Health inspection·November 17, 2022

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few aware of resident's needs to have a different call light system or bed rails, or any other devices through a system they have in the electronic system. Each unit manager will notify Maintenance Department through the system. If a resident needs the type of call light that they do not need to push the button, she believes that nurse and unit manager will be the first to know about it because the resident and or family will likely notify the staff about the need of having a different call light system. The DON stated she believes there is no chance for the residents to ask Maintenance about changing a call light because Maintenance staff only go to the rooms when they have to do something. The DON explained it is almost impossible the resident will ask the Maintenance Department about it. In case residents and or family members ask for the device from Maintenance or another staff, the facility's practice will be for them to notify the nurses about it because they cannot place a different call light just because the residents and or family requested one. It is a process, and they have to do assessment and document the need if needed or it is per resident's preferences. The DON stated they will complete the assessment and document it and make the Maintenance Department aware, so they can go and do the change. The DON stated she is not familiar with Resident #447, but if he has a diagnosis resulting in the resident having problems with the mobility of arms and legs, the resident with this kind of illness should be assessed to evaluates grade of immobilization. During an interview the Rehabilitation Director on 11/17/2022 at 10:35 AM revealed she is familiar with Resident #447 and his medical condition, and she is aware he cannot push the light with his hands, but he can do it with his elbow. The Rehabilitation Director stated Resident #447 is alert and oriented times three, he comes to therapy every day and is very cooperative with his rehabilitation. The Rehabilitation Director stated Resident #447 had a call light that he was able to push with his elbow, they had a conversation about it. Rehabilitation Director stated she was not sure if they changed Resident #447's room, and not aware Resident #447 does not have that type of call light right now. The Rehabilitation Director stated she would find out what happened. Observation on 11/17/2022 at 10:50 AM revealed Staff K, admission Assistant and Staff E, a Registered Nurse (RN) and Unit Manager were in Resident #447's room and revealed Resident #447 has a different call light the type he can push with his elbow. When Resident #447 was asked who gave him this type of call light he pointed the staff inside the room (Staff K and Staff E) and stated they just brought it in. Interview with Staff K, admission Assistant on 11/17/2022 at 10:53 AM revealed she works in admission Department, and she was informed by someone in therapy that the resident needed this type of call light, and she just came to bring one from another empty room. Staff K stated that she just wanted to help. Interview with Staff E, RN, and Unit Manager on 11/17/2022 at 11:00AM revealed she was aware Resident #447 does not have full control of his extremities, but she did not know he was not able to push the call light when he wants to call for assistance. Staff E stated she was not aware of that because at times she has seen Resident #447 was able to use his fingers. Interview with Resident #447 on 11/17/2022 at 11:05 AM revealed he can move his fingers but only to use the bed remote control, but he cannot push the call light. Resident #447 stated he does not remember the person he asked to bring a different call light the type he can push with his elbow and stated that everyone wears a mask, and it is not easy to identify anyone. Interview with the Rehabilitation Director on 11/17/2022 who came into the resident's room at 11:10 AM revealed Resident #447 had another call light that is gray and looks like a ball filled with air (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 2 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and he was able to push it with his elbow. The Rehabilitation Director explained that she was told when they moved the resident to another room the call light he had did not fit in his new room, and they did not inform anyone in her department that Resident #447 has a call light he was not able to use. The Rehabilitation Director agreed that something failed in their procedures, and they did not communicate about Resident #447's needs, but she can show the initial evaluation they did where the goal is to work on Resident #447's ability to reach things due to his condition with his extremities related to his illness. The Rehabilitation Director stated she will look in the records to see if there is any assessment done about his need to have a different call light. The Rehabilitation Director came back at 12:04 PM and stated she found out that the facility does not have any policy on doing an assessment to accommodate the resident for a certain call light. As part of the admission assessment, they identified his needs and provided with the type of call light he was able to use. Rehabilitation Director stated when they changed Resident #447's room they failed when they did not recognize the call light, he had in his previous room did not fit in his new room and nobody working with him reported it. The Rehabilitation Director stated she was never made aware about it and explained today it may look like they were intentionally trying to hide something when they did change the call light. The Rehabilitation Director stated today when they came into Resident #447's room and gave him the call light he was able to use it and they were just trying to accommodate the Resident needs and give him the call light he was able to use after they found out he did not have the proper one. During an interview with the Director of Social Services on 11/17/2022 at 11:15 AM it was revealed she did not receive any request for this resident's call light to be changed or any grievance related to this. Interview with the DON on 11/17/2022 at 11:20 AM revealed that when staff moved Resident #447 from his previous room, apparently, they realized the call light did not fit in the new room, but nothing else was done. When asked about what should have been done and regarding the facility's procedure in place in this case, the DON stated they should have communicated with the nurse and unit manager but apparently nobody did. The DON showed the type of call light Resident #447 had in his previous room and explained it did not work in the system they have in the actual room. In a further interview with the DON on 11/17/2022 at 11:45 AM, the DON stated she asked the Nursing Home Administrator (NHA) about the policy on assessment for the call light's needs and the NHA stated there is no assessment done for this situation, (need for special call light). The DON stated she is new doing this job and she had to ask her Administrator. The DON stated that according to her administrator by the assessment done on admission they will identify every resident's needs and they will provide residents with the things they