Health inspection·August 24, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Room# 213 - The exterior of the nightstand had exposed/sharp edges (X2) and the bathroom's mirror with desilverization(removal of silver). Room# 215A - The exterior of the nightstand had exposed/sharp edges and the bathroom's mirror with desilverization. Residents Affected - Few Room# 217 - The exterior of the nightstand had exposed/sharp edges (X3) and the bathroom's mirror with desilverization. Room# 219 - The exterior of the nightstand had sharp edges. Room# 225B - The exterior of the nightstand had sharp edges. Room# 229 - The exterior of the nightstand had exposed/sharp edges (X2). Room# 235 - The bed was in disrepair (headboard is peeling (X2). Room# 236A - The bed was in disrepair, a peeling surface. During an interview on 08/24/23 at 07:24 AM, with the Maintenance Director, it was revealed the room maintenance is monthly, the Maintenance Director reported, when there is a new admission, we check everything. On a monthly basis we check, touch up paint on the walls and bathrooms. The Maintenance Director reported, at the moment, I am in charge of checking night tables and beds, and I am changing some on a monthly basis. I started that project two months ago. He reported, for the night tables I have changed only three, and for the beds I have changed eleven. At the moment we are ordering 6 beds at month, and we haven't put a specific plan in place for the night tables. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105939 If continuation sheet Page 2 of 9 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 105939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palmetto Subacute Care Center 7600 SW 8th Street Miami, FL 33144 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 interview and record review, the facility failed to accurately code the Minimum Data Set (MDS) for two residents (Resident # 67, and Resident # 81) out of two residents MDS reviewed for accuracy. Resident # 67 was not coded for hospice care, and Resident # 81 was inaccurately coded for discharge to the hospital and the resident was discharged home. Residents Affected - Few The findings included: 1. Record review of the clinical records for Resident # 67 revealed, the resident was admitted to the facility on [DATE] and readmitted on [DATE]. Clinical diagnoses included, but were not limited to, Other Specified Degenerative Diseases of Nervous System; Dysphagia Following Other Cerebrovascular Disease; Unspecified Dementia, Unspecified Severity, Without Behavioral Disturbance, Psychotic Disturbance, Mood disturbance and Anxiety; Unspecified Psychosis Not Due to a Substance or Known Physiological condition; Major Depressive Disorder, Recurrent, Unspecified; Anxiety Disorder, Unspecified. Record review of the Physician Orders dated 08/26/2022 revealed, the resident had a Do Not Resuscitate Order. Record review of the Physician Orders dated 10/11/2022 revealed, Routine Hospice Care with a Hospice Company. Record review of the Physician Orders dated 10/12/202 revealed, the resident was admitted under Hospice Care with a diagnosis of Cerebrovascular Disease. Record review of the Quarterly Minimum Data Set (MDS) Section C Cognitive Status dated 07/22/2023 revealed, the resident's Brief Interview for Mental Status (BIMS) summary score was 03 out of 15, indicating severe cognitive impairment; Section O Special Treatments, Procedures and Programs revealed the resident was not coded for the resident being the under hospice care. Record review of Hospice Care Plan initiated on 7/22/2022 with the next review date 11/9/2023 revealed, the resident is at the end of life/diagnosis of terminal illness - Cerebrovascular Disease. Goal: Resident will receive comfort/palliative care according to individual wishes and facility policy through the review date. Interventions: Administer medications per physician orders. Assess and treat Pain. Assess emotional and spiritual needs of resident/family/caregiver and meet same when possible. Position for comfort. Provide comfort measures and honor preferences when possible. Refer to hospice program physician orders. Refer to Social Services for emotional support and assistance with advanced directives if necessary. Work cooperatively with hospice team to ensure the resident's spiritual, emotional, intellectual, physical, and social needs are met. Interview with Staff B, the MDS coordinator on 08/24/2023 at 11:32 AM revelaed, he started to work as the MDS Coordinator recently. He stated resident # 67 is under hospice care. He stated the resident should be coded as a hospice resident. Review of the facility's Policies and Procedures for Comprehensive Assessments dated 03/08/2023 revealed, that Policy Statement: Comprehensive Assessments are conducted to assist in developing person-centered care plans. Policy Interpretation and Implementation: 8-A significant error is an error in an assessment where: a) the resident overall clinical status is not accurately represented (i.e., (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105939 If continuation sheet Page 3 of 9 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 105939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palmetto Subacute Care Center 7600 SW 8th Street Miami, FL 33144 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 miscoded) on the erroneous assessment and/or results in an inappropriate plan of care; and b) the error has not been corrected via submission of a more recent assessment. 