Inspection·July 21, 2022

F 0584 dresser drawers (A-bed). Level of Harm - Minimal harm or potential for actual harm room [ROOM NUMBER]: Wall mounted air-conditioning unit leaking over the floor area. Residents Affected - Some room [ROOM NUMBER]: Over-bed tables (2) were noted to have exteriors in heavy disrepair, and soiled privacy curtain (A-bed). room [ROOM NUMBER]: Room walls in disrepair and areas of peeling paint. room [ROOM NUMBER]: Electric bed control not working (A-bed) , and exterior of bed rails in disrepair (A-bed). room [ROOM NUMBER]: Odorous stagnate water in sink drain, room wall noted to have areas of peeling paint, and room baseboards in disrepair. room [ROOM NUMBER]: Bathroom wall hand rails were rust laden, bathroom walls in disrepair, and bathroom mirror had areas of desilverization (black areas) . room [ROOM NUMBER]: Room air-conditioning unit not working and blowing hot air, and over-bed table exterior was in disrepair. room [ROOM NUMBER]: TV remote not working, and cable TV reception was poor (snowy). Laundry Area (clean folding room): The commercial wall mounted exhaust fan was dust laden . Following the tour, the findings were re-confirmed with the Administrator. During the review it was noted that the facility has a TEL's system available at the 4 nurses station for all staff to report housekeeping/maintenance issues via the computer. It was also noted that facility staff are trained for the use of the TEL's system during orientation, however it was stated that staff are not utilizing the TEL's system to report housekeeping and maintenance issues. 2) During the initial tour of the facility conducted on 07/18/22 at 12:00 PM, it was noted that multiple air conditioning vents in the ceiling of the C-and D wings were dirty and leaking-outside rooms [ROOM NUMBERS], outside the biohazard room on C-wing (by the nurse's station), outside room [ROOM NUMBER], outside room [ROOM NUMBER], outside room [ROOM NUMBER]. Also, in the ceiling outside room [ROOM NUMBER], an access panel appeared to be hanging slightly open. During an interview, the Maintenance Director was informed on 07/18/22 at 12:50 PM about the leaking vents. He replied that the vents leak due to the humidity in the air. The surveyor explained that the leaking can be hazardous as it causes the floor to become wet, which could potentially cause falls for residents and staff. The Maintenance Director agreed and asked the housekeeping staff to place Wet Floor signs under the leaking vents, which was done. However, when the meal carts came to the units with the lunch time trays, the signs were moved off to the side. The surveyor informed the Maintenance Director about the signs being moved, and he asked the housekeeping staff to put them back and not move them until the air conditioners were serviced. The Maintenance Director informed the surveyor that he would call the air conditioner company to have service completed. The surveyor asked for a copy of the work orders submitted to the maintenance department for the last 72 hours, this was provided by the facility Administrator. Review of the work orders revealed no requests had been made by the staff regarding the leaking air conditioning vents prior to surveyor intervention. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 2 of 14 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 105622 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerfield Beach Health and Rehabilitation Center 401 East Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete During a tour of the facility, completed on 07/19/22 at 8:40 AM, it was noted by the surveyor that the air conditioning vents were still leaking and the wet floor signs were still in the hallway. During a tour of the facility completed on 07/20/22 at 9:00 AM, it was noted by the surveyor that the air conditioning vents were still leaking and the wet floor signs were still in the hallway. There were paper signs placed on the wet floor signs that said Do not remove. Event ID: Facility ID: 105622 If continuation sheet Page 3 of 14 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 105622 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerfield Beach Health and Rehabilitation Center 401 East Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to address long fingernails for 1 of 3 sampled residents reviewed for Activities of Daily Living (ADL), Resident #370; and failed to ensure assistance during dining for 1 of 1 ampled residents, Resident #92. Residents Affected - Few The findings included: 1. A review of the facility's policy titled ADL: Assistance dated July 2022 showed that staff would assist with ADLs per care plan for nail care and eating. A chart review for Resident #370 showed that he was admitted to the facility on [DATE] with diagnoses of Gastric Ulcer, Parkinson's Disease, and Hypertension. In an interview conducted on 07/18/22 at 10:10 AM, Resident #370 stated that he needed his fingernails cut and trimmed. He stated that he told the staff, but they did not do it. In this interview, Resident #370 fingernails were noted to be unkempt with an unidentified matter underneath the fingernails. In an observation conducted on 07/19/22 at 2:05 PM, Resident #370 was noted in his room. Closer observation showed that his fingernails were unkempt, with an unidentified matter underneath the fingernails. In this observation, Resident #370 stated that he needed his fingernails trimmed and asked if the Surveyor could cut his fingernails. In an observation conducted on 07/20/22 at 8:30 AM, Resident #370 was noted in his room. Closer observation showed that his fingernails were unkempt, with an unidentified matter underneath the fingernails. (photographic evidence obtained). The Minimum Data Set (MDS) assessment dated [DATE] showed that under section G, Resident #370 needed one person to assist with his grooming. Section C for Brief Interview of Mental Status (BIMS) showed a score of 15, which is cognitively intact. The Care Plan, which was initiated on 07/12/22, showed the following: Resident #370 needed to be monitored for Parkinson's complications of poor balance, poor coordination, and Tremors. It further showed that Resident #370 would be able to independently or sometimes independently perform ADL functions, including but not limited to Bed Mobility, Personal Hygiene, Oral Care, Bathing, Dressing, Transferring, Feeding, and Toileting. A review of the Certified Nursing Assistants charting for nail care showed that Resident #370 was provided with fingernail care on 07/15/22, 07/16/22, 07/17/22, and 07/19/22. In an interview conducted on 07/21/22 at 8:20 AM, Staff B, Certified Nursing Assistants, stated that Resident #370 requested that his fingernails be cut and that she was going to do it later today. She further said that she needed to find the nail clipper before cutting Resident #370's fingernails. 2. A chart review showed that Resident #92 was readmitted to the facility on [DATE] with Cognition Communication Deficit, Muscle Wasting, and Unspecific Protein-Calorie Malnutrition. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 4 of 14 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 105622 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerfield Beach Health and Rehabilitation Center 401 East Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An observation conducted on 07/18/22 at 12:42 PM brought the lunch tray into Resident #92's room. At 12:47 PM, staff came into the room to assist the Resident with her meal. In an observation conducted on 07/19/22 at 8:06 AM, Resident #92's Breakfast tray arrived in the room. Resident #92 was observed eating her Breakfast with no assistance from staff. At 8:30 AM, she ate 25% of her Breakfast. In an observation conducted on 07/20/22 at 8:07 AM, Staff F, Licensed Practical Nurse, was observed setting up the breakfast tray for Resident #92 and walking out of the room. At 8:35 AM, she only ate 20% of her meal. In an observation conducted on 07/21/22 at 8:35 AM, Resident #92 was observed in her room with the breakfast tray and no assistance from staff. The tray was 20% consumed (photographic evidence obtained). A review of the MDS assessment dated [DATE] showed that under Section H, for eating, Resident #92 needs extensive assistance with 1 person assistance. The care plan dated 06/06/22 showed that Resident #92 has a nutritional problem or potential for nutritional problems related to Protein-Calorie Malnutrition. It further showed to observe meal consumption and assist with meals. In an interview conducted on 07/21/22 at 8:22 AM, Staff A, Certified Nursing Assistance, stated that Resident #92 needs assistance with her meals. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 5 of 14 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 105622 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerfield Beach Health and Rehabilitation Center 401 East Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 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 enteral nutrition had been followed by the practitioner's order and ensure that the tube feeding order was meeting the estimated needs for 2 of 3 sampled residents (Residents #371 and Resident #55) reviewed for tube feeding. The findings included: 1. A review of the facility's policy titled Weight Management dated October 2021 showed that weights are completed on admission and readmission, then weekly for four weeks, then monthly unless the physician orders are more frequent. In an observation conducted on 07/18/22 at 9:35 AM, Resident #371 was noted in his bed. Closer observation showed a tube feeding bottle with Jevity 1.5 (formulary) running at 50 ml (milliliters) an hour. The tube feeding started on 07/18/22 at 2:10 AM, with the tube feeding bottle at the 950 ml mark out of a 1000 ml