Inspection·November 9, 2023

F 0584 The findings included: Level of Harm - Minimal harm or potential for actual harm Review of the facility's policy titled Physical Environment with an effective date of 01/01/20 included: A safe, clean, comfortable, and home-life environment is provided for each resident/patient, allowing the use of personal belongings to the greatest extent possible. Sufficient space and equipment in dining, health services, recreation, and program areas are provided to enable staff to provide resident/patients with needed services. All essential mechanical, electrical, and resident/patient care equipment is maintained in safe operating condition through the facility's Preventative Maintenance Program. Residents Affected - Few 1) Record review for Resident #10 revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Reduced Mobility, Repeated Falls, and Muscle Weakness. Review of the Minimum Data Set (MDS) for Resident #10 dated 09/01/23 revealed a Brief Interview of Mental Status (BIMS) score of 15, indicating a cognitive response. During an observation conducted on 11/06/23 from 9:30 AM to 10:20 AM of Resident #10 lying in bed with a mechanical lift sling under the resident, it was noted there was no sheet covering the mattress and no sheets or blankets covering the resident (Photographic Evidence Obtained). During an interview conducted on 11/06/23 at 9:35 AM with Resident #10 who was asked why she had no blankets or sheets, she said the aid came to clean her up this morning and they were going to put her in the chair, but the aid just left her in the bed. The resident stated a lot of times they do not have any clean sheets. During an interview conducted on 11/06/23 at 10:20 AM with Staff W, Certified Nursing Assistant (CNA), who walked into Resident #10's room and stated she has worked at the facility since July 2023. When Staff W was asked why the resident was in the bed with no sheets or blankets, she stated she cleaned the resident this morning and was going to put her in the chair with the mechanical lift, but the other staff member was busy, and it takes two staff to use the mechanical lift, so she left the resident in the bed. When asked why the resident did not have any sheets or blankets while in the bed, she said there were not enough sheets on the cart, and she had to go get the sheets from another area. Staff W stated she left the resident in the bed with no sheets, and she apologized to the surveyor saying she made a mistake she should not have left the resident like that. 2) Record review for Resident #137 revealed the resident was originally admitted to the facility on [DATE] with the most recent readmission on [DATE] with diagnoses that included Encounter for Palliative Care, Muscle Weakness, and Unspecified Lack of Coordination. Review of the MDS for Resident #137 dated 10/11/23 revealed in Section C a BIMS score of 4, indicating severe cognitive impairment. On 11/06/23 at 9:53 AM, an observation was made of Resident #137 lying in bed with only a sheet wrapped around him and no blanket. The temperature of the room was cool. On 11/06/23 at 1:30 PM, an observation was made of Resident #137 who continued to lay in his bed with only a sheet and no blanket. During an interview conducted on 11/06/23 at 9:54 AM with Resident #137 who stated he was cold and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 2 of 30 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 11/09/2023 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 asked for a blanket. The resident stated they took his blanket this morning and did not bring another because they said they do not have any. He stated he was cold. 3) During a tour conducted on 11/06/23 from 9:15 AM to 12:00 PM of the B-wing in the facility an observation was made of the following: Residents Affected - Few In room [ROOM NUMBER] the bathroom ceiling exhaust fan was covered with rust and plaster crumbling around ceiling exhaust fan. In room [ROOM NUMBER] the wall between closets was missing a baseboard. In room [ROOM NUMBER] the wall next to the air conditioning unit had no baseboard, missing plaster. In room [ROOM NUMBER] 1 out of 3 of the bathroom lights were burnt out. In room [ROOM NUMBER] the bathroom wall under toilet tissue holder had crumbling plaster. In room [ROOM NUMBER] the nightstand located in the corner near the air conditioning unit had drawers misaligned and unable to close properly. In room [ROOM NUMBER] the air conditioning unit vents had a black mold like substance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 3 of 30 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 11/09/2023 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 review of policy and procedure, observation, record review and interview, the facility failed to provide care and services in accordance with activities of daily living including: nail grooming for 2 of 2 sampled residents observed, (Resident #327 and Resident #79). Residents Affected - Few The findings included: Review of the facility policy and procedure on 11/08/23 at 2 PM for ADL: Supervision/Assistance provided by the Director of Nursing (DON) effective July 2021 indicated that 1. Each resident will be encouraged to be as independent as possible with ADLs. 2. Staff will provide assistance with ADL's whenever requested by resident. 3. Staff may assist residents with: c. Routine Hygiene/Grooming . 1) Resident #327, was admitted to the facility on [DATE] with diagnoses which included Carrier or Suspected Carrier of Methicillin Resistant Staphylococcus Aureus, Resistance to Multiple Antibiotics, Seizures, Hypertension and Dysphagia. She had a Brief Interview Mental Status (BIMS) score of 15, indicating cognitively intact. During an initial observational tour conducted on 11/06/23 at 9:15 AM, Resident #327 was observed with long, sharp, unkempt, dirty, fingernails on both hands. Photographic Evidence Obtained. On 11/06/23 at 9:18 AM, a brief interview was conducted with Resident #327 in which she stated to this Surveyor that she would like to have her fingernails cleaned by staff and she indicated that she had mentioned this to them, but she is still waiting. During a second observational tour conducted on 11/06/23 at 2:24 PM, Resident #327 was still observed with long, sharp, unkempt, dirty, fingernails on both hands. During a third observational tour conducted on 11/07/23 at 11:04 AM, Resident #327 was still observed with long, sharp, unkempt, dirty, fingernails on both hands. During a fourth observational tour conducted on 11/07/23 at 3:48 PM, Resident #327 was still observed with long, sharp, unkempt, dirty, fingernails on both hands. During a fifth observational tour conducted on 11/08/23 at 10:15 AM, Resident #327 was still observed with long, sharp, unkempt, dirty, fingernails on both hands. Record review of the Resident # 327's Monthly CNA ADL (Activities of Daily Living) Task Flowsheet Record dated 10/27/23 thru 11/07/23 revealed that the facility was documenting in the record that nail care was being provided for this resident, when it had not been. Record review of the Resident #327's Care plan initiated 10/26/23 indicated Focus: Activities of Daily Living (ADL): She requires assistance with personal hygiene cannot complete ADL tasks independently assistance of one (1) Interventions: Anticipate Resident # 327's (ADL) needs and provide assistance as needed Goal: Resident #327 will have ADL Needs anticipated and met by staff through next review. However, observations revealed Resident # 23's fingernail care had not been done, on the dates from 11/06/23 thru 11/08/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 4 of 30 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 11/09/2023 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 interview was conducted with Staff Y, a certified nursing assistant (CNA) on 11/08/23 at 10:46 AM, in which she revealed that they had not provided fingernail care to Resident #327, and she said that it is the responsibility of the CNAs to clean and trim the residents fingernails. She further acknowledged that the resident's fingernails were long, sharp, unkempt and dirty. An interview was conducted with Staff H, a Registered Nurse (RN) Supervisor, A-wing on 11/08/23 at 11:38 AM, regarding Resident #327's long, unkempt nails and she also agreed that Resident # 327's fingernails were long, sharp, unkempt and dirty. On 11/08/23 at 11:49 AM, an interview was conducted with Staff A, Registered Nurse (RN), Unit Manager (UM) for A-wing, regarding Resident #327's fingernails being long, sharp and untrimmed and they she agreed that it is the responsibility of the CNAs to clean and trim the residents nails and they further acknowledged that the resident's fingernails were long and that they should have been cleaned/trimmed/cut. 2) Resident #79, was admitted to the facility on [DATE] and re-admitted to the facility on [DATE] with diagnoses which included Pneumonia, Anxiety Disorder, Muscle Wasting and Atrophy, and Dysphagia. Resident #79 had a Brief Interview Mental Status listed as severely impaired. During an initial observational tour conducted on 11/06/23 at 9:49 AM, Resident #79 was with observed long, thick, dis-colored with some jagged edges, and unkempt fingernails on both hands, with the ring finger fingernail of her left hand observed to be pressing deeply into the inner palm of her left hand. Photographic Evidence Obtained. During a second observational tour conducted on 11/06/23 at 2:24 PM, Resident #79 was still observed with long, thick, discolored dis-colored with some jagged edges, and unkempt fingernails on both hands, with the ring finger fingernail of her left hand observed to be pressing deeply into the inner palm of her left hand. During a third observational tour conducted on 11/07/23 at 11:06 AM, Resident #79 was still observed with long, thick, discolored dis-colored with some jagged edges, and unkempt fingernails on both hands, with the ring finger fingernail of her left hand observed to be pressing deeply into the inner palm of her left hand. During a fourth observational tour conducted on 11/07/23 at 3:47 PM, Resident #79 was still observed with long, thick, discolored dis-colored with some jagged edges, and unkempt fingernails on both hands, with the ring finger fingernail of her left hand observed to be pressing deeply into the inner palm of her left hand. During a fifth observational tour conducted on 11/08/23 at 10:29 AM, Resident #79 was still observed with long, thick, discolored dis-colored with some jagged edges, and unkempt fingernails on both hands, with the ring finger fingernail of her left hand observed to be pressing deeply into the inner palm of her left hand. An interview was conducted with Staff Y, a certified nursing assistant (CNA) on 11/08/23 at 10:46 AM, in which she revealed that they had not provided fingernail care to Resident #79 and she said that it is the responsibility of the CNAs to clean and trim the residents fingernails. She further acknowledged that the resident's fingernails were long, thick, discolored and unkempt. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 5 of 30 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 11/09/2023 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 interview was conducted with Staff H, a Registered Nurse (RN Supervisor, A-wing on 11/08/23 at 11:40 AM, regarding Resident #79's long, thick, discolored and unkempt fingernails and she also agreed that Resident #79's fingernails were long, untrimmed and unkempt. Record review of the Resident #79's Monthly CNA ADL (Activities of Daily Living) Task Flowsheet Record dated 10/27/23 thru 11/07/23 revealed that the facility was documenting in the record that nail care was being provided for this resident, when it had not been. Record review of the Resident #79's Care plan for Rash initiated 03/06/23 and revised 08/22/23 indicated Focus: Activities of Daily Living (ADL): She requires assistance with personal hygiene Interventions: Avoid scratching and keep hands and body parts from excessive moisture .Goal: Resident #79 will have no complications from rash through the review date. However, Resident #79's fingernail care had not been done, on the dates from 11/06/23 thru 11/08/23; until after surveyor intervention. An interview was conducted with the Activities Director, on 11/08/23 at 10:19 AM in which she stated that her department has been providing fingernail manicures, as an Activity, for any residents who are able and want to attend Activities, done by either her or one of her assistants. However, she added that her department is not allowed to cut any of the resident's fingernails; they will file them only. She added that if her staff were to see a resident with long, dirty fingernails that she would alert the nurse and CNA of the wing or unit involved and to let them know to follow-up with the resident. The Director also acknowledged that Resident #327 and Resident #79's fingernails were both long, thick, discolored and unkempt. On 11/08/23 at 11:52 AM, an interview was conducted with Staff A, Registered Nurse (RN), Unit Manager (UM) for A-wing, regarding Resident #79's fingernails being long, thick, discolored and unkempt and they she agreed that it is the responsibility of the CNAs to clean and trim the residents nails and they further acknowledged that the resident's fingernails were long and that they should have been cleaned/trimmed/cut. On 11/08/23 at 1 PM, an interview was conducted with the DON regarding Resident ##327 and Resident #79's fingernails being long, sharp and untrimmed, and she also acknowledged that it is the responsibility of the CNAs to clean and trim the resident's nails and she further acknowledged that the resident's fingernails were long and that they should have been cleaned/trimmed/cut. There was no documented evidence in any of the records reviewed, indicating that either Resident #327 or Resident #79 had refused any personal (ADL) care. Resident # 79's fingernails were not cleaned and trimmed, until after surveyor intervention. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 6 of 30 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 11/09/2023 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 0687 Provide appropriate foot care. 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 provide proper treatment and care for good foot health in a timely manner for 1 out of 5 sampled residents reviewed for ADL (Activities of Daily Living) care (Resident #40). Residents Affected - Few The findings included: Record review for Resident #40 revealed the resident was originally admitted to the facility on [DATE] and was readmitted to the facility on [DATE]. The resident's diagnoses included: Guillain-Barre Syndrome, Parkinson's Disease, and Abnormalities of Gait and Mobility. Review of the Minimum Data Set assessment for Resident #40 dated 10/02/23 revealed in a Brief Interview of Mental Status score of 14, indicating a cognitive response. Review of the Care Plan for Resident #40 dated 09/10/23 with a focus on the resident has an ADL (Activities of Daily Living) self-care performance deficit, weakness, recent hospitalization, and decline in function. The goals included OT (Occupational Therapy) are ordered and goals are established per the OT plan of care. PT (Physical Therapy) is ordered, and goals are established per the PT plan of care. Will Improve level of self-performance by next review. Will Maintain current level of self-performance with ADLs through next review. The interventions included: Converse with resident while providing care. Explain all procedures/tasks before starting. Observe for pain during activity and report to nursing if noted. Resident will be able to independently or sometimes independently perform ADL functions including but not limited to Personal Hygiene, Oral Care, Bathing, and Dressing. Anticipate Needs. Review of the admission Summary for Resident #40 dated 09/28/23 included: Patient admitted from hospital via stretcher accompanied by two medics. Patient transferred to bed with staff help. Patient noted with rash under bilateral armpit, under bilateral breast, redness to groin and sacrum, toenail long with white spots on nail bed, bilateral heels with redness. Patient lumbar region noted with sutures and dressing cover with border dressing, no drainage noted dressing re-enforce. Will continue to observe and proceed with plan of care. On 11/06/23 at 9:40 AM, an observation was made of Resident #40's toenails extending about 1 inch past the edge of the toes with jagged edges, a black spot was observed on the outer edge of the right great toenail (Photographic Evidence Obtained). During an interview conducted on 11/06/23 at 9:37 AM, Resident #40 stated she has been at the facility for 3 months and has been asking since she arrived here for her toenails to be cut and to be seen by a podiatrist because she has an ingrown toenail on her right big toe that sometimes has puss or bleeding. During an interview conducted on 11/09/23 at 9:55 AM with Staff Q, Licensed Practical Nurse (LPN) who stated she has worked at the facility for about 8 months. When asked if a resident has long jagged toenails what does staff do, she stated we do not cut the toenails, we would put in an order in the electronic medical record for the specific resident for a podiatry consult, that electronic order will generate a list that is accessible to the podiatrist, and he comes weekly to the facility or sooner if needed. When asked about an ingrown toenail or black spot on the toe near the nail, she said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 7 of 30 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 11/09/2023 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 0687 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete she would put the consult in for podiatrist and notify the physician. When asked about Resident #40's toenails and black spot on her right great toe, Staff Q LPN stated the resident was recently moved to this unit and when she noticed the toenail issues, she put an order in for a podiatry consult. Further record review revealed a Physician's Order for Resident #40 revealed an order dated 11/07/23 for Podiatry consult for elongated toenails. Event ID: Facility ID: 105622 If continuation sheet Page 8 of 30 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 11/09/2023 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, observations, and record review, the facility failed to ensure that services or treatment to increase range of motion (ROM) and to prevent further decrease in ROM was provided as ordered for 1 of 2 sampled residents (Resident # 116 ) reviewed for ROM. The findings included. On 11/06/23 at 3:06 PM, Resident #116 was observed with contracture of his left hand. Resident #116 reported when questioned that he had a splint, but he did not get help to put it on. Resident #116 showed that the splint was in his nightstand's top drawer. Resident #116 also stated that he was supposed to wear it daily, but staff only puts it on twice a week. Resident #116 was diagnosed with: Hemiplegia and Hemiparesis Following Cerebral Infarction Affecting Left Non-Dominant Side; Major Depressive Disorder, Single Episode, Unspecified; Muscle Wasting And Atrophy, Not Elsewhere Classified, Multiple Sites; Muscle Weakness (Generalized); Muscle Wasting And Atrophy, Left Shoulder; Muscle Wasting And Atrophy, Right Shoulder. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed that Resident # 116's mental status was fairly intact scoring 14/15 on the Brief Interview for Mental Status score, indicating intact cognition. Section G of the MDS showed that Resident # 116 required extensive assistance for most activities of daily living (ADL) except for eating, for which he required supervision. Section O documented that therapeutic intervention was provided on 10/6/2022 and ended on 12/13/22. Review of the Nursing Care Plan (CP) dated 11/1/2023 revealed Resident #116 had ADL Self Care Performance Deficit; weakness, related to hemiplegia. He may require more assistance than allowing staff to render, due to recent hospitalization and decline in function As interventions, Resident #116 will: o have ADL Needs anticipated and met by staff through next review date o Improve level of self-performance by next review date. o Converse with Resident while providing care. o Explain all procedures/tasks before starting. o (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 9 of 30 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 11/09/2023 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 0688 Observe pain during activity and report to nursing if noted. Level of Harm - Minimal harm or potential for actual harm o Residents Affected - Few have morning (AM) and hours of sleep (HS) ROUTINE CARE: Resident will be able to independently or sometimes independently perform ADL functions including but not limited to Personal Hygiene, Oral Care, Bathing, and Dressing. Encourage to perform at highest functional level. Staff will: o Anticipate the Resident's Needs o place Call Bell within reach while in room/ bathroom/shower room and remind to Use. o Provide Privacy for all care o Explain tasks to be performed including what resident will do and what staff will Do. Also, for o BED MOBILITY: Assist of 2 to turn and/or reposition is required. o BED MOBILITY: Resident will use enabler to assist in bed mobility. Review of the Physicians' orders (POS) dated 11/5/2023 revealed the following: Left resting hand splint to reduce future contracture, skin breakdown, and improve ROM. On in AM, off in PM. May remove for care, hygiene, meal services and ROM. Skin check prior to splint application and skin check after splint removal. Report any skin