Health inspection·January 19, 2024

F 0604 Level of Harm - Minimal harm or potential for actual harm Interview with the Director of Nursing (DON) on 1/17/24 at 10:28 AM. She stated, I was informed about the resident having a sock over her left hand. I spoke to the CNA, and she said she didn't want the resident to be cold and she put the sock on. I immediately educated her that we could get gloves to make her hands warm and if the resident takes off the blanket, we just put it back on. Our policy is not to use the sock because that is considered a restraint. I will be providing one to one education with her now. Residents Affected - Few Interview with Staff B, Certified Nursing Assistant (CNA) on 1/17/24 at 10:30 AM via a Spanish translator. Staff B revealed she placed the sock on the left hand of the resident. She thought she was making her comfortable because her hands were cold. She now knows she is not to do that. She received education on not putting a sock on the resident's hand. Review of One-to-One Education In-Service form dated 1/17/2024 documented Staff B, CNA received education about physical restraints. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 2 of 20 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 01/19/2024 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 0637 Assess the resident when there is a significant change in condition Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to complete a Significant Change Minimum Data Set (MDS) for hospice for one Resident (#307) out of 34 sampled residents. There were 171 residents residing in the facility at the time of the survey. Residents Affected - Few The Findings Included: On 01/17/24 at 02:49 PM, review of Resident #307's MDS revealed no Significant Change MDS was completed for the resident's status change to hospice effective 12/11/23. Review of the Physician's Orders Sheet for January 2024 revealed Resident #307 had orders that included but not limited to: admitted to Hospice effective (12/11/23) for diagnoses late effect Cerebral Vascular accident (CVA). Prognosis is for a life expectancy of 6 months or less if terminal illness runs its normal course, and Start continuous care 1/15/24 due to uncontrollable vomiting/ Intravenous hydration. Further review of the medical records for Resident #307 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to: Hemiplegia and Hemiparesis following unspecified Cerebrovascular disease affecting the right dominant side. Interview on 01/18/24 at 08:39 AM, the Minimum Data Set (MDS) Coordinator, (Staff E) stated: I am aware that when a resident goes on hospice we have to do a significant change report, I see here in the medical records there is no significant change report, I will have to open a significant change MDS to capture the change in the resident to hospice. Staff E then opened a Significant Change MDS for Resident #307 on 1/18/23 during the interview with the surveyor. Review of the facility's policy titled MDS Completion and Submission Timeframes revision date July 2017 indicated: Our facility will conduct and submit resident assessments in accordance with current federal and state submission timeframes. Policy Interpretation and Implementation 1. The assessment coordinator or designee is responsible for ensuring that the resident assessments are submitted to CMS' QIES Assessment Submission and Processing (ASAP) system in accordance with current federal and state guidelines. 2. Timeframes for completion and submission of assessments . based on the current requirements in the Resident Assessment Instrumental Manual. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 3 of 20 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 01/19/2024 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 0641 Ensure each resident receives an accurate assessment. 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 accurately code the Minimum Data Set (MDS) for one Resident (#100) out of 34 sampled residents. As evidenced by inaccurate coding of MDS section B for Corrective lenses. There were 171 residents residing in the facility at the time of the survey. Residents Affected - Few The Findings included: During observation on 01/16/24 at 09:21 AM Resident #100 was in bed eating breakfast with dark glasses on. On 01/17/24 at 09:07 AM Resident #100 was observed in bed asleep with dark glasses on, call light on the bed and no distress noted. On 01/18/24 at 09:15 AM Resident #100 had a room change and was observed in bed in new room with dark glasses on. Record review of Resident #100's Quarterly Minimum Data Set (MDS) dated [DATE], Section B for Vision and Hearing in subsection B 1200 documented the resident has no corrective lenses. Review of the Physician's Orders Sheet for January 2024 revealed Resident #100 had orders that included but not limited to: May use treat in place protocols and activity level as tolerated. Further review of the medical records for Resident #100 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to: Unspecified glaucoma, low vision right eye category 