Health inspection·December 7, 2023

F 0677 12/1/23 indicated a weight of 123.4 pounds. Level of Harm - Minimal harm or potential for actual harm A new weight was requested by the Surveyor, which showed that Resident #41 was 118.5 pounds. This showed a total weight loss of approximately 10 pounds in one month. Residents Affected - Few A progress note dated 12/4/23 revealed that Resident #41 was admitted to restorative dining and staff will continue to encourage Resident #41 to eat. The Care Plan dated 10/07/23 revealed that Resident #41 is at nutritional risk related to variable intake of meals with a history of Dysphagia and mechanically altered diet. A review of the percentage meal intake for Resident #41 revealed that on 12/04/23, it was documented that she ate 51 percent to 75 percent of her breakfast meal, which was different from what was observed. Further review revealed that on 12/06/23, Resident #41 consumed 0 to 25 percent of her breakfast meal. In an interview on 12/07/23 at 1:00 PM, the full-time MDS Coordinator stated that Resident #41 is coded under section 3 for eating and needing partial to moderate assistance during dining. This means that staff must always sit near the residents to help them cut the food, encourage them, and open containers. He codes residents based on therapy assessments; his interviews with the nursing team, and any observations of the residents. When asked what the difference is between set up and partial to moderate assistance, he stated that you need to be in the room to help Resident #41 with her meals. During an interview conducted on 12/07/23 at 2:00 PM with Staff D, Certified Nursing Assistant (CNA), she stated that she is familiar with Resident #41. When asked if Resident #41 needs assistance with dining, she said she needs to be fed; if she does not get fed, she will not feed herself and look at the food. When asked how long the resident needed to be fed, she said it has been at least a few weeks. In an interview conducted on 12/07/23 at 3:00 PM with the facility ' s Administrator, she was informed of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105685 If continuation sheet Page 2 of 13 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 105685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Menorah House 9945 Central Park Blvd N Boca Raton, FL 33428 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 provide needed care and services for residents with skin conditions for 5 of 5 sampled residents reviewed for skin conditions (Resident #13, #20, #34, #56, and #35). Residents Affected - Some The findings included: 1. An observation was conducted of Resident #13 on 12/04/23 at 12:30 PM. The resident was observed sitting in a wheelchair in the hallway outside of her room. The resident was observed scratching her arms. An interview was conducted with the resident at the time of the observation. Resident #13 stated she has been itching for months without any relief. The resident stated they (staff) were giving her some kind of cream, but it was not working. The resident proceeded to show the surveyor a rash/red lesions on both arms, legs, and feet. The resident could not recall if she had seen a dermatologist, but stated something has to be done about it. The resident further stated her old roommate (Resident #20) has the same thing, but worse. Record review revealed Resident #13 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident was cognitively intact and was a total two-person assist for activities of daily living. Resident #13 was care planned for a rash of the peritoneal area related to fungal infection dated 09/28/23. An intervention included to monitor skin rashes for increased spread or signs of infection. A review of Resident #13's orders revealed the following orders: 07/21/23 - Dermatology appointment 09/25/23 - Clotrimazole Cream 1% (antifungal) apply topically two times a day for fungal skin for 3 weeks. 10/02/23 - Clotrimazole Cream 1% apply topically to perineum two times a day for fungal rash for 3 weeks. 10/02/23 - Fluconazole tablet 150 mg (antifungal) one tablet a day for infection for 10 days. 10/21/23 - Elemite External Cream 5% (scabies treatment) apply topically to whole body one time for 10 hours for rash. 10/30/23 - Permethrin External Cream apply to whole body topically 1 time only for rash for 1 day. 11/01/23 - Permethrin External Cream apply to whole body topically 1 time only for rash for 1 day. 11/130/23 - Nystatin-Triamcinolone Cream (antifungal) apply to left and right foot topically two times a day for rash for 14 days. