Health inspection·June 8, 2023

F 0584 switches (2) were noted to be broken, and over-bed light pull cord was missing from A-bed. Level of Harm - Minimal harm or potential for actual harm room [ROOM NUMBER]: The room walls were noted to be damaged and in disrepair, and bathroom toilet was soiled and stained. Residents Affected - Some room [ROOM NUMBER]: The bathroom floor was heavily stained in black color, and room wall electric light switches (2) were noted to be broken. room [ROOM NUMBER]: The room walls were noted to be damaged and in disrepair, and the exterior of the bathroom entry door was damaged and was in a state of disrepair, metal bed frame (B-bed) was stained and rust laden, and over-bed light pull cord was missing from A-bed. Room# 119: The bathroom walls were noted to be damaged and in disrepair, the floor area at the entry to the bathroom was in disrepair and was a fall hazard. room [ROOM NUMBER]: The dresser (B-bed) was soiled with an unidentified white matter. room [ROOM NUMBER]: The floor area at the entry to the bathroom was in disrepair and was a fall hazard. room [ROOM NUMBER]: The bathroom entry door was damaged and was in a state of disrepair. room [ROOM NUMBER]: The bathroom entry door was damaged and was in a state of disrepair, and over-bed light pull cord was missing from B-bed. room [ROOM NUMBER]: The metal bed frame (B-bed) was noted to be rust laden and areas of peeling paint, The bathroom entry door was damaged and was in a state of disrepair, and landing/fall mat (B-bed) was noted to have a large tear and in need of replacement. (b) 200 Unit: room [ROOM NUMBER]: The room electric wall light switches (2) were broken and in need of replacement. room [ROOM NUMBER]: The room electric wall light switches (2) were broken and in need of replacement. room [ROOM NUMBER]: The room electric wall light switches (2) were broken and in need of replacement. room [ROOM NUMBER]: The room electric wall light switches (2) were broken and in need of replacement and exterior of bathroom entry door was in a state of disrepair. room [ROOM NUMBER]: The room electric wall light switches (2) were broken and in need of replacement and exterior of bathroom entry door was in a state of disrepair. room [ROOM NUMBER]: The room entry door was in disrepair. room [ROOM NUMBER]: The room electric wall light switches (2) were broken and in need of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105686 If continuation sheet Page 2 of 10 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 105686 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Springtree Rehabilitation & Health Care Center 4251 Springtree Drive Sunrise, FL 33351 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some replacement, IV Pole (B-bed) was soiled and stained, portable commode seat was rust laden, and the bathroom toilet requires re-caulking to the floor, room [ROOM NUMBER]: The room electric wall light switches (2) were broken and in need of replacement. (c). Main Hallway: The handrail located outside of the entry room to the rehab department was broken and noted to have exposed sharp plastic edges. Following the Environment Tour conducted on 06/06/23, the findings were again confirmed with the administrative staff and were discussed with the facility's Administrator. 2. A tour was conducted of the facility's laundry area with the District Manager over Environmental Services on 06/07/23 at 2:20 PM. Staff F, Laundry Services, was present during this tour as well. There were two washing machines present, both in working order. The District Manager stated the laundry machines are rented and the maintenance is done regularly by the rental company. There were two dryers also present. Both dryers had gaskets which were torn and not in proper working condition Photographic Evidence Obtained. Both dryers had lint traps which were full of lint, despite the documentation that they had been cleaned at 2:00 PM. Photographic Evidence Obtained. After showing the District Manager and Staff F the lint concern, Staff F used a broom and swept the lint trap areas clean. After the tour, the facility's Assistant Administrator brought the surveyor an invoice which stated two dryer gaskets were ordered for the dryers on 06/05/23. The Assistant Administrator did not know when the gaskets would be delivered or installed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105686 If continuation sheet Page 3 of 10 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 105686 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Springtree Rehabilitation & Health Care Center 4251 Springtree Drive Sunrise, FL 33351 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 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and interviews, the facility failed to provide foot care to 4 of 4 sampled residents reviewed for foot care, Residents #7, #28, #54, and #65. Residents Affected - Few The findings included: Review of the facility's policy, titled, Skin Integrity- Foot Care, implemented on 01/2023, documented, in part, .comprehensive assessment will include an assessment of the feet for disorders which may require treatment .nail disorders. Nursing assistants will inspect skin during bath and will report any concerns to the resident's nurse immediately after the task .the attending physician will assume responsibility for the overall care and treatment of the resident's medical conditions . 