2, and blindness left eye category 4. Record review of Resident #100 's Care Plans Reference Date 01/09/24 documented Resident has impaired vision and is at risk for falls and complications related to the aging process secondary to glaucoma, blindness left eye. Wears glasses. Interventions Include- Arrange consultation with eye care practitioner as required. Cleanse eyes with care daily and follow up with doctor for any concerns. Explain care and services before providing them. Keep resident in supervised area when out of bed. Inform doctor if sign/symptoms of pain, discomfort, or infection. Observe and report changes in vision status to doctor. Provide resident in an environment with adequate lighting and clutter free. Adapt environment to resident's needs. During an interview on 01/18/24 at 08:36 AM the MDS Coordinator (Staff E) stated that Social Services completed section B of the MDS, maybe at the time of the evaluation Social Services did not see the resident with the glasses on; I will go and personally look at the resident and make the modification to the MDS as soon as possible. Review of the facility's policy titled MDS Completion and Submission Timeframes revision date July 2017 states: Our facility will conduct and submit resident assessments in accordance with current federal and state submission timeframes. Policy Interpretation and Implementation 1. The assessment coordinator or designee is responsible for ensuring that the resident assessments (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 4 of 20 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 01/19/2024 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 0641 Level of Harm - Minimal harm or potential for actual harm are submitted to CMS QIES Assessment Submission and Processing (ASAP) system in accordance with current federal and state guidelines. 2. Timeframes for completion and submission of assessments is based on the current requirements published in the Resident Assessment Instrumental Manual. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 5 of 20 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 01/19/2024 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 record review and interview the facility failed to ensure a level 1 Preadmission Screening and Resident Review (PASRR) was revised following admission for one resident (#107) out of 34 sampled residents. There were 171 residents residing in the facility at the time of the survey. Residents Affected - Few The findings Included: During observation on 01/16/24 at 09:57 AM, Resident #107 was in bed well-groomed and had a cell phone in her hand. On 01/19/24 at 08:45 AM, Resident #107 was observed on a medical stretcher and leaving the facility, accompanied by two attendants. Record review of Resident #107's Level I PASRR (Preadmission Screening and Resident Review) documented Section I: PASRR Screen Decision Making: A: MI or suspected MI (check all that apply) - no mental Disorders checked off. Findings based on documented history were-Section II Other indicators for PASRR screening Decision-Making: All checked no. Does individual have validating documentation to support dementia or related Neurocognitive disorder - no. Section III Not a provisional admission. Section IV No diagnosis or suspicion of SMI or ID indicated. Level II PASRR evaluation not required. PASRR Level I completed by and Registered Nurse (RN) at a local hospital dated 11/6/2023. Record review of Resident #107's Psychiatrist Evaluation dated 11/13/2023 revealed a mental status examination was performed that showed Resident 107 was pleasant, cooperative, very tearful, overwhelmed, clear, coherent, reliable historian, admits to seeing people not there that hurt her, superficial, slowed. Diagnoses: Major Depression recurrent with psychotic features moderate anxiety, follow up in one month. Medications- Psychoactive Medications: Quetiapine 50 mg (milligrams) every night, Sertraline 100 mg each morning. Start Hydroxyzine 10 mg every day. Review of the medical records revealed Resident #107 was originally admitted to the facility on [DATE], readmitted on [DATE] and discharged from the facility on 1/19/2024. Resident # 107's clinical diagnoses included but not limited to: Major Depressive Disorder, Anxiety Disorder and Psychosis. Review of the current Physician's Orders revealed Resident #107 had orders that included but not limited to: Sertraline HCl 100 MG Tablet give one tablet by mouth one time a day for Depression dated 11/8/2023. Record review of Resident # 107's admission Minimum Data Set (MDS) dated [DATE] revealed: Section A for Identification Information revealed resident is not currently considered by the state level II Preadmission Screening and Resident Review (PASRR) process to have serious mental illness and or intellectual disability or a related condition. Section C for Cognitive Patterns documented Brief Interview for Mental Status score (BIMS), 15 on a 0-15 scale indicated the resident was cognitively intact. Section I for Active Diagnosis documented Psychotic