need depending on their condition. The DON stated that in the case of Resident #447 they did an assessment from head to toes completed by the nurse on admission, and on evaluation done by therapy they determine resident needs to have a different call light so he would be able to use with his elbow as he did not have strength on his extremities. The DON explained on admission when he was in the other room, they did provide the balloon type call light that he was able to press with his elbow. Everything was good until they moved the Resident to the current wing. When he was moved, the staff from Maintenance apparently brought the call light he had in the other wing, but because it is a different system, and it did not fit into the wall they did not put it in his new room. The DON stated they failed to communicate with the nursing staff about it when they came with the other call light (balloon), and they already realized the call light he had in East wing did not fit the device they have in his new room, and they did not report it. The DON acknowledged there was a failure because they did not report it to nursing and that was the reason why they did not notice he did not have the call light that fits his needs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 3 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0558 Level of Harm - Minimal harm or potential for actual harm During an interview with the Maintenance Director on 11/17/2022 at 02:19 PM, it was revealed Rehabilitation Department made him aware today about Resident #447's need for a different call light. Resident #447 was in another wing, and he was transferred to the west wing. The Maintenance Director stated the transfer is done by nursing, no one never requested to transfer the cord or call light from one room to another. Residents Affected - Few Interview with Staff L, Maintenance aide on 11/17/2022 at 01:29 PM revealed he was the one Resident #447 asked to change his call light. Staff L stated he went to look for one in the storage and he did not find it. He wanted to put one that they have here, but it did not fit in the wall. Staff L stated the one they have here are the call lights they push with fingers use the call light. Staff L stated he does not remember if he told the Maintenance Director, but he believes he did because they ordered and received new call lights, but it was different than the ones they ordered and clarified they received the same type of call light Resident #447 was using. Staff L stated that after they received the same type of call light, he did not follow up on this because he was not going to take any call light from other patient. Staff L stated he did not ask the Maintenance Director again about Resident #447's request, he had other work to do, and he just went to Resident #447's room and offered explanation about it, but he did not follow up through or communicated to anyone. Record review of Resident #447's face sheet revealed date of initial admission [DATE]. admission date 10/11/2022 included but no limited to Guillain- Barre Syndrome, Quadriplegia, Unspecified, Muscle Weakness (Generalized). Record review of Resident #447's MDS admission with assessment reference date (ARD) dated 10/10/2022 revealed Section C in the Brief Interview for Mental Status (BIMS) score of 14 out of 15 indicating the resident is cognitively intact. Section G Functional Status coded as Total dependence with Two person assist in all Activities for Daily Living (ADLs). Record review of Resident #447's admission Evaluation dated 10/11/2022 revealed diagnosis of Guillain-Barre syndrome and Quadriplegia are identified. Sensory Perception assessed resident as complete Immobile. Record review of the facility census records revealed Resident #447's was transferred from room on the East wing to a room on the [NAME] wing where he is residing. Transfer to the west wing occurred on 10/27/2022. Record review of Resident #447's Occupational Therapy Evaluation and Treatment dated 10/10/2022 revealed #3.0 New Goal to increase his ability to manipulate functional objects and to improve reaching. Record review of Grievance Log done earlier revealed no grievance filed on behalf of Resident #447. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 4 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 observations, interview and record review the facility failed to ensure the Preadmission Screening and Resident Review (PASSAR) Level I for Serious Mental Illness (SMI) or intellectual disability (ID) was completed at the time of admission for one (Resident # 19) out of two residents investigated. This deficiency had the potential to affect 160 residents residing in the facility at the time of the survey. Residents Affected - Few The findings included: Observations of the resident on 11/16/22 11:39 AM Resident was lying on her bed, sleeping. Observations of the resident on 11/17/22 10:40 AM Resident was observed seated in her wheelchair by her room door. Resident was talking but couldn't understand. Record review of admission Record revealed the resident was admitted to the facility on [DATE] and re-admitted on [DATE]. Medical diagnoses included, but were not limited to, Metabolic Encephalopathy; Parkinson's Disease; Schizophrenia, Unspecified; Unspecified Psychosis not due to a Substance or known Physiological Condition; Other Seizures; Cerebral Infarction, Unspecified; Type 2 Diabetes Mellitus without Complications. Record review of PASARR Level I dated 06/02/2022 revealed identification of a mental diagnosis under 1A. Section 1B was not checked for Serious Mental Illness (SMI). Section 4 revealed the individual had no diagnosis or suspicion of serious mental illness (SMI)or intellectual disability (ID) indicated. Level II PASRR evaluation not required. Record review of physician orders dated 10/02/2022 revealed Remeron oral tablet 15 milligrams (Mirtazapine). Give 7.5 milligrams by mouth at bedtime for depression. Orders dated 10/27/2022 revealed the resident was receiving Seroquel oral tablet 50 milligrams (Quetiapine Fumarate). Give 1 tablet by mouth at bedtime for Schizophrenia. Orders dated 10/27/2022 revealed the resident was receiving Seroquel oral Tablet 50 milligrams (Quetiapine Fumarate) Give 1 tablet by mouth in the morning for Schizophrenia. Review of Medication Administration Record for November 2022 revealed the resident was receiving Remeron Oral Tablet 15 milligrams (Mirtazapine) Give 7.5 milligrams by mouth at bedtime for depression -Started Date 10/02/2022. The resident was receiving Seroquel oral Tablet 50 MG (Quetiapine Fumarate) 1 tablet by mouth at bedtime for schizophrenia. -Started Date 10/27/2022. Seroquel oral tablet 50 MG (Quetiapine Fumarate). 1 tablet by mouth in the morning for Schizophrenia. -Started Date 10/28/2022. Record review of admission Minimum Data Set (MDS) Section A dated 06/07/2022 (Section 1500) revealed: Is the resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition? NO. Record review of Medicare -5 days Minimum Data Set (MDS) Section C dated 10/09/2022 revealed the Brief Interview for Mental Status (BIMS) summary score was left blank. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 5 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 Level of Harm - Minimal harm or potential for actual harm Record review of Medicare -5 days MDS Section I dated 10/09/2022 revealed the resident's diagnosis included schizophrenia, depression and psychotic disorder. Record review of Medicare 5-days Minimum Data Set (MDS) Section N dated 10/09/2022 revealed the resident is receiving antipsychotic and antidepressant medication seven (7) days in a week. Residents Affected - Few Record review of Care Plan initiated on 06/06/2022 revised on 09/14/2022 revealed the resident used antidepressant medication related to Depression. Goal: The resident will be free from discomfort or adverse reactions related to antidepressant therapy through the review date. Interventions: Consult with pharmacy, and physician to consider dosage reduction when clinically appropriate. Educate the resident/family/caregivers about risks, benefits and the side effects and/or toxic symptoms of (Specify: anti-depressant drugs being given). Give antidepressant medications ordered by physician. Monitor/document side effects and effectiveness. Antidepressant side Effects: dry mouth, dry eyes, constipation, urinary retention, suicidal ideations. Monitor/document/report to physician ongoing sign and symptoms of depression unaltered by antidepressant medications: Sad, irritable, anger, never satisfied, crying, shame, worthlessness, guilt, suicidal ideations, negative mood/comments, slowed movement, agitation, disrupted sleep, fatigue, lethargy, does not enjoy usual activities, changes in cognition, changes in weight/appetite, fear of being alone or with others, unrealistic fears, attention seeking, concern with body functions, anxiety, constant reassurance. Offer nonpharmacologic interventions such as conversation, hand massage, diversional activities, music therapy, redirection, reassurance, education on deep breathing and relaxation techniques, or assist to a quieter environment. Record review of Care Plan initiated on 10/03/2022 revised on 10/06/2022 revealed the resident used antipsychotic medications related to Behavior Management secondary to Schizophrenia. Goal: The resident will be/remain free of drug related complications, including movement disorder, discomfort, hypotension, gait disturbance, constipation/impaction or cognitive/behavioral impairment through review date. Interventions: Administer medications as ordered. Monitor/document for side effects and effectiveness. Consult with pharmacy, physician to consider dosage reduction when clinically appropriate. Discuss with physician, family ongoing need for use of medication. Monitor/record occurrence of for target behavior symptoms (Specify: pacing, wandering, disrobing, inappropriate response to verbal communication, violence/aggression towards staff/others. etc.) and document per facility protocol. Monitor/record/report to physician side effects and adverse reactions of psychoactive medications: unsteady gait, tardive dyskinesia, EPS (shuffling gait, rigid muscles, shaking), frequent falls, refusal to eat, difficulty swallowing, dry mouth, depression, suicidal ideations, social isolation, blurred vision, diarrhea, fatigue, insomnia, loss of appetite, weight loss, muscle cramps nausea, vomiting, behavior symptoms not usual to the person. Offer nonpharmacologic interventions such as conversation, hand massage, diversional activities, music therapy, redirection, reassurance, education on deep breathing and relaxation techniques, or assist to a quieter environment. Record review of Psychiatrist Consultation dated 10/11/2022 revealed the resident was seen by the psychiatrist. Plan: Adjustment disorder, unspecified. Continue with same medications. Follow up as needed. Interview with Social Services Director on 11/17/22 at 01:02 PM She stated she started 2 weeks ago in the position. She stated she was hired not promoted. She stated she will be training to oversee Preadmission Screening and Resident Review (PASSAR). She stated that right now she doesn't know who oversees PASRR. On 11/17/22 at 02:32 PM, Staff A Registered Nurse (RN) stated the resident is very special, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 6 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few sometimes she ate and sometimes she doesn't want anything. She stated the resident has mental health diagnosis of Schizophrenia, the resident has mood disorder, not aggressive but is a moody person. The resident receives Seroquel at bedtime and during the day. She tolerated the medication well. Interview with admission Director and Social Services Director on 11/17/22 at 04:58 PM. admission Director stated before the resident could be admitted they checked the hospital PASRR and did not realize the PASRR for this resident was incomplete. The Admissions Director stated that the Social Services Director started two weeks ago and the corporate nurse will start to work with an audit of all residents PASRR to see if they are completed. Review of the facility's undated Policies and Procedures for PASRR revealed General Statement of Policy: It is the policy of the facility that all residents have the required pre-admission scree prior to admission to the facility, and any time that there is a significant change that has bearing on the resident's specialized service needs. The facility will protect the rights of individuals by reviewing resident needs prior to admission to determine if specialized and services can be met by the facility. The facility will also protect the rights of facility residents by ensuring that identified specialized developmental and mental health services can be appropriately provided at the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 7 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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** Residents Affected - Few Observation of Resident #445 on 11/15/2022 at 10:15 AM revealed oxygen treatment provided at 3 liter per minute. Interview with the resident revealed she did not have oxygen treatment before, but it helps. Observation of Resident #445 on 11/16/2022 at 12:05 PM revealed resident was not in her room. Observation of Resident #445 on 11/16/2022 at 04:35 PM revealed resident had a room change. The resident was sitting in a chair with no oxygen. The resident was asked why she did not have her oxygen on. The resident stated the nurse placed her in the chair and she was expecting them to put it back on. The resident added that she likes to have her oxygen, and explained she has order for it and needed it. The Resident was calm and showed no distress. Review of Resident #445's face sheet revealed date of admission [DATE]. Diagnosis included Chronic Obstructive Pulmonary Disease with acute exacerbation. Review of Resident #445's physician orders sheet (POS) dated 11/8/2022, revealed order dated 11/10/2022 for oxygen (O2) via nasal cannula at 2 liters continuously every shift for Short of Breath (SOB). Review of Resident #445's Minimum Data Set (MDS) Medicare 5 Days with assessment reference date (ARD) date on 11/14/2022 revealed Section C in the Brief Interview for Mental Status (BIMS) a score of 15 out of 15 indicated the resident is cognitively intact. Section O for special treatments revealed oxygen treatment is coded. Record review of Resident #445's Care Plan dated 11/08/2022 revealed a care plan for Resident #445 for being at risk of