician orders revealed an order, dated 10/08/21, to cleanse the coccyx with NS (Normal Saline) and apply Medihoney hydrogel dressing daily and as needed every night shift for wound. Record review lacked any documentation of Resident #89's sacral wound condition from the date of 09/03/21, when the wound was first discovered, until 10/08/21, when the resident's dressing change orders were changed. A review of Resident #89's Treatment Administration Record (TAR) for October 2021 revealed lack of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 10 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 0686 Level of Harm - Minimal harm or potential for actual harm documentation or evidence that the resident received wound care treatment on 10/11/21, 10/14/21, and 10/15/21. A wound care consult was ordered on 10/16/21 for the coccyx wound. There was no documentation of the condition of Resident #89's sacral wound. Residents Affected - Few Resident #89 was transferred to the hospital on [DATE] and was readmitted to the facility on [DATE]. A Progress Note, dated 11/05/21 at 2:18 PM, documented a wound to Resident #89's sacrum and bilateral heels with dark area. Review of Resident #89's physician orders revealed orders, dated 11/05/21, for an air mattress and to cleanse sacral wound with normal saline, apply alginate (Calcium Alginate pad), cover with dry dressing daily one time a day. A wound care consult was again ordered on 11/08/21. A review of Resident #89's Treatment Administration Record (TAR) for November 2021 revealed lack of documentation or evidence that the resident received wound care treatment on 11/09/21, 11/10/21, 11/13/21, 11/15/21, 11/22/21, 11/23/21, 11/24/21, and 11/25/21. A review of wound care note, dated 11/15/21, documented Resident #89's sacral wound as unstageable due to necrosis, length 9.5 cm (centimeters), width 4.5 cm, and depth not measurable. The plan was to treat with Calcium Alginate and Santyl (debridement agent) daily. Resident #89's wound was debrided on 11/22/21 and was staged at a stage-4 by wound care. The sacral wound measurements were documented as 8 x 4 x 1 cm. The plan was to continue treatment with Calcium Alginate and Santyl daily. A review of Resident #89's TAR did not reveal any documentation of Santyl applied to the resident's sacral wound. A wound care note, dated 12/01/21, documented Resident #89's sacral wound measurement as 8 x 8 x 3 cm. The plan was to change to Dakin's solution for treatment. Review of Resident #89's physician orders revealed an order, dated 12/02/21, to cleanse sacral wound with normal saline, apply Dakin's soaked gauze, apply Zinc Ointment to the peri-wound, cover with dry dressing and secure with tape every night shift. Review of Resident #89's Treatment Administration Record (TAR) for December 2021 revealed lack of documentation or evidence that the resident received wound care treatment on 12/04/21. A wound care note, dated 12/09/21, documented the resident's sacral wound measurement as 8 x 10 x 3 cm, deteriorated, with a plan for a general surgeon consult for operative debridement of sacral wound. A Progress Note, dated 12/09/21, documented Resident #89 was seen by the Wound Care Doctor who requested the resident to go to the hospital for further debridement and suspected osteomyelitis (bone infection). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 11 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 0686 An interview was conducted with the Administrator (NHA) on 12/09/21 during Quality Assurance Performance Improvement review. The NHA was informed of Resident #89's worsening pressure ulcer. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 12 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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** 2. Review of Resident #59's clinical record documented an initial admission to the facility on [DATE] and a re-admission on [DATE]. The resident's diagnoses included, in part, Abnormal Posture, Pain in Joints of Left Hand, Contracture of Muscle of Left Hand, and Muscle Spasm. Review of the resident's Occupational Therapy Discharge summary, dated [DATE], documented, .patient presented with improve range of motion to 3rd and 5th fingers .patient and caregiver training: provided instructions to patient with nursing staff in safe task completion .and functional maintenance program .caregiver to apply the orthotics device .daily .patient is tolerating left hand orthotic device for 5-6 hours . Review of the physician orders, dated 08/13/21, documented, Patient to participate with caregiver in applying Left hand orthotic device (carrot) at least 5-6 hours daily. Provide hand hygiene between orthotic wearing schedule. Review of Resident #59's clinical record task for Restorative: Splint or Brace, Patient to participate with caregiver in applying left hand orthotic device (carrot) at least 5-6 hours daily. Provide hand hygiene between orthotic wearing schedule, lacked evidence or documentation that the care was provided from 11/11/21 to 11/15/21 and from 11/17/21 to 12/06/21. Documentation revealed the resident refused the care on 11/16/21. Review of the resident's Minimum Data Set (MDS) quarterly assessment, dated 10/31/21, documented a BIMS (Brief Interview Mental Status) score of 14 indicating that the resident has not cognition impairment. The assessment documented, under Functional Limitation, that the resident had no upper extremities (wrist, hand, elbow, or shoulder) impairment. Further review revealed that Resident #59 received Occupational Therapy from 06/28/21 through 08/13/21. The assessment was not coded for Restorative Nursing Program. Review of Resident #59's care plan, titled, Self-care performance deficit related to immobility .non ambulatory-Muscle spasm, initiated on 05/07/2021 and revised on 08/19/21, documented an intervention that read Patient to participate with caregiver in applying Left hand orthotic device (carrot) at least 5-6 hours daily. Provide hand hygiene between orthotic wearing schedules. Date Initiated: 09/22/2021. Further review revealed that the resident was totally dependent on the staff for dressing, personal hygiene, oral care, toilet use and transfers. Review of Resident #59's care plan, titled, Patient have contracture of the neck at risk for further contractures related to physical immobility .Total care .Non ambulatory, .initiated on 05/07/21 and revised on 08/19/21, was conducted. The care plan interventions included, in part, Support neck with pillow when in bed .Patient to participate with caregiver in applying Left hand orthotic device (carrot) at least 5-6 hours daily. Provide hand hygiene between orthotic wearing schedules . Further review of all active care plans lacked documentation of Resident #59 refusing to wear the Therapy Carrot, finger orthosis device. Review of Resident #59's Nspire Quarterly Data Collection date 10/03/21 documented, under Physical Functioning, that the resident was not using assistive devices. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 13 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 On 12/06/21 at 11:14 AM, observation revealed Resident #59's in bed with her hands resting on her over the bed table across her. Further observation revealed resident left hand three digits (fingers) closed tight. During interview at this time, Resident #59 was asked if she could open her left hand and she stated she could not. She stated it has been like that for weeks and it hurts to open them up. She was asked if the facility staff was doing therapy or applying anything to her hand to keep it open and she stated, 'No'. Further observation revealed a red colored soft cloth device that read, Therapy Carrot, finger orthosis, on the top of her over the bed table. On 12/06/21 at 12:40 PM, observation revealed Resident #59 in bed with her hands resting on her over the bed table across her. Further observation revealed the resident's Therapy Carrot, finger orthosis device continued to be on the top of her over the bed table. On 12/07/21 at 11:30 AM, observation revealed Resident #59 in bed with her hands under the covers. An interview was conducted with the resident who stated that she had been provided morning care. Further observation revealed the resident's Therapy Carrot, finger orthosis continued to be on the top of her over the bed table. On 12/07/21 at 3:46 PM, observation revealed Resident #59 in bed and awake. An interview was conducted with the resident and stated that the staff had not put anything on her left hand today. Further observation revealed the Therapy Carrot, finger orthosis device on the top of her table. The resident was asked if she knew what the carrot like device was for and she stated she did not know and had not had that on her hand today. The resident was asked if she would like to have it on and replied 'Yes'. She was asked if she refuses to have it on and stated 'No'. On 12/08/21 at 8:55 AM, observation revealed Resident #59 in bed holding a juice container with a straw in between left index and her closed heart finger. During an interview, the resident stated she fed herself with her left hand. The resident was asked if she would like something on her left hand to prevent it from getting worse and she replied 'Yes'. On 12/08/21 at 11:33 AM, an interview was conducted with Staff O, a Licensed Practical