Disorder. Section O for Special Treatments, Procedures and Programs revealed occupational and physical therapy were received while a resident. Record review of Resident #107 's Care Plans initiated date 06/16/2022 and revised date 11/9/2023 revealed: uses anti-anxiety medications related anxiety disorder. Interventions included: Consult with pharmacy, Medical Doctor (MD) to consider dosage reduction when clinically appropriate. Give (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 6 of 20 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 01/19/2024 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 anti-anxiety medications ordered by physician. Monitor/document side effects and effectiveness. Monitor/record occurrence of for target behavior symptoms (pacing, wandering, disrobing, inappropriate response to verbal communication, violence/aggression towards staff/others. etc.) and document per facility protocol. Antianxiety side effects: Drowsiness, lack of energy, Clumsiness, slow reflexes, Slurred speech, Confusion and disorientation, Depression, Dizziness, lightheadedness, Impaired thinking and judgment, Memory loss, forgetfulness, Nausea, stomach upset, Blurred or double vision. Paradoxical side effects: Mania, Hostility, and rage, Aggressive or impulsive behavior, Hallucinations. Resident 107 is taking Anti-anxiety meds which are associated with an increased risk of confusion, amnesia, loss of balance, and cognitive impairment that looks like dementia, falls, broken hips, and legs. Monitor for safety. Resident #107 uses antidepressant medication related to Depression. Interventions included: Consult with pharmacy, MD to consider dosage reduction when clinically appropriate. 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 MD as needed (PRN) and ongoing for signs and symptoms (s/s) of depression unaltered by antidepressant meds: Sad, irritable, anger, never satisfied, crying, shame, worthlessness, guilt, suicidal ideations, neg. 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 nonpharmacological 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. During an interview on 01/18/24 at 12:00 PM, the Director of Nursing (DON) when asked about the PASRR process at the facility the DON reported that all residents' most current PASRRs are in the electronic medical record and residents' physical charts. Registered Nurse (Staff G) is responsible for checking PASRRs and updating when a resident is admitted to facility. On 01/19/24 at 12:01 PM when asked about the PASRR process at the facility Staff G stated she is responsible for updating PASRR and Resident 107's most updated PASRR is located on the electronic medical record and the residents' physical charts. On 01/19/24 at 1:02 PM. The surveyor was approached by Staff G and given a PASSR for Resident #107, dated 1/18/2024 with appropriate diagnosis checked, and signed by Staff G. On 01/19/24 at 8:23 AM DON stated the PASRR process at the facility is that all new admissions from the hospital come to facility with a PASRR included in the admissions packet. The admissions office brings the PASSR to the morning meeting the next day and it is reviewed and updated by the interdisciplinary team. The interdisciplinary team includes social services, admissions, rehabilitation team, administrator, and unit managers. The DON further stated that each PASRR is reviewed to ensure the diagnosis matches the patient's hospital record, medications and an initial psych evaluation is scheduled. The DON informed that Resident #107 level I PASRR did not have any diagnosis checked. The DON stated that she does not know how the diagnosis for Resident #107 was omitted from the PASRR and that she plans to add additional personnel to assist with updating PASRR to ensure accuracy. On 01/19/24 at 08:46 AM Staff G stated the PASRR for newly admitted residents are reviewed during the morning meetings to ensure all diagnosis are updated and information matches from hospital records and medications. Residents' PASRR are updated on an ongoing basis whenever there is a change, she reviews physician orders daily and psychiatric evaluations to update PASRR. When the surveyor discussed with Staff G that Resident #107's level I PASRR was incomplete. Staff G stated the diagnosis for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 7 of 20 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 01/19/2024 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 Resident #107 was omitted from the PASRR dated 11/6/2023 by mistake due to the Resident #07's frequent hospitalizations. On 01/19/24 at 08:50 AM the admissions director stated that when a resident is readmitted from the hospital, a new PASRR is not received from the hospital; during morning meetings all readmissions' PASRR are reviewed. Review of the facility's PASRR Policy and procedure published 4/21/2022 general statement of Policy: It is the policy of the facility that all residents have the required pre-admission screen 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 the 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. Procedure: a. Prior to a resident's admission, the Admissions department/ designee will obtain: 1. A Screen and Level I Referral since the resident was referred to facility for rehabilitation. 