Health inspection·May 1, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few following: Temazepam Oral Cap (capsule) 30 mg (milligrams) 1 cap PO (by mouth) HS (at night) for insomnia, Insulin Lispro 100 unit/ml (milliliters) Solution pen-injector inj (inject) per sliding scale for diabetes mellitus, Abilify oral tab (tablet) 20mg 1 tab PO one time a day for mood disorder, Enoxaparin Sodium Injection Solution Prefilled Syringe 30mg/0.3ml inj 30ml subq (subcutaneous) one time a day for dvt (deep vein thrombosis) prophylaxis, Bupropion HCL (hydrochloric acid) ER (extended release) oral tab 24 hour 300mg 1 tab PO one time a day for depression and the bed in low position. Review of Resident number 1's ADL Self Care Performance care plan dated 3/03/23 documented the resident was at deficit related to impaired balance, limited ROM (range of motion) and pain; Goal: Will improve current level of function in ADLs through the review date; Intervention: Transfer-The resident requires Mechanical Lift with 2 staff assistance for transfer. Interview with Staff A, Certified Nursing Assistant (CNA) on 3/28/23 at 2:37 PM via telephone. She stated, The patient asked to be switched from the bed to the wheelchair and when she asked that I tried to do it on my own but I realized she was to heavy and went to go get my coworker and she sat back on the bed. Me and my co-worker tried to switch her to the wheelchair and we gently lowered her to the floor due to her having no lower body strength. I have not worked with her often and when I realized it wasn't possible to transfer her, I sat her back on the bed. We had to get three workers to lift her back into the bed. She didn't speak of having any pain. Interview with Staff B, CNA on 3/28/23 at 2:43 PM. She stated, This was on a Saturday. The CNA [Staff CNA, A] came and asked me to put the patient in the wheelchair. When we came into the room, she was sitting on the bed. We proceeded to lift her and realized she had no lower body strength. When we realized we couldn't up lift her up, we gently placed her on the ground. [Staff CNA, A] went out to get [Staff D, CNA] the CNA to help. The resident was on the ground when [Staff D, CNA] grabbed her legs. I grabbed the back part of her and [Staff CNA, A] lifted up the middle part. We placed her on the bed. We asked her if there was any pain and she shook her head no. I worked with her before and she was able to move herself, she had lower body strength then. Interview with Staff C, Registered Nurse (RN) on 3/28/23 at 3:03 PM via telephone. She stated, The cna told me they were trying to transfer the patient from the bed to the wheelchair and the patient did not have enough strength and they lowered her to the floor. The patient started complaining of pain and I called the doctor and called the family to tell them what happened. The doctor said to transfer to her the hospital for an evaluation. The x-rays were done at the facility. She had a dislocation of the hip, no fracture. Interview with Staff D, CNA on 3/28/23 at 3:13 PM via Spanish translator. She revealed, it was on a Saturday. I was in another room and the other two cnas they were in the room helping the patient. They called me to come and help and I grabbed the patient by the legs to help put her back in the bed. The resident was already on the floor when I came into the room. I have worked with the patient before. When she is in bed, she will assist you and I can help her by myself but to transfer her I always need two people to help. Interview with Staff E, Licensed Practical Nurse (LPN) Unit Manager on 3/29/23 at 12:21 PM. She stated, When transferring a patient from bed to the wheelchair is based on the mobility of the patient. If they are extensive or more we have a stand up lift or a [mechanical lift] for the cna to use. If the care plan says the patient needs two persons to lift, it should be two persons to lift the patient. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 2 of 10 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 105641 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Kendall 9400 SW 137th Avenue Kendall, FL 33186 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with the Registered Nurse, Assistant Director of Nursing on 3/29/23 at 12:34 PM. She stated, If the patient needs two cnas, two have to be there before the transfer begins. They need to check the [NAME], the information is there to make sure the patient is able to assist or if the patient needs the [mechanical lift] lift. Interview with the Administrator on 3/29/23 at 12:36 PM. She stated, The resident came in for left hip replacement at the hospital and came in for rehab. Three cnas were trying to transfer her from the bed to the chair. Two of them put her on the floor and the other one came to help to put her back in the bed. The cnas are supposed to see the [NAME] to see if the patient needs more than one to assist them. She sustained a dislocation of the hip. 2) Closed record