Inspection·August 9, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few she takes the resident to the dining room to be more comfortable for lunch or dinner. She stated, if she must feed the resident in bed, she grabs a chair and sits to be at the same level as the resident. Interview with the Director of Nursing (DON) on 08/09/2023 at 10:46AM revealed, the Certified Nursing Assistants (CNAs) receive orientation training when they were hired. In the training the CNAs were trained with the protocol for feeding the residents, to grab a chair and be seated to be at the same level as the resident in a dignified manner. She stated, the CNAs when they were hired, they were following the prior hired CNAs to see the process with care. After those days of training, if the CNAs required more training, the facility gave it to them. The DON reported, Staff A had a 1:1 teachable moment on Monday 08/07/2023. Review of the facility's Policies and Procedures for Residents rights dated 03/01/2021 revealed, the Policy: It is the policy of the facility to provide Resident Rights in accordance with State and Federal regulations. Procedure: The facility will follow the Resident Rights as follows: 1-The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 2 of 9 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 08/09/2023 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to electronically transmit the Quarterly Minimum Data Set (MDS) assessment to the Centers for Medicare and Medicaid Services (CMS) System within 14 days after completing the resident's assessment for one out of one sampled resident (Resident # 43 ) reviewed for timely submissions of resident assessments. Residents Affected - Few Findings included: Review of the resident #43's MDS Quarterly assessment revealed a completion date of 05/10/2023 but the MDS had not been submitted. During an interview with Staff C, the MDS Coordinator, on 08/09/23 at 09:38 AM, Staff C stated, What happened is someone put do not submit. I've only been here since March 2023. The person that was before me, always put do not submit or maybe that's how the system was set up. I don't know why they do that. Maybe because the resident was Medicare Part A, and he changed his insurance to another insurance. I don't know what really happened. Up here it says do not submit to CMS. It was completed. I'm going to submit it now. On 08/09/23 at 09:53 AM, a review of the resident MDS Quarterly assessment completed on 05/24/2023 revealed, a submission and accepting date of 08/09/2023. Review of the MDS policy and procedures with an effective date 11/30/2014 and a revision date 09/25/2017 revealed: Policy: The center conducts initial and periodic standardized, comprehensive and reproducible assessments no less than every three months for each resident including, but not limited to, the collection of data regarding functional status, strengths, weaknesses and preferences using the federal and/or state required RAI (Resident Assessment Instrument). Procedures: Maintain all resident assessments completed within the previous 15 months in the resident's active clinical record or in a centralized location that is easily and readily accessible. Specified section of the RAI process are completed by the center designated interdisciplinary team members. Each person completing a section or portion of a section of the MDS signs the attestation statement indicating its accuracy. A Registered Nurse signs and certifies that the assessment is complete. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 3 of 9 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 08/09/2023 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow pharmaceutical procedures for Residents (#44, #295) as evidenced by medications being left on the overbed table for Resident #44, Omission of one (1) medication for Resident #295 during the medication administration observation and two (2) loose pills found in the medication drawer of North Station 2100 Hall cart. Three residents were observed for medication administration totaling 29 opportunities. Three medication carts and One medication storage room was observed. There were 116 residents residing in the facility at the time of the survey. The Findings included: During an observation on 08/06/23 at 12:17 PM, Resident #44 was observed in the room about to have lunch, several pills observed in a medication cup on the resident's overbed table (Photographic evidence obtained). Resident #44 was unable to communicate properly, has a speech impediment, is hard of hearing and speaks primarily Spanish. Resident #44 refused to be interviewed by the surveyors. Review of the medical records for Resident # 44 revealed, the resident was admitted to the facility on [DATE]. Clinical diagnoses included but were not limited to: Unspecified Hearing Loss. Record review of Resident #44 's Annual Minimum Data Set (MDS) dated [DATE] revealed: Section C Brief interview for Mental Status Score 15 on a 0-15 scale indicating the resident is cognitively intact. Section G for Functional Status documented the resident requires supervision for activities of daily living (ADLs). Interview on 08/08/23 at 12:15 PM with the Director of Nursing (DON) revealed when told about the medications observed in the resident's room on the overbed table stated, I will do an in-service with the nurses about this issue. This resident is not allowed to take his medicine on his own. The DON was shown the picture taken of the pills on the overbed table in Resident#44's room. During the medication administration observation on 08/07/23 at 9:55 AM with Licensed Practical Nurse (Staff D) the medication Nifedipine Extended Release (ER) 30 Milligrams (MG) 1 tablet was not given to Resident #295, the medication was available but couldn't be crushed since it was an extended release tablet. Interview/observation on 8/7/23 at 10:05AM with Staff D, Licensed Practical Nurse recorded the resident's Blood pressure 118/45, dispensed medications from the bingo cards, crushed all the resident's medications, mixed with apple sauce, proceeded to enter resident's room to give the resident medications. The Surveyor requested the nurse to return to medication cart. Staff D was asked to check the Nifedipine ER 30 MG tablet, Staff D stated