alteration noted to MD. The order further clarified that the Splint will be applied every day by day shift staff and it will be removed at night by evening shift staff (order active as of 11/06/2023 07:00). On 11/08/23 at 10:29 AM, Employee CC, a Licensed Practical Nurse, (LPN) said that Resident # 116 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 10 of 30 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 11/09/2023 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was supposed to wear the splint every morning after care. She informed that Nursing was supposed to verify whether the Certified Nursing Assistant (CNA) put it on for him. Employee M also stated that the resident could not put the splint on by himself. Finally, Employee M was not sure whether the CNAs were supposed to document when they put the splint on for Resident #116. On 11/08/23 at 12:06 PM, Employee DD, a Certified Nursing Assistant (CNA) assigned to care for Resident #116 reported that she has seen Resident #116 with something (a ball) in his hand that therapy gave to him, but she had not seen him wearing a splint. She said that she had never seen him wearing a splint. Review of the Task tab revealed that Resident #116 needed to have his splint on as per order. However, the direction was unclear (Splints- _____ (Type/Body Part) Splint daily for up to ___hours or per patient tolerance. May remove for care and meal services). Yet, some of the staff documented that they placed the splint during the Night shift instead of during the day shift, as follows: 11/5/2023 splint on during the 11:00 PM to 7:00 AM shift since it was documented at 22:33 PM. On 11/6/2023, the CNA Tasks record revealed documentation that the Resident wore the splint during the morning shift. However, observations conducted by the Surveyor contradicted that information. Resident #116 was not observed wearing the splint in the morning of 11/6/2023. On 11/08/23 at 2:26 PM., Employee EE, a CNA who worked in the morning from 7:00 AM-3:30 PM, said that she puts the splint on for Residents when she works with them. She however admitted that because she is new and floats from one unit to another, she does not always know what each patient requires. Employee O said that she knows that she is supposed to ask what is required for each patient. She says that she always put the splint for Resident #116 when she works with him, even though it may be late when she puts it on, because she said that she has a lot of patients to care for. On 11/7/2023, Resident #116 wore the splint in the morning and in the afternoon. The morning staff documented at 14:59 PM, that they assisted the resident and the evening staff also documented at 21:04 PM that the Splint was applied. On 11/08/23 at 3:57 PM, Resident #116 reiterated that they sometimes help him put the splint but not consistently. Resident #116 said sometimes, they do not put it on for days. He said even though he informs them that he needs it, they do not always put it on him. Resident #116 further stated that since the surveyor met with him that week, on 11/6/2023, they have been putting the splint on for him daily. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 11 of 30 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 11/09/2023 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 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 observation, interview and record review, the facility failed to 1) ensure that it properly and correctly positioned the Foley catheter tubing for 1 of 2 sampled residents observed and reviewed for Foley Catheters (Resident #160); and 2) failed to ensure that it properly anchored the Foley catheter for 2 of 2 sampled residents observed for Foley Catheters (Resident #160 and Resident #53). The findings included: 1) Resident #160 was originally admitted to the facility on [DATE] and was re-admitted to the facility on [DATE] with diagnoses which included Bacteriuria, Dementia, Diabetes Mellitus, Cerebral Infarction, Aphasia, Dysphasia, Hypertension, Atherosclerotic Heart Disease and Obstructive and Reflex Uropathy. He had a Brief Interview Mental Status listed as moderately impaired. On 09/28/23 Resident #160's Foley Indwelling catheter care plan documented, Keep drainage bag below level of bladder. During an initial observation conducted on 11/06/23 at 10:02 AM, Resident #160 was observed with his Foley catheter tubing wrapped and twisted around his bed side rail and positioned up above the location of his urinary bladder. The resident's assigned nurse for the day, as well as other staff members were observed entering and exiting the resident's room multiple times, over a period of more than two (2) hours, with no attempts made to try and reposition Resident #160's Foley catheter to the correct level below his bladder. During a second observation conducted on 11/06/23 at 11:48 AM, Resident #160 was observed with his Foley catheter tubing, now at a different even higher angle level above his bladder, for a period of more than one (1) hour, with the nurse in the room, at the time, performing a Glucometer check for a survey observation. During a third observation conducted on 11/07/23 at 9:54 AM, Resident #160's assigned Certified Nursing Assistant (CNA), was observed raising the resident's Foley catheter tubing high above the level of his bladder while re-adjusting it. During a brief interview conducted on 11/07/23 at 11:15 AM with Staff Z, a CNA she acknowledged that she did raise the Foley catheter above the level of the resident's bladder, when she should not have. Computerized record review noted orders for: Urinary Catheter for Obstructive uropathy, Retention and Bacteriuria . Further computerized record review revealed that Resident #160 had a recent previous order for Ertapenem Sodium Injection Solution Reconstituted 1 GM (Ertapenem Sodium) use one (1) gram intravenously (IV) one time a day for Bacteremia. An interview was conducted with Staff Y, a CNA on 11/08/23 at 10:46 AM), regarding the twisted Foley catheter and the fact that it was raised above the level of the resident's bladder and she acknowledged that it should not have been and needs to always remain low. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 12 of 30 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 11/09/2023 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An interview was conducted with Staff H, Registered Nurse (RN) Supervisor, A-wing on 11/08/23 at 11:40 AM regarding the twisted Foley catheter and the fact that it was raised above the level of the resident's bladder, and he acknowledged that it should not have been. An interview was also conducted with Staff A, Registered Nurse (RN), Unit Manager (UM) for A-wing, on 11/08/23 at 11:49 AM the twisted Foley catheter and that fact that it was raised above the level of the resident's bladder, and she also acknowledged that it should not have been. A side-by-side record review was conducted of the Foley Indwelling care plan with A, Registered Nurse (RN), Unit Manager (UM) for A-wing, in which it was noted or indicated to Keep drainage bag below level of bladder. The Director of Nursing (DON) further recognized and acknowledged on 11/08/23 at 1:18 PM that the resident's Foley catheter must always be free of kinks, and in proper position below the resident's bladder at all times; this was not done. A Foley catheter and pericare observation was conducted on 11/09/23 at 11:11 AM, Staff AA, CNA and Staff Y, CNA. Resident #160 provided permission for the surveyor to observe the Foley catheter tubing which was located underneath the resident's right thigh. However, it was not observed to be properly anchored in place with a leg strap. There was no anchor leg strap in place to remove. Neither, was there an anchor leg strap left at the resident's bedside. This fact was confirmed by both CNAs involved with the observation. The CNAs were both asked, after the procedure, if there was anything else that they may have forgotten or needed to do before completing this specific task. They initially could not answer and proceeded to cover the resident and began preparing to exit the room after cleaning and finishing up. On 11/09/23 12:04 PM, during a brief interview with Resident #160, he was asked if he had worn a leg strap as late as yesterday, and he responded, no. There was no documented evidence in any of the records reviewed, indicating that Resident #160 was resistant to care or had any refusals regarding care. On 11/09/23 at 12:08 PM, an interview was conducted with Staff H, Registered Nurse (RN) Supervisor A-wing, and with Staff A, Registered Nurse (RN), Unit Manager (UM) for A-wing, regarding the absent Foley leg strap anchor, they both acknowledged that the resident should have had one in place. The DON also recognized and acknowledged on 11/09/23 at 12:22 PM that the Foley catheter leg strap should have been in place. 2) Record review for Resident #53 revealed the resident was originally admitted to the facility on [DATE] with the most recent readmission to the facility on [DATE]. The resident's diagnoses included: Urinary Tract Infection, Acute Cystitis Without Hematuria, and Obstructive and Reflux Uropathy. Review of the Minimum Data Set for Resident #53 dated 08/10/23 revealed in Section C a Brief Interview for Mental Status score of 5 indicating severe cognitive impairment. Review of the Physician's Orders for Resident #53 revealed an order dated 10/15/23 Urinary Catheter: Urinary catheter to drainage bag for diagnoses of Obstructive Uropathy every shift for observation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 13 of 30 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 11/09/2023 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Physician's Orders for Resident #53 revealed an order dated 07/02/23 Urinary Catheter: Urinary catheter care daily and as needed every day-shift for Preventative Measure. Review of the Care Plan for Resident #53 dated 02/13/23 with a focus on indwelling catheter, the resident uses a Urinary catheter with risk for infection and/or complications: related to: Obstructive Uropathy. The goals were early identification & treatment of UTI (Urinary Tract Infection) and will minimize the risk of complications associated with catheter usage. The interventions included: Change drainage bag routinely & as needed. Use catheter bag that promotes privacy/dignity. Provide catheter care daily & as needed. Educate Resident/Family regarding catheterization & minimizing complications. Observe for signs/symptoms of discomfort on urination and frequency. Observe/document for pain/discomfort due to catheter. Observe/document/report to physician for signs/symptoms of UTI: pain, burning, blood-tinged urine, cloudiness, no output, deepening of urine color, increased pulse, increased temperature, Urinary frequency, foul smelling urine, fever, chills, altered mental