2. Record review of Resident #81's Minimum Data Set (MDS) Discharge Return Not Anticipated/End of Prospective Payment System (PPS) Part A Stay dated 6/20/2023, admit date [DATE] revealed, Residents Affected - Few Section A-Identification Information revealed Entry/discharge reporting: Discharge - return not anticipated, Type of Discharge-Planned, discharge date : [DATE], Discharge Status: Acute hospital. Section I - Active Diagnoses included: Diabetes Mellitus (DM). Review of the Nursing Progress Note dated 6/20/2023 revealed, Patient is on the way home in family's car via wheel chair. Skin without impairment. Able to ambulate with assisting device. Prescriptions, clothing, and valuables were received by patient. Discharge instructions and follow up appointment with Primary Care Physician (PCP) in two weeks given. Patient verbalized understanding. Review of the Physician Visit Note dated 6/20/2023 revealed, Chief complaint-Discharge Summary, Plan: discharge home, home health evaluation and treatment. Record review of the document titled, Nursing Home Transfer And Discharge Notice with date notice is given as 6/16/23.The effective date was 6/19/23. Location to which resident is transferred or discharged (required): Name: Home. Reasons: Your health has improved sufficiently so that you no longer need the services provided by this facility. Brief explanation: discharged (D/C) home signed and dated 6/19/23. Reviewed Post Discharge Plan of Care signed and dated 6/19/23 with Discharge Destination: Home and Family. During an interview with Staff B, the (MDS) Coordinator on 08/24/23 at 11:28 AM, when asked about the MDS for Resident #81 and upon revision of Resident #81's MDS list there was a correction dated 08/24/2023. The MDS Coordinator was asked whether the MDS correction was done today? The MDS Coordinator stated, yes, a correction was done today, she came from an acute hospital and she was discharged to the community. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105939 If continuation sheet Page 4 of 9 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 105939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palmetto Subacute Care Center 7600 SW 8th Street Miami, FL 33144 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to follow the physician's orders and policy for a midline intravenous (IV) dressing change for one (Resident #25) out of five residents who were receiving intravenous therapy at the facility. As evidenced by the midline dressing being dated as changed on 7/20/2023. The midline dressing was not changed for one month. Residents Affected - Few The findings include: In an observation on 08/21/23 at 02:45 PM, Resident #25 was awake and sitting in a wheelchair. A midline intravenous catheter to the right arm was observed. The midline dressing was dated 7/20/23. (See photo evidence) In an observation on 08/22/23 at 11:07 AM, Resident #25 was awake in bed, and it was observed that the dressing to the midline was changed and dated 8/21/23. (See photo evidence) In an interview on 08/23/23 at 02:46 PM with the Director of Nursing (DON). When asked, What is your facility's policy for midline dressings changes for residents? The DON stated It is the night shift nurse's responsibility to change the midline dressings two times a week. Our protocol is to change the midline dressings on Mondays and Thursdays. The night shift (7 PM to 7 AM) Registered Nurse / Licensed Practical Nurse responsibilities are posted on the bulletin board in the nursing station. Record review of Resident #25 medical record revealed, an admission on [DATE]. The residents medical diagnoses included but were not limited to cellulitis of the right lower limb and right artificial knee joint and aftercare following joint replacement surgery. Record review of Resident #25 physician's orders revealed, an order start date of 7/10/2023 at 7:00 PM, intravenous midline catheter to measure external catheter length on admission, with each dressing change, and as needed. On every night shift on Mondays and Thursdays. An antibiotic order, Meropenem 2 grams two times a day by intravenous solution for right knee septic joint for six weeks. The antibiotic was started on 07/07/2023 at 9:00 AM and completed on 8/17/23 at 9:00 PM. Record review of Resident #25 medical record revealed, in the admission minimum data set (MDS) dated [DATE]. In Section C: Cognitive patterns, a brief interview of mental status (BIMS) was a fifteen (indicating cognitively intact). In section G: Functional status is bed mobility was extensive assistance with a one-person physical assist. In section I Active diagnosis, hip and knee replacement, aftercare following joint replacement. In section K: Swallowing/ Nutritional status, no swallowing disorders. In section J: health conditions, partial or total knee replacement. In section N: Medication, 4 days on antibiotics in the past 7 days. In section O: special treatments were resident on intravenous medication while as a resident. A record review of the care plans for Resident #25 revealed, on an intravenous antibiotic related to a right lower limb abscess with cellulitis. Initiated on 07/14/2023. The goal was the resident would be free from complications related to infection through the review date. Interventions were to administer antibiotics as per medical doctor orders and maintain universal precautions when providing resident care. Record review of the document titled 7P- 7A RN/LPN responsibilities revealed, on Mondays and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105939 If continuation sheet Page 5 of 9 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 105939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palmetto Subacute Care Center 7600 SW 8th Street Miami, FL 33144 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 0684 Thursdays to perform IV dressing changes. 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: 105939 If continuation sheet Page 6 of 9 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 105939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palmetto Subacute Care Center 7600 SW 8th Street Miami, FL 33144 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 Based on observation, interview, and record review, the facility failed to follow physician's orders for oxygen administration for one out of four sampled residents (Resident #334). Residents Affected - Few The findings included: Observation on 08/21/23 at 10:32 AM revealed, Resident #334 was lying in bed sleeping. Further observation showed the resident was receiving oxygen therapy; the oxygen concentration level was at 3.5 LPM (liters per minute). (photo evidence obtained) Review of the physicians order dated 08/18/2023 revealed, an order for Oxygen (O2) via nasal cannula at 2L/min as needed for O2 sat <92% as needed for