Nurse (LPN), who stated that Resident #59 is total care except that she fed herself and gets out of bed 2 times per week. Staff O-LPN stated the resident was not getting Physical nor Occupational therapy at the time. Staff O-LPN was asked if the facility had a Restorative Nursing Program in place and she stated she was not sure. Staff O-LPN stated that Resident #59 refuses to use the 'stuff' for her neck. She added that the resident had a carrot that therapy gave to her to hold on her hand. Staff O-LPN stated the staff (Floor Nurses and Certified Nursing Assistants) are responsible to put it on. Staff O-LPN was asked if she had put the carrot on Resident #59's left contracted hand and she stated she has not had the time to put on today. She stated she did not put it on 12/07/21. On 12/08/21 at 11:42 AM, a side by side observation of Resident #59's was conducted with Staff O-LPN. Staff O-LPN picked up the Therapy Carrot, finger orthosis from the top of the resident's over bed table. Staff O-LPN told the resident that she had to put the carrot on her hand to prevent it from closing. Staff O-LPN attempted to put it on the resident left contracted hand and the resident stated, 'It hurts'. Observation revealed the resident was able to pull the device through her hand with some difficulty utilizing the string attached to it. Staff O-LPN was asked to explain to the resident the reason of the device. Staff O-LPN was apprised that Resident #59 has not had her left hand Therapy Carrot, finger orthosis in place to prevent worsening of her contracture since 12/06/21. Staff O-LPN stated that the resident sometimes refused to have it on. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 14 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 On 12/08/21 at 11:55 AM, an interview was conducted with Staff N, a Certified Nursing Assistant, who stated she was familiar with Resident #59. Staff N-CNA stated that the resident did not want for her to put the Therapy Carrot, finger orthotists on and that she wants to do it herself. Staff N-CNA added that the resident is left handed and did not like to have it on because she eats her cookies with her left hand. Staff N-CNA was apprised that it was observed that Resident #59 has not had her Therapy Carrot in place since survey started on 12/06/21. Staff N-CNA stated she offered to put it on 12/07/21 and the resident did not want it. Staff N-CNA was asked if she reported this to anyone of Resident #59 refusing to have the Therapy Carrot put in place and stated No because she did not refuse at all times. On 12/08/21 at 1:34 PM, an interview was conducted with the facility's Director of Rehabilitation (DOR). The DOR stated that Resident #59 had been in facility before the transition to new corporation in 2018. The DOR stated that theoretically, a resident is screened quarterly but because of COVID-19 and staffing issues, everything got upside down. The DOR stated she had been working at the facility since June 2021. She stated that Resident #59 was last screened for therapy on 06/2021. The DOR stated the resident received Occupational Therapy (OT) treatment from 06/28/21 to 08/13/21, and was discharged on 08/13/21 to the facility's Restorative Nursing Program (RNP). She stated on discharge, the resident was able to wear a carrot (Therapy Carrot, finger orthotists) on her left hand, restorative teaching was done with 100% carried over, meaning that the RNP staff was responsible to apply the resident left hand device to prevent the contracture from worsening. The DOR added that a splint was tried but she was not able to tolerate. They tried the Therapy Carrot, finger orthosis for 5 -6 hours without any skin redness or blisters and that was the reason the resident has the Therapy Carrot, finger orthosis. The DOR was asked if the facility had a RNP and she stated as far as she knows, the Director of Nursing was in the charge of the RNP. She stated they had one restorative aide. The DOR was asked if she was aware of Resident #59 refusing to wear her Therapy Carrot, finger orthosis and she stated she was not aware. She added the staff need to let therapy knows that the resident refuses so they can re-assess. On 12/08/21 at 2:56 PM, observation revealed Resident #59 holding her Therapy Carrot, finger orthosis on her right hand. During an interview, she stated that she couldn't eat with it and took it off. She stated she will try to put it on again. On 12/08/21 at 2:59 PM, the DOR was asked to rescreen Resident #59's today. Review of Resident #59's therapy screening form dated 12/08/21 documented .significant tightness noted in Left finger flexion digits 3, 4, 5; with carrot (therapy device) in place . During an interview, the DOR stated that the resident had significant tightness noted in left finger flexion digits 3, 4, 5 and was complaining of pain. She stated she will discuss it with the Director of Nursing (DON) and will recommend a physiatrist consult and Baclofen (a muscle relaxant). On 12/08/21 at 4:18 PM, a side by side review of Resident #59's MDS assessments were conducted with the facility's MDS Coordinator. The review revealed that the resident's assessment was not coded for RNP. She stated that the Nspire Quarterly Data Collection, date 10/03/21, was coded wrong, should had been coded as 'splint/brace'. During the interview, the MDS coordinator stated that she had not heard that Resident #59 was refusing to use the Therapy Carrot, finger orthosis. She added that if the resident refuses, they need to make therapy aware of that and then they will update the care plan. The MDS Coordinator stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 15 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 Resident #59 is reliable, alert, and oriented. Level of Harm - Minimal harm or potential for actual harm On 12/09/21 at 2:38 PM, an interview was conducted with the facility DON. She stated that the only thing she knew was that the did not have a restorative nurse. She added that if a resident was coming off from therapy, their recommendation was given to her, she then would enter the recommendation under the task tab in the resident's record for the floor Certified Nursing Assistants to complete. She added after that, she would provide the information to the MDS coordinator to be entered into the resident's care plan. A side by side review of this resident's Certified Nursing Assistant task record was conducted with the DON. She noted the 'not applicable' documentation and stated 'what.' She added she did not know why it was reported not applicable. The DON was apprised that Resident #59 was not provided with her therapy device to avoid the worsening of her left hand contracture during the survey dates. She was apprised that Therapy was not aware that she was refusing to wear the device. Residents Affected - Few Based on observation, interview, and record review, the facility failed to provide residents with limited range of motion, appropriate treatment and services to prevent further decrease in range of motion for 2 of 2 sampled residents reviewed for range of motion, Resident #20 and Resident #59. The findings included: 1. Resident #20 was admitted to the facility on [DATE], with multiple re-admissions. A Comprehensive Assessment, dated 09/16/21, documented the resident had moderate cognitive impairment and required extensive 1 to 2 person assist with activities of daily living. The assessment further documented the resident was not on a restorative program, and had no splints or braces. Resident #20 was observed in bed on 12/06/21 at 10:00 AM. Two braces/splints were observed on the resident's bedside table. Resident #20 was observed in bed on 12/07/21 at 9:00 AM. Two braces/splints were observed on the resident's bedsife table. A review of Resident #20's record did not reveal a physician order or care plan for a brace/splint. An interview was conducted with Staff Z, a Licensed Practical Nurse (LPN), on 12/08/21 at 11:50 AM. Staff Z-LPN stated Resident #20 has a contracture to his left arm. Staff Z-LPN stated the resident used to have a splint for his hand, but the resident does not use it anymore. An interview was conducted with the Director of Rehabilitation on 12/08/21 at 1:30 PM. The Director stated Resident #20 was discharged from occupational therapy on 06/08/21 tolerating a left slim grip hand splint and left elbow brace. The Director stated they do not place orders for splints. The Director stated written communication of training on the use of splints were obtained, and it was the nurse's responsibility to place the physican order in the resident's chart. After the Director was informed of Resident #20 not wearing any splints, the Director stated she would screen the resident. A follow-up interview was conducted with the Director of Rehabilitation on 12/08/21 at 2:30 PM. The Director stated Resident #20 could no longer fit the left hand splint due to the contraction worsening. An interview was conducted with the Restorative Certified Nursing Assistant (RCNA) on 12/09/21 at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 16 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 12:10 PM. The RCNA stated Resident #20's splints were not on her tasks. The RCNA stated she knew the resident wore a splint, but the resident had been refusing to wear any splints. The RCNA further stated