Health inspection·March 3, 2022

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few hip. The Director of Rehabilitation stated that the Physical Therapist (PT) did an evaluation on Resident #71 as a result of a Certified Nursing Assistant (CNA) mentioning to nursing staff the resident was not as mobile as she had been. This is when therapy was advised which had prompted the screening. He stated the evaluation was completed on 10/18/21. He stated the PT noted the resident was having pain on her right side and the PT notified the resident's nurse of the findings and recommended an x-ray on 10/18/21. The Director of Rehabilitation provided the work schedule for the PT who conducted the evaluation of Resident #71 on 10/18/21 and her work hours were from 3:40 PM to 9:24 PM. Review of the Physical Therapy PT Initial Evaluation conducted on 10/18/21 documented under Reason for Referral: Patient referred to PT due to patient exhibits new onset of decreased strength of bilateral lower extremities, decreased transfers, decreased tolerance, decreased standing balance, and decreased ambulation at this time. Under Sensation is documented, Pain is Present. Clinician's response to reported pain = Communicated with Nursing, Pain Assessment Method = Verbal. Location: right hip / knee (recommended X-ray). Review of the Physical Therapy PT Discharge summary, dated [DATE], documented under Summary of Care: Right lower extremity not completed due to complain of pain right hip / knee, recommend X-ray, nursing reported. Review of the clinical record revealed no evidence of the Nursing Progress Note documentation on 10/18/21 regarding the PT completing the PT evaluation, identifying Resident #71 was experiencing acute right hip pain, or that an x-ray was recommended to determine the cause of the pain. Review of a Nursing Progress Note, dated 10/19/21 at 5:57 PM, written by Staff D-LPN documented, 'Resident was evaluate by physical therapy and an x-ray was order resident was unable to put weight on right side we continue to monitor.' Review of the Physician Order revealed the order was dated 10/19/21 at 6:04 PM for a portable right hip x-ray, a day after the PT's evaluation recommended a right hip x-ray to determine the cause of the resident's acute pain. Review of the Radiology Report revealed the x-ray examination was conducted on 10/19/21 with the results reported to the facility on [DATE] at 10:57 PM. The Significant Findings of the right hip x-ray and Impression documented an acute fracture of the right hip at the intertrochanteric region. Further review of the Nursing Progress Notes from 10/19/21 at 6:38 PM through 10/20/21 at 6:10 AM, revealed no evidence of documentation that Resident #71's physician was notified of the x-ray results revealing a right hip fracture. Review of Physician Orders revealed an order, dated 10/20/21 at 7:07 AM, to 'Transfer resident to hospital.' The right hip fracture was identified on x-ray with results reported to the facility on [DATE] at 10:57, however the physician was not notified until 7:07 AM on 10/20/21. Review of a Nursing Progress Note, dated 10/20/21 at 7:41 AM, the night shift LPN documented 'X-ray to right hip done per orders; results noted fracture; call placed to MD service, call return from Nurse Practitioner made aware. New orders received to transfer resident to hospital.' On 03/03/22 at 1:10 PM, an interview was conducted with the Director of Nursing (DON) who stated the resident was complaining of pain to her right hip so an x-ray was ordered which showed the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 2 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few fracture and that is when they sent her out to the hospital right away. The DON could not explain why it took from 10/18/21 to 10/20/21 to notify the physician, obtain the right hip x-ray and send the resident out to the hospital with a fractured right hip. On 03/03/22 at 2:00 PM, an interview was conducted with the Administrator regarding the incident involving Resident #71. In reviewing the facility investigative report revealed the incident occurred on 10/18/21. There was no evidence of documentation of an immediate report submitted to the regulatory agency within 24 hour of occurrence. The first evidence of mandatory reporting of the adverse incident was not completed until 11/04/21. Review of the report documented under 'Outcome: The resident suffered a fracture or dislocation of bones or joints; Any condition that required the transfer of the resident, within or outside the facility to a unit providing a more acute level of care due to the adverse incident.' An inquiry was made to the Administrator why it took so long to report and notify the physician that Resident #71 was experiencing pain to which he stated the resident has chronic pain and that is what they thought it was, so there was no sense of urgency to contact the physician. The Administrator was reminded per the documentation, the PT recommended an x-ray because of the pain which was presenting as more acute than chronic, to which the Administrator stated the resident had pain that they were giving Tylenol for and when they realized the medication was not working that is when they called the physician. The Administrator was reminded per the Nursing Progress Notes and Medication Administration Records, the resident was only medicated with Tylenol on 10/20/21 at 6:10 AM for a pain level of 8 out of 10, but she had been complaining of pain since 10/18/21. The Administrator was asked again why it took so long to contact the physician to which he stated he believes it was an issue with an inability to reach him on time and when they reached him they got the order for the x-ray, got the x-ray right away and when it came back as a fracture they called the physician right away and received the order to send the resident to the hospital. The Administrator was reminded the PT evaluation was conducted on 10/18/21 and an x-ray was recommended which was not followed up on timely. The physician was not called until late on 10/19/21 and the right hip x-ray was not done until later on 10/19/21 with results returning around 11:00 PM on 10/19/21. The physician was not notified of the positive fracture until the morning of 10/20/21. The Administrator reiterated there was an issue with reaching the physician. An inquiry was made if there was a process for following up or chain of command if the physician did not call back in a timely manner to which he stated they did reach the physician. Review of the facility policy for Notification of Change in Condition further documents under 'Procedure: The nurse will contact the physician. In the event that the attending physician does not respond in a reasonable amount of time, the Medical Director may be contacted.' On 03/03/22 at 2:30 PM, an interview was conducted with Staff D-LPN regarding the incident with Resident #71 on 10/18/21. An inquiry was made when the PT advised her on 10/18/21 Resident #71 was having pain to her right hip the PT recommended an x-ray on 10/18/21, however the x-ray was not done until the evening of 10/19/21 and the hip fracture results were not relayed to the physician until the morning of 10/20/21. LPN Staff D stated she remembers the therapist telling her about the pain and she called the physician and they got an x-ray, but she cannot remember why there was a delay in notifying the physician, further stating maybe she was busy, she did not remember, it happened a while ago. She further stated she was not working the day the resident went out to the hospital so she was not sure what happened. There was no explanation forthcoming from Nursing or Administrative staff of why on 10/18/21 Resident #71's physician was not notified that the resident was experiencing acute right hip pain. There was no explanation forthcoming of why it took until the evening of 10/19/21 to notify the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 3 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0580 Level of Harm - Minimal harm or potential for actual harm physician of the right hip pain and obtain an order for a right hip x-ray. There was no explanation of why the physician was not notified until 10/20/21 of the x-ray results showing a right hip fracture. Furthermore, there was no evidence of any proactive measures implemented to prevent reoccurrence of a delay in physician notification in the future. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 4 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to accurately complete the Minimum Data Set (MDS) assessments related to discharge MDS and Quarterly MDS for 2 of 24 sampled residents, Residents #2 and #239. Residents Affected - Few The findings included: 1. Chart review showed that Resident #2 was readmitted on [DATE] with Psychosis, Depressive Disorder and Muscle Weakness. The last Quarterly Minimum Data Set (MDS) compled was on 10/03/21. Further review showed that no Quarterly MDS was completed for Resident #2, which should have been done in January 2022. 