Health inspection·July 13, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to provide a safe, clean, and homelike environment on 1 of 4 units, the 400 unit. The findings included: During observations of residents' rooms conducted on 07/10/23 and 07/11/23, and a subsequent facility observation tour conducted on 07/12/23 at 8:09 AM with the Maintenance Director, the following environmental concerns were noted: 400 rooms unit: (a) 413 - bathroom floor linoleum was bubbling up and was uneven, bathroom sink cabinet was damaged, and the door was broken, overhead lights were not working and the closet wood was broken. (b) 412 - bathroom sink was loose, and the floor was stained. (c) 408 - bathroom sink cabinet was damaged and the baseboard around was loose. (d) 406 - the wall behind the bed was in disrepair. (e) 405 - baseboard behind the dresser was loose. (g) 402 - bathroom wall paint needed a touch up; bathroom cabinet was damaged and baseboard around it was loose. (h) 400 - the room television was on, and no picture noted. During the tour Staff C, Certified Nursing Assistant (CNA), stated she noticed that the television picture was not on but did not tell anybody. (i) Resident #88's wheelchair had padded arm rests that were in disrepair. On 07/12/23 at 8:40 AM, during the tour, Staff C, CNA, confirmed that the wheelchair belonged to Resident #88 and stated that the staff have to tell maintenance when the wheelchair arm rest were broken. During the tour, the Director of Maintenance stated the building was going through minor renovations, and that he ordered some resident's dresser and flooring. The Director was asked to submit invoices for flooring and dresser ordered. (j) On 07/12/23 at 9:52 AM, observation revealed the flooring bubbling up between the 400 unit's nurses station and the pantry. An interview was conducted with the Regional Nurse who stated that she told the Maintenance Director last week and he had ordered the flooring. Subsequently, an interview was conducted with the Maintenance Director who provided an invoice for flooring, which was dated 07/10/23 for flooring. The Maintenance Director stated the flooring was ordered for room [ROOM NUMBER] and the hallway. The flooring was ordered after surveyor identified the flooring issue in room [ROOM NUMBER] on 07/10/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 2 of 17 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 07/13/2023 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 0584 At the end of the survey, no invoices for the residents' dresser, as requested, were submitted. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 3 of 17 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 07/13/2023 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record and policy review, the facility failed to complete a Preadmission Screening and Resident Review (PASRR) form for 2 of 2 sampled residents reviewed for PASRR, Residents #46 and #299. Residents Affected - Few The findings included: Review of the facility's policy, titled, Pre-admission Screening revised on 11/30/14 documented .the pre-admission screening is completed by the referring human service agency .the company will review the pre-admission screening upon receipt . 1. Review of Resident #46's clinical record documented an admission on [DATE], and no readmissions. The resident's diagnoses included Unspecified Malignant Neoplasm of Skin, Diabetis Mellitus (DM), Anxiety, Parkinson's Disorder, Dementia, Depression and Psychosis. Review of Resident #46's Minimum Data Set (MDS) significant change assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 3 indicating the resident had severe cognition impairment. Review of Resident #46's revealed a hand written Preadmission Screening and Resident Review (PASRR) form dated 09/21/20. Review of the form section III, titled, PASRR, screen for Provisional admission or Hospital Discharge Exemption documented that Resident #46 was admitted under the 30-day Hospital Discharge exemption. On 07/12/23 at 10:45 AM, an interview was conducted with the facility's Social Services Director (SSD) who stated she had been working at the facility for over a year. The SSD stated she was not working at the facility in 2020 when Resident #46 was admitted and added she was not sure exactly what happened related to the residnt's PASRR. The SSD stated that a PASRR level I is done prior to an admission to the facility. The SSD stated that the screening is done to see if the resident needed a level II for any mental illness or disabilities, to see if the resident meets the level of criteria and that the facility can provide the services that the resident needs. The SSD stated the admission department will request the PASRR prior to admission, then the screen form is passed on to the SSD. The SSD added that if the facility does not receive a PASRR, she checks the clinical record and then she will complete the PASRR form. During the