she had been trained on the use of Resident #20's left hand and left arm splints. An interview was conducted with Staff Y, a LPN, on 12/09/21 at 1:38 PM. Staff Y-LPN stated when a resident goes on restorative program, there is a form to sign that states whether the resident requires any splint or brace, and they are taught by therapy how to apply. Staff Y-LPN stated Therapy keeps the form. Staff Y-LPN further stated she did not know who places the order for the splints in the resident's chart. A review of Resident #20's Electronic Interdisciplinary Screen Form, dated 12/08/21, documented, 'significant progression of left hand and upper extremity contracture. Orders requested for Physical Therapy, Occupational Therapy, and Speech Therapy.' FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 17 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to provide urinary catheter and peri-care appropriately to prevent possible urinary tract infections to the extent possible for 1 of 1 sampled resident, Resident #50. The findings included: Review of the facility's policy, titled, Catheter Care, Urinary, revised on 09/05/17, documented, in part, .wash perineal area with soap and water from front to back .clean catheter tubing .starting close to urinary meatus, cleaning in circular motion along its length for about 4 inches, moving away from the body. Rinse well using the same motion . Review of the facility's policy, titled, Perineal Care, revised on 09/05/17, documented, in part, .on female residents, wash from front to back to avoid urethral or vaginal contamination . Review of Resident #50's clinical record documented a physician order, dated 09/15/21, for Indwelling catheter care every shift. The resident's record documented an initial admission to the facility on [DATE] and a readmission on [DATE]. The resident's diagnoses included, in part, Post Laminectomy Syndrome, Cervicalgia, Presence of Urogenital Implants, Neuromuscular Dysfunction of Bladder, Chronic Pain Syndrome, Need for Assistance with Personal Care, Abnormal Posture, Muscle Wasting and Atrophy, Fecal Impaction, Abnormalities of Gait and Mobility, and Muscle Weakness. Review of the resident's Minimum Data Set (MDS) quarterly assessment, dated 11/02/21, documented a Brief Interview of Mental Status score of 14, indicating no cognitive impairment. The assessment documented that the resident had an indwelling catheter (Foley) and needed extensive assistance from the staff for her activities of daily living including toilet use. Review of Resident #50's care plan, titled, The resident has Indwelling Catheter related to Neurogenic Bladder, initiated on 05/18/20 and revised on 10/26/20, that documented interventions to include, in part, Monitor for signs and symptoms of discomfort on urination and frequency . On 12/08/21 at 8:59 AM, observation of catheter / perineal care performed by Staff N, a Certified Nursing Assistant (CNA), for Resident #50 was conducted. Observation revealed Staff N-CNA donned gloves, removed a catheter leg bag from a plastic bag. Observation revealed the leg bag had approximately 20-30 centimeters (cc) of urine in the bag. Staff N-CNA then disconnected the resident's catheter tubing from the drainage bag and connected it to the leg bag while the resident was lying in bed. Staff N-CNA did not rinse the leg bag before reconnecting it to the catheter. Staff N-CNA stated Resident #50's urinary catheter tubing is connected back to the drainage bag in the evening and to a leg urinary bag every morning. She was apprised of urine noted in the leg bag and stated she did not notice it. Staff N-CNA proceeded to provide the resident's care and stated that the resident had a bowel movement. She proceeded to clean the resident pubic area, her left (inguinal) side between legs and the private area with one wipe. A large bowel movement was observed. Observation revealed Staff N-CNA wiped the resident's pubic area, the sides between her legs and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 18 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few her private area with the same wipe with back and forth strokes with the same side of the wipe. Staff N-CNA cleaned the resident's right side between her leg and her private area; then with the same wipe, she was observed wiping the catheter tubing. Observation then revealed stool on the resident catheter. Staff N-CNA did not separate the resident's labial to clean inside them. The resident was then turned on her side and Staff N-CNA proceeded to clean her buttocks and rectal area with a wipe. Observation revealed Staff N-CNA wiping the buttocks twice with the same side of the wipe. Staff N-CNA turned the resident on her back and proceeded to clean her pubic area again with one wipe, she cleaned the area, but did not clean between the resident labial area to prevent from spreading germs to the urethra. On 12/08/21 at 9:15 AM, during an interview, Staff N was asked about her technique of using one wipe to clean back and forth Resident #50 private area and the catheter. Staff N-CNA stated she did the care wrong, added that she was to use one wipe to clean from top to bottom and then discard the wipe. She added she was nervous. On 12/08/21 at 3:03 PM, during an interview, the Director of Nursing (DON) was informed of the concerns during the peri-care and catheter care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 19 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a timely nutritional assessment, failed to obtain weights, failed to monitor nutritional status, and failed to ensure consistent meal intake documentation for 2 of 7 sampled residents reviewed for nutrition, Resident #89 and #296. Resident #89 had a significant weight loss and had a worsening pressure ulcer, which would indicate a need for increased nutrition. Residents Affected - Few The findings included: A review of the National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance, titled, Prevention and Treatment of Pressure Ulcers: Clinical Practice Guidelines, dated 2014, showed the following: Assess the weight status of each individual to determine weight history and identify significant weight loss (5% in 30 days or 10% in 180 days). A comprehensive nutrition assessment involves a systematic process of collecting, verifying, and interpreting data related to nutritional status, and forms the basis for all nutrition interventions. The assessment process is continuous, and early intervention is critical. The consensus statement by the Academy defines malnutrition as the presence of two or more of the following characteristics: insufficient energy intake, unintended weight loss, loss of muscle mass, loss of subcutaneous fat, localized or generalized fluid accumulation, and/or decreased functional status. Malnutrition impacts pressure ulcer healing. Both inadequate nutritional intake and poor nutritional status (malnutrition) have been shown to correlate to the development of pressure ulcers, pressure ulcer severity, and protracted healing of wounds. https://www.andeal.org/files/files/WoundCare/NPUAP-EPUAP-PPPIA%20CPG%202014.pdf A review of the facility's policy, titled, Weight Protocol, effective date of 09/17/18, revealed that weights are obtained and monitored on a regular basis. admission weight will be obtained by the restorative aid on the day after admission and recorded. All residents are weighted weekly times 4 weeks following admission, and monthly thereafter. Significant weight changes and/or noted trends will be evaluated by dietetic professionals and documented accordingly. A review of the facility's policy, titled, Nutritional Assessment, effective date of 09/17/18, revealed that a nutritional assessment will be initiated within 7 days and completed by the Registered Dietitian upon the next scheduled visit. To complete a nutritional assessment, the Dietitian must review the clinical records, height and weight data, lab data, and diet history. It further showed that the nutritional assessment is used to identify nutritional problems and formulate measurable goals. 