status, change in behavior, change in eating patterns. Change drainage bag as needed. Change catheter as needed. Keep catheter tubing free of kinks. Keep drainage bag below level of bladder On 11/06/23 at 10:00 AM, an observation was made of Resident #53 lying in bed with a urinary catheter drainage bag handing from the frame of the bed. Upon closer observation the resident revealed the indwelling urinary tubing coming out of the resident's brief with and not anchored (Photographic Evidence Obtained). On 11/08/23 at 9:30 AM, an observation was made of Resident #53 lying in bed with a urinary catheter tubing that continues to not be anchored. During an interview conducted on 11/06/23 at 10:00 AM, Resident #53 was asked if his indwelling urinary catheter was anchored to his leg, he stated no there is nothing attached to the tubing. During an interview conducted on 11/08/23 at 9:35 AM with Resident #53 when asked if the indwelling urinary tubing was anchored to his leg, he stated no there is nothing, he lowered his blanket and pulled up his shorts to show the surveyor that the tubing is not anchored. During an interview conducted on 11/09/23 at 9:55 AM with Staff Q, Licensed Practical Nurse (LPN) who stated she has worked at the facility for about months. When asked about residents with an indwelling urinary catheter, she stated the drainage bag is hung from the side of the bed off of the floor and below the resident's bladder and the bag is covered for privacy. When asked if the tubing needs to be anchored to the resident's leg, she said yes with a leg strap. The LPN then confirmed that Resident #53 did not have his indwelling catheter tubing anchored. The LPN stated she will put a leg strap on the resident. During an interview conducted on 11/09/23 at 10:35 AM with Staff R Certified Nursing Assistant (CNA) who stated she has worked at the facility for 3 years. When asked if a resident with an indwelling urinary catheter needs to have the catheter tubing anchored, she said yes. When asked about Resident #53, the Staff R CNA stated he did not have a leg strap when she worked the other day, and she told the nurse. When asked why she did not put the leg strap on the resident to secure/anchor the catheter tubing when she noticed it she stated she cannot do that, that is for the nurse to do. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 14 of 30 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 11/09/2023 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide nutritional interventions in a timely manner, failed to assist during dining, failed to ensure the accuracy of the scales, and failed to identify a significant weight loss for 2 of 4 sampled residents reviewed for nutrition (Resident #111 and Resident #143). Residents Affected - Few The findings included: A review of the facility's policy titled Weight Management, dated October 2021, showed the following: the nutrition reassessment and modification to the existing plan of care may be indicated. The dietitian will reassess the nutritional needs and intake of the Resident with weight change. Appropriate recommendations will be documented in the medical record and via the dietitian recommendation form. The dietitian will track resident weights monthly to ensure that all significant weight changes are recognized. A review of the facility's policy titled Weight Management, dated October 2021, showed the following: Weights are completed on admission and readmission, then weekly for four weeks, then monthly unless the physician orders is to reweigh more frequently. The Director of Nursing and Dietitian are to review the monthly and readmission weights and identify any resident requiring reweighing. Weight Loss: All residents with weight loss of 5% in 30 days, 7.5% in 3 months, and 10% in 6 months require physician notification and resident/resident representative notification. Speech and Occupational Therapy are notified as needed. Documentation of notification(s) is documented in the progress note; the care plan and [NAME] are updated with interventions. 1) A record review showed that Resident #111 was admitted to the facility on [DATE] with diagnoses of Protein-calorie-malnutrition, Muscle weakness, and Unspecific falls. A review of the Order Summary Report showed the following: Regular diet with fortified foods dated 10/04/23, and Med Pass three times a day for nutritional supplement dated 10/04/23. The Minimum Data Set assessment dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 07, which indicated moderate to severe cognitive impairment. Section B of the MDS, under vision, showed severe impairment. Under section GG, for eating, it revealed that Resident #111 needs set up or clean up assistance only. In an observation conducted on 11/06/23 at 8:45 AM, the meal carts arrived at Unit C. Resident #111 received his breakfast tray that was placed on the side table at 8:48 AM. Resident #111 was noted asleep at that time. At 9:00 AM, the Resident was still asleep and the meal tray was untouched. At 9:10 AM, the meal was still untouched at the beside. Continued observation at 9:20 AM, which was 32 minutes later, still showed that Resident #111 was asleep with the meal tray 100% untouched. In an observation conducted on 11/06/23 at 12:50 PM, the meal cart arrived at the C Unit. At 1:10 PM, the lunch tray was brought into Resident #111's room by the staff, who started assisting Resident #111 with his lunch tray. Continued observation showed staff leaving the room [ROOM NUMBER] minutes later with the lunch tray 25% consumed. A review of the amount eaten on 11/06/23 documented by staff that Resident #111 ate 76% to 100% of his meals for breakfast and lunch, which was different from what was observed by the Surveyor. In an observation conducted on 11/07/23 at 8:50 AM, Resident #111 was in his room with Staff F, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 15 of 30 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 11/09/2023 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 0692 Certified Nursing Assistant (CNA), assisting the Resident with his breakfast meal. Resident #111 ate about 75% of his meal. In this observation, Staff F stated that Resident #111 needs assistance with his meals. Level of Harm - Actual harm Residents Affected - Few In an observation conducted on 11/07/23 at 1:03 PM, Resident #111 was noted in his room with the lunch tray and no assistance from staff in the room. In this observation, Resident #111 was asked if he needed assistance with his meals and was not able to answer the Surveyor. Continued observation showed Staff F coming into the room to aid Resident #111 with his meal at 1:21 PM, which was 17 minutes later. She left the room with Resident #111's lunch tray 9 minutes later. In an observation conducted on 11/08/23 at 8:28 AM, Resident #111 was in his room eating the breakfast meal on his own. Staff B, the Licensed Practical Nurse, entered the room at 8:33 AM and sat near Resident #111, assisting him with the breakfast meal. Staff B was observed leaving the room at 8:52 AM, and the tray was observed to be 100% consumed. In this observation, she was asked by the Surveyor if Resident #111 needed assistance with his meals, and she said, he only needs cueuing. The Nutrition Evaluation Comprehensive dated 10/03/23 revealed the following: Resident #111's admission weight was 116.2 pounds with an Ideal Body Weight of 166 pounds, and his Body Mass Index (BMI) was noted at 16.7, which is underweight. It further showed that Resident #111 reported good appetite with 75 percent to 100 percent intake of meals. It further revealed that Resident #111 had inadequate oral intake, as evidenced by his BMI and signs of muscle wasting. Reviewing the Weights and Vitals Summary showed that only one weight was taken for Resident #111 on 10/04/23, and no other weights were recorded. The care plan initiated on 10/04/23 revealed the following: Resident #111 has a nutritional problem or potential nutritional problem related to Malnutrition, Low BMI, and nutritional supplements in place. To maintain weight, maintain nutritional intake, and monitor meal consumption, amount assistance needed with meals, and tolerance to diet/fluids. A progress therapy referral dated 10/03/23 revealed that Resident #111 has difficulty feeding self and is blind. He also needs assistance with eating, dressing, and toileting. In an observation conducted on 11/08/23 at 10:04 AM, the Surveyor requested that Resident #111's weight be taken. Resident #111 was taken by Staff E, Registered Dietitian, from Unit C to Unit A to be placed on the stationary scale. Staff E reported that the two Hoyer Lift scales that they have in the facility, are not working and they only have one stationary scale that is working on Unit A. Continued observation showed that Resident #111's weight was 106 pounds. This showed a weight loss from 116.2 pounds to 106 pounds, which was a significant weight loss of 9.8% in about one month. In an interview conducted on 11/08/23 at 10:00 AM, Staff B, Licensed Practical Nurse, stated that weights are usually decided between nursing and dietary and are taken right away after admission or the next day. When asked about the weight policy of the facility, she said, Let me check. She looked it up and reported that weights need to be taken on admission and every week after admission for one month. When asked who records the weight in the system, she said that it is done through communication between nursing and the dietary, and she thinks that the list is given to the Dietitians. She then said, If there is a specific form for the weights, I do not know. In an interview conducted on 11/08/23 at 12:20 PM with Staff E, Registered Dietitian, he was asked (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 16 of 30 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 11/09/2023 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 0692 Level of Harm - Actual harm Residents Affected - Few why Resident #111 did not have weekly weights since his admission on [DATE]. He stated, Looks like nursing did not do it. Staff E said that Resident #111 had a high nutritional risk since his BMI was very low. When asked by the Surveyor why Resident #111 has not been followed since his admission, he said that nursing did not report any poor intake of meals or any weight loss. Staff E then said I had been following up on his weekly weights, but they needed to be included, and that he addressed it in the morning meetings. He also stated that he gives the unit nurse manager a list of residents who need their weights taken, and even if he did not, they should be aware that their weekly weights still need to be included. When asked to clarify who is responsible for taking the weekly weights, he said that when residents get admitted , they have an order placed into the electronic system for weekly weights that need to be done. It is the responsibility of the admitting nurse or unit manager to verify that an order for weekly weights is placed upon admission. In an interview conducted on 11/08/23 at 4:20 PM, the Director of Nursing stated that in the morning meetings, Staff E will request the weights on residents that need to be done and are not done. Staff E provides them with a list of all weekly and monthly weights that are due for the day. In an interview with Staff V, the Minimum Data Set Coordinator, on 11/09/23 at 12:42 PM, stated that Resident #111 only needs set-up assistance with his eating. This means that the staff can bring the tray into the room, set it up for the Resident, and the Resident can eat on his own. Staff V further reported that this information is obtained by observing the residents, interviewing the staff, and reviewing documentation based on some evaluations. He further said that he observed the staff sitting near Resident #111 and that he could eat on his own. In an interview conducted on 11/09/23 at 12:55 PM with Staff U, CNA stated that Resident #111 needs assistance with all his meals and that a staff member has to sit with him during the meals. When asked by the Surveyor if Resident #111 could eat independently, she said, You need to feed the Resident. 