interview, a side by side review of Resident #46's PASRR on file was conducted with the SSD. The SSD stated that Resident #46's PASRR was handwritten and it was inappropriate. The SSD stated the PASRR was not done through Kepro portal that would of indicated if a level II was needed at the time of admission on [DATE]. The SSD confirmed that Resident #46 had no readmissions to the facility. The SSD stated that the resident did not have any mental illness or disabilities. The SSD stated she would have to update Resident #46's PASRR through Kepro and confirmed that the resident did not have a valid PASRR. On 07/12/23 at 11:05 AM, an interview was conducted with the Admissions Director (AD) who stated she had been working at the facility since 05/2023. The AD stated for new admissions usually she receives clinical documents and reviews them, then if the patient gets accepted, then she request from the hospital, a copy of the PASRR. The AD stated the residents come to the facility with a completed PASRR and added that sometimes the resident comes without it and she will go to the hospital to get (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 4 of 17 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 07/13/2023 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 0645 it. Level of Harm - Minimal harm or potential for actual harm 2. Resident #299 was admitted to the facility on [DATE] and [NAME] Acted on 05/30/23 for aggressive behavior. A [NAME] Act provides emergency services and a temporary detention for mental health services and treatment when required. Resident #299 had diagnoses that included Unspecified Psychosis, Suicidal Ideation, Dementia and Auditory Hallucination. The documented Brief Interview for Mental Status (BIMS) was not able to be done for this resident indicating the resident was not able to answer the questions on the BIMS. Residents Affected - Few Review of the Electronic Health Record (EHR) and hard copy chart documented a PASRR form dated 06/05/23. PASRR level I is to be done prior to an admission to the facility. It is done to see if a resident will need a level II for any mental illness or disabilities, to see if the resident meets the level of criteria and that the facility can provide the services that the resident needs. An interview was conducted with the Administrator on 07/12/23 at 11:45 AM regarding Resident #299's PASRR dated 06/05/23. The Administrator stated he was aware that the facility who discharged the resident did not send a PASRR and he asked them for it but they never sent it. They did not have time to do the PASRR before the resident was discharged from the facility. The Administrator stated they were not aware of the resident's aggressive behavior prior to admitting the resident on 05/30/23. The findings of the PASRR level I determined that the resident did need a level II to be done due to serious mental illness, but by the time the level I was done, the resident had been discharged . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 5 of 17 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 07/13/2023 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 5. Review of the facility's policy, titled, Disposal of Medications and Medication-Related Supplies: Controlled Substance Disposal, revised on January 2018, documented in part, .when a dose of a controlled substance medication is removed from the container for administration but .not given for any reason .it is destroyed in the presence of two licensed nurses .when controlled medications are destroyed at the facility, licensed staff as allowed by stated law will witness the destruction . Review of Resident #83's clinical record documented an initial admission on [DATE] and a readmission on [DATE]. The resident diagnoses included Encephalopathy, Dementia with Behavioral Disturbances, Psychosis and Anorexia. Review of Resident #83's Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a BIMS score of 5 indicating that the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed limited to extensive assistance from the staff to complete the activities of daily living. Review of Resident #83's physician orders dated 06/30/23 documented, Clonazepam give 0.5 milligrams (mg) by mouth every 12 hours for anxiety. Review of Resident #83's Medication Monitoring Control Record documented, Clonazepam 0.5 mg give one tablet every 12 hours. The record documented under record of waste and spoilage that the medication fell on floor and was signed by Staff E (RN) and Staff F (LPN). On 07/11/23 at 8:22 AM, a medication administration observation pass for Resident #83 was performed by Staff F, LPN. Observation revealed Staff F retrieved one tablet of Clonazepam 0.5 mg from the controlled substance box and poured the tablet into a medication cup, crushed up the tablet, then mixed it with apple sauce. Continued observation revealed Staff F walked to Resident #83's room, entered the resident's room, placed