1. In an observation conducted on 12/09/21 at 7:50 AM, Resident #89 was observed in bed. Closer observation showed sunken eyes, hollow cheeks, protruding clavicle bones, and thin-looking legs. Record review showed that Resident #89 was initially admitted to the facility on [DATE], was discharged to the hospital on [DATE], readmitted to the facility on [DATE], discharged to the hospital on [DATE], and readmitted to the facility on [DATE]. Resident #89 has a medical history of Diabetes, Stroke, and a feeding tube in place. Further review of the chart showed the following weight history: on 06/04/21 his weight was at 139.6 pounds, on 06/10/21 his weight was at 139.6 pounds, on 07/10/21, it was at 138.6, on 08/19/21 it (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 20 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Level of Harm - Minimal harm or potential for actual harm was at 137.2 pounds, on 09/16/21 no weight was recorded, and the last weight recorded was on 11/11/21 at 125 pounds. A review of the medical record, dated 10/22/21, showed that Resident #89 was intubated (in hospital) and had been consulted for Urinary Tract Infection (UTI), Sacral Decubitus, and Pneumonia. Residents Affected - Few During an observation on 12/09/21 at 7:50 AM, Resident #89 was noted in bed. A Tube feeding bag was noted with Glucerna 1.5 (Tube feeding formula) with a start date of 12/09/21 and a start time of 6:00 AM. Closer observation showed that the tube feeding was not running at this time. In an interview conducted on 12/09/21 at 8:10 AM, Staff H, Registered Nurse (RN), stated that she is not sure as to why the tube feeding was on hold, and further said that Resident #89 is tolerating his tube feeding well. Staff H then proceeded to connect the tube feeding as per the physician's orders. In an observation conducted on 12/09/21 at 8:30 AM, Staff D, Restorative Certified Nursing Assistant (RCNA), was asked by the surveyor to obtain the weight on Resident #89. Staff D-RCNA proceeded to locate a Hoyer lift and brought it into Resident #89's room. Resident #89's weight was recorded at 122.8 pounds, taking 2 pounds off for the weight of the sling. In this observation, Staff D-RCNA stated that the facility's Dietitian provides her with a list of all residents who need weekly weighing, and this is done via a text message every Monday. Staff D-RCNA further stated that all residents' weights are taken once a month as needed. A review of the Initial Nutritional Evaluation, dated 09/10/21, (7 days after his readmission) showed that Resident #89 is with an Ideal Body Weight of 166 pounds, pressure ulcer noted on the coccyx area, energy needs to be estimated at 2200 calories a day, protein needs to be estimated at 94 grams a day, and a plan to change the tube feeding to Glucerna 1.5 at 75 milliliters (ml) an hour times 20 hours to better meet needs. The physician order on readmission of 09/02/21 was for Nepro 40ml/hour unitl 480 mls was infused. A review of the Medication Administration Record (MAR) for the month of September 2021, showed that Resident #89 was receiving tube feeding with Nepro (tube feeding formula) at 40 ml an hour until 480 ml was infused from 09/02/21 to 09/11/21. From 09/02/21 to 09/11/21, (9 days) Resident #89 was provided with 864 calories a day and not the estimated needs of 2200 calories a day. The resident was also provided with 36 grams of protein daily and not the estimated protein needs of 94 grams daily. Further review of the September 2021 revealed a new order for Glucerna 1.5 at 75ml per hour for 20 hours was started on 09/10/21. Further review of this MAR showed missing documentations that the tube feeding Glucerna 1.5 at 75 ml an hour was provided for the month of September 2021. A review of the MAR for the month of October 2021 showed missing documentation that the tube feeding was provided daily for Resident #89. A review of the MAR for the month of November 2021 showed that when Resident #89 was readmitted to the facility on [DATE], the resident was not receiving any tube feeding for nutritional support until the Dietitian assessment on 11/11/21. A review of the November 2021 MAR showed that the tube (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 21 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 feeding of Glucerna 1.5 at 75 ml an hour had missing documentation that it was given daily. Level of Harm - Minimal harm or potential for actual harm A review of the Initial Nutritional Evaluation, dated 11/11/21, (6 days after his readmission) showed that the Dietitian used a weight of 125 pounds that was taken on 11/11/21, and no weight was taken from readmission that was on 11/05/21. Residents Affected - Few In this note, the Dietician estimated the energy needs from 2000-2300 calories a day and 85 grams of protein a day. The resident's needs were calculated using Resident #89's actual weight and not the Ideal Body Weight range. She further noted that Resident #89 is underweight and that he has a pressure ulcer wound to the sacrum, but no additional protein supplements were recommended. A review of the weights log showed the following: no weight was taken upon readmission on [DATE] and the first recorded weight after readmission was not until 09/16/21. No admission weight was taken after his latest readmission which was on 11/05/21 and his first readmission weight was taken on 11/11/21 which was 6 days later. Further review of the weights log did not show that weights were taken weekly after admission for up to 4 weeks as per policy. A review of the weights log showed that Resident #89 lost 8.89 percent of his body weight in about 3 months which is significant weight loss. Review of the Minimum Data Set (MDS) dated [DATE] showed that Resident #89 is with a Brief Interview of Mental Status (BIMS) score of 01 which is severe cognitive impairment. A review of the Care plan which was initiated on 11/11/21 showed that Resident #89 is at nutritional risk due to being on tube feeding, skin issues, and significant weight loss. The Resident will maintain adequate nutritional status as evidenced by maintaining weight within 3 percent of current weight. It further showed to provide tube feeding as ordered, monitor and record signs of malnutrition, and weight loss. Resident #89 is also at risk for further pressure ulcer development as evidenced by the pressure ulcer in the sacrum area. The Dietitian will monitor caloric intake and estimated needs and make a recommendation for change to the tube feeding when needed. A review of physician's orders showed that Resident #89 is receiving Glucerna 1.5 @ 75 ml an hour for 20 hours, starting at 2:00 PM and off at 10:00 AM. In an interview conducted on 12/08/21 at 10:04 AM with the facility's Dietitian, she reported working part-time in the facility. She covers mostly on Tuesdays and Wednesdays but can also work remotely as well. She stated that the resident's weights are taken upon admission, every week for up to 4 weeks and monthly thereafter. The weights are taken by the restorative aide or the nurse that is assigned to the resident. If she does not have an admission weight on a resident, she uses the hospital weight or weight from the previous admission. The initial nutrition assessments are done 7 days after admission and then it is done quarterly and as needed. High-risk nutrition residents are monitored monthly and if she can see them sooner, but there is no actual policy for the timing of the assessments for high-risk residents. When asked as to what is considered high-risk residents she said, new dialysis, new tube feeding, issues with poor appetite, food intake, and residents with wounds. The Certified Dietary Manager (CDM) will complete the Dietary profile upon admission to obtain likes and dislikes of foods, current diet orders, appetite, food preferences, current supplements, and much more. The Registered Dietitian (RD) often looks at the Certified Nursing Assistants' documentation which is in the task section of the electronic charting. She will look at their documentation regarding the percentage of meals consumed by the residents. The RD stated that she attends the morning (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 22 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few meeting with other department heads on the days that she is working and the CDM attends the other days of the week. She further stated that she is working mostly remotely now and does not come into the facility as before. She reviews the monthly weights for any weight loss that is reported. The RD continued to state that since coming back from maternity leave, she noticed an inconsistency with residents' weights. According to her, some nutritional supplements are given by nursing, and some are kept in the pantry on each floor. When asked about Resident #89's monthly weights, she reported that the restorative aide was not here yesterday, but she is in the process of evaluating the monthly weights and stated that she will check if the monthly weight was taken on Resident #89. In an interview conducted on 12/08/21 at 12:06 PM, Staff D-RCNA stated that monthly weights are taken from the 1st of the month to the 7th of the month. Since she is the only one taking the weights on residents sometimes, she is not able to complete all weights because of a staffing shortage. A record review of the Initial Wound Evaluation dated 11/15/21,10 days after Resident #89's readmission, showed the following: an unstageable sacrum full-thickness wound to the sacrum area, with a length of 9.5 centimeters and width of 4.5 centimeters. A wound evaluation completed on 11/22/21 showed an unstable sacrum wound with a length of 8.0 centimeters and a width of 4.0 centimeters. Another wound evaluation dated 12/01/21 showed that Resident #89 has the following: a stage 4 pressure ulcer with a length of 8.0 centimeters, the width of 8 centimeters, and a depth of 3.0 centimeters. A review of the Dietitian's notes and assessment did not show any recommendations addressing the pressure ulcer or providing extra protein for wound healing. A phone interview was conducted on 12/09/21 at 12:10 PM, with the Registered Dietician (RD), who stated that she was out on maternity leave from June to the middle of September. When asked as to why they did not have an admission weight on Resident #89 when he was readmitted on [DATE], she stated that she was out and someone else covered for her. She further stated that when she completed the initial assessment on 09/10/21, she attempted to get an admission weight of Resident #89 but was not able to. The surveyor asked as to why they did not start Resident #89 on Glucerna 1.5 at 75 ml an hour to meet his estimated needs when he was readmitted on [DATE]. She reported that it was not until she assessed Resident #89 on 11/11/21 that she made the recommendations to increase the tube feeding rate. According to her, the facility used the tube feeding rate that Resident #89 was provided in the hospital prior to his latest readmission. The surveyor expressed concern that Resident #89 was receiving less than half of his nutrition needs for 6 days prior to his readmission on [DATE], and that she did not address the higher need for protein because of the pressure ulcer. In this interview, the RD was asked about the tube feeding order that was not provided to Resident #89 from 11/05/21 to 11/12/21. The RD stated that the order for the tube feeding was probably placed under other and did not show up on the nursing MAR. Review of the progress note, dated 12/09/21, showed that Resident #89's wife was told that he was seen by the wound care doctor, and she requested for him to go to the hospital for further debridement of the wound and suspected osteomyelitis. Another progress note, dated 12/09/21, showed that Resident #89 was transferred to the hospital. In an interview conducted on 12/09/21 at 2:45 PM, with the facility's Administrator she was told of the findings. 