bottle. In an observation conducted on 07/19/22 at 7:10 AM, Resident #371 was in his bed. Closer observation showed a tube feeding bottle with Jevity 1.5 almost empty. Closer observation showed that it was started on 07/18/22 at 2:45 PM at 70 ml an hour. Chart review showed Resident #371 was admitted on [DATE] with diagnoses of protein/calorie malnutrition, hemiplegia, and gastrostomy. A review of the weight log showed an admission weight of 131.22 pounds which was taken on 07/09/22. No other weights were documented since admission weight. The Nutrition Evaluation Comprehensive completed on 07/11/22, two days after admission, showed the following: Resident #371 is with pressure ulcer stage 3, and at malnutrition related to inadequate energy intake and signs of wasting. The tube feeding order was documented at Jevity 1.5 at 70 ml an hour for 18 hours. A review of the Physician's orders showed an enteral feed order for Jevity 1.5 Cal Continuous via a tube to infuse at a rate of 50 mL/hr. A total volume of 1000 ml was infused in 24 hours. May turn off for care/services and start at 2 PM. Verify infusing every shift and clear the pump when the total volume has infused. This order was written on 07/09/22 and discarded on 07/13/22. Another order was noted for enteral feeding Jevity 1.5 Cal via a tube to infuse at a 70 ml/hr rate. The total volume of 1260 ml was infused in 24 hours. May turn off for care/services and start at 2 PM. Verify infusing every shift and clear the pump when the total volume has infused. The order was dated 07/11/22. A review of the Medication Administration Record (MAR) for the month of July 2022 showed that Resident #371 was given tube feeding Jevity at 50 ml an hour on 07/09/22, 07/10/22, 07/11/22, and 07/12/22. A review of the care plan stated that Resident #371 has a nutritional problem or potential nutritional problem related to Pancreatic cancer, peg tube, and increased nutrient needs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 6 of 14 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 105622 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerfield Beach Health and Rehabilitation Center 401 East Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview conducted on 07/21/22 at 8:00 AM, Staff C, Registered Nurse, stated that Resident #371 tolerates his tube feeding rate and feeding. In an interview conducted on 07/21/22 at 8:10 AM, Staff D, Registered Nurse, stated that the tube feeding was running all night for Resident #371 with no issues. When asked what the tube feeding rate for Resident #371 is, she said, I need to look it up. In an interview with Staff E, Registered Dietitian, on 07/21/22 at 8:30 AM, he stated that the tube feeding at 50 ml an hour provided 1500 calories, 63.8 grams of protein, and 760 ml of water daily. He further said that the tube feeding rate met 84% of Resident #371's caloric needs and 86% of Resident #371's protein needs. When asked about a new weekly weight for the Resident, he stated that no weekly weight was taken yet. Staff E reported that when he realized Resident #371 was not receiving the correct tube feeding order, he alerted staff. 2. A chart review showed that Resident #55 was readmitted to the facility on [DATE] with diagnoses of Cerebral Vascular Disease, and Protein-Calorie Malnutrition. In an observation conducted on 07/18/22 at 10:35 AM, Resident #55 was noted in his bed. Closer observation showed a tube feeding bag with Jevity 1.5 at the 300 ml mark out of a 1000 ml bottle. The bottle started the day before, on 07/17/22, at 2 PM and ran at 50 ml an hour. In an observation conducted on 07/19/22 at 7:15 AM, Resident #55 was noted in his bed. Closer observation showed a tube feeding bag at the 300 ml mark out of a 1000ml bottle. The bottle was started the day before on 07/18/22 at 7 PM, running at 70 ml an hour. A review of the MAR showed the following orders for Resident #55: Enteral feeding Jevity 1.5 via a tube to infuse at a rate of 70 ml an hour with a total volume of 1400 ml infusing in 24 hours. May turn off for care/services, which was dated 07/18/22.Start at 2 PM. No order was noted for tube feeding Jevity 1.5 at 50 ml an hour. The Nutrition Evaluation Comprehensive completed on 07/18/22 showed that Resident #55 was receiving tube feeding Jevity 1.5 at 70 ml an hour times 20 hours. It further showed that maintenance is desired at this time and that the tube feeding provides 2100 calories and 89 grams of protein daily. The tube feeding that was running at 50 ml an hour observed on 07/18/22 was not meeting the estimated nutritional needs. In an interview conducted on 07/20/22 at 3:00 PM, with the Administrator, she was informed of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 7 of 14 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 105622 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerfield Beach Health and Rehabilitation Center 401 East Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0698 Provide safe, appropriate dialysis care/services 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 record review and interview, the facility failed to ensure that 1 of 1 sampled residents (Resident #166) reviewed, who requires dialysis, received services consistent with professional standards of practice that include the administration of physician ordered dialysis medications. Residents Affected - Few The findings included: During the initial screening of facility residents on 07/18/22 at 10 AM, it was noted that the C-Wing Charge Nurse identified Resident #166 as a dialysis resident. It was further stated that the resident receives dialysis on Monday, Wednesday, and Friday (M/W/F), and leaves the facility for dialysis at approximately 9:30 AM -10 AM on these days and returns at approximately 4 PM - 4:30 PM on these days. Observation of Resident #166 on 07/18/22 at 9:45 AM, noted the resident to leave the facility via transportation van for the dialysis center. Review of the clinical record of Resident #166 noted the resident was admitted to the facility on [DATE], with the following diagnoses: End Stage Renal Disease, Protein -Calorie Malnutrition, HIV, Dysphagia, and History of Covid -19. Review of Quarterly MDS dated [DATE] noted the following: Section B: No speech, vision issues. Section C: BIMS (Brief Interview for Mental Status) score = 13 (No Cognition Issues) Section D (Mood): Feeling Down, Insomnia, Feeling Tired, Concentration and Speaking Slowly Section O: Dialysis Review of current physician medication orders noted the following: 07/06/22: Dialysis M/W/F with snack, resident Pick Up time 10 AM 05/04/22 - Sevelamer 800 mg (Phosphorus Binder) - 2 tabs BID on Tuesday/Thursday/Saturday and - 1 Tab with meals on Monday/Wednesday/ Friday/Sunday for ESRD Review of Progress Notes for Progress Notes for May, June, July of 2022 noted that the resident was documented to leave the facility for dialysis on Monday/Tuesday/Wednesday, at approximately 9:30 -10 AM and return to the facility at approximately 4-4:30 PM. During the review of the Clinical Record and Medication Administration Record for May 2022, June 2022, and July 2022 noted that the physician order for Sevelamer 800 mg - 1 Tab with meals on Monday, Wednesday, and Friday was not being administered as per physician orders for the 12 PM dose as evidenced by the following; May 2022: Documented as not administered on 05/25, 05/27, and 05/30 for the 12 PM dose. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 8 of 14 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 105622 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerfield Beach Health and Rehabilitation Center 401 East Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0698 Level of Harm - Minimal harm or potential for actual harm June 2022: Documented as not administered on 06/01, 06/03, 06/06, 06/08, 06/10, 06/15, 06/20, 06/24, 06/29. Documented as administered on 06/15, 06/22, and 06/27. July 2022: Documented as not administered on 07/01, 07/15, and 07/18. Documented as administered 07/04, 07/06, 07/08, 07/11, 07/13, and 07/20. Residents Affected - Few During an interview with the facility's Assistant Director of Nursing (ADON) on 07/21/22, it was revealed that the facility was aware that the Sevelamer order needed to be clarified, however the physician was not contacted for clarification of the 12 PM dose on Monday, Wednesday, and Sunday. Specifically it was confirmed with the ADON that Resident #166 was not in the facility at 12 PM on dialysis days (Monday/Wednesday/Friday) PM dose and nursing staff was documenting the 12 dose administration and that the physician should have been notified for clarification when the 12 PM dose was held without physician orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 9 of 14 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 105622 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerfield Beach Health and Rehabilitation Center 401 East Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy and procedure review, observation, interview and record review, it was determined that the facility failed to 1) ensure that it secured and locked un-ordered, and expired over-the-counter (OTC) medications for Resident # 97; 2) ensure that it secured and locked dry eye medication for Resident # 104; 3) ensure that it secured and locked a tube of Bacitracin Zinc Antibiotic ointment for Resident # 135, observed during an observational room tour; 4) promptly dispose of a prescription expired liquid medication in one (1) of four (4) medication rooms, medication room A-wing; 5) ensure that it promptly dispose of two (2) (OTC) stock Hemorrhoidal cream medications in one (1) of two (2) treatment carts, treatment cart A-wing during a Medication Storage Observation; and 6) discard one (1) bottle of 70% rubbing alcohol and