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105685 If continuation sheet Page 3 of 13 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 105685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Menorah House 9945 Central Park Blvd N Boca Raton, FL 33428 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 11/30/23 - Nystatin External Powder (antifungal) apply to right breast fold, left breast fold, and perineum topically every 8 hours for rash for 14 days. A review of Resident #13's Medication Administration Record revealed the resident was administered the Elimite Cream on 10/23/23. The resident was not administered the Elimite Cream on 10/30/23 or 11/01/23. There was no documentation of communication to the physician of the medication not administered. Further review of Resident #13's record revealed no documentation of the resident being seen by a dermatologist. An interview was conducted with the Director of Nursing (DON) on 12/07/23 at 12:00 PM. The DON acknowledged the above. 2. An interview was conducted with Resident #20 on 12/04/23 at 1:00 PM. The resident stated she had an itchy skin rash for a long time. The resident stated she had not seen a dermatologist but would like to. Resident #20 stated it was frustrating and annoying due to the fact she could only use her right hand to scratch. The resident's right arm was noted with red patches. Record review revealed Resident #20 was admitted to the facility on [DATE] with diagnoses including Stroke and contracture of the left upper extremity. A comprehensive assessment dated [DATE] documented the resident as cognitively intact with upper extremity impairment of one side. Resident #20 was not care planned for any skin issues. A review of Resident #20's orders revealed the following: 05/02/23 - Permethrin External Cream 5 % Apply to Head to Toe topically one time only for Scabies until 05/03/2023 - 07:00 Apply to entire Body except eyes and peri area. 05/02/23 - Wash and shower entire body one time only until 05/03/2023 05/02/23 - Contact Isolation Precaution/ Scabies (discontinued 05/04/23) 10/21/23 - Elemite External Cream 5% (scabies treatment) apply topically to whole body one time for 10 hours for rash. 10/24/23 - Elemite External Cream 5% (scabies treatment) apply topically to whole body one time for 10 hours for rash. A review of Resident #20's Medication Administration Record revealed the resident was administered the Elimite Cream on 10/24/23 and 10/28/23. Further review of Resident #20's records revealed the resident did not have a dermatology consult and had not seen a dermatologist. There was no evidence of a follow-up on the resident's rash/condition. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105685 If continuation sheet Page 4 of 13 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 105685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Menorah House 9945 Central Park Blvd N Boca Raton, FL 33428 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some An interview was conducted with the Director of Nursing (DON) on 12/07/23 at 12:00 PM. The DON acknowledged the concerns. 3. An interview was conducted with Resident #34 on 12/04/23 at 3:40 PM. The resident stated he has a rash on both arms and complains of itching. Resident #34 stated he had not seen a dermatologist but would like to. The resident further stated he sees everyone in the dining area scratching. There must be something going around. The resident stated his roommate (Resident #56) was worse. Record review revealed a comprehensive assessment dated [DATE] documented the resident was cognitively intact and required set-up only for activities of daily living. Resident #34 was not care planned for any skin conditions. A review of Resident #34's orders revealed the resident was not receiving any medication for a skin rash and did not have a dermatology consult. An interview was conducted with the Director of Nursing (DON) on 12/07/23 at 12:00 PM. The DON acknowledged the above. 4. An interview was conducted with Resident #56 on 12/04/23 at 3:50 PM. The resident stated he had been itching for approximately three weeks. The resident stated they started giving him some pills and it is better, but he would still like to see a dermatologist. Record review revealed Resident #56 was admitted to the facility on [DATE]. A comprehensive assessment dated [DATE] documented the resident was cognitively intact. A review of Resident #56's orders revealed the following: 10/16/23 - Diphenhydramine HCl Oral Tablet 25 MG Give 1 tablet by mouth every 8 hours as needed for Itchy. 10/16/23 - Permethrin External Cream 5 % Apply to all body topically one time only for Itchy. Use the tube to cover all body for 1 Day. Leave the cream for 8 Hrs. Give resident a shower @ 6 AM. 10/16/23 - Hydroxyzine HCl Oral Tablet 10 MG Give 1 tablet by mouth two times a day for Pruritus (itching). 