Health inspection·February 6, 2025

F 0551 Give the resident's representative the ability to exercise the resident's rights. 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 appoint a guardian in a timely manner for 1 of 1 resident sampled for guardianship (Resident #56). Residents Affected - Few The findings included: Resident #56 was admitted to the facility on [DATE] from another nursing facility. Diagnoses included Other Specified Disorders of Brain, Rhabdomyolysis and Alzheimer's Disease. A Brief Interview for Mental Status (BIMS) score was 2 on the quarterly Minimum Data Set (MDS) with an assessment reference date (ARD) of 10/25/24. This indicated the resident had severe cognitive impairment. In an interview conducted on 02/06/2025 at 12:05 PM with the Primary Physician, she stated that she is familiar with Resident #56. The family hasn't been involved in years. The resident doesn't have a guardian to make the decisions. A telephone call was placed to the resident's cousin on 02/06/25 at 12:24 PM with no answer and no ability to leave a voice mail. The cousin was the only representative listed on the facesheet. An interview was conducted with the Social Service Director (SSD) on 02/06/25 at 12:30 PM. The SSD stated that the resident has a cousin that he had spoken to in the past who doesn't want anything to do with her. She has been on his list for a guardian since April 2024. The hold up is finding an attorney that does it. She is indigenous status. If there is an emergency with the resident, we will send her to the hospital and they can assign her a proxy and this can be done quickly. On 02/06/25 at 1:30 PM , the SSD gave this surveyor a copy of a progress note written by a previous social worker. He stated he was wrong, the facility has been working on this longer that he thought. The progress note, dated 01/25/24, revealed writer and staff conducted a care plan meeting called cousin, he stated he no longer wants to be contacted to please remove him off her contact list. Facility will move forward with guardianship process due to the fact that resident doesn't have a legal representative. The SSD stated that the facility has been working on this at the corporate level but he could not find any paperwork regarding this. An interview was conducted with the Administrator on 02/06/25 at 2:00 PM. The Administrator stated it usually takes between 6 to 9 months to obtain guardianship. It depends on the court system. They have to assess mental capability, have a court hearing and the judge makes a ruling. She signed for 2 residents about 2 weeks ago for a lawyer but was not aware of this particular resident. She became aware of this resident's need for guardianship today. The Administrator was asked for a policy on guardianship and she stated there was none. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 2 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 interview and record review, the facility failed to complete a Level 2 Preadmission Screening and Resident Review Process (PASARR) for 1 of 1 resident sampled for PASARR (Resident #50). Residents Affected - Few The findings included: The facility's policy titled, Social Service-PASRR with an effective date of 04/01/22 revealed A Hospital Discharge Exception is given when an individual being admitted into the NF has a Dx of a SMI and/or behavior that accompanies the SMI (Serious Mental Illness) or Suspected SMI and the physician has certified, before admission to the facility that the patient is likely to require less than 30 days of nursing facility services for the condition for which the individual received care in the hospital. Time frame to request the Level II evaluation for Hospital Discharge Exemption: If the individual's stay is anticipated to exceed 30 days, the NF must notify the Level 1 screener by the 25th day of the stay and the Level II evaluation must be completed no later than the 40th day of admission. On 02/03/25, a review of the Electronic Health Record (EHR) was done and a Level 1 PASARR was located. The Level 1 PASARR was done at a hospital on [DATE] prior to the resident's admission to this facility on 11/16/22. Resident #50 was admitted to the facility with diagnoses that included Paralytic Syndrome, Bipolar Disorder, Current Episode Depressed, and Peripheral Vascular Disease. A Brief Interview for Mental Status (BIMS) score was 14 on the annual Minimum Data Set (MDS) with an assessment reference date of 11/23/24. This indicated the resident was cognitively intact. A review of the PASARR Level 1 revealed the resident was admitted with a hospital discharge exemption which indicated the resident was likely to require less than 30 days of nursing facility services for the condition for which the individual received care in the hospital. A Level 2 PASARR was not found in the resident's EHR. On 02/05/25 at 11:31 AM, during a side-by-side review and interview, the Social Service Director (SSD) was asked to locate and provide the Level 2 PASARR assessment for Resident #50. He was unable to locate it. The SSD agreed that a Level 2 should have been done based on review of the Level 1 PASARR. He stated that he will do a resident review and submit to Acentra Health with the latest Minimum Data Set assessment and the original PASARR as long as the resident gives consent. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 3 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to provide assistance during dining for 1 of 2 residents reviewed for activities of daily living (ADLs), for Resident #71 and Resident #52. Residents Affected - Few The findings included: 1. A record review showed that Resident #71 was admitted on [DATE] with diagnosis of Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris and Neuromuscular Dysfunction of Bladder. The quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score is 10, which indicated moderately impaired. Section GG of the MDS showed that Resident #71 needs Supervision or touching assistance during dining. In an Observation conducted on 02/03/2025 at 1:25 PM this Surveyor observed Resident #71 in her room staring at the lunch tray and not attempting to eat. This Surveyor further noticed that Resident #71 was in the room without staff. About 40 minutes later, Resident #71 was still unattended with her lunch tray. In an Observation conducted on 02/04/2025 at 9:10 AM this Surveyor observed Resident #71 in her room perplex staring at the breakfast tray and not attempting to eat. This Surveyor further noticed that Resident #71 was in the room without staff. About 30 minutes later, Resident #71 was still unattended with her breakfast tray. In an interview conducted on 02/05/2025 at 1:55 PM with Staff E, Certified Nurse Assistant (CNA), she stated that