the medication cup on top of the table, turned her back to the medication cup and then immediately turned around, touched the table and the resident's medication cup fell on the floor and spilt on the floor. Further observation revealed Staff F, LPN, wiped the apple sauce / medication with a paper towel off the floor, came out of the room, walked to the medication cart and discarded the paper towel and the medication cup into the medication cart's trash can. Observation revealed Staff F left the medication cart's trash can lid opened. The medication cup revealed some leftover of the controlled substance into the medication cup. During the observation, Staff F stated she had to waste the medication that spilled on the floor and added she needed someone, another nurse, to sign on the waste. The observation revealed Staff F dated and signed Resident 83's Clonazepam controlled sheet-record of waste, without another nurse witnessing the waste. Staff F asked the surveyor if she could get a nurse to sign the waste. Staff F was informed that the surveyor could not give her instructions on what to do. On 07/11/23 at 8:37 AM, observations revealed Staff F proceeded to retrieve another Clonazepam 0.5 mg from the controlled box, crushed the tablet and mixed it with applesauce. Staff F walked to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 6 of 17 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 07/13/2023 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #83's room, entered the resident's room, and administered the resident's Clonazepam medication. Staff F returned to the medication cart and documented the medication administered. On 07/11/23 at 8:46 AM, observation revealed Staff F, LPN approached Staff E, Registered Nurse (RN) and asked Staff E to sign the waste-controlled sheet. Further observation revealed Staff E and Staff F standing by the medication cart. Staff E asked Staff F to show her the Clonazepam medication tablets left in the box. Staff E then proceeded to check the Clonazepam (controlled substances medication) in the box and the controlled sheet-record of waste. Staff E then signed the controlled sheet-record waste and left the area. Observation revealed Staff E did not ask Staff F for the wasted medication, and did not ask Staff F where she wasted the medication. On 07/11/23 at 1:39 PM, an interview was conducted with Staff F, LPN, who stated that she was supposed to flush the medication down the toilet, then she said she was supposed to put into the drug buster. Staff F stated she was ashamed because she did not do it right. Staff F stated that she should have discarded the Clonazepam, a controlled substance medication, in front of another nurse. On 07/11/23 at 1:52 PM, during an interview, the Director of Nursing (DON) and the Regional Nurse, the DON stated she was aware of Staff F discarding medication into the medication cart's trash can. On 07/12/23 at 9:10 AM, an interview was conducted with Staff E, RN, who stated the facility's protocol for discarding controlled substances was that two nurses are to see the medication being wasted. Staff E, RN, stated that Staff F, LPN, told her that the Resident #83's controlled medication had spilt all over the floor. Staff E added that Staff F was supposed to collect the medication with a spoon and call her to witness the waste, but she did not. Staff E was apprised that Staff F discarded left over medication into the medication cart's trash can. 6a. On 07/11/23 at 8:33 AM, during the medication administration observation pass for Resident #83 performed by Staff F, LPN, revealed Staff F walked to Resident #83's room, entered the resident's room, placed the medication cup on top of the table, turned her back to the medication cup and then immediately turned around, touched the table and the resident's medication cup fell on the floor and spilled on the floor. Further observation revealed Staff F, LPN wiped out the apple sauce/medication with a paper towel off the floor, came out of the room, walked to the medication cart parked between rooms [ROOM NUMBERS] and discarded the paper towel and the medication cup into the medication cart's trash can. Observation revealed Staff F left the medication cart's trash can lid opened. The medication cup revealed some left over of the controlled substance into the medication cup. On 07/11/23 at 8:50 AM, observation revealed the 400 room's hallway medication cart parked between rooms [ROOM NUMBERS]. The medication cart's trash can lid continued to be wide open. The trash can contain the medication cup with the leftover of wasted controlled substance discarded in the trash can at 8:33 AM. The cart was unattended. On 07/11/2023 at 9:10 AM, observation revealed the 400 hallway medication cart's trash can lid continued to be opened. Staff F was at the cart preparing medications. 