one (1) bottle of Witch Hazel on Resident #46's bedroom nightstand. The findings included: Review of facility policy and procedure for Storage of Medications provided by the Director of Nursing (DON) effective date 09/18 indicated Policy: Medications and biologicals are stored properly, following manufacturer's or provider pharmacy recommendations, to maintain their integrity and to support safe effective drug administration. The medication supply shall be accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications Outdated, contaminated, discontinued or deteriorated medications and those in containers that are cracked, soiled, or without secure closures are immediately removed from stock, disposed of according to procedures for medication disposal . Review of facility policy and procedure for Bedside Medication Storage provided by the (DON) effective date 09/18 indicated policy: Bedside Medication storage is permitted for residents who are able to self-administer medications, upon the written order of the prescriber and when it is deemed appropriate in the judgment of the nursing care center's interdisciplinary resident assessment team. Procedures 1. The interdisciplinary team (IDT) will review and approve resident competencies and understanding prior to permission of bedside storage of medications as established in the nursing care centers policies and procedures. 2. A written order for the bedside storage of medication is present in the resident's medical record. 3. Bedside storage of medications is indicated on the resident medication administration record (MAR) for the appropriate medications .4. Bedside medications storage is permitted only when it does not present a risk to confused residents who wander into the rooms of, or room with, residents. Lockable drawers or cabinets are required (unless otherwise specified by state regulation) 5. All nurses and nursing aides are required to report to the charge nurse on duty any medications found at the bedside not authorized for bedside storage and to give unauthorized medications to the charge nurse for return to the family or responsible party 1) During an initial observational room tour conducted on 07/18/22 at 9:42 AM, Resident # 97 was observed resting in bed watching television (T.V.) with three (3) over-the-counter (OTC) medications left at the bedside: an open used container of Icy Hot balm with an expiration date of 12/21, a half-empty bottle of 70% Isopropyl Rubbing Alcohol with an expiration date of 06/2023 and a half-empty un-dated container of Vaporizing rub sitting on Resident #97's bedside table. All medications were in plain sight, unsecured and accessible to other residents, staff members and visitors. Photographic evidence was obtained of the expired Icy Hot balm container, 70% Isopropyl Rubbing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 10 of 14 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 105622 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerfield Beach Health and Rehabilitation Center 401 East Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Alcohol bottle and Vaporizing rub container, all over (OTC) medications. Level of Harm - Minimal harm or potential for actual harm Record review revealed resident # 97 was originally admitted to the facility on [DATE] with diagnoses which included Cerebrovascular Disease, Diabetes Mellitus Type II, Asthma, Hypertension and Major Depressive Disorder. She had a Brief Interview Mental Status (BIM) score of 14 (cognitively intact). Residents Affected - Few During a brief interview with Resident #97 on 07/18/22 at 9:48 AM, an inquiry was made with Resident # 97 regarding the Icy Hot balm, Isopropyl Rubbing Alcohol and a half-empty un-dated container of Vaporizing rub on her bedside dresser, Resident #97 acknowledged they were there, and that she uses them whenever she needs them. During a second observation conducted on 07/18/22 at 2:02 PM, Resident #97's room was observed with three (3) (OTC) medications left at bedside: used container of Icy Hot balm with expiration date of 12/21, half-empty bottle of 70% Isopropyl Rubbing Alcohol with an expiration date of 06/2023 and half-empty un-dated container of Vaporizing rub sitting on the resident's bedside table. During a third observation conducted on 07/19/22 at 10:00 AM, Resident #97's room was observed with three (3) (OTC) medications left at bedside: used container of Icy Hot balm with expiration date of 12/21, half-empty bottle of 70% Isopropyl Rubbing Alcohol with an expiration date of 06/2023 and half-empty un-dated container of Vaporizing rub sitting on the resident's bedside table. During a fourth observation conducted on 07/19/22 at 1:07 PM, Resident #97's room was observed with three (3) (OTC) medications left at bedside: used container of Icy Hot balm with expiration date of 12/21, half-empty bottle of 70% Isopropyl Rubbing Alcohol with an