the ER means extended release and the medication can't be crushed, Staff D stated, he will have to prepare the medications over again because they were all mixed up and afterwards call the Physician (MD) for new orders for the medication. Staff D proceeded to dispense new medications for the resident, crushed the medications, added apple sauce, disposed of the initially crushed medications into a drug buster, entered the resident room, identified the resident, completed hand hygiene, administered the medications, removed the lidocaine patch from the resident's lower back, applied another lidocaine patch initialed and dated the patch on the resident's lower back, repositioned the resident for comfort, washed his hands, exited the room, and signed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 4 of 9 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 08/09/2023 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 0755 off on the medications administration. Level of Harm - Minimal harm or potential for actual harm Review of the medical records for Resident #295 revealed, the resident was admitted to the facility on [DATE]. Clinical diagnoses included but were not limited to: Essential Primary Hypertension, Chronic Systolic Congestive Heart Failure, and Presence of Cardiac Pacemaker. Residents Affected - Few Review of the Physician's Orders Sheet for August 2023 revealed, Resident #295 had orders that included but were not limited to: Discontinued on 8/7/23 Nifedipine ER 30 MG-give 1 tab by mouth every 12 hours for hypertension Hold if systolic blood pressure less than 110 or pulse less than 70. Start date 8/7/23, discontinue 8/8/23 Amlodipine 10 milligrams (MG)-give 1 tablet by mouth one time a day, hold if systolic blood pressure less than 110. 8/9/23-Amlodipine Besylate Oral tablet 10 MG-Give 1 tablet by mouth one time a day for hypertension, hold for systolic Blood pressure less than 110 and diastolic blood pressure less than 60. Interview on 8/7/23 at 10:48 AM with the Director of Nursing (DON) revealed, the Physician (MD) was called about the residents Nifedipine ER 10 MG ER, and the MD changed the order to Amlodipine 10 mg, 1 tablet, the medication was obtained from the e-kit and administered to the resident. On 08/08/23 at 10:54 AM during the medication cart observation with Registered Nurse (Staff E), Two (2) loose pills, one (1) red in color and one (1) white in color were found in the third drawer on the North station 2100 medication cart. Interview on 08/08/23 at 11:00 AM with Staff E revealed, when asked what you do with loose pills when found on the cart, Staff E stated I will put them in the drug buster. Interview on 08/08/23 at 11:25 AM with the DON, when told about the loose pills and the nurse's response of how to dispose of loose pills, stated I will talk to the nurse and will have to do an in-service with her. Interview on 08/08/23 at 11:38 AM Director of Nursing (DON) and Staff E spoke with surveyor, stated there was a language communication issue, the nurse meant she disposes the medication in the drug buster, the nurse speaks primarily Spanish. Review of the facility's Policy and Procedures titled, Administering Medications revision date April 2019 states: Residents may self-administer their own medications only if the attending physician in conjunction with the Interdisciplinary Care Planning Team, has determined that they have the decision-making capacity to do so safely. Review of the facility's Policy and Procedure titled, Medication and Medication Supply Storage and Disposal dated 11/30/14 states: Medication will be stored in an organized manner under proper conditions and in accordance with manufacturers instructions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 5 of 9 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 08/09/2023 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure a resident was free of a significant medication error, as evidenced by Resident #295 Extended Release (ER) blood pressure medication being crushed by the nurse to be administered to the resident during the medication administration observation. Three residents were observed during medication administration totaling 29 opportunities. There were 116 residents residing in the facility at the time of the survey. Residents Affected - Few The findings included: During the medication administration interview/observation on 8/7/23 at 10:05AM with Staff D, Licensed Practical Nurse recorded the resident's Blood pressure 118/45, dispensed medications from the bingo cards, crushed all the resident's medications, mixed with apple sauce, proceeded to enter resident's room to give the resident medications. The Surveyor requested the nurse to return to medication cart. Staff D was asked to check the Nifedipine ER 30 MG tablet, Staff D stated the ER means extended release and the medication can't be crushed, Staff D stated, he will have to prepare the medications over again because they were all mixed up and afterwards call the Physician (MD) for new orders for the medication. Staff D proceeded to dispense new medications for the resident, crushed the medications, added apple sauce, disposed of the initially crushed medications into a drug buster, entered the resident room, identified the resident, completed hand hygiene, administered the medications, removed the lidocaine patch from the resident's lower back, applied another lidocaine patch initialed and dated the patch on the resident's lower back, repositioned the resident for comfort, washed his hands, exited the room, and signed off on the medications administration recrd. Review of the medical records for Resident #295 revealed, the resident was admitted to the facility on [DATE]. Clinical diagnoses included but were not limited to: Essential Primary Hypertension, Chronic Systolic Congestive Heart Failure, and Presence of Cardiac Pacemaker. Review of the Physician's Orders Sheet for August 2023 revealed, Resident #295 had orders that included but were not limited to: Medications included: Discontinued 8/7/23 Nifedipine ER 30 MG-give 1 tab by mouth every 12 hours for hypertension Hold if systolic blood pressure less than 110 or pulse less than 70. Start date 8/7/23, discontinue 8/8/23 Amlodipine 10 milligrams (MG)-give 1 tablet by mouth one time a day, hold if systolic blood pressure less than 110. 