11/30/23 - Lotrimin AF Cream 1 % Apply to both upper extremities topically everyday shift for pruritus until 12/15/2023. Apply sparingly to both arms. A review of Resident #56's Medication Administration Record revealed the resident was administered the Permethrin Cream on 10/16/23. Further review of Resident #56's records revealed the resident did not have a dermatology consult and had not seen a dermatologist. There was no evidence of a follow-up on the resident's rash/condition. An interview was conducted with the Director of Nursing (DON) on 12/07/23 at 12:00 PM. The DON acknowledged the above. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105685 If continuation sheet Page 5 of 13 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 105685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Menorah House 9945 Central Park Blvd N Boca Raton, FL 33428 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 5. A review of the policy titled Scabies Identification, Treatment, and Environmental Cleaning, revised on 08/21/23, showed the following: Diagnosis may be established by recovering the mite from its burrow and identifying it microscopically. Failure to identify scrapings as positive does not necessarily exclude the diagnosis. It is difficult to obtain a positive scraping because only one or two mites may cause multiple lesions. Often, diagnosis is made from signs and symptoms, and treatment is followed without scrapings, although scrapings are preferred. The facility will follow the primary physician's discretion on treatment and management. Resident #35 was admitted to the facility on [DATE] with diagnoses of Anemia, Depression, and Hypokalemia. The Quarterly Minimum Data Set (MDS) dated [DATE] showed that Resident #35 has a Brief Interview of Mental Status (BIMS) score of 15, which is cognitively intact. In an interview conducted on 12/05/23 at 1:10 AM with Resident #35, she stated that she first had symptoms of itching and scratching, which started 6-8 months ago. The in-house Dermatologist treated her for the first time when the initial symptoms began. She was given a white cream for 8-10 hours to be used only once and was treated again in October of 2023 by the in-house Dermatologist, and the same treatment was done earlier with the white cream. The symptoms never went away, and she only saw the in-house Dermatologist twice in 6-8 months. She further said that she could not sleep at night and was itching and scratching. She showed the Surveyor the bites all over her legs, back, and even the bottom of her feet. The Surveyor asked Resident #35 if skin scraping had ever been done, and she said no. In an interview conducted on 12/05/23 at 1:25 PM with Resident #35's husband, he stated that his wife has been suffering from a rash all over her body for months and that he asked the Director of Nursing for an outside Dermatologist to see his wife. The Director of Nursing told him that his wife needed to see another dermatologist since the rash and the itching did not go away, but his wife did not see another Dermatologist, and the issue has not been resolved. In an interview conducted on 12/05/23 at 2:11 PM with the Director of Nursing, he stated that they decided to move forward by looking for another in-house dermatologist and keeping the current one until they get another dermatologist. They had some issues with the in-house Dermatologist, and this is why the Medical Director stepped in and told the facility that he would see the residents who had skin issues. A Progress note dated 05/02/23 showed that Resident #35 was informed that she was exposed to a resident that had scabies and, therefore, she would be placed in isolation. A review of the medical chart showed a prescription note dated 05/03/23, which was prescribed by the in-house Dermatologist for Elimite (treatment cream for scabies) to be applied to the body and washed off after 10 hours and repeated after five days. The Medication Administration Record showed that the cream was applied once on Resident #35 but was not repeated after five days as prescribed by the in-house Dermatologist. Further review did not show any follow-up notes by the in-house Dermatologist regarding the continued symptoms of itching and scratching and treatments that Resident #35 had. Continued electronic chart review showed that Resident #35's Primary Doctor ordered Elimite to the entire body, which was dated 10/21/23, and was called again on 10/26/23. Another note by the Primary Physicians, dated 11/29/23, showed that Resident #35 had a rash on the upper chest and back. He prescribed Hydrocortisone Cream (general cream for itching) and Benadryl (treats pain and itching). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105685 If continuation sheet Page 6 of 13 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 105685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Menorah House 9945 Central Park Blvd N Boca Raton, FL 33428 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide equipment assessed as needed by therapy for 1 of 3 sampled residents reviewed for falls (Resident #297). The findings included: Resident #297 was admitted to the facility on [DATE] with diagnoses including Stroke and Diabetes. Record review revealed a comprehensive assessment dated [DATE] that documented the resident had severe cognitive impairment and required substantial/maximal assistance with activities of daily living. A review of Resident #297's record revealed a care plan for the resident, as at risk for falls, related to episodes of incontinence, impaired mobility, and medication side effects. The resident was further care planned for the need of assistance with activities of daily living care related to multiple factors including right sided weakness and decreased mobility. Record review revealed Resident #297 had a fall out of bed with injury on 10/18/23, which required hospitalization. An interview was conducted with the Director of Nursing (DON) on 12/06/23 at 1:30 PM related to Resident #297's family's request for bedrails. The DON stated the rehabilitation (rehab) would assess a resident for the need of a side rail, and a physician order was needed for two side rails. An interview was conducted with the Rehab Director on 12/07/23 at 10:30 AM. The Rehab Director stated when a resident initially comes into the facility, they determine if a resident would benefit from a side rail using the Restorative Bed Rail Observation form. If so, would communicate with maintenance using a communication log kept in therapy. Maintenance would install the side rail. A side-by-side review with the Rehab Director of the Restorative Bed Rail Observation form for Resident #297 dated 09/20/23 revealed the resident could benefit from the use of right-side enabler (side rail) to assist with functional mobility skills. An assessment of the resident post readmission dated 10/27/23 documented the same. A side-by-side review of the maintenance communication log was conducted with the Rehab Director. The maintenance log documented a request for a right-side rail dated 10/27/23, after Resident #297's readmission to the facility post fall. The Rehab Director confirmed there was no communication of the resident's need for a side rail documented in the maintenance communication log for the resident's initial assessment dated [DATE]. The Rehab Director stated they may have given verbal instructions to maintenance for Resident #297's initial request for side rail, as she believed the resident had a side rail. The Director further stated that the resident would have been coded for having a side rail in the initial comprehensive assessment, or the DON would know how to tell if Resident #297 had a side rail on the bed as initially assessed. An interview was conducted with the Minimum Data Set (MDS) Coordinator on 12/07/23 at 10:50 AM. The MDS Coordinator stated he was the one responsible for Resident #297's comprehensive assessments. The MDS Coordinator further stated side rails were not documented in the comprehensive assessments. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105685 If continuation sheet Page 7 of 13 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 105685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Menorah House 9945 Central Park Blvd N Boca Raton, FL 33428 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An interview was conducted with the Director of Nursing (DON) on 12/07/23 at 11:00 AM. The DON stated a resident would be documented as having a side rail in the comprehensive assessment, and rehab was responsible for initiating, providing, and documenting side rails. A subsequent interview was conducted with the Rehab Director in the presence of the DON. The Rehab Director stated again they assess new residents for the need/benefit of side rails. Maintenance was responsible for providing the side rails. They put the request in the maintenance logbook. The Rehab Director further confirmed Resident #297 did not have a request in the maintenance logbook for 09/23. An interview was conducted with the Maintenance Director on 12/07/23 at 2:00 PM. The Maintenance Director stated he gets requests from therapy for side rails by the maintenance log in therapy. Once he provides the side rails, he writes done next to the request. The Maintenance Director further stated if a verbal request was made, he would still write the resident's name and that it was done in the maintenance log. If the request for side rails was not in the maintenance logbook, the resident did not receive side rails. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105685 If continuation sheet Page 8 of 13 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 105685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Menorah House 9945 Central Park Blvd N Boca Raton, FL 33428 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation and record review, the facility failed to provide appropriate care to prevent urinary tract infections during perineal/foley care for 1 of 1 sampled resident reviewed for Catheter Care (Residents #32). The findings included: Review of the facility's procedure for foley catheter care provided by the Infection Preventionist documented .the catheter-meatal junction is a significant portal of entry for bacteria into the urinary tract, potentially causing urinary tract infections .provide privacy. Draw cubicle curtains completely around the resident's unit .starting at the catheter-meatal junction, wash tubing using friction and circular motion outward to the surrounding perineum. Always work from the area of least contamination to areas of more contamination and always from front to back . Review of Resident #32's clinical record documented an admission to the facility on [DATE] and a readmission on [DATE]. The resident's diagnoses included Chronic Kidney Disease, Abnormalities of Gait and Mobility, Atrial Fibrillation, Mild Cognitive Impairment, Benign Prostatic Hyperplasia, Cognitive Communication Deficit, Obstructive and Reflux Uropathy. Review of Resident #32's Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 4 indicating that the resident had severe cognition impairment. The assessment documented under Functional Status that the resident requires total assistance from the staff to complete his toileting activities. Review of Resident #32's care plan titled, Resident #32 has a foley Catheter related to bph (Benign Prostatic Hyperplasia,) initiated on 01/27/23 with a revision date on 01/27/23. Review of Resident #32's physician's order dated 08/26/23 documented re-insert indwelling foley catheter . Review of Resident #32's physician's order dated 02/06/23 documented Indwelling catheter care every shift. On 12/04/23 at 11:43 AM, observation revealed Resident #32 lying in bed with a foley catheter leg bag in place and clear yellow urine noted in the bag. On 12/06/23 at 8:54 AM, an interview was conducted with Staff H , Licensed Practical Nurse (LPN) who stated Resident #32 had a foley catheter and that the Certified Nursing Assistants (CNA) were responsible to provide catheter care. Staff H stated the resident had a diagnosis of Benign Hyperplasia Prostate. On 12/06/23 at 9:45 AM, an interview was conducted with Staff A, CNA who stated she was assigned to care for Resident #32 and that she will be giving him a shower. Staff A was informed that as part of the survey process, Resident #32 was selected for perineal/Foley catheter care observation. Staff A stated that she will provide the care around 10:30 AM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105685 If continuation sheet Page 9 of 13 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 105685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Menorah House 9945 Central Park Blvd N Boca Raton, FL 33428 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 12/06/23 at 10:41 AM, perineal/foley catheter care observation for Resident #32 performed by Staff A, CNA commenced. Observation revealed the resident's privacy (cubicle) curtains were not drawn; and blinds were open during the catheter care. Observation revealed a large urinary drainage bag covered by a privacy linen by the resident's left side of the bed. The bag contained approximately 300 cc of yellow urine. Observation revealed Staff A performed hand washing, retrieved a basin with water and donned gloves. Observation revealed Staff A, with one damped wash cloth, cleaned Resident #32's inguinal (between the legs) left and right area with one stroke down from top to bottom with the same wash cloth. Further observation revealed Staff A continued using the same wash cloth to clean the residents thighs and again wiped the inguinal/peri areas with up and down strokes breaking the infection control measures. Furthermore, observation revealed Staff A retrieved a clean wash cloth, pulled back the resident's foreskin, cleaned the area and then with the same wash cloth and without using a different area of the cloth, cleaned the catheter tubing straight down. Continuing observation revealed Staff A retrieved an alcohol pad and cleaned the foley catheter tubing port and connected a foley leg bag around the residents leg. During the observation, at 10:55 AM, the Maintenance Director knocked at the resident's door and without waiting for an answer form Staff A, he opened the door. Resident #32 was exposed, privacy curtains were not pulled, and he was covered with a sheet, privacy was not provided. Staff A was asked when she will do the resident's bottom and stated she will do it in the shower. At 11:01 AM, observation revealed Staff A, CNA assisted Resident #32 to the in room shower. The resident foley catheter tubing was connected to a leg bag attached to his leg. Observation revealed that Staff A disconnected the resident's foley leg bag and stated that she did not want the leg bag straps to get wet because it can cause skin