Health inspection·August 10, 2023

F 0584 08/10/23 at 10:26 AM, the Director of Maintenance acknowledged the concerns. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105837 If continuation sheet Page 2 of 5 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 105837 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boynton Beach Rehabilitation Center 9600 Lawrence Rd Boynton Beach, FL 33436 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** Based on observations, interviews, and record review, the facility failed to properly secure medications at the bedside for 3 out of 28 sampled residents (Residents #114, #62, and #120) The findings included: Review of the facility's policy titled, Storage and Expiration Dating of Medications, Biologicals with a revised date of 08/07/23 included under General Storage Procedures: Store all drugs and biologicals in locked compartments, including the storage of Schedule II-VI medications in separately locked, permanently affixed compartments, permitting only authorized personnel to have access. Facility should ensure that all medications and biologicals, including treatment items, are securely stored in a locked cabinet/cart or locked medication room that is inaccessible to residents and visitors. Bedside Medication Storage: Facility should not administer/provide bedside medications or biologicals without a Physician/Prescriber order and approval by the Interdisciplinary Care Team and Facility administration. Facility should store bedside medications or biologicals in a locked compartment within the resident's room. Review of the facility's policy titled, Self-Administration of Medication with a reviewed date of 04/25/17 included: to respect the wishes of competent residents to self-administer prescribed medications, as allowed by state regulations. To provide an assessment and evaluation process to determine if a resident is capable of self-administration. To provide instructions for those capable of self-administration. To maintain the safety and accuracy of medication administration. If a resident desires to participate in self-administration, the interdisciplinary team will assess the competence of the resident to participate, by completing a self-determination of medication assessment. The nurse will interview the resident to determine their ability to identify, prepare, and administer medications. Based on the interdisciplinary team's assessment, a decision is made as to whether or not the resident is a candidate for self-administration. This will be recorded on the self-administration of medication assessment. The nurse will obtain a physician's order for each resident conducting self-administration of medications. Document the self-administration of medication on the resident's comprehensive plan of care. 1. Record review for Resident #114 revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Metabolic Encephalopathy, Type 2 Diabetes Mellitus and Major Depressive Disorder. Review of the Minimum Data Set (MDS) for Resident #114 dated 06/25/23 revealed in Section C a Brief Interview of Mental Status (BIMS) score of 9, which indicated the resident had moderate cognitive impairment. Review of the physician orders for Resident #114 revealed no order for ultra lubricant eye drops, triple antibiotic ointment, 12hour decongestant nasal spray, or ibuprofen. There also was no order for the resident to self-administer medications. During an observation conducted on 08/07/23 at 10:50 AM in Resident #114's room, medications were observed on an overbed table between an empty bed with no linens and the resident's bed. This (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105837 If continuation sheet Page 3 of 5 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 105837 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boynton Beach Rehabilitation Center 9600 Lawrence Rd Boynton Beach, FL 33436 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 included ultra lubricant eye drops, 2 tubes of triple antibiotic ointment, and 12hour decongestant nasal spray (Photographic Evidence Obtained). There also was a bottle of ibuprofen in an open bag on the empty bed in Resident #114's room. It was discovered on 08/08/23 that the medications located in Resident #114's room belonged to his roommate. During an interview conducted on 08/07/23 at 10:54 AM with Resident #114 who was asked about the medications at the bedside, he said I don't know. When asked if he uses the eye drops and puts them in his eyes by himself or does the nurse do it, he stated I don't know. When asked about the nasal spray, he stated I don't know. When asked if he uses the triple antibiotic ointment, he said I don't know. 2. Record review for Resident #62 revealed the resident was originally admitted to the facility on [DATE], was sent out to the hospital