sometimes Resident #71 eats alone and some other times she needs to be fed. Staff E further stated the Resident needs to be encouraged and directed to feed herself. In an interview conducted on 02/05/2025 at 2:00 PM with Staff F, Registered Nurse (RN), she stated Resident #71 can eat without staff member presents in the room. Staff F further stated that Resident doesn't need assistance during dining. In an interview conducted on 02/05/2025 at 2:10 PM with Staff G, Minimum Data Set (MDS) Coordinator, Licensed Practical Nurse (LPN) and Staff H, MDS Coordinator, Registered Nurse (RN), Staff H stated that Supervision or touching assistance during dining means the Resident needs help setting up the tray. Staff H further stated that it also means that the Resident needs to be encouraged, cleaned and assisted as needed. Staff G stated that the Certified Nurse Assistants (CNA) are the one responsible for assisting with dining. Staff G further said that it wouldn't be expected for the CNA to be constantly present in the residents' room but in and out of the room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 4 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to identify a severe weight loss in a timely manner, and failed to provide adequate nutritional supplements to prevent further severe weight loss, for 2 of 6 residents reviewed for nutrition (Resident #52 and Resident #56). Residents Affected - Few The findings included: A review of the facility's policy titled, Nursing-Weights, revised on 02/21/23, showed that Weight monitoring schedules should be developed upon admission for all residents: Weights should be recorded timely. For Newly admitted residents' weights should be obtained and measured on admission and weekly for 4 weeks. If no weight concerns are noted, weights should be measured monthly thereafter or per Registered Dietician and or physician recommendations. Residents with weight loss should monitor their weight weekly or per physician's order until it is stable, then monthly. A significant change in weight is defined as a 5% change in weight in a month (30 days), a 7.5% change in weight in 3 months (90 days), and a 10% change in weight in 6 months (180 days). A review of the facility's policy titled Medical Nutrition Therapy-Assessment and Care Planning, revised on 09/2017, showed that the Registered Dietitian will be responsible for ensuring follow-up and appropriate documentation of recommended changes in the plan of care. 1. Resident #52 was admitted to the facility on [DATE] with diagnoses of Cognitive Communication Deficit, Muscle Weakness, and Anoxic Brain Damage. The admission Minimum Data Set (MDS) dated [DATE] showed that Resident #52 had a Brief Interview of Mental Status score (BIMS) of 03, which is severely impaired. Section GG of this MDS showed that Resident #52 needs partial to moderate assistance for eating. A review of the Physicians' orders revealed an order for Regular, Consistent Carbohydrates with thin liquids dated 12/14/24 and a Sugar snack at bedtime for Diabetes support dated 12/19/24. No orders were noted for nutritional supplements. In an observation conducted on 02/03/25 at 1:31 PM, Resident #52 was eating his lunch tray in his room. Resident #52 was in the room with no staff present and was observed attempting to eat his lunch meal but was not able to bring his left hand to his mouth. His left hand was shaking uncontrollably as he tried grabbing his food with his bare hand. In an observation conducted on 02/04/25 at 8:36 AM, Resident #52 was in his room eating his breakfast tray. No staff was noted in the room to help Resident #52 with his breakfast meal. Continued observation at 8:48 AM showed Resident #52 attempting to eat on his own with the utensil but was not able to pick up the food as his hand was shaking uncontrollably. He started using his hands to scoop the eggs on the plate. A large portion of the eggs were noted all over his bedding and clothes. A review of Resident #52's weight history revealed the following: admission weight of 182.6 pounds on 12/14/24. A weight of 174.6 pounds on 12/30/24. A weight of 174.6 pounds on 01/08/25. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 5 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0692 A weight of 170.2 pounds on 01/29/25. Level of Harm - Actual harm This showed a 6.7% weight loss in about 6 weeks. Residents Affected - Few The Initial Nutrition Evaluation dated 12/19/24 showed the following: Resident #52 eats independently, with set-up eating recorded. Meal intake is between 51% and 100% of his meals. Goals are in place to monitor weights and encourage meal intake. The next nutrition follow-up note dated 12/31/24 showed the following: Monitoring recently obtained weight for weight loss vs discrepancy. Resident #52's mom indicated that he had a poor appetite in the hospital and believed he lost weight. Resident #52 is consuming between 51% to 100% of his meals since admission and to continue monitoring. No other interventions were put in place. No follow-up nutritional note was completed after 12/31/24 addressing the weight loss of 6.7% from 12/14/24 to 01/29/25. The care plan initiated on 12/27/24 showed the following: Resident #52 has nutritional problems and is at risk for malnutrition. He will maintain adequate nutritional status, as evidenced by maintaining weight within 5% of his Current Body Weight. Interventions included to monitor significant weight loss of 3 pounds in one week, 5% in one month, 7.5% in 3 months or over 10% in 6 months. Registered Dietitian will evaluate and make diet change recommendations. It further showed that Resident #52 has a self-care deficit and that he requires partial to moderate assistance of one person with feeding. In an interview conducted on 02/5/25 at 1:30 PM with Resident #52's mother, she said that she lives out of state and that she comes to visit her son every few months. He had a stroke that damaged his right hand, and he normally uses his left hand, which is his good hand. She arrived this morning after not seeing him for some time and noticed that his left hand was shaking uncontrolled and that he was not able to eat on his own. He was not able to hold his drink, and she had to cut up the food into pieces to make it easier for him to eat. She then said, I watched him struggling, and it broke my heart. Resident #52's mom stated she could tell that her son lost a lot of weight and said, I am mostly upset about the weight loss. Resident #52's mom said that she would speak to the Unit Manager regarding his weight loss. In an interview conducted on 02/05/25 at 1:50 PM with Staff K, Certified Nursing Assistant (CNA), she stated Resident #52 can eat on his own, makes a little mess when eating, and sometimes messes up his