review of the Demographic Face Sheet for Resident number 2 documented the resident was admitted on [DATE] with a diagnoses to include arthritis, difficulty in walking, hemiplegia, blindness left eye, morbid obese, depression, hypertension and edema. The resident was discharged to the hospital on 3/14/2023. Review of the Minimum Data Set (MDS) admission Assessment for Resident number 2 dated 3/06/23 documented the resident's Mental Status (BIMS) Summary Score had a BIMS Summary Score of 13 out of 15 indicating no cognitive impairment. The resident required extensive assistance with one person physical assist for ADLs (Activities of Daily Living) and transfers and impairment on one side for the upper extremity. Review of the Physician's Order Sheets (POS) for Resident number 2 dated February 2023 and March 2023 documented the following: Melatonin oral tab 5mg 1 tab PO HS for insomnia, Paroxetine HCL oral tab 40mg 1 tab PO in the morning for depression, Furosemide oral tab 20mg 1 tab PO one time a day for edema for 30 days, Apixaban Starter Pack oral tab Therapy Pack 5mg 2 tab PO every 12 hours for dvt and the bed in low position. Review of Resident number 2's ADL Self Care Performance care plan dated 3/08/23 documented the resident was at deficit related to generalized weakness, left upper extremity and hemiparesis; Goal: Will improve current level of function through the review date; Intervention: Toilet use and Transfer-The resident requires extensive assistance x (times) 1-2 staff. Interview with Staff F, CNA on 3/28/23 at 1:56 PM. She stated, I was the cna for the day this was my first time with her. After she finished the breakfast, I tried to clean her. I don't know if the mattress was a problem, the mattress was too big and the bed was too little. She was a big woman, well over 200 pounds. When I finished cleaning the face, I tried to turn her over to clean the back. I told her I was going to clean her back she said okay. I tried to hold her with my left hand and put the [adult brief] on with my right hand and then she fell over on the bed. After that I saw that the mattress was too big for the bed. I did not know that she needed more than one person to move her. She was bleeding in the face, then I called the nurse. Five people came in to move her back to the bed, one man and four women. I finished dressing her and the nurse called 911. Interview with Staff G, Registered Nurse (RN) on 3/29/23 at 8:04 AM. She stated, I was in the hallway passing medication and the cna came out of the room and asked me to help her. When I went in the room I saw the patient on the floor on the right side of the bed, she was laying on her left side. I assessed the patient to see if she had any injuries. I noticed she was bleeding from the nose and had a skin tear to the left side of the arm. We called for help, so we can put the patient back to bed. I checked the patient vital signs. I asked the cna and the patient what happened. The cna stayed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 3 of 10 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 105641 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Kendall 9400 SW 137th Avenue Kendall, FL 33186 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete with the patient. I went to the DON (Director of Nursing) to tell her what happened, then I called 911. I stayed with the patient while I was waiting for 911. I cleaned the skin tear and put a dressing on it. The doctor and the family was called to let them know what happened. She was obese and heavy. I am not really sure how many people needed to transfer her. Interview with the Administrator on 3/29/23 at 12:39 PM. She stated, The resident came in for rehab and as the cna was providing care to her the mattress was bigger than the frames. So, when the cna went to turn her over on the right the resident rolled off the bed and rolled off the bed. She had injuries from the fall, a fractured nose. Event ID: Facility ID: 105641 If continuation sheet Page 4 of 10 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 105641 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Kendall 9400 SW 137th Avenue Kendall, FL 33186 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 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide adequate supervision to ensure the safety of vulnerable residents and to prevent falls that resulted in major injuries for two (Resident number 1, Resident number 2) out of three residents reviewed for falls. Resident number 1 sustained a left hip hemiarthroplasty posterior approach, secondary to left femoral neck fracture and Resident number 2 sustained a displaced nasal bone fracture. This practice has the potential to affect all 107 residents present in the facility at the time of the survey. The findings included: 1) Record review of the facility's Lifting and Moving Residents Policy and Procedure (effective November 2014) documented the following: Policy-All residents will be