1. Review of Resident #7's, clinical record documented an admission to the facility on [DATE] with no readmissions documented. The resident's diagnoses included Ataxic (awkward, uncoordinated walking) Gait, Unspecified Mood, Anxiety Disorder and Hereditary and Idiopathic Neuropathy (an illness where sensory and motor nerves of the peripheral nervous system are affected) and Muscle Weakness. Review of Resident #7's Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 6 indicating that the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed extensive assistance from the staff to complete her activities of daily living (ADL's). Review of Resident #7's care plan, titled, [resident's name] presents with a decline in functional mobility and ADL task performance related to generalized weakness . The care plan did not document that the resident refuse toenail care. Review of Resident #7's electronic clinical record under the Miscellaneous section revealed the lack evidence of any uploaded files related to a podiatrist consultation visit. On 06/05/23 at 9:37 AM, an interview was conducted with Resident #7 who stated she has not been seen by a foot doctor. The resident was accompanied by a female and a male who she stated they were her children. The resident allowed for the surveyor to check her feet. Observation revealed elongated toenails with fungus like nails. On 06/06/23 at 2:05 PM, a side-by-side observation and review of Resident #7's toe nails was conducted with Staff A, Licensed Practical Nurse (LPN). Staff A stated definitely the resident needed toenail care. During the review, Resident #7 stated I really do appreciate it, I'm tired at looking at my ugly nails. On 06/06/23 at 2:25 PM, a side-by-side review of Resident #7's uploaded files was conducted with Staff A who stated there was not a podiatrist consult uploaded. On 06/06/23 at 2:45 PM, an interview was conducted with Staff B, Certified Nursing Assistant (CNA), who stated she saw Resident #7's long toenails and did not tell the nurse because the podiatrist comes automatically every two months and sees them. A joint interview was conducted with Staff A, LPN, and Staff B, CNA. Staff A educated Staff B to tell her when the residents' toenails are long so she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105686 If continuation sheet Page 4 of 10 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 105686 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Springtree Rehabilitation & Health Care Center 4251 Springtree Drive Sunrise, FL 33351 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 0687 can tell the podiatrist. Level of Harm - Minimal harm or potential for actual harm On 06/06/23 at 3:42 PM, during an interview, the Assistant Director of Nursing (ADON) stated that as far as she knew, Resident #7 had not been seen by a podiatrist but that she would be contacting the Managed Care insurance's podiatrist to check and see if he had seen her. Residents Affected - Few On 06/07/23 at 8:35 AM, the ADON submitted Resident #7's podiatrist note dated 12/29/22. The note documented .a mechanical and surgical debridement of all nails was accomplished (acc). Provider to return (ptr) in two months. The ADON confirmed that Resident #7 had not been seen since 12/29/22. On 06/07/23 at 8:45 AM, an interview was conducted with the Director of Nursing (DON) who stated that she saw the podiatrist documentation and the unapproved abbreviations. The DON was asked what the facility's protocol was related to foot care. The DON replied there was not a protocol and added that the residents are seen as needed. 2. Review of Resident #28's clinical record documented an admission on [DATE] and a readmission on [DATE]. The resident diagnoses included COPD (Chronic Obstructive Pulmonary Disease), Polymyalgia (muscle pain and stiffness) and Anxiety. Review of Resident #28's MDS's quarterly assessment dated [DATE] documented a BIMS score of 6, indicating the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed extensive to total assistance from the staff to complete her activities of daily living. Review of Resident #'s care plan, titled, Resident presents with a decline in functional mobility and ADL task performance . initiated on 08/26/19 and revised on 03/17/2, documented an intervention that read .provide daily bed bath . The care plan did not document the resident refused toenail care. On 06/05/23 at 12:02 PM, observation revealed Resident #28 sitting up in a wheelchair in her room. An attempted to interview the resident was made and she was not answering the questions asked. Further observation revealed the resident was using open-toed sandals. The observation revealed Resident #28's feet skin was very dry and scaly with jagged and elongated toenails. On 06/06/23 at 10:34 AM, a telephone interview was conducted with Resident #28's responsible representative who stated the facility was supposed to cut the resident's toenails. On 06/06/23 at 2:01 PM, a side-by-side review and observation of Resident #28's toenails was conducted with Staff A, LPN. Staff A confirmed the resident's toenails were jagged and needed to be trimmed. Staff A stated the resident had very dry skin and needed a good moisturizing lotion. Staff A stated she would check with someone about who would come to do the resident's toenails. On 06/06/23 at 2:13 PM, a side-by-side review of Resident #28's clinical record was conducted with Staff