Inspection·November 13, 2024

F 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 11/12/24 at 9:40 AM, an interview was conducted with the Administrator and Director of Nursing (DON), who both stated the AC unit in these 2 residents' room had been fixed and was working. The rectangular gray plastic pan placed under the AC unit was to try and catch water condensation. The Administrator stated this room belongs to A wing. On 11/12/24 at 10:00 AM, an interview was conducted with Staff C, Maintenance Director, who stated he monitors the temperature of the facility, and the condensation on the AC vents are normal. On 11/12/24 at 1:30 PM, another interview was conducted with the Administrator who stated the water and discoloration on the AC ceiling vents are normal occurrences. On 11/12/24 at 2:00 PM, an interview was conducted with Staff B, the Housekeeping Director, who stated there are daily concierge rounds comprised of the facility's Unit Managers who checked and verified that each room is properly cleaned and maintained. On 11/12/24 at 3:30 PM, an interview was conducted with Staff D, CNA (Certified Nursing Assistant), who stated she believes there is no broken AC on A wing, because maintenance fixes any broken AC right away. On 11/13/24 at 9:25 AM, an interview was conducted with Resident #4 who stated he sees the puddles of water outside the rectangular gray pan under the AC unit every day and added that the room is warm. On 11/13/24 at 9:30 AM, an interview was conducted with Resident #4's visitor who stated she comes and visits Resident #4 every day and feels the warm air temperature inside the room. When asked about the water inside and outside the plastic pan and puddle under Resident #4's bed, she stated, It happens every day. This visitor added that staff would mop the floor, but the water puddle and flooding under and around the middle part of Resident #4's bed would come back immediately. She stated she is very careful in approaching Resident #4's bed because she does not want to slip and fall. She confirmed the water is coming from the wall-AC unit on the left side of Resident #4's bed. On 11/13/24 at 9:43 AM, an interview was conducted with Staff A, Housekeeping Staff, who has been working in the facility for 3 years. When asked if she had seen the water puddle and flooding around and under the Resident #4's bed and under the AC unit in this resident's room, she stated she 'heard the leak coming from a wall mounted AC unit' and has also 'seen the water puddle and flooding every time she cleans the room for several days.' Staff A added she reported the AC leakage and water flooding to a maintenance staff person who checked it on Monday (11/11/24 at 11:00 AM). During an observation conducted on 11/13/24 at 9:45 AM, a water puddle and poolinn of water were observed under the middle part of Resident #4's bed. A closer observation revealed the water was dripping from the wall mounted AC unit. There was a rectangular plastic gray pan located under the AC unit to the left of Resident #4's bed. Closer observation revealed the same water puddle and pooling of water were moving towards the bed of Resident #4's roommate, Resident #5. On 11/13/24 at 9:46 AM, continuing observation revealed when Staff H, CNA, opened the closed bathroom door, water gushed from the bathroom into the room, causing floor to pour unto the room floor on the foot part of Resident #5's bed. A few minutes later, Resident #5 came out from the bathroom and walked on a puddle of water. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 2 of 4 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 11/13/2024 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 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 11/13/24 at 9:58 AM, in an interview with Resident #5, he stated the shower drain in their (Resident #4 and #5) room-bathroom does not work, causing water to come out from the bathroom into the inside of their room. Resident #5 stated he had been in the facility since last week, and he noticed the shower and bathroom drain were emitting a bad smell. On 11/13/24 at 10:03 AM, an interview was conducted with Resident #5's spouse who when asked about the water coming from the bathroom in the bedroom, she stated she was worried about Resident #5 slipping and falling due to water flooding in the room. She added the AC was leaking and flooding under Resident #4's bed, while the bathroom flooding goes around the foot part of her husband's (Resident #5) bed. She stated she did not want to complain, but believed the water flooding is dangerous for both Residents #4 and #5. She added the bathroom has a musty bad smell. On 11/13/24 at 11:10 AM, an additional interview was conducted with Resident #5, who was sitting on a wheelchair, and stated he told staff about the shower drain not working but nothing was done about it. He added it was hard for him to get the staff's attention regarding the water coming into his room and pooling on the floor. He thought there were not enough staff to care for all residents, especially concerning the water coming from the bathroom. He stated that he wanted to go home but needed more Physical Therapy, there was no shower curtain providing privacy, and nothing to stop the water from going inside the room. On 11/13/24 at 11:28 AM, an interview was conducted again the Maintenance Director who stated the AC company contracted by the facility repaired the AC unit in the room of Resident #4 and #5, but the grounds-keeping staff accidentally trimmed the outside AC parts. When asked for paperwork confirming dates when the AC unit was repaired, and the accidental outside-AC parts trimming, he stated he would provide them. No paperwork was provided to the surveyor by the end of the survey on 11/13/24 at 2:00 PM. On 11/13/24 at 11:45 AM, an additional interview with the Housekeeping Director revealed she that Residents #4 and #5's room was deeply cleaned on 10/28/24 before Resident #4 and Resident #5 were admitted . She added that deep cleaning involved stripping everything, such as removing resident from the room, room inspection from top to bottom and scrubbing windows, windowsills, bed rails, floors, walls, shower drain, toilet, and sink and washing privacy and bathroom curtains. When asked if she knew about water coming into this room, she stated none of the housekeeping staff had informed her. When asked if she performed residents room rounds, she stated she does random daily room inspection on each wing. When asked for the room numbers she randomly inspected on 11/12/24, she stated she would bring the paper documentation, but no documentation was provided to the time of survey exit. During an exit conference on 11/13/24 at 1:44 PM, the Administrator and DON were informed of the above findings. 2. On 11/12/24 at 11:45 AM, observations during tour of A wing, in the shower room, revealed a blackish and brownish discoloration on a beige colored AC vent on the ceiling. There was an ammonia musty and old-standing urine smell noted. 3. In room [ROOM NUMBER], observation during the same tour revealed a musty, ammonia smell inside the bathroom. When the tap water was turned on in the shower area and the sink, a stronger musty smell and old-standing urine odor were noted. During a second tour of room [ROOM NUMBER] with the Administrator on 11/12/24 at 5:10 PM, it was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 3 of 4 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 11/13/2024 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 0908 noted that the toilet base had been re-caulked, resealed and there was a strong disinfectant odor. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105622 If continuation sheet Page 4 of 4