6b. On 07/11/23 at 9:27 AM, observation revealed Resident #92 walking by the 400 rooms medication cart with the trash can lid opened. The cart was unattended. Review of Resident #92's Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 0 indicating that the resident had severe cognition (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 7 of 17 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 07/13/2023 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 0761 impairment. Level of Harm - Minimal harm or potential for actual harm On 07/11/23 at 9:57 AM, observation revealed the 400 room's hallway medication cart's trash can lid continued to be opened. Staff F was at the medication cart crushing medications. Residents Affected - Few On 07/11/23 at 9:59 AM, observation revealed Staff F, LPN, walked away from the medication cart and did not close the trash can lid that contained a left over controlled substance medication cup in it. Further observation revealed the medication cart continued to be parked unattended between residents' rooms 400-402. On 07/11/23 at 10:01 AM, observation revealed Staff F returned to the medication cart and did not close the trash can lid. Further observation revealed the DON came out of her office located in the 400 rooms hallway, walked by the medication cart parked between room [ROOM NUMBER] and 402, entered room [ROOM NUMBER] and did not close the medication cart's trash can lid. On 07/11/23 at 10:04 AM, observation revealed Staff F moved the medication cart next to the nurses station. The medication cart's trash can lid continued to be opened. On 07/11/23 at 10:10 PM, observation revealed the Consultant Pharmacist and Staff F standing by the 400 hallway's medication cart parked by the nurses station. Further observation revealed the consultant pharmacist closed the medication cart's trash can lid. Subsequently, a joint interview was conducted with the consultant pharmacist and Staff F, LPN. The consultant pharmacist was apprised the medication cart's trash can lid was observed opened since medication administration observation performed by Staff F at 8:30 AM. Staff F confirmed the lid had been open since and should have been closed. 7. On 07/12/23 at 9:43 AM, observation revealed the 400 rooms hallway's medication cart was parked, unattended between resident's room [ROOM NUMBER] and 408. Further observation revealed the medication cart's trash can lid was opened. Staff G, RN, was att he cart preparing medications. On 07/13/23 at 12:36 PM, an interview was conducted with Staff G, RN who stated she was supposed to keep the medication cart's trash can lid closed at all times. Based on review of policy and procedure, observation, interview and record review, the facility failed to secure over-the-counter (OTC) medication packets for 1 of 24 sampled residents observed during initial pool process, Resident #75; failed to secure OTC nasal spray and chest rub for 1 of 24 sampled residents observed during initial pool process, Resident #71; failed to secure an unidentified, unsecured, loose pill capsule outside of the main dining room floor in the hallway; failed to secure an unlocked and unattended medication cart for 1 of 4 medication carts on North wing, cart 300 hallway; failed to properly dispose a controlled substance during Medication Administration for Resident #83; and failed to keep the medication cart trash-can lid closed on the North wing 400 hallway. The findings included: Review of the facility policy and procedure on 07/13/23 at 10 AM, titled, Medication Storage in the Facility, revised January 2018, provided by the Director of Nursing (DON), documented, in part: In the Policy Statement: Medications and biologicals are stored safely, securely and properly, following manufacturer's recommendations or those of the supplier. The medication supply is accessible (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 8 of 17 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 07/13/2023 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. Procedures: B. Only licensed nurses, pharmacy personnel, and those lawfully authorized to administer medications (such as medications aides) permitted access medications. Medication rooms, carts, and medication supplies are locked when attended by persons with authorized access H. Outdated, contaminated, or deteriorated medications and those in containers that are cracked, soiled, or without secure closures are immediately removed from inventory, disposed of according to procedures for medication disposal 1. Resident #75 was admitted to the facility on [DATE] with diagnoses that included Alzheimer's / Dementia, Coronary Artery Disease, Psychotic Disorder, Anxiety Disorder and Anemia. He had a Brief Interview Mental Status (BIMS) score of 12, indicating moderate cognitive impairment. During an initial observational room tour on 07/10/23 at 9:30 AM, Resident #75 was observed with a total of ten (10) Over The Counter (OTC) medicaitons and supplements, in which some were opened and some unopened packets of OTC