A, who stated the dermatologist saw the resident on 05/09/23 and ordered Triamcinolone for three (3) weeks for a body rash, but no treatment for the resident's scaly/crusted skin of the feet. Continued review revealed a podiatrist consult report, dated 10/06/22. Staff A stated she did not see any other podiatrist's note for Resident #28. On 06/07/23 at 8:38 AM, during an interview, the ADON stated Resident #28 was seen by the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105686 If continuation sheet Page 5 of 10 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 105686 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Springtree Rehabilitation & Health Care Center 4251 Springtree Drive Sunrise, FL 33351 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 0687 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Podiatrist on 04/25/23 and that he did not see her on 06/06/23 because it was less than two months. The ADON was apprised of the resident's long and jagged toenails and her toenails should have been done on 06/06/23 when the Podiatrist was in the facility. On 06/07/23 at 8:45 AM, an interview was conducted with the DON who was asked what the facility's protocol was related to foot care and hospice care. The DON replied there was not a protocol. The DON added the residents are seen by the Podiatrist regardless of been on hospice and they are seen as needed even if the insurance did not pay for it, the facility would. The DON was apprised of Resident #28's toenails long and jagged and was not seen on 06/06/23. The DON added this is their home, so the facility would pay for podiatry care if needed. 3. Review of Resident #54's clinical record documented an admission on [DATE] and a readmission on [DATE]. The resident diagnoses included Cerebral Infarction, Type 2 Diabetes Mellitus, Anemia, Depressive Episodes, Gout and Malignant Neoplasm of Prostate. Review of Resident #54's MDS quarterly assessment dated [DATE] documented a BIMS score of 12 indicating that the resident had moderate cognition impairment. The assessment documented under Functional Status that the resident needed extensive to total assistance from the staff to complete his ADLs. Review of Resident #54's care plan, titled, Resident presents with a decline in functional mobility and ADL task performance .initiated on 02/14/22 and revised on 05/11/23, documented an intervention that read .provide daily bed bath . The care plan did not document that the resident refused toenail care. On 06/05/23 at 11:56 AM, observation revealed Resident #54 lying in bed with eyes open. During an interview, the resident was not able to tell if his toenails had been trimmed or not. Resident #54 agreed to have the surveyor look at his toenails. Observation revealed elongated toenails. On 06/06/23 at 1:55 PM, a side-by-side review and observation of Resident #54's toenails was conducted with Staff A, who confirmed the resident had elongated toenails. Staff A stated definitely, his toenails need trimming. Staff A stated the facility had two podiatrists coming to see the residents. On 06/06/23 at 2:25 PM, a side-by-side review of Resident #54's clinical record was conducted with Staff A who stated there was not a podiatrist consult in the resident's record. On 06/06/23 at 2:41 PM, an interview was conducted with Staff C, CNA, who stated that she washed Resident #54 today, and noticed his toenails were long. Staff C stated she was supposed to tell the nurse but had not done so at the time of the interview. On 06/06/23 at 3:42 PM during an interview, the ADON stated that as far as she knew the resident had not been seen by a podiatrist, but she would be contacting the HMO podiatrist to check and see if he had seen the resident. On 06/07/23 at 8:39 AM, the ADON submitted Resident #54's last Podiatrist note which was dated 09/27/22. The note documented patient is type 2 diabetic with severe onychauxis (an overgrowth or thickening of the nail) all nails . mechanical and surgical debridement of all nails was accomplished (acc). Provider to return (ptr) in two months. The ADON confirmed that Resident #7 had not being seen since 09/27/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105686 If continuation sheet Page 6 of 10 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 105686 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Springtree Rehabilitation & Health Care Center 4251 Springtree Drive Sunrise, FL 33351 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 0687 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 4. Review of Resident #65's clinical record documented an admission on [DATE] with no readmissions. The resident's diagnoses included Heart Failure, Anxiety Disorder, Chronic Pulmonary Edema, Dyspnea and Atrial Fibrillation. Review of Resident #65's MDS quarterly assessment dated [DATE] documented a BIMS score of 14 indicating that the resident had no cognition impairment. The assessment documented under Functional Status that the resident needed extensive to total assistance from the staff to complete his ADLs. Review of Resident #65's care plan, titled, Resident's name has an ADL self-care performance deficit related to weakness, poor endurance .on hospice care .initiated on 02/15/23 and revised on 02/23/23, documented an intervention that read .check nail length .on bath days and as necessary. Report any changes to the nurse. The care plan did not document that