2. A Level II if the Level I Referral indicates that the resident is known to be affected by serious mental illness and or mental retardation/ developmental disability per the guidelines. b. Upon admission the Screen will be incorporated into the resident's clinical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 8 of 20 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 01/19/2024 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to develop and implement a hospice care plan in a timely manner for one resident (#307) out of 34 sampled residents. There were 171 residents residing in the facility at the time of the survey. The Findings Included: Review of the care plans with reference date 9/29/23 for Resident #307 revealed the hospice care plans created, were completed on 1/16/24, the first day of initial observation of the resident by the surveyor. The care Plans documented: Resident is at end of life, diagnosis of terminal illness and have chosen Hospice care. Date Initiated: 01/16/2024, Revision on: 01/16/2024. Interventions include-Administer medications per physician orders, Assess and treat Pain, assess emotional and spiritual needs of resident/family/caregiver, and meet same when possible and provide comfort measures and honor preferences when possible. Review of the Physician's Orders Sheet for January 2024 revealed Resident #307 had orders that included but not limited to: admitted to Hospice effective (12/11/23) for diagnoses late effect Cerebral Vascular Accident (CVA). Prognosis is for a life expectancy of 6 months or less if terminal illness runs its normal course and start continuous care 1/15/24 due to uncontrollable vomiting/ Intravenous hydration. Further review of the medical records for Resident #307 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to: Hemiplegia and Hemiparesis following unspecified Cerebrovascular disease affecting the right dominant side. During an interview on 01/18/24 at 08:39 AM, the Minimum Data Set (MDS) Coordinator, (Staff E) stated: I am aware that when a resident goes on hospice we have to do a significant change report, I see here in the medical records there is no significant change report, I will have to open a significant change MDS to capture the change in the resident to hospice. Staff E then opened a Significant Change MDS for Resident #307 on 1/18/23. Staff E stated the hospice care plans were created on 1/16/23 either by review of the medical chart or the resident's orders. We have three (3) MDS staff and any one of us could create the care plans. Interview on 01/18/24 at 08:47 AM, the MDS Coordinator, (Staff F) stated: I saw that the resident had an update in his orders for hospice on 1/16/23, so I added a care plan for hospice for this resident. Sometimes I create the care plans by looking at the updated orders, we get a printout daily for all residents with updated orders, if needed we update the care plans with the new orders, and if the resident's MDS is currently open we update the MDS also at that time. Review of the facility's policy titled Care Plans, Comprehensive Person Centered revision date March 2022 states: A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. Interpretation and Implementation (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 9 of 20 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 01/19/2024 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 0656 Level of Harm - Minimal harm or potential for actual harm 2. The comprehensive, person-centered care plan is developed within 7 days of the completion of the required MDS assessment (Admission, Annual or Significant Change in Status), and no more than 21 days after admission. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 10 of 20 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 01/19/2024 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** Based on observations, interviews, and record review the facility failed to ensure oxygen therapy was administered accurately as ordered for one out of two sampled residents (Resident #105) who were investigated for oxygen administration. This deficient practice has the potential to affect all residents who are on oxygen therapy. Residents Affected - Few The findings included: Observation on 01/16/2024 at 08:22 AM showed Resident #105 was lying down on her bed while receiving oxygen (O2) via nasal cannula. Further observation showed the oxygen was running at 1 liter per minute (LPM). (Photographic evidence obtained) Observation on 01/18/2024 at 08:19 AM showed Resident #105 was lying on her bed while receiving oxygen (O2) via nasal Cannula. Observed a third-party staff from a hospice care service was at Resident #105's bedside. Further observation showed the oxygen was running at 1 liter per minute (Photographic evidence obtained). Review of Resident #105's face sheet revealed an