2. Record review showed that Resident #296 was admitted to the facility on [DATE] with diagnoses of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 23 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Alzheimer's/dementia, needs assistance with personal care, muscle weakness, and hypokalemia. Level of Harm - Minimal harm or potential for actual harm In an observation conducted on 12/06/21 at 10:20 AM, Resident #296 was observed in bed. The closer observation did not show any nutritional supplement at the bedside. Residents Affected - Few In an observation conducted on 12/06/21 at 1:10 PM, Resident #296 was observed in her room eating lunch. She was observed using a straw to maneuver the food around the plate and not using silverware. Biting at the foil wrapping on the juice container to open the juice. Further observation showed that she ate about 10% of her meal with no assistance offered by staff during the duration of the entire meal. In an observation conducted on 12/08/21 at 8:45 AM, Resident #296 was observed in her room eating breakfast. Closer observation showed that she did not eat anything on her tray. No staff was present in the room to help her with the breakfast meal. In an observation conducted on 12/08/21 at 9:10 AM, Resident #296 was observed in bed. The closer observation did not show any nutritional supplement at the bedside A review of the Order Summary Report showed an order for nutritional supplement 120 milliliters twice a day dated 11/23/21. A review of the weights log showed that Resident #296's weight was not taken upon admission or weekly for 4 weeks. It only showed 1 weight recorded on 12/08/21 at 117.8 pounds. Review of the Baseline care plan, dated 11/20/21, showed that under self-care deficit-Activities of Daily Living (ADL) rehab potential (page 3) she is marked as independent for eating; all other interventions are marked as needing 1 person assistance. A review of the Initial Nutritional Evaluation, dated 11/22/21, showed that the RD used the hospital weight record to estimate her nutritional needs. It further showed Resident #296 was eating 25 percent to 75 percent of her meals. The RD assessed Resident #296 with inadequate energy intake related to varied oral intake of meals. A review of the Minimum Data Set that was still in progress showed a Brief Interview of Mental Status score of 04, which indicates the resident is cognitively impaired. In an interview conducted on 12/08/21 at 8:30 with Staff B, Certified Nursing Assistant (CNA), she stated that Resident #296 is not eating much because she is new to the facility. She further stated that Resident #296 is only eating 25% of her meals and when she tried to feed her, she spits out the food. She then proceeded to say, let me show you and attempted to spoon-feed Resident #296. Further, observation showed, Resident #296 was accepting of the feeding assistance and did not spit the food out. Staff B was asked by the surveyor if Resident #296 was on any nutritional supplement, she said I am not sure. In an interview conducted on 12/08/21 at 8:35 AM with Staff C, Licensed Practical Nurse (LPN), she stated she works all over the place and is not sure if Resident #296 is on any nutritional supplements. When asked as to when the nutritional supplements would be given, she stated, I am not sure when I will give it, it comes up in the system. She then proceeded to look up the Electronic System and reported Resident #296 gets nutritional supplements at 9:00 am. According to Staff C, all nutritional supplements are kept in the pantry or supply room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 24 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Chart review of the Certified Nursing Assistant's documentation for percent (%) intake of meals showed the following: from 11/25/21 to 12/07/21, Resident #296 ate 1 meal at 0%, 17 meals at 25%, 9 meals at 50%, 3 meals at 75% and 6 meals at 100%. In an interview conducted on 12/09/21 at 2:45 PM, with the facility's Administrator, she was informed of the findings. Event ID: Facility ID: 105609 If continuation sheet Page 25 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure that they followed practitioners' orders for enteral nutrition for 1 of 2 sampled residents, Residents #48, reviewed for nutrition. The findings included: Record review conducted on Resident #48 showed that he was readmitted on [DATE] with a diagnosis of Quadriplegic, Anxiety disorder, and Aphagia. Review of the Order Summary Report showed an order for Enteral Feeding Formula Jevity 1.5 at 75 ml an hour times 20 hours to start at 2:00 PM and off at 10:00 AM. A review of the Minimum Data Set (MDS), dated [DATE], showed that Resident #48 is severely cognitively impaired. The care plan, initiated on 04/28/21, showed that Resident #48 is dependent on tube feeding for his nutrition. Resident #48 will maintain adequate nutrition and hydration status and monitor and provide tube feeding as ordered. Review of the Dietitian's Assessment, dated 04/17/21, showed that the tube feeding running at 75ml an hour for 20 hours will provide estimated calories and protein needs for Resident #48. In an observation conducted on 12/06/21 at 10:34 AM, Resident #48 was observed in bed. Closer observation showed a tube feeding bottle that was 'on hold'. Closer observation showed a tube feeding bottle with Jevity 1.5 (formula) to start at 2:00 PM with a rate of 75 ml (milliliters) an hour. In an observation conducted on 12/06/21 at 3:30 PM, Resident #48 was in his room. Closer observation showed a tube feeding bottle with Jevity 1.5 that was at the 1000 ml mark out of a 1000 ml capacity bottle. The tube feeding formula had not infused from 2:00 PM to 3:30 PM. In an observation conducted on 12/07/21 at 7:35 AM, Resident #48 was observed in his room. Closer observation showed no tube feeding bag in the room. In an observation conducted on 12/07/21 at 8:40 AM, Resident #48 was observed in his bed. A tube feeding bottle was noted in the room, with Jevity 1.5 with a start date of 12/07/21 and a start time of 6:00 AM. The rate of infusion was noted at 75 ml an hour. Closer observation showed that the Tube feeding formula was at 1000 ml out of a 1000 ml capacity bottle. This showed that no tube feeding was not provided for the last 2 hours and 40 minutes. In an observation conducted on 12/08/21 at 7:10 AM, Resident #48 was observed in bed with the Tube feeding 'on hold'. The tube feeding was noted at the 850 ml mark out of 1000 capacity bottles. Closer observation showed that the tube feeding bottle was started at 6:00 AM the day before (12/07/21). The tube feeding bottle that started the day before at 6:00 AM should have had a new bottle observed on 12/08/21 at 7:10 AM. In an interview conducted on 12/08/21 at 7:20 AM, with Staff A, Licensed Practical Nurse (LPN), she stated that Resident #48 is tolerating his tube feeding well. When asked as to why the tube feeding is 'on hold', she said the morning nurse must have turned it off. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 26 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete In another interview conducted on 12/08/21 at 7:35 AM, Staff A-LPN reported that the tube feeding was running all night and that she turned it off for water flushes around 6:30 AM this morning. In an interview conducted on 12/08/21 at 10:26 AM with the facility Clinical Dietitian, she was asked as to when would a new tube feeding bottle need to be changed if Resident #48 tube feeding was running as ordered. She stated that a new tube feeding bottle should have been changed at around 4 AM. Resident #48's estimated protein need is at 85 grams a day and calories need between 2100 to 2500. The Registered Dietitian stated the tube feeding bottle observed by surveyor did not make sense. She further acknowledged that the tube feeding for Resident #48 was not running as ordered. Event ID: Facility ID: 105609 If continuation sheet Page 27 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and review of policy and procedure, the facility failed to ensure that it properly maintained the integrity of the resident's midline insertion dressing site, in a timely manner for 1 of 1 sampled resident observed for intravenous site, Resident #248. Residents Affected - Few The findings included: Review of facility policy and procedure on 12/08/21 at 12:31 PM for Clinical Nurse/Registered Nurse (RN) Job Description provided by the (DON) created September 2018 indicated the primary purpose of your position is to provide direct nursing care to the residents, and to supervise the day-to-day nursing activities performed by nursing assistants Conduct and document a thorough assessment of each resident's medical status upon admission and throughout the resident's course of treatment .Assist in the implementation of an individualized treatment plan for each assigned resident .assist nursing personnel to act in compliance with corporate policies, procedures and regulatory requirements provide routine nursing services for residents as directed. Review of facility policy and procedure on 12/08/21 at 12:38 PM for Midline Dressing Changes provided by the (DON) dated April 2017 indicated Policy: midline catheter dressings will be changed at specified intervals, or when needed, to prevent catheter-related infections associated with contaminated, loosened or soiled catheter-site dressings. General Guidelines: 1. Change midline catheter dressing 24 hours after catheter insertion, every 5-7 days, or if it is wet, dirty not intact, or compromised in any way . Resident #248 was re-admitted to the facility on [DATE] with diagnoses which included .Cerebrovascular Disease, Hemiplegia and Hemiparesis affecting left dominant side, Anemia in Chronic Kidney Disease stage III, Hypertension, Morbid (severe) Obesity and Major Depressive Disorder. Photographic evidence obtained of Resident #248's dirty, blood-tinged midline intravenous (IV) dressing. A computerized record review was conducted of the Basic Metabolic Panel (BMP) dated 12/03/21. It was noted that Resident #248 had the following abnormal labwork: Sodium 134 mEq/liter (low), Blood Urea Nitrogen (BUN) 36 mg/deciliter (high), Creatinine 3.43 mg/liter (high). A computerized record review was conducted of the care plan for Resident #248, dated 11/19/21. The care plan indicated that, 'The resident is on diuretic therapy related to Hypertension .Report pertinent lab results to MD (especially Hematocrit, Sodium and Potassium).' A computerized record review was conducted of the physician's order, dated 12/04/21, documented, may insert midline for intravenous (IV) access. Subsequently, a solution of Normal Saline at 75 ml/hour (IV) was administered to the resident beginning on 12/05/21 one time a day for elevated Creatinine level for four (4) days continuous. A computerized record review was conducted of the Medication Administration Record (MAR), dated 12/01/21 through 12/31/21, that indicated Resident #248 was ordered and administered the 'Normal Saline Flush Solution 0.9% (Sodium Chloride Flush). Use 75 ml/hour intravenously one time a day for elevated Creatinine level for four (4) days continuous.' During an tour on 12/06/21 at 11:39 AM, Resident #248 was observed in his bedroom with a dirty, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 28 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few blood-tinged partially saturated quarter-sized, right upper arm midline intravenous (IV) dressing in place, with no legible/identifiable date as to when it was last changed. On 12/06/21 at 11:41 AM, an interview was conducted with the resident who stated that he is not in any pain at this time. The resident indicated that he thinks his dressing was changed some days ago, but he is not sure. On 12/06/21 at 4:09 PM, Resident #248 again observed with a dirty, now partially saturated red blood-tinged area to right upper arm intravenous (IV) dressing gauze, still with no legible/identifiable date as to when it had been last changed. On 12/07/21 at 9:42 AM, Resident #248 now observed with a dirty, now fully saturated dried red blood-tinged area to right upper arm (IV) dressing gauze, with no legible/identifiable date as to when it had been last changed. On 12/07/21 at 3:48 PM Resident #248's arm still observed with a dirty, old fully saturated dried red blood-tinged area to right upper arm (IV) dressing gauze, with midline device in place, with no legible/identifiable date as to when it had been last changed. On 12/08/21 at 9:58 AM, Resident #248's arm still observed with a dirty, saturated dried red blood-tinged area to right upper arm (IV) dressing gauze, with no legible/identifiable date as to when it had been last changed. Resident #248's right arm midline (IV) insertion site dressing showed signs of increased blood saturation between the hours of 11:39 AM on 12/06/21 until 12/08/21 at 9:58 AM, with no evidence of nursing staff intervention being performed to the moist, blood-tinged (IV) insertion site dressing, for time frame listed above. On 12/08/21 at 12:17 PM, an interview was conducted with Staff J, a Registered Nurse (RN), who acknowledged that the (IV) site's integrity needed to be maintained at all times. During an interview with the Director of Nursing (DON) on 12/08/21 at 12:25 PM, she also acknowledged that the (IV) site's integrity should be maintained at all times. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 29 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and review of policy and procedure, it was determined that the facility failed to 1) ensure that it obtained the attending physician's current orders for oxygen and indication for use, for a resident receiving oxygen therapy for 1 of 1 resident observed for oxygen therapy, Resident #246. And, 2) failed to ensure that it assessed the resident's lung status, oxygen saturation and heartrate before and lung status after a Tracheostomy Care Observation for 1 of 1 residents observed for Tracheostomy care, Resident #73. Residents Affected - Few The findings included: 1. Review of facility policy and procedure on 12/08/21 at 12:46 PM for Medications provided by the (DON) revised 09/22/17 indicated Policies and Procedures Obtain and verify physician's order Chart on nurses' notes: Pertinent observations after administration. Education provided to resident or family regarding medication. Review of facility policy and procedure on 12/08/21 at 12:58 PM for Oxygen Therapy provided by (DON) effective date: 11/30/14 indicated Policy: In the event that a resident requires the use of oxygen to manage a medical condition, the Company will offer assistance as ordered by the resident's physician Procedure: 7. Adjust the flow of oxygen as ordered by the physician 11. Document in the resident's record the following information: The time the oxygen was started. The flow rate. The resident's response to the oxygen therapy. Resident #246 was re-admitted to the facility on [DATE] with diagnoses which included Severe Persistent Asthma with (acute) exacerbation, Anemia, Diabetes Mellitus Type II, Morbid Obesity, Hypertension and need for assistance with personal care. A computerized record review was conducted of Resident #246's current physician's orders. There were no current orders noted for the Oxygen that included parameters for this resident. Review of the Medication Administration Record (MAR) and the Treatment Administration Record (TAR) revealed there were no orders or other documentation written on Resident #246's to indicate any routine changing of the resident's oxygen tubing. Neither was oxygen administration addressed on her care plan. On 11/01/21 at 11:38 AM further computerized record review of the physician's order dated 09/13/21 revealed that Resident #246's Oxygen therapy two (2) liters/minute via nasal cannula was discontinued, at the time of her previous discharge home from the facility on 09/22/21. She was re-admitted to this facility on 12/05/21 for exacerbation of her Congestive Heart Failure with Debility. There was no re-order / renew for the oxygen therapy upon re-admission to the facility on [DATE]. On 12/06/21 at 11:14 AM, Resident# 246 was observed resting in bed watching television (TV) with her oxygen infusing at two-three (2)-(3) liters per minute via oxygen concentrator. There was no label noted on the oxygen tubing to indicate when it was last changed. Photographic evidence obtained of Resident #246's oxygen tubing with no label on it. On 12/06/21 at 4:06 PM, Resident #246 noted with her oxygen infusing at two (2) liters per minute via oxygen concentrator, and still with no label noted on oxygen tubing to indicate when it was last changed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 30 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 12/07/21 at 9:29 AM, Resident #246 was observed with her oxygen infusing at two (2) liters per minute via oxygen concentrator now with a blue label noted on oxygen tubing of 12/06/21. On 12/07/21 at 11:45 AM, an interview was conducted with Resident #246 and she was asked about her oxygen usage. She replied that her oxygen should be infusing at three (3) liters per minute. The resident was observed to not be in any acute distress or exhibiting any shortness of breath (SOB), at the time. The resident also stated that she routinely uses her oxygen everyday (24/7) and has done so for over two (2) years. On 12/08/21 at 12:15 PM, an interview was conducted with Staff J, a Registered Nurse (RN). She acknowledged that Resident #246 should have had an order for her oxygen and that the oxygen tubing should have been labeled and dated appropriately as to the current date when it was actually changed. During an interview conducted on 12/08/21 at 12:28 PM, the Director of Nursing (DON) further acknowledged that Resident #246 should have had an oxygen order. She also acknowledged that Resident #246's oxygen tubing should have been labeled on 12/06/21 and not 'back' dated. The oxygen order was not obtained and put in place for Resident #246, until after surveyor intervention. 