expiration date of 06/2023 and half-empty un-dated container of Vaporizing rub sitting on the resident's bedside table. During a fifth observation conducted on 07/20/22 09:53 AM, PM Resident #97's room was still observed with three (3) (OTC) medications left at bedside: used container of Icy Hot balm with expiration date of 12/21, half-empty bottle of 70% Isopropyl Rubbing Alcohol with an expiration date of 06/2023 and half-empty un-dated container of Vaporizing rub sitting on the resident's bedside table. An interview was conducted on 07/20/22 at 10:11 AM with Resident #97's nurse, Staff G, a Licensed Practical Nurse (LPN), regarding the expired medication containers and bottles observed on Resident #97's bedside table and he acknowledged that the (OTC) medications should not have been there. There was no order included on Resident #97's Medication Administration Record (MAR) nor on the Treatment Administration Record (TAR) for any of the aforementioned (OTC) medications to be administered to this resident. 2) During an observational room tour conducted on 07/18/22 at 10:28 AM, Resident # 104 was observed sitting up in his bed watching (T.V.). It was further observed that he had an open (OTC) bottle of dry eye drops located on his bedside dresser with an expiration date of 02/2024. The medication was in plain sight, unsecured and accessible to other residents, staff members and visitors. (Photographic evidence was obtained of the bottle of (OTC) dry eye drop medication). Record review revealed resident # 104 was admitted to the facility on [DATE] with diagnoses which included Malignant Neoplasm of Bladder, Alcoholic Cirrhosis of Liver without Ascites, Idiopathic (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 11 of 14 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 105622 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerfield Beach Health and Rehabilitation Center 401 East Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Peripheral Autonomic Neuropathy, Anemia, Anxiety Disorder, Hypertension, Heart Failure, Atrial Fibrillation, Chronic Obstructive Pulmonary Disease and Low Back Pain. He had a Brief Interview Mental Status (BIM) score of 14 (cognitively intact). During a brief interview with Resident #104 on 07/18/22 at 10:32 AM, an inquiry was made with Resident# 104 regarding the dry eye medication bottle on his bedside dresser, and Resident #104 replied that he brought it with him from home and added that he takes it whenever he needs it. During a second observational tour conducted on 07/18/22 at 12:03 PM, Resident #104's room was still observed with an open (OTC) bottle of dry eye drops located on his bedside dresser with an expiration date of 02/2024. An interview was conducted on 07/20/22 at 10:12 AM with Resident #104's nurse, Staff G, regarding the dry eye medication bottle observed on Resident #104's bedside table and he acknowledged that the (OTC) medication should not have been there. Further record review revealed there was no order on the Resident #104's Medication Administration Record (MAR) for this (OTC) medication to be administered to this resident. 3) During a subsequent observational room tour conducted on 07/18/22 at 10:45 AM, Resident # 135 was observed lying in bed on her right side with the T.V. on. It was observed that there was a used and un-dated tube of Bacitracin Zinc Antibiotic ointment located in a basket at the resident's bedside in plain sight, unsecured and accessible to other residents, staff members and visitors. (Photographic evidence was obtained of the tube of Bacitracin Zinc Antibiotic ointment (OTC) medication). Record review revealed Resident # 135 was admitted to the facility on [DATE] with diagnoses which included Pneumonia, Diabetes Mellitus with Diabetic Neuropathy, Atrial Fibrillation, Schizoaffective Disorder, Major Depressive Disorder, Hypertension and Gastrostomy Status. She had a Brief Interview Mental Status (BIM) score of 00 (severely impaired). During a second observation conducted on 07/18/22 at 1:32 PM, Resident #135's room was observed with a used and un-dated tube of Bacitracin Zinc Antibiotic ointment located in a basket at the resident's bedside. During a third observation conducted on 07/19/22 at 10:10 AM, Resident #135's room was observed with a used and un-dated tube of Bacitracin Zinc Antibiotic ointment located in a basket at the resident's bedside. During a fourth observation conducted on 07/19/22 at 1:07 PM, Resident #135's room was still observed with a used and un-dated tube of Bacitracin Zinc Antibiotic ointment located in a basket at the resident's bedside. An interview was conducted on 07/20/22 at 10:20 AM with Resident #135's nurse, Staff H, an (LPN), regarding the medication ointment tube observed on Resident #135's bedside table and she acknowledged that the medication tube should not have been there. Further record review revealed there was no order