itching. Staff A proceeded to provide the resident with his shower. Staff A left Resident #32's foley catheter disconnected and hanging down while he was sitting in a shower chair getting a shower. The foley tubing was disconnected from the bag from 11:01 AM to 11:16 AM and was exposed to potential infection. During the observation, Staff A stated that normally she pulls the privacy curtain but did not because the surveyor was in the room. Staff A confirmed the Maintenance Director opened the door. Staff A was apprised that Resident #32 was exposed to the Maintenance Director when he opened the door, and the resident was uncovered and the privacy curtain was not drawn/closed. Staff A stated that for pericare she used two wash cloths, one to clean the inguinal area, the legs and another cloth to do the penis and the tubing. On 12/06/23 at 11:34 AM, an interview was conducted with the Unit Manager and was apprised of the peri/foley catheter care observation's findings. A side by side review of the facility's foley care procedure was conducted with the Unit Manager. On 12/07/23 at 1:02 PM, a joint interview was conducted with the Infection Preventionist/Staff Development Educator and Staff A, CNA. Staff A stated that normally when a resident who has a foley catheter needs a shower, she brings the resident with the drainage bag connected to the catheter into the shower to provide a shower. Staff A stated that she was stressed-out because of the observation. Staff A stated that she cleaned the foley catheter tubing end (port) with the alcohol pad. The Infection Preventionist/Staff Development Educator stated that Staff A was to cleaned the tip of the urine bag tubing and not the foley catheter tubing port. The Infection Preventionist/Staff Development Educator stated the foley catheter had to be connected to the drainage bag not left open/disconnected from the bag while Staff A was providing the shower. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105685 If continuation sheet Page 10 of 13 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 105685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Menorah House 9945 Central Park Blvd N Boca Raton, FL 33428 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 reviews, the facility failed to follow the Physician's tube feeding orders for 1 of 2 residents reviewed for tube feeding (Resident #81). The findings included: A chart review showed that Resident #81 was readmitted on [DATE] with a history of Motor Vehicle Accidents resulting in multiple fractures. Resident #81 was hospitalized for three months prior to her transfer to this facility. The Order Summary Report showed the following: Regular diet, pureed texture, thin consistency for the breakfast meal tray only, which was dated 11/15/23, Enteral feeding with Jevity 1.5 (tube feeding formulary type) at 65 milliliters (ml) an hour for 20 hours to start at 10:00 AM and stopped at 6:00 AM which was dated 11/06/23. A review of Resident #81 Minimum Data Set (MDS) admission assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 0, indicating that the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed total assistance from the staff to complete the activities of daily living. In an observation conducted on 12/04/23 at 12:48 PM, Resident # 81 was in her room alone, in bed, sitting in a 90-degree position, and eating a pureed diet. Further observation revealed that the tube feeding Jevity 1.5 was running at 65 ml while Resident #81 was eating her lunch tray. In an observation conducted on 12/05/23 at 3:25 PM, Resident #81 was noted in her bed with the tube feeding on hold. Resident #81's mother, who was at the bedside, stated that she paused the tube feeding to give her daughter some juice. She further noted that Resident #81 was allowed to eat breakfast alone but needed the Speech Therapist to be with her while she ate lunch. In an observation conducted on 12/06/23 at 8:42 AM, Resident #81 was noted in her room with no tube feeding running. At 8:50 AM, staff came into the room with the breakfast tray, which showed a meal ticket for a Pureed diet. Continued observation at 9:10 AM showed that Resident #81 ate a few bites of her breakfast tray. On 12/06/23 at 10:00 AM, an observation showed Resident #81 in her bed with no tube feeding running. On 12/06/23 at 11:30 AM, an observation showed Resident #81 in her bed with no tube feeding running. An observation conducted on 12/06/23 at 1:03 showed that Resident #81 was noted in her room with the tube feeding Jevity 1.5 running at 65 ml an hour. The tube feeding bottle showed that it was started on 12/06/23 at 12:20 PM. The tube feeding bottle was noted at the 1000 ml mark out of a 1000 ml capacity bottle. An interview was conducted on 12/06/23 at 1:10 PM with Staff C, Licensed Practical Nurse, who stated that Resident #81 tolerates her tube feeding well and