respiratory distress related to abnormal breath pattern secondary to COPD, pulmonary hyperinflation, pulmonary nodules, wheezing, SOB, congestion, cough. Goal: Resident #445 will not exhibit signs of respiratory distress. Interventions among others included: Administer medications per physician order, assess degree or level of anxiety, auscultate lung sounds, avoid extremes of hot and cold, breathing, and coughing exercises, encourage resident to sit up straight in chair or bed or stand erect as tolerated, Give aerosol or bronchodilators as ordered. Monitor/document any side effects and effectiveness, give oxygen therapy as ordered by the physician. Change nasal cannula as ordered, head of bed to be elevated (semi-Fowlers to fowlers) or out of bed upright in a chair during episodes of difficulty breathing (Dyspnea). Monitor for difficulty breathing (Dyspnea) on exertion. Remind resident not to push beyond endurance, Monitor for s/sx (sign and symptom) of acute respiratory insufficiency: Anxiety, confusion, restlessness, SOB at rest, cyanosis, somnolence. Monitor lab values as ordered, monitor respiratory status- oxygen saturation, lung sounds . Observation of Resident #445 on 11/17/2022 at 12:45 PM revealed she was lying in her bed and no oxygen on. There was no oxygen concentrator at her side. When asked why she did not have oxygen, resident stated I did not have it since I was moved in this room. The surveyor called Staff I, a Registered Nurse who came in and checked on the resident. Staff I, stated she is not her nurse, but she can check if Resident #445 has an order for oxygen. Staff I, went to the nursing station and approached the resident's nurse Staff D, a Licensed Practical Nurse (LPN) and they both looked in the computer to check on the resident's orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 8 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with Staff D, LPN on 11/17/2022 at 12:50 PM revealed she works for this facility she is not from agency or per diem. Staff D checked the orders and stated Resident #445 is on continuous oxygen and she believes patient had it on when she gave her medication. When Staff D was informed by the surveyor that Resident #445 did not have on the oxygen, Staff D rushed to resident's room and verified Resident #445 had no oxygen on, and there was no concentrator. When asked who was responsible for checking to make sure the oxygen was in place Staff D stated; I am the responsible one. After the surveyor asked for the oxygen concentrator and it was no where to be found in the resident's room, the surveyor suggested to check in the resident's previous room. This surveyor and Staff D went into the resident's previous room and the oxygen concentrator was noted in the room at the bedside. When asked who was supposed to transfer the concentrator to the new room, Staff D stated the nurse should have moved it. Interview with Staff E, RN and Unit Manager on 11/17/2022 at 12:55 PM revealed Resident #445 is on continuous oxygen, and should have it on. The Unit Manager acknowledged the oxygen concentrator was in room the resident's old room and it should have been moved into the new room with all Resident #445's belongings. Staff E stated the nurse and Certified Nursing Assistant (CNA) are in charge of moving the concentrator and all the belongings. Staff E was asked the date and time Resident #445 was moved from the room to identify the staff working that day. At 02:45 PM Staff E stated she found out that Resident #445 was transferred from her room on 11/15/2022 in the afternoon, and added the nurse is not working today and the CNA stated did not remember. During the interview, Staff E was shown the medication administration record (MAR) with entries for 11/15/2022 and 11/16/2022 where the oxygen treatment monitoring was checked to indicate the treatment was in place by nurses working all shifts after resident the was transferred to her new room without the oxygen concentrator. Staff E looked at the record and agreed it was not accurate. When asked about why the entries in the MAR were checked out for the continuous oxygen treatment after the day Resident #445 was transferred without the concentrator, Staff E stated Yes I am seeing they checked it unfortunately Interview with the Director of Nursing (DON) on 11/17/2022 at 04:35 PM revealed she was informed by Staff E, Unit Manager about the incident with the Resident #445's continuous oxygen treatment. The DON stated it should not happen because all staff is instructed to move residents with all their belongings and there was no reason to leave the concentrator back in Resident #445's previous room. The DON stated it is worse because she is a resident who has orders for continuous oxygen and of shortness of breath. Based on observation, interview and record review, the facility failed to provide oxygen per physician's orders for two (Resident #104, Resident #447) of two residents reviewed for respiratory treatment out of 17 residents receiving oxygen. The findings included: The facility's policy titled Oxygen Administration, dated 10/25/22, documented the following: In the section titled, preparation 1. Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 9 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 2. Level of Harm - Minimal harm or potential for actual harm Review the resident's care plan to assess for any special needs of the resident. under the heading of 'Steps in the Procedure': Residents Affected - Few 8. turn on the oxygen Unless otherwise ordered, start the flow of oxygen at the rate of 2 to 3 liters per minute. Resident #104 was admitted to the facility on [DATE] and admitted to Hospice on 04/01/22. Resident's orders included: oxygen at 2 liters per minute continuously via nasal cannula dated 03/11/22 Resident #104's care plan, initiated on 05/26/22, documented, [Resident] has Shortness of Breath related to Cerebral Arteriosclerosis, Traumatic subdural hemorrhage and comorbidities. Interventions to the care plan included: Monitor respiratory status- oxygen saturation, lung sounds, complaints of shortness of breath, use of accessory muscles, cyanosis, etc. Provide Oxygen as ordered. On 11/14/2 at 2:20 PM, Resident #104 was observed awake in bed with oxygen at 1.5 liters per minute (LPM). On 11/16/22 at 9:07 AM, Resident #104 was observed in bed with head of bed elevated and bed in a raised position, with oxygen at 3 LPM. During an interview, on 11/16/22 at 3:57 PM, Staff H, a Certified Nursing Assistant (CNA)/Private Duty Aid (PDA) for Resident #104, stated that she works for the resident Monday through Friday and that Resident #104 had 24 hour care by PDAs. The PDA further stated, Tomorrow is the last day because Medicare. During the interview, it was noted that Resident #104's oxygen was being administered at 3 LPM. On 11/17/22 at 08:21 AM Resident #104 observed in bed with PDA completing the changing of the residents incontinent brief. the oxygen was set at 3 LPM. During an interview with Staff J, PDA/CNA for the resident, the PDA stated that she had been with Resident #104 for a year. When asked about the resident's orders for oxygen, the PDA stated, her order has always been for 3 LPM. Review of Resident #104's records showed no documentation to justify the oxygen order for 2 LPM not being followed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 10 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0732 Post nurse staffing information every day. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to have nurse staffing information posted prior to the beginning of shifts on 2 of 3 nurse's stations. Residents Affected - Few The findings included: During an observation at the East unit Nurse's station, on 11/16/22 at 8:02 AM, it was noted that the staffing information that was posted was dated Monday, 11/14/22. During an observation at the [NAME] Unit Nurse's station, on 11/16/22 at 8:06 AM, it was noted that the staffing information that was posted was dated Monday, 11/14/22. During an observation at the East Unit Nurse's station, on 11/17/22 at 7:31 AM, it was noted that the staffing information that was posted was dated Monday, 11/14/22. During an observation at the [NAME] Unit Nurse's station, on 11/17/22 at 7:58 AM, it was noted that the staffing information that was posted was dated Monday, 11/14/22. On 11/17/22 08:05 AM, Staff E, RN/UM posted updated nurse staffing information to reflect staffing hours on this day. On 11/17/22 at approximately 8:30 AM, the Assistant Director of Nursing (ADON) was made aware of the observations and shown the documents that were posted at the nurse's stations. The ADON acknowledged the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 11 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview, and record review the facility failed to ensure pharmaceutical procedures were followed during medication administration for two ( Resident #342, Resident # 446) out of six residents sampled, as evidenced by License Practical Nurse and Registered Nurse observed crushing extended release and enteric coating medications for administration to residents. This had the potential to affect the 160 residents residing in the facility at the time of the survey. The findings included: During medication administration observation on 11/17/22 at 8:12AM on North Cart #2, Registered Nurse (Staff A) placed all of Resident #342's medications in individual cups, crushed all medications individually, mixed the medications with apple sauce individually, entered Resident #342's room, identified resident, proceeded to wash hands to begin medication administration to Resident #342. The surveyor requested Staff A meet with her outside of the resident's room in the hallway before medication administration. Review of the medical records for Resident #342 revealed resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to: Other Specified Depressive Episode, Anxiety Disorder, and Unspecified Dementia-unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance. Review of the Physician's Orders Sheet for November 2022 revealed Resident #342 had orders that included but not limited to: No Added Salt/Cardiac diet, Mechanically Altered Chopped texture, Thin Liquids consistency. Medications included: Alprazolam Oral Tablet 0.25 Milligram (MG)-Give 1 tablet by mouth two times a day for Anxiety. 11/5/22-11/17/22-Bupropion HCl Extended Release (XL) Tablet Extended Release 24 Hour 300 MG-Give 1 tablet by mouth one time a day for depression. 11/17/22-Bupropion HCl Tablet 100 MG- Give 1 tablet by mouth three times a day for depression Record review of Resident #342 's Minimum Data Set (MDS) dated [DATE] revealed: Brief Interview for Mental Status Score-10, on a 0-15 scale indicating resident is moderately impaired. On 11/17/22 at 8:34AM surveyor asked Staff A in resident's room if she was about to give the resident the medication, Staff A stated yes, I am going to wash my hands first surveyor requested Staff A to meet her outside of the resident's room before giving the resident any medications. Surveyor had Staff A review Resident #342's medication on the electronic medication record (EMAR), surveyor showed Staff A the medication Bupropion HCI ER( XL) 300 MG and asked Staff A if the medication can be crushed,. Staff A stated, I did not know that extended release tablets cannot be crushed, I have been working here since February 2022, this area I work in have many new rehabilitation residents, this resident is new to me. I am going to dispose of all this resident's medications and have my supervisor witness the narcotic disposal and call the doctor for new orders. I cannot tell right now which medication is in each cup. On 11/17/22 at 8:41 AM Registered Nurse, North Unit Supervisor (Staff C), stated: I am aware that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 12 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few extended release medications cannot be crushed, we review the resident orders, but maybe they change the diet orders and now we have to change the medications, I am going to call the doctor to change the medications and also going to check with speech to see if the resident can swallow well and is able to take the pills whole with some apple sauce, her diet is mechanical soft. On 11/17/22 at 9:30AM, Staff C stated: the medications were destroyed in the Director of Nursing (DON) office with the drug buster with two witnesses, the resident's doctor(MD) was called, the MD changed the resident's Bupropion HCl Extended Release (XL) Tablet Extended Release 24 Hour 300 MG-Give 1 tablet by mouth one time a day for depression to Bupropion HCl Tablet 100 MG- Give 1 tablet by mouth three times a day for depression, I called the pharmacy and placed an urgent delivery, the medication will be here at 2:00 PM. I did some teaching with the nurse involved, I checked with speech department and the resident is pending for another swallowing test to check how she is improving. 2. During medication administration observation on 11/17/22 at 8:45AM on [NAME] cart #1 with Licensed Practical Nurse (Staff D), Staff D prepared medications to be administered in individual cups, individually crushed all medications, added apple sauce to each medication and proceeded to enter Resident's #446's room to administer medication to him. Surveyor intervened and requested Staff D to return to the medication cart to review Resident #446's medications. Review of the medical records for Resident # 446 revealed resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to: Unspecified Dementia- -unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance. Resident discharged on 11/17/2022 Review of the Physician's Orders Sheet for November 2022 revealed Resident #446 had orders that included but not limited to: No Added Salt/Cardiac diet, Puree Solids textures. Medications included: 11/17/22-Memantine HCl Oral Tablet 10 MG- Give 10 mg by mouth two times a day for Cognitive Deficiency 10/25/22-11/17/22-Memantine HCl ER Oral Capsule Extended Release 24 Hour 21 MG-Give 1 capsule by mouth one time a day for Dementia On 11/17/22 9:07 AM Licensed Practical Nurse Staff D stated I know that we do not crush extended-release medications, I am going to call the MD to get a change of order for this resident because he cannot swallow his pills whole, I have been working at this facility since June 2022. During an interview on 11/17/22 at 9:10AM, Registered Nurse [NAME] Station Supervisor (Staff E) stated, I will contact the MD to get the orders changed, I am aware that extended-release tablets cannot be crushed, I will be providing