assessed before attempting a transfer or move. Employees will employ proper body mechanics when lifting or moving residents to prevent a resident fall; Procedure: 1) Asses the resident's condition and mobility (Determine if resident has been designated as a 2 or 4 person lift), c) Strength/Endurance: Will fatigue and/or lack of strength prevent the resident from completing a transfer, d) Balance: Does the resident have a tendency to fall or lean to one side or have muscle spasms?, g) Lifting Aids: Are Hoyer Lifts or Gait Belts beneficial or required for transfer?; 2) Get help if at all in doubt about your ability to move the resident alone. Use resident transfer equipment as required. (Do not attempt to lift any resident alone that has been designated as a 2 or 4 person lift). Review of the facility's Fall Management Policy and Procedure (effective November 2014) documented the following: Overview-Residents are evaluated for fall risk. Patient centered interventions are initiated, based on resident risk. A fall refers to unintentionally coming to rest on the ground, floor or other lower level but not as the result of an overwhelming external force; Purpose: Is to identify residents at risk for falls and establish/modify interventions to decrease the risk of a future fall(s) and minimize the potential for a resulting injury; Process: A) Fall Mitigation: 1) Residents to be evaluated for fall risk on admission, B) Fall Mitigation Strategies: 1) Develop resident centered interventions based on resident risk factors. Observation and interview of Resident number 1 on 3/28/23 at 12:24 PM revealed the resident sitting in a wheelchair in her room, watching tv and eating CHO [Consistent Carbohydrate] Controlled, No Added Salt diet, Mechanical Soft texture lunch. She revealed via a Spanish translator that she was being transferred from the wheelchair to the bed by one cna (certified nursing assistant). The one cna could not transfer her and went and got 2 cnas to transfer her. In the process her left foot was crossed and she had pain on her left hip. Review of the Demographic Face Sheet for Resident number 1 documented the resident was admitted on [DATE] with diagnoses to include chronic obstructive pulmonary disease, encounter for other orthopedic aftercare, diabetes mellitus, acute kidney failure, morbid obesity, hypertension, depression and presence of left artificial hip joint. The resident was discharged to the hospital on 3/19/2023 and readmitted to the facility on [DATE]. Review of the Minimum Data Set (MDS) admission Assessment for Resident number 1 dated 3/10/23 documented the resident's Mental Status (BIMS) Summary Score had a BIMS Summary Score of 10 out of 15 indicating mild cognitive impairment. The resident required extensive assistance with two+ persons (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 5 of 10 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 105641 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Kendall 9400 SW 137th Avenue Kendall, FL 33186 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 0689 physical assist for ADLs (Activities of Daily Living) and total dependence with two+ persons physical assist for transfers and impairment on one side for the lower extremity. Level of Harm - Actual harm Residents Affected - Few Review of the Physician's Order Sheets (POS) for Resident number 1 dated March 2023 documented the following: Temazepam Oral Cap (capsule) 30 mg (milligrams) 1 cap PO (by mouth) HS (at night) for insomnia, Insulin Lispro 100 unit/ml (milliliters) Solution pen-injector inj (inject) per sliding scale for diabetes mellitus, Abilify oral tab (tablet) 20mg 1 tab PO one time a day for mood disorder, Enoxaparin Sodium Injection Solution Prefilled Syringe 30mg/0.3ml inj 30ml subq (subcutaneous) one time a day for dvt (deep vein thrombosis) prophylaxis, Bupropion HCL (hydrochloric acid) ER (extended release) oral tab 24 hour 300mg 1 tab PO one time a day for depression and the bed in low position. Review of Resident number 1's ADL Self Care Performance care plan dated 3/03/23 documented the resident was at deficit related to impaired balance, limited ROM (range of motion) and pain; Goal: Will improve current level of function in ADLs through the review date; Intervention: Transfer-The resident requires Mechanical Lift with 2 staff assistance for transfer. Review of the incidents/falls list dated February 2023-March 2023, documented that Resident number 1 had a fall on 3/18/23 at 6:00 PM. Review of the skilled progress notes for Resident number 1 documented the following: Dated 3/19/23 08:43-19:15pm making round pt (patient) stated was transferred from wheelchair to bed by 2 cnas on previous shift her L (left) foot was crossed and feeling pain on her L hip pt was informed will be medicated soon for pain, 19:30pm tramadol 50mg was given around, 19:35pm pt family member called the facility was informed the situation and also MD (medical doctor) will be called for