2. Review of facility policy and procedure on 12/08/21 at 11:50 AM for Tracheostomy Care .provided by the (DON) revised 08/24/17 indicated Procedure: .assess the resident. Review of facility policy and procedure on 12/08/21 at 12:31 PM for Clinical Nurse/Registered Nurse (RN) Job Description provided by the (DON) created September 2018 indicated the primary purpose of your position is to provide direct nursing care to the residents, and to supervise the day-to-day nursing activities performed by nursing assistants Conduct and document a thorough assessment of each resident's medical status upon admission and throughout the resident's course of treatment .Assist in the implementation of an individualized treatment plan for each assigned resident .assist nursing personnel to act in compliance with corporate policies, procedures and regulatory requirements provide routine nursing services for residents as directed. Review of the physician's order for Resident #73 documented as follows: Tracheostomy care daily and as needed (PRN). On 12/08/21 at 10:13 AM, a Tracheostomy care observation was performed by Staff E, a Licensed Practical Nurse (LPN), for Resident# 73. Resident #73 has a Tracheostomy collar set at twenty-eight (28%) Oxygen. Staff E-LPN washed her hands for thirty-forty five (30-45) seconds. Staff E, an (LPN) checked the physician order and verified the resident's identity. She then prepared her supplies and placed them on the cleaned / covered bedside table with a sterile barrier in place after sanitizing her hands. Staff E-LPN did not first check the resident's oxygen saturation, her heartrate or assess the resident's lung sounds before providing Tracheostomy care to the resident. Staff E-LPN then washed her hands 30-45 seconds after placing the supplies on the bedside table, donned a pair of clean gloves and removed the old tracheostomy collar dressings and cleaned around the tracheostomy area with a Peroxide and saline solution. She then removed the tracheostomy collar and applied another one. Staff E-LPN was also observed checking the resident to make sure the Tracheostomy collar was not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 31 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few too tight. Staff E-LPN then removed her dirty gloves and washed her hands again for 30-45 seconds then donned a pair of gloves and proceeded to remove, clean and rinse the resident's inner Tracheostomy cannula in a normal saline solution. The nurse then removed her dirty gloves and again washed her hands again for a final time for 30-45 seconds; the resident tolerated the procedure well. The resident's oxygen saturation was 98% and her heart rate was 82, after the procedure was completed. Staff E-LPN did not assess the resident's lung sounds after providing Tracheostomy care. On 12/08/21 at 11:35 AM, an interview was conducted with both the DON and with Staff E-LPN, regarding the nurse not first checking the resident's oxygen saturation, her heart rate and assessing of the resident's lung sounds before care. Both acknowledged that the finding and that it was not done and should have been. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 32 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, the facility failed to provide pain relief and monitor pain management for 1 of 1 sampled resident reviewed for pain management, Resident #72. Residents Affected - Few The findings included: Record review showed Resident #72 was admitted to the facility on [DATE] and readmitted to the facility on [DATE], with diagnoses that included fall, head injury; difficulty walking; Rheumatoid Arthritis and Lupus. In an interview conducted on 12/06/21 at 10:50 AM, Resident #72 stated that she has bilateral knee pain related to a history of arthritis for which she takes Tylenol. She reported receiving Tylenol 2-3 weeks ago, but then they stopped giving them to her and told her she had an allergy to Tylenol. Resident #72 further said that she does not have an allergy but it is charted that she has a severe allergy. She said they recently started giving her the Tylenol again. In this interview, Resident #72 grabbed her abdominal area, and said, I also have bad pain in my stomach, and I cannot eat much. A review of the Medication Administration Record (MAR), for the months of October, November, or December 2021, showed no Tylenol medication was administered to the resident for pain. There was no evidence or documenatation that any other pain medications were provided. The Order Summary Report showed a current order for 'Tylenol tablets 325 milligrams to give 2 tablets by mouth every 6 hours as needed for pain', dated 12/05/21. A review of the Care plan, initiated on 10/11/21 revealed the following: 'Resident #72 is alert and able to make her needs known. She has chronic pain related to lupus and arthritis. Resident #72 will verbalize adequate relief of pain or the ability to cope with pain. Anticipate the resident's need for pain relief and respond immediately to any complaint of pain. Evaluate the effectiveness of pain interventions, review for compliance, alleviating of symptoms, dosing schedules and resident satisfaction with results, and impact on functional ability and cognition. Identify and record previous pain history and management of that pain and impact of function. Identify previous responses to pain relief, side effects, and impact on function. Identify, record, and treat the resident's existing conditions that may increase pain and or discomfort. Monitor/document for side effects of pain medication.' Review of a progress note, dated 11/11/21, showed that Resident #72 was having abdominal pain and received new orders for an X-ray of the Kidney, Ureter and Bladder (KUB). A review of the Electronic Charting showed that Resident #72 is allergic to Tylenol. Review of the radiology report of the KUB, dated 11/11/21, showed that Resident #72 and suspected gall stone and a mild gas were noted. In a telephone interview with Resident #72's daughter, on 12/07/21 at 10:50 AM, she said she was in the facility last week and spoke to the Doctor, who stated he would write orders for pain medication for Tylenol, and Imodium for diarrhea. She further stated Resident #72 is not allergic to Tylenol, but only to Iodine. She stated her mom has been complaining of stomach pain related to gallstone identified at the hospital. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 33 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview with Resident #72 on 12/07/21 at 12:40 PM, she was asked if she still has pain and she said, the pain is still there. In an interview conducted on 12/08/21 at 11:55 AM, Staff E, Licensed Practical Nurse (LPN), stated that she was told by the resident that she had stomach pain; and a KUB test had been ordered. She said she had not given Resident #72 any pain medication or Tylenol. Staff E-LPN further stated that if she was in pain, she would be able to tell staff that she is. In an interview conducted on 12/08/21 at 12:05 PM, with Staff F-LPN, said that she spoke to Resident #72's Doctor, and he prescribed Tylenol for pain management. She stated that they had confusion as to the allergy to Tylenol, and the Doctor stated that he spoke to the daughter and that she is not allergic to Tylenol. Staff F-LPN also stated that she gave Tylenol to Resident #72 last Sunday (on 12/05/21). When asked by the surveyor, as to what system is in place to document any pain management, she said that if it is care planed then it is automatically generated in the MAR to assess. Further review of the MAR for the month of December 2021 did not show that Tylenol was given on 12/05/21 to Resident #72. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 34 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and review of policy and procedure, the facility failed to ensure that it secured a resident's insulin pen medication for 1 of 2 sampled residents observed during an Accucheck Observation, Resident #94. The findings included: Review of facility policy and procedure for Medication Storage in the Facility provided by the (DON), reviewed April 2018, indicated that ' .Policy: Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications .Only licensed nurses, pharmacy personnel, and those lawfully authorized to administer medications (such as medication aides) permitted to access medications. Medication rooms, carts, and medication supplies are locked when not attended by persons with authorized access .'