training and re-education for my nurses. On 11/17/22 at 10:58 AM, the Assistant Director of Nursing (ADON) was asked how the nurses know which residents' medications need to be crushed, the ADON revealed that the nurses go by the residents' diet, if the diet is not a regular diet-mechanical soft etc. the medications are crushed, and also by the resident's preference. The residents that are alert and oriented we would ask them how they would like to receive their medications. During an interview on 11/17/22 at 02:44 PM, the ADON and Director of Nursing (DON) reported a one-to-one reeducation was done with the two nurses this morning that were involved with the errors and then a reeducation with all the other nursing staff. They explained that we do not crush any (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 13 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0755 extended release or coated medications and why is it important to not crush those medications. Level of Harm - Minimal harm or potential for actual harm Review of the facility Policy titled, Crushing Medications dated 10/20/22 states: Medications shall be crushed only when it is appropriate and safe to do so, consistent with physician orders. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 14 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0759 Ensure medication error rates are not 5 percent or greater. 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, it was determined that the facility failed to ensure a medication error rate below five percent as evidence by licensed nurses observed crushing extended release and enteric coating medications during medication observation for Resident # 342 and Resident # 446 resulting in a 9.09 percent error rate out of 33 opportunities. There were 160 residents residing in the facility at the time of this survey. Residents Affected - Few The findings included: 1. During medication administration observation on 11/17/22 at 8:12AM on North Cart #2, Registered Nurse (Staff A) placed all of Resident #342's medications in individual cups, crushed all medications individually, mixed the medications with apple sauce individually, entered resident #342's room, identified resident, proceeded to wash hands to begin medication administration to Resident #342. Surveyor requested Staff A meet with her outside of the resident's room in the hallway before medication administration. Review of the medical records for Resident #342 revealed resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to: Other Specified Depressive Episode, Anxiety Disorder, and Unspecified Dementia-unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance. Review of the Physician's Orders Sheet for November 2022 revealed Resident #342 had orders that included but not limited to: No Added Salt/Cardiac diet, Mechanically Altered Chopped texture, Thin Liquids consistency. Medications included: Alprazolam Oral Tablet 0.25 Milligram (MG): Give 1 tablet by mouth two times a day for Anxiety. 11/5/22-11/17/22-Bupropion HCl Extended Release (XL) Tablet Extended Release 24 Hour 300 MG: Give 1 tablet by mouth one time a day for depression. 11/17/22-Bupropion HCl Tablet 100 MG: Give 1 tablet by mouth three times a day for depression. Record review of Resident #342 's Minimum Data Set (MDS) dated [DATE] revealed: Brief Interview for Mental Status Score-10, on a 0-15 scale indicating resident is moderately impaired. During an interview on 11/17/22 at 8:34AM, the surveyor asked Staff A in resident's room if she was about to give the resident the medication, Staff A stated yes, I am going to wash my hands first surveyor requested Staff A to meet her outside of the resident's room before giving the resident any medications. Surveyor had Staff A look up the Resident #342's medication on the electronic medication record (EMAR), surveyor showed Staff A the medication Bupropion HCI ER(XL) 300 MG and asked Staff A if the medication can be crushed, nurse stated, I did not know that extended-release tablets cannot be crushed, I have been working here since February 2022, this area .this resident is new to me. I am going to dispose of all this resident's medications and have my supervisor witness the narcotic disposal and call the doctor for new orders. I cannot tell right now which medication is in each cup. During an interview on 11/17/22 at 8:41 AM, Registered Nurse, North Unit Supervisor (Staff C) stated: I am aware that extended release medications cannot be crushed, we review the resident orders, but maybe they changed the diet orders and now we have to change the medications, I am going to call the doctor to change the medications and also going to check with speech to see if the resident can (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 15 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0759 swallow well and is able to take the pills whole with some apple sauce, her diet is mechanical soft. Level of Harm - Minimal harm or potential for actual harm On 11/17/22 at 9:30 AM, Staff C, (North Unit, RN Supervisor) reported that the medications were destroyed in the Director of Nursing (DON) office in the drug buster with two witnesses, the Resident #342's medical doctor (MD) was called, the MD changed the resident's Bupropion HCl Extended Release (XL) Tablet Extended Release 24 Hour 300 MG-Give 1 tablet by mouth one time a day for depression to Bupropion HCl Tablet 100 MG- Give 1 tablet by mouth three times a day for depression. The pharmacy was called, and order was placed for an urgent delivery, the medication will be here at 2:00 PM. Residents Affected - Few 2. During medication administration observation on 11/17/22 at 8:45AM on [NAME] cart #1 with Licensed Practical Nurse (Staff D), Staff D prepared medications to be administered in individual cups, individually crushed all medications, added apple sauce to each medication and proceeded to enter Resident's #446's room to administer medication to him. Surveyor intervened and requested Staff D to return to the medication cart to review Resident #446's medications. Review of the medical records for Resident # 446 revealed resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to: Unspecified Dementia- -unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance. Resident discharged on 11/17/2022. Review of the Physician's Orders Sheet for November 2022 revealed Resident #446 had orders that included but not limited to: No Added Salt/Cardiac diet, Puree Solids textures. Medications included: 11/17/22-Memantine HCl Oral Tablet 10 MG- Give 10 mg by mouth two times a day for Cognitive Deficiency. 