2. Chart review showed that Resident #239 was admitted to the facility on [DATE] and was discharged on 11/20/21. Further chart review did not show that a discharge MDS was completed for Resident #239 before discharge. An interview conducted on 03/02/22 at 3:45 PM with the MDS coordinator who stated that she is the only MDS coordinator in the facility and that another consultant MDS overlooks her work daily. She further noted that every day the electronic system would give her a pop-up alert on which MDSs are due that day, but once that day ends, the reminders go away. The only way to follow up on which MDSs are due is to go into each resident's system individually. The MDS coordinator also stated that she keeps a list of when each resident's MDS is due. She said that it is challenging to keep up with all the due dates of the different MDSs. She further acknowledged that Resident #2's MDS was 44 days overdue, and Resident #239's MDS was 88 days overdue. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 5 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to revise the care plan according to the resident's needs and follow the care plan according to the resident's needs for dining assistance for 2 of 24 sampled residents, Resident #56 and Resident #33. The findings included: 1. Record review showed that Resident #56 was readmitted on [DATE] with diagnoses, in part, of Dementia and Alzheimer's disease. Review of the Minimum Data Set (MDS) dated [DATE] showed that for eating under Section G, Resident #56 needed extensive assistance with one person assist. A review of the Care Plan, dated 02/25/22, showed Resident #56 has impaired cognitive function / dementia or impaired thought process related to Dementia. In an observation conducted on 02/28/22 at 12:52 PM, Resident #56 was noted in his room eating the lunch meal. Closer observation showed that staff was in the room assisting with the lunch meal. In an observation conducted on 03/01/22 at 8:10 AM, Resident #56 was noted in his room waiting on his breakfast tray. At 8:12 AM, staff came into the room to set up the breakfast tray and left to deliver the meal trays to other residents. At 8:25 AM, Resident #56 was observed attempting to eat on his own with the tray untouched. Closer observation showed Resident #56 asleep with his hand on the fork and the juice cup. An observation made at 8:45 AM showed that Resident #56 ate 20% of his breakfast meal with no assistance from staff (photographic evidence obtained). An observation conducted on 03/02/22 at 8:40 AM, showed Resident #56 eating his breakfast meal independently with no assistance from staff. Closer observation showed that the tray was 100% untouched. In an interview conducted on 03/02/22 at 3:15 PM, Staff B, Certified Nursing Assistants (CNA), stated that Resident #56 required assistance with eating. She further noted that Resident #56 could feed himself, but sometimes he does not want to eat and needed encouragement from the staff. The surveyor asked Staff B-CNA to clarify if the resident eats better when she is assisting him in eating, and she replied 'yes, he eats better when she is helping him with his meals'. 2. Record review showed that Resident #33 was readmitted to the facility on [DATE], with diagnoses in part of Depressive Disorders and Alzheimer's Disease. Review of the Minimum Data Set (MDS) dated [DATE] showed that for eating under Section G, Resident#33 needed supervision with setting up only. In an observation conducted on 02/28/22 at 1:05 PM, Resident #33 was observed in her room eating her lunch meal with no assistance from staff. At 1:20 PM, the lunch tray was observed 100% untouched, and at 1:25 PM, the meal tray was still 100% untouched with no assistance from staff. Continued observation showed that at 1:32 PM, Resident #33 ate 10% of her lunch meal and was playing with the fork inside her soup. In an observation conducted on 03/01/22 at 8:15 AM, Resident #33 was observed eating her breakfast meal in her room with Staff A- CNA assisting her at the bedside. At around 8:26 AM, Resident #33 was observed to have eaten 25% of her meal. Staff A-CNA took the tray out of the room at 8:32 AM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 6 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview conducted on 03/01/22 at 8:26 AM, Staff A-CNA, stated that Resident #33 always needs help with her meals and cannot eat well on her own. 3. Record review for Resident #36 revealed that the resident was admitted on [DATE] with diagnoses that included Encephalopathy, Moderate Protein-Calorie Malnutrition, Mental Disorders Due to Known Physiological Condition, Anxiety and Parkinson's Disease. The 5-day minimum data set (MDS) dated [DATE] revealed in Section C a brief interview of mental status (BIMS) score of 13 indicating intact cognitive response, and Section G revealed transfer self-performance of supervision and support of setup help only. An order, dated 02/25/22, revealed Bacitracin Ointment 500 UNIT/GM Apply to Left Lower Extremity topically every day and night shift for redness. An order, dated 03/03/22, revealed Ciprofloxacin HCl Tablet 500 MG Give 1 tablet by mouth two times a day for LLE (left lower extremity) Cellulitis. Record review for Resident #36 revealed no care plan for a left front thigh wound. The treatment administration record for February 2022 and March 2022 revealed the resident did receive treatment to his left lower extremity as ordered. On 02/28/22 at 1:22 PM, an observation was made of Resident # 36 with a blood soiled bandage, dated 02/27/22, to his left upper leg. During an interview conducted on 02/28/22 at 1:23 PM with Resident #36, when asked what happened to his left upper leg, he stated it was something small like a bite, he kept scratching it and it got infected. On 03/01/22 at 2:46 PM, an observation was made of Resident # 36 left thigh anf the wound was uncovered. During an interview conducted on 03/01/22 at 2:46 PM with Resident #36, he stated they removed the bandage from his leg, and he is waiting for them to come back and put a new bandage on it. On 03/01/22 at 2:46 PM, an observation was made of Resident #36 wound to left leg (with no bandage). The redness was approximately 8 centimeters across with an open beefy red center that was approximately 2 centimeters across. During an interview conducted on 03/01/22at 2:50 PM with Staff O-CNA, she stated that she is taking care of Resident #36 today and has not seen a bandage on his thigh today. She stated he has had the wound since last Thursday or Friday. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 7 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and records review, the facility failed to develop a discharge summary which included a complete recapitulation of residents stay and reconciliation of all the pre/post-discharge medications; and failed to develop a post-discharge plan of care that included discharge instructions for 1 of 3 sampled residents reviewed for discharge, Resident #238. The findings included: Record review revealed Resident #238 was admitted to the facility on [DATE] and was discharged from the facility on 11/24/21. The diagnoses included, Unspecified Dementia without Behavioral disturbance among others. A family member was delegated as the representative / durable power of attorney. During an interview conducted with Resident #238's authorized representative (AR) / Power of Attorney (POA) on 03/03/22 at 9:58 AM, the POA stated that Resident #238 was discharged from the facility on 11/24/21. She was contacted by the Social Services Director (SSD) of the facility who informed her that the nurse had forgotten to give her Resident #238's new prescription and some of other medications belonging to the resident. She was requested by the caller to come get them. The POA/AR reported that because Resident #238 was discharged without his required medications, he was subsequently readmitted to a community hospital for two days. Review of the nursing progress notes (NP) Discharge summary, dated [DATE], documented that: Resident discharged from the facility to home in stable condition. BP [blood pressure]125/83, P [pulse] 60, R [respirations] 18, 02 sat [oxygen saturation] 97 and T [temperature] 96.8. There was no indication that the resident's authorized representative or power of attorney (POA) was given any discharge instructions and a list of all medications that the resident was taking or was supposed to take. There was not a complete recapitulation of the resident's stay at the facility. Review of the 'Facility's Discharge plan and Instructions (p.4-p7)' regarding nursing care and medications showed no instructions of medications to be taken. There was no documentation that the facility provided a listing of the medications to the resident. The Brief Interview for Mental Status (BIMS), dated 11/24/21, showed that Resident #238 had a score of 8 out of 