initial admission date of 04/20/2021 and a re-entry date of 10/25/2023. Review of the physician's orders revealed an active order created on 01/10/2024 noting Consult to Respiratory Therapist for Incentive Spirometry. Also, an order placed on 01/13/2024 noting O2 at 3 liters per minutes via nasal cannula - every shift for O2 Supplement. Review of Resident #105 quarterly MD'S (Minimum data set) assessment dated [DATE] revealed in Section C: Cognitive Patterns BIMS (Brief Interview for Mental Status) score of 00 out of 15 that suggests severe cognitive impairment and Section J: Health Conditions showed shortness of breath or trouble breathing when lying flat. Review of Resident #105's clinical diagnoses included, but were not limited to, atherosclerotic heart disease of native coronary artery without angina pectoris, unspecified protein-calorie malnutrition, hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, hyperlipidemia (unspecified), chronic ischemic heart disease (unspecified), unspecified systolic congestive) heart failure, pulmonary hypertension (unspecified), acute kidney failure (unspecified), major depressive disorder (single episode, unspecified), hypothyroidism (unspecified), osteomyelitis (unspecified), essential (primary) hypertension, unspecified dementia, Alzheimer's disease (unspecified), anemia (unspecified), gastro esophageal reflux disease without esophagitis. During an interview with Staff I, Licensed Practical Nurse (LPN), on 01/19/2024 at 11:39 AM regarding the oxygen level for Resident #105, Staff I stated, According to the doctor's orders, the oxygen level is supposed to be 3 liters per minute, and it is continuous. I check it when I'm coming in between 07:15 AM to 07:30 AM. Basically, when I do the round, I check them. In my experience, the only way it can move down or up if someone moves it. It has a button to control it. Yesterday I wasn't here, Tuesday I wasn't here. My shift, I always check, I don't know if the other nurses check. Staff I then stated that Staff D, Registered Nurse (RN), worked On Thursday January 18, and Staff K, RN, worked Tuesday January 16. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 11 of 20 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 01/19/2024 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 On 01/19/2024 at 12:17 PM, The Director of Nursing stated that the nurses suppose are supposed to check the physician's orders and monitor the oxygen level for the residents. She then stated that if the resident is receiving hospice, the hospice nurse is supposed to monitor the oxygen level, and she has a respiratory therapist who is supposed to monitor the oxygen level as well. She further stated that she did not know what might cause the oxygen level to be at LPM. She then stated, Sometimes, when they clean the machine, they wipe it, that could be a possibility of the reason it was so low. Review of the facility's policy and procedures relating to Oxygen Administration revealed: Purpose: The purpose of this procedure is to provide guidelines for safe oxygen administration. Preparation: 1. Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. General Guidelines: 1. Oxygen therapy is administered by way of an oxygen mask, nasal cannula, and/or nasal catheter. Steps in the Procedure: 7. Check the tubing connected to the oxygen cylinder to assure that it is free of kinks. 8. Turn on the oxygen. unless otherwise ordered, start the flow of oxygen at the rate of 2 to 3 liters per minute. 10. Adjust the oxygen delivery device so that it is comfortable for the resident and the proper flow of oxygen is being administered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 12 of 20 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 01/19/2024 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, record review and interviews. The facility failed to ensure medications were securely stored as evidenced by four broken and three loose pills found on two out of four carts checked. There were 71 residents residing in the facility at the time of the survey. The findings included: On 01/17/24 at 02:18 PM, in an observation and interview with Registered Nurse (RN) Staff A on the North Wing's medication cart one, showed inside the cart two (2) broken pieces and three (3) white pills (stamped:C-128, F/91, T/07) were found. When asked about the facility's policy regarding loose pills found on medication carts and the cleaning of medication carts. Staff A, RN stated, Every day I clean my cart. When I receive my cart, I check the resident's insulins, check for expired medications, and refill medications. I check my cart in the morning and in the middle of the day to clean it. Every shift is to clean medication carts. I'm going to place the loose pills in the drug buster. On 01/17/24 at 03:16 PM; in an observation and interview with Staff L, RN on North Wing's medication cart two revealed two (2) half pills were found in the cart. When asked about the facility's policy regarding loose pills found and cleaning of medication carts. Staff L, RN stated, I