clothes. According to Staff K, Resident #52 eats well with little help and reaches for his food on the plate with his bare hands. When asked if his left-hand shakes, she said no. In an interview conducted on 02/05/25 at 1:55 PM, with Staff L, Licensed Practical Nurse, stated that Resident #52 needs supervision when he eats because he tends to make a mess. In an interview conducted on 02/5/25 at 2:15 PM with Staff H, the MDS Coordinator stated that partial to moderate assistance during eating means that Resident #52 always needs a staff member in the room while eating and that the staff would do less than 50% of the work. Staff needs to help Resident #52 with his drink, utensil, and encouragement. In an observation conducted on 02/05/25 at 3:50 PM, Staff J, CNA, was asked to take the weight on Resident #52 by this Surveyor. She used a chair scale to take the weight and calibrated the scale to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 6 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0692 Level of Harm - Actual harm Residents Affected - Few 0 before placing Resident #52 on the scale. A new weight showed that Resident #52 was at 162.8 pounds. This showed an additional weight loss of 7.2 pounds from 01/29/25 (170 pounds) to 162.8 pounds on 02/05/25. The overall weight loss showed a severe weight loss of 10.8% in less than 2 months. In this observation, Staff J stated that the list of all weekly and monthly weights is written on a piece of paper and given to the facility's Dietitian. A nutritional follow-up note dated 2/05/25, written at 2:49 PM, showed the following: the Registered Dietitian was made aware the Resident's mother had questions about weight status and requested large portions. Weight statuses were reviewed, and the mother was explained that a natural calorie deficit may occur on a standard facility diet, which is about 2000 calories a day, whereas at home the diet may be over 2000 calories a day. In this note, the Clinical Dietitian documented that Resident #52 was trending towards normal Body Mass Index (BMI), which was beneficial to support Resident #52 and current conditions. On this note, new recommendations were made to provide a large portion for the lunch meal and a large portion of vegetables for the dinner meal. No nutritional supplements were added, or weekly weights were ordered to monitor Resident #52's trending weights. An interview was conducted on 02/05/25 at 4:35 PM with the facility's Registered Dietitian. She stated the Certified Nursing Assistants take the weights of the residents they are assigned to. They write the weights on a piece of paper, and it is then given to her to place them in the electronic system. When she receives the weights, she can see the weight loss compared to previous weights or by looking at the residents themselves. For any weight loss, she will provide nutritional interventions on the same day or no later than 48 hours. When asked about Resident #52, she noticed the downward trend when she put the weight of 170.2 pounds into the system. Since she was unsure that his weight was accurate on admission at 182.6 pounds, she was not overly concerned that the weight dropped to 174.6 pounds. When she noticed the additional drop in weight to 170.2 pounds, she made a metal note to follow up on Resident #52 and visited the Resident but did not write a follow up note. According to the Registered Dietitian, Resident #52 was eating well and was eating all his meals, and monthly weights were going to be monitored and reviewed. During this entire interview, the Registered Dietitian was not aware of or told by Staff J that Resident #52's weight was taken earlier at 3:50 PM, which showed a severe weight loss of 10.8%. In an interview conducted on 02/05/25 at 5:10 PM with the Rehab Director, she stated that Resident #52 met his goal of eating with set up only on 01/10/25. He is still receiving occupational therapy (OT), but since eating was not one of his goals, he was not watched during mealtimes. If Resident #52 had tremors or decreased in strength, that would have noticed it. Looking at him today, she noticed he looked more tired than usual and noticed a decrease in overall strength. They have noted the spilling of food before, but not to the extent of what she was hearing today. In an observation conducted on 02/06/25 at 9:00 AM, Staff K was in the room feeding Resident #52's breakfast meal. Resident #52 seemed very receptive to the help and did not object when Staff K was feeding him his breakfast meal. In an interview conducted on 02/06/25 at 9:27 AM with the Registered Dietitian (RD), she stated that she observed Resident #52 eating in the past and did not remember seeing him shaking or spilling his food. The RD noted that the weight loss may be due to the caloric deficit that could have contributed to gradual weight loss since the diet in the facility is around 2000 calories a day, and the diet provided at home could have been over 2000 calories a day. She told Resident #52's mother that next month, they will see what the weight is, and if it continues to decline, she will put Resident #52 on weekly weights and provide him with Health Shakes (nutritional supplements). According to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 7 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0692 Level of Harm - Actual harm RD, Resident #52's mom did not tell her that Resident #52 was shaking uncontrollably and unable to eat independently. When asked by this Surveyor why she did not put Resident #52 on weekly weights, she stated that she would weigh him this month and see if there was a further decline in weight. The RD was still not aware of the new weight of 162.8 pounds, which was taken yesterday by Staff J. Residents Affected - Few In an interview conducted on 02/06/25, at 10:18 AM, with Staff N, the Registered Nurse stated that she noticed Resident #52's hand shaking this past Monday and that she had not seen his hand shaking before. He usually eats by himself and does not need assistance with eating. In an interview conducted on 02/06/25 at 10:30 AM with Resident #52's Mother, she stated that she was told by a staff member yesterday that he spilled most of his breakfast meal and his coffee all over himself. She further said that she spoke to the Clinical Dietitian on the phone yesterday and told her she was worried about her son's weight. She told the Dietitian that her son's hand was shaking and that he had spilled half of his food on himself. The Clinical Dietitian told her that she would increase the amount of food and that she would follow up on his weight at the end of the month. Resident #52's mother said to this Surveyor, I was wondering if he lost weight because half of his meals were on his lap. In an