10/25/22-11/17/22-Memantine HCl ER Oral Capsule Extended Release 24 Hour 21 MG-Give 1 capsule by mouth one time a day for Dementia. Interview on 11/17/22 9:07 AM Licensed Practical Nurse Staff D stated I know that we do not crush extended-release medications, I am going to call the MD to get a change of order for this resident because he cannot swallow his pills whole, I have been working at this facility since June 2022. During an interview on 11/17/22 at 9:10AM, Registered Nurse [NAME] Station Supervisor (Staff E) stated, I will contact the MD to get the orders changed, I am aware that extended-release tablets cannot be crushed, I will be providing training and re-education for my nurses. On 11/17/22 at 10:58 AM, the Assistant Director of Nursing (ADON) was asked how the nurses know which residents' medications need to be crushed. The ADON stated; the nurses go by the residents' diet, if the diet is not a regular diet-mechanical soft etc. the medications are crushed, and also by the resident's preference. The residents that are alert and oriented we would ask them how they would like to receive their medications. During an interview on 11/17/22 at 02:44 PM, the ADON and Director of Nursing (DON) reported that they did a one-to-one reeducation with the two nurses this morning that were involved with the errors and then did a reeducation with all the other nursing staff, explained that we do not crush any extended release or coated medications and why is it important to not crush those medications. Review of the facility Policy titled, Crushing Medications dated 10/20/22 states: Medications shall (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 16 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0759 be crushed only when it is appropriate and safe to do so, consistent with physician orders. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 17 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, the facility failed to store, prepare, distribute and serve food in a sanitary manner and in accordance with professional standards Residents Affected - Many The findings included: During the initial kitchen tour, on 11/14/22 at 8:19 AM, accompanied by the Registered Dietitian, the Administrator and the Dietary Director, the following were noted: -There was an accumulation of food debris on the floor in the dry storage area. -There was residue on the wall of the dry storage area indicative of something being splashed. -The walk in cooler floor had numerous broken tiles. -There was an accumulation of debris on the floor of the walk in cooler. -There was an accumulation of residue on the vents of the exhaust fans over the cooking equipment. -In the walk in freezer, there were two opened packages of meat that were not dated. -In the dry storage area, there were 3 containers of bulk ingredients that were not dated. During a follow up tour of the kitchen, on 11/16/22 at 11:10 AM, accompanied by the Dietary Director, the following were noted: -Staff F, Dietary Aid, was observed wrapping silverware by the plate assembly line without wearing any form of hair restraint. -Staff F was handling the uncovered plates of food and assembling the lunch meal while wearing bandage that covered her lower left arm. It was noted that he bandaging was not intact in a manner that threads from the wrapping were hanging from underneath of Staff F's lower left arm. -Staff G, Dietary Aid was observed wearing a loose-fitting bracelet while portioning coffee into open containers. -The handle of the convection oven was noted to be worn. -The knobs of the convection oven had an accumulation of food residue. -There was a wet towel left on the counter of the three compartment sink where cleaned and sanitized items were drying. -The interior of the walk in cooler door was damaged. During an interview with the Dietary Director at the conclusion of the tour, the Dietary Director acknowledged understanding of the concerns. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 18 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete During an observation of the mechanical ware washing machine, on 11/17/22 at 9:34 AM, it was discovered that the machine was not dispensing sanitizer to the unit at the end of the wash and rinse cycles as evidenced by the use of a chlorine sanitizer test strip. After testing the concentration of the sanitizer, the test strip did not react to being in contact with a wet sanitized surface. The Dietary Director acknowledged that the items that had been washed using the machine were not properly sanitized due to the machine not dispensing the chemical sanitizer and instructed staff to repeat the process when the machine was dispensing the sanitizer at the appropriate concentration. Event ID: Facility ID: 105910 If continuation sheet Page 19 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain communication with Hospice to ensure continuity of care for 1 of 2 residents reviewed for Hospice, Resident #104. The findings included: The contract between Vitas Healthcare Corporation of Florida and the facility documented the following. In section 2.1.3 Coordination, Supervision and Evaluation of Services. Vitas will coordinate, supervise, and evaluate the delivery of services provided to a Hospice Patient hereunder in the following Manner: 2.1.3.1 Vitas will promote open and frequent communication, in person, by phone or FAX, or in writing between Vitas and Facility staff concerning the Hospice Plan of Care and the Hospice Patient's needs. Vitas In Section III of the agreement, the contract documented the following: 3.2 Clinical Records. The parties will each maintain and, subject to applicable laws, rules and regulations governing the confidentiality of medical records, make available to each other for inspection and copying, detailed clinical records concerning each Residential Hospice Patient in accordance with applicable laws, rules and regulations and Medicare and Medicaid guidelines 3.3 Communication. The parties will communicate pertinent information with each other either verbally or in the Residential Hospice Patient's records at least weekly and/or at each hospice patient visit to ensure that the needs of each Residential Hospice Patient are addressed and met 24 hours per day. Documentation of such communication shall be included in the Residential Patient's medical record . Resident #104 was admitted to the facility on [DATE] and admitted to Hospice on 01/18/22. Resident #104's care plan, initiated on 05/06/22, documented, [Resident] has a terminal prognosis and receives Palliative care under Hospice services related to Cerebral Atherosclerosis, Traumatic subdural hemorrhage, acute pyelonephritis, hypertension, diabetes mellitus, hyperlipidemia, psychosis, Acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity, convulsions, Insomnia, glaucoma, dementia, depression . The goal of the care plan was documented as, [Resident's] dignity and autonomy will be maintained at highest level through the review date. 05/26/22 and most recently revised on 08/10/22 with a target date of 01/31/23. Interventions to the care plan included: Activate residents advanced directives as needed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 20 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess resident coping strategies and respect resident wishes. Assess spiritual preferences and arrange accordingly. Consult with physician and Social Services to have Hospice care for resident in the facility. Crisis care for SOB and Respiratory distress. every shift for SOB/Respiratory distress. Encourage support system of family and friends. Keep the environment quiet and calm. Keep linens clean, dry and wrinkle free. Keep lighting low and familiar objects nearby. Observe resident closely for signs of pain, administer pain medications as ordered, and notify physician immediately if there is breakthrough pain. Refer for Psychiatric/Psychogeriatric consult if indicated. Review resident's living will and ensure it is