15, indicating moderate cognitive impairment. An interview was conducted on 03/03/22 at 11:50 AM with Staff H(a)-Registered Nurse / RN, who completed the discharge summary. She stated she remembered Resident #238 and he was discharged from the facility around December 2021. She stated that she provided the list of medications to the social worker (SW) upon discharge. She added that the list was retrieved from the computer and a copy printed before giving it to the SW. She also stated that the actual medications remained with the facility, and they only provided the list. She said that the unused medications are usually placed in the medication room for Pharmacy to dispose of them as per the facility's protocol. Review of the Social Service Notes, dated 11/22/21, revealed the following: Writer returned call to resident's [representative / POA] today. D/C (discharge) plans discussed for Resident #238. A NOMNC was issued. Resident will be d/c on 11/24/21 as per request. Home health services will be provided. Representative [Rep] declined DME [Durable Medical Equipment]. Writer requested d/c address. Rep provided such. Rep, informed that she will provide transportation for resident. Writer acknowledged and thanked her for her cooperation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 8 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The Social workers' notes, dated 11/26/21, showed the following: Writer telephoned resident's (AR)[representative/POA], to do a post d/c check on former Resident #328. She indicated he was doing well. She stated that some of his clothing were sent with him, and that there were other residents clothing in his luggage. Writer acknowledged, and informed her to bring them back, and that his will be searched for. She acknowledged. Writer informed her that there were additional scripts to be picked up for resident. She acknowledged. There was no evidence that a discharge plan that included the pre/post medications was given to the resident or his authorized representatives. There was no documentation that the facility had developed a post-discharge plan of care that included discharge instructions for Resident #238 related to his medications. Interview with the resident's representative was conducted on 03/03/22 at approximately 10:00 AM. The representative stated the facility did not give Resident #238 the medications he needed to control his mood, and other medications. As a result of him being discharged from the facility without all his medications, he had an episode with hallucinations and was transported back to a community hospital and was readmitted for two days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 9 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0679 Provide activities to meet all resident's needs. 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, the facility failed to ensure 1 of 4 sampled residents reviewed for Activities, Resident #54, was offered and provided with preferred activities as evidenced by Resident #54 was not provided with activities of his choice. Residents Affected - Few The findings included: Review of the clinical record revealed Resident #54 was admitted to the facility on [DATE] with diagnoses to include Traumatic Subdural Brain Hemorrhage, Parkinson's Disease, Anxiety Disorder, Seizures, Aphasia (inability to communicate verbally) and Dysphagia (inability to eat or drink by mouth). Resident #54 has a feeding tube for all his nutrition and hydration needs, with the tube feeding commencing at 2:00 PM daily and infusing over a 20-hour period. Resident #54 is dependent on staff for all activities of daily living. Review of the facility's Activity Program Policy and Procedure, revised 11/01/15, stated in part, 'An ongoing wide range of therapeutic programs, interventions and techniques designed and offered to resident, endeavoring to meet the spiritual, intellectual, emotional, psychosocial, physical and leisure needs of each resident.' Review of a Care Plan, initiated on 01/27/22, documented, 'Focus - The resident is dependent on staff for meeting emotional, intellectual, physical and social needs. Diagnosis is dementia, bipolar disorder, anxiety, Parkinson's disease and dysphagia. Goal - The resident will maintain involvement in cognitive stimulation, social activities as desired through review date. Interventions - provide a program of activities that is of interest and empowers the resident by encouraging/allowing choice, self expression and responsibility. The resident enjoys listening to [NAME] and the Sunshine/80's music and watching western movies. He also enjoys the outdoors, western shows on the TV and social/cultural events. The resident needs assistance/escort to activity functions.' Review of a Minimum Data Set comprehensive resident admission Assessment, dated 01/28/22, under Section F, Preference for Routines & Activities, documented under - How important is it to you to listen to music you like? Somewhat important; How important is it to you to do things with groups of people? Somewhat important; How important is it to you to do your favorite activities? Somewhat important; How important is it to you to go outside to get fresh air when the weather is good? Very important. Review of the clinical record revealed an Activities Evaluation, dated 02/07/22, documenting Resident #54 finds strength in religion; he has interest in life/activities; he is interested in small group activities; his preferred location for activities is documented day/activity room; he is interested in TV; his demeanor is identified as depressed/anxious and withdrawn. On 02/28/22 at 9:15 AM, an initial observation was conducted of Resident #54 in his room in bed. At this time, he was wearing a hospital gown. The privacy curtain was closed blocking the view of the hallway. Additionally, the privacy curtain was closed between his bed and his roommate's bed. Tube feeding was infusing via a pump. An attempt was made to interview the resident, however, he was aphasic and unable to communicate verbally. Despite this, Resident #54 seemed to be able to understand and looked like he was attempting to communicate with his arms and by making vocal noises and he seemed like he was happy to have company. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 10 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0679 Level of Harm - Minimal harm or potential for actual harm Observations on the North Unit and South Unit on 02/28/22 at 10:00 AM, revealed no large Activity Calendars posted at or near the nursing stations to view what activities were being offered each day. Observation in resident rooms revealed one small Activity Room Calendar with small font posted on the wall by the door bed. Review of this Activity Room Calendar revealed on 02/28/22, activities suited to Resident #54 included Outdoor / Exercise at 10:00 AM and Movie at 4:00 PM. Residents Affected - Few On 02/28/22 at 11:05 AM, 12:30 PM and 1:00 PM, Resident #54 was observed in his room in bed wearing a hospital gown with the privacy curtain closed to the hallway and closed between his bed and his roommates. The tube feeding was infusing via a pump. There was no television or radio playing. On 02/28/22 at 1:30 PM, Resident #54 was observed in his room in bed wearing a hospital gown with the privacy curtain closed to the hallway and closed between his bed and his roommates. The tube feeding was now turned off. There was no television or radio playing. On 03/01/22 at 9:25 AM, Resident #54 was observed in his room in bed wearing a hospital gown with the privacy curtain closed to the hallway and closed between his bed and his roommates. The tube feeding was infusing via a pump. There was no television or radio playing. Review of the Activity Room Calendar posted in Resident #54's room next to his bed revealed on 03/01/22, activities suited to Resident #54 included Outdoor / Exercise at 10:00 AM, Mardi Gras Party at 2:30 PM and Movie at 4:00 PM. On 03/01/22 at 11:13 AM, Resident #54's door was closed, the privacy curtain was drawn between his bed and his roommates. The tube feedings were off. Resident #54 was in bed, now wearing a red shirt and only had adult briefs on. Resident #54's roommate had a television on, however, it was not visible or audible to Resident #54. At 11:14 AM, an observation was made of 4 residents in the activity room listening to music. On 03/01/22 at 1:05 PM, Resident #54 was observed in his room in bed with one leg hanging off the side of the bed. The curtain to the hallway was closed and the privacy curtain was drawn between the 2 beds. The tube feeds were off at this time. Resident #54's roommate was eating lunch at this time with the odor of the food wafting in room. On 03/01/22 at 2:40 PM, Resident #54 was observed in his room in bed with the privacy curtain closed to the hallway and the privacy curtain drawn between the 2 residents. The television was on for the roommate, however, was not visible or audible to