interview conducted on 02/06/25 at 11:13 AM with Staff O, Certified Occupational Therapy Assistant, she stated that she has been working with Resident #52 since his admission on [DATE]. He has always had some tremors on his left hand. She considered it part of his neurological condition but did not have anything interfering with his Activities of Daily Living (ADLs). She saw him yesterday and noticed his tremors, which had gotten worse. This was nothing like before, and these new symptoms impeded his eating abilities. She further stated that Resident #52 had a can of soda and was not able to bring the can of soda to his mouth. In an interview conducted on 02/6/25 at 3:25 PM with Staff J, she told Staff S, Registered Nurse, about the weight of 162.8 pounds but did not report the weight to the Registered Dietitian. She did not see the RD, so she gave the weight report to Staff S. In an interview conducted on 02/6/25 at 3:44 PM with Staff S, she stated that Staff J told her that she took the weight on Resident #52 as per this Surveyor's request. Staff S said that she was told by Staff J that Resident #52 was 162.8 pounds. She further reported that she did not put any weight in the electronic system and did not report the new weight to the RD because it was late in the day when the weight was taken. When asked if she told the RD about the weight this morning, she said no. In an interview conducted on 02/06/25 at 4:00 PM with the facility's Administrator, she was informed of the findings. 2. A record review showed that Resident #56 was admitted on [DATE] with diagnoses that included Alzheimer's disease, Anxiety, Depression and Rhabdomyolysis. The quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score is 2, which indicated severe cognitive impairment. Review of Resident #56's Care plan, dated 11/1/2024, for nutritional problems related to medical diagnoses, therapeutic restricted and textured consistency diet, history of variable oral intake. The goal was the resident will maintain adequate nutrition/hydration status. Interventions included: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 8 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0692 -Administer medications as ordered. Level of Harm - Actual harm -Encourage and assist with setup/intake of meals as needed. Residents Affected - Few -Monitor/document/report any signs of dysphagia. -Monitor/record/report to doctor signs of malnutrition: Significant weight loss: 3lbs in 1 week, >5% in 1 month, >7.5% in 3 months, >10% in 6 months. -RD to evaluate and make diet change recommendations PRN. -Weights per facility policy. A review of the weight log for Resident #56 showed the following: 1/28/2025 16:22 139.8 Lbs 1/21/2025 07:53 140.2 Lbs 1/14/2025 13:47 139.6 Lbs 1/3/2025 12:48 141.2 Lbs 12/11/2024 10:49 145.0 Lbs 11/7/2024 09:30 160.8 Lbs 10/4/2024 15:02 164.3 Lbs 9/6/2024 12:40 162.3 Lbs 8/1/2024 10:06 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 9 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0692 159.0 Lbs Level of Harm - Actual harm This showed a weight loss of 15.8 pounds, or a 9.8% severe weight loss in one month between 11/7/24 and 12/11/24. Resident #56 had an overall trending weight loss of 12% from 08/1/2024 to 01/28/2025 (past 6 months). Residents Affected - Few A review of the Dietary progress note dated 12/11/2024 (the day the 9.8% weight loss was identified) revealed the Registered Dietitian stated that Resident #56 meal intake was less than 50% per review over the past 30 days. Resident #56 received Eldertonic QD to TID (once a day to three times a day) for appetite support, fortified food QD (once a day) for nutrition support, encouraged extra oral hydration and continue to monitor protocol prn (as needed). A review of the Dietary progress note dated 01/03/2025 (23 days after the 9.8% weight loss was identified) revealed the Registered Dietitian (RD) stated that Resident #56 continues with trigger for weight loss of 23.1 pounds which representant a 14% of weight loss in 3 months. The progress note further revealed that weekly weight monitoring was difficult for staff members due to behaviors and the meal intake was recorded as more than 50% but less than 75-100% for three meals daily. Resident #56 received house shake BID (twice a day) for nutrition. A review of Resident #56's Physician's orders showed the following: House Supplement Shake once a day started on 01/22/2025 and was increased to twice a day on 01/27/2025. No orders were noted from 12/11/2024 to 01/22/2025. In an observation conducted on 02/03/2025 at 1:30 PM Resident #56 tray's consisted of chicken pot pie with 1 biscuit, ½ cup of green peas, ½ cup of deluxe fruit salad, 6oz of tea and 4oz of apple juice but no ½ cup of fortified mashed potatoes as indicated on the meal ticket. In an interview conducted on 02/05/2025 at 4:05 PM, the Registered Dietitian (RD) stated sometimes there is discrepancy between care plans and orders because Point Click Care (PCC) doesn't communicate the order of the shakes with the system. RD further stated, after reviewing the interventions put in place on 01/03/2025, that she forgot to put in the order for the House Shake once a day. It must have slipped her mind to put in the order after the note. The resident started getting House Supplement Shakes on 01/22/2025. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 10 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to ensure the resident's competency when performing respiratory care for 1 of 2 residents sampled for respiratory care (Resident #58). Residents Affected - Few The findings included: Resident #58 was admitted to the facility on [DATE] with diagnoses that included Respiratory Failure, Type 2 Diabetes Mellitus, and Tracheostomy Status. Her BIMS (Brief Interview for Mental Status) was 15 on the quarterly Minimum Data Set (MDS) assessment dated [DATE]. This indicated the resident was cognitively intact. On 02/04/25 at 9:32 AM, trach (tracheostomy) care was observed with Staff P, Respiratory Therapist. Staff P wore a gown, face mask, and gloves and cleaned around the area of the stoma and applied a new gauze pad. The surveyor asked Staff P why did she not change the inner cannula and she replied that the resident changes her own inner cannula. Asked if the resident had a competency for this and she replied that she did the competency over a year ago. Observation of the bedside table of Resident #58 revealed a box of disposable inner cannulas and a box of gloves. Interview with the resident was conducted on 02/04/25 at 2:35 PM. She stated she changes her inner cannula sometimes 3 times a day. She has disposable inner cannulas in her room with gloves. She has had the trach for over a year and prefers to do this on her own. She