STAT (immediately) L hip Xray order MD was called, order received. Portable Medical Xray was called around 12:30am L hip Xray was done upon rounds pt was sleeping easily with no complain awaiting for Xray result, around 5am pt was medicated for pain with effect, 7am Xray result received showed L hip dislocation MD notified order received to send pt out for further evaluation, daughter was also notified. Dated 3/19/23 09:00-General Progress Note: Resident received in bed on rounds without distress, c/o (complained of) pain to left hip r/t (related to) to hip dislocation. Resident transfer to hospital as per doctors order. Family member visiting accompanied resident. Review of Resident number 1's X-rays dated 3/19/23 documented the Hip X-ray Unilateral 2-3 views, Findings: There is left hip arthroplasty with superior dislocation. Review of the Nursing Home Transfer Form dated 3/19/23 for Resident number 1 documented the resident was sent to a local hospital on 3/19/23 and the reason for the transfer was a left hip dislocation. Review of the five day federal report for Resident number 1 documented the following: Resident requested CNA to be transferred from her bed to her wheelchair, CNA tried to do the transfer and was unable to. Resident had no strength in lower extremities, resident had a hip replacement. CNA called a second CNA to help her, resident was lowered to floor gently by both CNAs to avoid fall. A third CNA was called, and resident was transferred to her wheelchair. The facility reeducated related to transfers policy with competency to include transfer with gait belt, [mechanical lift] and sit to stand. Interview with Staff A, Certified Nursing Assistant (CNA) on 3/28/23 at 2:37 PM via telephone. She stated, The patient asked to be switched from the bed to the wheelchair and when she asked that I tried to do it on my own but I realized she was to heavy and went to go get my coworker and she sat (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 6 of 10 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 105641 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Kendall 9400 SW 137th Avenue Kendall, FL 33186 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 0689 Level of Harm - Actual harm back on the bed. Me and my co-worker tried to switch her to the wheelchair and we gently lowered her to the floor due to her having no lower body strength. I have not worked with her often and when I realized it wasn't possible to transfer her, I sat her back on the bed. We had to get three workers to lift her back into the bed. She didn't speak of having any pain. Residents Affected - Few Interview with Staff B, CNA on 3/28/23 at 2:43 PM. She stated, This was on a Saturday. The CNA [Staff CNA, A] came and asked me to put the patient in the wheelchair. When we came into the room, she was sitting on the bed. We proceeded to lift her and realized she had no lower body strength. When we realized we couldn't up lift her up, we gently placed her on the ground. [Staff CNA, A] went out to get [Staff D, CNA] the CNA to help. The resident was on the ground when [Staff D, CNA] grabbed her legs. I grabbed the back part of her and [Staff CNA, A] lifted up the middle part. We placed her on the bed. We asked her if there was any pain and she shook her head no. I worked with her before and she was able to move herself, she had lower body strength then. Interview with Staff C, Registered Nurse (RN) on 3/28/23 at 3:03 PM via telephone. She stated, The cna told me they were trying to transfer the patient from the bed to the wheelchair and the patient did not have enough strength and they lowered her to the floor. The patient started complaining of pain and I called the doctor and called the family to tell them what happened. The doctor said to transfer to her the hospital for an evaluation. The x-rays were done at the facility. She had a dislocation of the hip, no fracture. Interview with Staff D, CNA on 3/28/23 at 3:13 PM via Spanish translator. She revealed, it was on a Saturday. I was in another room and the other two cnas they were in the room helping the patient. They called me to come and help and I grabbed the patient by the legs to help put her back in the bed. The resident was already on the floor when I came into the room. I have worked with the patient before. When she is in bed, she will assist you and I can help her by myself but to transfer her I always need two people to help. Interview with Staff E, Licensed Practical Nurse (LPN) Unit Manager on 3/29/23 at 12:21 PM. She stated, When transferring a patient from bed to the wheelchair is based on the mobility of the patient. If they are extensive or more we have a stand up lift or a [mechanical lift] for the cna to use. If the care plan says the patient needs two persons to lift, it should be two persons to lift the patient. Interview with the Registered Nurse, Assistant Director of Nursing on 3/29/23 at 12:34 PM. She stated, If the patient needs two cnas, two