Resident #54. The tube feedings were infusing at this time with the resident laying almost flat in the bed. On 03/02/22 at 9:30 AM, Resident #54 was observed in bed wearing a hospital gown. The privacy curtain was closed to the hallway and the privacy curtain was drawn between the 2 residents. The tube feeding was infusing via the pump. The television was on for the roommate, however, was not visible or audible to Resident #54. Review of the Activity Room Calendar posted in Resident #54's room next to his bed revealed on 03/02/22, activities suited to Resident #54 included Outdoor / Exercise at 10:00 AM, Sensory Games at 11:00 AM and Movie at 4:00 PM. On 03/02/22 at 10:20 AM, 8 residents were observed in the activity room for a coffee social and singing to music. On 03/02/22 at 10:25 AM, Resident #54 was observed in his room in bed wearing a hospital gown. The privacy curtain was closed to the hallway and the privacy curtain was drawn between the 2 residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 11 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0679 The television was on for the roommate however was not visible or audible to Resident #54. Level of Harm - Minimal harm or potential for actual harm On 03/02/22 at 10:45 AM, 10 residents were observed in the activity room with Reggae music playing. Seen (7) residents were engaged in the music and 3 residents were at tables coloring. Residents Affected - Few On 03/02/22 at 11:35 AM, Resident #54's door was closed. The privacy curtain was drawn around his bed and between the 2 residents. The resident was in bed wearing a hospital gown. The tube feeding was infusing via the pump. The resident's roommate's television was on however not visible or audible to Resident #54. On 03/02/22 at 11:37 AM, 10 residents were observed in the activity room with reggae music still playing. Three (3) residents were dancing to the music, 2 were doing puzzles and the other 5 residents were engaged in the music. On 03/02/22 at 12:30 PM, Resident #54 was observed in his room in bed wearing a hospital gown. The door was open but the privacy curtain was pulled around the bed blocking the view of hallway and the privacy curtain was drawn between the 2 residents. The tube feedings were off at this time. The resident's roommate was eating his spaghetti lunch with the aroma wafting in the room. The roommate's television was on, however not visible or audible to Resident #54. On 03/02/22 at 2:50 PM, Resident #54 was observed in his room in bed wearing a hospital gown. The door was open but the privacy curtain was pulled around the bed blocking the view of the hallway and the privacy curtain was drawn between the 2 residents. The tube feedings were infusing via the pump. The roommate's television was on, however not visible or audible to Resident #54. On 03/02/22 at 3:00 PM, 4 residents were observed in the activity room. Lively music was playing. Three (3) residents were doing puzzles and 1 resident was getting her nails done by the Activity Director. On 03/02/22 at 3:50 PM, Resident #54 was observed in his room in bed wearing a hospital gown. The door was open but the privacy curtain was pulled around the bed blocking the view of the hallway and the privacy curtain was drawn between the 2 residents. The tube feedings were infusing via the pump. The roommate's television was on, however not visible or audible to Resident #54. It was noted Resident #54's eyes light up when he sees someone in the room, trying to communicate with his arms and vocal noises. On 03/02/22 at 3:55 PM, an observation was conducted of the activity room with dance music playing loudly with some residents dancing away and having a good time. One resident was having her nails done by the Activity Director. Review of the One to One Residents list provided by the Activity Director for the residents receiving in room one to one visits by the activities department, included 2 residents of the facility, which has a census of 82 residents. Resident #54 was not one of the 2 residents listed. Review of the Daily Recreation Activity Program Documentation form for February 2022 provided by the Activity Director documented for the month of February 2022, Resident #54 was provided with and active with Music / Singing, Socialization and Television/Movies on a daily basis. For the past 3 days, Resident #54 has been observed in his bed with no sensory stimulation and Resident #54 does not have a television in the room that is visible to him. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 12 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 03/03/22 at 9:10 AM, Resident #54 was observed in his room in bed wearing a hospital gown. The door was open but the privacy curtain was pulled around the bed blocking the view of hallway and the privacy curtain was drawn between the 2 residents. The tube feedings were infusing via the pump. The roommate's television was on, however not visible or audible to Resident #54. On 03/03/22 at 11:35 AM, an interview was conducted with the Activity Director and an inquiry made if Resident #54 is receiving one to one room visits to which the Activity Director stated he is not on their list of receiving one to one room visits. A further inquiry was made about what activities Resident #54 participates in. She stated the resident says he does not like to leave his room. An inquiry was made how could he say he does not want to leave his room when he is unable to verbally communicate, to which she had no response. An inquiry was made what activities the resident is interested in and what do they provide for him, to which she replied the television is on everyday and they play music for him. A request was made for her to show this surveyor the resident's television. Upon entering the resident's room, the privacy curtain was pulled blocking a view of the hallway and the other privacy curtain was pulled between the 2 beds. The television was not visible or audible to Resident #54. The Activity Director stated, See the television is on. An inquiry was made how the resident was supposed to see it with the curtain pulled. She proceeded to pull the curtain back so the resident could see the television. An inquiry was made if she could hear the television volume and she stated if there was not so much noise from the hall she could. The room door was closed and she concurred the volume was low and not audible to either resident. An inquiry was made how they can document daily that the resident was participating in television, socializing and music/singing when for the last 4 days the privacy curtains have been closed to the hallway and between the beds and the room door has been closed. Further, the resident has been dressed in a hospital gown for 3 of the 4 days and has not been out of the bed to a chair or wheelchair or out of his room. She stated, He has been like this for 4 days? The Activity Director was assured Resident #54 has been in bed looking at a wall and curtains with no sensory stimulation for 4 days. The Activity Director stated she will get the aide to address this as she is not allowed to touch the resident. On 03/03/22 at 12:40 PM, Resident #54 was observed in his room in bed wearing a hospital gown. The privacy curtain to the hallway was pulled so the hallway could not be viewed. The television was on but not visible to the resident. Music was now playing and a radio was observed on the nightstand between the beds. Resident #54 smiled when this surveyor mentioned the music playing. On 03/03/22 at 12:42 PM, an inquiry was made to Licensed Practical Nurse (LPN), Staff H(b), if there was a reason why the privacy curtains in Resident #54's room have been closed all week so he cannot see out of the room. She stated there is no reason for it and went to the room. She pulled the curtain back so the resident could have a view of the hallway. She then proceeded to pull the curtain between the 2 residents so now Resident #54 was able to watch his roommate eating lunch, when Resident #54 is not allowed to eat or drink anything by mouth. An inquiry was made if it was appropriate for Resident #54 to be able to see his roommate eating and she said He is NPO. (nothing to eat or drink by mouth). An inquiry was again made if it was appropriate for Resident #54 to be able to watch his roommate eat when he is not able to eat to which she stated, He cannot have anything by mouth. She then pulled the privacy curtain so the roommate could (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 13 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0679 no longer be viewed. Level of Harm - Minimal harm or potential for actual harm Taking the conversation out into the hall, Staff H(b)-LPN was asked why Resident #54 does not go to activities to which she stated he has tube feeding going, they start at 2:00 PM. An inquiry was made if residents who have feeding tubes are not allowed to leave their rooms because they have feeding tubes to which she stated, no they can leave their rooms, it would be ok for them to go to activities. Staff H(b)-LPN was informed Resident #54 has been observed in a hospital gown for 3 of the 4 days, to which she stated he does not have many clothes, I guess we should call the family. Residents Affected - Few On 03/03/22 at 12:50 PM, the Activity Director stopped this surveyor in the hallway and said she had the aides reposition the resident, further stating they are the ones who put the radio in the room. She stated she and her assistant will be on top of this to ensure the resident gets involved in activities. On 03/03/22 at 1:10 PM, an interview was conducted with the Director of Nursing apprising her of the observations of Resident #54 for the past 4 days. She had no comment. On 03/03/22 at 3:00 PM, Resident #54 was observed seated in a recliner chair in the hallway close to the nursing station. The feeding bag hanging on a pole was covered with a privacy cover. Resident #54 was observed with his eyes wide open and he was smiling as he was watching the other residents and staff walk by. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 14 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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, the facility failed to ensure measures were implemented to prevent the development of pressure ulcers for 1 of 1 sampled resident, Resident #68, reviewed for Pressure Ulcer/Injury, as evidenced by physician recommendations for pressure ulcer prevention were not followed, increasing the risk of pressure ulcer development for Resident #68. Residents Affected - Few The findings included: On 02/28/22 at 9:45 AM, an initial observation was conducted of Resident #68 seated in his wheelchair in the hallway outside of his room. In an attempt to conduct an interview, it was noted the resident was cognitively impaired and was not able to provide appropriate answers to the questions asked. An observation was then conducted inside of the resident's room and his bed was observed to have an air mattress on it with the air mattress compressor box attached to the foot board of the bed. Further observation revealed the air mattress compressor box was not turned on. When the end of the mattress was pushed down on, it felt hard and flat. Review of the clinical record revealed Resident #68 was admitted to the facility on [DATE] with diagnoses to include Alzheimer's disease and Psychosis. Review of the February 2022 current Active Physician Orders revealed an order from Resident #68's primary care physician dated 01/27/22 for a Pressure Relief Mattress. Review of a Wound-Weekly Observation Tool dated 02/16/22 documented Resident #68 had an in-house acquired unstageable deep tissue injury pressure ulcer to the left buttock. The date documented as being in-house acquired was 01/25/22. Under the section Special Equipment/Preventative Measures is documented Pressure Relief Mattress; Resident is on turning and repositioning routine. Review of the Braden Scale for Predicating Pressure Sore Risk assessment dated [DATE] scored Resident #68 at a 16, indicating Resident #68 was 'At Risk' for developing a pressure sore. Further review of the clinical record revealed a Progress Note from the Wound Care Physician dated 02/16/22, documenting the resident had an in-house acquired unstageable deep tissue injury pressure ulcer to his left buttock with dressing changes ordered to be done daily. Under the section Support Surface documented an intervention to include a chair gel cushion as a wound preventative measure. On 02/28/22 at 1:45 PM, Resident #68 was observed seated in his wheelchair in his room eating lunch. There was no cushion observed on the seat of his wheelchair. The air mattress compressor box attached to the resident's bed was not turned on. On 03/01/22 at 9:30 AM, 11:05 AM and 1:05 PM, Resident #68 was observed seated in his wheelchair in the hallway. There was no cushion observed on the seat of his wheelchair. In the resident's room, observations of the air mattress compressor box attached to the resident's bed revealed it was not turned on. On 03/01/22 at 2:40 PM, Resident #68 was observed seated in his wheelchair in the hallway by the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 15 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few nursing station. There was no cushion observed on the seat of his wheelchair. The resident was wearing a short sleeved shirt and the skin on his arms looked very fragile with multiple bruising and old skin tear looking sites. An inquiry was made to the resident if he had any pain on his arms related to the bruising and discolorations to which he looked at his arms and stated, I have bad skin. An observation was then conducted of the resident's room revealing the air mattress compressor box attached to the resident's bed was not turned on. On 03/02/22 at 9:30 AM, Resident #68 was observed seated in his wheelchair in his room next to his bed. There was no cushion observed on the seat of his wheelchair. The air mattress compressor box attached to the resident's bed was not turned on. On 03/02/22 at 10:20 AM and 12:30 PM, Resident #68 was observed seated in his wheelchair in the hallway outside of his room. There was no cushion observed on the seat of his wheelchair. In the resident's room, observations of the air mattress compressor box attached to the resident's bed revealed it was not turned on. On 03/02/22 at 11:15 AM, a request was made to the Director of Nursing (DON) to observe the wound care of the left buttock being conducted for Resident #68. The DON stated the wound care physician was in yesterday and stated the wound has resolved. A request was made to be provided with the wound care Physician notes, as there were no nursing notes to review in the clinical record documenting of the resolution of the left buttock wound. Review of the wound care physician Wound Evaluation and Management Summary report, dated 03/01/22, provided by the DON on 03/02/22 at approximately 12:30 PM, documented under History of present illness - prior healing wound has improved and requires confirmation of current clinical status and evaluation with preventative recommendations to prevent recurrence. Documentation under Support Surface - Chair - gel cushion. Under Coordination of Care documented, This patient was discussed with another health care provider Director of Nursing during this visit. Will sign off, please re-consult as needed, discontinue vitamin C and zinc sulphate (if applicable), continue present skin care and breakdown prevention. Review of the March 2022 current Active Physician Orders revealed an order from Resident #68's primary care physician, dated 03/01/22, for a Pressure Relief Mattress. On 03/02/22 at 2:50 PM, Resident #68 was observed seated in his wheelchair in his room next to his bed. There was no cushion observed on the seat of his wheelchair. The air mattress compressor box attached to the resident's bed was not turned on. On 03/03/22 at 11:25 AM, Resident #68 was observed in his room laying on his left side in bed with his wheelchair next to his bed. There was no gel cushion observed on his wheelchair seat. The air mattress compressor box was not turned on. At 11:26 AM, a request was made to Staff H-LPN, Resident #68's nurse, to observe Resident #68's skin on his backside. Staff H-LPN elicited the assistance of Certified Nursing Assistant (CNA) Staff N. In the resident's room, a comment was made that this was the first time in 3 days Resident #68 has not been observed to be in his wheelchair, to which Staff H-LPN stated Resident #68 can independently transfer himself from the wheelchair to the bed and gets in and out of bed throughout the day when he wants to. It was pointed out to Staff H-LPN that there was no gel cushion on his wheelchair seat per the wound care physician recommendations. Staff H-LPN had a confused look on her face. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 16 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few It was further pointed out the air mattress compressor was not turned on and has not been on for the past 4 days. Staff H-LPN stated, Are you sure? Staff H-LPN was assured the air mattress has not been observed to be on for the past 4 days. Staff H-LPN proceeded to pull on the electrical cord of the compressor which met with resistance. Staff N-CNA went to the head of the bed and pulled the bed away from the wall slightly and plugged the cord in fully and the air mattress compressor box lit up with green and red lights. Staff H-LPN reset the compressor settings and the compressor could be heard running. Once the air mattress was functioning, Staff H-LPN, with the consent of the resident, removed the resident's briefs on his right buttocks area. The right buttocks area was observed to be red with redness around the buttocks crack. Staff N-CNA and Staff H-LPN repositioned the resident to his right side and removed the resident's briefs from his left buttocks area. The left buttocks area was observed to be red with slight excoriation (non-intact skin) at the area of the prior deep tissue pressure injury. Staff H-LPN concurred the resident's bilateral buttocks were red, stating she will take care of it. Review of a Care Plan, dated as initiated on 03/02/22, documented, under 'Focus' - The resident has a DTI (deep tissue injury) to left buttock and has potential for pressure ulcer development related to urinary incontinence, cognitive loss, impaired skin integrity and restricted mobility. The 'Goal' documented - The resident will have intact skin, free of redness, blisters or discoloration by/through next review date. The 'Interventions' documented to include - Pressure relief mattress; Follow facility policies/protocols for the prevention/treatment of skin breakdown. On 03/03/22 at 1:10 PM, an interview was conducted with the Director Of Nursing (DON), apprising her that Resident #68's air mattress has not been functioning for the past 4 days, the lack of a gel cushion to the resident's wheelchair and observation of the redness and excoriation of Resident #68's buttocks area. An inquiry was made who reviews the progress notes and recommendations from the wound care physician, in particular the recommendation for a gel cushion for the resident's wheelchair to minimize the pressure on his bottom. The DON stated she reviews the notes and sometimes the wound care physician comes in late on Tuesday, so she will get the notes from the physician on Wednesday to review. The DON stated the wound care physician does not write orders and they get the information from the notes and will call the primary physician for orders. The DON stated she gets all the changes from the notes and if there are changes in treatment. She confirmed it could take a couple of days to implement them, depending on when the notes are reviewed. The wound care physician note, dated 03/01/22, was reviewed with the DON related to the recommendation to continue the present skin care and breakdown prevention and a recommendation, if applicable, to discontinue the Vitamin C and Zinc, to which she confirmed she was not aware of this note and has not contacted the primary physician to see if she wanted the medications discontinued. The DON did not comment on no gel cushion for the resident's wheelchair, why the air mattress has not been functioning for the past 4 days or of the redness and excoriation observed on the resident's buttocks on 03/03/22 at 11:30 AM. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 17 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 - Minimal harm or potential for actual harm Residents Affected - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to follow up on tube feeding regimen changes in a timely manner for 1 of 1 sampled resident reviewed for tube feeding, Resident #64. The findings included: A review of the facility's policy, titled, Nutritional Assessment, dated 09/17/18, showed that Residents at high nutritional risk will be assessed in a timely manner by the Dietitian. It further showed that the nutritional care plan is communicated to the rest of the interdisciplinary team. In an observation conducted on 02/28/22 at 10:13 AM, Resident #64's tube feeding was observed running with Jevity 1.5 (formulary) at 50 millimeters (ml) an hour. It further showed that the tube feeding bottle was started at 2:00 AM the night before. A review of the chart showed that Resident #64 was readmitted to the facility on [DATE] with diagnoses to include Dysphagia, and Schizophrenia. A review of the Physician's orders showed the following tube feeding changes: On 01/12/22, the tube feeding Jevity 1.5 at 70 milliliters (ml) an hour for 20 hours to start at 2 PM until 1400 ml has infused (which was dated 01/12/22); and on 02/12/22, an order for tube feeding Jevity 1.5 at 50 milliliters an hour for 20 hours to start at 2 PM and let it run until 1000 ml has infused (which was dated 02/12/22). Review of the care plan, dated 02/14/22, showed that Resident #64 is at risk for altered nutrition and hydration status and is with history of multiple hospitalizations. It further showed that Resident #64 became a hospice resident on 02/07/22 and that the Dietitian will evaluate and make diet change recommendations as needed. A review of the Nutritional Evaluation, dated 01/16/22, showed that Resident #64 was readmitted from a hospital stay for a change in condition. It further showed involuntary weight loss from a hospital stay and underweight status. In this assessment, the Dietitian estimated the daily caloric needs to be between 1769 and 1876 calories a day. The protein needs were estimated at 80 grams of protein a day. A review of the Nutritional Evaluation, dated 01/27/22, showed that Resident #64 is with tube feeding Jevity 1.5 at 30 ml an hour and to increase to 70 ml an hour. In this assessment, the Dietitian estimated the daily caloric needs between 1953 and 2187 calories a day. The protein needs were estimated at 78 grams of protein a day. It further showed that the tube feeding that Resident #64 is currently receiving is the main source of nutrition. A Dietitian's progress note, dated 02/07/22, prior to the tube feeding order change as above, showed that the tube feeding was held due to emesis and that they are no new recommendations at this time. Continued review of the Dietitian progress notes or assessment did not show any notes written after 02/12/22, regarding the tube feeding change in rate from 75 ml an hour to 50 ml an hour and from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 18 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 1000 ml to 1400 ml. Level of Harm - Minimal harm or potential for actual harm In an interview conducted on 03/02/22 at 11:00 AM, Staff G, Dietary Technician (DT), stated that the tube feeding order change was not picked up by dietary and that she was not aware that Resident #64 tube feeding was decreased and changed from 75 ml an hour to 50 ml an hour. When asked as to who made the recommendations to decrease the tube feeding rate, she did not know. Residents Affected - Few In a phone interview conducted on 03/03/22 at 11:30 AM, Staff L, Registered Dietitian (RD), Staff L-RD stated that she has been covering for the other Dietitian that is out sick. She stated that a follow-up note is done monthly for all residents on tube feeding and when there is a change in the tube feeding regimen. Staff L-RD also reported that any change in tube feeding orders is usually brought up in the morning meeting or an email is sent to the Dietitian letting her know of the change. When asked as to why no follow-up or reassessment was done for Resident #64 after the tube feeding order was changed, she said, the diet was changed, and we were not aware. Staff L-RD further acknowledged that a follow-up note should have been done regarding the changes on the tube feeding regimen for Resident #64. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 19 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to follow the residents' approved menu during dining observation for 2 sampled Residents #51 and #56, of the 13 residents receiving puree diets. This could affect all 13 residents receiving pureed diets. The findings included: A review of the Cycle 1, Week 2 Regular Diet menu showed the following: Glazed meatloaf, new potatoes, red cabbage, wheat roll, margarine, and apple pie. In an interview conducted on 02/28/22 at 1:50 PM with Staff E, Cook, he stated that because he didn't have enough red cabbage for all of the residents, he decided to substitute the menu on the pureed diet for green beans. 1. In an observation conducted on 02/28/22 at 1:24 PM, Resident #51 was observed with her lunch meal. Closer observation showed the following: pureed glazed meatloaf, pureed potatoes, and pureed green beans. A record review was conducted for Resident #51. She was originally admitted to the facility on [DATE]. Noted in her Quarterly Minimum Data Set completed on 01/15/22 in the section regarding cognitive patterns, it showed that a Brief Interview for Mental Status was unable to be conducted due to her mental status. She has a medical history of dementia and major depressive disorder. She has an order for a controlled carbohydrate, no added salt diet of pureed texture that was written 10/13/21. 2. Observation on 02/28/22 at 1:20 PM, showed Resident #56 was observed with their lunch meal. Closer observation showed the following: pureed glazed meatloaf, pureed potatoes, and pureed green beans. A record review was conducted for Resident #56. He was originally admitted to the facility on [DATE]. Noted in his Significant Change Minimum Data Set completed on 01/19/22 in the section regarding cognitive patterns, it shows that a Brief Interview for Mental Status was unable to be conducted due to his mental status. He has a medical history of schizophrenia, psychosis, anxiety, Alzheimer's/dementia, dysphagia, muscle weakness, and major depressive disorder. He has an order for a no added salt diet of pureed texture ordered 12/25/21. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 20 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. 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 food and drink that is palatable, attractive, and at a safe and appetizing temperature for 3 residents of 3 sampled residents observed during dining, Resident #27, Resident #51, and Resident #20. Residents Affected - Few The findings included: 1. In an observation conducted on 02/28/22 at 12:45 PM, the first tray cart arrived on the 100's unit with the lunch meals. The cart was placed in the hallway, and the staff was observed passing the lunch trays to all residents. Continued observation showed that Patient #51's lunch tray was left on the meal cart while all the other lunch trays were given to the residents. At 1:25 PM, 40 minutes later, the staff took the lunch meal from the meal cart and brought it into Resident #51's room. A record review was conducted for Resident #51. She was originally admitted to the facility on [DATE]. Noted in her Quarterly Minimum Data Set completed on 01/15/22 in the section regarding cognitive patterns, it shows that a Brief Interview for Mental Status was unable to be conducted due to her mental status. She has a medical history of dementia and major depressive disorder. She has an order for a controlled carbohydrate, no added salt diet of pureed texture that was written 10/13/21. 2. In an observation conducted on 02/28/22 at 12:52 PM, the second tray cart arrived on the 100's unit with the lunch meals. The cart was placed in the hallway, and the staff was observed passing the lunch trays to all residents. Continued observation showed that Resident #27's lunch tray was left on the meal cart while all the other lunch trays were given to the residents. At 1:30 PM, the lunch tray for Resident #27 was still left on the meal cart. At 1:42 PM, the lunch meal was taken from the meal cart and brought into Resident's #27 room, 50 minutes later. A record review was conducted for Resident #27. She was originally admitted to the facility on [DATE]. Noted in her Quarterly Minimum Data Set completed on 12/30/21 in the section regarding cognitive patterns, it shows that a Brief Interview for Mental Status was unable to be conducted due to her mental status. She has a medical history of dementia and extrapyramidal movement disorder. She has an order for a regular diet of pureed texture written 03/22/21. 3. In an observation conducted on 02/28/22 at 12:52 PM, the second tray cart arrived on the 100's unit with the lunch meals. The cart was placed in the hallway, and the staff was observed passing the lunch trays to all residents. Continued observation showed that Resident #20's lunch tray was left on the meal cart while all the other lunch trays were given to the residents. At 1:20 PM, the lunch tray for Resident #20 was still left on the meal cart. At 1:28 PM, the lunch meal was taken from the meal cart and brought into Resident's #20 room, 36 minutes later. 4. In an observation on 03/01/22, the second meal cart arrived on the 100 unit at 8:13 AM. At 8:30 AM, the staff brought the tray into Resident #20's room and left the meal tray at the resident's bedside. Continued observation showed that the breakfast meal was unattended at the bedside. At 8:43 AM, staff came into the room to assist Resident #20 with their breakfast tray which had been sitting for 30 minutes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 21 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. On 03/02/22 at 4:55 PM, during a medication pass observation conducted with Licensed Practical Nurse (LPN) Staff H(b) for Resident #29, the dinner meal tray was observed on the resident's overbed table. The meal ticket documented Reg M/S (Regular Mechanical Soft) Nectar Thick (liquids). While waiting for Staff H(b)-LPN to wash her hands, the plate lid was removed to reveal the dinner meal consisted of a whole hamburger bun with chopped up meat inside and a side of curly crispy seasoned fries. Photographic evidence was obtained. When Staff H(b)-LPN finished administering the medications to Resident #29, an inquiry was made to her what diet Resident #29 was on. Staff H(b)-LPN looked at the meal ticket and stated, regular. An inquiry was made what M/S meant to which she stated the resident is on a regular mechanical soft diet. A request was made to lift the plate lid. Staff H(b)-LPN observed the meal and said This is mechanical soft. A request was made for her to try to cut the curly crispy fries. Using a fork, Staff H(b)-LPN had to exert pressure to cut the curly crispy fry in half. Staff H(b)-LPN was advised to not let the resident eat this meal as curly crispy fries were not suitable for a mechanical soft diet. Upon exiting the room, the Administrator was observed to be walking down the hallway and an inquiry was made to him if there was any staff available to speak to from the dietary department. One minute later, the Administrator arrived with Dietary Manager (DM), Staff F. Staff F-DM was shown the picture of Resident #29's mechanical soft dinner. An inquiry was made to Staff F-DM if there were concerns addressed with her about the mechanical soft diet consistency 2 days ago, to which she stated the meat is mechanical soft. She further stated, We thought it was ok. Staff F-DM was shown the picture of the whole hamburger bun and curly crispy fries again and was advised Staff H(b)-LPN had to exert pressure to cut the curly crispy fries with a fork. Staff F-DM stated she would go to the kitchen to change the meal. 5. On 03/02/22 at 5:25 PM, during a medication pass observation conducted with Staff O-LPN for Resident #70, the dinner meal tray was observed on the resident's overbed table with the plate lid removed. The meal ticket documented M/S thickened (liquids). Resident #70 was starting to eat. The dinner meal consisted of a whole hamburger bun with chopped up meat inside and a side of curly crispy seasoned fries in addition to a bowl of fresh strawberries. Staff O-LPN was advised this is not a mechanical soft diet consistency and is not appropriate for this resident who has been ordered a mechanical soft diet. Staff O-LPN was unsure of what to say or do at this moment and just stood in front of the resident staring at the meal tray. A request was made to locate the Director of Nursing (DON) who had been observed in the hall prior to the observation of the medication pass for Resident #70. On 03/02/22 at 5:30 PM, an interview was conducted with the DON showing her Resident #70's mechanical soft diet consisting of a whole hamburger bun, curly crispy fries and fresh strawberries. An inquiry was made if it was believed the mechanical soft diet consistency concerns had been addressed with dietary staff 2 days ago, to which she stated she thought that it had, but guessed now it had not. Based on observations, interviews, and record review, the facility failed to provide the correct consistency for the mechanical soft diet during dining observation for 4 sampled residents, Residents #49, #17, #29, and #70, of the 14 residents ordered to receive mechanical soft diets. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 22 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0808 The findings included: Level of Harm - Minimal harm or potential for actual harm Review of the Nutrition Care Manual under section Dysphagia Level 3: Advanced or Mechanical Soft, showed the following: no hard sticky or crunchy foods, foods should be moist, meat cut up and chopped, food particles are served in bite-sized pieces and less than 1 inch, and crunchy bread are not allowed (https://www.nutritioncaremanual.org/topic.cfm?ncm_toc_id=273657). Residents Affected - Few 1. A record review was conducted for Resident #49 that showed initially being admitted to the facility on [DATE]. The Quarterly Minimum Data Set was completed on 01/17/22 in the section regarding cognitive patterns. It is shown that a Brief Interview for Mental Status was unable to be conducted due to her mental status. She has a medical history of Dementia, Psychosis, difficulty walking, falls, Major Depressive Disorder, and Dysphagia. She has an order for an enhanced/no added salt diet of soft mechanical consistency that was written on 04/14/21. In an observation conducted on 02/28/22 at 12:59 PM, it was noted that Resident #49 was attempting to eat her lunch meal without help from staff. Closer observation showed the following: meatloaf that was unevenly chopped with some pieces that were larger than 2 inches and rough to the touch; cooked cabbage with pieces bigger than 2 inches and firm to the touch; whole dinner roll larger than 3 inches that had a hard crust; a slice of double-crust apple pie that was dry and firm to touch. Continued observation showed that Resident #49 was unable to chew the food with unchewed food in her lap and on her clothes. (The surveyor explained the consistency of the food). In an observation conducted on 03/01/22 at 8:29 AM, Resident #49 was being assisted with her breakfast meal by the facility's DON. It was noted that she had a breakfast biscuit on her breakfast plate. Closer observation showed that it was dry, crusty, and hard to the touch. 