Inspection·August 26, 2021

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few potatoes with lunch and puree soup with dinner were added and on 06/21/21, the only intervention for this year, Medpass (a supplement) as ordered, was added. On 01/07/21 the RD documented: She is eating 76-100% of most meals. Current intake of meals should meet her needs with fortified foods to help maximize meal intakes. May be able to discontinue her Megace at this time since she is eating well and has a non-significant weight gain since readmission (census did not show a discharge/readmission to the facility since 10/20). Will continue current diet, monitor intake, weight and labs as available. On 04/05/2021 at 10:42 AM the RD wrote: She is eating 51-100% of most meals. Current intake of meals should meet her needs. Will continue current diet, monitor intake, weight and labs as available. On 06/03/2021 at 4:51 PM the RD wrote: CBW (current body weight): 144 pounds (6/2) Diet: puree No Added Salt, Nectar Thick Liquids with super potatoes and pureed soup. Resident is now total dependent for eating per nursing. She eats 50-100% of her meals. She is showing a non-significant weight loss of 2.7% x 30 days and 5.3% x 180 days. Trialed eating in main dining room but she did not like going. Happier eating in her room. BMI is acceptable. Goal for now is no further significant weight loss. Will monitor her weight and intakes and adjust Plan Of Care as needed. On 06/10/2021 at 2:29 PM the RD wrote: CBW: 142 lbs(6/9), Resident has additional 2 pound weight loss this week. Her meal intakes are variable and at times is eating < 50%. Will resume Medpass 120ml BID (twice daily) (480kcal, 20g protein) to help stabilize her weight. On 06/17/2021 at 12:56 PM the RD wrote: CBW: 141.2 pounds Resident eats 50-100% of her meals and is accepting her Medpass. She should meet her estimated needs with reported intakes. She has no significant weight loss over 30/90/180 days but weight is trending down. Her BMI remains acceptable for her age. Weight loss may be unavoidable related to advanced age and Alzheimer's dementia. At this time, the goal is no significant weight loss through next review date. Will continue diet with supplements. Monitor intakes, weight status and labs as available. On 08/10/2021 at 03:09 PM the RD wrote: CBW: 140 pounds (8/4), Resident continues to eat > 50% of her meals and accepts her supplements. Her weight continues to trend down, but rate of loss is slowing. Reported intakes and supplements should meet her estimated needs. Given her advanced age and Alzheimer's Dementia, weight loss may be unavoidable. Will continue to provide fortified foods, supplements and monitor intakes, weight status and labs as available. On 08/13/2021 the RD wrote: Spoke with resident's son to update him on her weight status. Discussed with him interventions in place. He verbalized understanding and appreciation for the call. Will continue current interventions. Encourage adequate intakes of meals, supplements and fluids. Monitor intakes, weight status and labs as available. On 08/25/21 at 1:00 PM, the resident was observed with her lunch tray. She can feed herself, however no staff assistance was observed. The documented intake was 26-50% for that meal. Review of the documented intake over the last 30 days showed her consumption varies from meal to meal and day to day. Very rarely does she eat 75% or more of what she is given in a day. Most days average around 50% total intake of what is given to her. Review of the documented staff assistance for the month of August revealed that of the 75 meals served, she received assistance from staff for only seven of them. The help she received ranged from limited assistance to total dependence. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105659 If continuation sheet Page 2 of 6 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 105659 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/26/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Worth Rehabilitation Center 1201 12th Avenue South Lake Worth, FL 33460 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 - Minimal harm or potential for actual harm Residents Affected - Few On 08/26/21 at approximately 4:00 PM, the RD (Registered Dietician) was interviewed and informed of the 3.7-pound weight loss over the recent week. The RD responded by saying, Well now that I know she has lost weight, I will do a nutrition assessment. It could be unavoidable weight loss. The RD further stated that sometimes the resident resists when staff tries to help her eat but not all the time. When asked what else she could do for the resident she said she will add a third dose of Medpass daily. Additionally, she said they could try Magic Cup and some other calorie dense foods/drinks based on the resident's preferences. The resident had been on Megace, an appetite stimulant, earlier in the year but it had been discontinued and she wasn't sure why it was discontinued or why it wasn't restarted. At approximately 5:00 PM, the RD provided a copy of the new interventions and progress note since surveyor intervention. The RD had contacted the physician to notify of recent weight loss and inquire about an appetite stimulant. She spoke with the resident's son to inform him of weight loss and discuss interventions. She added the third dose of Medpass supplement, Magic Cup and will trial juice supplement in the mornings. In addition, she had liberalized the no added salt restriction on her diet to improve taste and increase intake. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105659 If continuation sheet Page 3 of 6 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 105659 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/26/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Worth Rehabilitation Center 1201 12th Avenue South Lake Worth, FL 33460 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 policy review, the facility failed to properly label opened medications and remove expired/unusable medication from one of two medication carts reviewed. The findings included: Review of the facility's policy entitled Storage of Medications showed the policy statement as, The facility shall store all drugs and biologicals in a safe, secure, and orderly manner. 1. On [DATE] at 12:47 PM, during the observation of the East Wing Medication Cart with Staff B, an LPN, eye drops for Resident #45 were found in plain view in an upper drawer of the medication (med) cart with the resident's name and pharmacy label displayed upward. The resident was admitted to the facility on [DATE] and an open vial date of 5/22 was handwritten on the front of the box, meaning facility staff had opened and used these drops since the resident's admission. Review of the storage and expiration instructions on the manufacturers packaging revealed the following: After opening, the product may be kept at (36-77 degrees Fahrenheit) for up to 6 weeks. According to the manufacturer's instructions, the product expired for use on or about [DATE], making this medication unsafe for use but it remained in the medication cart for eight weeks past the expiration. Once expired, eye drops can become easily contaminated with bacteria and may become less effective. This particular medication is to reduce the pressure in the eye due to glaucoma to prevent long-term damage which could result in a loss of vision. 2. In addition to the above expired medication, artificial tears for Resident #30 were identified as opened without an open date on the box or the bottle. Manufacturer's instructions on the box indicated that once opened, the eye drops expire after 60 days. 3. The third observation revealed two bottles of glucose meter testing solutions that were opened and also without open dates. These drops are used for ensuring accurate test results on blood glucose meters and are only good for use for 90 days once opened. On [DATE] at 1:45 PM, the DON (Director of Nursing) and the facility's Pharmacist approached the team about the findings. The DON acknowledged that sometimes they keep a resident's home meds in the cart to return to them upon discharge. The Pharmacist said the pharmacy staff inspects the cart monthly and missed this one. Both acknowledged the discrepancy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105659 If continuation sheet Page 4 of 6 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 105659 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/26/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Worth Rehabilitation Center 1201 12th Avenue South Lake Worth, FL 33460 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, the facility failed to serve food in accordance with professional standards for food service safety. Residents Affected - Some The findings included: On 08/23/21 at 10:24 AM, during the initial tour of the main kitchen accompanied by the Registered Dietician (RD), the following was observed: (1) All ceiling vents in the kitchen had black dust. (2) The ceiling had rust spots on parts of it. (3) There was dried food on the side of the stove. (4) The stationary can opener and the can opener holder on the tabletop had evidence of dried food. (5) On 08/25/21 at 11:54 AM, during a follow up visit in the main kitchen during the lunch meal, accompanied by the RD, the temperature obtained from an 8-ounce container of milk was 43 degrees Fahrenheit (F). On 08/26/21 at 10:22 AM, an interview was conducted with the RD, who was informed of the findings. She confirmed the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105659 If continuation sheet Page 5 of 6 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 105659 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/26/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Worth Rehabilitation Center 1201 12th Avenue South Lake Worth, FL 33460 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation, interview and record review, the facility failed to dispose of refuse in a sanitary manner. Residents Affected - Many The findings included: During the initial tour of the main kitchen and dumpster area, on 08/23/21 at 10:24 AM, accompanied by the Registered Dietitian, it was observed that the dumpster area was littered with debris and that the dumpster was encrusted with food residues. The area around the dumpster had several dirty foam cups and plates with food and coffee; and several partially eaten ice cream cups, dirty napkins and plastic forks and spoons. On 08/26/21 at 10:22AM, an interview was conducted with the Registered Dietitian (RD) to review the findings. The RD confirmed the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105659 If continuation sheet Page 6 of 6