clean my medication cart every morning. I count narcotics and check my medications for expiration dates. I will throw these medications away in the drug busters. On 01/19/24 at 11:00 AM, the Director of Nursing was asked about the facility's policy for loose pills found in medication cart. The Director of Nursing stated, I work with the nurses to ensure their medication carts are cleaned. The nurses clean them every day during their shifts. We have two shifts that work per day. Review of the facility's policy titled Medication Labeling and Storage. Published 5/19/2023. The Policy statement stated the facility stores all medication and biologicals in locked compartments under proper temperature, humidity, and light controls. Only authorized personnel have access to keys. In the section titled Policy Interpretation and Implementation, Medication Storage, 1) Medications and biologicals are stored in the packaging, containers, or other dispensing systems in which they are received. 2) The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 13 of 20 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 01/19/2024 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that menus are developed and prepared to meet residents' choices including their cultural and ethnic needs for one (Resident number 207) out of three residents who triggered for food. The findings included: Initial observation and interview with Resident number 207 on 1/16/24 at 9:47 AM revealed the resident sitting up in bed, watching television and eating breakfast which her daughter brought in. The resident stated, They have been giving me Cuban food and I don't eat that. I have told them that I don't like it. My daughter has to bring me food every day to eat. Record review of the Demographic Face Sheet for Resident number 207 documented the resident was initially admitted on [DATE] with a diagnosis that include but not limited to anemia, diabetes mellitus, neuropathy, gastro esophageal reflux disease without esophagitis, chronic obstructive pulmonary disease, osteoarthritis, depression, insomnia, anxiety disorder, major depressive disorder, and gastrointestinal hemorrhage. Review of the Minimum Data Service (MDS) admission assessment dated [DATE] for Resident number 207 documented the resident's Mental Status (BIMS) Summary Score was 13, indicating no cognitive impairment and able to make her needs known and she required independent to supervision assistance for ADL (activities daily living) and eating. Review of the Physician's Order Sheets (POS) dated December 2023 and January 2024 for Resident number 207 documented the resident was on a CCD (Carbohydrate Control Diet), NAS (No Added Salt) diet, Regular texture, and Thin liquids consistency. Review of the Nutrition care plan (written 1/01/2024) for Resident number 207 documented the following: Focus: Resident is at high nutrition risk due to multiple chronic and acute health complications such as GI (gastrointestinal) bleeding, Dehydration, HTN (hypertension), Hyperlipidemia, DM (diabetes mellitus), GERD (gastroesophageal reflux disease); Goal: Resident will maintain weight plus/minus 2-3% (percent) thru NRD (next review date) with no further loss by 5% in 30 days; 7.5% in 90 days; 10% in 180 days; Interventions: Diet: CCD, NAS, Regular, Thin liquids; Honor resident's food/fluid preferences. No cream cheese, no sour cream. No Cuban food, only American foods. Second observation of Resident number 207 on 1/18/24 at 12:35 PM revealed the resident sitting up in bed watching television and waiting for lunch to be served. Her lunch arrived at 12:38 PM and her lunch consisted of Pork Chunk, [NAME] Rice, Capri Blend Vegetables, Pinto Bean Soup and Tropical Fruit. The meal ticket documented Dislikes: No Cuban food and Preferences: Likes American food. The resident refused to eat the lunch. Photographic evidence submitted. Interview with the Registered Dietitian (RD) on 1/18/24 at 12:42 PM. She reviewed the meal ticket. She stated, She should not have Cuban food, only American food. She offered the resident an alternative meal. Interview with the Kitchen Supervisor on 1/19/24 at 9:46 AM. She stated, The dietitian goes to her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 14 of 20 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 01/19/2024 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 0803 Level of Harm - Minimal harm or potential for actual harm room every day to write down what she wants for breakfast, lunch and dinner. We go by what she has told the dietitian. Interview with the RD on 1/19/24 at 9:49 AM. She stated, We will document her likes of foods she wants to eat and her dislikes of foods. We will try to accommodate her. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 15 of 20 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 01/19/2024 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 - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to store food under sanitary condition as evidence by: 1) failure to ensure reach-in freezer and the reach-in refrigerators in the kitchen contained thermometers on the inside and 2) failure to ensure the resident's foods were labeled and dated. 