. Record review revealed Resident #94 was admitted to the facility on [DATE] with diagnoses which included Diabetes Mellitus Type II Alcoholic Cirrhosis of Liver, Gastroesophageal Reflux and Unspecified Fracture of Shaft of Humerus. She had a Brief Interview Mental Status (BIM) score of 13 (cognitively intact). A computerized record review was conducted on 12/06/21 at 12:08 PM of the physician's order dated 11/29/21 for Humalog Kwikpen Solution (Insulin Lispro) to inject as per sliding scale. Resident #94 was to receive four (4) units for her blood sugar reading of 225. During an Accucheck Observation on 12/06/21 at 11:50 AM performed by Staff K, a Registered Nurse (RN), for Resident #94, the nurse was observed preparing Resident #94's Humalog Kwikpen insulin medication outside of her room. Staff K-RN placed this insulin pen on a white tray on top of medication cart 1 East 3. Staff K-RN entered Resident #94's room and walked over to the resident's bedside, beyond / behind a solid wall and out of sight of the medication cart with the insulin pen on it. The Insulin pen on top of the Medication cart 1 East 3 was accessible to other residents and staff members on the first floor unit, for a period of nearly two (2) minutes, while Staff K-RN spoke with the reident and washed his hands in the resident's room. Staff K-RN then returned to the medication on top of the medication cart 1 East and re-entered Resident #94's room, dialed up the correct amount of insulin, explained to the resident what he was going to do and then administered the insulin to the resident in the left arm, after cleaning the area first with an alcohol wipe. An interview was conducted on 12/06/21 at 12:15 PM, with Staff K, an (RN) in which he acknowledged that he should not have left the resident's insulin pen medication unattended and out of his line of sight on top of the medication cart 1 East 3 outside of Resident #94's room. During an interview conducted with the Assistant Director of Nursing (ADON) on 12/07/21 at 12:10 PM regarding the unattended/unsecured Resident #94's insulin pen medication, she also acknowledged (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 35 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 that the resident medication must be secured at all times. Level of Harm - Minimal harm or potential for actual harm During an interview conducted with the Director of Nursing (DON) on 12/07/21 at 12:17 PM regarding the unattended / unsecured insulin pen medication, she further acknowledged that the resident's medication should never be left unattended and unsupervised by staff. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 36 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 0914 Provide bedrooms that don't allow residents to see each other when privacy is needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure that each bed had ceiling suspended curtains, which extended around the beds to provide total visual privacy for 2 of 6 sampled residents reviewed for privacy, Resident #28 and #295. Residents Affected - Few The findings included: 1. Record review showed that Resident #28 was admitted on [DATE] with diagnoses to include, in part, Toxic Encephalopathy, Cerebral Infarction, and Generalized Weakness. Review of the Minimum Data Set (MDS), dated [DATE], showed that Resident #28 has a Brief Interview of Mental Status (BIMS) score of 15, which indicated the resident is cognitively intact. Review of the care plan dated 10/07/21 showed that Resident #28 has an Activities of Daily Living self-care performance deficit related to Cerebral Infraction. It further showed that Resident #28 needed assistance on bath days, grooming, and dressing every day. In an interview conducted on 10/06/21 at 11:10 AM, Resident #28 stated that she had told the facility's staff months ago that she needed bed curtains for privacy. The Maintenance Director promised that it would be replaced, but nothing was done. Resident #28 then pointed at a bag that was placed on a side chair and she said, 'this is the old curtains, still in a bag.' Resident #28 further reported that she has no privacy between her and her roommate. She said, at times she likes to sit naked on her bed but cannot do so without the curtains for privacy. The surveyor did not observe curtains around or on the curtain rack of Resident #28's bed at this time. In an interview conducted on 10/06/21 at 1:10 PM, Resident #28 stated that she does not like her front door to be opened because staff can always see her from the hallway. She further expressed frustration at not having her bed curtains replaced. In an interview conducted on 12/08/21 at 9:15 AM with Staff B, Certified Nursing Assistant (CNA), stated that she was aware that Resident #28 has not have a curtain around her bed for weeks now. She further said that she was told by Resident #28 that the Maintenance and Housekeeping directors knew of the issue. In an interview conducted on 12/08/21 at approximately 9:21 AM with the Director of Housekeeping, he said he has been working in the facility for the last 2 years. He said he attends the morning meeting held daily in the [NAME] dining room. He said they take down the curtains once a week, clean them, and place them back up. When they're taken down, a replacement curtain is placed until their own curtains are cleaned. He is told in the morning meeting of any curtains that need to be replaced or cleaned. Each room has two curtains, for each resident's privacy. He said the curtains must be suspended and cover / go around all beds completely. It takes between a week to 3 weeks to get new curtains for the residents. He said he also keeps extra curtains in his office. In a tour conducted on 12/08/21 at 9:30 AM with the Housekeeping Director, the surveyor asked him to come into Resident #28's room. On this tour, he stated that he was unaware that Resident #28 was missing her curtains and would immediately take care of the issue. During this observation tour, the curtain tracks above Resident's #28's bed were observed broken on one side. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 37 of 38 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 105609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Tamarac 5901 NW 79th Avenue Tamarac, FL 33321 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 0914 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. Record review showed that Resident #295 was admitted to the facility on [DATE] with heart failure and anxiety diagnoses. Review of the Minimum Data Set (MDS) dated [DATE] showed that Resident #295 has a Brief Interview of Mental Status (BIMS) score of 15, which indicates the resident is cognitively intact. The care plan, dated 12/06/21, showed that Resident #295 has limited physical mobility related to weakness. It further showed to provide supportive care and assistance with mobility as needed. In an observation conducted on 12/06/21 at 10:35 AM, Resident #295 was observed sitting on her bed. Closer observation showed that her bed's curtain was only halfway on the tracks and that it was not long enough to cover / go around the full length of the bed. In this observation, Resident #295 stated that it had been like this since her admission a few weeks ago and that she cannot have total privacy from her roommate. She said, a week ago, she told the Maintenance Director that she needed her curtain changed because it is only working halfway. The Maintenance Director told Resident #295 that he was working on it. Resident #295 reported not having the privacy she needed and feeling embarrassed with her roommate. She said, nothing has been done so far, and she is still waiting for staff to replace her bed's curtains. In an interview conducted on 12/08/21 at 9:03 AM with the facility's Maintenance Director, he reported working there since April of this year. He also has an assistant who comes in to help him 5 days a week. The staff will place any issues into an electronic system that he checks every morning. He will work on fixing the problem that same day. If he needs to order any parts, he will let the staff know its time frame. When asked about curtains in rooms, he stated that Housekeeping oversees replacing the curtains, and he manages the hardware like the tracks but not the actual curtains. He said, residents who are missing curtains in their room will be brought up in the morning meetings. In an interview conducted on 12/08/21 at 9:11 AM with the Director of Housekeeping, he has been working in the facility for the last 2 years. He attends the morning meeting held daily in the [NAME] dining room. They will take down the curtains once a week, clean them, and place them back up. When they're taken down, a replacement curtain is placed until their own curtains are cleaned. He is told in the morning meeting of any curtains that need to be replaced or cleaned. Each room has two curtains, for each resident for privacy. They must be suspended and cover / go around all bed completely. It takes between a week to 3 weeks to get new curtains for the residents. He also keeps extra curtains in his office. In a tour conducted on 12/08/21 at 9:30 AM with the Housekeeping Director, the surveyor asked him to come into the resident's room. In this observation tour, he stated that he was unaware that Resident #295 was missing her curtains and would immediately take care of the issue. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105609 If continuation sheet Page 38 of 38