Vitamin A & D ointment at his bedside. All were with an expiration date of 05/2025. These OTC medication packets were clearly visible, unsecured and accessible to other 'wandering' residents on the locked unit, staff members and visitors. they were sitting atop the resident's bedside table and bedside dresser. Photographic Evidence Obtained. During a second observational tour conduced on 07/10/23 at 11:30 AM, Resident #75 was still observed with a total of ten (10) packets of OTC, as above, at his bedside. During a third observational tour conduced on 07/12/23 at 8:57 AM, Resident #75 was now observed with one opened and used packets of OTC Vitamin A & D ointment on his bedside table. During a brief interview with Resident #75 on 07/10/23 at 11:35 AM, the surveyor asked about the OTC medication packets on his bedside table. The resident replied that these OTC medication packets are used for his feet, and he added that they are applied by the nurses. An interview was conducted on 07/12/23 at 8:49 AM with Resident #75's nurse, Staff E, Registered Nurse (RN), regarding the OTC medication packets observed on Resident #75's bedside table, who she acknowledged the OTC medication packets should not have been there. A side-by-side record review was conducted with Staff E, in which it was not noted in either of Resident #75's hard copy chart or computerized Point-Click-Care (PCC) medical record that the resident had any self-medication assessment completed, in order for him to administer his own medications. There was no order on the Resident #75's Medication Administration Record (MAR) for this OTC medication to be administered to this resident. 2. Resident #71 was admitted to the facility on [DATE] with diagnoses which included Hypertension, Anemia, Anxiety Disorder and Depression. She had a Brief Interview Mental Status (BIMS) score of 9, indicating moderate cognitive impairment. During an initial observational room tour conducted on 07/10/23 at 10:55 AM, Resident #71 was observed with two (2) open and used OTC medications: Nasal Relief Nasal Decongestant Oxymetetazoline HCL 0.05% with an expiration date of 05/2025 and Medicated Chest Rub Topical Analgesic Cough Suppressant with no expiration date. They were observed in a porous plastic box sitting atop her bedside table. These OTC medication containers were visible, unsecured and accessible to other wandering residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 9 of 17 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 07/13/2023 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few on the locked unit, staff members and visitors, atop her bedside table and bedside dresser. Photographic Evidence Obtained. During a brief interview with Resident #71 on 07/10/23 at 11 AM, the surveyor inquired of Resident #71, regarding the OTC nasal spray and medicated chest rub on her bedside table. The resident acknowledged that the nasal drops were for her nose and that the chest rub was for her chest. During a second observational room tour conducted on 07/10/23 at 1:27 PM, Resident #71 was still observed with have two (2) open and used OTC medications: Nasal Relief Nasal Decongestant Oxymetetazoline HCL 0.05% and Medicated Chest Rub Topical Analgesic Cough Suppressant, in a porous plastic box sitting atop her bedside table. During a third observational room tour conducted on 07/11/23 at 10:26 AM, Resident #71 was observed with two (2) open and used OTC medications: Nasal Relief Nasal Decongestant Oxymetetazoline HCL 0.05% and Medicated Chest Rub Topical Analgesic Cough Suppressant, in a porous plastic box sitting atop her bedside table. During a third observational room tour conducted on 07/11/23 at 1:49 PM, Resident #71 was again observed with two (2) open and used OTC medications: Nasal Relief Nasal Decongestant Oxymetetazoline HCL 0.05% and Medicated Chest Rub Topical Analgesic Cough Suppressant, in a porous plastic box sitting atop her bedside table. During a fourth observational room tour conducted on 07/11/23 at 8:39 AM, Resident #71 was observed with two (2) open and used OTC medications: Nasal Relief Nasal Decongestant Oxymetetazoline HCL 0.05% and Medicated Chest Rub Topical Analgesic Cough Suppressant, in a porous plastic box sitting atop her bedside table. An interview was conducted on 07/12/23 at 8:52AM with Resident #71's nurse, Staff E, an RN, regarding the OTC nasal spray and medicated chest rub observed on Resident #71's bedside table. The nurse acknowledged the OTC medications should not have been there. A side-by-side record review conducted with Staff E, indicated that in neither Resident #71's hard copy chart or her computerized Point-Click-Care (PCC) medical record, that the resident had any self-assessment completed in order for her to be able to administer her own medications. There was no order on the Resident #71's Medication Administration Record (MAR) for this OTC medication to be administered to this resident. The container of OTC nasal spray and the medicated chest rub were not removed from this resident's bedside, until after surveyor inquisition. 