2) Resident #143 was initially admitted to the facility on [DATE] and readmitted to the facility on [DATE] with diagnoses of Anemia, Diabetes, and Muscle weakness. The Order Summary Report showed an order for Boost Glucose Control three times a day for nutritional supplementation and record the percentage consumed dated 08/11/23. The Quarterly Minimum Data Set assessment dated [DATE] showed that Resident #143 has a BIMS score of 15, which indicated he is cognitively intact. Resident #143 was initially admitted to the facility on [DATE], readmitted on [DATE], readmitted on [DATE], readmitted on [DATE], and readmitted on [DATE]. A review of the Weight Log showed the following weights for Resident #143: on 03/17/23, a weight of 159.6 pounds, 122.0 pounds on 08/16/23, 124.2 pounds on 09/19/23 and dropped to 111.4 pounds on 10/05/23, which was 10% weight loss in less than a month. In an interview conducted on 11/07/23 at 1:10 PM, Resident #143 was noted eating his lunch meal in his room. He was observed eating 75% of his meals. In this observation, Resident #143 stated he used to get nutritional supplements (Boost) but has not gotten any in the last two weeks. He said that it was Boost with vanilla or chocolate flavors. Resident #143 stated that he needs to get more on his trays; sometimes, he feels insufficient and wants larger portions. In an observation conducted on 11/08/23 at 8:35 PM, Resident #143 was observed with his breakfast tray. Closer observation did not show any nutritional supplement on the tray. Resident #143 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 17 of 30 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 11/09/2023 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 0692 observed eating 100% of his breakfast tray. In this observation, Resident #143 stated that he is not getting enough food and that he wants more. He then said, I can eat a lot. Level of Harm - Actual harm Residents Affected - Few A Dietary progress note dated 10/06/23 revealed that Resident #143 had a good intake of meals between 75-100% of meals consumed. It showed that he is provided with Boost supplements three times a day. Further review did not show that the significant weight loss of 10% was addressed in this note. A Dietary progress note dated 10/13/23 revealed that Resident #143 had a good intake of meals between 75-100% of meals consumed. It showed that he is provided with Boost supplements three times a day. Further review did not show that the significant weight loss of 10% was addressed in this note. A Dietary progress note dated 10/20/23 revealed that Resident #143 had a good intake of meals between 75-100% of meals consumed. It showed that he is provided with Boost supplements three times a day. Further review did not show that the significant weight loss of 10% was addressed in this note. During an interview conducted on 11/08/23 at 9:55 AM with Staff G, Licensed Practical Nurse, who was asked when and how often a new resident is weighed, she stated they are weighed when they first come in and then weekly for four weeks, then monthly. During an interview conducted on 11/08/23 at 10:05 AM with Staff H, a Registered Nurse, who was asked when and how often a new resident is weighed, he stated the Resident is weighed right away on admission and then weekly on Tuesdays for at least four weeks so if there is any weight loss, they can correct it right away. In an interview conducted on 11/08/23 at 10:45 AM, Staff E stated that they only have two Hoyer lifts in the facility for taking the weights, with one not working and the other Hoyer lift broken all last week. They also have two stationary scales, with one not working, and the only stationary scale that is working is on Unit A. When asked who is responsible for the accuracy of the scales or calibration, he said, I do not know. In an observation conducted on 11/08/23 at 10:50 AM, the stationary scale showed that the scale was calibrated on 01/16/23 and that the next due date was supposed to be on 07/2023, which still needs to be done. In an interview conducted on 11/08/23 at 11:00 AM with Staff A, Unit Manager, it was stated that the Hoyer lift that was not working last week was just fixed and is now working. Staff E then said, Oh, I did not know that the Hoyer lift was fixed. In an interview conducted on 11/08/23 at 1:00 PM with Staff H, he stated that the nutritional supplements are taken from the supply room on the unit. He then proceeded to go into the supply room with the Surveyor. He said that before they run out of supplies, he will let staff know if they are low on a specific item. When asked who oversees ordering the nutritional supplies, he said it changes daily and that he did not know. He further said that he did not have a par-level list of what is needed on a daily or weekly basis and that he knows what is missing or what they are low stock on just by visually looking. He then said, for example, look at the Boost glucose control; we only have five bottles left. The Surveyor then said, Are you not going to let supply know that you are low, and he said, I will. An interview conducted on 11/08/23 at 4:27 PM with the Administrator revealed they purchased two new Hoyer lift scales that are in transit and that she rented the Hoyer lift scale for the A unit so they can take the weights. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 18 of 30 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 11/09/2023 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 0692 Level of Harm - Actual harm Residents Affected - Few In an interview conducted on 11/08/23 at 4:35 PM with the Maintenance Director, he stated that he was unaware that the scales on the floor needed to be fixed or needed calibration. He further said that he could be contacted by staff, or the team could contact the vendor directly, but he was not aware of any vendors coming in to fix the scales. He further said that in May 2023, he reached out to his vendors, who came out and inspected all the scales, and any work orders were addressed at that time. In an interview conducted on 11/09/23 at 8:14 AM, Staff E stated that he did not see Resident #143 or speak to Resident #143 when he made his dietary progress notes on 10/06/23, 10/13/23, and 10/20/23. These notes were done after he reviewed Resident #143's nutritional progress in the Interdisciplinary Team meetings. When asked by the Surveyor if he was aware of the weight loss from 124.2 pounds to 111.4 pounds, he said yes. Staff E reported that he questioned the accuracy of the weight loss in the meetings and would follow up with a reweigh, but he never did. When asked why he did not go to see Resident #143, he said since he was eating well and meeting his nutritional needs, he did not. Regarding the dietary supplements, he stated that they are not placed on the meal trays but are given by nursing staff. In an interview conducted on 11/09/23 at 8:40 AM, the Corporate Dietitian stated that there are processes in place to ensure that weekly weights and monthly weights are done, and that is why they have the Interdisciplinary Team meetings to discuss any significant weight changes. Nursing takes the weights of all residents, and it is given back to the Dietitians to place them into the electronic system or the Unit Manager. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 19 of 30 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 11/09/2023 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 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. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to monitor the nutritional status in a timely manner and failed to conduct weekly weights as per the facility's policy to identify a significant weight loss of 21% of body weight for 1 of 2 sampled residents reviewed for tube feeding (Resident #169). The findings included: A review of the facility's policy titled Weight Management, dated October 2021, showed the following: Weights are completed on admission and readmission, then weekly for four weeks, then monthly unless the physician orders is to reweigh more frequently. The Director of Nursing and Dietitian are to review the monthly and readmission weights and identify any resident requiring reweighing. Weight Loss: All residents with weight loss of 5% in 30 days, 7.5% in 3 months, and 10% in 6 months require physician notification and resident/resident representative notification. Speech and Occupational Therapy are notified as needed. Documentation of notification(s) is documented in the progress note; the care plan and [NAME] are updated with interventions. A review of the facility's policy titled Nutrition Assessment and Progress Note, dated January 2023, showed that Residents will receive a comprehensive nutrition assessment by a registered dietitian of an authorized designee. Assessment and documentation of nutritional concerns are recorded in a timely manner in the medical record. The nutrition assessment is an in-depth evaluation of objective and subjective data related to an individual's food and nutrient intake, lifestyle, and medical history. Reassessment is completed quarterly, annually, and with significant change or readmission as needed. Progress notes are completed for intermittent documentation as required and with changes in nutrition status or care. A review of the job description of the Dietitian dated August 1, 2020, showed the following: The Dietitian is primarily responsible for the assessment and evaluation of the Resident's nutritional needs, provides recommendations for nutritional needs, and monitors the Resident's nutritional