followed. Involve family in discussion. Work cooperatively with hospice team to ensure the resident's spiritual, emotional, intellectual, physical, and social needs are met. Work with nursing staff to provide maximum comfort for the resident. During an interview, on 11/16/22 at 3:57 PM, with Staff H, CNA/Private Duty Aid (PDA) for Resident #104, the PDA stated that she works for the resident Monday through Friday and that Resident #104 had 24-hour care by PDAs. The PDA further stated, Tomorrow is the last day because Medicare ran out of money for her. The PDA stated that she sees Hospice CNA 1-2 times per week between Tuesday and Friday. During an interview, on 11/16/22 at 2:26 PM, with Staff I, RN/Unit Manager, when asked about hospice services for Resident #104 Staff I replied, the last time I saw them was about a month ago. Private duty is here every day. When they come, they usually leave us a paper (Interdisciplinary Plan of Care Revision/Physician Orders) documentation. by phone, as needed. They come and visit and assess the patient. When asked for documentation of what services, treatments and tasks completed by Hospice staff, Staff I stated that the documentation is in a binder at the nurse's station. Review of Resident #104's records - electronic and paper-based - revealed no documentation of communication between Vitas Hospice and the facility, no documentation of Vitas Hospice staff being in the facility and providing care to Resident #104 and what service was completed by Vitas Hospice staff during visit since 09/06/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 21 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on interview and record review, the facility's quality assurance and assessment committee failed to identify quality concerns as evidenced by not implementing an effective plan of action for correcting repeated deficiencies related to reasonable accommodation of needs, respiratory treatment, pharmacy services, medication errors, food services, quality assurance and performance improvement activities resulting in repeated deficient practice. Cross reference of F 558 for Accommodation of Needs, F 695 for Oxygen Treatment, F 755 for Pharmacy Services, F 759 for Medication Error 5% of more, F 812 for Sanitary Food Handling, and F867 for QAPI/QAA Improvement activities. The facility had deficiency practice during the last recertification survey conducted in 2020. The facility had a census of 160 residents at the time of the survey. The findings included: Review of the facility's plan of correction for the last annual survey with an exit date 11/21/2020 related to F 558 Accommodation of Needs indicated as part of the correction measures that DON/designee will make rounds daily to ensure all call bells are within reach . The facility's plan of correction related to F 695 for Oxygen Treatment indicated The CNAs in-serviced by DON/designee on reporting issues i.e., oxygen tubing found out of place. The nurses in-serviced by DON/designee on following MD orders specifically related to oxygen treatments. The nurse and CNAs in-serviced by DON/designee on the importance of doing rounds every two hours. The facility's plan of correction related to F 755 Pharmacy Services indicated nurses were in-services by DON/designee, and in-service conducted by pharmacy RN. The plan of correction related to F 759 Medication Errors 5% or more indicated Nurses all shifts in-serviced on following MD orders, triple checking all medication before administration mar to pharmacy label. Review of the nine rights of administration of medications by DON/designee. The facility's plan of correction related to

F 812 Food procurement, store/prepare/serve-Sanitary indicated kitchen staff in-services by Dietitian/designee. The plan of correction for F867 QAPI/QAA Improvement Activities indicated In-service provided to DON and Department heads by administrator in regard to proper QAPI processes and implementation. During an interview with the Nursing Home Administrator (NHA) and the Director of Nursing (DON) on 11/17/2022 at 06:48 pm it was revealed facility has a QAA/QAPI Committee and they meet monthly the third Thursday of the month. The members included but no limited to the Medical Director, Director of Nursing, Nursing Home Administrator, Assistant Director of Nursing, Corporate QAPI member. Pharmacy Consultant and all Department heads. The Committee welcome to come in regular staff CNAs and nurses to the meetings and to bring any concern they want the Committee to be aware. The NHA explained the performance improvement plans (PIPs) the facility is currently working on and none of them identified the problems identified during the survey. The NHA explained the Committee has a QAPI agenda and each Department head conducts audits, and they discuss the trends and figure out how to fix the problems they identified and based on that they do PIPs. The NHA stated once they implement the PIP, they will set a threshold in percentage, ad once it is met, they discontinue the PIP. During the interview the NHA acknowledged the survey identified concerns on the same areas they were cited last survey two years ago. The NHA stated they discontinued the plan of correction they had in place, but now that the survey identified some of the same problems, they will have to reopen the PIPs, set a threshold, and extend the period of re-evaluation until they are in compliance. The NHA revealed she acknowledged the survey identified concerns in the same areas they were cited last survey. The NHA agreed some of the concerns identified during survey are repeated in comparison with the previous survey where the facility was cited (over 30 tags) the survey was about two years ago and they discontinued (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 22 of 23 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 105910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Reef Subacute Care Center LLC 9869 SW 152nd Street Miami, FL 33157 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the plan of correction they had in place , but now if the survey has identified some of the same problems they will have to reopen PIPs and set the threshold and extend the period of reevaluation to be in compliance. It has been a disadvantage to have a big turnover, nurses are educated but they need to keep them because they need to keep facility staffed with people who perform the job well. The NHA stated they will need to re-evaluate the threshold they set when working on improvements and as she has said extend the period to ensure compliance. During the interview with the NHA and DON on 11/17/2022 at 06:48 PM, the DON stated they have turnovers, and they will need to work on staffing and try to retain and train them. The NHA and the DON stated they are working on hiring people offering extra benefits and bonuses, and they tried to improve the nursing quality by adding extra unit managers and all of them are RNs. Review of the Quality Assurance and Performance Improvement (QAA) Committee Meeting Sign-in Sheets dated monthly documented the facility had a QAA Committee meeting monthly. Attendees included: Administrator, Medical Director, Director of Nursing (DON) and other department heads. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 23 of 23