3. On 07/10/23 at 1:06 PM, during an observational facility tour, it was noted that there was an unidentified, unsecured, loose cream-colored pill capsule on floor just outside main dining room on the floor in the hallway at lunch time. This unidentified, unsecured, loose cream-colored pill capsule was clearly visible, unsecured and accessible to other wandering residents on the locked unit, staff members and visitors. This surveyor briefly interviewed the Director Of Nursing (DON) who acknowledged the pill capsule should not have been there, should have been secured, and it was not. Photographic Evidence Obtained. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 10 of 17 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 07/13/2023 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 4. On 07/12/23 at 10:30 AM, during an observational facility tour, it was noted by two (2) nurse surveyors, that the medication cart on the North wing 300 hallway was left unlocked, unattended, unsecured, and accessible to other wandering residents on the locked unit, staff members and visitors. Photographic Evidence Obtained. On 07/12/23 at 8:41 AM, the Director of Nursing (DON) further acknowledged and recognized that the OTC medications should not have been left at either of the residents' bedsides, the unidentified, loose pill capsule should not have been left in the main hallway dining room unsecured and the medication cart should have been locked at all times. This was not done. Event ID: Facility ID: 105680 If continuation sheet Page 11 of 17 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 07/13/2023 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 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on interviews and record review, the facility failed to have a qualified Registered Dietitian to supervise and monitor the Dietetic Technician Register (DTR) scope of practice for high nutritional risk residents for 2 of 2 sampled residents reviewed for tube feeding initial assessments, Resident #251 and Resident #42. The findings included: A review of the Academy of Nutrition and Dietetics: Scope of Practice for the Dietetic Technician, Registered (DTRs) dated June 2013, showed, in part, the following: For DTRs, the scope of practice focuses on food and nutrition and related services provided by DTRs who work under the supervision of an RD when in direct patient / client nutrition care, and who may work independently in providing general nutrition education to healthy populations, consulting to foodservice business and industry, conducting nutrient analysis, data collection and research, and managing food and nutrition services in a variety of settings (https://www.jandonline.org/article/S2212-2672(12)01935-1/fulltext). Record review showed that Resident #251 was on tube feeding as the primary source of nutrition. Further review of the Nutritional Evaluation Initial Assessment, completed on 07/06/23 with estimated nutritional needs, revealed it was completed by the Registered Dietary Technician. Record review showed that Resident #42 was on tube feedings for nutirition. Further review of the Nutritional Evaluation Initial Assessment, completed on 05/15/23 with estimated nutritional needs, revealed it was completed by the Registered Dietary Technician. In an interview with the facility's Registered Dietary Technician on 07/12/23 at 9:02 AM, she stated that they do not have a Registered Dietitian. She can complete most of the assessment and the progress notes but feels uncomfortable completing any Initial Nutrition Assessments or the Reassessment of any high nutritional risk residents on tube feeding. When asked why, she said, It is not within my scope of practice. She further said she felt uncomfortable completing the estimated nutritional needs part of the above assessments. She said they had a Registered Dietitian, but they left last month. According to the Registered Dietary Technician, she sometimes consults with another Registered Dietitian working at another sister facility. When asked if she was the one who completed and signed the Nutritional Evaluation Initial with recommended estimated needs for Resident #251 and Resident #42, she said yes. An interview with the Administrator was conducted on 07/12/23 at 12:09 PM who stated that he is aware of the need for a Registered Dietitian that can overlook and monitor the Diet Technician assessments. He further said they are actively looking to fill the position at this facility. According to the Administrator, the Registered Dietitian working at the other sister facility may be unable to help at times. An interview was conducted on 07/14/23 with the Director of Nursing and she was made aware of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 12 of 17 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 