status in skilled nursing facilities/assisted living facilities providing counseling to residents and family to promote health, wellness, and disease control. Complete nutritional initial, quarterly, annual, and significant Resident change reviews. Review monthly and weekly weights to determine residents who have had a significant change. Complete nutritional reviews monthly on high-risk residents (significant weight loss/ gain, pressure ulcer, hemodialysis, and tube feeding). Assess nutritional needs, diet restrictions, and current health plans to develop and implement dietary care plans and provide nutritional counseling. Resident #169 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of Cerebral infarction, Schizoaffective disorder, and bipolar disorder. Progress readmission noted dated 10/19/23 showed the following: a history of malnutrition and dysphagia and is full code. The Resident previously resided in an Assisted Living Facility. The order review report showed an order for enteral feeding with Jevity 1.5 (tube feeding formulary type) running at 70 ml (milliliters) an hour until a total volume of 1260 ml infused in 24 hours. May turn for care and services and to start at 2:00 PM, and to verify infusing every shift dated 10/19/23. Another order was noted for weekly weights, every seven days for four weeks. The order is not a practitioner order but an order that is part of the care plan by nursing staff dated 10/18/23. It further revealed to record weights under the weight tab in the electronic system and to reweigh for change of 5 pounds in the last seven (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 20 of 30 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 11/09/2023 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 days. Level of Harm - Actual harm In an observation conducted on 11/06/23 at 8:15 AM, Resident #169 was noted in the room with a tube feeding Jevity running at 70 ml an hour. The tube feeding bottle showed that it was started the day before, on 11/05/23, at 3:00 PM. Continued observation showed that the tube feeding bottle was at the 350 ml mark out of a 1000 ml capacity bottle. This observation indicated that 650 ml of formulary was infused in about 17 hours. Residents Affected - Few In an observation conducted on 11/06/23 at 11:00 AM, the tube feeding was noted on hold, and the bottle was noted at the 250 ml level out of the 1000 ml capacity bottle. Continued observation at 12:30 PM revealed that the tube feeding was still on hold and was noted at the 250 ml level. This observation showed that 750 ml of formulary was infused in about 20 hours. In an observation conducted on 11/06/23 at 2:30 PM, the tube feeding was still on hold, and the bottle was noted at the 250 ml level out of the 1000 ml capacity bottle. This revealed that only 750 ml of tube feeding was provided to Resident #169 in about 24 hours. Resident #169 received 1123 calories, which is only 59% of their estimated energy needs in the last 24 hours. In an observation conducted on 11/07/23 at 9:30 AM, Resident #169 was noted in the room with the tube feeding running at 70 ml an hour. The tube feeding bottle was noted at the 450 ml level out of a 1000 ml capacity bottle. The tube feeding bottle was started on 11/06/23, the day before, at 4:00 PM. This showed that 550 ml of formulary was infused in the last 17.5 hours. In an observation conducted on 11/07/23 at 11:45 AM, Resident #169 was noted in the room with the tube feeding running at 70 ml an hour. The tube feeding bottle was noted at the 300 ml level out of a 1000 ml capacity bottle. The tube feeding bottle was started on 11/06/23, the day before, at 4:00 PM. This showed that 700 ml formulary was infused in the last 20 hours. In an observation conducted on 11/07/23 at 2:20 PM, Resident #169 was noted in the room with the tube feeding running at 70 ml an hour. The tube feeding bottle was still at the 300 ml level out of a 1000 ml capacity bottle. The tube feeding bottle was started on 11/06/23, the day before, at 4:00 PM. This showed that Resident #169 received 700 ml of tube feeding in the last 23 hours. This provided 1050 calories, which was 55% of Resident #169's estimated caloric needs. In an observation conducted on 11/07/23 at 4:10 PM, Resident #169 was noted in his room with the tube feeding running at 70 ml an hour. The tube feeding started at 4:00 PM on 11/07/23 and was at the 1000 ml capacity bottle. In an interview conducted on 11/07/23 at 4:11 PM, Staff D, Licensed Practical Nurse (LPN), stated that the earlier 7:00 AM to 3:00 PM shift changed the new tube feeding bag and that it was already running when she came for her shift today. She further said that Resident #169 tolerates his tube feeding. In an observation conducted on 11/08/23 at 7:14 AM, the tube feeding was noted at the 250 ml mark out of a 1000 ml capacity bottle. It started at 4:00 PM the day before, which was dated 11/07/23. In an interview conducted on 11/08/23 at 7:20 AM with Staff C, LPN stated that Resident #169's tube feeding was running all night and was only stopped for water flushes. Resident #169 is tolerating the tube feeding well with no issues. When asked by the Surveyor as to what is the tube feeding order (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 21 of 30 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 11/09/2023 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 - Actual harm Residents Affected - Few for Resident #169, she said that the tube feeding starts at 2:00 PM and stops at 10:00 AM the following day. She then said let me check the electronic system to ensure I have it correct. After looking at Resident #169's tube feeding orders, she reported that the order would start at 2:00 PM and run until it reached 1260 ml. Staff C said it needed to run for 18 hours, paused, and then said, This seems too early. I am so used to the 10:00 AM, 2:00 PM routine. According to Staff C, she does not let the tube feeding bag empty to change to a new tube feeding bottle. She changed the tube-feeding bottle with some tube-feeding formulary left at the end of the bottle. A review of the weight log for Resident #169 showed the following: 117 pounds dated 10/07/23, 117 pounds dated 10/12/23, and a weight of 120 pounds, which was dated 10/18/23 after his readmission to the facility on [DATE]. Further review of the weights did not show any additional weights that were taken for Resident #169 after his readmission to the facility. The Medication Administration Record for November 2023 showed that the tube feeding was administered as per the above order with no issues documented. The Nutrition Evaluation Comprehensive, dated 10/19/23, revealed that Resident #169 estimated needs are at 1636-1909 calories a day, 68-82 grams of protein a day, and 1636-1909 ml of fluids a day. The above tube feeding order will provide 1890 calories a day, 80 grams of protein daily, and 1957 ml of fluids daily. It further revealed that Resident #169's Ideal Body Weight was at 148, and his Body Mass Index (BMI) was noted at 18.8, which is low. In an interview with Staff E, Registered Dietitian, on 11/08/23 at 9:09 AM, he stated when residents get initially admitted , their weight is taken as soon as possible. After the initial weight is taken, the Resident's weights are supposed to be done weekly for four weeks and monthly after that. If he does not have the weekly weight, he will request it from the nursing staff. High-risk residents are those residents who are on dialysis, with pressure ulcers, tube feeding, and residents with malnutrition. If a resident has malnutrition, it is because the nutritional guidelines identified them. Staff E further stated that the nursing staff would take the weights in each unit. At the beginning of the month, when most of the monthly weights are done, he gives the nursing staff on the unit the list of residents who need their weights taken. Nursing will sometimes place the weights into the electronic system, and sometimes, it is given to him to input the weights in the electronic system. When asked how he knows which residents are missing their monthly or weekly weights, he said that there is an entry form that allows you to see who is missing any weights or when the weights were taken on specific residents. He will run this report every morning, and as per nutritional guidelines, he will monitor any weight losses of 2% in one week, 5% in one month, 7.5% in 3 months, and 10% in 6 months. Staff E reported that for any of the above weight loss percentages, the electronic system will initiate a warning on the specific weight loss. He then said, Sometimes the weight loss warning gets cleared in the electronic system by the nursing staff. In an observation conducted on 11/08/23 at 1:11 PM, Resident #169's weight was taken as requested by the Surveyor. A Hoyer lift scale was used to take the weight of Resident #169. Continued observation showed Staff I and Staff J, Certified Nursing Assistants, were in the room to take the weight of Resident #169, which showed a weight of 94 pounds. Resident #169's weight of 94 pounds in 20 days showed a significant weight loss from 120 pounds to 94 pounds, which was a 21 percent weight loss. This showed that Resident #169's BMI dropped from 18.8 to 14. 