have to be there before the transfer begins. They need to check the [NAME], the information is there to make sure the patient is able to assist or if the patient needs the [mechanical lift] lift. Interview with the Administrator on 3/29/23 at 12:36 PM. She stated, The resident came in for left hip replacement at the hospital and came in for rehab. Three cnas were trying to transfer her from the bed to the chair. Two of them put her on the floor and the other one came to help to put her back in the bed. The cnas are supposed to see the [NAME] to see if the patient needs more than one to assist them. She sustained a dislocation of the hip. Review of the local hospital records dated 3/19/23 documented the resident had a left hip hemiarthroplasty posterior approach, secondary to left femoral neck fracture. 2) Closed record review of the Demographic Face Sheet for Resident number 2 documented the resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 7 of 10 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 105641 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Kendall 9400 SW 137th Avenue Kendall, FL 33186 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 0689 Level of Harm - Actual harm Residents Affected - Few was admitted on [DATE] with a diagnoses to include arthritis, difficulty in walking, hemiplegia, blindness left eye, morbid obese, depression, hypertension and edema. The resident was discharged to the hospital on 3/14/2023. Review of the Minimum Data Set (MDS) admission Assessment for Resident number 2 dated 3/06/23 documented the resident's Mental Status (BIMS) Summary Score had a BIMS Summary Score of 13 out of 15 indicating no cognitive impairment. The resident required extensive assistance with one person physical assist for ADLs (Activities of Daily Living) and transfers and impairment on one side for the upper extremity. Review of the Physician's Order Sheets (POS) for Resident number 2 dated February 2023 and March 2023 documented the following: Melatonin oral tab 5mg 1 tab PO HS for insomnia, Paroxetine HCL oral tab 40mg 1 tab PO in the morning for depression, Furosemide oral tab 20mg 1 tab PO one time a day for edema for 30 days, Apixaban Starter Pack oral tab Therapy Pack 5mg 2 tab PO every 12 hours for dvt and the bed in low position. Review of Resident number 2's ADL Self Care Performance care plan dated 3/08/23 documented the resident was at deficit related to generalized weakness, left upper extremity and hemiparesis; Goal: Will improve current level of function through the review date; Intervention: Toilet use and Transfer-The resident requires extensive assistance x (times) 1-2 staff. Review of the incidents/falls list dated February 2023-March 2023, documented that Resident number 2 had a fall on 3/14/23 at 9:05 AM. Review of the Adverse Log dated February 2023-March 2023 documented the incident occurred on 3/14/23 and an investigation was in progress. Review of the alert progress notes for Resident number 2 documented the following: Dated 3/14/23 12:06-Was called for help by the CNA in patient room. Pt was observed on the floor lying on the left side. Assessed patient. Patient noticed bleeding from nose, pressure applied. Observed swelling on nose and left side of the mouth. Observed skin tear to left upper arm, dressing applied. Assisted patient back to bed with help of CNAs and therapist. Pt was able to move all extremities with no pain. Rescue came and assessed patient. Patient was transferred to [local hospital] at 9:53AM. Son and daughter called twice, left message. Received call back from daughter at 10:47AM and I let her know about her mom clinical condition and transferred to [local hospital]. ARNP (advanced registered nurse practitioner) made aware. Interview with Staff F, CNA on 3/28/23 at 1:56 PM. She stated, I was the cna for the day this was my first time with her. After she finished the breakfast, I tried to clean her. I don't know if the mattress was a problem, the mattress was too big and the bed was too little. She was a big woman, well over 200 pounds. When I finished cleaning the face, I tried to turn her over to clean the back. I told her I was going to clean her back she said okay. I tried to hold her with my left hand and put the [adult brief] on with my right hand and then she fell over on the bed. After that I saw that the mattress was too big for the bed. I did not know that she needed more than one person to move her. She was bleeding in the face, then I called the nurse. Five people came in to move her back to the bed, one man and four women. I finished dressing her and the nurse called 911. Interview with Staff G, Registered Nurse (RN) on 3/29/23 at 8:04 AM. She stated, I was in the hallway passing medication and the cna came out of the room and asked me to help her. When I went in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 8 of 10 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 105641 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Kendall 