2. A record review was conducted for Resident #17. He was originally admitted to the faculty on 11/18/21. Noted in his five-day Medicare Minimum Data Set completed on 12/08/21 in the section regarding cognitive patterns, a Brief Interview for Mental Status, his score is 13. He has a medical history of dementia, seizures, and falling. An order for no added salt diet of soft mechanical texture written 11/18/21. In an observation conducted on 02/28/22 at 12:55 PM, Resident #17 was observed with his lunch tray. Closer observation showed a meal ticket for mechanical soft with no added salt. The meal tray consisted of meatloaf that was unevenly chopped with some pieces that were larger than 2 inches and rough to the touch; cooked cabbage with pieces bigger than 2 inches and firm to the touch; whole dinner roll larger than 3 inches that had a hard crust; a slice of double-crust apple pie that was dry and firm to touch. 3. A record review was conducted for Resident #29. She was originally admitted to the facility on [DATE]. Noted in her Quarterly Medicare Minimum Data Set completed on 12/31/21 in the section regarding cognitive patterns, a Brief Interview for Mental Status was unable to be conducted due to her mental status. She has a medical history of Alzheimer's, major depressive disorder, anxiety, psychosis, muscle weakness, abnormal gait. She has an order for a regular diet of soft mechanical texture with nectar-like consistency for liquids written 12/15/21. In an observation conducted on 03/02/22 at 8:35 AM, Resident #29's breakfast tray was on her bedside table. The surveyor noted there was a breakfast biscuit on her tray. Closer observation showed the biscuit was dry, crusty, and hard to the touch. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 23 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an observation conducted on 03/03/22 at 8:28 AM, it is noted that Resident #29's breakfast tray was served a dry, crusty sliced waffle that was cut into pieces that were larger than 4 inches. (Photographic evidence obtained). In an interview conducted on 02/28/22 at 1:15 PM with the clinical food manager, she was asked if Resident #49 had the appropriate consistency for a mechanical soft diet on her lunch tray. She stated that a mechanical soft diet has to be a diet with chopped soft foods and that the consistency would have to be soft. In this interview, the surveyor attempted to cut through the roll and cabbage and could not without using extra force. The clinical food manager acknowledged that the food items on the mechanical soft tray were not the right consistency for the ordered diet. Record review of the Quantified Recipe for Glazed Meatloaf used by staff in the kitchen showed the following: For ground or chopped menu items, grind or chop food to appropriate consistency; all food pieces must be less than or equal to 15mm x 15mm in size. Further record review of the Quantified Recipe for Red Cabbage showed the following: cook until well cooked, and the product should be cooked until it is easily mash-able with a fork. In an interview with the Director of Nursing (DON) on 03/01/22 at 8:32 AM, the DON said she was not feeding Resident #49 the biscuit because it was too tough. During this interview, the surveyor attempted to cut through the biscuit and could not without using extra force. In an interview conducted on 03/01/22 at 9:18 AM with Staff G, Dietary Technician, she reported that all residents on mechanical soft diets are allowed to have biscuits according to today's menu. When asked to see the interpretation/breakdown on what is permitted on a mechanical soft diet, she stated, I don't have it, but I know that bread is allowed. When asked by the surveyor if that was her interpretation or taken from a reputable source, she replied, That is my interpretation. When asked by the surveyor if there are different types of mechanical soft diets, she stated there is a level 2 and a level 3 mechanical soft diet but could not provide the exact food items allowed on each diet. In a second interview conducted 03/01/22 at 11:00 AM with Staff G, Dietary Technician, she stated that they currently do not have any residents on Dysphagia Level 2 Mechanical Altered Diet. She further stated that they have residents on a dysphagia level 3 advanced diet and that it is based on the menus that are sent by Sysco (food company), which states a Dysphagia Level 2: Mechanically Altered Diet consists of soft foods that are easy to chew and swallow and that bread must be served with margarine. Also, meats are ground or chopped, based on the resident's tolerance. In an interview conducted on 03/03/22 at 9:20 AM with the speech therapist, the surveyor asked her to clarify how many stages of mechanical soft diet they follow at this facility. She said they only use 1 level, which is ground mechanical soft. When asked what size the pieces of food should be, she replied that the food should be no bigger than a quarter of an inch. She also said all fruits and vegetables should be cooked until they are moist and soft. When asked to clarify if it is ok for a resident on the mechanical soft diet to be given undercooked or raw fruits or vegetables, she stated it is unacceptable for residents to receive these foods on their meal trays. When shown the picture of the burger and fries given to Resident #29 for dinner on 03/02/22, she said that is unacceptable. When told that the Diet Technician said the kitchen follows two types of mechanical soft diets, she said that it is incorrect-they only follow 1 type. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 24 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations and interviews, the facility failed to keep food safety requirements with storage, preparation, and distribution that is in accordance with professional standards for food service safety that included failure to maintain sanitary conditions. The findings included: An initial tour of the kitchen was conducted on 02/28/22 at 8:51 AM with Staff F, Dietary Manager (DM), Staff E, Cook, and the Maintenance Director (MD). The following observations were noted: 1. In the food preparation area, 1 bin containing a bag of thickener powder was left open to air (Photographic evidence obtained) 2. Also in the food preparation area, a garbage can lid was left open (Photographic evidence taken) 3. In the plate warmer were 5 discolored scoop plates and 5 discolored plates noted (photographic evidence obtained) 4. In the walk-in refrigerator, it was noted that the ceiling had a moderate amount of black, spotty residue. 5. In the dry storage room, it was noted that a box of split bananas were on a shelf (Photographic evidence obtained); and there was a heavy accumulation of debris noted under the rolling shelves (Photographic evidence obtained). 6. An observation was made upon entering the kitchen that Staff E, Cook, was preparing the breakfast meal without wearing a beard covering or a facial mask. Staff E-Cook was observed to have a beard and mustache. In an interview conducted at 9:03 AM with Staff E-Cook, Staff E-Cook when asked as to why he was not wearing a mask or beard guard in the kitchen preparing food, he replied, I'm so sorry, and walked to the office and put on a mask but not a beard guard. In an interview with the Administrator on 03/03/22 at , he acknowledged all findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 25 of 26 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 105680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nspire Healthcare Lauderhill 2599 NW 55th Ave Lauderhill, FL 33313 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 - Minimal harm or potential for actual harm Based on observation and interviews, the facility failed to dispose of garbage and refuse properly to ensure a potential health hazard. Residents Affected - Few The findings included: During the initial kitchen / food service observation tour conducted on 02/28/22 at 9:10 AM, the outside dumpster area was noted with the following: 1. 1 large green garbage dumpster was noted to be overflowing with clear garbage bags on top. 2. The area surrounding the dumpster had dirty used gloves, debris, and broken glass with a flying insect around it. In an interview conducted on 02/28/22 at 9:11 AM, the facility's Maintenance Director stated that the garbage gets picked up 3 or 4 days a week but was unsure of the times and days of the week. In another interview conducted on 02/28/22 at 10:00 AM, the facility's Maintenance Director stated that he checked the schedule and that the garbage gets picked up 3 days a week. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 26 of 26