had a box of gloves and a box of disposable inner cannulas at the bedside and she stated she puts on her gloves and pulls out the inner cannula and puts a new one in and hears it snap. She calls the nurse when she changes the trach but at night she sometimes changes it when the nurse is not there. On 02/04/25 at 2:50 PM the surveyor interviewed Staff C, Unit Manager, as to where the competency checklist would be. She called Staff P on the phone and Staff P stated to her that the competencies would have been on paper and she gave the papers to the former Director of Nursing (DON). On 02/05/25 at 9:00 AM the surveyor spoke with the Regional Nurse Consultant. She stated that they could not find any competency because it was probably on paper with the other company. She agreed that there should be a competency in her Electronic Health record (EHR). Review of the EHR revealed a respiratory therapy progress note dated 01/06/25 (Resident) inner cannula is supposed to be changed twice a day. She is supposed to go through 14 inner cannulas in a week. Per (family) 14 is too little and should be changed more. (Resident) is running out of inner cannulas due to frequent changes. (Resident) will change out her own inner cannula despite being told her inner cannula should only be changed twice a day. RT gives (resident) two boxes at a time to prevent from running out. Per the administrator it is ok to double her inner cannula order. Further review of the EHR on 02/06/25 revealed Resident #58 had documentation in the EHR that she was educated on inner cannula change and demonstration was conducted on 02/04/25 at 5:26 PM and 02/05/25 which was after surveyor intervention. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 11 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to monitor behaviors and side effects for a Resident on psychotropic medications in 1 of 5 residents reviewed for Unnecessary Medication (Resident #52). Residents Affected - Few The findings included: A record review showed that Resident #52 was admitted to the facility on [DATE] with diagnoses of anxiety disorder and major depressive disorder. The admission Minimum Data Set (MDS) assessment dated [DATE] showed that Resident #52 had a Brief Interview of Mental Status score (BIMS) of 03, which is severely impaired. A review of the Physicians'orders showed an order for Lorazepam (anxiety medication) 0.5 milligrams, give 1 tablet by mouth two times a day which was dated 01/17/25. An order for Paroxetine Tablet 20 milligrams, give 1.5 tablet one time a day for depression which was dated 12/14/24. The Care plan dated 12/31/24 revealed the following: Resident #52 uses anti-anxiety medication related to anxiety. Administer medication as ordered and monitor for side effects. Monitor/record the occurrence of target behavior symptoms and document per facility protocol. It further showed that Resident #52 uses antidepressant medication related to depression. Administer antidepressant medicines as ordered by the physician and monitor/document side effects and effectiveness every shift. A review of the Medication Administration Record for the months of December 2024 and January 2025, did not show that Resident #52 ' s behaviors or side effects were being monitored. An interview was conducted on 02/05/25 at 1:55 PM with Staff L, Licensed Practical Nurse. She stated that any residents on anti-anxiety and antidepressant medications they monitor the behaviors and side effects of the medicines. This is documented in the Medication Administration Record of the electronic system. When asked if Resident #52 was being monitored for side effects and behaviors, she said yes. She proceeded to look in the electronic chart but could not show this Surveyor any documentation regarding the side effects and behavior monitoring for Resident #52. In an interview conducted on 02/06/25 at 4:00 PM with the facility's Administrator she was informed of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 12 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to provide the correct diet consistency for the Pureed diet for 3 out of 12 residents observed on pureed diet (Resident #35, Resident #102 and Resident #108). The findings included: A review of the facility's policy titled ASHAWIRE showed the following: National Dysphagia Diet (NDD) published in 2002 proposed four levels of semisolid/solid foods with level 1 being the pureed consistency. NDD Level 1: Dysphagia-Pureed (homogenous, very cohesive, pudding-like, requiring very little chewing ability). 1. A record review showed that Resident #35 was admitted on [DATE] with diagnoses of Atrial Fibrillation and Gastro-Esophageal Reflux Disease without Esophagitis. The quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score showed that Resident #35 was unable to conduct the interview. During an observation conducted on 02/03/25 at 1:50 PM in the main dining room, the surveyor realized that pureed Chicken Pot Pie was lumpy, and the green beans shell were easily identified. Resident #35 meal ticket consisted of 8 ounces (oz) of Pureed Chicken Pot Pie with #16 scoop (Scp) of Pureed Biscuit, #10 (Scp) of Pureed [NAME] Peas, #10 Scp of Pureed Sliced Peached & Pears, ½ Cup of Fortified Mashed Potatoes and 6 ounces of Tea which matched the meal tray. 2. A record review showed that Resident #102 was admitted on [DATE] with diagnoses of Combined Systolic (Congestive) and Diastolic (Congestive) Heart Failure and Muscle Wasting and Atrophy. The quarterly Minimum Data Set (MDS) dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score showed that Resident #102 was unable to conduct the interview. During an observation conducted on 02/03/25 at 1:57 PM in Resident #102's room, the surveyor observed that pureed Chicken Pot Pie was lumpy, and the green beans shell were easily identified. Resident #102 meal ticket consisted of 8 ounces (oz) of Pureed Chicken Pot Pie with #16 scoop (Scp) of Pureed Biscuit, #10 (Scp) of Pureed [NAME] Peas, #10 Scp of Pureed Sliced Peached & Pears, ½ Cup of Fortified Mashed Potatoes and 8 ounces of Nectar Thickened Lemonade which matched the meal tray. 3. A record review showed that Resident #108 was admitted on [DATE] and readmitted on [DATE] with diagnosis of Hemiplegia and Hemiparesis following Cerebral Infarction affecting Right Dominant Side. The admission Minimum Data Set (MDS) dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score showed that Resident #35 was unable to conduct the interview. During an observation conducted on 02/03/2025 at 1:54 PM in Resident #108's room, the surveyor observed the pureed Chicken Pot Pie was lumpy, and the green beans shell were easily identified. Resident #102's meal ticket consisted of 8 ounces (oz) of Pureed Chicken Pot Pie with #16 