the resident refused toenail care. On 06/05/23 at 10:10 AM, an interview was conducted with Resident #65 who stated he had not been seen by the foot doctor. Observation revealed elongated toenails. During the resident's interview, a hospice aide came into the room and stated the resident was on hospice and that she has seen the resident 3 times a week to do personal care. On 06/06/23 at 1:45 PM, an interview was conducted with Staff D, CNA, who stated a foot doctor comes to see Resident #65. Staff D was asked if she had seen the resident's toenails and stated she had not seen his toenails in a longtime. On 06/06/23 at 1:54 PM, a side-by-side review and observation of Resident #65's toenails was conducted with Staff A, LPN. Staff A confirmed the resident's toenail were elongated and stated the resident's left foot toenail needed trimming. Staff A added the right foot toenails were up to the flesh. On 06/06/23 at 2:25 PM, a side-by-side review of Resident #65's clinical record was conducted with Staff A who stated there was not a podiatrist consult in the resident's record. On 06/07/23 at 8:35 AM during an interview, the ADON stated Resident #65 was seen by the Podiatrist for the first time on 06/06/23. On 06/07/23 at 10:34 AM, an interview was conducted with Resident #65 who stated the doctor came in on yesterday and cut his toenails. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105686 If continuation sheet Page 7 of 10 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 105686 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Springtree Rehabilitation & Health Care Center 4251 Springtree Drive Sunrise, FL 33351 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** 6. On 06/07/23 at 9:34 AM, a side-by-side review of the facility's unit treatment cart #1 was conducted with the Wound Care Nurse (WCN). The review revealed one Arnica (pain relief gel) tube with an expiration date of 05/2023 for Resident #2. The WCN stated the floor nurses are responsible to check the tube expiration date. 7. On 06/07/23 at 1:17 PM, a side-by-side review of the facility unit two's medication cart #2 was conducted with Staff E, LPN. The medication cart review revealed one loose blue in color capsule, one opened / undated bottle of sterile water, and one unwrapped normal saline syringe of 10 cc with 7 cc left in the syringe. During an interview, Staff E stated she did not use the sterile water or the normal saline. Staff E stated the saline or sterile water are not supposed to be left in the cart once they are opened. On 06/07/23 at 3:45 PM, during an interview, the DON was apprised of the treatment and medication cart findings. Based on observations, interviews, and record review, the facility failed to ensure medications were not stored at residents' bedsides for 4 sampled residents, Residents #240, 44, 45, 255; failed to ensure proper medication disposal; failed to maintain medication carts in proper order for 1 of 3 medication carts reviewed for medication storage; and failed to ensure expired medications were properly disposed of in 1 of 1 treatment carts reviewed for medication storage. The findings included: Review of the facility policy, titled, Medication Storage in the Facility, last revised January 2018 revealed the following, in part: Medications and biologicals are stored safely, securely, and properly following manufacturers recommendations. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. Outdated medications are immediately removed from inventory, disposed of according to procedures for medication disposal, and reordered from the pharmacy. All expired medications will be removed from the active supply and destroyed in the facility. Review of the facility policy, titled, Disposal of Medications and Medication-Related Supplies, last revised January 2018 revealed the following: Unused, unwanted, and non-returnable medications should be removed from their storage area and secured until destroyed. Mix drugs with an undesirable substance. Put the mixture into a disposable container with a lid. 1. Resident #240's admission Minimum Data Set (MDS) was In Progress at the time of the survey; and there was no Brief Interview of Mental Status (BIMS) score documented. An admission Summary Note (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105686 If continuation sheet Page 8 of 10 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 105686 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Springtree Rehabilitation & Health Care Center 4251 Springtree Drive Sunrise, FL 33351 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 written on 06/01/23 at 12:28 PM documented Resident #240 was alert and oriented x 3. Level of Harm - Minimal harm or potential for actual harm An observation was conducted on 06/05/23 at 7:59 AM during a medication administration observation for Resident #240 which revealed Resident #240 had a container of Tums on his nightstand. Residents Affected - Few A secondary observation was conducted on 06/07/23 at 3:44 PM of Resident #240 which revealed the Tums bottle was still present on his nightstand. Record review revealed Resident #240 did not have an active order for Tums. No documentation was found of a Medication Self-Administration Assessment in Resident #240's chart. No care plan was found regarding self-administration of medication. A Health Status Note written on 06/07/23 at 9:02 PM documented, Dr. [name