runs for about 20 hours daily with no issues. It may be stopped during mealtimes and as needed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105685 If continuation sheet Page 11 of 13 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 105685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Menorah House 9945 Central Park Blvd N Boca Raton, FL 33428 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 In an observation conducted on 12/06/23 at 6:30 PM, Resident #81 was noted in her room with the tube feeding running at 65 ml an hour. The tube feeding bag showed that it was started on 12/06/23 at 12:20 PM. The closer review showed that the tube feeding was at the 850 ml mark out of a 1000 ml capacity bottle. This showed that only 150 ml was delivered in 6 hours and not the 390 ml that should have been administered according to Physicians' orders. Residents Affected - Few In an observation conducted on 12/07/23 at 8:50 AM, Resident #81 was noted in the room with her breakfast tray. Resident #81's mother, who was also at the bedside, stated that her daughter eats about 50 to 80 percent of her breakfast meals and gets a mechanical soft diet consistency for lunch but only during trials done with the Speech Therapist. A progress note dated 11/15/23 revealed the following: The speech therapist (ST) recommended at this time that the patient be at liberty for the pleasure of eating puree and thin liquids with the family. The mother has been educated on safe swallow strategies and is able to reteach/return demo strategies when assisting the patient. Resident #81 is not to receive meal trays from the kitchen and is on trials of mechanical soft consistencies to continue with ST only during dysphagia treatment. In an interview conducted on 12/07/23 at 10:38 AM, the full-time ST reported that when Resident #81 was admitted , she was on tube feeding only. After doing swallow exercises and oral motor exercises, she could manage her secretion and swallow on command. Resident #81 was then started on pureed food trials, and a Modified Barium Swallow Study (MBS) was done on 11/13/23. According to the MBS results, Resident #81 was placed on a mechanical soft diet for breakfast but tired towards the middle of the meal. The ST decided to discontinue that order and place Resident #81 on pleasure foods like pudding, but it is not for hydration or meeting any nutritional needs. The ST further stated that this past Monday, Resident #81 was started on a breakfast meal of a pureed diet, and during ST treatments, she gets trials of mechanical soft meals. When asked by the surveyor if it was okay for Resident #81 to eat her lunch while the tube feeding was running, she said, It may be okay. The ST stated that she tries to do her trials of mechanical soft consistency to not interfere with Resident #81's tube feeding scheduled times. When asked if she knew Resident #81's scheduled tube feeding times, she did not know. The Speech Therapist reported that the goal is to decrease tube feeding and slowly provide more meals by mouth. A Dietary progress note dated 11/06/23 showed a slow progressive weight decline, and it was recommended to increase the tube feeding to 65 ml an hour for 20 hours. An interview was conducted on 12/07/23 at 11:53 AM with the facility's clinical dietitian, who stated that she adjusted the tube feeding times to allow Resident #81 to be hungry enough to eat her breakfast meal. This is why the tube feeding was changed to stop at 6:00 AM and to restart at 10:00 AM. Staff told her that Resident #81 tolerates her pureed diet well but did not give her any specific percentage intake of the meals. According to the Dietitian, she will only reduce the tube feeding rate if she has a more accurate percent intake of Resident #81's meals and meets her nutritional needs by mouth to proceed further with making the tube feeding changes. An interview conducted on 12/07/23 at noon with Staff A, Certified Nursing Assistants, states that Resident #81 only eats about 25% of her breakfast meals. An interview conducted on 12/07/23 at 12:10 PM with Staff B, Certified Nursing Assistants, states that Resident #81 only eats about 30% of her breakfast meals. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105685 If continuation sheet Page 12 of 13 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 105685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Menorah House 9945 Central Park Blvd N Boca Raton, FL 33428 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 The percentage intake of meals documented by staff from 12/04/23 to 12/06/23 did not show any percentage intake for the breakfast meals for Resident #81. In an interview conducted on 12/07/23 at 3:00 PM with the facility ' s Administrator, she was told of the findings. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105685 If continuation sheet Page 13 of 13