scoop (Scp) of Pureed Dinner Roll/Bread, #10 (Scp) of Pureed [NAME] Peas, #10 Scp of Pureed Sliced Peached & Pears, ½ Cup of Fortified Mashed Potatoes and 6 ounces of Tea which matched the meal tray. During an interview conducted on 02/06/2025 at 2:51 PM, the Speech Therapist stated that pureed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 13 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete food should be blended, completely broken down into one uniform consistency. The Speech Therapist further stated that she has been working in this facility since July and hasn't done any training with the kitchen staff yet. She continued explaining that they follow the [NAME] guidelines for the texture of the food they serve. During an interview conducted on 02/06/2025 at 3:00 PM, the District Manager stated that 12 residents are on pureed consistency diet and that she always tries the pureed food in the kitchen before sending it out on the floor to make sure the consistency is adequate. Event ID: Facility ID: 105852 If continuation sheet Page 14 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 6. In an observation conducted on 02/03/25 at 12:40 PM, the tray cart arrived at the 400 unit with lunch meals. Staff A, Licensed Practical Nurse (LPN) was observed at the tray cart to distribute the lunch trays to the residents. Further observation revealed Staff A was checking the meal ticket, however, he did not uncover the plate to assure the food consistency matched the meal ticket. Then, at 12:47 PM the tray cart was moved to the 500 unit to be distribute by another nurse, Staff D, LPN; and again observed food plates were not uncovered to check for consistency by Staff D. 7. On 02/05/25 at 11:47 AM, another observation of the lunch trays was conducted. Staff A was observed distributing the lunch trays at 700 unit. Staff A checked the residents' meal tickets on the trays; however, he did not uncover the plates to check for correct consistency. At 12:13 PM the meal cart was observed at the 500 unit and the lunch trays were being distribute by Staff B, LPN. Further observation revealed Staff B checking the meal tickets and not uncovering the plate to check for correct consistency. 8. During an interview conducted with Staff B, who stated she has worked at the facility for 11 1/2 years. She stated that when distributing the meal trays, she checks the name, room number, fluids and correct diet/consistency on the meal ticket. Then she was asked if she uncovers the plate to check for the correct food consistency, Staff B stated oh, yes, of course! 9. During an interview conducted on 02/05/25 at 1:50 PM with Staff A, LPN, who stated he has worked at the facility for over a year. He stated the responsibility of the nurse during meal tray distribution is to check the meal ticket for the resident's name, room number, and confirm the right diet is correct on the meal trays. Staff A stated he knows which type of diet each resident is on because he knows most of the residents. He also stated he does uncover the food plate to check the consistency. Staff A was told that during a couple of observations the surveyor noticed that he did not uncover the plate to check the food consistency. He acknowledged that he did not uncover the plates to check the food consistency. Then he stated the Certified Nursing Assistants (CNAs) will let him know if the meal does not look like the consistency for the resident; in addition, Staff A stated if he is not too busy he sometimes assist feeding the residents and in that case he checks the food consistency. Based on observations, interviews and record reviews, facility failed to provide food that meets residents' preferences, allergies and intolerances for 4 o 4 residents observed during dining observation (Resident #56, Resident #15, Resident #118, Resident #368). Findings included: 1. A record review showed that Resident #56 was admitted on [DATE] with diagnosis of other specified disorders of brains and rhabdomyolysis. The Minimum Data Set (MDS) quarterly dated 10/25/2024 revealed that the Brief Interview of Mental Status (BIMS) score is 2, which indicates severe cognitive impairment. During an observation conducted on 02/03/2025 at 1:30 PM this surveyor observed that Resident #56 meal ticket consisted of: 1 Cup of Chicken Pot Pie with 1 biscuit, 1/2 cup of green peas, 1/2 cup of deluxe fruit salad, 1/2 cup of fortified mashed potatoes, 6oz of tea of choice and 4oz of apple (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 15 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0806 juice. Resident #56's tray did not have mashed potatoes nor fortified mashed potatoes. Level of Harm - Minimal harm or potential for actual harm 2. A record review showed that Resident #15 was admitted on [DATE] and readmitted on [DATE] with diagnosis of Cerebral Infarction and Atherosclerotic Heart Disease. The quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score is 14, which indicates no cognitive impairment. Residents Affected - Few In an observation conducted on 02/03/25 at 1:35 PM this surveyor saw that Resident #15's meal ticket consisted of: 8 ounces (oz) of Ground Chicken Pot Pie with bread, 1/2 cup of broccoli florets chop, 1 assorted ice cream, 8oz of whole milk, 6 oz of hot tea, and 1 can of diet Gingerale soda. The meal tray did not have ice cream on it. 3. A record review showed that Resident #118 was admitted on [DATE] with diagnosis of Intracranial Abscess and Granuloma and Encounter for Surgical Aftercare following Surgery of the Nervous System. The admission Minimum Data Set (MDS) dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score is 15, which indicates no cognitive impairment. In an observation conducted on 02/03/2025 at 1:20 PM this surveyor observed Resident #118 frustrated and taking out the green peas from the chicken pot pie and putting them on the plate. Resident #118 explained that he explicitly told multiple staff that he does not like peas or greens but unfortunately, they always put some sort of green on his plates. The Resident's plate consisted of 1 Cup of chicken pot pie with 1 biscuit, 1/2 cup of broccoli florets, 1/2 cup of deluxe fruit salad, and 8oz of lemonade. 