documented] on call physician for Dr. {name provided] made aware of resident request to have tums as needed in his profile for potential heartburn/indigestion, see new order. Further record review revealed an order was written on 06/07/23 for Tums. 2. An observation conducted on 06/05/23 at 8:43 AM during the initial tour of the facility revealed Resident #44 had a bottle of Biofreeze muscle relaxer cream on her bedside table and a tube of Hemorrhoid cream next to the toilet in her bathroom. A secondary observation was conducted on 06/07/23 at 3:38 PM of Resident #44 and the muscle relaxer cream was still present on her bedside table and the hemorrhoid cream was still present in her bathroom. Record Review revealed Resident #44 did not have an active order for Biofreeze or Hemorrhoid cream. No documentation was found of a Medication Self-Administration Assessment in Resident #44's chart. No care plan was found regarding Medication Self-Administration. A quarterly MDS was documented on 05/04/23. This MDS documented Resident #44 had a BIMS score of 15, which indicated she was cognitively intact. A Health Status Note written on 06/07/23 at 11:22 PM stated, RESIDENT ROOM CHECKED AND SOME OVER THE COUNTER MEDICATIONS FOUND. RESIDENT MADE AWARE THE FACILITY NOT ALLOW MEDICATION IN THE ROOM AND AGREE TO THE REMOVAL OF ALL OTC MEDICATIONS. Further record review revealed an order was written on 06/07/23 for Hemorrhoid cream and Biofreeze muscle relaxer cream. 3. An observation was conducted on 06/07/23 at 4:06 PM during a medication administration observation which revealed Resident #45 had a tube of medicated skin cream on her bedside table. The name of the cream was written in Spanish, so it was not clear what the cream was for. Record review revealed Resident #45 did not have an active order for medicated skin cream. No documentation was found of a Medication Self-Administration Assessment in Resident #45's chart. No care plan was found regarding Self-Administration of medication. An admission MDS was documented on 05/25/23. This MDS documented Resident #45 had a BIMS score of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105686 If continuation sheet Page 9 of 10 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 105686 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Springtree Rehabilitation & Health Care Center 4251 Springtree Drive Sunrise, FL 33351 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 14, which indicated she was cognitively intact. Level of Harm - Minimal harm or potential for actual harm Further record review revealed Resident #45 was going to be discharged home on [DATE]. Residents Affected - Few 4. An observation was conducted on 06/07/23 at 4:06 PM during a medication administration observation for Resident #255 which revealed Resident #255 had a bottle of Refresh eye drops on her bedside table. Record review revealed Resident #255 did not have an active order for eye drops. No documentation was found of a Medication Self-Administration Assessment in Resident #255's chart. No care plan was found regarding Medication Self-Administration. An admission MDS was In Progress at the time of this survey; there was no Brief Interview of Mental Status (BIMS) score documented. An admission Summary Note written on 05/30/23 at 12:56 PM documented Resident #255 was alert and oriented x3. A Health Status Note written on 06/07/23 at 9:03 PM stated, Dr. [name provided] on call physician for Dr. [name provided] made aware of resident request for refresh eye drops three times daily for dry eye syndrome, see new order. Further record review revealed an order was written on 06/08/23 for Refresh Eye Drops. 5. A medication administration opportunity was conducted on 06/05/23 7:46 AM with Staff G, Licensed Practical Nurse (LPN), for Resident #240. While Staff G was preparing Resident #240's medications, one medication capsule fell onto the top of the medication cart. Staff G picked up the capsule and placed it into the garbage on the side of the medication cart. An interview was conducted with Staff G after the medication administration was complete. The surveyor asked Staff G what the proper protocol for disposal of medications was. She stated she would normally crush a tablet and then put it into the garbage can, but since this was a capsule, she just threw it away. When the surveyor asked her about a drug disposal chemical such as Drug Buster, she stated she was unaware of what Drug Buster was. The surveyor then asked the facility's Consultant Nurse if a Drug Buster is kept in each medication cart or in the medication rooms. The Consultant Nurse stated the Drug Buster is kept in each cart; she then looked in Staff G's medication cart and found the Drug Buster container in the bottom drawer of the medication cart. The Consultant Nurse then explained the use of this chemical to Staff G. Staff G donned gloves and retrieved the medication capsule from the medication cart garbage and placed it into the Drug Buster. Interviews were conducted with the facility's Director of Nursing, Administrator, and Assistant Administrator on 06/07/23 at 5:10 PM regarding these observations. They stated they would have staff check each room and remove any found medications. They also stated continuing education would be conducted regarding proper medication disposal. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105686 If continuation sheet Page 10 of 10