3)The refrigerators were not working properly, and the refrigerator contained opened milk cartons in the snack/nourishment refrigerators on the resident's units. This has the potential to affect 163 out of 171 residents who eat orally residing in the facility at the time of the survey and potential to affect 55 out of 56 residents who eat orally residing on the East Wing. The findings included: 1) Observation of the initial kitchen tour on 1/16/24 at 8:34 AM with the Registered Dietitian (RD) and the Kitchen Supervisor revealed the following: 1) Reach-in freezer temperature outside was -4 degrees F and for the inside temperature, there was no thermometer noted. The reach-in freezer contained ice cream and desserts; 2) Reach-in Refrigerator #1 temperature outside was 40 degrees F and for the inside temperature, there was no thermometer noted. The reach-in refrigerator #1 contained sandwiches and juices and 3) Reach-in Refrigerator #2 temperature outside was 40 degrees F and for the inside temperature, there was no thermometer noted. The reach-in refrigerator #2 contained milk shakes, nectar juices and desserts. The facility was cited in November 2022 for failing to store, prepare, distribute, and serve food in a sanitary manner. Interview with the Kitchen Supervisor on 1/16/24 at 8:36 AM. She stated, There is no thermometer kept on the inside of the reach-in freezer and refrigerator. We only use the temperature on the outside of the reach-ins. Record review of the Refrigerators and Freezers Policy and Procedure (revision date November 2022); Policy Statement-The facility will ensure safe refrigerator and freezer maintenance, temperatures, and sanitation; Policy Interpretation and Implementation-1) Refrigerators and/or freezers are maintained in good working condition. Refrigerators keep foods at or below 41 degrees Fahrenheit (F) and freezers keep frozen foods frozen solid and 10) Supervisors will inspect refrigerators and freezers monthly for gasket condition, fan condition, excess condensation and any other damage or maintenance needs. Necessary repairs will be initiated immediately. Maintenance and or cleaning schedules will be monitored for compliance. 2) Observation of the East Wing Nourishment Pantry on 1/17/24 at 10:40 AM revealed the refrigerator was 60 degrees F (Fahrenheit) and the freezer was 54 degrees F. The refrigerator had three plastic bags which contained resident's foods that were not dated and labeled. A pint carton of whole milk was opened and not dated. The Freezer was noted empty with condensation. Photographic evidence submitted. Observation and interview with Staff M, Registered Nurse (RN) North and East Unit Manager on 1/17/24 at 10:42 AM of the East Wing Nourishment Pantry Refrigerator. She stated, The resident's food should be dated and labeled, the opened container of milk should not be there, and the refrigerator temperature should be 41 degrees and the freezer should be 0 degrees F. Interview with the Registered Dietitian (RD) on 1/17/24 at 11:00 AM. She stated, The kitchen is responsible for the refrigerators in the nourishment pantries. She confirmed that the refrigerator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 16 of 20 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 01/19/2024 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete temperature should be 40 or below and the freezer temperature should be 0 or below; the opened carton of milk should not have been in the refrigerator and the resident's food should be labeled and dated. Record review of the East Wing Nourishment Refrigerator and Freezer Temperature Log for January 2024 documented the following: 1/17/24 7:00 AM Refrigerator temperature was 39 degrees F, and the Freezer temperature was -2 degrees F. Event ID: Facility ID: 105910 If continuation sheet Page 17 of 20 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 01/19/2024 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 observations, interview and record review, the facility failed to demonstrate effective plan of actions were implemented to correct identified quality deficiencies in the problem area related to repeated deficient practices for F645 PASRR (Preadmission Screening and Resident Review) for Individuals with a serious mental illness (SMI), intellectual disability(ID), F695 Respiratory/Tracheotomy Care and Suctioning, and F812 Food Procurement, Store/Prepare/Serve-Sanitary. This deficiency has the potential to affect 171 residents residing in the facility at the time of survey. The findings included: Record review of the facility's survey history revealed, during a recertification survey with exit dated 11/17/2022, F645 PASRR (Preadmission Screening and Resident Review) for Individuals with a serious mental illness, intellectual disability, F695 Respiratory/Tracheotomy Care and Suctioning, and F812 Food Procurement, Store/Prepare/Serve-Sanitary were cited. Interview with Administrator and