7, which is underweight. In an interview conducted on 11/08/23 at 2:30 PM with Staff H, Registered Nurse, he stated that he is very familiar with Resident #169 and has been tolerating his tube feeding very well in the last few weeks with no issues. He did say that Resident #169 has the tendency to move around, and he would (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 22 of 30 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 11/09/2023 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 - Actual harm Residents Affected - Few always check on him to make sure that he did not strangle himself with the tube feeding around him. Staff H further stated that the tube feeding has been following the Physician's orders and that he starts it at 2:00 PM before he leaves his shift. The tube feeding order is to run until 1260 ml, or the formula is infused in 24 hours, running at 70 ml an hour. If the tube feeding had not been flushing, dislodged, or obstructed, he would have contacted the doctor, which did not happen. In another interview conducted on 11/08/23 at 4:03 PM with Staff E, he was asked as to how many bottles of feeding formulary are infused if the next day, after 23-24 hours, there is still some formula left in the bottle, he stated that it is okay because the tube feeding bottles are 1500 ml capacity bottles. He then said that if the tube feeding ran for 18 hours, it should have been done after 18 hours unless they stopped it to provide care. When asked about the 21% weight loss on Resident #169 from his readmission on [DATE], he stated, The Resident clearly has something that we did not know about, and that is for the doctor to figure it out. Staff E then said that he would follow up on Resident #169 to order a new lab and see why he needs to utilize the formula. He only realized it today when Resident #169 was placed on the scale that he had such a significant weight loss in 3 weeks. He further said that he addresses the issues with weights in the morning meetings and that some managers are more effective than others in making sure that he has the weekly weights to complete the nutritional assessments. The Surveyor expressed concern that the significant weight loss was missed within 3 weeks, and Staff E then said, It is only one week that he missed the weight on Resident #169. In an interview conducted on 11/08/23 at 4:50 PM with the Director of Nursing (DON), she stated that they have morning meetings daily, and she was not aware that some residents needed weekly weights that were not done. According to DON, Staff E would provide nursing staff with a list of any residents who needed the weekly or the monthly weights done. The care plan, which was initiated on 10/06/23, showed the following: to obtain adequate nutrition and hydration by administrating the enteral feeding as ordered. It further revealed that Resident #169 is at nutritional risk related to malnutrition, dysphagia, and low BMI. In an interview conducted on 11/08/23 at 6:00 PM with the facility's Administrator, she was told of the findings and that Resident #169 has a significant weight loss of 21%. She was told by the Surveyor that weekly weights were not obtained on high-risk residents and that Resident #169's weight loss was identified because of the Surveyor's interventions. In an interview conducted on 11/09/23 at 11:00 AM with the facility's Medical Director, he stated that Resident #169 went to the hospital on [DATE] for peg tube placement after Resident #169 was observed with a dislodged tube feeding. He further noted that Resident #169 did not get any nutrition via tube feeding for 3-4 days while in the hospital and was already compromised nutritionally. The Medical Director reported that Resident #169 was tolerating his tube feeding after he was readmitted to the facility on [DATE]. He further questioned the significant weight loss for Resident #169 and stated that he would investigate further and order more labs for any underlying causes that may have been missing. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 23 of 30 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 11/09/2023 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 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** 2) Review of facility policy and procedure on 11/08/23 at 1:30 PM for Oxygen Therapy provided by the (DON) dated 2013 indicated that Oxygen is a basic human need. Without it, we would not survive .Therefore .supplemental amounts are required to maintain normal body function Definition of Oxygen: 1) Oxygen is a drug which must be ordered by a physician .Initiation of Oxygen 1) Verify physician order . Residents Affected - Few Resident #79 was initially admitted to the facility on [DATE] and re-admitted to the facility on [DATE] with diagnoses which included: Pneumonia, Anxiety Disorder, Muscle Wasting and Atrophy, and Dysphagia. Resident #79 had a Brief Interview Mental Status listed as (severely impaired). During an observational screening tour conducted on 11/06/23 at 9:51 AM Resident #79 was observed with Oxygen infusing at two (2) liters via Oxygen concentrator with no physician's orders for Oxygen therapy administration, on file since before her last re-admission to the facility. Photographic Evidence Obtained. A computerized record review was conducted of Resident #79's current physician's orders, but there was no current order noted for the Oxygen with parameters, for this resident. Neither were there any orders or other documentation written on Resident #79's Medication Administration Record (MAR) nor on the Treatment Administration Record (TAR). A computerized record review was conducted of Resident #79's Minimum Data Set (MDS) section O for assessment reference date of 08/21/23, in which it was also not captured that the resident was receiving Oxygen therapy for dates-of-service (DOS). Neither did a computerized record review of Resident #79's nursing care plan dated 08/21/23 reflect or capture any Oxygen therapy usage for this resident. However, record review of the nursing progress notes dated 05/15/23 thru 07/11/23 and again dated 09/23/23 thru 11/07/23, as well as the Oxygen saturation readings range 94% to 98%; both indicated or documented current Oxygen usage by this resident. There was no active order noted or obtained for Oxygen therapy, for Resident #79. On 11/06/23 at 2:25 PM, Resident #79 was still observed with Oxygen infusing at two (2) liters via Oxygen concentrator with no physician's orders for Oxygen therapy administration, on file. On 11/07/23 at 9:47 AM, Resident #79 was still observed with Oxygen infusing at two (2) liters via Oxygen concentrator with no physician's orders for Oxygen therapy administration, on file. On 11/07/23 at 3:47 PM Resident #79 was still observed with Oxygen infusing at two (2) liters via Oxygen concentrator with no physician's orders for Oxygen therapy administration, on file. On 11/08/23 at 11:01 AM Resident #79 was still observed with Oxygen infusing at two (2) liters via Oxygen concentrator with no physician's orders for Oxygen therapy administration, on file. On 11/08/23 at 11:40 AM, an interview was conducted with Staff H, a Registered Nurse (RN Supervisor, A-wing, in which he was asked the following three (3) questions regarding the resident's oxygen: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 24 of 30 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 11/09/2023 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 1) Is this resident on oxygen? He replied, Yes, on two (2) liters. 2) Did you have or get an order to administer this resident's oxygen? He stated, no. 3) If no, why not? Staff H, acknowledged that he did not take the time to verify whether or not the resident actually had an order for the oxygen. On 11/08/23 at 11:52 AM an interview was conducted with Staff A, Registered Nurse (RN), Unit Manager (UM) for A-wing, in which she was also asked the following three (3) questions regarding the resident's oxygen: 1) Is this resident on oxygen? She replied, Yes, on two (2) liters. 2) Did you have or get an order to administer this resident's oxygen? She stated, no. 3) If no, why not? Staff A, acknowledged that she did not take the time to verify whether or not the resident actually had an order for the oxygen. In fact, the oxygen order was not obtained for Resident #79, until after surveyor intervention. During an interview conducted on 11/08/23 at 1 PM, the Director of Nursing (DON) further acknowledged that Resident #79 should have had an oxygen order; this was not done. 3) Record review for Resident #96 revealed the resident was originally admitted to the facility on [DATE] with the most recent readmission on [DATE]. The resident's diagnoses included: Atherosclerotic Heart Disease of Native Coronary Artery Without Angina Pectoris and Shortness of Breath. Review of the Physician's Orders for Resident #96 revealed an order dated 09/18/23 for oxygen at 2 LPM (Liters Per Minute) via nasal cannula as needed for SOB (Shortness of Breath). Review of the Treatment Administration Record for Resident #96 from 09/18/23 to 11/06/23 revealed no documentation of oxygen being administered. Review of O2 (Oxygen) Saturation under the Vital Signs tab in the electronic medical record for Resident #96 from 09/18/23 to 11/06/23 had documented on 09/18/23 and 09/19/23 the resident had oxygen via nasal canula. Review of the Care Plan for Resident #96 revealed a care plan dated 05/24/21 and a revised date of 09/19/23 with a focus on the resident has Oxygen Therapy related to SOB. The goal included the resident will experience minimal to no shortness of breath. The interventions included: Administer Oxygen as ordered (Refer to current POS/MAR for current order). Change and date respiratory equipment tubing weekly & prn. Encourage or assist with ambulation as indicated. Give medications as ordered by physician. Monitor/document side effects and effectiveness. Promote lung expansion and improve air exchange by positioning with proper body alignment. Report changes in respiratory status to physician. Special Equipment: Oxygen On 11/06/23 from 12:00 PM to 12:45 PM, an observation was conducted of Resident #96 wearing oxygen connected to an oxygen concentrator in his room. The oxygen concentrator had a beeping sound, upon closer observation the concentrator had an icon with an exclamation point inside a triangle lit up with a yellow light on next to an icon On 11/07/23 at 9:45 AM, an observation conducted of Resident #96 with an oxygen concentrator in his room with a beeping sound, upon a closer observation the concentrator with a yellow light on next to an icon with an exclamation point inside a triangle. On 11/08/23 at 1:40 PM, an observation conducted of Resident #96 with an oxygen concentrator in his (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 25 of 30 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 11/09/2023 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few room with a beeping sound, upon a closer observation the concentrator with a yellow light on next to an icon with an exclamation point inside a triangle. During an interview conducted on 11/06/23 at 12:10 PM with Resident #96 he was asked how often he wears oxygen, he said all the time, but sometimes he takes it off occasionally because it bothers his ears. When asked about the oxygen concentrator beeping, he said it does that sometimes. During an interview conducted on 11/08/23 at 1:45 PM with Staff S, Certified Nursing Assistant who stated she has worked at the facility since 2018. When asked if she has taken care of Resident #96, she said yes all of the time. When asked if Resident #96 wears oxygen, she said yes once in a while he will take it off. When asked about the oxygen concentrator for Resident #96 making a beeping noise, she said she never noticed it. During an interview conducted on 11/08/23 at 1:148 PM with Staff T, Registered Nurse, Unit Manager who stated she has worked at the facility for 2 years. When asked about the oxygen concentrator for Resident #96 beeping, she went into the room looked at the concentrator and said I will change it immediately it is not working properly. When asked if Resident #96 wears oxygen, she stated yes since he came back from the hospital the last time in September, he wears oxygen all of the time and occasionally takes it off. During an interview conducted on 11/08/23 at 2:20 PM with Staff BB, Registered Nurse who was asked if she has taken care of Resident #96 in the past she said yes, mostly she works the night shift. When asked if he receives oxygen she said yes, when asked how often she said most of the time every night. When asked where she documents the oxygen being used, she said it is documented on the TAR (Treatment Administration Record). Based on observations, interviews and record reviews, the facility failed to provide proper tracheostomy care and maintain a sterile field for 1 of 1 sampled resident reviewed for tracheostomy care (Resident #74). The facility also failed to obtain a physician's order for oxygen for 1 of 3 sampled residents (Resident #79) and failed to properly document the use of oxygen for 1 out of 3 sampled residents (Resident #96) reviewed for respiratory care. The findings included: Review of the facility's policy titled, Tracheostomy Care, undated, and Tracheostomy Suctioning Competency Skills Checklist undated, revealed the following: Purpose: Tracheostomy care is the process of aseptically cleaning the tracheostomy tube and soma site. The buildup of mucus and rubbing of the tracheostomy tube can irritate the skin around the stoma. The skin around the stoma should be cleaned at least twice a day to prevent odor, irritation, and infection. Procedure: Gather the necessary equipment and proceed to the patient's room. Wash your hands after suctioning. Aseptically open the sterile saline/water and equally dispense it into two containers. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 26 of 30 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 11/09/2023 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 0695 Aseptically don sterile gloves. Follow universal precautions and use gown, gloves, & mask if needed. Level of Harm - Minimal harm or potential for actual harm Precautions/Hazards: 1) Residents Affected - Few Accidental decannulation. 2) Infection from poor aseptic technique. Tracheostomy Suctioning Competency Skills Checklist: Gather supplies: Suction kit, Extra sterile gloves, extra sterile 4x4's. Explain procedure to the resident and turn on the suction machine. Wash hands and apply gloves (soap and water or hand sanitizer). Open suction kit: place on top of non-permeable barrier. Don sterile gloves and other PPE (as indicated). Attach the catheter to the connecting tube, keeping the sterile hand on the catheter and the clean hand on the connecting tube. 1) A tracheostomy care observation was conducted on 11/08/23 1:12 PM with Staff K, Licensed Practical Nurse (LPN) for Resident #74. Staff K reviewed the physician's orders and gathered supplies from the medication storage room in a zippered bag. Staff K was joined by Staff L, Registered Nurse (RN). Staff L stated she was also the facility's staff educator. Staff K introduced herself to Resident #74 and advised that she was going to perform tracheostomy care. The resident's room door was closed for privacy. Staff K donned clean gloves and with one hand cleaned bedside tabletop while holding the supplies (in the zippered bag) in the other hand. While waiting for the tabletop to dry, an interview was conducted with Staff K. She stated that she had been working at the facility for 21 years. She also stated that she was the nurse that usually cared for Resident #74. Once the tabletop dried, she placed the zippered bag containing the supplies on the table and washed her hands. She returned to the bedside and retrieved a pulse oximeter from the pocket of her scrub top, donned clean gloves and placed the pulse oximeter on Resident #74's right index finger. The oxygen level read 97%. Staff K then removed her gloves (no hand sanitizing performed) and donned clean gloves. Then, she placed a Bio-hazard bag on the waste basket. She retrieved her face mask from her scrub top pocket and put it on. She removed her gloves (no hand sanitizing performed) and donned clean gloves. She took out all the supplies from the zippered bag and placed them on the table. The supplies included: 1 Tracheostomy care kit, 1 Suction kit, 1 disposable inner canula, 4 gauze 4x4 pads, 1 sterile normal saline container, 1 Tracheostomy tube holder, and 1 abdominal (ABD) pad. Without changing her gloves, Staff K opened the Tracheostomy kit and removed the sterile protector sheet to set up the sterile field. She placed the sterile sheet on top of the Suction and Tracheostomy kits and then removed the kits from underneath the sterile sheet. She opened the disposable inner cannula package and dumped it onto (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 27 of 30 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 11/09/2023 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the sterile field. She ripped all 4 gauze packets together and attempted to drop them one at a time onto the sterile field. Some of the gauze packaging fell onto the sterile field and she removed it. At this time, Staff L stated that she would get another Tracheostomy kit and left the room. Then, Staff K continued to dump the other gauzes onto the sterile field. The surveyor asked Staff K if she was aware as to why Staff L went to get another Tracheostomy care kit. Staff K was unsure and continued to drop the gauze onto the sterile field. At 1:37 PM Staff L returned with another Tracheostomy care Kit and Suction kit. Staff L asked the surveyor if she could help Staff K, and the surveyor agreed. Staff L and Staff K washed their hands and donned clean gloves. Staff L told Staff K to throw everything away and to open the new tracheostomy care kit. Staff K removed her gloves (no hand sanitizing performed) and donned clean gloves. Staff K opened the Tracheostomy Care kit and removed the sterile sheet and as she was attempting to open it, she dropped the sterile sheet onto the floor. Staff L left the room again to get another Tracheostomy care kit. At 1:41 PM, Staff L returned with another Tracheostomy Care kit and asked if she could assist Staff K with the tracheostomy care. Under the direction of Staff L, Staff K proceeded with the reminder of Resident #74's Tracheostomy care. With Staff L's verbal instructions, Staff K continued to have difficulty with maintaining sterilization. Examples included the following: Staff K struggled to don the sterile gloves. The suction machine was not turned on prior to donning sterile gloves. Not performing hand sanitizing prior to donning clean gloves. Failed to identify non-sterile procedures versus sterile procedures in which she required assistance from Staff L. On 11/09/23 9:09 AM, an interview was conducted with Staff L, RN, and the Staff Educator. She stated she verbally reviewed the tracheostomy care steps with Staff K in the morning and then again prior to the Resident #74's tracheostomy care on 11/08/23 at 1:12 PM. Staff L stated she also went over the tracheostomy care procedure with Staff K after the observation and explained to her what went wrong. The surveyor explained that Staff K was unaware why Staff L went to retrieve another tracheostomy care kit the first time. Staff L was surprised and confirmed that Staff K will require education on sterilized field set-up and the overall tracheostomy care. This surveyor discussed these concerns with the Facility Administrator and the Director of Nursing (DON). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 28 of 30 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 11/09/2023 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 0759 Ensure medication error rates are not 5 percent or greater. 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; it was determined that the medication error rate was 7.59 percent, 2 medication errors were identified while observing a total of 26 opportunities, affecting Resident #91 and Resident #479. Residents Affected - Few The findings included: 1) On 11/07/23 at 8:52 AM, a medication pass observation was conducted with Registered Nurse (RN), Staff M for Resident #479. Staff M was observed preparing the resident's medications to include Advair Diskus Inhalation and 9 oral medications. Advair Diskus is a steroid and bronchodilator used for treatment of air flow. Staff M administered the 9 oral medications then gave the resident Advair to inhale. Resident #479 was not instructed to rinse her mouth out with water after inhaling. According to the prescribing information for Advair, after inhalation, the mouth should be rinsed out with water without swallowing to help reduce the risk of oropharyngeal candidiasis (yeast infection in the mouth). Resident #479 was initially admitted to the facility on [DATE] with diagnoses that included: Cerebral infarction, Hypertension and Hemiplegia. 2) On 11/07/23 at 9:20 AM, a medication pass observation was conducted with Licensed Practical Nurse (LPN), Staff N for Resident #91. Staff N was observed preparing the medications for Resident #91 to include 9 medications. Staff N administered the 9 medications to Resident #91. The medications that were administered to Resident #91 were reconciled to the Medication Administration Record (MAR). One of the medications prepared and given was Aspirin Tablet Chewable, 81milligrams (mg) by mouth instead of the medication that was prescribed which was Aspirin EC (enteric coated) 81mg 1 by mouth for prophylaxis. Resident #91 was admitted to the facility on [DATE] with diagnoses that included: Type 2 Diabetes Mellitus with Diabetic Chronic Kidney Disease, Gastrointestinal Hemorrhage, and End Stage Renal Disease. On 11/09/23 at 8:45 AM, an interview was conducted with the Director of Nurses (DON) apprising her of the medication pass observation and the reconciliation of the medications administered by Staff N. The DON verbalized understanding. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 29 of 30 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 11/09/2023 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 0924 Put firmly secured handrails on each side of hallways. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview the facility failed to equip the corridor between the therapy rooms with firmly secured handrails on each side. Residents Affected - Few The findings included: Review of the facility's policy titled, Physical Environment with an effective date of 01/01/20 included A safe, clean, comfortable, and homelife environment is provided for each resident/patient. On 11/06/23 at 12:28 PM, an observation was made in the corridor with therapy rooms on each side with no handrails on either side of the corridor (Photographic Evidence Obtained). During an interview conducted on 11/08/23 at 2:00 PM with the Director of Maintenance who was asked about handrails, he said they have handrails throughout the building. When asked about no handrails in the corridor between the two therapy rooms, he said he never noticed there were no handrails in the corridor, he just changed the lights above the corridor to be brighter. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 30 of 30