07/13/2023 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** Based on observations, interviews, and record review, the facility failed to ensure that a system was in place to ensure residents received the correct enhanced food items on their meal trays as per physicians' orders during dining observations for 3 of 3 sampled residents observed, Resident #13, Resident #23 and Resident #25. The findings included: A review of the facility's recipe book showed they have four food items that may be used as Enhanced foods: Enhanced Pudding, Enhanced Potatoes, Enhanced Cereal, and Enhanced Scrambled Eggs. 1. Record review showed Resident #13 was admitted to the facility on [DATE]; and had a physician order for an enhanced diet, pureed texture, dated 10/05/20. In an observation conducted on 07/11/23 at 8:31 AM, Resident #13 was noted in her room with her breakfast tray. Closer observation showed a tray with a meal ticket for Enhanced Pureed. The tray was noted with different types of pureed texture food items, but no identification was noted on which food item was the enhanced food for that meal. 2. A chart review showed Resident #23 was admitted to the facility on [DATE]; and had a physician order for an enhanced diet, and regular texture, dated 07/15/21. In an observation conducted on 07/10/23 at 12:55 PM, Resident #23 was noted in her room with her lunch tray. Closer observation showed a tray with a meal ticket for enhanced regular. The tray was noted with different types of regular-texture food items, but no identification was noted on which food item was the enhanced food for that meal. 3. Record review showed Resident #25 was readmitted to the facility on [DATE]; and had a physician order for an enhanced diet, pureed texture, dated 02/02/23. In an observation conducted on 07/10/23 at 1:11 PM, Resident #25 was noted in her room with her lunch tray. Closer observation showed a tray with a meal ticket for enhanced pureed foods. The tray was noted with different types of pureed food items, but no identification was noted on which food item was the enhanced food for that meal. In an interview conducted on 07/11/23 at 8:20 AM with the facility's Register Dietary Technician, she was asked as to what food was enhanced for the breakfast meal this morning. She stated that the eggs this morning were enhanced on the meal trays. In an interview conducted on 07/11/23 at 8:28 AM with Staff J, Cook, he was asked as to what food was enhanced for the breakfast meal this morning. He reported that it was the cream of wheat that was enhanced and that he made two types of cream of wheat. One type is the regular cream of wheat, and the other is the enhanced cream of wheat. He was then asked if it is labeled as enhanced when it is placed on the meal trays, and he said no. According to Staff J, he makes sure to check which cream of wheat is Enhanced and which one is the regular cream of wheat. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 13 of 17 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 07/13/2023 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 In an interview conducted on 07/12/23 at 9:02 AM with the facility's Register Dietary Technician, she said that for the Enhanced food items, it is usually the hot cereal in the morning that is enhanced. For lunch, it is mashed potatoes or mac and cheese, and for dinner, it is the same two options. She was asked if they have a specific meal plan that was completed as to what type of enhanced food is picked on that particular day, and she said no. Residents Affected - Few In an interview conducted on 07/14/23 with the Director of Nursing, she was told of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 14 of 17 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 07/13/2023 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and chart review, facility staff failed to practice adequate hand hygiene for 2 of 2 sampled residents during dining observations, Resident #13 and Resident #6. The findings included: Review of the facility policy, titled, Dietary, revised on 09/18/2018, showed that Staff must sanitize before passing each tray and wash hands before delivering the next tray if they have handled room items or Resident clothing. 