the Director of Nursing on 01/19/2024 at 12:15 PM. The Administrator stated that the QAPI (Quality Assurance and Performance Improvement) meetings are held on the third Tuesday of each month. Record review of the facility's policy and procedure revealed. Vision: Our vision is to become the preferred pos-acute care and long-term care provider in our community we serve. We commit to improving the lives of the people entrusted to our care through clinical excellence and extraordinary service offered in an atmosphere of compassion, hospitality, and respect for the dignity of each person. Mission: Our mission is to foster and provide unprecedent level of genuine care and customer service for our communities' rehabilitation and nursing needs, in a soothing, tranquil, and state-of-the-art environment. Performance Improvement Projects (PIPs): The QAA committee will review data input on a monthly basis to look for potential topics for PIPs. We will monitor and analyze data, and review feedback and input from residents, staff, families, volunteers, providers, and stakeholders. We will look at issues, concerns, and areas that need improvement as well as areas that will improve the quality of life and quality of care and services for the residents living and staying in our facility. Factors we will consider high risk, high volume, or problem prone areas that affect health outcomes, quality of care and services, and areas that affect staff. Systematic Analysis: Our uses a systematic approach to determine when in-depth analysis is needed to fully understand the problem, any change that is made and has the potential to have a broader impact than intended. The impact of all changes to specific system or processes are reviewed and assessed for both intended and unintended consequences/outcomes. The QAPI committee monitors progress to ensure that intervention or actions are implemented and effective in making and sustaining improvements by choosing indicators that tie directly to the new action and continue ongoing periodic measurements. Scope: Our facility provides services across the full spectrum that have an impact on the clinical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 18 of 20 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 01/19/2024 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 care and quality of life for our residents. All departments and services will be involved in QAPI activities and the facility efforts to continuously improve services and overall resident outcomes. On an annual basis, and as needed, a Facility Assessment will be conducted to include an overview of the services and care areas that are provided. Any new service areas or changes in population or services to our residents will be included in our QAPI Plan. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 19 of 20 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 01/19/2024 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews and record review the facility failed to ensure the refrigerator in the East Wing Nourishment Pantry used to store resident's food was working properly. This has the potential to affect 55 out of 56 residents who eat orally residing in the East Wing at the time of the survey. Residents Affected - Some The findings included: Observation of the East Wing Nourishment Pantry on 1/17/24 at 10:40 AM revealed the refrigerator was 60 degrees F (Fahrenheit) and the freezer was 54 degrees F. Photographic evidence submitted. Observation and interview with Staff M, Registered Nurse (RN) North and East Unit Manager on 1/17/24 at 10:42 AM of the East Wing Nourishment Pantry Refrigerator. She stated, The refrigerator temperature should be 41 degrees and the freezer should be 0 degrees F. Record review of the East Wing Nourishment Refrigerator and Freezer Temperature Log for January 2024 documented the following: 1/17/24 7:00 AM Refrigerator temperature was 39 degrees F and the Freezer temperature was -2 degrees F. Interview with the Registered Dietitian (RD) on 1/17/24 at 11:00 AM. She stated, The kitchen is responsible for the refrigerators in the nourishment pantries. She confirmed that the refrigerator temperature should be 40 or below and the freezer temperature should be 0 or below. Record review of the Refrigerators and Freezers Policy and Procedure (revision date November 2022); Policy Statement-The facility will ensure safe refrigerator and freezer maintenance, temperatures and sanitation; Policy Interpretation and Implementation-1) Refrigerators and/or freezers are maintained in good working condition. Refrigerators keep foods at or below 41 degrees Fahrenheit (F) and freezers keep frozen foods frozen solid and 10) Supervisors will inspect refrigerators and freezers monthly for gasket condition, fan condition, excess condensation and any other damage or maintenance needs. Necessary repairs will be initiated immediately. Maintenance and or cleaning schedules will be monitored for compliance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105910 If continuation sheet Page 20 of 20