SOB (shortness of breath). Review of Resident #334's medical diagnoses dated 08/17/2023 revealed, Gout unspecified (primary), essential (primary) hypertension, myocardial infarction, chronic kidney disease, and polyneuropathies. Review of Resident #334's progress notes dated 08/21/2023 (e-medication administration notes) revealed, an Oxygen via nasal cannula at 2L/min as needed for O2 sat <92% as needed for SOB was administered. Further review revealed, on 08/22/2023 an Oxygen via nasal cannula at 2L/min as needed for O2 sat <92% as needed for SOB was administered. During an interview with Staff C, a Registered Nurse (RN), on 08/23/23 at 12:39 PM, Staff C stated that they provide supervision for Resident #334 only when she needs it. Staff C then stated, She's receiving oxygen as PRN (as needed) when her saturation is low at 92. If there is a problem with her oxygen administration, I will call the pulmonary doctor. I monitor the oxygen level in the morning, in the afternoon. I check all the vital signs, if there is a problem, I call the doctor. On 08/23/2023 at 12:56 PM Staff D, a RN, stated that he takes the vital signs for all the residents in the morning, and that's how he monitors the residents' oxygen saturation. When he comes in the morning, he checks the oxygen level. He stated that the oxygen saturation has to be less than 92% for the resident to receive oxygen. He then stated that Resident #334 is only receiving oxygen as PRN. He stated he only worked with Resident #334 the day before, and the resident's oxygen saturation level was below 92%, so the resident was receiving oxygen. Review of the Oxygen Administration policy and procedures dated 05/19/2023 revealed: Level III 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. 2. Review the resident's care plan to assess for any special needs of the resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105939 If continuation sheet Page 7 of 9 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 105939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palmetto Subacute Care Center 7600 SW 8th Street Miami, FL 33144 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 3. Assemble the equipment and supplies as needed. Level of Harm - Minimal harm or potential for actual harm General Guidelines: Residents Affected - Few 1. Oxygen therapy is administered by way of an oxygen mask, nasal cannula, and/or nasal cannula, and/or nasal catheter. a. The oxygen mask is a device that fits over the resident's nose and mouth . Steps in in the procedures: 8. Turn on the oxygen. Unless otherwise ordered, start the flow of oxygen at the rate of 2 to 3 liters per minutes. 10. Adjust the oxygen delivery device so that it is comfortable for the resident and the proper flow of oxygen is being administered. 13. Observe the resident upon setup and periodically thereafter to be sure oxygen is being tolerated. 14. Periodically re-check water level in humidifying jar. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105939 If continuation sheet Page 8 of 9 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 105939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palmetto Subacute Care Center 7600 SW 8th Street Miami, FL 33144 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 record review, observation, and interviews, the facility failed to properly secure a controlled medication for one out of three medication carts observed. The findings include: On 08/21/23 at 09:38 AM, during a medication cart observation with Staff A, Registered Nurse (RN) on Two - South - cart one. The Surveyor observed the narcotic count binder was placed on top of the treatment cart next to Staff A's medication cart. Staff A, RN and the Surveyor performed a narcotic count, and it was correct, but the Surveyor observed a bingo card containing one remaining Lorazepam 0.5 mg(milligram) tab at the end of the narcotic count sheets with its narcotic count record sheet. On 08/21/23 at 09:45 AM, in an interview with Staff A, RN, when asked, How are controlled substances to be stored and reason the Ativan was placed in the back of the binder? Staff A, RN stated, these medications are always to be stored in a locked box. The nurse from the previous shift did this. Review of the narcotic count sheet revealed, Lorazepam 0.5 mg tab was signed out on 8/21/23 a 4:45 PM with one tablet remaining. (See photo evidence) Record review for resident #42 revealed, a medical diagnosis of anxiety disorder. A physician order for Lorazepam 0.5 milligrams was to be discontinued on 8/21/2023 at 11:59 PM and a new order for Lorazepam 0.5 milligrams was to be discontinued on 9/5/2023 at 10:29 AM. On 08/23/23 at 02:52 PM, during an interview with the Director of Nursing. When asked, What is your facility procedure for storing controlled medications? The Director of Nursing stated, This medication was discontinued at midnight. Normally, the nurse would give me the medication in the morning, and it needed to be reordered for the resident. I collect all narcotics and place them in a locked box in my office. It shouldn't have been in the binder. It should be in the locked box on the cart. Review of facility policy titled, Storage of Controlled Substances. Revised on August 2020. The policy statement was medications classified by the Drug Enforcement Administration as controlled substances are subject to special handling, storage, disposal, and record-keeping in the facility in accordance with federal, state, and other applicable laws and applicable laws and regulations. In the section, titled Procedures, 2. Schedule two through five medications and other medications subject to abuse or diversion are stored in either a permanently affixed, double-locked compartment separate from all other medication or in accordance with state regulations. 10. Controlled substances remaining in the facility after the order has been discontinued or the resident has been discharged are retained in the facility in a securely locked area with restricted access until destroyed in accordance with facility policy and state regulations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105939 If continuation sheet Page 9 of 9