1. Record review showed Resident #13 was admitted on [DATE] with diagnoses that included Dementia and Cerebral Atherosclerosis. The care plan dated 07/10/23 revealed that Resident #13 is rarely understood. The Quarterly Minimum Data Set (MDS) dated [DATE] showed that under section G for eating, Resident #13 needs extensive assistance with one-person physical assistance. In an observation conducted on 07/10/23 at 12:50 PM in the memory lock unit, Resident #13 was noted in her room. Continued observation showed Staff A, Certified Nursing Assistant (CNA), looking at her private cell phone in the hallway. She then returned the phone to her pocket and entered Resident #113's room. She touched the curtains, the chair, and the head of the bed with her dirty bare hands. She proceeded to step outside the room and grabbed Resident #13 meal tray, and took it into Resident #113's room. Staff A sat near Resident #13 and assisted her with her lunch meal. During the observation, Staff A did not use hand sanitizer or hand washing before assisting the resident with her meal. 2. Record review showed that Resident #6 was admitted on [DATE] with diagnoses that included Dementia and Depressive Disorder. The Annual Minimum Data Set (MDS) dated [DATE] showed that under section G for eating, Resident #6 needs extensive assistance with one-person physical assistance. In an observation conducted on 07/11/23 at 5:19 PM, Resident #6 was in her bed. Staff B, Certified Nursing Assistant (CNA), was observed walking into Resident #6's room and placing the dinner tray on the side table. She was observed adjusting the side table and picking up a chair from the corner of the room, and placing it near Resident #6. Staff B then touched her hair and continued to touch the food items and the silverware on the tray. Staff B started feeding Resident #6 her dinner meal. Staff B did not use hand sanitizer or wash her hands during this observation. An interview was conducted on 07/13/23 at 9:25 AM with Staff H, Certified Nursing Assistant (CNA), who stated she was educated on using a hand sanitizer or handwashing during meal delivery last week. She was told to wash her hands between 2 to 3 tray deliveries. Staff H further said that if she touches any items in the residents' rooms, she would also clean her hands. An interview was conducted on 07/13/23 at 9:33 AM, Staff I, Certified Nursing Assistant (CNA), who stated she was educated on using a hand sanitizer or handwashing during meal delivery. She further noted that when the meal carts arrive on the unit, she would use a hand sanitizer before taking the trays into the rooms. An interview was conducted on 07/14/23 with the Director of Nursing, who was made aware of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 15 of 17 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 07/13/2023 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 findings. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 16 of 17 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 07/13/2023 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 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure that the binding arbitration agreement explicitly granted the resident or their representative the right to rescind the contract within 30 calendar days of signing it for 3 of 3 sampled residents reviewed for arbitration agreements, Resident #61, Resident #38, and Resident #399. Residents Affected - Few The findings included: 1. Record review showed that Resident #61 was admitted to the facility on [DATE] and that she had entered into a binding arbitration agreement. Further review showed that the agreement needed to be signed and dated by Resident #61. Review of the Quarterly Minimum Data Set (MDS) dated [DATE] showed that Resident #61 has a Brief Interview of Mental Status (BIMS) score of 05, which indicated moderate to severe cognitive impairment. Review of the arbitration agreement that the facility provided did not show that the resident / family had the right to rescind the contract within 30 calendar days of signing it. 2. Record review showed that Resident #38 was admitted to the facility on [DATE] and that she had entered into a binding arbitration agreement. Further review showed that Resident #38's daughter had signed the agreement. Review of the arbitration agreement that the facility provided did not show that the resident / family had the right to rescind the contract within 30 calendar days of signing it. 3. Record review showed that Resident #399 was admitted to the facility on [DATE] and that she entered into a binding arbitration agreement. Further review showed that the agreement was signed by Resident #399's representative. Review of the arbitration agreement that the facility provided did not show that the resident / family had the right to rescind the agreement within 30 calendar days of signing it. An interview was conducted on 07/12/23 at 2:00 PM, the facility's Administrator who stated that the arbitration agreement is part of the admission packet. He further noted that it is an agreement that lets the residents know of the options and care areas that are available to them. In an interview conducted on 07/12/23 at 3:32 PM, the admission Director stated that the arbitration contract is part of the admission packet. She explains to the residents and their families that if they have an issue with the facility, it will be done internally, using their lawyers if they want to sue the company. A signed copy is then given to the resident / family, and one is kept in the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105680 If continuation sheet Page 17 of 17