on [DATE] and was readmitted to the facility on [DATE] at 10:40 PM. The resident's diagnoses included: Cataract Bilateral (Both Eyes), and Legal Blindness, Acute Respiratory Failure with Hypoxia, and Anxiety Disorder. Review of the Minimum Data Set (MDS) for Resident #62 dated 07/14/23 revealed in Section C a Brief Interview of Mental Status (BIMS) score of 14 indicating a cognitive response. Review of the Physician's orders for Resident #62 only revealed 1 order for medication that included it may be self-administrated and it was dated 06/18/23 for Propylene Glycol-Glycerin Ophthalmic Solution 1-0.3 % (Propylene Glycol-Glycerin) Instill 1 drop in both eyes every 8 hours for Dry eye syndrome may be self-administered. Review of the Self-Administration of Medication Evaluation for Resident #62 dated 05/21/22 included: Under Section A Resident Request documented that the resident has requested to self-administer the following medications: Artificial Tears. Under Section D IDT member's determination of a self-administration medication program for this resident: Approved (obtained physician's order). Review of the Care Plan for Resident #62 dated 07/06/18 with a focus on the resident impaired visual function. The goal was for the resident to have no indications of acute eye problems through the review date (10/23/23). The interventions included: MD orders for eye gtts (drops)at bedside. Resident to use himself. Date Initiated: 03/20/2023, observe/document/report to MD the following signs of acute eye problems: Change in ability to perform ADLs, Decline in mobility, Sudden visual loss, Pupils dilated, gray. On 08/08/23 at 9:05 AM, an observation was made of Resident # 62 sitting up in bed. Upon a closer observation the resident had ultra lubricant eye drops, and 2 tubes of triple antibiotic ointment located on his overbed table next to the bed. There also was a 12hour decongestant nasal spray located on a container next to his bed. During an interview conducted on 08/08/23 at 9:07 AM with Resident #62 who was asked about the medications at the bedside, he stated they are all over the counter medications and he uses the triple antibiotic ointment for a rash, and he uses eye drops for dry eyes, and he needs the nasal spray, or he has to wear his bi-pap machine to sleep. During an interview conducted on 08/08/23 at 9:19 AM with Staff B Licensed Practical Nurse (LPN) who was asked about the medications at the bedside for Resident # 62, she stated he just came back from the hospital this morning. When she was informed that the medications were in plain sight on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105837 If continuation sheet Page 4 of 5 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 105837 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boynton Beach Rehabilitation Center 9600 Lawrence Rd Boynton Beach, FL 33436 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 overbed table yesterday and believed to be the roommate's personal property, she said the room should have been cleaned. When asked if he is supposed to have medications at the bedside, she said no. She went to inform the Resident Care Specialist. During an interview conducted on 08/08/23 at 9:25 AM with the Resident Care Specialist who was asked if Resident # 62 can have medications at the bedside, he said absolutely not. 3. Record review for Resident #120 revealed the resident was originally admitted to the facility on [DATE] with the most recent readmission on [DATE]. The diagnoses included: Encephalopathy, Type 2 Diabetes Mellitus, Anxiety Disorder, Obesity, Dysphagia, and Major Depressive Disorder. Review of the Minimum Data Set (MDS) for Resident #120 with a date of 06/12/23 revealed in Section C a Brief Interview of Mental Status (BIMS) score of 11, indicating moderate cognitive impairment. On 08/08/23 at 8:42 AM, an observation was made of Resident #120 sitting up in bed with the overbed table in front of her. Upon closer observation, there was a medication cup containing several medications sitting on the overbed table. During an interview conducted on 08/08/23 at 8:42 AM with Resident #120 when asked about the medication cup with several medications she stated the nurse had just brought them in. During an interview conducted on 08/08/23 at 8:48 with Staff A, Registered Nurse (RN) who had entered the room for Resident #120 and was asked about the medication cup with several medications sitting on the resident's overbed table, she stated she brought the medications in the room for the resident and had been called away and left the medications to return and make sure the resident took the medications. When asked if she is supposed to leave the medications at the bedside unattended, she said no. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105837 If continuation sheet Page 5 of 5