4. A record review showed that Resident #368 was admitted on [DATE] with diagnosis of Chronic Inflammatory Demyelinating Polyneuritis and Type 2 Diabetes Mellitus without complications. The Minimum Data Set (MDS) is not yet available due to Resident being newly admitted . In an interview conducted on 02/03/2025 at 10:00 AM Resident #368 stated that food is inedible, they don't put any condiments like salt, pepper, ketchup, or seasonings. Resident #368 further stated that her preferences are not taken into consideration. For example, she doesn't drink milk or juice, she doesn't eat pancakes or white bread but always gets these things on her tray. Resident continued by explaining how the food is always served cold. 5. In an observation conducted on 02/05/25 at 11:45 AM in the kitchen, the surveyor was given the menu of the day that consisted of: Open-Faced Roast Pork Sandwich (2oz sliced Pork) alternative 3oz of Salisbury Steak, ½ cup of Herbed [NAME] Beans or ½ cup of Brussels Sprouts, ½ cup of Mashed Potatoes or ½ cup of Buttered Noodles, 1 Dinner roll or 1 Bread and 1 square of Lemon Cake with Lemon Icing. The surveyor further asked to weigh the Roasted Pork and the Salisbury Steak which weighed respectively 2 ounces and 3 ounces. In an interview conducted on 02/06/25 at 2:00PM, the District Manager stated that they have three checkpoints to make sure that the meal ticket always matches the meal tray. The three checkpoints are: the first one is the aide that puts the tray together, the second one is another aide in the kitchen, and the third one is the nurses on the floor who take the lids off to checkwhat was on the tray matches what is on the meal ticket. The District Manager further stated that she and her assistant are also always in the kitchen double checking. In another interview conducted on 02/06/25 at 3:15 PM, the District Manager stated that the pork on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 16 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0806 Level of Harm - Minimal harm or potential for actual harm the Open-Faced Roast Pork Sandwich was 2oz and that Salisbury Steak 3oz on the alternative menu was different portion because as the pork cooks the weight is reduced. The District Manager further stated that another reason could be because the pork is served on bread which would make up for the ounce missing. The District Manager continues saying that a resident ordering the Open-Faced Roast Pork Sandwich would get 2oz and a resident ordering the Salisbury Steak would get 3oz. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 17 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Resident #7 was admitted on [DATE] with a diagnosis of Parkinson's and muscle weakness. The admission Minimum Data Set (MDS) dated [DATE] showed a Brief Interview of Mental Status Score (BIMS) score of 15, which is cognitively intact. In an interview conducted on 02/03/25 at 12:42 PM, Resident #7 stated that the lunch meals are always late and usually arrive at the Main dining room between 12:30 PM and 1:00 PM and sometimes past 1:00 PM. 4. A record review revealed that Resident #269 was admitted to the facility on [DATE] with diagnoses of Muscle Weakness and Difficulty Walking. The MDS dated [DATE] revealed that Resident #269 had a BIMS score of 15, which is cognitively intact. In an interview conducted on 02/03/25 with Resident #269, at 1:09 PM, it was stated that the food comes late on the 300 Unit all the time, and it is not unusual for the trays to arrive around 1:30 PM. In an interview conducted on 02/05/25 at 11:45 AM with the kitchen District Manager, she stated that the timing of the meals was changed a while ago. She changed them for the breakfast and dinner meals but forgot to change them for the lunch meal on 02/3/35. Based on observations, interviews, and record review, the facility failed to follow their posted scheduled mealtime for tray deliveries on 2 out of 2 observations. The findings included: 1. In an observation conducted on 02/03/2025 between 12:00 PM and 2:00 PM this surveyor observed discrepancies between the stipulated lunch tray's arrival time and the actual arrival time. The lunch trays stipulated arrival time were as follow: Main Dining Room: 12:00 PM, Assisted Dining Room: 12:10 PM, 100 Hall: 11:30 AM, 200 Hall: 11:40 AM, 300 Hall: 11:50 AM. The lunch trays actual arrival time were as follow: Main Dining Room: 12:52 PM, Assisted Dining Room: 1:10 PM, 100 Hall: 1:15 PM, 200 Hall: 1:43 PM, 300 Hall: 1:38 PM. 2. In an observation conducted on 02/04/2025 between 11:30 PM and 12:30 PM this surveyor observed discrepancies between the stipulated lunch tray's arrival time and the actual arrival time. the lunch trays stipulated arrival time were as follow: Main Dining Room: 12:00 PM, 500 Hall: 11:50 AM, 600 Hall: 11:40 AM, 700 Hall: 11:30 AM. The lunch trays actual arrival time were as follow: Main Dining Room: 12:25 PM, 500 Hall: 12:00 PM, 600 Hall: 11:53 AM, 700 Hall: 11:50 AM. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 18 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interviews and record review, the facility failed to ensure disposal of garbage and refuse in a sanitary manner. Residents Affected - Few The findings included: A review of the facility's policy titled, Dispose of Garbage and Refuse, dated 8/2017, showed the following: all garbage and refuse will be collected and disposed of in a safe and efficient manner. The Dining Service Director coordinates with the Director of Maintenance to ensure that the area surrounding the exterior dumpster area is maintained in a manner free of rubbish or other debris. In an observation conducted on 02/03/25 at 8:42 AM, in the outside area, a large blue metal construction dumpster was noted. The opened dumpster showed garbage bags and multiple food boxes inside the dumpster. Closer observation revealed a foul smell and insects flying around the construction dumpster. In this observation, the facility's maintenance director stated that he has told the kitchen staff multiple times that this construction dumpster is only used for construction garbage and not to throw any other garbage that is coming from the main kitchen. He further stated garbage that is coming from the main kitchen can attract rodents and insects and then said, I am not here 24/7. In an interview conducted on 02/06/25 at 4:00 PM with the facility's Administrator, she was informed of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 19 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2) Resident #79 was admitted to the facility on [DATE] with diagnoses which included Cerebral Infarction, Major Depressive Disorder and Anemia. He had a Brief Interview Mental Status (BIM) score of 14, indicating no cognitive impairment. Residents Affected - Few During a Medication Administration Observation which began on 02/03/25 at 9:37 AM with Staff D, Registered Nurse (RN), she was observed touching four (4) different oral capsule and pill medications (some stored in bottles and some in Bingo paks), directly with her gloved hand for Resident #79. Staff D consecutively prepared all above four (4) of Resident #79's medications with her gloved hands while touching both the pills and capsules directly with her gloved hand, prior to placing them in the medication cup. On 02/03/25 