9400 SW 137th Avenue Kendall, FL 33186 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 0689 Level of Harm - Actual harm Residents Affected - Few room I saw the patient on the floor on the right side of the bed, she was laying on her left side. I assessed the patient to see if she had any injuries. I noticed she was bleeding from the nose and had a skin tear to the left side of the arm. We called for help, so we can put the patient back to bed. I checked the patient vital signs. I asked the cna and the patient what happened. The cna stayed with the patient. I went to the DON (Director of Nursing) to tell her what happened, then I called 911. I stayed with the patient while I was waiting for 911. I cleaned the skin tear and put a dressing on it. The doctor and the family was called to let them know what happened. She was obese and heavy. I am not really sure how many people needed to transfer her. Interview with the Administrator on 3/29/23 at 12:39 PM. She stated, The resident came in for rehab and as the cna was providing care to her the mattress was bigger than the frames. So, when the cna went to turn her over on the right the resident rolled off the bed and rolled off the bed. She had injuries from the fall, a fractured nose. Review of the Adverse Incident Report for Resident number 2 documented: Date of Incident: 3/14/2023, Incident Time: 0832; Incident Location: Patient Room; Equipment Involved: Yes; List Equipment Involved: Mattress/bed; Outcome: Fracture or dislocation of bones or joints; Investigation: Resident on 3/14/23 was receiving care by assigned cna. When cna rolled resident over she proceeded to roll off the bed onto the floor sustaining injury requiring transfer to hospital; Analysis: While turning over the resident during care she rolled out of bed. The mattress did not fit the bedframe; Corrective Action: Facility wide audit to ensure all bed frames have an appropriate sized mattress. Facility wide audit to evaluate bed for entrapment zones. Review of the local hospital records dated 3/14/23 documented the resident had a displaced nasal bone fracture with overlying soft tissue injury. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 9 of 10 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 105641 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Kendall 9400 SW 137th Avenue Kendall, FL 33186 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on interview and record review, the facility's quality assurance and assessment committee failed to identify quality concerns to implement effective plans of action related to adequate supervision and a safe environment resulting in repeated deficient practice. The facility's history includes deficient practice for failing to supervise residents. The facility was cited for Free of Accident Hazards, Supervision and Devices in 2022. These repeated deficient practices has the potential to affect any of the 107 residents residing in the facility. The findings included: Review of the facility's policy titled, Quality Assurance Performance Improvement Program (QAPI) effective date was on 11/2014, documented the following: Policy: The Center and organization has a comprehensive, data-driven Quality Assurance Performance Improvement Program that focuses on indicators of the outcomes of care and quality of life. The Quality Assessment and Assurance Committee (QAA) meetings are at least quarterly but may be held more frequently as appropriate. The committee members include, at minimum, the Medical Director, Executive Director, Director of Nursing, Infection Preventionist, Social Services Director, Community Life Director, Medical Records, Staff Development, Business Office, Director of Dining Services, Rehabilitation Manager and Pharmacy Consultant. The purpose of the Committee is to review and analyze facility related data and direct appropriate actions for the facility response. The appointment of a QAPI team may be necessary to explore the depth of the issue and identify the root cause so that interventions are appropriately resourced. Review of the Quality Assurance and Performance Improvement (QAPI) Committee Meeting Sign-in Sheets dated 1/18/23, 2/22/23 and 3/15/23: documented the facility had a QAA Committee meeting monthly. Attendees included: Administrator, Medical Director, Director of Nursing (DON) and other department heads. On 3/29/23 at 12:50 PM, the Administrator stated, The QAA Committee meets monthly on the third Wednesday of the month. Committee members consist of the Administrator, DON, Medical Director and Department Heads. We have a QAPI tool for each department for anything that needs to be improvement or that was improved. The purpose of the QAA committee for us to know how we are performing facility wide, if we have any room for improvement or to make any changes or implementation of new policies that we encounter the same concern. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 10 of 10