8/9/23-Amlodipine Besylate Oral tablet 10 MG-Give 1 tablet by mouth one time a day for hypertension, hold for systolic Blood pressure less than 110 and diastolic blood pressure less than 60. Interview on 8/7/23 at 10:48 AM with the Director of Nursing (DON) stated the Physician (MD) was called about the residents Nifedipine ER 10 MG ER, MD changed the order to Amlodipine 10 mg, 1 tablet, the medication was obtained from the e-kit and administered to the resident. Review of the facility's Policy and Procedures titled, Medication Oral Administration revision date 05/15/2019 states: Review physician orders and refer to pharmacist if unsure if a medication should be crushed. Review of the facility's Policy and Procedures titled, Administering Medications revision date (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 6 of 9 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 08/09/2023 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 0760 April 2019 states: Each Nurses' station has a current Physician Desk reference and/or other medication reference as well as a copy of the surveyor guidance for 755-761 (pharmacy services) available. 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: 105641 If continuation sheet Page 7 of 9 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 08/09/2023 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to demonstrate effective plan of actions were implemented to correct identified quality deficiencies in the problem area related to repeated deficient practices for F640 Encoding/Transmitting Resident Assessments and F755 Pharmacy Services/Procedures/Pharmacist/Records. This practice has the potential to increase the risk of negative resident outcomes and affect all 116 residents residing in the facility at the time of this survey. The findings included: Review of the facility's survey history revealed, during a recertification survey with an exit date 07/28/2022, Encoding/Transmitting Resident Assessments was cited related to the facility failed to timely transmit an Minimum Data Set (MDS) assessment for one resident reviewed for timely submissions of resident assessments and failed to provide pharmacy services to meet the needs of the residents. Review of the facility's policy titled, Performance Improvement Quality Assurance/Quality Improvement (QAPI) Policy and Procedure with the revision date of 10/29/2020, the policy documented: The center and organization have an ongoing Performance Improvement Program with a design and scope that is ongoing and comprehensive dealing with a full range of services offered by the center that addresses aspects of care. The design and scope of the program is to systematically monitor and evaluate the quality and appropriateness of resident care, pursue opportunities to improve resident care, resolve identified problems and identify opportunities for improvement. During an interview on 08/09/2027 at 03:28 PM, the Administrator revealed that the Quality Assessment and Assurance Committee (QAA) meets the third Wednesday of every month. The administrator stated that the QAA Committee is comprised of the following members: the Director of Nursing Services, Administrator, Medical Director, Business Office Manager, Registered Dietitian, Environmental Director, Maintenance Director, the heads of all departments, and two regular staff members to include one nurse and one CNA. The last meeting was conducted 7/19/2023 and before that 6/21/2023. The meeting was conducted with all required members and they reviewed the last 6 months of QAPI. Regarding quality concerns, Nursing Home Administrator further stated, we are working on a Performance Improvement Plans (PIP) right now for falls. We are aware of the call light issue because it is attached to falls. We did a QA on 6/26/2023 all the call lights were working. On 6/23/2023, we did a QA where the call light on room [ROOM NUMBER] was not working. We also got a QAPI forms from each department. We also review psychotropic medication for each resident. On 6/19/2023, we had a grievance on call lights. We continue to do audits on call lights. For June 2023, we had discussed call lights, the falls committee met every 2 weeks. In addition, we had a meeting on changing the mattresses so the residents can have good mattresses to sleep. We continue training CNAs about answering the call lights and how to reduce falls. Regarding corrective actions taken, the Nursing Home Administrator stated, We review all (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 8 of 9 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 08/09/2023 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 medications and meet with the pharmacy to see how we can correct medications issues. We continue to do rounds, continue to check the mattresses. We check them weekly, and the nurses do them daily. The CNAs get educated and observed when we do rounds, so they can improve their communication with our residents. We do have less staff during the weekends, but we still do activities. We also use the 24-hour communication log so the nurses can be aware of the issues. We reviewed the issue, met with the pharmacy. Continued to do rounds, to check the mattresses. For example, since we started doing that, I can talk about the call lights and falls because right now I can see a decrease from falls. We do stop and watch. We have some forms that family members can report any issue or concerns. We prioritize all the issues that are arisen. The highest priorities right now are falls. We work on all the issues, so we don't leave anything behind. We look at any intervention we did before, what we had implemented, and see how the trends are going. We also base it on the data we collect. We keep track of trends. Right now, we know what we implemented for falls is working because there is big decline on falls. Call lights are monitored twice daily. If something is out of compliance, we monitor it for a minimum of 3 months or until the compliance is met. Our falls have been monitored for 9 months now. We want to make sure we don't have any repeated citation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105641 If continuation sheet Page 9 of 9