at 9:42 AM the Medication Administration Observation conducted with Staff D, included this medication: 1) Eliquis 5mg one (1) tablet was ordered twice a day (BID). Staff D, was observed preparing this medication. She subsequently dropped this tablet on the top of the 600 hallway medication cart and discarded it. However, Staff D, was then observed touching the tablet directly with her gloved hand after having popped it out of the Bingo pack; instead of first placing the pill medication in the cap and then transferring it to the medication cup. Then, on 02/03/25 at 9:43 AM Staff D, was observed preparing these medications: 2) Fluoxetine 10mg two (2) capsules were ordered daily. Staff D, was observed touching the capsules directly with her gloved hand after having popped them out of the Bingo pack; instead of first placing the capsule medications in the cap and then transferring it to the medication cup. Next, on 02/03/25 at 9:44 AM Staff D, was observed preparing this medication: 3) Folic Acid one (1) tablet ordered daily. Staff D, was observed touching the tablet directly with her gloved hand, and then placing it directly into medication cup; instead of first placing the pill medication in the cap and then transferring it to the medication cup. Finally, on 02/03/25 at 9:45 AM Staff D, was observed preparing this medication: 4) Midodrine 10mg one (1) tablet ordered three times per day (TID). Staff D, was observed touching the tablet directly with her gloved hand after having popped it out of the Bingo pack; instead of first placing the pill medication in the cap and then transferring it to the medication cup. During an interview conducted on 02/03/25 at 9:46 AM with Staff D, she acknowledged that she should not have touched Resident #79's medications directly with her gloved hand. On 02/04/25 at 3:05 PM an interview was conducted with Staff C, Licensed Practical Nurse/Unit Manager/(LPN)/(UM), for the 400, 500, 600 and 700 hallways,, in which she acknowledged that the nurses' gloved hand should not have touched Resident #79's medications. The DON, further recognized and acknowledged on 02/04/25 at 3:17 PM that Resident #79's medications should not have touched the nurses' gloved hand and should have been transferred directly into the medication cup; this was not done. 3. A record review revealed that Resident #101 was readmitted to the facility on [DATE] with diagnoses of End Stage Renal Disease, Anemia, and Psychotic Disorder. A review of the Physicians' orders (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 20 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0880 revealed an order for in-house hemodialysis dated 02/01/25. Level of Harm - Minimal harm or potential for actual harm In an observation conducted on 02/5/25 at 12:25 PM, Staff M, Patient Care Technician, was in the dialysis room performing the disconnection of the Central Venous Catheter (CVC) dialysis site on Resident #101. She was observed sanitizing her hands and putting on a pair of cleaned gloves. She then touched the hand sanitizing bottle, moved it from one side to the other, and proceeded to disconnect the dialysis access site with the same gloves. She did not practice hand hygiene and changed gloves after touching the hand sanitizing bottle. Residents Affected - Few Based on observations, interviews, and record review, the facility failed to properly follow hand hygiene protocol during respiratory treatments and failed to handle medications in a sanitary manner while dispensing medications for 2 of 5 sampled residents reviewed for medication administration (Resident #90 and #79). In addition, the facility failed to follow sanitary procedures for disconnecting dialysis treatment for 1 of 1 sampled resident reviewed for dialysis (Resident #101). The findings included: Review of the facility's policy titled, Administering Medications, revision date 02/21/23, included the following: To ensure that medications are administered in a safe and timely manner, and as prescribed. General Guidelines: 3.Medications are administered in accordance with prescriber orders, and current standards of practice. a. Staff follows established facility infection control procedures (e.g., handwashing, antiseptic technique, gloves, isolation precautions, etc.) for the administration of medications, as applicable. 1) Record review for Resident #90 revealed that the resident was admitted to the facility on [DATE] with the following diagnoses: Chronic Obstructive Pulmonary Disease with (Acute) Exacerbation, Shortness of Breath. Review of Section C of the Minimum Data Set (MDS) dated [DATE] revealed that Resident #90 had a Brief Interview for Mental Status of 15, which indicated that she was cognitively intact. During a medication administration observation conducted on 02/04/25 at 8:46 AM with Staff C, Unit Manager and Licensed Practical Nurse (LPN), who stated she would start Resident #90 on the respiratory treatment via nebulizer prior to dispensing the oral medications. Without performing hand hygiene (HH), Staff C gathered the respiratory treatment and entered the room. She did not wash her hands nor don on gloves and went to the nebulizer machine located on the bedside table and grabbed the mask and assisted Resident #90 to put on the mask. Staff C returned to the medication cart without performing HH and opened the cart and began dispensing the medications for Resident #90 including an inhaler. Without performing HH, she again entered the resident's room, gave the inhaler to Resident #90. After the resident finished with the inhaler, Staff C took the inhaler back from the resident and returned to the medication cart, again no HH was observed. Then, Resident #90 mentioned to Staff C that she must rinse her mouth after using the inhaler and needed a cup of water. Staff C handed a cup of water to Resident #90 and the resident rinsed her mouth and spit the water back into the cup. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105852 If continuation sheet Page 21 of 22 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 105852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Boca Circle Rehabilitation Center 7225 Boca Del Mar Drive Boca Raton, FL 33433 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Staff C donned a glove on her right hand and took the cup and discarded the water in the bathroom sink and at that moment washed her hands. During an interview conducted on 02/04/25 at 9:15 AM, Staff C, stated she has worked at the facility for 8 years. She acknowledged she did not sanitize her hands as much as she should during the medication administration for Resident #90. Staff C then stated she did wash her hands once during the observation. Event ID: Facility ID: 105852 If continuation sheet Page 22 of 22