on the Resident #135's Medication Administration Record (MAR) nor on the Treatment Administration Record (TAR) for this (OTC) medication to be administered to this resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 12 of 14 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 105622 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerfield Beach Health and Rehabilitation Center 401 East Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Side-by-side record review was conducted with Staff I a Registered Nurse Unit Manager (RN/UM) of the B-wing, which indicated that neither Resident #97, Resident #104 nor Resident #135's hard copy chart nor their computerized Point-Click-Care (PCC) medical record indicated any of these residents had self-assessments completed in order for them to administer their own medications. During an interview conducted on 07/20/22 at 10:55 AM with Staff I, for the B-wing, she indicated that none of these residents self-administer any of their own medications and were never assessed to do so. In fact, the un-secured/assesible (OTC) medications were not removed from any of the above resident's bedsides, until after surveyor inquisition/intervention. 4) During a Medication Storage Observation conducted on 07/19/22 at 1:29 PM, of the Medication Room on the A-wing, with the Assistant Director of Nursing (ADON), it was observed that there was an approximately quarter (1/4) filled bottle of prescription Magic Mouthwash located in the refrigerator with an expiration date of 07/04/22 for a discharged resident who had been discharged home on [DATE]. (Photographic evidence was obtained of the quarter (1/4) filled bottle of Magic Mouthwash.) 5) Subsequently, during a Medication Storage Observation conducted on 07/19/22 at 1:37 PM, of the Treatment Cart on the A-wing, with the (ADON), it was noted that there were two (2) open/used tubes of stock Hemorrhoidal ointment, with expiration dates 03/2022, located in the top drawer of treatment cart A-wing. (Photographic evidence was obtained of the two (2) open/used tubes of stock Hemorrhoidal ointment.) On 07/19/22 at 1:58 PM An interview was conducted with the (ADON) who acknowledged that the expired medications should have all been promptly discarded. On 07/20/22 at 1:58 PM the Director of Nursing (DON) further acknowledged and recognized that the one (1) prescription medication and all of the (OTC) medications should not have been left at any of the resident's bedsides. She further acknowledged that all of the expired medications should have been promptly discarded. 6) On 07/18/22 at 1:20 PM an observation was made in Resident #46's room revealing on her nightstand, a partial bottle of 70% rubbing alcohol and a partial bottle of witch hazel. During an interview conducted on 07/18/22 at 1:22 PM with Resident #46, she was asked if the rubbing alcohol and witch hazel were hers and she stated yes, she uses them to rub on her legs when they hurt. On 07/19/22 at 10:00 AM, an observation was made in Resident # 46's room on her nightstand was observed a partial bottle of 70% rubbing alcohol and a partial bottle of witch hazel. During an interview conducted on 07/20/22 at 10:25 AM with Staff J, RN, when asked if she was aware that Resident #46 had 70% rubbing alcohol and witch hazel on her nightstand, she stated no and will remove the items. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 13 of 14 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 105622 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerfield Beach Health and Rehabilitation Center 401 East Sample Road Pompano Beach, FL 33064 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, it was determined that the facility failed to dispose of garbage and refuse properly. Residents Affected - Some The findings included: During the tour of the Garbage/Refuse area located in the rear of the facility on 7/18/22 at 10 AM, accompanied with the Dietary Manager, it was noted that there was no garbage compactor, but there were 2 individual garbage/trash dumpster's and 1 cardboard/paper dumpster. Further observation of the dumpster's noted the ground areas to be littered with used, numerous Personal Protection Equipment (PPE), including gloves, aprons, and masks. It was also noted that the ground area around the dumpster's was littered with trash and garbage. The Dietary Manager stated that the Housekeeping Department is responsible for the daily cleaning of the Garbage/Refuse area and that the used PPE's and garbage and trash were from the nursing department. On 7/21/22 at 8 AM a subsequent observation was conducted of the facility's Garbage/Refuse area, and it was noted that the ground area was free of the used PPE equipment, however the area remained littered with numerous pieces of garbage and trash . Photographic Evidence obtained on 7/18/22 and 7/21/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 14 of 14